What is a continuous episode of depression

depression

Depression: treatment

Every third person develops depression in the course of their life. According to statistics, there are currently more than four million people affected in Germany. In the best case scenario, treatment should be started as quickly as possible for depression, because those affected suffer greatly from their condition. In addition, therapy becomes more difficult after a long period of time and the risk of the disease becoming chronic increases.

Depending on the severity of the illness, depression is usually treated with psychotherapy, antidepressant medication, or a combination of both. Combination therapy is particularly indicated for chronic and recurring depression. Even for severe depression, experts recommend a combination of both treatment approaches.

Psychotherapy for depression

Psychotherapy requires patience and commitment on the part of the patient over a period of months. However, those who get involved can often overcome their depression in the long term and improve their overall psychological stability.

There are many psychotherapeutic offers for people with depression. The health insurances cover the costs for psychotherapy based on depth psychology, analytical psychotherapy (psychoanalysis) and systemic therapy (since July 1, 2020).

Classical psychoanalysis and psychotherapy based on depth psychology belong to the psychodynamic psychotherapies. They are based on the idea that depression is often triggered by experiences of loss and hurt that could not be processed properly. These should be worked up in the course of therapy.

Cognitive behavior therapy - an extension of classic behavior therapy - is paid for by the health insurers for depressed patients. The prerequisite is that the treatment is carried out by a medical or psychological psychotherapist with a license to practice medicine. With the support of the therapist, the patient looks for ways to get out of the depression. For this purpose, among other things, negative thoughts, patterns and beliefs are uncovered, checked for their correctness and, if necessary, replaced by new, more positive ways of thinking.

Other forms of psychotherapy for depression

Interpersonal therapy (IPT) is a short-term therapy method that was specially developed for the treatment of depressive illnesses. It combines therapeutic concepts from behavioral therapy and psychodynamic therapy. An important goal of therapy is to learn skills and strategies for dealing with conflicts that contribute to the development or maintenance of depression.

However, the costs for the ITP are not yet covered by the health insurers. This also applies to various other forms of therapy such as family therapy, gestalt therapy or art therapy. However, they are often offered as supportive therapies as part of inpatient treatment.

Additional therapeutic measures for depression include, for example, psychoeducation, occupational therapy, groups of relatives, learning relaxation techniques, and body and movement-related therapies

Depression: drug therapy

Antidepressants are usually prescribed for more severe depression or when the patient is opposed to psychotherapy. It can be used to successfully treat the symptoms of depression. However, the drugs often take weeks to take effect.

In addition, there is no guarantee that the medication will have the desired effect. Everyone reacts differently to the active ingredients: some benefit a lot from antidepressants, others have hardly any effect or the patients mainly feel the side effects.

If the medication is stopped, there is a risk of relapse - especially if it happens suddenly. Therefore, do not stop taking antidepressants on your own, but discuss the procedure with your doctor!

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRI) or serotonin norepinephrine reuptake inhibitors (SNRI) are currently used to treat depression. They increase the level of the "happiness hormone" serotonin in the brain and thus have a mood-enhancing effect. These drugs have significantly fewer side effects than older drugs. Typical side effects are nausea, restlessness and sexual dysfunction.

Tricyclic antidepressants

The tricyclic antidepressants are among the oldest drugs used against depression - they have been available since the 1950s. They inhibit the resumption of serotonin and noradrenaline, but also of histamine and acetylcholine. As a result, they have strong side effects such as dry mouth, tremors, tiredness and constipation. Cardiac arrhythmias and an increased heart rate can also occur, especially in older people. Tricyclic antidepressants are therefore almost only prescribed when newer drugs are not effective against the depressive symptoms.

Monoamine oxidase inhibitors

The monoamine oxidase inhibitors (MAO) have also been used against depression for a long time. They have side effects similar to those of the tricyclic antidepressants.

Particular caution applies to tranylcypromine. This active ingredient requires a strict low-tyramine diet. For example, tyramine is found in dairy products, wine, sausage products and finished products. If a patient being treated with tranylcypromine does not avoid foods rich in tyramine, serious side effects such as high blood pressure can occur.

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Other drugs for depression

lithium is not a classic antidepressant, but is still often used as a mood stabilizer for depression. It works by influencing signal transmission in the brain. It should also reduce the risk of suicide. Lithium is often given as a supplement to antidepressants if they do not have the desired effect. However, patients with kidney or heart disease should not take lithium.

St. John's wort preparations can help especially with mild to moderate depression. However, the possible interactions with other drugs are problematic. St. John's wort, for example, impairs the effectiveness of contraceptive hormone preparations and reduces the effectiveness of drugs used to thin the blood and treat epilepsy. As a side effect, taking St. John's wort preparations can lead to photosensitization of the skin - the skin is more sensitive to sunlight, so it is more prone to sunburn, among other things.

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Electroconvulsive therapy

With the help of electroconvulsive therapy, depression can be treated in many cases where medication and psychotherapy fail. A short "epileptic seizure" is triggered by current pulses under short anesthesia. This idea may be terrifying at first. In fact, the patient is unaware of the procedure and the risks are low.

Waking therapy

For awake therapy, patients must remain awake for the second half of the night or the entire night. Although this method cannot cure the depression, it can temporarily relieve the symptoms. Patients feel good for the first time in a long time, if only for a short time. Not only is this a tremendous relief, it also gives them hope that they will actually be able to overcome their depression. And a hopeful attitude contributes a lot to the success of the therapy.

Repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation is a new technique that can be considered if there is no medication to treat depression. Different areas in the front right or left half of the ear are stimulated by magnetic fields. This non-painful treatment is carried out in a clinic for ten to 30 minutes a day for three to six weeks.

Depression - helping people to help themselves

More recent studies come to the conclusion that offers of help without direct contact with therapists can also be helpful. One possibility are instructions for self-help. Those affected can read a lot of information themselves and only occasionally have contact with an expert who will support them. This can, for example, help bridge the waiting time until therapy.

Internet-based therapies and apps

Another option for people with depression is to seek professional advice online. The therapy is carried out with the help of a special computer program. There are now so-called depression apps and chatbots that make it easier to deal with depression. They are based on elements of cognitive behavioral therapy.

Exercise as an antidepressant

Get out of the house, get out of the depression! For depression, experts recommend regular exercise. This can significantly reduce depressive symptoms - both in the short term and in the longer term. In fact, regular exercise can work as well as an antidepressant. This is because it reduces stress and can possibly have a positive effect on the levels of messenger substances in the brain (such as serotonin and norepinephrine).

However, the psychological effect of sport could have an even greater effect: the physical activity allows patients to get out of the spiral of listlessness and withdrawal. They experience that they can do something for their emotional wellbeing themselves. Self-esteem is strengthened and hopelessness is suppressed. Those who do sport in a group also benefit from the sense of community and social contact that is usually less and less common in depression.

Inpatient or outpatient therapy for depression?

A mild or moderate depressive phase can often be treated with outpatient psychotherapy. The inpatient stay in a clinic is especially necessary in the case of severe depression. The combination of drug treatment, a wide range of psychotherapeutic therapy offers and intensive care in the clinic helps the patient to return to a structured daily routine.

If there is a high risk of suicide, depressed people can be admitted to a clinic against their will.

Read more about the therapies

Read more about therapies that can help here: