Depression: souls in lockdown

Christiane 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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Life at a distance: Most people find the measures to contain the pandemic oppressive. For people with depression, however, the limitations have a completely different dimension: They rob them of the supports that stabilize their mental health.

During the pandemic, scientists working with Prof. Ulrich Hegerl, Chairman of the Board of the German Depression Aid Foundation, asked people with and without depression about the effects that contact restrictions and other measures have on them. The result of their "Germany Depression Barometer" is clear: People with depression are hit many times harder by the pandemic.

Depressed people are more heavily burdened by corona measures and for longer

People with depression were no more afraid of contracting the corona virus than the rest of the population (43 percent versus 42 percent). However, they experienced the lockdown much more often as stressful (74 percent versus 59 percent). And in the long term too: In July of this year, 68 percent of them said they found the situation depressing. In the general population it was only 36 percent.

One who experienced the lockdown as a person with depression is Lena Ulrich. The 37-year-old reported about her personal experiences at a press conference for the presentation of the depression barometer. Ulrich has lived with her mental illness for many years, but has learned to deal with it.

When the supports break away

Different pillars are decisive for their stability. There is her work as a freelancer, which, in addition to financial security, also entails exchange with other people. There is a network of friends that strengthens them. In addition, there is regular exhaustion in the fitness studio, because sport, as experts and those affected know, supports the mental stability of depression quite considerably.

“All of this broke away from one day to the next in lockdown,” recalls Ulrich. The effects were quickly felt. Instead of the mild depressive episodes that still haunt her from time to time, she fell into the hole of major depression for the first time in years. “It feels like you imagine hell as a child,” says Ulrich.

10 years less lifetime

“Such a phase cannot be compared with the feeling of being in a bad mood that mentally healthy people experience from time to time,” says Hegerl. Depression is a serious illness. The lifespan of those affected is shortened by around ten years.

One of the effects of the disease is that those affected are less able to take care of themselves - less exercise, poor nutrition, and often more alcohol and cigarettes. In addition, there are sleep disorders and constant stress, which, among other things, can damage the cardiovascular system considerably.

And so it is not surprising to the psychiatrist that, according to current studies, depressed people are more likely to get seriously ill with Covid-19. "Depression is a disease that negatively affects the body in many areas, including the immune system, for example."

Brooding in bed

In lockdown, the Barometer survey showed, behaviors that adversely affect depression increased. For example, the Depression Barometer survey showed that people in a depressed phase were almost twice as likely to suffer from a lack of daily structure (75 percent) and brooding (89 percent) than the general population (39 and 41 percent). In isolation at home, depressed patients stayed in bed much more often during the day (48 percent versus 21 percent).

Therapeutic care falls by the wayside in lockdown

Medical and therapeutic care also fell by the wayside in the lockdown: every second person affected reported that psychiatric and therapist appointments had been canceled - 13 percent canceled the appointments themselves for fear of infection. Likewise, every tenth planned hospital stay was omitted.

The meetings of self-help groups, which are an important support for many people with depression, often did not take place. It also hit everyone particularly hard who suffered from depression for the first time during the Corona period. The already arduous task of organizing help was made even more difficult by the effects of the pandemic.

Online consultation hours help in lockdown

Lena Ulrich, on the other hand, was lucky in this regard: her therapist immediately switched her offer to online operation. “That worked surprisingly well for me,” reports Ulrich. A very nice atmosphere would also have developed online.

Psychiatrist Hegerl also rates therapeutic online offers positively. If the diagnosis has already been made and there is a relationship of trust between the client and the therapist, that is a good bridge. However, he restricts: "Online offers can help, but they are not a complete replacement". Many signals were lost digitally. "As a therapist, I rate the chance of recognizing a critical escalation higher if you sit directly across from each other and look into the eyes."

In fact, according to the Association of Statutory Health Insurance Physicians, psychotherapeutic online consultation hours are not an option anyway if the patient is in an acute crisis or does not yet know the therapist. Overall, however, the acceptance of online consultation hours has increased significantly in the Corona crisis.

Behavior Therapy as an Online Course

Another digital support for the soul can be online programs based on the principles of cognitive behavioral therapies. In various modules, the patient learns to decipher disease mechanisms and to develop new ways of thinking and behaving. However, these online programs are most effective in combination with professional support, says Hegerl.

In view of the second part lockdown, he fears that the misery in the care of the mentally ill will repeat itself: "For people with depression, retreating into their own four walls will again have many negative effects," the psychiatrist predicted. Depressed sufferers would have more time to ponder and could get deeper into the depression. "These are aspects that cause me great concern."

Will there be more suicide attempts?

He feared that the number of suicide attempts would rise if the quality of care went down again, said Hegerl. People are not driven to suicide by financial problems, but because an underlying depression is not being adequately treated.

The statistics show how crucial good care is: In the last few decades it has been possible to almost halve the number of suicides in Germany through appropriate offers.

"Don't fear a depression epidemic"

However, Hegerl does not fear that more people will become depressed due to a renewed lockdown. "We do not expect a depression epidemic triggered by corona," explains the scientist. Because depression is above all a matter of predisposition. “The influence of external circumstances is often overestimated in the population,” says Hegerl. If a person does not have the appropriate disposition, he will not develop depression even in times when he is feeling very badly.

Jogging instead of the gym

Ulrich, on the other hand, is facing the renewed lockdown with confidence. “I expected that to happen,” she says. Her professional order book, which had collapsed in the spring, has recovered, the psychotherapy via video chat works, and instead of going to the gym, she has now - like many other people - started jogging. But not everyone who is depressed has the power to take matters into their own hands. A “lockdown light” remains problematic for them.

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