All information about depressionDepression, or a depressive episode, is a mental illness characterized by a disturbance of mood.
Depression: Everything you need to know!
What is depression?
Definition
Depression or a depressive episode is a mental illness characterized by a disturbance in mood.
It manifests itself through a range of symptoms, including depressed mood, loss of interest and energy, and difficulty concentrating, which have persisted for at least two weeks.
This disorder occurs at all stages of life, with adulthood predominating.
Depression has a significant impact on social and professional life and is associated with an increased risk of suicide (10-20%).
Depressions are to be distinguished from a simple dejection or a temporary sadness.
Do depressions occur frequently?
Depression is one of the most common diseases in Germany . In fact, 8.2% of the German population suffer from depression in the course of a year. However, according to studies, 40% of people suffering from depression do not use appropriate care.
A 2017 bulletin from the RKI reports that payers have been reporting a significant increase in depression for 15 years, which translates into early retirement and disability, official data show no such increase in prevalence. This is mainly explained by the fact that depressive disorders are less often given this diagnosis.
It is estimated that nearly one in five people will be affected by depression during their lifetime .
WHO estimates that depression is the most common cause of morbidity (disease character) and disability worldwide. According to their latest estimates, more than 300 million people worldwide live with this disorder.
Mental health represents a major public health challenge due to its economic, health, and social implications . The high prevalence of mental disorders, as well as the costs they generate, make mental health one of the largest cost drivers for health insurers.
Risk factors for depression
There are several factors that can favor the occurrence of a depressive episode. In fact, there is not only one cause responsible for depression, but it involves several factors that may be biological, psychological, sociological, …
Among these factors are:
– A complicated personal history , including childhood emotional or sexual trauma, a complicated relationship with parents, difficult experiences, etc. – The death of a loved one. Grief is not considered a characteristic depressive episode. In fact, it is a psychological reaction to the loss of a loved one, which is not a pathological condition. However, grief can sometimes be complicated by a depressive episode – A separation, the loss of a job, family or professional conflicts – An illness , a disability – Addictions to tobacco, alcohol or other substances – Neurobiological factors such as a deficiency of neurotransmitters (serotonin, norepinephrine, dopamine, . ) – Genetic predisposition : those who have a parent who is or has been affected by depression have a two to four times higher risk of also developing depression during their lifetime. In fact, certain genetic variations have been identified. However, since depression is a multifactorial disorder, this predisposition is usually expressed only when unfavorable environmental factors are present. In this case, we speak of interactions between genes and environment .
Diagnosis of depression
The diagnosis of a depressive episode is made through a clinical examination in which the clinician first questions and then examines the patient. The diagnosis is based on several criteria. Also other symptoms such as pain. Sexual disorders can be observed.
During the clinical interview, the physician conducts an initial examination of the depressive episode and looks for a possible associated psychiatric disorder, impairment of sensory, physical or cognitive functions, auto- or hetero-aggressiveness in the patient, . And it estimates the risk of suicide. It also assesses the personal. Family history of psychiatric disorders.
Assessment of severity
Finally, there are two classifications for assessing the severity of depression: the ICD-10 of the WHO and the DSM-5 resp. DSM-IV.
Three levels of intensity can be used to assess the severity of the disorder:
Depression can also be associated with suicidal thoughts, psychotic symptoms, as well as the inability to perform daily activities. The assessment of suicide risk is very important. Should be done regularly.
Finally, inpatient treatment may be considered in some cases.
Treatment of depression
Before treatment begins, a helpful, trusting and supportive relationship must be established with the patient.
The treatment plan is drawn up together with the patient, who is informed above all about the nature of his or her disease, the positive effects and possible side effects of the treatment, and the care to be established. If necessary, with the patient's consent, his or her environment can also be informed. Regular reassessment of the treatment plan is crucial. If necessary, a readjustment can be made. Treatment will take into account the patient's preferences. The severity of the depression.
Psychotherapy
Regardless of the intensity of the depressive disorder (mild, moderate, or severe), psychotherapy is recommended as treatment .
In mild forms, it may be the only type of treatment; in moderate and severe forms, it may be combined with antidepressants. And the choice depends on the symptoms. The wishes of the patient.
Treatment with antidepressants
Antidepressants are prescribed in combination with psychotherapy , in certain cases for moderate forms of depressive episodes (depending on the choice of the patient or the general practitioner) and from the beginning for severe forms.
It is also recommended not to prescribe antidepressants in the following situations:
– Symptoms of subsyndromal depression: Symptoms whose number is insufficient to meet the criteria of a depressive episode, or symptoms of severe intensity but lasting less than two weeks (according to ICD-10 or DSM-5) – Depressive episodes of mild intensity (according to ICD-10 or DSM-5)
There are many different antidepressants and the choice is individualized to each patient , depending on the characteristics of his disease and the recommendations for use.
It is important to know that the possible side effects of these treatment options usually occur before the positive effects.
Medical monitoring
If a depressive episode has been diagnosed, long-term medical care should be initiated.
This will make it possible to assess the effectiveness of treatment, address possible side effects of drug treatment and prevent complications of depression , d.h. the risk of suicide, chronicity and relapse.
This care is provided through regular appointments with the family doctor or psychiatrist.
Four to eight weeks after the start of treatment, an evaluation of the effectiveness of the treatment must be carried out. The physician will determine whether the patient has achieved complete or partial remission or, on the contrary, whether depression persists or worsens.
In cases where remission is only partial or in situations where the disease persists or worsens, readjustment of treatment may be undertaken.
Discontinuation of drug treatment should not be done without medical supervision. This should be done gradually to prevent the risk of relapse.
In addition to medical care, it is also possible to influence everyday life through lifestyle advice:
– Maintain the nycthemeral rhythm (day-night) – Maintain a healthy lifestyle – Engage in regular physical activity – Eat meals at regular times and eat a balanced diet – Avoid the use of alcohol or other addictive substances – Engage in regular social activities by connecting with family, friends . Is kept – Continue enjoyable or interesting activities
In summary, it can be said that depression is a very common mental illness in Germany as well as all over the world. Because of their economic, health and social impact, they represent a major public health challenge. Precise diagnostic criteria make it possible to diagnose a depressive episode and determine its severity. Treatment of depression is mainly based on psychotherapy, combined with antidepressants in more severe forms. Medical care is very important to assess the effectiveness of treatment, prevent complications of depression, and address possible side effects of drug treatment.