Depression, an underrated illness

A man covers his face with his hands.
Depression: a state of severe despair. (Gerd Altmann/

Definition: depression is a state of severe despair

A depressive disorder, or depression, is a state of severe despair. If you are suspecting a depression, so-called depression tests can give you an overview of the situation. However, consulting your doctor is an absolute imperative. From a medical point of view, the terms depressive episode and recurrent depressive disorder are also used. The World Health Organisation (WHO) has established a classification and distinguishes between five types of depression:

  • A depressive episode: some of the typical symptoms of a depression appear for the first time and stay for at least two weeks.
  • Recurrent depression: relapse of a depressive episode.
  • Dysthymic disorder: the symptoms of the depression are less severe, but occur over a longer period of time, usually for more than two years.
  • Adjustment disorder: depressive symptoms may occur after a stressful event or drastic change in your life. The symptoms may be less severe than with a recurrent depression or dysthimic disorder.
  • Bipolar mood disorder: this disorder is characterised by intense emotional states and mood episodes which may include symptoms of both euphoria and depression. People may find themselves in one moment depressed and shortly after in a state of extreme self-awareness, feeling sleepless and needing little sleep.

Depression is usually characterised by a lasting state of despair. Symptoms may include sadness, anxiety, restlessness, exhaustion, sleeping disorders, lack of appetite, memory or concentration disorders, a tendency to feeling guilty or to bodily complaints (such as stomach pains).

Many people affected by depression may also feel a state of hopelessness, of emptiness, which, in extreme situations, may manifest itself in suicidal tendencies. Severely depressive people might feel unworthy and see death as the final solution.

In a depression, there are always changes taking place in the cerebral neurotransmitter systems. Hormonal changes can also occur.

Causes: depression as a result of drastic changes or an overload of stress

Being susceptible to depression might depend on genetic disposition. Although depressions are not directly passed on from one generation to the other, there are specific genetic traits which may increase the risk of having depression. Apart from a genetic disposition, negative thoughts can also contribute to developing a state of depression. During depression, the way one considers his own abilities, the environment or the perspectives for the future are usually very bleak and pessimistic.

Traumatic experiences or radical changes, for example the loss of a partner through death or separation, or a severe illness, are common reasons for a depression. Long-lasting burdens, such as a conflict situation in the family or at work, can also trigger a depression. Although the symptoms are usually easy to identify, the causes are not always apparent.

Depression due to old age occurs frequently, often because of a deteriorating state of health. Aging people may not be able to go about their daily duties without having to face constraints and begin to lose gradually their autonomy. This situation can lead ultimately to depression.

Treatment and therapy: identify depression through dialogue

A thorough consultation with the doctor will allow to establish a diagnostic for depression. The patient explains his situation, describing his feelings, state of mind and complaints. Through specific questions, the doctor will try to identify if the patient is suffering from depression. Psychological tests may be also used to complete the diagnostic. Medical imaging or blood tests are sometimes done, in order to rule out an organic origin to the depression.

Because aging people are particularly susceptible to organic illnesses and to depression, it is very important to keep those two distinct from each other, in order to avoid that a depression remains undiagnosed.

The treatment of a depression is as complex as the illness itself. The aim of all the measures taken is to improve the mood of the patient and to contribute to a lasting improvement of the life quality. This can be achieved through ambulant therapy.

In the case of a very severe depression, or if the ambulant treatment is not bringing the expected results, a stationary treatment in a psychiatric hospital may be the next thing to take into consideration. This would also be the case if the patient represents a danger to himself or to others (such as with suicidal tendencies).

At first, a depression will be treated through psychotherapy, in which the psychotherapist adjusts the measures in order to best fit the needs of the patient. Various goals are set, such as re-establishing the contact to other people, focusing on positive experiences, or changing one's attitudes in order to weaken negative thoughts and reinforce optimism. Furthermore, the patient will learn about strategies which can help him to deal with difficult situations. Sport, or other relaxation exercise, can contribute to fight against depression.

A medical treatment may be necessary to treat a severe depression. Specific medications, such as antidepressants, make sure that the brain metabolism is influenced positively.

Depression as a long-lasting constraint

If a patient suffers chronically and is significantly limited in regards to his quality of life, a verification with the invalidity insurance (or the relevant office in other countries) may allow to check if a pension can be given. In any case, such a request must be discussed with the treating doctor.

Text: Philipp Jauch / Simon Müller 11-2012
Translation: MyH 05/2013
Photo: Gerd Altmann /

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