Expert interview on depression

Jens Molthan is a resident specialist for psychiatry and psychotherapy in Passau. In an interview with the counselling centre he talks about common causes of depression and how to avoid them.

What is depression?
The main symptoms of depression are a depressed mood, loss of interest, lack of joy, loss of drive, reduced energy, increased fatigue and often also loss of appetite. Sometimes suicidal thoughts also occur, and in severe cases a sick person may take his or her own life. A pessimistic future perspective, the feeling of worthlessness and reduced self-esteem are also part of the symptoms. Cognitive limitations such as attention and concentration deficits are often added. Some of the patients also complain about physical symptoms such as abdominal pain, tightness in the chest, lumpiness in the throat or headaches.

What are the common causes of depression?
Often several factors are triggers. Depressions may be caused by external events, such as certain life situations, misfortunes or work and study situations. It does not always have to be the result of special circumstances. Sometimes the combination of various burdens can simply become too much. Besides the high workload, burnout can also be impacted by other factors such as a stressful family or partnership situation. However, some patients may also be genetically predisposed. Moreover, learned thought patterns and the personality structure of the affected person can also play a role.

Who is particularly often affected by depression?
Depression and anxiety disorders are the most common mental illnesses. Depending on the survey, every 3rd to 10th person develops depression at some point in their lives; most studies assume that every 5th person develops depression. Statistically speaking, the proportion of women is higher, although in my experience women are also more likely to seek help and, after some examinations, the proportion of men increases. In terms of age, people over 50 are often affected. However, depression can occur in any age group. The study on adult health in Germany (DEGS1) found in the direct personal diagnostic examination that over 15% of women between the ages of 18 and 34 met the criteria for depression.

What is the difference between depression and an adjustment disorder?
The adjustment disorder is a psychological reaction to psychosocial stress factors. For example, if someone starts studying and then develops a mental disorder due to several factors (loss of the old circle of friends, higher demands or not coping with the new environment), this symptomatology is initially classified as an adjustment disorder. For example, this can be a depressive reaction, but also an anxiety reaction. If this symptomatology does not subside in a short period of time or if suicidal thoughts occur that inhibit social or occupational functions or the ability to study, then I recommend seeking help. Depression is the persistence of the symptoms mentioned at the beginning for at least 2 weeks. The severity of depression is classified according to the type and number of symptoms.

What types of therapy are available?
A basic distinction can be made between psychotherapy and drug therapy. Medicinal therapies may only be prescribed by physicians; the majority of antidepressants are not prescribed by psychiatrists, but by general practitioners. This is also due to the lack of availability of appropriate specialists and long waiting times for an appointment. Counselling and sometimes also psychotherapy is provided by counselling centres, such as the psychological counselling centre at the university, the social psychiatric service (located in Passau at the social welfare organisation), Caritas or other institutions. Within the health system, outpatient therapy is provided by psychological and medical psychotherapists, specialists in psychiatry and psychotherapy or specialists in psychosomatic medicine and, if prescribed by a physician, by specialised occupational therapists or nursing services. In Germany, outpatient care includes intensive psychology based psychotherapy, psychoanalysis and behavioural therapy. In the future, systemic therapy will also be approved and reimbursed by health insurance funds.

In addition to outpatient treatment options, inpatient or day clinic treatment in psychiatric or psychosomatic clinics is also possible. Other biological treatment methods, such as sleep deprivation therapy, light therapy, transcranial magnetic stimulation and electroconvulsive therapy, can also play a role in the treatment and are mainly initiated and performed by clinics. Access is usually triggered by general practitioners, specialists or psychotherapists. General practitioners are often the first point of contact for psychological problems.

What are potential problems during therapy?
A big problem is the lack of availability and the long waiting times at most places involved in mental health care. It is also not always easy for the affected person to find the right treatment option that is suitable for him or her, since, for example, the first appointment with the psychiatrist cannot be made very quickly. A psychiatrist can perform a professional diagnosis and explain the treatment options. He knows the people and institutions involved in the care and can also provide psychotherapeutic and medical treatment himself. Psychotherapists can also provide the indication for psychotherapy or other forms of treatment, e.g. within the framework of psychotherapeutic emergency consultation. In this context I would like to point out that the term psychotherapy is not protected and therefore not only doctors and psychologists with the appropriate classification operate under this term, but also completely different practitioners with very different qualifications and training. Accordingly, treatment does not always measure up to scientific criteria.

A variety of problems can occur during the treatment, like reduced or no effect as well as side effects of all possible therapy forms (even psychotherapy can have side effects); the therapy must then be changed or adapted. Unfortunately, the effect of most therapies does not start immediately, so that patience is required from patients and relatives.

What is the best way to protect yourself against depression?
A good work/life balance and a strong social network are important. It also makes sense to look for signs of an onset of depression, and then to consider whether you can take countermeasures yourself or whether you should seek professional help right away. Ignoring the first signs of mental illness is certainly a great risk, which even happens to experts, according to the motto: ‘That will never happen to me.’

If you know someone who is depressed, what is the best way to deal with them?
If you notice that someone might be depressed, I would ask them about my observation if the relationship allows it. Generally, most mentally ill people prefer to be treated normally. There are people who deal with their illness very openly while others do not. With the latter you have to accept that. If those affected accept help, it can be useful to motivate and praise them and thus help them. This can only be accomplished with intuition and in consultation with those affected. If an outsider notices that a friend or partner is not well and that something is wrong, it is OK to talk about it calmly and see how the person reacts. In rare cases, such as acute suicidal tendencies, it may also be necessary for relatives or friends to contact a physician, an outpatient clinic, hospital or the emergency medical service directly.

Is depression a widespread disease today?
As mentioned above, depression is a very common disease. Statistics by the health insurance companies show a clear increase in the number of diagnoses of depression as well as an increase in the number of sick days due to these diagnoses. Mental health issues and especially depressive disorders are the leading causes. Epidemiological studies often show no serious increase but also a high proportion of depressive disorders in the population. That is why it is applicable to call it a widespread disease. The fact that depressive disorders and other mental illnesses are gaining public awareness is very important for the de-stigmatisation of mental illnesses, which also increases the willingness to be treated and to make use of appropriate assistance programmes. It would be desirable to adapt the health system and also complementary assistance programmes to the increased demand. I also believe that preventive services should be expanded and that it should be possible to eliminate common causes of mental illness, such as excessive stress during vocational training and at work or constant overload.

Thank you very much for the interview!

The questions were posed by Tim Ende.