Is there a threshold for depression

Psychiatry, Psychosomatics & Psychotherapy

According to the international classification system ICD-10 (International Classification of Diseases), doctors speak of one mild depressive episodeif at least two main symptoms such as depressed mood and lack of drive and two additional symptoms such as feelings of guilt and sleep disorders occur. At a moderately depressed phase there are two main symptoms and at least three, but no more than four other symptoms. Major depressive episodes are diagnosed when all three main symptoms and at least four additional symptoms are present. In addition, the complaints must last for at least two weeks. In the American classification system DSM-IV, one speaks of “major depression” (corresponds to a severe depressive episode) and “minor depression” for a less severe episode.

Special forms (subtypes)

Depressive episodes can also be specified; this classification requires special therapeutic measures in part due to the presence of additional symptoms. Below are some of these so called subtypes:

Chronic Depressive Disorders

If the symptoms are always or most of the time below the threshold of a "real" depression, i.e. a depressive episode, the diagnosis of a chronic, mildly depressed mood that usually lasts for 2 years is made (Dysthymia) in question. Depressive episodes that last more than 2 years and courses without symptom-free intervals between the depressive episodes are also referred to as chronic. Chronic depression is often associated with illnesses such as obsessive-compulsive disorder, eating disorders, substance abuse or personality disorders, which often require additional treatment measures.

Psychotic depression

Doctors speak of psychotic depression if, in addition to the depressive episode, there are also psychotic signs such as delusional ideas. These can manifest themselves, for example, in an impoverishment mania, indebtedness mania, sinfulness or diminution mania. The symptoms are often more severe and the duration of the depressive episodes longer than in depression without additional delusional signs. In addition, the risk of relapse and recurrence is increased in patients with psychotic depression.

There is also depression with accompanying symptoms of anxiety or combined with an anxiety disorder that requires therapy. About 20 to 30% of depressed patients have a panic disorder, and a social phobia or generalized anxiety disorder is also common.

Melancholic depression

Melancholic depression means a severe expression of the depression or the core symptom of the mood disorder. Those affected complain that they can no longer feel anything, that they can no longer feel any pleasure. In the case of many depressed people, on the other hand, the mood can still be stimulated (non-melancholic depression).
Depression with physical symptoms

In the so-called somatized depression, various uncharacteristic physical complaints and abnormal sensations such as head pressure, dizziness, racing heart, digestive disorders and other non-specific organ complaints are in the foreground, for which no organic cause can be found after adequate investigation. Targeted questions are used to clarify whether the physical complaints are also present regardless of the depressive symptoms. In this case, it is not a question of depression, but something called a somatoform disorder.

Seasonal Depression (SAD)

Seasonal affective disorder (SAD) is a depressive episode that begins and ends at certain times of the year. The rest of the time, the patients are healthy or can develop a (hypo) manic phase as part of a bipolar disorder. One form of seasonal depression - winter depression - occurs in the low-light season, i.e. from autumn or winter to spring. The patients, mostly women, suffer from listlessness, sleepiness, lethargy and have increased cravings, especially for sweets. In the summer, however, those affected are symptom-free. The signs usually improve with light therapy - from daylight to therapy with a special 10,000 lux lamp.

Mental disorders after childbirth

The mental disorders that may occur after childbirth can be roughly divided into three categories:

The period of moody instability and depressive mood in the first 3 to 5 days after the birth is called "baby blues" in English-speaking countries. According to studies by various authors, such changes can be observed after about 40 to 70% of all deliveries.

On the other hand, so-called postpartum depression (postpartum depression) with a frequency of about 1 in 10 births. They usually occur in the first few weeks after the birth and can usually be treated on an outpatient basis. They can last for several months and in individual cases can also be very pronounced with suicidal thoughts, so that inpatient treatment cannot be avoided.

Transitions to the difficult ones, which are very rare overall Postpartum psychoses occur in a few patients with postpartum depression (about 1 to 2 in 1,000 births).

Special forms

In the case of persistent mood instability with numerous episodes of mild depression and slightly elevated mood that do not reach the severity of depressive or manic episodes, one speaks of one Cyclothymia.