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“A depression can come out of the blue”
Professor Florian Holsboer is one of the most eminent researchers into depression in the world. The chemist and doctor has treated celebrities such as the former German goalie Oliver Kahn and the national football player Sebastian Deisler. In the interview with Helsana he talks about the dangers of depression, its bad reputation and how best to cure depression.
Professor Florian Holsboer was Director of the Max Planck Institute of Psychiatry for 25 years. His findings in the treatment of depression are considered groundbreaking.
Professor Holsboer, depression is very common, but many sufferers are still afraid to talk about their illness. Why?
Because, in contrast to diabetes or rheumatism, depression cannot be identified in the body. There are no laboratory tests for this. Depression is therefore much more difficult to understand and accept.
Is it simply a mental disease?
No. Depression is an organic illness like other disorders. But the mechanisms that trigger the illness are so tiny that they cannot be seen. They happen in the wide-ranging neural circuits of the brain.
Is the brain sick?
Yes, depression is a brain disease. The brain is the place where the illness develops. And the brain is not just an organ, it is the most important and most complex organ in our bodies and also the organ that uses the most energy.
How does depression develop?
Through biochemical processes that are triggered by environmental factors such as stress. To this must be added disposition - inherited from the parents or acquired during the course of life, e.g. due to childhood trauma.
Can a disposition be acquired during the course of life?
Yes. This is called epigenetics, i.e. external factors change the activity of our genes. I always say: DNA is not a restful place.
Can you also get a depression without any external triggers?
Of course. It can come out of the blue. And you search for reasons but cannot find any. Or you make them up. Many patients complain about burnout, which is better accepted by society, but in reality they are suffering from depression.
How do I notice that I have a depression?
When you are deeply saddened and can no longer enjoy the things that used to make you happy. When you isolate yourself, even from your family and friends. When every task is difficult and you can only think about how bad things are going for you.
How can a doctor diagnose depression if it is so difficult to identify?
The doctor allocates the impressions gained from the discussion with the patient to specific diagnostic points. But first he has to exclude other illnesses. A lack of energy, fatigue or a negative mood can also be caused by other illnesses, such as a thyroid disorder or the beginning of Parkinson’s or Alzheimer's disease.
You therefore need a good doctor who does not simply prescribe antidepressants.
Exactly. Psychiatrists have to be good doctors. It is not enough for them to work well with their patients when it comes to therapy, while forgetting the traditional medical issues. Does one always have to go do a doctor? Is it not possible for a depression to heal itself? No, it is not possible. There is no greater risk of chronification - i.e. for the disease to become a chronic condition - than insufficient or no treatment. And chronification leads directly to early disability. It also poses a considerable risk for other disorders.
Cardiovascular disease, diabetes, neurodegenerative disorders such as Parkinson's and Alzheimer's.
Why do severely depressed people kill themselves?
It is actually almost impossible to understand why an otherwise healthy person in the prime of life would take their own life. When I still worked in the clinic, a patient said to me: “You know, I once had a very big operation - or cancer - and that was really quite terrible. But what I’m going through emotionally with this depression, this feeling of being deadened, no longer wanting anything, no longer feeling anything - that’s much worse.” That made a big impression on me.
That sounds incredible!
Yes. And it is this hopelessness that makes someone take their life. Suicide is a very serious consequence of depression. Patients with other serious physical disorders seldom tend to commit suicide, although that would be easier to understand. In this sense, depression is a feared disease - one of the worst illnesses you can have. It is a potentially lethal illness. Every year more than a million people worldwide commit suicide, almost always because of depression.
How does one correctly treat a severe depression?
Medication combined with talk therapy. The criteria for depression are the same for everyone, but the reasons differ from person to person. You therefore cannot give the same treatment or medication to everybody. Medication does not have the same effect on everyone.
And how do you know which drug is best?
We have discovered that a person's DNA can make it possible to say to which drug they will have a positive reaction. Until now psychiatrists have relied on their personal experience when they prescribe medication for a patient exhibiting specific symptoms. In future they will also be able to use the results of the DNA laboratory test to identify the correct drug and dosage. This is a quantum leap in psychiatric treatment.
Does it always have to be medication? Is talk therapy on its own not enough?
No, not for severe depression. Currently, every fifth person who is severely depressed can only be partially cured, and every tenth sufferer remains chronically depressed. These are terrible statistics. They also show that we successfully treat too few patients with the medication that is currently available. The drugs take too long to work and have too many side effects. These three “toos” are important.
How common is depression? The media are reporting very different figures.
But depression is very common. Ten to fourteen percent of the population suffer from a severe depression during their lifetimes.
Is the illness more frequent nowadays?
Difficult to say. Depression is diagnosed more often today, but I doubt that the illness is actually occurring more often. People just talk about it more today, and are more accepting of the illness. Celebrities who suffer from depression such as Catherine Zeta Jones and Lindsay Vonn have contributed to this change.
One often hears that depression is a sign of our stressful times. Is this true?
No, depression is nothing new. In earlier times it was just called something else, such as “melancholia” or “the black bile”. The illness has been around for many thousands of years. Since antiquity.
Who is affected more often: men or women?
For mild depression, mostly women - probably because they tend to be more open about the illness during surveys. When it comes to severe depression, men and women are equally affected.
And the age groups?
Depression mostly affects younger people and is the main cause of early disability and incapacity for work. It robs the working world of trained workers. When a 30-year old is finally ready to start a successful career after a long period of training but then falls victim to depression, it has an enormous socio-economic impact. All of us have to pay for this.
What should I do if I recognise the above symptoms in myself?
That is a difficult question. When you dislocate your knee, you can think about the problem with a clear mind and take a decision: “I’m going to see an orthopaedic specialist.” But when the brain is ill, it is very difficult to think about how to heal the brain. This is the main problem. Those who notice changes should talk to their family doctor.
And if a family member shows signs of a depression? Is patience enough, or should you do more?
You should definitely not recommend a long vacation. That will not help, as the depression will go along in the suitcase. And certainly no statements like “Pull yourself together, you are doing well and have everything you need, why are you unhappy?” I also counsel against trying to give some therapy yourself.
What would be the right thing, then?
You should say, openly and quietly: “You don't seem to be the same person any more. Is something making you sad?” And when the suspicion of a depression becomes more specific, you should say: “Come, I've read that it's quite common,” and then you show them this interview and say: “See, it's an illness like any other. As with any illness, you go to the doctor and ask his advice. And if you think that his advice is good, you follow it and do something against the illness. The doctor will find the right therapy for you, and with the right medication and talk therapy everything will be over in a few months, or even earlier.”
Yes. If you talk to a sufferer in this way, you will do them some good.
Interview: Daniela Diener