The many faces of depression

Just as no two people are alike, there are no two equally suffering depressed patients.

The International Classification of Diseases 10th edition does not provide for the isolation of the leading syndrome, but identifies only two variants of depression:

  1. Depressive disorder with somatic symptoms;
  2. Depressive disorder with psychotic manifestations.

The American classification of mental illness provides for melancholic, catatonic, delusional variants of depression. Domestic psychiatrists base the classification of depressive disorders on the isolation of the underlying syndrome.

So S.N. Mosolov identifies the following types of depression:

  • simple hypothetical;
  • asthenic;
  • apathetic;
  • alarming;
  • with sleep disorders;
  • tearful;
  • dysphoric;
  • masked;
  • major depressive episode;
  • delusional;
  • anesthetic;
  • with obsessions;
  • hypochondriacal;
  • atypical.

All classifications of depression are based on a clinical approach and do not provide for objective criteria for the disease, the characteristics of the etiology and pathogenesis of depressive states. The main task of treating depression is to eliminate the most painful symptoms of the disease. This reduces the risk of suicide and maladaptive behavior. The effectiveness of antidepressants is 50-70%. Their effect is manifested from 3-4 weeks of therapy, achieving remission requires 6-8 weeks. When prescribing antidepressants, the qualifications of the doctor play an important role. Since the appointment, control of admission, the end of treatment are still subjective. Objective biological markers are not used for a differential treatment approach. There are also no molecular or gene-level predictive markers of disease that would personalize the approach to treating depression. The existing standards for the treatment of depression in the Russian Federation do not provide for the objectification of therapy. Therefore, replenishing the arsenal of antidepressant drugs without objectifying diagnostics and therapy is an ineffective step in the treatment of depressive conditions. Research in the field of neuroimaging, genetics, biochemistry, molecular biology can serve as the beginning of the objectification of depression therapy. And identifying biological markers of the effectiveness of treatment can do away with subjectivity and the harm that low qualifications of a psychiatrist bring.

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