Recognising and treating depression

If you have depression, you will suffer from strong feelings of despondency or unhappiness. Problems sleeping at night are also common. The effects are often so severe that they can burden or destroy partnerships and friendships. Some sufferers are no longer able to do their job and, in severe cases, even have suicidal thoughts.

The Swiss Health Observatory (Obsan) cites mental illness as the most common cause of disability and the main cause of suicides. According to the World Health Organization (WHO), about 7% of people in Europe suffer from depression every year. It is more common in women.

What forms of depression are there?

The most common forms of depression are:

• Unipolar depression – typical depression symptoms such as grief or lack of drive persist for weeks or months. If symptoms resolve thanks to therapy, there is a risk of them returning after a certain period of time.
• Bipolar depression – depressive phases alternate with manic episodes, i.e. elevated mood, feelings of being on a high.
• Chronic depression (dysthymia) – although the depressive symptoms are less severe, they last for at least two years.
• Winter depression – temporary, seasonal, mostly mild form of depression.
• Postnatal depression – occurs in women after childbirth.
• Agitated depression – typical symptoms include constant agitation and anxiety and hectic, restless behaviours.

People suffering from depression exhibit the following three main symptoms:

• Depressed mood
• Loss of interest and joy
• Lack of drive combined with tiredness

Other secondary or additional symptoms may also occur. Patients often suffer from feelings of self-doubt and guilt or severe anxiety that affects their ability to concentrate. Loss of libido, weight gain and sleep disorders can also occur, as can self-harm and suicidal thoughts.

If you want to know whether you are suffering from depression, you can find various tests online – for example, via the German Depression Aid Foundation. However, such self-tests are no substitute for a visit to the doctor. During an initial consultation and based on the patient’s medical history, the doctor can determine very precisely whether depression should be diagnosed or not.

Several factors play a role in the development of depression. In general, it can affect anyone at any age. There may also be underlying genetic, biological and psychosocial reasons, such as:

• Stress
• Mental vulnerability, low resilience
• Genetic predisposition (people with relatives who suffer from depression are more likely to develop the condition themselves)
• Imbalance of the brain messenger substances noradrenaline and serotonin
• Imbalance of stress hormones (e.g. cortisol)
• Certain medications (such as hormonal contraceptives or blood pressure medication) or drugs can cause depression
• Depression may also occur as a result of other underlying diseases (e.g. hyperthyroidism or hypothyroidism)

Women are in the high-risk group. They suffer from depression twice as often as men. This may be due to hormonal fluctuations.

Depression is considered to be curable. For example, discontinuing a medication that triggers depression may cause the depression to go away. Depression may recur (recurrent depression). Some sufferers do not manage to recover from depression despite trying a variety of treatment methods.

The aim of therapy is to combat the symptoms and restore mental balance so that active participation in social or professional life becomes possible again. Treatment may include different components and typically consists of psychotherapy in combination with specific medications such as antidepressants.

Psychotherapeutic services include, for example, deep psychological therapies, psychoanalysis or systemic therapies. They deal with the origin and development of depression, which is to be treated in the course of therapy. The patient can make use of it on an outpatient basis or – in severe cases – on an inpatient basis.

Cognitive behavioural therapy teaches patients how to deal with depression. Certain patterns of thought are broken in order to show a way out of the illness.

Therapy with medication can be used for severe depression. The following means are used:

• Selective serotonin reuptake inhibitors (SSRIs) or serotonin noradrenaline reuptake inhibitors (SNRIs) that increase serotonin levels in the brain.
• Tricyclic antidepressants block the reuptake of serotonin and noradrenaline.
• Monoamine oxidase inhibitors (MAOs) influence the enzyme monoamine oxidase so that noradrenaline and serotonin are not broken down.

Alternative medicinal products with St. John’s Wort can have a mood-enhancing effect in mild to moderate depression.