Outwardly he looked happy, funny. A jester, with wife, children, success, money. A person who needs to be happy. Only with his suicide was known: actor Robin Williams suffered for years under a disease that prevented happiness. Depressions. They pull people into a deep, black hole. Make life joyless, gloomy, desperate. The WHO warns of the new widespread disease depression. In Austria, an estimated 800,000 people suffer from depressive illnesses, especially women. How do you know if it's not just an intermediate low? What are the symptoms of depression, how do you best support those affected? We spoke with Kristina St№rz, health psychologist at the Department of Psychiatry and Psychotherapy at the University of Innsbruck. "I can not anymore, I'm a burden for everyone …" WOMAN: What exactly is depression?
Kristina St№rz: Depression is a disease that changes a person's feelings, thoughts and behavior. There are several criteria for this finding, of which at least two main and two so-called minor criteria must apply. The main criteria include: a depressed mood, loss of interest and reduction of the drive. Side criteria include: reduced concentration and attention, lack of self-esteem and self-confidence, feelings of guilt and worthlessness, negative and pessimistic outlook, suicidal thoughts or acts of suicide, sleep disorders, loss of appetite or cravings. Depression is also referred to as a "solvency disorder", ie all adjectives that end in "los". You are joyless, sleepless, impotent, unappealing … And most importantly, these symptoms must be consistent over a period of at least two weeks!

WOMAN: How does one differentiate real depression from a bad phase of life?
St№rz: One often says in everyday life "I am depressed …" These sometimes occurring mood swings or feelings of sadness, which each of us knows are not the diagnosis, as I said, are very important, for example, the persistent symptoms over a period of more than two weeks.

WOMAN: What is depression like, especially in women?
St№rz: Often it is women, even mothers, who say: "I can not and do not do anything anymore, I can not handle anything anymore, I'm a burden for everyone, I'm worse than the other women, I'm a bad mother, I am unattractive. "The combination of negative self-image and emotions such as fear and insecurity prevent those affected from fulfilling their roles in work and family in the usual way. Internal and external pressure increase enormously. As a reaction, then often follows a strong retreat. The main symptom of lack of drive does not mean that one no longer wants, but that one can not do more. With severe depression, it can get so far that you can not even get out of it. It is then so impotent that normal everyday things, such as shopping, body care, etc. can not be done.
Mothers may experience problematic parenting practices due to their low self-esteem and sense of incompetence, they may intervene less or not reflect important emotions of the child. This leads to conflicts, children feel little "held" and uncertain.

Robin Williams: No one can say what it really looks like in a person. WOMAN: How can I help as a partner?
St№rz: That depends on the severity of the depression. When it comes to mild depression, it often helps to say, "Come, we'll do something, let's go somewhere, let's take a break, that'll do you good." For example, you can do sports together, and you often have already a slightly antidepressant effect.
If the partner has a severe depression, this behavior would be just the wrong thing, because the sufferer can no longer enjoy a trip. Here you have to have a lot of understanding and attention, and that's not always easy. Many partners become impatient, helpless, angry, and say, "There is not that, can not you pull yourself together." Family members must realize that their assistance is limited, that they can not and should not replace therapists that then professional help needs to be claimed.

WOMAN: But some people just do not want to get help …
St№rz: Yes, many people reject help first, do not admit their problem – often out of shame – not one. Some women and men go beyond their own limits for years, clench their teeth and say, "That's fine, I still managed everything!"
"You have a problem – this statement is taboo!" WOMAN: How do you deal with it?
St№rz: Very important: Do not say: "You have a problem." Always stay with the "me". So rather say, "I'm worried about you, I realize you've changed. Do we want to see together, if there is perhaps a specialist to whom you can turn to? "One can also offer to go along to take the shyness and fear. Or you say, "I'm helpless, I do not know how to respond." Definitely talk about it and ask: Do not blame or blame. And save yourself advice like "Yes, a day of wellness, then you feel better." Or "Take a day off, then it will be back." You have to take the problem seriously! Phrases like: "Everything is not so bad." Or "There are others, who are worse" help in any case!
WOMAN: What does the treatment look like?
St№rz: The so-called "gold standard", the drug of choice, is a drug treatment in combination with an accompanying psychotherapy. The latter begins to grip when the first "deep hole" is overcome. But most importantly, depression is treatable!
WOMAN: If I fought the depression, am I healed forever?
St№rz: A depression can be unique – for example, after a major burden, such as the death of a family member. But it can also occur without obvious trigger.
And there are recurrent – so-called recurrent depressions. The patient is doing well in the meantime, but unfortunately this is no guarantee that they can not occur again.
"Positive things are no longer perceived …" WOMAN: How is it that a patient chooses suicide?
St№rz: 60% of suicides are due to depression. It is difficult to explain, but someone who suffers from severe depression is so limited in their thinking and feeling that they can slip into a so-called "presuicidal syndrome". He then can no longer think like someone who is healthy sees nothing positive in the future. Normally, for example, you are looking forward to the wedding of your best friend or to the birth of your grandchild, these patients then no longer have these feelings. Suicide is the last resort for her from her suffering.
WOMAN: Is there depression in children?
St№rz: Not to the extent, but yes. One differentiates children under 12 years of age, as 0.3-2.5% are affected and in the 12-17-year-olds 3-10%.
WOMAN: That sounds awesome!
St№rz: Yes, it is also quite serious. The difficulty with young children is that they have too few words to express their state of mind, emotional distress is often more likely to be due to stomach ache, headache, but they are also sad and withdrawn, have nightmares or no joy. Often then changes in school performance, a change in eating habits, pondering, difficulty concentrating …
WOMAN: What can I do then?
St№rz: Do not ignore the warning signals. Do not be shy, go to family counseling, school psychologist, child psychiatrist. First you will look for burdens there, for example, bullying in school, high pressure to perform or separation of parents. The psychiatric-psychological care of children is in Austria but definitely expandable and unfortunately still somewhat neglected.
WOMAN: 800,000 people in Austria suffer from depression. Are there differences between men and women?
St№rz: Women are twice as likely to be affected as men, every fourth woman and every eighth man in the course of their life from depression, women are sometimes more open, get help faster. Often very high performance, perfectionism, and adjustment play together. It must also be said here that women tend to develop an anxious-depressive symptomatology and that men are more inclined to flee, for example, into dependence (eg alcohol) during exercise. Hormonal fluctuations, such as menopause, often play an additional role in women.
WOMAN: At what stage is research, what will the future bring?
St№rz: In addition to the large areas of psychopharmacological and neurobiological research, other aims are early detection and prevention, including suicide. The range of treatment also in the field of psychotherapy must be optimized in Austria. Many programs are committed to education, prevention and rehabilitation. But it urgently needs more women-specific offers! And, most importantly, the disease needs to be stigmatized. We have to talk more openly about it. According to the WHO, depression will be the second most common disease by 2020. Often people push the burn-out syndrome today, because it is more recognized in society. But depression is not weakness or lack of willpower, but a disease that can be treated!

Dr. Kristina St№rz, health psychologist at the Department of Psychiatry and Psychotherapy at the University of Innsbruck