SHS Series: Milestones in Medicine: Episode 3 Depression

History of depression
“Anxiety and terror by night as well as by day, sleeplessness, blunders, errors, misplaced worries, lack of insight into the actual situation and acting contrary to habit …” – this is how Hippocrates, the most famous physician of antiquity, described depression, which at that time was still called melancholia. The name depression was only given to the disease in the 19th century. Plants like basil, hellebore, pepper, ginger or cauliflower were supposed to help against it.

Friedrich Hölderlin
One of the most famous mentally ill people was the poet Friedrich Hölderlin, who lived in Tübingen for a long time. The certainly also tormented by fears and depressions was even called insane by many of his contemporaries. A more precise medical diagnosis has long been disputed – and will probably never be possible. In any case, in 1806 the poet had to undergo 231 days of treatment in what was then the Tübingen Clinic (today the Tübinger Burse) by Professor Autenrieth – a traumatic treatment for the highly sensitive Hölderlin. The Tübingen master carpenter Zimmer finally took Hölderlin in on May 3, 1807. For almost 40 years Hölderlin lived with the Zimmer family, who lovingly cared for him. On June 7, 1843, at the age of 73, he died in the Hölderlin Tower, Tübingen’s landmark on the Neckar River. Today, Hölderlin’s poems are among the most beautiful that German and Western literature has produced.

First anti-depressant at the World Congress of Psychiatry 1957
Today’s anti-depressants have little to do with the earlier herbs and roots. In 2019, according to FAZ, 1.609 billion daily doses were prescribed in Germany. Compared to 2010 (1.174 billion daily doses), this was an increase of 37 percent, although their effectiveness is not always undisputed. The WHO predicts that depression will probably be the most common disease in industrialized nations by 2030, ahead of cardiovascular disease. However, even today the diagnosis of depression is still not very precise: a variety of mental illnesses with different causes such as stress, trauma and genetic predisposition are hidden behind it.

Impact of the pandemic
The proportion of children suffering from depression and anxiety disorders doubled worldwide as a result of the Corona pandemic. Particularly in states where schools were closed for many weeks and months and thus the everyday structure with its various social contacts was lost, the mental effects accumulated in the form of sadness, listlessness, fears and restlessness, sleeping and eating disorders. According to the Copsy Study of the University Hospital Hamburg-Eppendorf, every third child in Germany now shows a mental abnormality. The treatment places are by far not sufficient. Even extremely desperate children and adolescents cannot be offered professional therapy immediately. Instead, psychiatrists and psychotherapists have to put even emergency cases on a waiting list, knowing that the patients often get even sicker. Experts warn that the effects of the pandemic cannot yet be assessed and are therefore calling for suitable treatment programmes for depression patients as soon as possible.

Online therapy courses on prescription
Online therapy courses cannot replace a real therapy, but they can alleviate the suffering somewhat during this waiting period for a therapy place: Since the end of 2020, the twelve-week online course for depression by Selfapy is available on prescription. This is made possible by the Digital Care Act (DVG). That this offer is accepted, the numbers show. Over 35,000 people, many of them younger, have already taken the Selfapy online courses.