yogabook / pathologie / depression

Depression

Definition of

Chronic mental illness characterized by a depressed mood, frequent brooding, a feeling of hopelessness and reduced drive. A distinction must be made between two different pictures according to severity and course: Depressive episode (ICD: F32, major depression, major depressive disorder) and depressive mood disorder (F34.1, dysthymia, neurotic depression, chronic depression or persistent depressive disorder) as a long-lasting depressive mood disorder with the same symptoms but of lesser severity; the symptoms must persist for two years (one year for children and adolescents) in order to be diagnosed. The annual incidence in Germany is around 1.5%, 1.3% in men and 1.8% in women. The USA has a higher prevalence. Dysthemia does not rule out the possibility of depressive episodes occurring during it (double depression). If mild phases alternate with hypomanic, euphoric phases rather than mild and severe phases, this is cyclothomia, a mild form of bipolar disorder. Incisive experiences, such as the loss of a loved one or other deep grief, can also lead to a depressive phase in mentally normal people, but depression is only diagnosed when the duration and severity are out of proportion to the trigger. Depression often sets in without a specific trigger, usually unexpectedly and sometimes suddenly. It is not uncommon for those affected to give descriptions such as „From yesterday to today, everything is gray. Nothing is fun anymore, nothing has any meaning.“ Emptiness, loss of meaning and a feeling of numbness are described. The symptoms cannot be influenced by the affected person’s own willpower or self-discipline, nor do they react positively to encouragement or encouragement.

The German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) recommends 3 main and 7 secondary criteria:

Main criteria:

1. Depressed, depressed, constricted mood, feeling of numbness, persistent inner emptiness
2. Loss of interest and joylessness, loss of commitment, hobbies, desire to socialize. No affective response, i.e. no positive reaction to encouragement
3. Lack of drive and increased fatigability, inhibition of drive, non-physical inability to perform the simplest tasks

Secondary criteria:

1. Reduced concentration and attention
2. Lack of self-esteem, self-confidence (feeling of insufficiency)
3. Feeling of inferiority, feelings of guilt
4. Hopelessness: negative, pessimistic outlook for the future. Feeling of helplessness, exaggerated worries, possibly hypochondria
5. Suicidal thoughts or attempts. In severe cases, a feeling of complete futility in one’s own life. Danger of suicide!
6. Lack of appetite

Other symptoms have also been described which are not relevant to the diagnosis:

1. lack of ability to react emotionally to the environment, i.e. lack of affect, empathy, participation, interest, etc.
2. Sleep disorders, premature awakening (2 hours ahead of time). Frequent: disruption of the circadian rhythm, i.e. your own chronobiology
3. Morning low: particularly severe symptoms in the morning hours. Rarely: Evening low with difficulty falling asleep
4. Motor restlessness, agitation, which can be perceived as agonizing.
5. Loss of appetite
6. Unwanted weight loss or weight gain
7. Loss or reduction of libido
8. Agonizing feeling of pressure on the chest
9. Increased susceptibility to infection
10. Thought inhibition
11. social withdrawal
12. Compulsive brooding (pointless, obsessive circles of thought)
13. Disturbed sense of time
14. Irritability
15. Anxiety
16. Hypersensitivity to noise
17. Impairment of learning, memory, processing speed, attention as executive (as opposed to affective) functions

It is divided into three degrees of severity:

1. mild: 2 main symptoms + 2 additional symptoms
2. medium: 2 main symptoms + 3-4 additional symptoms
3. severe: 2 main symptoms + at least 5 additional symptoms

ICD F32

Cause

1. unknown

Predisposing

1. Acquired vulnerabilities
2. Biological factors and genetic factors have a certain, but not dominant, influence. The identical twin sibling of an affected person develops the disease in less than 50% of cases. A variation in the promoter region of the serotonin transporter gene 5-HTTLPR, further 5HTTP/SLC6A4, APOE, DRD4, GNB3, HTR1A, MTHFR, and SLC6A3 has been confirmed.
3. Biographical factors (social or psychological), e.g. learned helplessness; negative cognitive schemata; tendency to interpret perceptions negatively; inadequate handling of interpersonal relationships, self-withdrawal; loss of reinforcers; stressors, traumas; lack of social recognition, familial disposition (behavior, cognition); suppression of own interests (inhibition of aggression)
4. chronic infections are suspected: cytokine-mediated
5. psychotropic substances
6. Depressive symptoms can be triggered by the following medications: Anticonvulsants, benzodiazepines (especially after withdrawal), cytostatics, glucocorticoids, interferons, antibiotics, statins, neuroleptics, retinoids, sex hormones, beta-blockers, potentially also diazepam, cimetidine, amphotericin B and barbiturates.
7. Anabolic steroid addiction
8. Postnatal depression: 10-15% experience the „baby blues“ postparum, probably neuroendocrinologically caused
9. Winter depression
10. hormonal contraceptives can lead to depression-like symptoms, but they do not worsen an existing depression.
11. Gravity: Pregnancy depression

Diagnosis

1. (according to main and secondary criteria)

Symptoms

1. (see main and secondary criteria)

Complications

1. Suicide: around half of all suicides were depressive.
2. The change in motivation and neglect leads to many health risks, such as the consequences of smoking, lack of exercise, irregular medication, poor diet and obesity
3. CHD and its consequences

Therapy

1. Various psychotropic drugs
2. Catecholamines can improve alertness
3. Antidepressants
4. Psychotherapy, especially for more severe degrees
5. Electroconvulsive therapy and other stimulation procedures without proof of efficacy such as transcranial magnetic stimulation, magnetic convulsive therapy, transcranial direct current stimulation (tDCS)
6. Light therapy, not only but especially for seasonal depression
7. Sports and exercise therapy, at least 3 / week á 45 min
8. Meditation
9. Waking therapy, sleep deprivation
10. Depressive episodes, treated or untreated, often subside on their own over time. The median duration is 23 weeks. However, residual symptoms often remain, which allow a prognosis regarding the tendency to relapse. A co-occurring personality disorder has a negative effect on the course of the disease and the chances of recovery are then reduced by half.
11. Sleep hygiene, avoidance of light with a higher blue component in the evening