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Depression: symptoms, therapy, causes

by Josephine Andrews
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Index

Depression is a serious mental illness that can occur at any age. The patients feel very depressed, lose their interests and are exhausted and listless. The disease persists for a long time and usually does not improve on its own without treatment. How do you recognize depression, how does it develop and which therapies help? Read everything you need to know about it here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

F53 F39 F92 F33 F34

quick overview

  • Symptoms : Main symptoms are deep depression, loss of interest and listlessness. Side symptoms include insomnia, self-doubt, feelings of guilt, difficulty concentrating.
  • Causes : Partly genetic predisposition, mental injuries, disturbed messenger metabolism in the brain , stress
  • Therapy : Various forms of psychotherapy , medication (antidepressants)
  • Suicidal risk : 10 to 15 percent of patients take their own lives. Therapy protects!

Depression: symptoms

Depression is a serious mental illness that should definitely be treated professionally! Unlike the sadness and listlessness that are part of life, depression does not go away on its own over time, nor does it get better with distraction or encouragement. Sometimes there is even a risk of suicide!

Three main symptoms of depression

How do you recognize depression? The following three main symptoms are typical of the disease:

  • Depressed Mood : Those affected suffer greatly from a deep depression. The depressed mood is almost continuous, severe, and lasts for at least two weeks.
  • Inner emptiness and loss of interests : A characteristic sign of depression is that those affected feel neither joy nor other feelings. Inside they feel empty and dead of emotion. Interest in social contacts, work and hobbies disappears. Attempts at encouragement by fellow human beings have no effect. Even positive experiences do not improve mood. Everything seems hopeless to those affected. Some even lose the will to live.
  • Listlessness and tiredness : Depressed people have difficulty or are unable to cope with everyday tasks. You feel constantly mentally and physically exhausted. Even getting up in the morning becomes an act of strength, so that some do not even get out of bed because of their depression. Fatigue becomes the norm.

If depressive phases alternate with manic phases – so someone varies between “dead to death” and “cheering to the skies” – this speaks more for a bipolar disorder than for a depression.

side symptoms of depression

The following secondary symptoms are also typical of depression:

  • strong self-doubt
  • feelings of guilt and self-reproach
  • Concentration and attention disorders
  • extreme need for sleep or difficulty sleeping
  • severe restlessness and inner agitation
  • loss of sexual interest

Depression Symptoms in Men

Men are less likely to be diagnosed with depression. Part of the reason is that the condition often manifests differently in men than in women. Aggression, severe irritability, poor impulse control and low stress tolerance are common side effects here. Many affected men also take more risks than usual, for example driving a car much too fast. They also often consume more alcohol than usual or smoke more. They blame their fellow human beings and are dissatisfied with themselves and the world. One reason for this could be that they feel weak and unmanly because of the depressive feelings and therefore act out their feelings differently.

Attention, risk of suicide!

In severe depression, the negative thoughts can become so strong that suicidal thoughts arise. Some depressed people have a very high risk of suicide. The suicide rate is rising steadily among the elderly and is highest among the very old. About 10 to 15 percent of people with depression die by suicide.

Searching for help! If you’re having suicidal thoughts, or if you suspect a loved one is having suicidal thoughts, don’t hesitate to seek help! Hopelessness and apparent hopelessness are signs of depression that can be overcome with the right support. You can get first aid for depression and suicidal thoughts nationwide from the telephone counseling service on 0800-1110111 (Protestant), 0800-1110222 (Catholic) and 116123. You can call them anonymously, free of charge and around the clock. The German Depression League offers offers from self-help groups at www.depressionsliga.de.

Self test for depression

Do you think you might be suffering from depression? Online self-tests, such as the renowned Goldberg test , which was developed by the psychiatrist Ivan K. Goldberg, provide important information. But be careful: Such a self-test cannot replace a diagnosis by a doctor or therapist. Be sure to seek help if the test makes this recommendation or if you are concerned regardless of the test result.

Physical symptoms of depression

Depression is often accompanied by physical complaints that have no recognizable organic cause. Such symptoms are called somatic. Typical physical symptoms include:

  • cardiovascular problems
  • headache and back pain
  • stomach and bowel problems
  • sleep disorders
  • Loss of appetite, more rarely: increased appetite
  • morning low
  • sexual displeasure

somatization disorder

Sometimes the physical complaints are so much in the foreground that the depression is not recognized immediately. Doctors then speak of a somatic syndrome. The physical symptoms appear in phases and subside as the depression is treated.

If the doctor cannot find an organic cause for the symptoms, he can reveal the hidden depression as the actual cause by asking precise questions. If this is the case, he will diagnose a so-called somatization disorder. This does not mean that the patients only imagine the symptoms, but only that the depression manifests itself in physical form.

Delusions and hallucinations in depression

A major depressive episode is sometimes accompanied by delusions and hallucinations . The patients then suffer, for example, from delusions of persecution or obsessive thoughts . Such delusional depression is particularly difficult to treat. In addition to antidepressants, antipsychotic medications are also used.

Sadness or Depression?

Depression symptoms can resemble those of deep grief. But there are crucial differences. This includes the fact that in contrast to depression in a bereavement, the depressed mood does not always remain the same. Most bereaved people, despite their loss, are able to laugh and feel joy in between. People with depression can’t do that.

In addition, the mood of mourners usually improves over time. The grief can come back suddenly through the thought of the loss. But little by little, a grieving person will increasingly enjoy beautiful experiences again. The support of friends and family can also be a comfort to him. In some cases, however, a grief reaction turns into depression.

Depression: Treatment

One in three people will develop depression in their lifetime. According to statistics, there are currently more than four million people affected in Germany. In the best case, treatment for depression is started as quickly as possible, because those affected suffer greatly from their condition. In addition, therapy becomes more difficult over time and the risk of the disease becoming chronic increases.

Depending on the severity of the illness, depression is usually treated with psychotherapy, antidepressant medication, or a combination of both. Combination therapy is particularly indicated for chronic and recurrent depression. Experts also recommend a combination of both treatment approaches for severe depression.

Psychotherapy for depression

Psychotherapy requires months of patience and commitment from the patient. However, those who engage in it can often overcome their depression in the long term and improve their mental stability overall.

There are many psychotherapeutic options for people with depression. The health insurance companies cover the costs for psychotherapy based on depth psychology , analytical psychotherapy ( psychoanalysis ) and systemic therapy (since July 1st, 2020).

Classic psychoanalysis and psychotherapy based on depth psychology belong to the psychodynamic psychotherapies. They are based on the idea that depression is often triggered by experiences of loss and hurt that cannot be properly processed. These should be worked through in the course of therapy.

Cognitive behavioral therapy – an extension of classic behavioral therapy – is also paid for by health insurance for depressive patients. The prerequisite is that the treatment is carried out by a licensed medical or psychological psychotherapist. With the support of the therapist, the patient looks for ways to get out of the depression. Among other things, negative thoughts, patterns and beliefs are uncovered, checked for accuracy and, if necessary, replaced by new, more positive ways of thinking.

Other forms of psychotherapy for depression

Interpersonal therapy (IPT) is a short-term therapy method that was specially developed for the treatment of depressive disorders. It combines therapeutic concepts from behavioral therapy and psychodynamic therapy. An important goal of therapy is to learn skills and strategies for dealing with conflicts that contribute to the development or maintenance of depression.

However, the costs for the ITP are not yet covered by health insurance companies. This also applies to various other forms of therapy such as family therapy, gestalt therapy or art therapy. However, they are often offered as supportive therapies as part of inpatient treatment.

Psychoeducation, ergotherapy , groups of relatives, learning relaxation techniques as well as body and movement-related therapies are also offered as additional therapeutic measures for depression

Depression: therapy with medication

Antidepressants are usually prescribed for more severe depression or when the patient refuses psychotherapy. It can be used to successfully treat the symptoms of depression. However, the effect of the medication often only sets in after a few weeks.

In addition, there is no guarantee that the medication will have the desired effect. Everyone reacts differently to the active ingredients: Some people benefit greatly from antidepressants, while others hardly have any effect or the patients mainly feel the side effects.

If the medication is stopped, there is a risk of a relapse – especially if it is done abruptly. Therefore, do not stop taking antidepressants on your own, but discuss the procedure with your doctor!

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRI) or serotonin-norepinephrine reuptake inhibitors (SNRI) are currently used to treat depression. They increase the level of the “happiness hormone” serotonin in the brain and thus have a mood-enhancing effect. These drugs have significantly fewer side effects than older drugs. Typical side effects are nausea, inner restlessness and sexual dysfunction.

SSRI effect in depression
SSRIs block the reuptake of serotonin into nerve cells. This increases the content of the messenger substance in the brain fluid. The free serotonin can thus increasingly bind to suitable receptors and have a positive effect on mood.

Tricyclic antidepressants

Tricyclic antidepressants are among the oldest medications used to treat depression – they have been around since the 1950s. They inhibit the reuptake of serotonin and noradrenaline, but also of histamine and acetylcholine. As a result, they have severe side effects such as dry mouth, tremors, fatigue and constipation . Cardiac arrhythmias and an increased heart rate can also occur, especially in older people. Tricyclic antidepressants are therefore almost only prescribed when newer drugs are not effective against the depressive symptoms.

monoamine oxidase inhibitors

Monoamine oxidase inhibitors (MAO) have also been used to treat depression for a long time. They have side effects similar to those of tricyclic antidepressants.

Particular care should be taken with tranylcypromine. This compound requires a strict low-tyramine diet. Tyramine is found, for example, in dairy products, wine, sausages and convenience products. If a patient being treated with tranylcypromine does not avoid foods rich in tyramine, serious side effects such as high blood pressure can occur.

Other medications for depression

Although lithium is not a classic antidepressant, it is often used as a mood stabilizer in depression. It works by affecting signal transmission in the brain. It should also reduce the risk of suicide. Lithium is often given as a supplement to antidepressants when they are not working as desired. However, patients with kidney or heart disease should not take lithium.

St. John’s wort supplements can help with mild to moderate depression. However, the possible interactions with other drugs are problematic. For example, St. John’s wort impairs the effect of contraceptive hormone preparations and reduces the effect of drugs for blood thinning and for the treatment of epilepsy. As a side effect, taking St. John’s wort preparations can lead to photosensitization of the skin – the skin reacts more sensitively to sunlight, so it is more susceptible to sunburn , among other things .

electroconvulsive therapy

Electroconvulsive therapy can often be used to treat depression where medication and psychotherapy fail. A brief “epileptic seizure” is triggered by electrical impulses under short-term anesthesia. This idea may be frightening at first. In fact, however, the patient is not aware of the procedure and the risks are low.

awake therapy

For awake therapy, patients must remain awake the second half of the night or all of the night. Although this method cannot cure depression, it can relieve the symptoms in the short term. Patients are feeling well for the first time in a long time, but for a short time. Not only is this an enormous relief, it also gives them hope that they can actually overcome their depression. And a hopeful attitude contributes a lot to the success of the therapy.

Repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation is a new technique to consider when depression cannot be treated with medication. Various areas in the front right or left hemisphere of the brain are stimulated by magnetic fields. This non-painful treatment is carried out in a clinic for ten to 30 minutes a day for three to six weeks.

Depression – help for self-help

Recent studies come to the conclusion that offers of help without direct contact with the therapist can also be helpful. One option is self-help guides. Those affected can read a lot of information themselves and only occasionally have contact with an expert who supports them. This can help to bridge the waiting time until therapy, for example.

Internet-based therapies and apps

Another option for people with depression is professional counseling via the internet. The therapy is carried out using a special computer program. There are now also so-called depression apps and chatbots that make it easier to deal with depression. They are based on elements of cognitive behavioral therapy.

Exercise as an antidepressant

Get out of the house, get out of the depression! Experts recommend regular exercise for depression. This can significantly reduce depressive symptoms – both in the short term and in the longer term. In fact, regular exercise can work as well as an antidepressant. Because it reduces stress and can possibly have a positive effect on the level of messenger substances in the brain (eg serotonin and norepinephrine).

However, the psychological effect of sport could have an even greater effect: through physical activity, the patients get out of the spiral of listlessness and withdrawal. They experience that they themselves can do something for their mental well-being. Self-esteem is strengthened and hopelessness suppressed. Anyone who does sport in a group also benefits from the sense of community and social contact, which is otherwise becoming increasingly rare in the case of depression.

Inpatient or outpatient therapy for depression?

A mild or moderately severe depressive phase can often be treated with outpatient psychotherapy. A stay in a clinic is necessary, especially in the case of severe depression. The combination of drug treatment, a wide range of psychotherapeutic therapies and intensive care in the clinic helps patients to return to a structured daily routine.

If there is a high risk of suicide, depressed people can be admitted to a clinic against their will.

Dealing with depressed family members

Do you have the impression that someone close to you is suffering from depression? Then you should encourage him to talk to a doctor about it. If the person concerned lacks the drive to do this, you may be able to take over the organization and possibly even accompany them. It is important to act quickly! Depression usually doesn’t go away on its own and is more likely to get worse if left untreated.

But also take care of yourself: Supporting a depressed relative is extremely exhausting. The gloomy mood, listlessness and loss of interest – also towards partners, family and friends – of the affected person can severely impair their own zest for life. Normally, a relationship is based on mutual give and take. But now you have to give the person concerned patience, attention and support without getting much in return – and perhaps without the situation improving significantly quickly.

This is distressing and frustrating. Therefore, it is quite normal for loved ones of depressed people to feel helpless and angry while at the same time feeling guilty. Allow yourself these feelings. Not only your relative is affected by the disease, but you too!

As a relative, you should therefore seek help. First, find out about depression. A deeper understanding of the background and mechanisms of the disease is very important for dealing with the disease properly. Only then can you understand that it is not possible for a depressed person to “pull himself together” and that attempts at encouragement cannot help.

Self-help groups for relatives also provide assistance. You can find offers on this on the website of the Federal Association of Relatives of Mentally Ill People eV at www.bapk.de.

You can read about what else you can do to help your loved ones and protect yourself from burning out in the Depression – Relatives text .

Depression: causes and risk factors

How depression develops has not yet been fully elucidated. However, it is assumed that several factors always play together – internal and external. These include biological, genetic and psychosocial triggers. The extent of the influence of the various factors varies from case to case.

risk factors for depression
Usually several factors lead to the development of depression.

Genetic Influences

Twin and adoption studies have shown that depression also has a genetic root. The risk of developing depression is 50 percent higher if other first-degree blood relatives already have the disease. So if a mother has a depressive disorder, for example, this is a risk factor for the child – especially if the disorder started at an early age.

If, for example, an identical twin falls ill with depression, the other will also develop depression in around 40 percent of the cases. In the case of dizygotic twins, this happens about half as often, ie in 20 percent of the cases. To a certain extent, depression is hereditary.

Vulnerability – Susceptibility to depression

Vulnerability describes how susceptible a person is to a mental disorder. In people with high vulnerability, even a little stress can lead to depression. If, on the other hand, vulnerability is low, people can also cope well with very stressful events. Such people are called resilient. Not only the objective severity of the stress decides whether a person suffers from depression.

The experiences that a person has made in his life also have a significant influence. For example, people who have experienced traumatic experiences such as abuse or neglect in childhood have a particularly high risk of developing depression. But it is also crucial which skills a person has acquired in order to cope with stressful situations.

Disturbed messenger metabolism in the brain

Nerve cells in the brain communicate with each other via electrical impulses and messenger substances, so-called neurotransmitters. There are indications that this so-called cerebral metabolism is altered during depression.

A disturbed norepinephrine or serotonin level in the brain tissue could be partly responsible for depression. If these messenger substances are not in balance, this disrupts the exchange between the nerve cells. And that in turn affects feelings and thoughts negatively.

The effect of antidepressant drugs such as serotonin reuptake inhibitors suggests that the neurotransmitters in the brain actually play a role in depression. So far, however, this hypothesis has not been able to explain why it usually takes weeks for the drugs to take effect.

Misregulated stress hormones

Other approaches to explaining the cause of depression focus on a dysregulation of the stress hormones adrenaline , noradrenaline and cortisol. In particular, depressed people have been found to have elevated cortisol levels. Such a depression can be both a trigger and a consequence of it.

stress as a trigger

Stress plays a crucial role in the development of depression. Conversely, depression itself also causes stress – for example because the illness loses a lot of quality of life, one’s own job can no longer be practiced or tensions arise with one’s social environment.

Some life bunnies are inherently associated with increased stress. This includes, for example, puberty or retirement. In such phases, the risk of depression increases.

Significant life events are also stressful. This includes negative experiences such as job loss, separation or a serious illness. However, positive events also cause stress: The likelihood of developing depression increases when you get promoted, have a child or get married.

In fact, people with depression often report difficult events before the onset of the illness. In many other cases, however, depression appears to appear out of nowhere.

negative thought patterns

It’s not always fate or genes: personal attitudes towards life also have an impact on the risk of depression. People who think badly of themselves and the world and see pessimism about the future are more likely to become depressed. Good self-esteem and optimism, on the other hand, protect against depression.

Negative thought patterns and ideas can be positively changed through appropriate exercises.

Female gender

Women are about twice as likely to suffer from depression as men. One possible explanation is that women are more at risk due to hormonal fluctuations.

Such hormone fluctuations occur, for example, in the course of the menstrual cycle. Pregnancy also brings with it strong hormonal changes – and in some women they result in pregnancy depression . The so-called postpartum depression also affects many women.

Low socioeconomic status is also a risk factor for depression – and more women live in poverty than men.

In addition, depression is less common in men. Some are reluctant to show weakness and seek help. However, they also sometimes have atypical symptoms such as aggressive and excessive behavior, which makes diagnosis difficult.

Physical illnesses and depression

Some physical illnesses can promote depression. Diseases of the brain and hormonal imbalances in particular affect the emotional world. The latter include hypothyroidism and hyperthyroidism , but also what is known as Cushing’s syndrome , in which the adrenal glands release excessive amounts of cortisol – the result is often a depressive phase.

Serious and chronic illnesses are also a constant burden on the psyche. People who suffer from cancer, severe cardiovascular diseases or diabetes often develop depression. It is also possible that the drugs used for treatment or physiological processes associated with the disease increase the risk of depression.

Conversely, depression can adversely affect the course of such diseases or, in some cases, even promote their development. With such a combination of physical and mental illnesses, it is always important to treat the mental and physical suffering equally.

depression and somatoform disorders

In addition, depression promotes so-called somatoform disorders. These are chronic complaints for which no organic cause can be found. This includes primarily pain, for example in the area of ​​the back, abdomen or joints. But digestive disorders, heart problems or breathing problems can also be somatoform.

Additional mental illnesses

People with depression often suffer from other mental disorders. These include

  • anxiety disorders
  • obsessive compulsive disorder
  • alcoholism
  • personality disorders
  • eating disorder

Winter depression: lack of light as a trigger

Some people are only depressed in the dark season – but every year again. Depression in winter is one of the seasonal affective disorders (SAD). Those affected report a lack of drive, loss of interest and depression – symptoms that also occur in classic depression. In the case of winter depression , however, they are usually milder.

A pronounced need for sleep and a craving for sweets are also typical of winter depression. This is why people with winter depression tend to gain weight in the winter months.

The cause of the disorder is suspected to be the lack of daylight, to which some people are particularly sensitive. In the dark, the body releases larger amounts of the sleep hormone melatonin . This hormone not only makes you tired, it also depresses your mood.

If you want to learn more about the causes, symptoms, and treatment of this disorder, read the article Winter Depression .

medicines and drugs

Taking certain medications can also affect mood. These include cardiovascular drugs such as beta blockers, but also cortisone and related substances, hormonal contraceptives and some neurological drugs such as antiepileptics and antiparkinson drugs.

Drugs such as alcohol, cannabis and other substances that influence the psyche can also promote the onset of depression.

Depression in children and adolescents

Depression also affects young people: around one to two percent of children of preschool and primary school age and three to ten percent of young people between the ages of 12 and 17 suffer from it. In rare cases, even very young children become ill.

But how does depression manifest itself in children? Unfortunately, symptoms such as sadness and withdrawal are quickly classified as hypersensitivity that goes away on its own. In addition, depression often manifests itself differently in children than in adults. Some of the little ones throw tantrums, others are extremely clingy. Younger children in particular often find it difficult to describe their feelings. They then complain, for example, of stomachaches or headaches , although the soul is actually suffering. All of this makes the diagnosis difficult.

Recognizing depression in teenagers is also not easy. Melancholy and moodiness are considered normal side effects of puberty. In some cases, however, there is a depression that requires treatment. Because puberty as a time of upheaval with hormonal turbulence and stress makes young people particularly susceptible to depression.

You can find out more about how depression manifests itself in children and adolescents and how those affected can be helped in the article Depression in children and adolescents .

old age depression

For many people, growing old is a process that entails losses above all: Retiring from professional life and the feeling of no longer being needed plunges many into a void. The partners or good friends die. Physical performance decreases and various ailments and illnesses appear. All of these changes can weigh on those affected and cause them stress. This is why the risk of depression increases with age. About 15 percent of people over the age of 65 are depressed.

But this is often overlooked: 40 percent of depression in old age remains undiagnosed. Social withdrawal, exhaustion and depression are all too easily misinterpreted as the result of natural aging processes. Symptoms such as lack of concentration and forgetfulness are often hastily classified as the onset of senile dementia.

If you want to learn more about how depression affects older people and what to do about it, read the post Depression in Older People .

Depression: investigations and diagnosis

If you are concerned that you are suffering from depression, you should urgently contact your family doctor or a psychiatrist or psychotherapist directly. Depression is a serious condition that should be treated as early as possible. The sooner therapy begins, the better the chances of recovery!

anamnese

The doctor will first talk to you in detail to collect your medical history (anamnesis). The following questions, aimed at typical symptoms of depression, can be part of this initial consultation:

  • Has your mood often been depressed or depressed in the past few weeks?
  • Have you often felt unhappy lately?
  • Have you often been listless and tired lately?
  • Have you had a lot of self-doubt, guilt, or negative thoughts lately?
  • Do you suffer from insomnia?
  • Have you had trouble concentrating lately?
  • Has your appetite changed recently?
  • How long have these symptoms lasted?

The diagnosis is more difficult when physical symptoms are the main focus. Many patients complain of headaches, backaches, abdominal pains and cardiovascular problems. Describe all your symptoms to the doctor in as much detail as possible.

Talking about physical symptoms is easier for many people than talking about mental problems. Men in particular often emphasize the physical signs more and go less into their mental symptoms.

Physical exams

Physical causes of the symptoms can be ruled out using various examinations. This includes a blood test and possibly also a computed tomography (CT) of the brain. Because sometimes depressive symptoms can be traced back to, for example, low blood sugar levels, a lack of vitamin B12 , substance abuse, dementia , hypothyroidism or changes in the brain.

If the suspicion of depression is confirmed, the doctor will refer you to a specialized clinic or an outpatient psychiatrist or psychotherapist.

depression and other illnesses

Depression often occurs in combination with various other mental illnesses and disorders. It is important to recognize these in depression. Because the therapy can only be successful if the other mental problems are also treated. Mental illnesses associated with depression include:

  • anxiety or panic disorders
  • addictions
  • eating disorder
  • personality disorders
  • dementia diseases

Some physical illnesses are also often associated with depression. Physical and mental stress seem to reinforce each other. These include above all

  • cardiovascular diseases
  • diabetes

diagnosis depression

The diagnosis of a (clinical) depression requiring treatment is made after other causes have been ruled out on the basis of the International Classification of Diseases, ICD 10. Depression is attested if certain requirements regarding the type and duration of the symptoms are met. You can read about them in the next section.

Depression: definitions and explanations of terms

What is meant by depression has changed fundamentally several times over the course of time. Since outdated ideas of depression are still in circulation, this is often confusing.

Definition of depression today

One speaks of a depressive episode when two of the three main symptoms (dejection, loss of interest and reduced drive) and two of the seven additional symptoms (eg feelings of guilt, sleeping disorders or problems concentrating) occur for at least two weeks.

Experts today classify a depressive episode as mild, moderate or severe depression according to its severity and course.

In English-speaking countries, the depressive episode is referred to as “major depression”.

Endogenous and exogenous depression

A few years ago, depression was divided into endogenous and exogenous depression, depending on the suspected causes. These terms are no longer common in the professional world, but are otherwise still widespread.

An “ endogenous depression ” was understood to be a depression without a recognizable external trigger or organic cause. This form of the disease was attributed to altered metabolic processes in the brain, for example due to a corresponding genetic predisposition.

If, on the other hand, a specific trigger for a depression seemed to be recognizable, one spoke of an ” exogenous depression “. The term “reactive depression ” or “ depressive reaction ” was also frequently used. When mental stress was assumed to be the cause of reactive depression, this was referred to as “ psychogenic depression ”.

Depression or Adjustment Disorder?

Today we speak of adjustment disorders when current mental stress triggers depression. Such a burden can be the death of a loved one or unemployment.

In such cases, depressive symptoms such as sadness, hopelessness and listlessness are a natural reaction. For some people, however, they become overwhelming. Social behavior disorders are also common.

The symptoms of an adjustment disorder usually subside after six months at the latest. However, the disorder can also progress to long-term depression.

Recurrent depressive disorder

Depression recurs in around two-thirds of patients. There may be months between the episodes, but also many years.

If depression flares up again and again, it is difficult for the patient to bear. Your life will be severely restricted. They are often no longer able to practice their profession. Their social relationships also suffer from the recurring depressive phases and can break up as a result.

The more frequently depressive phases occur, the more likely it is that there will be another relapse. Women are more likely than men to have depression again. The risk is also increased for patients who develop depression at a young age or later in life.

Chronic depression and dysthymia

For some people, depression does not progress in phases, but those affected suffer from depressive symptoms continuously. However, the symptoms are usually less pronounced than in an episodic course. Doctors refer to this as dysthymia. It is characteristic that those affected suffer from depressive symptoms consistently or regularly over a period of at least two years.

This form of the disease begins early in adult life and lasts for years. There are many possible triggers. However, research shows that patients with chronic depression have had traumatic experiences such as abuse more often than other depression patients.

Unfortunately, this form of depression is often not recognized – even those affected often find their persistent depressed mood normal. This also makes it difficult for them to recognize that they are actually ill. Nevertheless, even a less severe chronic depression significantly affects the quality of life, performance and social life of those affected. It should therefore definitely be treated. Cognitive behavioral therapy can also help here. Drugs are even more effective in this form of depression.

You can read more about the signs and treatment of this form of the disease in the text Dysthymia .

Bipolar Disorder

As soon as manic phases appear in addition to the depressive phases, a bipolar disorder is present. This is also one of the affective disorders, but is not depression. Rather, those affected oscillate between two emotional poles: depressive phases with depression and alternate listlessness with manic phases characterized by extreme euphoria, overconfidence and excessive actionism. Bipolar disorder is often more difficult to treat than classic depression.

Agitated depression

An agitated depression expresses itself in anxious drive. Those affected walk around restlessly and complain of shortness of breath and tachycardia. An agitated depression is therefore also referred to as “jammer depression”.

While depressed people tend to have trouble pulling themselves together to do anything, people with agitated depression have a constant urge to move. Her behavior is hectic and aimless.

Atypical depression

In contrast to the classic form of depression, the mood in atypical depression can be improved by positive events. Other signs include increased appetite and a strong need to sleep during the day. Those affected are often very theatrical and are easily offended.

Atypical depression is not uncommon. About 15 to 40 percent of depressed patients are affected. In addition, this depressive disorder occurs predominantly in women.

Depression: disease course and prognosis

Depression progresses very differently from person to person. However, most people who suffer from depression can be helped with consistent treatment. This also applies to older people! The therapy makes it possible to break through depressive episodes or to let them subside completely. It is possible to heal depression!

If left untreated, however, there is a high probability that depression will persist for months or years. This is especially true for major depression. The earlier treatment is started, the better the outlook.

A third of those affected experience a depressive episode only once in their life. The chances of this happening are particularly good if they are treated adequately at an early stage. With each relapse, however, the likelihood of further depressive phases occurring increases. Chronic depression is particularly difficult to cure. They often become lifelong companions and require constant treatment.

Suicide risk in depression

About ten to fifteen percent of people with depression take their own lives. This risk is particularly high for patients with chronic or very severe depression.

A comorbidity, for example with an anxiety disorder, often complicates the treatment of depression. In patients who also suffer from an anxiety disorder, the disease often develops unfavorably. It is also unfavorable if depression occurs at a young age and if the patient does not have sufficient social support.

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