depression

9511213674_31a3c06cc7_z

Introduction

Clinical, unipolar depression is more than just feeling low for a day or two.

Depression is characterised as episodes of sadness, loss of interest and pleasure, often including feelings of low self-worth. Depression can also include a range of physiological symptoms, such as fatigue, pain, diminished appetite, lack of interest in sex, disturbed sleep, and poor concentration.

The World Health Organisation estimates that, globally, as many as 350 million people are affected at any given time, with one person in 20 reporting an episode of depression in a 12 month period (in a global sample of 17 countries). They describe depression as the leading cause of disability worldwide.

What we know already

We know that, despite the considerable global burden of depression, not everybody receives treatment, with figures ranging from 50% to 10% in less developed countries.

Evidence suggests that combined psychological and pharmacological treatments seem to work well. Broadly, we know that psychotherapies work in many cases – but not every time. We know that neurochemical factors, such as serotonergic dysfunction, play an important role in depression, which goes a long way in explaining the efficacy of SSRI treatments.

We also know that depression has a nasty habit of recurrence, and some psychological interventions, such as Mindfulness-Based Cognitive Therapy (MBCT) is recommended particularly for people who have experienced multiple episodes of depression, but not are currently severely depressed.

We know that people living with chronic physical illness are more likely to experience depression, and this combination is linked with poorer clinical outcomes.

Importantly though, we know that people with depression can still enjoy themselves, and a common misconception in depression is that people feel totally awful all of the time.

Areas of uncertainty

There is much still to determine. For example, we know that depression is hereditable, however the extent of heredity versus environmental influences are unclear.

We are also unsure as to the precise mechanisms that determine those who respond best to treatments, be they psychopharmacological, or psychological, or both.

What’s in the pipeline?

Despite advances in our understanding of depression, and how it is treated, it remains a highly recurrent difficulty, with many people not achieving complete remission between episodes.

Preventative interventions, either physiological, or psychological, may improve people’s resilience to depression, particularly those identified as being highly prone.

References

Cuijpers, P. (2015). Psychotherapies for adult depression: recent developments. Current Opinion in Psychiatry, 28, 24-29. [Abstract]

Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M. and Galea, A. (2012) Long-term conditions and mental health: the cost of co-morbidities. The King’s Fund, London, UK [PDF]

World Health Organisation (2015).Factsheet 369: Depression [Link]

Photo Credits

Sascha Kohlmann CC BY 2.0

Acknowledgement

Written by: Patrick Kennedy-Williams
Reviewed by:
Last updated: Nov 2015
Review due: Sep 2016

Our depression Blogs

Cellular immune phenotypes of depression: a gateway to precision medicine 

national-cancer-institute-jeT_DE3esSI-unsplash

In her debut blog, Fabiana Corsi-Zuelli summarises a recent systematic review and meta-analysis investigating the role of peripheral immune cells in depression, with a focus on implications for future immunotherapy trials.

[read the full story...]

Interventions to foster resilience in nursing staff may help (a little) in the short-term

medicalert-uk-XjlyFT-ibd0-unsplash

Olga Lainidi summarises a recent systematic review and meta-analysis investigating the effectiveness of resilience interventions on the mental health of nursing staff.

[read the full story...]

Add on iCBT: weak evidence of modest benefits in depression and anxiety

iCBT can be effective in reducing symptoms of depression, anxiety, OCD and PTSD - could its accessibility help reach more people?

Liesbeth Tip and Antigone Lanitis reflect on a recent systematic review and meta-analysis that investigated internet-delivered psychological treatment as an add-on to treatment as usual in depression, anxiety, and PTSD.

[read the full story...]

Serotonin hypothesis of depression: balance (and imbalance) is in the eye of the beholder

Sadness,And,Loneliness,Concept.,Despaired,,Stressed,Woman,Body,3d,Rendering.

The 2022 review by Moncrieff et al on the serotonin theory of depression received a great deal of media coverage. In this blog, Rebecca Wilkinson and Sameer Jauhar shed fresh light on this research and what it means for mental health science and practice.

[read the full story...]

Does what you eat affect how you feel?

ca-creative-kC9KUtSiflw-unsplash

Daisy Crick summarises a recent paper on the casual relationship between polyunsaturated fatty acids and depression.

[read the full story...]

What treatment outcomes are important to adolescents with depression? Novel findings from a Q-study

While this study demonstrated strengths in participant involvement and novelty, participants identified important missing outcomes, and the recruitment method excluded participants who may have prioritised different outcomes.

In her debut blog, Danielle Brocklebank summarises a Q-sort study which sought to identify which treatment outcomes are the most important to young people with depression.

[read the full story...]

“Like being a pretender”: A meta-synthesis of experiences of loneliness in perinatal depression

Lonely,Pregnant,Woman,Standing,In,A,Field,Worried,About,Her

In her debut blog, Francesca Kingston explores experiences of loneliness among women with perinatal depression, reported in a new meta-synthesis published in BMC Psychiatry.

[read the full story...]

Parents’ depression can be linked to children’s emotional difficulties

patricia-prudente-wZybkWjETWo-unsplash

Lisa Lloyd summarises a new paper in the BJPsych, which focuses on parental depression symptoms in both mothers and fathers, and how they are linked with emotional difficulties in their children.

[read the full story...]

Detection of depression in primary care settings in low- and middle-income countries

Male,Detective,Looking,Through,Magnifying,Glass,On,Grey,Background

Lucy Barrass considers a systematic review exploring the detection of depression in primary care settings in low- and middle-income countries.

[read the full story...]

Online support more helpful for youth anxiety than depression, according to recent review

annie-spratt-W0pMGlPogow-unsplash

In her debut blog, Laura Hankey summarises findings from a recent systematic review and meta-analysis investigating the effectiveness of internet-based interventions for depression and anxiety in children and young people.

[read the full story...]