Depression is dangerous. Vitamins and minerals. Stages of treatment for depression

Unfortunately for most depressed patients, "recovery" has always meant a return to the comfortable state of unhappiness we were in before the illness became unbearable. Research shows that feeling really good is the most last step recovery and most people never get there. However, those who do are much less likely to have episodes in the future than people who do not fully recover. They have learned new skills that separated them from depression and have changed their brains so that they are no longer subject to the onslaught of depression and stress hormones that make it easier to relapse.

Experience of Joy

Remember that the constant struggle with depression causes damage to the brain, especially those parts of it that are associated with the experience of joy and pleasure. We stop producing chemical messengers of happiness, and nerve centers, created for their perception, disappear. We don't just find life dull and dull - we really feel it that way. And, of course, the consequences go far beyond our brains. If we fail to express happiness when appropriate, people resent us or avoid us altogether. We lose motivation because we don't want anything. It takes a focused effort to undo the damage that has been done, and we do this when we look for positive experiences and are mindful of the feelings they evoke.

Regular practice of mindfulness meditation has been shown to rewire the brain accordingly. The use of mindfulness skills in everyday life helps to concentrate attention, see things as they are, stop judging and enjoy the beauty of man and nature, sensory experiences. It turns out that we all have individual points on the "thermostat of happiness" to which we return after each positive or negative experience.

Depressed people have a set of points shifted to the gloomy side, but this can be corrected. The Positive Psychology movement* has recently questioned whether psychological principles can be used to help people feel good rather than just relieve grief, and has made some headway in this area. Proponent Chris Peterson's book A Primer in Positive Psychology is full of practical tips and techniques designed to help you see more joy in life.

*The movement was born in 1999 in the USA, among the founders are Martin Seligman and Mihaly Csikszentmihalyi. In 2002, it left the country. The main slogan of the movement is to shift the focus from the negative and problematic aspects to the positive and strengths without breaking away from scientific methodology.

Here are some of my tips for achieving mindfulness:

• Set aside some time each day when you are by yourself and enter into a state of reflection - through focused meditation, a long walk, in a warm bath, in church - somewhere where you are not distracted. In the process, try to maintain a compassionate curiosity about yourself. See yourself as a wise and loving friend.
• Watch where your mind goes when you leave it unattended. Develop an "inner eye" that controls thoughts when you are not paying attention to them. When you drive, walk, or fall asleep, does your mind linger on successes or failures? Do you constantly return to cases of shame and humiliation? Are you constantly worrying about the next item on your mental to-do list? Are you afraid to think too deeply about the future? If so, it's no wonder you're depressed. Practice monitoring your thoughts and don't let them command you.
• If you find yourself constantly judging yourself, try to convince yourself that judging is depression. An inner bully lives in you, who constantly upsets you and arranges beatings. Instead of unconsciously defending yourself when he appears, try to remember that he is not telling the truth, but just a distorted version of reality, trying his best to find flaws in you. If you have ever encountered such a person, you must understand that it is impossible to convince, argue or defend against him. Whatever you say, he will throw it back. You need a sudden rescue that comes from above like a rope and pulls you out of the confrontation. Such a rope is awareness and the detachment that comes with it. As you move away from the fight and soar, the scores and attacks seem to get smaller and smaller, weaker and weaker.
• If you worry too much, constantly reacting to fears, consider that the problem may be the very handling of fear. If you try to drown it out or forget about it, it will just come back later, maybe in a different form. If you are afraid to look closely at him, he will simply come closer. Perhaps there is a deepest fear - that you are incompetent and flawed, doomed to hard work and you have no hope for happiness. One big secret I've learned from my patients is that all people, even the most successful and productive ones, experience these kinds of fears sometimes. Take them out into the daylight, examine them with sympathetic curiosity. No person who can read this book is 100% competent or perfect. Perhaps this thought came to you from some old, bad experiences, but now they are in the past. If you can face your fears about yourself, they will lose power over you.
• Pay attention to dreams. Keep a stack of paper next to your bed and write them down if you can remember when you woke up. What are they about? Are you lost or trapped? Are you fighting or running? Is there a scene from your childhood that keeps coming back? Such dreams often represent an attempt by the psyche to solve a problem that has been driven into the subconscious.
• Look for patterns in your life. Do you constantly feel like you are being used? Disappointed? Rejected? Do your novels always end badly? Do you always come across overly strict bosses, unfaithful lovers and work colleagues who ride on you? Maybe one of these problems is the luggage you carry with you. If so, try to leave it behind, let it go. Approach each new situation without ready assumptions, expect it to bring you something good.
• Where do you feel pain? Sometimes somatic symptoms have a symbolic meaning. Digestive problems may mean that you are trying to "swallow" something that you shouldn't. Back pain may indicate that you are carrying too much weight. Chronic fatigue may be trying to say that you are scared and depressed. Breathing problems - that someone is blocking your air.
• Talk to the people closest to you. Is there anything your friend would say about you if you let me? Maybe you are doing yourself a disservice - others see it, but you do not?
• Consider the course of your life. At what point did it all go wrong? When did you start to be afraid, to feel different, flawed? What was going on around you at that time? Were there problems with your parents or while studying at school? Have you been sick? Maybe something hurt or scared you and you didn't get help?
• If you can isolate such a trauma or loss, consider how you have adjusted to it. Adaptation actually creates most of the problems. If you, for example, began to feel flawed, what did you do to cover it up?

If you can't convince yourself that all this will work, pretend. "Play the role until the role is you" - remember this good advice from Alcoholics Anonymous. You are trying to change yourself at a deep level, and of course doubts will arise, but keep practicing no matter what. You don't have to believe everything I tell you - practice will lead to changes, and in the end you will be able to believe me, or maybe you will find another explanation for your way out of depression. The point is to practice.

Below is an exercise so simple that there is no excuse not to do it. Studies have shown that it has a prolonged positive effect on a person3.

Exercise: three good things

When you turn off the lights and go to bed, clear your mind of many thoughts and focus on the three good things that happened during the day. It can be small things - for example, dinner, an attractive person on the street, a familiar song heard. Sometimes it will be more significant things - your achievements or very pleasant experiences, but small events will also go.

Focus on the details of pleasant sensations. Do you feel pride, excitement, nostalgia, love, satisfaction? Do you want to smile at the memory? Focus on the facial muscles as the lips curl into a smile. Where else in your body do you feel these sensations? Are you getting warmer? Where? Do you feel an exciting lump in your throat? Can you hear the tension leaving you? Are you more comfortable in bed?

Imagine how the neurons in the brain form new paths to happiness - like little, tiny bulldozers, they expand the channels for joy. Remember that brain cells form new pathways simply because we are making memories. Imagine: to the withering receptors of joy, like streams of fresh water that feed the plants of the desert, endorphins flow. Remember that if you do this exercise regularly, you will change the points on the "thermostat of happiness" - you will rejoice more, easier and more often.

Fall asleep focusing on these pleasant sensations.

One study on this exercise found that participants felt happier and less depressed for a full six months, even though they were only asked to do it for a week. It turned out that many continued to do the exercise on their own initiative. Perhaps this will become a habit for you for life. It will be interesting if at some point in the future you start to feel depressed and angry and remember that you stopped exercising.

Thanks to this exercise, you will be able to “seize the moment” more often and easier, it will help you notice beauty, enjoy and be proud. “What a beautiful sunset! We must remember this evening. It is extremely difficult for depressed people to live in the present, to be fully aware, because they are distracted by their own suffering. This exercise will help you forget about them.

Maturity and wisdom

Depressed people need more support to feel complete, competent, and hopeful. However, they rarely seek help directly. Instead, patients distort their needs by presenting them in a variety of self-defeating ways, largely due to immature defense mechanisms that warp reality. These defensive reactions only increase the depressive situation.

Defensive reactions are a way to deal with the conflict between parts of our "I" that want different things. They are designed to keep this situation outside of consciousness. There is always conflict between desires and fears, impulses and the restraining forces of the mind. That's why depression is a defense mechanism: we "forget" what made us feel bad even though we still feel bad. The defensive reaction is directed not against emotions, but against awareness of the conflict. A loved one hurts us, but for some reason we don't want to feel anger or see the consequences of it in a relationship. Our mood is getting worse, and we don't know why.

Hope that explained: defense mechanisms- not a bad thing, they are necessary in life, but some of them are less useful than others. Defensive responses like acting out or passive aggression mask reality and can expose us to real danger or just have negative consequences. Other defensive responses, such as denial and projection, interfere very strongly and perhaps persistently with our ability to perceive reality, causing damage - in comparison with reactions that allow us to perceive life more correctly. These immature defense mechanisms can drive feelings and impulses out of our minds, but the biggest irony is that we still feel guilty and don't know why. This is why I recommend using a mood journal to track the relationship between shifts in emotional state and external events that caused them. We need a tool to bypass the defensive reactions and see that a depressed mood is a response to an external event that has awakened feelings that we try not to experience.

There is an alternative to these immature defensive reactions - ways to protect yourself from the realization of an uncomfortable conflict that distort reality much less. If we are able to perceive reality correctly, our actions are more likely to have the desired effect. An excellent overview and guide to understanding defensive reactions is George Vaillant's The Wisdom of the Ego. In it, he lists five mature defensive responses.

1. Altruism makes it possible to see that others have the same needs as I do and feel better about taking care of them. The paranoid looks at the mansions of the rich and considers himself deceived. An altruist cares for the poor and considers himself blessed. In addition, by doing so, he opens himself to the love and respect of other people.
2. Sublimation allows you to express uncontrollable feelings in a direct but socially acceptable way. Sublimation is a defense mechanism of poets, writers, playwrights. When Eugene O'Neill "transports" his tormented family onto the stage, he turns inner experiences into high art. When I come home from a meeting that has driven me and watch The Terminator, I indirectly sublimate the rage by watching someone else act it out.
3. suppression- a conscious decision to postpone the action. It is the awareness of conflict - an unacceptable desire or change in our world that we must inevitably make - and the decision to take no action, to leave the situation alone for the time being. We may consciously decide that it is best to wait, or we may simply feel embarrassed and unsure. But if we decide to move our remaining awareness of the conflict—perhaps gaining some time through intimate conversations about it, daydreaming, venting anxiety—we apply suppression, and that usually leads to better solutions.
4. Premonition means that we deal with conflict anxiety in advance, little by little. It's like a vaccine against future stress. As with suppression, the conflict here is conscious, but we deal with it drop by drop, not buckets. Vaillant cites the example of Chuck Yeager and other “correct” test pilots: “Underestimating the danger is deadly. Exaggerate - limit the ability. So they worried in advance, made lists, practiced, and then, judging that they had prepared as well as possible, relaxed. Easy to say, hard to do."
5. humor hardest to define. At the moment of conflict, dilemma, when we find ourselves between the rock of desires and the stones of reality, mature humor makes us take a step back and look at the absurdity of the situation. It does not push the conflict and even anxiety out of our consciousness, but takes the edge off, removes some of their energy, shows that we can have fun even if everything goes wrong. Depressed people are very prone to black humor, and most of the best comedians are actually depressed. Learning to laugh at the absurdity of life is much better than fighting windmills, and if we let others laugh at a joke, our bonds with them will be strengthened.

The uninitiated reader may object that these are not skills, not defensive reactions, and not personality styles, but a conscious choice. Religion teaches altruism. Suppression is simply a mature delay in gratification. Everyone is able to see the funny side of the situation. But everything is not so simple. If everyone could suppress their impulses, there would be no need for prisons. If everyone were conscious altruists, there would be no need for charitable organizations. If people could anticipate reality, they would brush their teeth regularly. I would like to believe that we are able to find these abilities in ourselves, because we really like to look down on people who do not have them. But if we are honest with ourselves, we have to admit that we tried many times and nothing came of it. Try again and use the methods in this book to maximize your success.

On the other hand, many of my professional colleagues will object that it is pointless to advise people to practice mature defensive responses or cultivate compassion. There is an opinion in the circle of psychotherapists that patients can overcome deep-seated problems only through intensive psychotherapy. Representatives of the medical community believe that the problematic behavior that accompanies depression is not a cause, but just one of the consequences of a chemical imbalance. Both believe that it is futile, and perhaps even cruel, to expect great success from the patient's conscious attempts to change his behavior.

I don't agree with this. The more I get to know people, the more I believe that problems are caused by ignorance of alternatives, and not by pathology or resistance. This is an old philosophical debate about the opposition of free will and predestination. Do we have the power to choose the course of events, or does it only seem so? Maybe everything that happens to us is prescribed from above? Perhaps this is a logical consequence of a chain of events that goes back directly to the Prime Mover that launched life in the Universe? I do not intend to shy away from legitimate scientific questions, but I feel compelled to point out that the position of scientists on such topics is influenced not only by scientific factors, but also by personal values ​​and beliefs. Also, I know that true change comes with practice, not through therapy or medication. Both can help prepare you for change, but it takes hard practice to get started. The pragmatic answer is to act as if we have the power and the power to make a difference. And if it's not, we have no hope.

An optimistic observation: there is still such a thing as wisdom. When we grow up and at the same time learn from our experience, we see better what is really important, we become wiser. We don't lose sleep over the little things, we learn to appreciate what we have and let go of what we can't control. It's a little easier for us to laugh at the irony of fate. Altruism, humor and other mature defensive reactions are taught by life itself - we just have to learn the lessons diligently.

creative life

To the list of mature defenses compiled by Vaillant, I would add one more quality necessary for recovery from depression - the ability to be creative.

We tend to believe that creativity is unique to people of art - creative individuals who write, draw, dance, compose music, create sculptures and earn a living from this. But it is necessary in everyone's life. Creativity is the antithesis of depression. It's a way of saying that what I think and feel is important. Everyone participates in the creative process, whose work allows him to express himself or achieve something important; parents who devote themselves to raising children; people whose leisure gives them the opportunity to express themselves or change the world for the better.

Depression is not only a disease, but also an inability to create; she convinces us that there is no point in this. To recover, we must create meaning for ourselves. You have to make an effort to be fruitful. If we are suffering from depression, this is all the more important - vitally important. The challenge facing an adult is to create more life and serve a purpose, otherwise we are doomed to stagnation. Our challenge is to find a way to grow above ourselves, create and create, when we realized that life is short and it is impossible to do everything you want. To rot, to close in on oneself, to decompose - it's scary.

Once in my group, a patient stated that depression was satisfying. Everyone looked at her in surprise: this is far from what we were thinking at that moment. “I'm serious,” she said. - Sometimes I feel that I have a right to be depressed. I feel like I've endured a lot in my life, and if anyone deserves self-pity, it's me. In depression, a person is safe and comfortable, you can wrap yourself in it, like in a big old blanket. At night I am warm with all my grievances. It may be lonely, but I am sure of my righteousness.” I have never heard anyone better describe the seductive side of stagnation. Stagnation implies something simple, quiet and unambitious. You can sit at home, watch TV and feel sorry for yourself. It's easier than working out of depression. The problem is that stagnation is not static. Once you start to rot, you can't stop the situation. You can watch TV in a bathrobe for several weeks without harm to your health, but if you continue to do so, you will harm yourself. Your self-esteem, ambitions, humor will suffer, vital juices will dry up. Soon it will be difficult to leave the house at all, you will stop answering the phone and very soon put your head in the gas oven.

The fact is that the only choice for us to evolve or die. The only long-term cure for depression is to live right: be productive, generous, caring, think about others. We achieve happiness by our own efforts, it cannot be bought or received, it will not be given by someone else. It's a side effect of a certain lifestyle that helps us feel good about ourselves. Happiness comes from full participation in life, attention to the current moment, to the life process.

But right life does not boil down to loyalty to duty. It implies constant joy in the process. This means being not only responsible, but also creative. For creativity, an element of the game is necessary, so you can try to look at ordinary things with new perspective- for example, through the eyes of a child who has not yet learned to see them in the usual way, and can notice interesting combinations, fresh solutions. A new whole emerges that is greater than the sum of its parts, and this is where the appreciation of humor and paradox comes in handy. Creativity is a synthesis of rationality and emotion. For example, in fine arts, literature and music, the creator, through self-discipline, creates a work that expresses the emotions of the author and includes the emotions of the viewer. We admire craftsmanship and technique, but without the emotional involvement, we wouldn't be touched by it. In science and engineering, a creative person is driven by emotional involvement in a problem - to go beyond the usual, to find a unique solution. A person is challenged, and the problem stimulates him. Solving it means being on the wave.

Creativity is the perfect mastery of anxiety. There is a recognized process of creativity that begins with hard work. You dive into a problem or a project and collect all the available information that you might need. The more open you are to new knowledge, fresh points of view, the more more likely interesting solutions. But it creates stress. We hear conflicting ideas and advice on a topic that is important to us and become confused. It is difficult for us to keep all this information in our heads. We can fall into despair: why is there no simple answer? Then we turn despair on ourselves: what is wrong with us if we cannot find the answer? And we continue to search for information until it overloads us. Anxiety becomes unbearable and we put the problem aside.

If we are depressed, the creative process will most likely end there, because we will self-censor the next phase in which our unconscious works on a task. If there is no depression, the unconscious will begin to play with the problem, connecting and rearranging information in a way that consciousness cannot. In the end, during a run, in the shower or before falling asleep, the pieces of the puzzle will fall into place, and we will understand: “This is it!” The solution is clear and obvious. We forget about all the hard work and worries that preceded it.

We must consider that we are capable of creativity in all aspects of our lives, and not just in the artist's studio or in the research laboratory. The same principles can be applied to all the challenges we face: raising children, earning a living, difficult relationships with people. We should not just work on the problem, but play with it.

Most of us are familiar with the notion of a vicious circle—virtually all psychotherapist patients fall into it. One bad event sets off a reaction that sets off other bad events, causing more negative reactions, and so on down the well. A patient depressed after the death of her mother finds it difficult to concentrate on work; this pisses off the boss, and he fires her. She loses her health insurance, is unable to help her sick children, and becomes even more depressed as a result. A lesser known concept adaptive spiral. It is not as dramatic and lively as the vicious circle, but, fortunately for all of us, it is much more common. In it, our reaction to one good event increases the likelihood that something else good will happen to us. The couple make love, and as a result, the next day, the wife smiles a little more than usual. The boss notices her joy and gives her a special assignment. She enjoys the trust, continues to feel great, and eventually gets promoted.

In order to feel truly good about ourselves, we must see challenges ahead of us. Here, at the end of the book, I will give you one of them: consider that your "I" is your work. You are responsible for reshaping your personality. Ask for any help you need, but remember that in fact we are responsible for ourselves. Remember that if the goals are overly difficult, they lead to anxiety and frustration, and if the bar is set too low, we become bored and uninterested. So practice constructive behavior at a pace that motivates you. Find out your own feelings. Question your assumptions. Cultivate awareness and a sense of humor. Be an altruist. Smile more. Let these things at first seem insincere and imposed. You always feel this way when learning new things, and the feeling of insincerity will quickly pass. I hope I was able to explain: the brain and mind are very malleable, and what we perceive as "I" is the result of the gradual accumulation of habits, good and not very good. It is quite possible to change the "I" - your fundamental nature - and make yourself into anyone: for example, a strong, resilient person who can fight depression without even thinking about it. Because with enough practice, healthy new skills will become ingrained in our brains and become part of ourselves.

Depression is mental disorder, which has become a real "scourge" in modern society. The disease is being diagnosed more and more often, according to statistics, 30% of the female population and 15% of men have certain forms and stages of the disease.

But often a sick person denies the very fact of the existence of his disorder, therefore only half of those who need it seek professional help. The disease can reduce the quality of life of a person and worsen overall health.

Reasons for the development of the disease

The causes of depressive depressive state are gendered and differ significantly between both sexes. This is due to the difference in the way of thinking, social orientation and many other factors. In men, the disorder often occurs against the background of failures in the professional sphere, in women - with stress related to the family.

We list the main root causes of the disease:

• social factor. It includes the loss of a job, the lack of permanent earnings, the loss loved one or severe traumatic event;
• burdened heredity;
• side effects of certain types of drugs. For example, cyclosporins, corticosteroids, Trihexyphenidyl;
• diseases of neurological origin (dementia, epilepsy, narcolepsy, multiple sclerosis), somatic pathologies (oncological disease of any organ, liver cirrhosis, celiac disease), endocrine disorders (sugar and diabetes insipidus, Addison's disease). Hormonal changes. Especially affects the lack of serotonin, dopamine, norepinephrine.

Among the many forms and types of depression, we single out only those that occur most often. For example:

• neurotic. It develops after exposure to a traumatic factor. Most often proceeds as a protracted form of psychosis.
• Psychogenic or reactive. Becomes reciprocal pathological reaction body for long periods of stress.
• Postpartum. characteristic of women in postpartum period. It is manifested by a feeling of depression, unconscious anxiety, internal devastation, loss of interest in life, up to the alienation of your newborn child.
• Somatogenic. This kind depression occurs against the background of severe somatic pathologies.
• Circular or cyclic. This is a chronic course of depression, which is characterized by periods of exacerbation and subsidence of the pathological symptomatic picture. For example, seasonal apathy.

State of depression: risk group, symptoms

The risk group for depression primarily includes people who have been diagnosed with a serious diagnosis - oncological process, HIV infection, stroke

Depressive states are a common companion of patients who have received disability and helplessness. American scientists, through many years of observation and analysis of statistical data, have identified a risk group for people prone to developing such a condition.

It included:

• creative personalities;
• transsexuals (transgenders);
• people who have recently gone through or are going through a divorce;
• combat veterans and their children and adolescents;
• age over 45 years;
• African Americans.

It is believed that Virginia Woolf, Charles Dickens, Ernest Hemingway, Russian writer Leo Tolstoy had typical symptoms of chronic depression.

early and late signs

Early signs include the so-called bipolar "pressing triad", expressed in significant reduction performance, depressed mood and disorders associated with thinking.

More late symptoms can be divided into groups:

• psychological manifestations. They are expressed in a sharp and significant decrease in self-esteem, self-flagellation. A person loses interest in favorite activities, because the ability to rejoice disappears results. Communication in society is reduced to a minimum due to the loss of interest in others;
• physical manifestations. Patients complain of changes in appetite. Moreover, not only its increase can manifest itself, but also a complete loss of desire to eat. Sleep is disturbed, there are problems with falling asleep, drowsiness brings inconvenience or insomnia worsens the condition. Leading a normal life is prevented by pain in the epigastric region and the heart, decreased performance and sexual desire, weakness.

The state of depression is provoked by changes in mental activity and confusion of thoughts. For example, the process of memorizing a new amount of information is significantly reduced, the ability to independently and timely make decisions is lost, it is difficult to deal with the persistent feeling of helplessness, uselessness, lack of faith in the normalization of life in the near future.

Diagnosis of depression: methods of modern diagnostics and briefly about the features of the course

Set after a detailed diagnosis. The diagnostic methods are different kind tests and questionnaires. The most widely used is the Beck Depression Inventory, the accuracy of which is confirmed by famous specialists in the field of psychology and psychotherapy.

The average patient spends 10-14 minutes to complete the survey, the technique consists of 21 groups of statements, but allows you to identify masked signs of the disorder.

The "visual psychological test No. 4 for depression" is gaining more and more popularity. Testing can be carried out online and get a quick answer to the question of the presence / absence of this disorder in you. Doctors use specially designed scales to analyze the depth of the disorder.

Instrumental diagnostic measures are in "demand". For example, changes in the bioelectrical activity of the brain are recorded, especially during the period when the patient is sleeping. The vast majority of patients with this disorder have extended and asymmetric lateral ventricles brain. Sometimes laboratory tests for hormones are required to verify the diagnosis.

In children and adolescents, diagnosis consists in a physical examination of the patient, conducting and evaluating the results psychological tests, laboratory tests. Big diagnostic value have conversations not only with the child, but also with his parents. In a confidential form of communication, the doctor identifies family problems - the most common root causes of the disease in childhood and adolescence.

Features of the pathological condition in neurology and neurosurgery

According to statistics from the Russian Ministry of Health, a record 47% of neurological patients have depressive disorders, and major depression - 27%. A particularly high risk of getting sick in patients who have had a stroke. If the disorder could not be avoided, then suicidal tendencies are added to the main symptoms of the post-stroke state, cognitive functions worsen and overall quality life. Positive results of rehabilitation are not so noticeable, often there is an aggravation of disability.

Depression in traumatic brain injury usually appears in remote period. In duration, they last from several weeks to many years. They are manifested by affective psychoses, which are replaced by manic disorders. Dysphoria (depressed mood), hypochondria and tearfulness are the most striking and frequent symptoms characteristic of depression after TBI.

The most frequent questions of patients

A person who suspects a diagnosis of "chronic depression" traditionally asks several questions:

• Do I need to see a doctor? The answer is unequivocal - yes, you need to go for medical help at the first suspicions and the first symptoms of the disorder. The sooner the treatment starts to work, the lower the risk to your body.
• To what to go to the doctor? First of all, you should go to an appointment with a psychologist in the district clinic. If such a specialist is not available, then his functions are performed not only by a neuropathologist and psychiatrist, but also by a neurologist. The clinical psychologist will develop a medical program, incorporating traditional medical methods into the therapeutic scheme. A social psychologist will draw up a program to get out of a crisis situation. Clinical and social psychologists work on the basis of large clinics and crisis centers, where they will provide comprehensive assistance to every person.
• Methods of treatment that a specialist will prescribe? After assessing the severity of the course and the degree of neglect of the disease, the specialist will decide on the appointment of drug and non-drug therapy. Many therapeutic measures do not require a lot of time and / or significant financial expenses.

What is dangerous depression and how to treat it with vitamins, minerals, proper diet

Pharmacotherapy for depression may include antidepressants of various mechanisms of action: tricyclic and selective serotonin reuptake inhibitors. Antidepressants, as a means of drug therapy for depression, are prescribed only by the attending doctor. Many drugs in this group are capable of developing addiction, which is quite difficult to get rid of. Therefore, they are sold according to a doctor's prescription.

It is possible that the treatment regimen will require the appointment of tranquilizers, neuroleptics, vitamin complexes, hormones. Great benefit will bring antioxidants and lithium salts. They select drugs that qualitatively improve cellular metabolism, especially GM cells. They monitor the state of the body's defenses, preventing a drop in immunity.

Vitamins and minerals

It is good to take vitamin C. This connection is especially valuable in life periods with frequent stresses, if difficult physical exercise, long-distance flights and transfers. A lack of vitamin C will “come around” with rapid fatigue or a feeling of persistent fatigue, sad thoughts and a sad mood.

Vitamin B. Pyridoxine is able to significantly increase irritation and a sense of unconscious anxiety, positively affect nerve cells, strengthen the immune system, restore the cardiovascular system, help in the absorption of food.

Folic acid. Vitamin 9 is involved in the synthesis of serotonin, the most important hormone responsible for the feeling of happiness. Serotonin "kills" melancholy, depression, sadness. Vitamin B9 also has the ability to prevent the development of the oncological process, improves human cognitive abilities and memory, especially in the elderly age group.

Trace element zinc. It is with the lack of this substance that many doctors associate the onset of the development of depression as disease state organism. Zinc plays a leading role in the coordinated work of nerve synapses. Its deficiency often leads to substance abuse, bulimia, alcoholism, anorexia.

Magnesium. It is necessary for the harmonious functioning of the nervous system, therefore its deficiency in the body is fraught with the appearance serious problems with sleep, unconscious restlessness, hyperactivity, panic attacks, the appearance of serious fears, up to the development of phobias, a significant drop in stress resistance.

Psychotherapy

The method of removing the patient of such conditions is selected individually, depending on the type of disease. Therapeutic results for the treatment of depression with psychotherapy largely depend on the desire of the patient himself to productively contact the doctor. And the task of the doctor is to develop in the patient the desire and understanding to be cured. Although such a task when working with some patients becomes impossible.

• cognitive-behavioral. The technique provides for the identification of negative attitudes in the mind of a person with a demonstration of the fallacy of his own beliefs. The doctor, in an attempt to activate the process of change, pushes the patient to the fact that it would be more correct to think and look at the problem differently. Thus, getting rid of the pathology occurs due to a change in the approach to the root cause of the depressive state;
• interpersonal. In this case, the specialist teaches how to get rid of isolation in society, establish harmonious connections in modern society, increase communication, and adapt expectations from relationships.

Psychodynamic therapy is rarely used. It involves identifying inconsistencies in the internal conflict and ways to eliminate it. The patient is taught the techniques of auto-training.

Food

Nutrition plays a huge role in the life of not only a healthy, but also a sick person.

We list the most important vitamins that can improve the condition of a depressed patient:

• vitamin C. There is a lot of it in broccoli, the peel of most citrus fruits, Bulgarian red pepper, spinach leaves.
• vitamin B. A storehouse of pyridoxine is potato peel, meat, it is not chicken skin, fish fillet, beans, whole wheat grain products;
• folic acid. We use in enough liver and dishes from it, green-skinned vegetables, asparagus, ripe melon, avocado fruit;
• zinc. The maximum amount of this element is found in oysters (60 mg per 100 grams), slightly less in dark chocolate, chicken hearts, liver, sunflower seeds;
• magnesium. Contained in seafood, caviar, hard cheeses, whole milk, red fish, amaranth.

This food should be in sufficient quantities on the menu, then it will be much easier to deal with pathologies. Scientists point out that chocolate, ripe bananas, red caviar and oysters, quail eggs, nutmeg are natural antidepressants capable of coping even with prolonged depression.

What usually prevents seeking psychotherapeutic help

For many decades in our country, psychotherapy has not been practiced widely enough, then today there are many obstacles to seeking help from a psychotherapist or psychologist. For example, few people believe that a professionally constructed dialogue brings real moral relief and really heals a person.

The second factor of fear in the office of a psychotherapist is the fear of publicity of purely personal information. Dedicate stranger and not everyone considers it necessary to “bare the soul”, fearing the leakage of important data. In this case, we advise you to contact a crisis center or a separate practitioner on an anonymous basis.

Let's debunk another myth. Many people do not see much difference between psychiatric and psychological help. Therefore, “passing for a psycho” is another non-existent “horror story”. And instead of getting adequate help, a person only delays time and deepens in a depressive state.

Forecast

The prognosis of recovery largely depends on the patient himself and his desire to defeat the disease. With the provision of timely professional assistance, the symptoms of the disease disappear without a trace and the person returns to normal life. In most cases, a lot of recovery depends on close relatives and strong family ties.

Most often, the prognosis for depression is favorable. Religious principles in Russia are categorically against suicide, which minimizes the risk of such a formidable complication of the disease. The first step to recovery is the desire to fight and improve the quality of your life.

This disease has been known since the time of Hippocrates, and an experienced psychotherapist will tell you how to get rid of it.

During prolonged depression, there is a decrease in self-esteem, and there is also a loss of interest in life and the usual routine.

In certain situations, a sick person is predisposed to alcohol, nicotine or other types of addiction. Treatment and causes are varied.

Symptoms of the course of the disease

Depressive symptoms are divided into main and additional.

In order to confirm the diagnosis, the presence of two main and at least three additional signs is required. The symptoms of chronic depression vary. The main ones are:

• a depressed state that does not depend on situations for a long time (14 days or more);
• loss of interest or satisfaction from past activities;
• deeply pronounced fatigue and lack of strength, manifested by the invariability of this state (for example, within 30 days).

Additional symptoms of the disease:

• doom, sadness;
• feelings of guilt, meaninglessness, confusion, panic and fear;
• excessive self-criticism;
• inability to concentrate and find a way out of the situation;
• thoughts of death and suicide;
• loss of appetite, marked decrease or increase in body weight;
• sleep disturbance, manifestation of insomnia or, conversely, a long sleep.

Depression is not more common in children than in adults. Her symptoms:

• loss of appetite;
• sleep problems (nightmares);
• Difficulties in learning that were not noticed before;
• character problems: arrogance or hostility.

For 14 days, 4 or more of the following symptoms may occur:

• depression (children and adolescents may experience irascibility);
• a significant decrease in satisfaction or interest in most activities;
• weight loss and appetite loss (probably increased food cravings and weight gain);
• mental agitation or inhibition;
• decreased activity and increased fatigue;
• a feeling of "worthlessness" and increased self-criticism, as well as an unjustified sense of guilt;
• passivity of thinking or decrease in capacity, concentration of attention;
• suicidal tendencies;
• disruption of the digestive organs;
• decrease in energy, increased fatigue during ordinary physical exercises and intellectual stress, excessive relaxation;
• pain and various discomfort in the body (for example, heart, stomach, muscle pain).

Protracted depression appears after prolonged stressful condition but often for no reason. In this case, a person feels a deterioration in well-being every day. It should be understood that in some people the presence of several signs does not at all indicate the presence of the disease. However, it is important to know how to get out of a protracted depression. The condition is unlikely to be self-limiting and must be treated.

Forms of depression

1. Major depressive disorder (major depression) refers to the clinical form. During a couple of courses, there is no improvement from treatment with antidepressants.
2. Minor depression, in which several typical manifestations observed for more than 14 days.
3. atypical form. Simultaneously with the main signs, specific ones are also observed: increased appetite, weight gain, drowsiness, emotionality.
4. The postnatal type of pathology develops after childbirth.
5. Recurrent transient depression, during which the symptoms make themselves felt no more than once every 30 days for 3 days.
6. Dysthymia (considered long term), referring to chronic mood swings. The patient indicates a daily unsatisfactory mood for more than two years.

How the disease manifests itself

At first, neurasthenia, sleep problems, loss of desire to perform daily duties are observed. Symptoms may worsen within 14 days, indicating the onset of the disease. Full manifestation occurs after 60 days or more. One-time attacks are observed.

If the disease is left untreated for a long time, the possibility of a suicide attempt increases. There is a distance from relatives and friends for no apparent reason. Possible neurosis. The duration of the disease is on average from 20 to 32 weeks. The disease brings mental suffering to the person himself and to the people around him. Relatives are not always able to help the sick. Especially when the disease has already developed into a protracted or severe form. A specialist can help. After all, sometimes ignoring pathology can lead to death. You need to contact a psychiatrist, psychotherapist, neurologist or psychologist.

The main advice of psychologists may be as follows: do not feel sorry for yourself, fight your condition and try to get out of it, come to terms with the cause of depression, get enough sleep.

It is necessary to keep yourself in good shape, exercise if possible and eat right, which is especially necessary for women. Unfortunately, often patients are afraid to go to a specialist in the treatment of psychological problems because of the imaginary adverse effects:

• likely social restrictions;
• universal condemnation if anyone finds out that a person is being seen by a psychiatrist;
• concerns negative impact on the well-being of medicines, which is based on often false ideas about the damage caused by psychotropic drugs.

Ways to treat protracted depression

Methods for treating the disease depend on the condition. As a result, therapy takes place either with full hospitalization, or partially within the walls medical institution. Protracted depression is usually treated with pharmacological preparations, psychotherapy and social adaptation. First of all, the patient must abandon the previous way of life, otherwise even the strongest antidepressants will not lead to a positive result.

With pharmacotherapy, stimulating and sedative medications are taken. The former are used for deep depression with manifestations of melancholy and apathy. The appointment of a dosage of drugs such as Clomipramine, Imipramine, Paroxetine, Desipramine, Pyrazidol, Fluoxetine, should be done by a doctor. Sedative drugs are prescribed for a protracted form of anxiety disorder with manifestations such as panic, irritation, suicidal thoughts. Preparations: Lyudiomil, Azafen, Amitriptyline, Coaxil. With mild long-term depression, herbal preparations are used: St. John's wort.

The main thing is not to forget that when wrong dosage the disease may worsen. Psychotherapy is considered not a replacement, but a significant addition to drug rehabilitation. Unlike drug therapy, it implies a more active role of the patient in the treatment process and contributes to the development of new skills of emotional self-regulation, which in the future ensures more productive overcoming of critical situations without going into depression.

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Effective measures to combat protracted depression

What is dangerous

Protracted depression appears after prolonged stress. In this state, a person feels worse every day.

Here are some of the consequences that this condition can lead to:

1. Health problems. Depression is, as a rule, a passive way of life, constant nervous tension, lack of desire for a healthy diet and sports. Increasingly, the best friends of people in this state are alcohol, cigarettes, drugs. All this inevitably leads to poor health.
2. Nervous breakdowns. Pessimism, bad mood, irritability, apathy accumulate negative energy in a person. An excess of these emotions promises nervous breakdown. And sometimes they have terrible consequences - in a state of such affect, a depressed person can create a real disaster with his own hands.
3. Loss of the meaning of life. Depression gradually nullifies communication with relatives and friends, fewer people want to provide help, support is less and less evident, self-esteem falls lower and lower. “Why then live if no one needs me?” - sounds in the head of a person who has fallen into depression. The general state of these thoughts is only getting worse.
4. Terrible appearance. All of the above in consequence can cause some of the following disadvantages in appearance:

• obesity or, on the contrary, ugly thinness;
• "dull" eyes;
• bags under the eyes;
• fatigue;
• ugly posture (usually stoop);
• unkempt hair, skin;
• for girls - the lack of attractive makeup, manicure;
• bad taste in clothes, etc.

Signs and symptoms

In fact, there are many types of depression. Some are associated with some event (postpartum, a consequence of parting, etc.), others - with age (in a teenager, in older people, after all, a midlife crisis). But the manifestations of this disease are almost always the same.

This condition has the following symptoms:

• constant bad mood;
• tearfulness;
• apathy;
• a feeling of complete misunderstanding (of people and people);
• sleep disorders;
• lack of appetite;
• early fatigue even at low loads;
• decreased sexual desire;
• unwillingness to strive for something;
• increased anxiety, despair;
• distrust of others;
• refusal of someone else's help;
• craving for loneliness;
• low self-esteem;
• loss of interest in everything that happens;
• self-flagellation.

It is important to understand that in some people, the manifestation of some of the signs does not at all indicate the presence of a stressful condition. For them, it is just a character trait and an acceptable way of life for them. In a person who is in prolonged depression, at least 80% of these symptoms can be noted.

How to treat

Psychotherapy

Most likely, a person with prolonged depression will not be able to return to a normal life on their own. There are some professionals working to help manage this condition and other mental disorders.

What are the symptoms of bipolar depression? Read on.

Here is a list of people who have the power to make a significant positive impact:

Everyone works in their own way. Some people get out of despondency with conversations, others with medicines, others with hypnosis, etc. But you need to remember that you should only go to them if you have a sincere and overwhelming desire to cope with a severe form of apathy. Otherwise, the help of doctors, most likely, will be invisible.

Medical treatment

This situation will have to be dealt with with the help of special medicines. Their action is aimed at calming the nervous system, reducing susceptibility to irritating factors.

However, these drugs cannot be the only way treatment. They are appointed to muffle given state to start more effective follow-up work with the patient.

Please note that some drugs have a number of side effects. You cannot assign them yourself. Only a specialist can choose for you a comprehensive and useful treatment.

Homework

To get out of a long depression, a person must help himself first of all. Below are the main techniques that will enable you to make a big leap towards getting rid of this condition.

1. Dream. To stay in a good mood, you need to get enough sleep. High-quality and long sleep also allows you to partially forget about the "eternal" fatigue, weakness, decreased concentration and other ailments. Please note that people with low blood pressure need more time to sleep.
2. Proper nutrition. Speeches about this are always so inspiring, but after 1-2 days of steamed cereals and cutlets, the desire to watch your table disappears. In fact, everything is much simpler than it seems. It just takes good preparation. You need to go on the Internet and look for recipes that are useful and affordable for you and your wallet recipes for every day. You will see how diverse this cuisine is! Schedule a menu for 2-3 weeks. Important: write down a list of “on-duty” meals that you can cook if you don’t want to bother with what is scheduled for lunch or dinner in your schedule. But still it is desirable not to deviate from what was stated earlier. After a month of such nutrition, you can feel the lightness and restoration of the work of the whole organism. Feeling better naturally.
3. Phytotherapy. Use various herbs has a great effect on both the state of mind and well-being. Decoctions, infusions, dry mixes, rinsing, steaming are the most gentle way to solve many problems. In addition, it is a great alternative to medications.
4. Sport. Daily exercise is the bare minimum. For residents of large and developed cities, there are many options available. There are many areas where everyone can find themselves: swimming, dancing, yoga, aerobics, playing basketball, volleyball and much more. It is also easy to find friends here, which can also affect the course of life. Jump rope, hoop, yoga classes - you can do this and more every day, without leaving your home. The most "desperate" can start running, skiing, skating, etc. Among other things, playing sports favorably affects the formation of an excellent figure.
5. Attractive appearance. When a person is liked by people of the opposite sex, self-esteem grows noticeably, and this has a beneficial effect on mood. You can take the first steps towards changing your image with the help of online programs, advice taken from magazines, online lessons, etc. Yes, in the end, changing your image costs some money, but if you start working on yourself gradually, the costs will probably not be much for you. noticeable.

How to get rid of severe depression? Read the article.

1. Don't feel sorry for yourself. As long as a person sympathizes with his condition, he feeds his enemy - depression - with new forces. You need to be stronger, because life passes, and not the most in the best way but everything can be fixed...
2. Do not dramatize. Many go through what can be called the cause of depression. It is necessary to come to terms with the fact that caused this condition and either try to fix it or move on in life, depending on the situation.
3. Don't sit on your hands. If a person with such a problem locks himself in the house near the TV, nothing will happen. On the contrary, after a certain time he will sink more and more into his condition. And if he comes out and starts to develop himself, move, work on himself, make new friends, communicate, then the problem will gradually begin to be forgotten.

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Symptoms and treatments for chronic depression

But what if the person has always been like this? Self-absorbed, depressed, with a negative outlook on life, lethargic and apathetic. Maybe he's just a pessimist? Alas, things are not always so simple. If depression has a long, protracted form, and began as early as childhood, it is really very difficult to diagnose. And the patient himself is in no hurry to go to the doctors, because over the years he has got used to considering all these symptoms as just features of his character. Nevertheless, this disease has a name - prolonged depression.

Formation, signs and course of the disease

Protracted depression can last for years. Most often this disease occurs in people with severe somatic diseases, which can present real threat life. For example, about a third of all patients who have had a myocardial infarction suffer from prolonged depression. Persons with oncological pathology and patients with tuberculosis are also significantly susceptible to it. This is due to the fact that having a chronic disease that directly threatens life, a person experiences constant super-stress. Over time, in the absence of positive dynamics in the general somatic disease, the mental state of a person becomes worse and symptoms of prolonged depression appear: depression, loss of interest in life, negative outlook on life, low self-esteem, etc. For this reason, long-term depression is usually expressed predominantly through psychological symptoms. Often this condition later turns into a neurotic personality development - a depressive or hypochondriacal type.

The clinical picture (symptoms) of chronic depression in general is often similar to hypochondriacal depression. The patient has various fears associated with the underlying, somatic disease. In addition, self-esteem is significantly reduced, the patient considers himself a burden for the family, blames himself.

Another factor conducive to the formation of a protracted form of depression is alcoholism. In general, the initial emotional and personal characteristics of a person lead to alcohol abuse. And with prolonged alcoholization, permanent psycho-emotional disorders are formed, turning into a protracted course of depression. In the future, the problem grows like a snowball: taking alcohol with already existing depression leads to a decrease in critical evaluation and self-control, and as a result, even to suicide attempts.

Features of the disease in children and adolescents

When we talk about adults, it is clear that for the formation of a protracted course of the disease, more than weighty factors are needed (for example, the presence of a severe oncological disease). And what about the children? After all, there are situations when a person feels the symptoms of prolonged depression all his life, from childhood, it becomes like a part of his personality.

As for children, the symptoms of prolonged depression can be formed in them due to the following factors:

• prolonged illness, frequent hospitalizations in childhood;
• features of the child's personality (anxiety, suspiciousness, a tendency to hysterical reactions predominate);
• chronically unfavorable psycho-emotional climate in the family;
• comorbid psychiatric disorders (eg, schizophrenia);
• organic lesions of the central nervous system of the child.

It is important to understand that in this case, we are talking not only about children, but also about those adults who have been accompanied by symptoms of a protracted depressive disorder all their lives. Most likely, the prerequisites for its formation were formed in childhood, and then the disease passed into chronic stage. In such cases, treatment can be difficult, because the disease has time to gain a foothold in the nervous system and the human psyche.

All about protracted, deep depression

The character of a person is so multifaceted that he himself often does not even suspect that he has a protracted (deep) depression, attributing the main signs about feeling unwell or the influence of external circumstances. Irritation, resentment, sadness - these emotional signs can cause very irreparable harm to mental health if they occur too often, or even become a habit.

Most people do not consider mental anguish a reason to see a specialist, bashfully hiding their suffering, considering the problems too insignificant and personal. But in fact, prolonged depression is like a mechanism of self-destruction and it requires the support of loved ones and relatives and proper treatment.

If a person is left alone with depression, he must help himself by contacting a psychotherapist, otherwise the result may be suicide, or moral emptiness and facelessness. Prolonged and deep depression destroys the protests of the individual, destroys individuality. A person ceases to perceive reality, does not want to do anything, there is no vital stimulation.

Symptoms and signs

Depression goes hand in hand with time, so the phenomenon is ambiguous and elusive. Gradually, starting with some kind of internal breakdown, she repaints bright colors into very dull tones, a bad mood becomes commonplace. Everything is wrong, everything is not right - life does not bring the former joy of perception. It seems to a person that there is no need to live, there is no one to love and there is nowhere to wait for salvation.

These hidden thoughts are greatly reflected in the outward appearance of a person. He is not interested in how he looks, he is annoyed by any circumstances that require his active participation. A person who has a deep depression is not able to analyze, do and think - he is completely absorbed in self-digging, analysis of past mistakes and disappointments.

The melancholy expression does not leave his face, dark circles under the eyes indicate insomnia. The place in the social society is bursting at the seams, and now it seems to a person that he has found the only correct solution - to leave this deceptive world. All these are symptoms and signs of an illness, the treatment of which must be carried out immediately. But from a medical point of view, a potential suicide might just have to treat the thyroid gland.

Teenagers as an example

A mockery of fate - human mood is closely related to health. If everyone knew what to do with the body in order to cure the spirit, as the psychoanalyst knows, the suicidal statistics in the world would significantly decrease.

Especially to such phenomena as constant depression, adolescents are very prone to their transition period, associated with the frequency of hormonal surges. Known signs such as:

caused by nothing more than a restructuring of the body. And, if you do not provide all possible assistance in resolving internal contradictions in time and do not treat you with a specialist, depression is quite capable of striking.

External preconditions

The human psyche is designed in such a way that no mental health specialist can know exactly what to do. The only symptoms that scientists rely on are based on the human immune system and external factors, very influencing the will and love of life.

Immunity plays important role not only in the life of the organism, but also in personal development. Iron deficiency, for example, can have a negative effect on certain areas of the brain that are responsible for emotional mood.

But also quite healthy person can capture severe depression if he has gone through some kind of upheaval. Several common prerequisite factors for depression have been identified:

• early loss of loved ones;
• personal tragedy;
• alcohol or drug addiction;
• neurological diseases;
• hereditary character traits;
• innate sensitivity;

If emotionally it is not clear from a person that he is hiding depressive tendencies, somatic signs appear, they can help to recognize impending problems. These are insomnia, appetite disorders, headaches and dizziness.

Sometimes treatment with certain drugs provokes melancholy and depressive states.

The point of view of a professional doctor

Since a very neglected depression is indeed capable of irrevocably destroying a person's life, scientists and pillars of psychiatry have elevated it to the rank of complex mental illness. This is not surprising, since moral emptiness can lead to complications such as:

And these are more serious diseases that can accompany depression, or be its continuation. The amazing relationship between emotions and health has not yet been unraveled. Only three consequences have been found that help to prescribe the correct treatment.

Psychology of life

There is such a thing as personality types. Some are more prone to depression than others:

• Statothymic - exaggerated principles, conscientiousness.
• Hyperthymic - very low self-esteem, self-doubt.
• Melancholic - excessiveness in everything, pedantry.

All these qualities are fertile ground for the germs of neurosis, since reality does not always correspond to ideas, as it should be.

The division into personality types is of great help to psychiatry in identifying the following signs of impending major depression, the treatment of which takes a long time. These are isolation and complexes - their presence almost always predisposes to disorders.

Biology

Terrible depression can also begin without any long prerequisites. These are hereditary factors that do not depend on the human essence. Or side effects medicines intensive care. Here are a few basic points for the development of a nervous disease:

Very often somatic diseases are inherited. Symptoms can be veiled up to a certain age, in particular, it is important to survive adolescence, do something and not let depression develop. The treatment of such depressive conditions is very complex and multifaceted.

Sociology

Due to social factors, terrible depression can also appear, mainly in women and adolescents. So, because of migration, men do not suffer, easily taking root in any conditions. Adaptation of women occurs according to a different scenario, very often complicated by nervous disorders.

Deep depression does not necessarily begin with a change of residence, but this step in itself is fraught with negative emotions, because it is difficult for women and children to create a new social circle. The signs and symptoms of the onset of melancholia are divided into several long months of adaptation:

• chronic stress associated with moving and chores;
• feeling of insecurity;
• financial difficulties;
• quarrels and disagreements in the family;
• fear of not finding like-minded people.

The social upheavals that cause phenomena such as depression and apathy include the following factors:

• family discord;
• abrupt changes in life;
• moving;
• strict and harsh upbringing;
• lack of love.

Any life upheavals imperceptibly for a person endow him with chronic stress. And something needs to be done with it, otherwise there is a possibility that a very terrible depression will develop, from which there is no way out.

Treatment

Doctors consider depression in any of its manifestations to be a disease of the brain, and a complex one at that. More than half of the world's population suffer from this disease, many are unaware of its presence and how to get out of deep depression. If you briefly describe all the symptoms of such a disease as neglected depression, then the most important signs are apathy and depression for a long time, and the accompanying ones:

• feelings of guilt and anxiety;
• psychomotor anomalies;
• chronic insomnia;
• decrease or increase in appetite;
• negative thoughts.

Against the background of depression, the following somatic disorders very often progress:

• cardiac ischemia;
• complications with the thyroid gland;
• osteochondrosis;
• gastrointestinal disorders;
• pain in the joints;
• hepatitis.

Not all consequences are listed. Women are more likely to seek medical help after recognizing symptoms than men, who have a habit of flooding depression with alcohol, encouraging their own alcoholism. As a result, they get a number of diseases, coupled with social problems.

Psychotherapists have several effective methods of dealing with the disease, whose name is deep depression.

Hypnosis is recognized as the most popular, helping to convince a person in the opposite direction from his established thinking as a result of neglect of the disease.

Used and drug treatment, as well as psychotherapy sessions with relaxing treatments. In treatment, it is important not only to eliminate stress with antidepressants, but also to cure accompanying illnesses, strengthen the spirit and body. It is important to understand the patient that he really needs help, to be aware of the problem, otherwise it makes no sense to do anything.

Major depression: causes, symptoms and treatments for the disorder

Major depression or prolonged depression is a severe mental disorder characterized by a sharp decrease in mood, apathy, mental and physical lethargy.

Often this form of the disease is confused with somatic diseases or even a mental disorder, due to which the patient does not always receive specialized assistance and support. This is partly due to the excessive popularity of the word "depression", which today has become fashionable to refer to any emotional distress or low mood.

One of the main differences between real depression, a severe mental illness, is considered to be a permanently lowered mood and a lack of connection with the deprivation or loss of something. If a person declares that he has depression due to the loss of a job, money, separation from a loved one, or due to any other reasons, this may be a depressive episode, a “push” to the development of the disease, but not prolonged depression. With this disease, the patient ceases to feel his connection with the outside world, everything seems unnecessary, uninteresting to him, thoughts, feelings, desires disappear, melancholy, apathy, and physical weakness pile up.

Major depression usually lasts from several weeks to several years before a person is treated or admitted to a specialized hospital.

Causes of depression

Everyone is at risk of chronic depression, with approximately 5% of the population aged 18 years and older suffering from this disorder.

The development of the disease is associated with the impact on the human body of several pathological factors simultaneously. Most often, this form of the disease develops in women after 40 years of age and in older people of both sexes. It is related to hormonal age-related changes in the body, frequent stress and general deterioration in health.

Causes of Prolonged Depression

1. Endogenous or biological - deep depression can be caused by hormonal imbalance in the body, a decrease in the concentration of norepinephrine, dopamine and serotonin causes a sharp deterioration in mood, apathy and other symptoms of the disease. This pathology, like other mental illnesses, is considered a hereditary pathology precisely because the predisposition to a low content of certain hormones, such as serotonin, is transmitted genetically and in people with a hereditary predisposition, the risk of depression is several times higher. According to latest research scientists, depression may occur due to a slowdown in the supply of nutrients and oxygen to the cerebral cortex, this may be due to endocrine pathologies, metabolic disorders, lack of vitamins and nutrients in the diet, and even seasonal changes. So, autumn or spring depression develops due to a lack of vitamins, shortening daylight hours and hypodynamia.
2. Psychogenic - it is commonly believed that it is precisely because of psychological trauma and stress develops prolonged depression. Most often, this occurs when a person "lingers" in negative experiences and "does not let go" of the situation. Depression can be caused by the death of a loved one, separation or divorce from a life partner, abrupt change lifestyle, for example, in case of job loss, bankruptcy, change of residence and other similar circumstances. Sometimes the disease occurs without visible reasons- it is caused by the impossibility of achieving the set goals, incorrectly set priorities, the feeling that life has not been lived the way one would like (for example, the so-called midlife crisis) and other similar reasons.
3. Social - every person, living and interacting with the people around him, feels the pressure of society, its requirements. Social problems, uncertainty about the future, military conflicts, the danger of terrorism, drug addiction and other issues that a person cannot influence the solution of, many times increase the personal level of anxiety of each of us, which can also cause deep depression.
4. Physiological - prolonged overwork, chronic lack of sleep, somatic diseases, alcohol abuse, nicotine and other psychoactive substances can become the cause of prolonged depression. Diseases and wrong image of life cause a strong weakening of the body, and when using any doping, the nervous system is overexcited, mediators are synthesized and consumed in increased amount, because of which their deficiency quickly occurs, which can become a risk factor for the development of the disease.
5. Other reasons - a prolonged nervous breakdown can occur due to taking medications - hormonal, antihypertensive, anticonvulsant, sedative and some others. If you take such drugs for a long time and without the control of the attending physician, a deep prolonged depression may occur, which will be quite difficult to cope with, since a pronounced deficiency of neurotransmitters has formed in the body.

Symptoms

The symptoms of major depression depend on the severity and stage of the illness.

At the beginning of the disease, the behavior and lifestyle of the patient remains normal, only his way of thinking and feeling changes.

As the disease develops and the condition worsens, pronounced symptoms of the disease appear.

General

1. Apathy - a violation of the emotional-volitional sphere is observed in all patients with deep depression. In this state, the patient does not want anything, he becomes passive, not talkative, too calm, ceases to be interested in others. Sometimes apathy in depression is not clearly manifested, the patient continues to lead a normal life, performs daily duties, but at the same time experiences a complete loss of interest, becomes emotionally cold, sad and "lazy". The development of abulia is also characteristic - the complete absence of desires and motivation for action, as well as the inability to make strong-willed decisions. The first sign of emotional and volitional disturbances is a deterioration in the patient's mood, his behavior and appearance change - he ceases to monitor the condition of his clothes, cleanliness and neatness, does not maintain communication with others, spending most of his time alone.
2. Akinesia - a slowdown in motor activity in severe cases with depression can be replaced by a sharp decrease in muscle tone and limitation of range of motion. At the beginning of the disease, a person experiences constant weakness, unwillingness to move, his working capacity, muscle activity decrease, the need to move, something to do causes irritation, as the disease develops muscle weakness increases, movements slow down more and more, the patient tries to move as little as possible and may simply refuse to leave his house or his room.
3. Changing your mindset is one of the biggest dangers of deep depression. Moreover, these changes occur imperceptibly, both for others and for the patient himself, anxiety and irritability increase, fears, self-doubt, a negative attitude to life events and the inability to cope with the influx of negative emotions. Professional skills, memory worsen, thinking slows down, the patient has difficulty concentrating, performs any complex tasks or highly intellectual work.
4. Physical manifestations - in addition to mental changes, depression appears weakness, headaches and muscle pain, loss of appetite, sleep disturbance, weight loss or a sharp increase, pain in the heart, digestive organs or pain no specific location.

Psychotic symptoms

In addition to the classic manifestations of depression, with a major depressive disorder, psychotic symptoms such as hallucinations, delusions, and depressive stupor may develop.

In severe depression, patients hear accusing or condemning voices, feel unpleasant odors, can see dead people, monsters, insects, snakes or other unpleasant creatures.

Usually, depression is dominated by ideas of one's own guilt, insignificance, delusions of persecution, impoverishment, jealousy. Unfortunately, often patients hide the psychotic symptoms of the disease, and their behavior is misinterpreted by others who do not pay attention to the "eccentricities" and "bad character" of the person.

Without medical treatment and the help of a specialist, it is impossible to get rid of the psychotic symptoms of depression on your own. The condition of the patient without treatment worsens, he may attempt suicide or harm himself.

Treatment

It is almost impossible to get out of such a serious condition - prolonged depression - on your own. For treatment, it is necessary to restore normal work nervous system and increase the level of neurotransmitters in the blood.

Drug therapy helps to stop the psychotic and general symptoms of depression, but without appropriate psychotherapeutic treatment and lifestyle changes, it is impossible to achieve a complete recovery of the patient. Only complex therapy helps to get rid of all clinical manifestations diseases and prevent their occurrence in the future.

If you suspect this form of depression in yourself or someone close to you and do not know what to do, you should seek the advice of a specialist who can assess the severity of the patient's condition and recommend treatment.

Sometimes you can even get out of a prolonged depression on your own by changing your lifestyle, getting rid of a traumatic situation, devoting more time to sleep, rest, physical activity and healthy lifestyle. Psychotherapy helps to solve many problems, but with a severe mental disorder, most often such methods are not enough and treatment begins with the normalization of the state of the psyche with the help of drug therapy.

Medical treatment

1. Antidepressants - it is with these drugs that the treatment of any depression begins. Antidepressants increase the concentration of neurotransmitters in the blood, thereby helping to normalize mood and improve general condition sick. Tricyclic antidepressants (amitriptyline, clomipramine, imipramine) are used for treatment - drugs of this group are the most well studied, despite a large number of side effects and generalized effects on the body, they are still very popular due to their proven effectiveness and low price. 2nd and 3rd generation drugs (sertraline, fluoxetine, paroxetine, fluvoxamine) are considered safer, they are prescribed for prolonged depression in patients with concomitant pathologies of the cardiovascular system, diseases of the kidneys, liver and endocrine system. All antidepressants have a delayed effect, the result of their use becomes noticeable only after 2-3 weeks from the start of treatment.
2. Tranquilizers - drugs of this group help to cope with anxiety, fears and sleep disorders. Diazepam, chlorazepam, lorazepam, atarax, alprazolam are most often used for treatment. Tranquilizers should be taken only as prescribed by a doctor and at the dose recommended by him, since drugs in this group are addictive, slow down thinking and reaction. When treating with tranquilizers, it is forbidden to drive vehicles or perform work that requires high concentration and reaction speed.
3. Antipsychotics - This group of drugs helps to cope with the psychotic symptoms of depression. Antipsychotics have a pronounced inhibitory effect on the brain, thereby relieving the patient of hallucinations, delusions and other symptoms of the pathology of the nervous system. This form of depression is usually treated atypical antipsychotics new generation, which have fewer side effects on the patient's body (olanzapine, risperidone, amperoside, neuleptil, triftazin).

Psychotherapy

Without the help of a psychotherapist, it is impossible to permanently get rid of a severe mental disorder. Cognitive, cognitive-behavioral, family or rational therapy is used for treatment. All these methods help the patient to realize their problems that caused the disease, learn to cope with them on their own or change their attitude towards life and others.

Other treatments

In the most severe cases, for the treatment of prolonged depression, use:

• magnetic stimulation - the cerebral cortex is affected by magnetic impulses, due to the stimulation of certain parts of the brain, the patient's mood stabilizes and the general condition improves;
• electro-convulsive therapy - it is considered a very dangerous and traumatic method, it is carried out only with the complete ineffectiveness of other methods, the patient is immersed in a narcotic sleep and the brain is affected by a short current shock, due to which hormones of joy begin to be released, which the patient lacked.

Protracted depression is a severe mental disorder, which is almost impossible to cope with on your own, this requires medication and the help of professionals.

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The word "depression" can be found quite often, some people use it without understanding what depression is.

So, depression It is primarily a mental disorder. Depression is one of the most common human diseases today.

Depression is often confused with a "bad" mood, but what separates true depression from low mood?

Typical symptoms of depression:

emotional

Anguish, suffering, oppressed, depressed mood, despair;

anxiety, feeling internal stress, expectation of trouble;

Increased irritability;

Feelings of guilt, frequent self-accusations;

Dissatisfaction with oneself, decrease in self-confidence, decrease in self-esteem;

Decrease or loss of the ability to experience pleasure from previously enjoyable activities;

Decreased interest in the surrounding reality.

Physiological

You note a violation of appetite, sleep / wakefulness;

You have reduced sexual activity and attraction;

Increased fatigue during normal exertion, decreased energy tone, feeling of weakness, loss of strength;

The bodily symptoms are heartaches, migraines, skin and gastrointestinal disorders.

Behavioral

Passivity, difficulties in performing purposeful activities;

Avoidance of contact, inclination to solitude, loss of interest in other people;

Rejection of entertainment;

Alcoholism, the use of psychotropic substances.

Thought Manifestations

Difficulty concentrating, concentrating;

The predominance of gloomy, negative thoughts about your life, yourself, others;

Pessimistic vision of the future, lack of perspective, thoughts about the meaninglessness of existence;

Thoughts of suicide;

Thoughts about one's own helplessness, insignificance, uselessness;

Slow thinking.

For a diagnosis of depression to occur, these symptoms must be observed for at least two weeks. Chronic depression can last six months or more. Depressions vary in severity: from persistent low mood to severe conditions in which a person cannot get out of bed.

Types, causes and treatments for depression

Psychotherapy for psychogenic depression is aimed at resolving interpersonal, intrapersonal conflicts and overcoming a stressful situation.

What happens if depression is not treated?

Depression is often perceived both by the person himself and by his environment as a manifestation of a bad character, laziness and selfishness, promiscuity or innate pessimism. It should be remembered that depression is not just a bad mood, but a serious emotional problem, a painful disorder or even a serious illness, so it is important to seek help from specialists in a timely manner.

What usually prevents people from seeking help for depression?

Possible social restrictions, registration in the PND;

Negative attitude and critical assessments of others if someone finds out that a person is being treated by a psychiatrist;

Fear of the negative impact of drug treatment, which is based on widespread, but inadequate ideas about the dangers of psychotropic substances.

Depression without treatment can lead to serious consequences. If a person has been depressed for many years and does not seek help, treatment can be lengthy and difficult. People suffering from depression, over time, can reach the loss of work, friends, the destruction of the family. Depressed people tend to abuse alcohol and other substances. The most dangerous consequence of depression can be suicidal attempts. Thus, contacting specialists of the appropriate profile (psychiatrist, psychotherapist) helps to prevent negative consequences.

You should also remember that your own efforts are also important in the treatment of depression, without them the results will be achieved more slowly.

How can you help yourself?

1) Observe the daily routine: no matter how trite it may sound, nevertheless, the correct sleep and wakefulness, alternation of work and rest will do you good.

2) Avoid alcohol, drugs, cut down on caffeine.

4) Try to keep in touch with friends and loved ones, ask them for support, and not hide behind a mask Have a good mood. Disguise requires energy and does not improve the condition.

5) Go about your daily activities without waiting for the depression to end. This, of course, does not mean that you should bring down on yourself all the mass of cases that you have left. Remember, “better a tit in the hand than a crane in the sky”, therefore, set “titmouse” goals, not cranes. Do everyday things every day: self-service, try to cook your own food at least once in a while, do minimal exercises.

There are no barriers, many people who suffered from depression have learned to cope with their condition, have found new goals and meanings.

Remember that those who are treated for depression recover from depression.

In the elderly, the treatment of this disorder is complicated by the peculiarities of this category of patients. They are studied in a special section medical science– geriatric psychiatry – within the framework of which the causes of occurrence, features of manifestations, clinic, course and treatment of mental disorders in the elderly are studied.

All methods of treating depression can be divided into 2 large blocks:

1. Medications (antidepressants).
2. Psychotherapy.

The best solution would be their combination.

Features of treatment in the elderly

Senile depression is the most commonly observed mental disorder in the elderly. The complexity of its treatment is exacerbated by the difficulties at the stage of diagnosis. Instead of complaining of a bad mood, elderly patients complain of somatic diseases, bad memory, demonstrate apathy and a low desire to be cured.

Chosen treatments are often ineffective. The disease is difficult to treat because of the "blurring" of its signs and root causes.

It is likely to be associated with stroke, dementia, Parkinson's disease, a number of chronic diseases of blood vessels, heart, respiratory organs, so treatment must be carried out in combination.

There are a number of drugs that can cause organic depression, such as beta-blockers, corticosteroids, or benzodiazepines used to treat or treat insomnia.

In the treatment of organic depression, the root cause is important - it is either changes in the brain (some scientists call it only organic), or general diseases (symptomatic). Common are infectious, endocrine, hemodynamic and other diseases (hypothyroidism, hypercalcemia, lack folic acid, Cushing's syndrome, carcinoma, brucellosis, neurosyphilis).

For example, 50% of patients with hypothyroidism have symptoms of depression. In such cases, the methods of dealing with depression are aimed at solving the underlying problem, although in the case of hypothyroidism, complaints of low mood often precede the onset of signs of the underlying disease.

Robert Baldwin (a specialist in gerontology at the Royal Manchester Hospital) believes that modern drugs aimed at reducing the manifestations of depression in the elderly, despite their variety, do not give the desired effect.

Features of the treatment of minor and major depression

Small differs from large in lesser severity of symptoms and their shift to the cognitive sphere. There is a concept of dysthymia - this is a chronic type of depression, the symptoms and treatment of which are almost the same as usual. However, its symptoms are not so severe and are more extended in time (the diagnosis is made if the patient has been ill for more than 2 years).

There is very little evidence in the scientific literature about its effective treatment. Mentioned drugs and techniques (Paroxetine,). Moreover, in one case, drug treatment gave average effect, and psychotherapeutic was not successful, and in another - it was the method of solving problems that turned out to be effective.

At the same time, even implicitly expressed symptoms can lead to noticeable negative consequences: the result of a "major" depression in an elderly person can be weight loss, dehydration, and even bedsores.

Treatment of vascular depression

Its symptoms are cognitive decline, loss of vitality, lethargy, lethargy, ; characteristic of the elderly (over 65 years). Patients complain of various somatic disorders, which, as a rule, are not explained only by existing diseases: pain in the back, joints, head, various internal organs, dizziness. Rarely: guilt, sadness, depression.

Treatment should take into account the existing organic changes in the brain, somatic and, probably, additional mental illnesses. It is desirable that the prescribed drugs enter into minimal interaction with other drugs.

Possible medicines and therapeutic measures:

1. Venlafaxine, Mirtazapine, SSRIs (third generation antidepressants: Paroxetine, Escyta, Sertraline, Escitalopram, etc.). Of the SSRIs, Escitalopram and Citalopram stand out as the safest and most effective. Well tolerated in depression with cerebrovascular disease.
2. Transcranial magnetic stimulation (TMS) of neurons in the prefrontal cortex. This method can be effective in the treatment of vascular and post-stroke. But there are almost no studies on the use of such a technique in the elderly.
3. Electroconvulsive therapy. A risky method, because it has a lot of side effects: from nausea, vomiting and headache to delirium.

Interestingly, 4 of the antidepressants mentioned above—sertraline, mirtazapine, escitalopram, and venlafaxine—were named the most effective of the 12 modern drugs studied (The Lancet, 2009). The problem is that in the treatment of depression in the elderly, drugs are rarely effective or often difficult to take, for example, sertraline is used with caution in the elderly due to their predisposition to hyponatremia.

Hyponatremia, which outwardly often manifests itself with symptoms similar to depression (lethargy, headaches, fast fatiguability, insomnia), may be among the side effects after drugs of any generation, especially. Age is also a risk factor.

Drugs and medicines

In old age, the mechanisms of action and effects of drugs change. Metabolism becomes more individual, it is already more difficult to calculate the required dosage. Therefore, start with low doses. Particular care is required for elderly people with impaired renal and hepatic function. In these cases, even new, that is, safer, generations of antidepressants require carefulness. Although the modern variety of drugs (at least 20) allows you to choose the right medication, guided by the symptoms of the disease, a set of side effects and features of interaction with drugs already prescribed to the patient.

Another feature: it will take longer for the symptoms to disappear. Younger people demonstrate pronounced reaction for medicines 1 month after the start of the course, the elderly - after 1.5-2.

As a rule, the use of SSRIs is justified: they have fewer side effects, but in some cases they also show less effectiveness than tricyclic antidepressants (that is, 1st generation drugs). When prescribing drugs and monitoring the course of therapy, it is imperative to take into account the insufficiency of the patient's resources, which affects all ages, but the degree is different. At elderly woman higher risks of side effects than the same, but young.

Not every patient can be brought out of depressive states with medication. Some patients either do not respond or respond poorly. If no changes are observed within 1 month, then the drug is replaced with an antidepressant of another class. If there is a partial reaction, then another drug may be added.

Among the side effects of medications that can be used to treat depression in the elderly, one can list: decreased visual acuity, arrhythmia, dry mouth, digestive disorders (constipation or even bleeding in the gastrointestinal tract). All of them are more difficult to tolerate in old age, and some can be deadly. Anti-depression drugs should be used with caution in patients taking Aspirin or NSAIDs. The withdrawal from the depressive state is carried out after 2 months.

In the treatment of senile depression, Moclobemide and Venlafaxine are well tolerated; there are side effects, but they are mild and transient. However, there are few studies on this topic.

Electroconvulsive therapy and magnetic stimulation

Treatment of depression in the elderly with ECT (electroconvulsive therapy) is carried out only after the decision of the commission, which came to the conclusion that other methods were ineffective. The duration of the procedure is about 10 minutes. The patient is put into drug sleep. Perhaps course treatment.

ECT is used when senile depression cannot be cured with medication, and the manifestations of the disease have led to a danger to the life of the patient (there is a possibility of suicide, he refuses to eat). Effective in psychotic depression.

Transcranial magnetic stimulation is similar to ECT but uses a magnet to stimulate neurons in the brain. It can be effective for the treatment of patients, even if with age, for one reason or another, they experience atrophic changes frontal lobes.

Psychological treatments

Until quite recently, the disease was treated mainly with medication. However, today more and more patients prefer, especially when it comes to mild or medium degree the severity of the disease. Can be used:

1. Cognitive Behavioral Therapy. With the help of the therapist, the patient is aware of the attitudes and cliches that can lead him to failure and grief.
2. Interpersonal psychotherapy. Aimed at solving problems in relationships with other people.
3. Family therapy.
4. Problem solving method. No matter how successfully people struggle with problems, there is a step-by-step technique that allows you to go through this path faster and more efficiently, having received a “dose” of hormones of joy and pleasure.

If a depressive disorder has pronounced signs, then a combination of techniques will be most effective. Especially from the position of prevention of recurrences of a depressive state, since a patient who has undergone a course of psychotherapy acquires independence. In the future, he is able to become more aware of the state of depression and take steps to fight it. Useful educational work. This is the case when “knowledge is power”. Prevention of depression largely depends on the degree of awareness of the patient, the ability to reflect on his condition, noting the level of change in his mood and perception.

Attention: in the case of the treatment of depression, the elderly have even less opportunity to purchase a "magic pill" on the principle of "took and - got the result." A doctor is needed who will bring the patient out of his condition - this is a long and complex process that involves active monitoring, the correct selection of drugs and methods.

The most important thing to watch out for if you suspect depression in someone close to you or yourself is that depressive disorders in old age are difficult to diagnose. Often they are "masked" by complaints of a hypochondriacal nature. The most efficient is combined treatment with individually selected psychotherapy methods and medications.