Many questions reach us from sufferers and relatives about the treatment of depression. You can’t know everything about it, but you can see through the principles to the point where you can have a fruitful educational discussion with your doctor.
The therapy of depression is urgent with all possibilities pharmacologically, socially and psychotherapeutically. Nevertheless, many depressives resist this evil. They wait too long, misjudge symptoms as a temporary predicament, build up resistance to medication and help as if it were a slight. And they scare away and demotivate their environment, in which they burden it more and more, without building a professional way out.
The first step
Accordingly the first step of depression therapy is the education and Destigmatization in the public sphere. Any institution that works with depression therapy has to deal with all the partners of a city, a region in contact with each other and share the common philosophy develop that depression is a curable disease and that every has a right to access therapy at all stages.
How can lay people who are affected directly or as relatives or friends find their way through the information jungle? The first point of contact is most likely to be a family doctor or therapist, who can be selected via the database of the Association of Statutory Health Insurance Physicians or the telephone directory. Rather too seldom it is the specialist*s for psychiatry. The first steps of depression treatment are easily done. If things don’t improve immediately, it will be difficult and opinions will differ.
In Germany, the guidelines of the DGPPN (German Society for Psychiatry, Psychotherapy and Neurology) exist for this purpose. Currently, it is called S3 guideline according to the scientific grade and can be viewed by professionals and affected persons at the link above.
This is also intended to address patients and their relatives. This corresponds to a coordination of the approach to depression in a national consensus, which also makes the therapy more transparent and easier to monitor for the person affected.
The greatest risk of depression is suicide, which in lifetime terms can probably occur in 1 in 5 cases. It is certainly not only related to the disease depression, but also to personality traits and, above all, severe stress. Therefore, the primary goal of treatment is the improvement of symptoms to a minimal level and the elimination of problems caused by the depression. And especially in the event that the success of the therapy is delayed, the rebuilding of a social network is of great importance, in addition to a reliable doctor/therapist-patient relationship.
How does the psychotherapy proceed?
In the case of mild depressive disorders and when clear conflicts can be identified as a trigger or cause, a trial of psychotherapy can be made at the beginning of treatment. Several procedures are available for this purpose, with designations and abbreviations:
- Cognitive therapy according to Aaron Beck is understood as behavior-oriented therapy less related to childhood and family than to current conflicts.
- Interpersonal therapy (IPT) and CBASP(Cognitive-Behavioral AnalysisSystem of Psychotherapy) are psychotherapy methods that have been combined from different schools and developed in a practice-oriented manner for depressive pateints.
- Brief psychodynamic psychotherapies are based on psychoanalysis, but are shorter in duration and more related to current conflicts
- All the other increasingly sophisticated so-called behavioral therapies of the third waves cannot all be mentioned in detail.
Many studies demonstrate the acute and long-term effects of psychotherapy alone and in combination with psychotropic drugs. In principle, above a certain level of severity, psychopharmacological support should always be provided as well; on the other hand, there is no psychopharmacotherapy without psychotherapeutic guidance. Thus, one should not see a contradiction, but a useful complement of the two approaches. As in the case of antidepressant pharmacotherapy, it is especially important here to take a good look at the therapist despite long waiting times and to get good advice from him or her in a trial session with regard to the method, duration and requirement for cooperation. There are also guidelines for psychotherapy, it is not secretive and it should provide noticeable relief from symptoms in the foreseeable future using transparent methods.
How is the therapy with antidepressants ?
Together with the doctors, a drug is sought that should initially have as few side effects as possible. There are several groups that differ chemically and in their mode of action
Mode of action
When one nerve cell transmits a signal to another, then this is done with transmitters, the so-called transmitting substances. Thereby over a microscopic gap between the cells substances across, a kind of liquid electricity. The two main transmitters in the case of antidepressants are norepinephrine and serotonin. These meet letterboxes – receptors – at the outer wall of the cell. When a message arrives triggered avalanches of reactions inside the cell. They cause further messages to other cells, but also conversion measures in of the cell, such as the build-up or degradation of receptors, of transmitters and also growth of connections to other cells, so-called neurotrophic processes.
Intervention options are the inhibition of the degradation of transmitters in the cell or the inhibition of its reuptake into the cell, whereby it respectively accumulates in the synaptic cleft in front of the mailboxes.
To stay in the picture: If someone has depression, then in certain news systems the letter delivery is no longer correct. The mailboxes are too few, too many, stuck, not emptied – you don’t really know. In a healthy person, the mood is capable of oscillating, adapting to all events and swinging back from extremes. In depression, it is frozen and hardened. This comes from a certain predisposition, but also from stresses in the course of life. Antidepressants work by triggering a flood of letters, an output of transmitter substances. As a result, the insensitive mailboxes are revived, reset and receive messages again. These conversion measures sometimes take many weeks. Other measures such as sleep deprivation, electroconvulsions also do the same. It takes longer than neuroleptics to regulate the disturbed equilibrium, and an effect is noticeable after 2 weeks at the earliest.
About these chemical pathways also affect the daily positive and negative experiences depending on the skill of how you deal with them. Analogously, psychotherapy helps, Uncover and correct mistakes in dealing with stressful experiences. improve
For all psychotropic drugs, they should never be taken without a doctor’s should be discontinued abruptly, otherwise special Weaning symptoms may occur with troubling symptoms. Resume lower doses eliminates these conditions.
At all psychotropic drugs, laboratory values must be such as blood count, liver values, blood sugar and electrolytes checked become because of possible changes.