Four million people in Germany suffer from depression – and many sufferers perceive it as a flaw of which they should be ashamed. But depression is neither a mental illness nor a sign of personal weakness. It can affect anyone. Depression is an illness with clear causes, symptoms and treatment options. It affects feelings, thoughts and behavior. But the body also reacts – for example with gastrointestinal complaints, back pain and headaches, weight fluctuations or insomnia. Experts predict that depression will continue to advance in the ranking of the most significant diseases.
Causes of depression
Biologically, depression can be explained as a metabolic disorder in the brain. Messenger substances, which as neurotransmitters control communication between the many billions of nerve cells, are out of balance and trigger physical and psychological changes. The causes are very diverse. Science assumes an interplay of genetic factors and psychological stress. Drastic experiences, constant excessive demands, difficult childhood conditions, but also medication and illnesses can trigger depression. In this context, many physicians and psychologists interpret depression as a protective mechanism that intervenes in a life from the unconscious when the affected person pursues illusory goals and puts health and integrity at risk.
Symptoms and signs
Typical mental symptoms of depression are:
- Joylessness and helplessness
- Lack of drive
- Inner restlessness and emptiness
- Feelings of guilt
- Concentration problems
- A feeling of worthlessness, which in extreme cases is expressed in suicidal thoughts
The body responds to depression with striking deviations from normal states: With rampant or little appetite, with a slowed or agitated speech, with an increased or decreased need for sleep. A basic fatigue as well as headache, heartache, abdominal pain, or back pain may accompany depression.
Depression: here’s how the diagnosis is made
Not every “gray” day in a person’s life is immediately the result of a serious depressive disorder. Sadness, inner turmoil or feelings of guilt can be normal, healthy reactions and need not be a cause for concern. However, if the symptoms occur every day or at least every other day for a period of at least two weeks and cause a lasting reduction in performance, a doctor should be consulted. Depression has many symptoms that are sometimes difficult for the doctor to interpret. It is crucial that patients talk openly about physical and emotional complaints, about worries and fears. The diagnosis of “depression” is only made if other illnesses, medications or drugs can be ruled out as the cause of the symptoms. A complete physical examination by a general practitioner or internist, as well as laboratory tests are therefore essential.
Therapy for depression
For many affected people – after often a long period of suffering in uncertainty – the diagnosis of “depression” is a relief. For some, however, it is also a severe shock, because mental illnesses are less socially accepted and the possibilities of successful therapy are underestimated. Today, the chances of recovery are high. However, recovery usually takes some time. Treatment is essentially based on two complementary therapeutic approaches: psychotherapy (talk therapy) and drug therapy. The patient and physician usually decide together which treatment method is best for each patient or whether they should be used in combination.
Psychotherapy
Psychotherapy is a process of learning and insight. It explores causes and develops strategies to help the patient better cope with life’s problems. Talk therapy usually lasts three to six months.
- Cognitive behavioral therapy (CBT) helps patients recognize their own negative thought patterns and destructive behaviors and replace them with life-affirming patterns that fit their personality and life circumstances.
- Interpersonal Psychotherapy (IPT) focuses on working through disturbed personal and social relationships.The depressed person learns to relate more effectively with others to reduce conflict and gain the support of family and friends.
- Psychodynamic therapy allows the patient to look inside himself. It uncovers emotional conflicts or unresolved childhood issues as the cause of depression.
The drug therapy
Talk therapy is often sufficient to effectively help people with milder forms of depression. For patients with moderate or severe depression, medication supplements psychotherapy. Antidepressants have the task of bringing the symptoms of the illness under control, thus creating good conditions for effective talk therapy. Biologically, antidepressants correct the imbalance of certain neurotransmitters in the brain. However, the drugs should not be confused with sedatives, intoxicants, tranquilizers or addictive drugs. Antidepressants generally have no stimulating effect on people who do not suffer from depression. Important: The therapeutic effect only occurs after regular use over a longer period of time. Today, more than 20 different antidepressants are available for the drug therapy of depression, all of which are indicated for treatment in principle. However, the therapeutic options have evolved significantly in recent years. Instead of tricyclic antidepressants (TCAs), whose side effects limit their use in clinical practice, the more modern SSRIs, antidepressants that act only on the serotonergic system, are now increasingly used. Another therapeutic option was achieved when researchers succeeded in developing a selective substance with dual action on both the serotonergic and noradrenergic systems (sSNRI). Patients and physicians confirmed that drug therapy combined with talk therapy led to better results than one form of therapy alone. The success of any therapy depends largely on the patient’s willingness to cooperate. The support of relatives and friends can be of great importance. If they accept the difficult situation of the ill person, as well as strengthen the patient’s own initiative and self-responsibility without paternalism, they contribute significantly to recovery.
