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Depressions

 

Universal


About 15% of the German citizens fall ill in the course of her life once or several times with a depression. 15% of those with severe depressions commit suicide. Currently the number the suicide lies in Germany with 12,000 per and Dark figure-considerably might be higher. Every 10th patient in the family doctor's practise is depressive, this books a study of the Max-Planck-Instiuts in Munich, only 8% of the patients point to the psychic problems. A cause for the fateful misjudgement depressive illnesses are numerous interdependent factors. On the one hand there is no uniform appearance of the depressions which would make easier the diagnosis. The lamina of the symptoms reaches from sad mood about concentration disorder up to physical complaints. On the other hand depressions sometimes resemble the signs of a normal sadness or dejection which disappears after a short time without special therapy again. Therefore, they are often underestimated in her gravity. And, finally, many patients do not describe her complaints completely, because they are afraid of the diagnosis and the social proscription linked with it. A worry which is not groundless, because the depression is accepted till this day with many laymen not as a disease, but becomes as a will infirmity, flaw in the character, or hysteria is looked.


Sadness or depression?


Every person experiences in the course of his life phases in which he is knocked down and is despondent. Incriminating living conditions often lie behind like the loss of the job or personal failures. Even banal experiences are sometimes sufficient to press the mood and to let look black the world. Such phases of the dejection in a crisis is no disease, but a passing retreat which is required to the reflexion and to the re-orientation. Also the funereal reaction after the death of a beloved person shows such a retreat phase. After weeks or months the emptiness and Hoffungslosigkeit new perspectives stand out bit by bit for other lives. Bone of a depression originates against it a not correctable retreat which admits no re-orientation and of which the affected person does not find out. Instead of a constructive reflexion develops unstoppable brooding which makes the patient constantly more tiredly and more ill, until a life-menacing state enters.


"The depression is like a lead coat which lies down over body and mind."

 
Typical symptoms of the depression are:


Fatigue, cephalalgia and back pains, stomach trouble, pressure feeling in the breast, chronic Miss's feelings in the epigastrium, sleep disorders, spastic abdomen discomforts. Appetite or libido disorders. The typical sleep disorders with depressions distinguishes itself by "chopped" sleep and early awakening with the "morning low-pressure area". Constant brooding, and circles of thought does not let patients fall asleep or not go on sleeping after an early-early morning awakening. In the morning after a little restful night the patient feels himself floppy, tired and low-spirited. Moreover, many depressive are tormented by constant fears. Some believe, they are her people a load, others are afraid of the future or of incurable diseases. Panic fits sometimes appear, they can be the first tip to suicide danger. As a danger signal every therapeutist should evaluate portrayals about constantly stronger growing thoughts of the futility and the internal emptiness. The death appears to these patients on a continuing basis the only way out from her infaust situation and redemption of her torture. A depression draws itself by dejection, listlessness, indifference, irritability, contact poverty, stimulus poverty and vegetative disorders (sleep disorders, appetite disorders, bad digestion, bad circulation) from, it must be also considered always that perhaps a suicide inclination exists. Studies prove that 25% of the diabetics are depressive, with cardiac failure patients there are 20%, 50% suffer after a stroke and 40% of the patients with atypical pains, above all back pains, suffer from depressions. Also between multiple sclerosis and depressions a connection exists.


Diagnostically relevant symptoms of the depressions


Definition / symptoms


Main symptoms:


- Depressive disgruntlement
- Loss of joy and interest
- Decrease of the stimulus


Additional symptoms:


- Concentration disorder
- Lacking self-esteem,
- trust
- Feeling of obligation and worthlessness
- Pessimistic future perspectives
- Suicidal tendency - sleep disorders
- Decrease the appetite


If after anamnesis and physical examination no organic findings are to be found, must be thought causally to a depression, to the so-called larvierte depression.


Agitated depression:


This form of the depression draws itself by worried excitation, nervous mood, moaning, restless running around from, these patients not always look depressive.


Melancholia:


This kind of the depression is not caused organically, appears informally as piled up, often walks along with manic phases, nevertheless, these manic phases can be also absent. The depression is without motive, there is a stimulus inhibition, mental inhibitions and willing inhibitions, guilt and Versündigungsideen. Physically often passes Inappentenz, sleep disorders, circulation regularisation disorders and Obstipation (blockade). Organ-felt fear (e.g., head, heart) often exists. The melancholia can originate as a result of a strain (abnormal experience reaction).


However, depressive states can also seem with schizophrenia (personality disorder), Hirnorganikern (illnesses with disorders of the functions of the brain) and psychic illnesses. At the beginning and end of the depressive phase the ill are especially suicide-threatened.


Typically for all depressions is the phasische occurrence. An episode is able several weeks, sometimes also months stop and then decreases again. With 30% of the patients there remains with one single depressive episode in her life. Indeed, the likelyhood that the second episode follows, greater than 50%. If the affected person has already gone through three depressive phases, the Rezidiv likelyhood lies even with 90%.


In difference to the university-polar depression, depressive episodes alternate by bipolar affective disorder with manic phases. These are marked by enormously energy, raised spirits, missing sleep need or purchase drunkenness. About 10% of all depressive patients suffer from these manic episodes. If themselves no single episodes reveal, but a lighter distinctive however chronically running depression is given, one speaks of Dysthymie.


The single course forms with which one believes to know a bringing on cause can be separated from the classical depression. Moreover the puerperal depressions and the depression belong in the menopause. In both cases are held responsible hormonal transposition for the outbreak of the illness. An other special form shows the depression dependent on season. Above all in the autumn month and winter months it comes by low sunlight to disgruntlement symptoms. Here a special light therapy is an advantage.


Causes of the depressions


The depression is multifaktorielles events in which biological, biochemical, genetic and psychosocial factors are tied together with each other and influence themselves mutually unfavorably. All factors lead, finally, too neuro-biological change of the cerebral metabolism which flow then into a depression.


The role of the genes:


On the basis of family examinations one knows that the genes are an important biological factor for the genesis of the depression. Then relatives of a depressive patient in at least 20% of the cases become also depressive, while the frequency lies in the general population with from 5 to 10%.


If it concerns with the relatives uniovular twins, the risk doubles even on 40%. Nevertheless, this doubling is not valid for dizygotic twins. An international research team has recently identified that the people who carry the short variation of the gene for the serotonin transport on her genotype, become 2.5 times more often depressive as that which have inherited the long genetic variation from her parents.


Psychological factors:


There is a row of psychological models which are brought with the genesis by depressions in connection. The deep psychological model: goes out from it that the root of the depression in the quite early childhood lies. It constructs on the acceptance that a disturbed respect with the mother and the insufficient satisfaction of the childish needs lead to an interference of the development. The selfvalue problem from which to many depressive suffer is derived from it. The affected persons are dependent in considerable measures on the esteem more different and develop an emotional Überbedürftigkeit which is to be fulfilled by the environment only very seriously. These patients try to compensate her low self-esteem with high achievement norms.
Another model means: the fact that depressive patients have acquired negative experiences in the childhood and Having young a negative self-image. If similar situations appear in the later life, so that the affected person sees everything the environment, the future, and above all own person - negative.


The so-called qualified helplessness is a basis of the third psychological depression model. The patients have learnt from the experiences in which they have failed that they are incapable to master her own life. The events which they cannot inspect or menacing separations of a being close person bring on feelings of helplessness and Nichtgeliebtwerden. To bend forward such situations, patients often avoid every criticism of her partners and behave conformistly and perfektionistisch from which puts back his own personality because of fear of loss of love and security about long years. Nevertheless, the besides originating pressure is hardly to be stood on a continuing basis. as soon as a trigger comes in the form of an emotionally or physically incriminating situation, the depression breaks out.


The neuro-biochemical model gives the first insight into the pathophysiologischen processes in the brain which lead to a depressive illness. Serotonin deficiency leads to the fact that certain signals cannot be passed on by nerve cell to nerve cell. Here at this point the antidepressants (drugs against depressions) attach her effect. They raise the concentration the serotonin in the synapse. With the manic phases of bipolar depressions one supposes a raised concentration of noradrenaline and Dopamin.
Depressions also seem to stand with a disturbed hormone household of the stress hormones CRH (Cortisol releasing hormone) and Cortisol in connection. Why these hormones are produced with depressions in the profit, finally is not cleared yet. Is certain that high concentrations of CRH lead in the brain to fear, loss of appetite, concentration disorder and sleep disorder, so to symptoms, the depressive frequent are to be found. The überschießende production of these hormones could also explain the typical internal restlessness depressive patients.


Virus and depressions


One supposes that depressions stands in Zusammenhag with Borna virus. The virus is known up to now by domestic animals and benefit animals. Bie of the patients with melancholias could be proved the virus in the acute phase of the illness in white blood cells. The researchers suppose that it comes under the virus infection for a disorder of the chemical balance of the cerebral neurotransmitters.


Creativity and depressions: Are creative people more susceptible for depressions or are depressive extremely creative?


An American study from 1995 has produced amazing results. Within the scope of the examination the biographies were analysed by more than thousand important personalities from different social area. With more than two thirds of the authors, musicians, composer and painters remarkable symptoms could be proved psychiatrically. With it more art-creative were concerned three times than, e.g., scientist and businessmen. Above all an otherwise seldom appearing illness of the mind and the soul could be proved with exceptionally many creative: the manic-depressive (bipolar) form of the depression.
There is also a test to the capture of the gravity of a depression, briefly TSD. Here 12 questions to the patient are put and thus the gravity of the depression are identified.


Test questions TSD


1. I am nervous and internally worried.


1 point = not at all
2 points = a little 3 points = quite strongly
4 points = very strongly


2. I feel easily bothered and angry.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


3. I feel weak and sluggish


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


4. I remember to break off the life.

1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


5. My appetite is bad.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


6. I easily cry.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


7. Compared with the other sex I am shy and unsafe.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


8. I feel restricted and enclosed.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


9. Suddenly I frighten without external occasion.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


10. I suffer from reproaching to myself.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


11. I am afraid without reason.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


12. I feel sad.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


13. I feel inhibited in the implementation of some works


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


14. I worry too much


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


15. I have the feeling that I lose the interest to many things.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


16. My feelings are slightly vulnerable


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


17. I have heart hurry (heart lawn)


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


18. I feel put under to others


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


19. I have difficulties and to sle throughpt


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


20. It is difficult for me to make decisions.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


21. I look hopelessly in the future.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


22. I have concentration difficulties.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


23. I feel tense and overtaxed.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


24. I think of the death and the death.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


25. In the morning I wake too early


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


26. My sleep is worried and disturbed.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


27. I have the feeling that I must exert myself to all.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


28. Even among people I feel lonesome.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


29. I feel worthless.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


30. I have feelings of guilt.


1 point = not at all
2 points = a little bit
3 points = quite strongly
4 points = very strongly


Evaluation

 
to 45 points: no depression
46 - 57 points: Depression doubtfully, other examination necessarily
from 58 points: Depression


Therapy


The treatment of a depression always exists in psychagogisch-psychotherapeutic talks and according to kind and gravity of the illness if necessary of medicinal therapy. After the depressive disorder the second depressive episode follows with 50% of iger likelyhood, this with 80 %iger likelyhood an other episode. Therefore, should be roofed with the medicinal therapy that the drugs must be taken very long in isolated cases even lifelong. Depressive falling ill must be treated early and long enough. Otherwise threaten rezidivierende courses with which it becomes more and more difficult to achieve a persistent therapy success.


Today under the different treatment possibilities the combination of psycho Pharmakotherapie (therapy with drugs) is valid as especially successful


Psychotherapeutics:


The psychotherapeutics knows two different treatment attempts: the deep-psychological and the behaviour-therapeutic beginning. The classical depth psychology assumes from the acceptance that the reasons lie for a mental disorder in the early childhood of the patient. Therefore, in a conversation therapy it is tried to grasp these causes to work off them then with the help of the therapeutist.


The cognitive behaviour therapy assumes from the fact that a learnt failure forms the basis of the depression which can be overcome by practising other behaviour patterns. This treatment has turned out during the last years especially effective.


The medicinal therapy should be continued first, even if fast improvement enters, half a year. If no success enters, a transfer is indicated to the specialist. Neuroleptika and Benzodiazepine should be used only symptomatically, in addition to antidepressants, by severe sleep disorders or delusional disorders.


Patients are often depressive after a cardiac infarction, then a 3.5-fold higher Sterberisiko exists (untreated); nevertheless, are given SSRI, the Sterberisiko drops again considerably.

Also with the diabetes mellitus are often found with ill depressions, then these are treated with SSRI, the insulin resistance also decreased.

With MS patients the dose of the drug can bring on interferon depressions, this is the case it should be set down, however, only under strict clinical control. Often back pains are brought on with patients by mental strains, which is why often painkillers do not help in this illness. Here has proved itself Johanniskraut.

Natural medicine therapy


Belong to the therapeutic options:


1-acupunctures: with depressions certain psychic points are stung like anti-depression point, relaxation point, anti-aggression point and joy point. The acupuncture is also a very effective therapy with gestation depressions.


2-respiration therapies: it is recommendable anyway.


3-Ausleitende procedures: here bloody and bloodless zones of the depression are treated.


4-brook blossoms: good success with mind-oriented treatment with depressions.


5-own hemotherapies: here natural medicine is mixed together with own blood and is injected. Also certain medicine is injected in the form of drips in the vein.

6-remedial starvations: nevertheless, on this occasion, is to be followed: to carry out the so-called starvation crisis, hence, only among experienced people.

7-homeopathies: here everybody is considered mental, physical and environment factors (employer-employee relationships, informal) and appropriate suitable medicine is taken.

8-Orthomolekulare medicine: emotionally stabilising magnesium and certain vitamins work. Especially good success with light to moderately severe depressions are achieved with tryptophan.

9-physical therapies: in the form of hydropathy, therapeutic exercises, photo therapy and Balneotherapie.

10-phyto therapies: here have proved themselves Johanniskraut and Kava Kava. With severe cases, e.g., melancholias certain medicine is merged and prescribed for the patient.

11-foot reflex zone therapies: neutral whole-like slightly working as tonic treatment among other things head, solar plexus, spleen, adrenal gland, bowel, sphincter.

 

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