Depression

Depression is one of the most common mental illnesses. Now recognised as a widespread disease, the WHO ranks it alongside cardiovascular disorders as one of the most common illnesses worldwide.

Epidemiology

• Women suffer from depression twice as often as men
• A quarter of all those who recover become depressed again within one year
• Within a period of 10 years, even three quarters
• Every 5th depression becomes chronic
• Every seventh person suffering from depression dies by suicide

Important

The suffering of people with depression is all too often underestimated, as a large proportion of the population, but also general practitioners, equate it with low mood or sadness.

Core Features

In mild, moderate, or severe depressive episodes, the affected person typically suffers from:

• Depressed mood — changes little from day to day
• Loss of interest and joylessness
• Reduced drive — leading to increased fatiguability
• Reduced concentration and attention
• Reduced self-esteem and self-confidence
• Feelings of guilt and worthlessness
• Negative and pessimistic future perspectives
• Suicidal thoughts or self-harm
• Sleep disturbances
• Reduced appetite

The Somatic Syndrome

Typical features of the somatic syndrome are:

• Loss of interest or loss of pleasure in normally enjoyable activities
• Lack of ability to react emotionally to a friendly environment or joyful events
• Early morning awakening (two or more hours before the usual time)
• Morning low
• Psychomotor inhibition or agitation
• Marked loss of appetite
• Weight loss (often more than 5% of body weight in the past month)
• Marked loss of libido

Diagnostic Criterion

The somatic syndrome should only be diagnosed when at least 4 of the listed symptoms are clearly identifiable.

Forms of Depression

There is not THE ONE DEPRESSION — various forms are distinguished:

Reactive Depression

Occurs as a consequence of crises or stressful events. Every person experiences crises with varying intensity.

Recurrent Depression

Depressive episodes that come and go — not bipolar or manic-depressive.

Bipolar Disorder

Manic-depressive: unnatural excitement/euphoria alternating with depressive paralysis, occurring in phases.

Dysthymia

Often begins in adolescence or early adulthood and is a chronic persistent low mood.

Difference Between Depression and Grief

	Depression	Grief
Time-limited	No	Yes (4 phases)
Self-devaluation	Yes	No
Self-blame	Yes	Only in Phase 2
Suicidal thoughts	Yes	No
Helplessness/Anger/Rage	No	Yes
Sleep disturbances	Yes	Initially possible
Exhaustion	Yes	Yes
Contact with others	No	Yes
Does consolation help?	No	Yes
Acceptance of help	No	Yes

Note

Unprocessed grief can transition into depression. Depression, in contrast to grief, can only be resolved with medical help. Over 60% of all depressions arise from unprocessed or repressed grief.

Forms of Therapy

Cognitive Behavioural Therapy

The focus is on the fact that thoughts and the future are immersed in a uniform grey. Here, new attitudes and behaviours are learned.

Interpersonal Therapy

Concentrates on the central present interpersonal problem that is connected with the depression.

Depth-Psychological/Psychoanalytic Therapy

Frequently applied in dysthymia. Here, unprocessed feelings from childhood and conflicts from past relationships are the focus.

Depression and Borderline Personality Disorder

Important Connection

Depression belongs closely to Borderline Personality Disorder — not the other way around! Analysts speak of the depressive core conflict in depression: “On the one hand, wanting to be close to a loved one to the point of fusion, and on the other hand, feeling the rage that goes as far as the wish to destroy the other or oneself.”

More on this in the psychodynamic model of depression.

At the same time, the self-worth conflict is present: “Excessive demands on oneself and simultaneously complete self-devaluation.” This applies precisely to Borderline Personality Disorder and is, among other things, also its core conflict.

The rejection and devaluation that the child experiences from their parents — particularly the mother — inevitably leads to the question: “What is wrong with me that I am not loved?” This question becomes so deeply internalised that it forms the basis of the adult’s later self-doubt.

Treatment with Antidepressants

• Antidepressants take effect after approximately 2 weeks
• They are not addictive (in contrast to barbiturates or benzodiazepines)
• Side effects in the first 2 weeks: dry mouth, possibly tremor, insomnia, sweating, loss of libido
• These side effects usually disappear after 2 weeks

In Bipolar Disorder

An exception is manic-depressive disorder, as it is generally managed through the use of lithium. Lithium levels out the up (mania) and down (depression).

What Loved Ones Should NEVER Do

Important Note for Loved Ones

Depression is an illness — the soul and body are in a state of emergency. Statements like “Pull yourself together” do not help; on the contrary, they can increase feelings of guilt and worthlessness — and thus also intensify suicidal thoughts.

Strongly discouraged are also major activities such as travel. Any excessive demand will reinforce the feeling of incapacity.

Self-Help Tips

• Seek professional help (crisis intervention services exist in every larger city)
• Do not be afraid of antidepressants
• Take advantage of therapy
• Try small steps: going for a walk or visiting friends who are aware of your condition
• Avoid anything that could remind you of the trigger
• Create a daily routine with small, achievable steps
• Recall your childhood — things that gave you joy
• Do not listen to music that pulls you down emotionally
• Do not isolate yourself
• Do not put yourself under pressure — healing takes time

Avoid

Do not resort to psychotropic substances (alcohol, drugs). They release serotonin, dopamine, and noradrenaline in elevated amounts and provide only short-term euphoria. After they are metabolised, you fall back again, as these neurotransmitters are no longer being produced in sufficient quantities.