assignment on depression

13 Helpful Worksheets for Combating Depression

However, when a depressed mood or unbearable sadness is present for a long time – a couple of weeks or months – then it might meet the criteria for depression.

Depression affects over 264 million people worldwide. Between 76% and 85% of those experiencing depression do not seek or receive treatment for their disorder (World Health Organization, 2020a).

This article provides a starting point to understand depressive symptoms and also offers helping professionals resources to assist their patients with recovery.

Please note that the resources provided in this article are not a substitute for treatment from a medical professional. If you are suffering from depression or know someone who is, we recommend you seek help. Guidance is provided at the end of this article.

Before you continue, we thought you might like to download our three Stress & Burnout Prevention Exercises (PDF) for free . These science-based exercises will equip you and those you work with, with tools to manage stress better and find a healthier balance in your life.

This Article Contains:

2 worksheets to help combat depression, handouts for cbt sessions, 2 group therapy worksheets, depression worksheets for teens and youth, 4 worksheets on coping skills, positivepsychology.com’s toolkit resources, a take-home message.

Individuals who experience depression often deal with difficult emotions and engage in unhelpful thought patterns that worsen their depression. One of those responses that is widely recognized is excessive guilt .

Excessive guilt is one of the distinctive symptoms of depression, as it is often exaggerated and experienced out of context (Pulcu, Zahn, & Elliott, 2013).

Typically, individuals with major depressive disorder feel guilty for their emotions and are often upset at themselves for being affected by depression, as they feel they are worthless for being in a depressive state.

One of the most common types of guilt experienced by individuals who have depression is called omnipotent responsibility guilt , which is defined as “taking responsibility for events which may be out of one’s control and feeling guilty about their consequences” (Pulcu et al., 2013, p. 312).

Often, individuals with depression take responsibility for situations they have little or no control over, causing them to feel a sense of overwhelming guilt, even when they had nothing to do with the outcome.

Understanding what parts of a situation you can control or influence is an essential part of seeking treatment for depression. The Control–Influence–Accept Model (Thompson & Thompson, 2008) originated as a means to help people be more productive at work.

However, the basic principles of the model aim to identify pieces of a situation that you can control or influence, as well as aspects of a situation you may have to adapt to or accept.

If these sound like issues you are struggling with, feel free to consult the following worksheets:

1. Control–Influence–Accept Model

This is a good activity for individuals with depression to help break down situations. The model allows better visualization of different aspects of a situation and what specifically can be controlled, instead of worrying about all the possible outcomes.

2. Guilt and Shame: Emotions That Drive Depression

Guilt and shame are two emotions that drive your emotions when depression manifests. This exercise will help you identify guilt and shame that drives your depression and provides suggestions for channeling those emotions to facilitate more positive thinking patterns.

CBT operates on the principle that emotional reactions and behaviors are influenced by cognitions (Westbrook, Kennerley, & Kirk, 2011).

Our behavior is governed by these cognitions, meaning that someone with anxiety might display more anxious behavior or engage in negative thinking patterns.

When an individual is affected by depression, they can experience cognitive distortions that are negatively biased errors in thinking. When individuals experience automatic thoughts, they are typically consistent with their core beliefs about aspects of themselves, others, and the world (Rnic, Dozois, & Martin, 2016).

Therefore, individuals who are experiencing depressive thoughts or symptomatology tend to have negatively charged core beliefs, which activate negative automatic thoughts. The cycle of negative thinking causes the symptoms of depression to continue and consolidate negative thoughts as part of an individual’s emotional response.

Our worksheet on Unhelpful Thinking Patterns categorizes the unhelpful thinking patterns that are present when someone is experiencing depression. It also provides strategies for individuals to reconstruct their thinking and identify the negative thinking patterns they might engage in.

Because of negative thinking patterns or cognitions, individuals often develop negative beliefs about everyday situations. This may cause them to change their behavior.

This worksheet on Behavioral Experiments to Test Beliefs encourages you to challenge your negative thoughts or beliefs. You are assisted to develop a hypothesis from your beliefs and test whether your negative core beliefs actually come true.

It is a useful worksheet if you are trying to confront negative beliefs about a specific situation, such as going out in social situations, or struggling to leave home. Having a concrete situation will allow you to better challenge the negative thinking patterns you might experience.

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Delivering CBT in a group therapy format is sometimes recommended for those who may benefit from a group to relate to when dealing with symptoms and situations specific to depression.

Individuals may also benefit from group cohesion and can potentially use the group as an arena for challenging their negative thoughts and behavior (Thimm & Antonsen, 2014).

1. Awareness of the mind

One of the most important goals in group therapy is for participants to get comfortable telling their story and learning about themselves. I Am is an introductory activity for people doing group therapy. Filling out the prompts helps them define themselves, specifically their boundaries and strengths.

The ultimate goal of the ‘I Am’ exercise is for the individual to gain an awareness of their own mind. They can then share this activity with other participants so they can all get to know each other better, form a trusting bond, and promote a safe space to discuss their depression.

2. Contributing events

Often, people with depression can identify a series of events that may have contributed to the development or worsening of their condition.

My Depression Story is designed for individuals taking part in group therapy. It encourages participants to make a timeline of their lives, highlighting key moments that have shaped their individual perceptions. It then asks them to do the same thing with their depression so they can better understand what the contributing factors may have been.

By sharing these events with the group, they can determine how depression has affected their perceptions and figure out a healthier way to map out their goals from now on.

According to the World Health Organization (2020b), one in six youths between the ages of 10 and 19 are affected by a mental illness. Moreover, depression is one of the leading causes of illness and disability among adolescents.

Therefore, it is essential to have resources and information for teens and their parents so they can identify the symptoms of depression. If you suspect your teen is experiencing depressive symptoms or you simply want to learn more, read on for resources you could use.

Recognizing the warning signs of depression is one of the most important preventative measures a parent or guardian can take to ensure that their teenager gets the help they need.

Our Depression Fact Sheet for Teenagers is designed to break down the symptoms and behaviors that characterize depression specific to teenagers. It also provides resources for teenagers to consult if they have a friend who is experiencing these symptoms and don’t know what to do.

Teenagers in particular may struggle to put their emotions into words, specifically when they are experiencing depression. This Letter to a Loved One About My Depression activity provides ideas for teenagers to help express their feelings. It even has a template that they can fill in and print if they are having trouble finding the right way to tell a parent or another loved one about their depression.

As discussed in the previous section, confronting negative thoughts is a central part of dealing with depression. The Depressive Thoughts for Teens worksheet acts as a companion to the Unhelpful Thinking Styles worksheet.

It has specific activities for teenagers to break down their responses to various situations and an example to follow when confronting their negative thoughts. We encourage parents to complete this alongside their teenager to help them identify trigger situations and provide more productive problem-solving solutions.

An important part of facilitating long-term recovery from depression is to encourage coping skills that individuals can implement in their everyday lives when they feel overwhelmed or upset.

Coping strategies “consist of behaviors, primarily management and problem-solving techniques that are implemented to manage stressful situations” (Bautista & Erwin, 2013, p. 687).

Coping skills can either focus on targeting the problem (problem-based) or seek to make yourself feel better when the circumstances are out of your control (emotion-based).

The point of introducing these coping skills is not only to give individuals strategies to fight off depression, but also to discourage the use of unhealthy coping strategies (e.g., drugs, alcohol, avoidance, overeating, or overspending). These are strategies that provide instant gratification but could have negative consequences if the unhealthy patterns continue.

1. Deep breathing

If you are looking for a technique that is easy to do and free of charge, consider exploring deep breathing. Three Steps to Deep Breathing gives you a quick overview of how to use deep breathing when you are feeling stressed, upset, or overwhelmed.

Our Power of Deep Breathing article also provides more details about how deep breathing can help you overcome stress and anxiety, and introduces practices where deep breathing is commonly used (e.g., yoga, meditation).

2. Coping style

Part of knowing how to implement coping skills into your daily routine is to understand what your coping style is and what strategies might work best for you. This Coping Styles Formulation activity helps individuals work with their therapist to identify the problem that is causing them distress.

By delving deeper into the events and actions that caused the problem, they may be able to better understand what coping style or skills they need to implement, especially if this is a recurring issue that causes distress.

3. Self-care

Another important part of coping is to implement self-care. Self-care is any activity that involves taking care of our mental, emotional, or physical health. Self-care not only leads to improved mood and reduced anxiety, but can also improve your self-esteem (Michael, 2016).

This Self-Care Checkup gives ideas for self-care and allows you to rate how often you engage in each activity. This worksheet also divides self-care into emotional, physical, social, professional, and spiritual self-care. It will reveal which area of your life needs the most attention and help you implement the strategies as needed.

4. Self-love

Additionally, this Self-Love Journal is helpful for daily self-care, as it gives you an opportunity to think about the moments and aspects of yourself that are positive, rather than focusing on more difficult things that are happening.

17 Exercises To Reduce Stress & Burnout

Help your clients prevent burnout, handle stressors, and achieve a healthy, sustainable work-life balance with these 17 Stress & Burnout Prevention Exercises [PDF].

Created by Experts. 100% Science-based.

We have an excellent selection of resources that can assist those battling depression. For therapists, the following masterclasses and worksheets will equip you to be better able to support your clients.

Self-Acceptance Masterclass

The Science of Self-Acceptance Masterclass© is an excellent tool for practitioners and individuals who are struggling with accepting themselves. Often, a strong driver of depression is an individual’s difficulty with loving and accepting themselves for who they are.

This course focuses on building a healthy relationship with yourself first by using science-based activities to help build your self-esteem. This is also an excellent resource for practitioners who have a client who is struggling with depression and low self-esteem.

Meaning & Valued Living Masterclass

This masterclass on Meaning and Valued Living aims to help individuals find meaning in everyday life. People with depression often struggle to find meaning or value in themselves or their everyday actions, as they are caught in a cycle of negative thought patterns and experiences.

This course aims to help them regain a sense of purpose and find value in the contributions they are making, no matter how small or insignificant they may seem.

17 Stress & Burnout Prevention Exercises

If you’re looking for more science-based ways to help others manage stress without spending hours on research and session prep, this collection contains 17 validated stress management tools for practitioners. Use them to help others identify signs of burnout and create more balance in their lives.

Depression can be a difficult condition to overcome, especially when you feel lonely or isolated. Changing your thinking and behavior can be a daunting task, as it is often less intimidating to stick with something you are familiar with, even if it has a negative impact on your daily living.

Reading this article is a great first step to understand depression and struggles with negative thoughts. Be kind to yourself, and remember that every small step you take along your self-improvement journey is an important one and should be celebrated.

Reach out to a professional, close friend, or family member to help you with the next steps. Getting out of the hole is a challenging journey, so asking for help and someone to be on your side is the best decision you can take. You don’t have to do this alone.

If you are struggling with severe symptoms of depression or suicidal thoughts, please call the following number in your respective country:

USA: National Suicide Prevention Hotline at 988
UK: Samaritans hotline at 116 123
The Netherlands: Netherlands Suicide Hotline at 0900 0767
France: Suicide écoute at 01 45 39 40 00
Australia: Lifeline at 13 11 14
Germany: Telefonseelsorge at 0800 111 0 111 or 0800 111 0 222

For a list of other suicide prevention websites, phone numbers, and resources, see this website or consult Open Counseling’s list of International Suicide and Emergency Hotlines . Resources are listed by country, and you can click on the ‘more hotlines’ and ‘in-person counseling’ tabs to get further help.

Please know that there are people who care and treatments that can help.

We hope you enjoyed reading this article. Don’t forget to download our three Stress & Burnout Prevention Exercises (PDF) for free .

Bautista, R. E., & Erwin, P. A. (2013). Analyzing depression coping strategies of patients with epilepsy: A preliminary study. Seizure , 22 , 686–691.
Michael, R. (2016, August 10). What self-care is and what it isn’t. Psych Central. Retrieved April 23, 2021, from https://psychcentral.com/blog/what-self-care-is-and-what-it-isnt-2#1
Pulcu, E., Zahn, R., & Elliott, R. (2013). The role of self-blaming moral emotions in major depression and their impact on social decision making. Frontiers in Psychology , 4 , 310–319.
Rnic, K., Dozois, D. J. A., & Martin, R. A. (2016). Cognitive distortions, humor styles and depression. Europe’s Journal of Psychology , 12 (3), 348–362.
Thimm, J. C., & Antonsen, L. (2014). Effectiveness of cognitive behavior group therapy for depression in routine practice. BMC Psychiatry , 14 (292), 1–9.
Thompson, N., & Thompson, S. (2008). The critically reflective practitioner . MacMillian International Higher Education.
Westbrook, D., Kennerley, H., & Kirk, J. (2011). An introduction to cognitive behavior therapy: Skills and applications (2nd ed.). SAGE.
World Health Organization. (2020a). Depression . Retrieved April 21, 2021, from https://www.who.int/news-room/fact-sheets/detail/depression
World Health Organization. (2020b). Adolescent mental health . Retrieved April 22, 2021, from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

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Diseases & Conditions
Depression (major depressive disorder)
What is depression? A Mayo Clinic expert explains.

Learn more about depression from Craig Sawchuk, Ph.D., L.P., clinical psychologist at Mayo Clinic.

Hi, I'm Dr. Craig Sawchuk, a clinical psychologist at Mayo Clinic. And I'm here to talk with you about depression. Whether you're looking for answers for yourself, a friend, or loved one, understanding the basics of depression can help you take the next step.

Depression is a mood disorder that causes feelings of sadness that won't go away. Unfortunately, there's a lot of stigma around depression. Depression isn't a weakness or a character flaw. It's not about being in a bad mood, and people who experience depression can't just snap out of it. Depression is a common, serious, and treatable condition. If you're experiencing depression, you're not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It's really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That's why it's important to get an accurate diagnosis.

While there's no single cause of depression, most experts believe there's a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.

The good news is that treatment helps. Effective treatments for depression exist and you do have options to see what works best for you. Lifestyle changes that improve sleep habits, exercise, and address underlying health conditions can be an important first step. Medications such as antidepressants can be helpful in alleviating depressive symptoms. Therapy, especially cognitive behavioral therapy, teaches skills to better manage negative thoughts and improve coping behaviors to help break you out of cycles of depression. Whatever the cause, remember that depression is not your fault and it can be treated.

To help diagnose depression, your health care provider may use a physical exam, lab tests, or a mental health evaluation. These results will help identify various treatment options that best fit your situation.

Help is available. You don't have to deal with depression by yourself. Take the next step and reach out. If you're hesitant to talk to a health care provider, talk to a friend or loved one about how to get help. Living with depression isn't easy and you're not alone in your struggles. Always remember that effective treatments and supports are available to help you start feeling better. Want to learn more about depression? Visit mayoclinic.org. Do take care.

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.

More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. Most people with depression feel better with medication, psychotherapy or both.

Depression care at Mayo Clinic

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Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

Feelings of sadness, tearfulness, emptiness or hopelessness
Angry outbursts, irritability or frustration, even over small matters
Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
Sleep disturbances, including insomnia or sleeping too much
Tiredness and lack of energy, so even small tasks take extra effort
Reduced appetite and weight loss or increased cravings for food and weight gain
Anxiety, agitation or restlessness
Slowed thinking, speaking or body movements
Feelings of worthlessness or guilt, fixating on past failures or self-blame
Trouble thinking, concentrating, making decisions and remembering things
Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

Memory difficulties or personality changes
Physical aches or pain
Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
Often wanting to stay at home, rather than going out to socialize or doing new things
Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you're reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 in the U.S. or your local emergency number immediately.

Also consider these options if you're having suicidal thoughts:

Call your doctor or mental health professional.
Contact a suicide hotline.
In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat . Services are free and confidential.
U.S. veterans or service members who are in crisis can call 988 and then press “1” for the Veterans Crisis Line . Or text 838255. Or chat online .
The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
Reach out to a close friend or loved one.
Contact a minister, spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

More Information

Depression (major depressive disorder) care at Mayo Clinic

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It's not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.
Marijuana and depression
Vitamin B-12 and depression

Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren't clearly male or female (intersex) in an unsupportive situation
History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
Abuse of alcohol or recreational drugs
Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn't treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

Excess weight or obesity, which can lead to heart disease and diabetes
Pain or physical illness
Alcohol or drug misuse
Anxiety, panic disorder or social phobia
Family conflicts, relationship difficulties, and work or school problems
Social isolation
Suicidal feelings, suicide attempts or suicide
Self-mutilation, such as cutting
Premature death from medical conditions
Depression and anxiety: Can I have both?

There's no sure way to prevent depression. However, these strategies may help.

Take steps to control stress, to increase your resilience and boost your self-esteem.
Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
Get treatment at the earliest sign of a problem to help prevent depression from worsening.
Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.
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Essay On Depression: Causes, Symptoms And Effects

Our life is full of emotional ups and downs, but when the time of down lasts too long or influences our ability to function, in this case, probably, you suffer from common serious illness, which is called depression. Clinical depression affects your mood, thinking process, your body and behaviour. According to the researches, in the United States about 19 million people, i.e. one in ten adults, annually suffer from depression, and about 2/3 of them do not get necessary help. An appropriate treatment can alleviate symptoms of depression in more than 80% of such cases. However, since depression is usually not recognized, it continues to cause unnecessary suffering.

Depression is a disease that dominates you and weakens your body, it influences men as well as women, but women experience depression about two times more often than men.

Since this issue is very urgent nowadays, we decided to write this cause and effect essay on depression to attract the public attention one more time to this problem. I hope it will be informative and instructive for you. If you are interested in reading essays on similar or any other topic, you should visit our website . There you will find not only various essays, but also you can get help in essay writing . All you need is to contact our team, and everything else we will do for you.

Depression is a strong psychological disorder, from which usually suffers not only a patients, but also his / hers family, relatives, friends etc.

General information

More often depression develops on the basis of stress or prolonged traumatic situation. Frequently depressive disorders hide under the guise of a bad mood or temper features. In order to prevent severe consequences it is important to figure out how and why depression begins.

Symptoms and causes of depression

As a rule, depression develops slowly and insensibly for a person and for his close ones. At the initial stage most of people are not aware about their illness, because they think that many symptoms are just the features of their personality. Experiencing inner discomfort, which can be difficult to express in words, people do not ask for professional help, as a rule. They usually go to doctor at the moment, when the disease is already firmly holds the patient causing unbearable suffering.

Risk factors for depression:

being female;
the presence of depression in family anamnesis;
early depression in anamnesis;
early loss of parents;
the experience of violence in anamnesis;
personal features;
stressors (parting, guilt);
alcohol / drug addiction;
neurological diseases (Parkinson's disease, apoplexy).

Signs of depression

Depression influences negatively all the aspects of human life. Inadequate psychological defense mechanisms, in their turn, affect destructively not only psychological, but also biological processes.

The first signs of depression are apathy, not depending on the circumstances, indifference to everything what is going on, weakening of motor activity; these are the main clinical symptoms of depression . If their combination is observed for more than two weeks, urgent professional help is required.

Psychological symptoms:

depressed mood, unhappiness;
loss of interest, reduced motivation, loss of energy;
self-doubt, guilt, inner emptiness;
decrease in speed of thinking, inability to make decisions;
anxiety, fear and pessimism about the future;
daily fluctuations;
possible delirium;
suicidal thoughts.

Somatic symptoms:

vital disorders;
disturbed sleep (early waking, oversleeping);
eating disorders;
constipation;
feeling of tightness of the skull, dizziness, feeling of compression;
vegetative symptoms.

Causes of depression

It is accepted to think in modern psychiatry that the development of depression, as well as most of other mental disorders, requires the combined effect of three factors: psychological, biological and social.

Psychological factor (“Personality structure”)

There are three types of personality especially prone to depression:

1) “Statothymic personality” that is characterized by exaggerated conscientiousness, diligence, accuracy;

2) Melancholic personality type with its desire for order, constancy, pedantry, exessive demands on itself;

3) Hyperthymic type of personality that is characterized by self-doubt, frequent worries, with obviously low self-esteem.

People, whose organism biologically tends to depression development, due to education and other social environmental factors form such personality features, which in adverse social situations, especially while chronic stress, cause failure of psychological adaptation mechanisms, skills to deal with stress or lack of coping strategies.

Such people are characterized by:

lack of confidence in their own abilities;
excessive secrecy and isolation;
excessive self-critical attitude towards yourself;
waiting for the support of the close ones;
developed pessimism;
inability to resist stress situations;
emotional expressiveness.

Biological factor:

the presence of unfavorable heredity;
somatic and neurological head injury that violated brain activity;
changes in the hormonal system;
chronobiological factors: seasonal depressive disorders, daily fluctuations, shortening of REM sleep;
side effects of some medications.
Heredity and family tendency to depression play significant role in predisposition to this disease. It is noticed that relatives of those who suffer from depression usually have different psychosomatic disorders.

Social factor:

the presence of frequent stress situations, chronic stress;
adverse family relationships;
adverse childhood experience, the absence of tenderness from parents, ill-treatment and sexual harassment, interpersonal loss, severe methods of education, negative childhood memories;
urbanization;
significant changes in the life;
population migration;
increased lifetime.

People in a state of chronic stress suffer from depression more often. If some acute stress situation happens during the period of chronic stress, the probability of depression symptoms development increases.

If you decide to fight the depression, remember that you are not alone! Every fifth person in the world at least once in the life experienced depression. If you notice the signs of depression that disturb you for more than two weeks, you should go to the specialist.

Do not delay visit, in this case time does not heal. The professionalism of the doctors and a complex program of treatment will help to get rid of any kind of depression.

Where to go for help

If you do not where to go for help, ask your family physician, obstetrician, gynecologist or the clinic. In an emergency situation, the emergency doctor can provide temporary help for patients with emotional problems and give them an advice where and how they can ask for the further help.

Here is the list of people and organizations that can diagnose and suggest a course of treatment, or can give a direction to the examination and treatment.

Family doctors.
Such specialists as psychiatrists, psychologists, social workers and consultants on mental health.
Health maintenance organizations.
Local centers for the treatment of mental illness.
The Department of Psychiatry in hospitals and outpatient clinics.
Programs at universities and medical schools.
Family assistance services and social services departments.
Private clinics and institutions.
Care centers in the workplace.
Local health and (or) mental health communities.

It is very important in depressive episode treatment to understand that this is depression of a certain person, do not make attempts to excessive generalization of symptoms and factors of disease development. It requires personal approach to each patient.

So, as you can see, depression is a serious disease that requires professional treatment. If you manage to recognize the signs of depression at its early stage and ask for professional help, you can successfully overcome this problem. I hope this essay about depression was useful for you, and you got what you were looking for.

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Published: 15 March 2019

The genetics of depression: successful genome-wide association studies introduce new challenges

Johan Ormel ORCID: orcid.org/0000-0002-5463-037X 1 ,
Catharina A. Hartman 1 &
Harold Snieder 1

Translational Psychiatry volume 9 , Article number: 114 ( 2019 ) Cite this article

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The recent successful genome-wide association studies (GWASs) for depression have yielded more than 80 replicated loci and brought back the excitement that had evaporated during the years of negative GWAS findings. The identified loci provide anchors to explore their relevance for depression, but this comes with new challenges. Using the watershed model of genotype–phenotype relationships as a conceptual aid and recent genetic findings on other complex phenotypes, we discuss why it took so long and identify seven future challenges. The biggest challenge involves the identification of causal mechanisms since GWAS associations merely flag genomic regions without a direct link to underlying biological function. Furthermore, the genetic association with the index phenotype may also be part of a more extensive causal pathway (e.g., from variant to comorbid condition) or be due to indirect influences via intermediate traits located in the causal pathways to the final outcome. This challenge is highly relevant for depression because even its narrow definition of major depressive disorder captures a heterogeneous set of phenotypes which are often measured by even more broadly defined operational definitions consisting of a few questions (minimal phenotyping). Here, Mendelian randomization and future discovery of additional genetic variants for depression and related phenotypes will be of great help. In addition, reduction of phenotypic heterogeneity may also be worthwhile. Other challenges include detecting rare variants, determining the genetic architecture of depression, closing the “heritability gap”, and realizing the potential for personalized treatment. Along the way, we identify pertinent open questions that, when addressed, will advance the field.

The genetic basis of major depressive disorder

Minimal phenotyping yields genome-wide association signals of low specificity for major depression

Multi-ancestry genome-wide association study of major depression aids locus discovery, fine mapping, gene prioritization and causal inference

Introduction.

Major depressive disorder (MDD, henceforth: depression) is a common mental disorder. In most Western countries, MDD has a 1-year prevalence of ~5% 1 , 2 and a lifetime prevalence of ~15% 3 . Depression is in the top three of the leading causes of years lived with disability and a significant contributor to premature mortality due to suicide 4 , 5 . Twin-based heritability estimates typically fluctuate around 35%. Candidate gene studies have not implicated replicable gene variants 6 and—until very recently—genome-wide association studies (GWASs) had neither 7 , 8 .

This long drought without much progress in understanding the genetics of depression has recently ended. The CONVERGE consortium focused on a homogeneous subtype of carefully phenotyped recurrent, severe depression, and identified two genetic loci exceeding genome-wide significance levels 9 . Shortly thereafter, GWASs that used the alternative strategy of increasing sample size while using a more lenient, easy to measure, depression phenotype (i.e., “minimal” phenotyping) have identified additional genetic variants 10 , 11 , 12 , culminating in the most recent successes of GWASs conducted in the UK Biobank ( n = 322,580; 16 independent loci associated with broad depression phenotypes) 13 , the PGC MDD working group (130,664 MDD cases and 330,470 controls; 44 independent loci) 14 , and the Howard et al. meta-meta-analysis of data on 807,553 individuals (246,363 cases and 561,190 controls) from the three largest GWASs of depression using minimal phenotyping 15 . Howard and colleagues identified 102 independent variants of which 87 replicated in an independent sample. Finally, GWAS findings on multiple psychiatric phenotypes were leveraged to identify eight novel independently replicated depression loci 16 .

With this successful harvest of GWAS loci for depression, the next wave of challenges has come to the fore. Using the watershed model of genotype–phenotype relationships as a conceptual aid and recent genetic insights on other complex traits such as height, we discuss first why it took so long, followed by seven challenges that need further work to advance the field. The biggest challenge is probably the identification of genetic variants that are causally involved in MDD. These challenges are not unique to depression but apply in varying degrees to highly polygenic conditions in general. Nonetheless, we focus this paper on depression for two reasons: (1) Depression is an interesting mental disorder because of its high prevalence and relatively small twin-based heritability, and (2) It affords a clear focus and obviates the need to include information about many other polygenic conditions. Depression contrasts strongly with human height, a complex trait like depression, which is—unlike depression—highly heritable and measured with less error. Below, we often use height as a contrasting complex trait. Gene finding studies for height have shown much more rapid returns than for depression and may give insight into what we might expect for depression in the near future with much larger sample sizes compensating for its lower heritability and larger measurement error.

Why did it take so long?

Keller and Cannon’s watershed analogy of the genotype–phenotype relationship is helpful in explaining why the identification of genetic loci for depression has been extremely difficult (Fig. 1 ) 17 . Much like the numerous streams of the Amazonian watershed that merge and eventually empty into the Atlantic Ocean, sets of genetic variants influence upstream micro-biological processes (narrowly defined mechanisms; e.g., dopamine transmission) that influence intermediate “downstream” meso-biological processes (e.g., working memory, facial emotion recognition) that in turn affect macro-biological processes (e.g., stress sensitivity, affect regulation), which contribute to the overall fitness of the individual. Gene variants that are directly involved in an upstream process not only affect that upstream process, but indirectly also many processes and traits downstream. If enough noise is present in particular upstream processes, specific behavioral syndromes may arise, such as symptoms of mental disorder. The more upstream (specific, narrow) the (intermediate) phenotype is, the closer its relationship to the genetic variants that affect it, thereby increasing the probability that the associated genetic variants are truly involved in the production of the phenotype.

Mutations at specific loci (1 a , 1 b ) disrupt narrowly defined mechanisms such as transmission of dopamine in the prefrontal cortex (2 b ). This and other narrowly defined mechanisms contribute noise to more broadly defined mechanisms, such as working memory, facial emotion recognition (3 c ). The latter mechanisms in conjunction with several other mechanisms (3 a , 3 b , 3 d ) affect observable phenotypes, such as stress sensitivity, affect regulation. All tributaries eventually flow into fitness (4). Adapted from Keller & Miller, 2006 17

Depression is a rather downstream phenotype, almost at the level of fitness (Fig. 1 ). This feature may explain why it took so long for GWASs of depression to become successful. First, as illustrated by the watershed model of genotype–phenotype relationships, multiple tributaries may lead to the same phenotypic outcome (so-called equifinality), with the implication that depression is etiologically heterogeneous, consistent with current insights. This hampers attempts to identify the genetic loci for depression since all individuals with depression are lumped together, which dilutes the explained variance of a particular variant 18 .

Second, depression is not only etiologically but also phenotypically heterogeneous. Approximately 1500 DSM-IV symptom combinations can fulfill the diagnostic criteria 19 . Two patients diagnosed with depression may have very few symptoms in common. In addition, phenotypic heterogeneity will be enhanced by co-occurring psychiatric problems. Two patients having similar depression symptoms may have different comorbid conditions (e.g., anxiety disorder versus substance use disorder). Again, this will dilute the effects of a particular variant.

Third, the upstream processes involved in depression are hardly known, with problematic consequences for the use of “endophenotypes”. To date, the endophenotype approach in depression has not been able to live up to its promises. Many depression-related endophenotypes proposed in the past were based on stress research and neuroimaging, and thus still at relatively low levels in the watershed model. Such endophenotypes tend to be as genetically complex as their outcome phenotypes 20 .

Fourth, phenotypes downstream in the watershed are more likely to be “constructs” rather than biological “entities”, which introduces measurement error. Depression, whether measured by inventories, (semi-)structured interviews, or clinical assessments, is subjective and based on reported and observed affect, cognition, and behavior. Human height, by comparison, is a much simpler phenotype that can be obtained objectively and reliably. Moreover, measurement of depression is complicated by its mixed course, ranging from a single lifetime episode to chronic-recurrent. Even during an episode symptoms often fluctuate. This complicates measurement since retrieving “the most severe episode” from memory implies retrospective assessment with all its reliability problems. For example, it has been shown that SNP heritability is considerably higher for emotional problems when focusing on the stable variance over time compared to single measures per time point, which further illustrates the relative advantage of height, which remains constant over the adult life course, over depression as a phenotype for genetic studies.

Challenges pertinent to the interpretation and utility of detected genetic variants

With the recent GWAS successes of identifying more than 80 replicated loci, the next wave of challenges for the genetic study of depression come to the fore.

Challenge 1. Prioritizing likely causal genes for functional follow up

An important characteristic of GWASs is that the identified variants merely flag genomic regions without necessarily providing a direct link to the underlying biological mechanisms 21 . In addition, the identified variant may not be (directly) causal to the phenotype of interest but to other phenotypes that are strongly associated with the phenotype of interest, including comorbid conditions and intermediate traits in the causal pathway leading to the final outcome. Furthermore, effect sizes of individual genetic variants are typically very small (although this does not rule out that effect sizes on currently unknown micro-biological phenotypes higher in the watershed can be large) 22 . All in all, the selection of the most promising signals and the discovery of their functional consequences represent a major challenge. Given the costs and difficulties of conducting functional studies, prioritization of likely causal genes is very important. For the approximately 80+ depression loci this is a formidable task. To date, bioinformatics analyses have been the main strategy.

Fine-mapping of identified loci is typically used as a first step to limit the “credible set of SNPs” that likely include the causal variant(s) responsible for the observed GWAS signals. Transethnic differences in linkage disequilibrium can be used to improve its resolution 23 . However, with the exception of the CONVERGE study of recurrently depressed Han Chinese women, depression GWASs have been limited to individuals of European ancestry. Therefore, more GWASs in other ethnic groups are needed to aid fine mapping efforts. Further bioinformatic post-GWAS follow up analyses leverage the fact that there are only two biological mechanisms that can explain true SNP–phenotype associations: (1) the SNP may alter the amino acid coding (i.e., a nonsynonymous SNP) changing the protein structure and potentially its function, alternatively; (2) it may exert its phenotypic effect through influencing the expression of the gene. Therefore, bioinformatic post-GWAS pipelines will check whether GWAS signals will be in high linkage disequilibrium with nonsynonymous SNPs within nearby genes and use publicly available expression Quantitative Trait Loci (eQTL) resources from relevant tissues such as the brain (GTEx, Braineac) or whole blood to check which SNPs in the identified loci are also associated with gene expression 24 .

Recent tools integrate evidence from GWAS with eQTL data within a Mendelian randomization framework allowing assignment of likely causality of genes within loci 25 , 26 , 27 . The Mendelian randomization approach is based on the fact that the DNA sequence is fixed, which implies that causation can only flow in one direction, allowing the use of genetic markers as instrumental variables. With the advent of GWAS and the recent explosion in variant discovery, this simple idea has been applied to great effect 28 . It has been used in particular to examine the causality of correlated phenotypes and the origins of genetic correlations (see also Challenge 4). But it can also be used to explore the causal role of genes within identified genetic loci for the phenotype of interest 25 .

Mendelian randomization in its most basic form is summarized in Fig. 2 where the causal relationship between an exposure (e.g., obesity) and an outcome (e.g., depression) is investigated (association 1 in Fig. 2 ) using genetic variants known for influencing the exposure (obesity) (association 2) as an instrumental variable, by estimating the association between the genetic variants and the outcome (depression) (association 3) 27 .

Adapted from Verduijn, 2010 27

Mendelian randomization has three important assumptions (see Fig. 3 ). First, the genetic variants should have a robust and strong relationship with the exposure (a). Second, the variants must not be associated with factors that confound the association between exposure and outcome (b). Third, the genetic markers for the exposure only influence the outcome through their effect on the exposure and not through any other pathway (c). Although the latter two assumptions are hard to prove, many Mendelian randomization sensitivity analyses have recently been developed that are less reliant on these assumptions 29 .

( a ) presence of a robust association between genetic variants and exposure (here depression), ( b ) absence of (direct/indirect) association between generic variant and confounding factors, and ( c ) absence of other pathways between genetic variants and outcome. Adapted from Verduijn, 2010 27

Further bioinformatic analyses may explore whether genes within the GWAS loci are preferentially expressed in certain tissues or enriched in certain networks and pathways, and whether these genes are targets of existing (e.g., psychiatric) medications 22 , 30 . Ultimately, unequivocal evidence of underlying mechanisms will have to come from functional studies such as the one showing a role in synapse pruning for the C4A gene in schizophrenia 31 . Developing and increasing throughput of either cell-based or animal model assays to investigate the many GWAS loci for function will be one of the main challenges for the immediate future.

Challenge 2. Finding rare and more common variants

Given the relationship between sample size and the number of detected loci, it is to be expected that larger sample sizes will identify additional loci. These will include common variants with (even) small(er) effects and probably rare variants of moderate-to-large effect although their role in depression is currently unknown 32 . The brief history of GWASs of, for example, schizophrenia, supports the expectation that with larger sample sizes rare variants can be discovered. In general, the contribution of rare variations of strong effect tends to be larger for early-onset, highly heritable, severe (e.g., neurodevelopmental disorders, including schizophrenia) disorders and lesser for disorders that are less heritable, less severe and with a later onset, such as depression 30 . But that does not exclude a role for rare variants in depression.

The support that rare variants may play a role in depression also comes from large GWASs of complex traits outside psychiatry, most notably human height 33 , 34 . Some rare variants (minor allele frequencies [MAFs] 0.8–2.1%) had large effects, implicating a 2 cm difference in height. The explained variance of genetic variants is a simple function of both effect size and MAF. As such, despite their much larger effect size, the rare height-associated genetic variants each explain, on average, similar amounts of variation at the population level as common variants. The much lower effect size of common variants is “compensated” by their much higher frequency.

Fortunately, costly whole genome or exome sequencing may not be necessary to find rare variants, as large GWAS sample sizes of a million individuals or more, imputed to very large sequenced reference samples will offer sufficient resolution and power in the low frequency range and are now increasingly feasible 35 , 36 . Furthermore, the strong phenotypic and genetic correlation between depression and other mental disorders may be leveraged to improve power and identify both additional common and novel rare variants for depression 16 .

Challenge 3. Establishing the genetic architecture of depression

Initially, GWASs of complex traits operated from the simple common disease–common variant (CDCV) model, positing that a moderate number (<100) of gene variants of intermediate frequency (MAF > 5%) with small-to-moderate effect (OR > 1.5) account for the heritability of the trait. The results of recent GWAS studies of complex traits, including height, have shown this CDCV model to be wrong for most types of complex traits 37 , 38 , 39 . Four alternative models of genetic architecture have been proposed: (i) the infinitesimal model assuming that heritability is due to a large number (»100) of small-effect common variants, (ii) the rare allele model, assuming that heritability is due to a large number of rare variants with relatively large-effects (including copy number variants), (iii) the broad-sense heritability model, assuming that in addition to additive effects of common variants, heritability is due to rare variants, non-additive GxG (dominance, epistasis) and GxE interactions as well as epigenetic effects, and (iv) the omnigenic model hypothesizing that the genetic architecture of complex traits is characterized by very large numbers of peripheral, more general genes and a limited number of “core” genes, assumed to be more disease specific 37 , 40 .

Apart from the yet to be detected occasional rare variants, the infinitesimal model may provide a good approximation for a highly polygenic disorder like depression. Regarding non-additive GxG and GxE interactions, decisive evidence is lacking as to date GWASs have not been designed and powered to detect GxG and GxE interactions, neither for depression, nor for other mental disorders or height. Recent studies were unable to show a sizable influence of dominance for a wide range of complex traits 41 . Previous attempts to study GxE on the basis of single candidate genes 42 , 43 are now being replaced by the use of polygenic risk scores (e.g., refs. 44 , 45 ). which may offer more promise for detection of GxE interaction, although the polygenic risk scores will only provide a general measure of genetic susceptibility for depression that does not directly indicate underlying mechanisms. Moreover, the use of polygenic risk scores neglect the possibility that the impact of GxE interaction is not consistent across different genes or pathways; some genetic pathways may show GxE interaction but others may not or in the reverse direction. Nonetheless, it is likely that these interaction studies will eventually be successful given, for example, “indirect” evidence of substantial GxE interactions between personality traits and environmental exposures 46 , 47 . Regarding the omnigenic model, Wray and colleagues have recently argued that, although intuitively appealing, there is insufficient empirical evidence for the existence of its hypothesized core genes 18 .

Irrespective of the correct model for the genetic architecture, it must reserve an honorable seat for environmental influences. In addition to the aforementioned interactions, two epidemiological observations support a substantial environmental component in the etiology of depression: Although depression can be found everywhere, substantial national and regional variations in prevalence exist 3 , 48 . Because of the ultimately subjective nature of the measurement process, these prevalence differences are hard to interpret. Furthermore, strong effects on risk for depression have been documented for long-term difficulties (e.g., taking care of a dementing partner, persistent unemployment, victim of chronic bullying) which in addition moderate the depression risk of stressful life events (e.g., acute illness of child, let down by friend) 46 , 49 , 50 , 51 . The latter short-term factors are typically thought to play a role in the timing of depression onsets pushing susceptible individuals across the diagnostic threshold. Although such environmental effects partly reflect depression’s genetic background (i.e., gene–environment correlation); they are nonetheless likely to have an extra, additive, contribution to, as well as interaction with, genetic risk in explaining the depression phenotype.

Challenge 4. Genetic pleiotropy and unraveling causal relationships with other traits

Pleiotropy is the phenomenon whereby a genetic variant influences two or more phenotypes 52 . In line with high comorbidity across mental disorders, GWAS findings also indicate substantial genetic overlap, although the extent thereof was perhaps unexpected 53 . SNP-based genetic correlations ( r g ) between depression and other mental disorders are substantial 14 . Pleiotropy is not specific to psychiatry and has also been shown between depression and somatic conditions 14 , 54 , 55 .

Part of the genetic correlations may derive from symptom/diagnostic overlap, comorbidity or can even be an artefact of diagnostic misclassification. It is useful to make a distinction between heterogeneity due to different symptom patterns that all meet MDD’s diagnostic criteria and heterogeneity due to comorbidity with other mental disorders, a common phenomenon. Genetic correlations may also reflect a common cause. For example, virtually all mental disorders involve sensitivity to stressful situations which is why individual differences in appraisal of and coping with stressful experiences have an impact on the severity of their manifestation. This commonality implies that genetic variants that influence appraisal and coping may turn up in GWASs of these mental disorders, although they are at best causally involved in a generic way, not strictly part of the specific disorder’s pathophysiology. In the watershed model, these shared appraisal-coping or executive functioning related variants are probably located relatively upstream, with many confluences downstream. The higher hierarchical position makes it “easier” to be involved in multiple phenotypes than variants more downstream.

A unique feature of genetic as opposed to classic epidemiological associations that aids in unraveling causality is that confounders (or third variables) that influence both genetic markers and outcome phenotypes do not exist (DNA is fixed). Mendelian randomization can thus also be used to disentangle the causes of correlated traits using genetic markers to distinguish between alternative causal explanations such as reverse causation and shared causes 56 . One important requirement for effective Mendelian randomization is the availability of a sufficient number of genetic markers associated with the exposure as their combined effect determine the strength of the instrumental variable. This means that distinguishing causality between depression and associated traits using Mendelian randomization has only recently become possible. The continued discovery of additional genetic variants for depression will be important to improve their strength as an instrumental variable and hence the power of Mendelian randomization analyses in order to distinguish between alternative causal pathways, thereby providing fresh clues to old questions.

Challenge 5. Closing the “heritability gap”

Genetic variants detected by GWAS typically explain only a fraction of the total family- or twin-based heritability. This has become known as the missing heritability problem or heritability gap 41 , 57 . Recently introduced methodology now also allows calculation of the SNP- or chip-based heritability ( h 2 SNP ), which is the proportion of phenotypic variance jointly accounted for by all variants on a standard GWAS chip. h 2 SNP provides an upper bound estimate of the genetic effects that could be detected by a (well-powered) GWAS 58 . The remainder is likely due to rarer and structural variants that have until recently not been captured by regular GWAS arrays 35 . The latest PGC depression GWAS estimates this h 2 SNP at ~9%, which is only around a quarter of the heritability based on twin and family studies of ~35%. However, measurement error and heterogeneity in phenotype definition between the different PGC cohorts may explain part of the difference in heritability as the CONVERGE study found a h 2 SNP between 20 and 29% within their cohort of carefully assessed women with early-onset recurrent depression.

Another part of the heritability gap may be attributed to potentially inflated twin heritability estimates caused by gene by common (C) (or shared) environment (GxC) interactions 45 . That is, genetic effects depend on environmental factors shared by twins that grow up in the same family but not by unrelated individuals in the GWAS samples. The statistical models used in twin studies to estimate twin-based heritability fully attribute the joint effect (GxC) to the genetic component, thus inflating heritability estimates and reducing the contribution of shared environment. The GxC explanation “solves” not only (part of) the heritability gap but the shared environment paradox as well. This paradox refers to the apparent inconsistency that, in contrast to epidemiological studies, the statistical models used in twin studies typically find hardly any shared-environmental variance while many (distal) environmental risk factors are shared by twins in the same family, e.g., poverty, family instability, child neglect, neighborhood stressors, minority status, SES 59 . As pointed out by Uher and Zwicker 45 , this paradox disappears if we realize that the impact of these shared-environmental factors depends on characteristics shared to a larger extent by monozygotic than dizygotic twins, i.e., genetic variants.

The difference between heritability explained by GWAS identified variants and the h 2 SNP has also been more aptly termed “hidden” heritability as future larger GWASs are expected to detect additional signals still hidden in the noise. Furthermore, new generations of denser and better-imputed GWAS arrays are expected to capture more rare and structural variants, which will increase the h 2 SNP and decrease its gap with the total (potentially inflated) (family and twin-based) heritability 35 , 57 .

Challenge 6. Reducing the phenotypic heterogeneity

A major challenge is the identification of genetic variants that are causally involved in MDD and this is aggravated by the use of minimal phenotyping (based on a few symptoms), which, as recently shown, may have yielded cases unrepresentative of MDD that are enriched by people “with non-specific sub-clinical depressive symptoms and depression secondary to a comorbid disease” 60 .

Traditionally, endophenotypes of depression have been used in the hope that this would shorten the distance between genes and phenotype, and consequently reduce genetic heterogeneity. To date, the expectations have not come true as the used endophenotypes were genetically not less complex. However, the recently identified genetic signals may provide new insights into underlying pathophysiological pathways and networks providing clues on more suitable less complex endophenotypes (micro-biological phenotypes) that are at higher levels in the watershed model and thus closer to the genes. Constructs assessed through task performance such as reward sensitivity and attentional biases may have potential utility as endophenotypes if they are associated with genetic signals. Given their transdiagnostic relevance, they may also account for other disorders in which these mechanisms are active as well.

Some argue that another way forward lies in the reduction of phenotypic heterogeneity, by targeting a specific subtype such as early-onset recurrent melancholia or a specific symptom cluster 9 . Others believe that a broader phenotype approach will provide a more tractable target for genetic studies, as this identifies more signals 11 . Findings of the CONVERGE consortium based on a sample size that was much smaller than the other recent depression GWASs suggests that in-depth phenotyping may pay off 9 . In addition to high-quality measurement of depression, this study focused on recurrent severe depression which may be genetically more homogeneous. However, CONVERGE differed in additional aspects from the other MDD GWASs, including the Chinese sample, the focus on women, and analytical approach. We cannot rule out that these differences contributed to CONVERGE’s success.

The recent GWASs successes with broad phenotypes of depression and neuroticism 61 seem to support the broad trawl approach 13 . But note that phenotype broadness is subject to more noise because the likelihood that identified loci are not involved in the physiology of the phenotype of interest increases with broadness (see Challenge 4).

In contrast to broader milder depressive states, other clinically recognizable “subtypes” of depression including early-onset recurrent depression and the more severe subtypes of melancholic, bipolar, and psychotic depression may also be less heterogeneous 62 , 63 , 64 . It is also important to keep in mind that even highly homogeneous subtypes defined by behavioral symptoms are still placed low in the watershed model and remain multifactorial, with multiple underlying etiological pathways although they may be less genetically heterogeneous than all “depressions” lumped together.

Novel approaches improving the phenotype definition of depression may be needed. We outline two complementary approaches below that make use of depression measured at the most narrow level of individual symptoms.

Bottom-up: individual symptoms of depression as a starting point

Symptom-specific GWASs to examine their genetic background may be an interesting next step. Previous depression GWASs have used composite scores or diagnostic case-control designs. Based on data from the UK Biobank, Nagel and colleagues 65 showed that the composite score of neuroticism, an important personality trait that partially overlaps with depression 66 , directs the focus to genetic variants that affect the majority of aggregated items, i.e., “global variants”. The genetic signal of “local” variants, affecting only one or a few of the aggregated items, was severely diluted 65 . Given its multidimensional and heterogeneous nature, it is plausible that symptom-specific GWASs of depression will yield similar findings. Some initial evidence comes from a relatively small sample showing that h 2 SNP of four depression symptom components (appetite, depressed mood and anhedonia, insomnia, and anxiety) was different, suggesting the possible merit of more narrowly defined phenotypes 67 .

Top-down: use hierarchical dimensional models

Hierarchical dimensional models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) 68 show how psychopathology dimensions can be arranged in a hierarchy, ranging from very broad “spectrum level” dimensions (e.g., distress, thought disorder, disinhibited externalizing, etc.), to more specific clusters of symptoms. For instance, the distress spectrum, one of the five internalizing spectra consists of the lower clusters (sub-dimensions) of irritability, anhedonia, numbing, physical panic, suicidality, dysphoria, retardation, lassitude, appetite loss, insomnia, and generalized anxiety 69 . These models hypothesize a hierarchy linking spectrum level dimensions with highly pleiotropic variants which subsume lower order symptom clusters with less pleiotropic variant clusters. This phenotypic ordering from narrow to broad may help in the interpretation of genetic findings.

Challenge 7. Personalized treatment

An important issue is the utility of identified variants for individualized treatment of depression. Three applications may be genomic (polygenic) risk prediction, genome editing, and the identification of novel “druggable” targets, respectively. GWAS results can be used for genomic risk prediction. Increased risk could prompt more intensive surveillance or even prophylactic treatments unrelated to a specific causal mechanism (cf. preventive mastectomy in case of high genetic breast cancer risk). The widespread pleiotropy among mental disorder phenotypes (genetic correlations) can be used to improve genomic risk prediction, so that this might benefit personalized medicine 70 . However, genetic risk-driven prophylactic treatment is not realistic yet, given the low effect size of SNP-based genetic predictors 70 .

Genome-editing technology such as CRISPR/Cas9 may make it possible to change or disable genes in living cells in a precise, cheap, and fast way by cutting, replacing, or adding pieces from the DNA 71 , 72 . However, it is highly doubtful whether this will ever have relevance for “fixing” depression-associated genetic variants due to their small effect sizes, unknown individual relevance (from population to individual), causal relevance (too upstream), and unwanted “side” effects of genome-editing (genetic pleiotropy).

With regard to pharmacotherapy, virtually all currently used drugs in psychiatry have their origins in chance findings in the previous century, while rational approaches to develop new pharmacological treatments have mostly not paid off. The recent findings from the PGC depression GWAS indicated that lead SNPs in some loci were within genes known to play a role in neuronal development, synaptic function, transmembrane adhesion complexes, and/or regulation of gene expression in brain. In addition, genes that are targets of antidepressant medications were strongly enriched for depression-associated signals, which may indicate pharmacotherapeutic relevance 73 . In addition, some identified loci were associated with clinical features of depression including early-onset, recurrence, and severity, and implicated prefrontal and anterior cingulate cortex in the pathophysiology of depression (brain regions showing MRI anatomical and functional differences between MDD cases and controls). Thus, current genomic findings may have substantial potential for the development of new depression medications. The future will tell.

However, the complex genetic nature of depression raises the question for whom drugs developed on the basis of GWAS findings will work. For a highly complex trait-like depression, each individual probably carries a unique combination of protective and risk alleles (see ref. 18 for an illustration). The more polygenic a trait, the more combinations of these sets of alleles are possible, implying that each individual is likely to have a different combination, including affected individuals whose symptom levels have crossed the diagnostic threshold. This explains why most mental disorders are highly heritable but only weakly inheritable 22 . Due to genetic recombination, the probability that a child will inherit a mix of alleles from an affected parent resulting in a genetic risk sufficiently high to also pass the diagnostic threshold remains fairly small. Thus, effect sizes derived from GWASs of a genetic variant with depression should be interpreted in the context of an averaged background; in individual carriers the contribution of a certain variant may be much larger. A particular drug can be effective only in the subgroup of individuals that share the genetic variant and pathway targeted by the drug. The effectiveness of a drug in the individual case thus depends on the number of possible combinations in which the particular variant is a necessary component to become depressogenic. Ultimately, precision medicine for highly polygenic disorders like depression may depend on successfully matching these unique individual genomic profiles to drug treatments 18 .

Clearly, the excitement for investigating the genetic background of depression has returned. Prospects to unravel the pathogenesis and etiology of depression and rationally develop pharmacotherapies are better than ever. Now that depression-associated genetic variants have been found, the next wave of challenges has taken center stage. It is likely that larger samples will identify additional common variants and the first batch of rare variants, which will reveal the genetic architecture of depression, its subtypes and broader phenotypes. It is also likely that taking common (C) (or shared) environment (GxC) interactions into account will contribute to unearthing part of the missing heritability 45 . The GxC explanation not only bridges (part of) the heritability gap but also may explain the shared environment paradox.

The largest challenges will be to identify the causal variants of depression itself and to determine which variants merely correlate with the depression phenotype because they are causally involved in its determinants. In addition to bioinformatics, Mendelian randomization may help to resolve this causal web and will become increasingly effective with the identification of additional genetic variants of depression and related phenotypes. To date, Mendelian randomization has almost exclusively been used to aid in the interpretation of genetic correlations between correlated phenotypes, but it may also assist in distinguishing causal from pleiotropic depression variants. Another approach to clarify the causal status of genetic variants might be comparing markers associated with narrowly (e.g., early-onset recurrent melancholic depression) versus broadly defined depression phenotypes. Likewise, comparing the variants associated with different levels of the “depression hierarchy” (symptoms, clusters of symptoms, internalizing dimensions, general psychopathology factor) might be informative. Finally, the fact that highly polygenic traits are only weakly inheritable despite substantial heritability 22 could explain the seeming paradox that antidepressants may benefit individual patients enormously despite their modest average efficacy on a group level compared to pill-placebo 74 .

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Ormel, J., Hartman, C.A. & Snieder, H. The genetics of depression: successful genome-wide association studies introduce new challenges. Transl Psychiatry 9 , 114 (2019). https://doi.org/10.1038/s41398-019-0450-5

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7 Depression Research Paper Topic Ideas

Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.

Cara Lustik is a fact-checker and copywriter.

In psychology classes, it's common for students to write a depression research paper. Researching depression may be beneficial if you have a personal interest in this topic and want to learn more, or if you're simply passionate about this mental health issue. However, since depression is a very complex subject, it offers many possible topics to focus on, which may leave you wondering where to begin.

If this is how you feel, here are a few research titles about depression to help inspire your topic choice. You can use these suggestions as actual research titles about depression, or you can use them to lead you to other more in-depth topics that you can look into further for your depression research paper.

What Is Depression?

Everyone experiences times when they feel a little bit blue or sad. This is a normal part of being human. Depression, however, is a medical condition that is quite different from everyday moodiness.

Your depression research paper may explore the basics, or it might delve deeper into the definition of clinical depression or the difference between clinical depression and sadness .

What Research Says About the Psychology of Depression

Studies suggest that there are biological, psychological, and social aspects to depression, giving you many different areas to consider for your research title about depression.

Types of Depression

There are several different types of depression that are dependent on how an individual's depression symptoms manifest themselves. Depression symptoms may vary in severity or in what is causing them. For instance, major depressive disorder (MDD) may have no identifiable cause, while postpartum depression is typically linked to pregnancy and childbirth.

Depressive symptoms may also be part of an illness called bipolar disorder. This includes fluctuations between depressive episodes and a state of extreme elation called mania. Bipolar disorder is a topic that offers many research opportunities, from its definition and its causes to associated risks, symptoms, and treatment.

Causes of Depression

The possible causes of depression are many and not yet well understood. However, it most likely results from an interplay of genetic vulnerability and environmental factors. Your depression research paper could explore one or more of these causes and reference the latest research on the topic.

For instance, how does an imbalance in brain chemistry or poor nutrition relate to depression? Is there a relationship between the stressful, busier lives of today's society and the rise of depression? How can grief or a major medical condition lead to overwhelming sadness and depression?

Who Is at Risk for Depression?

This is a good research question about depression as certain risk factors may make a person more prone to developing this mental health condition, such as a family history of depression, adverse childhood experiences, stress , illness, and gender . This is not a complete list of all risk factors, however, it's a good place to start.

The growing rate of depression in children, teenagers, and young adults is an interesting subtopic you can focus on as well. Whether you dive into the reasons behind the increase in rates of depression or discuss the treatment options that are safe for young people, there is a lot of research available in this area and many unanswered questions to consider.

Depression Signs and Symptoms

The signs of depression are those outward manifestations of the illness that a doctor can observe when they examine a patient. For example, a lack of emotional responsiveness is a visible sign. On the other hand, symptoms are subjective things about the illness that only the patient can observe, such as feelings of guilt or sadness.

An illness such as depression is often invisible to the outside observer. That is why it is very important for patients to make an accurate accounting of all of their symptoms so their doctor can diagnose them properly. In your depression research paper, you may explore these "invisible" symptoms of depression in adults or explore how depression symptoms can be different in children .

How Is Depression Diagnosed?

This is another good depression research topic because, in some ways, the diagnosis of depression is more of an art than a science. Doctors must generally rely upon the patient's set of symptoms and what they can observe about them during their examination to make a diagnosis.

While there are certain laboratory tests that can be performed to rule out other medical illnesses as a cause of depression, there is not yet a definitive test for depression itself.

If you'd like to pursue this topic, you may want to start with the Diagnostic and Statistical Manual of Mental Disorders (DSM). The fifth edition, known as DSM-5, offers a very detailed explanation that guides doctors to a diagnosis. You can also compare the current model of diagnosing depression to historical methods of diagnosis—how have these updates improved the way depression is treated?

Treatment Options for Depression

The first choice for depression treatment is generally an antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) are the most popular choice because they can be quite effective and tend to have fewer side effects than other types of antidepressants.

Psychotherapy, or talk therapy, is another effective and common choice. It is especially efficacious when combined with antidepressant therapy. Certain other treatments, such as electroconvulsive therapy (ECT) or vagus nerve stimulation (VNS), are most commonly used for patients who do not respond to more common forms of treatment.

Focusing on one of these treatments is an option for your depression research paper. Comparing and contrasting several different types of treatment can also make a good research title about depression.

A Word From Verywell

The topic of depression really can take you down many different roads. When making your final decision on which to pursue in your depression research paper, it's often helpful to start by listing a few areas that pique your interest.

From there, consider doing a little preliminary research. You may come across something that grabs your attention like a new study, a controversial topic you didn't know about, or something that hits a personal note. This will help you narrow your focus, giving you your final research title about depression.

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National Institute of Mental Health. Depression .

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By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.

Empowering Progress: Effective Therapy Homework for Depression

The role of therapy homework.

Therapy homework plays a vital role in the treatment of depression, providing individuals with an opportunity to actively engage in their healing process. By completing assignments outside of therapy sessions, individuals can reinforce the concepts learned in therapy, apply new skills, and make progress towards their treatment goals. In this section, we will explore the importance of therapy homework and how it can specifically help with depression.

Understanding the Importance of Homework in Therapy

Homework assignments serve as an extension of therapy and allow individuals to continue their progress beyond the confines of the therapy room. It provides an opportunity for individuals to practice and integrate new insights, coping strategies, and techniques into their daily lives. Through regular engagement with therapy homework, individuals can reinforce the therapeutic work, develop new habits, and enhance their overall well-being.

Therapy homework offers several benefits for individuals with depression. It allows for increased self-awareness, as individuals are encouraged to reflect on their thoughts, emotions, and behaviors. This self-reflection promotes a deeper understanding of oneself and the factors contributing to their depression, enabling individuals to identify patterns and make positive changes.

Additionally, therapy homework empowers individuals by giving them a sense of control and agency in their recovery journey. It fosters a sense of ownership and responsibility for one’s mental health, promoting active participation and engagement in the therapeutic process.

How Therapy Homework Can Help with Depression

Therapy homework can be particularly effective in addressing various aspects of depression. It can help individuals challenge negative thought patterns and develop more adaptive and positive thinking. Cognitive Behavioral Therapy (CBT) worksheets, for example, provide structured exercises to identify and reframe negative thoughts. These worksheets, along with journaling and thought records, allow individuals to track their thoughts and emotions, identify cognitive distortions, and develop healthier thinking patterns.

Behavioral activation exercises are another valuable component of therapy homework for depression. They involve engaging in activities that provide a sense of accomplishment, pleasure, or mastery, even when motivation is low. By gradually increasing participation in enjoyable and fulfilling activities, individuals can combat the inertia often associated with depression and experience an improvement in mood.

By consistently engaging in therapy homework, individuals with depression can experience a sense of progress, growth, and empowerment. However, it’s essential to collaborate with a therapist to develop a personalized homework plan that aligns with individual goals, needs, and preferences. This collaboration ensures that the homework assignments are tailored to the specific challenges and circumstances faced by each individual.

In the following sections, we will explore different types of therapy homework for depression and provide tips for developing a personalized homework plan that maximizes the benefits of therapy.

Types of Therapy Homework for Depression

When it comes to managing depression through therapy, various types of homework assignments can be incorporated to enhance the therapeutic process. These assignments aim to reinforce the skills and techniques learned in therapy sessions and provide individuals with opportunities for self-reflection and growth. Here are three common types of therapy homework for depression:

Cognitive Behavioral Therapy (CBT) Worksheets

Cognitive Behavioral Therapy (CBT) is a widely used approach for treating depression. CBT worksheets are valuable homework tools that help individuals identify and challenge negative thought patterns and beliefs. These worksheets typically involve exercises such as identifying automatic negative thoughts, examining evidence for and against these thoughts, and developing more balanced and realistic thinking patterns. CBT worksheets can be used to address distorted thinking commonly associated with depression, such as overgeneralization, personalization, and catastrophizing.

Journaling and Thought Records

Journaling and thought records are effective homework assignments for promoting self-awareness and monitoring thoughts and emotions related to depression. By encouraging individuals to write down their thoughts and feelings, these assignments provide an opportunity to identify negative thinking patterns and emotions that contribute to depressive symptoms. Thought records, in particular, involve documenting a specific negative thought, examining evidence for and against it, and generating alternative, more positive thoughts. Journaling and thought records can be powerful tools for increasing self-reflection and challenging negative self-perceptions.

Behavior Activation Exercises

Behavior activation is a key component of therapy for depression . Homework assignments focused on behavior activation aim to increase engagement in pleasurable and meaningful activities, even when motivation is low. These assignments may involve creating a schedule of daily activities, setting achievable goals, and gradually increasing involvement in enjoyable activities. By actively participating in positive experiences, individuals with depression can counteract the cycle of withdrawal and isolation often associated with the condition.

By incorporating these types of therapy homework into the treatment plan, individuals with depression can actively engage in their own healing process. It is important for therapists to collaborate with their clients, identifying specific goals and areas of focus, to tailor the homework assignments to each individual’s needs and preferences. Consistency, tracking progress, and seeking support are essential for making therapy homework a meaningful and effective part of the journey towards overcoming depression.

For more information on therapy homework assignments and ideas for other areas of focus, visit our articles on therapy homework assignments and therapy homework ideas .

Developing a Personalized Homework Plan

To make the most out of therapy homework for depression, it’s essential to collaborate with your therapist and develop a personalized plan. This plan should be tailored to your specific needs, goals, and areas of focus. By working together with your therapist, you can create a realistic and manageable homework plan that complements your therapy sessions.

Collaborating with Your Therapist

The first step in developing a personalized homework plan is to collaborate with your therapist. Through open and honest communication, express your goals, challenges, and preferences. Your therapist will use their expertise to guide you in selecting appropriate homework assignments that align with your therapy objectives.

Your therapist may suggest specific therapy techniques or resources that can be incorporated into your homework plan. These may include cognitive behavioral therapy (CBT) worksheets , journaling , thought records , behavior activation exercises , or other relevant tools. By discussing your preferences and comfort level, you can ensure that the chosen homework assignments resonate with you.

Identifying Goals and Areas of Focus

During therapy sessions, you and your therapist will identify specific goals and areas of focus. These goals may include developing coping skills, challenging negative thought patterns, improving self-esteem, or enhancing communication skills. By identifying these goals, you can create homework assignments that directly address the areas you want to work on.

For example, if one of your goals is to challenge negative thought patterns, your therapist may suggest completing CBT worksheets that help you identify and reframe negative thoughts. By integrating these worksheets into your homework plan, you can reinforce the skills learned during therapy sessions and continue working on them independently.

Creating a Realistic and Manageable Plan

When creating your homework plan, it’s crucial to ensure that it is realistic and manageable. Your therapist will help you set realistic expectations and establish a schedule that fits your lifestyle. It’s important to strike a balance between challenging yourself and avoiding overwhelming tasks.

By breaking down larger goals into smaller, achievable tasks, you can maintain motivation and progress steadily. Your therapist may also suggest incorporating self-care activities, relaxation exercises, or mindfulness practices into your homework plan to foster emotional well-being and resilience.

To help you stay organized and track your progress, consider using a journal or a digital tool specifically designed for therapy homework. These tools can help you monitor your assignments, record your thoughts and emotions, and reflect on your progress over time.

Remember, the success of your therapy homework plan depends on your consistency, commitment, and willingness to actively engage in the process. By collaborating with your therapist, identifying goals, and creating a realistic plan, you can maximize the benefits of therapy homework for depression.

Tips for Effective Therapy Homework

To make the most out of therapy homework and enhance the effectiveness of your treatment for depression , it’s important to keep a few key tips in mind. These tips will help you stay on track and maximize the benefits of your therapy sessions.

Consistency and Commitment

Consistency is key when it comes to therapy homework. Make a commitment to regularly engage in your assigned exercises or activities. Set aside dedicated time each day or week to work on your homework. Treat it as a priority and integrate it into your routine. By being consistent and committed, you’ll reinforce the therapeutic progress and build momentum towards achieving your goals.

Tracking Progress and Making Adjustments

Keep track of your progress as you engage in therapy homework. Maintain a record of your experiences, observations, and any changes you notice. This tracking will help you identify patterns and trends, providing valuable insights into your journey. It can be helpful to use a journal or a tracking app to record your thoughts and progress. Regularly review your records with your therapist to assess your growth, make adjustments, and refine your homework plan if necessary.

Seeking Support and Accountability

Seek support and accountability to stay motivated and committed to your therapy homework. Share your goals and progress with a trusted friend, family member, or support group. Consider joining a therapy or coaching community where you can connect with others who are also working on their mental health. Engaging in discussions, sharing experiences, and receiving encouragement from others can provide a sense of support and accountability that keeps you motivated and engaged.

Remember, therapy homework is an integral part of the treatment process for depression. By following these tips for effective therapy homework, you can enhance your progress and experience the full benefits of your therapeutic journey. Stay consistent, track your progress, and seek support to make the most out of your therapy experience.

For more information and resources on therapy homework for various topics, visit our therapy homework assignments page.

Overcoming Challenges with Therapy Homework

While therapy homework can be an effective tool for managing depression, it’s important to acknowledge and address the challenges that may arise during the process. Here are some common challenges individuals may encounter when completing therapy homework and strategies for overcoming them.

Addressing Resistance and Motivation Issues

Resistance and lack of motivation can hinder progress when it comes to therapy homework. It’s not uncommon to feel resistant or unmotivated, especially when dealing with the symptoms of depression. However, it’s important to remember that therapy homework plays a significant role in your overall treatment and recovery.

To address resistance and motivation issues, consider the following strategies:

Explore the underlying reasons : Reflect on why you may be resistant or lacking motivation. Are there specific barriers or fears that need to be addressed? Share your concerns with your therapist to gain a deeper understanding and explore possible solutions.
Break tasks into smaller steps : Overwhelming tasks can lead to resistance. Break down your therapy homework into smaller, more manageable steps. This can help make the tasks feel less daunting and increase motivation.
Find intrinsic motivation : Connect with the deeper reasons behind why you want to engage in therapy homework. Remind yourself of the potential benefits, such as improved coping skills or increased self-awareness. Focusing on these intrinsic motivations can help reignite your motivation.

Dealing with Time Constraints

Finding time to complete therapy homework can be challenging, especially when juggling other responsibilities and commitments. However, dedicating time to your therapy homework is essential for making progress in your treatment.

To overcome time constraints, consider the following strategies:

Prioritize and schedule : Prioritize your therapy homework by scheduling specific times in your daily or weekly routine dedicated solely to completing the tasks. Treat these scheduled times as non-negotiable commitments to yourself and your well-being.
Break tasks into shorter sessions : If the length of the tasks feels overwhelming, break them into shorter sessions spread out over several days. This can help you fit therapy homework into your schedule more easily.
Utilize downtime : Identify pockets of time throughout your day that can be used to complete smaller tasks. For example, you can work on journaling exercises during your morning commute or listen to guided meditation during your lunch break.

Modifying Homework to Fit Individual Needs

Therapy homework is not one-size-fits-all, and it’s important to tailor it to your individual needs and preferences. If you find that certain exercises or assignments are not resonating with you or are not producing the desired outcomes, it may be necessary to modify them.

Consider the following strategies for modifying therapy homework:

Communicate with your therapist : Discuss any challenges or concerns you have with your therapist. They can help modify the homework assignments to better suit your needs and provide alternative options if necessary.
Explore alternative techniques or activities : If a particular exercise is not effective for you, discuss alternative techniques or activities with your therapist. They may be able to suggest different approaches that align better with your preferences and goals.
Experiment and adapt : Be open to experimenting with different approaches and techniques. Therapy homework is a collaborative process, and it may take some trial and error to find what works best for you. With the guidance of your therapist, adapt and modify the homework assignments to suit your unique circumstances.

By addressing resistance and motivation issues, managing time constraints, and modifying therapy homework to fit your individual needs, you can overcome challenges and make the most of your treatment. Remember to communicate openly with your therapist, as they are there to support you in your journey toward healing and recovery.

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327 Depression Essay Titles & Examples

When choosing a title about depression, you have to remain mindful since this is a sensitive subject. This is why our experts have listed 177 depression essay topics to help you get started.

🌧️ How to Write a Depression Essay: Do’s and Don’ts

🏆 unique titles about depression, 🥇 most interesting depression title ideas, 📌 good titles for depression essay, ✅ simple & easy depression essay titles, 🎓 interesting topics to write about depression, 📑 good research topics about depression.

❓ Research Questions for a Depression Essay

Depression is a disorder characterized by prolonged periods of sadness and loss of interest in life. The symptoms include irritability, insomnia, anxiety, and trouble concentrating. This disorder can produce physical problems, self-esteem issues, and general stress in a person’s life. Difficult life events and trauma are typical causes of depression. Want to find out more? Check out our compilation below.

A depression essay is an important assignment that will help you to explore the subject and its impact on people. Writing this type of paper may seem challenging at first, but there are some secrets that will make achieving a high grade much easier. Check below for a list of do’s and don’ts to get started!

DO select a narrow topic. Before starting writing, define the subject of the paper, and write down some possible titles. This will help you to focus your thoughts instead of offering generic information that can easily be found on Wikipedia. Consider writing about a particular population or about the consequences of depression. For example, a teenage depression essay could earn you excellent marks! If you find this step challenging, try searching for depression essay topics online. This will surely give you some inspiration.

DON’T copy from peers or other students. Today, tutors are usually aware of the power of the Internet and will check your paper for plagiarism. Hence, if you copy information from other depression essays, you could lose a lot of marks. You could search for depression essay titles or sample papers online, but avoid copying any details from these sources.

DO your research before starting. High-quality research is crucial when you write essays on mental health issues. There are plenty of online resources that could help you, including Google Scholar, PubMed, and others. To find relevant scientific articles, search for your primary and secondary topics of interest. Then filter results by relevance, publication date, and access type. This will help you to identify sources that you can view online and use to support your ideas.

DON’T rely on unverified sources. This is a crucial mistake many students make that usually results in failing the paper. Sources that are not academic, such as websites, blogs, and Wiki pages, may contain false or outdated information. Some exceptions are official publications and web pages of medical organizations, such as the CDC, APA, and the World Health Organization.

DO consider related health issues. Depression is often associated with other mental or physical health issues, so you should reflect on this in your paper. Some examples of problems related to depression are suicide, self-harm, eating disorders, and panic attack disorder. To show your in-depth understanding of the issue, you could write a depression and anxiety essay that shows the relationship between the two. Alternatively, you can devote one or two paragraphs to examining the prevalence of other mental health problems in people with depression.

DON’T include personal opinions and experiences unless required. A good essay on the subject of depression should be focused and objective. Hence, you should rely on research rather than on your understanding of the theme. For example, if you have to answer the question “What is depression?” look for scientific articles or official publications that contain the definition rather than trying to explain it in your own words.

DON’T forget about structure. The structure of your essay helps to present arguments or points logically, thus assisting the reader in making sense of the information. A good thing to do is to write a depression essay outline before you start the paper. You should list your key points supported by relevant depression quotes from academic publications. Follow the outline carefully to avoid gaps and inconsistencies.

Use these do’s and don’ts, and you will be able to write an excellent paper on depression! If you want to see more tips and tricks that will help you elevate your writing, look around our website!

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Depression: A Cognitive Perspective Therefore, the cause of depression on this line may be a real shortage of skills, accompanied by negative self-evaluation because the individual is more likely to see the negative aspects or the skills he lacks […]
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Depression Among University Students The greatest majority of the affected individuals in different universities will be unable to take good care of their bodies and living rooms.
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Depression and Anxiety Among African Americans Finally, it should be insightful to understand the attitudes of friends and family members, so 5 additional interviews will be conducted with Black and White persons not having the identified mental conditions. The selected mental […]
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Depression Detection Tests Analysis The problem of the abundance of psychological tests leads to the need to compare multiple testing options for indicators of their purpose, features, and interpretations of the evaluation and validity.
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Depression in Primary Care: Screening and Diagnosis The clinical topics for this research are the incidence of depression in young adults and how to diagnose this disorder early in the primary care setting using screening tools such as PHQ9.
Major Depression and Cognitive Behavior Therapy Since the intervention had no significant effect on Lola, the paper will explore the physical health implication of anxiolytics and antidepressants in adolescents, including the teaching strategies that nurses can utilize on consumers to recognize […]
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Depression Disorder Intervention The researchers evaluated the socioemotional signs of mental illnesses in a sample of diagnostically referred adolescents with clinical depression required to undergo regular cognitive behavioral therapy in a medical setting.
Financial Difficulties in Childhood and Adult Depression in Europe The authors found that the existence of closer ties between the catalyst of depression and the person suffering from depression leads to worse consequences.
Activity During Pregnancy and Postpartum Depression Studies have shown that women’s mood and cardiorespiratory fitness improve when they engage in moderate-intensity physical activity in the weeks and months after giving birth to a child.
Clinical Depression: Causes and Development Therefore, according to Aaron Beck, the causes and development of depression can be explained through the concepts of schema and negative cognitive triad.
Aspects of Working With Depression It also contributes to the maintenance and rooting of a bad mood, as the patient has sad thoughts due to the fact that the usual does not cause satisfaction.
Depression Among Nurses in COVID-19 Wards The findings are of great significance to researchers and governments and can indicate the prevalence of anxiety and depression among nurses working in COVID-19 wards in the North-East of England during the pandemic.
Depression Associated With Sleep Disorders Y, Chang, C. Consequently, it directly affects the manifestation of obstructive sleep apnea, restless leg syndrome, and periodic limb movement disorder in people with depression.
Depression in a 25-Year-Old Male Patient Moreover, a person in depression complains of the slowness in mental processes, notes the oppression of instincts, the loss of the instinct of self-preservation, and the lack of the ability to enjoy life.
Aspects and Manifestation of Depression Although, symptoms of depression in young people, in contrast to older adults, are described by psychomotor agitation or lethargy, fatigue, and loss of energy.
Complementary Therapy for Postpartum Depression in Primary Care Thus, the woman faced frustration and sadness, preventing her from taking good care of the child, and the lack of support led to the emergence of concerns similar to those in the past.
Depression and Anxiety Clinical Case Many of the factors come from the background and life experiences of the patient. The client then had a chance to reflect on the results and think of the possible alternative thoughts.
Uncontrolled Type 2 Diabetes and Depression Treatment The data synthesis demonstrates that carefully chosen depression and anxiety treatment is likely to result in better A1C outcomes for the patient on the condition that the treatment is regular and convenient for the patients.
Technology to Fight Postpartum Depression in African American Women I would like to introduce the app “Peanut” the social network designed to help and unite women exclusively, as a technology aimed at fighting postpartum depression in African American Women.
Complementary Therapy in Treatment of Depression Such practices lower the general level of anxiety and remove the high risks of manifestation of states of abulia, that is, clinical lack of will and acute depression.
Social Determinants of Health and Depression Among African American Adults The article “Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research” examines the current research on the relationship between social determinants of health and depression among African American […]
Outcomes Exercise Has on Depression for People Between 45-55 Years According to the WHO, the rate of depression in the U.S.was 31. 5% as of October 2021, with the majority of the victims being adults aged between 45 and 55 years.
The Postpartum Depression in Afro-Americans Policy The distribution of the funds is managed and administered on the state level. Minnesota and Maryland focused on passing the legislation regulating the adoption of Medicaid in 2013.
Depression Among the Medicare Population in Maryland The statistics about the prevalence and comorbidity rates of depression are provided from the Medicare Chronic Conditions Dashboard and are portrayed in the table included in the paper.
Depression as Public Health Population-Based Issue In regard to particular races and ethnicities, CDC provided the following breakdown of female breast cancer cases and deaths: White women: 128 new cases and 20 deaths per 100.
Managing Mental Health Medications for Depression and its Ethical Contradiction The second objective is to discover ethical contradictions in such treatment for people of various cultures and how different people perceive the disorder and react to the medication.
Aspects of Depression and Obesity In some cases, people with mild to severe depression choose not to seek professional care and instead try to overcome their depression with self-help or the support of family and friends.
Antidepressant Treatment of Adolescent Depression At the same time, scientists evidenced that in the case of negative exposure to stress and depression, the human organism diminishes BDNF expression in the hippocampus.
Online Peer Support Groups for Depression and Anxiety Disorder The main objective of peer support groups is connecting people with the same life experiences and challenges to share and support each other in healing and recovery.
Depression in Adolescence and Treatment Approaches The age of adolescence, commonly referred to as children aged 10-19, is characterized by a variety of changes to one’s physical and mental health, as the child undergoes several stages of adjustment to the environment […]
Emotional Encounter With a Patient With Major Depression Disorder I shared this idea with him and was trying to create the treatment plan, sharing some general thoughts on the issue.
Childhood Depression in Sub-Saharan Africa According to Sterling et al, depression in early childhood places a significant load on individuals, relatives, and society by increasing hospitalization and fatality and negatively impacting the quality of life during periods of severe depression.
Anxiety and Depression: The Case Study As he himself explained, he is not used to positive affirmation due to low self-esteem, and his family experiences also point to the fact that he was not comforted often as a child.
Breastfeeding and Risk of Postpartum Depression The primary goal of the research conducted by Islam et al.was to analyze the correlation between exclusive breastfeeding and the risk of postpartum depression among new mothers.
Nursing Intervention in Case of Severe Depression The patient was laid off from work and went through a divorce in the year. This led to a change in prescribed medications, and the patient was put on tricyclic anti-depressants.
Screening for Depression in Acute Care The literature review provides EB analysis for the topic of depression to identify the need for an appropriate screening tool in addition to the PHQ-9 in the assessment evaluation process.
Social Media Use and the Risk of Depression Thapa and Subedi explain that the reason for the development of depressive symptoms is the lack of face to face conversation and the development of perceived isolation. Is there a relationship between social media use […]
Depression in the Field of a Healthcare Administrator According to Davey and Harrison, the most challenging part of healthcare administration in terms of depression is the presence of distorted views, shaped by patients’ thoughts.
Emotional Wellness: The Issue of Depression Through Different Lenses As for the humanities lens, the increasing prevalence of depression causes the institution of religion to incorporate the issue into major confessions’ mindsets and messages.
The Treatment of Adolescents With Depression While treating a teenager with depression, it is important to maintain the link between the cause of the mental illness’ progression and the treatment.
Depression in the Black Community The speaker said that her counselor was culturally sensitive, which presumes that regardless of the race one belongs to, a specialist must value their background.
Loneliness and Depression During COVID-19 While the article discusses the prevalence of loneliness and depression among young people, I agree that young people may be more subject to mental health problems than other population groups, but I do not agree […]
Depression Screening in the Acute Setting Hence, it is possible to develop a policy recommending the use of the PHQ-9, such as the EBDST, in the acute setting.
Ketamine for Treatment-Resistant Depression: Neurobiology and Applications It is known that a violation of the functions of the serotonergic pathways leads to various mental deviations, the most typical of which is clinical depression.
Treating Obesity Co-Occurring With Depression In most cases, the efficiency of obesity treatment is relatively low and commonly leads to the appearance of a comorbid mental health disorder depression.
Treadmill Exercise Ameliorates Social Isolation-Induced Depression The groups included: the social isolation group, the control group, and the exercise and social isolation and exercise group. In the treadmill exercise protocol, the rat pups ran on the treadmill once a day for […]
Depression and Anxiety Among Chronic Pain Patients The researchers used The Depression Module of the Patient Health Questionnaire and the Generalized Anxiety Disorder Scale to interview participants, evaluate their answers, and conduct the study.
Postpartum Depression in African American Women As far as African American women are concerned, the issue becomes even more complex due to several reasons: the stigma associated with the mental health of African American women and the mental health complications that […]
The Depression Construct and Instrument Analysis For the therapist, this scaling allows to assess the general picture of the patient’s psychological state and obtain a result that is suitable for measurement.
The Effects of Cognitive Behavioral Therapy (CBT) on Depression in Adults Introduction It is hard to disagree that there is a vast number of mental disorders that prevent people from leading their normal lives and are quite challenging to treat. One such psychological condition is depression (Li et al., 2020). Since there is a social stigma of depression, and some of its symptoms are similar to […]
Stress and Depression Among Nursing Students The study aims to determine how different the manifestations of stress and depression are among American nursing students compared to students of other disciplines and what supports nursing students in continuing their education.
Depression in Diabetes Patients The presence of depression concomitant to diabetes mellitus prevents the adaptation of the patient and negatively affects the course of the underlying disease.
Depression among Homosexual Males The literature used for the research on the paper aims to overview depression among homosexual males and describe the role of the nurse and practices based on the Recovery Model throughout the depression.
“What the Depression Did to People” by Edward Robb Ellis Nevertheless, the way the facts are grouped and delivered could be conducive to students’ ability to develop a clearer picture of the catastrophic downturn’s influences on the nation’s and the poor population’s mentalities.
Economic Inequality During COVID-19: Correlation With Depression and Addiction Thus, during the pandemic, people with lower incomes experienced depression and increased their addictive behaviors to cope with the stress of COVID-19.
Depression in the Black and Minority Ethnic Groups The third sector of the economy includes all non-governmental, non-profit, voluntary, philanthropic, and charitable organizations and social enterprises specializing in various types of activities, which did not find a place in either the public or […]
A Description on the Topic Screening Depression If there is the implementation of evidence-based care, a reduction in the proportion of disability for patients with depression would be expected. A proposal was written describing the need for screening depression patients of nearly […]
“Disclosure of Symptoms of Postnatal Depression, …” by Carolyn Chew-Graham Critique In light of hypothesizing the research question, the researchers suggest that health practitioners have the ability to create a conducive environment for the disclosure of information.
Depression – Psychotherapeutic Treatment Taking into account the fact that the specialist is not able to prescribe the medicine or a sort of treatment if he/she is not sure in the positive effect it might have on the health […]
Depression as a Major Health Issue The purpose of the study was to examine the implications of cognitive behavior approaches for depression in old women receiving health care in different facilities.
Effective Ways to Address Anxiety and Depression Looking deep into the roots of the problem will provide a vast and detailed vision of it, and will help to develop ways to enhance the disorders.
Einstepam: The Treatment of Depression The treatment of depression has greatly revolutionized since the development of tricyclic antidepressants and monoamine oxidase inhibitors in the 1950s. In the brain, it inhibits the NMDA receptors and isoforms of NOS.
The Potential of Psilocybin in Treating Depression First of all, it is essential to understand the general effects of psilocybin on the brain that are present in the current literature.
Depression Among High School Students The major problem surrounding depression among adolescents is that they are rarely diagnosed in time and therefore do not receive treatment they need.
Depression: Diagnostics, Prevention and Treatment Constant communication with the patient and their relatives, purposeful questioning of the patient, special scales and tests, active observation of the patient’s appearance and behavior are the steps in the nursing diagnosis of depression.
Depression and Anxiety Intervention Plan John’s Wort to intervene for her condition together with the prescribed anti-depressant drugs, I would advise and educate her on the drug-to-drug relations, and the various complications brought about by combining St. Conducting proper patient […]
Depression and Generalized Anxiety Disorder Therapy On the other hand, behavioral therapy relies on the assumption that “both abnormal behavior and normal behavior are learned”. The two approaches are thus highly complementary, as while humanistic therapy aims at perceiving and resolving […]
The Use of Psychedelic Drugs in Treating Depression This study aims to establish whether depressive patients can significantly benefit from psilocybin without substantial side effects like in the case of other psychedelic drugs.
Postpartum Depression Among the Low-Income U.S. Mothers Mothers who take part in the programs develop skills and knowledge to use the existing social entities to ensure that they protect themselves from the undesirable consequences associated with the PPD and other related psychological […]
The Beck Depression Contrast (BDI) The second difference between the two modes of the BDI is in the methodology of conducting the survey. This is where the interviewer first gets the history of the patient to try and get the […]
Depression: Description, Symptoms and Diagnosis, Prognosis and Treatment A diagnosis is made in situations where the symptoms persist for at least two weeks and lead to a change in the individual’s level of functioning.
Psychedelic Drugs and Their Effects on Anxiety and Depression The participants must also be willing to remain in the study for the duration of the experiments and consent to the drugs’ use.
VEGA Medical Center: The Quality of Depression Management This presentation is going to provide an overview of a project dedicated to the implementation of NICE guidelines at the VEGA Medical Center.
Anxiety and Depression in Hispanic Youth in Monmouth County Therefore, the Health Project in Monmouth County will help Hispanic children and adolescents between the ages of 10 and 19 to cope with anxiety and depression through behavioral therapy.
Anxiety Disorders and Depression In her case, anxiety made her feel that she needed to do more, and everything needed to be perfect. She noted that the background of her depression and anxiety disorders was her family.
Clinical Case Report: Depression It is possible to assume that being in close contact with a person who has depression also increases the probability of experiencing its symptoms.
Interventions for Treating Depression after Stroke Inherently, the link between depression and stroke can be analyzed on the basis of post-stroke depression that is identified as the major neuropsychiatric corollary of stroke.
Depression: The Implications and Challenges in Managing the Illness At home, these people lack interest in their family and are not be able to enjoy the shared activities and company of the family.
Expression Symptoms of Depression A major finding of the critique is that although the research method and design are appropriate to this type of study, the results may be speculative in their validity and reliability as the researchers used […]
Researching Postnatal Depression Health professionals suggest that the fluctuations in the level of hormones cause changes in the chemical composition of the brain. The researcher has stated that the sample was selected from the general practitioners and health […]
The Older Women With Depression Living in Long-Term Care The researchers used the probability-sampling method to select the institutions that were included in the study. The health care professionals working in the nursing homes were interviewed to ascertain the diagnosis of depression as well […]
Medical Evaluation: 82-Year-Old Patient With Depression Her extreme level of weakness unfolded when the patient admitted that she lacked the strength to stand on her feet and to head back to her sleeping bed on a disastrous night.Mrs.
Depression in Adults: Community Health Needs The challenge of depression in the elderly is the recognition of signs and symptoms or the frequent underreporting of the symptoms of depression in adults over the age of 65.
The Discussion about Depression in Older Patients Depression is often identified as the most prevalent psychiatric disorder in the elderly and is usually determined by symptoms that belong to somatic, affective, and cognitive categories.
Depression in Older People in Australia Although a good number of depressed elderly patients aspire to play an active role in the treatment decision-making process, some prefer to delegate this role to their doctors.
In-Vitro Fertilization and Postpartum Depression The research was conducted through based on professional information sources and statistical data collected from the research study used to further validate the evidence and outcome of this study.
Depression: Screening and Diagnosis What he tries to do is to live a day and observe the changes that occur around. What do you do to change your attitude to life?
Depression in Australia. Evaluation of Different Factors In attempts to identify the biological causes of depression, the researchers focus on the analysis of brain functioning, chemical mediators, their correlations with the neurologic centers in the brain, and impact on the limbic system […]
Mental Health Paper: Depression The prevalence of mental health conditions has been the subject of many studies, with most of these highlighting the increase in these illnesses.
The Two Hit Model of Cytokine-Induced-Depression The association between IL-6 polymorphism and reduced risk of depressive symptoms confirms the role of the inflammatory response system in the pathophysiology of IFN-alpha-induced depression.
Ante-Partum & Postpartum Exposure to Maternal Depression The researchers engaged in the research work on this particular study topic by approaching it on the basis of maternal behavior and circumstances, as they connect to depressive conditions in their own lives and the […]
Depression in Australia, How Treat This Disorder According to The World Health Organization, depression is defined as a disorder in the mental health system that is presented with feelings of guiltiness, low concentration, and a decrease in the need for sleep.
Steroid Use and Teen Depression In this manner, the researcher will be in a position to determine which of the two indicators is strongest, and then later, the indicators can be narrowed down to the most basic and relevant.
Depression Among Minority Groups Mental disorders are among the major problems facing the health sector in America and across the world in the contemporary society.
Aspects and Definition of Depression: Psychiatry This is the personal counseling of a patient with the doctor, and it is one of the very best processes. In the case of a physician dealing with a mental patient, the most preferable way […]
Dual Illness – Depression and Alcohol Abuse The intention of the research paper is to assess if indeed there is an association between alcoholism as manifested by Jackson, and a case of depression.
Depression and Paranoid Personality Disorder Bainbridge include: The analysis of paranoia and anxiety caused by substance abuse reveals that the diagnosis can be correct based on the symptoms, but the long-lasting nature of the symptoms rejects this diagnosis in favor […]
Antidepressant Drugs for Depression or Dysthymia These are the newer form of antidepressant that are based on both the principle of serotonin reuptake prevention and norepinephrine action.
The Relationship of Type 2 Diabetes and Depression Type 2 diabetes is generally recognized as an imbalance between insulin sensitivity and beta cell function We have chosen a rural area in Wisconsin where we can focus our study and select a group of […]
Teenage Depression and Alcoholism There also has been a demonstrated connection between alcoholism and depression in all ages; as such, people engage in alcoholism as a method of self medication to dull the feelings of depression, hopelessness and lack […]
“Relationships of Problematic Internet Use With Depression”: Study Strengths and Weaknesses One of the study strengths is that the subject selection process is excellently and well-designed, where the subjects represent the study sample, in general.
Depression Treatment: Biopsychosocial Theory More to the point, the roles of nurses, an interprofessional team, and the patient’s family will be examined regarding the improvement of Majorie’s health condition.
Postpartum Depression and Its Impact on Infants The goal of this research was “to investigate the prevalence of maternal depressive symptoms at 5 and 9 months postpartum in a low-income and predominantly Hispanic sample, and evaluate the impact on infant weight gain, […]
Postpartum Depression: Statistics and Methods of Diagnosis The incorporation of the screening tools into the existing electronic medical support system has proved to lead to positive outcomes for both mothers and children.
Comorbidity of Depression and Pain It is also known that dysregulation of 5-HT receptors in the brain is directly related to the development of depression and the regulation of the effects of substance P, glutamate, GABA and other pain mediators. […]
Hallucinations and Geriatric Depression Intervention Sandy has asserted further that the cleaners at the residence have been giving him the wrong medication since they are conspiring to end his life with the FBI.Mr.
Changes in Approaches to the Treatment of Depression Over the Past Decade In spite of the fact that over the past decade many approaches to the treatment of depression remained the same, a lot of new methods appeared and replaced some old ones due to the development […]
Management of Treatment-Resistant Depression The significance of the problem, the project’s aims, the impact that the project may have on the nursing practice, and the coverage of this condition are the primary focuses of this paper.
Teenage Depression: Psychology-Based Treatment This finding underlines the need to interrogate the issue of depression’s ontology and epistemology. Hence, there is the need to have an elaborate and comprehensive policy for addressing teenage depression.
Depression and Anxiety in Dialysis Patients However, the study indicates the lack of research behind the connection of depression and cognitive impairment, which is a significant limitation to the conclusive statement.
Adolescent Grief and Depression In looking for an activity that may help him or her keep away from the pain he or she is experiencing, the victim may decide to engage in sexual activities. Later, the adolescent is also […]
Suicide and Depression in Students Students who belong to racial and ethnic minorities constitute the group of risk connected with high depression and suicidal rates and it is the primary task of health teachers to reduce suicidal rates among all […]
Depression Disorder: Key Factors Epidemiology refers to the study of the distribution and determinants of health related events in specific populations and its applications to health problems.
Depression Effects of School Children However the present difficulties that he is going through being a 16 year old; may be associated to a possible cause of Down syndrome complications, or the feelings and behavioral deficiency he associates to the […]
Depression, Hallucination, and Suicide: Mental Cases How they handle the process determines the kind of aftermath they will experience for instance it can take the route of hallucinations which is treatable or suicide which is irreversible thus how each case is […]
Depression, Its Perspective and Management Therefore this paper seeks to point out that stress is a major ingredient of depression; show the causes, symptoms, highlight how stresses is manifested in different kinds of people, show how to manage stress that […]
Daily Living, Depression, and Social Support Activities of Elderly Turkish People Navigating the delicate and often convoluted maze of the current issues affecting the elderly has continued to present challenges to the professionals in the field especially with the realization that these issues and needs are […]
The Theory of Personality Psychology During Depression The study concerns personality pathology, and the results of the treatment given to patients who are under depression, and how personalities may have adverse effects on the consequences of the cure.
Depression and the Media Other components of the cognitive triad of depression are the aspect of seeing the environment as overwhelming and that one is too small to make an impact and also seeing the future as bleak and […]
Poor Body Image, Anxiety, and Depression: Women Who Undergo Breast Implants H02: There is no difference in overt attractiveness to, and frequency of intimacy initiated by, the husband or cohabitating partner of a breast implant patient both before and after the procedure.
Reducing Anxiety and Depression With Exercise Regardless of the type of results achieved, it is recommendable for people undergoing mental problems like depression and anxiety to exercise regularly.
Stress, Depression and Psychoneuroimmunology The causes and symptoms of stress may vary from person to person and the symptoms can be mental as well as physical.
A Critical Evaluation of Major Depression This paper has actively shown how factors such as financial insecurity, job loss, income, and educational inequalities, lifestyle diseases, and breakdown of the social fabric have acted to propel the mental disorder by making use […]
Depression, Substance Abuse and Suicide in Elderly
Adult Depression Sufferer’s and Withdrawal From Family and Friends
Depression: Helping Students in the Classroom
Major Depression: Treating Depression in the Context of Marital Discord
Family Therapy for Treating Major Depression
Adverse Childhood Experiences Cause Depression
Depression and Alzheimer’s Disease
Rumination, Perfectionism and Depression in Young People
“Gender Differences in Depression” by Nolen-Hoeksema
Anxiety and Depression Disorders
Beck’s Cognitive Therapy Approach to Depression Treatment
Cannabis Abuse Increases the Risk of Depression
Depression: Risk Factors, Incidence, Preventive Measures & Prognostic Factors
Depression Diagnostics Methods
Concept Analysis of Loneliness, Depression, Self-esteem
Teen Suicide and Depression
Depression and Diabetes Association in Adults
The Correlation Between Perfectionism and Depression
Geriatric Dementia, Delirium, and Depression
Dementia, Delirium, and Depression in Older Adults
Dealing with Depression in the Workplace
Depression in People With Alcohol Dependence
Depression and Anxiety Due to School and Work-Related Stress
Creating a Comprehensive Psychological Treatment Plan: Depression
Experimental Psychology. Bouldering for Treating Depression
Depression and Psychotherapy in Adolescence
Postpartum Depression: Treatment and Therapy
Atypical Depression Symptoms and Treatment
Dementia, Delirium, and Depression in Frail Elders
Depression & Patient Safety: Speak Up Program
Mindfulness Meditation Therapy in Depression Cases
A Review of Postpartum Depression and Continued Post Birth Support
Psychodynamic Therapy for Depression
Depression Screening in Primary Care for Adolescents
Freud’s Depression: Cognitive-Behavioral Interventions
Optimal Mental Health Approaches: Depression & Anxiety
Great Depression in “A Worn Path” by Eudora Welty
Depression in Adolescents and Interventions
Bipolar Disorder: Reoccurring Hypomania & Depression
Postpartum Depression: Understanding the Needs of Women
Major Depression Treatment During Pregnancy
Patients’ Depression and Practitioners’ Suggestions
Traditional Symptoms of Depression
Social Media Impact on Depression and Eating Disorder
Anxiety and Depression in Children and Adolescents
Depression Studies and Online Research Sources
Drug Abuse and Depression Treatment
Depression Explanation in Psychological Theories
Food Insecurity and Depression in Poor Families
Peer Popularity and Depression Among Adolescents
Alcohol Abuse, Depression and Human Trafficking
Depression Assessment Using Intake Notes
Depression in Adolescents and Cognitive Therapy
Diagnosing Depression: Implementation and Evaluation Plan
Beck Depression Inventory: Evaluation Plan
Depression in Iranian Women and Health Policies
Depression Patients and Psychiatrist’s Work
Depression Patients’ Needs and Treatment Issues
Suicide and Depression: Connection, Signs and Age
Health Promotion: Depression Awareness in Teenagers
Depression and Cancer in Caucasian Female Patient
Depression in Patients with Comorbidity
Depression After Transcranial Magnetic Stimulation Treatment
Depression and Psychosis: 32-Year-Old Female Patient
Postpartum Depression and Acute Depressive Symptoms
Women with Heart Disease: Risk of Depression
Exercises as a Treatment for Depression
Depression Treatment Changes in 2006-2017
Depression in Elders: Social Factors
Depression Among High School Students
False Memories in Patients with Depression
Postpartum Depression Analysis in “Yellow Wallpaper”
The Canadian Depression Causes
Widowhood Effects on Men’s and Women’s Depression
Teen Website: Fish Will Keep Depression Away
Bipolar Expeditions: Mania and Depression
Obesity and Major Depression Association
Fast Food, Obesity, Depression, and Other Issues
Depression in the Future Public Health
Depression: Patients With a Difficult Psychological State
Depression: Pathophysiology and Treatment
Stress, Depression, and Responses to Them
Beck Depression Inventory in Psychological Practice
Problem of the Depression in Teenagers
Supporting the Health Needs of Patients With Parkinson’s, Preeclampsia, and Postpartum Depression
Hamilton Depression Rating Scale Application
Psychological Measures: The Beck Depression Inventory
Yoga for Depression and Anxiety
Sleep Disturbance, Depression, Anxiety Correlation
Depression in Late Life: Interpersonal Psychotherapy
Postpartum Depression and Comorbid Disorders
Arab-Americans’ Acculturation and Depression
Organizational Behaviour: Depression in the Workplace
Relationship Between Depression and Sleep Disturbance
Child’s Mental Health and Depression in Adulthood
Parents’ Depression and Toddler Behaviors
Managing Stress and Depression at Work Places – Psychology
Job’ Stress and Depression
Depression Measurements – Psychology
Methodological Bias Associated with Sex Depression
Relationship Between Sleep and Depression in Adolescence
The Effects of Depression on Physical Activity
Psychological Disorder: Depression
Depression and Workplace Violence
The Effects of Forgiveness Therapy on Depression, Anxiety and Posttraumatic Stress for Women After Spousal Emotional Abuse
Depression Diagnosis and Theoretical Models
The Impact of Exercise on Women Who Suffer From Depression
Evolutionary Psychology: Depression
Effect of Social Media on Depression
Depression in the Elderly
Poly-Substance Abuse in Adolescent Males With Depression
How Does Peer Pressure Contribute to Adolescent Depression?
How Do Genetic and Environmental Factors Contribute To The Expression of Depression?
Depression and Cognitive Therapy
Cognitive Treatment of Depression
Book Review: “Breadwinning Daughters: Young Women Working in a Depression- Era City, 1929-1939” by Katrina Srigley
Depression: A Critical Evaluation
Psychopharmacological Treatment for Depression
“Breadwinning Daughters: Young Working Women in a Depression-Era City” by Katrina Srigley
Depression in female adolescents
Interpersonal Communication Strategies Regarding Depression
Depression: Law Enforcement Officers and Stress
Social Influences on Behavior: Towards Understanding Depression and Alcoholism Based on Social Situations
Depression Experiences in Law Enforcement
Childhood Depression & Bi-Polar Disorder
Depression Psychological Evaluation
Concept of Childhood Depression
Correlation Between Multiple Pregnancies and Postpartum Depression or Psychosis
Depression and Its Effects on Participants’ Performance in the Workplace
Catatonic Depression: Etiology and Management
The Children’s Depression Inventory (CDI) Measure
Depression: A Cross-Cultural Perspective
Depression Levels and Development
Depression Treatment: Rational Emotive Behavior Therapy
Concept of Depression Disorder
Does Divorce Have a Greater Impact on Men than on Women in Terms of Depression?
Oral versus Written Administration of the Geriatric Depression Scale

❓Research Questions for a Depression Essay

Does Poverty Impact Depression in African American Adolescents and the Development of Suicidal Ideations?
Does Neighborhood Violence Lead to Depression Among Caregivers of Children With Asthma?
Does Parent Depression Correspond With Child Depression?
How Depression Affects Our Lives?
Does Brain-Derived Neurotrophic Factor Have an Effect on Depression Levels in Elderly Women?
How Can Overcome Depression Through 6 Lifestyle Changes?
Does Maternal Depression Have a Negative Effect on Parent-Child Attachment?
Can Providers’ Education About Postpartum Depression?
Can Vacation Help With Depression?
How Children Deal With Depression?
Can Diet Help Stop Depression and Violence?
Does Depression Assist Eating Disorders?
Does Depression Lead to Suicide and Decreased Life Expectancy?
Can Obesity Cause Depression?
Can Exercise Increase Fitness and Reduce Weight in Patients With Depression?
Does Fruit and Vegetable Consumption During Adolescence Predict Adult Depression?
Does Depression Cause Cancer?
Does Money Relieve Depression?
Does the Average Person Experience Depression Throughout Their Life?
Are Vaccines Cause Depression?
Does Social Anxiety Lead to Depression?
Does Stress Cause Depression?
How Bipolar and Depression Are Linked?
Does Postpartum Depression Affect Employment?
Does Postpartum Depression Predict Emotional and Cognitive Difficulties in 11-Year-Olds?
Does Regular Exercise Reduce Stress Levels, and Thus Reduce Symptoms of Depression?
Does the Natural Light During Winters Really Create Depression?
How Can Art Overcome Depression?
How Anxiety and Depression Are Connected?
Does Positive Psychology Ease Symptoms of Depression?
Chicago (A-D)
Chicago (N-B)

IvyPanda. (2024, February 24). 327 Depression Essay Titles & Examples. https://ivypanda.com/essays/topic/depression-essay-examples/

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IvyPanda . 2024. "327 Depression Essay Titles & Examples." February 24, 2024. https://ivypanda.com/essays/topic/depression-essay-examples/.

1. IvyPanda . "327 Depression Essay Titles & Examples." February 24, 2024. https://ivypanda.com/essays/topic/depression-essay-examples/.

Bibliography

IvyPanda . "327 Depression Essay Titles & Examples." February 24, 2024. https://ivypanda.com/essays/topic/depression-essay-examples/.

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Malays Fam Physician
v.17(1); 2022 Mar 28

Case scenario: Management of major depressive disorder in primary care based on the updated Malaysian clinical practice guidelines

Uma visvalingam.

MBBS (MAHE), Master of Medicine (Psychiatry) (UKM), Department of Psychiatry and Mental Health, Hospital Putrajaya, Putrajaya, Malaysia

Umi Adzlin Silim

MD (UKM), M. Med (Psychiatry) (UKM), Department of Psychiatry and Mental Health, Hospital Serdang, Serdang, Selangor, Malaysia

Ahmad Zahari Muhammad Muhsin

MB., BCh., BAO (UCD, Ireland), M. Psych Med (Malaya), Department of Psychological Medicine, Faculty of Medicine Universiti Malaya, Kuala Lumpur, Malaysia

Firdaus Abdul Gani

MBBS (Malaya) M.Med (Psy) (USM) CMIA (NIOSH), Department of Psychiatry and Mental Health, Hospital Sultan Haji Ahmad Shah, Temerloh, Pahang, Malaysia

Noormazita Mislan

MB, BCh, BAO (Ireland), M Med. (Psychiatry) (UKM), Department of Psychiatry and Mental Health, Hospital Tuanku Ja'afar, Seremban, Negeri Sembilan, Malaysia

Noor Izuana Redzuan

MBBS (Malaya), Dr in Psychiatry (UKM), Department of Psychiatry and Mental Health, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia

Peter Kuan Hoe Low

MB, BCh, BAO (Ireland), M.Psych Med (UM), Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

Sing Yee Tan

MBBS (Malaya), M.Med (Family Med) (UM), Klinik Kesihatan Jenjarom, Jenjarom Selangor, Malaysia

Masseni Abd Aziz

MD (USM) M Med (Fammed) USM, Klinik Kesihatan Umbai, Merlimau, Melaka, Malaysia

Aida Syarinaz Ahmad Adlan

MBBS (Malaya), M. Psych Med (UM), PostGrad. Dip. (Dynamic Psychotherapy) (Mcgill University), Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya Kuala, Lumpur, Malaysia

Suzaily Wahab

MD (UKM), MMed Psych (UKM), Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia

Aida Farhana Suhaimi

B. Psych (Adelaide), M. Psych (Clin. Psych) (Tasmania), PhD (Psychological Medicine) (UPM), Department of Psychiatry and Mental Health, Hospital Putrajaya, Putrajaya, Malaysia

Nurul Syakilah Embok Raub

BPharm (Hons) (CUCMS), MPH (Malaya), Pharmacy Enforcement Branch, Selangor Health State Department, Shah Alam, Selangor, Malaysia

Siti Mariam Mohtar

BPharm (UniSA), Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health Malaysia, Putrajaya, Malaysia

Mohd Aminuddin Mohd Yusof

MD (UKM), MPH (Epidemiology) (Malaya), Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health Malaysia, Putrajaya, Malaysia, Email: moc.oohay@rd2ma

Major depressive disorder (MDD) is a common but complex illness that is frequently presented in the primary care setting. Managing this disorder in primary care can be difficult, and many patients are underdiagnosed and/or undertreated. The Malaysian Clinical Practice Guidelines (CPG) on the Management of Major Depressive Disorder (MDD) (2nd ed.), published in 2019, covers screening, diagnosis, treatment and referral (which frequently pose a challenge in the primary care setting) while minimising variation in clinical practice.

Introduction

MDD is one of the most common mental illnesses encountered in primary care. It presents with a combination of symptoms that may complicate its management.

This mental disorder requires specific treatment approaches and is projected to be the leading cause of the disease burden in 2030. 1 Patients experiencing this ailment are at elevated risk for early mortality from physical disorders and suicide. 2 In Malaysia in particular, MDD contributes to 6.9% of total Years Living with Disability. 3

Ensuring full functional recovery and prevention of relapse makes remission the targeted outcome for treatment of MDD. In contrast, nonremission of depressive symptoms in MDD can impact functionality 4 and subsequently amplify the economic burden that the illness imposes.

About the new edition

The highlights of the updated CPG MDD (2nd ed.) are as follows:

emphasis on psychosocial and psychological interventions, particularly for mild to moderate MDD
inclusion of all second-generation antidepressants as the first-line pharmacotherapy
introduction of new emerging treatments, ie. intravenous ketamine for acute phase and intranasal esketamine for next-step treatment/treatment-resistant MDD
improvement in pre-treatment screening and monitoring of treatment
integration of mental health into other health services with emphasis on collaborative care
addition of 2 new chapters on special populations (pregnancy and postpartum, chronic medical illness) and table on safety profile of pharmacotherapy in pregnancy and breastfeeding
comprehensive, holistic biopsychosocial-spiritual approaches addressing psychospirituality

Details of the evidence supporting the above statements can be found in Clinical Practice Guidelines on the Management of Major Depressive Disorder (2nd ed.) 2019, available on the following websites: http://www.moh.gov.my (Ministry of Health Malaysia) and http://www.acadmed.org.my (Academy of Medicine). Corresponding organisation: CPG Secretariat, Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia; contactable at ym.vog.hom@aisyalamath .

Statement of intent

This is a support tool for implementation of CPG Management of Major Depressive Disorder (2nd ed.).

Healthcare providers are advised of their responsibility to implement this evidence-based CPG in their local context. Such implementation will lead to capacity building to ensure better accessibility of psychosocial and psychological services. More options in pharmacotherapy facilitate flexibility in prescribing antidepressants among clinicians. Further integration of mental health into other health services, upscaling of mental health service development in perinatal and medical services, and enhancement of collaborative care will incorporate holistic approaches into care.

Case Scenario

Tini is a female college student aged 24 years old. She comes to the health clinic accompanied by a friend and complains of several symptoms that she has experienced over the past 4 weeks. She reports:

difficulty falling asleep, feeling tired after waking up in the morning and experiencing headaches
difficulty staying focused during classes. These symptoms have led to deterioration in her study and prompted her to seek advice from the doctor.

Will you screen her for depression?

Yes, because the patient presents with multiple vague symptoms and sleep disturbance. 5 (Refer to Subchapter 2.1, page 3 in CPG.)

What tools are used to screen for depression?

Screening tools for depression are:

Beck Depression Inventory (BDI)
Depression Anxiety and Stress Scale (DASS)
Patient Health Questionnaire-9 (PHQ-9)
Hospital Anxiety and Depression Scale (HADS)
Whooley Questions

Screening for depression using Whooley Questions in primary care may be considered in people at risk. 5

( Refer to Subchapter 2.1, pages 3 and 4 in CPG. )

“During the past month, have you often been bothered by feeling down, depressed or hopeless?”
“During the past month, have you often been bothered by having little interest or pleasure in doing things?

The doctor decides to use Whooley Questions, and Tini answers “yes” to both questions.

How would you proceed from here to further assess for depression?

Assessment of depression consists of:

detailed history taking (Refer to Subchapter 2.2, page 4 in CPG.)
mental state examination (MSE), including evaluation of symptom severity, presence of psychotic symptoms and risk of harm to self and others
physical examination to rule out organic causes
investigations where indicated — biological and psychosocial investigations

Upon further assessment, Tini reveals that she feels overwhelmingly sad. She is frequently tearful and reports feeling excessively guilty, blaming herself for not performing well enough in her studies. Her postings on social media have been revolving around themes of self-defeat. Despite feeling low, she still strives to attend classes and complete her assignments. However, her academic performance has exhibited a marked deterioration. There is no history to suggest hypomanic, manic or psychotic symptoms. She denies using any illicit substances or alcohol. Her menstrual cycle is normal and does not correspond to her mood changes.

MSE reveals a young lady who appears to be in distress. Rapport is easily established, but her eyes are downcast. Her speech is relevant, with low tone. She describes her mood as sad; she is tearful while talking about her poor results, with appropriate affect. She harbours multiple unhelpful thoughts, eg. “I’m a failure” and “I’m useless”. She exhibits no suicidal ideations, delusions or hallucinations. Her concentration is poor, and insight is partial.

Physical examination reveals no recent selfharm scars, and examination of other systems is unremarkable. Biological investigations such as full blood count and thyroid function test are within normal range. Corroborative history is taken from accompanying person to verify the symptoms.

How would you arrive at the diagnosis and severity?

Diagnosis of depression can be made using the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or the 10th revision of the International Statistical Classification of Disease and Related Health Problems (ICD-10). 5 (Refer to Appendix 3 and 4, pages 73-76 in CPG.) 6 , 7

In the last 2 weeks, Tini has been experiencing:

poor concentration
excessive guilt

These symptoms have caused marked impairment in her academic functioning. Thus, she is diagnosed as having MDD with mild to moderate severity in acute phase and can be treated in primary care.

Severity according to DSM-5

Five or more symptoms are present, which cause distress but are manageable
Result in minor impairment in social or occupational functioning
Symptom presentation and functional impairment between 2 severities
Most of the symptoms are present with marked impairment in functioning

What can be offered to this patient?

Psychosocial interventions and psychotherapy with or without pharmacotherapy. 5 (Refer to Algorithm 1. Treatment of Major Depressive Disorder, page xii in CPG)

ALGORITHM 1. TREATMENT OF MAJOR DEPRESSIVE DISORDER

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Psychosocial interventions include the following:

symptoms and course of depression
biopsychosocial model of aetiology
pharmacotherapy for acute phase and maintenance
drug side effects and complications
importance of medication adherence
early signs of recurrence
management of relapse and recurrence
counselling/non-directive supportive therapy - aims to guide the person in decision-making and allow to ventilate their emotions
relaxation - a method to help a person attain a state of calmness, eg. breathing exercise, progressive muscle relaxation, relaxation imagery
peer intervention - eg. peer support group
exercise - activity of 45-60 minutes per session, up to 3 times per week, and prescribed for 10-12 weeks

(Refer to subchapter 4.1.1, pages 9-12 in CPG.)

However, the doctor may choose to start antidepressant medication as an initial measure in some situations, for example:

past history of moderate to severe depression
patient’s preference
previous response to antidepressants
lack of response to non-pharmacotherapy interventions

What are the types of psychotherapy that can be offered in mild to moderate MDD, and what factors should be considered before starting psychotherapy?

Psychotherapy for the treatment of MDD has been shown to reduce psychological distress and improve recovery through the therapeutic relationship between the therapist and the patient.

In mild to moderate MDD, psychosocial intervention and psychotherapy should be offered, based on resource availability, and may include but are not restricted to the following 5 :

Cognitive behavioural therapy (CBT)
Interpersonal therapy
Problem-solving therapy
Behavioural therapy
Internet-based CBT

The type of psychotherapy offered to the patient will depend on various factors, including 5 :

patient preference and attitude
nature of depression
availability of trained therapist
therapeutic alliance
availability of therapy

(Refer to Subchapter 4.1.1, page 17 in CPG.)

After shared-decision making, Tini receives psychosocial intervention, that includes:

psychoeducation
non-directive supportive therapy
lifestyle modification, e.g. restoring healthy sleep hygiene and adopting healthy eating habits
relaxation, e.g. progressive muscle relaxation, imagery and breathing technique

Tini will benefit from CBT due to her multiple unhelpful thoughts, for example, “I’m a failure” and “I’m useless”.

CBT helps improve understanding of the impact of a person’s unhelpful thoughts on current behaviour and functioning through cognitive restructuring and a behavioural approach. By learning to correctly identify these negative thinking patterns, Tini can then challenge such thoughts repeatedly to replace disordered thinking with more rational, balanced and healthy thinking. However, she is not able to commit to regular sessions of CBT due to a demanding academic schedule and upcoming final examination. After further discussion, Tini opts for pharmacotherapy.

What are the options for pharmacotherapy?

The choice of antidepressant medication will depend on various factors, including efficacy and tolerability, patient profile and comorbidities, concomitant medications and drug-drug interactions, cost and availability, as well as the patient’s preference. Taking into account efficacy and side effect profiles, most second-generation antidepressants, namely selective serotonin reuptake inhibitors (SSRIs), serotonin noradrenaline reuptake inhibitors (SNRIs), noradrenergic and specific serotonergic antidepressants (NaSSAs), melatonergic agonist and serotonergic antagonist, noradrenaline/dopamine-reuptake inhibitors (NDRIs) and a multimodal antidepressants may be considered as the initial treatment medication, while the older antidepressants such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) may be subsequently considered for a later choice. 5 (Refer to Subchapter 4.1.2, page 18 in CPG.)

Since Tini is being seen at a health clinic, the widely available SSRIs are sertraline and fluvoxamine. Sertraline has fewer gastrointestinal side effects and drug interactions compared with fluvoxamine. TCAs are not the treatment of choice due to prominent side effects. Tini is put on tablet sertraline 50 mg daily and educated on the anticipated onset of response and possible side effects. Short-term and low dose benzodiazepine, eg. alprazolam or lorazepam, may be offered as an adjunct to treat her insomnia. (Refer to Subchapter 4.1.2, page 24 in CPG.) Tini is given tablet lorazepam 0.5 mg at night for 2 weeks. She is asked to come in for a follow-up.

What is her follow-up and monitoring plan?

The following should be done:

(Refer to Appendix 8, page 81 in CPG.)

Titrate up by 50 mg within 1-2 weeks (but may be done earlier based on clinical judgement)
Monitor biological parameters if indicated (Refer to Table 5. Ongoing monitoring during treatment of MDD, page 57 in CPG.)

During follow-up at 2 weeks, she is noted to show partial response despite being compliant with good tolerability. She is not experienceing nausea, diarrhoea, headache, constipation, dry mouth or somnolence. She reports being less tearful. Her sleep and ability to focus have improved. Tini has started engaging in regular exercise and practises relaxation, especially before sleep. Tablet sertraline is optimised to 100 mg daily, while tablet lorazepam is reduced to 0.5 mg PRN.

Tini is reviewed again within 4 weeks; during this subsequent follow-up, she achieves full remission. Tablet lorazepam is stopped. She is then advised to continue tablet sertraline for at least 6-9 months in maintenance phase. The aim in this phase is to prevent relapse and recurrence of MDD. In view of her young age, no comorbidities and good tolerability, repeated electrolyte monitoring is not indicated.

(Refer to Algorithm 2. Pharmacotherapy for Major Depressive Disorder, page xiii in CPG.)

ALGORITHM 2. PHARMACOTHERAPY FOR MAJOR DEPRESSIVE DISORDER

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