Depression – From Exhaustion to Suicide. What’s behind it?

Depression – a term that comes up incredibly often in our society. Affected individuals often feel no pleasure or joy in life and never want to leave their beds again. Others, on the other hand, sacrifice themselves day after day in their daily lives even when their concentration or focus becomes harder. Affected individuals feel exhausted because of their overthinking, and still, others find themselves sleepless, powerless, and without any appetite – even at the most beautiful beach. Many of us may tend to feel sad, exhausted, or depressed at times, and people are quick to say that they are depressed. But what does depression mean? What are the symptoms of depression, how does it occur, and at what point am I considered depressed?

What is depression and what are its symptoms?

Depression encompasses a mental state that ranges from a depressed mood and lack of interest to apathy. Depression includes a variety of different symptoms that interact, reinforce, and perpetuate each other. The symptoms range from negative thoughts and overthinking to dejection, sadness or inner emptiness to concentration and memory disorders, sleep disturbances or suicidal thoughts. Often, those affected can no longer think anything positive. A lack of strength, a loss of appetite, inner restlessness, self-doubt, an irritable temper or slowed speech can also be the result of depression. The symptoms are not necessarily all present, because depression is very individual. Some people are more severely affected than others and also the characteristics and duration of depression can be very different so that it is difficult to speak of “the one typical depression”. 

Often, depression leads to considerable suffering and restrictions in private or professional life, so that those affected find it difficult to attend family celebrations, go to work or do the shopping. Depression can occur as an independent mental disorder, as an accompanying symptom of another illness or as a reaction to a stressful situation.

How common is depression?

Worldwide, the risk of developing depression in the course of a lifetime, i.e. the lifetime prevalence of depression, is around 16-20%. Depending on the study, this prevalence can vary, as depression is assessed differently in the studies and medical and psychological diagnoses can also differ. In Germany, the number of people affected is estimated at about 4.1 million, or 5.2% of the population (WHO, 2017). Women are more often affected by depression than men.

What causes depression?

There are many different causes for developing depression. There is not only one specific cause, but different influences that can contribute to the development of depression, such as genetic influences, the environment, and personal characteristics.

Genetic influences and biological factors

If a parent suffers from depression, children are more likely to develop depression themselves later in life. In addition, sensitivity and emotional susceptibility to external stress or social factors may be genetically inherited (vulnerability). Abnormalities of various neurotransmitters in the brain also seem to contribute to depression. Thus, there is an assumption that a deficiency of serotonin in the brain (serotonin hypothesis) or a low concentration of monoamines (monoamine hypothesis) in the brain are associated with depression. These hypotheses are linked to some antidepressants, which through their mode of action ensure a higher concentration of the responsible neurotransmitters in the brain and consequently reduce the symptoms of depression. However, these deviations in the neurotransmitter concentration in the brain alone cannot explain depression. Experiences and environmental influences also play a significant role in the development of depression.

Individual experiences and environmental influences

Experiences, such as a “learned helplessness” in childhood, play a role in the development of depression. Learned helplessness involves the attitude of not being able to control or influence situations, but being exposed to them. Unprocessed loss situations, such as the loss of a parent, a trauma, or a dysfunctional parent-child relationship, also seem to lead to a higher susceptibility to depression. In addition to these experiences and our genetic predisposition, however, personal factors also play a role in the development of depression.

Personal factors and characteristics

Personal characteristics and factors can also promote the development of depression. Accordingly, people who are very correct, self-sacrificing, neat, insecure, and achievement-oriented seem to be more prone to developing depression. A very well-known model in the explanation of the development of depression is the vulnerability-stress model, which assumes that a genetic or personal susceptibility (vulnerability), as well as critical and stressful life events in combination, can lead to depression.

The various influences that can contribute to the development of depression explain why depression can have so many faces and varies from person to person. Therefore, one should not compare the own depression, one’s symptoms, or oneself to others.

Recognizing depression: Diagnosis depressive – what is behind it?

Depression is diagnosed according to the so-called ICD10-GM (International Statistical Classification of Diseases and Related Health Problems). 

The diagnosis of a depressive disorder requires persistence of symptoms of at least 2 weeks. Due to the number of different symptoms, the appearance of depression varies greatly from person to person. There are three core symptoms and additional symptoms.

The core symptoms of depression include:

• a depressed mood and persistent sadness
• a loss of pleasure and declining interest
• a decrease in drive and activity, as well as increased fatigue or low energy

Secondary symptoms:

• Decreased concentration
• Fatigue
• Sleep disturbances
• Early waking 
• Morning low
• Impaired self-esteem and self-confidence
• Negative and pessimistic thoughts
• Suicidal thoughts
• Feelings of guilt
• Feelings of worthlessness
• Restlessness
• Motor impairments
• Loss of appetite
• Weight loss
• Loss of libido

Severity of depression

Depending on the number and severity of the symptoms, depression is classified as mild, moderate or severe (“major depression”). It is primarily a matter of how many symptoms the sufferer has and how severely the sufferer is impaired: 

• Mild depression: includes two core symptoms and two other symptoms (four symptoms in total) with mild impairment in daily life.
• Moderate depression: includes at least two core symptoms and 3-4 other symptoms (five to six symptoms in total) with difficulty continuing activities of daily living.
• Major depression: includes three core symptoms in conjunction with at least five other symptoms (seven or more symptoms in total) often paired with the loss of one’s own self-esteem and possible suicidal thoughts.

Types of depression

Depression has many faces. They vary in severity, intensity, as well as symptomatology depending on the individual. Nevertheless, there are certain types or subtypes of depression that have been classified and are familiar to many people, such as bipolar disorder (also known as manic depression including periods of depression and mania), postpartum depression (depression after giving birth, also known as postnatal depression), seasonal depression (such as winter depression), and dysthymia.

In addition, there are some mental conditions that are similar to depression but are not officially considered a diagnosis, such as the winter blues as well as the baby blues or burnout.

“I can’t take it anymore” – What do I do if I suspect depression?

First of all, it’s best to contact your physician for a medical diagnosis to determine whether your symptoms are an expression of depression or a side effect of another illness (e.g., brain disease). If psychotherapy is subsequently recommended to you or if you suspect that therapy would be useful for you, you can contact a psychotherapist yourself for an initial consultation. 

Within the therapeutic offers, there are different measures to treat depression. Often, depression is treated with a combination of psychotherapeutic treatments and psychopharmacological (medication) treatments. You can read more about this in our article “How to fight depression: What can I do about depression and how I can I prevent it?“

In case of emergency: There is a telephone counselling service that can be reached 24 hours a day, free of charge and anonymously: 1-800-273-8255. Further information can be found at https://suicidepreventionlifeline.org/

Feedback & Community

If you have any feedback, questions or additions to the article, please feel free to message us here or on instagram (@psychologyjungle). The anonymous comment function allows for an exchange of content and experiences. Make sure you treat everyone with respect, even when we are on the Internet 🙂