Dealing with depression
Have you noticed that you or people close to you are feeling low, lack drive or have lost interest in things? This article explains what depression is and how you can combat it: negative thoughts and withdrawal are countered by alternative thoughts and helpful behavior.
At a glance
- Depression is one of the most common mental illnesses in Germany but few people with depression seek and find professional help.
- People with depression often become withdrawn, which can trigger a downward spiral.
- Depressive thoughts are often characterized by black-and-white thinking and an overemphasis on the negative.
- It can be helpful to analyze difficult situations, identify negative thoughts and replace them with positive ones.
- Doing things even if you have no motivation to do so and setting realistic goals can also help, as well as speaking to others affected by depression.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
What is depression?
In Germany, about 8 percent of people develop depression each year. However, the condition is only diagnosed in about a third of these. And only about 4 percent of people with depression receive appropriate long-term treatment.
This article is particularly aimed at people who are not yet sure if they are actually depressed or simply experiencing “normal” sadness or despondency, and at their relatives. It is also aimed at people who have already been diagnosed with depression but are still waiting to receive treatment or have not (yet) decided upon a treatment.
The main indications of depression are:
- low mood
- loss of interest and joylessness
- lack of drive and increased fatigue (often even after only a small amount of effort) as well as a reduction in activity
- decreased concentration and attention span
- decreased self-esteem and self-confidence
- feelings of guilt and worthlessness
- negative and pessimistic thoughts about the future
- thoughts of suicide, self-harm or suicide attempts
- sleep disorders (insomnia)
- decreased appetite
- decreased libido
Depressive symptoms can be triggered by stressful events such as separation, illness or the death of a loved one. However, depression can also occur without recognizable triggers.
What is depression?
The video below explains the signs of depression. What triggers it and what treatment options are there?
This and other videos can also be found on YouTube
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What is the difference between severe grief and depression?
In the event of complicated grief after a loss, unlike with depression, the focus is on yearning for the deceased. However, it is also possible for depression to develop alongside the grief. The aim with complicated grief is to accept the loss and process the emotional pain.
What typical behavior is associated with depression?
In depressive phases, a low mood, loss of interest and lack of drive are very often accompanied by withdrawal. In this way, people with depression avoid everyday situations that increasingly trigger negative feelings. However, this often results in a downward spiral.
For example, people with depression may initially find it a relief to have a sick note that means they are no longer required to function at their job. However, the loss of structure that working gave to their everyday life means they have more time to think about things. Unpleasant feelings intensify. The positive aspects of working, such as chatting to colleagues and celebrating little successes, are also lost.
In many cases, people then start to find it too stressful to meet friends or do their hobbies. They often become increasingly socially isolated during this phase. As they are also less physically active now, they can become even more susceptible to negative thoughts and feelings.
People with depression now start to spend increasing amounts of time in bed. Often, all they want to do is sleep and they no longer feel able to endure their condition. This is the point where they are most likely to experience suicidal thoughts.
What can you do differently when feeling depressed?
You may recognize some of the behaviors described as your own. The sooner you can interrupt such a downward spiral, the better.
Do things anyway
Many people with depression feel like it doesn’t matter what they do as nothing seems to really bring them joy. It is understandable that people who think this way no longer want to get out of bed. However, psychotherapy often shows that this assessment is not entirely correct.
If people in a depressive phase can make themselves go for a jog or do some relaxation exercises, for example, their mood usually improves – at least a little. Even completing unpleasant tasks, such as household chores, can feel good afterwards.
Realistic goals
The negative downward spiral can be interrupted by people adapting their goals to their current condition. Imagine someone whose job usually involves giving presentations to large audiences. How should this person now consider it a success to get out of bed and go for a walk? This is certainly difficult. But if they have not managed to leave the house for a week due to their depression, then a walk is an initial, achievable goal – and it helps to class this as a success.
How would you treat or appraise your best friend in this situation? If you would acknowledge his or her little successes, do the same of your own.
No-one with depression is alone
Advice such as “just pull yourself together” or “it’s not all bad” is based on the assumption that people with depression simply have to flick a switch to start working properly again. This shows a lack of understanding of depression.
On the other hand, understanding can be found among other people with depression. After all, no-one is ever the only person to be in a depressive phase. In Germany alone, there are millions of people who are experiencing similar things.
If you have depression, you can visit a self-help group, for example. A Germany-wide database of support groups and family caregiver groups is provided by the National Contact and Information Point for Encouraging and Supporting Self-Help Groups (Nationale Kontakt- und Informationsstelle zur Anregung und Unterstützung von Selbsthilfegruppen, NAKOS).
The German Alliance against Depression of the German Foundation for Depression Relief (Deutsche Bündnis gegen Depression der Stiftung Deutsche Depressionshilfe) aims to improve the health of people with depression. It is furthermore committed to heightening the public’s understanding of the condition and preventing suicide.
What can help combat negative or depressive thoughts?
People’s thoughts often come and go automatically so that they do not realize how much they are affecting their mood. Before they can change these, it is therefore important to notice and identify negative thoughts. One of the aims of psychotherapy is to help people understand which thoughts drastically affect their mood. By identifying depressive thoughts, these can be changed.
There are certain “thought patterns” that are particularly prone to causing negative feelings:
Generalizations
Depressive thought
- “My friend canceled on me. That shows that nobody loves me.”
Helpful thought
- “My friend often cancels on other friends too and is really busy at the moment. It’s got nothing to do with me. And anyway, I’m still lovable even if some people don’t like me.”
Taking things personally
Depressive thought
- “My partner cheated on me. That shows that no-one can love me.”
Helpful thought
- “My being lovable has nothing to do with my partner’s behavior.”
Black-and-white thinking
Depressive thought
- “Things are either good or bad. I make lots of mistakes, so I’m bad.”
Helpful thought
- “Everyone makes mistakes and no-one is all bad or all good. I’m okay despite my mistakes.”
Unrealistic wishes
Depressive thought
- “I should be more beautiful and more successful.”
Helpful thought
- “I accept myself for the way I am – unless I want to make a specific, achievable change.”
Overemphasizing the negative
Depressive thought
- “The customer consultations went okay but the fact I won’t get this task done will cost me the job.”
Helpful thought
- “If my best friend were in this situation, I wouldn’t regard it as catastrophic or ignore the positives.”
Typical thoughts with complicated grief
If a loved one dies, certain thoughts or attitudes can make it hard to process the loss. In such situations, it can again help to consider alternative, helpful thoughts.
Example thought 1
Obstructive thought
- “I’m betraying my love for him/her if I move on with my life.”
Helpful thought
- “She/he would want me to be happy again.”
Example thought 2
Obstructive thought
- “I could have prevented the death if I had done XY.”
Helpful thought
- “I did what I could with my knowledge at the time.”
Example thought 3
Obstructive thought
- “I don’t want to go on living without her/him.”
Helpful thought
- “She/he would not want me to suffer so much.”
Example thought 4
Obstructive thought
- “It is so unfair that she/he had to die.”
Helpful thought
- “His/her suffering finally ended.”
A depressive phase passes
Some people with depression feel like it will never end. Despondency and hopelessness often seem as though they will last forever. But that is not the case: depressive phases last an average of about 16 weeks. For the vast majority of people with depression that means that the difficult phase will soon be over.
How can depressive thoughts be identified and changed?
A situation analysis is about taking a closer look at emotionally straining experiences. First, the situation should be described in a neutral and factual manner. It is then important to find out which thoughts are related to the stressful feelings.
Situation, thoughts and feelings
What happened exactly? An example: a friend messages to say that she can no longer meet up. Another friend already canceled the previous day. The following thoughts go through the person’s head: “People are constantly canceling on me. Yesterday, Tom. Today, Sara. No-one wants to meet me anymore. I’m worthless. I can no longer take it.” The person regards the situation as terrible and hopeless. The strongest feeling is despondency.
Review negative thoughts
The next step is to review the negative thoughts and find alternative, helpful thoughts. These can help you feel better in similar situations in the future. One useful approach can be to look for evidence of the negative thoughts: “Two friends canceled two days in a row. Those are the facts. But I can’t find any evidence to back up my conclusion that I’m worthless and can no longer take it except that I’m really pretty exhausted.”
Develop helpful thoughts
The person will now find it easier to develop helpful thoughts: “My friend will be telling me the truth and need to be there for her son today. That doesn’t mean that she doesn’t like me or want to meet me.” The person’s mood will improve slightly if they focus on these thoughts: “I don’t feel as down. I’m a bit sad that we weren’t able to meet but also slightly more upbeat.”
Important: You can try to apply this approach to situations in your life. This is easier if you do it as part of cognitive behavioral therapy.
When does treatment become necessary?
Both psychotherapy and a variety of anti-depressant drugs are effective for most people. Treating depression with psychotherapy or medication early increases the chance of recovery.
Consult your doctor as soon as you start to wonder if you could have depression. If your symptoms have only just presented themselves and are pretty mild, you may decide after consulting with your doctor to wait and see if they go away of their own accord. However, you should arrange a follow-up appointment within two weeks to jointly assess how the symptoms have developed.
If your mood has not improved after two weeks, you should arrange an appointment for a psychotherapeutic or psychiatric consultation. You can also discuss the options for medication-based treatment with your general practitioner.
How can you find professional assistance?
Local psychotherapists and psychiatrists can be found through the Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen – KV). Call 116 117 or use the online directory for physicians.
For more information about finding a psychotherapist and understanding emotional stress, visit the website Wege zur Psychotherapie (Pathways to Psychotherapy) by the Chamber of Psychotherapists (Bundespsychotherapeutenkammer).
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e.V. (DGPPN). Basisdaten Psychische Erkrankungen. Berlin 2020. Aufgerufen am 19.02.2021.
- DGPPN, BÄK, KBV, AWMF (Hrsg.) für die Leitliniengruppe Unipolare Depression. Unipolare Depression. S3-Leitlinie/Nationale Versorgungsleitlinie – Langfassung. AWMF-Registernummer nvl – 005. 2015. doi: 10.6101/AZQ/000364. 2. Auflage, Version 5. 03.2017.
- Margraf & Schneider. Lehrbuch der Verhaltenstherapie, Band 2: 7 Depression (Martin Hautzinger). Springer: Heidelberg 2009.
- Robert Koch-Institut (RKI) in Zusammenarbeit mit dem Statistischen Bundesamt. Depressive Erkrankungen. Gesundheitsberichterstattung des Bundes, Heft 51. RKI: Berlin 2010.
- Rosner R, Pfoh G, Rojas R et al. Anhaltende Trauerstörung: Manuale für die Einzel- und Gruppentherapie. Hogrefe: Göttingen 2015.
- Stavemann, H H. KVT-Praxis: Strategien und Leitfäden für die Kognitive Verhaltenstherapie. Beltz: Basel 2008.
Reviewed by the German Association for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e.V., DGPPN).
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