Depression: Symptoms, Causes, Diagnosis, and Treatment of a Mental Illness

Between 16 and 20 percent of the population will develop a depressive disorder requiring treatment at some point in their lives (lifetime prevalence).

In everyday life, the term “depression” often comes up in connection with low moods. Such fluctuations in one’s emotional state are a normal part of life and are temporary. Depression, however, is persistent, and those affected cannot overcome it through willpower alone.

With modern treatment methods, depression can often be cured or at least alleviated to the point where the person’s quality of life improves.

Medicine distinguishes three forms of the condition, namely:

• mild
• moderate, and
• severe depression

Depressed mood, lack of energy, and loss of interest and pleasure are the primary symptoms.

In addition, other symptoms (secondary symptoms) may occur, such as:

• difficulty concentrating
• reduced self-esteem and lack of self-confidence
• Feelings of worthlessness
• negative outlook on the future
• Suicidal thoughts
• Sleep disturbances and
• weight loss

People with mild depression may feel unwell, but they are still able to manage their jobs and daily lives. Those with moderate depression tend to withdraw and find it very difficult to cope with everyday life. People with severe depression can no longer cope with daily demands. They need support.

Women are affected by depression more often than men @ MP Studio /AdobeStock

The illustration above highlights the scope of this mental illness and its impact on the quality of life of those affected.

The diagnosis is made by a primary care physician, a psychiatrist, or a psychologist.

The clinician diagnoses mild depression when two of the three main symptoms are present, along with at least two secondary symptoms. A moderate depressive episode is diagnosed when two main symptoms and at least three to four secondary symptoms occur simultaneously. Severe episodes are characterized by all three primary symptoms in combination with at least four secondary symptoms.

In all cases, the symptoms last for at least two weeks. The diagnosis is preceded by a comprehensive medical history, which consists of a detailed interview and a physical examination.

Certain medications, as well as viral infections and thyroid disorders, can cause symptoms similar to those of depression. To rule these out, the doctor orders laboratory tests. An important aspect of the medical history is whether any family members have had or currently have depression.

Standardized questionnaires are also typically used to assess the severity of the mental disorder.

The following instruments are most commonly used:

• Beck Depression Inventory (BDI)
• Symptom Checklist-90 Standard (SCL-90-S)
• General Depression Scale (ADS)

The German Depression Aid Foundation offers a self-assessment test on its website. The test cannot replace a visit to the doctor. However, it helps you better assess your own situation.

Modern treatment for depression is based on two pillars:

1. psychotherapy and
2. medication

Treatment can be provided on an outpatient or inpatient basis. The specific methods used depend on the severity of the depression and the patient’s personal circumstances.

For mild cases, outpatient psychotherapy is usually sufficient. It focuses primarily on examining and changing negative feelings and thought patterns.

Cognitive behavioral therapy is a specific form of psychotherapy. It helps patients cope better with the condition. Art, music, and movement therapies have proven effective as complementary treatment options. For moderate and severe depression, a combination of psychotherapy and medication—specifically antidepressants—may be considered.

The doctor selects the appropriate medication from various classes of drugs. The most commonly used are selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications restore the balance of the neurotransmitters serotonin and norepinephrine. It takes several weeks for an antidepressant to take effect.

An important note: Antidepressants do not lead to dependence and do not cause personality changes. The illness itself causes changes in thinking, feeling, and behavior. However, the effects of these medications do not become apparent until after a few weeks.

Psychotherapy is one of the two cornerstones of depression treatment @ Photographee.eu /AdobeStock

According to recent studies, light therapy can alleviate depression. The treatment involves the use of a UV therapy lamp that mimics direct sunlight. It is used as a complementary treatment to other methods.

Another type of therapy, which is used only during inpatient treatment, is sleep deprivation. In this method, the patient must stay awake at night and during the day several days a week.

Studies have shown that this leads to significant improvement in depressive disorders. Like light therapy, this treatment has no side effects, but it often needs to be repeated.

Transcranial magnetic stimulation (TMS) represents a completely new therapeutic approach, one that is currently offered by only a few university hospitals.

In this procedure, doctors place a magnetic coil on the head. The magnet stimulates the underlying areas of the brain, thereby boosting the energy metabolism of the nerve cells. This painless treatment must be administered daily for about three weeks.

Digitalization is also driving new developments in the treatment of depression. In particular, the long wait times for appointments with specialists and psychotherapists present an interesting area of focus for researchers.

They are developing apps that help patients structure their daily lives or regularly monitor their mood. In an emergency, the apps connect patients with their treating physician or therapist. They also alert patients if their condition deteriorates rapidly.

Such services are still under development. Those interested can find an overview of current studies on the website of the German Depression Aid Foundation, as well as information on specific digital services and the development of online-based therapy tools in general.

Modern therapeutic approaches consist of several elements tailored to the patient’s needs and the severity of the illness.

Depression is generally very treatable. It typically occurs in episodes (for a limited time). For this reason, medical professionals refer to it as a depressive episode.

Such an episode can resolve completely, so that the affected person subsequently shows no symptoms at all (complete remission). If the symptoms do not fully subside (incomplete remission), the medical community refers to this as residual symptoms. In these cases, the risk of a recurrent depressive episode increases.

The term “dysthymia” is used when a patient has suffered from depressive symptoms for at least two years. This does not correspond to the full-blown picture of depression. A depressive episode that lasts for at least two years without remission is referred to as a chronic depressive episode.

Please note:

If you notice symptoms in yourself or a loved one that may indicate depression, consult a doctor. Without treatment, the risk of relapse increases. There may also be a link between depression and coronary heart disease. Depression is linked to stress. Prolonged stress has a negative effect on the nervous system, blood pressure, and heart rate. Furthermore, prolonged and severe depression is associated with an increased risk of suicide. However, medical treatment can help most people affected.