Depressed people mostly feel sad, powerless, passive and worthless. Every action and decision is difficult; some have difficulty speaking, thinking, remembering, and losing interest in what is going on around them. Many people begin to fear situations that they have previously managed without difficulty. Fear of the future and existence is also common.
The body reacts with sleep disturbances, more severe back pain, headaches, or digestive problems; the appetite and desire for sex are lost. Hopelessness, weakness, and fear often lead to the affected person withdrawing from their environment. In severe cases, depressive delusions can occur, and thoughts of death and dying are common. Suicide often becomes a central theme.
Who can be affected?
Almost everyone is depressed and "depressed" at some point.
There are many causes of ill health, and many times such a condition does not require influential experiences at all, such as job loss, divorce or death. Depressed mood can be caused by physical or mental under- and overload or even too little sunlight in winter.
The transition from these uncommon well-being disorders to medically functionally impaired depression is often difficult to determine. But unlike mental problems, in which life can still be managed, depression affects all aspects: thinking, feelings, and behavior change, physical health drops, and a normal life becomes impossible.
Experts distinguish two forms:
& # 8226; endogenous depressions occur independently of mental and physical illness,
& # 8226; reactive depressions are a “reaction” to problems.
Depression that needs to be treated is when the feeling of depression lasts for at least two weeks and if the following points occur:
& # 8226; malaise is stronger than usual, lasts most of the day (almost) every day, and is not affected by external circumstances;
& # 8226; interest and joy in activities that previously brought satisfaction, including sexuality, are lost;
& # 8226; it is difficult to "start the engine", the affected feel powerless and tired, sometimes they do not even have enough energy to get out of bed;
& # 8226; self-confidence and self-esteem are greatly weakened;
& # 8226; self-blame takes control, inappropriate and exaggerated ones appear for no reason
& # 8226; thinking is increasingly prone to death and suicide (sometimes even the first steps in this direction have already been taken);
& # 8226; affected people have difficulty thinking, gathering, remembering or apologizing;
& # 8226; affected people are very nervous, restless, unable to sit still, or move a little and more slowly;
& # 8226; sleep is disturbed;
& # 8226; the run is lost or becomes too large, resulting in a change in body weight.
Depressed men, in contrast to women, often express their depression with strong irritability and aggression.
Mild depression: at least two of the first three signs are present, and a total of at least four; a lot of effort is needed to get the urgent things done.
Moderate depression: at least two of the first three signs are present, and a total of at least six; signs prevent urgent things from being done.
Severe or severe depression: the first three and at least five remaining signs are present; as a result, it is almost never possible to control everyday life.
On average, one in six people suffers from a depressive disorder once in a lifetime; women twice as often as men. True depression is developed by 19 percent of women and 12 percent of men. The World Health Organization (WHO) believes that this disorder will become the most common cause of early retirement by 2020.
The number of depressions increases with age: 20 percent of people over the age of 65 are depressed, and children are becoming more and more depressed (which is often underestimated).
About half of those affected are healthy again after the first three months, a quarter can last up to a year, and 70 percent of those affected have recurrent periods of depression later in life.
Causes
There are various theories for the development of well-being. In general, alternating operations and comprehensive mutual reinforcement of various areas are envisaged today. These include:
& # 8226; biological genetic factors: other cases are much more common in families with depressed members; the tendency may increase from generation to generation;
& # 8226; body factors: in the brain of depressed people, too little serotonin and norepinephrine are secreted, which are responsible for nerve cell communication. There are also diseases that allow depression, such as thyroid dysfunction or Parkinson's disease. A possible explanation for why women are more often depressed is the balance of hormones. Depressive feelings before menstruation or immediately after childbirth are especially well known;
& # 8226; environment: in about a third of cases, depression occurs after a stressful life
events:
problems of overload in the family and profession, increasingly triggered! so " burn out & # 171; or dissatisfaction at work, followed by financial difficulties, loss / death of a loved one, or new life stages (such as retirement);
& # 8226; previous experience: psychological models see depression as a skin reaction to previously learned patterns of behavior. This is especially dangerous for people who do not see themselves as active shapers of their lives, which also explains the higher number of depressions in women, who are still mostly engaged in instruction-related activities. Depressed people already have a negative image of the world before they appear. They often attribute guilt to themselves, while they attribute success to luck or chance. They often interpret situations in a way that is less favorable to them. Many people are also achievement-oriented, self-centered and very aware of their responsibilities. Neurotic depression is thought to be caused by unresolved psychological conflicts. Milder forms of depression, which depend on the seasons, are thought to be caused or at least exacerbated by a lack of sunlight.
The following are more at risk of depression:
& # 8226; single people and people without social support, such as the elderly or even women who are double or triple burdened in marriage.
& # 8226; people with other mental illnesses, such as alcoholism, drug addiction or eating disorders; conversely, depression also allows these diseases to occur. It is also the cause of more depression in men who drown their problems in drinking.
& # 8226; those who are taking medication or have stopped taking it.
Depression weakens the general immune defenses.
If left untreated, there is a high risk of suicide: a large proportion of suicides are associated with depression. About half of the people in their lifetime attempt suicide at least once, and up to 15 percent of those affected end their lives prematurely. Men are radically predominant: in the case of suicide, the ratio between men and women is 4: 1 (the percentage is particularly high in older men), and in the case of unsuccessful suicide attempts, the ratio is exactly the opposite.
Everything, even unsuccessful suicide attempts, must be taken extremely seriously.
Can depression be avoided?
An effective anti-depressant is regular outdoor exercise. There are two factors involved: movement as such and daylight. Even ten minutes of light a day has a pleasant effect in autumn and winter.
Balanced, active and satisfied people find it difficult to throw even difficult life circumstances off the track than those who consider themselves powerless, self-critical, constantly dissatisfied or helplessly committed to the situation.
It is certainly difficult to get over the blows of fate, and mourning is also an important process that needs to be given enough time. But if life is called into question by a painful event, help must be sought.
Anyone who often sees life as gray and empty, is often sad or cannot cope with the blow of fate for a long time can try to achieve change with psychological help and thus more joy in life. However, endogenous depressions cannot be avoided for the time being.
What can those affected do themselves?
Even with mild depression, it makes sense to call a doctor and start therapy: the sooner treatment begins, the better the chances of a cure. Medications are often recommended to alleviate acute symptoms and prevent recurrence. When well-being improves and the successes of therapy are greater, paraleino begins to perform psychotherapy, which is not successful in the acute phase of depression.
Psychotherapy. Not every therapeutic method is suitable for everyone; it can take quite some time before the right method is found.
Cognitive behavioral therapy targets patterns of thinking and behavior to change the negative assessment of reality and oneself.
Family therapy methods deal with communication within the family and between the family and with the social environment. Deep psychological procedures are used to trace previous mental injuries and conflicts, and conversational therapies or non-verbal procedures are appropriate.
Movement and light. Depressed people are not active: for depressions caused by the seasons, and for milder depressions, outdoor exercise can work almost miraculously. Try a daily one-hour walk in daylight.
Another method to have enough light in the cold season is photo or light therapy with a special artificial light, which is very similar to sunlight. This light does not cause tanning.
St. John's wort in concentrated form is a proven effective natural remedy. “Natural” does not mean harmless: St. John’s wort, along with many medications such as heart medications, hormonal contraceptives, or epilepsy medications, can lead to unpleasant side effects. Therefore, you need to be extremely careful when using it and be sooner
talk to your doctor about it. St. John's wort tea does not work against depression.
Dealing with patients with depression. Often family members or friends notice the symptoms of depression in a timely manner: if those affected often cry, they cannot get up in the morning or drown in hopelessness. Dealing with such situations can be difficult and tedious. It is important to understand that those affected cannot easily come together and improve the situation, but that they have a serious illness that needs to be treated. It is in this place that the immediate environment can have a positive effect on the affected person: to notice and treat the symptoms seriously and to encourage the affected to take action and treat. Sometimes this requires very careful handling, as too much pressure and impatience only make the disease worse, and too much consideration can lead to the affected person not being aware of the seriousness of the situation and the need for treatment.
For those who find the situation too difficult, they should not hesitate and seek advice and support from a specialized institution, a doctor or self-help groups.
Decisions with the help of a doctor
If depressive symptoms affect quality of life, professional help with medication is recommended - one should not wait so long for suicidal thoughts to occur.
Medications. In severe depression, it is important for doctors to work together to determine if and which medications are working in each case in about half of the cases - to reduce the number of side effects and to change the type of medication if necessary.
Any change (amount and type of medicine, frequency and time of taking) should be determined together with your doctor.
It can take several weeks before the effect is expressed: if no improvement occurs, the preparation should be replaced. Even when the condition improves, this does not mean that taking it can be stopped, as abrupt cessation can cause (often very severe) recurrence. For endogenous depression, therapy should not be discontinued.
Today, there are a number of drugs that do not cause addiction. Relatively few side effects of modern serotonin and serotonin-norepinephrine reuptake inhibitors or selective MAOIs have side effects. If these do not work, it may still make sense to use older medications, namely tricyclic and tetracyclic antidepressants.
Lithium or carbamazepine are sometimes prescribed for recurrent illness or increased risk of suicide. Lithium requires constant monitoring of the amount in the blood, therefore
to prevent poisoning. Other rarely used drugs are valproic acid, oxacarbamazepine and lamotrigine.
For those who develop additional delusions, treatment with a combination of antidepressants and neuroleptics is tried.
In severe sleep disorders and attacks of fear, therapy can be upgraded with antipsychotics (anxiolytics) and sedatives (benzodiazepines). However, due to the risk of addiction, they only need to be taken for a few weeks.
Additional measures. Light therapy can achieve good effects in diseases caused by the seasons, and in severe depression, for which no medication helps, electric spasm therapy can be tried. If it is successful, it should be continued regularly. The therapy is performed under complete anesthesia and with the help of muscle relaxants to relieve pain. Because temporary memory loss used to occur frequently, only one electrode is used today, which has less of an effect on memory.
