Depression today, how to avoid it
Depression, ICD-10 code F32 is a persistent decrease in the mood background for at least 2 weeks. However, it is always necessary to take into account the presence of existing comorbidities of the person, the medications he or she is taking, and the individual parameters of body formation. Therefore, this period is always conditional. The main criterion of the disease is a decrease in the quality of life. The impact on the external and internal life of the patient. As long as the body and the psyche cope with the condition on their own - the help of specialists is not needed.
How does depression manifest itself?
Often depression goes along with anxiety, sleep disturbance and general weakness. It occurs in response to adverse life circumstances or occurs as a result of a disorder of the brain's biochemistry. There are also some forms of depression that are difficult to recognize. For example, somatized or postpartum depression, they masquerade as other illnesses. These features require careful medical diagnosis and a completely different approach to treatment.
Depression is always associated with a loss of energy. Whether it is the body's struggle with a serious illness, a severe shock, or prolonged difficult life circumstances from which one cannot get out on one's own.
In today's world, depression can be avoided by very few people. Everyone experiences depression to one degree or another. But, does everyone and always need treatment?
How often does depression occur?
Doctors of various specialties often encounter depressive manifestations in their clients. A person's emotions are a very fluid area of the psyche. But at times, a person seems to freeze on one emotional tone and is unable to return to their previous level.
Any statistics on depression will not reflect its true spread, since any illness, in one way or another, upsets us and spoils our mood. This means that neurotic depressive symptoms will be added to the underlying illness. Pain will become more painful, blood pressure will spike more, and the heart will beat more frequently than objective organ changes reflect. All of this adds confusion to the therapeutic diagnosis of illness. Doctors, and the patients themselves, are surprised that the treatment prescribed does not help to the extent it should. And this causes even more anxiety for the sick person.
At the same time, competent psychological help can almost completely relieve the pain syndrome even in patients with advanced cancer or lower blood pressure without resorting to chemical agents. All this indicates a significant influence of the subjective factor of the perception of disease symptoms and reactions to the surrounding reality.
Types of depression
To begin with, we need to sort out whether the depressive symptomatology has reached the level of the disease or it is a manifestation of a secondary depressive syndrome within the underlying condition.
The depressive syndrome has less pronounced manifestations, the cause of these disorders is clearly traceable, the manifestation of symptoms is not stable: short "light" and "dark" periods alternate with each other.
When depression proper, a person feels as a burdensome state of loss of strength, lack of interest in life and has a persistent decrease in mood.
Classification of depression
Perhaps the clearest division of depression into exogenous and endogenous.
Exogenous depression - the cause of formation in external factors.
Endogenous depression - the cause of formation in the metabolic disorders occurring in the body.
This neurotic state against any external cause: a difficult situation in life or an illness. Sometimes it is not possible to track it down, but the patient's explanation that depression decreases when resting, feels better in the morning and the presence of other manifestations of neurosis - testify to its psychogenic nature. One more criterion of exogenous depression is an unstable character of stabilization of the condition from the treatment carried out. As patients themselves say, "it helps with varying success.
Often, the effect of therapy for this disorder depends on subjective factors: disposition to the doctor, pleasant or unpleasant events in life, internal thoughts and the person's own mood. It is necessary to take this phenomenon into account and look for possible causes of an objective nature: hormonal disorders, taking medications that depress the nervous system, long-term infections, etc. If examination by a therapist, narcologist and neurologist reveals no organic pathology, you can safely refuse psychotropic drugs and be treated only with the help of psychotherapy.
Depression in the background of neurasthenia
Chronic fatigue syndrome, or neurasthenia in jargon: a painful psychological condition. It develops in people who are responsible, serious, with high moral requirements to themselves and others. These comrades pull all by themselves "for themselves and for that brother" and in the end exhaust themselves. A characteristic sign of neurasthenia is severe asthenization (weakness), when one no longer has the strength not only to help others, but even to take care of one's basic needs. Such a condition often requires hospitalization, at least in a day hospital, and intensive rehabilitation therapy.
This is a more complex mental illness within the framework of affective disorders. It is caused by a disorder in the production and interaction of neurotransmitters of the central nervous system: serotonin, dopamine, melatonin, GABA and noradrenaline. That's why this form of depression is well treated with drug therapy: antidepressants, neuroleptics, normotimics, anticonvulsants. In this disorder, the changes are so profound that constant chemical adjustments to the unbalanced biochemical system of the brain are required.
The risk of developing endogenous depression depends on the psycho-constitutional type of individuals and is more common in families with a history of the disorder. Although a clear genetic predisposition to the disease is not declared by geneticists, a similar family scenario, the tendency to get stuck in a certain emotional tone and the habit of reacting in a certain way to difficult situations - creates an additional background for the manifestation of the disease.
Of course, like any other mental illness, it can worsen against a background of stress and anxiety, but no direct correlation is found. Its course is more stable, already in the morning the patient gets up in a bad mood, and only by the end of the day does he walk around a little. Exactly the background of the mood suffers: from anger to apathy, without an admixture of other neurotic manifestations. Sometimes it can be accompanied by so-called depressive delirium with ideas of self-blame, sinfulness, committing imaginary mistakes. There can even be hallucinations with voices of accusation and images of disaster, of one's own helplessness and uselessness. Psychosis may also appear in the form of a stupor, i.e. immobility of the patient with no possibility of contact with him. Even in moments of stable remission, such patients appear melancholic and complain about increased fatigability, weakness and inability to rest enough to start doing everything with full force.
Larvied or masked depression gets its name from the fact that it appears covertly. It is sometimes called latent or somatized depression. They differ greatly in their course. These forms of the disease as it hides under the guise of physical illness, and have an atypical form of course. That is why after visiting different outpatient clinic doctors, undergoing a bunch of unnecessary tests and staying at all hospital departments, such patients end up at the psychiatrist's or psychotherapist's office with permanent destructive habits of hiding from vital processes behind the image of a sick person. Such a condition is treated with intensive neurometabolic therapy, good exercise and psychotherapy. Usually, somatized depression affects men or women with a reserved character, who believe that showing weakness and asking for help is above them.
Depression in the context of BAR
Depression often also occurs within the context of bipolar affective disorder (manic-depressive psychosis).
Most often in this disorder, one is admitted to a psychiatric hospital at the time of the manic state, and the depression either goes unnoticed or, with the first implicit depressive episode, goes under a different name. It is only then, when the stages recur, that a fuller and more accurate diagnosis is made.
The manifestation of depression in BAR has its own peculiarities. First, depressive periods here are much longer than manic episodes. Secondly, the decrease in mood after mania is more difficult for the patient, since the decline of energy against the background of the rise subjectively seems more depressing. And, thirdly, it resembles endogenous mania in its characteristics, but it can also have hypomaniacal inclusions:
- increased appetite
- agitation (agitation with elements of anxiety and motor restlessness)
- Inadequate cheerfulness.
Another severe form of manifestation is reactive depression. This is an acute psychotic disorder against the background of the strongest psychotraumatic situation. The person is so shaken by the events that he or she literally disconnects from the world and retreats into himself or herself. Outwardly, he or she may look either extremely excited, or completely keeping to himself or herself, reasonable and even chipper. But this is only apparent calmness. At any minute, such a person can snap and do mischief. Therefore, under difficult circumstances in life is better not to leave the patient, especially if his behavior has changed to the opposite. Talk to him or her in a calm tone, give a herbal sedative. Along with acute depressive phenomena, in this disorder, psychotic phenomena are also observed: psychomotor agitation, fears, there can also be delirium-hallucinatory symptoms.
Depression in schizophrenia
Depression accompanying an exacerbation of the disease requires mandatory hospitalization and rapid administration of medications. Usually such conditions are accompanied by a feeling of universal longing and hopelessness. It can either be a reaction to the illness itself or be included in the general structure of delirium.
The depressive state in schizophrenia reaches its apogee in Kotar syndrome.The patient is in a wistful and anxious mood, claims to be a great criminal and all the troubles in the world are from him. They may believe that they have unusual, incurable illnesses or generally believe that they are "long dead.
This is residual phenomena after relapse of schizophrenia, when there are no acute symptoms, but certain ideas, thinking and mood disorders remain. In spite of the absence of psychosis, due to a strongly reduced mood, such patients may also represent a danger of suicide attempts. For this reason, an appointment with a psychiatrist and, in some cases, hospitalization is necessary.
Depression with organic brain changes
Depression in organic brain diseases: atherosclerosis, dementias, post-traumatic states and other CNS diseases, usually have a persistent and progressive character. Patients are apathetic, sleep a lot, refuse food and any pleasures. They usually do not complain about anything and rarely seek help. Relatives of such patients should be particularly wary if the family member has fallen ill and stopped complaining, because they commit suicide just as quietly and unnoticed. It is better to call such person a psychiatrist at home and he will prescribe medicines stimulating brain processes, to shake up the patient at least a little. If there is no possibility to observe the patient at home, it is better to put him in the hospital for this time.
Depression in alcoholism
Alcoholic depression is often of a mixed nature. There are both peculiarities of the personality, which prevent the person to cope adequately with all the difficulties of life, which creates a certain depressive background and desire to cope with the situation with the help of alcohol, and the toxic effect of alcohol metabolites causes lesion of the cerebral cortex, which is an organic cause of depression of the mental sphere of the patient.
Depression of the addict intensifies with alcohol withdrawal syndrome, has a melancholy and spiteful character, can be accompanied by ideas of accusation and delirium of jealousy.
This topic requires a separate article, and it is on our website. But for a general idea, let's describe the signs of postpartum depression in 2 words.
Physiological and psychological changes in the female body during pregnancy, childbirth and after childbirth are so great that disruption in these areas is justified. Initially available circumstances: unwanted or difficult pregnancy, rupture of relations with the father of the child, lack of help from relatives, existing diseases - are unfavorable factors for the development of depression after childbirth.
Such depression manifests itself in a very unusual way and is often interpreted by the patient herself and her environment as fatigue, bad temper or capriciousness, and is actually a sign of mental illness. For example, a young mother is annoyed with her child or loses interest in him. She may be aggressive toward him or overly concerned about his health. Along with this, there are other signs of illness: asthenia, sleep disturbance, anxiety, perversion of appetite, etc.
Depression, in itself, is a sun-dependent illness. Not without reason, physical therapists treat it with white light. Some experts distinguish seasonal depression as a separate form. In this type of depression, there is a clear cyclicity in the onset of symptoms, depending on the time of year or weather. Neurophysiologists even explain it by the production of serotonin from the amino acid tryptophan at sunny times of the day. During inclement weather and at night, serotonin is converted to methatonin, which causes drowsiness and sedation.
There is virtually no mental or somatic illness that is not accompanied by a depressive syndrome. Another thing is how much it affects a person's general well-being and whether or not there is a danger of aggressive actions toward yourself. If you have stopped coping with your mood or have heard from a loved one thoughts of wanting to leave your life, this is a sufficient sign to run to a psychiatrist.
Symptoms of depression depend largely on the form of the illness in which the depression occurred. The modern classification of diseases does not consider the degrees of severity of depression, but many doctors continue to divide it into different levels of symptom severity. This allows you to accurately assess the condition of the patient and determine the form of treatment for the disease. The mild severity of depressive manifestations allows it to be treated as an outpatient in an outpatient clinic. The average degree of depression requires prescription of antidepressants and many other drugs. And its severe course needs to be treated only in a psychiatric hospital, resorting to injectable forms of drugs and the constant supervision of medical staff.
Despite the variety of symptoms of depression, there are basic criteria that allow to talk about the presence of this mental condition.
- Constant and prolonged decrease in the mood background;
- anxiety, restlessness, irritable weakness;
- narrowing of the sphere of interests and the level of pretensions;
- absence of a sense of satisfaction from habitual activity;
- persistent insomnia, with long periods of falling asleep, early awakening, and daytime sleepiness;
- tearfulness, hypersensitivity and sentimentality;
- a decrease in the body's defenses, literally and figuratively;
- increased fatigue and constant fatigue;
- low self-esteem;
- problems with memory and concentration of attention;
- worsening of chronic diseases, colds and allergic manifestations;
- poor appetite and weight loss;
- pains of a functional nature may occur, which are not confirmed by an objective examination.
Numerous psychological tests popular in the population do not reflect the true picture of depression and the variety of its forms. They play only an auxiliary role in monitoring the dynamics of the illness.
Tests for depression
These are: Beck melancholy scale, visual and drawing tests for depression, SKL-90,DEPS.
So far there are no instrumental or laboratory instrumental parameters to determine a decreased mood background. The attempt to link the blood concentrations of the main neurotransmitters: serotonin and dopamines with the clinical picture of depression has not been successful. The fact is that our brain is well protected from other body systems by the blood-encephalic barrier, where the content of these biologically active substances is quite different than in the blood. And you shouldn't go into your head with crude instruments.
The diagnosis of depression is made exclusively by a psychiatrist at a face-to-face appointment. The doctor relies on his experience and knowledge of the illness, as well as using professional intuition.
For differential diagnosis and to determine the form of depression, the doctor may prescribe consultations with other specialists: a neurologist, a drug addict, an endocrinologist and a therapist. Laboratory tests for signs of chronic inflammation, autoimmune complexes and hormonal background also help rule out the secondary nature of depression. If organic brain pathology is suspected, the neurologist may conduct instrumental diagnostics: EEG, MRI or CT scan.
Help with depression
When the diagnosis is established and the presence of a depressive episode is revealed, the form of assistance to the patient is individually selected. A difficult and interesting stage of therapy begins. It is difficult because it makes no sense to treat the depressive syndrome separately from the main illness. And it is interesting because sometimes the methods of alternative medicine can stabilize the patient's mood no worse than the most modern antidepressants. Depression is a mental condition that responds gratefully to any concern for the person.
This can be explained by the location of the feeling of "grief" on the scale of emotional tones. Below it is "apathy," and above it is the tone of "sympathy. That is, all people who cry need sympathy and empathy. If the person has already fallen into apathy and doesn't care about themselves, then you need to add bodily influence to emotional care. Physical treatments, baths, showers, massage - are able to bring such a patient back to life. And if the patient cried and started complaining about his life, that's already good, because he got some energy and is able to ask for help.
So, if it is psychogenic depression, then it must be treated exclusively with psychotherapy. Taking even the most modern SSRI antidepressants is secondary here and will bring only temporary relief. Symptoms of depression will blunt, but the thoughts that cause them will continue to plague the soul and body. The point is that our brain doesn't care whether the sad and frightening event is happening in reality or the scene is unfolding inside a person's head. In both cases, it reacts equally emotionally. This property of the brain can also be used to work with emotion. If you make it a habit to concentrate on the pleasant and helpful events that happened during the day, you will feel much better over time.
Psychotherapy for depression
Of course, this is more of a short-term therapy, and neurotic depression itself has its roots far beyond our parents' generation and often you can cope with the condition only by working through the existing life scenarios in depth. Look for a psychotherapist who prioritizes inner psychological work on oneself as a treatment for depression. Whether it is cognitive-behavioral therapy, client-centered counseling, or systemic family psychotherapy, it does not matter. The main thing is that the therapist and method are right for you. Gestalt therapy is just as good at working through problems that are stuck on an emotional level. The main thing is to make a step forward and ask for help. "The hen nibbles on the seed" is an important approach in the treatment of depression.
Psychotherapy for endogenous depression is also very important in maintaining a stable mental state for the patient. The person learns to react more calmly to the cyclic nature of mood swings: not to become elated during mania and not to despair at moments of a drop in the emotional background. He begins to understand and accept the peculiarities of his psyche and adjust his life plans with these fluctuations in mind.
Medications for depression
For any type of depression, a psychiatrist or psychotherapist may suggest taking medication. Psychological work on yourself requires strength, and this requires at least some balancing of your emotional state. Especially if it is depression within the framework of endogenous mental illness, or if it is accompanied by general asthenia, fatigue, sleep disorders and unstable mood background.
The powerful and fast-acting medication for depression remains amitriptyline - a tricyclic antidepressant with a strong sedative (sedative) action. It is convenient because it can be administered by injection in the form of droplets and shots.
Other tricyclic antidepressants include imipramine, doxepin, mianserine, trazodone and lofepramine. Usually they are well tolerated, have a pronounced therapeutic effect and doctors have accumulated experience of their use for various mental conditions.
A separate class of tetracyclic antidepressants is distinguished. They are somewhat different in action. For example, Lerivon has a longer duration of action and a good sedative effect.
The second popular group of antidepressants are MAO (monoamine oxidase) inhibitors. This large group of drugs, unfortunately, is less common, due to more pronounced side effects, excretion through the liver is almost 100%, unwanted interactions with other medications and a special diet that excludes the consumption of cheese, liver and alcohol. But as the drugs of choice can be prescribed moclobemide, imipramine - in senile (senile) depression, selegiline - used in Parkinson's disease. They have a good stimulant effect and can activate the elderly patient. Iprazid is a selective representative of this group with a powerful antidepressant effect. But now it is rarely used due to possible unwanted effects and a long stay in the patient's body.
SSRIs for depression
Selective serotonin reuptake inhibitors are the latest generation antidepressants. They have good anti-anxiety properties, stabilize the mood background and almost do not cause drowsiness. Most of the drugs in this group are well tolerated, a wide range of means - you can pick up the drug for each patient: fluoxetine, escitalopram, paroxetine, sertraline and many others. The mechanism of antidepressant action is based on blocking the capture of serotonin in the chain of its transmission from the nerve to the blood. In this way, it is kept in a free form and makes up for the lack of serotonin in the body. Some members of this class have the same effect on dopamine and noradrenaline, which is just as beneficial for maintaining mental balance during stress, when the amount of these mediators rapidly decreases.
Antidepressants are now the most popular medications for a variety of mental and somatic illnesses. They can relieve certain types of pain (for example - migraine).
They are often prescribed for psychosomatic illnesses: hypertension, peptic ulcer disease, irritable bowel syndrome. The treatment of anxiety, anxiety, obsessive-compulsive disorder, anorexia, bulimia and many other diseases is with the addition of an antidepressant to the drug regimen.
Because of this, people taking antidepressants have many questions about their use. Let's try to answer at least some of them.
How to take antidepressants?
Usually antidepressants are prescribed for at least four to six months. There are some acute conditions (e.g., - post-traumatic stress disorder, reactive conditions), when they may be prescribed a shorter course, along with other drugs of longer duration. For some depressions, they may be taken for years or even a lifetime. But this does not mean that a once prescribed treatment does not need to be corrected. If you take an antidepressant for a long time, you should have regular check-ups with your attending psychiatrist, therapist and endocrinologist to evaluate the effect of therapy and prevent side effects of the drug.
Why doesn't an antidepressant work?
Antidepressants are drugs that don't take effect right away. It takes at least 2 to 4 weeks for the drug to work to its full potential. If within 1.5 to 2 months of taking the medication improvement is not observed, then you need to change the therapy. The arsenal of antidepressants is very wide and you can find an approach to almost any patient. Keep in touch with your psychiatrist and tell him how you are feeling. Then the treatment will be more successful.
Antidepressant prescription, can't take it well
An antidepressant, like any medication, changes your body chemistry. Therefore, the body needs time to get used to the drug. Usually these phenomena go away by the end of 2-3 weeks of taking it. If after this time you continue to feel bad - see a psychiatrist in person.
While taking an antidepressant, anxiety has increased, and sleep has become disturbed
An antidepressant is a drug that stimulates the central nervous system. Therefore, this effect may well be. If these phenomena are strongly pronounced, you need to take the drug under the cover of another group of drugs for the first time of admission. Most antidepressants are taken in the morning and afternoon hours. Taking them in the evening and at night may cause anxiety and insomnia. Follow your doctor's strict recommendations.
In addition, some patients are shown antidepressants with a pronounced sedative effect. Such drugs, on the contrary, are taken half an hour before sleep and contribute to soothing and falling asleep.
Can I take two antidepressants at the same time?
Yes, sometimes doctors prescribe two antidepressants from different groups to create a combined effect. In this case, the doctor will monitor your condition more closely and observe possible side effects, while at the same time, you cannot combine antidepressants from the MAO inhibitor group.
How to avoid withdrawal symptoms?
Antidepressants from any chemical group do not have withdrawal symptoms. They are not drugs, sleeping pills, or tranquilizers, which can cause withdrawal if taken uncontrollably. Antidepressant can be withdrawn immediately, but it is better to do it gradually, so as not to provoke the return of previous symptoms. Withdraw from antidepressant drugs according to the scheme proposed by the attending psychiatrist. And only upon the doctor's recommendation.
Getting tested by a narcologist. Will the antidepressant I am taking be detected? How long must it take for my body to clear the antidepressant?
Usually narcologists will determine the presence of alcohol, essential drugs and sleeping pills in the body. But in some cases, other groups of drugs may also be tested. Also, the drug may give a false positive on rapid tests. That's why you need to tell your narcology doctor that you are taking medication. And it is better to bring prescriptions from your doctor or an extract from your outpatient records. Then you will have no problems at the narcologist's office.
Medications from a variety of psychopharmacotherapy groups may be used to treat depressive disorders. For example, normotimics are used to treat bipolar affective disorder, doctors often prescribe anticonvulsants for alcoholic depression, and nootropics may be added to therapy for organic and senile depression. In addition, nervous system recovery often requires the use of B vitamins, essential amino acids and anti-anxiety drugs. It all depends on the type of depression and related conditions.
Depression is amenable to many types of therapy. Reflexology neurologists widely use acupuncture and other types of acupuncture to treat this type of disorder. But you need to be patient for a full course of treatments and keep your reflexologist informed of your current well-being.
However, acupuncture has many contraindications for depression, so in order not to harm yourself, it is necessary to get approval for the use of acupuncture for depression from the attending psychiatrist. Otherwise, either complications may arise or depression will worsen.
Physical therapy for depression
Color therapy is most suitable for depressed patients. Everyone is familiar with the Lüscher Relevance Emotion Test. So, this procedure is able, using the colors of certain tones, to change the feeling state of a person.
Light therapy - white light around: walls, linen, tiles are able to actively reflect ultraviolet and infrared rays of the sun. The patient is placed in such a room and spends some time there. This may be accompanied by aromatherapy with brain-activating smells and music therapy. The effect of this procedure is noticeable immediately - a smile on the face and a light head.
Since ancient times in Russia, melancholy was banished by brooms in the steam room and diving into the ice-hole. Therapeutic baths, showers and saunas help a person regain a taste of life.
Depending on the condition, an experienced rehabilitation therapist works on the reflex zones with different intensity. A course of massage pumps up the blood, stimulates the brain indirectly through the active areas of the body and restores the body to its former tone and firmness.
What disorders go hand in hand with depression
It is not uncommon for depression to accompany other mental disorders. In these cases, depression is seen as a symptom. In order to make therapy meaningful, we conduct differential diagnostics, not infrequently using a medical consilium.
- Bipolar disorder. Includes sudden, often unexpected mood swings. Mania (agitation) alternates with depression and vice versa. It is not uncommon to require special diagnostics to distinguish it from one of the variants of the course of usual depression.
- Cyclothymia. Symptomatology is similar to bipolar disorder, but is much milder.
- Destructive disorder. Mostly children are affected. It is not registered in the adult state. It occurs chronically in the form of outbursts of severe irritability, anger, often unreasonable. Such outbursts are followed by a period of depression. At a later age, usually in the pubertal period, very often develops into depression or anxiety disorders.
- Dysthymia. A persistent depressive disorder, runs mild but has a chronic form. It does not lead to disability, but can strongly reduce quality of life.
- Premenstrual dysphoric disorder. It occurs with symptoms of depression, which is associated with the hormonal background. Usually manifests itself 5-7 days before menstruation and ends within a few days. On other days, the symptoms disappear completely or are not significant.
- Other disorders. Almost any disorder runs with symptoms of depression. In such cases, it goes away after recovery. However, any illness can provoke the formation of any kind of depression. Therefore, remember that it is better to prevent the formation of depression in time than to treat it later.
With depression, the hardest thing to do the first step. But to get out of the maelstrom of apathy need to grasp at straws. Tell loved ones about your condition and ask them to accompany you to the doctor. This is where your journey back to an active life begins.