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At a glance
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If you are thinking about taking your own life, get help immediately: emergency number 112 or Telefonseelsorge on 0800 111 0 111 or 0800 111 0 222 (free, around the clock).
Depression is a serious but very treatable illness — not a character flaw and not a passing low mood. It affects how you feel, how you think and how your body functions. Unlike normal sadness, which comes after a stressful event and passes again, depression lasts for at least two weeks, weighs on your mood almost continuously and cannot simply be "shaken off" or dissolved by a pleasant moment.
Central to it is a trio of three complaints: a low, downcast mood, a loss of interest and pleasure in things that used to matter, and a lack of drive and energy that turns even simple everyday tasks into an effort. These three are called the core symptoms. They are at the heart of every diagnosis.
It is important to understand: depression is not "all in your head". It goes hand in hand with measurable changes in the regulation of neurotransmitters and stress systems in the brain and often shows up physically first — as a sleep disturbance, loss of appetite, pressure on the chest or persistent fatigue. Men and older people in particular more often report such physical complaints rather than sadness. This is precisely why depression sometimes goes unrecognised for a long time.
Not all depression is the same. What matters for treatment is how severe the episode is — because this determines whether to wait and see at first, begin psychotherapy or additionally use medication. The severity depends on how many of the core and additional symptoms are present and how strongly they limit everyday life.
| Severity | Symptoms | Everyday life |
|---|---|---|
| Mild | 2 core symptoms + 2 additional symptoms | Everyday life still manageable, but with effort |
| Moderate | 2 core symptoms + 3–4 additional symptoms | Marked limitation, many things are hard |
| Severe | 3 core symptoms + at least 4 additional symptoms | Everyday life barely or no longer manageable |
Alongside severity, there are different patterns of progression. In some people it remains a single episode (ICD-10 F32); in others the episodes recur over the course of life — this is then called a recurrent depressive disorder (F33). Common special forms:
The diagnosis is based on a fixed pattern of core and additional symptoms that are present almost daily for at least two weeks. The three core symptoms form the foundation:
Added to these are the additional symptoms, which complete the picture and help determine the severity:
Not everyone has all the symptoms, and they can present very differently. Some people seem sad and slowed down, others are restless and irritable. Many first report physical complaints — headaches or back pain, gastrointestinal problems, palpitations — behind which no organic problem can be found. This is then called a "larvate" (masked) depression.
Depression rarely has a single cause. It arises from an interplay of biological, psychological and social factors — experts speak of a vulnerability-stress model: those who bring an increased vulnerability (for example through predisposition) are more likely to fall ill when additional burdens come on top. Importantly: no one is "to blame" for a depression.¹
Often a situation does not tip over because of a single event, but through the coincidence of several factors over time. This also explains why a depression sometimes seems to come "out of the blue", even though outwardly everything appears fine. The biological vulnerability was already there — the burden was what made the barrel overflow.
The diagnosis is made by a doctor or a psychotherapy professional in a consultation — based on the criteria named above, often supported by standardised questionnaires. There is no blood test and no imaging procedure that proves a depression. However, blood tests do serve to rule out physical causes such as an underactive thyroid or a vitamin deficiency, which can produce similar complaints.¹,²
Two distinctions often cause confusion:
The second important distinction concerns anxiety disorder. Anxiety and depression often overlap and frequently occur together. The key difference: in an anxiety disorder, excessive fear, worry and physical tension are to the fore — drive tends to be preserved or even increased (restlessness). In depression, loss of pleasure and drive and a low underlying mood dominate. Because the two can occur together, the precise classification is the task of the professional — and it influences which therapy and which medication make sense.
How a depression is treated depends above all on its severity. There is no single right therapy for everyone — mild episodes often need something different from severe ones. The three building blocks are psychotherapy, antidepressants and supporting measures; they can be used individually or in combination.¹
Antidepressants are not addictive and do not change your personality. They act on the balance of neurotransmitters in the brain and help to bring mood, drive and sleep back into balance. Which drug fits depends on the complaints, coexisting illnesses and tolerability. Here are the most important groups in plain terms:¹
Another honest point concerns stopping. If an antidepressant is reduced too quickly or stopped abruptly, discontinuation symptoms can occur: dizziness, a flu-like feeling, "electric shock" sensations in the head, restlessness, sleep problems. This is not dependence but the body's readjustment reaction — it can almost always be avoided by slowly tapering the dose over weeks. How to do this in practice is explained in the guide Stopping SSRIs correctly.
brite reminds you of every dose and documents your mood and side effects — precisely in the crucial first few weeks.
Depression is as a rule time-limited: an untreated episode often lasts several months, with treatment it is usually quicker. Once the symptoms have subsided, an antidepressant is not stopped straight away but continued for several more months (maintenance therapy) to prevent a relapse. With repeated episodes, longer-term preventive use can be sensible.¹
Record in brite how your mood, sleep and drive develop — this way you spot changes early and have everything ready for your next appointment.
Thoughts of death or of no longer wanting to live are a common symptom of depression — and a reason to actively seek help. Such thoughts do not mean that you are "crazy" or that there is no way out. They are an expression of the illness, and the illness is treatable.
If you are worried about another person: speak openly about what you have noticed. Asking about suicidal thoughts does not put "the wrong ideas" into anyone's head — on the contrary, it relieves them and opens the door to help. Always take such statements seriously and encourage professional support.
Depression is not treated in days but over months — and especially at the start, when the medication is not yet working, it takes patience and structure. That is exactly where brite supports you.
