Selective serotonin reuptake inhibitors (SSRIs). Der Psychologe Paul Ekman hat sechs kulturübergreifende Basisemotionen definiert, die sich in charakteristischen Gesichtsausdrücken widerspiegeln: Freude, Ärger, Angst, Überraschung, Trauer und Ekel. [2022]. [2009], 1.2.4 Consider using a validated measure (for example, for symptoms, functions and/or disability) when assessing a person with suspected depression to inform and evaluate treatment. [2022]. [2009, amended 2022]. See the recommendations on starting and stopping antidepressant medication for more details. [2022]. Gibt es einen Zusammenhang zwischen musikalischem Engagement und psychischen Problemen? [2022], 1.12.6 For more advice on prescribing and monitoring antipsychotics see the recommendations on use of oral antipsychotics as augmentation and the NICE guideline on psychosis and schizophrenia in adults. Depression Depression Last revised in April 2023 Depression is characterised by persistent low mood and/or loss of pleasure in most activities and a range of associated emotional, cognitive, physical Diagnosis Diagnosis Assessment Differential diagnosis Management Scenario: Initial management Scenario: Ongoing management Prescribing information Traditionally, depression severity has been grouped under 4 categories (subthreshold, mild, moderate and severe) but in the development of this guideline the committee wanted to develop a way of representing the severity of depression which best represents the available evidence on the classification and would help the uptake of the recommendations in routine clinical practice. [2009, amended 2022], 1.1.3 Provide people with depression with up-to-date and evidence-based verbal and written information about depression and its treatment, appropriate to their language, cultural and communication needs. This could include: details of online or written resources that may be helpful, increased support from a clinician or therapist (for example, regular check-in phone calls, seeing them more frequently, providing advice about sleep hygiene). Individual intervention delivered by a practitioner with therapy-specific training and competence. Zu diesem geregelten Leben gehören eine ausgewogene Ernährung, ein Verzicht auch auf die kleinen Alltagsdrogen wie Alkohol oder Koffein und ein regelmäßiger Schlaf-Wach-Rhythmus. Discussions about their mood and symptoms initiated by a healthcare practitioner may help them access treatment and services. Auch nach einem Herzinfarkt gehören Patienten schließlich erst einmal in die Reha, trainieren ihr Kreislaufsystem langsam wieder auf die Anforderungen des Alltags. When stopping lithium, whenever possible reduce doses gradually over 1 to 3 months. 1.3.1 Discuss with people with depression: what, if anything, they think might be contributing to the development of their depression (see recommendation 1.2.7), whether they have ideas or preferences about starting treatment, and what treatment options they have previously found helpful or might prefer, their experience of any prior episodes of depression, or treatments for depression, what they hope to gain from treatment. Options include: switching to a psychological therapy (see the suggested treatment options for more severe depression). Uses an empirically validated protocol developed specifically for depression. Allows flexibility in terms of fitting sessions in around other commitments. Das ist also die absolute Mindestzeit, über die Sie ihre Medikament (Anti-Depressivum) einnehmen müssen, um überhaupt eine Wirkung zu spüren. Alternatives include: low-dose amisulpride (maximum dose of 50 mg daily, as higher doses may worsen depression and lead to side effects such as hyperprolactinaemia and QT interval prolongation).In June 2022, this was an off-label use for amisulpride. See the NICE guideline on shared decision making. An unhelpful form of coping behaviour in which a person changes their behaviour to avoid thinking about, feeling or doing difficult things. The physical symptoms of depression include: moving or speaking more slowly than usual changes in appetite or weight (usually decreased, but sometimes increased) constipation unexplained aches and pains lack of energy low sex drive ( loss of libido) changes to your menstrual cycle [2022]. [2009, amended 2022], 1.4.6 Consider using competence frameworks developed from treatment manual(s) for psychological and psychosocial interventions to support the effective training, delivery and supervision of interventions. Usually consists of 6 to 12 regular sessions. This study aims to map the knowledge map of depression research and show the current research distribution, hotspots, frontiers, and trends in the field of . Auch die Psychotherapie hilft, mit den depressiven Symptomen zumindest besser umzugehen, Verhaltensweisen zu ändern und eventuell vorhandene zwischenmenschliche Probleme zu lösen. [2022], 1.8.10 Continue the same therapy for people who wish to stay on a psychological therapy for relapse prevention (either alone or in combination with an antidepressant), adapted by the therapist for relapse prevention. [2022], 1.4.2 Match the choice of treatment to meet the needs and preferences of the person with depression. For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on starting and stopping antidepressants. Es wird auch wieder besser. Wellenförmige Verläufe der Depression sind normal, aber die weitaus meisten Patienten werden auch wieder gesund! Research suggests that there's unlikely to be one single cause. [2009, amended 2022]. Minimal time commitment although regular reviews needed (especially when starting and stopping treatment). The person will need to be willing to complete homework assignments, including using mindfulness recordings at home in between sessions. The goal is to change relationship patterns rather than directly targeting associated depressive thoughts. [2022]. Und später können Sie daran erkennen, wenn Sie in depressive Verhaltensmuster zurückfallen sollten. 1.10.9 For people with chronic depressive symptoms that have not responded to the treatments recommended in the sections on further-line treatment and chronic depressive symptoms, and who are on long-term antidepressant medication: review the benefits of treatment with the person, consider stopping the medication (see the recommendations on stopping antidepressants), discuss with the person possible reasons for non-response and what other treatments and support (including from other agencies) may be helpful. Less severe depression encompasses subthreshold and mild depression, and more severe depression encompasses moderate and severe depression. Wie viel Kraft das kostet, wissen Sie selbst am besten. Dann können sich Ihre Lieben auch selbst über die Krankheit informieren und Ihr verändertes Verhalten besser einordnen. May need to be adapted if the person has physical health problems that make it difficult to exercise. 1.4.29 Monitor serum lithium levels 12 hours post dose, 1 week after starting treatment and 1 week after each dose change, and then weekly until levels are stable. „Und das funktioniert in der Regel nicht gut.“ Dabei sind sich Betroffenenverbände einig, dass Depression gut behandelbar ist. Das gilt auch noch, wenn Sie bereits erste Fortschritte sehen.Dr. switching to a medication of a different class (for example, an SSRI, SNRI, or in secondary care a TCA or MAOI); take into account that: switching medication may mean cross-tapering is needed; see the NICE clinical knowledge summary on switching antidepressants, switching to or from an MAOI, or from one MAOI to another, will need to take place in, or with advice from, secondary care, TCAs are dangerous in overdose, although lofepramine has the best safety profile, changing to a combination of psychological therapy (for example, CBT, interpersonal psychotherapy [IPT] or STPP) and medication.Consider whether some of these decisions and treatments need other services to be involved (for example, specialist mental health services for advice on switching antidepressants). See the matched care model visual summary. Die Depression ist eine häufige und in nicht wenigen Fällen schwere Krankheit. Dabei wirkt zwar nicht jedes Antidepressivum bei jedem Menschen gleich gut (https://www.dasgehirn.info/entdecken/krankheiten-1/den-schwarzen-hund-zaehmen); für den Großteil der Erkrankten lässt sich jedoch ein passendes Mittel finden. Diese Fragen beantwortet der folgende Beitrag. Doch die Chancen auf Gesundung sind groß. To help people choose between these psychological treatments, see the information on them provided in table 1 and table 2. Depression ist eine schwere Krankheit. See the visual summary on treatment of depression with personality disorder. Follow the sections on communication and information in the NICE guideline on patient experience in adult NHS services. [2022], 1.10.5 If a person with chronic depressive symptoms that significantly impair personal and social functioning cannot tolerate a particular SSRI, consider treatment with an alternative SSRI. [2022]. Um dir wirklich zu helfen, erfordert es vom sozialen Umfeld ein starkes Durchhaltevermögen. [2022]. This page covers: Self-help resources Talking therapies Medication Other treatments for depression What happens if medication or therapy aren't working? lacking in self-confidence and self-esteem. Die Heilungschancen nach einer einzelnen depressiven Episode sind gut. These can be delivered in person, by telephone, or online. Most people go through periods of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days. 1.4.19 When reducing a person's dose of antidepressant medication, be aware that: withdrawal symptoms can be experienced with a wide range of antidepressant medication (including tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors [SSRIs], serotonin–norepinephrine reuptake inhibitors [SNRIs], and monoamine oxidase inhibitors [MAOIs]), some commonly used antidepressants such as paroxetine and venlafaxine, are more likely to be associated with withdrawal symptoms, so particular care is needed with them. [2022]. Die Broschüre zitiert einen Patienten: „Es geht um DICH, und er soll gut für DICH sein, und wenn er es nicht ist, dann ist er es halt nicht. [2022]. „Das ist das Tagesziel: nicht liegen zu bleiben“, sagt die Ärztin. Take into account that switching medication may mean that an adequate wash-out period is needed, particularly when switching to or from irreversible MAOIs or moclobemide. Die Depression ist eine schwere Krankheit, die jedoch mit Medikamenten und Psychotherapie bekämpft werden kann. 1.9.6 If a person's depression has had no or a limited response to treatment with a combination of antidepressant medication and psychological therapy, discuss further treatment options with the person and make a shared decision on how to proceed based on their clinical need and preferences. [2009]. [2022], 1.5.3 Do not routinely offer antidepressant medication as first-line treatment for less severe depression, unless that is the person's preference. [2009, amended 2022]. May be helpful for people who want to develop a different perspective on negative thoughts, feelings or bodily sensations. [2022]. Being depressed can show itself in different ways and each person's experience will be different. For a short explanation of why the committee made these consensus recommendations and how they might affect practice, see the rationale and impact section on use of lithium as augmentation. The 9 symptoms are: depressed mood – indicated by subjective report or observation by others, loss of interest or pleasure in almost all activities – indicated by subjective report or observation by others, significant (more than 5% in a month) unintentional weight loss or gain or decrease or increase in appetite, sleep disturbance (insomnia or hypersomnia), psychomotor changes (agitation or retardation) severe enough to be observable by others, tiredness, fatigue, or low energy, or decreased efficiency with which routine tasks are completed, a sense of worthlessness or excessive, inappropriate, or delusional guilt (not merely self-reproach or guilt about being sick), impaired ability to think, concentrate, or make decisions – indicated by subjective report or observation by others. Sie fördert zum Beispiel seine Bereitschaft, sich zu verändern und anzupassen. It can occur for a variety of reasons and it has many different triggers. For full details of the evidence and the committee's discussion, see the evidence reviews for the NICE guideline on safe prescribing (evidence review A: patient information; evidence review B: prescribing strategies; evidence review C: safe withdrawal; evidence review D: withdrawal symptoms; evidence review F: monitoring. Auch bei einer Psychotherapie ist es wichtig, genau die richtige Behandlung zu bekommen. Strukturieren Sie Ihren Tagesablauf. Manche Betroffene erzählen, dass ihnen eine Selbsthilfegruppe besonders gut getan hat: Dort verstehen alle Ihre Gefühlslage in einer Weise, die Ihren Angehörigen nicht immer möglich ist. In ICD-11, depression is defined as the presence of depressed mood or diminished interest in activities occurring most of the day, nearly every day, for at least 2 weeks, accompanied by other symptoms such as: reduced ability to concentrate and sustain attention or marked indecisiveness, beliefs of low self-worth or excessive or inappropriate guilt, recurrent thoughts of death or suicidal ideation or evidence of attempted suicide, significantly disrupted sleep or excessive sleep, significant changes in appetite or weight. Check if they have any of these symptoms and: ensure that the person knows how to seek help promptly, review the person's treatment if they develop marked and/or prolonged agitation. [2022], 1.13.7 Trusts which provide ECT services should ensure compliance with the ECTAS standards for administering ECT through board-level performance management. Emotionen entstehen im limbischen System, einem stammesgeschichtlich alten Teil des Gehirns. See NICE's information on prescribing medicines. [2009, amended 2022], 1.4.28 For women of reproductive age, in particular if they are planning a pregnancy, discuss the risks and benefits of lithium, preconception planning and the need for additional monitoring. Dann bringt auch die Therapie nichts.“ In der Zwischenzeit können soziale Dienste helfen, sowie Beratungsstellen etwa der Caritas oder der Diakonie. [2009], 1.16.16 Consider using CRHT teams for people with depression having a period of inpatient care who might benefit from early discharge from hospital. [2022]. [2022]. The decision about if and when to stop antipsychotic medication should be made by, or in consultation with, specialist services. [2022], 1.13.4 If a person with depression cannot give informed consent, only give ECT if it does not conflict with a valid advance treatment decision the person made. For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on preventing relapse. 1.1.1 When working with people with depression and their families or carers: build a trusting relationship and work in an open, engaging and non‑judgemental manner, explore treatment choices (see the recommendations on choice of treatments) in an atmosphere of hope and optimism, explaining the different courses of depression and that recovery is possible, be aware that stigma and discrimination can be associated with a diagnosis of depression, be aware that the symptoms of depression itself, and the impact of stigma and discrimination, can make it difficult for people to access mental health services or take up offers of treatment, ensure steps are taken to reduce stigma, discrimination and barriers for individuals seeking help for depression (for example, reducing judgemental attitudes, showing compassion, parity of esteem between mental illness and physical illness, treating people as individuals), ensure that discussions take place in settings in which confidentiality, privacy and dignity are respected. Printed or digital materials that follow the principles of guided self-help including structured CBT, structured BA, problem-solving or psychoeducation materials. Sessions with a therapist provide immediate support while the medication takes time to work or medication can be started immediately, and then CBT started as soon as possible afterwards to obtain combined effects. 1.4.21 If a person has mild withdrawal symptoms when they stop taking antidepressant medication: reassure them that such symptoms are common and usually time‑limited, advise them to contact the person who prescribed their medication (for example, their primary healthcare or mental health professional) if the symptoms do not improve, or if they get worse. fluoxetine's prolonged duration of action means that it can sometimes be safely stopped in the following way: in people taking 20 mg fluoxetine a day, a period of alternate day dosing can provide a suitable dose reduction. Overview - Clinical depression Symptoms - Clinical depression Causes - Clinical depression Diagnosis - Clinical depression Treatment - Clinical depression Living with - Clinical depression Support groups - Clinical depression Related information Das Rückfallrisiko nach einer ersten Episode (bezogen auf die Lebenszeit) beträgt - ohne Vorsorge - etwa 50%, bei schweren Depressionen 75%. [2022], 1.12.3 If a person with depression with psychotic symptoms does not wish to take antipsychotic medication in addition to an antidepressant, then treat with an antidepressant alone. 1.4.11 When prescribing antidepressant medication, ensure people have information about: how they may be affected when they first start taking antidepressant medication, and what these effects might be, how long it takes to see an effect (usually, if the antidepressant medication is going to work, within 4 weeks), when their first review will be; this will usually be within 2 weeks to check their symptoms are improving and for side effects, or 1 week after starting antidepressant medication if a new prescription is for a person aged 18 to 25 years or if there is a particular concern for risk of suicide (see recommendations on antidepressant medication for people at risk of suicide), the importance of following instructions on how to take antidepressant medication (for example, time of day, interactions with other medicines and alcohol), why regular monitoring is needed, and how often they will need to attend for review, how they can self-monitor their symptoms, and how this may help them feel involved in their own recovery, that treatment might need to be taken for at least 6 months after the remission of symptoms, but should be reviewed regularly, how some side effects may persist throughout treatment, withdrawal symptoms and how these withdrawal effects can be minimised (see also the recommendations on stopping antidepressant medication). If a person's depression has not responded to treatment after addressing any problems raised (see recommendation 1.9.1), and allowing an adequate time for treatment changes to work, review the diagnosis and consider the possibility of alternative or comorbid conditions that may limit response to depression treatments. Full details of the evidence and the committee's discussion are in evidence review C: preventing relapse. Collaborative use of emotion focused activities to increase self-awareness, to help people gain greater understanding of themselves, their relationships, and their responses to others, but not specific advice to change behaviour. Bis zur Genesung geht es darum, Ihre eigene Hoffnung aufrecht zu erhalten, Geduld und Nachsicht mit sich selbst zu üben. [2022], 1.9.8 If a person whose depression has had no response or a limited response to antidepressant medication does not want to try a psychological therapy, and instead wants to try a combination of medications, explain the possible increase in their side-effect burden.

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