What is depression: causes, symptoms, therapy

What is depression?

Depression is a treatable mental illness. Common symptoms include persistent low mood, sadness, lack of motivation, loss of interest, fatigue, and various physical symptoms ranging from insomnia to appetite disturbances to pain. Depression can occur at any age. Without treatment, depression rarely disappears on its own.

What are the causes of depression?

The causes of depression are often complex and can be influenced by various factors. What exactly causes depression has not yet been clarified but the factors can be divided into biological and psychosocial triggers. Some of the possible factors are:

a) Biological factors

o Genetics

o Seasonal changes

o Medication and drugs

o Hormonal birth control

o Pregnancy

o Misregulated stress hormones

o Chronic illnesses

b) Psychosocial triggers

o Stressors

o Overload

o Trauma

o Lack of social recognition

o Personal outlook on life

What are other factors that contribute to depression?

In addition to the triggers mentioned above, there are other current contributing factors that can lead to depression in individuals.

Isolation and loneliness

As humans, we need human contact to feel good. Hence, isolation and loneliness represent a double burden for those who are emotionally stressed. As social beings, we need to interact with others to feel understood and accepted. Interacting with others helps us not only to address our feelings of loneliness but also to realize that we are not alone.

Existential worries and job loss

Job loss and disruption of regular work routines can often lead to existential worries. Fear is often a trigger for further negative feelings that can lead to depressive thoughts and mood changes. The negative thought of not being enough and the resulting shame makes it difficult to open up to others and talk about one’s feelings. Along with the shame that holds us back from seeking help, the lack of motivation also plays a big role.

How can you recognize depression?

That is why it is so important to recognize depression as early as possible so that you can seek preventative help. Recognizing depression early on is possible with our self-test. Recognizing this on your own is extremely difficult, which is why we have listed below a guide for the self-test.

According to the international diagnostic criteria ICD-10, main and secondary symptoms of depression are recorded. The results are anonymous and confidential but cannot provide a clinical diagnosis. This is only possible with your trusted family doctor, a psychiatrist, psychologist or neurologist. If you have had concerns about depressive symptoms for some time, you can contact your doctor after a positive result.

What depression self-tests are available?

The Beck Depression Inventory (BDI), as a structured interview, gives you the opportunity to get a diagnosis. The BDI is one of the most reliable clinical-psychological diagnostic tools. In the current original version, 21 typical symptoms of depression are recorded via four statements of increasing difficulty each. (Beck & Steer, 1987; German: Hautzinger, Bailer, Worall & Keller, 1994).

The Goldberg Self-Test in questionnaire form is based on the recognition of depressive symptoms (Goldberg Mood Scales) (Depression Scale).

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The Geriatric Depression Scale (GDS) by Sheikh and Yesavage (1986) consists of the Mini-Mental Status (MMS) and clock test among others. The GDS makes early detection of depression in aging people possible.

It is also interesting that there is a stigma around depression in the elderly because many people do not realize that in older age not all symptoms come from a medical background. Interestingly, many older people are very open to drug treatment, unlike the younger generation.

Yes, there are many online self-tests. However, these are no substitute for a specialist diagnosis. Depression comes from Latin (=deprimere, translated as to depress) and it was not for nothing that the WHO named it a widespread disease a few years ago. This is all the more likely now if we consider what the current state of the world is doing to us.

How does depression start?

At the beginning of a depressive phase, those affected often go to the doctor with symptoms such as fatigue, difficulty concentrating, bad mood, etc. Some affected people describe their mood as despair, hopelessness, and apathy.

Other possible early symptoms such as pain, irritability or anxiety can occur without cause or as a reaction to stressful events and slowly develop over weeks or months into a depressive phase.

Symptoms of depression

You feel run down, tired and without energy? You have lost interest in things and activities that once gave you pleasure? You lack the necessary energy to go out and do sports? And you generally feel that the joy you once had in your life and in the lives of others has been somewhat lost?

It should be pointed out that oscillations and crises are something completely normal. Everyone has to struggle with phases in their lives when they lack energy, joy in life, and motivation. Therefore, there is not always an urgent need to be alarmed.

Nevertheless, it is important to take the time to listen within and look closely at what is bothering you and sort out your feelings.

The first important step is to inform yourself and reflect on your situation and feelings. In the next step, it is important to see whether it is a short-term and temporary mood or whether the symptoms should rather be interpreted as signs of a depressive episode.

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What are the physical symptoms of depression?

Typical physical symptoms of depression are:

Reduced appetite and weight loss
Loss of sexual interest
Headaches
Dizziness
Back pain
Breathing problems
Heart problems
Gastrointestinal issues

We often notice physical symptoms first, but these do not directly alert us to depressive symptomology. This is because additional physical issues that were already present before, such as back pain, can be even more distressing during a depressive episode.

The various physical symptoms can make it extremely difficult to recognize depressive traits because the main complaints appear as physical symptoms. So, it is very worthwhile to get a second opinion here and discuss this with your treating physician.

How does depression manifest itself on a psychological level?

A depressive episode often manifests itself with feelings of lethargy, and lack of interest and joy. These feelings can quickly lead to social withdrawal and feelings of inner emptiness. Most importantly, sufferers are plagued by massive feelings of guilt and self-doubt, making them feel ashamed of their current emotional state. These feelings can weigh heavily on you in the long run and should be remedied as quickly as possible. It often helps to talk to others.

If the symptoms persist for more than two weeks, so that they make everyday life difficult, it is advisable to think about seeking medical help.

In addition to the typical symptoms of depression just mentioned, there are additional symptoms:

Decreased self-esteem
Ruminating, pessimistic future perspectives, and fears
Helplessness and hopelessness, sometimes resulting in suicidal thoughts
Loss of appetite, weight and libido
Inner restlessness, problems with concentrating, sleep disorders

All these symptoms are very stressful, and it is very important to get preventive help at an early stage. However, many people are ashamed or afraid of their symptoms and the impact on their social and professional life, and thus avoid getting the necessary help. A diagnosis from a specialist or psychologist can give you relief. We therefore recommend that you inform yourself early enough and get help.

Depressive disorders and their classification

Depressive symptomology can occur on a wide spectrum. We have listed and described some known ones in more detail below. Bipolar disorder should be distinguished from unipolar depression and is a separate disorder.

Unipolar depression includes all the features of depression.

Other depressive disorders include:

Chronic depression
Depressive disorders due to medical disease factors
Premenstrual dysphoric disorder
Substance/medication-induced depressive disorder (see alcohol addiction)

Burnout

For several years, the collective awareness of burnout syndrome has increased. In 2019, the World Health Organization (WHO) recognized burnout, as a risk factor for health. Burnout is defined as experiencing stress at work that is not successfully managed. In 2022, it will be included in the ICD-11, the international classification system of diseases.

More and more people received burnout syndrome as a diagnosis. Different symptoms show up, but a listing remains non-specific.

What are the first signs? Permanent stress situations can cause symptoms of fatigue in the sense of physical and mental exhaustion, accompanied by concentration problems.

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The exhaustion syndrome can also be a first sign of depression. Burnout threatens every other person in Germany.

But how can you take preventive action? Leisure time should be positively connotated and set apart from the work atmosphere. An awareness of excessive demands should arise and with it an understanding of the high workload, starting with research into the causes: Where does this work pressure come from, and does it possibly have to do with recognition through performance?

Suicidality: When are depressive symptoms life-threatening?

According to the S3 guidelines for unipolar depression, severe depression must be treated with psychotropic drugs and additional psychotherapy. Not without reason, because depression is a life-threatening illness that must be taken seriously. Thus, suicide is a devastating consequence of depression or depressive episodes. When hopelessness fades and people see life as torture, a death wish arises and the only salvation is suicide.

If you are affected yourself or know someone who is suicidal, seek medical help immediately. Every year, 10,000 people in Germany commit suicide, and the number of suicide attempts is a lot higher. The suicide risk of men is about 70%. With increasing age, the risk of suicide increases for both men and women. Comparing suicide rates with other causes of death, it is clear that as many people commit suicide as there are deaths from traffic accidents, AIDS, illegal drugs, and acts of violence.

The WHO suspects that behind every suicidal act, there are 6 to 23 affected people.

Resources for suicidal people from Deutsche Depressionshilfe:

Is depression curable?

The short answer to that question is yes.

“Very important for us is the acceptance of the disease.”

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This is how Dr. Marina Strauß, head of the outpatient clinic for affective disorders and ADHD in adulthood at Leipzig University Hospital, puts it. The first step in the right direction is to get informed! The second step is to accept help from others: You don’t have to go through this alone, nor should you.

Many patients are able to rebalance their emotion regulation through medication and have a consistently better mood as a result. Stay patient, setbacks are normal. Treating depression is a dynamic process. It is important to understand that depressive illness is one of the most widespread diseases in the world and that those affected accept this, i.e., stop dismissing it as something harmless and break down in self-reproaches. With patience and forbearance, we create a good basis on the road to recovery.

DGS: The German Society for Suicide Prevention provides education for professionals on suicide prevention.
Freunde fürs Leben: For teenagers and young people. Freunde furs Leben is an association that educates about suicide and depression, especially young people.
NEUhland: A non-profit organization that provides information for suicidal children and adolescents with the goal of suicide prevention.
FraPPE: FraPPE is the „Frankfurter Projekt zur Prävention von Suizid mittels Evidenzbasierter Maßnahmen“, funded by the German Federal Ministry of Health and does evidence-based research on suicide prevention with the aim of reducing suicide rates.
AGUS eV: Home: For relatives. AGUS is an association that cares for relatives after suicide, provides counseling, and mediates with other affected persons.
“Hilfe-nach-Suizid”: For relatives. Offers an internet-based support program for bereaved families.
NASPRO: Germany’s National Suicide Prevention Program NASPRO is an initiative linking more than 90 institutions, organizations and associations with the goal of suicide prevention in Germany. Crisis intervention also for people at risk of suicide.

Online offers and self-help

Neben den bekannten Therapieverfahren für die Depressionsbehandlung gibt es auch ein diverses online Angebot. Zu dem Online Angebot zählen:

In addition to the well-known therapy methods for depression treatment, there are also various online offers. Online offerings include:

1. Access to psychological support by the employers

Many employers nowadays offer employees access to mental health services. This can be done in the form of an Employee Assistance Program (EAP) (https://www.likeminded.care/de/ressourcen/mitarbeitergesundheit/was-ist-ein-employee-assistance-program) or through digital platforms (https://www.likeminded.care/de/wie-es-funktioniert) that offer access to various mental health improvement formats.

2. Forums and Facebook groups

Forums and Facebook groups are not only used by young adults but can also be helpful for sufferers of all ages. This is because written online exchanges also make it easier for us to deal with our symptoms. Exchanging ideas with people who are going through the same thing can be very helpful. A small overview of some forums:

Withdrawal forum, especially on topics such as "stopping psychotropic drugs": https://adfd.org/austausch/
- Online forum/discussion board for depression: https://www.diskussionsforum-depression.de/forum-depression/

3. Self-help groups

Self-help groups offer concrete help, as they are also represented online. Especially in times of acute crisis, it makes sense to look into online self-help offerings as well. Offline self-help groups can be found in various search directories.

How can I overcome depression?

Although depression often occurs due to biochemical or genetic causes and there is often no avoiding therapy or drug treatment, there are encouraging statistics. Within four to six weeks, there seems to be an initial improvement in people who approach treatment. How can you support this positive development and prevent mild depression or resentment? You can experience initial improvement with the following tips.

Tips against mild depression?

A depressive episode can occur gradually or very suddenly. Initially, it is sometimes difficult to judge whether one is just not feeling well or in the middle of a depressive phase. Therapy is not always the right solution for people. We as humans are equipped to get everyday problems and bad feelings under control on our own. So, there are some useful everyday measures that can help us.

However, we must point out that these measures are of course not an alternative to drug treatment or psychotherapy. If you suffer from depression and need help, you can find out with the help of our online depression test. With mild illnesses, you can try to achieve an improvement with advice and restructuring of everyday life.

Daily structure and diet help with depression

These things can help you feel better: In addition to seeing a doctor and taking medication, there are a number of ways to have a positive impact on our mood. First, we should look at what we are doing in our everyday lives to help our mental health. Do we demand to feel better, but do we still get in our own way with simple things? Do we eat healthy? Do we maintain our social contacts? Do we exercise? Here it is advisable to make a list to understand which areas in our everyday life need attention.

Self-help groups are a tried and tested tool

There are a few ways to help yourself during a difficult time. Well-tried are self-help groups. For a long time now, these meetings have not only existed for alcoholics but there are thematic offers for almost all difficult life situations. The special added value lies in having a protected place where one can communicate with other people. This exchange is usually already a first step towards feeling better.

In addition, the communal feeling and the insight into the problems of others is healing. One puts one’s problems in relation to those of others, feels better understood through them, and no longer so alone. Often, only people who have been in similar situations can really understand you.

The groups are often organized regionally, and you can quickly find a suitable group by searching online. However, the meetings are usually at fixed times and also not always within close proximity.

What does online self-help mean?

Additionally, there is a variety of proven tools available online these days. For quite some time now, you have not been required to go to a meditation retreat or find a support group far away anymore. There are several apps that offer meditation and yoga classes. Online therapy is also becoming more popular. Online support groups such as forums or Facebook groups are especially helpful. However, these are not anonymous and almost not moderated, therefore, you should be careful here.

How is depression treated?

Depression can be treated pharmacologically or purely psychologically. This depends on the severity of symptoms and other individual factors. There are different intervention approaches in depression treatment. In addition to psychotherapy, mindfulness and acceptance-based therapy, which is rooted in Buddhism, is also a treatment approach used in the acute treatment of depressive episodes.

Different forms of therapy

Behavioral therapy: Behavioral therapy focuses on the behavior and actions of depressed people. Wrong-learned things should be actively relearned and positive new ones should be added so that positive behaviors are actively built.

In therapy, behavior patterns are analyzed, and the learning history of inhibiting behaviors is considered so that treatment goals are defined and specified within a treatment plan. Elements of cognitive therapy are incorporated into behavioral therapy, as are relaxation techniques such as progressive muscle relaxation.

Cognitive behavioral therapy: Cognitive behavioral therapy is based on a behavioral-cognitive approach and has been proved effective for depression treatment with numerous studies.

Cognitive psychotherapy assumes that depression is automatically based on negative perceptual and thought patterns that override behavior and feelings. Also like behavioral therapy, these negative thought patterns are owed to past experiences.

Therapy, after recognizing these patterns, serves to positively reinterpret them in the form of challenges.

Cognitive therapy in combination with behavioral therapy can be combined it a so-called cognitive behavioral therapy.

Depth psychology-based psychotherapy, psychodynamic psychotherapy: Depth psychology-based psychotherapy refers to unconscious inner conflicts that are rooted in the life history of the depressed person in childhood. In practice, the focus is on raising awareness of the conflict, through repeated recollection, the symptoms can be explained and the patient can find a better way to deal with them. There are studies with evidence of the effectiveness of depth psychology-based short-term therapies for mild to moderate depression. Long-term depth psychology or psychoanalytic therapies (over 80 hours) are more difficult to prove scientifically.

Interpersonal therapy (IPT): Interpersonal therapy uses many of the therapeutic techniques of the methods mentioned in the beginning. Critical life situations conceal inner and social conflicts, which need to be clarified in practice. The therapeutic discussions center the patient and his or her relationships with the environment. Scientifically, this form of therapy has been proven to be successful, especially for older depressed people.

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FAQs

What is depression?

Depression is a mental illness that requires treatment. It can occur at any age.

What causes depression?

The causes are often complex and depend on various factors. A general distinction is made between biological factors, e.g., genetics, seasons, or pregnancy, and psychosocial factors, e.g., trauma, overwork, or lack of social recognition.

What factors promote depression?

Isolation and loneliness can promote depression, as people need to interact with each other in order to feel understood and accepted. In addition, existential fears can be conducive, as these are often triggers for further negative feelings.

What are the symptoms of depression?

Common symptoms include: persistent exhaustion, lethargy, loss of interest, as well as a variety of physical symptoms such as insomnia, appetite disorders, or painful conditions.

How can you recognize depression?

A clinical diagnosis can only be made by a psychiatrist, psychologist or neurologist. However, there is the possibility to do self-tests to investigate a first suspicion. One of the most reliable tests is the Beck Depression Inventory.

Can depression be cured?

Yes, that is possible. Most patients can rebalance their emotion regulation with medication. However, treatment is a dynamic process and requires patience.

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What is depression? Causes, symptoms, therapy