Depression, otherwise known as Clinical Depression or Major Depressive Disorder (MDD), is a common mental disorder with an estimated life time prevalence of %10 in the general population1. Only %50 of those affected receive treatment2. World Health Organisation classify depression as the single largest contributor to global disability and also as the major contributor to suicide deaths3. Currently, depression is the leading cause of disability and premature death among adults between the ages of 18 and 444.
Depression as a syndrome involves occurrences of sadness, loss of interest, pessimism, negative beliefs about the self, decreased motivation, passive behaviour, suicidal ideation and changes in sleep, appetite and sexual interest. As a disorder, depression comes in two forms; unipolar and bipolar. Unipolar depression includes only episodes of depression while bipolar depression includes episodes of mania or hypomania. Manic episodes are manifested by euphoria or irritability, sleeplessness, grandiosity, recklessness and uncontrollable impulses5.
Currently, no validated biological tests exist to aid in diagnosis of depression. There are no biomarkers, such as changes in gene expression or tumour marker, that are associated with either pharmacotherapy or psychotherapy treatments. Approximately one-third of the risk for the development of depression is inherited and the remaining two-thirds is environmental6. Stressful life events are associated with a high risk of depression7. Negative affectivity or neuroticism, adverse childhood experiences and stressful life events are established risk factors. Prevalence rates are higher in females compare to males. Suicidal behaviour exists at all times during depression with an increased risk for completed suicide in males8. Low self-esteem is the strongest predictor of depression in early adolescents9. Social support is shown to be a protective factor against depression10.
The most common psychiatric comorbidities with depression are substance-related disorder, panic disorder, obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, and borderline-personality disorder8. Research has repeatedly demonstrated high co-morbidity of depression and anxiety11. Moreover, depression is a frequent comorbid condition in individuals with chronic pain12.
A large body of research have examined the effects of various psychotherapy treatments for depression. The results showed that all types of psychological therapies are efficient in the treatment of depression and the difference between these therapies are small13,15,16,17,18,19. The findings show that internet-delivered therapies produce consistently clinically significant improvements in depressive symptoms20. The efficacy of pharmacotherapy (anti-depressant medication) is also established by research14 however there is no evidence suggesting that anti-depressant medication reduce future risk of depressive episodes once their use ends5.
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Counselling and psychotherapy can help!
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References:
1: Kessler, R.C. & Bromet, E.J. (2013). The epidemiology of depression across cultures. Annual Review of Public Health, 34, 119–38
2: Kohn, R., Saxena, S., Levov, I., & Saraceno, B. (2004) The treatment gap in mental health care. Bulletin of the World Health Organisation, 82 (11), 811-890.
3: World Health Organisation (2017). Depression and other common mental disorders: Global health estimates, Geneva, Switzerland: WHO Document Production Services.
4: Greden, J.F. (2001). The burden of disease in treatment resistant depression. Journal of Clinical Psychiatry, 62, 26-31.
5: deRubeis, R., Siegle, G.J., & Hollon, S.D. (2008). Cognitive therapy versus medication for depression: Treatment outcomes and neural mechanisms. Nature Reviews Neuroscience, 9(10), 788-796.
6: Sullivan, P.F., Neale, M.C., & Kendler, K.S. (2000). Genetic epidemiology of major depression: Review and meta-analysis. American Journal of Psychiatry, 157, 1552-1562
7: Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1, 293-319.
8: American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.), Washington, DC: American Psychiatric Association.
9: MacPhee, A.R., & Andrews, J.J. (2006). Risk factors for depression in early adolescence. Adolescence, 41, 435-466.
10: Jensen, M.P., Smith, A.E., Bombardier, C.H., Yorkston, K.M., Miro, J., & Molton, I.R. (2014). Social support, depression, and physical disability: Age and diagnostic group effects. Disability and Health Journal, 7(2), 164-172.
11. Ferdinand, R.F., Nijs, P.F.A., Lier, P., & Verhults, F.C. (2005). Latent class analysis of anxiety and depressive symptoms in referred adolescents. Journal of Affective Disorders, 88, 299-306.
12: Linton, S.J. & Bergbom, S. (2011). Understanding the link between depression and pain. Scandinavian Journal of Pain, 2, 47-54.
13: Cuijpers, P., Andersson, G., Donker, T., & van Straten, A. (2011) Psychological treatment of depression: Results of a series of meta-analyses. Nordic Journal of Psychiatry, 65, 354-364.
14: Thase, M.E. & Rush, A.J. (1997). When at first you don’t succeed: Sequential strategies for antidepressant responders. Journal of Clinical Psychology, 58(13), 23-29.
15: Scott, J. (2000). New evidence in the treatment of chronic depression. New England Journal of Medicine, 342, 1518-1520.
16: Tolin, D.F. (2010). Is cognitive-behavioural therapy more effective than other therapies?: A meta-analytic review. Clinical Psychology Review, 30 (6), 710-720.
17: Cooper, M., Wild, C., can Rijn, B., Ward, T., McLeod, J., Cassar, S., Antoniou, P., Michael, C., Michalitsi, M., & Sreenath, S. (2015). Pluralistic therapy for depression: Acceptability, outcomes and helpful aspects in a multisite study. Counselling Psychology Review, 30(1), 6-20.
18: Hundt, N.E., Calleo, J.S., Williams, W., & Cully, J.A. (2016). Does using cognitive-behavioural therapy skills predict improvements in depression? Psychology and Psychotherapy: Theory, Research and Practice, 89, 235-238.
19: Nordahl, H.M. (2009). Effectiveness of brief metacognitive therapy versus cognitive behavioural therapy in a general outpatient setting. International Journal of Cognitive Therapy, 2 (2), 152-159.
20: Stefanopoulou, E., Lewis, D., Taylor, M., Broscombe, J., Ahmad, J., & Larkin, J. (2018). Are digitally delivered psychological interventions for depression the way forward?: A review. Psychiatric Quarterly, 89, 779-794.