If you are depressed: what to do and who to contact

Medical information is reliable Checked by Shaidullin Renat Flyurovich

Depression is a disease of our time, as the disorder is called at the everyday level. Every day the number of recorded cases is growing; according to statistics, about 20% of the population of countries with a good standard of living suffers from it. The disease is serious; when the first signs appear, you should contact a specialist. Treatment of depression will help you return to normal life, get rid of apathy and bad mood, and increase your ability to work.

The difficulty of therapy is that patients are very little aware of the causes of the disorder and its consequences. Prolonged mental and physical illness is often mistaken for bad character, whims, and constant dissatisfaction, so they do not pay attention to it. The condition does not go away on its own; you need the help of a specialist. At Dr. Isaev’s Clinic, the patient is not only prescribed a therapeutic course, but also relapse prevention is carried out, information is provided about the preconditions for the disorder and ways to avoid them.

Depression today, how to avoid it

Depression, ICD-10 code F32 – persistent decrease in mood for at least 2 weeks. However, it is always necessary to take into account the presence of existing concomitant diseases of a person, the medications he is taking, and the individual parameters of the formation of the body. Therefore, this period is always conditional. The main criterion of the disease is a decrease in quality of life. Influence on the external and internal life of the patient. As long as the body and psyche cope with the condition on their own, the help of specialists is not needed.

Treatment of depression - modern methods of restorative medicine 8.

How does depression manifest itself?

Depression often goes hand in hand with anxiety, sleep disturbances and general weakness. It occurs in response to unfavorable life circumstances or manifests itself as a result of a violation of brain biochemistry. There are also certain forms of depression that can be difficult to recognize. For example, somatization or postpartum depression, they are disguised as other diseases. These features require careful medical diagnosis and a completely different approach to treatment.

Depression is always associated with loss of energy. Be it the body’s struggle with a serious illness, a severe shock, or long-term difficult life circumstances from which a person cannot get out on his own.

In today's world, only a few manage to avoid depression. Depression affects everyone to one degree or another. But does everyone always need treatment?

How common is depression?

Doctors of various specialties often encounter depressive symptoms in their clients. Human emotions are a very mobile area of ​​the psyche. But at times a person seems to be frozen on one emotional tone and is unable to return to his previous level.

Any statistics on depression will not reflect its true prevalence, since any disease, one way or another, upsets us and spoils our mood. This means that neurotic depressive symptoms will be added to the main disease. The pain will become more painful, the pressure will jump more strongly, and the heart will beat faster than this is reflected by objective changes in the organs. All this brings confusion to the therapeutic diagnosis of diseases. Doctors, and even patients themselves, are surprised that the prescribed treatment does not help as much as it should. And this will cause even more anxiety for the sick person.

At the same time, competent psychological assistance can almost completely relieve pain even in patients with advanced cancer or lower blood pressure without resorting to chemicals. All this indicates the significant influence of the subjective factor of perception of the symptoms of the disease and reaction to the surrounding reality.

Types of depression

First, you need to figure out whether depressive symptoms have reached the level of a disease or whether this is a manifestation of a secondary depressive syndrome within the framework of the underlying condition.

Depressive syndrome has less pronounced manifestations, the cause of these disorders is clearly visible, the manifestation of symptoms is not stable: short “light” and “dark” periods replace each other.

When depression itself is felt by a person as a painful state of loss of strength, lack of interest in life and has a persistent decrease in mood.

Disease statistics

Depression is the most common mental disorder in the world. According to statistics, 280 million people experience depression, which is as much as 4 percent of the total world population. In our country, according to the Ministry of Health, every tenth person suffers from depression. This is about 15 million people of different ages and genders. Experts say that the female half of humanity is most susceptible to the development of mental disorders of a depressive nature.

Classification of depression

Perhaps the clearest division of depression into exogenous and endogenous.

Exogenous depression is caused by external factors.

Endogenous depression is the cause of the formation of metabolic disorders occurring in the body.

Exogenous depression

This is a neurotic state against the background of some external cause: a difficult life situation or illness. It happens that it is not possible to track it, but the patient’s explanation that depression decreases on vacation, it is easier in the morning, and the presence of other manifestations of neurosis speak for its psychogenic nature. Another criterion for exogenous depression is the unstable nature of stabilization of the condition from the treatment. As the patients themselves say: “it helps with varying degrees of 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 mood of the person himself. It is necessary to take this phenomenon into account and look for possible objective causes: hormonal disorders, taking medications that depress the nervous system, long-term infections, etc. If an examination by a therapist, narcologist and neurologist does not determine organic pathology, then you can safely refuse psychotropic drugs and be treated only with the help of psychotherapy.

Depression due to neurasthenia

Chronic fatigue syndrome or scientifically called neurasthenia: a painful psychological condition. It develops in people who are responsible, serious, and have high moral demands on themselves and others. These comrades pull everything alone “for themselves and for that brother” and eventually run out of steam. A characteristic sign of neurasthenia is severe asthenia (weakness), when there is no longer enough strength not only to help others, but even to take care of one’s basic needs. Often this condition requires hospitalization, at least in a day hospital, and intensive rehabilitation therapy.

Endogenous depression

This is a more complex mental illness within the framework of affective disorders. The reason is a disruption in the production and interaction of neurotransmitters of the central nervous system: serotonin, dopamine, melatonin, GABA and norepinephrine. That is why this form of depression is well treated with drug therapy: antidepressants, antipsychotics, mood stabilizers, anticonvulsants. In this disorder, the changes are so profound that constant chemical adjustments to the brain's imbalanced biochemical system are required.

The risk of developing endogenous depression depends on the psycho-constitutional type of people and is more common in families where there have already been cases of the disease. Although geneticists have not stated a clear genetic predisposition to the disease, a similar family scenario, a tendency to get stuck on 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 due to stress and anxiety, but no direct relationship is found. The flow is more stable; already in the morning the patient gets up in a bad mood and only at the end of the day he walks around a little. It is the background of the mood that suffers: from anger to apathy, without admixture of other neurotic manifestations. Sometimes this may be accompanied by so-called depressive delusions with ideas of self-blame, sinfulness, and making imaginary mistakes. There may even be hallucinations with voices of accusation and images of disaster, one's own helplessness and uselessness. Psychosis can also manifest itself in the form of stupor - immobility of the patient with no possibility of contact with him. Even in moments of stable remission, such patients look melancholic, complain of increased fatigue, weakness and the inability to rest enough to start doing everything with full strength.

Larval depression

Larval or masked depression got its name due to the fact that it manifests itself hidden. It is sometimes called hidden or somatized depression. They are very different in flow. Such forms of the disease seem to be hidden under the masks of physical diseases, and have an atypical form of progression. Therefore, after visiting different doctors at the clinic, undergoing a bunch of unnecessary tests and lying in all departments of the hospital, such patients end up in the office of a psychiatrist or psychotherapist with already persistent destructive habits of hiding from life’s crossroads behind the image of a sick person. This condition is treated with intensive neurometabolic therapy, good physical activity and psychotherapy. Typically, somatized depression affects men or women with a reserved character who believe that showing weakness and asking for help is beyond them.

Depression in the context of bipolar disorder

Depression often manifests itself as part of bipolar affective disorder (manic-depressive psychosis).

Most often, with this disorder, people end up in a psychiatric hospital at the time of a manic state, and depression either goes unnoticed or, with the first subtle depressive episode, goes under a different name. And only then, when the stages are repeated, a full and more accurate diagnosis is made.

The manifestation of depression in bipolar disorder has its own characteristics. Firstly, depressive periods here are much longer than manic episodes. Secondly, a decrease in mood after mania is more difficult for patients, because the decline of strength against the backdrop of recovery subjectively seems more depressing. And, thirdly, in its characteristics it resembles endogenous, but it can also have hypomanic inclusions: increased appetite, agitation (excitement with elements of anxiety and motor restlessness) and inadequate fun.

Reactive depression

Another severe form of manifestation is reactive depression. This is an acute psychotic disorder against the backdrop of a severely traumatic situation. A person is so shocked by the events that have happened that he literally disconnects from the world and withdraws into himself. Outwardly, he may look either extremely excited, or completely in control, reasonable and even cheerful. But this is only apparent calm. At any moment such a person can break loose and cause trouble. Therefore, in difficult life circumstances, it is better not to leave the patient, especially if his behavior has changed to the opposite. You need to talk to him in a calm tone and give him a herbal sedative. Along with acute depressive symptoms, with this disorder, symptoms of psychosis are also observed: psychomotor agitation, fears, and possibly delusional-hallucinatory symptoms.

Depression in schizophrenia

Depression that accompanies an exacerbation of the disease requires mandatory hospitalization and rapid administration of medications. Usually such states are accompanied by a feeling of universal melancholy and hopelessness. This can be either a reaction to the disease itself or be included in the general structure of delusional ideas.

The depressive state in schizophrenia reaches its apogee with Cotard's syndrome. The patient is in a sad and anxious mood, claims that he is a great criminal and all the troubles in the world are from him. They may believe that they have unusual incurable diseases or even believe that they are “long dead.”

Postschizophrenic depression

These are residual effects after a relapse of schizophrenia, when there are no acute symptoms, but individual ideas, disturbances in thinking and mood remain. Despite the absence of psychosis, due to their greatly reduced mood, such patients can also pose a danger in captivity of suicidal attempts. Therefore, a visit to a psychiatrist and, in some cases, hospitalization are necessary.

Depression due to organic changes in the brain

Depression in organic diseases of the brain: atherosclerosis, dementia, post-traumatic conditions and other diseases of the central nervous system is usually persistent and progressive. Patients are apathetic, sleep a lot, refuse food and any pleasures. They usually don’t complain about anything and rarely ask for help. Relatives of such patients should be especially wary if a family member becomes ill and stops complaining, since they commit suicide just as quietly and unnoticed. It is better to call such a person a psychiatrist at home, and he will prescribe medications that stimulate brain processes in order to at least stir the patient up a little. If it is not possible to observe the patient at home, then it is better to place him in a hospital for this time.

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Depression in alcoholism

Alcoholic depression often has a mixed character. There are both personality traits that prevent a person from adequately coping with all life’s difficulties, which creates a certain depressive background and the desire to cope with the situation with the help of alcohol, and the toxic effect of alcohol metabolites causes damage to the cerebral cortex, which is an organic cause of depression in the patient’s mental sphere.

The addict's depression intensifies during alcohol withdrawal syndrome, has a sad and angry character, and can be accompanied by ideas of accusation and delusions of jealousy.

Postpartum depression

This topic requires writing a separate article, and it is on our website. But for a general idea, we will describe the signs of postpartum depression in 2 words.

The physiological and psychological changes in the female body during pregnancy, childbirth and after the birth of a child are so great that failure in these areas is completely justified. Initially existing circumstances: an unwanted or difficult pregnancy, a breakdown in relations with the child’s father, lack of help from loved ones, existing illnesses are unfavorable factors for the development of a depressive state after childbirth.

Such depression manifests itself in a very unusual way and is often interpreted by the patient herself and those around her as fatigue, bad character or moodiness and is in fact a sign of a mental disorder. So, a young mother is annoyed by her child or she loses interest in him. She may be aggressive towards him or overly concerned about his health. Along with this, there are other signs of illness on the face: asthenia, sleep disturbance, anxiety, perversion of appetite, etc.

Seasonal depression

Depression, in itself, is a sun-related disease. No wonder physiotherapists treat her with white light. Some experts distinguish seasonal depression as a separate form. With this type of depression, there is a clear cyclical pattern of symptoms depending on the time of year or weather. Neurophysiologists even explain this by the production of serotonin from the amino acid tryptophan in the sun. In bad weather and at night, serotonin turns into metatonin, which causes drowsiness and calm.

There is practically no mental or physical illness that is not accompanied by depressive syndrome. Another thing is how much this affects a person’s general well-being and whether there is a danger of aggressive actions towards oneself. If you can no longer cope with your mood or have heard from a loved one thoughts about wanting to die, this is a sufficient sign to run to a psychiatrist.

Depression in men

Constitutional differences between the male and female body lead to the fact that mental disorders have different manifestations. This condition in a man is often unnoticeable to those around him; the patient tries to appear joyful and cheerful, telling everyone about the absence of problems.

The depressive triad, characteristic of men, is expressed as follows:

• anhedonia – the ability to experience pleasure and joy is reduced or absent;
• changes in thinking processes - new, sometimes absurd, judgments arise, negativism and pessimism predominate;
• motor retardation, slowness.

One of the reasons for the development of the disease in the stronger sex is erectile dysfunction. Decreased libido, lack of attraction to the opposite sex, fear of being ridiculed by a partner causes a feeling of slight dissatisfaction with oneself, and then turns into a severe form, accompanied by a feeling of one’s own helplessness and insignificance, the man does not feel strong and self-confident.

Signs

Symptoms of depression largely depend on the form of the disease in which depression occurs. The modern classification of diseases does not consider the severity of depression, but many doctors continue to divide it into different levels of symptom severity. This allows you to accurately assess the patient’s condition and determine the form of treatment for the disease. The insignificant severity of depressive symptoms allows it to be treated on an outpatient basis, in a clinic. Moderate depression requires the use of antidepressants and many other medications. And its severe course must be treated only in a psychiatric hospital, resorting to injectable forms of medications and constant supervision of medical personnel.

Despite the variety of symptoms of depression, there are basic criteria that allow us to talk about the presence of this mental condition.

• constant and long-term decrease in mood;
• anxiety, restlessness, irritable weakness;
• narrowing the range of interests and level of aspirations;
• lack of feeling of satisfaction from usual activities;
• persistent insomnia, with a long time to fall asleep, early awakening and daytime sleepiness;
• tearfulness, increased sensitivity and sentimentality;
• reduction of the body's defenses, literally and figuratively;
• increased fatigue and constant fatigue;
• decreased self-esteem;
• problems with memory and concentration;
• Chronic diseases may worsen, colds and allergic manifestations may be tormented;
• poor appetite and weight loss;
• There are pains of a functional nature that are not confirmed by an objective examination.

Diagnostics

Numerous psychological tests popular among the population do not reflect the true picture of depression and the variety of its forms. They play only a supporting role in tracking the dynamics of the disease.

Tests for depression

These are: Beck Melancholy Scale, visual and drawing tests for depression, SKL-90, DEPS.

There are no instrumental or laboratory instrumental parameters yet to determine the reduced background mood. An attempt to link the blood concentrations of the main neurotransmitters: serotonin and dopamine with the clinical picture of depression was unsuccessful. The fact is that our brain is well protected from other body systems by the blood-brain barrier, where the content of these biologically active substances is completely different than in the blood. But it’s not worth getting into your head with rough tools.

The diagnosis of depression is made exclusively by a psychiatrist during a face-to-face appointment. The doctor relies on his experience and knowledge of the disease, and also uses professional intuition.

For differential diagnosis and determination of the form of depression, the doctor may prescribe consultations with other specialists: a neurologist, narcologist, endocrinologist and therapist. Laboratory tests for signs of chronic inflammation, autoimmune complexes and hormonal levels also help to exclude the secondary nature of depression. If an organic pathology of the brain is suspected, a neurologist can conduct instrumental diagnostics: EEG, MRI or CT.

Help for depression

When the diagnosis is established and the presence of a depressive episode is identified, the form of assistance to the patient is individually selected. A complex and interesting stage of therapy begins. It is complicated because it makes no sense to treat depressive syndrome separately from the underlying disease. And it’s interesting because sometimes alternative medicine methods can stabilize a patient’s mood no worse than the most modern antidepressants. Depression is a mental state that responds gratefully to any concern for a person.

This can be explained by the location of the feeling of “grief” on the emotional tone scale. Below it is “apathy”, and above it is the tone of “sympathy”. Those. all crying people need sympathy and empathy. If a person has already fallen into apathy and does not care about himself, then physical influence must be added to emotional care. Physiotherapy, baths, showers, massages can bring such a patient back to life. And if the patient cried and began to complain about his life, then this is already good, because... he has gained some energy and is able to ask for help.

So, if this is psychogenic depression, then it should be treated exclusively with psychotherapy. Taking even the most modern SSRI antidepressants is secondary here and will only bring temporary relief. Symptoms of depression will dull, but the thoughts that cause them will continue to rattle your soul and body. The fact is that our brain doesn’t care whether a scary and sad event is happening in reality or the scene is unfolding inside a person’s head. In both cases, he will react equally emotionally. This property can also be used to work with emotions. If you make it a habit to focus on the pleasant and useful events that happened during the day, then over time it will become much easier for you.

Psychotherapy for depression

Of course, this is more of an emergency therapy, and neurotic depression itself has its roots far back in the generation of our parents, and often the condition can only be dealt with through an in-depth study of existing life scenarios. Look for a psychotherapist who puts internal psychological work on yourself at the forefront of treating depression. Whether it is cognitive behavioral therapy, client-centered counseling or systemic family psychotherapy does not matter. The main thing is that the specialist and the method suited you. Gestalt therapy is also good at working through problems that are stuck on the emotional level. The main thing is to take a step forward and ask for help. “The hen pecks at the grain” is an important approach in the treatment of depression.

Psychotherapy for endogenous depression also plays a very important role in maintaining a stable mental state of the patient. A person learns to react more calmly to the cyclical nature of mood swings: not to be deluded during manias and not to despair when the emotional background drops. He begins to understand and accept the peculiarities of the structure of his psyche and adjust his life plans taking into account these fluctuations.

Medicines for depression

For any type of depression, a psychiatrist or psychotherapist may suggest taking medications. Psychological work on yourself requires strength, and for this you need to at least slightly balance your emotional state. Especially if it is depression as part of endogenous mental illnesses or it is accompanied by general asthenia, fatigue, sleep disturbance and mood instability.

Antidepressants

Amitriptyline, a tricyclic antidepressant with a pronounced sedative (calming) effect, remains a powerful and fast-acting drug for depression. It is convenient in that it can also be used by injection in the form of droppers and injections.

Also included in the group of tricyclic antidepressants are imipramine, doxepin, mianserin, trazodone and lofepramine. They are usually well tolerated, have a pronounced therapeutic effect, and doctors have accumulated experience in their use for various mental conditions.

There is a separate class of tetracyclic antidepressants. They differ somewhat in action. Thus, lerivon has a longer duration of action and a good hypnotic effect.

The second popular group of antidepressants are MAO inhibitors (monoamine oxidase). This large group of drugs, unfortunately, has become less widespread due to more pronounced side effects, elimination through the liver in almost 100% form, unwanted interactions with other medications and a special diet that excludes the consumption of cheese, liver and alcohol. But moclobemide can be prescribed as the medicine of choice, imipramine can be prescribed for senile (senile) depression, selegiline is used for Parkinson’s disease. They have a good stimulating effect and can activate an elderly patient. Iprazide is a selective representative of this group with a powerful antidepressant effect. But now it is rarely used due to possible undesirable effects and long-term presence in the patient’s body.

SSRIs for depression

Selective serotonin reuptake inhibitors are the latest generation antidepressants. They have good anti-anxiety properties, stabilize mood and almost do not cause drowsiness. Most drugs in this group are well tolerated, there is a large selection of drugs - you can choose a drug for each patient: fluoxetine, escitalopram, paroxetine, sertraline and many others. The mechanism of antidepressant action is based on blocking the uptake of serotonin in the chain of transmission from the nerve to the blood. Thus, it is preserved in a free form and replenishes the deficiency of serotonin in the body. Some representatives of this class have the same effect in relation to dopamine and norepinephrine, which also has a beneficial effect on maintaining mental balance under stress, when the amount of these mediators rapidly decreases.

Antidepressants are now the most popular medications for a wide variety of mental and physical illnesses. They are able to relieve certain types of pain (for example, migraine). They are often prescribed for psychosomatic diseases: hypertension, gastric ulcer, irritable bowel syndrome. Treatment of fears, anxiety, obsessive-compulsive disorder, anorexia/bulimia and many other diseases occurs with the addition of an antidepressant to the drug regimen.

In view of this, people taking antidepressants have many questions about their use. Let's try to answer at least some of them.

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How to take antidepressants

Typically, antidepressants are prescribed for at least 4-6 months. There are some acute conditions (for example, post-traumatic stress disorder, reactive states) when they can be prescribed in a shorter course, along with other longer-term medications. For some depressions, they can be taken for years or even a lifetime. But this does not mean that once prescribed treatment does not require correction. If you take an antidepressant for a long time, you need to undergo regular examinations with your treating psychiatrist, therapist and endocrinologist to assess the effect of therapy and prevent side effects of the drug.

Why antidepressants don't help

Antidepressants are medications that do not work immediately. It takes at least 2-4 weeks for the drug to reach its full potential. If there is no improvement in the condition within 1.5 - 2 months of taking the medication, then you need to change the tactics of therapy. The arsenal of antidepressant drugs is very wide and you can find an approach to almost any patient. Keep in touch with your psychiatrist and let him know how you are feeling. Then the treatment will be more successful.

They prescribed me an antidepressant, I can’t tolerate it well

An antidepressant, like any other medicine, changes the chemical structure of your body. Therefore, the body needs time to get used to the drug. Usually these phenomena disappear by the end of 2-3 weeks of use. If after this time you continue to feel unwell, contact a psychiatrist in person.

While taking an antidepressant, anxiety increased and sleep was disturbed

An antidepressant is a drug with a stimulating effect on the central nervous system. Therefore, such an effect may well exist. If these phenomena are very pronounced, then you need to take the medicine under the cover of another group of drugs for the first time. Most antidepressants are taken in the morning and afternoon. Evening and nighttime intake may cause anxiety and insomnia. Follow your doctor's recommendations strictly.

In addition, some patients are prescribed antidepressants with a pronounced calming effect. Such drugs, on the contrary, are taken half an hour before bedtime and promote calm and sleep.

Is it possible to take 2 antidepressants at the same time?

Yes, sometimes doctors prescribe two antidepressants from different groups at once to create a combined effect. In this case, the doctor monitors your condition more clearly and the possible occurrence of side effects; at the same time, you cannot combine antidepressants from the group of MAO inhibitors.

How to Avoid Withdrawal Syndrome

Antidepressants from any chemical group do not have withdrawal symptoms. These are not drugs, sleeping pills or tranquilizers, the uncontrolled use of which can cause such a phenomenon. The antidepressant can be discontinued immediately, but it is better to do this gradually so as not to provoke a return of the previous symptoms. They go off the antidepressant according to the regimen suggested by the treating psychiatrist. And only on the recommendation of a doctor.

I'm getting tested by a narcologist. Will the antidepressant I am taking be detected? How long does it take for the body to clear the antidepressant?

Typically, narcologists determine the presence of alcohol, major drugs and sleeping pills in the body. But in some cases, testing for other groups of drugs can be carried out. The medicine may also give a false positive reaction to rapid tests. Therefore, you need to warn your narcologist that you are taking medications. And it’s better to bring prescriptions from a doctor or an extract from an outpatient card. Then there will be no problems at the appointment with the narcologist.

Russian Academy of Medical Sciences RESEARCH CENTER FOR MENTAL HEALTH DEPRESSION (from hope to confidence). (INFORMATION FOR PATIENTS AND THEIR FAMILIES)

MOSCOW 2008

Oleychik I.V. — Candidate of Medical Sciences, Leading Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States © 2008, Oleychik I.V. © 2008, NCPZ RAMS The vast experience accumulated by humanity and reflected in many literary works convincingly shows that sadness (sadness, blues) has always walked side by side with people, being one of the natural human emotions. None of us are immune from failure, illness, breakup, loss of loved ones, or financial collapse. Every person can face something inevitable and inevitable, when it seems that life loses its meaning and despair becomes limitless. However, normally, sadness, melancholy and melancholy, as natural reactions to events traumatic to the psyche, weaken over time and the person’s condition normalizes without special treatment. The situation is different with depression, which is a mental disorder that differs from natural physiological reactions in its greater intensity, special severity of experiences and persistence of manifestations. True depression rarely goes away on its own, requiring persistent, sometimes long-term treatment. Depressive state (from the Latin word depressio - suppression, oppression) is a disease that concerns not only the individual specific sick person, but is also a significant burden of modern society, since it is spreading more and more widely in the world, causing enormous damage to the health of the population and the state. economy. Moreover, this applies to all countries, regardless of their level of social development. Every year, at least 200 million people worldwide suffer from depression. It is possible that these rates are even higher because most victims of depression do not seek help because they do not realize the severity of their condition. Scientists have calculated that almost every fifth person who has reached adulthood experiences at least one episode of depression during their lifetime. In the most general sense, a depressive state is one of the possible forms of a person’s response to the influence of stress factors. In some cases, depression can be triggered by external negative influences, for example, mental trauma, excessive educational or work overload, infection or other serious somatic illness, traumatic brain injury, changes in hormonal levels, which is especially important for the female body, regular taking certain medications, such as hormones, blood pressure lowering drugs, or abusing alcohol or other drugs. In other cases, depressive states develop as a manifestation of mental illnesses in which the main influence is heredity or characteristics of the nervous system (cyclothymia, dysthymia, manic-depressive psychosis, schizophrenia, etc.). If, based on the description of depressive symptoms contained later in our brochure, you realize that you have indeed developed a depressive state, do not fall into despair, do not “try to pull yourself together”, remember that depression is not a manifestation of weakness of will or character, on the contrary, weakening of volitional qualities is one of the main symptoms of depression. Depression is the same disease as rheumatism, arthritis or hypertension; it responds well to treatment, resulting in complete recovery almost always. You should not blame yourself for the occurrence of depression; it does not indicate either your guilt, or your weakness, or the possible development of a more severe mental pathology. Below we will tell you about the symptoms of depression, which can be extremely varied.

Manifestations of depression

Manifestations of depression can be very different. Depressive states can manifest themselves as disturbances in almost all aspects of mental life: mood, memory, will, activity, which is expressed in the appearance of sadness, sadness, mental and muscular retardation, lasting at least 2 weeks. A depressed mood during depression can manifest itself as mild sadness, melancholy, or boundless despair. It is often accompanied by a feeling of melancholy, unbearable heaviness in the soul, with excruciating pain in the chest, a feeling of hopelessness, deep depression, hopelessness, helplessness, despair and uncertainty. At the same time, the patient is completely immersed in his gloomy experiences, and external events, even the most joyful ones, do not affect him, do not affect his mood, and sometimes even worsen the latter. A constant “companion” of a depressive mood is also anxiety of varying severity: from mild anxiety or tension to frantic excitement and violence. Anxiety and bad mood arise at the mere thought of having to make a decision or change your plans due to suddenly changed circumstances. Anxiety can also manifest itself at the physical (bodily) level in the form of belching, intestinal spasms, loose stools, frequent urination, shortness of breath, palpitations, headaches, increased sweating, etc. The picture of depression is complemented by the disappearance of desires, interests, pessimistic high assessment of everything around him, ideas of his own low value and self-blame. A deficiency of vital impulses manifests itself in patients with a variety of symptoms - from lethargy, physical weakness to a state of weakness, loss of energy and complete impotence. Where an important decision is required, a choice between various options, human activity is greatly hampered. Those suffering from depression are well aware of this: they complain that insignificant everyday tasks, small issues that were previously resolved almost automatically, take on the meaning of complex, painful, insoluble problems. At the same time, a person feels that he has begun to think, act and speak slowly, notes suppression of drives (including food and sexual instincts), suppression or loss of the instinct of self-preservation and the absence of the ability to enjoy life, up to complete indifference to what he previously liked , evoked positive emotions. People suffering from depression often feel “stupid,” “mentally retarded,” or “weak-minded.” Thinking during depression becomes viscous, painful, requires special efforts, one mental image is hardly replaced by the next. The sick person is oppressed by a feeling of his own intellectual inadequacy and professional collapse. Depressed patients have difficulty describing their painful experiences to the doctor. Only after recovering from depression, many of them say that their mood at that moment was low, their thinking was slow, all their undertakings (including treatment) seemed in vain, and the years they had lived were empty and useless. However, at the time of the first visit to the doctor, they could not explain this due to the almost complete absence of thoughts in their heads, “paralysis of thinking.” With depression, there are also often complaints of memory loss, which is why those suffering from it assume that they have “Alzheimer’s disease,” “schizophrenia,” or “senile dementia,” which is not true. These complaints are especially common in depression that develops in adolescence. A typical story Alexey, 18 years old, a 1st year student at a technical university, describes his condition during depression: “Since childhood, I was interested in technology and modeling, could read specialized literature for hours, won school and regional olympiads in mathematics and physics. After finishing school, my dream came true - I passed the exams to a prestigious university with flying colors. Then it seemed to me that the whole world was at my feet, I was flying with happiness “as if on wings.” In September I happily started studying. At the beginning, everything worked out well, but after 2 months I began to notice that it was becoming more and more difficult for me to assimilate what I read, I could not remember the simplest text, and could not solve problems that I had previously “clicked like nuts.” Trying to achieve success by brainstorming for hours or drinking several cups of coffee led to the fact that I completely stopped thinking about anything. It seemed to me that I had “completely and irreversibly become stupefied.” At night I cried, wrapped in a blanket and thought about how best to commit suicide. Fortunately, I met a senior student in the library and shared my problems with him. My new friend said that he had experienced something similar and advised me to contact a psychiatrist at the student clinic. After an examination, I was diagnosed with “adolescent depression” and was sent for treatment to a specialized medical center. After 2 months, I felt completely healthy, returned to my studies and caught up with my classmates.” Depression can also be accompanied by real failures: for example, a decrease in academic performance, quality of work, family conflicts, sexual dysfunction and their consequences for personal relationships. As a rule, the significance of these failures is exaggerated and as a result, a false sense of the irreparability of what happened, the “collapse of all hopes” arises. Another generally recognized danger of depression is the possibility of suicidal thoughts, which often lead to suicide attempts. The condition of a person suffering from depression can suddenly deteriorate sharply, which occurs either without clear external reasons, or under the influence of traumatic situations or unpleasant news. It is in these hours, and sometimes even minutes, that a fatal decision is made. Factors that increase the risk of suicide in depression are past suicide attempts, the severity and duration of the depressive state, the presence of anxiety in its structure, prolonged insomnia, loneliness or alienation in the family, alcohol and drug abuse, job loss and sudden changes in lifestyle, as well as suicides among relatives. Typical story Evgeniy E., 35 years old, leading manager of the company. Almost all my life my career was on an upward trajectory; my goals were clear, clear and achievable. The marriage was extremely harmonious, two beloved children grew up. He devoted almost all his time to the affairs of the company, occasionally, once every 1-2 months, he escaped with his family out of town, to the dacha. He often didn’t get enough sleep, stayed late at work, took assignments home, and was deeply worried about the company’s affairs. Gradually, irritability, fatigue, insomnia, difficulty concentrating appeared, and more and more often he suffered a “fiasco” in his intimate life. Thoughts arose that life had been lived in vain, that it was a “chain of tragic mistakes” that led to a dead end. I began to believe that the choice of work, friends, family was wrong, for which now “there is a reckoning.” Analyzing the past years for a long time, I found more and more evidence and examples of my “duplicity, hypocrisy, insincerity, etc.” I realized that the only way to solve all problems is to voluntarily die. At the same time, he believed that by this act he would free his family from the “burden”, “loser”, “loser”. I decided to lock myself in the garage and poison myself with car exhaust fumes. However, by chance, in a semi-conscious state, he was discovered by an employee of a garage cooperative. He explained what happened as an “accident.” The thought of dying did not leave the patient. I decided to shoot myself with a gas pistol, which I had long ago acquired for self-defense. After being shot in the mouth, he was taken to the Research Institute named after him in serious condition. Sklifasovsky, from where he was discharged a week later. The alarmed wife, suspecting something was wrong, decided to consult her husband with a psychiatrist. He was admitted to the clinic. He agreed to this only out of respect for family relationships; he himself believed that treatment by psychiatrists was completely useless, because... his situation is hopeless and no medicine will help here, but will only “stupefy” his psyche. However, after two weeks of taking a modern antidepressant, the patient’s point of view changed. Everything began to look not so bleak and unpromising, interest in work and in life in general returned, I began to feel more cheerful, more energetic, and an interest in intimate life appeared. I took work to the clinic and called up my colleagues. After two months of treatment, he completely returned to his normal life. I recalled with bewilderment my thoughts about failure, the collapse of life, and suicide. I took the drug prophylactically for about six months, then, on the doctor’s recommendation, I gradually reduced the dose and stopped taking it. Over the next two years, her condition remained stable, career growth continued, and another child was born. Depression is also characterized by sleep disturbances, which occur in approximately 80% of patients. As a rule, these are early awakenings with the inability to fall asleep, lack of feeling of sleep, difficulty falling asleep. These disorders, as well as restless sleep with unpleasant dreams, are often the very first symptoms of incipient depression. If the depression is not deep, it is sometimes difficult to recognize it. This is due to the fact that people are ashamed to tell others about their problems and admit their “weaknesses.” Quite often, especially in Russia, depressive states are masked by alcohol abuse (“vodka cures”). In addition, often patients suffering from depression, in order to “shake themselves up”, “throw themselves into all kinds of troubles”, engage in casual sex, get involved in gambling or extreme sports, go to serve under contract in “hot spots”, lead an idle lifestyle with constant attendance at entertainment events. People around them, relatives who do not have psychiatric knowledge, often accuse them of debauchery, drunkenness, riotous lifestyle, and parasitism. Meanwhile, this behavior is a kind of “cry for help,” an attempt to fill the spiritual emptiness brought by depression with new acquaintances and impressions. Depressive states can occur in mild forms that are easily treatable, but at least a third of depressions are more severe. Such depressions are characterized by: - ​​ideas of guilt, sometimes reaching the level of delirium, i.e. unshakable conviction in their sinfulness, low value (patients consider themselves great sinners, believe that because of them all relatives and Humanity will die, that they are “moral monsters” from birth, allegedly deprived of the foundations of morality and a sense of empathy for other people that they have no place on earth. They find in their past numerous “confirmations" of the above, they believe that the doctor and other patients are aware of these sins and express contempt and indignation with their facial expressions and gestures, but in words, “they are hiding, denying the obvious.” This must be remembered both by the patients themselves and their loved ones in order to prevent the impending threat in time: remove all firearms, piercing and cutting objects, ropes, strong medicines and poisonous substances. household liquids, close windows or shutters, do not let the patient go anywhere alone.If these ideas become persistent and cannot be dissuaded, you must urgently seek advice from a psychoneurological institution or call a psychiatrist at home. - mood swings during the day: in typical cases, the patient, upon waking up, immediately feels melancholy. Sometimes, even before he fully awakens, through his sleep he experiences a painful premonition of the difficult coming morning. In the evening, my health improves somewhat. - the patient may experience a feeling of unmotivated hostility towards loved ones, friends, constant internal dissatisfaction and irritation, which makes him unbearable for the family. - for a number of people suffering from depression, constant doubts, fear for the health and well-being of loved ones, obsessive, i.e. come to the fore. ideas about the misfortunes and troubles of family members that arise against one’s will. A typical story: Dmitry Petrovich, 58 years old, teacher. “After minor troubles at work, I began to feel strange anxiety and agitation. Unpleasant thoughts came into my head that I had done something wrong at work, which is why I double-checked everything many times and went home later than everyone else. But even at home, the anxiety did not go away: as soon as a daughter or wife lingered for even half an hour, terrible pictures of road accidents or violence were drawn in the imagination. I fell asleep only in the morning, got up exhausted and felt drowsy all day. I took valerian and corvalol, but it practically didn’t help. At work they hinted if I should take a vacation. Friends advised me to see a neurologist, but he did not find his pathology and referred me to a psychiatrist. I was diagnosed with anxiety depression. After a course of outpatient treatment, I completely came to my senses.” — in many cases, depression is characterized by unpleasant sensations in the body, disturbances in the activity of internal organs in the absence of objective signs of true somatic, i.e. non-mental illness. At the same time, many patients constantly note pain and internal discomfort. Some complain of headaches, pain in the stomach, joints, and lower back, others complain of intestinal disorders: constipation, indigestion, irritation of the colon, while others pay attention to a decrease in libido and potency. Women often experience painful and irregular periods. Approximately 50% of people suffering from depression complain of such physical ailments when visiting a doctor, without mentioning the depressed mood or state of mind that underlies the depression. Experiencing chronic pain or other unpleasant sensations in the body, patients may not realize that they are suffering from depression, even with severe melancholy, considering the latter a reaction to painful bodily discomfort. — some patients are convinced that they have some rare and difficult to diagnose disease and insist on numerous examinations in general medical institutions. Doctors call this condition masked (hidden) depression, in which a person may experience pain in the head, limbs, chest, abdomen and any other parts of the body, he may be haunted by anxiety, he may suffer from insomnia or, on the contrary, sleeping too much. - Patients may experience disturbances in the cardiovascular system, itchy skin or lack of appetite. And all these are manifestations of depression. - the pathological sensations that patients experience with such depression are quite real, painful, but they are a consequence of a special mental state, and not an internal disease. It must be remembered that the frequency of latent depression exceeds the number of overt ones many times. - with such depression, patients, as a rule, have a changed attitude towards food: they can go without food for a long time and not feel hungry, and when they sit down at the table, they eat only 1-2 spoons - they have neither the strength nor the desire for more . — a sign of depression can be a weight loss of more than 5 kg. within a month. In some people, especially women, appetite during depression, on the contrary, increases, sometimes reaching the level of painful hunger, accompanied by severe weakness and pain in the epigastric region. In some cases, food is taken in excess due to an increased desire for sweets or attempts to distract oneself from painful thoughts by eating frequently. Thus, we see that depression is a disease with many different manifestations that do not go away on their own, requiring special, sometimes long-term, medical intervention. Therefore, if the symptoms described above appear, you must seek help from a psychiatrist who will prescribe and monitor antidepressant treatment.

TREATMENT OF DEPRESSIVE DISORDERS

By now we can say: the vast majority of cases of depression respond well to treatment. According to modern views, effective treatment of depression consists of a combination of pharmacotherapy, psychotherapy and, if necessary, other types of treatment. At the same time, the main role in therapy, of course, belongs to antidepressants - drugs specially designed for the treatment of various types of depression. The creation of antidepressants is based on the discovery of scientists that depression develops as a result of a disruption in the mechanism of biochemical transmission of nerve impulses in parts of the brain responsible for mood, behavior, response to stress, sleep and wakefulness, appetite and some other functions. To ensure coordination of the work of all these functional units, the brain sends special “commands” to them in the form of chemical impulses transmitted from the processes of one nerve cell (neuron) to the processes of another. This transmission is carried out with the help of chemical intermediaries (neurotransmitters), which, having transmitted the signal, partially return to the original neuron. This process is called transmitter reuptake. Thanks to it, the number of transmitters in the microscopic space between the processes of neurons (in the so-called synaptic cleft) decreases, which means that the necessary signals are transmitted worse. As numerous studies have shown, mediators of different structures, in particular norepinephrine and serotonin, are involved in the transmission of signals that ensure the normal functioning of the nervous system. The first of them has a general activating effect, maintains the level of wakefulness of the body and takes part in the formation of adaptive reactions, and the second has a main antidepressant effect, controls impulsive actions, anxiety, aggressiveness, sexual behavior, falling asleep, feeling of pain, which is why it is called serotonin sometimes a “good mood” regulator. A decrease in the amount of transmitters in the synaptic cleft causes symptoms of depression; an increase, on the contrary, prevents their appearance. The ability of some drugs to increase the concentration of neurotransmitters in the synaptic cleft in one way or another allows them to be used as antidepressants. Nowadays, antidepressants are used in Russia, which can be roughly divided into 4 generations based on the time of their creation. The first antidepressants to find widespread clinical use were drugs with a tricyclic structure: amitriptyline and imipramine. They have a fairly powerful effect on most depressive conditions by blocking the reuptake of both norepinephrine and serotonin. However, the real clinical effect of these drugs is significantly offset by their undesirable side effects, which sharply reduce the quality of life of patients during treatment. Side effects of tricyclic antidepressants arise due to the nonspecificity of their effects on receptor structures. Acting in addition to the serotonin and norepinephrine system and on other neurotransmitters (acetylcholine, histamine, dopamine), these antidepressants cause side effects such as urinary retention, dry mucous membranes, constipation, rapid heartbeat, fluctuations in blood pressure, confusion, tremors, sexual dysfunction functions, weight gain. In such cases, it is necessary to prescribe other drugs to correct side effects or reduce the therapeutic dose of drugs, which naturally affects the effectiveness of the antidepressant effect. It has been observed that up to 50% of patients refuse to take tricyclic antidepressants due to severe side effects. For the same reason, doctors are increasingly less likely to prescribe these drugs to patients on an outpatient basis. The situation was somewhat improved by the introduction into practice of second generation drugs - tetracyclic antidepressants, which, along with the ability to block the reuptake of norepinephrine and serotonin, could also affect some other receptors. Being analogues of tricyclic compounds, these drugs have comparable antidepressant activity, but unlike their predecessors, they are safer because they are much less likely to cause unwanted side effects. In addition to antidepressant, mianserin (lerivon) has a clear sedative, anti-anxiety and hypnotic effect. Maprotiline (Ludiamil) has a mild, balanced antidepressant effect. In general, these drugs can treat mild to moderate depression, but are ineffective in patients with severe depression. Today, third generation antidepressants such as fluoxetine (Prozac), fluvoxamine (fevarin), paroxetine (Paxil), sertraline (Zoloft), citalopram (cipralex) and some other drugs that selectively affect the serotonin metabolism system have received widespread recognition today. , preventing its reuptake in the synaptic cleft. Based on the mechanism of action, these antidepressants are combined into the group of selective serotonin reuptake inhibitors. In addition to treating depression, they are used to correct eating disorders, level out panic disorders, so-called social phobias, various obsessive states and chronic pain symptoms. These drugs have gained popularity due to the possibility of once-daily dosing, the accompanying anti-anxiety effect, the presence of a psychostimulant component and a small number of side effects. In addition, they have little toxicity and are well tolerated by elderly patients. However, some researchers note their lack of effectiveness in the treatment of severe forms of depressive conditions, probably associated with selective activity in relation to only one neurotransmitter - serotonin. It should be noted that in recent years, some American scientists have associated the use of these drugs with an increased risk of suicide, which, however, has not been proven. Considering the high frequency of side effects in some of the above drugs and the insufficient antidepressant activity in others, psychopharmacologists have taken the path of developing more effective antidepressants - fourth generation drugs that selectively block the reuptake of both serotonin and norepinephrine, without affecting other neurotransmitters. system and having minor side effects. Three drugs currently meet these requirements: milnacipran (Ixel), duloxetine (Cymbalta) and venlafaxine (Effexor). Their antidepressant activity in the treatment of patients with severe and moderate depression has been confirmed in a number of specially conducted studies, which have simultaneously shown that these drugs are well tolerated. It should be noted that in mild depressive states, antidepressants of plant origin (negrustin, gelarium hypericum, deprim, etc.) can be effective, but there is no reliable data guaranteeing their effectiveness. The opinion of a number of doctors that all depression can be treated with herbs or, say, acupuncture should be considered unfounded. For extremely severe depression that does not go away despite the use of the most powerful antidepressants, electroconvulsive therapy (ECT) can be effective, but this situation is extremely rare and requires careful justification by a committee of doctors and the consent of the patient. An important additional role in antidepressive therapy, especially with concomitant anxiety, is played by tranquilizers - anti-anxiety drugs, such as Xanax, phenazepam, diazepam, nitrazepam, atarax, etc. Drugs that, when taken systematically, can prevent mood swings in various depressive disorders include so-called mood stabilizers or mood stabilizers - lithium preparations, carbamazepine, valproic acid salts, lamotrigine, topiramate. When taken systematically, in most patients, the clinical manifestations of depression either completely disappear or become rare and mild, not requiring hospitalization and not significantly affecting the ability to work. Antipsychotics play a significant role in the treatment of some forms of depression. These include both traditional drugs - fluanxol, triftazin, eglonil, teralen, neuleptil, sonapax, and atypical antipsychotics that are gaining increasing recognition among doctors: seroquel, solan, zeldox, rispolept, abilify, serdolect and others. In drug therapy for depressive conditions, an unconventional, strictly individual approach is used, with the obligatory provision of fruitful cooperation between the patient and the doctor. Otherwise, there may be a violation of medical recommendations regarding the doses and regimen of taking medications. The patient’s faith in the possibility of recovery, the absence of prejudice against the “harm” caused by psychotropic drugs, and systematic adherence to the doctor’s prescriptions largely contribute to the achievement of therapeutic success. Drug treatment for depression takes time. You should not expect a complete cure in the first days of taking the drug. It must be remembered that all modern antidepressants begin to act on depressive symptoms no earlier than 1-2 weeks after the start of treatment. Cancellation of an antidepressant, as well as its prescription, should only be carried out by a doctor. Cancellation is usually made no earlier than 6 months after normalization of the mental state. Even after all symptoms of depression have completely disappeared, do not rush to stop taking the drug yourself, as there is a risk of exacerbation of the disease. Therefore, doctors recommend continuing to take an antidepressant for a certain period of time. A common mistake is premature discontinuation of medications soon after a significant improvement in the condition or due to “forgetfulness.” To avoid this, try to include taking the drug in the list of daily urgent tasks - for example, store it in the bathroom and take it after performing hygiene procedures. When planning a trip, calculate exactly how many tablets you need for the entire period you are away from home. Disruption of therapy is fraught with serious troubles. Psychotherapy for patients with depressive conditions, carried out along with drug treatment, involves various systems of influence, including individual conversations, family and group therapy, etc. An important element of social rehabilitation is participation in mutual support groups for patients who have suffered from depression. This allows other patients to feel helped in understanding their problems, to realize that they are not alone in their misfortune, and to see opportunities for personal participation in rehabilitation activities and in public life.

Other drugs for depression

To treat depressive disorders, medications from a variety of psychopharmacotherapy groups can be used. Thus, mood stabilizers are used to treat bipolar affective disorder; for alcoholic depression, doctors often prescribe anticonvulsants; nootropic drugs can be added to the treatment of organic and senile depression. In addition, restoration of the nervous system often requires the use of B vitamins, essential amino acids and anti-anxiety drugs. It all depends on the type of depression and concomitant diseases.

Acupuncture for depression

Depression is responsive to many types of therapy. Neurological reflexologists widely use acupuncture and other types of acupuncture to treat this type of disorder. But you need to be patient to complete the full course of procedures and constantly inform the reflexologist about your current health.

Physiotherapy for depression

Color therapy is most suitable for depressed patients. Everyone knows the Luscher test for actual emotion. So, this procedure is capable, using colors of certain tones, to change a person’s sensory state.

Light therapy - white light around: walls, linen, tiles can 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 scents and music therapy. The effect of this procedure is noticeable immediately - a smile on your face and a light head.

For a long time in Rus', the blues were banished by using a broom in the steam room and diving into an ice hole. Therapeutic baths, showers and saunas help restore a person’s taste for life.

Massage for depression

Depending on the condition, an experienced rehabilitation therapist influences the reflex zones with different strengths. A course of massage accelerates the blood, stimulates the brain indirectly through the active zones of the body, and returns the body to its former tone and elasticity.

Diagnostics

As mentioned earlier, one of the difficulties in diagnosing depression is separating its symptoms from signs of various psychosomatic diseases. It is also necessary to determine the form of depressive disorder and separate it from the symptoms of other mental illnesses in order to correctly determine the treatment strategy. Diagnosis begins with the study of the “depressive triad”:

Motor retardation is detected in slowness, which can reach stupor and stiffness of movements. Slowness of thinking and speech is manifested in difficulty comprehending events happening around, difficulty in making decisions, and the virtual absence of spontaneous speech. These signs are usually observed with ideomotor retardation. Decreased mood during depression is long-lasting. Under normal conditions, melancholy and depression go away when the source of stress is eliminated. This does not happen with depression.

Diagnosis usually includes a conversation with the patient, the use of various tests and questionnaires. They allow you to identify the presence of depression in general and assess the severity of its various symptoms, such as anxiety or anhedonia (a decrease or loss of the ability to experience pleasure). A comprehensive clinical assessment of depression is performed. Also, to exclude somatic (physical) causes of the disease, additional tests may be prescribed. For example, it is important to evaluate the functioning of the thyroid gland, which is often associated with mood disorders.

You can complete the first part of the diagnosis yourself - fill out the Zung scale and find out how severe your depression is.

Find out how severe your depression is by completing the Zung scale (20 questions, 10 min.)