Therapy for depression

introduction

Depression is a psychiatric illness. This manifests itself through various symptoms such as a depressed mood, listlessness, social withdrawal, or sleep disorders. Nowadays there are different approaches and methods to treat depression. You should always remember that depression is a serious illness and that the appropriate therapy for your own form of depression is selected with the treating psychiatrist or psychotherapist, taking into account the severity.

Also read our topics: How can you overcome depression?

Synonyms

• Depressive symptoms
• Depressions,
• melancholy

English: depression

therapy

A fundamental distinction is made between drug therapy and non-drug therapy.

Medical therapy

A so-called antidepressant, i.e. a drug that is typically used to treat depression, is understood to be a drug from a whole group of drugs, some of which have very different mechanisms of action, but whose goal is always the same. These are: Brightening, i.e. improving mood and increasing drive. It is important here that the mode of action of even the most modern antidepressant usually only begins after two to four weeks. Some of the therapy discontinuations are based on the assumption that a drug that has not brought about a significant improvement after three days cannot be a good or effective drug.

Further information on this topic can be found at: These drugs help with depression

How antidepressants work

In the human brain, different communications take place between the billions of cells. The "bearers" of these messages from one cell to another are called the "transmitters". By releasing these very transmitters, a reaction is triggered in the directly connected cell. When this reaction is triggered, the transmitter substances are reabsorbed into the cells. As an example one can cite that when two houses are facing each other and the residents of one want to give the other a signal, they hang a certain number and arrangement of flags in the window. But what happens if either too few flags are available or the flags are brought in too early? The most likely thing is that the people in the house across the street don't really know what to do ...

Applying this theory to the cellular level explains how most antidepressants work. They ensure that the transmitter substances (messenger substances) either remain longer in the gap between the cells or else they can prevent the premature breakdown or resumption of the transmitter in the cell. The names of the transmitters that play a major role in the treatment of depression are serotonin and norepinephrine (and, to a limited extent, dopamine).

The antidepressants that are used today can be divided into the following groups:

• herbal supplements (St. John's wort)
• Tricyclic and tetracyclic antidepressants
• SSRI (Selective Serotonin Reuptake Inhibitors)
• SNRI (Selective Norepinephrine Reuptake Inhibitors)
• SSNRI (Selective Serotonin and Norepinephrine Reuptake Inhibitors)
• MAO inhibitors (MAO stands for monoamine oxidase, an enzyme that breaks down transmitters)

Read more on the topic: Effect of antidepressants and antidepressant drugs

SSRIs

SSRIs are the first choice for treating depression today. They have replaced the tricyclic antidepressants. The abbreviation SSRI is English and means something like serotonin reuptake inhibitor. In contrast to the tricyclic antidepressants, which lead to the unselective inhibition of the uptake of various neurotransmitters, the SSRIs achieve the targeted inhibition of the uptake of a messenger substance: serotonin. In addition to treating depression, SSRIs are also used for anxiety disorders and obsessive-compulsive disorder. Typical representatives of this group are sertraline, citalopram and fluoxetine.
Citalopram or sertraline are most often used as monotherapy (individual therapy, i.e. only one drug is taken) for patients who have developed depression for the first time. SSRIs have fewer side effects than the tricyclic antidepressants. The most common side effects affect the gastrointestinal tract and may include loss of appetite, nausea, vomiting and diarrhea. Sexual dysfunction also occurs. Especially at the beginning, the (usually desirable) drive-increasing effect can lead to states of excitement, restlessness and insomnia. If painkillers from the group of non-steroidal anti-inflammatory drugs (e.g. ibuprofen or diclofenac) or blood thinners (aspirin, falithrom, etc.) are taken in addition to SSRIs, the risk of bleeding in the gastrointestinal tract is increased, so that the additional intake of gastrointestinal tablets is increased should be reconsidered. Switching to another antidepressant substance can also be considered here.

Also read our topic: SSRI

Tricyclic antidepressants

Tricyclic antidepressants are among the oldest drugs used to treat depression.They are called tricyclic because their chemical compound has three ring structures. Tricyclic antidepressants work by inhibiting the reuptake of various neurotransmitters. These include serotonin, norepinephrine and dopamine. In the case of depression, there appears to be a deficiency in these messenger substances, which should be compensated for by inhibiting the uptake of the tricyclic antidepressants. They have a mood-enhancing and often stimulating effect. However, there are also some representatives of the group who tend to inhibit drive. Nowadays, tricyclic antidepressants are no longer the first choice for treating a depressive illness. This has to do with their side effect profile, among other things. So-called anticholinergic side effects such as dry mouth, visual disturbances, constipation and difficulty urinating are typical. Weight gain is also relatively common and can be very stressful for the patient. If an overdose is taken, this can lead to life-threatening cardiac arrhythmias. The group of tricyclic antidepressants includes amitriptyline, opipramol and doxepin.

Side effects of antidepressants

A word in advance: The side effects listed below are real and exist and it is also not uncommon for part of the typical side effect profile to occur before the actual therapeutic effect. Nevertheless, the newer antidepressants in particular have few side effects. The burdens and torments of depression are usually out of proportion to the side effects of antidepressant therapy.

With the multitude of mechanisms of action mentioned above, it is not possible to create “a” typical side effect profile for antidepressants. However, the so-called main side effects of drug therapy for depression can be shown. These usually occur at the beginning of treatment. “Beginning” is understood here as a period of between one and four weeks.

• Fatigue and dizziness - if this symptom is perceived as a clear restriction, you could talk to the prescribing doctor (and only with him!) About postponing the intake to the evening; this could lead to an improvement in wakefulness during the day and for one come deeper night sleep.
• Weight gain - on the one hand, this is a very frequently lamented, but also no less frequently feared problem. First a correction: the tablets as such do not make you fat.
  In a not inconsiderable number of patients, they can lead to an increase in appetite, which can ultimately lead to weight gain. It is therefore important to ensure that you observe yourself critically at the start of treatment and, if necessary, seek nutritional advice.
• Sexual dysfunction - As part of the treatment, it can not only lead to a loss of libido, but also to erectile dysfunction or ejaculation disorders in men. As already under the chapter Depression mentioned above, the distinction between depression and a possible side effect can be very difficult.
• Visual disturbances in the sense of "focusing" (accommodation disorders)
• Dry mouth due to reduced saliva production
• Urination disorders and constipation
• in very rare cases epileptic seizures can also occur
• Positional drop in blood pressure (orthostasis). Above all, when standing up, the blood "sinks" briefly in the legs, which can lead to dizziness, which in turn can lead to falls.
• Conduction disorders in the heart (cardiac arrhythmia). This side effect is especially true of the “old”, tricyclic drugs. In the case of known pre-existing heart diseases, caution should be exercised here.
• Restlessness. In particular, the serotonin or norepinephrine / serotonin reuptake inhibitors can lead to massive states of restlessness, which can lead to sleep disorders, especially at night.

You might also be interested in the following topic: Side effects of antidepressants

lithium

Lithium is first of all a chemical element that can be found in the periodic table of the elements. Some lithium salts are used as medicines. So the drug called lithium is actually a lithium salt. Lithium has been used as a drug in psychiatry for around 70 years. It belongs to the group of mood stabilizing drugs, also known as mood stabilizers. There is only a relatively narrow therapeutic window for treatment with lithium. This means that the dose that is effective but not toxic is only slightly lower than the dose that is toxic. Therefore, the lithium level in the blood must be checked regularly during lithium therapy in order to avoid underdosing or overdosing. Lithium plays a particularly important role in the treatment of bipolar illness, also known as manic-depressive illness. But it can also be used for pure depression. Antidepressants are primarily used to treat pure (unipolar) depression. If the depression is therapy-resistant, i.e. the symptoms do not go away, lithium can be used. One then speaks of a so-called augmentation therapy. This means combining an antidepressant and lithium (augmentation). Often this leads to a significant improvement in effectiveness. Lithium is more of a reserve drug in a depression, but as such it has a lot of potential.

You might also be interested in this topic: lithium

Non-drug therapy

Can you treat depression without medication?

The clinical picture of depression can be divided into mild, moderate and severe episodes. A mild depressive episode does not usually require any drug therapy; supportive discussions and, if necessary, further procedures such as light therapy are sufficient. A mild depressive episode can in certain cases go away without much outside help. Nevertheless, it should be taken seriously. Moderate and severe depression should usually also be treated with medication. Psychotherapy should also take place. Especially in the case of moderate and severe depression, therapy with so-called antidepressants is urgently recommended; according to the current state of knowledge, drug therapy is the treatment of first choice for the clinical picture of depression.

Cognitive behavioral therapy

In recent years, psychotherapy has become increasingly important in the treatment of depression. In particular, so-called "cognitive behavioral therapy" offers a high probability of long-term improvement in this context.

Cognitive behavior therapy, is the therapy that works with both the thoughts and the behavior of the depressed person. On the one hand, the patient is motivated to participate more actively in life again, for example, detailed daily plans are drawn up in which care is taken that the patient also plans sufficient pleasant activities in addition to his duties.

Example: cognitive behavioral therapy

Ms. S., 24 years old, has been sad and listless for many weeks since the separation from her boyfriend. After work, she no longer goes to sports, or meets up with her friends as she used to, but just lies on the sofa and watches TV. Everything else is too much for her. With the help of the therapist, she is encouraged to call friends and arrange occasional meetings. When she notices that this is gradually improving her mood, she goes back to her sports club. This again experiences further successes and is thus reinforced in their actions.

The limited resilience of the patient is taken into account and the patient is motivated to take up activities that he had previously enjoyed. Experience has shown that an increase in activity leads to a significant improvement in mood in many people with mild depression.

Depression (in addition to many other disorders) is usually characterized by a massively distorted “negative thinking”.

Example: limited resilience

Mrs. M., 48 years and housewife. While she used to be able to organize her household with ease, it has become increasingly difficult lately. She blames herself for this and feels worthless. So she thinks: “I can't do anything! My husband will find a better wife for himself! I'm no good and the neighbors will despise me when they see what my apartment looks like. She has no hope that this will ever improve. She broods a lot and often and sees herself living alone in a trashed apartment in the near future.

This “negative thinking”, which is based on profound convictions, is questioned in therapy with the therapist and its reality content is checked. In this way, the patient can succeed in developing a more realistic and thus less negative view of himself and his situation and his future.

Once the patient has overcome the depression, part of the therapy must be to provide the patient with rules of conduct that enable him to act early and independently if the depression returns or in difficult life situations.

Depth psychological psychotherapy (psychodynamic PT)

The basic idea of ​​depth psychological - psychoanalytical psychotherapy consists primarily in the clarification and processing of conflicts. In theory, these conflicts are explained by an early emergence of self-directed (narcissistic) neediness. These conflicts that arose in childhood are often not clear to adults who are depressed. The therapist tries to deal with these conflicts and, if necessary, to let the patient experience his anger or aggression. The most important factor here is the severity of the depression. In severe episodes, therapy should be supportive rather than revealing.

Complementary therapy methods

sleep deprivation

Sleep deprivation is not understood to be a torture method, but rather the deliberate stay awake through the whole night. One day after the first sleep deprivation therapy, more than half of the patients examined showed a clear improvement in mood. But be careful: a depressive relapse can already occur the next day, especially if the patient fulfills his need for sleep during the day. Sleep deprivation therapy should therefore only be carried out under medical supervision. Inpatient therapy in the hospital offers the best prerequisites.

Light therapy for depression

In this therapy method, which is used in addition to others, the knowledge comes into play that a half-hour session in front of a light source with at least 10,000 lux can bring the depressed person significant improvement. As far as I know, the actual effectiveness has not yet been significantly proven. Sleep disorders are described as possible side effects.

Light therapy is one of the non-drug therapies that are successfully used for depression. Light therapy can be very helpful, especially for patients who tend to develop depression in the darker winter months. One speaks here of a seasonal depression.
But light therapy also shows success in depressed patients whose illness is independent of the season. Light therapy should be used shortly after awakening and usually lasts about half an hour. The recommended duration depends on the light intensity of the lamp. Light intensities between 2500 and 10,000 lux are recommended. For comparison: A normal lamp for interior lighting only has around 300 to 500 lux. The person concerned sits at a distance in front of a lamp that imitates daylight.
The mechanism of action of light therapy has not yet been conclusively researched. However, there is evidence that exposure to light leads to a decrease in the body's own messenger substance melatonin. Melatonin is a sleep-inducing hormone and is increasingly produced in the dark. An excess of melatonin in the body can promote the development of depression. Exposure to light should also increase the concentration of the neurotransmitter serotonin in the body. This is important because there is a serotonin deficiency in depression. The light therapy has few side effects. However, there are some patient populations who should exercise caution. Certain skin diseases such as lupus erythematosus can be aggravated by light. Patients with pre-existing eye conditions would also do well to speak to their ophthalmologist before starting light therapy. Occasionally, light therapy can lead to headaches and dry eyes.

Further information on this topic can be found at: Light therapy for depression

ECT (electroconvulsive therapy)

Who doesn't know the pictures of Jack Nicholson in the “cuckoo's nest” when he was given his “electric shocks”? Most patients are rightly unsettled by this and by a lot of hearsay and even more dubious sources of information on the Internet.

Here now the truth as it is practiced in this our country.

First of all, the mostly seriously ill patient is put into a state of short anesthesia with muscle relaxation by an anesthetist. Then a doctor artificially provokes an epileptic seizure with the help of an ECT device. This procedure is stress-free and pain-free for the patient due to the short anesthesia. Unfortunately, this method has a very bad reputation (wrongly nowadays). Images from the time when this method was still used almost indiscriminately or as a punishment and without anesthesia are too clearly captured in the mind. Contrary to popular belief, this method does not cause permanent damage. In fact, this method can be described as one of the safest and fewest side effects.

The most common side effects are: lack of concentration on the day of therapy, possible confusion after waking up from anesthesia, headache and nausea.

Nowadays, ECT is usually used (in Germany) in patients with severe depression with psychotic symptoms or with so-called catatonic schizophrenia (see Chapter schizophrenia) who do not experience sufficient improvement under drug therapy. This can improve almost 60% of the patients. The therapy is carried out in 8-12 sessions and may have to be repeated after a few months because, and this should not be concealed here, the relapse rate after about 6 months can be described as high.

In a few patients, the time to relapse is much shorter, so that you may have to take the route of maintenance ECT. EKT sessions are held here at defined intervals (1-4 weeks).

Hypnotherapy for depression

In addition to psychotherapy, non-drug therapy methods include light therapy, sleep deprivation therapy or waking therapy and electroconvulsive therapy in the treatment of depression. So far, hypnotherapy has not been mentioned in the guidelines for the treatment of unipolar depression.

Meditation for depression

Meditation has not yet found its way into the guidelines for the treatment of depression. Individuals report that meditation helped them overcome their depression. However, the effectiveness cannot be sufficiently proven without scientific studies. In general, everyone concerned should decide for themselves what is good for them. It is important, however, that basic therapy, usually consisting of psychotherapy and drug therapy, is initiated in moderate and severe depression. Other forms of treatment such as hypnotherapy or meditation can be tried out.

Homeopathy for depression

In homeopathy there are numerous globules that are said to have a positive effect in the treatment of symptoms that can occur in the context of depression. Depending on which symptoms are in the foreground, come here for example Nux vomica (Refractory nut), Ambergris (Amber), Acidum phosphoricum (Phosphoric acid), Pulsatilla pratensis (Meadow pasque flower), Lycopodium (Club Moss), Cimicifuga (Black cohosh) and Ignatia amara for use.
However, the greatest popularity for the homeopathic treatment of depressive episodes is probably St. John's wort (Hypericum perforatum).The effect of St. John's wort is said to be superior to the placebo, although it is still not entirely clear via which mechanism of action St. John's wort develops its effect. The effectiveness of St. John's wort is limited to light, and in some cases also moderate, depressive episodes. Its use in severe depressive episodes is not sufficient. St. John's wort is freely available in pharmacies and drugstores, but has side effects that should not be underestimated: headache, restlessness, increased sensitivity to light.
In addition, St. John's wort can reduce certain drug levels in the blood. For example, the effective level of the “pill” can be weakened when taking St. John's wort at the same time, and pregnancies have been described under a combination therapy of “pill” and St. John's wort. Other drugs such as immunosuppressants and blood thinners can also be weakened by St. John's wort, so it is important to inform the doctor treating you about the intake.

Read more on the topic: Homeopathy for Depression

Johannis herbs

St. John's wort is a 60 cm high plant with golden yellow flowers. It grows naturally in Europe, West Asia and North Africa and is cultivated for agriculture, for example in Germany. St. John's wort is used in medicine as a medicinal plant and antidepressant. Its active ingredient Hypericum, which is present in the flower petals and buds of the plant, is administered in the form of tablets for mild to moderately severe depressive phases as well as for inner restlessness. During depression, fewer chemical compounds, so-called neurotransmitters, work in the brain. The result is a sinking mood and the sad nature of the illness. St. John's wort causes the neurotransmitters to work longer in the brain, making the mood more stable and possibly better.
The medicinal plant has hardly any direct side effects on the human body and is generally very well tolerated. Gastrointestinal complaints, restlessness or an allergic reaction to St. John's wort are rarely reported. The rarely occurring photosensitivity (Photosensitization) can be counteracted by avoiding excessive sun exposure.
St. John's wort inhibits enzymes in the liver (Isoenzyme CYP3A4). These are responsible for the breakdown and activation of some drugs. As a result, if the patient takes such drugs, their potency decreases. This can become a problem with important drugs. St. John's wort should not be combined with the following drugs:

• have various drugs that affect the psyche
• drugs that suppress the immune system (immunosuppressants)
• the asthma drug theophylline
• special HIV or AIDS drugs
• Blood thinners or anticoagulants (anticoagulants)
• birth control pills

After discontinuing treatment with St. John's wort, the effects of various drugs may increase, which must be observed by the attending physician. For a long time it has been debated whether the medicinal plant St. John's wort has any scientifically proven effect against depression. In the area of ​​mild to moderate depression, experts now agree that this is the case. In the case of severe depression, however, no actual effect of the plant on the course of the disease has yet been proven. Further uncertainties exist with the subjects of dosage and individual effects of the available drugs in patients. In addition, pregnant women must be advised against taking it.

Also read our topic: Johannis herbs

Course of therapy for depression

A depression can develop over the course of several weeks, months, or even relatively suddenly. The triggers are often events that traumatize the patient, such as separation from a partner, the loss of a job or the death of a loved one. The personality structure of the patient plays a major role here. Women are often more concerned with their feelings than men and then seek psychological or psychiatric treatment for their depression more often.

The mood during depression is in the form of a wave or an interval. After the onset of the disease, the symptoms of depression gradually increase, whereupon the patient reacts with a rapidly deteriorating mood. At the lowest point of the interval, suicidal ideation often occurs. If such thoughts occur, a caregiver or medical staff should be contacted immediately.

With successful therapy and patient support, the symptoms of depression can be alleviated and endured. In addition, the mood improves during recovery, until it mostly returns to its original state. For some depression sufferers, however, this is not the end of the disease. About half of all sick people develop a new depression after about 4 years. On average, patients go through 4 depressive intervals in their life. The chance of getting sick again increases with each interval.

Duration of therapy for depression

Drug therapy plays an important role in the treatment of depression. It is the drug of choice for moderate and severe depression, but it is recommended to combine it with accompanying psychological care. How long drug therapy is necessary depends, among other things, on whether it is the first depressive episode or whether there have already been repeated recurrences of depressive episodes; one then speaks of so-called relapses.
In general, drug therapy for depression is divided into an acute therapy phase, a maintenance therapy phase and a relapse prevention phase.
The acute therapy usually lasts 6-12 weeks.
In the subsequent maintenance phase, the drug that was also used effectively in the acute phase is continued to be administered in the same dosage. The drug therapy in the maintenance phase should be continued for 6-9 months, sometimes 12 months. In most cases, an attempt is then made to slowly taper the drug. This means that the dose is slowly reduced until the drug can be stopped completely. If depressive symptoms recur during this phase, consideration should be given to continuing drug therapy during the maintenance phase for a further few months.
In patients who have already suffered several relapses, i.e. in whom the depression has reappeared after some time after the symptoms have disappeared, relapse prophylaxis can be useful, this follows on from the maintenance phase. Its purpose is to prevent symptoms from returning after a while. The duration of the phase of relapse prevention depends very much on the patient's history; it usually lasts at least a year, but can be necessary for several years or even for life. During this time, the drug that was effective in the acute and maintenance phase should continue to be given.
Depending on whether it is the first occurrence of depression or whether it has already recurred several times, the duration of therapy for depression ranges from a minimum of 7-8 months to lifelong therapy.

An untreated single-phase depression can last for six months. When starting therapy, the prospects are significantly better. Depressive phases last an average of 3-4 months and have a lower relapse rate. Therapy usually extends beyond the duration of the depression. This reduces the risk of getting sick again.
Only 25% of patients are cured after a single treatment, the remainder have to fight their depression again. In the course of life, people suffering from depression have to endure an average of 4 intervals of deterioration, depression and build-up of their mood. The risk of reliving a depressive phase is 70%. Thus, a once pronounced depression can last for years, in severe cases for decades.
In the case of an interval-like course of depression, the mood-stable episodes vary in length. In general, however, they get shorter with each depressive phase and in many cases no longer reach the patient's usual mood level. The duration of depressive phases and the risk of chronification increase with age.

Cost of therapy for depression

Depression in Germany costs around 22 million euros a year. These sums are covered almost exclusively by statutory and private health insurances. How high the costs are depends on gender and the severity of the depression; on average these are around 3800 euros per patient per year.

There are seldom costs for those affected, but the need for treatment is carefully checked before starting therapy. For this purpose, 3-5 preliminary talks with a psychotherapist or resident psychiatrist take place in advance, in order to determine whether a mental disorder is present. If this occurs and the specialist confirms, for example, the existence of depression, therapy from the list of established guideline procedures can be started. The established procedures include behavior therapy, psychoanalysis and psychotherapy based on depth psychology. Initially, a treatment period of 30-50 hours is usually approved by the health insurance. If necessary and if the psychotherapist requests an extension, the number of hours can be increased further.

Is it possible to treat depression without a doctor / psychiatrist?

As already described above, the mild depressive episode in particular is a form of depression that can, under certain circumstances, be treated without medical / psychiatric help. Although psychotherapy is said to have a positive effect here, too, depending on the attitude of the person concerned and how much his social environment supports him, such a mild depressive episode can subside even without medical support.
However, it is recommended to consult the attending physician in the case of depressive moods that last for several days or weeks, as there is a risk that this will lead to a higher-grade depressive episode which can be dangerous and in most cases requires drug and psychotherapeutic therapy. In general, if you have suicidal thoughts, you should consult a doctor as soon as possible.

When should one treat inpatient and when outpatient?

This question can not be answered generally. Particularly in the case of mental illnesses, the symptoms, the degree of severity and the level of suffering of the patient vary so much from one affected person to another that a clear answer is not possible. As a general rule, major depressive episodes should be treated as inpatients in the majority of cases. On the one hand, because people with severe depression often do well to get out of their own environment for a while, to have daily therapeutic contact and to come into contact with fellow sufferers, and on the other hand, because the drug setting is somewhat easier in an inpatient setting. In addition, patients suffering from a major depressive episode often have suicidal thoughts. These are often not actively addressed, but only disclosed on request. Often also because suicide is still seen as a kind of taboo subject in today's society. In such cases, inpatient admission can be a significant relief for the person concerned.
In most cases, mildly depressive episodes do not require inpatient treatment. Moderately severe depressive episodes can - depending on the severity and symptoms - also be treated on an outpatient basis. Outpatient treatment can also take the form of day-clinic treatment, for example. During the week, the patient comes to the facility every day from morning to afternoon and is cared for, for example, with one-on-one discussions, group therapy or occupational therapy, and then spends the evening and night at home.

Osteopathy

Osteopathy is not a recognized treatment concept for the therapy of depression. Studies on effectiveness are also very thin. In addition, osteopaths do not have to be medical professionals. In this respect, according to the current status, osteopathy is not a sensible concept for treating depression. It should therefore only be used in addition to medicinal and psychotherapeutic therapy.

forecast

Usually, episodes or phases of depression last about 7 months without therapeutic help. Therapeutic help can reduce this time frame to about 2 months (for half of the patients). After about 4 months, about 80% of the patients feel much better.

In 10% of the sick it can come to a bad, permanent (chronic) course.

The risk of experiencing a worse course of the disease increases if the age of the first disease is well before the age of 35. It is also unfavorable if there is a "tendency" to depression in the family (genetic disposition). Permanent social or occupational stress or disruptions in conflict management can lead to an unfavorable course or to an increased risk of relapse.

diagnosis

The diagnosis is made by therapists experienced in depression. These are, of course, psychiatrists but also psychologists with experience in psychotherapy. Of course there are also a large number of general practitioners who are confident in making a diagnosis, but if in doubt, the specialist should be consulted. The most important part of making the diagnosis is the so-called diagnostic interview. There are also a large number of questionnaires that can be used to determine the severity in particular.

Of course, there is not only the simple depressive illness, but such a disorder can also be related to physical (somatic) illnesses. One can think in particular of:

• Tumor diseases
• Brain diseases
• Metabolism disorders
• Respiratory diseases
• Hormonal imbalances

Depressive episodes can also occur as side effects with drugs that are used to treat physical illnesses. There are different drugs. The most important groups of drugs are mentioned here:

• Cytostatics
• Heart medication to control high blood pressure or arrhythmia
• Benzodiazepines (e.g. Valium)
• Antibiotics
• Birth control pills
• Cortisone

It should be noted, however, that you should never stop taking medication only if you suspect a side effect without consulting the prescribing doctor! Tell your doctor about new symptoms, but do not treat yourself!
Other comorbidities - such as a mania - must always be taken into account when choosing medication.

Also read: How can you recognize depression?

Symptoms

Depression can express itself in many ways and vary in the severity of the illness.

Depression can also be different in men, older people, adolescents and children. The predominant symptoms are the depressed mood and a general weakness or physical and mental exhaustion without prior exertion. Life seems meaningless to those affected and they are no longer able to feel joy or to show interest in things that would have been fun for them in the past. Interpersonal relationships are given up or impaired because the person concerned is often no longer able to understand or respect the feelings of the other person while at the same time feeling insensitive.

Feelings of guilt and shame also play a role, as one perceives oneself as worthless and as a burden for others. Small mistakes long ago also become a source of endless reproaches and self-reproaches. The desire for closeness and security is still partly unabated, with the simultaneous inability to demand it and the often exaggerated fear of being abandoned and rejection.

Disturbances in normal thinking can also occur; this is often slowed down and monotonous. One is fixated on small incidents or past events and accepts new thoughts and suggestions poorly. In addition, attention is noticeably reduced. Sleep disturbances, appetite disorders, an indefinite physical discomfort (especially abdominal pain and headache), and loss of sexual desire are also common.

The relationship between depression and pain is worth mentioning, as this is one of the most common reasons that depressed patients actually see their doctor. The pain in this case masks the depression. There is a connection between the messenger substances serotonin and dopamine, depression and the transmission of pain in the spinal cord. Both messenger substances are released from the brain in order to dampen the transmission of pain in the spinal cord. This played an important role in the early human development, because despite pain, it was often necessary to fight for bare survival, i.e. the pain should be a warning signal, but without being paralyzing at the same time. In addition, they also play a role in mood and drive - they are often reduced in depression. Therefore, depression should always be considered in the case of indeterminate pain and, conversely, the treatment of pain in the therapy of depression should not be forgotten.

Read more on this topic: The role of serotonin / neurotransmitters in depression

A gender-dependent difference in severity can also be observed in depression, for example the proportion of male patients suffering from depression has long been underestimated and depression as a "Women's disease”Treated. On the one hand, this is due to the fact that women go to the doctor far more often than men (especially with psychological problems), who often do not want to be weak. On the other hand, the symptoms in men are also expressed differently and therefore more difficult to recognize because they do not fit into the usual pattern of depression.Male patients are often irritable, uncomfortable and uncomfortable with their own skin - but this is just another form of self-doubt, negative thoughts, and feelings of guilt and shame that most depression sufferers grapple with. Their ability to withstand stress is reduced, they can freak out at the smallest occasion and are often unable to stop these attacks, even if they themselves find them inappropriate. The body reacts to such attacks - the head turns red, sweat breaks out, the heart races, it is difficult to breathe, and tremors and dizziness can occur. In general, it can happen more often in men that depression manifests itself as physical complaints for which no underlying cause can be determined. In particular, pain that occurs for no reason and of which no precise place of origin can be determined should also be clarified with regard to the diagnosis of depression.

With children, one should pay more attention to behavior that differs from that of their peers, such as an extremely fearful and negative view of the future or the conscious delimitation and general reluctance to play with their peers. Symptoms similar to adults may experience, especially difficulty sleeping, a general bad mood, inability to complete thoughts or tasks, and listlessness. An irritable mood can also become noticeable through fits of anger and rebellion towards the parents. But also increased physical restlessness, including the inability to sit still or physical symptoms such as vague pain and general malaise may occur.

You might also be interested in the following topic: Symptoms of depression