Vegetative disturbances in the clinic of latent depression can manifest as vegetovascular dystonia and crises. In dystonia, autonomic disorders are in the form of severe sympathicotonia (increased heart rate, increased blood pressure, dry mouth, coldness of the limbs, white dermographism, etc.) or vagotonia (slowed pulse, lowered blood pressure, increased salivation, increased intestinal peristalsis, redness of the skin, red dermographism). Sometimes the symptoms of sympathicotonia and vagotonia are combined. Against the background of dystonia, vegetative crises that are usually associated with the emotional state can be observed: sympathetic-adrenal, vagoinsular and mixed.
The first are expressed in increased heart rate, pain and discomfort in the heart area, high blood pressure, pallor of the skin, numbness and coldness of the limbs, often chills. The second – in the sense of fading or interruptions in the heart, a sense of lack of air, suffocation, unpleasant sensations in the epigastric region, increased peristalsis. At the same time the hyperemia of integuments, sensation of heat, sweating, polyuria is noted. Crises are usually accompanied by anxiety or fear. The duration of crises is from several minutes to several hours.
Such patients get to a cardiologist most often in connection with complaints of pain and discomfort in the chest (heaviness and pressure in the chest), often mistaken for stenocardia, for peculiar (with a feeling of heaviness, squeezing or burning), not relieved by organic nitrates (nitroglycerin, etc.) pains in the region of the heart, sometimes accompanied by palpitations. In some cases, acute, similar to rheumatic pains in the joints appear.
Often in the clinical picture clearly manifest functional disorders of the gastrointestinal tract. Patients complain of pain in the abdomen, a feeling of heaviness in the stomach, a decrease in taste, loss of appetite, and in some cases a complete aversion to food. They are more often examined by a gastroenterologist for peptic ulcer, gastritis, and liver disease.
In eczema, functional disorders in the activity of the nervous and endocrine systems are observed. Possible reduction of pain and temperature sensitivity in the hysterical type. Eczema can begin and recur as a result of severe psychological injuries, prolonged unrest. There are neurotic states, which are expressed in sleep disturbance up to complete insomnia, increased irritability and depression. There is a susceptibility of skin changes to hypnotic effects. In the treatment of eczema, electrosleep, hypnosuggestion and low doses of corticosteroid drugs are indicated . In cases of persistent itching at night, the use of antihistamines and tranquilizing drugs is indicated. Balneotherapy also helps to consolidate the results.
Sometimes the most pronounced phenomenon of anorexia nervosa, accompanied by a decrease in body weight, in some cases significant (10-15 kg in one to two months). Less common is bulimia, sometimes associated with a loss of a feeling of satiety ( acoria ). There are also feelings reminiscent of nausea (“stirs up,” “pulls the soul” – more often in the morning), but there are also vomiting, bitterness, metallic taste in the mouth. Often marked constipation, rarely – diarrhea. Possible biliary dyskinesia, not accompanied by the development of obstructive jaundice or leukocytosis, increased thirst.
Somatized depression is often manifested in the form of premenstrual tension syndrome. In these cases, the patient first comes to an appointment with a gynecologist with complaints of recurrent, usually before menstruation, pain in the abdomen, paresthesia, palpitations, general malaise, irritability, tearfulness. However, along with vegetative and asthenic disorders in these cases, anxiety, a feeling of internal tension, a distinct decrease in mood, and depression are closely associated with the menstrual cycle. Frequent dysmenorrhea and amenorrhea.
However, its somatic equivalents in the form of periodic metabolic disorders, sexual desire, headache, sleep disorders, nocturnal enuresis , eczema, asthmatic attacks, etc., and various pathological sensations from the body are especially characteristic of somatized depression . Some of them, for example, psychalgia (pains, which are due to their occurrence to the mental factor, and not to real injuries), are found in almost all such patients. Other painful sensations are possible – twisting, compression, swelling, transfusion, etc.
Sometimes behavioral disorders (unfocused fussiness, periods of continuous smoking, alcohol or sexual excesses), pathocharacterological manifestations dominated by drive disorders (dipsomania, substance abuse, gambling tendencies, etc.) act as “masks” of somatized depression .
Sometimes, unexpectedly for themselves, the patients begin to draw almost continuously, with motives of sadness, sadness, hopelessness prevailing in their work.
For effective treatment of such conditions, it is necessary to know their pathogenetic mechanisms. In a significant proportion of patients whose clinical picture meets the criteria for “masked depression,” thedexamethasone test is normal or subnormal, and the diazepam ( seduxen ) test is of anxiety type. They respond well to anxiolytics ( phenazepam , etc.). This indicates that pathogenetic mechanisms of anxiety underlie violations. The action of antidepressants described in these cases is due to their inherent anxiolytic and analgesic effects. The somatic symptoms of these conditions are due to sympathotonia and hormonal changes inherent in anxiety .
The fact that similar vegetative-somatic disorders are observed during depression is explained by the fact that anxiety is always inherent in depression. In a significant proportion of patients with hypertension during the period of developed depression, the arterial pressure decreases. The inclusion of the mechanisms of depression is aimed at reducing anxiety, including at the somatovegetative level. This explains the fact that some patients in the described group may experience a real depressive phase.