What is depression?
Depression is the word used to describe a range of mental health problems characterised by low mood and a loss of interest and enjoyment in ordinary life. It has proven difficult to distinguish between mood changes which are normally occurring and those which are clinically significant, so it is best to consider depression on a continuum of severity. The term 'major depressive episode' is often used to describe more severe, persistent symptoms which combine a degree of social impairment and loss of functionality whilst the term ''dysthmia' is used to describe less severe, low level chronic symptoms.
Someone who is depressed would commonly experience persistent low mood, feelings of sadness and guilt which are unresponsive to circumstances. For others any improvement in mood as a response to a positive would not be sustained. Depressed mood may be experienced thought the day or mainly in the mornings.
Depression can manifest in how we feel about ourselves and our existence for instance:
- low self-confidence
- feelings of worthlessness
- a loss of hopefulness and feelings that life is not worth living
- suicidal thoughts and attempts to self-harm or commit suicide
In addition to the emotional symptoms of depression there are a number of physical and behavioural symptoms which are typical:
- social withdrawal
- exacerbation of pre-existing pains
- muscle tension leading to pain
- lack of libido
- lower levels of activity
- reduced sleep
- increased appetite
...for others there can be increased sleep and appetite.
Cognitive changes in depression may include poor concentration, diminished attention, mentally slowing down, recurrent negative thoughts about one's past and future.
Depression can be linked to anxiety and consequently three diagnoses are possible:
- Mixed depression and anxiety
How many people suffer from depression?
Across the globe World health Organisation estimates of the number of people who suffer from depression indicates varies from country to country with the United States experiencing the highest and Japan the lowest incidence of depression. The UK lies in the top third of countries and estimates indicate that up to 10% of individuals will experience a major depressive episode during their lifetime and up to 5% would experience dysthmia.
Depression is prevalent in the age range 16-74 and it is estimated that females are up to 2.5 times more likely to experience it than men.
What is the evidence that CBT is an effective treatment of depression?
The National Institute for Health and Care Excellence (NICE) produces evidence based guidance on a range of physical and mental healthcare problems to the NHS. NICE's last guidance note on depression, CG90, considered the evidence from 46 large studies, considerably more than any other psychotherapeutic approach in the treatment of depression. The following recommendations were made:
- CBT is effective in the treatment of depression
- CBT alone or in combination with an anti-depressant is more effective than an anti-depressant alone in the treatment of depression
- CBT is effective in reducing relapse rates of depression
How many sessions does NICE recommend?
NICE recommends that the duration of treatment should typically be 16 - 20 sessions over 3 or 4 months. In addition three or follow up sessions over the next 6 months are recommended to reduce the potential for relapse.
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