We searched Medline, and for some topics EMBASE and PsychInfo, initially limiting the search to systematic reviews and meta-analyses, then if necessary to controlled studies. Recent national guidelines and reports were also reviewed.
SeminarRecent developments and current controversies in depression
Section snippets
Genetics and pharmacogenetics
There is no doubt that genetic factors have an important role in the aetiology of depression. Heritability has been estimated from twin studies as 31–42%, with a substantial contribution of environmental effects unique to individuals (including measurement error) of 58–67%.12 Depression with recurrent episodes and possibly early onset may be associated with greater familial aggregation.12
Traditional genetic linkage studies and candidate gene methods have been used with fairly limited success in
Efficacy of psychological treatments
Cognitive behavioural therapy is a psychological treatment which was first formalised in the late 1970s.93 The main premise is that depressive symptoms arise from dysfunctional beliefs and thought processes as a result of early learning experiences. These beliefs lie dormant for a number of years, but are activated by a situation or an event that has a specific meaning for the individual.94 Schema focused work tries to directly address this premise; by definition, a schema is a cognitive
Summary
Depression is not only a very common, incapacitating, and occasionally lethal illness that deserves our full attention, but also spans a wide range of severity and requires a large choice of treatments. It is common in non-psychiatric medical settings and crucially affects presentation with physical illness and recovery from such illness. All effective treatments for this condition, which is by its very nature associated with the most profound suffering, have to be welcomed.
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