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Mark depressive disorders are a sadness that is so strong and persistent that it interferes with the normal functioning, as well as diminished interest or pleasure in activities restricted. The exact causes are unknown, involved are probably genetic factors, changes in neurotransmitter levels, modified neuroendocrine functions and psychosocial factors. The diagnosis is made on the basis of medical history. Treatment usually includes pharmacotherapy and / or psychotherapy and sometimes electroconvulsive therapy.
In common usage, the term depression is often used for various depressive disorders. Some are in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classified by specific symptoms:
Mark depressive disorders are a sadness that is so strong and persistent that it interferes with the normal functioning, as well as diminished interest or pleasure in activities restricted. The exact causes are unknown, involved are probably genetic factors, changes in neurotransmitter levels, modified neuroendocrine functions and psychosocial factors. The diagnosis is made on the basis of medical history. Treatment usually includes pharmacotherapy and / or psychotherapy and sometimes electroconvulsive therapy. In common usage, the term depression is often used for various depressive disorders. Some are in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classified by specific symptoms: major depression Persistent depression (dysthymia) Other specific or non-specific depressive disorder Others are classified according to the etiology: Premenstrual Dysphoric Disorder Depressive Disorder as a result of other physical disease substance / drug-induced depressive disorder depressive disorders occur at any age, but typically develop in the middle teenager, in the third or fourth decade of life. Up to 30% of patients in primary care practices report depressive symptoms, but <10% have major depression. Demoralization and grief The term depression is often used to describe a depressed or low mood after disappointment (z. B. financial disaster, natural disaster, serious illness) or losses (eg. As death of a loved one). However, better terms for such moods are demoralization and grief. However, the negative feelings or demoralization and grief, unlike the depression occurred in waves associated with thoughts or memories of the triggering event, usually resolve when the circumstances or events improve, can good with periods of positive emotion or alternating humor and are not accompanied by persistent feelings of worthlessness and self-hatred. The depressed mood lasts usually only days and not weeks or months, and suicidal thoughts and longer-term functional deficits are much less likely. However, events and stressors that demoralization and grief can also cause trigger a depressive episode, v. a. among vulnerable people (for example, those with a history or family history of major depression). Etiology The exact cause of a depressive disorder is unknown, but genetic and environmental factors contribute. Heredity accounts for about half the etiology of (less than in late onset depression). Thus, depression is more common among 1st degree relatives of depressed patients; the concordance rate in monozygotic twins is high. Genetic factors also likely to influence the development of depressive reactions to adverse events. Other theories focus on changes in neurotransmitter levels incl. The dysregulation of cholinergic, catecholaminergic (noradrenergic or dopaminergic), and serotonergic (5-hydroxytryptamine) neuronal transmission. A Dysegulation in the neuroendocrine system may play a role, focusing on three axes: hypothalamus-pituitary-adrenal cortex, hypothalamus-pituitary-thyroid and growth hormone. Psychosocial factors also appear to be involved. Major depressive episodes often go major stressful life events require particular separations and losses; However, such events do not cause persistent severe depression usually, except for people with predisposing conditions for a mood disorder. In people who have had an episode of major depression, the risk of renewed episodes is increased. People who are less resilient and / or have a tendency to anxiety, can lead to a depressive disorder more likely. Such people often do not develop social skills in order to adapt to severe stressful life situations. Even in people with other mental disorders to depression may develop. For yet unexplained reasons, the risk is higher in women. Among the possible factors include the following: Increased exposure to or increased in response to daily (n) loads higher levels of monoamine oxidase (the enzyme that neurotransmitters, which are considered important for the mood deteriorated) Higher rates of thyroid dysfunction Endocrine changes associated with menstruation and the menopause occur for a depression with peripartalem outbreak symptoms appear within 4 weeks after birth (postpartum depression); endocrine changes were brought into connection, but the exact cause is unknown. When seasonal affective disorder, the symptoms develop in a seasonal rhythm and typically occur in the fall or winter; the disorder tends to occur in regions with long or harsh winters. Depressive symptoms or disorders can along with various physical illnesses occur, including thyroid disorders and adrenal dysfunction, benign and malignant brain tumors, stroke, AIDS, Parkinson's disease and multiple sclerosis (see table:. Causes symptoms of depression and mania certain drugs such as corticosteroids, some beta-blockers, interferon and reserpine may lead to depressive disorders. the abuse of some so-called. recreational drugs (eg., alcohol, amphetamines) can lead to depression or accompany them. the toxic effects or withdrawal of drugs / medicines can cause temporary depressive symptoms produce. causes symptoms of depression and mania type of fault depression Mania connective tissues SLE rheumatic fever SLE Endocrine Addison Cushing's syndrome diabetes mellitus hyperparathyroidism hyperthyroidism hypothyroidism hypopituitarism Male hypogonadism hyperthyroidism Infectious AIDS General paralysis (parenchymatous neurosyphilis) Influenza Infectious mononucleosis TB viral hepatitis viral pneumonia AIDS General paralysis influenza St. Louis Encephalitis Neoplastic head of pancreatic cancer Disseminated carcinomatosis - Neurological brain tumors Complex partial seizures (temporal lobe) head trauma Multiple sclerosis Parkinson's disease sleep apnea stroke (left frontal) Complex partial seizures (temporal lobe) between brain tumors Head trauma Huntington's disease multiple sclerosis stroke diet Because pellagra Pernicious anemia - Other * Coronary heart disease fibromyalgia kidney failure or liver failure - Pharmacological amphetamine withdrawal amphotericin B anticholinesterase insecticides barbiturates Beta-blockers (some such. As propranolol) cimetidine corticosteroids cycloserine estrogen therapy Indomethacin interferon mercury methyldopa metoclopramide oral contraceptives, phenothiazines, reserpine thallium vinblastine vincristine amphetamines Certain antidepressants bromocriptine cocaine corticosteroids levodopa methylphenidate sympathomimetic Mentally alcoholism and other substance abuse Antisocial personality anxiety disorders borderline personality disorder dementia in the early stages of schizophrenic disorders - Depression often occurs in these diseases, it WUR de However, no causal relationship established. Symptoms and complaints Depression caused cognitive, psychomotor and other disorders (eg. As lack of concentration, fatigue, loss of libido, loss of interest or pleasure in almost all activities that were previously enjoyed, sleep) and depressed mood. People with a depressive disorder often have suicidal thoughts and can take a suicide attempt. Other mental symptoms or disorders (eg. As anxiety and panic attacks) are often additionally before and sometimes complicate diagnosis and treatment. Patients with any kind of depression abuse are more likely to use alcohol or other recreational drugs, and thus try to treat insomnia or anxiety symptoms themselves; but depression is a rare cause of alcohol, drug and substance abuse than previously thought. Patients are also more likely to be heavy smokers or tend to neglect their health, increasing their risk of developing or progression of existing disease (eg. As COPD). Depression can weaken protective immune responses. the risk of cardiovascular disease, myocardial infarction and stroke is increased by depression, perhaps because of the increase of cytokines and factors that increase blood clotting, and the reduction in heart rate variability in depression-all are potential risk factors for cardiovascular disease. Major depression (unipolar depressive disorder) Patients can look miserable, with tears in his eyes, furrowed brow, pulled-down mouth, sunken posture, lack of eye contact, immovable face, small body movements and changes in the language (eg. As small voice, monotonous, monosyllabic language). The appearance can be confused with Parkinson's disease. In some patients the depressed mood is so profound that they are petrified; they are unable to feel anything, and describe the world as a colorless and lifeless. The diet can be poor, which may require immediate intervention. Some depressed patients neglect their personal hygiene or even their children, loved ones or pets. For diagnosis ? 5, the following points have almost every day occur in the same two-week period, and one of these depressed mood or loss of interest or pleasure must be: Depressed mood most of the day Markedly diminished interest or pleasure in all or almost all activities for most of the day Significant (> 5%) Gewichtszu or decrease or decreased or increased appetite Insomnia (asleep) or hypersomnia from others watched psychomotor agitation or retardation (not self-reported) fatigue or listlessness feelings of worthlessness or excessive or to think inappropriate guilt Diminished ability or concentrate or indecisiveness Recurrent thoughts of death or suicide, suicide attempt or a limited hours th plan to commit suicide called Persistent depressive disorder Depressive symptoms persist for ? 2 years without remission as persistent depressive disorder (PDD) – a category that diseases that were previously known as chronic major depression and dysthymia, classified. The symptoms typically begins insidiously during adolescence and can persist for many years or decades. The number of symptoms often fluctuates above and below the threshold for a major depressive episode. Affected patients may be klagsam towards themselves and others, and constantly depressed, pessimistic, humorless, passive, lethargic, introverted, supercritical. Patients with PDD, also tend to have an underlying anxiety, substance use or personality disorders (i. E. A borderline personality). For the diagnosis, the patient must have a depressed mood have most of the day over several days for ? 2 years plus ? 2 of the following symptoms:. Low appetite or overeating Low self-confidence to make insomnia or Hyperinsomnie Low energy or fatigue difficulty concentrating or difficulty decisions feelings of hopelessness premenstrual dysphoric Disorder premenstrual dysphoric Disorder includes mood and anxiety symptoms that are clearly related to the menstrual cycle in connection with the start during the premenstrual phase and a symptom-free interval after menstruation. The symptoms must be present during most menstrual cycles of the past year. Manifestations of premenstrual syndrome are similar to, but are heavier, leading to clinically significant strain and / or significant impairment in social or occupational functioning. The disorder may begin at any time after menarche. It can get worse if the menopause approaches, but stops after menopause. The prevalence is estimated to be 2 to 6% of menstruating women in a given 12-month interval. To diagnose patients ? 5 symptoms during the week before menstruation need. show. The symptoms must subside within a few days after the onset of menstruation and are minimal in the week after menstruation or disappear. Symptoms must be ? 1 of the following information: Significant mood swings (. Eg suddenly sad or tearful) Marked irritability or anger or increased interpersonal conflicts. Marked depressed mood, hopelessness or lack of self-respect Significant anxiety, tension, or a nervous feeling addition must ? 2 of the following conditions exist: Decreased interest in usual activities Difficulty concentrating Low energy or fatigue Significant change in appetite, overeating or specific food cravings Hyperinsomnie or insomnia feeling to be overwhelmed or losing control Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a feeling of Aufgedunsenseins and weight gain other depressive disorder cluster of symptoms with characteristics of a depressive disorder that does not meet the full criteria for other depressive disorders, however, clinically significant distress or impairment of Operability causes are classified as other depressive (definite or indefinite) disorder. Included are recurring periods of dysphoria with ? 4 other depressive symptoms that persist in people <2 weeks, never the criteria for other affective disorder (z. B. recurrent brief depression) have met and depressive periods that last longer, but the lack of symptoms for the diagnosis of other depressive disorder haben.Spezifikatoren major depression and persistent depressive disorder may include one or more specifiers that describe additional manifestations during a depressive episode include: Anxious care: patients feel tense and unusually restless; they have difficulty concentrating because they have the worry or fear that something terrible might happen, or they believe that they will lose control of himself. Different patterns: Patients have also ? 3 manic or hypomanic symptoms (eg, elation, grandiosity, more talkative than usual, flight of ideas, decreased sleep.). Melancholic: Patients have the pleasure lost almost all activities or do not respond to other pleasurable stimuli. You can put down and be desperate to have excessive or inappropriate guilt, morning waking up early and significant psychomotor retardation or agitation, and significant exhibit Appetilosigkeit and weight loss. Atypical: The patient mood brightens temporarily in response to positive events (such as a visit by children.). They also have ? 2 of the following symptoms: overreaction to perceived criticism or rejection, feelings of leaden paralysis (a heavy or oppressive feeling, usually in the extremities), weight gain or increased appetite and hypersomnia. Psychotic: Patients have delusions and / or hallucinations. Delusions about having committed unpardonable sins or crimes to hide incurable or shameful disease or being persecuted. Hallucinations auditory (e. B. listening accusing or condemning voices) or visually. If only voices, it should be carefully considered whether the votes represent real hallucinations. Catatonic: patients have severe psychomotor retardation or excessive zweckose activities, withdrawal and, in some patients, grimacing and mimicking language (echolalia) or movements (echopraxia). Peripartum Starting outbreak during pregnancy or in the 4 weeks after birth. Psychotic features may be available; Infanticide is often associated with psychotic episodes, the command giving hallucinations to kill the infant or delusions that the child was possessed include. Seasonal patterns: episodes occur in a certain season, most often in the fall or winter. Diagnosis Clinical criteria (DSM-5) blood count, electrolytes and TSH, vitamin B12 and folic acid to exclude physical disorders that can cause depression The diagnosis of depressive disorders is based on the observation of symptoms and complaints and the clinical criteria described above. To distinguish depressive disorders of normal mood variations, significant distress or obvious impairment of social, occupational and other important functional areas must be present. For screening, various short questionnaires available. With them, some depressive symptoms can be determined precisely, but they alone are not sufficient for the diagnosis. Specific closed questions contribute to consider whether patients have symptoms that are required for the diagnosis of major depression according to DSM-5-Kritereien. The severity and is determined by the extent of the pain and disability (physical, social, occupational) by the duration of symptoms. A doctor should the patient carefully but ask directly about thoughts and plans to harm themselves or other people something after previous suicide threats and / or suicide attempts, and other risk factors. Psychosis and catatonia are indications of severe depression. Show melancholic features a severe and moderate depression. Concurrent physical illness, addiction disorders and anxiety disorders may increase the severity. Differential diagnosis Depressive disorders are distinguished from demoralization and grief. Other mental disorders (eg. As anxiety disorders) can mimic or obscure the diagnosis of depression. Sometimes more than one failure are. It between major depression (unipolar depression) and bipolar disorder must be distinguished. In older patients, depression may as depressive dementia (formerly called Pseudodemenz) pose that has many symptoms and signs of dementia, such as psychomotor retardation and lack of concentration. However, an early dementia may cause a depression actually. Generally, a depression treatment should first be tried in unclear diagnosis. The distinction between chronic depressive disorders such as dysthymia and addictive diseases can be difficult, v. a. because both occur simultaneously and can be mutually reinforcing. Physical illnesses must be excluded as the cause of depressive symptoms. Hypothyroidism often causes symptoms of depression and is often especially in the elderly. In particular Parkinson's disease can manifest itself with symptoms that mimic depression (z. B. loss of energy, lack of expression, lack of exercise). Careful neurological examination is to exclude this disorder erforderlich.Tests There are no laboratory findings that are pathognomonic for depressive disorders. Tests for limbic-diencephalic dysfunction are rarely displayed or helpful. However, laboratory tests are needed to rule out physical illness that can cause depression. These tests include: blood count, TSH levels and routine electrolyte, vitamin B12 and folate levels. Sometimes a drug screening makes sense. Treatment support psychotherapy pharmacotherapy Symptoms may remit spontaneously, especially if they are easy or short-lived. A slight depression can be treated with general support and psychotherapy. Moderate to severe depression with medication and / or psychotherapy and sometimes treated with electroconvulsive therapy. Some patients need a drug combination treatment. Improvement may be visible only after 1-4 weeks medicated. A depression occurs, especially in patients who have had> 1 major depressive episode, probably again; Therefore, in severe cases, a long-term drug maintenance therapy is often justified. Most people with depression are treated as outpatients. Patients with significant suicidal ideations, especially those with a lack of family support, must be hospitalized; this also applies to patients with psychotic symptoms or physical disability. Go in patients with addictions depression symptoms often within a few months after the end of drug use back. Antidepressant treatment is effective less likely, as long as the substance abuse continues. Could be causing a physical disease or drug toxicity be first is to treat the underlying disorder. However, there are doubts about the diagnosis or the symptoms are disabling or include Suizidieadtionen or hopelessness, a therapeutic trial can help with an antidepressant or mood stabilizer one. The first measures until a definitive improvement sets in, it may be necessary that a doctor sees patients weekly or every 2 weeks in order to give them support and psychoeducation and to monitor progress. Telephone calls may complement the consultations in practice. Patients and their families can at the idea of ??having a mental disorder, be worried and ashamed. By explaining that depression is a serious medical illness, biological irregularities underlie that requires special treatment and the treatment has a good prognosis, the doctor can help them. Patients and their families should be assured that a depression not a character flaw (z. B. laziness, weakness). If the patient informed that the healing process fluctuates frequently, they can see more easily feelings of hopelessness in the right perspective, and this improves adherence. to encourage patients to take increased again gradually simple activities (eg. as walking, regular exercise) and social contacts, and to recognize their desire to avoid activities should be weighed against each other. The doctor may recommend the patient to avoid self-accusations, and explain to them that dark thoughts are part of the disease and pass away werden.Psychotherapie Numerous controlled studies have shown that psychotherapy, particularly cognitive behavioral therapy and interpersonal therapy, in patients with severe depression is effective both to treat the acute symptoms and to reduce the likelihood of relapse. Patients with a weak depression tend to perform better than those with major depression, but the degree of improvement is greater in those with more severe Depression.Medikamentöse therapy Several classes of drugs and medications can be used to treat depression: Selective serotonin reuptake inhibitors ? (SSRI) serotonin modulators (5-HT2 blockers) serotonin-norepinephrine reuptake inhibitor norepinephrine dopamine reuptake inhibitor Heterocyclic antidepressants monoamine oxidase inhibitors (MAOIs) Melatonerges antidepressant drug selection can be based on previous response to a given antidepressant. Otherwise, SSRIs are often the initial drug of choice. The various SSRIs are indeed in typical cases of comparable effectiveness, but due to certain drug properties for certain patients more or less suitable (antidepressants) .Elektrokrampftherapie (ECT) The following are frequently treated with ECT if drugs are ineffective: Heavy suicidal depression depression with agitation or psychomotor retardation delusional depression depression during pregnancy also in patients who refuse food, ECT may be necessary to prevent the patient’s death. ECT is extremely effective in psychotic depression. The response to 6-10 ECT treatments is often dramatic and sometimes life-saving. Since after ECT often a relapse occurs, following the ECT usually a drug treatment beibehalten.Lichttherapie Light therapy is also just to be best known for its impact on seasonal affective disorder, but seems effective in non-seasonal depression. Treatment with 2,500 to 10,000 lux at a distance of 30-60 cm over 30-60 min / day (corresponding to longer and weaker light source treatment time) can be done at home. In patients who only go to bed late and get up late, the light therapy in the morning is the most effective, it is sometimes in the afternoon by a brief treatment for 5-10 min 3:00 to 7:00 supplemented evening. Patients who go to bed early and get up early to benefit most from a light therapy between 3 pm and 7:00 abends.Weitere therapies psychostimulants (eg dextroamphetamine, methylphenidate.) Are sometimes used, often in combination with antidepressants; they are, however, not been studied in controlled clinical trials. Some patients use herbal medicines. St. John’s wort may be effective in mild depression; However, the data situation is not unique. St. John’s wort can interact with other antidepressants, and other drugs. Some placebo-controlled studies of omega-3 supplementation, as augmentation or as monotherapy suggest that eicosapentaenoic acid 1-2 g once daily has useful antidepressant effects. In the vagus nerve stimulation of the vagus nerve is stimulated intermittently via an implanted pulse generator. It can be helpful in refractory depression, the effect usually occurs, however, only after 3-6 months. The use of repetitive transcranial magnetic stimulation (rTMS) for the acute treatment of major depressive disorder has considerable support from controlled studies. Low-frequency rTMS may the right dorsolateral prefrontal cortex applied (DLPC), and high-frequency rTMS can be applied on the left DLPC. The most common side effects are headache and scalp complaints; both occur more frequently used in high frequency rather than low-frequency rTMS. Tiefenhirnstimulation , die auf den subgenualen cingulären Cortex oder das “anterior ventral internal capsule/ventral striatum” zielt, hatte vielversprechende Ergebnisse bei unkontrollierte Fallserien(1). Wenige kontrollierte Behandlungsstudien sind im Gange.Behandlungshinweis 1. Bergfeld IO, Mantione M, Hoogendoorn MLC, et al: Deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression: A randomized clinical trial. JAMA Psychiatry 1:73(5):45664, 2016. doi: 10,1001 / jamapsychiatry.2016.0152. Wichtige Punkte Depression ist eine häufige Erkrankung, die depressive Stimmung und/oder nahezu vol