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Supporting natural mood regulation is a new direct target for developing novel treatments, optimising existing ones and integrating drug and psychotherapies to reduce the disease burden of depression, according to new research, published in JAMA Psychiatry, from the Department of Psychiatry, University of Oxford.

Mood varies from hour-to-hour, day-to-day and healthy mood regulation involves choosing activities that help settle one’s mood. However, in situations where personal choices of activities are constrained, such as during periods of social isolation and lockdown, this natural mood regulation is impaired which might result in depression.

This new study, Mood homeostasis, low mood, and history of depression in 2 large population samples, looked at 58,328 participants from low, middle and high income countries, comparing people with low mood or a history of depression with those of high mood. In a series of analyses, the study investigated how people regulate their mood through their choice of everyday activities. In the general population, there is a strong link between how people currently feel and what activities they choose to engage in next. This mechanism - mood homeostasis, the ability to stabilise mood via activities - is impaired in people with low mood and may even be absent in people who have ever been diagnosed with depression.

When we are down we tend to choose to do things that cheer us up and when we are up we may take on activities that will tend to bring us down. However, in our current situation with COVID-19, lockdowns and social isolation our choice of activity is very limited. Our research shows this normal mood regulation is impaired in people with depression, providing a new, direct target for further research and development of new treatments to help people with depression. - Guy Goodwin, Professor Emeritus of Psychiatry, University of Oxford.

One in five people will develop major depression at some point in their life. The current lockdown strategies used by different countries to control the COVID-19 pandemic is expected to cause even more depressions. About 50% of people will not see their symptoms improve significantly with an antidepressant and the same applies to psychological treatments. The total annual cost of depression in the UK is about £8 billion. A key priority for mental health research is therefore to develop new treatments or optimise existing ones for depression.

Using computer simulations, this study also showed that low mood homeostasis predicts more frequent and longer depressive episodes. Research suggests that by monitoring mood in real time, intelligent systems could make activity recommendations to increase mood regulation and such an intervention could be delivered remotely, improving access to treatment for patients for whom face-to-face care is unavailable, including low and middle income countries.