Depression: Therapy

General measures

  • Nicotine restriction (refraining from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for underweight. In one study, it was demonstrated that in overweight people, depressive symptomatology is associated with weight-associated outcomes (outcome) i.e., a reduction in body weight and an improvement in diet quality may contribute to an improvement in symptoms of depression.
  • Physical activity – patients who can exercise should exercise (see below Sports Medicine/Endurance and Strength Training)!
  • Review of permanent medication due topossible effect on the existing disease.
  • Avoidance of psychosocial stress:
    • Loneliness in old age – Old people are no more likely to suffer from depression than young people, but depressive episodes in old age are longer lasting and more likely to be mismanaged
    • Stress (acute stress and life crises), especially continuous stress.
  • Avoidance of drugs
  • Regular rest and sleep (sleep hygiene; see “Sleep hygiene” below).

Conventional non-surgical therapy methods

  • Electroconvulsive therapy (ECT; synonym: electroconvulsive therapy) Indications:
    • First-line therapy:
      • Delusional depression, depressive stupor, schizoaffective psychosis with major depressive disorder,
      • Depression with severe suicidality (suicidal tendencies) or refusal to eat.
      • Acute, life-threatening (pernicious) catatonia.
    • Second-line therapy:
      • Patients who have not previously responded to antidepressant treatment.
      • Elderly patients with major depression: faster rate of remission.

    Treatment takes place under general anesthesia and medication muscle relaxation (muscle relaxation). Risks or side effect are thus minimized. Response rate (response rate): 50-75%. This makes electroconvulsive therapy the most effective antidepressant procedure. Common side effects are cognitive impairment (short-term memory impairment) up to 4 days after the end of electroconvulsive therapy. To reduce the risk of recurrence (risk of recurrence) after ECT should be followed by pharmacotherapy.Since there is an association of ECT and Takotsubo cardiomyopathy (female patients; average age: 65 years), should be monitored not only for appropriate clinical symptoms, but should also be heart-specific laboratory parameters and ECG checks in the course of ECT.

  • Magnetic convulsion therapy (MST) – a form of transcranial magnetic stimulation (TMS): procedure with which an electric current is generated painlessly through the intact skull (transcranial) in the brain tissue by means of fluctuating magnetic fields (approx. 1 Tesla strong pulsed magnetic fields), thereby triggering neuronal action potentials. This method has the advantage of stimulating much smaller regions of the cortex (cerebral cortex). Indication: patients with therapy-resistant major depressionMCT may be an alternative to electroconvulsive therapy.
  • Vagus nerve stimulation (VNS) with implantation of an electrode in the neck; Indication (in the United States): treatment-resistant depression when at least four different therapies – including psychotherapy and ECT – have not helped sufficiently.Treatment success: patients first responded under this therapy after a median of one year and after four years with conventional therapy. The first remission was achieved under this therapy at a median of 49 months and after 65 months in the control group.
  • In a meta-analysis, bitemporal ECT and right unilateral high-dose ECT in particular showed increased response compared with other active therapy methods.

Operative therapy method

  • Deep brain stimulation (THS; synonyms: Deep Brain Stimulation; DBS; “brain pacemaker“; deep brain stimulation) – therapeutic procedure in neurosurgery and neurology that can be used successfully primarily to treat movement disorders, particularly advanced idiopathic Parkinson’s syndrome. The procedure can also be successful in treatment-resistant depression. Target regions include the subgenual cingulate cortex and the nucleus accumbens.
    • The first controlled trial of deep brain stimulation for depression showed response rates no better than with sham stimulation.
    • Approximately 40% of depression responds to capsular internal stimulation.

Regular checkups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means:
    • A total of 5 servings of fresh vegetables and fruits daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grain products).
  • Observance of the following special dietary recommendations:
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training)Endurance training three times a week in the range of 50-85% of maximum heart rate (HRmax) for ten to twelve weeks.
  • Numerous studies confirm the great importance of sports and exercise for the treatment of depression (even suitable as an adjunct therapy in severe depression).
    • Especially suitable are endurance sports such as golfing, cross-country skiing, dancing, cycling, swimming and playing tennis. But also long walks help as an adjunctive therapy of depression.
    • Not suitable for the prevention of depression in adolescence.
  • A meta-analysis of 25 studies demonstrated benefit with relatively high effect sizes in depressive disorders (major depressive disorder (MDD); milder forms of the disease).
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

  • Winter depression: some patients respond well to light therapy: The patient sits in front of a light device for a maximum of one hour each day before sunrise and after sunset for two weeks. This artificially lengthens the day. With a stronger light wall of 10,000 lux, 30 minutes a day is sufficient. Already after a few days, it can come to the mood brightening.
  • Major depression: patients with moderate depression showed a better response rate with light therapy than with an SSRI. In half of patients, therapy resulted in at least 50% symptom reduction versus 29% in patients with an SSRI. Patients treated with a combined SSRI and light therapy showed the best response rate (76%).
  • Whole-body hyperthermia (body heated to 38.5 °C).

Psychotherapy

  • Psychotherapy (in this case: cognitive behavioral therapy (CBT); efficacy is proven by controlled studies); the relapse rate (“recurrence”) after psychotherapy is relatively high after more than 2 years, but still significantly lower than after other therapies.
  • Other psychotherapeutic procedures include:
    • Interpersonal Psychotherapy (IPT) – short-term therapy specifically designed for patients with acute depression. This procedure assumes that most depression develops in an interpersonal or psychosocial context.
    • Client-centered conversational psychotherapy (GPT) – a model developed by Rogers (1902-1987) to motivate the patient to self-exploration (discovery of self) through verbalization of feelings. The therapist’s task is to offer support and acceptance of the patient’s problems. According to Rogers, the person is able to work out solutions for himself through this assistance. The function of the treating therapist is to be seen in the exercise of compassionate behavior.
    • Systemic therapy – psychotherapeutic method whose special focus is on the social context of mental disorders.
    • Depth psychologically based psychotherapy (TP).
  • Depression in the peri- and postpartum period:
    • To address depression in the peripartum period, pregnant women should be offered psychotherapy.
    • The US Preventive Services Task Force (USPSTF) recommends cognitive behavioral therapy (CBT) or even interpersonal psychotherapy (IPT) for perinatal depression (major depression). Both therapies have been shown in studies, to reduce the incidence of perinatal depression by 39%.
    • Yoga for postpartum depression (PPD; postpartum depression; as opposed to a short-lasting “baby blues,” this carries the risk of permanent depression) – In one study, participants who practiced yoga were shown to have significantly more marked improvements in depression, anxiety, and quality of life than the control group.
  • Hatha yoga – strong antidepressant and anxiolytic effect.
  • Detailed information on psychosomatic medicine (including stress management) is available from us.
  • A list of psychotherapists in your region you can often also get from your health insurance or a resident psychiatrist / neurologist / neurologist.

Complementary treatment methods

  • Aromatherapy (Rosmarinus officinalis)
  • Occupational therapy – work or occupational therapy.
  • Sociotherapy – psychosocial therapy method: includes training and motivation methods and coordination measures.