What is Major Depression
What is Depression?
Everyone has a bad day, feels down, sad and doesn't want to get up all day. Sometimes you are in a bad mood for several days and you don't know why. Low moods are normal and we all know them. In everyday parlance, however, the term "depressed" is often mistakenly used to refer to any of these temporary gloomy moods. However, one should only become vigilant if the depressed mood persists consistently for a period of at least two weeks, because only then could it be psychologically speaking a depression.
Depression comes from the Latin "depressio" and means "to depress". From a medical perspective, depression is one of the most common mental illnesses of our time and in psychology is assigned to the category of mood disorders (changes in mood).
About 16-20% of all adults will develop depression at least once in their life. The average length of a depression-related sick leave is between 35-50 days and is one of the most common causes of persistent inability to work. Women (24%) are probably more often affected than men (15%). However, experts estimate that men tend to report only fewer symptoms of depression, so that depression in men is diagnosed less often - the number of unreported cases could therefore be high.
Depression also occurs in combination with other mental illnesses such as anxiety disorders (e.g. social phobias). People who already suffer from chronic illnesses such as diabetes, cancer or cardiovascular disorders have a statistically higher probability of developing depression in addition to their existing condition. Statistics have shown that 53% of all those affected by depression find themselves receiving inadequate primary care treatment instead of seeking the help of a psychotherapist. It is estimated that 10-15% of all sufferers attempt suicide because of their depression.
Contacting your general practitioner or a psychologist is therefore extremely important, as depression is a serious condition that needs to be diagnosed and treated by a professional.
How does depression develop?
Depression is not to blame! Anyone can be affected by this condition.
The causes of depression cannot be clearly assigned and are individually different. The current state of research assumes that there are genetic predispositions, personal development and personality factors, but also family conditions and traumatic life experiences that contribute to the development of depression. In summary, one speaks in psychology of so-called "endogenous" factors, i.e. predispositions and "exogenous" factors, i.e. environmental influences. These influence each other.
One contribution to the development of depression lies in the genetic predisposition. If depression was a common occurrence in the family tree, there is a likelihood that you can experience it as well. If direct relatives of the first degree (parents, siblings) are affected, this increases the risk of developing your own depression by 15%. In identical twins, the risk of both developing depression if another direct relative was affected is around 50%. However, it is not scientifically possible to say exactly whether environmental influences are not included in these observations, since, for example, siblings usually grow up under similar conditions. A parent's depression does not have to be genetic either, but could have been caused by experience. So there is no such thing as a "depression gene" and the role of genetics should not be overstated. The biological research branch of so-called epigenetics also assumes that our genes are not definitively determined from birth, but can be changed through experiences that we have and bring about.
Depression is related to hormonal changes in certain neurotransmitters (messenger substances) in the brain. These messenger substances such as serotonin, dopamine and noradrenaline are in a hormonal imbalance in depression. Serotonin and dopamine are neurotransmitters that make us happy. In depressed patients, the measured concentrations of serotonin and dopamine are lower than in healthy people. This is why treatment with antidepressants is often successful, as the active ingredients in the drugs increase the production of these messenger substances, among other things. It should be noted, however, that antidepressants are not effective for everyone. The reason for this can be an individual neurotransmitter disorder that causes the hormonal imbalance.
In addition to the hormonal imbalance, a change in the activity of the limbic system can be determined in the case of depression. The limbic system is responsible, among other things, for the regulation of stress and controls emotions. A disruption of this system changes the processing of feelings, so that psychological vulnerability increases. Everyday low moods, but also blows of fate are rated more strongly and experienced more intensely, which can lead to depression.
A popularly known form of depression is the so-called "winter depression". Everyone knows it when the days get shorter and more uncomfortable, we sink into the sofa at home and wait until spring sets in. The "winter depression" is one of the seasonal affective disorders because, as the name suggests, it occurs in certain recurring seasons (autumn, winter). With the onset of spring, the symptoms usually subside. Winter depression is caused by a disruption of the biorhythm, as the increased darkness means that too little light reaches the pineal gland in the brain through the retina. On the one hand, the pineal gland produces the sleep hormone melatonin, which makes us tired and suppresses stimulating hormones such as norepinephrine and dopamine. Therefore, those affected by winter depression feel persistent tiredness and listlessness. Light therapy is an established form of therapy against winter depression. Patients are placed in front of a bright daylight lamp for a certain period of time so that the retina receives light and the pineal gland is prevented from releasing the sleep hormone melatonin.
Depressive symptoms can occur as a result of drug treatments and their withdrawal. In particular, stopping certain medications can trigger withdrawal symptoms, which result in depression. Anabolic steroids are a great example as they are very addicting. Withdrawal from the drug is similar to drug withdrawal. Many other prescription drugs such as antibiotics, neuroleptics, beta blockers or hormonal contraceptives (e.g. "the pill") can cause depressive symptoms as side effects. It is therefore advisable to consult your family doctor before taking such medication.
Drugs and psychotropic substances have a direct influence on neuronal messenger substances and their transmitters. In this way, you can specifically influence their release and inhibition. Drugs are also highly addictive, which in the event of withdrawal can lead to serious physical and psychological withdrawal symptoms. These withdrawal symptoms often lead to depression, as the body and the psyche long for the supposedly missing substance.
Pregnancy and childbirth
From a hormonal perspective, pregnancy is a phase of many changes for all women. Your own hormonal balance is turned upside down and mood swings are regularly noticeable. Studies have shown that around one in ten women experience depression during their pregnancy.
The birth of a child naturally also represents an exceptional emotional situation, both physically and mentally, which has an impact on one's mood. In extreme cases, two types of postpartum (Latin post = after; partus = delivery) disorders can occur:
1. Postpartum mood / baby blues
As a result of the abrupt change in hormones after birth, it is estimated that 50 - 80% of all new mothers experience postpartum mood swings and sadness immediately after birth. This phenomenon, known as “baby blues”, is the mildest form of postpartum emotional irritation and is characterized by frequent and sometimes sudden crying and sadness. In addition, there may be general irritability, worrying about the child, exhaustion, loss of appetite, difficulty concentrating, anxiety and insomnia. As a rule, however, the baby blues subside after a few days.
2. Postpartum depression
If the baby blues do not set in until about a week after the birth or last for more than two weeks, it is referred to as postpartum depression. Typical symptoms of depression, such as joylessness and listlessness, occur. Statistically speaking, 10-20% of all new mothers experience a depressive episode in the first year after giving birth. The triggers of this postpartum depression can not only be traced back to the lack of sleep, the physical adjustment or the newly created role as a mother. Instead, there is a combination of hormonal changes in your own body and certain feelings such as fear, a feeling of overload and insecurity. Mothers who have postpartum depression feel constantly exhausted, overwhelmed, easily irritable, and accuse themselves of not loving their child properly. They cannot cope with their tasks and feel guilty because they are not happy about the baby.
According to studies, a critical factor in the development of postpartum depression is the lack of social support during the puerperium.
If the mother suffered from depressive episodes or other mental illnesses before birth, the risk of postpartum depression is increased. Postpartum depression should be treated, as the depressive symptoms experienced cause considerable suffering and the mother-child relationship can be impaired.
Upbringing style and other environmental influences
Another cause of the development of depression can already be found in the parenting style of one's own parents. A fearful, caring parenting style can result in what is known as “learned helplessness” in the child. This means: If the child grows up in an overprotected environment, it does not learn to deal with problems sufficiently independently, so that the psychological vulnerability increases accordingly in adulthood without protective parents.
This learned helplessness lowers the ability to deal with stressful stimuli (stressors) properly, affects self-esteem and therefore offers a risk factor for the development of depression.
Traumatic experiences such as the loss of a loved one, sexual abuse, accidents, experiences of disasters or crisis situations, such as separation from a partner, can also promote the development of depression.
Other risk factors
What are the symptoms of depression?
When it comes to the type of symptoms of depression, one first differentiates between main and secondary symptoms. Symptoms vary in severity and frequency depending on the type and severity of the depression.
The main symptoms of depression are:
- gloomy mood
- Loss of interest
- Lack of drive
The side symptoms of depression are:
- Lack of concentration
- decreased self-esteem
- lack of future prospects
- the feeling of worthlessness
- sleep disorders
- Loss of appetite
- suicidal thoughts or even attempted suicide
To be able to speak of depression, two main symptoms and at least two secondary symptoms must be present over a period of at least two weeks.
What types of depression are there?
First, the classification of a depression is divided into the severity. A distinction is made between mild, moderate and severe depression.
With mild depression, those affected manage to cope with their own everyday lives with great effort. With mild depression there must be a total of 4 symptoms (2 main and 2 secondary symptoms).
With moderate depression, the ability to cope with everyday life independently is already severely limited. Those affected also withdraw socially and the ability to work is severely impaired. Moderate depression must have between 5 - 6 symptoms (2 main and 3 - 4 secondary symptoms).
In the case of severe depression, the person affected is no longer able to cope with everyday life independently. Severe depression must have a total of 7 symptoms (3 main and at least 4 secondary symptoms). In addition to the severity, there are four different types of depression, depending on the course.
1. Classical depression (unipolar)
Unipolar depression, or major depression in the clinical context, is the classic type of depression. The well-known depressive symptoms such as listlessness, dejection, loss of appetite, insomnia and social withdrawal occur. Unipolar depression occurs in single episodes. Major depression can only be diagnosed when these episodes persist for at least 2 weeks - otherwise one speaks of a depressive episode or phase.
2. Bipolar Depression
Bipolar depression differs from unipolar depression in that it is also described as a manic-depressive illness. This means that, in contrast to classic, unipolar depression, those affected experience extreme mood swings between depressed behavior on the one hand and exaggeratedly euphoric behavior on the other. These periods of exhilaration and extreme activity are known as manic episodes. There can also be periods of balanced mood between the depressive and manic episodes. One speaks of bipolar disorder when the duration of a depressive or manic episode is at least 14 days.
3. Dysthymia (chronic depression)
In adults, one speaks of chronic depression if the symptoms have been present for at least two years. In children and adolescents, symptoms of depression must have existed for a year. The intensity of the symptoms of chronic depression is not as severe as that of acute. Nevertheless, because the symptoms are constant, those affected feel a low level of energy and drive and find little joy in daily life. Chronic depression can often go undetected, as sufferers see permanent melancholy as part of their personality. Chronic depression can occur in combination with acute depression, anxiety disorders, personality disorders and alcohol and drug abuse.
4. Atypical depression
The symptoms of atypical depression are contrary to classic depression. So whoever suffers from atypical depression does not experience the typical side symptoms of depression, such as loss of appetite. Instead, sufferers feel more hungry, which results in sudden weight gain. Atypical depression occurs in conjunction with other mental disorders, such as social phobias, anxiety disorders or disorders of sexual pleasure perception. The fact that symptoms of atypical depression are so different from typical depressive symptoms makes it difficult to diagnose correctly.
How can you prevent depression?
There is no one hundred percent protection against depression. Still, there are a few things to keep in mind. Studies have shown that exercise can have a preventive effect on depression. If you have already overcome a depressive phase, the effectiveness of regular sport as a preventive measure has been proven. The following also applies to those who don't like sports: During sporting activities, stress hormones are broken down and happiness hormones are released. As a prevention of winter depression, it is therefore advisable to do sports outside so that you can get additional daylight.
There are also some methods of so-called "positive psychology" that can be used to promote your own well-being. This overlaps with behavioral therapy measures so that the effectiveness can be proven. The same applies to mindfulness exercises, which are successfully used to prevent relapse from depression. Furthermore, social support, i.e.(Close) friendships and good relationships with family members, an important aspect in the prevention and treatment of depression.
What can you do about existing depression?
First of all, it helps if everyone involved and their relatives find out about the clinical picture of depression. In this way, those affected learn to understand the situation better and can adapt their behavior accordingly. Since depression is an illness that requires treatment, the professional support of a psychotherapist is essential. Cognitive behavioral therapy is very effective in treating depression. In addition, antidepressants may, but need not, be used to relieve symptoms. But this should be done in close consultation with a psychiatrist.
A decisive factor in the fight against depression, in addition to support from the social environment, is your own motivation and willpower to stay on the ball.
Self-help measures such as exercises, books, online training and apps can positively support the therapy process and offer scientifically proven alternatives to traditional therapy.
When treating depression, a distinction is made between three different forms of therapy, depending on the severity and previous course:
- Prevention (when symptoms first appear)
- Acute therapy (in the case of existing symptoms, until they have subsided, for all people who suffer from acute depressive symptoms)
- Follow-up care (following acute therapy to prevent a relapse, is recommended for those affected who have already experienced relapses or people who were very limited in their everyday actions during the depressive phase)
HelloBetter training against depression
We have developed scientifically tested and certified training for depression prevention that can help you alleviate depressive symptoms and prevent depression. In this online training, explanatory texts, videos and exercises are used to convey psychologically tested methods that support you in self-help. In this way you can bridge the waiting time for a therapy place sensibly. In addition, a trained psychologist will be at your side throughout the training, who will give you feedback on your exercises and your progress after each lesson.
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