Conditions Depression

Phases in which a person feels down or low are normal and pass. For a person with depression, this is not the case. Sad feelings and negative thoughts persist for a longer period of time and control their entire life. Everyday activities, work, or studying become difficult. The person withdraws from friends, family, and hobbies. Many people with depression sleep poorly.

People with depression experience a phase of deep sadness that can last for many weeks. This is known as a “depressive episode”. Some typical signs of these episodes are listed below:

• continuous despondency and a depressed mood
• loss of interest
• exhaustion and lethargy
• apathy and indifference
• inner turmoil
• low sense of self-esteem
• guilty feelings and continuous rumination
• difficulty concentrating and making decisions
• withdrawal from family members and friends
• hopelessness and anxiety about the future
• suicidal thoughts

Physical symptoms that can occur with depression:

• fatigue
• insomnia
• loss of appetite
• weight loss or weight gain
• loss of sex drive
• gastrointestinal problems such as constipation

In older people, in particular, symptoms of depression manifest themselves frequently also as physical disorders, for example, as unexplainable pain. 

Many people also have chronic depression. This means that their symptoms last for many years.

Visit gesundheitsinformation.de to read about how people with depression have experienced the disease.

The cause of depression is still unclear. Specialists believe that there are many factors that interact to cause depression – biological processes, emotional and social factors, life circumstances, and specific events. For example, the following factors can foster depression and impact its progression:

• genetic predisposition: other family members have suffered from the disease
• stressful experiences, such as abuse and neglect, but also the death of a loved one or a separation
• other mental illnesses, such as anxiety disorders, addictions or personality disorders
• biochemical changes: the metabolism and hormonal changes may play a role.
• physical illnesses such as a stroke, heart attack, cancer, or an underactive thyroid
• difficult personal circumstances, such as stress and pressure, loneliness or low income
• insufficient light: some people experience depression in the dark months of fall and winter due to a lack of sunlight.

Depression is one of the most common mental illnesses. Experts believe that 16 to 20 percent of people experience depression at least once in their lives or suffer from a chronic depressive mood (dysthymia), many before the age of 30. Women become ill more often than men, and older people more often than younger ones.

Depression causes a person to feel and act differently. Many blame themselves for their condition. They avoid social contact, withdraw, and rarely leave their home. Working is also difficult in many cases. This behavior can intensify symptoms. Help is often necessary at this point.

Depression can manifest itself in very different ways:

• For some people, the symptoms disappear after some time without treatment and do not return.
• Many other people regularly alternate between depressive phases and phases without symptoms.
• And some have sometimes more, sometimes less severe symptoms of depression over longer periods of time.
• Other people develop chronic depression. This is the case when the depressive episode lasts longer than 2 years.

In the case of depression, typical symptoms persist for at least 2 weeks and can last for several months. The end of a depressive episode ends when the symptoms subside after a period of time. About half of the people who are treated for depression feel a significant improvement in their symptoms after about 3 to 6 months.

If depression recurs within 6 months after the symptoms have subsided, it is referred to as a relapse (recurrence). This happens for around half of all people after they experience depression for the first time. If the symptoms reappear after more than 6 months or even years later, this is referred to as recurrent depression.

More than half of those with depression also have other illnesses. They include: 

• mental health conditions, such as anxiety and panic disorders, addictions, eating disorders and personality disorders 
• physical illnesses, such as cardiovascular diseases, headaches and back pain, diabetes mellitus, infectious diseases, asthma or allergies 

These illnesses can both cause depression and be caused by depression.     

You can find more detailed information about depression and its various forms at gesundheitsinformation.de.

Stressful events, such as the loss of a partner or chronic stress, are likely partially responsible for depression. Some types of stress can be reduced. Learning how to deal with crises can also lower the risk of depression. A person’s social environment also plays an important role. People with stable bonds experience depression less often.

People experiencing difficult personal circumstances can access psychological support or counseling and advisory services at an early stage.

Long-term treatment with medication or psychotherapy helps to prevent relapses in people with an increased risk of recurrent depression. These two treatments can also be combined.

Some people view their depression as a personal failure or temporary phase linked to stress and not a disease. In contrast, many others are so seriously ill that they cannot see a doctor or ask for help on their own. In both cases, family members should offer their support and, for example, accompany the affected person to an initial doctor visit.

In order to diagnose depression, doctors ask, on the one hand, questions about typical symptoms of depression. However, it is important to rule out diseases or problems that can cause similar symptoms. Therefore, it may be necessary to conduct a physical examination.

When checking for typical indications of depression, a differentiation is made between primary and secondary symptoms.

The primary symptoms are:

• a depressed, low mood
• inability to feel joy and little interest in things that were previously considered important
• lethargy and a tendency to quickly become fatigued, even after the slightest activity

Secondary symptoms are often:

• loss of appetite
• insomnia
• decreased concentration and attention span
• low self-esteem and self-confidence
• feelings of guilt
• inner turmoil
• hopelessness
• suicidal thoughts or attempts at suicide

Certain questionnaires are often used to diagnose depression. If they indicate that multiple primary and secondary symptoms have lasted for 2 or more weeks, a diagnosis of depression is made. Depending on the number, type, and intensity of symptoms, trained professionals differentiate between mild, moderate, and severe depression. They also distinguish between chronic depression and a depressive episode. 

Therapists will also ask about other illnesses and about how the symptoms of depression are impacting daily life. Both of these considerations play a role in choosing treatment. 

There are a variety of treatments available for depression. The most important are:

• psychotherapy, such as cognitive behavioral therapy, and/or
• treatment with medication

Other options are also available, such as counseling, self-help groups, psychoeducation, online programs, neurostimulation or exercise therapy. Treatment can be provided on an outpatient basis or in hospital.

The process of deciding which treatment is suitable involves considering, for example:

• the severity of the illness 
• which form of depression the person has
• what symptoms they have
• whether they have other illnesses
• how the illness is impacting their individual life situation
• how the symptoms are developing

The advantages and disadvantages of possible treatments, as well as the expected results, can be discussed with the therapist.

For more information about the treatment of depression, visit gesundheitsinformation.de.

Depression can make everyday life feel like a huge mountain that cannot be climbed. Meeting work requirements, fulfilling personal obligations and completing household tasks can all seem to take endless reserves of energy. Often, a person with depression will begin to interact differently with the people closest to them. Depression can also be difficult for loved ones to cope with. When the person they care about pulls away and becomes emotionally unavailable, this can lead to misunderstandings and conflict – which only serves to make the situation even more difficult for all.

Often, partners, friends, or family members of the person are the first to notice or learn about the symptoms of depression and changes because they are the first point of contact. For people suffering from depression, their support is particularly important. People who are close to someone suffering from depression can also reach their limits, and often need to seek help themselves in severe cases. Support groups are one option, but medical or psychological support can also be helpful.

In the event of indications of suicidal thoughts, help and active support is particularly important. For the most part, these remain just thoughts. However, they must be taken seriously. Those with such thoughts should confide in others.

There are various support options for these types of situations, both for those directly affected and for their loved ones. These include social psychiatric services, crisis centers, or telephone helplines. These services maintain anonymity if required and are often available day and night. If someone is in danger, the number to call is 112. This can result in admission to a psychiatric hospital.

For suggestions and tips on how to effectively speak to someone suspected of suffering from depression, visit gesundheitsinformation.de.

For most people, family doctors are the first point of contact even for psychological issues. However, it is also possible to receive help directly from psychological counseling centers, psychotherapists or psychologists. A doctor’s referral is not necessary for an initial consultation in a psychotherapeutic practice.

Further information on psychotherapy and tips on how to find appointments quickly or learn which services are covered by statutory health insurance can be found at gesundheitsinformation.de.

The University Hospital of the Ludwig Maximilian University in Munich has collaborated with the Beisheim Foundation to develop the website ich‑bin-alles.de. This website is designed for children and adolescents with depression and their parents, as well as for children and adolescents looking for information about depression.