Depression

What is Depression? Firsts all, depression is a mental illness. The main symptom is a very depressed mood.

Affected people often feel so depressed that they can no longer think clearly and no longer have the drive to do things that they would otherwise have daily for them. Also insomnia , anxiety or pain may be associated with depression.

Depression is a common diseases among the population . It is estimated that five percent of people in Germany suffer from depression. One to two in a hundred people develop it anew every year. The probability that someone in Germany will develop depression at some point in their life is between seven and 18 percent. Women are twice as like to get the disease compared to men.

It is difficult to say at what age people are most likely to develop depression. Basically, depression can occur at all ages . They occur at retirement age, and there are also children who develop them. Statistically, however, the peak is in people who are between 30 and 40 years old.

Depression: signs

Recognizing depression is not that easy. Everyone feels depressed or in a bad mood, some are more, others less. It should therefore not infrequently happen that someone asks himself: Do I have depression?

With depression, as with almost all other mental illnesses, it is also true that there is not only sick or not sick. Some levels of depression are quite normal. But when the negative feelings take over, determine everyday life and cause suffering to those who experience them, then those affected need help .

The symptoms of depression can vary, and not everyone experiences the disease the same way. What makes it difficult at the beginning, however, is that the first signs point to illnesses other than depression. What they have in commons, however, is that there is no obvious physical cause for them. Some of the first symptoms of depression include:

• Constant fatigue
• Difficulty concentrating
• Pain that seems to have no cause ( headache , abdominal pain )
• Listlessness, listlessness (including sexual disinterest)
• sleep disorders
• No appetite

Signs like this appear sporadically at first. However, over time, usually over weeks or months, they get stronger. Eventually they can grow into a depressive episode.

It is not uncommon for there to be a trigger for the first symptoms. For example a bereavement or another stroke of fate that hit someone hard. In the event of death or other bereavement, the grief usually subsides after a few weeks to two months.

But depression, too , is often wave-like . The symptom are not always the same in those affected. Usually they become very evident over a few weeks or months, then they disappear again for a few weeks, months or even years. Unfortunately, they often come back. Doctors therefore speak of a depressive episode. However, there are very different courses. Sometimes it sticks to an episode and the depression doesn't return, sometimes the symptoms persist and the episode doesn't seem to end. There are also many different types of gradients in terms of strength and frequency.

If the symptoms are weak and sometimes irregular at first, in an acute depressive episode they are present almost every day. The depressive mood even prevails almost around the clock. If this disgruntlement lasts for at least two weeks at a time, doctors can make the diagnosis. The exact diagnosis criteria are detailed in the section "Depression: Diagnosis".

In addition to the diagnosis of depression, psychiatrists and psychotherapists can make certain additional diagnoses . For example, when the depression is accompanied by anxiety or psychotic features appear.

It is true that women are diagnosed with depression much more frequently than men. Scientists are still researching why this is so. There are theories: women experience stress differently than men. Men hold back their symptoms more and see a doctor less often. Depression could also be hormonally influenced and women may have a higher risk of developing the disease before or after giving birth or during menopause. However, the symptoms of depression in men do not seem to be different from the symptoms of depression in women.

 Depression: treatment

There are basically three levels of treatment for depression. First, psychiatrists and psychotherapists treat the worst symptoms as part of acute therapy , such as suicidality.

In step two, maintenance therapy, you try to treat the depressive episode to the extent that those affected are well again and perhaps even recover.

The third step, relapse prevention , ultimately focuses on ensuring that the patient does not relapse. Sometimes this is not possible, and doctors try to at least delay the time between two depressive episodes as long as possible.

For depression, there are several approaches that doctors use to manage an episode of depression. The two main routes of treatment are medication and psychotherapy . What psychiatrists and psychotherapists use of this depends on the circumstances and the severity of the illness. Sometimes patients get both.

For mild depression, studies have shown that medication doesn't work any better than a placebo. Because of the possible side effects, most psychiatrists and psychotherapists therefore rely on psychotherapy. In moderate depressive episodes, on average, both forms of therapy have proven to be equally effective. In severe depression, medication and psychotherapy are usually combined.

Unfortunately, doctors can hardly predict which of the two methods will work best for a particular patient. Sometimes people with depression respond very well to medication, but psychotherapy doesn't work at all. Sometimes it is exactly the other way around and the psychotropic drugs do not help, but psychotherapy does. Even if an initial attempt at treatment may not be successful, it may still work to overcome depression at a later point in time.

The drugs that psychiatrists use to treat depression are called antidepressants . They aim to compensate for a lack of special messenger substances in the space between the nerve cells in the brain. This should ensure that the nerve cells can send their signals on again better.

So far, almost all antidepressants approved in Germany are based on this mechanism of action. Different antidepressants try to compensate for the deficiency in different ways.

Overview of different classes of antidepressants:

• Tricyclic (and tetracyclic) antidepressants (TCAs) or non-selective monoamine reuptake inhibitors (NSMRI)
• Selective Serotonin Reuptake Inhibitors (SSRI)
• Monoamine Oxidase (MAO) Inhibitors (MAOI)
• Selective Serotonin / Norepinephrine Reuptake Inhibitors (SSNRIs)
• Alpha2 receptor antagonists
• Selective Norepinephrine Dopamine Reuptake Inhibitors (Bupropion)
• Melatonin receptor agonists (MT1 / MT) and serotonin 5-HT2C receptor antagonists (agomelatine)

There are also other, unclassified antidepressants. They include lithium salts or St. John's wort.

In addition to medication, psychotherapy is an effective therapy in the treatment of depression. According to the national treatment guidelines, psychotherapy should focus on the following points:

• Active, flexible and supportive approach, conveying encouragement and hope
• Empathic contact, building a trusting relationship
• Exploration of the subjective disease model, clarification of current motivations and the patient's therapy expectations
• Conveying an understanding of the symptoms, their treatability and their prognosis, teaching a "biopsychosocial disease model" to relieve the patient of feelings of guilt, self-reproach and feelings of failure
• Clarification of current external problem situations, relief from currently overwhelming duties and demands at work and in the family situation
• Prevention of depression-related wishes for hasty changes in life situation, support in formulating and achieving concrete, achievable goals to regain success (positive reinforcement)
• Providing insight into the individual need for adequate therapies (e.g. antidepressants, guideline psychotherapy)
• Involvement of relatives, strengths of resources
• Addressing suicidal thoughts and impulses, developing crisis management

If depression is treated on an outpatient basis, the health insurance companies reimburse the costs of psychotherapy if it is behavioral therapy or analytical psychotherapy based on depth psychology. If, on the other hands, a patient is treated as an inpatient in a clinic, doctors can use behavioral, conversational, psychodynamic, modified analytical and systemic (family) therapeutic procedures as well as interpersonal psychotherapy.

In addition, there are a number of other methods that can help against depression. If neither psychotherapy nor antidepressants are effective, electroconvulsive therapy (ECT) has proven to be an effective method. Patients are given a short electric shock to the brain under anesthesia.

In addition, potentially helpful therapies:

• Awake therapy: the patient is not allowed to sleep for half a night or a full night. This method can provide a short-term antidepressant effect on the same day.
• Light therapy: patients are irradiated by a specific lamp. Can especially help with mild and seasonally dependent depression.
• Ketamine treatment: Relatively new procedure in which patients receive ketamine in several sessions (intravenous or intranasal). Can help if neither other antidepressants nor psychotherapy help.
• Exercise: Exercise is an effective remedy for depression.
• Meditation: Unsuitable as a sole therapy. But it can also help and is used as mindfulness-based meditation, especially in mindfulness-based cognitive therapy.

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