Psychodynamik Berlin Psychodynamik Berlin
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Depression

From Initial Diagnosis to Treatment-Resistant Depression

Depression is more than sadness. It affects drive, concentration, sleep, appetite – and often one's entire experience of life. Many people describe a feeling of inner emptiness or emotional numbness.

Neurobiologically, depression can be understood as a disruption in brain network communication. Certain networks – such as those for rumination and self-focus – are overactive, while others – such as those for action planning and concentration – are underactive.

Depression is Treatable
Even long-standing or severe depression has effective treatment options. Careful diagnosis is the first step.

Common Symptoms

Persistent low mood or emptiness
Loss of interest and pleasure
Exhaustion, even without physical exertion
Sleep disturbances (too little or too much sleep)
Difficulty concentrating and making decisions
Rumination, hopelessness, guilt
Social withdrawal
Physical complaints without clear cause

Diagnosis

Thorough diagnosis is the foundation of any treatment. We assess:

1

Symptoms and Course

How does the depression present? Since when? Have there been previous episodes?

2

Differential Diagnosis

Other conditions can cause similar symptoms – such as thyroid disorders, sleep disorders, or ADHD.

3

Medical Workup

Laboratory tests, additional diagnostics if indicated (e.g., brain MRI).

Why Thorough Diagnosis Matters
Similar symptoms can have different causes. A solid diagnosis protects against mistreatment.

Treatment-Resistant Depression

Treatment-resistant depression refers to cases where at least two antidepressants at adequate doses and duration have not produced sufficient improvement. This affects about 30% of all patients with depression – and is one of our specialties.

Treatment Resistance Does Not Mean Hopelessness
That previous treatments did not work sufficiently does not predict future success chances.

Therapeutic Drug Monitoring (TDM)

Not everyone metabolizes medications the same way. With TDM, we measure actual medication levels in the blood. This helps determine whether a medication is underdosed, overdosed, or optimally adjusted. We collaborate with Labor28 Berlin for this service.

Additional Strategies

  • Augmentation: Adding lithium or other agents
  • Combination Treatment: Two antidepressants with different mechanisms
  • Switching Medication Class: Sometimes a different medication works better

rTMS (Repetitive Transcranial Magnetic Stimulation)

rTMS is a non-invasive procedure that stimulates specific brain areas using magnetic pulses. For treatment-resistant depression, rTMS shows response rates of 30–50%. We assess indication for rTMS and plan treatment together. Our goal is to offer rTMS at our practice during 2026. Until then, we refer to specialized centers. If interested, please speak with us – we can provide consultation and add you to a waiting list.

Treatment

Treatment depends on severity and course:

Medication

Antidepressants of various classes. Selection is individualized based on symptom profile, prior treatment, and tolerability.

Psychotherapy

Cognitive behavioral therapy, psychodynamic approaches. We offer psychotherapy, though capacity is limited.

Combined Treatment

For moderate to severe depression, the combination of medication and psychotherapy is most effective.

Appointments

Appointments are usually available within a few days. Diagnosis and treatment are available in English.

Costs: Private insurance, Beihilfe, or self-pay (GOÄ).