depression

Synonyms in a broader sense

• mania
• Cyclothymia
• Depressive symptoms
• Antidepressants
• antidepressant
• depressions
• Delusion
• bipolar disease
• melancholy

English: depression

definition

Like mania, depression is a so-called mood disorder. In this context, mood is to be understood as the so-called basic mood. It is not a question of disturbing outbursts of feeling or other upsurges of feelings.

In psychiatry there is a classification according to the so-called severity of depression. A distinction is made between mild, moderate and severe depressive episodes.
But who is depressed now?

Information on the diagnosis and therapy of depression can be found under Diagnosis and therapy of depression!

Epidemiology

The first onset of depression is most likely between the ages of 35 and 40. After the age of 60, only about 10% of patients become ill.

The likelihood of developing depression in the course of life is around 12% for men and around 20% for women.

The so-called lifetime risk is around 17%.

The risk of developing an additional illness in addition to depression (the so-called comorbidity risk) is up to 75%.
The most common additional illnesses are here:

• Anxiety disorder (50%)
• Obsessive-compulsive disorder
• post-traumatic stress disorder
• eating disorder
• Substance abuse
• social phobia
• Substance addiction
• sleep disorders
• sexual disorders
• somatoform disorders
• Mania (in the form of a manic - depressive illness)
• Personality disorders

Symptoms

The typical characteristics that a person must have in order to be referred to psychiatrically as depressed are the following:

• depressed mood
• Feeling numb
• fear
• Listlessness
• social withdrawal, social phobia
• Insomnia / sleep disorders
• Difficulty concentrating
• Delusion
• Hallucinations
• Suicidal thoughts
• eating disorder

Depressed mood

The mood is "depressed". This can be experienced and reported very differently by the individual patient. Certainly the simple sadness is very common.

Feeling numb

Far more often, however, the so-called "feeling of numbness" is described. This is an extremely excruciating state of emotional freezing. For the patient there is no event which enables him to react adequately as normal to things which would normally move him very much.

Example: winning the lottery would not be perceived as a moving event any more than e.g. the loss of a job or a loved one.

It is therefore important to note that it is both negative and positive events that no longer reach people with a depressed mood.

fear

Furthermore, the person suffering from depression is faced with massive fear. These fears can revolve around all areas of life. Most often, however, there is fear about the future (one's own, but also those of the immediate vicinity). This fear is reinforced by an almost permanent feeling in which the patient feels overwhelmed with all the tasks that are being asked of him. Sometimes social phobias can also develop.

In this context, the fear of loss often occurs. Over time, those affected can develop strong compulsions to control that relate almost exclusively to someone close to them. Read more about this under: Fear of loss

Listlessness

Loss of drive: The simplest things, such as doing the daily housework or even just getting up in the morning and taking care of the body are experienced as almost impracticable. Whenever the depressed person deals with something that requires drive, he experiences himself physically drained and exhausted at almost the same moment.

Social withdrawal

Maintaining social contacts also becomes an insurmountable task. There is a marked so-called “social withdrawal”. This in turn means that the patient can become more and more lonely (socially isolated - social isolation / phobia).

Example: social isolation

A patient who has previously actively participated in a club life can no longer really get himself up to do his club business. In the course of time he comes to the meetings more and more irregularly and neglects his duties. He can only tell the inquiring colleagues that he does not feel well and is somehow powerless. Initially tolerated by the club mates, the absence of further activities is interpreted as a lack of interest and the comrade is threatened with exclusion. This can ultimately lead to total social isolation.

sleep disorders

Insomnia / sleep disorders: Although the depressed patient experiences an almost constant feeling of exhaustion and also tiredness, the sleep disorder is one of the most pressing problems in depression.

The disorders can show up in very different ways. The most tormenting complaints, however, are difficulty sleeping through the night, especially with awakening in the early morning hours.

Everyone needs regular sleep. If it loses its relaxing effect and is even perceived as a burden, it can be a very serious problem.

There are also depressed patients who have an increased need for sleep, but this is only a few percent of the total.

Delusion

Delusion: At least one third of patients diagnosed with depression have delusional symptoms. The delusional symptoms or delusions are a distorted perception of reality. This reality does not have to have anything in common with actual reality, but the patient accepts it as immovable. This is a particular problem for relatives in particular, as they often discuss their delusional ideas with the patient and want to refute them. (see separate chapter for this Delusion and mania).

Note: madness is knowledge

Madness is knowledge! The delusional does not believe that something is wrong, he knows it and has to warn or protect his surroundings or otherwise communicate it.

Example: delusion

A successful businessman who has been suffering from depression for a long time comes to his wife excitedly one day to tell her that he has just had his life insurance canceled because he needs money to support his family. A hint from the wife that the family is doing well and that everyone is being taken care of is not accepted. Even presenting bank statements cannot induce a man to reverse things.

Such knowledge can and is very likely to result in abnormal behavior. The onset of madness is not sudden. It usually takes place in different stages.

1. Level: delusional mood
2. Level: delusional perception
3. Level: delusional certainty / delusional idea (see chapter Wahn (still to follow)
   

Some typical delusions of depressed patients are:

1. Maniacal poverty: Here the patient knows about his impending financial ruin. Here, the concerns in particular often revolve around the care of relatives
2. Hypochondriac madness: Here the patient knows that he is suffering from at least one serious physical illness. This disease is often perceived as incurable and fatal by the patient.
3. Sin delusion: The sick person knows that he has sinned against a higher or lower power. If the person is a believer, the content of the madness is often religious. If there is no particular spirituality, sin can extend to worldly concerns.
4. Nihilistic delusion: This is a delusion that is perceived as particularly disturbing by outsiders in particular. As a result of his perceived emptiness, the patient denies existence as a person and possibly also the existence of the world around him.

Hallucinations

Hallucinations: In very rare cases, so-called hallucinations can occur as part of a depressive episode (less than 7%).These are usually acoustic hallucinations. This means that the patient hears one or more familiar or unfamiliar voices.

Read more on the topic Hallucinations

These voices either talk to him (in dialogue), about him (commenting) or give him instructions and commands (imperative) (see also chapter Schizophrenia / mania). Depending on how the voices speak and what they speak, hallucinations can be dangerous if they speak into the mood of the patient.

Example: A 20-year-old student who has been suffering from depression for a few weeks and therefore can hardly leave the house, hears his mother's voice one day, who initially persuades him that everything will get better after all. After a while, however, the voice changes to a commanding tone that tells him he might as well jump off the balcony, since he won't finish his studies anyway because he's a lazy guy.

Suicidal thoughts

Thoughts of suicide / suicidality: An open word is very important here! Depression can be life threatening. More than two thirds of all depressed people think during the illness that death is the better alternative. It does not always have to be a question of specific suicide intentions, but can also be a passive desire, for example, to suffer an accident or to die of a fatal illness. However, the thought of active suicide is a very common one. The background to this is often the helplessness and hopelessness. The suicidal believes that through suicide they are creating a way out of their suffering.

It can be particularly dramatic if the patient suffers from delusions or hallucinations, as mentioned above.

If you suspect suicidal thoughts, you should always consult a professional who will have a careful but honest conversation about the subject.

It is difficult to make concrete statements on such a topic, but clinical experience has shown that the following criteria in particular speak for an increased risk of suicide:

• male gender
• previous suicide attempts
• Long-term depression
• Guilt life
• an aggressive basic personality

Today in psychiatry one regards as fundamentally wrong the approach of not addressing the topic of suicidal thoughts in order not to “get the patient on stupid thoughts”.

Depression and suicide

In about half of all suicide cases, depression can be identified as the trigger for suicide, a much higher number of unreported cases is assumed. 10-15% of all patients with severe depression take their own lives, many more have survived a suicide attempt or are at least struggling with suicidal thoughts. This makes depression a potentially fatal disease and the need for immediate action becomes apparent. For this reason, too, in the initial treatment, depressant rather than stimulating drugs are used in order to avoid suicidal acts.

You might also be interested in the following article: What can be signs of suicide?

Physical symptoms

Physical symptoms (so-called somatic or vegetative symptoms) occur in a variety of mental illnesses. However, they are very common, especially in depression. Often times, the symptoms experienced in depression are directly related to problems known in advance. The main physical symptoms are often pain. These particularly affect the head, abdomen and muscles. Furthermore, it can lead to constipation, which can be a very central problem, especially for older people.

In younger people there is almost always a total loss of sexual drive and an actual dysfunction of the sexual organs.

Another common point is dizziness, which can appear in all ages and at any time of the day.

Heart complaints are of particular importance. A possible, harmless so-called “heart stumbling” can be seen as very dramatic in the context of a hypochondriac madness, as it could herald the certainty of imminent death.

These can be typical signs of depression!

Recognizing depression is not always easy. To identify early signs, ask yourself the following questions (or present these questions to the person you suspect may be suffering from depression):

• Do you often feel depressed and sad?
• Do you tend to brood more?
• Do you feel trapped in your own thoughts?
• Are you still able to experience joy, especially in things that you used to enjoy?
• Have you lost interest in things that were important and fun to you in the past?
• Have you had a harder time making decisions lately?
• Do you feel like your life has lost its meaning?
• Do you feel powerless and easily exhausted, even with little or no previous effort?
• Do you have sleep disorders or appetite disorders?
• Have you been feeling physically unwell lately without being able to name an exact cause?

All of these questions are aimed at the symptoms of depression mentioned above. If several of these can be answered in the affirmative, an appointment should be made with a doctor for more detailed clarification. The earlier depression is recognized, the better the chances that it will pass quickly and that the patient can be better helped.

Depression is also not perceived as an illness by the suffering person, which makes it difficult to recognize it early on. Depression can also hide behind addictions, e.g. Alcohol and gambling addiction.

Frequent partner changes can also be signs of depression or a depressed mood.

Read more extensive information at: Signs of depression

How can you recognize depression?

Depression has typical characteristics such as Loss of drive, poor concentration, or physical symptoms. How strong these characteristics are and how exactly they manifest themselves in the individual differs from person to person and depression therefore looks slightly different for each patient.
Recognizing the symptoms as such is not always easy, partly because they are completely natural to a lesser extent or with an adequate trigger. With excessive stress or traumatic events, a depressive mood is quite normal and part of the psychological processing. However, if there is a pronounced lack of interest and joyless, listlessness, depressive mood and other characteristics for more than two weeks that cannot be adequately explained by external circumstances, depression is possible.
If a person notices over a longer period of time that he or she cannot really get excited about anything, sleeps poorly and is constantly tired, is not hungry, can only find negative things in something, etc., clarification is advisable. It is not uncommon for the person not to come to the doctor on his own initiative, but is pressured to do so by family or friends. Many people still feel inhibited about seeking help for psychological problems today.

causes

Depression can have many underlying causes. Read more about the topic on our Causes of Depression page.

What cause does serotonin play in depression?

Serotonin is also known as the "mood hormone" because a sufficiently high concentration in the brain suppresses fear, grief, aggression and other negative feelings and leads to calm and serenity. Serotonin is also important for a regulated sleep-wake cycle.
In some depression patients, a lack of serotonin or a disorder of the serotonin metabolism or signaling pathway can be established as the cause of the symptoms. Such disorders can be inherited, which explains, among other things, the familial accumulation of the disease. Various studies have been able to trigger an artificial serotonin deficiency in animal models, thereby producing depressive symptoms and proving the role of serotonin in depression. Thus, drugs were developed to increase the concentration of serotonin and are now firmly established in depression therapy. However, since this messenger substance has many functions, many of them outside the brain (for example in the gastrointestinal tract), these drugs have their typical side effects.

Read more on the subject at: The role of serotonin in depression

What influence do vitamins have on depression?

A vitamin deficiency can lead to exhaustion and tiredness, which also lowers motivation and drive through a worsening of the general condition. If there is already a depression, it can be intensified. A vitamin deficiency is not enough as the sole trigger of a depressive episode, just as a therapy with vitamins alone cannot cure a depression. A sufficient supply of all essential nutrients should nevertheless supplement the depression therapy in order to prevent any negative influences.

Read more on the subject at: What role do vitamins play in depression?

How does the pill affect depression?

The influence of the pill on mood is a common side effect and is listed as such in the package insert. Hormonal contraceptives should not be considered the sole trigger of depression, but if there are other risk factors they can promote the development of depression and exacerbate existing symptoms. The pill should therefore not be taken by patients with depression.

Read more on the subject at: Depression from the Pill?

Depression and Burnout - What's the Connection?

Depression and burnout syndrome often go hand in hand, but are not the same. Burnout always occurs in a specific context, e.g. the workplace. Patients feel overworked and unable to perform, the burden creeps up and is initially not noticed. Depression is independent and encompasses all of everyday life, patients feel overwhelmed and incapable even outside of work, and symptoms can appear suddenly.
Burnout can trigger depression if the stress is so severe that it affects other areas of life. Depression can also lead to burnout if the patient's work and performance suffer from his symptoms. Depression and burnout can therefore cause and reinforce each other, but are not the same and occur independently of each other in many patients. The strong connection between the two clinical pictures is known to doctors and should be taken into account during treatment in order to prevent the development of the other symptoms or to treat both at the same time.

Read more on the subject at: Depression or burnout - what do I have?

Is Depression Hereditary?

Basically, depression is not a disease of the genetic material, i.e. there is not a defect that has been built into the genetic material and leads to precisely this disease with precisely these symptoms.

Nevertheless, a connection between the genetic material passed on from parents and grandparents and the occurrence of depression is suspected. A decisive role is ascribed to the messenger substances in the brain (such as serotonin, dopamine and norepinephrine), which can occur in different distributions and play an important role in the development of depression.

It is believed that both the genetic material and stress influence the formation and networking of nerve cells and can thus trigger depression. But this connection has not yet been finally scientifically proven.

You are more likely to develop depression yourself if you have one or more family members who have it. However, this relationship does not only exist between depression itself, but many psychological illnesses. However, not everyone with a family history of depression has to be affected themselves.

Environmental factors, one's own social network, formative life events and the fundamental ability to deal with stress (also Resilience called) can have a decisive influence on whether, when and to what extent depression develops.

A connection between losses and problematic living conditions and the development of depression are likely. In addition, the presence or absence of a stable, healthy, partnership-like relationship also plays an important role, which to a certain extent can act as a protective factor against the onset of depression.

alcohol

Depression can do that too Dealing with addictive substances affect, often in an unfavorable way. Sometimes a increased alcohol consumption the first or only sign of a depressed mood.

Since many depressed people often find themselves in a spiral of thoughts that can occupy their entire consciousness without leading to a satisfactory result and which only further depresses them, they often seek the "Forgotten in the bottle”.

Alcohol may not seem like the solution to their problems, but it can be a way out of a bad mood or an escape from illness. In addition, alcohol has one mood-enhancing effect through his Affecting the nerve cells in the brain.

If alcohol is consumed Dopamine released, which plays an important role in the brain's reward response. This makes the sick person feel better after they have consumed alcohol, which prompts them to keep drinking so as not to sink into the bad mood again. This relationship plays an important role in the interplay of alcohol, drugs that have a similar effect, and depression.

Depression and alcohol - what is the connection?

Alcohol abuse and depression are mutually reinforcing. Depressed people use alcohol more often than non-depressed people, as the intoxication temporarily numbs the symptoms and provides relief for the patient. In the long run, this intensifies the depression, as alcohol is a poison for the body and the psyche and also worsens the state of health. Alcoholism and other addictions are the result.

Duration

Depression can last different lengths of time depending on the severity and it is difficult to give an exact time.

Depressive episodes don't just start overnight, they start develop over weeks and months. Likewise, they often don't just suddenly subside, but keep getting better.

Severe depression is only spoken of when the symptoms persist 2 weeks. Most depression resolves within 6 months, and it is not uncommon for symptoms to resolve within a year. Still, depression can be too several years last for. That is questionable high likelihood of relapse years after the episode has successfully ended.

The main symptoms of depression can also disappear completely, but reduced performance and resilience and the tendency to depressive moods can remain.

How can you overcome depression?

If depression has been diagnosed, pharmacotherapy, i.e. treatment with medication, is the quickest help. Various antidepressants are intended to lighten the patient's mood and alleviate the immediate distress. Thereafter, the causes of depression can be effectively addressed, provided that they can be found. Psychotherapy plays an important role here. If the trigger cannot be found or removed, the patient learns in therapy to deal with the negative sensations and to regain his or her self-esteem.
The phased character of depression should also be taken into account. The depressive mood usually lasts for a few weeks, then goes away on its own, but then comes back again. Thus, it must be made clear to the patient that the immediate psychological stress will go away again and that he should not despair of it, but that active work must still be carried out against relapses in the long term.

Read more about this under: How can you overcome depression?

Is there a permanent cure for depression?

As described above, depression is phased, recurring episodes that should be prevented with medication after successful treatment in order to avoid relapses. In some cases, when the depression has been particularly severe and persistent, lifelong treatment is needed. In most patients, however, the medication can be discontinued after a while and a cure can be assumed if the psychotherapy is successful.
Ideally, those affected have learned to deal with burdens and their very own demons. Patients who are firmly integrated into a social network and supported by family and friends have a particularly good prognosis. In this way, depression can also be overcome permanently. Problematic, however, are the risks associated with depression that can have long-term consequences, such as an unhealthy lifestyle, other comorbidities or a risk of suicide. For example, patients with depression suffer from coronary artery disease more than average and have an increased risk of heart attacks.

Classification

The division of the depression is first of all into the single occurring (monophasic) or recurring (recurrent) depression. The further classification takes place in the following categories:

monophasic depression

• mild depressive episode
  without somatic symptoms
  with somatic symptoms
• moderate depressive episode
  without somatic symptoms
  with somatic symptoms
• major depressive episode without psychotic symptoms
• major depressive episode with psychotic symptoms
• other / unspecified

recurrent depression

• currently mild depressive episode
  without somatic symptoms
  with somatic symptoms
• currently moderate depressive episode
  without somatic symptoms
  with somatic symptoms
• current major depressive episode without psychotic symptoms
• current major depressive episode with psychotic symptoms
• currently remitted
• other / unspecified

Depression and burnout syndrome usually have similar symptoms. Would you like to find out whether burnout has already passed into the next level - a depression - read more about this under: Depression or Burnout - What do I have?

Special forms

Special forms of depression are:

• Pregnancy depression
• Winter depression

Pregnancy depression is a variant of depression that occurs after pregnancy and can have different characteristics.
You can also find more information on this topic at: Pregnancy Depression.

Winter depression is found during the winter months and is caused by a lack of light. For help and information on the subject, see Winter Depression.

Read more on the subject at: Differential Diagnoses of Depression

Medication

The drugs that can be used for depression are divided into different groups.

They often work by influencing the control and messenger substances in the brain and increasingly intervene in the serotonin, noradrenaline and dopamine balance. Serotonin is especially responsible for our good mood, while noradrenlin can increase our motivation and dopamine is released as a reward reaction.

Tricyclic antidepressants work by increasing the messenger substances (especially serotonin, dopamine and noradrenaline) at the switching cells between nerve cells. This leads to an increase in the signal and a lightening of the mood. However, only after a few weeks, which in connection with the increased activity that occurs earlier can lead to an increased risk of suicide. Side effects are mainly their depressant effect on the circulatory system.

Drugs that largely block the docking point of a messenger substance (e.g. selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors) have fewer side effects.

Care should be taken not to combine the mood enhancer lithium (which can also be given for depression) with these active ingredients.

Another active group are the MAO inhibitors, which hinder the breakdown of messenger substances, more precisely amines such as serotonin and dopamine, and thus increase their effect. These can inhibit the degradation completely or only for a certain period of time and belong to the second choice remedies.

Read more on the subject at: These drugs help with depression

Tricyclic antidepressants

Tricyclic antidepressants get their name because of their chemical structure. They increase the concentration of messenger substances, especially serotonin and noradrenaline, and thus improve signal transmission in the brain. This, for example, reduces the patient's lack of drive, motivation and joyless. The effect only occurs after 1-2 weeks. Typical side effects are tiredness, dry mouth, constipation, headaches and many more, which is why they are not always the first choice of therapy for depression.

Read more on the subject at: antidepressant

SSRIs

So-called SSRIs (“selective serotonin reuptake inhibitors”) also increase the concentration of messenger substances, but only serotonin. They are most commonly used nowadays, but also have a delayed effect and have typical side effects, especially those affecting the gastrointestinal tract (e.g. nausea, diarrhea). Compared to tricyclic antidepressants, many SSRIs have a stimulating rather than depressant effect, so that they should only be given under observation in patients at risk of suicide.

Read more on the subject at: SSRIs

lithium

Lithium salts are a long-established drug for the treatment of depression and have been shown to prevent suicide. Unfortunately, the therapeutic index of lithium is very narrow, which means that the concentration of the drug in the patient's blood must be closely monitored, as even a small increase in lithium levels is harmful. Nowadays the medicine is mainly used to prevent a relapse of depression.

Read more on the subject at: lithium

Johannis herbs

St. John's wort preparations are derived from “echtem St. John's wort” (Hypericum perforatum) won. Its mechanism of action has not yet been clarified with certainty, but it is assumed that its effect is based on an increase in the neurotransmitter serotonin in the brain, which is responsible for mood.

Even if St. John's wort has proven to be more effective than a placebo in studies, no definitive statement about its effectiveness is possible from a scientific point of view.

Neither the therapeutically most sensible dose (i.e. the one with the best ratio of desired and undesired effect) nor which component of St. John's wort is responsible for the mood-enhancing effect have been finally clarified.

Nevertheless, St. John's wort has proven to be as effective as the commonly used drugs, but only in mild and moderate depression. St. John's wort should not only be given for a short time if necessary, but over a longer period of time, as it does not work immediately and it also has to reach a certain amount in the body to be effective.

A disadvantage of St. John's wort is that it can be freely sold, as this means that there is no medical control. This is particularly dangerous, as St. John's wort, in combination with other drugs, can influence their effect and thus also cause considerable harm to the patient.

Relatives

A Supportive family structure can be helpful in case of depression or possibly counteract the occurrence of such. Because Depressionven often in connection with decisive life events or problematic living conditions occur, relationships with close family members or close friends are important.

In the case of e.g. In the event of a loss, family structures can accompany and support the person concerned in their grief reaction and thus prevent the development of depression. Overloading problems and decisive life events, which can possibly end in depression, can also be avoided with the help of friends and relatives.

At the same time, relatives are often the ones when the disease occurs first point of contact. Your willingness to understand and sympathize is crucial for the course of a depression. Since depressed people tend to withdraw and avoid being close to other people, it is particularly important to counteract this in order to slow down the course of the disease or, in the best possible case, to change it for the better. Not only can this possibly enable professional help to be called in earlier, it also means that people suffering from depression are not left alone with their self-destructive thoughts and suicidal intentions can be recognized better and earlier.

You can also find relevant information at: This is what relatives of a person with depression should know!

What are the consequences of depression for the partner?

Depression is a real illness that cannot be overcome by the patient's willpower or self-discipline alone. This is often difficult for relatives to understand. If the person concerned lives in a partnership or marriage, the partner experiences the suffering of the other first hand and is often the target of the bad mood himself.
Since only professional treatment is really effective, the partner's attempts to help mostly fail, which both sides frustrate. Often, consciously or subconsciously, the accusation is raised that the person concerned is simply not trying hard enough and sinking into self-pity. This subliminal to open criticism leads to further deterioration of the patient. In addition, lack of drive and physical symptoms often bring joint activities to a standstill and the relationship is additionally stressed. Nonetheless, the partner is essential to overcoming depression and should be actively involved in treatment in order to learn how to deal with the patient's symptoms and provide effective support. If this does not succeed, the parties involved risk the breakdown of the relationship.

test

The physical examination is an integral part of every psychological examination. Possible underlying physical causes (such as the presence of a Thyroid disease) can be excluded from the outset. There is often one for that Blood test necessary.

Various specially tailored solutions are used to determine the presence of depression and confirm symptoms Questionnaires used. These tests are based on the standard works of medical diagnostics such as DSM (Diagnostic and Statistical Manual of Mental Disorders) of the American Psychiatric Association APA or that ICD (International Statistical Classification of Diseases and Related Health Problems) of the World Health Organization WHO created. They can do that worldwide are used and achieve a high comparability.

Self-tests for depression are widespread on the Internet, but caution should be exercised and the results obtained from them should not be taken uncritically for granted. If in doubt, it is advisable to always consult a doctor.

Read some here Tests for depression there are!

What is the Anxiety Test?

The DASS (Depression-Anxiety-Stress-Scale) test is a questionnaire developed to record symptoms of depression, anxiety and / or stress that are not caused by a physical illness and must therefore be psychological. To this end, the patient is asked 21 (in the short version) or 42 questions (in the long version), which are answered with values ​​from 0 to 3 (“Does not apply to me at all” to “Strongly applies to me”) should be. This test is often used because it is so informative.