Struggle with depression?
What is a depression?
Depression is a mental health condition characterized by a persistent low mood, loss of interest, and low energy. It affects daily functioning and can take different forms. You are considered depressed when, over a longer period of time, you experience a consistently low mood and/or a loss of interest or pleasure in almost all activities. This is accompanied by other symptoms such as fatigue, sleep problems, concentration difficulties, feelings of worthlessness or guilt, and sometimes thoughts of death.
These symptoms must be present on a daily basis and significantly interfere with functioning in social, work-related, or other areas of life. Everyday tasks such as work, household responsibilities, or personal hygiene may become difficult to maintain. Activities require much more effort, which can lead to disrupted sleep patterns. Depression can range from mild to severe and can be diagnosed and treated by mental healthcare professionals such as psychiatrists, psychologists, and therapists.
Neurological
Depression is caused by a complex interaction of biological, psychological, and social factors. It affects brain chemistry and neural circuits.
Behandelbaar
With the right treatment, most people with depression can experience significant improvement. There are several effective treatment options available.
Veelvoorkomend
Worldwide, more than 300 million people suffer from depression, with estimates reaching over 350 million. It can affect anyone, regardless of age, gender, or background.
Symptoms of depression according to the DSM-5
For a depressive disorder, at least five DSM-5 symptoms must be present. At least one of the first two symptoms (depressed mood or loss of interest/pleasure) must be present.
The symptoms occur for most of the day, nearly every day, for a minimum of two weeks, and cause significant distress or impairment in daily functioning.
The symptoms cannot be better explained by another disorder, and there must have been no manic or hypomanic episodes.
- Depressed mood: Feeling sad, empty, or hopeless
- Loss of interest or pleasure: In nearly all activities
- Weight change: Significant weight loss or gain, or changes in appetite
- Sleep disturbances: Insomnia or excessive sleeping
- Psychomotor changes: Agitation or slowing down
- Fatigue or loss of energy: Nearly every day
- Feelings of guilt: Feelings of worthlessness or excessive/inappropriate guilt
- Concentration difficulties or indecisiveness: Reduced ability to think, concentrate, or make decisions
- Thoughts of death: Recurrent thoughts of death, suicidal ideation, plans, or attempts
Important
If you are having thoughts about suicide or making plans to harm yourself, seek help immediately. Contact your local suicide prevention hotline, reach out to emergency mental health services, or go to the nearest emergency department.
What happens in the brain during depression?
Disruption of brain communication
In depression, the brain functions differently than normal. Communication between brain cells, also known as neurons, is disrupted, particularly in areas responsible for emotions, motivation, and reward processing. Two key neurotransmitters, serotonin and dopamine, play a crucial role in this process. In people who struggle with depression, the balance of these substances is often disrupted, leading to feelings of low mood, loss of interest, and lack of energy.
Amygdala and prefrontal cortex
In addition, there is often increased activity in the amygdala, the part of the brain that processes emotions, while the prefrontal cortex, responsible for decision-making and emotional regulation, is less active. As a result, negative emotions can feel more intense and are harder to control.
The hippocampus, the region involved in memory and learning, is also often affected. Disruptions in this area can contribute to feelings of hopelessness and a negative self-image. Due to these changes in brain functioning, the symptoms of depression can be both mentally and physically burdensome.
The impact depression can have on your life
Depression affects all aspects of life. It is important to acknowledge its impact and understand that treatment can help.
Personal life
Depression affects how you see and feel about yourself. Self-confidence decreases, enjoyment fades, and everyday tasks can feel overwhelming.
Work and study
In addition to concentration problems, indecisiveness, fear of failure, and mental exhaustion can significantly impair daily functioning.
Physical health
Depression affects the body as well and can lead to health problems such as chronic fatigue, sleep problems, tension, and physical complaints.
Social contact
Contact with others can require more energy. You may feel misunderstood. Withdrawal, shame, or the feeling of being a burden to others can lead to loneliness.
Emotions and energy
Emotions may become blunted or feel heavy and overwhelming. Things that once brought pleasure can feel empty or meaningless. Tasks require more energy than usual.
Meaning and perspective
The future can feel hopeless. Making plans or looking forward to things often becomes difficult. Hope and perspective fade into the background.
Causes and forms of depression
The causes of depression are complex and can rarely be traced back to a single factor. Depression develops as a result of a combination of influences, not from weakness or a lack of willpower. It usually involves an interaction between biological processes—such as imbalances in neurotransmitters like serotonin and noradrenaline—and psychological factors, such as personality traits or the way someone copes with stress.
Social circumstances, including major life events, problems at home, or prolonged overload, can increase the risk of developing depression. Genetics also play a role, as some people are more vulnerable to developing depressive symptoms.
What forms can depression take?
Depression does not present the same way in everyone. There are different forms and variants, each with its own characteristics. The overview below shows the different types of depression that exist.
Treatment-resistant depression
When previous treatments have not been as effective.
Seasonal depression
Low mood that often occurs during the winter months.
Postnatal depression
Psychotic depression
Depressive symptoms with delusions or hallucinations.
Guideline for the treatment of depression
Treatment for depression does not follow a fixed step-by-step plan that works for everyone. That is why healthcare professionals use a treatment guideline: an overview of evidence-based treatment options that are applied step by step, based on an individual’s needs. In the diagram below, you can see how treatment is usually structured.
Treatment often starts with psychotherapy and/or medication. When these options do not have sufficient effect, neuromodulation treatments such as rTMS may be considered. It is important to know that this guideline serves as a framework. Sometimes steps are skipped, combined, or an alternative approach is more appropriate. Your individual situation is always the starting point.
For family members and loved ones
Depression affects not only the person experiencing it, but also those around them. As a loved one, you may feel powerless, uncertain, or exhausted. You want to help, but sometimes don’t know how. It’s important to understand that you cannot simply cheer someone with depression up.
What does help is staying present without applying pressure. Listen without immediately offering advice, take feelings seriously, and acknowledge that the symptoms are real, even if you don’t always understand them. Small gestures of support, such as taking a short walk together or simply being there, can mean a great deal.
At the same time, it’s important to take care of yourself. Setting boundaries is necessary in order to continue offering support. You don’t have to do everything perfectly. Sometimes the most valuable things you can give are patience, understanding, and the reassurance that someone is not alone. If you’re unsure what to do as a loved one, or if it starts to feel overwhelming, support or guidance can also be helpful for partners and family members.
What if you are experiencing depressive symptoms or are depressed?
If you are depressed, everything can feel heavier than it “should.” Things that seem effortless for others may take an enormous amount of energy for you. Try to be gentle with yourself. The fact that you are taking steps to care for yourself is already significant. You are working to recognize and process your inner experiences, emotions, and patterns—and that is no small task.
You don’t have to make big changes right away or do everything perfectly. Small steps, no matter how small, are valuable. Getting out of bed, drinking a glass of water, or stepping outside for a moment all count. What feels manageable can differ from day to day. Creating structure can help, but only at a pace that suits you. Try not to compare yourself to others or set expectations higher than you can handle.
Reach out for support from people you trust and seek professional help. Asking for help early is important, as it increases the chances of a faster recovery. The earlier symptoms are recognized, the greater the chance of improvement and of breaking the negative cycle that depression can create—preventing symptoms from reinforcing one another.
Recovery is not a straight line. There will be periods when things improve and times when it feels heavier again. This is part of the process of healing and learning to trust yourself again. Even if previous treatments have not been effective, that does not mean recovery is impossible. Sometimes it simply takes a different approach—one that better matches how your brain is functioning right now.
How can you reduce the risk of depression?
You can’t always prevent depression, but you can take steps to reduce the risk of developing it. This is often referred to as mental hygiene: small, consistent habits that support resilience and help your brain cope better with stress, setbacks, and emotional strain. These steps can also help prevent symptoms from worsening.
Strengthen your mental resilience
Mental resilience helps you cope better with difficult moments. It means learning how to recover after setbacks. By regularly reflecting on what is going well, breaking problems down into smaller steps, and viewing mistakes as learning opportunities, you can strengthen your resilience.
Take good care of your body
Healthy nutrition, sufficient physical activity, and fresh air support the production of substances that are important for your mood. Paying attention to self-care and personal hygiene can also help you feel more connected to yourself and your body.
Maintain a daily routine
Your brain functions best with predictability. Regular times for sleeping, waking, and eating help keep your biological clock in balance during periods of stress or low mood. A consistent routine brings calm to your mind and supports your energy levels.
Stay connected with others
Contact with the people around you is an important protective factor. Even when you feel like withdrawing, it can help to keep someone close. You don’t have to feel okay all the time to stay connected—sharing how difficult things feel can actually provide support.
Take the step towards recovery
There is a treatment that works, even when previous therapies have not helped enough. Discover rTMS or ask a question.