depression
and Christiane Fux, medical editor Updated onJulia Dobmeier is currently completing her master's degree in clinical psychology. Since the beginning of her studies, she has been particularly interested in the treatment and research of mental illnesses. In doing so, they are particularly motivated by the idea of enabling those affected to enjoy a higher quality of life by conveying knowledge in a way that is easy to understand.
More about the expertsChristiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.
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Depression is a serious mental illness that can occur at any age. Patients feel very depressed, lose interest, and are exhausted and listless. The disease persists for a long time and usually does not get better on its own without treatment. How do you recognize depression, how does it develop and which therapies help? Read everything you need to know about it here!
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. F53F39F92F33F34
Brief overview
- Symptoms: The main symptoms are deep depression, loss of interest and listlessness. Side symptoms include insomnia, self-doubt, feelings of guilt, and difficulty concentrating.
- Causes: Partly genetic predisposition, emotional injuries, disturbed messenger metabolism in the brain, stress
- Therapy: Various forms of psychotherapy, medication (antidepressants)
- Risk of suicide: 10 to 15 percent of patients commit suicide. Therapy protects!
Depression: symptoms
Depression is a serious mental illness that should definitely be treated professionally! Unlike sadness and listlessness, which are part of life, depression does not go away on its own after a while and does not improve through distraction or encouragement. Sometimes there is even a risk of suicide!
Three main symptoms of depression
How do you recognize depression? The following three main symptoms are typical for the disease:
- Depressed mood: Those affected suffer very much from a deep depression. The depressed mood is almost uninterrupted, strong and lasts for at least two weeks.
- Inner emptiness and loss of interests: A characteristic sign of depression is that those affected feel neither joy nor other feelings. Inside they feel empty and emotionally dead. The interest in social contacts, work and hobbies disappears. Attempts to encourage other people have no effect. Even positive experiences do not improve the mood. Everything seems hopeless to those affected. Some even lose the will to live.
- Loss of drive and tiredness: Depressed people find it difficult or impossible to cope with everyday tasks. You feel mentally and physically exhausted all the time. Even getting up in the morning becomes an act of strength, so that some don't even get out of bed because of their depression. Fatigue is becoming the norm.
If depressive phases alternate with manic phases - someone fluctuates between "saddened to death" and "cheering sky high" - this speaks more for a bipolar disorder and not for a depression.
Side symptoms of depression
The following side symptoms are also typical of depression:
- strong self-doubt
- Feelings of guilt and self-blame
- Concentration and attention disorders
- extreme need for sleep or sleep disorders
- severe restlessness and inner excitement
- Loss of sexual interest
Depression symptoms in men
Depression is less likely to be diagnosed in men. In part, it is because the disease often manifests itself differently in men than it does in women. Aggression, strong irritability, poor impulse control and little tolerance for stress are common side effects here. Many affected men also take more risks than usual, for example driving a car far too fast. They also often consume more alcohol than usual or smoke more. They reproach their fellow human beings and are dissatisfied with themselves and the world. One reason for this could be that they perceive themselves as weak and unmanly due to the depressive feelings and therefore live out their feelings differently.
Caution, risk of suicide!
The negative thoughts in severe depression can become so strong that suicidal thoughts arise. Some depressed people have a very high risk of suicide. The suicide rate rises continuously among the elderly and is highest among the very old. About ten to fifteen percent of patients with depression die from suicide.
Searching for help! If you are thinking of suicide or have had suicidal thoughts in a loved one, seek help without hesitation! Hopelessness and seeming hopelessness are signs of depression that can be overcome with the right support. You can get first aid for depression and suicidal ideation nationwide from telephone counseling on 0800-1110111 (Protestant), 0800-1110222 (Catholic) and 116123. You can call them anonymously, free of charge and around the clock. The German Depression League offers offers from self-help groups at www.depressionsliga.de.
Self-test for depression
Do you have the impression that you may be suffering from depression? Online self-tests, such as the renowned Goldberg test, which was developed by the psychiatrist Ivan K. Goldberg, provide important information. But be careful: Such a self-test cannot replace the diagnosis by a doctor or therapist. Be sure to seek help if the test makes this recommendation or if you are concerned regardless of the test result.
Physical symptoms of depression
Depression is often associated with physical complaints that have no apparent organic cause. Such symptoms are called somatic. Typical physical symptoms are for example:
- Cardiovascular complaints
- Headache and back pain
- Stomach and intestinal problems
- sleep disorders
- Loss of appetite, less often: increased appetite
- Morning low
- sexual aversion
Somatization disorder
Sometimes the physical complaints are so much in the foreground that the depression is not immediately recognized. Doctors then speak of a somatic syndrome. The physical symptoms appear in phases and subside with the treatment of the depression.
If the doctor cannot find an organic cause for the symptoms, he can reveal the hidden depression as the real cause by asking carefully. If this is the case, he will diagnose what is known as a somatization disorder. This does not mean that the patient is just imagining the symptoms, just that the depression is physical.
Delusions and hallucinations in depression
A major depressive episode is sometimes accompanied by delusions and hallucinations. The patients then suffer from paranoia or obsessive thoughts, for example. Such delusional depression is particularly difficult to treat. In addition to antidepressants, antipsychotic drugs are also used.
Sadness or depression?
Depression symptoms can resemble those of deep grief. But there are crucial differences. This includes that, in contrast to depression, in a bereavement the depressed mood does not always remain equally strong. Most mourners, despite their loss, are able to laugh and feel joy in between. People with depression can't do that.
In addition, the mood of mourners usually improves over time. The grief can come back suddenly because of the thought of the loss. But gradually a grieving person will increasingly enjoy beautiful experiences again. The support of friends and family can also be a comfort to him. In some cases, however, a grief response turns into depression.
Depression: treatment
Every third person develops depression in the course of their life. According to statistics, there are currently more than four million people affected in Germany. In the best case scenario, treatment should be started as quickly as possible for depression, because those affected suffer greatly from their condition. In addition, therapy becomes more difficult after a long period of time and the risk of the disease becoming chronic increases.
Depending on the severity of the illness, depression is usually treated with psychotherapy, antidepressant medication, or a combination of both. Combination therapy is particularly indicated for chronic and recurring depression. Even for severe depression, experts recommend a combination of both treatment approaches.
Psychotherapy for depression
Psychotherapy requires patience and commitment on the part of the patient over a period of months. However, if you get involved, you can often overcome your depression in the long term and improve your overall psychological stability.
There are many psychotherapeutic offers for people with depression. The health insurance companies cover the costs of psychotherapy based on depth psychology, analytical psychotherapy (psychoanalysis) and systemic therapy (since July 1, 2020).
Classical psychoanalysis and psychotherapy based on depth psychology belong to the psychodynamic psychotherapies. They are based on the idea that depression is often triggered by experiences of loss and hurt that could not be processed properly. These should be worked up in the course of therapy.
Cognitive behavioral therapy - an extension of classic behavioral therapy - is paid for by the health insurers for depressed patients. The prerequisite is that the treatment is carried out by a medical or psychological psychotherapist with a license to practice medicine. With the support of the therapist, the patient looks for ways to get out of the depression. For this purpose, among other things, negative thoughts, patterns and beliefs are uncovered, checked for their correctness and, if necessary, replaced by new, more positive ways of thinking.
Other forms of psychotherapy for depression
Interpersonal therapy (IPT) is a short-term therapy method that was specially developed for the treatment of depressive illnesses. It combines therapeutic concepts from behavioral therapy and psychodynamic therapy. An important goal of therapy is to learn skills and strategies for dealing with conflicts that contribute to the development or maintenance of depression.
However, the costs for the ITP are not yet covered by the health insurers. This also applies to various other forms of therapy such as family therapy, gestalt therapy or art therapy. However, they are often offered as supportive therapies as part of inpatient treatment.
Additional therapeutic measures for depression include, for example, psychoeducation, occupational therapy, groups of relatives, learning relaxation techniques, and body and movement-related therapies
Depression: drug therapy
Antidepressants are usually prescribed for more severe depression or when the patient is opposed to psychotherapy. It can be used to successfully treat the symptoms of depression. However, the drugs often take weeks to take effect.
In addition, there is no guarantee that the medication will have the desired effect. Everyone reacts differently to the active ingredients: some benefit a lot from antidepressants, others have hardly any effect or the patients mainly feel the side effects.
If the medication is stopped, there is a risk of relapse - especially if it happens suddenly. Therefore, do not stop taking antidepressants on your own, but discuss the procedure with your doctor!
Selective Serotonin Reuptake Inhibitors (SSRI)
Selective serotonin reuptake inhibitors (SSRI) or serotonin norepinephrine reuptake inhibitors (SNRI) are currently used to treat depression. They increase the level of the "happiness hormone" serotonin in the brain and thus have a mood-enhancing effect. These drugs have significantly fewer side effects than older drugs. Typical side effects are nausea, restlessness and sexual dysfunction.
SSRI effects in depression
Tricyclic antidepressants
The tricyclic antidepressants are among the oldest drugs used against depression - they have been available since the 1950s. They inhibit the resumption of serotonin and norepinephrine, but also of histamine and acetylcholine. As a result, they have strong side effects such as dry mouth, tremors, tiredness and constipation. Cardiac arrhythmias and an increased heart rate can also occur, especially in older people. Tricyclic antidepressants are therefore almost only prescribed when newer drugs are not effective against the depressive symptoms.
Monoamine oxidase inhibitors
Monoamine oxidase inhibitors (MAO) have also been used against depression for a long time. They have side effects similar to those of the tricyclic antidepressants.
Particular caution applies to tranylcypromine. This active ingredient requires a strict low-tyramine diet. For example, tyramine is found in dairy products, wine, sausage products and finished products. If a patient being treated with tranylcypromine does not avoid foods rich in tyramine, serious side effects such as high blood pressure can occur.
Other drugs for depression
Lithium is not a classic antidepressant, but it is still often used as a mood stabilizer for depression. It works by influencing signal transmission in the brain. It should also reduce the risk of suicide. Lithium is often given as a supplement to antidepressants if they do not have the desired effect. However, patients with kidney or heart disease should not take lithium.
St. John's wort preparations can help especially with mild to moderate depression. However, the possible interactions with other drugs are problematic. St. John's wort, for example, impairs the effectiveness of contraceptive hormone preparations and reduces the effectiveness of drugs used to thin the blood and treat epilepsy. As a side effect, taking St. John's wort preparations can lead to photosensitization of the skin - the skin is more sensitive to sunlight, so it is more prone to sunburn, among other things.
Electroconvulsive therapy
With the help of electroconvulsive therapy, depression can be treated in many cases where medication and psychotherapy fail. Under short anesthesia, a short "epileptic seizure" is triggered by electrical impulses. This idea may be terrifying at first. In fact, the patient is unaware of the procedure and the risks are low.
Waking therapy
For awake therapy, patients must stay awake for the second half of the night or the entire night. Although this method cannot cure the depression, it can temporarily relieve the symptoms. Patients feel good for the first time in a long time, if only for a short time. Not only is this a tremendous relief, it also gives them hope that they will actually be able to overcome their depression. And a hopeful attitude contributes a lot to the success of the therapy.
Repetitive transcranial magnetic stimulation
Repetitive transcranial magnetic stimulation is a new technique that can be considered if there is no medication to treat depression. Different areas in the front right or left hemisphere of the brain are stimulated by magnetic fields. This non-painful treatment is carried out in a clinic for ten to 30 minutes a day for three to six weeks.
Depression - helping people to help themselves
More recent studies come to the conclusion that offers of help without direct contact with therapists can also be helpful. One possibility are instructions for self-help. Those affected can read a lot of information themselves and only occasionally have contact with an expert who will support them. This can, for example, help bridge the waiting time until therapy.
Internet-based therapies and apps
Another option for people with depression is to seek professional advice online. The therapy is carried out with the help of a special computer program. There are now so-called depression apps and chatbots that make it easier to deal with depression. They are based on elements of cognitive behavioral therapy.
Exercise as an antidepressant
Get out of the house, get out of the depression! For depression, experts recommend regular exercise. This can significantly reduce depressive symptoms - both in the short term and in the longer term. In fact, regular exercise can work as well as an antidepressant. Because it reduces stress and can possibly have a positive effect on the levels of messenger substances in the brain (such as serotonin and norepinephrine).
However, the psychological effect of sport could have an even greater effect: the physical activity allows patients to get out of the spiral of listlessness and withdrawal. They experience that they can do something for their emotional wellbeing themselves. Self-esteem is strengthened and hopelessness is suppressed. Those who do sport in a group also benefit from the sense of community and social contact, which is usually less and less common with depression.
Inpatient or outpatient therapy for depression?
A mild or moderate depressive phase can often be treated with outpatient psychotherapy. The inpatient stay in a clinic is especially necessary in the case of severe depression. The combination of drug treatment, a wide range of psychotherapeutic therapy offers and intensive care in the clinic helps the patient to return to a structured daily routine.
If there is a high risk of suicide, depressed people can be admitted to a clinic against their will.
Dealing with depressed relatives
Do you have the impression that someone close to you is suffering from depression? Then you should encourage them to talk to a doctor about it. If the person concerned lacks the drive to do this, you may be able to take over the organization and possibly even accompany them. It is important to act quickly! This is because depression usually does not go away on its own and is more likely to get worse if it is not treated.
But also take care of yourself: Supporting a depressed relative is extremely exhausting. The gloomy mood, listlessness and loss of interest - also towards partners, family and friends - of the person affected can greatly impair their own joy of life. Usually a relationship is based on give and take. But now you have to give the person affected patience, attention and support without getting much in return - and perhaps without the situation improving quickly.
It's stressful and frustrating. Therefore, it is normal for loved ones to feel helpless and angry while feeling guilty at the same time. Admit these feelings to yourself. Not only your loved one is affected by the disease, but you too!
As a relative, you should therefore seek help. First, find out about the clinical picture of depression. A deeper understanding of the underlying causes and mechanisms of the disease is very important for the correct handling of the disease. This is the only way you can understand that it is not possible for a depressed person to "pull themselves together" and that attempts at encouragement cannot help.
Support groups for relatives also provide assistance. You can find offers for this on the website of the Federal Association of Relatives of Mentally Ill People e.V. at www.bapk.de.
Read about what else you can do to help your relatives and to protect yourself from being burned out in the text Depression - Relatives.
Depression: causes and risk factors
How depression develops is still not fully understood. It is assumed, however, that several factors always play a role - internal and external. These include biological, genetic, and psychosocial triggers. How great the influence of the various factors is varies from case to case.
Risk factors for depression
Genetic Influences
Twin and adoption studies have shown that depression also has a genetic root. The risk of developing depression is 50 percent higher if other first-degree blood relatives are already infected. So if a mother has a depressive disorder, for example, this is a risk factor for the child - especially if the disorder appeared at an early age.
For example, if an identical twin falls ill with depression, the other will also develop depression in around 40 percent of cases. In the case of dizygotic twins, this happens about half as often, i.e. 20 percent of the time. So to a certain extent, depression is hereditary.
Vulnerability - susceptibility to depression
Vulnerability describes how susceptible a person is to a mental disorder. For people with high vulnerability, even a little stress can lead to depression. If, on the other hand, the vulnerability is low, people can cope well with very stressful events. Such people are referred to as resilient, i.e. resistant. So it is not only the objective severity of the stress that decides whether a person suffers from depression.
The experiences that a person has had in their life also have a considerable influence. For example, people who have traumatic experiences such as abuse or neglect in childhood have a particularly high risk of developing depression. But it is also decisive which skills a person has acquired in order to cope with stressful situations.
Disturbed messenger metabolism in the brain
Nerve cells in the brain communicate with each other via electrical impulses and messenger substances, so-called neurotransmitters. There is evidence that this so-called brain metabolism is altered during depression.
A disturbed norepinephrine or serotonin level in the brain tissue could be partly responsible for a depression. If these messenger substances are not in equilibrium, this disrupts the exchange between the nerve cells. And that in turn has a negative impact on feelings and thoughts.
The effect of antidepressant drugs such as serotonin reuptake inhibitors speaks for the fact that the messenger substances in the brain actually play a role in depression. However, this hypothesis does not yet explain why it usually takes weeks for the drugs to work.
Dysregulated stress hormones
Other explanations regarding the cause of depression see a dysregulation of the stress hormones adrenaline, noradrenaline and cortisol at the center. In particular, people who are depressed have been found to have elevated cortisol levels. Such a disease can be the trigger of a depression illness as well as its consequence.
Stress as a trigger
Stress plays a crucial role in the development of depression. Conversely, depression itself also causes stress - for example because the disease loses a lot of quality of life, one's own job can no longer be exercised or tensions arise with the social environment.
Some harbors of life are associated with increased stress per se. This includes, for example, puberty or retirement. In such phases, the risk of depression increases.
Far-reaching life events are also stressful. These include negative experiences such as job loss, separation or a serious illness. However, positive events also cause stress: for example, a promotion, the birth of a child or a wedding increase the likelihood of developing depression.
In fact, people with depression often report difficult events prior to the onset of the disease. In many other cases, however, depression appears to appear out of nowhere.
Negative thought patterns
It is not always fate or genes: the personal attitude towards life also has an influence on the risk of depression. People who think badly of themselves and the world and see black for the future are more likely to become depressed. A good self-esteem and optimism, on the other hand, protect against depression.
Negative thought patterns and ideas can be positively changed through appropriate exercises.
Female gender
Women are about twice as likely to develop depression as men. One possible explanation is that women are more at risk due to hormonal fluctuations.
Such hormonal fluctuations occur during the course of the menstrual cycle. However, pregnancy also entails major hormonal changes - and in some women they lead to pregnancy depression. The so-called postpartum or postpartum depression also affects many women.
Low socioeconomic status is also a risk factor for depression - and more women live in poverty than men.
In addition, depression is less likely to be discovered in men. Some shy away from showing weakness and seeking help. However, they also sometimes have atypical symptoms such as aggressive and excessive behavior, which makes diagnosis more difficult.
Physical illness and depression
Some physical illnesses can lead to depression. Brain diseases and hormonal disorders in particular affect the world of emotions. The latter include hyperthyroidism and hyperthyroidism, but also the so-called Cushing's syndrome, in which the adrenal glands release excessive amounts of cortisol - the result is often a depressive phase.
Serious and chronic illnesses are also a constant strain on the psyche. For example, people with cancer, severe cardiovascular disease, or diabetes often develop depression. It is also possible that the drugs used for treatment or the physiological processes associated with the disease increase the risk of depression.
Conversely, depression can have an unfavorable effect on the course of such illnesses or, in some cases, even promote their development. With such a combination of physical and mental illness, it is always important to treat the mental and physical ailments equally.
Depression and somatoform disorders
In addition, depression can lead to so-called somatoform disorders. These are chronic complaints for which no organic cause can be found. Above all, this includes pain, for example in the back, abdomen or joints. But digestive disorders, heart problems or breathing problems can also be somatoform.
Additional mental illnesses
People with depression often have other mental disorders. These include
- Anxiety disorders
- Obsessive-compulsive disorder
- alcoholism
- Personality disorders
- eating disorder
Winter depression: lack of light as a trigger
Some people are only depressed in the dark season - but every year. Depression in winter is one of the seasonal affective disorders (SAD). Those affected report about listlessness, loss of interest and dejection - symptoms that also occur in classic depression. In the case of winter depression, however, they are usually milder.
Typical of winter depression are also a pronounced need for sleep and a craving for sweets. That is why people with winter depression usually put on weight in the winter months.
The cause of the disorder is suspected to be the lack of daylight, to which some people are particularly sensitive. When it is dark, the body releases larger amounts of the sleep hormone melatonin. This hormone not only makes you tired, it also depresses your mood.
If you want to learn more about the causes, symptoms, and treatments for this disorder, check out the Winter Depression article.
Medication and drugs
Taking certain medications can also affect mood. These include cardiovascular drugs such as beta blockers, but also cortisone and related substances, hormonal contraceptives and some neurological drugs such as anti-epileptic drugs and Parkinson's medication.
Likewise, drugs such as alcohol, cannabis and other substances that affect the psyche can promote the onset of depression.
Depression in children and adolescents
Depression also affects young people: around one to two percent of children of preschool and elementary school age and three to ten percent of adolescents between 12 and 17 years of age suffer from it. In rare cases, even very young children become ill.
But how does depression manifest itself in children? Symptoms such as sadness and withdrawal are unfortunately quickly classified as hypersensitivity that disappears on its own. In addition, depression in children often expresses itself differently than in adults. Some of the little ones get tantrums, others are extremely clingy. Smaller children in particular often find it difficult to describe their feelings. They then complain of stomach aches or headaches, for example, even though the soul is actually suffering. All of this makes diagnosis difficult.
Recognizing depression is not easy in teenagers either. Melancholy and moodiness are considered normal side effects of puberty. In some cases, however, there is depression that needs treatment. Because puberty as a time of upheaval with hormonal turbulence and stress makes young people particularly susceptible to depression.
You can find out more about how depression affects children and adolescents and how you can help those affected in the article Depression in Children and Adolescents.
Depression of old age
For many people, getting old is a process that primarily entails losses: retiring from professional life and feeling that you are no longer needed plunges some into a void. The partner or good friends die. The physical performance decreases, and various niggles and diseases occur. All of these changes can be stressful and stressful for those affected. That is why the risk of depression increases with age. About 15 percent of people over 65 are depressed.
But that is often overlooked: 40 percent of age depressions remain undiagnosed. Social withdrawal, exhaustion and depression are all too quickly misinterpreted as a result of natural aging processes. Symptoms such as poor concentration and forgetfulness are often prematurely classified as the onset of dementia.
If you'd like to learn more about how depression affects the elderly and what to do about it, read the post Age Depression.
Depression: examinations and diagnosis
If you are concerned that you are suffering from depression, you should urgently contact your family doctor or a psychiatrist or psychotherapist directly. Depression is a serious condition that should be treated as early as possible. The sooner the therapy begins, the better the chances of recovery!
anamnese
The doctor will first talk to you in detail to collect your medical history (anamnesis). The following questions, which are aimed at typical symptoms of depression, can be part of this initial consultation:
- Has your mood been depressed or depressed a lot in the past few weeks?
- Have you felt joyless a lot lately?
- Have you been listless and tired a lot recently?
- Have you had a lot of self-doubt, guilt, or negative thoughts lately?
- Do you suffer from insomnia?
- Have you had trouble concentrating lately?
- Has your appetite changed recently?
- How long have these symptoms been going on?
Diagnosis is more difficult when the focus is primarily on physical symptoms. Many patients complain of headache, back pain or stomach ache as well as cardiovascular problems. Describe all your symptoms to the doctor as precisely as possible.
Many people find it easier to talk about physical symptoms than to talk about mental problems. Men in particular often emphasize the physical signs more and go less into their emotional symptoms.
Physical examinations
Physical causes of the symptoms can be ruled out on the basis of various examinations. This includes a blood test, possibly also a computed tomography (CT) scan of the brain. Because sometimes depressive symptoms can be traced back to a low blood sugar level, a lack of vitamin B12, substance abuse, dementia, an underactive thyroid or changes in the brain, for example.
If the suspicion of depression is confirmed, the doctor will refer you to a specialized clinic or an outpatient psychiatrist or psychotherapist.
Depression and other illnesses
Depression often occurs in combination with various other mental illnesses and disorders. It is important to recognize these in those who are depressed. Because the therapy can only be successful if the other mental problems are also treated. The psychological comorbidities associated with depression include:
- Anxiety or panic disorder
- Addictions
- eating disorder
- Personality disorders
- Dementia
Some physical illnesses are also often associated with depression. Physical and psychological stress seem to reinforce each other. Above all, this includes
- Cardiovascular diseases
- diabetes
Diagnosis of depression
The diagnosis of (clinical) depression requiring treatment is made after excluding other causes on the basis of the International Classification of Diseases, ICD 10. Depression is attested if certain requirements are met with regard to the type and duration of the symptoms. You can read about them in the next section.
Depression: Definitions and Clarifications of Terms
What is meant by depression has changed fundamentally several times over the course of time. Since outdated ideas about depression are still in circulation, it is often confusing.
Definition of Depression Today
One speaks of a depressive episode if two of the three main symptoms (depression, loss of interest and decreased drive) and two of the seven additional symptoms (e.g. feelings of guilt, sleep disorders or concentration problems) occur for at least two weeks.
Experts today classify a depressive episode according to its severity and course as mild, moderate or severe depression.
In the English-speaking world, the depressive episode is referred to as "major depression".
Endogenous and exogenous depression
A few years ago, depression was divided into endogenous and exogenous depression depending on the suspected causes.These terms are no longer common in the professional world today, but are otherwise still widespread.
“Endogenous depression” was understood to mean depression without any recognizable external trigger or organic cause. This form of the disease was attributed to altered metabolic processes in the brain, for example due to a corresponding genetic predisposition.
If, on the other hand, a specific trigger for a depression appeared recognizable, one spoke of an “exogenous depression”. The term “reactive depression” or “depressive reaction” was also frequently used. If emotional distress was assumed to be the cause of reactive depression, this was referred to as "psychogenic depression".
Depression or Adjustment Disorder?
Today we speak of adjustment disorders when current emotional stress causes depression. Such a burden can be the death of a loved one or unemployment.
In such cases, depressive symptoms such as sadness, hopelessness, and listlessness are a natural reaction. In some people, however, they get out of hand. Often there are also disturbances in social behavior.
The symptoms of an adjustment disorder usually subside after six months at the latest. However, the disorder can turn into long-term depression.
Recurrent depressive disorder
Depression occurs repeatedly in around two thirds of patients. There can be months between episodes, but also many years.
If depression flares up again and again, it is difficult for the patient to endure. Your life will be severely restricted. Often they can no longer do their job. Their social relationships also suffer from the recurring depressive phases and can break as a result.
The more often depressive episodes occur, the more likely another relapse becomes. Women are more likely to recur than men. The risk is also higher for patients who develop depression at a young age or at an advanced age.
Chronic depression and dysthymia
For some people, the depression does not run in phases, but the affected person suffer from depressive symptoms all the time. However, the symptoms are usually less pronounced than in an episodic course. Doctors then refer to this as dysthymia. It is characteristic that those affected suffer from depressive symptoms continuously or regularly for a period of at least two years.
This form of the disease begins early in adult life and lasts for years. There are many possible triggers. However, research shows that chronic depression patients are more likely than other depression patients to have traumatic experiences such as abuse.
Unfortunately, this form of depression is often not recognized - even to those affected, their persistent depressed mood often seems normal. This also makes it difficult for them to realize that they are actually sick. Nevertheless, a less severe chronic depression also has a considerable negative impact on the quality of life, productivity and social life of those affected. It should therefore definitely be treated. Here, too, cognitive behavioral therapy can help. However, drugs are even more effective in this form of depression.
Read more about the signs and treatment of this form of disease in the text Dysthymia.
Bipolar disorder
As soon as manic phases appear in addition to the depressive phases, a bipolar disorder is present. This is also one of the mood disorders, but is not depression. Rather, those affected oscillate between two emotional poles: Depressive phases with dejection and listlessness alternate with manic phases that are characterized by extreme euphoria, overconfidence and excessive actionism. Bipolar disorder is often more difficult to treat than classic depression.
Agitated depression
An agitated depression manifests itself in fearful urgency. Those affected run around restlessly and complain of shortness of breath and a racing heart. An agitated depression is therefore also referred to as "woe depression".
While depressed people usually have difficulty getting themselves up to any action, people with agitated depression have a constant need to move. Your behavior is hectic and aimless.
Atypical depression
In contrast to the classic form of depression, the mood of atypical depression can be improved by positive events. Other signs include increased appetite and a strong need to sleep during the day. Those affected are often very theatrical and easily offended.
Atypical depression is not uncommon. About 15 to 40 percent of depressed patients are affected. In addition, this depressive disorder occurs predominantly in women.
Depression: disease course and prognosis
Depression progresses very differently from person to person. Most people who suffer from depression can be helped well by consistent treatment. This also applies to older people! The therapy makes it possible to break through depressive episodes or to let them subside completely. So healing depression is possible!
If left untreated, however, there is a high probability that depression will persist for months or years. This is especially true for severe depression. The earlier treatment is started, the better the outlook.
A third of those affected experience a depressive episode only once in their life. The chances of this are particularly good if they are treated adequately at an early stage. With each relapse, however, the likelihood that further depressive phases will occur increases. Chronic depression is particularly difficult to cure. It is not uncommon for them to become a lifelong companion and require constant treatment.
Depression risk of suicide
About ten to fifteen percent of people with depression take their own lives. This risk is particularly high for patients with chronic or very severe depression.
Comorbidity, for example with an anxiety disorder, often makes it difficult to treat depression. The disease often develops unfavorably in patients who also have an anxiety disorder. It is equally unfavorable if depression occurs at a young age and if the patient does not have adequate social support.
Additional information
Book recommendations
- Pfeil, M .: Learning positive thinking: How you can increase your well-being through positive thoughts. CreateSpace Independent Publishing Platform, 1st edition, 2017
Guidelines
- S3 guideline and national care guideline (NVL) "Unipolar Depression" of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (as of 2015)
Support groups
- German Depressionsliga e.V .: https://www.depressionsliga.de/
- German Depression Aid: https://www.deutsche-depressionshilfe.de/depression-infos-und-hilfe/wo-finde-ich-hilfe
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