Symptoms of depression: "I was not even sad ..."
It's spring, when Kathrin begins to forget. Until then, her job had always given her pleasure: He is varied, she has to do with many people. Now Kathrin no longer knows exactly who she's talking to, can barely concentrate, starts things she has already done, a second timeshe lies in bed in the morning and does not remember appointments that are due today.
Then panic rises in her. Recently her mother died. For years this had lived in a nursing home - dementia. For a long time, neither daughter nor husband had recognized her, had become a stranger to her family and herself, and finally fell silent.
Kathrin is only in her mid-50s, but she is afraid to have Alzheimer's as well. She goes to the neurologist, lets her brain shine through - it is perfectly healthy - is sent on to the psychologist and learns from this the real reason for her memory loss: she has depression. A relief. And at the same time a shock! Depressive? You? She was not even very sad.
Relationship, vacation plans, canteen food - everything has always been great and great
Like Kathrin, an estimated four million people in Germany alone suffer from depression, including twice as many women as men. About one in five already has the disease in the course of his life. A number that will continue to increase in the future - according to forecasts.
Depression is a common disease: it has arrived in our consciousness. But we do not know much about their different forms. And Often the symptoms of depression are far removed from what we and even some doctors "expect" from depression.
For example, the 38-year-old Meike suddenly started talking a hell of a lot - about their relationship, their vacation plans, everyday things like the last canteen dinner - and everything was always great and great. Nevertheless, friends and colleagues did not feel that they could really have a conversation with her. Meike's hilarity was lifted, no one poked, alienatedbecause, no matter what happened around Meike, it always remained constant. At the same time, Meike quite literally did not let anyone get close to her and shut herself up in her apartment.
In truth, she already had no more power to cope with their everyday lives, go shopping, do the household, And so it was a lucky coincidence that her roommate found her on time and called the ambulance when Meike tried to kill herself with medications. The subsequent diagnosis in the clinic: depression.
Bettina also received the same diagnosis - her previous history, on the other hand, is completely different: the 36-year-old went to the doctor because she felt weak and limp. She also had stomach problems. The family doctor recorded blood values, referred them to the gastroscopy, then to the MRI, and the more frequently these examinations did not produce any results, the stronger Bettinas became Fear of being seriously ill, suffering from an unknown infection, infecting others with it That's why she soon barely walked out the door. In the end, she even feared dying from this disease. And only at the urging of her cousin and with her, did she go to a psychiatrist a few months later.
Three times depression, three completely different symptoms. For all - concerned, relatives and doctors - a challenge.
As more people become depressed overall, the number of people whose illness is less obvious also appears to be hidden Concentration disorders, a cheerful facade or various physical complaints.
"Some people have just about nothing in terms of mood or mood," says Prof. Martin Hautzinger, a psychologist at the University of Tübingen. For them, limited thinking, for example, weighs heavier. "The fear of suffering from Alzheimer's is very common especially with older depressives and their relatives," says Hautzinger.
Ear noises or pain get the quality of the unbearable.
The overlap of symptoms is fatalEspecially in old age - and depression is more likely to affect older people than younger people - the disease is often not properly recognized and treated. There are clear differences to dementia: The memory failures Depressiver do not begin creeping, but it can be a starting point.
In addition, people who suffer from depression usually complain about their problems because they are aware of them. And then when the depression is treated, unlike dementia, the memory failures go back.Kathrin, too, has been able to concentrate better since taking antidepressants and going to a day clinic twice a week for therapy.
And how can one explain that, as in the case of Bettina, stomach problems or other physical problems are at the center of the disease? "In depression, all physical sensations become discomfort"And, for example, back pain or ear noises, which are otherwise well cope, get the quality of the intolerable," said Prof. Ulrich Hegerl, Director of the Department of Psychiatry and Psychotherapy in Leipzig.
For example, in depressed people, muscle tension often increases. As with Bettina, this can lead to an oppressive feeling in the area of the esophagus, or it is easier to pain, especially in the back. A depressed person not only takes these tensions more seriously, he also evaluates them differently, for example, as an expression of a serious, the future obstructing disease, which in turn increases the hopelessness.
In fact, 30 to 50 percent of patients visiting a general practitioner can not find any organic causes for their physical ailments. "But many doctors do not think then of depression," said Hautzinger. And so, such as "somatised" or "larvated" depressions are often overlooked, and it takes precious time. Because logically, depression that has remained unrecognized for many years is often even harder to treat. In addition, there is also a danger that those affected will slip so far in their negative spiral of thoughts that they perceive their situation as completely hopeless and even try to commit suicide.
So how can sufferers and especially doctors recognize a hidden depression? The key is that the doctor asks the right questions. Because the least affected directly report on their mental health problems and if, then only as a result of pain, digestive problems or sleep disorders. "Many patients say, for example, 'I am lacking sleep and that's why I'm feeling sick'," says expert Ulrich Hegerl.
The specialist in psychiatry and psychotherapy is also the chairman of the German Depression Aid Foundation. Among other things, the foundation trains doctors to ask their patients about these things: "Are you hopeless?", "Do you feel guilty?". One of the key pieces of information is the trivial question: "Is there something that gives you pleasure?" For example, a person who "only" suffers from back pain is still looking forward to eating a favorite meal or visiting an old friend. In contrast, depressives will usually not be able to call such a positive event.
Is there something that gives you pleasure?
But what happens if we know more and more about hidden depression? In the end, do we run the risk of assuming the first signs of a mental illness behind every mother's wilfulness, behind every incomprehensible emotional state of the girlfriend, or after every stomach oppression?
No, a warning sign for relatives is especially when the whole person changes. And Despite their different facets, depression is still clearly defined, even if not all symptoms are present or equally pronounced. So a few years ago, experts vehemently disagreed with a supposedly new form of depression, which was named "Sissi Syndrome" after the former Austrian Empress Elisabeth. This syndrome has been shown to affect more and more women through self-esteem, self-control, over-sport, the pursuit of outer perfection through dieting, clothing and make-up. Incidentally, this new disease was "discovered" by a pharmaceutical company that also sold an antidepressant.
Despite this case, we are frighteningly far from any overdiagnosis or therapy: Because only about every second to third depression is recognized as such, and treated adequately in type and duration of therapy, only ten percent of those affected. So there is clearly a deficit in the care of people suffering from depression - for example, they often wait for months for an appointment with the therapist.
An additional problem: For many it is difficult at first to accept the diagnosis at all. This is especially true for hidden forms of the disease. "Most people prefer stomach ulcer rather than depression," says Professor Martin Hautzinger of the University of Tübingen. For depression is still stigmatized and many still consider themselves indebted, lack of discipline, "hanging". "The disease can really affect anyone," explains Ulrich Hegerl. "I too could become depressed, you just can not pull yourself out of the swamp in a severe depression."
You just can not pull yourself out of the swamp yourself.
Nevertheless, prescribed medications are sometimes simply not taken, discontinued on their own, or psychotherapy is discontinued. Doctors and therapists are faced with a dilemma: "I can only prescribe what the patient is doing," Dr. Catri Tegtmeier.The chief physician at the Schön Klinik Große Allee in Bad Arolsen specializes, among other things, in the treatment of chronic tinnitus: "People with so-called complex tinnitus are severely impaired by their ear noises and they suffer from about 85 percent of depressive symptoms."
When these are treated, the sound does not disappear in the ear, but it becomes bearable again and can be overheard again. Nevertheless, Tegtmeier deals very carefully with the diagnosis of depression. "We try to make those concerned cautious about the idea that their tinnitus affliction could also be related to mental health problems, otherwise we would lose them immediately," she says. "It's about helping people, and we want them to learn to deal with their symptoms."
Jutta also managed that in the clinic: she suffered from an extreme sensitivity to noise, so she was always wearing earplugs for years. During therapy in Bad Arolsen she practiced no longer perceiving sounds as a threat. Today she just wears the earplugs in her handbag and is happy. However, she still rejected the fact that she suffered from a moderate depression at the same time in the dismissal talk. Only for the new condition she has found a name: "A new life," she says simply.
That's how I recognize depression
The various hallmarks of the disease are assigned to two areas:
Count to the first area Depressed mood, loss of interest and pleasure and increased fatigue.
Count to the second area decreased concentration and attention, decreased self-esteem and self-confidence, the feeling of guilt and worthlessness, negative and pessimistic perspectives for the future, thoughts of suicide or suicidal acts, sleep disorders and loss of appetite.
Diagnosis: A mild depressive episode is diagnosed when there are at least two symptoms from both areas. As a moderately depressed is considered who suffers from at least two symptoms of the first and three of the second area. In severe depression, sufferers have all the symptoms of the first area and at least four of the second. In particularly severe depressive episodes, delusions such as sin of despondency or impoverishment often come along.
Read more: Ulrich Hegerl and Svenja Niescken: "Coping with depression: rediscovering the joie de vivre" (19.95 euros, Trias Verlag).
