Depression

Synonyms in a broader sense

English: depression

Mania
Cyclothymia
Depressive symptoms
Antidepressants
Antidepressant
Depressions
Delusion
Bipolar disorder
Melancholy

Definition

Depression is, similar to mania, a so-called mood disorder. Mood in this context means the so-called basic mood. It is not a disorder of emotional outbursts or other surges of feelings.

In psychiatry there is a classification according to the so-called severity of a 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 occurrence of depression is most likely between the ages of 35 and 40. After the age of 60 only about 10% of patients fall ill. The probability of contracting depression during the course of life is about 12% for men and about 20% for women.

The so-called lifetime risk is about 17%. The risk of developing an additional illness in addition to depression (the so-called comorbidity risk) is up to 75%. The most frequent additional illnesses are here:

Anxiety disorder (50%)
OCD
Post-traumatic stress disorder
Eating Disorder
Substance misuse
Social phobia
Substance dependence
Insomnia
Sexual disorders
Somatoform disorders
Mania (in the form of a manic-depressive illness)
Personality Disorders ̈rungen

Symptoms

The typical characteristics that a person must have in order to be considered depressed psychiatrically are as follows:

Depressive mood
Numbness
Fear
Avolition
Social withdrawal, social phobia
Insomnia / Sleep disorders
Concentration disorders
Delusion
Hallucinations
Suicidal thoughts
Eating Disorder

The mood is “depressed”. This can be experienced and reported by the individual patients as quite different. Certainly, the simple sadness is very common.

But much more often the so-called “feeling of numbness” is described. This is an extremely agonizing state of emotional numbness. For the patient there is no event which enables him to react adequately than normally to things which would normally move him a lot.

For example, winning the lottery would not be perceived as a moving event, nor would losing a job or a loved one. It is therefore important to note that these are both negative and positive events that no longer reach the person with a depressed mood. Furthermore, the person suffering from depression faces massive anxiety.

These anxieties can revolve around all areas of life. Most frequently, however, the fear about the future (one’s own, but also that of one’s immediate surroundings) is the most common. This fear is intensified by an almost permanent feeling in which the patient feels overwhelmed by all the tasks that are put before 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, which almost exclusively relate to someone close to them.

Lack of drive: The simplest things, such as doing the daily housework or even just getting up in the morning and personal hygiene are experienced as almost impracticable. Whenever a depressive person deals with something that requires drive, he experiences himself almost at the same moment as being physically exhausted. Also the maintenance of social contacts becomes an insurmountable task.

There is a clear so-called “social withdrawal”. This in turn leads to the patient becoming more and more lonely (socially isolated – social isolation/phobia). Insomnia / insomnia: Although the depressive patient experiences an almost continuous feeling of exhaustion and also tiredness, sleep disorder is one of the most pressing problems in depression.

The disorders can manifest themselves in a variety of ways. However, the most tormenting symptoms are those of sleep disorders, especially with an awakening in the early morning hours. Every person needs regular sleep.

If it loses its relaxing effect and is even felt as a burden, it can be a very serious problem. There are also depressive patients who have an increased need for sleep, but this is only a few percent of the total. Delusion: As many as one third of patients diagnosed with depression experience delusional symptoms.

The delusional symptoms or delusion is a distorted perception of reality. This reality need not have anything in common with the actual reality, but is assumed by the patient to be immutable. This poses a particular problem for relatives in particular, as they often discuss the patient’s delusional ideas with the patient and want to refute them.

(please see separate chapter on delusion and mania). Such knowledge can and will in all probability also lead to abnormal behaviour. The appearance of the delusion is not sudden.

It usually occurs in different stages. Some typical delusions of depressive patients are

Stage: Delusional mood. – Level: Delusional perception
Stage: Delusional certainty / delusional idea (please see chapter Delusion (to follow)
Impoverishment mania: Here the sick person knows about his imminent financial ruin.

Here the worries often revolve in particular around the care of relatives

Hypochondriac delusion: Here the patient knows that he is suffering from at least one serious physical illness. This disease is often perceived by the patient as incurable and fatal. – Delusions of sin: The patient knows that he has sinned against a higher or lower power.

If the person is a believer, the content of the delusion is often religious. If there is no special spirituality, the sin can extend to worldly matters. – Nihilistic delusion: This is a delusion that is perceived as particularly disturbing, especially by outsiders.

As a result of the perceived emptiness, the sick person denies the existence as his own person and possibly also the existence of the world around him. Hallucinations: In very rare cases, so-called hallucinations (less than 7%) can occur during a depressive episode. These are usually acoustic hallucinations.

This means that the patient hears one or more voices, known or unknown to him. These voices either talk to him (dialoguing), about him (commenting) or give him instructions and commands (imperative) (see also chapter Schizophrenia / Mania). Depending on how the voices speak and what they say, hallucinations can become dangerous if they speak into the patient’s mood.

Example: A 20-year-old student, who has been suffering from depression for several weeks and is therefore almost unable to leave the house, hears his mother’s voice one day, which initially tells him that everything will get better again. After some time, however, the voice changes to a commanding tone, telling him that he might as well jump off the balcony, as he won’t finish his studies anyway, as he is a lazy man. Suicidal thoughts /suicidality: Here an open word is very important!

A depression can be life threatening. More than two thirds of all depressive people think during the illness that death is the better alternative. It does not always have to be a concrete suicidal intention, but can also be a passive desire to suffer an accident or to die of a fatal illness.

However, the thought of active suicide is a very common one. The background is often the helplessness and hopelessness. The suicidal person believes that suicide is a way out of his suffering.

It can be particularly dramatic if the patient suffers from delusions or hallucinations, as mentioned above. If suicidal thoughts are suspected, a specialist must always be consulted, who will conduct a careful but honest conversation on the subject. With such a topic it is difficult to make concrete statements, but clinical experience has shown that the following criteria in particular indicate an increased risk of suicide: In psychiatry today, it is considered fundamentally wrong not to address the issue of suicidal thoughts in order to avoid “giving the patient ideas”.

Male sex
Former suicide attempts
Depression over a long period of time
School life
A basic aggressive personality

In about half of all suicide cases, depression can be identified as the trigger for suicide, and a far higher number of unreported cases is suspected. 10-15% of all patients with a severe depression take their own lives, many more have survived a suicide attempt or at least struggle with suicidal thoughts. This makes depression a potentially fatal disease and the immediate need for action becomes apparent.

For this reason, too, the initial treatment is more likely to use dampening than stimulating medication to avoid suicidal acts. Physical symptoms (so-called somatic or vegetative symptoms), occur in a variety of mental illnesses. However, they are very common, especially in depression.

Often, the symptoms experienced in depression are directly related to problems already known in advance. Pain is often at the forefront of the physical symptoms. These particularly affect the head, abdomen and muscles.

Furthermore, constipation can occur, which can become a very central problem, especially for older people. Younger people almost always experience a total loss of sexual drive and also an actual functional disorder of the sexual organs. Another common point is dizziness, which can occur in all age groups and at any time of day. Heart complaints are of particular importance. A possible, harmless so-called “heart stumbling” can be considered very dramatic in the context of a hypochondriac insanity, as it could herald the certainty of imminent death.