The content of this page is for informational purposes only. It does not endorse advice or any particular treatment. Only individual consultation with a doctor/clinician can establish accurate diagnosis and relevant treatment option.
What is Depression
Depression is a result of complex interactions of personal, situational, social, neuro-biological, historical, and psychosocial factors rather than a result of a single cause.
Depression is different from just a low mood or mood fluctuations. The depressive episode has a longer duration of feeling sad, irritable, and empty; it is characterized by a negative view of self, others, the world or the future. It is often accompanied by diminished or loss of interest in activities and withdrawal from social life.
Other symptoms of Depression may include:
Lack of motivation
Difficulties to concentrate
Tiredness, fatigue, or low energy
Restlessness or agitation
Trouble sleeping
Feeling bad about yourself, thinking of yourself as a failure, or feeling hopeless about the future
Feelings of excessive guilt or low self-worth
Changes in appetite or weight
Feeling lonely and 'cut off'
other
Prevalence
Depression can negatively affect all aspects of life. It is the most predominant mental health problem worldwide, followed by anxiety (World Health Organization, WHO).
According to NHS statistics in the UK -in 2021/22, 1.81 million people were referred to Psychological Therapies - IAPT, compared to 2020/2021 (1.41 million) and 2019/20 (1.69 million). The f figures for antidepressant drugs prescribed only for 2022 are estimated at 21.2 million(quarterly) but with the tendency to decrease. Depression is about 50% more common among women than among men (WHO, 2022).
People who are more likely to experience Depression are those with a solid predisposition, those who have gone through stressful life events (grief, end of a relationship, losing a job), major life transitions (leaving home, retiring, having a baby), physical illness, or early experiences of abuse.
Some people may experience a single episode and recover without treatment. Other people may experience recurrent episodes that more easily trigger further episodes.
Current theories
There are two main psychological approaches to explaining the nature of Depression – behavioural and cognitive.
Behavioural Theories explain Depression as a result of a reduction of positive social reinforcement or/and a significant increase in avoidance behaviours and social withdrawal. Some authors suggest that habituation of a positive reinforcer also leads to developing and maintaining Depression (e.g., getting bored with the same reinforcer).
Cognitive Theories of Depression suggest that the symptoms of Depression can be understood as arising from thoughts relating to negative views of self (I am wrong, worthless, unlovable), negative views of the world (the world is terrible, hard work, unpleasant) and negative views of the future (the future is dark, nothing I can do will change how bad the world is).
Treatments
There are many psychological and medical treatments for Depression.
Psychological therapies are recommended as the first-line treatment. They can be combined with antidepressant medications in moderate and severe presentations.
According to the World Health Organisation (WHO), the most effective psychological therapies are:
Cognitive Behavioural Therapy (CBT)
Behavioural Activation (BA)
Acceptance and Commitment Therapy (ACT)
Interpersonal Therapy (IPT)
Mindfulness-Based Cognitive Therapy (MBCT) for preventing relapse
In the UK, according to the National Institute for Health and Care Excellence (NICE) Guidelines, as well as The American Psychiatric Association (APA), CBT is recommended as a first-line treatment for Depression.
This typically includes 12-20 weekly sessions of 50 minutes each. For relapse prevention, follow-up sessions in 1, 3, and 6 months are recommended.
References
American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) https://doi.org/10.1176/appi.books.9780890425787.x04_Depressive_Disorders
An overview of Beck's Cognitive Theory of Depression in Contemporary Literature, J Allen, Rochester Institute of Technology in : http://www.personalityresearch.org/papers/allen.html
Behavioral Models of Depression: A Critique of the Emphasis on Positive Reinforcement, P.R.,Abreu & Carlos E. Santos; International Journal of Behavioral Consultation and Therapy Volume 4, No. 2, 2008
International Classification of Diseases, Eleventh Revision (ICD-11), World Health Organization (WHO) 2019/2021 https://icd.who.int/browse11. Licensed under Creative Commons Attribution-NoDerivatives 3.0 IGO licence (CC BY-ND 3.0 IGO).
National Institute for Health and Care Excellence (NICE), Depression in adults: treatment and management (NG222). Retrieved from
https://www.nice.org.uk/search?q=depression
NHS Psychological Therapies, Annual IAPT Report 2021/22 in https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-annual-reports-on-the-use-of-iapt-services/annual-report-2021-22
King R. Cognitive therapy of Depression. Aaron Beck, John Rush, Brian Shaw, Gary Emery. New York: Guilford, 1979. Aust N Z J Psychiatry. 2002 Apr;36(2):272-5. doi: 10.1046/j.1440-1614.2002.t01-4-01015.x. PMID: 11982560.
National Institute For Health And Care Excellence (2009). Depression in adults: recognition and management. Retrieved from: https://www.nice.org.uk/guidance/cg90 https://www.nice.org.uk/guidance/cg90/resources/depression-in-adults-recognitionand-management-pdf-975742638037
Overview Depression in adults. Retrieved from https://www.nhs.uk/mental-health/conditions/depression-in-adults/overview/
https://www.nhsbsa.nhs.uk/statistical-collections/medicines-used-mental-health-england