Every year, around 5 million people in Germany fall ill with depression; statistically, every third person is affected once in their lifetime. Prof. Samuel Pfeifer, M.D., Professor of Psychotherapy and Psychiatry, reports on how to recognize depression and how best to deal with it as a sufferer or family member.

Prof. Dr. Pfeifer, What do you think is the biggest common misconception or prejudice about depression?
I recently had a 40-year-old woman in counseling who had previously been very successful in her family and career. And now everything had become too much for her. When I mentioned depression, she exclaimed, “No, that can’t be! What do people think about me! I don’t want to be weak!” Often guilt is added to the mix: What did I do wrong to have depression?

How can you tell that you have depression and are not just “in a bad mood”? How does depression differentiate itself from normal sadness?
There are a number of key questions for diagnosing depression, such as: Can you still feel happy, do you still have energy and drive, how is your sleep, do you withdraw from other people? If these areas of life are disturbed for days or weeks, then it is depression, especially if there are no current reasons for sadness.

How does depression develop, what are the causes and triggers?
In medicine we distinguish between biological, social and psychological elements that cause depression. There are people who have a hereditary burden in the wider family. For others, stress, broken relationships, or losses are too much. And then there is the way people think about themselves and others: nobody likes me, I’m not worth anything, I’m a total failure. They see everything through “black glasses,” and that leads to a whirlpool of negative thoughts.

Are there factors that promote depression, such as gender, genes, age?
Women are affected by depression significantly more often than men. They are more sensitive, more self aware, and are more exposed to their feelings. But there are also genetically determined depressions, especially bipolar disorders, in which there can be severe depressive phases for no external reason, but also phases with a high feeling in between. And, age is a risk factor insofar as the circle of life is reduced, one becomes increasingly ill and loses loved ones. It is understandable that this leads to depression.

Is depression purely a disease of the soul?
Body and soul are closely connected. Thus, depression can also manifest itself physically: Headaches, muscle tension, digestive problems or a pressure on the chest. These are referred to as psychosomatic complaints.

Does every depression have to be treated or can it also disappear on its own?
Mild depression can also disappear on its own. However, if the depression leads to a clear disturbance of the joy of life, contact with other people and a drop in performance in everyday life, then treatment is indicated.

How is depression treated?
Talking is essential: the affected person is listened to and feels accepted and understood. They can talk about what is troubling them. Together, they then develop a strategy for dealing with the dark thoughts, which provides comfort and encouragement. Because the exhaustion is often great, it would be necessary to consider who can support the person practically. Last but not least, I encourage people to make a plan for each day: It’s okay to get rest, but the person should get at least an hour of fresh air each day, even if it’s difficult for them at first.

What about pills? Many sufferers are afraid that antidepressants would change them?
For moderate to severe depression, medication is a great help: it improves sleep, dulls the emotional pain and gives increased strength for everyday life. Some people ask me whether the antidepressants would change them. I then ask: “Is your current state the normal one? Wouldn’t you like to be happier and have more energy again? Don’t you want change?” The fact is that the benefits of the medication far outweigh the disadvantages. And then when you are stable again, the pills can be phased out.

Christians can have depression, too. What negative impact can depression have on people’s faith?
The dark glasses of depression can also darken faith: “God has abandoned me! He no longer hears my prayers! My guilt separates me from God. There is no hope for me!” I hear such phrases from people who struggle wholeheartedly for faith. But the thoughts are negative expressions of their illness, not a reflection of reality.

Many believers with depression feel cut off from God, can no longer pray, and feel guilty because of it. How can one deal with these negative aspects?
We also read similar complaints in the Bible, for example in the Psalms. It is essential that God is there, even if we do not feel him – due to illness. He loves us and carries us through. Surely you know the image of footprints in the sand. Christian music can be helpful, whether traditional or praise-style. I like the song by Lynda Randle, who sings: “The God of the mountains is also God in the dark valley! After the depression subsides, faith will also become confident again.

What positive influence can faith have on depression?
In accompanying my patients, I have observed three positive effects of depression on faith: 1. a deepening of the relationship with God, 2. faith as a protection against despair and suicide, and finally 3. faith as a source of strength in depression. Just recently, a man told me, “In this depressive time, I have grown so much closer to God! He is my strength, even in my weakness!”

What advice do you give to people who suspect depression in a person in their circle of acquaintances or friends?
Take the person seriously, listen to them, and advise them to see a doctor. Sometimes it can help to fill out a depression questionnaire on the Internet to see what symptoms are present.

Is there anything you can do wrong when dealing with sufferers?
There is one phrase that should never be used, “Get a grip!” By doing so, one reinforces the false claims of achievement in depressive thinking. It is also problematic when one represses the negative and tells the person to look only to the good and to God. Sometimes the valley we walk through is a dark valley – it’s okay to say that and grieve about it.

Depression is often a big challenge for relatives, too, when the person changes a lot. What can be done to avoid losing patience or hope?
Accompanying depressed people requires a lot of empathy and patience. Often, one is dragged down by the sadness and negative thoughts themselves. It is not always easy to distinguish where a person needs to be spared and where they should be encouraged to be more active. For relatives, it is important to be able to talk to a trusted person outside the affected family system, be it in conversation, prayer, or simply in a light-hearted hour over coffee and cake. It takes time for someone to recover from depression.

What would you like to share with readers who are struggling with depression themselves?
There is hope! Depression passes in the vast majority of cases. Talks and medication are a great help and ease the emotional pain. The path through the dark valley often cannot be shortened, but the Lord comes along!