Clinical depression can be cured
depression (Dysthymia, in contrast to the special case of reactive depression, also called endogenous or depressive neurosis): Most common and at the same time very severe affective disorder. The sick person experiences the world “gray on gray”, he is depressed, depressed, feels nothing for anything. The diagnosis “depression” is made if the symptoms persist for more than 14 days. Depression occurs most frequently as the first illness between the ages of 30 and 40. If the depression is cured, the depressive episode remains - but many sufferers experience one or more relapses every one and a half to five years. In old age, depression is the most common mental disorder, often accompanied by chronic illnesses or the consequence of them (e.g. immobility). The risk of suicide is particularly high in old age.
About 15% of all people suffer from depression that requires treatment at least once in their life. Women and old people are affected twice as often as men and young people. The danger of depression is the high risk of suicide: half of all suicides are committed by depressed patients. Mainly for this reason, depression is often initially treated as an inpatient. Once the acute phase is over, 80% of those affected manage to cope with everyday life again, but usually only after months of therapy. In the long term, there is often a risk of relapses.
Depressive disorders often accompany chronic physical illnesses such as cardiovascular diseases, severe allergies, pain syndromes (such as fibromyalgia), tumors, multiple sclerosis, diabetes mellitus or dementia. Depression also occurs with chronic mental illnesses, such as anxiety and personality disorders. Clinical experience shows that adequate treatment of the depressive symptoms can also have a positive effect on the treatment of the underlying disease - and vice versa.
Depressive moods must be distinguished from depression, which are viewed as pathological changes in mood, but which usually pass without therapeutic help.
A borderline case is that reactive depression: Here the depression fulfills all diagnostic criteria and shows the typical leading complaints (see below), but the trigger is clearly an external one. Reactive depression includes traumatic grief reactions, postpartum depression and postpartum psychosis and depression as a result of another psychiatric illness such as B. a post-traumatic stress disorder. Reactive depression is also characterized by a high risk of suicide, but relapses are much less common with the right therapy (except for postpartum psychosis).
Another borderline case is the depressive personality disorder, which is very common and characterizes passive-anxious and overadaptive people. Although this personality disorder, insofar as it is perceived as a disease at all, does not have the main complaints of depression, those affected often have depressive episodes more often than not.
The larvae depression is a depressive condition that hides behind the mask (larva) of physical complaints. The focus here is not on the depressive mood, but on a variety of physical complaints: headache and stomach ache, dry mouth or heart problems. The masked depression is not an independent clinical picture, basically its diagnosis is only possible retrospectively: Because once a depression is recognized as such, it is inevitably no longer "masked".
Fibromyalgia must be differentiated diagnostically from larvae depression, as the symptoms are very similar.
The terms neurotic depression or depressive neurosis, which were often used in the past, have been so inconsistently defined that they have not been abandoned in medicine as a whole, but within psychiatry.
- Loss of interest
- Loss of pleasure in otherwise pleasant activities
- Loss of sexual interest
- Feeling of inner emptiness
- Lack of drive, increased fatigue
- Decreased focus and attention
- Decreased self-esteem and self-confidence
- Feelings of guilt, feelings of worthlessness
- Fear of the future, lack of perspective in life
- Suicidal thoughts and attempts
- Significantly reduced appetite
- Waking too early in the morning
- Mood in the morning, improvement during the day
- Strong physical tension or great nervousness
- Weight loss
When to the doctor
In the next few days if the condition of the person concerned worsens and is hardly bearable or has already gone through depression in the past and is now threatened with relapse. If an additional burden (conflict, bad event) emerges, which the patient can only cope with with difficulty, this is also a reason to visit the doctor in the next few days.
Immediately if Tormenting suicidal thoughts occur, suicidal intentions are expressed or preparations are made (e.g. tablets are collected) or the person concerned harms himself by e.g. B. his job is endangered by inappropriate behavior or unexcused absenteeism.
In general practitioners or internal medicine practices, depression is often recognized late or not at all: instead of confiding in their general practitioner with their worries and fears, the patients mostly talk about physical complaints. The family doctor would be the right person to talk to who can be taken into confidence in the event of psychological problems. Of course, those affected can also contact psychotherapists or psychiatrists directly.
What creates Depressions? Who is particularly susceptible to this? As is often the case in psychiatry, the interplay of several factors is the key to understanding.
www.salevent.de, Michael Amarotico, Munich
The cause of the development of depression seems to be the complex interplay of various factors:
Genetic factors. Hereditary predisposition probably plays a role, as the disease occurs more often in families. Close relatives of patients with depression fall ill three times as often as relatives of healthy people. The hereditary predisposition leads to a disruption of the interaction of certain transmitter substances in the brain (neurotransmitters). There is supposed to be a deficiency in the “happiness hormone” serotonin and an excess of the opponent norepinephrine. Psychosocial factors. Lonely people are more likely to suffer from depression than people who have strong support from close family or friends. In addition, certain personality traits such as overaccuracy, insecurity, excessive expectations and self-sacrifice seem to favor the development of depression.
The first depressive episode is often preceded by stressful life events: loss of job, death of a relative, financial collapse, conflicts in the family. It seems to be particularly critical when such events take place in quick succession and the person concerned does not have time to catch himself again. In the further course of the depressive illness, however, the connection between the external events and the depression can often no longer be recognized, the illness seems to "take on a life of its own" and psychotic symptoms such as delusions and hallucinations can occur. Many sufferers no longer perceive themselves and their surroundings as positive during the depression: They feel worthless, superfluous or guilty. The patients no longer have any hope of recovery. Going on life sometimes seems so unbearable or pointless to them that suicide appears as a last resort.
Up to two thirds of patients regain their old performance levels after antidepressant therapy. However, within five years of stopping treatment, about 60% of patients have relapses that require further therapy. Studies show that 15-25% of patients develop permanent illness (chronification) with symptoms lasting two years or more.
The doctor does that
The doctor's assessment that a patient has a depressive disorder is based on the main complaints and also the external circumstances - such as B. Long sick leave - usually to be met quickly. However, the diagnosis of "depression" requires a lot of medical experience and care because the differential diagnosis is difficult. Many depression is a side effect of another illness, e.g. B. An anxiety disorder, eating disorder, addiction, personality disorder or part of a manic-depressive illness. Organic diseases, e.g. B. the thyroid, can simulate depression. In all of these cases it is of great importance to know the causal clinical picture in order to be able to treat.
The therapy of depression is based on the pillars of psychotherapy and antidepressants, other methods such as light therapy or sleep deprivation are added. It is difficult to make the decision whether therapy should be carried out on an outpatient or inpatient basis. It depends on the severity of the depression, the assessment of the risk of suicide and the social environment of the sick person. However, a hospital admission is always required in the following situations:
There is a risk of suicide The depressive symptoms are very severe The condition worsens during outpatient treatment There are particularly stressful factors in the patient's environment (e.g. crisis in the partnership, sole provider) or he is unable to cope with everyday life.
The duration of treatment is 1–2 weeks for acute reactive depression, and several weeks to months for severe, slowly improving depression.
Psychotherapy. Psychotherapeutic treatment makes sense for all forms of depression: In studies on the success of therapy, methods such as cognitive behavioral therapy have proven to be particularly effective in overcoming the view of depressed people (cognitive triad): the negative view of oneself, one's environment and the future. First, negative, "automatically" recurring thoughts are identified with the help of daily logs. These basic attitudes are analyzed and replaced by alternative attitudes and interpretations, e.g. B. by deliberately distancing yourself from negative thoughts or positive reinterpretation by z. B. not always seen as a catastrophe, but also as a challenge.
The Interpersonal psychotherapy (IPT) is a short-term therapy with a total of 10–20 sessions that take place once a week and was specially developed for the treatment of depression. Based on the observation that depressive illnesses always take place in a context with other people, the IPT deals with the current interpersonal relationships of the patient. The focus of treatment is on coping with relationship problems that are related to the occurrence of depression: These can be partnership conflicts, the loss of a trusted person or a change in lifestyle. The aim of the therapy is both to alleviate the symptoms of depression and to cope with relationship difficulties. The therapist takes on an active and supportive role; a standardized procedure is followed. After it has been proven that IPT is an effective therapy for depression, various special programs have now been developed, such as B. IPT-LL (Late Life) for the treatment of older depressed patients.
In addition to IPT, expressive procedures such as art, dance or music therapy are also tried and tested therapies for depressive symptoms. They are traditionally offered in inpatient and semi-inpatient facilities, and in recent years increasingly also in the outpatient area.
Psychotropic drugs. The drug treatment takes place with antidepressants, the mood-enhancing, activating or - z. B. with strong fears and sleep disorders - have a calming effect. The choice of suitable substances is a matter of medical experience. It should be noted that it takes several weeks for the drug to take effect. Only then can the doctor determine whether he has chosen the correct remedy and the correct dosage. Some antidepressants first increase drive and only then improve mood. In this intermediate phase, patients may be at greater risk of suicide. In order to avoid a flare-up of the depressive symptoms (relapse), the treatment should be continued for several weeks to months even after the depression has subsided (Maintenance therapy). Years of treatment may be required for patients with chronic depressive moods.
Severe depression usually has to be treated with antidepressants. Use is mandatory at least if the patient is not motivated to therapy and is lonely and absent from close caregivers, as well as if the depression worsens - and of course if the patient expressly requests it.
Antidepressants are not absolutely necessary for mild depression. Herbal, mood-enhancing drugs such as St. John's wort are helpful. In a meta-analysis of 29 studies, St. John's wort has proven to be just as effective as synthetic antidepressants in mild depression, while at the same time being better tolerated. A regular intake of 600 to 900 mg per day is important. The onset of action occurs after two to four weeks. Prescription drugs should be used because many over-the-counter medicines containing St. John's wort are too low in doses and their effectiveness has not been proven.
Electroconvulsive therapy. In the case of therapy-resistant, severe depressions, this is Electroconvulsive therapy (ECT) is often the only effective help for the patient. The cramps cause neurochemical changes to the nerve cells in the brain. The result: The patient is torn out of his psychotic or severely depressed state. The ECT is carried out as a series of eight to twelve treatments, usually two to three days apart. The success rate of electroconvulsive therapy in these cases is between 50 and 75% and is now carried out under anesthesia and with medicinal muscle relaxation, so that the strong cramps that used to be common with possible bone fractures do not occur. Contrary to popular belief, it does not lead to personality changes. A common consequence of ECT, however, is a slight memory impairment, which, however, disappears within a few weeks. Irreversible brain damage occurs in up to ten cases in a million treatments. Even after successful electroconvulsive therapy, the drug must be continued, otherwise there is a risk of relapses.
Due to shocking individual reports in which electroconvulsive therapy was used to discipline the mentally ill, ECT has a bad image. However, experts advocate an unbiased and rational use of electroconvulsive therapy. Because the alternative to treating the most severe depression, multiple therapy with different psychotropic drugs, is an equally invasive procedure and not really “gentler” for the patient.
Magnetic convulsion therapy. Magnetic convulsive therapy (MCT) is a suitable alternative to ECT or multiple therapy with psychotropic drugs. Two magnetic coils are attached to the patient's head, which generate a strong magnetic field one hundred times a second. This triggers a seizure in the brain. The MKT works like the EKT, but is based on a different principle. In addition, an MCT is less stressful. Symptoms such as dizziness or headache and muscle pain, which patients report after an ECT, do not occur with MCT. Like ECT, doctors perform magnetic convulsion therapy under anesthesia. It is also of particular benefit to therapy-resistant patients.
Sleep deprivation. Regardless of whether total sleep deprivation (awake all night) or partial sleep deprivation (woken up around 1 a.m.) is carried out, many mentally ill people experience a significant improvement in mood on the following day. The sleep deprivation (Waking therapy) is well suited for patients with depression; every second person benefits from it. The effect usually only lasts for a short time, but even this minimal improvement means a great deal of relief for many patients and is also free of side effects.
Ketamine infusion. The anesthetic ketsmin can provide rapid help in the event of severe suicidal ideation or acute mania. Given a cycle of three infusions per week, 60% of patients report improvement.
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Seek professional help.
The best self-help for depression is to seek help from a psychiatrist in a timely manner. If you don't know anyone, family doctors or gynecologists are the first point of contact, who often have advanced training in basic psychotherapeutic care, which enables them to have an initial consultation.Many depressive patients prefer to walk this route because they are afraid of psychiatry. With today's antidepressants and the possibilities of psychotherapy, however, only some of the patients are admitted to the hospital. The most important thing, however, is to first get clarity about what is missing. That alone often has a healing effect.
Creative methods such as art therapy help depressed sufferers to express feelings and then talk about them. Here is the picture of a depressed patient from her worldview.
Georg Thieme Verlag, Stuttgart
Don't be afraid to take weeks or months of sick leave. There is usually no alternative to this.
It is difficult to answer the question of whether one should communicate depression openly. On the one hand, employers do not always react appropriately when they hear about an employee's mental illness. On the other hand, many bosses know that depression is a serious illness that involves months of absence - and it creates understanding if you tell your boss or HR manager your diagnosis in a confidential conversation in good time (possibly also through your partner): You can then adjust to it better than if you get sick leave every week. Last but not least, you need the cooperation of your boss when you feel more or less able to work again. Because then it is important that you can take it slowly again (e.g. in the form of work attempts). To do this, the workplace has to be relieved of work pressure - which you usually cannot do on your own.
The stress on the spouses or the children of depressed patients is very great when they live with them. Research shows that over 40% of relatives need therapeutic help themselves over time. They suffer from the fact that the sick become more and more monosyllabic, no longer show any interest in joint ventures and attempts to help fail. Often there are also feelings of guilt that you have contributed to the depression through your own misconduct. And the fear that the sick person might harm himself is a constant and frightening threat.
That is why psychiatric and psychotherapeutic clinics, outpatient clinics and other providers offer discussion groups for relatives (psychoeducation).
www.kompetenznetz-depression.de - website of the Competence Network Depression (Spokesperson: Prof. Dr. Ulrich Hegerl, Leipzig). The site is not only aimed at sick people but also at people who feel at risk as well as anyone who wants to find out more about the disease. The information offered is supplemented by a self-test with evaluation, experience reports from those affected and a well-attended forum. U. Hegerl et al .: The mystery of depression - a disease is deciphered. C.H. Beck, 2005. The authors are professionals as well as a victim. The book explains the causes of the disease, the most successful treatment options and the problem of suicidality. G. Niklewski; R. Riecke-Niklewski: Overcoming Depression. Stiftung Warentest, 2005. Detailed information on the latest therapeutic approaches including drug options. L. Epstein-Rosen; X. F. Amador: When the person you love is depressed. How to help loved ones and friends. Rowohlt, 2002. The title speaks for itself: Many tips to help those affected without being infected by depression.
AuthorsGisela Finke, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:10
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