However, family doctors diagnose only about 60% of all mental health disorders. The detection rate rises as the severity and clarity of the symptoms increase. The mental health problems which are often not recognized are those which do not have fully developed symptoms of a depressive illness. These mental health problems are the ones for which there are increasingly treatment options which can lower the occurrence of serious depressive illness.

The focus of secondary prevention is on reducing the number and severity of depressive episodes and on reducing the suicide risk. Since it can be assumed that over 50% of depressions are not diagnosed and over 75% are inadequately treated, appropriate care requires an improvement in the knowledge level of general practitioners. Medication can significantly reduce the probability of relapse. This can also be accomplished through psychotherapeutic treatment without medication though with less success. A combination of psychotherapy and appropriate medication appears to be the most effective solution. However, only a small percentage of persons with depression in Germany receive such treatment.⁸

Defining Depression

 

Recent efforts have focused on defining depression as an autonomous set of pathological symptoms, rather than feelings of despondency, sadness or despair, which belong to the fundamental phenomenon of human experience.

There is a discrepancy between the "academic view", which sees depression in the narrow sense, as a condition triggered by a chemical imbalance, and popular science, which tends to propagate a wide-ranging definition of depression which includes conditions due to environmental and social factors.

Popular science, depicts the "mental torment of depression"⁹ as caused by problems which get out of control and burden a person's emotional state. Life as a whole becomes too much to handle, and so uncontrollable stress leads to exhaustion, fatigue and emptiness. In popular medical and practical guides, depression is described as the "disease of the age." It is attributed, in part, to isolation and various types of stress triggered by work, family, and other environmental and social factors. Pfeiler (1996)¹⁰ points out that when describing the symptoms of depression, these publications only consider depression due to chemical imbalance. Nuber (1993)¹¹ therefore warns against an excessive use of the term depression. She points out that depressions have been mistakenly identified in cases of despondency, fluctuating moods, or sadness due to loss. "Depressions are an illness, whereas fluctuating moods and sadness are not,"¹² she writes. This highlights a problem which is neglected by most general practitioners and established neurologists¹³, that is the general tendency in German society to scorn acting emotionally. Even sadness is judged negatively. When men in particular give way to their feelings, sadness is quickly regarded as depression requiring treatment. This attitude partly explains the enormous rise in the incidence of depression. This situation analysis reflects a broader approach in understanding and defining depression rather than a narrow academic definition.

 

Caring for depression

 

Mental health care services for people who have depression are provided primarily by general practitioners or physicians and consultants in