Antidepressants in Germany, not prescribed as often as never before – when they are really useful and when

Seven Times as many antidepressants are currently prescribed as 25 years ago. Why experts criticize this high number, what are the reasons and what treatment would be in the case of certain mental disorders make more sense than to just swallow antidepressants.

25 million packs of antidepressants were settled in the year 2017, in the case of the health insurance funds and the amounts increase even further. These Numbers are called the society for Psychosomatic medicine and Medical psychotherapy (DGPM) on the European Depressionstag.

Mental illness, especially depression, to take so rapidly, as the apparent reason. Not infrequently, important causes were Overloading due to pressure of time and performance, permanent accessibility, the loneliness of the Singles, existence and fear of the Future. Every fourth man and every third woman will suffer because of it, at least temporarily, under a mental disorder.

Why today the diagnosis of Depression much more often is made

“A scientifically proven increase in these diseases there is not, however,” says Harald Gündel, Medical Director of the University clinic for Psychosomatic medicine and psychotherapy, Ulm, and the speaker of the DGPM, “however, a clear increase in the Doctors diagnosis.” However, in the future, for the reasons stated, stress-induced disorders could also psychological problems such as Burnout and Depression are on the increase.

Diagnoses such as depressive disorders, are now more often than in the past, because patients are more willing to talk about their mental health problems. Also, Doctors would pain, instead of the earlier “vegetative complaints” or “back”, now more often the true cause, namely “Depression” as a diagnosis, the Professor.

In mild depression the pills work only slightly better than Placebo

But even if the diagnosis is Depression or depressed mood is called antidepressants are prescribed too often and taken. “For mild depression, the guidelines do not provide for their use, but rather recommend, where appropriate, out-patient psychotherapy”, writes Harald Gündel.

Current overview studies, such as one on the press conference of the DGMP by Falk Leichsenring (Giessen) presented a meta-analysis, have shown that antidepressants exert only a small effect, especially in the case of light and medium depression. Only in moderately severe, but especially severe depression the effect is more pronounced.

Controversial efficacy of antidepressants

The effect of these drugs is already long in doubt. Studies to compare the effect of antidepressants with Placebo, show that the so-called effect size, a measure of the effectiveness is statistically only 0.2, this means low effectiveness.

This effect is weakness, is according to Falk Leichsenring, but only if the drug is used against light and medium depression. With the Severity of that mental illness the effect of antidepressants is increasing, and the proof is over that of a placebo, such as the already cited study shows.

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Psychotherapy is often more important than antidepressants

Antidepressants are, therefore, in the case of mild depression almost ineffective. The most important treatment is psychotherapy. Because most of the light and medium depressive disorder is caused by certain triggers: bullying, job loss, family problems, fear of the Future.

With the help of psychotherapy, the Affected person learns to be sustainable, to respond to such stressful situations in such a way that the Psyche suffers in the future, at least as strong or better yet:/the Affected person can transform a disease-inducing life situation. These self-operative effect of psychotropic drugs have not, they seem to be, as long as you take and also change certain disease-promoting behavior of the Affected.

Psychotherapy often fails at date deficiency

Psychotherapy, then, is the better choice in case of mild depression. But in Germany, a psycho-therapeutic treatment, sometimes like a lottery game. “Access is often difficult, very difficult, especially in rural regions,” confirms Harald Gündel, “although the Situation has improved and the corresponding supply in Germany is seen internationally with to the top.”

Nevertheless, the specialists, doctors and therapists are booked out usually weeks to months of Therapy may, in addition, it is difficult for the psychologically-loaded to overcome the hurdle of the personal application.

It is therefore understandable, when patients go to their family doctor first for a tablet to decide which takes no time at all – even if the problems themselves are not solved, but, if at all, only the symptoms are alleviated.

Antidepressants have hardly any side effects

The effect of the drugs in mild depression is lower than I thought. Taking harm, however, may, if the funds are to be taken in this Situation anyway? “Hardly, modern antidepressants such as selective Serotonin reuptake inhibitors (SSRIs) and selective Serotonin-norepinephrine reuptake inhibitors (SNRIs) have fewer side effects than the old drug groups, such as tricyclic antidepressants (TCA) or nonselective monoamine-reuptake inhibitors, and monoamine oxidase inhibitors (MAOIs)”, says the expert. Particularly important: The antidepressants of the newer Generation, according to our present knowledge not of the state.

Especially in the first few weeks, less frequently after that, however, you may experience side effects such as, for example:

  • Weight gain
  • Restriction of the Libido
  • Dryness of the mouth

In which mental illnesses antidepressants are important and which are not

However, these drugs are recommended for many mental disorders. The most common diseases and their therapy, when in addition, antidepressants are necessary and when not, and, or other medicines out of the range of psychotropic drugs:

Depressive Disorders

For mild depression, the guidelines will see little effect due to antidepressants. The most important treatment is psychotherapy, especially cognitive-behavioral therapy. In the case of moderate and severe Depression it is supplemented by the drugs.

In the case of severe depressive episodes, such as with acute risk of suicide, is the treatment in General, inpatient psychiatric-therapy, but also psycho-somatic-psychotherapy in chronic mental disorders that do not respond, for example, outpatient psychotherapy and/or medication is sufficient.

Anxiety disorder

For the treatment of cognitive-behavioral therapy or psychodynamic psychotherapy, where the Affected person learned for example how he arranges the fear trigger properly and, in the future, without the morbid fear or panic responds to. In addition, relaxation exercises and sports are important.

In addition, the guidelines antidepressants recommend. Other rapid-acting Anxyiolytika, how quickly do depending on the ends of the benzodiazepines, are possible only in exceptional cases and in the short term.

Disorders due to alcohol or drug abuse

Harmful dependence is discussed in the light of substance, something different. Important is the withdrawal or detoxification is always, where, in individual cases, certain antidepressants may help. This is especially in the case of alcohol withdrawal is a relief for the Affected. In addition, later antidepressants can play a role, because often alcoholism and Depression go Hand in Hand.

While alcohol use withdrawal abruptly, drugs, or other drugs is withdrawn from slowly or not-so-harmful substances (for example, methadone).

However, no matter what substance Addiction is based: In any case, psychotherapy is important in order to avoid a relapse as far as possible and to enable them to live without the drug. Expert Harald Gündel said: “First of all, roughly speaking, is treated specific to the Addiction, the personality.”

Bipolar Disorder

Depending on whether, in the context of bipolar disorder, a manic and depressive Episode occurs, prescribed to the psychologist, mood-lifting antidepressants or, on the contrary, depressant drugs (based on the guidelines from 2012, which will be revised at the time).

The goal is to stabilize in the case of recurrent depression (unipolar) and bipolar disorders (depressive and manic phases) to the mood, with Lithium, anticonvulsants and antipsychotics make a Option. In addition, psychotherapy is outside the acute disease phase is often very helpful for the person Concerned to understand his disease better can handle, and the trigger detects.

Borderline Personality Disorder

This profound personality disorder with emotionally unstable and fluctuating self-image and feelings speaks especially to psychotherapy. This will be further treatment, if needed, with antidepressants, in cases of special stress and Suicidal ideation also, for example, with low-dose of the newer antipsychotics. Often, the treatment is carried out first, or in between (part of)stationary.


Although the Burnout is defined syndrome only in the work of psychology is clear. Because the word is not stigmatized as such still the Depression (especially for men), Burnout used more common today. Because the mental Overload due to work, family, possibly care of a sick person often goes Hand-in-Hand with Depression. Accordingly, psychotherapy is important, to interpret stressors differently, and to arrange so that they exert less pressure on the soul. Also relaxation techniques help in the beginning an antidepressant may be appropriate.

Schizophrenia and psychotic States

These basic disturbances of perception and thinking, as well as loss of reality to be treated with psychotropic drugs such as neuroleptics, as well as, where appropriate, with specific psychotherapy. It is about conveys how the person Concerned and his environment, the disease to accept and anxiety can reduce.

Trauma and post-traumatic stress disorder

After an exceptionally strong incriminating life event (accident, serious mental injury, rape, torture) can occur immediately or years after a disturbance. Therapy option the trauma-specific psychotherapy, such as cognitive-behavioral therapy, but even short-term treatments such as the Trauma Buster therapy is in the first line worth a try. In the short term, the doctor may additionally prescribe an antidepressant.

Dementia, Alzheimer’s

An important role in the treatment of dementia diseases such as Alzheimer’s disease, the psychological plays social treatment, in order to obtain the mental ability for as long as possible. Psychotherapy helps the disease to accept and to respect life still worth living.

Although there are still no drugs that cure dementia, anti-dementia, such as Acetylcholinesterase inhibitors and memantine may affect the brain metabolism sometimes so that the disease progresses at least at a slower pace. In some cases, antidepressants are appropriate if the burden of the inevitable increasing dementia is felt strongly.

Conclusion: antidepressants are many mental disorders is an important therapeutic agent. Any Form of mental discomfort that last longer, but it should clarify a medical specialist for Psychosomatic medicine and psychotherapy, or various “Psycho-technical colleagues” (psychiatry and psychotherapy, psychotherapist). In the case of depression, these experts recommend antidepressants only against serious and sometimes also medium-sized molds. Because the medicines in the case of light and medium depression for only a small effect, only in more severe forms, they act.

It is, therefore, in the case of depression, this is not always necessary, this medicine or take this. A lot more important to severe depending on the disease, appropriate psychotherapy, or the combination of antidepressants plus psychotherapy.