Depression can also make family and friends feel worried, anxious and helpless. They often would like to help but do not know how. It is not always easy for them to tell whether it is a passing phase or a serious illness.
Symptoms
People with depression fall into an emotional black hole for weeks or months, and often cannot see any way out. Different people experience depression
differently: Some mainly feel sad and down. Everything seems pointless.
Nothing and nobody can lift their spirits. Others are not sad, but
instead have a deep emptiness inside, feel exhausted and emotionally
numb. And others may suffer from agonizing worries, fears and anxiety.
Typical signs of depression include:
Depression can arise at any age, in various phases of life and under various circumstances. These things influence the symptoms of depression and sometimes also how sufferers and others around them experience the disease too. For example, in old people depression is often wrongly interpreted as being a sign of old age or dementia.
- continuously feeling emotionally low or down
- loss of energy and motivation, exhaustion
- lack of joy and interest, even in activities and hobbies that you used to enjoy
- low self-esteem and low self-confidence
- feeling guilty and constantly brooding over things
- difficulties concentrating and making decisions
- apathy and emotional numbness
- withdrawing from friends and family
- hopelessness and worrying about the future
- not wanting to live anymore, or suicidal thoughts
- Fatigue
- Sleep disorders
- Loss of appetite
- Losing or gaining weight
- Loss of sexual desire
- Digestion problems, such as constipation
- Increased sensitivity to pain
Depression can arise at any age, in various phases of life and under various circumstances. These things influence the symptoms of depression and sometimes also how sufferers and others around them experience the disease too. For example, in old people depression is often wrongly interpreted as being a sign of old age or dementia.
Causes and risk factors
The cause of depression
is not exactly clear. It is thought that biological processes,
psychological factors, people's personal circumstances and particular
events in their lives play a role. Here are some examples of things that
can make depression more likely and influence the course of the condition:
- Genes: People have an increased genetic risk of depression if other people in their family have had depression
- Traumatic childhood experiences, such as abuse and neglect
- Chronic anxiety disorders in childhood and puberty, combined with low self-esteem and insecurity
- Biochemical changes: Metabolism in the brain has been found to be different in people with depression and nerve impulses travel more slowly; certain chemical messengers and hormonal changes can also play a role
- Personality traits such as a lack of self-confidence
- Dependence on alcohol, tablets or drugs: This can be a consequence of depression, but it might also lead to depression or make it worse
- Physical medical problems such as strokes, heart attacks, cancer or an underactive thyroid
- Taking particular medications
- Distressing events such as the death of a loved one or the end of a relationship
- Long-term stress and feeling overburdened, or also feeling under-challenged
- Loneliness
- Lack of light: The dark fall and winter months can lead to depression in some people
Prevalence
Outlook
The course of depression can vary greatly: In many people things get better after a few weeks or month – even without treatment – and the depression does not come back. Others have regular phases of depression followed by depression-free phases. Some people have depression over a long period of time, with severe phases and less severe phases, and some people develop chronic depression.
The typical symptoms of depression last at least two weeks and can last up to several months. If they go away again after a certain amount of time, what is known as a depressive episode has ended. Research has shown that about half of all people who are treated for depression feel a noticeable improvement in symptoms after about three to six months.
If depression comes back within six months after the last depressive episode it is called a relapse (recrudescence). If depression comes back more than six months after the last episode, or even years later, it is referred to as recurrent depression. If depression depression returns several times, then the depression-free phases might get shorter and the depressive episodes might get longer over the years. If a depressive episode lasts longer than two years it is called chronic depression.
The typical symptoms of depression last at least two weeks and can last up to several months. If they go away again after a certain amount of time, what is known as a depressive episode has ended. Research has shown that about half of all people who are treated for depression feel a noticeable improvement in symptoms after about three to six months.
If depression comes back within six months after the last depressive episode it is called a relapse (recrudescence). If depression comes back more than six months after the last episode, or even years later, it is referred to as recurrent depression. If depression depression returns several times, then the depression-free phases might get shorter and the depressive episodes might get longer over the years. If a depressive episode lasts longer than two years it is called chronic depression.
Effects
Depression makes people feel different and behave differently than
before. They often feel like it is their own fault, and are plagued by
self-doubt. They say they have feelings that they can no longer control
or cope with. They may also have suicidal thoughts. Many people become
withdrawn, avoid social contact and hardly leave the house any more.
They might start abusing alcohol, medication or drugs. These things can
make the depression last longer and more severe. It is often only possible to stop this vicious circle with the help of other people.
Diagnosis
Some people have such severe depression
that they cannot summon up the energy to get help and see a doctor.
Other people do not see their suffering as part of a treatable illness,
but instead believe that they feel that way because they are a failure
or weak-willed, or due to stress at work or in their private lives. In
these situations it is important that their family and friends offer
them support and accompany them to the doctor.
To find out whether somebody has depression, psychotherapists do two things: They ask what symptoms the person has, to see whether these could be signs of depression. They also try to rule out other illnesses or health problems that could cause similar symptoms. That means that physical examinations or medical checks by a doctor might be needed as well.
The typical symptoms of depression can be split up into "core symptoms" and ""secondary symptoms".
The core symptoms include:
To find out whether somebody has depression, psychotherapists do two things: They ask what symptoms the person has, to see whether these could be signs of depression. They also try to rule out other illnesses or health problems that could cause similar symptoms. That means that physical examinations or medical checks by a doctor might be needed as well.
The typical symptoms of depression can be split up into "core symptoms" and ""secondary symptoms".
The core symptoms include:
- Low mood, sadness, feeling down
- Lack of interest and joy
- Lack of motivation and feeling very tired, even after minor activities
- Loss of appetite
- Sleep disorders
- Difficulty concentrating and making decisions
- Low self-esteem
- Feelings of guilt
- Negative and pessimistic thoughts about the future
- Suicidal thoughts or suicide attempts
Prevention
Psychological programs, counseling services or sports can help to prevent depression
in children and teenagers. There is not enough research to say if this
applies to adults as well. For people with a high risk of recurring depression,
long-term treatment with medication might be an option to prevent a
relapse. Others prefer long-term outpatient psychotherapy sessions.
Learn more
Treatment
Many people with depression find it hard to accept the diagnosis.
One possible reason for this is that they are ashamed about having a
mental illness and do not want their friends, family and colleagues to
find out. Some people therefore do not want to have treatment. But
treatment can often help people get better more quickly and relieve
their symptoms.
There are various treatment options for depression. The main treatments are psychotherapy, such as cognitive behavioral therapy, and/or medication. Which type of treatment is the most appropriate, where it takes place and how long it lasts will depend on several factors, including how severe the person's depression is, their personal circumstances and how their symptoms develop. People can talk to a therapist about the advantages and disadvantages of the possible treatments, as well as what they expect from the treatment and any fears they might have.
There are various treatment options for depression. The main treatments are psychotherapy, such as cognitive behavioral therapy, and/or medication. Which type of treatment is the most appropriate, where it takes place and how long it lasts will depend on several factors, including how severe the person's depression is, their personal circumstances and how their symptoms develop. People can talk to a therapist about the advantages and disadvantages of the possible treatments, as well as what they expect from the treatment and any fears they might have.
Learn more
Everyday life
People with depression
find it difficult to cope with everyday life. The demands of work,
private commitments and even small household chores can become a major
effort. Relationships with partners, friends and family often change.
The people who are close to someone with depression
usually find it very distressing too. Emotional withdrawal and apathy
can lead to arguments and people might become even more withdrawn.
Many people who have mental health problems or illnesses do however still turn to their partner, family or friends first. It is also often those people who first notice the symptoms of depression and the changes. Their comfort and support is particularly important to people who have depression.
But partners, family and friends often also find it hard to cope if the depression is severe. Some people who have depression prefer to seek professional help because they do not want to be a burden, or because they are ashamed and would rather not talk about their illness with those close to them. Self-help groups might be helpful here too.
Active help and support are especially important if there is reason to believe that someone is thinking of taking their life. Many people with depression have suicidal thoughts. Although they do not usually act upon them, it is extremely important that these thoughts are taken seriously and that they talk to other people. If that is not possible in an acute situation, there are various places you can turn to for help. In Germany, these include social-psychiatric services (in German: Sozialpsychiatrische Dienste), crisis support centers and helplines – which can be anonymous, and some are available 24 hours a day.
Many people who have mental health problems or illnesses do however still turn to their partner, family or friends first. It is also often those people who first notice the symptoms of depression and the changes. Their comfort and support is particularly important to people who have depression.
But partners, family and friends often also find it hard to cope if the depression is severe. Some people who have depression prefer to seek professional help because they do not want to be a burden, or because they are ashamed and would rather not talk about their illness with those close to them. Self-help groups might be helpful here too.
Active help and support are especially important if there is reason to believe that someone is thinking of taking their life. Many people with depression have suicidal thoughts. Although they do not usually act upon them, it is extremely important that these thoughts are taken seriously and that they talk to other people. If that is not possible in an acute situation, there are various places you can turn to for help. In Germany, these include social-psychiatric services (in German: Sozialpsychiatrische Dienste), crisis support centers and helplines – which can be anonymous, and some are available 24 hours a day.
Learn more
- Strategies for family and friends