Depression

Build up your spirits again

Every one of us knows about feeling low. A lot of us go through a low mood when processing the events that caused it. But if these heavy spirits continue for a long time, this is called depression. According to a study by the World Health Organization (WHO), it’s the most common cause of poor health worldwide.

At Schoen Clinic, we have years of experience in curing the body and soul. We place great value on an accurate, individual diagnosis, as this is decisive for successful treatment. Together, we’ll show you the way out of your depression.

Causes & symptoms

International ICD-10 classification system

In the ICD-10, the internationally recognised diagnosis system from the WHO, depressive disorders are differentiated on the basis of their severity, duration, course and frequency of symptoms:
  • depressive episodes occurring for the first time, where a minimum amount of characteristic symptoms have persisted for at least two weeks
  • recurring depressive disorders, where depressive episodes occur repeatedly
  • dysthymic disorders, where fewer and less severe depressive symptoms have been present for more than two years
  • adjustment disorders, where depressive symptoms occur after a certain life change, but which do not last as long as with depressive episodes or dysthymic disorders
  • bipolar disorders, where alongside depressive moods, episodes occur for limited amounts of time which may be so-called manic or hypomanic episodes. These are characterised by an abnormally elevated, euphoric or irritable mood, which is accompanied by a higher drive, increased activity, higher spending, increased confidence and reduced need for sleep, among other things.

Causes: how does depression occur?

Depressive disorders can have different causes. These include certain lifestyle changes and tragedies, such as the death of someone close or severe illness. Long-lasting stresses, such as conflicts in a relationship or in the family or chronic stress at work, can also trigger a depressive episode. One special case is postnatal depression after giving birth. Furthermore, there may be no direct cause detectable. The possible causes are as follows:
  • Biological causes
    Certain genetic characteristics increase the risk of reacting to external factors with depression.
  • Messenger and hormonal system changes
    Changes in the complex messenger systems of the brain occur in all forms of depression, regardless of the cause. Changes in the regulating system of the hormones of the hypothalamus, hypophysis (pituitary glands) and adrenal glands have also been detected.
  • Psyche
    Distorted, predominantly negative thought patterns can contribute to depression.
  • Social environment
    Relationships with other people, early or even current losses, familial factors and social factors such as loneliness also play an important role.

  • Physical disorders
    In old age, reductions in physical ability above all increase the likelihood of suffering from depression. And vice versa: depression in old age is also a risk factor for reductions in physical ability.

Symptoms: what are the signs of this disorder?

Alongside low spirits, sadness, a lack of motivation and a reduced drive, depression comes with a list of other symptoms:
  • Sleep disorders
  • Loss of appetite
  • Concentration and memory problems
  • Reduced confidence
  • Feelings of guilt
  • Anxiety
  • Internal unrest
  • Frequent broodiness
  • Tiredness
  • Fatigue
  • Hopelessness
  • Suicidal thoughts
Physical symptoms can also be present, which are sometimes even at the forefront. If symptoms have already persisted for more than two weeks and are causing significant limitations in everyday life, you should urgently receive treatment.

Signs of depression in old age

  • Emotional symptoms:
    Low spiritedness, helplessness, hopelessness, feelings of abandonment, loneliness, inner emptiness, unhappiness, anxiety and fear, feelings of guilt, lack of emotion and distancing from the world

  • Behavioural symptoms:
    Physical status (lack of strength, bending, no stretching), slowing down of movement, nervousness, (fidgety) unrest, facial expression (sad, crying, worried, corners of the mouth pulled down, frozen and mask-like, nervous, alternating tense facial expressions), speech (quiet, monotone, slow), general reduction in activity, problems with coping with practical activities in everyday life, withdrawal and avoidance behaviours

  • Physical symptoms:
    Inner unrest, agitation, tension, irritability, crying, tiredness, feeling of weakness, sleep disorders, loss of appetite, headache, stomach ache and indigestion, memory problems

  • Thought symptoms:
    Negative opinion of self, of others and of the future, pessimism, self-criticism, uncertainty of self, hypochondria, laborious thinking, issues with concentration, broodiness, suicidal thoughts

  • Motivational symptoms:
    Focussed on failure, loss of interest, loss of drive, indecisiveness, feeling that everything’s too much, feeling of not being in control

Diagnostics

Diagnosis: how we determine depression

The symptoms mentioned above can be an indication that you have depression. But only an experienced doctor or therapist can make a diagnosis after an extensive interview with you.  After you’ve provided an unprompted account of your symptoms, we’ll clarify whether you have depression and the type of depression using targeted questions. These diagnostics can be complemented by psychological tests. Lab examinations or imaging procedures are not suitable for assessing whether depression is present. However, under special circumstances, these are used to rule out disorders of the organs that have the same or similar symptoms.

Diagnosis of depression in old age

When starting retirement, many people fall into a rut. If other negative experiences occur as well, depression can develop.
The diagnosis in this case is also based on an extensive interview and psychological tests. However, there are often other physical and psychological symptoms present in old age. It’s therefore very difficult to distinguish these.  It’s estimated that 30 to 40% of older patients being treated by a general practitioner suffer from undiagnosed depression. Often, these patients specifically deny and downplay their depressive feelings and thoughts and concentrate on their physical symptoms. This is due to principles when growing up (“You aren’t allowed to cry!”) and the stigma of psychological disorders in the past. We therefore carry out thorough medical clarification with older patients.