Depression is a serious mental illness . Its symptoms affect the entire organism. The illness changes the way the person affected thinks, feels and acts, impairs bodily functions and causes considerable suffering. Only general practitioners, psychiatrists and psychologists can make a reliable diagnosis.
Between 16 and 20 percent of the population will develop a depressive disorder requiring treatment in the course of their lives (lifetime prevalence).
In everyday life, the term depression is often used in connection with low moods. Such fluctuations in personal well-being are part of normal life and will pass. Depression lasts and the person affected cannot free themselves from it through willpower.
With modern treatment methods, depression can often be cured or at least alleviated to such an extent that the affected person's quality of life improves.
Medicine distinguishes between three forms of depression, namely mild, moderate and severe depression.
Depressed mood, listlessness and loss of interest and pleasure are the main symptoms. In addition, there are other complaints (secondary symptoms) such as
People with mild depression may feel ill, but are able to cope with work and everyday life. In the case of moderate depression, people withdraw and are only able to cope with everyday life with great difficulty. Patients with severe depression are no longer able to cope with daily demands. They need support.
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The diagram above illustrates the extent of this mental illness and its impact on the quality of life of those affected.
The illness is diagnosed by the family doctor, a specialist in psychiatry or a psychologist.
The doctor will diagnose mild depression if two of the three main symptoms are present, plus at least two secondary symptoms. A moderate depressive episode is present when two main symptoms and at least three to four secondary symptoms occur simultaneously. Severe episodes are characterized by all three main symptoms in combination with at least four secondary symptoms.
The duration of the symptoms is at least two weeks in all cases.
Diagnosis is preceded by a comprehensive medical history, which consists of a detailed interview and a physical examination .
Certain medications, viral infections and thyroid disorders can cause symptoms similar to depression. To rule this out, the doctor will order laboratory tests. An important aspect of the medical history is the question of whether relatives have been or are suffering from depression.
As a rule, standardized questionnaires are also used to assess the degree of the mental disorder.
The following instruments are used most frequently:
The German Depression Aid Foundation offers a self-test on its website. The test cannot replace a visit to the doctor. However, it does help you to better assess your own situation.
Modern treatment for depression is based on two pillars: psychotherapy and medication. It can be carried out on an outpatient or inpatient basis. Which methods are used depends on the severity of the depression and the patient's personal circumstances.
In mild cases, outpatient psychotherapy is usually sufficient. It is primarily aimed at questioning and changing negative feelings and thought patterns. Cognitive behavioral therapy is a special form of psychotherapy . It helps patients to cope better with the illness. Art, music or movement therapies have proven to be effective as supplementary treatment measures.
For moderate and severe depression, a combination of psychotherapy and medication, known as antidepressants, may be considered.
The doctor selects the appropriate medication from different groups of active ingredients. Serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are most commonly used. These drugs restore the balance of the neurotransmitters serotonin and noradrenaline. It takes a few weeks for an antidepressant to take effect.
An important note: antidepressants do not lead to addiction and do not cause a change in personality. The illness itself causes changes in thinking, feeling and acting. However, the effect of these medications only takes effect after a few weeks.
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According to recent studies, light therapy can alleviate depression. The treatment is carried out using a UV therapy lamp, which is similar to direct daylight. It is used in addition to other methods.
Another type of therapy that is only used during inpatient treatment is sleep deprivation. Here, the patient has to stay awake several days a week during the night and also during the day. Studies have shown that this can significantly improve depressive disorders. Like light therapy, this treatment has no side effects, but must be repeated often.
A completely new therapeutic approach is transcranial magnetic stimulation (TMS), which has so far only been carried out in studies at a few university hospitals. A magnetic coil is applied to the head. The magnet stimulates the underlying areas of the brain and in this way stimulates the energy metabolism of the nerve cells. This painless treatment must be carried out daily for around three weeks.
Digitalization is also providing new impetus in the treatment of depression. The long waiting times for specialists and psychotherapists in particular offer researchers an interesting field of work.
They are developing apps that help patients to structure their everyday lives or regularly check their mood. In an emergency, they establish contact with the attending doctor or therapist. They also warn patients if their condition deteriorates acutely.
Such services are still being developed. Interested parties can find an overview of current studies on specific digital services and the development of online-based therapy tools in general on the website of the German Depression Aid Foundation.
Modern therapy approaches usually consist of several elements that are specifically tailored to the needs of the patient and the severity of their illness.
Depression is generally very treatable. It is typically episodic (temporary). For this reason, medicine also refers to it as a depressive episode.
Such an episode can heal completely so that the person affected no longer shows any symptoms (complete remission). If the symptoms do not completely disappear (incomplete remission), medicine also refers to this as residual symptoms. In these cases, the risk of a new depressive episode increases.
Dysthymia occurs when the patient suffers from depressive symptoms for at least two years that do not correspond to the full-blown symptoms of depression.
If the patient shows the full picture of a depressive episode without remission over a period of at least two years, medicine speaks of a chronic depressive episode.
If you notice symptoms in yourself or relatives that indicate depression: consult a doctor. Without treatment, the risk of relapse increases . A connection between depression and coronary heart disease cannot be ruled out.
Depression is associated with stress. Prolonged stress has a negative effect on the nervous system, blood pressure and heart rate. In addition, there is an increased risk of suicide in the case of prolonged and severe depression.
However, most sufferers can be helped by medical treatment.
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