Trigger warning: suicide risk in depression is addressed in factual language, as is the death of national goalkeeper Robert Enke.
Depression is a common mental illness. Most of us know at least one person in our immediate environment who has to struggle with depression at times – or has even had experience of it themselves.
On the homepage of the Deutsche Depressionshilfe it says about the spread of depression:
“Depression is one of the most common and underestimated illnesses in terms of severity. Overall, 8.2%, or 5.3 million, of adult Germans (18-79 years) have a unipolar or persistent depressive disorder in the course of a year […]. This number is further increased by children and adolescents and people over the age of 79, who are not included in this study but may also suffer from depression. Over the lifespan, according to various studies, about every 5. until 6. adult once affected by depression […].”
The bipolar depression
What usually goes unmentioned in this frequency figure for the prevalence of depression is the clinical picture of bipolar disorder. This is manifested by various recurrent extreme emotional phases such as (hypo)-mania, mixed states but also depression, mostly alternating with more stable phases of life. In Germany, around 4 million people are affected by bipolar disorder and thus also experience depression.
Assisting people suffering from depression
It’s hard to be a friendStephen Fry, English writer
to someone who’s depressed,
but it is one of the kindest, noblest,
and best things you will ever do.
Assisting someone who is acutely depressed can be an enormous challenge that can push us to our limits or make us feel overwhelmed at times. This makes every successful contact during this difficult time all the more valuable – for everyone involved.
The European Day of Depression
The better our society is informed about the clinical picture of depression, but also about possible help measures, the better we can support each other and stand up for each other when it becomes necessary.
Since 2004, this has been the reason for the 1st Sunday in October the European Depression Day takes place – this year on October 2, 2022. The aim is to raise public awareness of depression as a widespread disease. Numerous campaigns are taking place within Germany and throughout Europe, and the topic is present in all media.
How dangerous is depression?
Is there really a risk of suicide?
Education on depression and the vulnerability of sufferers is urgently needed. It is imperative to state very clearly:
- Depression is mostly well treatable and often even curable,
- if you seek professional support – the sooner, the better.
- However, they are also a potentially fatal disease.
- Because people suffering from depression can despair so much,
- That they develop suicidal ideation,
- which some of them translate into action.
Is it okay or appropriate to talk about suicide risk?
To name suicide so clearly as a danger in an online article?  Whereas here in this Mental Health column it seems to be mostly “only” about wellness for the soul?
Yes, it must be, in my opinion. I ask the general practitioner Dr. Maren Buhl for her assessment:
“Anyone who speaks or writes about depression should not exclude the difficult topic of suicidality – otherwise one does not do justice to the clinical picture and the suffering of some of those affected. For some sufferers, self-imposed death appears to be the only way out. Those who have suicidal thoughts often seek support in advance. Sometimes these are only brief, irritating remarks. Here it is important to be attentive and sensitive, to inquire carefully but persistently.”
Telephone counselling as a professional conversation offer
If a person suffering from depression does not want to or cannot communicate with anyone in their personal environment, the German telephone counselling service is there to help – as it is for all relatives or friends who are overwhelmed by the situation. Available 356 days a year, by phone or online
Self-test depression available online
There is often insecurity and speechlessness towards depressives and their environment. After all, how can one know whether the current crisis cannot simply be overcome with interpersonal support or whether there really is a depression behind it where professional support is urgently needed? An online self-test with nine questions can help here, which is available on the website of the German Depression Aid and, as Dr. Maren Buhl explains to me, is also used by doctors and therapists under the name “PHQ-9 Test” to diagnose depression.
Remembering Stephen Fry’s quote, “Supportive interpersonal contact can make the subtle difference in helping a depressed person stay connected to life – and away from possible suicidal thoughts or even concrete intentions.
In some cases, a trusted person may be able to recognize when a person is a danger to him or herself more quickly than the person him- or herself and accompany him or her, for example, to the doctor or the emergency room of a psychiatric outpatient clinic.
What does depression feel like?
Every depression can feel different – because every depression has its own face. Dr. Maren Buhl lists the following symptoms in our interview:
- The two main symptoms are considered to be depressed/depressed mood (lasting longer than 14 days)
- and the loss of joy or interest in things that used to be meaningful and enjoyable (hobbies, leisure activities, parties, etc.).
- In addition, lack of concentration and drive,
- Decreased self-esteem with negative thought loops,
- Feelings of worthlessness or guilt,
- Future fears,
- Sleep disorders,
- Sexual life disorders
- and decreased appetite occur.
Not all sufferers show all symptoms, and the degree of severity can vary considerably. That is why it is so important to place diagnostics and, if necessary, treatment in professional hands.
How do medical professionals diagnose depression?
Now I am even more curious and want to know how Dr. Maren Buhl recognizes depression in her patients:
“Every one of us is tired from time to time, has less appetite or problems sleeping – are we depressed yet? The answer is no. Two things are crucial for the diagnosis. One is the duration and the other is the severity of the symptoms. Here, the two-question test helps with orientation. If either of the two questions about dejection and joylessness is answered in the affirmative, then further diagnostic testing should be done, for example, using the above-mentioned online questionnaire based on the PHQ-9 medical standard.”
Depression or Acute Stress Reaction – what’s the difference medically?
But how can we distinguish between an extremely stressful life situation (severe blow of fate, death of a loved one), which may show all the signs of depression, and a classic depression? Again, the doctor can give me the information I need:
“There is a fine line between a completely natural reaction to a life-changing, possibly traumatic event and depression – some sufferers cross this line, some do not. The diagnosis “depression” must always be considered in the context of the respective life situation. Not every severely depressed, low drive and suffering person needs medication. But all those affected need a sympathetic ear, sympathy and often psychotherapeutic support.”
Public Discourse Needs Food I.: Grimme Prize for Krömer and Sträter
But regardless of this special anniversary of depression, it is important to constantly raise awareness of this mental illness – as well as other, often still lesser-known mental health conditions. Most recently, it was comedian Kurt Krömer who shook up the public and got people talking about this mental illness with his bestseller published in March of this year, “Du darfst nicht alles glauben, was du denkst. Meine Depression.” shook up the public and got them talking about this mental illness. In an episode of his show “Chez Krömer,” in which he and comedian Torsten Sträter talked about their shared experiences of depression, both were so open, touching and passionate that they were jointly honored with the 2022 Grimme Prize for this TV entertainment, with the keywords “outstanding television moment” and “coming out to depressive disorders.”
Public discourse needs nourishment II: Remembering Robert Enke
It is important that there are always new impulses like these from Krömer and Sträter to talk about mental illnesses such as depression. Longer-ago events need to be brought back to the forefront of people’s minds. In my hometown of Hanover, for example, the bus stop in front of the soccer stadium was renamed in the summer of 2022. It is now called Robert-Enke-Strasse. Teenagers today might say to that, “Robert who?”
The bus stop is named after the former German national goalkeeper, who committed suicide on November 10, 2009 due to deep depression. Just two days earlier, he had guarded the goal in the Bundesliga for Hannover 96 against Hamburger SV with a score of 2:2, sporting top performance and not letting on in front of his fans. Family, friends, fans and the public were deeply shocked. The funeral service at the soccer stadium was attended by 40,000 guests.
Public Relations of the Robert Enke Foundation
Only 19 hours after Robert Enke’s suicide, his widow Teresa Enke succeeded in making talking about depression respectable for the first time at a press conference with her courageous report about her husband’s illness and the circumstances of his death.
Through the subsequent committed public relations work of the Robert Enke Foundation and Teresa Enke’s great personal commitment, I believe that the topic of depression became part of the public discourse and thus of society, that basic knowledge about the disease was conveyed, and that it was thus de-tabooed.
Role model function of affected celebrities
Krömer and Sträter show us with their openness how shame can be shed, how important and beneficial it is for our mental health to talk about mental illness. The Robert Enke case has affected and touched the general public. This gives celebrities an important role model function for public discourse. But they cannot replace the experiences and experiences of non-prominent sufferers. This is exactly why it is so important that more and more people dare to talk about their mental challenges, about their struggle for inner balance and mental health.
Book tips on the subject of depression
In addition to Kurt Krömer’s current book, I have two favorite books about depression. Matt Haig: Pretty Good Reasons to Stay Alive (dtv, 2016). Sally Brampton: The Monster, Hope, and Me. How I Conquered My Depression (Bastei Lübbe, 2009).
Bipolar depression – the unknown sister
As mentioned at the outset, people diagnosed with bipolar disorder also suffer from phases of severe and very severe depression. Having bipolar disorder myself, I have first-hand experience of what depression can feel like – which, by the way, can recur at any time with my clinical picture (as it does with unipolar depression). However, unlike unipolar depression, there is no cure for bipolar disorder because it is a permanent metabolic disease of the brain.
Reconciled with your own diagnosis
Nevertheless, I am reconciled with my diagnosis, because my illness allows me to experience the complete emotional range of vibrations in my everyday life. I know sadness and darkness as well as joy, gratitude and light. I have described my experiences with depression in the following poem, which I wrote in response to a call from the Stuttgart writers’ collective Frei!Geist for an anthology competition on the subject of depression and which I am allowed to reproduce here with the kind permission of Frei!Geist:
Tread the path
Thoughts circle wild, faster - fly racy. Landing site, it is missing. Gloom attacks. Claws strike in soul. Depression, oh no! Air, air! I wrestle for air, must breathe - breathe -. Fear of suffocation. Help - from where only? The song of the blackbird sounds far away. Inhale and exhale. Do you feel the tightness? In my throat, so tense, no flow of air ... The load weighs tons. Smile freezes on face. My interior: rigid. Where and how only find myself again, find myself? Dare to start over? Psychotherapy. A new path lies ahead of me, crosses my fears. I walk it slowly, carefully, courageously. Put foot in front of foot. Way times year, The descent into the soul: so deep, so dark. And yet I see a light in the darkness - still away from me. I go on, dare the path of courage despite my fears. The song of the blackbird, distant, but audible, gives strength. Confidence germinates. I move forward, Light and hope towards. The darkness gives way. Then I stand there: flooded with light, am light myself. Breathe very slowly. Soul ache subsides down, a tired animal. I stroke his fur. "Shhhh," I whisper. "It's good now, go to sleep. I won't forget you." Soul ache relaxes, enjoys caressing hands. Feels heeded. Soul ache sleeps, dreams. Snores quietly full of confidence in me, who now loves. Self-love learned, Gratitude for my life. And yes: God with me. Who loves and wants me for this world, every day My being a miracle. My life is mine - finally, after such a long time. Land thoughts.
Poem by Nora Hille, published with the kind permission of the authors’ collective Frei!Geist (Alex, Marie and Blancheflor): Young, growing and independent literature from Stuttgart.
 Source: https://www.deutsche-depressionshilfe.de/depression-infos-und-hilfe/was-ist-eine-depression (accessed October 02, 2022). Prof. Peter Bräunig, MD: “Living with Bipolar Disorders. Manic-depressive: Answers to the most frequently asked questions.”, TRIAS, Stuttgart, 3rd edition 2018. S. 15.
 In addition, information from the Federal Statistical Office: “In 2020, 9,206 people died by suicide in Germany, about 75 percent of whom were men.”
Source: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Todesursachen/Tabellen/suizide.html (accessed October 02, 2022). And the Stuttgarter Zeitung commented on this back in 2017: “Often a depressive mood is the cause.”
Source: Markus Brauer: “October 1: European Day of Depression: In the Deep Valley of Gloom. In: Stuttgarter Zeitung online, published on September 30, 2017.
 Source: https://www.patienten-information.de/patientenleitlinien/depression (accessed October 02, 2022).
About the author
Nora Hille was born in 1975, is happily married and has two children. She studied history, literature and media studies, worked in communications/public relations for 12 years and has now retired for health reasons. Today she writes articles on the topics of mental health and mental illness as a sufferer and experience expert. She also writes literary essays, poems (preferably haikus) and short prose. She regularly publishes her mental health column here at FemalExperts Magazine and is Editor of eXperimenta - the magazine for literature, art and society. Anti-stigma work is close to her heart: she is an encourager at Mutmachleute e.V. and is committed to Anti-Stigma-Texts against the stigmatization (exclusion) of the mentally ill in our society for more togetherness, tolerance and equality. In autumn 2023 her book "When Light Defeats Darkness" will be published by Palomaa Publishing. A book of encouragement about how to live a good and rich life despite bipolar illness - and the enormous challenge that this means every day for the inner balance of those affected.