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Please note that health information can only support the conversation with a psychotherapist or physician: It should never be a substitute for it!

What is depression?

Having a bad day, feeling downhearted or just not feeling "in good form" over a certain period of time – who doesn't experience this? Depression, however, differs from these generally known dips in mood, even just through the symptoms themselves, which occur much more markedly. For instance, many people with depression report that they can no longer feel any joy at all, but only carry negative feelings in them and experience an inner emptiness. Recurrent thoughts about death and suicide often accompany depression.

If a person goes through the following situation over a period of at least two weeks, it might be an indicator of depression:

  • Feeling downhearted, depressed or having a subdued mood
  • Loss of interest in things that use to give joy
  • Lack of drive, increased fatigue

Accompanying these, further symptoms can occur, e.g. concentration and attention disturbances, lack of self-confidence, feelings of guilt and worthlessness, hopelessness, sleep disturbances or loss of appetite. Many people who are suffering from depression also suffer from various physical complaints such as headaches, digestive problems or sexual dysfunctions.

16 to 20 out of 100 people suffer from depression in the course of their lives

How frequent is depression?

16 to 20 out of 100 people suffer from depression in the course of their lives. Women are around twice as frequently affected as men. Moreover, people with a chronic physical illness (e.g. cancer, coronary heart diseases or diabetes) are, statistically speaking, more likely to battle with depression. Depressive illnesses can occur at any age, often in combination with a further mental illness such as an anxiety disorder. In every case, the symptoms should be discussed with a physician or psychotherapist.

Are there different forms or progressions?

Depressive illnesses mostly progress in phases over several weeks, or sometimes months. Often, more than one depressive phase occurs in the course of the illness.

In general, three levels of severity of depression are distinguished:

Mild depression
The sufferer can still cope with everyday life (e.g. job, leisure time, tasks in the family), albeit with great effort.

Moderate depression
The ability to work is already strongly limited. Social contacts are also cultivated increasingly less.

Severe depression
In this state, it is generally no longer possible to work, to perform household chores or to pursue leisure-time activities.

The division of the levels of severity is geared towards the number of signs or symptoms that are present. In a mild depression at least four out of a total of ten symptoms must be present, and in a severe depression at least eight.

"It can be a long road to recovery, but it is one that is worth taking."

Rolf S., experience of depression

Decision aid

How does depression emerge?

Taken into consideration for the emergence of depression are both biological factors (e.g. metabolic changes in the brain) and family conditions (e.g. parents with depression) as well as burdensome life events in the past (e.g. separations, death of an important person).


These factors result in a more or less high risk of becoming ill from depression. If current burdensome or far-reaching life circumstances (e.g. job loss, serious illnesses such as cancer) are added to this risk, they can trigger depression.

It is important to know that: Nobody suffering from depression is himself "to blame". This illness can affect anybody. The aforementioned examples (e.g. biological or family conditions) can make people vulnerable to depression. If it then breaks out, however, one might not even be aware of the reason, or understand why it has occurred now. Nevertheless, support from others (e.g. in a psychotherapy) can help to find out these reasons or to change areas in one's own life which foster or maintain the illness.

How do you find out if you are suffering from depression?

First of all, it is important to take depressive complaints seriously. If they persist for a lengthy period of time, a first appointment with a physician (generally the GP) or psychotherapist should be made. In a detailed conversation, he will then ask you about individual complaints, your general state of health, family history and about physical and mental illnesses. Possibly, he will also ask you to fill out a questionnaire.

This diagnostic interview is important in order to find out whether somebody is suffering from depression and how strong it is. Moreover, a physical examination, for instance by the GP or a specialist in internal medicine, is necessary. This will rule out whether a previously undiscovered illness, such as a thyroid disorder, is responsible for the depressive symptoms.

How is depression treated?

If you have a mild depressive illness, it is possible that you will get better without any specialist treatment. Nevertheless, it is recommendable to seek out a physician or psychotherapist who can accompany you during this time. It is recommended that you first of all observe together whether the complaints change. If the symptoms do not improve or get even worse after two weeks at the latest, supportive conversations, a general counseling, education about the disease, guided self-help (e.g. by self-help books or online programs) as well as problem-solving approaches can be helpful before a psychotherapy or treatment with antidepressants is started.

With moderate depressive illnesses, a physician or psychotherapist should offer either psychotherapy or treatment with antidepressants.

With severe and chronic-depressive illnesses, a combination of psychotherapy and antidepressants is advisable. If the depressive complaints nevertheless remain as severe, or increase, particularly with marked suicidal thoughts, an inpatient therapy in the hospital is necessary.

Particularly people with depression often have difficulties overcoming the step of seeking out a physician or therapist. Often, their thoughts are negatively distorted; they may feel hopeless and are unable to believe that they will ever feel better. The search for a physician or psychotherapist – which is often not simple – can be a first hurdle. We would like to encourage you to try to do this anyway. Sometimes it can help to set yourself very small goals, for example firstly looking for the number of a physician or asking family or friends for support. Our service telephone can provide you with support in your search.

What can friends and family do?

Family and friends should first of all inform themselves about depression. In this way they get to know the sufferer's situation better and understand how to assess his behaviour. Moreover, motivation plays a role in many respects. Family members can support the sufferer to seek professional help, to take his medication regularly and to stick to the appointments with the physician providing treatment or the therapist. Are there things that do the sufferer some good (e.g. sport)? Here too, support is very helpful – even if it is initially rebuffed. Family members should respect this but continue to give their attention to the sufferer.

At the same time, it is important not to forget about your own well-being. The depressive illness of a family member, good friend or work colleague is challenging for those around him. Space for other activities should equally be taken into account to enable you to cope with the situation. For this purpose, there are special offers such as counselling and self-help groups available.

Sources:

Ärztliches Zentrum für Qualität in der Medizin (ÄZQ) (2011). Wartezimmerinformation “Depression - Ratgeber für Angehörige“. Verfügbar unter www.patienten-information.de [Stand: 01.10.2013]

Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN), Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2011). S3 Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression. Verfügbar unter: www.awmf.org/leitlinien/detail/ll/nvl-005.html [Stand: 16.11.2015]

Loh, A. & Härter, M. (2007). Informationen für Patienten mit depressiven Erkrankungen. In M. Härter, I. Bermejo & W. Niebling (Hrsg.), Praxismanual Depression: Diagnostik und Therapie erfolgreich umsetzen (S. 77-80). Köln: Deutscher Ärzte-Verlag.

Written by:

Dr. Lisa Tlach (Psychologist), Dr. Sarah Liebherz (Psychological psychotherapist), PD Dr. Jörg Dirmaier (Psychological psychotherapist), Prof. Dr. Dr. Martin Härter (Physician and psychological psychotherapist)

Advisory Board:

Prof. Dr. Birgit Watzke, (Psychological psychotherapist), Dr. Claudia Lehmann (Psychological psychotherapist)

Date of creation: 15.06.2011
Date of last editing of content: 13.09.2016
Date of next editing of content: 13.09.2017