Where does depression come from? How to get out of depression - causes, types, symptoms and treatment. Side effects of drugs
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Mental disorders, characterized mainly by a decrease in mood, motor retardation and thought failures, are a serious and dangerous disease, which is called depression. Many people believe that depression is not a disease and, moreover, does not carry any special danger, in which they are deeply mistaken. Depression is a rather dangerous type of disease, caused by the passivity and depression of a person.
This disease is characterized by signs of reduced self-esteem, indifference to one's life, loss of taste for it. Very often, a person with symptoms of depression finds salvation in alcoholic or, worse, psychotropic substances. These substances, of course, help get rid of the signs and symptoms of the disease, but the issue of the cause of depression is not resolved. In addition, the use of harmful substances worsens the situation and leads to the complete loss of a person.
Let's take a closer look at what depression is and what are the main types of this disease.
Kinds
Depression is a mental disorder that is most common in women and less common in men. The age of people who fall under the influence of the disease ranges from 18 to 55 years, but the occurrence of the disease at an earlier and later age is not excluded, but only in rare cases.
Depending on the causes that provoke the appearance of depression in a person, this disease is divided into types. These types are called:
- Chronic depression or dysthymia due to the flow for a long time (up to 2-3 years).
- Acute or clinical depression- the most complex form of the disease, which is characterized by a pronounced severity of symptoms. Clinical depression is characterized by a short duration of the course, but has a complex character. Every adult is familiar with the symptoms of the acute form of this disease.
- Reactive depression characterized by spontaneity of occurrence against the background of the appearance of serious stressful situations.
- neurotic depression arises through emotional disorders in which the dominant link is occupied by neuroses.
- - actually this type of malaise, through which a person loses the use of alcohol-containing beverages. This may occur due to coding or the identification of another disease in which a person is prohibited from drinking alcohol.
- protracted depression It is characterized by a long accumulation of negative factors, which are eventually localized into malaise.
- masked depression It is caused by pain symptoms that indicate somatic forms of diseases.
- - occurs, respectively, after the birth of a child.
- Bipolar or manic depression- characterized by the predominance of emotional lability (unstable mood) in the human psyche.
Each of the above types has its own reasons for which this or that form of malaise actually occurs. What are these reasons, we will consider in more detail.
Causes of mental disorders
The emergence of a mental disorder in both women and men is primarily due to negative changes in their lives. This is the main factor or sign that plays a major role in the initiation of the disease. But in addition to negative changes, there are a number of other reasons that affect the appearance of a depressive disorder. If you know these reasons, then in some situations, it is possible to avoid the occurrence of a psychological illness on your own.
The main reasons include the following factors:
- Conflict situations that arise between relatives, friends and loved ones. As a result of such conflicts, this unpleasant situation is deposited in the human brain. Constant worries and thoughts of only one lead to a depressive state.
- The loss of a loved one or friend also leads to the fact that a person cannot withstand psychological trauma and withdraws into himself. Most people develop reactive depression, which disappears after a certain time. But for some people, especially for women, the loss leads to a complete psychological breakdown, that is, neurotic depression. If you do not take therapeutic measures, then this can lead to mental insanity.
- Violence. For women, the sign of sexual violence is no less significant than the loss of a loved one. In addition to sexual abuse, abuse can also be both emotional and physical. The last two types of violence in most cases are not capable of leaving psychological trauma for life.
- genetic predisposition. Cases of manifestation of depression in ancestors can cause its occurrence in descendants.
- Problems. The presence of problems directly affects the occurrence of symptoms of a depressive state. Moreover, problems can be both personal and business in nature. A problem of a social nature is not excluded.
- Disease. Upon learning of a fatal disease, a corresponding reaction occurs in the form of a decadent mood.
- Alcohol addiction. A person suffering from bad habits also has a characteristic property of being depressed. In such people, two types of disease are distinguished: chronic and alcoholic. The first occurs against the background of any events, leading to the fact that a person finds painkillers in alcohol or drugs. And the second type arises due to the ban on the use of alcoholic beverages, which actually leads a person to confusion. Alcoholic depression was previously found exclusively in the representatives of the male side, but at the present time this type of disease is often diagnosed in women.
- Medicines. Taking medication causes in some cases the appearance of depressive disorders. These disorders occur under the influence of drugs taken that have a side effect on a person.
Thus, a depressive state can occur not only in women. This disease is widespread among people of all sexes, ages and nationalities. Mental disorders are diagnosed both in the ordinary middle class people and in the rich and even famous. This is explained by the fact that modern values have a direct negative impact on a person and his condition. Each person has his own specific goal, but when he realizes that he is unable to achieve it, then here comes a feeling of despair, isolation and uncertainty. It is here that the first sign of depression is born, which, if not sought to be cured, can lead to much more serious diseases, such as the development of cancerous tumors of the cerebral cortex, etc.
Only in some cases, depression can occur against the background of the absence of problems, but there are reasons for this, because, most likely, this is caused by the genetic subconscious of a person.
Symptoms
Often people ask themselves the following question: “What is depression, and how to deal with it?” It is already known that depression is a complex and serious illness that manifests itself due to the predominance of psychological trauma. Considering the question of how to deal with the disease, it is necessary first to pay attention to the symptoms of depression, since it is the first sign of the disease that makes it clear about the localization of one or another type of ailment in a person.
The symptoms of depression are quite diverse and manifest differently in each person, depending on the type of prevailing ailment. The main symptoms of the disease are:
- anxious feelings;
- feelings of guilt or despair;
- lowering self-esteem;
- self-isolation.
Symptoms in women are more pronounced than in men, which is associated with the physiological characteristics of the brain. A man can be depressed for many years and hide it. In women, the picture of symptoms is visible quite clearly, so if the first signs of localization of the disease are found, then you should immediately consult a doctor.
For your information! Depression is a serious illness that requires medical attention. It is possible to treat the disorder on your own, but in most cases this treatment of depression is negated.
Symptoms of the disease also manifest themselves in the form of constant fatigue, lack of interest in life. The patient is no longer interested in what previously brought him joy and pleasure. Symptoms of the disease even affect sexual life, contributing to the development of impotence in men and infertility in women.
The disease is also observed by a change in a person's behavior: he becomes inattentive, loses the ability to purposeful actions, and cannot concentrate his attention. Often, the sick person begins to avoid his family and friends, he becomes lonely and withdrawn. Often, people find salvation from such symptoms in alcohol-containing drinks or psychotropic, and even worse, narcotic substances.
Thoughts in a depressed person become negative, negative, and directed against oneself. A person tends to fix the denial of himself, he considers himself unnecessary, worthless, burdening relatives and friends. It is difficult for him to make any decisions.
Symptoms of the disease affect not only the emotional sphere, they also manifest themselves in the form of sleep disturbance, insomnia appears. During the day, the patient can sleep during the night, but at the same time the dreams are short, and filled with frequent awakenings, phobias. On the nutrition side, the picture can develop in two scenarios:
- The patient may lose his appetite altogether, while the body begins to quickly deplete, which leads to weight loss.
- Appetite may increase, and at the same time the patient begins to overeat, eat at night and gain weight actively.
With the course of the disease, physical pains appear in the region of the heart, abdomen, and sternum. Often depression leads to constipation. Against the background of a decrease in the energy reserve, there is a rapid overwork of the body both during physical and mental stress. The first sign, which is characteristic of the occurrence of psychological and emotional malaise, is the problem of sexual life, which the sexual partner will understand on the very first day.
Symptoms by type
Depending on the type of prevalence of the disease, the characteristic symptoms of manifestation also differ. It is important to know the symptoms in order to notice them in time and seek help. If the picture of symptoms is indistinct, then in this case it is impossible to postpone the medical diagnosis of the detection of the disease.
Symptoms for each type of ailment are manifested in the form of:
clinical depression characterized by feelings of oppression and uselessness. The patient has delusional thoughts about guilt and the meaninglessness of existence. At the same time, the patient has a violation of sleep, appetite and pain in the stomach. Often this species causes migraines and skin diseases. Constant irritability leads to disorders of the genital organs.
Reactive depression characterized by both short-term symptoms, which are characterized by a duration of no more than a month, and prolonged - up to two years.
Characteristic symptoms are the emergence of a feeling of deep despair, thoughts of suicide, the appearance of fears, phobias. There are headaches and overwork, appetite and night sleep are disturbed. All these signs indicate the predominance of a mental disorder - reactive depression. Sometimes reactive depression leads to suicidal attempts, especially among women. If the first signs of such inclinations are noticed, then it is necessary to constantly monitor the patient.
neurotic depression has the following symptoms: a feeling of lethargy, weakness, weakness, which are accompanied by predominant headaches. Often, neurotic depression leads to the appearance of nervous diseases. The symptoms of this type are not persistent and carry a successful recovery if appropriate measures are taken. The patient is characterized by exciting experiences, with which he is constantly fighting, trying to influence the psycho-emotional environment, while maintaining self-consciousness. Neurotic depression also, together with neurosis, leads to the appearance of mental attacks and hysteria.
It is caused by a manifestation of a violation in the work of the digestive and nervous systems, as well as the functioning of the liver. The first signs of an alcoholic type of the disease are characterized by the occurrence of vomiting.
Alcoholic depression is expressed in a deterioration in well-being, the occurrence of lethargy and the appearance of thoughts of suicide. This type of disease is most common among older men, so suicide attempts occur precisely with alcoholic depression. The main symptoms include:
- slowness when moving;
- general lethargy;
- facial expressions correspond to a sad mood;
- insomnia;
- feeling of constant anxiety.
Alcoholic depression can occur a week after an unwanted withdrawal from alcohol and last up to 2 years.
lingering view characterized by the following symptoms:
- apathy;
- increased anxiety and despair;
- distrust of others;
- low self-esteem;
- tearfulness;
- isolation and a desire for solitude.
masked depression manifests itself in the form of the following picture of symptoms:
- headaches and migraines;
- skin itching;
- sexual disorders;
- pain when inhaling;
- the appearance of vegetovascular dystonia.
Masked depression is also called latent depression, which indicates the difficulty of diagnosing. The most characteristic sign of this type of ailment is the lack of improvement even with medical intervention. Against this background, in order to try to get rid of the ailment, the patient finds other alternative ways to get rid of the symptoms. Masked depression often leads to a shortened life, so even during treatment, patient care is required.
manic depression manifests itself in the form of the following symptoms of malaise:
- irritability to objects, society and any activities;
- feelings of helplessness and guilt;
- lethargy: physical, mental and speech;
- sadness, anxiety, sadness;
- lack of appetite and sleep.
In addition to emotional disorders, manic depression causes disturbances in the functioning of the cardiovascular system, arrhythmia, tachycardia, and bradycardia appear. Constipation occurs, the patient gradually passes into a stop state, manifested in the form of refusal of food and lack of response to people around.
chronic depression is determined by a change in a person's behavior: he loses the ability to purposeful actions, concentration of attention is disturbed. He withdraws into himself, does not want to have long spiritual conversations, loneliness becomes his habitual habitat. The patient finds friends, such as alcohol and drugs. Constant thoughts only about the bad, lowering self-esteem, complete apathy for the outside world. During alcohol intoxication, frequent suicidal relapses occur.
All of the above symptoms indicate the predominance of mental disorders in a person. The sooner the first signs of the disease are detected, the more likely it is to completely get rid of the disease. Treatment for depression begins with an accurate diagnosis.
Diagnostics
“I was “attacked” by depression, what should I do?” is a question that is widespread among young people. Yes, most people can already identify themselves with depression and are trying to find ways to get rid of it. But is depression really depression? In order to find out whether a person really suffers from depression, it is necessary to undergo a diagnostic course.
Diagnosis of the disease is carried out by an experienced doctor, who, at the first complaints, begins with simple questions about the mood and thoughts of the patient. Next, they move on to tests, on the basis of which the doctor becomes aware of the picture of the disease. If, nevertheless, the doctor reveals a suspicion of depression, then a series of procedures are carried out to examine the patient, which make it possible to exclude other similar diseases.
So, the diagnosis includes:
- Checking the physical condition: weight, height, pressure and pulse.
- Laboratory tests: it is necessary to donate blood for analysis to detect abnormalities.
- Psychological research: a visit to a psychotherapist who talks about the symptoms and finds out the cause of the disease. Also, based on this, the doctor finds out the presence of thoughts about suicidal tendencies, which is important in diagnosing depression.
After an appropriate diagnosis is made, it is necessary to immediately proceed to the treatment of depression.
Treatment
Treatment of depression begins, first of all, with a correct diagnosis and determination of the form of exacerbation in which the disease is located. If you treat depression correctly and in a timely manner, then, as a result, you can achieve a full recovery. Most people do not want to visit a doctor, since the diagnosis is fraught with negative consequences for the patient: the introduction of social restrictions, registration, a ban on driving vehicles and traveling abroad. The patient in most cases believes that everything will pass after a certain time, but, unfortunately, this will only aggravate the situation. Thus, if a mental disorder is not treated, then in the end the patient expects either a suicidal relapse against the background of an emotional breakdown, or the appearance of a fatal disease.
The disease is prone to a tendency of localization based on stressful situations, which leads to somatic ailments of the following systems:
- cardiovascular;
- endocrine;
- gastrointestinal.
Depression in such situations tends to become more complicated, but if it is treated in a timely manner, it is possible to achieve complete relief from the malaise.
If a person has mental disorders, then it is necessary to understand that it is not worth treating this disease on your own, since this will have practically no effect. Depression treatment consists of the following complex techniques:
- biological therapy, which is divided into drug and non-drug treatment of depression.
- Psychological therapy.
Treatment of depression through biological therapy according to the method of drug use involves the use of special medications. These drugs include tricyclic antidepressants:
- Melipramine;
- Amitriptyline;
- paroxetine;
- Tianeptine.
Treatment of the disease with these antidepressants is not only effective, but also safe. For each patient, a certain dose is prescribed on an individual basis. It is worth noting that the effectiveness of these drugs is in duration, so you do not need to count on a positive effect in the first weeks. In addition, antidepressants do not cause addiction and addiction, so their use is prescribed in the first place.
Depression is treated with benzodiazepine tranquilizers, which have a positive effect in the first month of taking. But unlike tricyclic drugs, benzodiazepines are addictive, so their intake is strictly controlled. Benzodiazepine drugs include:
- Phenazepam;
- Tazepam;
- Elenium;
- Corvalol;
- Valocordin.
Treatment with psychological therapy
Treatment of depression according to the method of using psychotherapy consists of three types:
- cognitive;
- psychodynamic;
- behavioral therapy.
The main purpose of therapy is to identify the conflict and its constructive way of resolving.
The treatment of depression with cognitive therapy is the most effective, since it is based not only on identifying the conflict, but also on changing the way of thinking to a more acceptable, that is, optimistic one.
Behavioral therapy allows treatment of depression by eliminating behavioral symptoms. These symptoms include: refusal of entertainment and pleasures, maintaining a monotonous lifestyle, etc.
At the same time, the treatment of depression should rely not only on the attending physician, but also on the people around the patient. It is important that all actions of the patient are perceived without aggression, it is necessary to constantly support him, speak only on optimistic topics and tune the patient to positive moments. In the end, you need to distract him from your thoughts, give him a smile and joy, and the more often you observe these manifestations on his face, the faster he will recover from depression.
A fairly common phrase of psychotherapist clients is “Why am I depressed? I'm all right." “In order” usually refers to a good family, employment, and general social well-being. It seems that this should be a platinum protection against the loss of pleasure from life, interest in what is happening - but depression also comes to prosperous people. Practicing psychotherapist Adriana Imzh explains where.
Let's start with a biological fact: depression is not a fictional disease, it has a bodily justification. That is, our nervous system can simply “break down” and stop perceiving or producing substances responsible for the ability to rejoice. The disease is unfair and does not understand whether a person has a good life or a bad one. It just happens and the disease needs to be treated.
Norepinephrine, dopamine and serotonin are the main brain mediators associated with depression, the "lubrication" of our nervous system. Their interaction and the combination that causes depression is still being investigated, but it is already known that in almost always depression there is a violation of their work. Also, depression can occur due to organic damage to the brain, the use of drugs and other potent drugs that damage brain pathways or disrupt the functioning of neurotransmitters. In severe cases, such damage and impairment can be irreversible and lead to years of depression. In less severe, but also unpleasant cases, you need to take drugs for a long time.
Unfortunately, there are a lot of myths around depression, and the biological component is often forgotten. At the same time, it would never occur to anyone to ask “I have such a good life, why do I have the flu?”. The flu doesn't care. Depression doesn't matter either.
neurotransmitters - chemicals through which an electrochemical impulse is transmitted between neurons or from neurons to muscle tissue and glandular cells
The disease is unfair and does not understand whether a person has a good life or a bad one.
The second important thing is that in the post-Soviet space they often say “everything is in order” about a state that is quite far from order. Just as a husband who “does not drink, does not beat, does not cheat” is not automatically a good husband, the state of “we are not starving and we have not been beaten in the family” is not in itself a sign of well-being.
Often a client at a psychologist’s appointment says “I have a good family, excellent understanding parents”, and after a couple of minutes - “I always dreamed of living separately.” He does not notice the contradiction and does not ask himself why he always wanted to get away from these good understanding people.
If you open this question, it turns out that the family is not entirely good - it is simply indifferent. The child was not beaten, not insulted, they said they loved him, but all his problems were indifferent. They didn’t go anywhere with him, they didn’t talk about anything: he was invisible in his own house.
Also, abuse can be directed to other family members - to the mother, brothers or sisters, to elderly relatives. When we watch someone being humiliated, despised, or forced to do something they don't want, we get hurt too.
The state “we are not starving and we were not beaten in the family” is not in itself a sign of well-being.
If we live in a toxic environment (for example, in a city where there are constant terrorist attacks, kidnappings, a man-made disaster, a high crime rate, or natural disasters), then the likelihood of depression also increases. Many clients of psychologists do not even realize how traumatic the environment they are in until they begin to compare their experience with the experience of other group members. Or they don’t begin to read stories from the childhood and youth of other people: to realize that your childhood with gangs, detente of shells or exhausting labor on the ground was hard only if you know that, in general, other children grow up in slightly different conditions.
The third option is "beautiful" stress. Not only terrible events take resources, but beautiful ones too. The birth of a desired child (this is one of the most important points - every seventh young mother suffers from depression), a wedding, a move, a job change to a more successful one, emigration, home repairs, a fallen inheritance, a sharp change in lifestyle or changes in the body can also undermine health and strength. Of course, less likely than terrible processes, but nonetheless.
Positive stress often distorts ideas about one's own capabilities - there comes a feeling “I can do anything” or “I'm on the wave”, and a person takes more than he has. And then comes the rollback - depression. This is what BAD looks like - bipolar affective disorder, when the stage of fun and power is followed by a period of recession and depression. But even without BAR, some cyclicity of periods occurs in healthy people.
The fourth option is taking medication. A number of drugs are associated with a risk of depression. Of the most common - oral contraceptives and painkillers. Of course, not everyone who takes such a drug has a side effect, otherwise it is simply removed from production. Admissible numbers of side effects are one in a thousand or ten thousand, but you can always be "lucky".
In this case, it is recommended to change the method of contraception or replace the drug: if this is a side effect, then the cause will disappear - and, most likely, it will also disappear. It is the connection of oral contraceptives with depression that leads many women to look for alternative methods of contraception - spirals, female condoms and others.
The fifth option is repressed memories. Incest, rape in early childhood, deprivation in the hospital can simply "disappear" from memory. People do not want to remember it and do not remember. Sometimes they mentally return to these events and again push them out of their memory - this information causes them too much pain.
But be that as it may, these terrible things happened and were stored in our nervous system. Of course, they influence our perception of reality and leave somatic traces. Including painful memories can be the cause of many years of suicidal attempts and mental illness. The person seems to be fine, but in fact - no.
Even forgotten terrible things have been stored in our nervous system.
But even without repressed trauma, a lot of our life depends on genetics and health. Unfortunately, it is not always enough to avoid difficult events of a psychological nature.
In addition, all of the above factors can interact with each other. Two, three or four processes can take place at the same time, and this will increase the likelihood of depression by several times. For example, taking oral contraceptives, moving, a new job, a terrorist attack in the city - and voila, the body can not withstand stress: depression sets in.
Thus, often to say that a person has “out of the blue depression” is a somewhat distorted reality. We live in a complex world that can injure us in a variety of ways - from man-made disasters to a simple disruption in the functioning of the body.
To say that a person has “out of the blue depression” is to distort reality.
Therefore, if there are signs of depression - constant fatigue, loss of appetite, apathy, inability to formulate one's desires, suicidal thoughts - it is better to contact a psychologist, neurologist, psychotherapist, and in severe cases - a psychiatrist. Depression is not just a mood disorder. This is a disease that can be fatal or turn off a person from family, work and social life for a long time, giving him “torn years”.
Somehow it is not accepted to be considered a disease. Laziness, melancholy from idleness and weak will are depression in the eyes of our compatriots. A person who is prescribed antidepressants is likely to be considered unbalanced. Meanwhile, as a result of real depression, the functioning of the brain changes in a person and he cannot be cured by an effort of will.
What is depression?
Depression is not just one of the varieties of quickly passing sadness, but a serious and fairly common disease that can disrupt the usual course of life. A person in one of the last stages of depression can seriously harm himself. Brain research shows that in a depressed person, the parts of the brain that control mood, behavior, thinking, appetite, and sleep are malfunctioning. In addition, it changes the properties of important substances responsible for the transmission of electrical impulses from nerve cells.
Unfortunately, due to the prejudice associated with depression, only 39% of people with severe depression seek professional psychiatric help. Most often, patients with depression go to ordinary general practitioners, as a result of which they receive an incorrect diagnosis. Some cases of depression are very difficult to cure, but most can be easily treated with antidepressants and a course of psychotherapy.
How to properly treat depression?
Treatment of depression is more effective the earlier it starts: the easiest way to treat depression is less than six months. If a person postpones visiting a specialist for two or three years, or even for eight to ten years, then the course of treatment increases significantly, and can reach one and a half to two or more years.
Because depression often runs in families, scientists hypothesize that genes are involved in an individual's depression. However, if one of your parents had depression, this does not mean that it will definitely overtake you too. But alas, a genetic predisposition still exists: in this case, you are three times more likely to get sick than people whose relatives have never been depressed. Scientists believe that a combination of genetic and mental factors, as well as life circumstances, which cannot be predicted, contributes to the development of the disease.
It is a mistake to think that older people are most susceptible to depression - they say, their life is already running out, activity is declining, and thoughts of death are depressing. In fact, depression affects people of all social groups, ages and temperaments. Most often, it affects people aged 40 to 59 years, as well as adolescents. Often it is also among young ambitious people with an active lifestyle. A depressive state can appear against the backdrop of some kind of life drama: divorce, death or departure of a loved one, physical injury, and even dismissal from work. Often depression due to overwork, so this disease is a frequent companion of workaholics and excellent students.
Despite its psychological nature, prolonged depression also affects the physical state. Depression can cause neuralgic chest pains, nausea and vomiting, dizziness, insomnia, constant fatigue, changes in weight and appetite (both ways), and exacerbation of chronic diseases.
The myth that depression is cured by "positive thinking" can lead to suicide. A person in a state of depression, even moderate thoughts of "good" only irritate - they seem to be something distant and unrealizable, like the wealth of an Arab sheikh for a homeless person. It is also not true that by talking about depression a person drives himself deeper into melancholy. In fact, depression needs to be treated and its causes analyzed.
How to get out of depression?
To date, the combination of drug treatment and has proven the most effective, during which a person is aware of the psychological component of his illness.
If you have had a positive experience with depression, please leave your feedback in the comments below.
Depression as a state of emotional depression has been known since ancient times. Even eight centuries before the birth of Christ, the great ancient Greek poet Homer described the classical depressive state of one of the heroes of the Iliad, who “... wandered around, alone, gnawing his heart, running away from the traces of a person ...”
In the very first collection of medical treatises of ancient Greece, the authorship of which is attributed to the “father of scientific medicine” Hippocrates, the suffering caused by depression was quite clearly described, and the definition of the disease was given: “if sadness and fear continue long enough, then we can talk about a melancholic state” .
The term "melancholia" (literally black bile) has been used in medicine for a long time and has been preserved in the names of some mental pathologies to this day (for example, "involutional melancholia" - depression that develops in women during menopause).
Descriptions of pathological emotional experiences that lead to inadequate perception of the surrounding world are also found in the Old Testament. In particular, the First Book of Kings describes a clinic of severe depression in the first king of Israel, Saul.
In the Bible, such a state is interpreted as a punishment for sins before God, and in the case of Saul, it ends tragically - the king committed suicide by throwing himself on a sword.
Christianity, largely based on the Old Testament, for a long time maintained an extremely negative attitude towards all mental illnesses, associating them with the machinations of the devil.
As for depression, in the Middle Ages it began to be denoted by the term Acedia (lethargy) and considered as a manifestation of such mortal sins as laziness and despondency.
The term "depression" (oppression, depression) appeared only in the nineteenth century, when representatives of the natural sciences began to study diseases of the mental sphere.
Current Statistics on Depression
The themes of loneliness in the crowd and the feeling of the meaninglessness of existence are among the most discussed topics on the Internet,Today, depression is the most common mental pathology. According to the WHO, depression accounts for 40% of cases of all mental illnesses, and 65% of mental pathologies that are treated on an outpatient basis (without placing the patient in a hospital).
At the same time, the incidence of depression is steadily increasing from year to year, so that over the past century the number of annually registered depressed patients has increased by more than 4 times. Today in the world every year about 100 million patients go to the doctor for the first time because of depression. It is characteristic that the lion's share of depressive patients falls on countries with a high level of development.
Part of the increase in reported cases of depression is due to the rapid development of psychiatry, psychology and psychotherapy. So even mild cases of depression that used to go unnoticed are now being diagnosed and successfully treated.
However, most experts associate the increase in the number of depressed patients in civilized countries with the peculiarities of the life of a modern person in big cities, such as:
- high pace of life;
- a large number of stress factors;
- high population density;
- isolation from nature;
- alienation from centuries-old traditions, which in many cases have a protective effect on the psyche;
- the phenomenon of "loneliness in the crowd", when constant communication with a large number of people is combined with the absence of close warm "unofficial" contact;
- lack of motor activity (it has been proven that a banal physical movement, even ordinary walking, has a positive effect on the state of the nervous system);
- population aging (the risk of depression increases many times with age).
Different Differences: Interesting Depression Facts
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- The author of "gloomy" stories Edgar Allan Poe suffered from bouts of depression, which he tried to "treat" with alcohol and drugs.
- There is a hypothesis that talent and creativity contribute to the development of depression. The percentage of depressive and suicidal among outstanding figures of culture and art is much higher than in the general population.
- The founder of psychoanalysis, Sigmund Freud, gave one of the best definitions of depression when he defined pathology as self-directed irritation.
- People suffering from depression are more likely to have fractures. Studies have shown that this is associated with both a decrease in attention and a deterioration in the condition of the bone tissue.
- Contrary to popular belief, nicotine is in no way able to “help relax”, and puffing on cigarette smoke only brings visible relief, in fact, aggravating the patient’s condition. Among smokers, there are significantly more patients suffering from chronic stress and depression than among people who do not use nicotine.
- Addiction to alcohol increases the risk of developing depression several times.
- People suffering from depression are more likely to fall victim to the flu and SARS.
- It turned out that the average gamer is a person suffering from depression.
- Danish researchers have found that paternal depression has a very negative effect on the emotional state of infants. These babies cry more often and sleep worse.
- Statistical studies have shown that overweight children of kindergarten age have a significantly higher risk of developing depression than their peers who are not overweight. At the same time, obesity significantly worsens the course of childhood depression.
- Women who are prone to depression have a significantly higher risk of preterm birth and other complications during pregnancy.
- According to statistics, every 8 out of 10 patients suffering from depression refuse specialized help.
- The lack of affection, even with a relatively prosperous financial and social situation, contributes to the development of depression in children.
- Approximately 15% of depressed patients commit suicide each year.
Causes of depression
Classification of depressions according to the cause of their development
A number of factors are involved in the development of almost any depressive state:- external influences on the psyche
- acute (psychological trauma);
- chronic (state of constant stress);
- genetic predisposition;
- endocrine shifts;
- congenital or acquired organic defects of the central nervous system;
- somatic (bodily) diseases.
- Psychogenic depression, which are the reaction of the psyche to any adverse life circumstances.
- Endogenous depressions(literally caused by internal factors) which are psychiatric diseases, in the development of which, as a rule, a genetic predisposition plays a decisive role.
- organic depressions caused by a severe congenital or acquired defect of the central nervous system;
- Symptomatic depressions, which are one of the signs (symptoms) of a bodily disease.
- Iatrogenic depressions which are side effects of a drug.
Reasons for the development of reactive and neurasthenic depression
Psychogenic depression is the most common type of depression, accounting for up to 90% of all types of depression. Most authors subdivide all psychogenic depressions into reactive - acute depressive states and neurasthenic depressions, which initially have a chronic course.
Most often the reason reactive depression become a severe psychological trauma, namely:
- tragedy in personal life (illness or death of a loved one, divorce, childlessness, loneliness);
- health problems (severe illness or disability);
- cataclysms at work (creative or production failures, conflicts in the team, job loss, retirement);
- experienced physical or psychological abuse;
- economic troubles (financial collapse, transition to a lower level of security);
- migration (moving to another apartment, to another district of the city, to another country).
A common feature of all reactive depressions, without exception, is the presence of a traumatic factor in all emotional experiences of the patient, who is clearly aware of the reason for which he suffers, whether it is the loss of a job or disappointment after entering a prestigious university.
The reason neurasthenic depression is chronic stress, therefore, in such cases, the main traumatic factor is usually not detected by the patient or is described as a long streak of minor failures and disappointments.
Risk factors for the development of psychogenic depression
Psychogenic depression, both reactive and neurasthenic, can develop in almost any person. At the same time, as banal experience shows, people accept the blows of fate in different ways - one person perceives dismissal from work as a minor nuisance, the other as a universal tragedy.
Therefore, there are factors that increase a person's propensity for depression - age, gender, social and individual.
age factor.
Despite the fact that young people lead a more active lifestyle and, therefore, are more susceptible to adverse external factors, in adolescence, depressive states, as a rule, occur less frequently and proceed more easily than in old people.
Scientists link older people's susceptibility to depression to an age-related decrease in the production of the "happiness hormone" - serotonin and a weakening of social ties.
Gender and depression
Women, due to the physiological lability of the psyche, are more prone to depression, but in men, depression is much more severe. Statistics show that women suffer from depression 5-6 times more often than men, and yet, among 10 suicides, there are only 2 women.
This is partly due to the fact that women prefer "chocolate to cure sadness", and men are more likely to seek solace in alcohol, drugs and casual relationships, which greatly exacerbates the course of the disease.
social status.
Statistical studies have shown that wealth and poverty are most prone to severe psychogenic depression. People with average incomes are more resilient.
In addition, each person also has individual characteristics of the psyche, worldview and microsociety (the immediate environment), which increase the likelihood of developing depressive conditions, such as:
- genetic predisposition (close relatives were prone to melancholy, made suicide attempts, suffered from alcoholism, drug addiction or some other addiction, often masking the manifestations of depression);
- psychological trauma suffered in childhood (early orphanhood, divorce of parents, domestic violence, etc.);
- congenital increased vulnerability of the psyche;
- introversion (a tendency to self-deepening, which, when depressed, turns into fruitless self-digging and self-flagellation);
- features of character and worldview (pessimistic view of the world order, overestimated or, conversely, underestimated self-esteem);
- poor physical health;
- lack of social support in the family, among peers, friends and colleagues.
Endogenous depressions make up only about 1% of all types of depressions. A classic example is manic-depressive psychosis, which is characterized by a cyclical course, when periods of mental health are replaced by phases of depression.
Quite often, phases of depression alternate with phases of the so-called manic states, which, on the contrary, are characterized by inadequate emotional uplift and increased speech and motor activity, so that the patient's behavior in the manic phase resembles the behavior of a drunk person.
The mechanism of development of manic-depressive psychosis, as well as other endogenous depressions, has not been fully studied, however, it has long been known that this disease is genetically determined (if one of the identical twins falls ill with manic-depressive psychosis, then the likelihood of developing such a pathology in a genetic twin is 97%).
Women are more often ill, the first episode, as a rule, occurs at a young age immediately after adulthood. However, a later development of the disease is also possible. The depressive phase lasts from two to six months, while emotional depression gradually worsens, reaching a certain critical depth, and then the normal state of the psyche is also gradually restored.
"Light" intervals in manic-depressive psychosis are quite long - from several months to several years. An exacerbation of the disease can provoke some kind of physical or mental shock, but most often the depressive phase occurs on its own, obeying a certain internal rhythm of the disease. Often, the change of season (autumn and / or spring phases) becomes a critical period for the disease, some patients note the occurrence of depression on certain days of the menstrual cycle.
Another example of a relatively common endogenous depression is involutionary melancholy. The disease develops at the age of 45-55 years, mainly in women.
The causes of the disease remain unknown. The hereditary factor in this case is not traced. Any physical or nervous shock can provoke the development of involutionary melancholia. However, in most cases, the disease begins as a painful reaction to wilting and approaching old age.
Involutional melancholy, as a rule, is combined with such symptoms as increased anxiety, hypochondria (fear of death from a serious illness), sometimes there are hysterical reactions. After getting out of depression, patients most often have some mental defects (decreased ability to empathize, isolation, elements of egocentrism).
Senile (senile) depression develop in old age. Many experts believe that the cause of the development of this pathology is a combination of a genetic predisposition to the disease with the presence of small organic defects of the central nervous system associated with age-related circulatory disorders of the brain.
Such depression is characterized by a peculiar deformation of the patient's character traits. Patients become grouchy, touchy, features of selfishness appear. Against the background of a depressed gloomy mood, an extremely pessimistic assessment of the surrounding reality develops: patients constantly complain about the “incorrectness” of modern norms and customs, comparing them with the past, when, in their opinion, everything was perfect.
The onset of senile depression is usually acute and is associated with some traumatic factor (the death of a spouse, moving to another place of residence, a serious illness). In the future, depression takes a protracted course: the circle of interests narrows, previously active patients become apathetic, one-sided and petty.
Sometimes patients hide their condition from others, including those closest to them, and suffer in silence. In such cases, there is a real threat of suicide.
Depression associated with physiological endocrine changes in the body
Hormones play a leading role in the life of the organism as a whole and in the functioning of the central nervous system in particular, therefore any fluctuations in the hormonal background can cause serious emotional disorders in susceptible individuals, as we see in the example of premenstrual syndrome in women.
Meanwhile, the life cycle of a person implies the existence of periods when a kind of hormonal explosion occurs. These periods are associated with the functioning of the reproductive system and include growing up, reproduction (in women) and extinction (menopause).
Accordingly, depressions associated with physiological endocrine changes in the body include:
- teenage depression;
- postpartum depression in women in labor;
- depression in menopause.
- increased fatigue;
- reversible decline in intellectual functions (attention, memory, creativity);
- reduced performance;
- increased irritability;
- tendency to hysteroid reactions;
- emotional weakness (tearfulness, capriciousness, etc.).
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Another characteristic feature of depressive states associated with deep hormonal restructuring is that their development is in many ways similar to psychogenic depressions, since there is a significant traumatic factor for the psyche (growing up, giving birth, feeling of approaching old age).
Therefore, the factors that increase the risk of developing such depressions are the same as in psychogenies (genetic predisposition, increased vulnerability of the psyche, psychological trauma, personality traits, lack of support from the immediate environment, etc.).
organic depressions
The frequency of depression in some brain lesions is quite high. So clinical studies have shown that about 50% of stroke patients show signs of depression already in the early recovery period. At the same time, emotional depression develops against the background of other neurological disorders (paralysis, sensory disturbances, etc.) and is often combined with characteristic bouts of violent crying.
Depression is even more common in chronic cerebrovascular insufficiency (about 60% of patients). In such cases, emotional depression is combined with increased anxiety. Patients, as a rule, constantly disturb others with monotonous complaints about their difficult physical and mental condition. For this reason, vascular depressions are also called "aching" or "complaining" depressions.
Depression in traumatic brain injury occurs in 15-25% of cases and most often develops in a long-term period - months or even years after the tragic event. As a rule, in such cases, depression occurs against the background of already developed traumatic encephalopathy - an organic pathology of the brain, manifested by a whole range of symptoms, such as headache attacks, weakness, memory and attention loss, irritability, malice, resentment, sleep disorders, tearfulness.
With neoplasms in the frontal and temporal lobe, as well as with such serious diseases of the nervous system as parkinsonism, multiple sclerosis and Huntington's chorea, depression occurs in most patients and may be the first symptom of the pathology.
Symptomatic depressions
Symptomatic depressions are registered rather seldom. This is partly due to the fact that depressions that develop at the advanced clinical stage of a serious illness are usually considered as a patient's reaction to their condition and are classified as psychogenies (reactive or neurasthenic depressions).
Meanwhile, many diseases are especially often combined with depression, which allows us to speak of emotional depression as a specific symptom of this pathology. Such diseases include:
- damage to the cardiovascular system (ischemic heart disease, chronic circulatory failure);
- lung diseases (bronchial asthma, chronic pulmonary heart failure);
- endocrine pathologies (diabetes mellitus, thyrotoxicosis, Itsenko-Cushing's disease, Addison's disease);
- diseases of the gastrointestinal tract (peptic ulcer of the stomach and duodenum, enterocolitis, hepatitis C, cirrhosis of the liver);
- rheumatoid diseases (systemic lupus erythematosus, rheumatoid arthritis, scleroderma);
- oncological diseases (sarcoma, uterine fibroids, cancer);
- ophthalmic pathology (glaucoma);
- genitourinary system (chronic pyelonephritis).
With some bodily ailments, a depressive state may be the first symptom of a disease that still does not make itself felt. First of all, this applies to oncological diseases, such as pancreatic cancer, stomach cancer, lung cancer, etc.
A characteristic feature of symptomatic depression that occurred at the preclinical stage of cancer is the predominance of the so-called negative symptoms. It is not sadness and anxiety that come to the fore, but the loss of the "taste of life", patients become apathetic, avoid colleagues and friends, in women the first sign of this kind of depression may be a loss of interest in their own appearance.
With malignant neoplasms, depression can occur at any stage of the development of pathology, therefore, many oncological clinics employ psychologists who specialize in providing assistance to cancer patients.
Depressions that develop in patients with alcohol and/or drug addiction
Depressions that develop in alcoholism and/or drug addiction can be considered as signs of chronic poisoning of brain cells by neurotoxic substances, that is, as symptomatic depressions.
However, alcohol and / and drug addiction often occurs against the background of prolonged psychogenic depression, when the patient tries to “treat” mental pain and longing with brain-stupefying substances.
As a result, a vicious circle often forms: emotional drama encourages the patient to use substances that weaken moral suffering, and alcohol and drugs cause a whole cascade of everyday hardships (quarrels in the family, problems at work, poverty, social exclusion, etc.) new experiences, from which the patient gets rid of with the help of the usual "medicine".
Thus, in the early stages of the development of alcoholism and drug addiction, depression can in many ways resemble psychogenic depressions (prolonged reactive or neurasthenic).
At the advanced stage of the disease, when a physiological and psychological addiction to a psychoactive substance is formed, this kind of depression has pronounced features of its own. The patient perceives the whole world through the prism of addiction to alcohol and / or drugs. So in such cases, group psychotherapy sessions (groups of anonymous alcoholics and drug addicts, etc.) can be especially effective.
In the last stages of the development of alcohol and drug addiction, when irreversible changes develop in the central nervous system, depression takes on a pronounced organic character.
The characteristic features of depression in alcohol and drug addiction became the reason for the allocation of these pathologies into a separate group. The effectiveness of treatment in such cases is ensured by the involvement of several specialists (psychologist, psychotherapist, narcologist, and in the last stages also a neuropathologist and psychiatrist).
Iatrogenic depressions
The very name "iatrogenic" (literally "caused by a doctor" or "having a medical origin") speaks for itself - this is the name of depression associated with the use of drugs.
The most common "culprits" of iatrogenic depression are the following medications:
- antihypertensive drugs (drugs that lower blood pressure) - reserpine, raunatin, apressin, clonidine, methyldopa, propranalol, verapamil;
- antimicrobials - sulfanilamide derivatives, isoniazid, some antibiotics;
- antifungals (amphotericin B);
- antiarrhythmic drugs (cardiac glycosides, novocainamide);
- hormonal agents (glucocorticoids, anabolic steroids, combined oral contraceptives);
- lipid-lowering drugs (used for atherosclerosis) - cholestyramine, pravastatin;
- chemotherapeutic agents used in oncology - methotrexate, vinblastine, vincristine, asparaginase, procarbazine, interferons;
- drugs used to reduce gastric secretion - cimetidine, ranitidine.
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Therefore, any medicines designed for long-term use must be used as directed and under the supervision of a physician.
Iatrogenic depression, as a rule, occurs only with long-term use of these drugs. In such cases, the state of general depression rarely reaches a significant depth, and the emotional background of patients is completely normalized after the withdrawal of the medication that caused the symptoms of depression.
The exception is iatrogenic depression that has developed in patients suffering from pathologies such as:
- disorders of cerebral circulation (often accompanied by hypertension and atherosclerosis);
- coronary heart disease (as a rule, is a consequence of atherosclerosis and leads to arrhythmias);
- heart failure (often treated with cardiac glycosides);
- peptic ulcer of the stomach and duodenum (usually occurs with high acidity);
- oncological diseases.
In such cases, the appointment of "suspicious" drugs can provoke an exacerbation of symptomatic depression or aggravate the course of depression associated with an organic defect in the nervous system. Therefore, in addition to the abolition of the drug that caused depression, special treatment for symptoms of depression (psychotherapy, prescription of antidepressants) may also be needed.
Prevention of iatrogenic depression consists in observing all precautions when prescribing drugs that can cause depression, namely:
- patients with a tendency to depression need to select drugs that do not have the ability to suppress the emotional background;
- these drugs (including combined oral contraceptives) should be prescribed by the attending physician, taking into account all indications and contraindications;
- treatment should be carried out under the supervision of a doctor, the patient should be informed of all unpleasant side effects - timely replacement of the drug will help to avoid many troubles.
Symptoms and signs of depression
Psychological, neurological and vegetative-somatic signs of depression
All signs of depression can be conditionally divided into the actual symptoms of a mental disorder, symptoms of a violation of the central nervous system (neurological symptoms) and symptoms of functional disorders of various organs and systems of the human body (vegetative-somatic signs).TO signs of a mental disorder refers, first of all, to the depressive triad, which combines the following groups of symptoms:
- decrease in the general emotional background;
- inhibition of thought processes;
- decrease in motor activity.
The inhibition of thought processes is expressed in slow speech, short monosyllabic answers. Patients think for a long time about solving simple logical tasks, their memory and attention functions are significantly reduced.
A decrease in motor activity is manifested in slowness, sluggishness, a feeling of stiffness of movements. In severe depression, patients fall into a stupor (a state of psychological immobility). In such cases, the posture of patients is quite natural: as a rule, they lie on their backs with outstretched limbs or sit, bent over, bowing their heads and resting their elbows on their knees.
Due to a decrease in general motor activity, the facial muscles seem to freeze in one position, and the face of depressed patients acquires the character of a kind of mask of suffering.
Against the background of a suppressed emotional background, even with mild psychogenic depression, patients have a sharp decrease in self-esteem, and delusional ideas of their own inferiority and sinfulness are formed.
In mild cases, we are talking only about a clear exaggeration of their own guilt, in severe cases, patients feel the burden of responsibility for all, without exception, the troubles of their neighbors and even for all the cataclysms taking place in the country and in the world as a whole.
A characteristic feature of delirium is that patients are practically not amenable to persuasion and, even fully realizing the absurdity of the assumptions made and agreeing with the doctor, after a while they again return to their delusional ideas.
Psychiatric disorders are associated with neurological symptoms , the main of which is sleep disturbance.
A characteristic feature of insomnia in depression is early awakening (about 4-5 am), after which patients can no longer fall asleep. Often patients claim that they did not sleep all night, while medical staff or loved ones saw them sleeping. This symptom indicates a loss of the sense of sleep.
In addition, a variety of appetite disorders are observed in depressed patients. Sometimes bulimia (gluttony) develops due to loss of satiety, but loss of appetite up to complete anorexia is more common, so patients can lose significant weight.
Violations of the activity of the central nervous system lead to functional pathology of the reproductive sphere. Women experience menstrual irregularities up to the development of amenorrhea (absence of menstrual bleeding), men often develop impotence.
TO vegetative-somatic signs of depression applies Protopopov's triad:
- tachycardia (increased heart rate);
- mydriasis (dilated pupil);
Another characteristic sign of a violation of the activity of the autonomic nervous system is the abundance of complaints of pain (heart, joint, head, intestinal), while laboratory and instrumental studies do not reveal signs of serious pathology.
Criteria for the diagnosis of depression
Depression refers to diseases, the diagnosis of which, as a rule, is established by external signs without the use of laboratory tests and complex instrumental examinations. At the same time, clinicians identify the main and additional symptoms of depression.The main symptoms of depression
- a decrease in mood (determined by the sensation of the patient himself or from the words of relatives), while a reduced emotional background is observed almost daily for most of the day and lasts at least 14 days;
- loss of interest in activities that used to bring pleasure; narrowing the range of interests;
- decreased energy tone and increased fatigue.
- decreased ability to concentrate;
- decreased self-esteem, loss of self-confidence;
- delusions of guilt;
- pessimism;
- thoughts of suicide;
- sleep disorders;
- appetite disorders.
Positive and negative signs of depression
As you can see, not all the symptoms that occur with depression are included in the criteria for making a diagnosis. Meanwhile, the presence of certain symptoms and their severity make it possible to recognize the type of depression (psychogenic, endogenous, symptomatic, etc.).In addition, focusing on the leading symptoms of emotional and volitional disorders - whether it is longing, anxiety, detachment and withdrawal into oneself or the presence of delusional ideas of self-abasement - the doctor prescribes one or another drug or resorts to non-drug therapy.
For convenience, all the psychological symptoms of depression are divided into two main groups:
- positive symptoms (the appearance of any sign that is not normally observed);
- negative symptoms (loss of any psychological ability).
- Longing in depressive states is in the nature of painful mental suffering and is felt in the form of intolerable oppression in the chest or in the epigastric region (under the pit of the stomach) - the so-called precordial or epigastric longing. As a rule, this feeling is combined with despondency, hopelessness and despair, and often leads to suicidal impulses.
- Anxiety often has an indefinite character of a painful premonition of an irreparable disaster and leads to constant timid tension.
- Intellectual and motor retardation is manifested in the slowness of all reactions, impaired attention function, loss of spontaneous activity, including the performance of everyday simple duties, which become a burden to the patient.
- Pathological circadian rhythm - characteristic fluctuations in the emotional background during the day. At the same time, the maximum severity of depressive symptoms occurs in the early morning hours (for this reason, most suicides occur in the first half of the day). By the evening, the state of health, as a rule, improves significantly.
- Ideas of one's own insignificance, sinfulness and inferiority, as a rule, lead to a kind of reassessment of one's own past, so that the patient sees his own life path as a continuous series of failures and loses all hope for "light at the end of the tunnel."
- Hypochondriacal ideas - represent an exaggeration of the severity of associated physical ailments and / or fear of sudden death from an accident or fatal illness. With severe endogenous depression, such ideas often take on a global character: patients claim that “everything is already rotten in the middle”, certain organs are missing, etc.
- Suicidal thoughts - the desire to commit suicide sometimes takes on an obsessive character (suicide mania).
- Painful (mournful) insensitivity - most common in manic-depressive psychosis and is a painful feeling of complete loss of the ability to experience such feelings as love, hate, compassion, anger.
- Moral anesthesia is mental discomfort due to the realization of the loss of elusive emotional ties with other people, as well as the extinction of such functions as intuition, fantasy and imagination (also most characteristic of severe endogenous depressions).
- Depressive devitalization - the disappearance of the desire for life, the extinction of the instinct of self-preservation and the main somatosensory urges (libido, sleep, appetite).
- Apathy - lethargy, indifference to the environment.
- Dysphoria - gloominess, grouchiness, pettiness in claims to others (more common with involutional melancholy, senile and organic depressions).
- Anhedonia - the loss of the ability to enjoy everyday life (communication with people and nature, reading books, watching television series, etc.), is often recognized and painfully perceived by the patient, as another proof of his own inferiority.
Treatment for depression
What medications can help with depression
What are antidepressantsThe main group of drugs prescribed for depression are antidepressants - drugs that increase the emotional background and return the patient the joy of life.
This group of medicines was discovered in the middle of the last century quite by accident. Doctors used the new drug isoniazid and its analogue, iproniazid, to treat tuberculosis and found that patients' mood improved significantly even before the symptoms of the underlying disease began to subside.
Subsequently, clinical trials have shown a positive effect of the use of iproniazid for the treatment of patients with depression and nervous exhaustion. Scientists have found that the mechanism of action of the drug is to inhibit the enzyme monoamine oxidase (MAO), which inactivates serotonin and norepinephrine.
With regular use of the drug, the concentration of serotonin and norepinephrine in the central nervous system increases, which leads to an increase in mood and an improvement in the overall tone of the nervous system.
Today, antidepressants are a popular group of medicines, which is constantly updated with more and more new drugs. A common feature of all these drugs is the specificity of the mechanism of action: one way or another, antidepressants potentiate the action of serotonin and, to a lesser extent, norepinephrine in the central nervous system.
Serotonin is called the “joy” neurotransmitter, it regulates impulsive desires, facilitates falling asleep and normalizes the change of sleep cycles, reduces aggressiveness, increases pain tolerance, eliminates obsessions and fears. Norepinephrine potentiates cognitive abilities and is involved in maintaining the state of wakefulness.
Different drugs from the group of antidepressants differ in the presence and severity of the following effects:
- stimulating effect on the nervous system;
- sedative (calming) effect;
- anxiolytic properties (relieves anxiety);
- anticholinergic effects (such drugs have many side effects and are contraindicated in glaucoma and some other diseases);
- hypotensive effect (lower blood pressure);
- cardiotoxic effect (contraindicated in patients suffering from serious heart disease).
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Prozac drug. One of the most popular first-line antidepressants. It has been successfully used for teenage and postpartum depression (breastfeeding is not a contraindication to Prozac).
Today, doctors are trying to prescribe new generation antidepressant drugs that have a minimum of contraindications and side effects.
In particular, such drugs can be prescribed to pregnant women, as well as to patients suffering from heart disease (IHD, heart defects, arterial hypertension, etc.), lungs (acute bronchitis, pneumonia), blood system (anemia), urolithiasis (including including complicated renal failure), severe endocrine pathologies (diabetes mellitus, thyrotoxicosis), glaucoma.
Antidepressants of new generations are called first-line drugs. These include:
- selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Fevarin), citalopram (Cipramil);
- selective serotonin reuptake stimulants (SSOZS): tianeptine (coaxil);
- individual representatives of selective norepinephrine reuptake inhibitors (SNRIs): mianserin (lerivon);
- reversible inhibitors of monoamine oxidase type A (OIMAO-A): pirlindol (pyrazidol), moclobemide (Aurorix);
- adenosylmethionine derivative - ademetionine (heptral).
For second-line drugs include drugs of the first generations of antidepressants:
- monoamine oxidase inhibitors (MAOIs): iproniazid, nialamide, phenelzine;
- thymoanaleptics of a tricyclic structure (tricyclic antidepressants): amitriptyline, imipramine (melipramine), clomipramine (anafranil), doxilin (sinequan);
- some representatives of SNRIs: maprotiline (ludiomil).
However, a significant number of contraindications and side effects, poor compatibility with many therapeutic agents, and in some cases the need to follow a special diet (MAOI) significantly limit their use. Therefore, second-line antidepressants are used, as a rule, only in cases where first-line drugs for one reason or another did not suit the patient.
How does a doctor choose an antidepressant?
In cases where the patient has already successfully taken an antidepressant, doctors usually prescribe the same drug. Otherwise, drug treatment for depression begins with first-line antidepressants.
When choosing a drug, the doctor focuses on the severity and prevalence of certain symptoms. So, in depressions that occur mainly with negative and asthenic symptoms (loss of taste for life, lethargy, apathy, etc.), drugs with a slight stimulating effect are prescribed (fluoxetine (Prozac), moclobemide (Aurorix)).
In cases where positive symptoms predominate - anxiety, melancholy, suicidal impulses, antidepressants with a sedative and anti-anxiety effect are prescribed (maprotiline (ludiomil), tianeptine (coaxil), pirlindol (pyrazidol)).
In addition, there are first-line drugs that have a universal effect (sertraline (Zoloft), fluvoxamine (Fevarin), citalopram (Cipramil), paroxetine (Paxil)). They are prescribed to patients in whom the positive and negative symptoms of depression are equally pronounced.
Sometimes doctors resort to the combined prescription of antidepressant drugs, when the patient takes an antidepressant in the morning with a stimulating effect, and in the evening - with a sedative.
What drugs can be prescribed additionally in the treatment of antidepressants
In severe cases, doctors combine antidepressants with drugs from other groups, such as:
- tranquilizers;
- neuroleptics;
- nootropics.
The combination of antidepressants with tranquilizers is also used in patients with severe sleep disorders. In such cases, a stimulating antidepressant is prescribed in the morning, and a tranquilizer in the evening.
Antipsychotics- a group of drugs intended for the treatment of acute psychosis. In the combined therapy of depression, neuroleptics are used for severe delusions and suicidal tendencies. At the same time, "light" antipsychotics (sulpiride, risperidone, olanzapine) are prescribed, which do not have side effects in the form of a general depression of the psyche.
Nootropics- a group of drugs that have a general stimulating effect on the central nervous system. These drugs are prescribed in the combined therapy of depression that occurs with symptoms of exhaustion of the nervous system (fatigue, weakness, lethargy, apathy).
Nootropics do not have a negative impact on the functions of internal organs, they are well combined with drugs from other groups. However, it should be borne in mind that they can, albeit slightly, increase the threshold for convulsive readiness and can cause insomnia.
What you need to know about medication for depression
- Tablets are best taken at the same time. Depressed patients are often absent-minded, so doctors suggest keeping a diary to keep track of drug use, as well as notes on its effectiveness (improvement, no change, unpleasant side effects).
- The therapeutic effect of drugs from the group of antidepressants begins to appear after a certain period after the start of administration (after 3-10 or more days, depending on the specific drug).
- Most of the side effects of antidepressants, on the contrary, are most pronounced in the first days and weeks of admission.
- Contrary to popular belief, drugs intended for the medical treatment of depression, when taken in therapeutic doses, do not cause physical and mental dependence.
- Antidepressants, tranquilizers, antipsychotics and nootropics do not develop addiction. In other words: there is no need to increase the dose of the drug for long-term use. On the contrary, over time, the dose of the drug may be reduced to the minimum maintenance dose.
- With a sharp cessation of antidepressants, the development of a withdrawal syndrome is possible, which is manifested by the development of such effects as melancholy, anxiety, insomnia, and suicidal tendencies. Therefore, drugs used to treat depression are discontinued gradually.
- Treatment with antidepressants should be combined with non-drug treatments for depression. Most often, drug therapy is combined with psychotherapy.
- Drug therapy for depression is prescribed by the attending physician and is carried out under his supervision. The patient and / or his relatives should promptly inform the doctor about all adverse side effects of treatment. In some cases, individual reactions to the drug are possible.
- The replacement of an antidepressant, the transition to combined treatment with drugs from different groups and the termination of drug therapy for depression are also carried out on the recommendation and under the supervision of the attending physician.
Do I need to see a doctor for depression?
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Almost everyone endured transient periods of blues and melancholy, when the world around them is seen in gray and black colors. Such periods can be associated with both external (breakup of relationships with loved ones, trouble at work, moving to another place of residence, etc.) and internal causes (adolescence in adolescents, midlife crisis, premenstrual syndrome in women and so on.).
Most of us are saved from general depression by already proven means at hand (reading poetry, watching TV, communicating with nature or loved ones, a favorite job or hobby) and can testify to the possibility of self-healing.
However, doctor-time may not help everyone. Professional help should be sought if any of the following warning signs of depression are present:
- depressed mood persists for more than two weeks and there is no tendency to improve the general condition;
- previously helped methods of relaxation (communication with friends, music, etc.) do not bring relief and do not distract from gloomy thoughts;
- there are thoughts of suicide;
- disrupted social ties in the family and at work;
- the circle of interests narrows, the taste for life is lost, the patient "goes into himself."
A person who is depressed will not be helped by advice that “you need to pull yourself together”, “get busy”, “have fun”, “think about the suffering of loved ones”, etc. In such cases, the help of a professional is necessary, because:
- even with mild depression, there is always a threat of a suicide attempt;
- depression significantly reduces the patient's quality of life and performance, adversely affects his immediate environment (relatives, friends, colleagues, neighbors, etc.);
- like any disease, depression can worsen over time, so it is better to consult a doctor in a timely manner to ensure a speedy and full recovery;
- depression can be the first sign of severe bodily ailments (oncological diseases, multiple sclerosis, etc.), which are also better treated in the early stages of pathology development.
Which doctor should be consulted for the treatment of depression
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Before visiting a doctor, it is better to think over the answers to questions that are usually asked at the initial appointment:
- About complaints
- what worries more melancholy and anxiety or apathy and lack of "taste of life"
- whether depressed mood is combined with sleep disturbances, appetite, sexual desire;
- at what time of the day are pathological symptoms more pronounced - in the morning or in the evening
- whether there were thoughts of suicide.
- History of present illness:
- with what the patient associates the development of pathological symptoms;
- how long ago they appeared;
- How did the disease develop?
- what methods the patient tried to get rid of unpleasant symptoms;
- what medications the patient took on the eve of the development of the disease and continues to take today.
- Current state of health(it is necessary to report all concomitant diseases, their course and methods of therapy).
- Life story
- past psychological trauma;
- have had episodes of depression before;
- past illnesses, injuries, operations;
- attitude towards alcohol, smoking and drugs.
- Obstetric and gynecological history(for women)
- whether there were menstrual irregularities (premenstrual syndrome, amenorrhea, dysfunctional uterine bleeding);
- how the pregnancies went (including those that did not end with the birth of a child);
- whether there were signs of postpartum depression.
- Family history
- depression and other mental illnesses, as well as alcoholism, drug addiction, suicide among relatives.
- Social history(relationships in the family and at work, can the patient count on the support of relatives and friends).
Severe endogenous depression, as a rule, is treated by a psychiatrist in a hospital setting. Therapy of organic and symptomatic depression is carried out by the psychologist together with the doctor in charge of the underlying pathology (neurologist, oncologist, cardiologist, endocrinologist, gastroenterologist, phthisiatrician, etc.).
How a specialist treats depression
An obligatory method of treatment of depressive conditions is psychotherapy or treatment with a word. Most often, it is carried out in combination with pharmacological (drug) therapy, but can also be used as an independent method of treatment.The primary task of a specialist psychologist is to establish a trusting relationship with the patient and his immediate environment, provide information about the nature of the disease, methods of its treatment and possible prognosis, correct violations of self-esteem and attitude to the surrounding reality, create conditions for further psychological support of the patient.
In the future, they proceed to the actual psychotherapy, the method of which is chosen individually. Among the generally accepted methods, the most popular are the following types of psychotherapy:
- individual
- group;
- family;
- rational;
- suggestive.
- deep study of the personal characteristics of the patient's psyche, aimed at identifying the mechanisms of development and maintenance of a depressive state;
- the patient's awareness of the features of the structure of his own personality and the causes of the development of the disease;
- correction of the patient's negative assessments of his own personality, his own past, present and future;
- rational solution of psychological problems with the closest people and the surrounding world in all its integrity;
- informational support, correction and potentiation of ongoing drug therapy for depression.
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Family Psychotherapy– psychocorrection of interpersonal relations of the patient with the immediate social environment. At the same time, work can be carried out both with one family and with a group consisting of several families with similar problems (group family psychotherapy).
Rational psychotherapy consists in the patient's logical evidence-based conviction of the need to reconsider his attitude towards himself and the surrounding reality. At the same time, both methods of clarification and persuasion, as well as methods of moral approval, distraction and switching attention are used.
suggestive therapy is based on suggestion and has the following most common variants:
- suggestion in the waking state, which is a necessary moment of any communication between a psychologist and a patient;
- suggestion in a state of hypnotic sleep;
- suggestion in a state of medical sleep;
- self-hypnosis (autogenic training), which is carried out by the patient on his own after several training sessions.
- physiotherapy
- magnetotherapy (using the energy of magnetic fields);
- light therapy (prevention of exacerbations of depression in the autumn-winter period with the help of light);
- acupuncture (irritation of reflexogenic points with the help of special needles);
- music therapy;
- aromatherapy (inhalation of aromatic (essential) oils);
- art therapy (therapeutic effect of the patient's fine arts)
- physiotherapy;
- massage;
- treatment with the help of reading verses, the Bible (bibliotherapy), etc.
For severe, drug-resistant depression, shock therapy methods can be used, such as:
- Electroconvulsive therapy (ECT) involves passing an electric current through the patient's brain for a few seconds. The course of treatment consists of 6-10 sessions, which are carried out under anesthesia.
- Sleep deprivation - refusal of sleep for a day and a half (the patient spends the night without sleep and the whole next day) or late sleep deprivation (the patient sleeps until one in the morning, and then goes without sleep until the evening).
- Unloading and dietary therapy is a long-term fasting (about 20-25 days) followed by a restorative diet.
What is postpartum depression?
postpartum depression called a depressive state that develops in the first days and weeks after childbirth in women prone to such a pathology.A high likelihood of developing postpartum depression should be said when there are risk factors from different groups, such as:
- genetic (episodes of depression in close relatives);
- obstetric (pathology of pregnancy and childbirth);
- psychological (increased vulnerability, psychological trauma and depressive states);
- social (absence of a husband, conflicts in the family, lack of support from the immediate environment);
- economic (poverty or the threat of a decrease in the level of material well-being after the birth of a child).
These fluctuations occur against a background of strong physiological (weakening of the body after pregnancy and childbirth) and psychological stress (anxiety in connection with the birth of a child) and, therefore, cause transient (transient) signs of depression in more than half of women in labor.
Most women experience mood swings, decreased physical activity, decreased appetite, and sleep disturbances immediately after childbirth. Many women in childbirth, especially primiparas, experience increased anxiety, they are tormented by fears of whether they can become a full-fledged mother.
Transient signs of depression are considered a physiological phenomenon when they do not reach a significant depth (women perform their duties of caring for a child, participate in the discussion of family problems, etc.) and completely disappear in the first weeks after childbirth.
Postpartum depression is referred to when at least one of the following symptoms is observed:
- emotional depression, sleep and appetite disturbances persist for several weeks after childbirth;
- signs of depression reach a considerable depth (a woman in labor does not fulfill her duties in relation to the child, does not participate in the discussion of family problems, etc.);
- fears become obsessive, ideas of guilt towards the child develop, suicidal intentions arise.
Depressive states of moderate depth are characterized by various phobias (fear of the sudden death of a child, fear of losing a husband, less often fears for one's health), which are accompanied by sleep and appetite disorders, as well as behavioral excesses (often of the hysteroid type).
With the development of deep depression, as a rule, negative symptoms predominate - apathy, narrowing of the circle of interests. At the same time, women are disturbed by the painful feeling of inability to feel love for their own child, for their husband, for close relatives.
Often there are so-called contrasting obsessions, accompanied by a fear of harming the child (hit with a knife, pour boiling water over it, throw it off the balcony, etc.). On this basis, ideas of guilt and sinfulness develop, and suicidal tendencies may appear.
Treatment of postpartum depression depends on its depth: for transient depressive states and mild depression, psychotherapeutic measures are prescribed (individual and family psychotherapy), for moderate postpartum depression, a combination of psychotherapy and drug therapy is indicated. Severe postpartum depression often becomes an indication for hospitalization in a psychiatric clinic.
Prevention of postpartum depression includes attending classes to prepare for childbirth and care for the newborn. Women who have a predisposition to the development of postpartum depression, it is better to be under the supervision of a psychologist.
It has been noted that depressive states after childbirth often develop in suspicious and "hyper-responsible" primiparas, who spend a long time on "mother's" forums and reading relevant literature, looking for symptoms of non-existent diseases in the baby and signs of their own maternal failure. Psychologists say that the best prevention of postpartum depression is proper rest and communication with the child.
What is teen depression?
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According to statistics, about 10% of teenagers suffer from signs of depression. At the same time, the peak of psychological troubles falls on the middle of adolescence (13-14 years). The psychological vulnerability of adolescents is explained by a number of physiological, psychological and social characteristics of adolescence, such as:
- associated with puberty endocrine storm in the body; increased growth, often leading to asthenia (depletion) of the body's defenses;
- physiological lability of the psyche;
- increased dependence on the immediate social environment (family, school staff, friends and buddies);
- the formation of a personality, often accompanied by a kind of rebellion against the surrounding reality.
- symptoms of sadness, melancholy and anxiety characteristic of depressive states in adolescents often manifest themselves in the form of gloom, capriciousness, outbursts of hostile aggression towards others (parents, classmates, friends);
- often the first sign of depression in adolescence is a sharp decline in academic performance, which is associated with several factors at once (decreased attention function, increased fatigue, loss of interest in learning and its results);
- isolation and withdrawal in adolescence, as a rule, manifests itself in the form of a narrowing of the social circle, constant conflicts with parents, frequent changes of friends and acquaintances;
- the ideas of own inferiority characteristic of depressive states in adolescents are transformed into an acute rejection of any criticism, complaints that no one understands them, no one loves them, etc.
- apathy and loss of vitality in adolescents, as a rule, is perceived by adults as a loss of responsibility (missing classes, being late, careless attitude to one's own duties);
- in adolescents more often than in adults, depressive states are manifested by bodily pains unrelated to organic pathology (headaches, pains in the abdomen and in the region of the heart), which are often accompanied by fear of death (especially in suspicious adolescent girls).
Most cases of teenage depression respond well to psychotherapy. With severe manifestations of depression, pharmacological drugs are prescribed that are recommended for use at this age (fluoxetine (Prozac)). In extremely severe cases, hospitalization in a psychiatric department of a hospital may be necessary.
The prognosis for adolescent depression in the case of timely treatment to the doctor is usually favorable. However, if the child does not receive the help he needs from doctors and the immediate social environment, various complications are possible, such as:
- aggravation of signs of depression, withdrawal into oneself;
- suicide attempts;
- running away from home, the appearance of a passion for vagrancy;
- propensity to violence, desperate reckless behavior;
- alcoholism and / or drug addiction;
- early promiscuity;
- joining socially unfavorable groups (sects, youth gangs, etc.).
Does stress affect the development of depression?
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Such depressions develop gradually, so that the patient sometimes cannot say exactly when the first symptoms of depression appeared.
Often, the root cause of neurasthenic depression is the inability to organize one's work and rest, leading to constant stress and the development of chronic fatigue syndrome.
The exhausted nervous system becomes especially sensitive to external influences, so that even relatively minor life hardships can cause severe reactive depression in such patients.
In addition, constant stress can provoke an exacerbation of endogenous depression and worsen the course of organic and symptomatic depression.