Six myths about depression: how to distinguish the disease from the blues and how to escape from it

Together with the authors of the book “Go crazy!”, Who recently received the prestigious “Educator” award, we are going through a depression that torments millions of residents of large cities.

The book of Anton Zayniev and the former journalist of “Komsomolskaya Pravda” Darya Varlamova “Go crazy!” became a bestseller and has just been awarded the prize “Illuminator” in the nomination “Natural and Exact Sciences”. While the speech in it is not about physics and not about mathematics, but about psychology and psychiatry. About those mental diseases that make people suffer, from the point of view of others – out of the blue.

Daria and Anton themselves suffered clinical depression; cured and united, they wrote this book. Let us now try to understand with them that, in the generally accepted ideas about depression and its treatment, it is true, and that it is a lie.

Depression is just a very bad mood. And patients should just pull themselves together!

FALSE, AND DANGEROUS. Depression is a serious illness that makes a huge number of people disabled. Among its main symptoms – suffocating apathy. Varlamov and Zayniyev compare it with the dementor’s kiss from Harry Potter: the dementors were able to suck the soul out of a person, and he, devastated, lost his taste for life. Andrew Solomon, a disease researcher, said that the opposite of depression is not joy, but life force. He himself went through this state and recalled: “Everything was deadly difficult for me. For example, the desire to take the handset required efforts comparable to the need to squeeze a two-hundred-kilogram bar while lying down.”

Unfortunately, many people think that incredible grief and suffering should be written on a depressed person’s face. Without noticing them, the patient begins to say something like “Get it together, a rag!”, “You really are fine – you would look at disabled and starving children in Africa!”, “Remember that life is beautiful!” And similar phrases, in this case completely useless. Everything else, the word “depression” is used to the left and right as a designation of the usual blues and bad mood (for example, after parting with a girl or young man, and not because the weather is bad) – and many do not belong to the disease seriously, not realizing how painful she is.

Distinguishing depression from sadness is not so difficult. In depression, apathy and bad mood usually last more than two weeks and (this is very important) do not directly depend on external circumstances. That is, the mood drops without noticeable reasons. Someone sharply decreases self-esteem, someone sees the future in a gloomy light, someone starts to gnaw himself for past mistakes without end … Depression does not apply to any one sphere of life, but to everything at once (for example, if a person is bad at work, and in the evenings he dances at parties and turns his novels, he does not have depression – most likely, just need to change jobs). Finally, depression is usually associated with psychosomatic disorders, and they can be very different. Often there are unexplained headaches, shortness of breath, a feeling of heaviness in the whole body … Or a person has an increased appetite, he “seizes” his discomfort, and sometimes, on the contrary, he does not eat anything at all. He may have chronic insomnia, or, on the contrary, he can sleep all day, trying to get away from the world with his problems.

The sufferings of a person whose joy was removed from life are unbearable and can cause suicide. Although at the peak of depression, the patient, as a rule, has no will: he simply has no strength for anything, including suicide. Paradoxically, suicidal tendencies can manifest themselves during treatment, at its very beginning. Sometimes, when taking modern drugs, the will with energy returns to the patient earlier than a good mood. And this period is considered the most dangerous: the person is still very bad, and he can already commit suicide.

Antidepressants don’t help anything

HELP, AT LEAST NOT SO JUST PICK UP SUITABLE. Like it or not, they are the main way to deal with depression. The mechanism of their impact on neurons and neurotransmitters in the book of Varlamova and Zayniev is devoted to many pages. They are their ardent supporters.

Although the opponents of the pills immediately say that the brain is the most complex and worst studied organ in the human body. And psychiatry as a science was born only a century ago with a little back. A pill that allows you to achieve a cure, began to produce at all in the 1950s – 80s. And at the same time, each patient suffering from depression, bipolar or obsessive-compulsive disorder, needs its own combination of medicines – that which heals one does not cure the other. In the meantime, the correct treatment will be selected, the patient may have time to be disappointed in the pills …

In fact, there is a rather broad movement of “antipsychiatrists” who are categorically against modern psychiatry as such. They compare it in its current state with medieval astronomy, which did not know Copernicus or Galileo. And they love to remember the experiment, set up in 1973 by psychologist David Rosenhan. He and seven of his colleagues specifically decided to become mental hospital patients, complaining of hallucinations (everyone told the doctor that he heard a voice repeating the words “empty”, “hollow” and “splashes”, and the rest behaved completely normal). Although all experimenters were simulators, they immediately received serious diagnoses (mainly schizophrenia) and stuffed them with drugs for several weeks – they barely got out of the hospital!

Then, the leadership of one clinic, having learned about the experiment, stated that no simulator would definitely slip from them. Then Rosenhan said that within three months, he would specifically send several “false patients” to them. As a result, the clinic management caught more than forty imaginary patients … and was shocked when Rosenhan confessed that he had inflated the doctors and had not sent a single pretender to the hospital at all!

And yet, there is an obstinate fact: antidepressants work, they have a very high cure rate. There are thousands of living people whom they dragged out of hell, and they are wildly grateful for that.

Anton Zayniev says: “Falling mood, loss of appetite, apathy is all nephrophysical processes, specific malfunctions in the brain, in nerve cells. Yes, we do not fully know what exactly causes these or other malfunctions, and we can not X-ray as in the case of a broken arm. But we understand that there is a failure. On the one hand, a person’s neural connections become less branched, on the other hand, a specific neurotransmitter, presumably serotonin, is missing in the brain. And all this can be repaired with the help of tablets. It has long been proven: if taking patients with depression, to divide them into two groups, and the first to give pills, a placebo, and the second – real medicines, people from the second group are much more likely to recover.”

If depression is the result of biochemical processes in the brain, then why does a person fall into it after the tragic events and cannot get out for months?

EVERYTHING IS INTERCONNECTED. Depression is conditionally divided into endogenous (due to internal causes) and exogenous (caused by external – permanent failures at work, death of a spouse, etc.). But one can flow smoothly into another. On the one hand, the lack of magnesium can cause a very real existential crisis in a person. On the other hand, obsessive unpleasant thoughts can change biochemistry in the head. Suppose a person has died someone close to: first, depression began due to psychological stress, then he constantly thinks about it, “winds up” himself – and changes the brain’s neurochemistry.

And psychotherapy, therefore, is not needed. This is about talking about nothing, just a way for a doctor to make a lot of money on chatter!

NOT. Daria Varlamova: “It happens that a person has a terrible spiritual crisis – but in fact the body simply lacks a certain substance. The medicine as a whole level the affective state: removes dips in the mood, gives energy, reduces anxiety. But I, having survived depression, began to believe in psychotherapy. In my case, it was cognitive-behavioral, although there are other methods. Depression causes a lot of mental garbage: low self-esteem, or “toxic” perfectionism: either I have to do everything perfectly, or I am a nonentity … That’s all well cut out by psychotherapy, and drugs can and should be combined with it. ”

If I go to the doctor, everyone will consider me crazy. Also, in the hospital stuffed. And in general – this is the stigma! Then at work they will learn about it …

NOT TRUE. Since Soviet times, there is a horror in front of “registration in the mental hospital”, but now there is not even such a formulation. With anxiety disorders or depression, no one will send you to the hospital if it is not about very serious cases: there are enough patients in hospitals and without you. Of course, if you declare a psychiatrist with an ax and say that reptilians hunt you, the place will be found instantly, but most likely you will be prescribed medication and you will be treated on an outpatient basis: according to statistics, less than 1% of visits to a psychiatrist will end with hospitalization.

Further problems may arise except with obtaining a driver’s license. But there should be no trouble when entering a job – officially, the medical institution has no right to show anyone the information about you.

Daria Varlamova says: “Personally, it seems to me that it is better to go to a good private psychiatrist, because the state mental hospital is a lottery. You can get an adequate specialist, but you can – a very inadequate, which does not help you, and even wrong diagnoses. Especially if you are painfully afraid that you will be put on some kind of “lists”, “archives”, etc. – it’s better to go to a private trader:

But among Western psychiatrists there is another position. Some of them, themselves prone to depression, severely punish their colleagues: “If I start it, do not treat it with pills, immediately drag on EST!” In fact, it is a painless and effective procedure that reloads the brain – like a frozen computer in which too many programs were opened. Frequent complication is amnesia: you can completely forget what happened to you in the last year (in Doctor House, the patient lost all his memory after EST forever, but this is also a fantasy of scriptwriters, in reality, memory is usually restored).

Indeed, the barbaric and hellish method of direct influence on the brain is a lobotomy, a method of excision of certain proportions in order to heal from mental illness. But nobody uses it now. In this case, the Portuguese scientist Egash Moniz, who invented the lobotomy, in 1949 received the Nobel Prize in medicine. In the 90s, when Monesh was already dead, they were retroactively tried to deprive the Nobel prizes – but to no avail, the Nobel Committee defended him. In his difficult times, when there were no antidepressants, no haloperidol, or mood stabilizers, a lobotomy looked like a panacea.

Now in Britain, patients with an extremely severe form of obsessive-compulsive disorder who are on the verge of suicide because of illness are sometimes carried out neurosurgical operations, making neat cuts to the so-called. striatum, the part of the brain that is thought to be responsible for the disease. And sometimes after that it really passes. However, this is an extremely risky procedure.


Howard Hughes (Leonardo DiCaprio’s hero in the film “Aviator”): obsessive-compulsive disorder (OCD)

Film heroes sometimes wash their hands several times, step over cracks in the asphalt (and if they come, they come back and still step over), arrange things in a strictly defined perfect order, close and open the front door, trying to carry out this action “correctly.” What is “right” or “ideal” is only they who understand.

All these are symptoms of OCD, a very many-sided and painful disease. Symptoms can be different – from the desire for pathological purity (there are so many dangerous germs around!) To painful thoughts that come to mind (a believer in the temple thinks that he can defile icons in some terrible way, a person who loves children suddenly thinks that children can be hurt badly, etc. – despite the fact that, naturally, they are not going to do anything of the kind). And someone, going out on the street, is afraid that he forgot to turn off the iron, and now the fire will start at home. He comes back, checks, comes out again and thinks: “What if he didn’t check it out well?” And so – 15 times. And he is well aware of all the absurdity of his behavior. Simply irrational anxiety turns out to be stronger than logic.

All of this – obsessions, or, to put it simply, obsessions, they are obsessions, they are also obsessions. As the hero of the same Dicaprio said in the Beginning, the most enduring parasite is the idea: if she settles in her head, you will not get rid of her. Obsessive thoughts come to people with OCD infinitely, spinning in your head, like a sticky melody, causing terrible discomfort. To “shake off” them, it is necessary to perform actions that look idiotic in the eyes of others. For example, go to the bathroom and, as it were, metaphorically wash off all bad things. Or wash your hands to literally remove germs from them. Or pronounce certain phrases in a certain sequence. Or, for the sixteenth time, go home and check the iron. These are compulsions, obsessive rituals.

Perhaps these are fragments of magical consciousness, attempts to find a connection between completely different phenomena. “As a child, Turner tried many times to convince himself that it was foolish to try to prevent his mother’s sudden death by just not stepping on the asphalt pavement near the school playground. And yet he never stepped on them – and his mother remained alive.” This is from Ian MacUen’s novel The Atonement, and this is quite a description of OCD, which the hero didn’t develop with age, however, many accidents develop.

There is another theory. As Anton and Daria write in their book, “the origins of OCD lie in the same place as other diseases of the anxious spectrum, but the particularity of this disorder lies in the fact that the striatum (striatum) is involved in its development and the amygdala does not take part (therefore the fear emotion on its own is not realized.) Dysfunctions in the striatum create an alarming background, the prefrontal cortex “converts” it into concrete fears, the thalamus creates rituals that protect them, and the leap to each new stage of the cycle consolidates the previous one. a circle that is very difficult for the patient to break. ”

Carrie Matheson (heroine Claire Danes in the TV series “Motherland”): bipolar affective disorder (BAR).

In Soviet times, it was known as manic-depressive psychosis. The stages of euphoria, ecstasy and delight in this disease are replaced by stages of deep depression. You flew like on wings and felt like a king – but then suddenly everything became very bad, you want to lie and look at one point. A person in the manic stage is able to collect bank loans and give all the money to the poor (“Well, what, I make the world a better and brighter!”) Or buy a sailboat to go around the globe. It was about them saying “keep me seven”. Well, when this stage is replaced by depression, the person is simply in hell.

There is a mild and simple stage of BAR, the so-called cyclothymia, when an inexplicable spiritual ascent (hypomania) gives way to a slight gloom and melancholy. Many believe that seasonal cyclothymia was with Pushkin, who did not like summer, but who loved autumn very much. In particular, it is this burst that explains the number of brilliant texts that he once, without looking up from the paper, wrote in Boldino. Pushkin, of course, was not diagnosed, but this version looks quite plausible.

Hypomania for creative people is a welcome and blissful state. You are full of inspiration and energy, do not understand where good thoughts come from, and you do not know tiredness. Everything seems to be fine, but alas, it can turn into BAR-2, when hypomania is replaced by a full-fledged depression. And not even in BAR-1, an even more serious disease, where it is no longer about hypomania, but about mania in its purest form. Here the psychosis can already begin – say, delirium of greatness. For example, a person in the euphoria will start thinking that he may be jumping from a balcony to a balcony, like a superhero from films – and all this will end sadly.

Daria Varlamova says: “Easy hypomania is what any person would have dreamed of, I think. It probably sounds unprofessional, but nonetheless … But there is a group of drugs, mood-control agents, which remove this manic state. They can be combined with antidepressants – that is, a little “hack” up and down so that people do not go into ecstasy or agony, but remain somewhere in the middle. The most well-known modemist is lithium. He is now considered obsolete, but, nevertheless, one of the most effective ways for a pronounced “bipole trials. “In his complain that it creates a more” gray “,” no “mood, but the peaks and valleys it removes quite efficiently.”

Rambo (Sylvester Stallone’s hero in several films): post-traumatic stress disorder

As we remember, Rambo is a veteran of the Vietnam War who had to face torture and other horrors. He has a classic PTSD. It is characterized by intrusive memories of an experienced trauma (they can also be in the form of nightmares), attempts not to think and not talk about it (for example, a stewardess who witnessed a plane crash, quit work in aviation), dark thoughts, negative attitudes towards herself and / or to others and unwillingness to communicate with them. These are the three main symptoms – and there is also partial amnesia, when a person simply erases the memory of a terrible event (then it can suddenly return).

In Hollywood, they like to make PTSD films very much – this is a convenient plot engine in thrillers, and in general the characters with him look bleak, harsh and spectacular. Batman, for example, also suffers from injury (in his eyes, both parents were killed in childhood – since then he has become a “dark knight”, sullen and unsociable, which is difficult even to make relationships with women). But the disease is, unfortunately, not only cinema – it is found, for example, in many soldiers who have returned from hot spots, women who have experienced rape, and so on.

But after all, many do not occur. Why do some extremely painfully react to trauma, while others – relatively calm? According to Varlamov and Zayniev, “according to one theory, the disorder is caused by a malfunction of the hippocampus (for example, in PTSD patients an increased blood supply was found). This section of the brain is responsible for working with memory. It is assumed that the stress memory does not” archived ” therefore, the body repeatedly experiences it as if it were happening in reality.”

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