First of all, these are changing living conditions. Survived in the XX century. the hardest world and local wars. These common problems are supplemented for our country by the difficult consequences of the revolution, the tragic civil war, the radical restructuring of the forms of peasant life, the transition of many peasants to an alien way of life in the city, the dire consequences of unjustified repressions and, more recently, the problems associated with perestroika. All these political, social, economic factors have a significant impact on the state of the mental sphere, contribute to the formation of psychosomatic diseases, which are based on depressive and anxiety disorders, very often manifested simultaneously. A certain role is played by the demographic factor, which manifests itself as a tendency to increase average life expectancy. Depression is submissive for all ages, but in older years it occurs more often, and it is based on both the characteristic psychological problems of old age and biological factors.
The revolutionary factor in the doctrine of depression was the creation of modern antidepressants, which became possible as a result of the formation of the neurobiochemical theories of the nature of depression, the role of catecholamines, and especially serotonin.
All available forms of pathology can, with some assumption, be divided into two classes: organic and psychogenic diseases. From this perspective, it is possible to consider depression. Organic forms are manifested in endogenous mental diseases and organic diseases of the brain. Along with them, psychogenic forms of depression are distinguished. Undoubtedly, in these cases, there are certain structural and biochemical changes, but the initiation and course of depression is determined by environmental, psychogenic factors. It is this group that determines the significant increase in depressive disorders, which we wrote about above.
Among patients with depressive disorders, women dominate. The “sexual” analysis of pathology has long been the subject of our interest and reveals a lot when studying the nature of various diseases. Returning to depression, we give only one figure: at the appointment with a general practitioner among patients with depressive symptoms, the ratio of men to women was 1: 8. This situation is excusable and partly determined by the greater consumer power of women in relation to health resources. However, the predominance of women is undeniable. This situation is maintained when considering all depressive models available in neurology. Women dominate among patients with sleep disturbance, chronic pain, autonomic and motivational disorders. Along with the specificity factor of female psychology, the characteristics of affective reactivity, greater stress availability, and characteristic endocrine cyclicality, one can recently use the fact of a lower serotonin content in a woman’s brain.
It is fundamental to understand the role of depression in many of the most common forms of neurological pathology, which, along with the articles described in the articles of this journal (autonomic, pain, dissomic, motivational-endocrine), also include such forms as parkinsonism, multiple sclerosis, hypothalamic insufficiency, residual manifestations strokes etc. According to our data, in a neurological hospital some form of depression is found in 80% of patients.
Two inextricably existing tasks flow from this position. It is difficult for a neurologist in modern conditions to successfully work without developing the skills for diagnosing depressive disorders (often hidden, masked) and without finding a connection between them and neurological syndromes. Well, the second obvious task is to learn how to treat this category of patients. Currently, antidepressants have firmly entered the circle of the most popular drugs in a neurological clinic. It is important to hone the skill of the choice of drugs, their doses, the duration of treatment. We will also outline the basic principles in an article in this journal. Finally, we wanted to emphasize that non-drug methods of treatment are developing, which is very important for many patients who are either biased against the use of “chemistry” or objectively poorly tolerate certain drugs.
At present, non-drug treatment cannot yet fully compete with pharmacology, but it can be included in complex therapy regimens, reducing the proportion of drugs.