Depression (synonyms: Depressive episode; Melancholia agitata; ICD-10-GM F32.0: Mild depressive episode; ICD-10-GM F32.1: Moderate depressive episode; ICD-10-GM F32.2: Severe depressive episode without psychotic symptoms) is a disorder that affects the emotional side of mental life and can manifest itself differently in different individuals. Depression is one of the most common diseases of the brain. It is diagnosed according to the criteria of the International Classification of Diseases (ICD 10-GM). According to severity, depression is divided into:
- Mild depression (minor depression) – some not too severe symptoms, which are easily treated and usually quickly manageable.
- Moderate depression – wide range of symptoms, usually associated with problems in coping with private everyday life or professional life.
- Severe depression* is a serious illness (major depression) – the everyday life situations are not manageable and are often accompanied by suicidal thoughts.
* Major depression must be treated by a neurologist or psychiatrist. A special case of depression is winter depression, also called seasonal affective disorder (SAD) (see below “winter depression”). It begins in the dark season and does not end again until the spring months. Furthermore, there is the special case of perinatal depression (period shortly before or after birth). A distinction is made in depression between a bipolar and a unipolar form:
- Bipolar depression (manic-depressive form) – the mood of those affected is characterized by fluctuations: extreme high phases (mania) alternate with periods of complete listlessness
- Unipolar depression – manic phases are missing
According to the symptomatology, unipolar depression is divided into:
- Depressive episodes – an episode lasting at least 2 weeks.
- Recurrent depressive episodes
- Persistent affective disorders in which there is a chronic mild depressive mood in the affected person (= dysthymia)
- Depressive episodes in the context of a bipolar course.
A depressive episode is divided into:
- Monophasic
- Relapsing/chronic
- In the context of a bipolar course
Recurrent depression is distinguished by onset:
- Occurring in middle or early adulthood: “early onset depression” (EOD).
- Occurring for the first time in old age: “late onset depression” (LOD).
Sex ratio: males to females is 1: 2.5 in unipolar depression. In bipolar depression, the sex ratio is balanced. Frequency peak: depression is on the one hand an aging disease, that is, it itself contributes to aging, and on the other hand occurs clustered in old age (= age disease). We speak of old-age depression when a person first becomes depressed after the age of 60. Today, however, geronto-psychiatry assumes that there is no such thing as a special old-age depression. All types of depressive syndromes occur in old age. Therefore, it is better to speak of depression in old age.Bipolar depression tends to affect younger people. The prevalence (frequency of illness), here lifetime prevalence, is nationally as well as internationally 16-20%; for a diagnosed depression in women 15.4% and in men 7.8% (in Germany). The 12-month prevalence of depression in Europe is 6.9%.Unrecognized and untreated depression is more common in men.Postpartum depression (PPD; postpartum depression; as opposed to a short-lasting “baby blues,” this carries the risk for permanent depression) has a prevalence of 13-19%. The 12-month prevalence is for
- Unipolar depression is 7.7%.
- Major depression at 6.0 %
- Dysthymia (persistent affective disorder in which there is a chronic mild depressed mood in the sufferer) at 2%.
- Bipolar disorders at 1.5%.
Unrecognized and untreated depression is more common in men.A depressive symptomatology show about 18% of all pregnant women and about 19% of all new mothers in the first three months after delivery. Course and prognosis: It is assumed that about half of all depressions are not recognized and thus remain untreated. Early diagnosis and treatment improves the prognosis.The therapy is very individual and includes psychotherapeutic procedures as well as pharmacotherapy (drug treatment). Approximately 50% of depressed patients are healthy again after six months and can lead a normal life. Postpartum depression (PPD) is most often associated with a low mood in the first two months (maximum 6-8 weeks after delivery). Those most at risk for depression are young and socially deprived mothers, as well as those with a history of depression (medical history). More than 12% of mothers with postpartum depression show more severe signs of depression even three years after the birth of a child. Classically, depression occurs episodically, but in 15-25% of sufferers it becomes chronic (depressive syndrome > 2 years).If irritability or aggression occurs in patients with unipolar major depression, this is indicative of a severe, complex, chronicizing course. Major depression is likely to be characterized by a chronic course in obese patients. This patient group should participate in a medically supervised obesity program (weight loss program)! Over the course of their lives, patients with unipolar depression experience at least one further depressive episode in at least 50% of cases after the initial illness. The probability of a relapse increases to 70% after two episodes and to 90% after the third episode. Approximately 10-15% of all patients suffering from depression commit suicide. Patients with schizophrenia die on average 7-11 years earlier. Comorbidities: Depressive disorders are often associated with generalized anxiety disorder (GAS) and panic disorder. Patients with depressive disorders may have a predisposition to develop substance dependence (alcohol, medication, and drug dependence).Other comorbidities include eating disorders, cognitive disorders (memory disorders; here: Disorders of memory and cognitive flexibility), somatoform disorders (mental illness that results in physical symptoms without physical findings), personality disorders, and obsessive-compulsive disorder.
