Q: How does depression affect physical health?

Depression is bidirectionally linked to NCDs: depression doubles the risk of type 2 diabetes and cardiovascular disease; people with depression have substantially higher mortality from all causes. Conversely, chronic pain, cancer, cardiovascular disease, neurological conditions and diabetes dramatically increase the risk of depression. Treating co-morbid depression improves glycaemic control, cardiac outcomes and overall chronic disease management. Depression is not a "mental" problem separate from physical health — it is a whole-person condition.

Q: What is the difference between depression and bipolar disorder?

Bipolar disorder (previously called manic-depressive illness) involves episodes of mania (elevated/irritable mood, decreased sleep, grandiosity, impulsivity, risky behaviour) alternating with depressive episodes. Depression without manic/hypomanic episodes is "unipolar" major depressive disorder. Distinguishing bipolar from unipolar depression is critical because antidepressants alone in bipolar disorder can trigger mania. Mood stabilisers (lithium, valproate, lamotrigine) are the cornerstone of bipolar treatment.

Q: What is cognitive behavioural therapy?

CBT is a structured, time-limited psychological therapy — typically 8-16 sessions — based on the model that thoughts (cognitions), emotions and behaviours are interconnected. CBT teaches patients to: identify negative automatic thoughts; challenge cognitive distortions (catastrophising, black-and-white thinking, mind-reading); test negative beliefs against evidence; and use behavioural techniques (activity scheduling, relaxation). It is the most extensively evidence-based therapy for both depression and anxiety disorders, with effects comparable to antidepressants for mild-moderate depression and potentially more durable.

Question 1

What is the difference between depression and normal sadness?

Accepted Answer

Normal sadness is a transient emotional response to loss, disappointment or adversity — it is proportionate and time-limited. Major depression is a medical condition characterised by persistent (>2 weeks) depressed mood or loss of interest in activities, plus associated symptoms (fatigue, cognitive impairment, appetite/sleep changes, guilt, suicidal thoughts) that significantly impair daily functioning. Depression is not a character weakness or a response to be "snapped out of" — it has neurobiological underpinnings and responds to evidence-based treatment.

Question 2

How many people have depression and anxiety?

Accepted Answer

WHO estimates 280 million people globally have depression and 301 million have anxiety disorders — making them the world's most common mental health conditions and together the largest cause of disability globally. Rates increased dramatically during COVID-19 — rising by approximately 25% in the first year of the pandemic (predominantly from isolation, uncertainty and economic stress).

Question 3

What causes depression?

Accepted Answer

Depression results from the interaction of biological (genetic predisposition, neurobiological factors — altered serotonin, dopamine and noradrenaline neurotransmission; hypothalamic-pituitary-adrenal axis dysregulation; neuroinflammation), psychological (negative cognitive schemas, rumination, poor problem-solving) and social factors (adverse life events, childhood trauma, social isolation, poverty, discrimination, domestic violence). No single cause; it is a complex, multifactorial condition.

Question 4

What are the most effective treatments for depression?

Accepted Answer

Effective treatments include: psychological therapies — cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and behavioural activation are first-line for mild-moderate depression; antidepressants — SSRIs (fluoxetine, sertraline, escitalopram) and SNRIs for moderate-severe depression; and combination therapy (CBT + antidepressant) for severe depression. For treatment-resistant depression: augmentation strategies, TMS, ECT (electroconvulsive therapy) and ketamine/esketamine. Response rates are approximately 50% for any single treatment; remission rates improve with persistent treatment trials.

Question 5

What are anxiety disorders?

Accepted Answer

Anxiety disorders are a family of conditions characterised by excessive, uncontrollable fear and worry causing significant distress and functional impairment. The main types: generalised anxiety disorder (chronic worry about multiple topics); panic disorder (recurrent panic attacks and fear of further attacks); social anxiety disorder (fear of social situations and judgement); specific phobias (intense fear of specific objects/situations); OCD (obsessive thoughts and compulsive behaviours); and PTSD (anxiety following trauma). Each has specific evidence-based treatments.

Question 6

What is WHO mhGAP?

Accepted Answer

The WHO Mental Health Gap Action Programme (mhGAP) scales up mental health services in LMICs where psychiatrists are absent or scarce (1 per million in some LMICs). The mhGAP Intervention Guide (mhGAP-IG) provides evidence-based decision algorithms for detecting and treating priority mental disorders — including depression and anxiety — by non-specialist health workers (nurses, general physicians, community health workers). mhGAP has been implemented in 100+ countries and trained hundreds of thousands of non-specialists.

Question 7

Why is the treatment gap for depression so large?

Accepted Answer

More than 50% of people with depression receive no treatment in high-income countries; in LMICs the gap exceeds 75-80%. The barriers are: stigma (discouraging help-seeking and disclosure); inadequate workforce (critical shortage of psychiatrists and psychologists globally); unaffordable cost of treatment; limited primary care integration of mental health; poor awareness of depression as a medical condition (often attributed to weakness or spiritual failure); and insufficient political commitment to mental health investment (typically <2% of health budgets).

Question 8

How does depression affect physical health?

Accepted Answer

Depression is bidirectionally linked to NCDs: depression doubles the risk of type 2 diabetes and cardiovascular disease; people with depression have substantially higher mortality from all causes. Conversely, chronic pain, cancer, cardiovascular disease, neurological conditions and diabetes dramatically increase the risk of depression. Treating co-morbid depression improves glycaemic control, cardiac outcomes and overall chronic disease management. Depression is not a "mental" problem separate from physical health — it is a whole-person condition.

Question 9

What is the difference between depression and bipolar disorder?

Accepted Answer

Bipolar disorder (previously called manic-depressive illness) involves episodes of mania (elevated/irritable mood, decreased sleep, grandiosity, impulsivity, risky behaviour) alternating with depressive episodes. Depression without manic/hypomanic episodes is "unipolar" major depressive disorder. Distinguishing bipolar from unipolar depression is critical because antidepressants alone in bipolar disorder can trigger mania. Mood stabilisers (lithium, valproate, lamotrigine) are the cornerstone of bipolar treatment.

Question 10

What is cognitive behavioural therapy?

Accepted Answer

CBT is a structured, time-limited psychological therapy — typically 8-16 sessions — based on the model that thoughts (cognitions), emotions and behaviours are interconnected. CBT teaches patients to: identify negative automatic thoughts; challenge cognitive distortions (catastrophising, black-and-white thinking, mind-reading); test negative beliefs against evidence; and use behavioural techniques (activity scheduling, relaxation). It is the most extensively evidence-based therapy for both depression and anxiety disorders, with effects comparable to antidepressants for mild-moderate depression and potentially more durable.

Question 11

How does COVID-19 affect mental health?

Accepted Answer

COVID-19 caused a global mental health crisis: WHO estimated a 25-28% increase in prevalence of major depressive disorder and anxiety disorders in the first year. Drivers included: social isolation; economic stress; bereavement; uncertainty; direct neurological effects of SARS-CoV-2 infection; and healthcare system disruption. "Long COVID" psychiatric sequelae (depression, anxiety, cognitive impairment, PTSD) affect a significant proportion of COVID-19 survivors. Post-pandemic mental health system recovery — addressing the backlog of untreated cases — is a global priority.

Question 12

How does GMJ News cover depression and anxiety?

Accepted Answer

GMJ News covers WHO depression and anxiety prevalence data, mhGAP implementation, treatment gap analyses, COVID-19 mental health impacts and psychopharmacology developments. Depression and anxiety are major public health concerns in Georgia — PHIG's mental health work includes primary care integration of mental health services, which the Georgian Medical Journal covers as a health system priority.

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