The COVID-19 pandemic and associated measures to restrict the spread of the virus correlated with limitations in healthcare and changes in depression-related lifestyle elements for depressed patients, both of which are known to negatively affect the course of depression. This paper examines, the reporting of a worsening state of illness as a result of COVID-19-related measures among individuals with depressive disorders; and whether this worsening was related to restrictions in healthcare for depression or changes in depression-related lifestyle. The analysis was (...) based on a population-representative survey of the German population aged 18–69 years. The key findings were: 49% of respondents with self-reported diagnosed depression reported that the measures against the pandemic had a negative impact on their depressive illness. Of those who reported impaired access to healthcare for their depressive illness, 70% also reported a worsening of their depressive illness. This was a significantly higher percentage than those who did not experience impaired access to healthcare. Of those who reported changes in depression-related lifestyle, 58% reported a worsening of their depressive illness. This was a significantly higher percentage than those who did not exhibit any of the outlined behaviours. Worsening of the depressive illness was most common among those who reported a lack of daily structure or extended bedtimes. People who mentioned a lack of exercise also reported a worsening of their depressive illness. These findings reinforce the need to consider the suffering and possible increased suicide risk to people suffering from depression induced by measures designed to constrain the COVID-19 pandemic; an important consideration in identifying the optimal risk-benefit ratio when setting pandemic measures. Our study highlighted the importance of maintaining healthcare, even in crisis situations, and ensuring access to guideline-based treatment for people who need urgent care. It also showed that political interventions can influence individual behaviours that can have negative effects on depressive illness. (shrink)