Depression is becoming more and more widespread in modern times. Although it is a common disorder, many people are unsure and shy away from correctly classifying symptoms of depression at an early stage. Is it a temporary sadness or does an upset already have the value of a disease?? What is the difference between depression and burnout??
The following article on the subject of depression provides a valuable overview of the disease itself and what signs it brings with it.
What is depression?
Depression is a mental illness that can manifest itself in different facets and degrees of severity. It is a complex disease, for which a depressed mood, lack of interest and drive are characteristic main symptoms.
However, these are also symptoms independent of depression, which everyone notices from time to time. However, depression is characterized by the fact that the signs remain permanent and do not disappear after a short period of time. A characteristic feature of the clinical picture is that the early symptoms persist for at least two weeks, which can be a first indication of depression. There are also depression courses that have a constant symptomatology, but also such manifestations in which the symptoms of depression manifest themselves in episodes.
Although in common parlance a "depressed state" often refers simply to a common moodiness, in medical terms this is a very serious condition. It is responsible for a large proportion of work incapacities. In the case of recurring depressive phases, about 10 to 15 % of all those affected commit suicide.
Depression can traditionally be divided into different groups:
– Physical depression (symptomatic) – Endogenous depression – Neurotic depression (psychosocial)
In the case of physical depression, the causes lie in physical illnesses such as cancer. In endogenous depression, genetic predispositions are among the causes. Neurotic depression, on the other hand, is caused by life events that the person affected is unable to cope with.
Depression – forms
Depression occurs in various forms and degrees of severity and develops, for example, under certain circumstances. The different forms of depression are presented in the following sections.
Unipolar depression is the most common form of depression and is characterized by several depression-typical signs persisting for at least two weeks. The typical signs include exhaustion, dejection, lack of joy and drive, but also sleep disturbances and loss of appetite. A distinction is made between mild, moderate and severe depression depending on the number of symptoms and their severity.
Chronic depressive mood disorder (dysthymia)
Some people suffer from chronic depressive moods, or dysthymia, i.e., pronounced mood changes that are comparable to depressions. In these cases, one feels inwardly restless, dissatisfied, depressed and melancholic. However, these symptoms fluctuate on a daily basis and only as soon as they last for at least two years, they are called chronic depressive disorder. Affected individuals are not as impaired in their daily lives, compared to depressive episodes, but are equally stressed. Many people develop in the fall-. Winter time a so-called winter depression. A main cause is mainly the lack of light. The therefore incoming vitamin D deficiency. These are seasonal depressions that usually disappear in the springtime.
Many mothers experience mood swings and feel depressed after giving birth. This can develop into what is called "baby blues," which is postpartum depression or postpartum depression. The symptoms resemble those of clinical depression.
In some cases, mothers are unable to care for their child and are treated with incomprehension, as it is expected that a mother should be happy after the birth of her child. As a result, self-blame and feelings of guilt towards the mother herself and the baby increase.
Depression can also develop in combination with bipolar disorder. Bipolar disorder is a manic-depressive illness in which sufferers experience extreme mood swings in alternating phases. One of the phases consists of typical symptoms of depression, while in other phases a euphoric high mood is present. Depression has a variety of causes. Develop not only in people in difficult life situations. Depression can occur regardless of age, health, social environment or status. Depression can be triggered by internal and external factors. Depression can also have genetic causes. May be caused by hereditary predisposition. Depression occurs more frequently in families under stress. A genetic factor is present. May increase sensitivity to psychosocial stresses. If a first-degree relative suffers from depression, the risk of developing depression oneself is 15%. If the twins are identical, the risk of both having the disease is 50%.
Changes in the systems of messenger substances and hormones
Depression can also result from changes in neurotransmitters in the brain. These messenger substances get into an imbalance. This involves certain neurotransmitters, such as:
– Serotonin – Dopamine – Norepinephrine – Acetylcholine – Gamma-aminobutyric acid
Serotonin and norepinephrine are responsible for nerve cell communication and support the processing of sensory impressions. In depressed patients, the activity of dopamine, serotonin and norepinephrine is lower and affects the feelings and thoughts of the affected person.
Other changes that can trigger depression take place in the limbic system. This is important for the regulation of stress as well as partly the sensation of depression. Responsible for processing feelings. If this activity changes, for example due to strokes of fate, this can lead to increased psychological vulnerability.
Physical illnesses can also trigger depression. These include:
– pain – cancers – cardiovascular diseases – dementia diseases – Parkinson's disease – hypothyroidism – hormone disorders
Often, however, it is not possible to say exactly whether a physical illness has triggered the depression or whether the depression has arisen as a reaction to the illness.
Chronic stress, acute psychological trauma or infectious diseases, in which the stress hormone cortisol is increasingly released, can also be a cause of depression. An increased stress hormone concentration can lead to depression-typical behavioral changes:
– Difficulty concentrating – Impaired thinking – Loss of appetite – Loss of sexual desire – Increased anxiety reactions
Many sufferers have experienced psychologically stressful life events, such as loss, role change, or conflict, before the onset of their depression.
Vulnerability – susceptibility to depression
Vulnerability means vulnerability or susceptibility to harm. It means that people are more susceptible to developing specific mental illnesses and depends on various factors, such as genetic causes or psychosocial influences. Every person experiences vulnerable phases, such as adolescence, in their life. In these phases, the risk of developing a mental disorder is higher.
Other risk factors
There are many other factors that can promote depression:
– Women – Living in a big city – Single – Little social contact – Unemployment – Alcohol abuse – Low level of education
Events in childhood can also lead to depression. An overprotective approach to children by an anxious and caring parent creates risk factors, such as helplessness and poor stress management, that can trigger depression.
If a child loses a parent at an early age, has a disturbed mother-child relationship, suffers from trauma or has struggled with a lack of self-esteem since a young age, this also promotes depression.
There are people whose personality is called "type melancholicus" and is characterized by self-uncertainty, neatness, overcorrectness, self-sacrifice and emphasis on achievement – these are particularly at risk of developing depression.
Depression – Symptoms
Early symptoms of depression
The first signs of depression are called early symptoms. These are often very unspecific, d.h. they can indicate depression, but do not have to be. For example, stressful life events such as the loss of a loved one, the end of a relationship or even the loss of a job can trigger. These can then develop into depression over several weeks. In particular, if the signs persist for longer than two weeks and a variety of different symptoms become apparent, they may be the first signs of depression.
Physical early symptoms
– Constant fatigue – Lack of energy – Sleep disturbances – Loss of appetite – Declining sexual function – Headaches – Abdominal pain
Mental early symptoms
– Sadness – Apathy – Listlessness – Strong mood swings – Irritability – Anxiety – Lack of self-esteem
Classification of depression according to ICD-10
According to the ICD (International Classification of Diseases), depression can be divided into three groups:
– Mild depression – Moderate depression – Severe depression
The classification into the respective group is based on main and additional symptoms. The main symptoms refer to a change in the person's mood. The additional symptoms refer to further signs of depression.
The classification into the three groups is based on the frequency of the number of main and additional symptoms:
If, for example, two main symptoms and two additional symptoms occur over a period of at least two weeks, one speaks of a mild depression. If 4 or more additional symptoms occur, one speaks of a severe depression.
In order to identify depression and before possibly starting therapy, it is important to correctly interpret the symptoms regarding depression. The ten main and secondary symptoms are described in detail in the following overview.
Main symptoms of depression
The ICD classification defines the following 3 main symptoms of depression.
Listlessness and increased fatigue
The symptom of listlessness describes the condition in which those affected feel listless and lacking in energy, and even the simplest activities are too strenuous. One feels permanently tired and exhausted, even simple activities such as shopping, preparing meals, washing or cleaning are perceived as exhausting. Patients prefer to lie in bed or on the sofa all day long. Also maintaining social contacts. Dating is perceived as stressful. Often the affected are still depressed in their mood, if they are given little understanding by their environment for it.
Loss of interest and joy
One of the main symptoms is a loss of interest, which reflects a lack of interest in things that the patient used to enjoy. Hobbies are no longer enjoyable. The patient often neglects them. But other areas of everyday life are also affected, such as work and home.
What everyone knows from time to time is often a permanent condition in depressives: A constant dejection and sadness, which often cannot be explained by certain things, is a typical main symptom of a depression. If this persists, it leads to despair and hopelessness. Also emotional coldness. Inner emptiness can show itself. At the same time, those affected not infrequently describe themselves as incapable of having emotions. Neither positive nor negative events influence the feeling of numbness, i.e. neither joy nor sadness are triggered by such events, but they are accepted emotionlessly.
Additional symptoms of depression
According to the ICD classification, a total of 7 additional symptoms exist that are indicative of depression.
Lack of concentration
Decreased concentration and attention leads to inability to focus on a task, whether at work or in everyday life. Everyday tasks previously perceived as easy suddenly appear difficult. Performance at school or work becomes worse. Difficulty concentrating leads to slowed thinking. Also to an increased decisionlessness. This in turn leads to self-doubt and brooding, which in turn increases the other symptoms.
Reduced self-esteem and reduced self-confidence
In depressives there is often a strong lowering of self-esteem. Patients blame themselves for not functioning. Those affected feel useless and worthless and as a burden to their personal environment. Ignorance of the environment, with its complex demands, often exacerbates this. The affected person rejects himself, the self-esteem is lowered and accordingly the self-confidence is low. Patients are unaware of how much harm they are doing to themselves by thinking negative thoughts.
Guilt and feelings of worthlessness
Guilt and feelings of worthlessness often develop as affected individuals can no longer perform many things of normal life. Not only for oneself, but also for others not. Feelings of guilt towards family. Partners are not uncommon. This also leads to the fact that depressed mood often manifests itself so persistently in patients. Even people who previously had a high level of self-confidence suddenly feel worthless and useless. This is due to the fact that things that were previously considered easy and self-evident at work, during leisure time and in the social environment suddenly become difficult or can no longer be mastered.
Negative and pessimistic outlook on the future
The feeling that an endeavor will not lead to a positive outcome often prevents depressed people from starting anything at all. They no longer see things logically, but very pessimistically and unrealistically negatively. Everything is evaluated negatively. This attitude usually also prevents the patient from having the positive experiences that are important for him or her and that help to overcome the depression. Many patients also have a negative expectation regarding the prognosis that the depression can improve and they can recover again. This in turn makes recovery from depression enormously more difficult.
In the round of depression symptoms are also insomnia, as well as other sleep problems. This includes, in particular, sleep disturbances. A very early morning awakening. Difficulty falling asleep is also one of the sleep problems. These signs occur on the one hand because the patients often ruminate about their problems. On the other hand also because they are less active during the day and therefore do not get tired properly.
Frequently, depression is diagnosed with symptoms that are related to nutrition. This includes a loss of appetite, but also a lack of desire to buy or cook anything at all. An unbalanced diet can add digestive and circulatory problems to depression, which can naturally dampen the patient's mood as well. Some people with depression have to force themselves to eat. All this can also lead to an enormous weight loss.
Suicide is a complication of depression that must be avoided at all costs. Between 40% and 70% of patients with depression report having had suicidal thoughts at one time or another. It is therefore always important to take symptoms of suspected depression seriously, especially if the patient expresses suicidal thoughts. Many feel uncomfortable talking openly about suicidal thoughts. Nevertheless, the best thing to do is to talk openly about it. Relatives who have such a suspicion should confidently contact the family doctor and seek professional support if the patient cannot do this themselves.
Frequency of depression
Studies show that depression is much more common in humans than one might think. The disease is still underestimated, although the complications can even include possible suicide. Therefore, anyone who notices or suspects symptoms of depression in themselves or others should take action.
A study conducted by the Robert Koch Institute between 2008 and 2011, according to which depression is one of the most common and consequential mental disorders, found over 8.Underwent 000 interviews, examinations and tests to investigate the prevalence of depression. The following results have emerged:
– Of all adults between the ages of 18 and 79, 8.1% exhibit depressive symptomatology – At 10.2%, women exhibit a significantly higher rate than men at 6.1% – Older people over the age of 70 exhibit a lower rate of depression than younger people (men 4.2% / women 7.7%)
Frequency of depression by age and gender in percent
Depression – Diagnosis
It is better to visit the doctor once too often than not enough. Of course, this also applies to depression and the symptoms that this illness can bring with it. More and more absences from work today are also the result of mental illnesses. It is important that those affected and their relatives realize that this is not a mood in which one can "pull oneself together" should, but that depression is a common illness that belongs in therapeutic hands and can also be treated well there.
The general practitioner is already the right contact for this; he usually ies a sick note for depression directly. But a psychotherapist can also be consulted without the need for a referral. For this purpose, it is best to contact a therapist by telephone and request an appointment. The earlier treatment can be initiated, the sooner the patient's quality of life can be improved.
To make a diagnosis, a psychiatric-psychotherapeutic consultation is helpful. Here, psychological findings are collected and a detailed conversation is held, which, for example, deals with current stressful situations and complaints from previous illnesses. Standardized questionnaires are often used, or relatives are also involved in the interviews if the person concerned agrees to this. It must also be clarified whether there is a family burden, that is, whether there have been previous cases with depression in the family.
In order to obtain a reliable diagnosis, the affected person must be physically examined. How to rule out organic diseases that can trigger depressive symptoms. These diseases include:
– Brain tumors – Meningitis – Parkinson's disease – Multiple sclerosis – Migraine – Epilepsy – Thyroid disease – Adrenal dysfunction – In the elderly: Dementia
It must also be clarified whether the patient is taking certain medications or addictive substances that can trigger depression. These medications include, for example:
– Cardiovascular drugs – Steroid hormones – Antibiotics – Cytostatic drugs
Differential diagnosis involves distinguishing depression from other mental disorders, such as schizophrenia or anxiety disorders, and checking whether bipolar disorder may be associated with it.
course of the disease and prognosis
The course of a depressive illness often takes place in different phases. Two-thirds of those affected fluctuate between depressive phases and the greatest possible health. These phases do not have a fixed duration. The other third experience partial improvement, but about 15% remain chronically depressed after the first depressive episode. Many of the depressive episodes, if they are treated appropriately, also disappear again. Therefore, the chances of recovery are good in many cases. Only 15 to 20% experience depression that lasts at least 12 months.
However, there is often a risk of relapse. A relapse means that signs of illness reappear while recovery has not yet been fully achieved. After the first episode, the risk is 50% if no precautions are taken, and 75% if the depression is severe. Since there are different forms of depression, three of the forms and their course are presented in the next sections. The figure provides a graphical overview.
In unipolar depression, a depressive episode can vary in length. It can be a few weeks or several months and depends on when treatment is started.
If a sufferer has several depressive episodes in his or her life, this is called "recurrent unipolar depression" and affects the majority of sufferers. Between the episodes themselves, sufferers are healthy and this period can also vary in length. As a sufferer, it is only important to take care to prevent a relapse or recurrence of the depressive episode.
In bipolar depression, depressive and manic episodes occur. In the manic phases, the person is in a good mood and restless. However, this phase can quickly change into a depressive one, which is why a quick and lasting treatment with medication is necessary here. Bipolar depression is a lot less common than unipolar depression.
Dysthymia, or chronic depressed mood, does have depressive symptoms, but they are not severe. They remain for a long period of time and once the sufferer has been suffering from them for two years, they are first referred to as dysthymia.
Depression – treatment
Over 80% of those affected can be successfully treated with modern therapies. Treatment varies according to the severity of the disorder. How long has the condition existed? Is it a one-time disorder or does depression progress in repetitive phases?
– Antidepressants are often used to inhibit the state of depression. – For some time now, there have been online therapy programs that help combat depression. – Joint psychotherapy is the more intensive form if the disorder is already entrenched. – Depending on the severity, individual therapies are also used to provide optimal treatment.
In the first place, it is important to consult a doctor in good time. Since depression can affect anyone and the symptoms are often ambiguous, it is all the more important to be sensitive and attentive to oneself and others. Even doctors often do not correctly classify the symptoms.
Psychotherapy involves intensive discussions and behavioral exercises. Most commonly used for depression, cognitive behavioral therapy incorporates depth psychology, analytic psychotherapy, and systemic therapy. Here, unknown connections are worked out and processed in conversations. One must be prepared to deal intensively with one's past and painful memories and experiences.
If it is an acute depressive illness, short-term psychotherapy is possible, also in combination with medication. After that, outpatient psychotherapy can be used.
A self-help group offers the opportunity to meet and exchange ideas with other people with similar problems and illnesses. Sufferers give each other support, comfort, and encouragement. There is no professional guidance and can be a helpful adjunct to treatment with medication and psychotherapy. Also, most groups are open and anonymous, so you can always join one.
Another advantage of a self-help group is that it is actively. Depression often causes listlessness. Affected people withdraw. With a support group, sufferers take a more active part in life.
Other forms of psychotherapy
In addition to the forms of therapy already mentioned, there are other ways to treat depression:
– Cognitive behavioral therapy – Systemic therapy – Yoga and relaxation methods – Exercise and sports – Light therapy – Wake therapy – Electroconvulsive therapy
If the depression is only mild, medications are not particularly helpful. In addition, one should initially refrain from taking medication, since the symptoms of depression often stop or decrease after a short time and these medications also have side effects.
If the symptoms are more severe, medication can of course be useful. This concerns especially those who suffer from severe and recurrent depression and practice self-harm or think about suicide. Often, psychotherapy can only be started after the symptoms have been alleviated by medication.
To treat depression with medication, people use antidepressants, often in combination with psychotherapy. These lift the mood. Increase the drive. Once started, it often takes several days to weeks for them to take effect and are taken daily for several weeks to months. The duration of use depends on the development of the symptoms. the risks of renewed depressive episodes depending. Once intake is stopped, 4 to 9 months of maintenance therapy follows. Initially, intake is reduced, as abrupt discontinuation can lead to sleep disturbances, restlessness, and nausea. The independent discontinuation, increases the risk of relapse.
Antidepressants have a number of side effects, most of which occur in the first few weeks of taking them. Exactly how often and which side effects occur depends on the active ingredient and the dosage. Possible side effects include:
– dry mouth – headaches – inner restlessness – circulatory problems – sexual dysfunction
Instead of taking antidepressants, there are also herbal medicines that can help with depression. St. John's wort is often used for mild depression. Sometimes used for moderate depression. Medicines for moderate depression sometimes require a prescription. However, there's also a lot of over-the-counter medicines that contain a very low dose.
Herbal medicines can also cause side effects and interactions with other medicines, so it is important to consult your doctor before taking them.
Emergency numbers for suicidal people offer support and help for people who are thinking about suicide themselves or are worried about loved ones. The number of the telephone counselling service in Germany is: 0800 111 0 111.