Stress does not cause depression for a long time

Is there really more depression today?

Time and again, health insurance companies report that mental illnesses are increasing. For example, according to the BKK Health Atlas 2015, the days that employees have been on sick leave have more than doubled since 2003. However, this is not because depression and other emotional ailments are more common, but more visible. According to the health survey of the Robert Koch Institute, about eight percent of the German population meets the criteria for depression within a year - and this rate has been constant for at least 14 years.

Meanwhile, people just dare to talk about mental health issues - and doctors are more likely to pronounce appropriate diagnoses. In the past, however, physical problems such as back pain were brought to the fore. "Nevertheless, we clearly need more education and encouragement to seek help," Dr. Iris Hauth, chief physician of the Department of Psychiatry, Psychotherapy and Psychosomatics at the Alexian St. Joseph Hospital Berlin-Weißensee. Because, as a result of the fact check health of the Bertelsmann Foundation: Half of those suffering from depression is not in treatment.



Are more and more psychotropic drugs prescribed?

Yes, the prescription numbers of antidepressants are increasing. According to an OECD report, within four years by 46 percent. There is an increase especially in the so-called serotonin reuptake inhibitors (SSRI). Time and again it is claimed that behind the rising numbers is the pharmaceutical industry, which is constantly creating new indications to maximize profits. "Of course, it is right to be critical of the influence of the pharmaceutical lobby, and of course the funds should only be used if they are really indicated," said Professor Ulrich Hegerl, Head of the Department of Psychotherapy and Psychiatry Leipzig and Chairman of the Foundation German depression help.



Because even if SSRIs are considered to be well tolerated, they can have side effects. "The risk of frivolous prescription but is low with us." Across Europe, Germany is in last place with Greece in terms of taking antidepressants. In Spain and Portugal, for example, they are used much more frequently. "Still, the vast majority of people who need an antidepressant do not get it, because not all those affected are looking for help and because in Germany there is a lot of skepticism about psychotropic drugs," says Hegerl. "The problem of undersupply is thus greater than that of the oversupply."

Do antidepressants make you dependent?

"Although many people still believe that, it is clearly not true," says Hauth. "They have a specific influence on mood and drive." How effective they are, however, is discussed vigorously among experts. The US psychologist David Kirsch, for example, concludes on the basis of studies that the remedies for mild and moderate depression are not superior to placebo, at best for the severe form they have a slight positive effect. "Many of these investigations have methodological shortcomings and are not transferable to everyday life," Hegerl countered. And there are also studies that prove an effect of the drugs.



It has been proven that the effect of the medication varies from person to person - sometimes it is necessary to change preparations until patients feel better. And: antidepressants are not always useful and necessary. The treatment guidelines published in the winter provide for mild depression that does not improve on its own after 14 days, psychotherapy, moderate psycho- or pharmacotherapy (or both if desired), and a combination of both treatments for severe depression. "This therapy is based on the evaluation of all available studies and has high evidence," said Hauth.

How do you get depression?

In fact, that's not really understood. "It is clear that messenger substances play a role in the brain," says Hegerl. "But actually that's trivial: In depression, the brain functions are changed, and these are sometimes controlled by messenger substances." It is known that most antidepressants act on the serotonin system, ie nerve cells that transmit signals via this neurotransmitter. For example, SSRIs cause the serotonin released into the gap between the neurons to remain there longer. "But it would be too easy to say that depressives lack serotonin, and that has to be compensated," says Hegerl. "Our brain is much more complicated."

It is also unclear what causes the change of the messenger substances at all. Genetic factors play a role, but they do not trigger depression but only increase the risk. "At the moment there are different theories about what exactly is behind the disease," says Hegerl.

One - relatively recent - suspects that the intestine is responsible.Animal experiments have shown that disturbances of the intestinal flora and the resulting inflammation affect the psyche. Hegerl himself believes that something else is more plausible: "About 60 percent of those affected get better sleep-deprived, indicating a mechanism of development." We assume that there is a permanent hyperarousal in depression - a constant high level of internal arousal with difficulty falling asleep Sleep-deficit promotes the propensity to fall asleep and counteract the hyperarousal, which we are currently systematically investigating. "

What role do external factors and crises play as triggers?

"Depression causes stress," explains Hegerl, "but stress does not necessarily play a causal role." The expert believes that even many professionals overestimate external factors when it comes to the development of depression - and that this can prevent effective treatment. "It is often said: no wonder that he has depression, he also has a lot of stress at work or a serious illness or just a separation behind him, and studies show that this naive causal attribution is not true eliminating these problems, many would still have depression. "

Just last November, a study by the Max Planck Institute of Psychiatry proved that workplace factors play no role in depression? even if the term burn-out suggests this. "Reducing stress, making things a little quieter, sometimes going on holiday, therefore helps little," says Hegerl, "and the advice of having a good night's rest can even be counterproductive."

The expert also observes that the mental illness is not taken seriously, especially in older people, because the environment and doctors push them on the experience of loss and illness: "Here, depression is not a side effect, but a disease that needs to be treated consistently. " And why do many affected people then claim for themselves a supposed trigger, such as workload, mobbing or conflicts? "Depression increases everything that is negative and puts it in the center," says Hegerl. "So she's looking for her own reasons."

Are depression curable?

"They are easy to treat", says Hegerl. According to the Max Planck Institute for Psychiatry, more than half of those affected are better off after six weeks thanks to appropriate therapy. Another 20 to 30 percent require a more complicated treatment, such as a combination of different procedures or even an electroconvulsive therapy, which is used when drugs fail. In spite of all attempts, five to ten percent of those affected remain permanently suffering from complaints, such as sleep disturbances or a drive disorder.

"These problems are then less pronounced than in a depressive episode," said Hauth. The vast majority of people are after the decay of the depressive episode so happy and powerful as before. "But a vulnerability remains," says Hauth. "The risk for a renewed episode remains elevated." According to studies, it is 50 to 85 percent. All the more important is an early treatment. "Psychotherapy and antidepressants can significantly reduce the risk of relapse," says Hegerl.

Only sad or already depressed?

A first clue is the fairly simple so-called "two-question test":

  1. Did you feel depressed, sad, depressed or hopeless in the past month?
  2. Did you have much less desire and enjoyment of things that you would like to do in the past month?

If you answer both these questions, you should consult a doctor or psychotherapist.

The diagnosis of depression requires that at least two of the three core symptoms? Depressed mood, reduced drive and loss of pleasure and interest? exist over more than two weeks. These may include other complications such as lack of concentration, reduced self-esteem, guilt, sleep disorders, anxiety, suicidal thoughts, but also physical symptoms such as poor appetite, back pain or palpitations. Depending on how many symptoms are present, a distinction is made between mild, moderate and severe depression.
More info: Background information, offers of help and a self-test offers the German Depressionshilfe Foundation www.deutsche-depressionshilfe.de

Coping with Anxiety and Depression During Pregnancy (March 2024).



Stress, Illness, Germany, RKI, Psychotherapy, Bertelsmann Foundation, Ulrich Hegerl, University of Leipzig, Greece, Spain, Portugal