Depression

Depression is a medical, psychological impairment that brings with it symptoms such as low spirits, mental and physical disorders. Among other things, it can involve sleep disorders, digestive problems or listlessness.

Currently, about 5% of the population is affected by depression. The proportion of those who suffer from depression at some point in their lives is 15-20%, with women being affected twice as often as men.
Es wird angenommen, dass eine gewisse Veranlagung zu Depressionen vererbt wird. Das Risiko zu erkranken steigt ebenfalls, wenn bereits eine Depression durchlebt wurde.

Types of depression

Unipolar depression

Unipolar means unipolar. This means that those affected only experience depressive phases and not manic ones. It is the most common representative of depression. Characteristic are a low in the morning, early waking, problems sleeping through the night (especially in the 2nd half of the night) and dejection.

Bipolar affective disorder

Here, both depressive and manic phases coincide. Typical for the manic episodes is an exaggerated self-confidence. One's own abilities are overestimated, as a result of which some sufferers work through nights for weeks without feeling tired.

Dysthymia, cyclothymia

Beginning in adolescence and usually running chronically, the disorder manifests itself over entire periods of life. Dysthymia has somewhat milder symptoms than unipolar depression, whereas cyclothymia involves milder manic and depressive phases similar to bipolar affective disorder.

Winter Depression

Anyone who has depressive symptoms in the fall/winter and they last until spring/summer is probably suffering from SAD - seasonal affective disorder.
Symptome sind eher Antriebslosigkeit als starke depressive Verstimmungen.

Why depression occurs is still unclear today. In many cases, internal and external factors come together, whereupon the disease develops. Other factors are hereditary predisposition and psychosocial aspects.

Explanatory approaches

Although intensive research is still underway, there is already evidence that brain activity changes during depression. Nerve cells in the brain are active with every sensation, feeling or thought. Electrical impulses and neurotransmitters (chemical messengers) serve to exchange information.

In theory, this exchange of information is probably disturbed during depression, as messenger substances such as serotonin and noradrenalin are out of balance. This results in listlessness, loss of appetite and sleep disturbances.

Other theories focus on a faulty regulation of stress hormones. A disturbed regulation of the sleep-wake rhythm is also suspected as an influencing factor.

Trigger

Chronic, severe illnesses have a favourable effect on depression. This is particularly true of brain diseases, thyroid disorders and other hormonal disorders, as they affect emotions.

Medications can also affect the mood. These include cardiovascular drugs (e.g. beta-blockers), cortisone (and related substances), hormonal contraceptives (e.g. "the pill") and certain neurological preparations (e.g. anti-epileptic drugs, Parkinson's drugs).

Flowing transitions

Everyone feels down in certain life situations. There is no clear boundary between a normal low mood and mild depression. In most cases, however, a normal mood swing can be clearly distinguished from depression. It is important to note that depressive illnesses do not necessarily need an external trigger.

In most cases, depression comes as a surprise to the sufferer and their relatives or friends. Often they are not caused by a crisis or other events.

The most common symptoms of depressive illness are:

• Morning low, general dejection, loss of interest
• loss of interest, joylessness in everyday activities and pleasures
• Loss of appetite and weight, and in exceptional cases the opposite.
• Trouble sleeping through the night (especially in the 2nd half of the night)
• Restlessness and tendency to withdraw
• Inhibition in thinking and acting, indecisiveness
• Impaired concentration, slowed thinking
• Loss of libido
• Lack of energy and drive, fatigue
• Reduced self-confidence, exaggerated feelings of guilt, fear of impoverishment
• Frequent thoughts about death, suicide and suicide attempts

The diagnosis is made by a psychotherapist or psychiatrist on the basis of a detailed medical history. Further indications of depression are provided, for example, by the Goldberg test. However, there is no absolutely reliable test to determine depression.

In some cases it is necessary to uncover the causes of the depressive mood.

Further examinations are both physical and blood tests and a CT of the brain (computer tomography). They are necessary because depression can also be triggered by low blood sugar, vitamin B12 deficiency, dementia or hypothyroidism (i.e. underactivity of the thyroid gland).

After physical causes have been ruled out, an attempt is made to assess the severity of the depression. An aid for this is, for example, the Hamilton Depression Scale.

Hamilton Depression Scale

Originally, the Hamilton Depression Scale was defined with 17 points - other variants list 21 (HDRS21) or 24 questions. The patient is assessed by an examiner within a 30-minute patient interview.

The possible points include e.g:

• depressive mood
• feelings of guilt
• suicidality
• difficulty falling asleep
• Trouble sleeping through the night
• Sleep disturbances in the morning
• work and other activities
• depressive inhibition
• agitation
• psychological and somatic anxiety
• gastrointestinal symptoms (e.g. loss of appetite)
• general physical symptoms (e.g. headaches)
• genital symptoms (e.g. loss of libido)
• hypochondria
• Weight loss
• Illness insight
• diurnal fluctuations
• depersonalisation and derealisation
• paranoid symptoms and obsessive-compulsive symptoms.

The treatment strategy is tailored to the severity of the depression and its symptoms.

Severity

Different degrees and symptoms of depression require corresponding treatment measures. In general, a distinction can be made between mild depression, moderate depression and severe depression.

Mild depression

Outpatient treatment such as talk therapy or other psychotherapies are usually sufficient and lead to good results. A psychotherapy specifically developed for depression is, for example, cognitive behavioural therapy. The treatment focuses on the social environment of the affected person (family, friends, work colleagues). The use of antidepressant medication must be decided on an individual basis.

Moderate depression

Psychotherapy combined with medication or medication alone is used here. Treatment is provided by a psychiatrist or psychotherapist, whose cooperation with the general practitioner is significantly important.

Severe depression

Inpatient treatment is absolutely necessary for severe depression, especially if there is a risk of suicide. Medication is combined with psychotherapeutic strategies. Inpatient admission makes it possible to offer patients a fixed daily structure. There are fixed appointments for group discussions, movement therapy and occupational therapy, which help to escape the grey of everyday life. The mood-lifting effect of movement is put to good use.

Medication

Possible drugs for the treatment of depression:

• SSRI (Selective Serotonin Reuptake Inhibitors) enhance the effect of the body's own serotonin.
• NARI (Selective Norepinephrine Reuptake Inhibitors) increase the effect of the body's own norepinephrine.
• SSNRIs (Selective Serotonin-Norepinephrine Reuptake Inhibitors)
• Tricyclic antidepressants enhance the effect of endogenous serotonin and norepinephrine
• MAO (monoamine oxidase) inhibitors slow the breakdown of serotonin and norepinephrine in the brain
• Alpha-2 receptor antagonists
• Selective norepinephrine dopamine reuptake inhibitors
• Melatonin receptor antagonists
• Lithium-containing drugs

Other treatment options include light therapy (for winter depression) or awake therapy (sleep deprivation treatment), in which sufferers must stay awake for the 2nd half of the night and are not allowed to sleep until the following evening.

Many patients experience a mood lift as a result and their sleep-wake rhythm returns to normal. Although the effect only lasts 1-2 days, those affected often gain courage from it.

Preparations made from St. John's wort are also frequently used in the treatment of depression. Their effect relates to the messenger substances in the brain, just like common medicines. However, their treatment success is limited to mild depression. Furthermore, the dosage is problematic, as the concentration of active ingredients in the extracts varies greatly. Furthermore, it is not yet known which ingredient is responsible for the positive effect. Preparations always contain a high concentration of substances, otherwise they would not work.

Even if St. John's wort is freely available, the intake should be discussed with a doctor beforehand, as there may be interactions with other medications.

In most cases, depression can be brought under control with adequate treatment. Depressive episodes are broken or made to subside. However, if left untreated, they can last for months or years.

Not to be ignored is the risk of relapse. Rarely, depression even takes a chronic course. For this reason, long-term treatment often makes sense in order to prevent relapses.

Since severe depression is often accompanied by suicide attempts, treatment is recommended as early as possible.

Those who suffer from recurrent depressive episodes can significantly reduce the risk of relapse by taking medication. For this purpose, antidepressants should be taken for at least 2 years, this is called maintenance therapy. A combination of medication and psychotherapy has proven particularly effective for older patients.

Additional control appointments are arranged with the doctor in order to be able to observe the illness as well as the success of the treatment. An imminent relapse can thus be detected more quickly and any side effects of medication can be dealt with.

Lithium-containing drugs are used in particular in manic-depressive illnesses to prevent depression.

Long-term therapies are always useful as soon as several (even life-threatening) depressive episodes have been experienced.

Tips for relatives

If you know someone who suffers from depression, you've probably noticed noticeable changes. Active and fun-loving people suddenly complain, suffer from feelings of guilt and feel hopelessness. This should not unsettle you, nor should it tempt you to try to cheer this person up by coaxing him or her.

Relatives and friends quickly experience feelings of guilt, as they feel powerless. In the case of prolonged depression, overwork and exhaustion are added as they have to take on many of the sufferer's tasks.

Accept depression as an illness

It is usually a serious illness that negatively affects mood, sleep and drive. However, it is by no means a sign of a weak character.

Seek medical support

As with any serious illness, a doctor should be consulted as soon as possible if depression is suspected. Take the initiative and make an appointment with a doctor, as many sufferers do not see the reason themselves or are unable to do so. They are more likely to feel their own failures and weaknesses are responsible for how they feel. This is why family members can often work closely with the doctor against depression.

Be patient

Depressed people often complain, despair, and then withdraw and are dismissive. Their libido also decreases and they are less responsive to their partner's sexual needs. Show patience in these moments, reassure your counterpart that depression is an illness and is easily treatable.

Avoid trying to convince sufferers that their feelings of guilt are exaggerated. Avoid arguing about whether or not there is justification for the negative feelings. Depressed individuals do not exaggerate their feelings, do not dismiss them as psychological. Do not withdraw, even if the other person is dismissive.

Do not overexert yourself

A long-lasting depression of a relative is probably very exhausting for you. Therefore, do not forget about yourself and your need for rest. Also take care of your circle of friends and acquaintances, treat yourself to something good more often.

It often helps to build up a network of helpers. Do not try to feel completely responsible and to sacrifice yourself.

Be sparing with advice

They are well-intentioned, but a delicate subject in depression. Advice should be used carefully and judiciously. Recommendations such as going away for a few days can plunge the person deeper into depression, as it is experienced more strongly in a foreign environment.

You should also refrain from saying "Pull yourself together." By doing so, you would be asking for something that your counterpart simply cannot fulfill, which will only intensify their feelings of guilt. Instead, support your loved one as soon as they show initiative.

No far-reaching decisions

Remember that depressed individuals often see facts in a distorted way and make decisions differently than they would if they were sane.

Keep this fact in mind for situations that affect personal or professional futures.