Amitriptyline (lat. Amitriptylinum, trade name "Damylene", 5- (3-Dimethylaminopropylidene) -10,11-dihydrodibenzocyclohepten) is a drug in the form of yellow-coated round biconvex tablets (made in Slovakia) or white tablets (made in Russia), on cross section of which two layers are visible. Registration number: P No. 016138/01. Trade and international non-proprietary name of the drug are the same - amitriptyline. ATX code: [N06AA09].
Amitriptyline, like imipramine, is one of the main representatives of tricyclic antidepressants. The structure differs from imipramine in that the nitrogen atom in the central part of the tricyclic system is replaced by a carbon atom. Is a tertiary amine.
The drug consists of active and auxiliary substances: the active substance is 25 mg of amitriptyline as hydrochloride 0.0283 g.
Auxiliary substances are contained in the core and the shell of the drug. The core contains: lactose monohydrate, corn starch, gelatin, calcium stearate, talc, colloidal silicon dioxide. Shell contains: Dimethicone SE-2, macrogol, Sepifilm 3048 Yellow (hypromellose, microcrystalline cellulose, polyoxyl 40 stearate, titanium dioxide, quinoline yellow)
It is an inhibitor of reverse neuronal seizure of mediator monoamines, including norepinephrine, dopamine, serotonin, and others. MAO does not cause inhibition.
Characterized by significant M-anticholinergic (anticholinergic), antihistamine and alpha-adrenolytic activity.
The antidepressant (thymoanaleptic) effect is combined in amitriptyline with a pronounced sedative, hypnotic and anxiolytic (anti-anxiety) effect.
However, amitriptyline is not completely devoid of stimulating, psycho-energizing effects. The stimulating effect is especially pronounced in a certain dose range (for each patient this interval is individual) and is partly associated with an increase in these concentrations of the concentration of the main active metabolite of amitriptyline, nortriptyline, which has a pronounced stimulating and psycho-energizing effect, partly with the antidepressant and stimulating-energizing effect of amitriptyline itself. When the upper limit of this "window" of doses is exceeded, the sedative effect of amitriptyline begins to predominate again, and the visible stimulating (and sometimes antidepressant) effect weakens. At low doses, below some individual "anti-depressive threshold," neither stimulating nor anti-depressive action is practically observed - only non-specific sedative, hypnotic and anti-anxiety.
In terms of sedative, hypnotic, and anti-anxiety effects, amitriptyline in the tricyclic class is inferior only to trimipramine and fluoroacizine, and in terms of the stimulating and psycho-energizing effect, it is inferior to clomipramine, imipramine and tricyclics of the secondary amine subgroup (nortriptyline, desipramine, and anti-anxiety, and tricyclics of the secondary group of amines (nortriptyline, disipramine,), and dipyramine. That is, amitriptyline is closer to the "sedative" end of the tricyclic spectrum, but not at the very end of the spectrum.
Clinical use and indications
Used mainly in endogenous depressions, but also used in the treatment of depression of any other etiology. Especially effective in anxiety-depressive states; reduces anxiety, psychomotor agitation (agitation), internal tension and fear, insomnia and depressive manifestations proper. It is also used for the treatment of phobic disorders, childhood enuresis (with the exception of children with hypotonic bladder), psychogenic anorexia, bulimic neurosis, chronic neurogenic pain syndrome, and also for the prevention of migraine.
Amitriptyline usually does not cause exacerbation of delirium, hallucinations and other productive symptoms, which is possible with the use of antidepressants with a predominantly stimulating effect (imipramine, etc.).
Dosage and administration
Assign inside, intramuscularly or into a vein.
Inside take after meals, ranging from 0.05-0.075 g (50-75 mg) per day. Then the dose is daily increased by 25-50 mg / day (with a predominant increase in the evening dose), until a "working" dose of 150–200–250 (up to 300) mg / day is reached. With poor tolerance to amitriptyline, as well as in elderly or somatically impaired patients, in adolescents and young people, in primary (previously untreated) patients or in relatively mild depression, when there is time to wait for the effect, you can choose a slower rate of dose buildup 25 mg every 2-3 days). Conversely, in severe, suicidally dangerous depressions, in situations requiring the fastest possible antidepressant effect, as well as in patients previously treated with tricyclics and well tolerated in this group of drugs, it is acceptable to give a full therapeutic dose from the first days of therapy (say, 100 mg / day) and more rapid and aggressive build-up to the "working" dose.
The magnitude of the "working" dose, which should be considered when increasing doses, is determined by the severity of the depression and the experience of treating previous depressive phases in this particular patient, as well as the tolerability of the drug to this patient. The average daily dose in the treatment of endogenous depressions is 0.15-0.25 g (150-250 mg), divided into 2-3-4 doses (during the day and before bedtime). Sometimes you can give the entire daily dose at night, before bedtime. In severe depressions, it is permissible to increase the daily dose of amitriptyline to 400-450 mg / day, if tolerance allows, which is more than the prescribed maximum dose of 300 mg / day.
The therapeutic effect of amitriptyline usually occurs in 2-3-4 weeks (sometimes after a week), counting from the moment of reaching the "working" anti-depressive dose (not less than 150 mg / day). A more rapid onset of the antidepressant effect and a stronger effect compared with SSRIs, NRI and other modern, but weaker antidepressants.
In severe depression, you can start with the introduction of the drug intramuscularly or intravenously (injected slowly!) At a dose of 0.02-0.04 g (20-40 mg) 3-4 times a day. Injections are gradually replaced by the intake of the drug.
Elderly patients drug is prescribed in smaller doses; children reduce the dose in accordance with age.
Amitriptyline is relatively widely used in somatic medicine for depressive and neurotic states. Assign inside in relatively small doses (0,0125-0,00625 g = 1 / 2-1 / 4 tablets).
Complications and side effects
Amitriptyline is usually well tolerated (better than irreversible MAO inhibitors, but worse than many other tricyclics and than modern selective anti-depressants), subject to certain precautions, sufficiently smooth dosage increases at the start of therapy and timely prevention or correction of side effects. Due to the presence of sedation does not disrupt sleep, and it is prescribed throughout the day, including at bedtime.
The main side effects are associated with a pronounced anticholinergic effect. Often (especially at the beginning of therapy and with increasing doses) dry mouth, dilated pupils, impaired accommodation of the eyes (blurred and blurred vision near, inability to focus eyes at close range - for example, reading and embroidering), constipation, sometimes severe, up to the development of paresis or complete atony (paralysis) of the intestine, fecal blockages and acute dynamic obstruction of the intestine. At higher doses, there may be difficulty and delay of urination up to complete atony of the bladder. Hand tremor also appears at higher doses and is associated with stimulation of the peripheral beta-adrenergic system (removed by beta-blockers). Also often observed (especially at the beginning of therapy) is a feeling of intoxication (the so-called "anticholinergic intoxication", similar to intoxication from cyclodol or atropine), drowsiness, lethargy, apathy due to excessive sedation, dizziness.
Due to the pronounced alpha-adrenolytic effect of amitriptyline, there are often observed (especially at the beginning of therapy and with a rapid increase in doses) hypotensive action (lowering blood pressure), orthostatic hypotension when getting up to fainting and collaptoid states, tachycardia, weakness.
There may be paresthesia, allergic reactions.
The most formidable complication of amitriptyline therapy is a heart rhythm disorder, in particular a conduction disorder and a prolonged QT interval. The appearance of these cardiac arrhythmias dictates the need for either a dose reduction or very close monitoring of the patient’s condition with frequent ECG.
Also, epileptiform convulsions are sometimes observed (usually at high and very high doses or when intravenous drip is too fast). In patients with epilepsy and other convulsive states or with organic brain damage, a history of cranial injuries, even small doses of amitriptyline can cause convulsions or their equivalents. The appearance of epileptiform convulsions during treatment with amitriptyline dictates the need to reduce the dose of amitriptyline or administer simultaneously anticonvulsants.
It is often observed (especially in patients with concomitant thyroid function deficiency, with bipolar affective disorder, bipolar form of schizoaffective disorder, but it can also be observed in a patient who was assumed to be monopolar depressed before treatment) inversion of the sign of the phase from depression to mania or hypomania, or development mixed "dysphorically irritable state, or an increase and acceleration of the cycle with the formation of the disease with rapid phase change (rapid cycling). At the same time, depending on the clinical situation, it may be necessary to either reduce the dose or even completely abolish amitriptyline and other antidepressants, or the addition of mood stabilizers, thyroid hormones, neuroleptics, or both.
Interaction with other drugs
Incompatible with MAO inhibitors. Potentiates the effect of compounds that depress the central nervous system (including sedatives, hypnotics, alcohol), sympathomimetics, antiparkinsonian drugs, weakens hypotensin and anticonvulsant drugs. Inducers of microsomal oxidation (barbiturates, carbmazepine) are reduced, cimetidine increases plasma concentration.
Amitriptyline is a drug that poses a greater risk of death with a relatively small overdose. Reception of 1000-1500 mg leads to the development of deadly poisoning. At the same time, with the improvement of the patient's condition under the influence of treatment, suicidal ideas often disappear and the mood returns to normal much later than the energy and amount of physical strength increases. As a result, the patient may have more energy and strength to commit suicide against the background of still lingering melancholy and bad mood.
Therefore, patients with severe endogenous depression and high suicidal risk can be treated with amitriptyline only in a psychiatric hospital (preferably with placement in a supervisory ward), or at least provided that it is possible to ensure strict supervision of the patient’s family or relatives for regular medication and the amount remaining drug packaging. Patients should not be prescribed with endogenous depression, just starting outpatient treatment, for one prescription (for one visit to the doctor) quantities of the drug that are more than one to two weeks of therapy.
After the patient's condition improves and the suicidal risk disappears, the severity of supervision can be gradually reduced up to the prescription of one month and even 2-3 months of the drug for one prescription.
Amitriptyline as a drug with pronounced anticholinergic activity is contraindicated in glaucoma, prostatic hypertrophy, and atony of the bladder. It should not be administered simultaneously with monoamine oxidase inhibitors.
How to beat depression
Depression is not just a "blues", it is a serious illness that causes suffering to the person himself, his family and friends. Depression affects millions of people, both HIV-positive and HIV-negative. However, depression is more common in people with HIV. But this is not a reason to endure depression in your life, it can and should be overcome.
What causes depression in people with HIV?
Of course, if a person has HIV, this does not mean that he should suffer from depression. Most people with HIV feel completely normal and not at all depressed. However, depression occurs in one in ten of HIV-positive people, which is much more than the average in the population. At the stage of AIDS, depression is observed in 30% of people. Some even experts believe that the virus itself may contribute to the development of depression. However, it is difficult to separate the very effect of the infection from the way a person treats his diagnosis.
Some opportunistic or other infections, such as chronic hepatitis B or C, can also cause depression. Also, some medications can cause depression in some people. For example, interferon preparations used to treat hepatitis C can cause serious depression.
Substance abuse, such as alcohol and drugs, also leads to depression. Although such substances improve mood when consumed, they gradually destroy the system of natural regulation of emotions in humans. As a result, the brain does not have enough substances to support a normal mood. Unfortunately, it is people who use alcohol and drugs for self-treatment of depression. As a result, a vicious circle is formed and the depression is delayed for many months or even years.
Stress, which is associated with a positive result for HIV and possible problems associated with this, if not the main cause of depression, then the main one. Depression can be caused by various types of stressful events - for example, a diagnosis of HIV infection. However, sometimes a positive event can cause depression if it is associated with strong experiences and changes in lifestyle, for example, marriage or a change of job. Severe life events usually always precede the first bout of depression. In this case, subsequent bouts of depression can occur "easier", even with minor troubles. After the first severe depression, the brain becomes "more sensitive" to various troubles, as a result, for many people, problems and depression become closely related and feed each other. It seems to a person that his condition is caused by a particular difficulty, while the depression itself makes him see everything in a dark light and exaggerate the troubles.
Another cause of depression can be chronic stress - the difficulties that are present in our lives day after day. Depression often occurs if a person experiences a "role conflict" if he does not feel himself to be "himself." For example, if a person hides his HIV status from everyone around him and his family, and this is a cause of frequent anxiety, this can lead to depression. Another example would be a person who is trying to combine the role of a loving mother and an excellent specialist who succeeds in everything.
Scientists have discovered that under chronic stress, the cause of depression is the phenomenon of "acquired helplessness." This means that the person internally accepted the fact that he can not do anything with the daily troubles. With acquired helplessness, a person looks at the world pessimistically and does not believe in his own ability to cope with problems. It is often said that with HIV it is important to control your life and to be active in relation to your own health. Indeed, studies show that people with HIV who take a passive stance in their relationship with their doctor and in general with regard to treatment are more likely to suffer from stress because they do not feel in control of HIV infection.
How does depression appear
There is no special test that would accurately determine the presence of depression. The very word depression has become so popular that people often do not know what it means. "I'm depressed," usually means, "I’ve been in a bad mood lately." However, depression is not just a bad mood or ordinary sadness. This is a mental illness, although very common, depression is even called the "common cold among mental illness."
Like any illness, depression has symptoms, both physical and psychological. However, it is very difficult to diagnose depression yourself - for all people, depression manifests itself in different ways. In addition, depression itself prevents a person from adequately assessing his condition. Therefore, if you think that you may have depression, it is best to directly ask your relatives or friends if they do not notice any changes in your behavior, mood, or physical condition. Indeed, the signs of depression are often easier to notice. For example, a person may not notice that lately he began to quickly and nervously gesticulate.
Depression has two main features - a constant feeling of depression and a loss of interest in the joys of life, indifference to what you used to like. You can talk about depression only when this condition lasts longer than two weeks. In addition, these manifestations should be pronounced - that is, to interfere with working normally and communicating with other people. Usually with depression, these symptoms are combined with at least four of the following:
- A noticeable weight loss (without diet), or a marked increase in body weight.
- Insomnia, or, conversely, drowsiness.
- Accelerated or slow motion.
- Weakness, fatigue.
- Feeling of worthlessness, disproportionate guilt.
- Inability to focus, think clearly, make decisions.
- Thoughts of death, suicide, suicide plan, or suicidal attempt.
If you think you have these symptoms, the best thing is to seek help. On the other hand, people rarely admit that they have depression. Usually they are confident that they adequately assess the situation and everything is "really so bad."
Most people in a state of depression feel depressed, their own worthlessness, emptiness. Some experience constant tearfulness, others, on the contrary, lose the ability to cry, which is restored only after recovery.
Do not think that when people are depressed sad. Many, especially men and young people, feel not grief, but irritability. Some people are depressed and become not dull, but grumbling, irritable, even angry and aggressive.
With depression, people gradually lose their former interests. Often, this reduces sexual desire. The world around as if "loses paint". Many people rely on themselves, they no longer want to communicate with friends, they prefer to go home as soon as possible and not see anyone. People are only offended at questioning about the reasons for such a mood, and even more self-contained.
Often depression is accompanied by physical symptoms. Most people lose their appetite, even at the thought of food it becomes bad. Some, on the contrary, begin to overeat. Insomnia occurs in about 80% of people in depression. A person can hardly fall asleep in the evening, or wake up several times during the night. Especially often there is the so-called "early awakening." You wake up at three o'clock, although you didn’t get enough sleep, but you can’t go back to sleep. Almost all people in a state of depression complain of weakness and loss of working capacity. With depression, the person constantly feels tired. Some people have pains - headaches or stomach pains. Women often have painful and irregular periods. Every second person with depression complains to the doctor about physical ailments, without even mentioning psychological problems.
Depression also changes a person’s thoughts and feelings. In depression, all thoughts and feelings are colored with negative light. You do not see an opportunity to cope with yourself and you are sure that you will never feel good again. The person becomes absent-minded and forgetful. Thoughts are confused, it becomes difficult to make even a simple decision, for example, what kind of shirt to wear today.
In 90% of cases, people with depression experience anxiety and anxiety. Some people constantly expect some kind of trouble. For example, if the phone rings, the person immediately decides that now he will be told something terrible.
Also during depression there is a reduced self-esteem. For example, in depression, a person would rather say that HIV is a "punishment" for his sins and transgressions. When depressed, a person is always dissatisfied with himself For example, if due to depression a person is no longer able to devote as much time to children, he will feel a great sense of guilt that will only worsen the depression.
However, no matter how bleak the life of depression might seem - it is not forever. For most people, depression goes away by itself. However, it is better not to tolerate all these symptoms. Moreover, there are many ways to treat and reduce the symptoms of depression.
Medications are widely used to treat various depressions. In many cases, drugs are not required, but they have helped many people. It is important to remember that self medication is dangerous and ineffective. A psychiatrist or psychotherapist with a higher medical education should pick up the drug and observe its action. In most cases, depression can be treated on an outpatient basis (outside the hospital), but in some cases hospitalization is required. Since not all patients need medications, only a doctor can decide whether you personally need them. The more severe the depression, the greater the likelihood that medications may be needed. Some people start taking medicines only if they have not been helped by other means.
Starting medication for depression is a serious and responsible decision. It is likely that drugs will have to take several months. Like all medicines, they can have unpleasant side effects. In addition, they can not be expected to instant action - in order for them to start helping, it will take at least several weeks. Do not start taking medications without preparing for this, you may have unrealistic expectations regarding their actions, and when they do not materialize, you may leave, perhaps, the treatment you need.
You can assume that taking medications is a manifestation of your weakness. But we repeat that depression is a disease, and taking medicine against a disease is not a sign of weakness. The drugs used in depression, do not cause chemical dependence. These drugs gradually return the brain to normal and lead to the disappearance of depression.
Many people using drugs do not experience any side effects, rarely there are serious side effects that may require discontinuation of the drug. The most common harmless side effects - dry mouth, constipation, dizziness, lethargy, sleep disturbance. Any possible side effects should be discussed in advance with the doctor, so as not to be caught off guard. In addition, most side effects are most pronounced in the first weeks of taking the drug, when the body has not yet adapted to the medication. Before taking the drug, you need to find answers to the following questions:
- What is the name of this medicine?
- What dose do I need?
- What are some side effects?
- How will this medicine help me?
- Are there other drugs with the same effect?
- Will I pay for it and how much will it cost?
- What foods can not be eaten while taking this medication?
- Can I drink alcohol while taking this drug?
- Can I take other medications with this drug?
- If I forget to take the medicine on time, can I then take a double dose?
- How long will I need to take it?
- How realistic is it that the medicine will help me?
- How do I feel it helps me?
- How soon will there be an improvement after starting treatment?
Be sure to take the drug strictly on schedule, trying not to miss. Inform your doctor about any changes in health and side effects, as well as how they affect your life.
An antidepressant is usually prescribed to treat depression. There are different classes of antidepressants, depending on which biochemical process in the brain they affect. Antidepressants change the content of mediators in the brain - chemicals that are responsible for signal transmission between brain cells and regulating emotions. As a result of depression in the brain, an incorrect level of mediators is observed. Antidepressants interfere with this level, normalizing the biochemistry of the brain.
Tricyclic antidepressants are the first antidepressants that have appeared in the world. These include aminotriptyline (Endep, Elavil, Amitid), amoxapine (Azendin), clomipramine (Anafranil), desipramine (Norpramine, Pertofran), doxepin (Adapin, Sinekwan), maprotiline (Lyudomil), Nripriplin-CV-Aventine, Aventine (Adapin, Sinekwan), maprotilin (Lyudomil), Nripripine, Aventine, Adventin, Sinequane, Muprotil, Lymphoramine (Norpramine, Pertofran) (Vivaktil). These antidepressants are often prescribed if a person first takes anti-depression medications. With depression, these drugs help 70-80% of patients. In addition, they are inexpensive and are usually assigned free of charge. It takes a few weeks for them to start helping. Why this process takes so long is still unknown. The main problem with this group of antidepressants is the strong side effects found in most patients. The most common are lethargy and drowsiness. Other possible side effects are dry mouth, constipation, difficulty urinating, visual disturbances, palpitations, dizziness. Other side effects may occur less frequently. True, these effects usually go away or diminish when the body gets used to the drug.
Monoamine oxidase inhibitors (MAO) are also good for treating depression, and for many people much better. However, while taking them you need to avoid many foods, drugs and beverages. Violations of these restrictions can lead to an increase in blood pressure. Often, they help those who are not affected by other drugs, and besides, some people have a hard time complying with food restrictions.
Selective serotonin seizure inhibitors are the latest generation of antidepressants. Many doctors consider them the most effective drugs for treating depression. Although they also have side effects, they are much smaller than those of other groups. The main disadvantage of these drugs is their high price. This group includes fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox) and sertraline (Zoloft). When taking these drugs, improvement usually occurs after 3-5 weeks. However, some people begin to feel better after a few days. The most common side effects of taking them are nervousness, anxiety, insomnia, headaches, nausea, diarrhea. One of the most serious side effects is reduced sexual desire. As the body adapts to the drug, the side effects disappear naturally in most people. If this does not happen, the doctor will reduce the dose, change the drug, or prescribe medications to relieve side effects. However, these drugs are not suitable for everyone.
There are also antidepressants that are not related to any of the groups. The most commonly used are bupropion (Wellbutrin) and trazodone (Desirel).
Medications have helped many people, but they are not needed by everyone, and their effectiveness depends on effective and open relationships with the doctor who prescribed them. However, many people resort to other means of dealing with depression.
Psychotherapy can be a treatment for depression, either alone or in combination with medication. Treatment in this case consists of attending individual or group lessons in which you discuss your experiences, events or difficulties. Psychotherapy can be practiced by psychiatrists, psychotherapists, or clinical psychologists. For psychotherapy, a person must have special education and qualifications.
Finding the right psychotherapist is no easy task. This is more like a choice of life partner, one therapist is good for one person and bad for another. In addition, there are many charlatans in this area who call themselves psychologists but do not have training for psychotherapy. In addition, psychotherapy often costs money, and it is often not cheap. A separate problem may be the attitude of the psychotherapist to HIV. Unfortunately, in our universities, psychologists and psychiatrists do not teach anything about HIV / AIDS, so even a good psychotherapist can turn out to be AIDS-free. In this case, you will have to either part with him, or engage in the upgrading of his skills, and often at his own expense. A partial solution to this problem may be psychotherapists working in AIDS service organizations, or searching for a psychotherapist on the recommendation of other HIV-positive people.
According to studies, psychotherapy helps in the treatment of depression in 50% of patients, regardless of the views and methods of the psychotherapist. At the same time, there are a lot of "teachings" in psychotherapy, and if you decide to seek this type of help, it is better to know what these theories are and which one is better for you.
Cognitive psychotherapy is a method whose goal is to improve a person’s perception of himself and the world around him. After all, depression often forces one to relate to what is happening biased and inadequate. According to cognitive psychotherapists, if you eliminate negative thoughts and learn to think more positively, then depression will disappear. In the classroom, a cognitive therapist will identify your negative thoughts and help assess the real state of things. He will lead you, helping to master new ways of thinking, securing new ways to evaluate events. The psychotherapist will teach you to question the depressing thoughts. For example, he may invite you to jot down these thoughts on paper and bring this leaflet to the classroom in order to critically examine them. A course of cognitive psychotherapy usually lasts 12–16 lessons. In very rare cases, it can last up to 2 years.
Interpersonal psychotherapy - aims to change your relationship, which became the cause of depression. An interpersonal psychotherapist will try to improve your understanding of yourself and your ability to communicate. With the help of special techniques, the therapist will try to identify your problems in relationships with people and will try to improve the corresponding abilities. The course of such psychotherapy can last 12-16 weeks.
Behavioral psychotherapy - helps patients change the actions and actions that exacerbate their depressive experiences. According to these psychotherapists, depression occurs when too much is required of us, and the reward for this is too little. A behavioral therapist usually behaves very actively, this is not the psychotherapist who listens more to the patient than he himself says. He will build a treatment plan with you, and will work according to it. The psychotherapist will select techniques that will help you avoid unwanted behavior and reinforce what is desired.
Psychodynamic psychotherapy (psychoanalysis) is based on the theory that a person’s feelings and behavior are influenced by his past experience, subconscious desires and fears. According to this theory, depression can be cured, if you change the patient's views on yourself, your mind and emotions. Such therapy is often very attractive to people, although it takes much longer. The psychotherapist will use various techniques to identify your repressed conflicts between your unconscious desires and conscious views. Such psychotherapy can take 3-5 years. However, there are also "abbreviated versions" that last up to several months. There is still no objective research on whether such psychotherapy is effective.
Family therapy - should "mobilize" the family members of the patient to support him during the depression. The family is a powerful source of strength for the person, and if the relatives understand what is happening and support it, it can lead to healing. During such psychotherapy, the patient and his relatives meet with the therapist from five to ten times. Often the best treatment option for depression is a combination of medications, personal and family psychotherapy.
Self-help groups are not a psychotherapy method. They do not have a psychologist or psychiatrist, they are present only to people living with HIV. At mutual aid groups, people share experiences, talk about their experiences, and support other people. Contrary to the common myth on mutual aid groups, no one "wears a vest", rather, these are meetings of people who do not want to "cry for life", but decide to change it for the better. Now, in many cities, there are mutual aid groups for people living with HIV. Another option may be support groups that differ from the mutual aid group in that they are led by a specialist who may be HIV-negative. Although depression is not directly related to the self-help group, they allow both to reduce depression and prevent its occurrence. By communicating with people in a similar situation, a person can gain confidence, increase self-esteem, learn to look at their problems more objectively and get important information about living with HIV.
How to help yourself
You can reduce the period of depression due to several rules for your daily life. These recommendations are not a panacea, but they will make the period of depression less painful.
Spare yourself. Depression absorbs your strength and reduces performance. Do not demand too much from yourself. Imagine that your leg hurts or there is another physical disease. When a person is sick, you need to "lower the bar", the same applies to depression. You will return to normal life when the depression has passed. Break big things in a few small stages and do as much as you can. Do not scold yourself if you can not do more. Do not make any important decisions, do not undertake the implementation of complex tasks - if it is possible, put it all off for later.
Avoid stress. This is easier said than done, but you can try. Determine which situations usually cause you stress. Think about how to avoid such situations.
Take a physical activity. Simple exercise can be an excellent remedy for depression. Half an hour of gymnastics at least three times a day is quite enough. Instead of charging, you can use long walks in the near park. Charging will relieve nervous and muscular tension, improve mood. Exercise in the brain stimulates the production of endorphins and enkephalins - these substances are natural antidepressants.
Follow the daily routine. Write a suitable daily routine and strictly follow it. This simple technique helps to significantly reduce the feelings associated with depression. Get up at the same time, eat at certain hours, go to bed early. This will adjust your body clock and reduce depression. But do not overload your routine, do not try to "squeeze everything into it." It is better to include in it entertainments, walks and communication with friends.
Do not drink alcohol and other psychoactive substances. Drugs and alcohol relieve the symptoms of depression for a while, but in general, they only worsen it and delay it, and for a long time.
Pay attention to what you think. When depression, listen to your thoughts. Pay attention to whether you have low self-esteem, do not execute yourself, do not you consider your situation a disaster. Conscious attitude to such thoughts will allow you to objectively look at them and abandon the distorted view of the world.
Do not withdraw into yourself. Many of us have been taught that any manifestation of feelings is a sign of weakness. Forget about it. It is those people who all "keep in themselves" more often and longer suffer from depression. Do not be alone, even if you want it. Communicate with others, spend leisure time together, for example, go to the cinema with someone. Talk about your feelings with someone from your family or friends; if this is not possible, try to find a mutual help group.
Be patient. Depression does not go away right away, overnight. Be patient, and do not expect quick miracles. However, remember that recovery from depression is the rule, not the exception. And if you are depressed, then you are on your way to getting rid of it.