How is depression treated?

Depression is generally considered to be curable. However, this does not mean that all patiens will get rid of their depression or not have a recurrence (recurrent depression). Since the suffering of those affected is often great, it is important that depression is treated promptly and professionally. In addition, the therapy becomes more difficult after a longer period of time. The risk of the disease becoming chronic is increasing.

Depending on the severity of the illness, depression is usually treated with psychotherapy, antidepressant medication, or a combination of both. Combination therapy is particularly indicated for chronic and recurrent depression. Experts also recommend a combination of both treatment approaches for severe depression.

Psychotherapy for depression

Psychotherapy requires months of patience and commitment on the part of the patient. However, those who get involved often overcome their depression in the long term and improve their overall mental stability.

There are many psychotherapeutic options for people with depression. The health insurers cover the costs for psychotherapy based on depth psychology , analytical psychotherapy ( psychoanalysis ) and systemic therapy.

Classical psychoanalysis and psychotherapy based on depth psychology belong to the group of psychodynamic psychotherapies. They are based on the idea that depression is often triggered by experiences of loss and hurt that have not been properly processed. These are processed during the course of therapy.

Cognitive behavioral therapy – an extension of classic behavioral therapy – is also used to treat depression. With the help of the therapist, the patient looks for ways to get out of the depression. Among other things, negative thoughts, patterns and beliefs are uncovered, checked for accuracy and, if necessary, replaced by new, more positive ways of thinking.

Other forms of psychotherapy for depression

Interpersonal therapy (IPT) is a short-term therapy method that was specially developed for the treatment of depressive disorders. It combines therapeutic concepts from behavioral therapy and psychodynamic therapy. An important goal of therapy is to learn skills and strategies for dealing with conflicts that contribute to the development or maintenance of depression.

Depression treatment: therapy with drugs

Antidepressants are usually prescribed for more severe depression or when the patient refuses psychotherapy. It can be used to successfully treat the symptoms of depression. However, the effect of the medication often only sets in after a few weeks.

Examples of medications used to treat depression include:

Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) : They increase the level of the “happiness hormone” serotonin in the brain and thus have a mood-enhancing effect.
Tricyclic antidepressants: They inhibit the reuptake of serotonin and norepinephrine.
Monoamine oxidase inhibitor (MAO): This active ingredient blocks the enzyme monoamine oxidase, which breaks down the messenger substances norepinephrine and serotonin.
Although lithium is not a classic antidepressant, it is often used as a mood stabilizer in depression.
St. John’s wort preparations have a mood-enhancing effect and are mainly used for mild to moderate depression.

Electroconvulsive therapy

In many cases, electroconvulsive therapy can be used to treat depression where medication and psychotherapy fail. A short “epileptic seizure” is triggered under short-term anesthesia by electrical impulses. This idea may be frightening at first. In fact, however, the patient is not aware of the procedure and the risks are low.

Awake therapy

For awake therapy, patients must remain awake the second half of the night or all of the night. This method does not cure the depression, but the symptoms are relieved in the short term. Patients are feeling well for the first time in a long time, albeit for a short time. Not only is this a tremendous relief, it gives them renewed hope that they may actually be able to overcome their depression. And a hopeful attitude contributes to the success of the therapy.

Repetitive transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation is a new technique that can be considered when depression cannot be treated with medication. Various areas in the front right or left hemisphere of the brain are stimulated by magnetic fields. This painless treatment is carried out in a clinic for ten to 30 minutes a day for three to six weeks.

Self-help assistance with depression

Recent studies come to the conclusion that offers of help without direct contact with the therapist are also helpful. One option is self-help guides. Those affected read a lot of the information themselves and only occasionally have contact with an expert who supports them. This helps, for example, to bridge the waiting time until therapy.

Internet-based therapies and apps

Another option for people with depression is professional counseling via the Internet. The therapy is carried out using a special computer program. There are now also so-called depression apps and chatbots that make it easier to deal with depression. They are based on elements of cognitive behavioral therapy.

Exercise as an antidepressant

Get out of the house, get out of depression: experts recommend regular physical training for depression. This can significantly reduce depressive symptoms – both in the short term and in the longer term. In fact, regular exercise works as well as an antidepressant for some patients. Because it reduces stress and may have a positive effect on the levels of messenger substances in the brain (e.g. serotonin and noradrenaline).

The psychological effect of sport may have an even greater effect: through physical activity, patients break out of the spiral of listlessness and withdrawal. Self-esteem is strengthened, hopelessness suppressed. Anyone who does sport in a group also benefits from the sense of community and social contact, which is otherwise becoming increasingly rare in the case of depression.

Inpatient or outpatient therapy for depression?

A mild or moderately severe depressive phase can often be treated with outpatient psychotherapy. A stay in a clinic is necessary, especially in the case of severe depression. The combination of drug treatment, a wide range of psychotherapeutic therapies and intensive care in the clinic helps patients to return to a structured daily routine.