Depression

Depression causes the deep-seated feeling of being inescapably trapped in a prison of dark thoughts and weakness. The helplessness experienced is one of the symptoms of depression. In fact, help is almost always possible. The terms depression or depressed are often used in everyday life. Often times they relate to a depressed mood or sadness. A distinction must be made between depression in the sense of an illness. With depression, those affected sit hopelessly and locked in a prison of dark thoughts and physical weakness. An escape appears – this is part of the clinical picture – impossible. In fact, the therapy is often less difficult than assumed. The ideal solution for the treatment of depression is cognitive-behavioral therapy. This is often accompanied by drug therapy.

One of the pitfalls of depression is that it usually doesn’t start suddenly. Rather, many patients experience the disease as a gradual process. If you lose interest in your hobbies or work, withdraw more and more often, hardly make friends anymore, and feel more and more indifferent, you should discuss this with a doctor.

If you have thoughts of suicide, you should see a doctor or therapist immediately. This is often easier when you confide in a family member or a loved one.

According to the Federal Statistical Office, around six million adults between the ages of 18 and 65 will develop depression within a year. Around 12 percent of young people between the ages of 15 and 17 also experience depression. According to this, women are affected about twice as often as men in all age groups. According to the Federal Statistical Office, more than 260,000 Germans go to full inpatient treatment every year. In the past 10 years, the number of sick days due to depression has more than doubled.

In 2018, the number of sick leave due to mental illness fell for the first time in 12 years. The proportion of the total number of 236 days absent per 100 employees is 5.6 percent lower than in the previous year. These are the results of a DAK study with more than 2.5 million employees. Mental illnesses are still the third most common cause of sick leave – behind back pain and colds.

Every 6th employed person now takes antidepressants. According to Professor Dr. Gerd Glaeske, University of Bremen, the number of daily doses has increased sevenfold within 22 years: from 200,000 units in 1991 to more than 1.4 billion units in 2013. This amount is enough to feed 3.7 million people for a whole year Treat antidepressants.

More than 322 million people around the world have depression. According to the World Health Organization (WHO), that is an increase of 18 percent within 10 years.

Symptoms

Depression is an often severe mental illness that is associated with a high rate of suicide. The sadness and listlessness of depression have nothing in common with normal sadness (after a bereavement or a breakup, for example). Depressed people often describe their condition as indifferent, empty, and burned out. Not being able to feel and not being able to grieve depresses the patient and often fills them with fear.

The numbness is usually combined with inhibition of drive. With depression, sufferers often find themselves unable to perform even simple tasks. You can’t get yourself up to anything, have no initiative and no vigor, every activity becomes torture. The mood is often worst in the morning and improves slightly during the day. Often the posture is slack and hunched, the speech soft and monotonous. The symptoms of depression can vary widely. In addition to defensive signs such as sadness or withdrawal, symptoms such as inner feelings of fear, irritability, impotence, sleep disorders or inner restlessness occur.

Depression And Bipolar Disorder

Sometimes the depression alternates with unfounded or exaggerated high spirits (manias). The affected person is overly active, cheerful, and lively. This condition was formerly known as manic depression. The term bipolar disorder is now gaining ground.

Causes

In the current research, it is now undisputed that the tendency to depression is hereditary. Children of parents with a history of depression are more than twice as likely to develop depression themselves later than children of healthy parents.

Neurobiologists explain the significantly higher frequency of depression in women, among other things, with the female hormone balance. Women are significantly more susceptible to the onset of depression before menstruation, during pregnancy, or after giving birth. But men can also get depression. In contrast to depression and extreme sadness in women, they often focus on increased irritability, disgruntlement, anger, and aggressiveness up to and including suicidal intentions.

Depression

The Tendency To Depression Is Also Learned

According to the assessment of medicine and psychology, learned behavior patterns and ways of thinking play the greatest role in the development of depression. For example, those who are more pessimistic about the world run a higher risk of falling into a downward spiral and thus into a depression. Psychology assumes that such pessimism is largely shaped in childhood and further internalized in the course of life as a familiar point of view.

Depression is favored by stress, fear, and traumatic experiences such as the death of a loved one, job loss, or separation.

Physical Causes Of Depression

In rare cases, depression can also be traced back to a direct physical cause, for example after a stroke or when taking drugs that affect hormone or brain metabolism. Alcohol abuse or addictions can also trigger depression.

Depression From Inflammation

Patients with chronic inflammatory diseases with multiple sclerosis or rheumatism are more often affected by depression. Recently there have been increasing voices that it is not the accompanying circumstances of these diseases, but inflammation that cause depression. Urinary tract infections, ulcerative colitis or periodontal disease could also promote depression.

Treatment

The therapy of depression belongs in the hands of an experienced doctor or psychologist. Depending on the cause and severity of the depression, the doctor, preferably a specialist in psychiatry or neurology, will first treat the depression with medication. He has the choice between activating and depressant drugs.

The drugs against depression, also called antidepressants, intervene in the unbalanced brain metabolism. In this way, they can reduce the severity or frequency of the depressive phases. The antidepressant effects of these drugs only set in after about two weeks.

Risk Of Suicide From Antidepressants

Drug therapy for depression should be closely monitored. It is by no means uncommon for suicidal thoughts, for example, to be put into practice when an activating drug gives the patient the energy for this act of desperation.

Behavioral Therapy For Depression

In any case, depression should also be treated psychotherapeutically as soon as possible. So-called cognitive behavioral therapy has proven to be particularly successful. The aim of this therapy is to test learned inner convictions using examples, to practice new experiences, and thus to find constructive new thoughts and attitudes.

Self Help

In contrast to depressive moods, depression is a serious illness that can usually not be dealt with on its own. Hence, the best self-help is to acknowledge the fact of depression and seek help. Go to a doctor, counseling center, psychotherapist, or psychologist. Self-help groups or internet forums help to find the way out of depression. Remember: It is a symptom of depression that sufferers do not believe in a cure or a solution. It is all the more important to focus the strength on the beginning of treatment. Help is possible!

Mild symptoms of depression can be relieved with a herbal medicine made from St. John’s wort. However, it takes about two weeks to take effect.

Role Of Family And Friends In Depression

Often it is family, friends or colleagues who first notice the symptoms of depression in another person. As a rule, the disease is already relatively advanced at this point. One of the symptoms of depression is that those affected cannot perceive an illness and very often refuse help. This can make it difficult to deal with people who are suspected of having depression.

If you are looking to help, try following the recommendations below for dealing with people who are depressed.

    • Compassion and comfort confirm depressed people in their misery and are of no help in finding the way out of depression. Let those affected whines without feeling sorry for them.
    • Calls like “Don’t let yourself get down like that” or “Others are doing badly too” increase the pressure and thus the feeling of helplessness. Such well-intentioned appeals usually drive those affected further into social retreat. It is better to act with empathetic questions rather than advice.
    • Hold back with evaluations. Convey the feeling of being there for the sick person. However, do not make yourself an accomplice of the depression by promoting sadness or social withdrawal through special assistance. Try to keep a certain distance from the person concerned.
    • Make the depressed person feel like they can help themselves. Point out information about depression and the good chance of therapy for success.
    • Take suicide threats particularly seriously, even if they are made more often and not carried out. Most people give advance notice of their suicide. A special warning sign is when those affected are sorting out your financial affairs, for example. Do not hesitate to seek professional help if necessary. Better a false alarm than committed suicide.
    • As a relative or friend of a depressed person, you benefit from self-help groups for these groups of people or from psychological counseling.

Prevention

Depression often follows a prolonged phase of excessive stress, stress, or anxiety. Similarly, avoiding stress and anxiety can help prevent depression.

Another trigger is so-called traumatic experiences such as death or separation. If you feel that you are changing your behavior after a trauma (or you notice this in relatives or friends), you should seek discussion with others or psychological counseling at an early stage.

Basically, the risk of depression decreases with intact social ties, a positive self-image, and a realistic assessment of the environment.

Heartburn (Pyrosis)

Heartburn is the reflux of stomach contents into the esophagus. Heartburn can be harmless, but in the long run, it can also be pathological and indicate reflux disease or cause esophagitis. Read more about the symptoms, causes, therapy, and prevention of heartburn.

Most people are familiar with heartburn (pyrosis) or acid regurgitation (ructus). As a rule, it is uncomfortable – but it also quickly passes and is harmless. Recurring or regular heartburn, on the other hand, should be examined by a doctor. Either the constant reflux of gastric acid into the esophagus is due to the disease and indicates a reflux disease or it injures the esophagus and causes esophagitis (esophagitis). With a few exceptions, heartburn can be treated very well with medication and a change in diet or behavior.

A typical symptom of heartburn is a burning pain in the center of the chest (above the stomach area) that can radiate to the throat, throat, or even face. This often happens after meals (due to overcrowding or acidification of the stomach) or when bending over and changing positions.

Occasionally, stomach acid or digested food gets into the oral cavity with the acidic burping. This leads to an unpleasant burning sensation in the throat and a sour or bitter taste in the mouth. This can cause nausea and, rarely, vomiting.

Heartburn is often accompanied by an unpleasant, sour-smelling bad breath. Heartburn or the pain associated with heartburn are sometimes also perceived as heart pain. In English, heartburn is therefore also called heartburn.

Heartburn Complications

Recurring heartburn puts stress on the esophagus. The result can be inflammation of the esophagus. In turn, esophagitis could increase the risk of esophageal cancer.

Causes

Heartburn is caused by acidic stomach contents flowing back into the esophagus (acid regurgitation). The causes of stomach contents getting back into the esophagus can be very different.

Typically, very large meals trigger heartburn once we’ve eaten enough to fill the stomach. Then a slight pressure – for example by moving – is enough to let the stomach contents get into the esophagus.

As the pregnancy progresses, the child puts pressure on the stomach and can cause stomach contents to enter the esophagus. Heartburn can also indicate conditions such as stomach ulcers, duodenal ulcers, or stomach cancer.

Cause Reflux Disease

Heartburn is the main symptom of acid reflux disease. This is a malfunction of the lower esophageal muscle (lower esophageal sphincter) that separates the esophagus from the stomach. As a result, the weakened sphincter muscle can get stomach contents easily into the esophagus.

Heartburn

Other Causes Of Heartburn

The excessive production of stomach acid and the resulting heartburn can have a variety of other causes:

    • excessive consumption of alcohol, coffee, or cigarettes
    • Obesity
    • nervous stomach
    • Diaphragmatic hernia
    • Use of certain medications such as pain relievers and anti-rheumatic drugs (e.g. acetylsalicylic acid, diclofenac, and ibuprofen), cortisone, and chemotherapy drugs
    • Stress or other psychological stress.

Cause In The Duodenum

In the case of heartburn with bitter and bilious belching, the cause is often in the duodenum. Often the intestine is overactive (so-called motility disorder) or the gastric sphincter (also called gastric gatekeeper or pylorus) does not close properly.

Investigation

The main focus of diagnosing heartburn is finding the cause of the backflow of stomach contents into the esophagus. A frequently used examination method for this is the esophagus and gastroscopy. You will find detailed information on this under gastroscopy.

Treatment

Inhibiting gastric acid production with medication is usually the essential element of medical treatment for heartburn. Different groups of drugs are used.

    • Antacids are drugs with aluminum or magnesium salts such as aluminum hydroxide or magnesium hydroxide. Other active ingredients are Algedrat, Magaldrat or Simeticon. These drugs bind excess stomach acid for heartburn and also relieve the symptoms of inflammation of the stomach lining (gastritis) or a stomach ulcer. The chewable tablets or sachets of suspension are chewed or swallowed approximately one hour after eating and before going to bed. Sometimes it takes 2 chewable tablets or sachets for the heartburn to go away. Suspensions work faster than chewable tablets because the milky solution quickly lines the stomach lining and protects it from acid. Antacids are also useful during pregnancy.
    • H2 blockers are another group of heartburn medication. So-called H2-receptor blockers such as cimetidine, famotidine and ranitidine inhibit the production of stomach acid. For some time now, various H2-receptor blockers have been available in pharmacies without a prescription.
    • Proton pump inhibitors, such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole, are another group of drugs that can be used to treat heartburn. For example, the proton pump inhibitors omeprazole, pantoprazole, or esomeprazole are now freely available (see also below: gastric acid blockers involve risks)
    • Prokinetics such as metoclopramide accelerate the intestinal transit and the further transport of food in the intestine. As a result, less acidic food pulp can get into the esophagus.

Recall Of Drugs Containing Ranitidine

Numerous drugs with the active ingredient ranitidine may no longer be used for the time being since September 2019. A current list of the drugs concerned can be found here: Recall ranitidine drugs due to nitrosamine contamination. Ranitidine belongs to the active substance group of H2 antihistamines and is also mainly used in the following clinical pictures:

    • Anaphylactic shock
    • gastritis
    • Diaphragmatic hernia

The European Medicines Agency ordered the EU-wide recall because impurities had been detected at a manufacturer of the active ingredient in India (Saraca Laboratories Limited). According to the Federal Institute for Drugs and Medical Devices (BfArM), this is N-nitrosodimethylamine (NDMA). These nitrosamines are thought to be potentially carcinogenic.

In 2018, NDMA contaminants had already caused numerous recalls for another group of active ingredients, the sartans. The Central Laboratory of German Pharmacists has now examined 38 preparations and declared them not to be contaminated.

Heartburn Surgery

In rare cases, surgery is needed to get rid of heartburn. Reasons for an operation can be, for example, stomach and duodenal ulcers, stomach cancer, or a rupture of the diaphragm.

Self-Help Against Heartburn

To help yourself with heartburn – assuming no other illnesses – you can usually use the above-mentioned over-the-counter medications or sodium hydrogen carbonate (such as baking soda and Bullrich’s salt). However, this only applies if the heartburn occurs occasionally and another disease is excluded as the cause. In the best-case scenario, discuss any medication with your doctor.

Chamomile, yarrow, or liquorice root in the form of teas or drops, like peppermint, caraway, anise or fennel tea, have a digestive and calming effect on the stomach.

Stomach Acid Blockers Involve Risks

Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are among the best-selling drugs in Germany. According to the drug report from the Barmer health insurance company, almost 12 million German proton pump inhibitors were prescribed in 2018. In public perception, gastric acid blockers from the active ingredient group of proton pump inhibitors are considered to be simple and safe drugs. However, two aspects are left out: the side effects and the fact that proton pump inhibitors can be addictive.

Kidney Damage as a Side Effect

The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a number of studies. It is even more serious that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 and 64 percent of patients remain permanently dependent on the medication.

Connection Between Proton Pump Inhibitors And Allergies Is Possible

Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published a study in the specialist magazine “Nature Communications” (August 2019) (see sources) that at least produced a striking statistical connection between the long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing antiallergic drugs increases by up to 300 percent if gastric acid blockers were previously prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. In the opinion of the study authors, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very dosed quantities.

The German Society for Gastroenterology, Digestive and Metabolic Diseases assessed the study results differently. According to the press release, the specialist society does not see an “obvious connection between gastric acid blockers and allergies”. The design of the Austrian study does not give a corresponding assessment.

Prevention

There are few meaningful studies on the effects of behavior change on heartburn. However, many experiences confirm that, for example, avoiding coffee, alcohol, and smoking relieves heartburn or prevents heartburn from developing in the first place. If you have a tendency to heartburn, you should also take note of the following tips:

    • Avoid very spicy or citrus-acid foods and drinks
    • Avoid fatty foods and chocolate if possible
    • eat in an upright position
    • Keep evening meals as small as possible
    • Avoid being overweight
    • no overly tight clothing and constant sitting
    • Do not bend forward after meals
    • Increase the headboard of the bed if you have heartburn at night.