Depression, mania, affective disorders
Depression is very common and can affect anyone. Common signs of depression can include a depressed mood, negative thoughts, brooding and sleep problems. It can have many causes, for example stress, which in turn can exacerbate depression. It is therefore important to recognize depression at an early stage, which gives the person affected a good chance of treatment.
Depression can occur at any age. Around 20 percent of the population will suffer from severe depression at least once in the course of their lives. Women are affected more often than men. They can occur in episodes that can usually last several months if left untreated, with around a third of depression becoming chronic.
Typical symptoms of depression are a depressed mood, negative thoughts and a lack of drive. A sense of joy and pleasure, self-esteem, performance and interest in life can also be reduced or lost. In the case of depression, these symptoms last for at least two weeks and are very pronounced. People with severe depression in particular often suffer from suicidal thoughts. Depressive symptoms can also have an impact on work and family life. The symptoms can start quickly or develop slowly over a longer period of time or only occur in phases.
In medicine, we speak of multifactorial causes, i.e. biological components (such as changes in hormone levels), genetic factors (a relative already suffers or has suffered from depression), as well as environmental factors (loss of work or a separation) can lead to a depressive episode alone or in combination. Sometimes a trigger for the symptoms can be found, in other cases the onset of symptoms cannot be assigned to a specific event. Chronic depression is often linked to stressful life experiences in childhood and adolescence. Stress and depression reinforce each other.
The exchange with people who are affected by the same disease can be a great support in coping with the disease. Advice on finding a suitable self-help group is available from Selbsthilfe Zürich. Self-Help Zurich and the University Hospital Zurich are cooperation partners in the national project “Health literacy thanks to self-help-friendly hospitals”.
Many depressed patients are tormented by the fact that their illness – unlike a broken bone, for example – cannot be “proven”. As a result, they are exposed to greater suffering than patients with other illnesses.
Depression can affect anyone. However, many people find it difficult to seek help and support. However, optimal medical and therapeutic care can only be provided after a clear diagnosis has been made. If you have the feeling that you are suffering from depression, you should visit us, because depression is generally very treatable.
The detailed discussion required for the diagnosis takes place with a doctor of psychiatry or with psychological psychotherapists. If necessary, we also use standardized questionnaires to assess symptoms.
In individual cases, a cranial MRI may also be considered for clarification.
Once the diagnosis has been made, the available treatment options are discussed together. The treatment decision is always tailored to the individual needs and possibilities of those affected. Ideally, optimal therapy combines psychotherapy with symptom-oriented drug treatment, if this is necessary. In severe cases, especially if there is a risk of suicide, inpatient treatment in a clinic may be necessary for the protection and relief of those affected.
Various methods are used to treat depression:
Behavioral therapy often promises good results. However, which form of therapy is chosen also depends on the patient’s preference.
The aim of behavioral therapy is to question thought patterns and relearn behaviors through positive experiences.
Analytical psychotherapy is based on Sigmund Freud. The aim here is to work through unresolved conflicts or traumatic experiences from earlier times (e.g. childhood). The sick person lies on a couch and talks while the therapist sits behind them.
The depth psychology method works in a similar way, except that the therapist and patient sit opposite each other and the focus is on solving specific problems.
Talk therapy creates a close and intimate relationship between therapist and patient. The therapist expresses their thoughts on the patient’s everyday situations.
In cases of severe depression, psychotropic drugs, usually antidepressants, often support the therapy. They do not work immediately, but often only after two, sometimes three, four or five weeks. Antidepressants influence the neurotransmitters, the messenger substances in the brain. These are mainly serotonin and noradrenaline. They serve to bridge tiny gaps between nerve cells in the brain during the transmission of emotions. In depressed people, this transmission of emotions is often disturbed. Antidepressants ensure that the neurotransmitters function better again. However, side effects can occur.
There are the following groups of antidepressants:
Tri- and tetracyclic antidepressants: They inhibit the breakdown of neurotransmitters in the nerve cells. This means that more messenger substances are available for transmitting stimuli. Possible side effects include cardiac arrhythmia, weight gain, visual disturbances and digestive problems.
ssRI/ssNRI: These antidepressants also ensure that nerve cells break down the neurotransmitters more slowly. Typical side effects include cardiovascular problems, nausea, headaches and digestive problems.
MAO inhibitors: These suppress the effect of the enzyme monoamine oxidase (MAO), which breaks down the neurotransmitters in the brain. Side effects include sleep disorders, dry mouth, restlessness and changes in blood pressure.
Lithium: We only use lithium if other medications do not help. It often enhances the effect of other antidepressants. Diarrhea, increased urination and muscle weakness were observed as side effects.
Alpha-2 antagonists: They increase the production of the neurotransmitters serotonin and noradrenaline by suppressing their antagonists.
St. John’s wort: St. John’s wort often helps with mild depression. However, we should also be consulted here, as this can lead to gastrointestinal complaints and allergic skin reactions.
We clarify interactions with other medications before prescribing them. If the person feels significantly better, they should continue to take the antidepressant for a few months. This prevents a relapse (maintenance therapy).
