Depression can also be a healing process

Is Depression Curable?

Depression is a widespread phenomenon: in Austria, up to a fifth of all people develop it in the course of their lives. There are two periods of time in which the mental illness occurs particularly frequently: between 30 and 45 years - here twice as often in women as in men - and from the age of 65. Depression often has a severe, protracted course, especially in old age. According to the World Health Organization (WHO), depression is the disease that causes the most suffering after cardiovascular problems.

The good news: the situation is not hopeless, help is available. The extent to which this is possible depends on the causes and symptoms. "However, symptoms are reduced in all people so that they can lead a good life again," explains Wolfgang Aichhorn, Director of the University Clinic for Psychiatry, Psychotherapy and Psychosomatics (Christian Doppler Clinic) at the University Hospital Salzburg.

The most common symptoms of depression include a low, sad mood, hopelessness, and lack of drive. "Of the numerous other possible symptoms, the sleep disorder is usually the subjectively most stressful for those affected," says Aichhorn. However, this can usually be managed well, which generally leads to a more relaxed attitude towards life.

Residual symptoms can remain

Is Depression Completely Curable? Aichhorn answers the question with a yes. Medication and psychotherapy could help those affected to be symptom-free - in this case, the depression would no longer exist either. However, residual symptoms may remain, for example of a physical nature, such as gastrointestinal problems, headaches or back pain. In addition, tiredness, listlessness or listlessness.

The doctor adds a big but to the yes: In addition to the treatment in the here and now, prophylaxis is at least as important. That means: preventing the depression from recurring. The risk for this is relatively high. "Within the first two years it is around 50 percent," says Aichhorn.

The more often a person has a depressive phase, the higher the risk of falling ill again - a vicious circle. If the depression becomes chronic, it is difficult to get a grip and requires special treatment methods. That is precisely why prophylaxis is important in the first depressive phase. "If it is possible to prevent a new depression, then it is entirely possible that the disease will never recur and the person is considered cured," summarizes Aichhorn.

Threshold sinks

It is difficult to answer why the risk of recurrence increases with each further depressive phase. In general, it can be said: Depression does not come out of the blue, it has various causes and usually a relevant life event as the trigger. "These stress factors shift neurotransmitters, especially serotonin, but norepinephrine and dopamine also play a role," explains Aichhorn. The more often the depression recurs, the less triggers are relevant and the threshold sinks.

Experience has shown that the first episode of depression can be treated very well in half to two thirds of patients, according to Aichhorn. In around a third, the therapy is more difficult, but still useful. Antidepressants are used to bring the neurotransmitters back into balance. It usually takes several weeks for the drugs to work and the symptoms to go away. In addition to drug treatment, psychotherapeutic talk therapy is common. Psychosocial counseling may also be necessary, for example in the event of unemployment or conflicts in the family.

In order to prevent the disease from recurring after the first depression and thus the risk of chronic suffering, early and consistent treatment is essential. This also includes adequately informing those affected about the disease, the duration of treatment and the side effects. Because even after the symptoms have subsided, taking medication is still necessary as a prophylaxis for a longer period of time.

Strengthen resilience

In addition to taking medication and psychotherapy, those affected should also become active themselves in order to counteract a renewed depressive phase. This includes learning to strengthen the internal defenses and thus resilience. This can be achieved, for example, through mindfulness exercises or cultivating relationships. "If you manage to control the stress axes yourself under certain stress conditions, then the susceptibility to depression is significantly lower," explains Aichhorn. A healthy lifestyle with sufficient exercise also has a positive effect and can serve as a preventive measure.

As already mentioned, chronic depression is very difficult to treat. Most of those affected do not respond to antidepressants and talk therapy. In severe individual cases, the drug ketamine or electroconvulsive therapy is used. But even with chronically depressed people, there are now good experiences with positive relationship building. For almost two years, a concept has been in use in Austria that has healing relationship experiences as a central element.

The Cognitive Behavioral Analysis System of Psychotherapy - CBASP for short - developed in the USA is used at the University Clinic for Psychiatry and Psychotherapeutic Medicine at the LKW University Clinic in Graz. In three stages, with the active involvement of caregivers, occupational and physiotherapists, psychotherapists and social workers, those affected are supported in coming to terms with their past and working out solutions. (Maria Kapeller, June 2nd, 2018)