What causes despair

Psychiatry, Psychosomatics & Psychotherapy

Most depressed patients are initially unable to classify their symptoms and are not aware that it is a mental disorder. Often they go to the doctor at the beginning of a depressive phase with uncharacteristic symptoms such as fatigue, difficulty concentrating, bad mood, etc. Some sufferers describe their mood mostly as despair, hopelessness and apathy. Other patients feel depressed in depressive episodes, internally empty or even numb, unable to react in the usual, normal way to happy or depressing events. Affected people lose their drive as well as their interest and joy in life and are constantly tired. Your everyday life is characterized by a lack of energy and listlessness. It is typical that those affected have to force themselves to do everything - initially only to more complex and unloved, but later also to easier and pleasant activities. They no longer pursue goals and neglect their family, work and even everyday activities such as eating and hygiene.

According to the international classification system ICD-10, the main symptoms of depression are:

  • Depressed mood (no sadness!);
  • Loss of interest, joylessness;
  • Lack of drive, increased fatigue.

Frequent additional symptoms according to the international classification system ICD-10 are:

  • Disorders of concentration, attention, and thinking skills;
  • decreased self-esteem and self-confidence;
  • Feelings of guilt and worthlessness;
  • negative and pessimistic ideas about the future;
  • Suicidal thoughts or acts;
  • Sleep disorders;
  • decreased appetite.

Depressed patients complain of at least two symptoms from both groups. The severity of the symptoms mostly fluctuates during the day. Furthermore, early morning awakening as well as a morning mood depression and a significantly reduced sexual desire (loss of libido) can occur. Weight loss due to lack of appetite is often observed.

In 70 to 80% of patients, the depression occurs in connection with feelings of anxiety, in some cases up to an anxiety disorder that requires treatment. About 15% of depressed patients experience psychotic signs such as delusional ideas (psychotic, "delusional" depression).

The inhibition of the drive can also make itself felt in the external appearance with a slowing down of reactions, movements and language, facial expressions and gestures are rigid. In extreme cases, those affected can only talk or move with great effort. Thinking and comprehension are also inhibited: creativity, the ability to concentrate and remember, dwindle, in extreme cases to the point that dementia is falsely suspected.

Physical complaints in the context of depression can include, for example, pain, feelings of pressure on the chest or breathing difficulties - in some cases these can even be in the foreground.

In general, phases of hormonal changes, especially in women e.g. after childbirth or during menopause, can be accompanied by depressive disorders.