What is the point of emotional depression

Depressive episode

One speaks of a depressive episode if pronounced depressive symptoms persist for at least 2 weeks. A depressive episode can vary in severity. The duration of the course is variable. On the statistical average, however, a definable phase duration of 4 to 6 months can be assumed. In about 15% of the cases, the phase can take a protracted (delayed) course and in some cases can last well over a year. Such depressive episodes can appear for the first time at practically any age. However, the greatest accumulation of initial illnesses is found in young adulthood. The chance of remission, i.e. H. the complete regression of the depressive symptoms is good. In about 1/3 of the cases, however, if the episode has subsided, residual depressive symptoms remain untreated. In approx. 50 to 75% of all cases it is not just a single depressive illness.

If another depressive episode occurs, one speaks of a recurrent depressive disorder. If a manic phase occurs at least once in the long term, one speaks of cyclothymia or manic-depressive illness. Manic phases can be understood simply as the reverse of depression. You are z. B. characterized by baseless cheerfulness, overconfidence, volatility, a significantly reduced need for sleep, an increased urge to speak, move and confirm.

The diagnosis of a depressive episode is based on the international classification of mental disorders (ICD-10). A distinction is made between main and additional symptoms. The severity of a depressive episode is also determined on the basis of the number of main and additional symptoms present. In a somewhat simplified way, it can be said that with a slight depressive episode, the suffering of a person is often compensated socially and professionally and that person can still meet his social obligations with great effort. Even with a moderately severe depressive episode, the functionality, e.g. B. at work, at least partially severely impaired. In the case of a severe depressive episode, on the other hand, the illness-related impairment is so high that a person can generally no longer meet their social and professional obligations.

Typical symptoms of a depressive episode:

Mental symptoms

  • Feelings: The mood is unhappy, depressed, depressed, desperate and resigned. It can be that someone bursts into tears at every little thing or that they feel deeply depressed and desperate, but actually suffer from not being able to cry. The range of normal emotional experience is severely limited. A person in a pronounced depressive episode cannot be happy about positive events. Perhaps he can no longer even perceive such a thing. Many depressed people describe a "feeling of numbness". They suffer from being unable to feel feelings of love anymore and express that everything is empty, dull and dead. You speak of a “cooling down through feelings” or a “mental wall” that surrounds you.
  • Energy / drive: Depressed people suffer from not being able to bring themselves up to do something. The will to be active may well be there, but in a depressive episode the person concerned experiences himself to a great extent listless, lackluster, weak and powerless, without drive and without initiative. He can't get up. The "inner weaker self" becomes insurmountable. Some people describe it as a feeling of "an invisible force keeping you away from any activity". In contrast to this depressive inhibition, which is also visible to the environment at least in the case of severe depression, many people experience strong inner restlessness. You are nervous, stressed, rushed and driven, "like electrified". In an attempt to overcome the depressive inhibition with the effort of will, there is often a hectic urge to get busy. A lot is started, but without being able to lead the activity to a meaningful end.
  • Attention / concentration: Concentration is mostly impaired. Prolonged concentrated occupation with one thing becomes impossible. Thinking is inhibited, memory is restricted. Attention is increasingly withdrawn from the surroundings (private or professional matters). It narrows more and more to the depressive symptoms. It is becoming increasingly difficult to deal with several things at the same time, you experience yourself as absent, with your thoughts elsewhere.
  • Think: Brooding thinking is typical of depression. The thoughts turn in a circle, the same thought contents force themselves on. There is no result. The depressive thinking wears down. Past or current events are overestimated, resulting in a guilty conscience. Perhaps minor past failures become present, with the tendency to constantly have to justify oneself to oneself. The ability to make decisions is greatly reduced. In the case of a major depressive episode, a person can find himself brooding over a mundane question, feeling torn, unable to come to a decision.
  • Self worth: In a depressive episode, the person concerned appears very thin-skinned. He is very sensitive to criticism and quickly feels attacked. He may have a tendency to develop feelings of guilt, even where it is not his own fault. Overall, self-esteem is significantly reduced. Severely depressed people often experience themselves as a burden for their surroundings and develop thoughts that are tired of life. This can begin with the unspecific thoughts that you can no longer take it all, that you no longer want to wake up. It is not uncommon for specific suicidal thoughts or plans to emerge. Approx. 50% of all fatal suicide attempts are committed in the context of depressive illnesses.
  • Interpersonal and professional area: Interest in hobbies is lost. It is becoming increasingly difficult to keep in touch. The depressed person withdraws, hides himself, and often cancels appointments under pretexts. It is difficult to make new contacts. Because you don't dare to tell your friends that you are suffering from depression, they often misunderstand your own reactions and turn away out of anger. At first, there is a feeling of permanent overwhelming at work. Work takes longer than usual. Ultimately, there is also an objective drop in performance. The workload is not made. It is not uncommon to take files with you after work, on the weekend or on vacation. This usually accelerates the downward spiral of depressive experience, as there is an increasing lack of regeneration times.

Physical symptoms:

  • Sleep disorders: Difficulty falling asleep can occur, but overall they are less typical than disturbances to sleeping through, which are almost never absent from any depressive episode. Sometimes at the height of a major depressive episode, someone wakes up in an hour or two and is unable to sleep for an extended period of time. Or sleep remains superficial from the first awakening and is disturbed by many phases of wakefulness. Cumulative nightmares can occur. In the morning you feel as if you haven't slept at all.
  • Appetite: A major depressive episode is often associated with loss of appetite and severe weight loss, so that people often fear that they have a tumor. In other cases there is cravings and consequently weight gain (atypical depression).
  • Head pressure: Diffuse pressure throughout the head is typical of depression. It is not actually a headache that pounds, stings or pounds somewhere. Depressed people often describe this head pressure as a feeling of constantly wearing a helmet or as if the skull was constantly lightly clamped in a vise.
  • Breathing: Chest tightness, pressure on the chest, shallow breathing, heavy breathing, and wheezing.
  • Heart problems: Palpitations, racing heart. Stitching and burning in the region of the heart, feeling of pressure behind the sternum.
  • Circulatory / autonomic nervous system: Hot flashes and chills. Tremble. Slight blushing. Cold hands and feet. Temperature hypersensitivity. Fluctuations in blood pressure or constantly high blood pressure. Dizziness, weak knees.
  • Gastrointestinal tract: Nausea, nausea and vomiting. Frequent flatulence. Heartburn. Stomach pressure. Often constipation, less often diarrhea.

The Treatment of a depressive episodee requires targeted diagnostics. It is not enough to simply state that a person is depressed. The targeted initial diagnosis is important in order to recognize the various causes of depressive illnesses and the various forms of their course. The diagnosis of a depressive episode always includes a detailed physical examination and a medical history-taking. Furthermore, the diagnosis includes the identification of individually predisposing, disease-causing and disease-sustaining factors. Ultimately, it is a matter of recording in as differentiated a manner as possible how the depressive experience of a person affects his or her specific life relationships (work, family, leisure time).

Whenever a depressive episode is triggered by psychosocial stress factors, the psychotherapeutic treatment are of great importance, both for coping with the disease and for the prophylaxis of later disease recurrences (recurrence of the disease). Regardless of the psychotherapeutic method used (depth psychotherapy, behavioral therapy), how the depressed patient is dealt with varies depending on the severity and acuteness of the depressive episode. Acutely occurring major depressive episodes require a therapeutic attitude that is comparable to that of a doctor in the case of a serious physical illness. It is about appropriate information and advice, the promise of hope for improvement and the initiation of suitable medication. In addition, the significantly increased risk of suicide in acute phases of illness must be taken into account through regular contact and suitable monitoring measures.

While a mild depressive episode can generally be treated purely psychotherapeutically, a patient suffering from a major depressive episode is considered to be malpractice medication to withhold. In many cases, antidepressant treatment is a matter of discretion. Here the patient should be adequately informed about the opportunities and risks (side effects) of drug treatment so that he is able to help make decisions.

Outside of the very acute phases of the illness, the psychotherapeutic treatment of a depressive episode now places greater demands on the patient. Psychotherapy is about working out together with the patient which conditions in his individual case led to the triggering or maintenance of a depressive episode. Behavioral therapy and depth psychological therapy methods differ in their basic assumptions and treatment management.

In the Behavior therapy it is less about uncovering past causes of a depressive episode. Rather, the attempt is made to identify unfavorable behavior patterns and thinking habits of which the patients are usually not even aware. Under the guidance of the psychotherapist, the patient then learns to develop and practice other, more favorable behaviors. For example, very small steps can be attempted to encourage a patient to give up his social retreat a little and to socialize again, to resume his work or to cope with everyday tasks again in an appropriate gradation. Depressed self-doubt, self-accusation, and negative views about other people and about yourself are discussed in depth. With the help of the therapist, the patient can gradually learn to exchange his negative (depressive) view of things for a more neutral or positive attitude.

Depth psychological therapy approaches also assume that learning processes play a role in the development of depression. But they attach a little less importance to them. Certain conflicts from earlier phases of life that could not be adequately dealt with and that now develop a disease-causing effect in adult life are seen as central here. The conflict situation that triggers depression is identified in the therapeutic conversation. It is not just about an external, so to speak objectifying description of the conflict situation, but above all about shedding light on how the person concerned experienced the situation subjectively on their personal background. Often it is only through an understanding of conflict situations that have an impact on life history that the emotional dimension of the current conflict can be properly understood.

Example: A 47-year-old employee comes to a rehabilitation clinic with symptoms of a moderate depressive episode. He reports that the depressive symptoms appeared with only a short delay after his department head canceled the vacation he had discussed long before for operational reasons. The dutiful and ambitious employee did not go on vacation, but after a short time developed sleep disorders and then the full picture of a depressive episode. The current conflict is easy to identify. It is about a conflict between the desire for rest, relaxation and vacation on the one hand and the sense of duty to do one's job and stand up for the interests of the company on the other.

However, just looking at the current conflict cannot explain why this employee developed a depression. The in-depth discussion shows that the employee is quite capable of understanding the operational situation. He realizes that not all employees can go on vacation because a large and important project has to be completed. However, he feels that the fact that his vacation has been canceled is arbitrary and harassing. The extended history taking from a depth psychological point of view finally provides important information on biographically significant conflicts between the patient and his father. This was experienced as sometimes arbitrarily punitive and harassing. The patient had already given up in his early years looking forward to something too openly because his father had thwarted his plans by prohibiting him massively. He did not see the prohibitions. But rebellion was pointless. In the end he submitted to his fate and gave up. It is only on this background of understanding that it becomes understandable that the factually justified postponement of a vacation on a subjective meaning background was equated with arbitrariness and harassment. Massive feelings of disappointment, hurt, anger, and anger were incapable of being conscious of the patient in the current occupational conflict situation. They remained repressed and experienced a “turn against their own self” in the form of depressive symptoms. The depth psychological therapy procedures assume that the patient receives essential help from the fact that he comes back into contact with his defended feelings. This expands the spectrum of emotional reaction options. Due to the greater variety of emotions available to him, the patient can better cope with social situations and better endure conflict tensions, both of which lead to an (antidepressive) increase in self-esteem.

The treatment of the depressive episode in the Hardtwalklinik II

The Hardtwaldklinik II is a psychotherapeutic / psychosomatic rehabilitation clinic with more than 25 years of tradition. Every year around 2000 patients are treated within the framework of an average of 6 weeks of treatment. In the past few years, various forms of depressive illness each made up just over 50% of the main diagnoses. If you take the main and secondary diagnoses together, a little more than 2/3 of all patients suffer from various depressive disorders. About 600 to 700 of our patients are diagnosed with a depressive episode of varying severity as the main or secondary diagnosis.

In principle, all depressive episodes can be treated in the clinic unless:

  • there are serious thoughts of suicide which urge action, which requires close monitoring.
  • the depression is so pronounced that a sick person is no longer able to independently carry out basic everyday activities (getting up, personal hygiene, feeding, etc.) or
  • the concentration is insufficient to conduct psychotherapeutic discussions.

After admission, a detailed medical and psychotherapeutic diagnosis is carried out.This includes a full-body admission examination (especially internal and neurological status), a laboratory screening, a detailed illness-related and biographical anamnesis, the creation of a psychological report and a behavioral analysis or psychodynamic hypothesis formation on the development of the disease. If necessary, psychological tests are used.

An essential feature of inpatient psychotherapeutic treatment is always first of all the relief from domestic and professional obligations. For many patients, effective psychotherapy can only be initiated with such relief. The psychotherapeutic treatment in the Hardtwaldklinik II is usually always a combination of high-frequency group psychotherapy and accompanying individual psychotherapeutic discussions. In group therapy, linguistic processes (analytical-interactive therapy or behavioral therapy depression group) alternate with a creative process (Creative therapy, concentrative movement therapy or music therapy).

In group therapy of depressed patients, in our experience, the general effects of group therapy described by I. D. Jalom are of particular importance. In a therapy group, the depressed patient will encounter like-minded people and thus understanding. In contrast to previous domestic or business experience, according to which one did not believe he was sick, the understanding of fellow patients has a relieving effect. Experiencing the improvement of the depressive symptoms in fellow patients will give hope to overcome their own depression, as well as the reports heard about coping with earlier phases of illness. The group also offers opportunities to rediscover one's own health reports and to better understand and classify one's own life story with the help of feedback from others. In the social matrix of the group, one's own unfavorable behavior patterns can be recognized. At the same time, this marks the beginning of developing newer and cheaper techniques for dealing with human beings. Overall, group therapy offers the opportunity to gain a deeper understanding of one's own depression and the possibility of corrective emotional experiences.

Are an important part of an inpatient healing process various information and lecture eventsthat deal with issues of depression and coping with depression in a narrower and broader sense. Learning the basics of one is compulsory Relaxation procedure. Graduated sporting activities, terrain hikes in the great outdoors, swimming (and sauna) represent important offers to experience your own body in a positive way again.

A compulsory history-taking and medical examination should provide information on whether there are physical illnesses or pharmacological side effects that favor depression. If necessary, a medical antidepressant treatment is initiated or an existing therapy is modified. Individual counseling is provided on whether and why accompanying psychopharmacological treatment is considered useful. The Psychopharmacotherapy happens according to the guidelines of the scientific specialist societies.

In our clinic, following our basic understanding as a rehabilitation facility, a key focus is placed on the concrete effects of depression on everyday private and professional life. In cooperation WithSocial pedagoguen and rehabilitation advisors outside the clinic we determine at an early stage whether there will still be a need for further rehabilitation measures after the inpatient treatment. As far as possible, such measures are not only discussed in advance in the clinic, but also initiated.