Are you battling depression

Now they meet again and announce the good news of psychotherapy: Healing is possible! Starting today, 8,000 doctors and therapists will meet at the annual congress of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) in Berlin, the largest congress of its kind in Europe.

For weeks now, the DGPPN spokespersons have been sending out press releases with headings such as "Depression: When the world sinks into gray." It cites leading psychiatrists who report the underestimated widespread disease and vividly describe the symptoms of melancholy.

At the end of each of these communications there is inevitably the great promise: Thanks to advances in psychotherapy and pharmacology, depression is now easily treatable. So what? Off to the therapist!

At first glance, there is nothing wrong with such campaigns. If the epidemiologists are right, four million people in Germany are currently suffering from depression. 12,000 suicides annually - not counting the high number of unreported cases - indicate that this is a serious problem.

In addition, the majority of depressed people apparently remain treated incorrectly. If you believe the professional associations, only every third depression is recognized as such and not even every tenth is treated according to the state of medical science.

The overdiagnosed

If you then take into account the poor compliance rates, i.e. that many patients do not take their medication at all, only 2.5 percent of those affected may receive the optimal therapy. So far so bad.

However, there are still doubts as to whether the problem is adequately described. It starts with the suspicion that, in addition to the people who avoid going to the doctor, there are also a large number of overdiagnosed people.

Anyone who exposes themselves to the screening tests of psychiatrists, for example on the website of the Competence Network Depression, will suspect this: If you click on "Yes" for the questions, whether you have been in "low mood" for more than two weeks, " Lack of interest ", suffering from" negative prospects for the future "and" persistent sleep disorders ", already receives the advice:" You should consult your doctor. Your information indicates a depression that needs treatment. "

And ceterum censeo: "By the way: Depression is usually easy to treat." This diagnosis flashes even when one clicks the mouse to assert that one is neither lacking energy nor suffering from a lack of self-esteem, difficulty concentrating, feelings of guilt, loss of appetite or even thoughts of death. After such tests, one wonders whether every young man with lovesickness needs professional help?

Psychiatrists defend such screenings with the argument that they should prevent potential patients from neglecting them and that the specialist will sort out the really sick. It may be, but it is the case that the majority of depressed people are only treated by a family doctor who does not have the appropriate expertise.

But if one assumes that many people are classified as depressives who actually only indulge in melancholy for a while, then the therapeutic successes of the guild can also be seen in a new light. Even optimistic estimates assume that at least 20 percent of those who are depressed are resistant to therapy.

Evolutionary reasons for pondering

According to official statistics, that would be 800,000 people. If one assumed a smaller population of sick people, then the percentage success rate would be even smaller. This does not even include the fact that the study situation, especially with antidepressants, is very controversial and the relapse rate is high.

Many psychiatrists and psychotherapists shy away from discussions about questionable studies and resistance to therapy, if only because they do not want to confuse those seeking help. You are wasting the chance to ask about the deeper causes of mental illness.

Because there is increasing evidence that depression is not just a modern widespread disease like obesity, caused by performance stress and excessive demands. It can be found in all times and cultures, be it among the Ache Indians in Paraguay or the! Kung Bushmen in South Africa.

There must be an evolutionary reason for this, claim psychiatrists like Paul Andrews and Anderson Thomson from the University of Virginia in a study in the journal Psychological Review (Vol. 116, p.620, 2009). In it they argue that the persistence of the depression suggests that the disease must also have brought certain selective advantages. They speculate that the constant brooding typical of the disease may have been helpful in solving complex social problems as far back as prehistoric times.

Whether one can then immediately derive new therapy recommendations from such insights, as Andrews and Thomson believe, is open to debate. But studies like yours show that depression is probably part of the basic equipment of the human psyche and that we will have to grapple with it longer than the pharmaceutical industry and therapist congresses would have us believe.