What are depression symptoms. What is depression - the main signs, symptoms and treatment recommendations. Life circumstances and culture

Depressive disorders are becoming more common as a person is exposed to regular stress at home, at work, in personal relationships. The sooner the disease is diagnosed, the more likely it is to get rid of it completely. Often depression is combined with other mental disorders.

What is depression

A disease such as depression is a mental disorder that manifests itself in a long-term decrease in mood and lack of muscle activity. The disease is accompanied by inhibited actions, lethargy, as well as negative thoughts that are present in a person every day and can interfere with a good night's sleep.

Depressive disorders affect 25% of people worldwide. This disease is one of the most common in psychiatric practice.

It is an affective disorder, that is, accompanied by a violation of the natural perception of events. People with this disease are more difficult than others to tolerate ordinary somatic diseases. Even minor eating disorders are often perceived as wake-up calls from the body. Patients with depression are prone to suicide, alcoholism and drug addiction. Especially if the disease is of a protracted nature.

People with a similar disorder feel inhibited thought processes, which interferes with work that requires special concentration. A common person having a healthy psyche, perceives problems as they are. People with depression tend to exaggerate minor annoyances to the point of panicking themselves. In this case, vegetative disorders often occur: hand trembling, dizziness, changes in blood pressure.

There are two main types of depressive disorders: exogenous and endogenous. The first form of the disease is provoked by external factors - the death of a friend, the loss of a loved one, etc. Endogenous depression occurs against the background of internal conflicts and other problems of a similar nature, for example: rejection of oneself, etc.

Additional classification of the disease:

1. Dysthymia is a chronic form of depression that occurs long years and manifested by lack of appetite, lethargy and bad mood.
2. Postpartum disorder - occurs after the birth of a child, is associated with hormonal changes in the body and new functions assigned to a person as a parent.
3. Neurotic - appears against the background of neuroses that have a protracted character.
4. Manic-depressive - proceeds in waves, with periods of exacerbations and remissions, a person feels bouts of anger, which are replaced by a bad mood.
5. Recurrent - recurrent depression lasting several days.
6. Reactive - occurs suddenly against the background of severe stress.

Depression is accompanied by a lack of activity and mood

How and why the disease occurs

An affective disorder is provoked by prolonged stress or psychological trauma. These conditions are triggers - starting points for the development of depression. When the human psyche cannot cope with the problem, then a depressed mood arises. In the process of the onset of depression, neurochemical factors also play a role, which are expressed in a violation of the metabolism of biogenic amines. This can occur with various hormonal disorders. In simple words, in the brain there is a failure in the usual chemical processes.

Provoking factors:

• stroke;
• chronic disorders cerebral circulation;
• menopause;
• endocrine disorders;
• AIDS;
• malignant tumors;
• heart disease;
• taking psychotropic drugs;
• difficult childhood: violence from peers and parents, abuse, etc.;
• a large amount of stress;
• constant employment and lack of proper rest;
• brain and spine injuries;
• failures in personal life or other significant areas of life.

Long-term use of glucocorticoids and drugs for high blood pressure can provoke depression.

The mechanism of depressive disorder is a violation of the chemical processes in the brain

Who is most susceptible to disease

According to statistics, women suffer from depression 1.5 times more often than men. The peak incidence occurs between the ages of 15 and 25 and occurs in 40% of people. This is due to hormonal changes during adolescence and with reproductive period. It is at this age that a person most often encounters complex psychological problems: studying at school, entering a university, getting a job, getting married, etc. People over 40 get sick only in 10% of cases. And patients with depression at age 65 make up 30%.

The fair sex gets sick more often due to hormonal changes in the body during menstrual cycle. In some women, this is more pronounced, while in others it is weaker. At the same time, depression often occurs in the second phase closer to menstruation and disappears without a trace in the first half of the cycle.

Symptoms of the disease

Symptoms of a depressive disorder:

• feeling of hopelessness;
• blaming others for their problems;
• unwillingness to communicate;
• constant fatigue;
• low self-esteem;
• increased anxiety;
• feeling of despair.

In people with affective disorders, the ability to learn is reduced, memory suffers, memorization worsens. The speech of patients is often slowed down. It takes a lot of effort to focus. People with depression often sit in the same position with a sad expression on their faces. Advanced forms of the disease lead to the fact that patients do not get out of bed at all.

Sleep is disturbed as the pathology progresses. Then somatic disorders join. A person is tormented by constipation, the pupils are in a constantly dilated state, the heartbeat quickens. Gradually, the skin is involved in the process. She becomes pale and dry. Nails begin to break and exfoliate. Hair falls out.

Other body systems also suffer. Often, patients complain of discomfort in the stomach, stool disorders, and nausea. Although the examination of the organs does not show any pathology associated with these systems.

Sick people always feel sleepy during the daytime. Some people have a sharp decrease in weight, while others, on the contrary, have an increase in appetite, which leads to obesity. A sudden headache may occur. Apathy is replaced by nervousness. The person almost completely loses social adaptation and does not feel satisfied with the performance of daily activities.

As the disease progresses, the feeling of tension increases. A person practically does not relax, which worsens the course of the disease. Adolescents with depression have little to no friends, they are withdrawn and not sociable, they are lagging behind in learning and do not eat well. In women, libido decreases, the menstrual cycle is disturbed. Men often experience impotence.

Lethargy and lack of interest in daily activities always accompany depression.

What is dangerous disease

Prolonged depression can lead to severe consequences for a person. Against the background of affective disorders, anorexia develops, which in advanced cases is irreversible and ends in death. A person can completely lose working capacity due to lack of ability to concentrate. The risk of ending your life by suicide increases.

Many people who deal with depression talk about the intensity of their emotional experiences. Anxiety becomes so strong that it does not allow even elementary actions to be performed. Man is in captivity of his thoughts.

Anorexia often occurs against the background of prolonged depression

How to get rid of the disease

Treatment for depression is always complex. Apply methods of art therapy, self-hypnosis, as well as individual and group psychotherapy. Physiotherapy gives a good effect. Medications are used for prolonged depression when other treatments become ineffective.

To get rid of depression, the very desire of the patient to get rid of the disease is important. Otherwise, any methods of therapeutic intervention will be useless.

You can get rid of the problem forever, for this you should follow all the prescriptions of the doctor. Depression is a reversible disease.

How to deal with depression - video

Independent ways to get rid of the disease

At home, you can use the methods of self-hypnosis, visualization and art therapy. The first method is the basis of auto-training. A person daily repeats affirmations (a set of positive phrases), while being in a relaxed state. Meditation allows you to touch the depths of the subconscious. It is important that the phrases contain information directly opposite to the negative self-image. For example, a person feels like a failure. Every day he should repeat: “I am a lucky person. Luck itself comes into my hands. Everything works out for me.” Every person has a different set of affirmations.

Before embarking on this method, it is necessary to relax the muscles of the body as much as possible. To do this, you can turn on the music for meditation. You can repeat phrases to yourself or out loud. The course of treatment is at least 2-3 months. The procedure must be repeated daily. The best time to do this is 10 minutes before bed.

Auto-training allows you to get out of depression

The visualization method used in modern psychotherapeutic practice makes it possible to eliminate the source of depression. It is necessary to present what worries you the most - a negative thought. This picture must be mentally placed in front of you. Then imagine how the colors floated on it, as if they were washed away by rain. Eventually the image should be completely erased. And after that, you need to present a picture of what you would like to replace the negative image with. A positive image must be visualized in all colors. It is advisable to do this daily before bedtime for 3-4 months.

Visualization helps to replace negative thoughts with positive ones.

To enhance the effect of visualization, the author of these lines regularly views the desired images on the computer. If it is difficult to fantasize, then you can print pictures and make a target slide out of them. A lot of photos can be pasted on whatman paper and placed in the most visible place. Most people find it easier to process information that way. Photos can be attached with magnets to the refrigerator, then the desired result will always be in front of your eyes. A little trick - it is better to place positive slides just above the eye line. Thus, according to experts in the field of neurolinguistic programming, the desired quickly reaches the subconscious.

An excellent way to get rid of an affective disorder is art therapy. It consists in reflecting your negative thoughts on paper with paints. You can draw whatever you want. The main thing is to throw out negative emotions to the maximum.

Art therapy is to throw out all the negative emotions on paper.

Additional ways to get rid of depression at home:

• modeling from plasticine;
• sports;
• random dances.

Group and individual psychotherapy

Methods of psychotherapy give good results and are the most effective. You can work with a patient individually or in a group. The second method is not always suitable for patients with severe depression who avoid contact with other people. Hypnosis has a good effect, allowing you to immerse a person in a special trance state. At the same time, the psychotherapist recognizes hidden psychological problems that could become a prerequisite for the development of depression.

To get rid of an affective disorder, Gestalt therapy methods are often used. It is based on the fact that the psychotherapist is an active participant in the process. At the same time, the patient expresses hidden emotions, works through a difficult situation, sorting it out on the shelves in real time.

Congentive-behavioral therapy is currently the most commonly used. It allows you to look at yourself from the outside. The doctor asks the patient unexpected questions, answering which the person understands the absurdity of his condition and begins to look at the disease with completely different eyes, without exaggeration. In other words, the psychotherapist convinces the patient that all responsibility for what is happening lies entirely with him. And when the patient wants, he can start a completely different life without depression.

Interruption Based Congenital Behavioral Therapy pathological cycle thoughts

The psychotherapist tries to break the cycle that makes up chronic depression. It is important to convince the patient to abandon negative thoughts and replace them with positive ones.

Medical management of depression

Medications used to treat depression:

1. Antidepressants. Improve mood, stimulate mental activity. They have a number of side effects, so they are prescribed in the minimum dosage. The course of treatment is 4 weeks.
2. Tranquilizers. It is used for depression, which is accompanied by anxiety disorders. Tranquilizers are taken in a short course of no more than 2 weeks.
3. nootropic drugs. Improve cerebral circulation and concentration. Such drugs are used as an auxiliary method of treatment with a course of 4 weeks.

It is dangerous to use antidepressants and tranquilizers without a doctor's prescription, as they have a lot of side effects and can provoke cardiac arrest if the dose is exceeded.

Physiotherapy

Physiotherapy that will be effective:

1. Acupuncture. Accelerates blood circulation, strengthens the immune system, has an effect on the entire body. It is used as an auxiliary way to eliminate depression. The course of treatment - 10 procedures or more. Contraindications: acute psychosis, epilepsy and infections.

   Aromatherapy - an auxiliary way to get rid of depression

Physiotherapy is not an independent method of treatment, but is used only in combination with psychotherapy.

Fighting depression - video

– mental disorder, manifested by a steady decrease in mood, motor retardation and impaired thinking. The cause of development can be traumatic situations, somatic diseases, substance abuse, metabolic disorders in the brain, or lack of bright light (seasonal depression). The disorder is accompanied by a decrease in self-esteem, social maladjustment, loss of interest in habitual activities, own life and surrounding events. The diagnosis is established on the basis of complaints, an anamnesis of the disease, the results of special tests and additional studies. Treatment - pharmacotherapy, psychotherapy.

Causes of depression

In about 90% of cases, acute psychological trauma or chronic stress becomes the cause of the development of an affective disorder. Depression resulting from psychological trauma is called reactive depression. Reactive disorders are provoked by divorce, death or serious illness of a loved one, disability or serious illness of the patient himself, dismissal, conflicts at work, retirement, bankruptcy, a sharp drop in the level of material security, moving, etc.

In some cases, depression occurs "on the wave of success", when an important goal is achieved. Experts explain such reactive disorders as a sudden loss of the meaning of life due to the absence of other goals. Neurotic depression (depressive neurosis) develops against the background of chronic stress. As a rule, in such cases, the specific cause of the disorder cannot be established - the patient either finds it difficult to name a traumatic event, or describes his life as a chain of failures and disappointments.

Patients suffering from depression complain of headaches, pain in the heart, joints, stomach and intestines, however, during additional examinations somatic pathology either not detected, or does not correspond to the intensity and nature of pain. Typical signs of depression are disorders in the sexual sphere. Sexual desire is significantly reduced or lost. Women stop or become irregular menstruation, men often develop impotence.

As a rule, with depression there is a decrease in appetite and weight loss. In some cases (with atypical affective disorder), on the contrary, there is an increase in appetite and an increase in body weight. Sleep disturbances are manifested by early awakenings. During the day, patients with depression feel sleepy, not rested. Perhaps a perversion of the daily rhythm of sleep-wake (drowsiness during the day and insomnia at night). Some patients complain that they do not sleep at night, while relatives say the opposite - such a discrepancy indicates a loss of the sense of sleep.

Diagnosis and treatment of depression

The diagnosis is established on the basis of anamnesis, patient complaints and special tests to determine the level of depression. Diagnosis requires the presence of at least two symptoms of the depressive triad and at least three additional symptoms, which include guilt, pessimism, difficulty concentrating and making decisions, decreased self-esteem, sleep disturbances, appetite disorders, suicidal thoughts and intentions. If a patient suffering from depression is suspected of having somatic diseases, they are referred for a consultation with a general practitioner, neurologist, cardiologist, gastroenterologist, rheumatologist, endocrinologist and other specialists (depending on the existing symptoms). The list of additional studies is determined by general practitioners.

Treatment of minor, atypical, recurrent, postpartum depression and dysthymia is usually performed on an outpatient basis. At big upset hospitalization may be required. The treatment plan is made individually, depending on the type and severity of depression, only psychotherapy or psychotherapy in combination with pharmacotherapy is used. Antidepressants are the mainstay of drug therapy. With lethargy, antidepressants with a stimulating effect are prescribed, with anxious depression, sedative drugs are used.

The response to antidepressants depends both on the type and severity of the depression and on the individual patient. At the initial stages of pharmacotherapy, psychiatrists and psychotherapists sometimes have to change the drug due to insufficient antidepressant effect or pronounced side effects. A decrease in the severity of symptoms of depression is noted only 2-3 weeks after the start of antidepressants, therefore, at the initial stage of treatment, patients are often prescribed tranquilizers. Tranquilizers are prescribed for a period of 2-4 weeks, the minimum period for taking antidepressants is several months.

Psychotherapeutic treatment for depression may include individual, family, and group therapy. They use rational therapy, hypnosis, gestalt therapy, art therapy, etc. Psychotherapy is supplemented with other non-drug methods of treatment. Patients are referred to exercise therapy, physical therapy, acupuncture, massage, and aromatherapy. During treatment seasonal depressions good effect achieved with the use of light therapy. With resistant (not treatable) depression, electroconvulsive therapy and sleep deprivation are used in some cases.

The prognosis is determined by the type, severity, and cause of the depression. Reactive disorders usually respond well to treatment. With neurotic depression, there is a tendency to protracted or chronic course. The condition of patients with somatogenic affective disorders is determined by the characteristics of the underlying disease. Endogenous depressions do not respond well to drug therapy, with the correct selection of drugs in some cases, stable compensation is observed.

Depression as a state of emotional depression has been known since ancient times. Even eight centuries before the birth of Christ, the great ancient Greek poet Homer described the classical depressive state of one of the heroes of the Iliad, who “... wandered around, alone, gnawing his heart, running away from the traces of a person ...”

In the very first collection of medical treatises ancient greece, the authorship of which is attributed to the "father scientific medicine” Hippocrates, the suffering caused by depression was quite clearly described, and the definition of the disease was given: “if sadness and fear continue long enough, then we can talk about a melancholic state.”

The term "melancholia" (literally black bile) was used in medicine long time and has been preserved in the names of some mental pathologies to this day (for example, "involutional melancholia" - depression that develops in women during menopause).

Descriptions of pathological emotional experiences that lead to inadequate perception of the surrounding world are also found in the Old Testament. In particular, the First Book of Kings describes a clinic of severe depression in the first king of Israel, Saul.

In the Bible, such a state is interpreted as a punishment for sins before God, and in the case of Saul, it ends tragically - the king committed suicide by throwing himself on a sword.

Christianity, largely based on the Old Testament, for a long time maintained an extremely negative attitude towards all mental illnesses, associating them with the machinations of the devil.

As for depression, in the Middle Ages it began to be denoted by the term Acedia (lethargy) and considered as a manifestation of such mortal sins as laziness and despondency.

The term "depression" (oppression, depression) appeared only in the nineteenth century, when representatives of the natural sciences began to study diseases of the mental sphere.

Current Statistics on Depression

Today, depression is the most common mental pathology. According to the WHO, depression accounts for 40% of cases of all mental illnesses, and 65% of mental pathologies that are treated on an outpatient basis (without placing the patient in a hospital).

At the same time, the incidence of depression is steadily increasing from year to year, so that over the past century the number of annually registered depressed patients has increased by more than 4 times. Today in the world every year about 100 million patients go to the doctor for the first time because of depression. It is characteristic that the lion's share of depressive patients falls on countries with a high level of development.

Part of the increase in reported cases of depression is due to the rapid development of psychiatry, psychology and psychotherapy. So even mild cases of depression that used to go unnoticed are now being diagnosed and successfully treated.

However, most experts associate the increase in the number of depressed patients in civilized countries with the peculiarities of life. modern man in big cities such as:

• high pace of life;
• a large number of stress factors;
• high population density;
• isolation from nature;
• alienation from centuries-old traditions, which in many cases have protective influence on the psyche;
• the phenomenon of "loneliness in the crowd", when constant communication with a large number of people is combined with the absence of close warm "unofficial" contact;
• deficit motor activity(it is proved that the banal physical movement, even ordinary walking, favorably affects the state of the nervous system);
• population aging (the risk of depression increases many times with age).

Different Differences: Interesting Depression Facts

• The author of "gloomy" stories Edgar Allan Poe suffered from bouts of depression, which he tried to "treat" with alcohol and drugs.
• There is a hypothesis that talent and creativity contribute to the development of depression. The percentage of depressive and suicidal among outstanding figures of culture and art is much higher than in the general population.
• The founder of psychoanalysis Sigmund Freud gave one of the better definitions depression, designating pathology as an irritation directed at oneself.
• People suffering from depression are more likely to have fractures. Studies have shown that this is associated with both a decrease in attention and a deterioration in the condition of the bone tissue.
• Contrary to popular belief, nicotine is in no way able to “help relax”, and puffing on cigarette smoke only brings visible relief, in fact, aggravating the patient’s condition. Among smokers, there are significantly more patients suffering from chronic stress and depression than among people who do not use nicotine.
• Addiction to alcohol increases the risk of developing depression several times.
• People suffering from depression are more likely to fall victim to the flu and SARS.
• It turned out that the average gamer is a person suffering from depression.
• Danish researchers have found that paternal depression has a very negative effect on emotional condition babies. These babies cry more often and sleep worse.
• Statistical studies have shown that overweight children of kindergarten age have a significantly higher risk of developing depression than their peers who are not overweight. At the same time, obesity significantly worsens the course of childhood depression.
• Women who are prone to depression have a significantly higher risk of preterm birth and other complications during pregnancy.
• According to statistics, every 8 out of 10 patients suffering from depression refuse specialized help.
• The lack of affection, even with a relatively prosperous financial and social situation, contributes to the development of depression in children.
• Approximately 15% of depressed patients commit suicide each year.

Causes of depression

Classification of depressions according to the cause of their development

• external influences on the psyche
  • acute (psychological trauma);
  • chronic (state of constant stress);
• genetic predisposition;
• endocrine shifts;
• congenital or acquired organic defects of the central nervous system;
• somatic (bodily) diseases.

1. Psychogenic depression, which are the reaction of the psyche to any adverse life circumstances.
2. Endogenous depressions(literally called internal factors) representing psychiatric diseases, in the development of which, as a rule, the determining role belongs to genetic predisposition.
3. organic depressions caused by a severe congenital or acquired defect of the central nervous system;
4. Symptomatic depressions, which are one of the signs (symptoms) of a bodily disease.
5. Iatrogenic depressions which are side effects of a drug.

Reasons for the development of reactive and neurasthenic depression

Psychogenic depression is the most common type of depression, accounting for up to 90% of all types of depression. Most authors subdivide all psychogenic depressions into reactive - acute depressive states and neurasthenic depressions, which initially have a chronic course.

Most often the reason reactive depression become a severe psychological trauma, namely:

• tragedy in personal life (illness or death of a loved one, divorce, childlessness, loneliness);
• health problems (severe illness or disability);
• cataclysms at work (creative or production failures, conflicts in the team, job loss, retirement);
• experienced physical or psychological abuse;
• economic troubles (financial collapse, transition to a lower level of security);
• migration (moving to another apartment, to another district of the city, to another country).

A common feature of all reactive depressions, without exception, is the presence of a traumatic factor in all emotional experiences of the patient, who is clearly aware of the reason for which he suffers, whether it is the loss of a job or disappointment after entering a prestigious university.

The reason neurasthenic depression is chronic stress, therefore, in such cases, the main traumatic factor is usually not detected by the patient or is described as a long streak of minor failures and disappointments.

Risk factors for the development of psychogenic depression

Psychogenic depression, both reactive and neurasthenic, can develop in almost any person. At the same time, as banal experience shows, people accept the blows of fate in different ways - one person perceives dismissal from work as a minor nuisance, the other as a universal tragedy.

Therefore, there are factors that increase a person's propensity for depression - age, gender, social and individual.

age factor.

Even though young people lead more active image life, and, therefore, are more susceptible to adverse external factors, in adolescence, depressive states, as a rule, occur less frequently and proceed more easily than in the elderly.

Scientists link older people's susceptibility to depression to an age-related decrease in the production of the "happiness hormone" - serotonin and a weakening of social ties.

Gender and depression

Women, due to the physiological lability of the psyche, are more prone to depression, but in men, depression is much more severe. Statistics show that women suffer from depression 5-6 times more often than men, and yet, among 10 suicides, there are only 2 women.

This is partly due to the fact that women prefer "chocolate to cure sadness", and men are more likely to seek solace in alcohol, drugs and casual relationships, which greatly exacerbates the course of the disease.

social status.

Statistical studies have shown that wealth and poverty are most prone to severe psychogenic depression. People with average incomes are more resilient.

In addition, each person also has individual characteristics psyche, worldview and microsociety (the immediate environment), which increase the likelihood of developing depressive conditions, such as:

• genetic predisposition (close relatives were prone to melancholy, made suicide attempts, suffered from alcoholism, drug addiction or some other addiction, often masking the manifestations of depression);
• transferred to childhood psychological trauma (early orphanhood, divorce of parents, domestic violence, etc.);
• congenital increased vulnerability of the psyche;
• introversion (a tendency to self-deepening, which, when depressed, turns into fruitless self-digging and self-flagellation);
• features of character and worldview (pessimistic view of the world order, overestimated or, conversely, underestimated self-esteem);
• poor physical health;
• lack of social support in the family, among peers, friends and colleagues.

Endogenous depressions make up only about 1% of all types of depressions. A classic example is manic-depressive psychosis, which is characterized by a cyclical course, when periods of mental health are replaced by phases of depression.

Quite often, phases of depression alternate with phases of the so-called manic states, which, on the contrary, are characterized by inadequate emotional uplift and increased speech and motor activity, so that the patient's behavior in manic phase resembles the behavior of a drunk person.

The mechanism of development of manic-depressive psychosis, as well as other endogenous depressions, has not been fully studied, however, it has long been known that this disease is genetically determined (if one of the identical twins falls ill with manic-depressive psychosis, then the likelihood of developing such a pathology in a genetic twin is 97%).

Women are more often ill, the first episode, as a rule, occurs in young age immediately after adulthood. However, a later development of the disease is also possible. The depressive phase lasts from two to six months, while emotional depression gradually worsens, reaching a certain critical depth, and then the normal state of the psyche is also gradually restored.

"Light" intervals in manic-depressive psychosis are quite long - from several months to several years. An exacerbation of the disease can provoke some kind of physical or mental shock, but most often the depressive phase occurs on its own, obeying a certain internal rhythm of the disease. Often, the change of season (autumn and / or spring phases) becomes a critical period for the disease, some patients note the occurrence of depression on certain days of the menstrual cycle.

Another example of a relatively common endogenous depression is involutionary melancholy. The disease develops at the age of 45-55 years, mainly in women.

The causes of the disease remain unknown. The hereditary factor in this case not tracked. Any physical or nervous shock can provoke the development of involutionary melancholia. However, in most cases, the disease begins as a painful reaction to wilting and approaching old age.

Involutional melancholy, as a rule, is combined with such symptoms as increased anxiety, hypochondria (fear of death from a serious illness), sometimes there are hysterical reactions. After getting out of depression, patients most often have some mental defects (decreased ability to empathize, isolation, elements of egocentrism).

Senile (senile) depression develop in old age. Many experts believe that the cause of the development of this pathology is a combination of a genetic predisposition to the disease with the presence of small organic defects of the central nervous system associated with age-related circulatory disorders of the brain.

Such depression is characterized by a peculiar deformation of the patient's character traits. Patients become grouchy, touchy, features of selfishness appear. Against the background of a depressed gloomy mood, an extremely pessimistic assessment of the surrounding reality develops: patients constantly complain about the “wrongness” modern norms and customs, comparing them with the past, when, in their opinion, everything was perfect.

The onset of senile depression is usually acute and is associated with some traumatic factor (the death of a spouse, moving to another place of residence, a serious illness). In the future, depression takes a protracted course: the circle of interests narrows, previously active patients become apathetic, one-sided and petty.

Sometimes patients hide their condition from others, including those closest to them, and suffer in silence. In such cases, there is real threat suicide.

Depression associated with physiological endocrine changes in the body

Hormones play a leading role in the life of the body as a whole and in the functioning of the central nervous system in particular, therefore, any fluctuations in the hormonal background can cause serious violations emotional sphere, as we see it in the example of premenstrual syndrome in women.

Meanwhile life cycle human implies the existence of periods when a kind of hormonal explosion occurs. These periods are associated with the functioning of the reproductive system and include growing up, reproduction (in women) and extinction (menopause).

Accordingly, depressions associated with physiological endocrine changes in the body include:

• teenage depression;
• postpartum depression in women in labor;
• depression in menopause.

• increased fatigue;
• reversible decline in intellectual functions (attention, memory, creativity);
• reduced performance;
• increased irritability;
• tendency to hysteroid reactions;
• emotional weakness (tearfulness, capriciousness, etc.).

Another characteristic feature of depressive states associated with deep hormonal restructuring is that their development is in many ways similar to psychogenic depression, since there is a significant traumatic factor for the psyche (growing up, giving birth to a child, a feeling of approaching old age).

Therefore, the factors that increase the risk of developing such depressions are the same as in psychogenies (genetic predisposition, increased vulnerability of the psyche, psychological trauma, personality traits, lack of support from the immediate environment, etc.).

organic depressions

The frequency of depression in some brain lesions is quite high. So clinical studies have shown that about 50% of stroke patients show signs of depression already in the early recovery period. At the same time, emotional depression develops against the background of other neurological disorders(paralysis, sensory disturbances, etc.) and are often combined with characteristic bouts of violent crying.

Depression is even more common in chronic cerebrovascular insufficiency (about 60% of patients). In such cases, emotional depression is combined with increased anxiety. Patients, as a rule, constantly disturb others with monotonous complaints about their difficult physical and mental condition. For this reason, vascular depressions are also called "aching" or "complaining" depressions.

Depression in traumatic brain injury occurs in 15-25% of cases and most often develops in remote period– months or even years after the tragic event. As a rule, in such cases, depression occurs against the background of already developed traumatic encephalopathy - an organic pathology of the brain, manifested by a whole range of symptoms, such as headache attacks, weakness, memory and attention loss, irritability, malice, resentment, sleep disorders, tearfulness.

With neoplasms in the frontal and temporal lobe, as well as with such serious diseases of the nervous system as parkinsonism, multiple sclerosis and Huntington's chorea, depression occurs in most patients and may be the first symptom of pathology.

Symptomatic depressions

Symptomatic depressions are registered rather seldom. This is partly due to the fact that depressions that develop at the advanced clinical stage of a serious illness are usually considered as a patient's reaction to their condition and are classified as psychogenies (reactive or neurasthenic depressions).

Meanwhile, many diseases are especially often combined with depression, which allows us to speak of emotional depression as a specific symptom of this pathology. Such diseases include:

• defeat of cardio-vascular system(ischemic heart disease, chronic circulatory failure);
• lung diseases (bronchial asthma, chronic pulmonary heart failure);
• endocrine pathologies (diabetes mellitus, thyrotoxicosis, Itsenko-Cushing's disease, Addison's disease);
• disease gastrointestinal tract(gastric ulcer and duodenum, enterocolitis, hepatitis C, cirrhosis of the liver);
• rheumatoid diseases (systemic lupus erythematosus, rheumatoid arthritis, scleroderma);
• oncological diseases (sarcoma, uterine fibroids, cancer);
• ophthalmic pathology (glaucoma);
• genitourinary system (chronic pyelonephritis).

With some bodily ailments, a depressive state may be the first symptom of a disease that still does not make itself felt. First of all, this applies to oncological diseases, such as pancreatic cancer, stomach cancer, lung cancer, etc.

A characteristic feature of symptomatic depression that occurred at the preclinical stage of cancer is the predominance of the so-called negative symptoms. It is not sadness and anxiety that come to the fore, but the loss of the "taste of life", patients become apathetic, avoid colleagues and friends, in women the first sign of this kind of depression may be a loss of interest in their own appearance.

At malignant neoplasms depression can occur at any stage in the development of pathology, so many oncology clinics employ psychologists who specialize in providing assistance to cancer patients.

Depressions that develop in patients with alcohol and/or drug addiction
Depressions that develop in alcoholism and/or drug addiction can be considered as signs of chronic poisoning of brain cells by neurotoxic substances, that is, as symptomatic depressions.

However, alcohol and / and drug addiction often occurs against the background of prolonged psychogenic depression, when the patient tries to “treat” mental pain and longing with brain-stupefying substances.

As a result, a vicious circle often forms: emotional drama encourages the patient to use substances that weaken moral suffering, and alcohol and drugs cause a whole cascade of everyday hardships (quarrels in the family, problems at work, poverty, social maladaptation etc.), entailing new experiences, from which the patient gets rid of with the help of the usual "medicine".

Thus, on early stages development of alcoholism and drug addiction, depression can in many ways resemble psychogenic depressions (prolonged reactive or neurasthenic).

At the advanced stage of the disease, when a physiological and psychological addiction to a psychoactive substance is formed, this kind of depression has pronounced features of its own. The patient perceives the whole world through the prism of addiction to alcohol and / or drugs. So in such cases, group psychotherapy sessions (groups of anonymous alcoholics and drug addicts, etc.) can be especially effective.

In the last stages of the development of alcohol and drug addiction When irreversible changes develop in the central nervous system, depression takes on a pronounced organic character.

The characteristic features of depression in alcohol and drug addiction became the reason for the allocation of these pathologies into a separate group. The effectiveness of treatment in such cases is ensured by the involvement of several specialists (psychologist, psychotherapist, narcologist, and in the last stages also a neuropathologist and psychiatrist).

Iatrogenic depressions

The very name "iatrogenic" (literally "caused by a doctor" or "having a medical origin") speaks for itself - this is the name of depression associated with the use of drugs.

The most common "culprits" of iatrogenic depression are the following medications:

• antihypertensive drugs (drugs that reduce arterial pressure) - reserpine, raunatin, apressin, clonidine, methyldopa, propranalol, verapamil;
• antimicrobials - sulfanilamide derivatives, isoniazid, some antibiotics;
• antifungals(amphotericin B);
• antiarrhythmic drugs (cardiac glycosides, novocainamide);
• hormonal agents (glucocorticoids, anabolic steroids, combined oral contraceptives);
• lipid-lowering drugs (used for atherosclerosis) - cholestyramine, pravastatin;
• chemotherapeutic agents used in oncology - methotrexate, vinblastine, vincristine, asparaginase, procarbazine, interferons;
• drugs used to reduce gastric secretion - cimetidine, ranitidine.

Depression

Therefore, any medicines designed for long-term use must be used as directed and under the supervision of a physician.

Iatrogenic depression, as a rule, occurs only with long-term use of these drugs. In such cases, the state of general depression rarely reaches a significant depth, and the emotional background of patients is completely normalized after the withdrawal of the medication that caused the symptoms of depression.

The exception is iatrogenic depression that has developed in patients suffering from pathologies such as:

• cerebrovascular accident (often accompanied by hypertension and atherosclerosis)
• coronary heart disease (as a rule, is a consequence of atherosclerosis and leads to arrhythmias);
• heart failure (often treated with cardiac glycosides);
• peptic ulcer of the stomach and duodenum (usually occurs with hyperacidity);
• oncological diseases.

In such cases, the appointment of "suspicious" drugs can provoke an exacerbation of symptomatic depression or aggravate the course of depression associated with an organic defect in the nervous system. Therefore, in addition to the abolition of the drug that caused depression, it may also be necessary to special treatment symptoms of depression (psychotherapy, prescription of antidepressants).

Prevention of iatrogenic depression consists in observing all precautions when prescribing drugs that can cause depression, namely:

• patients with a tendency to depression need to select drugs that do not have the ability to suppress the emotional background;
• these drugs (including combined oral contraceptives) should be prescribed by the attending physician, taking into account all indications and contraindications;
• treatment should be carried out under the supervision of a doctor, the patient should be informed of all unpleasant side effects - timely replacement of the drug will help to avoid many troubles.

Symptoms and signs of depression

Psychological, neurological and vegetative-somatic signs of depression

To signs of a mental disorder refers, first of all, to the depressive triad, which combines the following groups of symptoms:

• decrease in the general emotional background;
• inhibition of thought processes;
• decrease in motor activity.

The inhibition of thought processes is expressed in slow speech, short monosyllabic answers. Patients think for a long time about solving simple logical tasks, their memory and attention functions are significantly reduced.

A decrease in motor activity is manifested in slowness, sluggishness, a feeling of stiffness of movements. In severe depression, patients fall into a stupor (a state of psychological immobility). In such cases, the posture of patients is quite natural: as a rule, they lie on their backs with outstretched limbs or sit, bent over, bowing their heads and resting their elbows on their knees.

Due to a decrease in general motor activity, the mimic muscles seem to freeze in one position, and the face of depressed patients acquires the character of a kind of mask of suffering.

Against the background of a suppressed emotional background, even with mild psychogenic depression, patients have a sharp decrease in self-esteem, and delusional ideas of their own inferiority and sinfulness are formed.

In mild cases, we are talking only about a clear exaggeration of their own guilt, in severe cases, patients feel the burden of responsibility for all, without exception, the troubles of their neighbors and even for all the cataclysms taking place in the country and in the world as a whole.

A characteristic feature of delirium is that patients are practically not amenable to persuasion and, even fully realizing the absurdity of the assumptions made and agreeing with the doctor, after a while they again return to their delusional ideas.

Psychiatric disorders are associated With neurological symptoms , the main of which is sleep disturbance.

A characteristic feature of insomnia in depression is early awakening (about 4-5 am), after which patients can no longer fall asleep. Often patients claim that they did not sleep all night, while medical staff or loved ones saw them sleeping. This symptom indicates a loss of the sense of sleep.
In addition, depressed patients have various disorders appetite. Sometimes bulimia (gluttony) develops due to loss of satiety, but loss of appetite up to complete anorexia is more common, so patients can lose significant weight.

Violations of the activity of the central nervous system lead to functional pathology of the reproductive sphere. Women experience menstrual irregularities up to the development of amenorrhea (absence of menstrual bleeding), men often develop impotence.

To vegetative-somatic signs of depression applies Protopopov's triad:

• tachycardia (increased heart rate);
• mydriasis (dilated pupil);

Another characteristic sign of a violation of the activity of the autonomic nervous system is the abundance of complaints of pain (heart, joint, head, intestinal), while laboratory and instrumental studies do not reveal signs of serious pathology.

Criteria for the diagnosis of depression

• a decrease in mood (determined by the sensation of the patient himself or from the words of relatives), while a reduced emotional background is observed almost daily for most of the day and lasts at least 14 days;
• loss of interest in activities that used to bring pleasure; narrowing the range of interests;
• decreased energy tone and increased fatigue.

• decreased ability to concentrate;
• decreased self-esteem, loss of self-confidence;
• delusions of guilt;
• pessimism;
• thoughts of suicide;
• sleep disorders;
• appetite disorders.

Positive and negative signs of depression

In addition, focusing on the leading symptoms of emotional and volitional disorders - whether it is longing, anxiety, detachment and withdrawal into oneself or the presence of delusional ideas of self-abasement - the doctor prescribes one or another drug or resorts to non-drug therapy.

For convenience, all the psychological symptoms of depression are divided into two main groups:

• positive symptoms (the appearance of any sign that is not normally observed);
• negative symptoms (loss of any psychological ability).

• Longing in depressive states is in the nature of painful mental suffering and is felt in the form of intolerable oppression in the chest or in the epigastric region (under the pit of the stomach) - the so-called precordial or epigastric longing. As a rule, this feeling is combined with despondency, hopelessness and despair, and often leads to suicidal impulses.
• Anxiety often has an indefinite character of a painful premonition of an irreparable disaster and leads to constant timid tension.
• Intellectual and motor retardation is manifested in the slowness of all reactions, impaired attention function, loss of spontaneous activity, including the performance of everyday simple duties, which become a burden to the patient.
• Pathological circadian rhythm - characteristic fluctuations in the emotional background during the day. At the same time, the maximum severity of depressive symptoms occurs in the early morning hours (for this reason, most suicides occur in the first half of the day). By the evening, the state of health, as a rule, improves significantly.
• Ideas of one's own insignificance, sinfulness and inferiority, as a rule, lead to a kind of reassessment of one's own past, so that the patient sees his own life path as a continuous series of failures and loses all hope for "light at the end of the tunnel."
• Hypochondriacal ideas - represent an exaggeration of the severity of associated physical ailments and / or fear of sudden death from an accident or fatal illness. With severe endogenous depression, such ideas often take on a global character: patients claim that “everything is already rotten in the middle”, certain organs are missing, etc.
• Suicidal thoughts - the desire to commit suicide sometimes takes obsessive nature(suicide mania).

• Painful (mournful) insensitivity - most common in manic-depressive psychosis and is a painful feeling of complete loss of the ability to experience such feelings as love, hate, compassion, anger.
• Moral anesthesia - mental discomfort in connection with the realization of the loss of elusive emotional ties with other people, as well as the extinction of such functions as intuition, fantasy and imagination (also most characteristic of severe endogenous depressions).
• Depressive devitalization - the disappearance of the desire for life, the extinction of the instinct of self-preservation and the main somatosensory urges (libido, sleep, appetite).
• Apathy - lethargy, indifference to the environment.
• Dysphoria - gloominess, grouchiness, pettiness in claims to others (more common in involutional melancholia, senile and organic depressions).
• Anhedonia - the loss of the ability to enjoy everyday life (communication with people and nature, reading books, watching television series, etc.), is often recognized and painfully perceived by the patient, as another proof of his own inferiority.

Treatment for depression

What medications can help with depression

Subsequently clinical trials showed positive effect use of iproniazid for the treatment of patients with depression and nervous exhaustion. Scientists have found that the mechanism of action of the drug is to inhibit the enzyme monoamine oxidase (MAO), which inactivates serotonin and norepinephrine.

With regular use of the drug, the concentration of serotonin and norepinephrine in the central nervous system increases, which leads to an increase in mood and an improvement in the overall tone of the nervous system.

Today, antidepressants are a popular group of medicines, which is constantly updated with more and more new drugs. A common feature of all these drugs is the specificity of the mechanism of action: one way or another, antidepressants potentiate the action of serotonin and, to a lesser extent, norepinephrine in the central nervous system.

Serotonin is called the “joy” neurotransmitter, it regulates impulsive cravings, facilitates falling asleep and normalizes the change of sleep cycles, reduces aggressiveness, increases pain tolerance, eliminates obsessions and fears. Norepinephrine potentiates cognitive abilities and is involved in maintaining the state of wakefulness.

Different drugs from the group of antidepressants differ in the presence and severity of the following effects:

• stimulating effect on the nervous system;
• sedative (calming) effect;
• anxiolytic properties (relieves anxiety);
• anticholinergic effects (such drugs have many side effects and contraindicated in glaucoma and some other diseases);
• hypotensive effect (lower blood pressure);
• cardiotoxic effect (contraindicated in patients suffering from serious heart disease).

First and second line antidepressants

In particular, such drugs can be prescribed to pregnant women, as well as to patients suffering from heart disease (CHD, heart defects, arterial hypertension, etc.), lungs (acute bronchitis, pneumonia), blood system (anemia), urolithiasis (including including complicated renal failure), severe endocrine pathologies (diabetes mellitus, thyrotoxicosis), glaucoma.

Antidepressants of new generations are called first-line drugs. These include:

• selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Fevarin), citalopram (Cipramil);
• selective serotonin reuptake stimulants (SSOZS): tianeptine (coaxil);
• individual representatives of selective norepinephrine reuptake inhibitors (SNRIs): mianserin (lerivon);
• reversible inhibitors of monoamine oxidase type A (OIMAO-A): pirlindol (pyrazidol), moclobemide (Aurorix);
• adenosylmethionine derivative - ademetionine (heptral).

For second-line drugs include drugs of the first generations of antidepressants:

• monoamine oxidase inhibitors (MAOIs): iproniazid, nialamide, phenelzine;
• thymoanaleptics of a tricyclic structure (tricyclic antidepressants): amitriptyline, imipramine (melipramine), clomipramine (anafranil), doxilin (sinequan);
• some representatives of SNRIs: maprotiline (ludiomil).

However, a significant number of contraindications and side effects, poor compatibility with many therapeutic agents, and in some cases the need to follow a special diet (MAOI) significantly limit their use. Therefore, second-line antidepressants are used, as a rule, only in cases where first-line drugs for one reason or another did not suit the patient.

How does a doctor choose an antidepressant?

In cases where the patient has already successfully taken an antidepressant, doctors usually prescribe the same drug. Otherwise, drug treatment for depression begins with first-line antidepressants.
When choosing a drug, the doctor focuses on the severity and prevalence of certain symptoms. So, in depressions that occur mainly with negative and asthenic symptoms (loss of taste for life, lethargy, apathy, etc.), drugs with a slight stimulating effect are prescribed (fluoxetine (Prozac), moclobemide (Aurorix)).

In cases where positive symptoms predominate - anxiety, melancholy, suicidal impulses, antidepressants with a sedative and anti-anxiety effect are prescribed (maprotiline (ludiomil), tianeptine (coaxil), pirlindol (pyrazidol)).

In addition, there are first-line drugs that have universal action(sertraline (zoloft), fluvoxamine (fevarin), citalopram (cipramil), paroxetine (paxil)). They are prescribed to patients in whom the positive and negative symptoms of depression are equally pronounced.

Sometimes doctors resort to the combined prescription of antidepressant drugs, when the patient takes an antidepressant in the morning with a stimulating effect, and in the evening - with a sedative.

What drugs can be prescribed additionally in the treatment of antidepressants

In severe cases, doctors combine antidepressants with drugs from other groups, such as:

• tranquilizers;
• neuroleptics;
• nootropics.

The combination of antidepressants with tranquilizers is also used in patients with severe violations sleep. In such cases, a stimulating antidepressant is prescribed in the morning, and a tranquilizer in the evening.

Antipsychotics- a group of drugs intended for the treatment of acute psychosis. AT combination therapy depression, antipsychotics are used for severe delusions and suicidal tendencies. At the same time, "light" antipsychotics (sulpiride, risperidone, olanzapine) are prescribed, which do not have side effects in the form of a general depression of the psyche.

Nootropics- a group of drugs that have a general stimulating effect on the central nervous system. These drugs are prescribed in the combined therapy of depression that occurs with symptoms of exhaustion of the nervous system ( fast fatiguability, weakness, lethargy, apathy).

Nootropics do not have a negative impact on the functions of internal organs, they are well combined with drugs from other groups. However, it should be borne in mind that they can, albeit slightly, increase the threshold for convulsive readiness and can cause insomnia.

What you need to know about medication for depression

• Tablets are best taken at the same time. Depressed patients are often absent-minded, so doctors suggest keeping a diary to keep track of drug use, as well as notes on its effectiveness (improvement, no change, unpleasant side effects).
• Therapeutic action drugs from the group of antidepressants begins to appear after a certain period after the start of administration (after 3-10 or more days, depending on the specific drug).
• Most of the side effects of antidepressants, on the contrary, are most pronounced in the first days and weeks of admission.
• Contrary to popular belief, drugs intended for drug treatment depressions, if taken in therapeutic doses, do not cause physical and mental dependence.
• Antidepressants, tranquilizers, antipsychotics and nootropics do not develop addiction. In other words: there is no need to increase the dose of the drug for long-term use. On the contrary, over time, the dose of the drug may be reduced to the minimum maintenance dose.
• With a sharp cessation of antidepressants, the development of a withdrawal syndrome is possible, which is manifested by the development of such effects as melancholy, anxiety, insomnia, and suicidal tendencies. Therefore, drugs used to treat depression are discontinued gradually.
• Treatment with antidepressants should be combined with non-drug treatments for depression. Most often, drug therapy is combined with psychotherapy.
• Drug therapy for depression is prescribed by the attending physician and is carried out under his supervision. The patient and / or his relatives should promptly inform the doctor about all adverse side effects of treatment. In some cases, individual reactions to the drug are possible.
• The replacement of an antidepressant, the transition to combined treatment with drugs from different groups and the termination of drug therapy for depression are also carried out on the recommendation and under the supervision of the attending physician.

Do I need to see a doctor for depression?

Almost everyone endured transient periods of blues and melancholy, when the world around them is seen in gray and black colors. Such periods can be associated with both external (rupture of relationships with loved ones, trouble at work, moving to another place of residence, etc.) and internal reasons ( transitional age adolescents, midlife crisis, premenstrual syndrome in women, etc.).

Most of us are saved from general depression by already proven means at hand (reading poetry, watching TV, communicating with nature or loved ones, a favorite job or hobby) and can testify to the possibility of self-healing.

However, doctor-time may not help everyone. Professional help should be sought if any of the following warning signs of depression are present:

• depressed mood persists for more than two weeks and there is no tendency to improve the general condition;
• previously helped methods of relaxation (communication with friends, music, etc.) do not bring relief and do not distract from gloomy thoughts;
• there are thoughts of suicide;
• disrupted social ties in the family and at work;
• the circle of interests narrows, the taste for life is lost, the patient "goes into himself."

A person who is depressed will not be helped by advice that “you need to pull yourself together”, “get busy”, “have fun”, “think about the suffering of loved ones”, etc. In such cases, the help of a professional is necessary, because:

• even with mild depression, there is always a threat of a suicide attempt;
• depression significantly reduces the patient's quality of life and performance, adversely affects his immediate environment (relatives, friends, colleagues, neighbors, etc.);
• like any disease, depression can worsen over time, so it is better to consult a doctor in a timely manner to ensure a speedy and full recovery;
• depression can be the first sign of severe bodily ailments (oncological diseases, multiple sclerosis, etc.), which are also better treated in the early stages of pathology development.

Which doctor should be consulted for the treatment of depression

Before visiting a doctor, it is better to think over the answers to questions that are usually asked at the initial appointment:

• About complaints
  • what worries more melancholy and anxiety or apathy and lack of "taste of life"
  • whether depressed mood is combined with sleep disturbances, appetite, sexual desire;
  • at what time of the day are pathological symptoms more pronounced - in the morning or in the evening
  • whether there were thoughts of suicide.
• History of present illness:
  • with what the patient associates the development of pathological symptoms;
  • how long ago they appeared;
  • How did the disease develop?
  • what methods the patient tried to get rid of unpleasant symptoms;
  • what medications the patient took on the eve of the development of the disease and continues to take today.
• Current state of health(must report all comorbidities, their course and methods of therapy).
• Life story
  • past psychological trauma;
  • have had episodes of depression before;
  • past illnesses, injuries, operations;
  • attitude towards alcohol, smoking and drugs.
• Obstetric and gynecological history(for women)
  • whether there were menstrual irregularities (premenstrual syndrome, amenorrhea, dysfunctional uterine bleeding);
  • how the pregnancies went (including those that did not end with the birth of a child);
  • whether there were signs of postpartum depression.
• Family history
  • depression and other mental illnesses, as well as alcoholism, drug addiction, suicide among relatives.
• Social history(relationships in the family and at work, can the patient count on the support of relatives and friends).

Severe endogenous depression, as a rule, is treated by a psychiatrist in a hospital setting. Therapy of organic and symptomatic depression is carried out by the psychologist together with the doctor in charge of the underlying pathology (neurologist, oncologist, cardiologist, endocrinologist, gastroenterologist, phthisiatrician, etc.).

How a specialist treats depression

The primary task of a specialist psychologist is to establish a trusting relationship with the patient and his immediate environment, provide information about the nature of the disease, methods of its treatment and possible prognosis, correct violations of self-esteem and attitude to the surrounding reality, create conditions for further psychological support of the patient.

In the future, they proceed to the actual psychotherapy, the method of which is chosen individually. Among the generally accepted methods, the most popular are the following types of psychotherapy:

• individual
• group;
• family;
• rational;
• suggestive.

• deep study of the personal characteristics of the patient's psyche, aimed at identifying the mechanisms of development and maintenance of a depressive state;
• the patient's awareness of the features of the structure of his own personality and the causes of the development of the disease;
• correction of the patient's negative assessments of his own personality, his own past, present and future;
• rational solution of psychological problems with closest people and the surrounding world in all its integrity;
• informational support, correction and potentiation of ongoing drug therapy for depression.

Rational psychotherapy consists in the patient's logical evidence-based conviction of the need to reconsider his attitude towards himself and the surrounding reality. At the same time, both methods of clarification and persuasion, as well as methods of moral approval, distraction and switching attention are used.

suggestive therapy is based on suggestion and has the following most common variants:

• suggestion in the waking state, which is necessary moment any communication of a psychologist with a patient;
• suggestion in a state of hypnotic sleep;
• suggestion in a state of medical sleep;
• self-hypnosis (autogenic training), which is carried out by the patient on his own after several training sessions.

• physiotherapy
  • magnetotherapy (using the energy of magnetic fields);
  • light therapy (prevention of exacerbations of depression in the autumn-winter period with the help of light);
• acupuncture (irritation of reflexogenic points with the help of special needles);
• music therapy;
• aromatherapy (inhalation of aromatic (essential) oils);
• art therapy (the therapeutic effect of the patient's fine arts)
• physiotherapy;
• massage;
• treatment with the help of reading verses, the Bible (bibliotherapy), etc.

For severe, drug-resistant depression, shock therapy methods can be used, such as:

• Electroconvulsive therapy (ECT) involves passing an electric current through the patient's brain for a few seconds. The course of treatment consists of 6-10 sessions, which are carried out under anesthesia.
• Sleep deprivation - refusal of sleep for a day and a half (the patient spends the night without sleep and the whole next day) or late sleep deprivation (the patient sleeps until one in the morning, and then goes without sleep until the evening).
• Unloading and dietary therapy is a long-term fasting (about 20-25 days) followed by a restorative diet.

What is postpartum depression?

A high likelihood of developing postpartum depression should be said when there are risk factors from different groups, such as:

• genetic (episodes of depression in close relatives);
• obstetric (pathology of pregnancy and childbirth);
• psychological (increased vulnerability, psychological trauma and depressive states);
• social (absence of a husband, conflicts in the family, lack of support from the immediate environment);
• economic (poverty or the threat of a decrease in the level of material well-being after the birth of a child).

These fluctuations occur against a background of strong physiological (weakening of the body after pregnancy and childbirth) and psychological stress (anxiety in connection with the birth of a child) and, therefore, cause transient (transient) signs of depression in more than half of women in labor.

Most women experience severe mood swings, decreased levels immediately after childbirth. physical activity, loss of appetite and sleep disturbances. Many women in childbirth, especially primiparas, experience increased anxiety, they are tormented by fears of whether they can become a full-fledged mother.

Transient signs of depression are considered a physiological phenomenon when they do not reach a significant depth (women perform their duties of caring for a child, participate in the discussion of family problems, etc.) and completely disappear in the first weeks after childbirth.

Postpartum depression is referred to when at least one of the following symptoms is observed:

• emotional depression, sleep and appetite disturbances persist for several weeks after childbirth;
• signs of depression reach a considerable depth (a woman in labor does not fulfill her duties in relation to the child, does not participate in the discussion of family problems, etc.);
• fears become obsessive, ideas of guilt towards the child develop, suicidal intentions arise.

Depressive states of moderate depth are characterized by various phobias (fear of the sudden death of a child, fear of losing a husband, less often fears for one's health), which are accompanied by sleep and appetite disorders, as well as behavioral excesses (often of the hysteroid type).

With the development of deep depression, as a rule, predominates negative symptoms- apathy, narrowing the circle of interests. At the same time, women are disturbed by the painful feeling of inability to feel love for their own child, for their husband, for close relatives.

Often there are so-called contrasting obsessions, accompanied by a fear of harming the child (hit with a knife, pour boiling water over it, throw it off the balcony, etc.). On this basis, ideas of guilt and sinfulness develop, and suicidal tendencies may appear.

Treatment of postpartum depression depends on its depth: for transient depressive states and mild depression, psychotherapeutic measures are prescribed (individual and family psychotherapy), for moderate postpartum depression, a combination of psychotherapy and drug therapy is indicated. Severe postpartum depression often becomes an indication for hospitalization in a psychiatric clinic.

Prevention of postpartum depression includes attending classes to prepare for childbirth and care for the newborn. Women who have a predisposition to the development of postpartum depression, it is better to be under the supervision of a psychologist.

It has been noted that depressive states after childbirth often develop in suspicious and "hyper-responsible" primiparas, who spend a long time on "mother's" forums and reading relevant literature, looking for symptoms of non-existent diseases in the baby and signs of their own maternal failure. Psychologists say that the best prevention postpartum depression - proper rest and communication with the child.

What is teen depression?

According to statistics, about 10% of teenagers suffer from signs of depression. At the same time, the peak of psychological troubles falls on the middle of adolescence (13-14 years). The psychological vulnerability of adolescents is explained by a number of physiological, psychological and social characteristics adolescence, such as:

• associated with puberty endocrine storm in the body;
increased growth, often leading to asthenia (depletion) of the body's defenses;

• physiological lability of the psyche;
• increased dependence on the immediate social environment (family, school team, friends and acquaintances);
• the formation of a personality, often accompanied by a kind of rebellion against the surrounding reality.

• symptoms of sadness, melancholy and anxiety characteristic of depressive states in adolescents often manifest themselves in the form of gloom, capriciousness, outbursts of hostile aggression towards others (parents, classmates, friends);
• often the first sign of depression in adolescence is a sharp decline academic performance, which is associated with several factors at once (decrease in the function of attention, increased fatigue, loss of interest in learning and its results);
• isolation and withdrawal in adolescence, as a rule, manifests itself in the form of a narrowing of the social circle, constant conflicts with parents, frequent changes of friends and acquaintances;
• the ideas of own inferiority characteristic of depressive states in adolescents are transformed into an acute rejection of any criticism, complaints that no one understands them, no one loves them, etc.
• apathy and loss of vitality in adolescents, as a rule, is perceived by adults as a loss of responsibility (missing classes, being late, careless attitude to one's own duties);
• in adolescents more often than in adults, depressive states are manifested by bodily pains unrelated to organic pathology (headaches, pains in the abdomen and in the region of the heart), which are often accompanied by fear of death (especially in suspicious adolescent girls).

Most cases of teenage depression respond well to psychotherapy. At pronounced manifestations depression is prescribed pharmacological drugs that are recommended for admission at this age (fluoxetine (Prozac)). In extremely severe cases, hospitalization in a psychiatric department of a hospital may be necessary.

The prognosis for adolescent depression in the case of timely treatment to the doctor is usually favorable. However, if the child does not receive the help he needs from doctors and the immediate social environment, various complications are possible, such as:

• aggravation of signs of depression, withdrawal into oneself;
• suicide attempts;
• running away from home, the appearance of a passion for vagrancy;
• propensity to violence, desperate reckless behavior;
• alcoholism and / or drug addiction;
• early promiscuity;
• joining socially unfavorable groups (sects, youth gangs, etc.).

Does stress affect the development of depression?

Such depressions develop gradually, so that the patient sometimes cannot say exactly when the first symptoms of depression appeared.

Often, the root cause of neurasthenic depression is the inability to organize one's work and rest, leading to constant stress and the development of chronic fatigue syndrome.

emaciated nervous system becomes especially sensitive to external influences, so that even relatively minor life adversities can cause severe reactive depression in such patients.

In addition, constant stress can provoke an exacerbation of endogenous depression and worsen the course of organic and symptomatic depression.

Depression threatens modern society. Such a disappointing forecast is shown by the annual statistics of diseases. Depressive disorders occupy an honorable second place among ailments, second only to cardiovascular pathologies. How to treat depression, which affects more than 30% of the world's population?

Few people know about typical signs impending disaster. Most seek help when a depressive disorder becomes protracted, dangerous. According to WHO, 50-60% of all suicides are committed by people who are in a depressed state. In order not to face a serious situation, you need to learn everything about depression.

Depressive disorder is the number 1 threat in modern life

Depression is a mental disorder perceived by most people as a manifestation of selfishness, laziness and pessimism. But the pathological situation is not just an indicator bad mood. This is a serious somatic disease that requires competent and timely treatment.

Women, due to their innate emotionality and sensitivity, are prone to depression much more often than the representatives of the stronger sex.

Domestic psychiatry divides the manifestation of depression and the disease itself into two large groups. They are divided into simple and complex.

Simple depressions

Doctors characterize simple depressive disorders as depressions of the I level. These include the following types of pathology:

Adynamic. This type of depressive disorder is manifested by general weakness, loss of interest in life. The patient has no desires, indifference to others is pronounced. During the day, drowsiness prevails, and at night a person is tormented by insomnia.

The term "adynamia" means a sudden, severe loss of strength, proceeding with muscle weakness.

Adynamic depression is manifested by physical and emotional retardation. The patient develops a sense of worthlessness, self-pity and a sense of inferiority.

Agitated. This type of disorder is accompanied by increased arousal, accompanied by a constant feeling of anxiety and fear. Patients are tormented by feelings of guilt, they want punishment, they reproach themselves for any actions.

Dysphoric. Manifested by eternal dissatisfaction with everything that surrounds the patient. The disorder provokes outbursts of irritability, discontent and deep longing. There may be aggressive manifestations towards others, sometimes reaching indomitable rage.

ironic. The patient, faced with this type of pathology, does not pay attention to internal anxiety. The main sign of ironic depression is a deliberate demonstration of a good mood.. The patient begins to sneer, joke, smile, scoff, hiding true feelings.

Stuporous. A depressive disorder of this type is accompanied by motor inhibition, sometimes reaching partial or complete immobility and mutism (prostration). The patient falls into the deepest depressive affect. He refuses food, all reactions are inhibited.

Anxious. This common type of depressive disorder occurs against the background of depression, anxiety, and a sense of danger. The patient has mood swings, various phobias: darkness, strangers, streets, cars, animals.

Patients exhibit increased arousal: they talk a lot and often, their thinking is confused, accelerated. The disorder proceeds with the development of suicidal moods and gloomy thoughts.

melancholic. It is characterized by a manifestation of oppressive melancholy, tearfulness, a deep drop in mood. This type of depressive disorder often develops in middle-aged people. The patient complains of a feeling of severe mental pain (it is also called "vital longing"), accompanied by pain in the heart region.

Complex depression

Depressive disorders classified as level II. Pathologies of this type combine more complex symptoms and psychopathological syndromes.. Complex depressions include the following types of disorders:

asthenic. Depression of this kind brings with it a manifestation of inadequate perception of any impressions. A person loses the ability to respond to external stimuli, his emotional reaction disappears. Patients complain of a feeling of emptiness, inability to perceive and express feelings.

People become painfully impressionable, suspicious, insecure. There is a sharp drop in working capacity, increased fatigue and irritability.

hysterical. A type of depression in which patients demonstrate vivid affective states. They are characterized by expressive behavior, an exaggerated attitude to all events, tearfulness, reaching hysteria.

hypochondriacal. In such patients, there is a combination of a feeling of depression with the development of any overvalued ideas close to a delusional state. According to observations, this type of depression often develops in lean, slender women.

Psychasthenic. It proceeds against the background of a persistent decrease in mood, complete lethargy. A person develops a feeling of insecurity in their abilities, indecision and timidity.

Additional types of depression

Also, depressive disorders are classified according to the reasons that caused the pathology and the nuances of the course of the disorder. Depressions are divided into the following additional types:

1. Chronic. It is diagnosed if the symptoms of a classic depressive disorder are observed for a long time (up to 2-2.5 years).
2. Clinical (or acute). One of the most complex types of pathology. Such depression is characterized by a number of pronounced symptoms. Clinical depression is usually short-lived. This type of disorder is common and most people are familiar with it.
3. Reactive. Depressive disorder of this type develops against the background of long-term, severe stressful situations.
4. Neurotic. The trigger in the development of neurotic depression are emotional disorders of varying degrees and neurotic states.
5. Alcoholic. Experienced by people who have begun the fight against drunkenness. Such depression develops as a result of coding or identification dangerous diseases where the consumption of alcoholic beverages is prohibited.
6. Protracted. It develops due to the long-term accumulation of any negative factors, which at one fine moment result in a depressive disorder.
7. Masked. It manifests itself due to various pain symptoms that accompany various forms of somatic diseases.
8. Postpartum. The culprit of this type of depression are sharp hormonal changes in women after childbirth.
9. Manic (or bipolar). This depression is caused by innate nuances of a person's character (when emotional lability prevails in the mental warehouse of a person).

Depressive disorders are rich in manifestations and varieties. Each of the many types of pathology has its own symptoms.

Symptoms of depression

Depressive manifestations are variable, their brightness of manifestations depends on the personality type, the presence of additional somatic disorders, the cause and type of depression. Doctors have grouped the main signs of the disorder into four separate classes:

Regardless of what symptoms of depression appear, any type of anxiety disorder is accompanied by a fear of a large number of people, a panic fear of public speaking. Sometimes people are afraid to even go outside.

Often, depressive disorders are accompanied by thoughts about the possibility of contracting an incurable disease.

To diagnose a depressive disorder, it is enough for a psychiatrist that at least 3 signs are present in the clinical symptoms. And the manifestations of the pathology were observed continuously for 1.5-2 weeks.

How does the disorder develop?

At the heart of the development of all depressive states is a violation of the normal production of hormones responsible for biorhythms and emotional background. Predisposing biochemical factors under the influence of any external causes and give rise to depressive manifestations.

Psychiatrists distinguish the following steps in the development of depression. They are basic. Know them in order to recognize the impending danger in time:

First stage (development of hypotemia)

Physicians call hypothermia a persistent drop in mood. A decrease in the emotional background is not restored after a good rest and is fundamentally different from the usual annoyance, boredom or sadness.

What used to bring pleasure now causes disgust and apathy. The emotional coloring of hypotension can vary - from feeling blues to pronounced self-flagellation.

The patient reproaches himself for any reason, exaggerating problems and fantasizing their gloomy development. Gradually, a person moves away from any manifestation of social activity, withdraws into himself and falls into an apathetic state.

Second stage (manifestation of bradypsychia)

In medicine, this term refers to lethargy (motor and mental). The patient begins to feel a gradual increase in a certain inhibition. The former liveliness, optimism, cheerfulness disappears.

Working capacity suffers, a person does not want to do anything. Life ceases to bring the former satisfaction. A favorite hobby is relegated to the background, a person ceases to take care of himself. Now, even to make the right phone call, you have to force yourself to go to the phone and dial the number.

All the usual routine things are now done with obvious efforts, on "autopilot". Human movements become mechanical, stereotyped. The body gradually depletes itself.

With bradypsychia, the intellectual abilities of the individual suffer to a greater extent. Physical performance remains at the same level. That is, a person is able to carry heavy bags home, but is not able to comprehend what needs to be bought, forgetting about the essentials.

The third stage (the occurrence of hypobulia)

Or a significant decrease in instinctive and volitional human urges. The patient loses interest in the opposite sex, delicious food, cravings for a night's rest. The person cannot fall asleep, often wakes up. Chronic lack of sleep further exacerbates hypobulia.

Hypobulia often begins before the onset of classic symptoms of depression. A person can feel these signs long before they completely go “minus”, into a state of psychomotor retardation.

At this stage, a person already understands that something is wrong with him and is looking for the causes of malaise. Visits to doctors and diagnostic centers are starting. Of course, there are additional somatic diseases. Treatment begins, which does not affect the real cause, which leads to an aggravation of the disorder.

What to do with depression

Often people do not turn to a psychotherapist, even knowing what depression is and how it manifests itself. The usual prejudice dictates their will to them:

• what will my colleagues and friends think of me when they find out that I am being treated by a psychiatrist;
• I don't want to turn into a slobbery vegetable because I have to take heavy drugs;
• what if they forbid me to drive a car, register me or offer to go to a mental hospital.

A person, fearing public censure, writes off the symptoms of depression as ordinary fatigue. Spends money and time on the treatment of somatic diseases accompanying a depressive disorder, bringing himself to complete exhaustion and severe neurotic states who are already being treated in the hospital.

Is such a development of events better than timely seeking help from a psychologist or psychotherapist? After all, the sooner a depressive disorder is diagnosed, the easier and faster it will be possible to get rid of it and live a full life again.

Depression(from Latin deprimo - “pressure”, “suppress”) - a mental disorder characterized by a “depressive triad”: a decrease in mood and a loss of the ability to experience joy (anhedonia), impaired thinking (negative judgments, a pessimistic view of what is happening, and so on), motor retardation. With depression, self-esteem is reduced, there is a loss of interest in life and habitual activities. In some cases, a person suffering from it may begin to abuse alcohol or other psychotropic substances. It is a type of affective disorders (mood disorders). Depression is treatable, but depression is currently the most common mental disorder. It affects one in ten over the age of 40, two-thirds of them are women. Depression is three times more common among people over 65 years of age. Also depression and depressive states affects about 5% of children and adolescents aged 10-16 years. According to the World Health Organization, depression is the leading cause of adolescent illness and disability. The overall prevalence of depression (of all varieties) in adolescence ranges from 15 to 40%. Many studies emphasize that the greater prevalence of affective disorders at this age corresponds to a higher frequency of suicides.

Types of depressive illnesses

• People with major depression (sometimes called unipolar or clinical depression) experience some or all of the following symptoms for at least two weeks, most often for several months or longer. Episodes of this disease may occur 1-2 times or several times during a lifetime.
• People who have dysthymia experience the same symptoms, but they are not as severe and last for at least two years. These people are often devoid of "thirst" for life and enthusiasm, their existence is bleak and tiring, and this seems to be a natural extension of their character. In addition, they may experience episodes of major depression.
• Manic-depressive psychosis (or bipolar disorder) is not as common as other forms of depression, episodes of depression come in fits and starts and alternate with episodes of mania. During episodes of mania, people can be overly active and talkative, can enjoy everything for no reason, get irritated, spend money frivolously, and become embroiled in sexual misadventures. And for some, mild episodes of mania, or hypomania, alternate with episodes of depression. Unlike other cases of mood disorders, men and women are equally susceptible to bipolar disorder, although, on the other hand, women in such cases experience more episodes of depression and fewer episodes of mania or hypomania.

Causes of depression

Depressive disorders can appear at any age and in any social group. This is primarily because the values modern society put a lot of pressure on people.

People strive for social well-being, professional success, external attractiveness. If this is not achieved, a person may fall into despair, it is hard to experience failures, and, as a result, depression develops. Severe psychological trauma can also lead to a depressive disorder, such as the death of a loved one, the breakup of a family, the breakup of a relationship with a loved one, and a serious illness.

AT rare cases depression occurs without any obvious cause. Scientists suggest that in such situations, the features of neurochemical processes play a role, in particular, the exchange of neurotransmitters (serotonin, norepinephrine, etc.).

Symptoms of depression

Depression negatively affects every aspect of a person's life. Inadequate psychological defense mechanisms, in turn, have a destructive effect not only on psychological, but also on biological processes.

The first signs of depression - apathy, independent of circumstances, indifference to everything that happens, weakening of motor activity - are the main clinical symptoms depression. If their combination is observed for more than two weeks, it is necessary urgent help specialist.

Mental symptoms:

• depressed mood, joylessness;
• loss of interest, decreased motivation, loss of energy;
• self-doubt, guilt, inner emptiness;
• decreased speed of thinking, inability to make decisions;
• anxiety, fear and pessimism about the future;
• daily fluctuations;
• delirium is possible; suicidal thoughts.

Somatic symptoms:

• vital disorders;
• sleep disturbances (early awakening, the ability to wake up);
• appetite disorder;
• constipation;
• sensations of compression of the skull, dizziness, a feeling of pressure;
• vegetative symptoms.

When talking with a patient, a psychologist or psychotherapist identifies the following criteria:

• Depressed mood.
• Feeling tired.
• Rising concern.
• Lack of desires and interests.
• Decreased sexual interest.
• Frequent nervousness and photophobia.
• Careless attitude to personal hygiene and daily duties.
• Constant need for rest.
• Irritability, restlessness and nervous tension.

The above symptoms are starting. If they last long, they lead to mania.

Early warning symptoms of depression

• Fatigue, feeling of exhaustion, lack of energy
• Depressed mood, depression
• Increased need for rest
• Decreased self-confidence, self-doubt
• Increased sophistication and concern
• Lack of interest and desire
• Sleep disturbances and sleep maintenance
• Careless attitude to daily duties
• Attention disorder (thinking is difficult)
• Decreased sexual interest
• Fear, nervousness
• Decreased resistance to stress, decreased performance
• A person takes everything personally, believes that others talk badly about him
• Changes in the daily routine
• physical ailment
• Increased alcohol consumption
• Tension, anxiety
• Irritability

Various parameters of depression in women

When studying depression in women, scientists pay special attention to the following issues:

adolescence

Before adolescence, boys and girls experience very little difference in their levels of depression, but between the ages of 11 and 13, girls' levels of depression skyrocket. By the time they are 15, girls are twice as likely as boys to experience major depression, and this is happening at a time when teen assignments and expectations are undergoing significant changes. Personality development, awakening sexuality, separation from parents and the first time you have to make independent decisions, as well as physical, mental and hormonal changes - all this causes stress in adolescents. Stressful situations of this kind usually affect boys and girls differently and may be more commonly associated with depression in girls. Studies show that, compared with boys, who have more cases of aggressive behavior, high school students have significantly more high level depression, anxiety disorder, eating disorder and adjustment disorder.

Coming of Age - Relationships and Responsibilities

Usually, stress contributes to depression in cases where people are biologically susceptible to this disease. There is an opinion that the high level of depression in women is not due to the fact that they are more vulnerable, but to the fact that women face certain stressful situations. Such stressful situations can be basic responsibilities at home and at work, raising a child without a father, and caring for children and aging parents. It is not yet entirely clear how all these peculiar factors affect women. Major depression is high in both men and women who are divorced or separated from their spouse, and low in married people, although women also have higher rates of major depression. One way or another, and the quality of marriage can significantly contribute to the disease of depression. Relationships that lack intimacy and trust, as well as repetitive quarrels between spouses, are now known to be associated with depression in women. So, it turned out that among women who are unhappy in marriage, there is the highest level of depression.

reproductive period

The reproductive period in women includes the menstrual cycle, pregnancy, post-pregnancy, infertility, menopause, and sometimes the decision not to have children. All of these events can cause mood swings and, in some women, depression. Scientists have confirmed that hormones act on the brain chemicals that control emotions and mood, but they do not know the specific biological mechanism that explains the effects of hormones.

Many women experience certain changes in mood as well as physical changes associated with different phases of the menstrual cycle. For some women, these changes can be abrupt, occur regularly, and cause feelings of depression, irritability, and other emotional and physical changes. Called premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), these changes usually start after ovulation and continue to get worse until menstruation begins. Scientists are investigating how the cycling up and down levels of estrogen and other hormones can affect brain chemistry associated with depressive illness.

Pregnancy, if desired, rarely leads to depression, and the same is true of abortions - they do not lead to widespread depression. Women suffering from infertility may experience feelings of extreme anxiety or sadness, but it is not known whether infertility leads to increased levels of depressive illness. Motherhood, in turn, can be a time when the risk of depression increases due to the stress and responsibilities of motherhood. As for menopause, it is usually not associated with the risk of depression. So, although depression was once considered a unique illness, studies have shown that depression that occurs during menopause is no different from depression during other periods. life periods. Women who are more susceptible to life-changing depression are women who have had depression before.

Circumstances associated with a particular culture

In terms of depression per se, rates are twice as high among African-American and Hispanic women as among men, but there are some indications that major depression and dysthymia

may be found less frequently in African American women and somewhat more frequently in Hispanic women than in white women. Information about the spread of this disease in other racial and ethnic groups is not conclusive.

Possible differences in how symptoms manifest may affect how depression is defined and diagnosed among minorities. African-American women, for example, may be the most likely to complain of somatic symptoms, such as changes in appetite and body aches. In addition, people of different cultures may interpret episodes of depression in different ways. Such factors should be taken into account in cases involving women who represent certain population groups.

Victimization

Studies show that women who have been molested as children are more likely to develop clinical depression at some point in their lives than those who have not. In addition, according to some studies, among women who were raped in adolescence or in adulthood, the level of depressive illnesses is higher. Since the seduction of young girls happens much more often than the seduction of boys, insofar as such conclusions are directly related to this issue. Women who experience other common forms of abuse, such as physical abuse or sexual harassment at work, may also experience higher levels of depression. Violence leads to depression because it contributes to low self-esteem, feelings of hopelessness and guilt, and causes social isolation. The risk of depression is associated with both biological and environmental factors and may be the result of growing up in a dysfunctional family. More research is needed to understand whether victimization is specifically related to depression.

Poverty

Women and children represent 75% of the US population considered poor. Economic hardship leads to stress, isolation, insecurity, frequent adverse events and poor access to support services. Feelings of depression and low morale are common among people with low incomes and lack of social assistance, but scientists have not yet determined whether depressive illnesses are actually more common among people living in such conditions.

depression in old age

It was once thought that women were especially prone to depression when their children moved away, they were seized by the “empty nest syndrome”, and they began to feel that they had lost their purpose in life and their individuality. However, studies show that there is no increase in depressive illnesses at this stage of life.

As with younger people, rates of depressive illness are higher among older women than among older men. And, just like in all age groups, unmarried people (this includes widowhood) are also at risk of depression. Most importantly, depression should not be treated as a natural consequence of the physical, social, and economic problems of the elderly. On the contrary, studies show that most older people are satisfied with their lives.

Each year, approximately 800,000 people become widows or widowers, most of them older women who experience varying degrees of symptoms of depression. Many of them don't need regular treatment, although for those who are experiencing bouts of moderate to severe depression, attending self-help groups or various psychotherapy sessions may seem to have a beneficial effect. One way or another, but during the first month after the death of a spouse (s), the condition of a third of widows and widowers meets the criteria for major depression, and half of them continue to experience clinical depression a year later. The various forms of this illness are amenable to conventional antidepressant treatment, but research on when to start treatment or how to combine medication and psychotherapy sessions is at an early stage.

Clinical Research on Symptoms of Depression

As a result of clinical studies, depression is called a disease that cannot be treated on its own. Due to psychological disorders, a person cannot cope with it by a simple effort of will. The main symptom of pathology is the oppression of the spirit and the ability to self-heal. A feeling of despondency and constant anxiety indicates problems in the psychological sphere. If depression is triggered by a tragic event, such as a loss of loved ones, a divorce, or being fired from a job, the person often becomes addicted to alcohol. However, in some cases, the symptoms of pathology occur without a clear cause. They affect the daily activities of a person. Gradually, he becomes aggressive towards the people around him.

One of the frequent signs of pathology is a violation of concentration. A person focuses on internal experiences, so it is difficult for him to perform the necessary production or home task. Severe depression causes a person to stop responding normally to ordinary things.

Problems such as the inability restful sleep, high blood pressure, sudden weight loss - common symptoms diseases. The cause of their appearance is unknown, but they must be treated. When patients with depressive disorders lose interest in life, they stop looking after themselves. In this case, only the help of relatives and friends will lead to the return of a person to the social environment.

Diagnostics

Diagnosis of depression “I was “attacked” by depression, what should I do?” is a question that is widespread among young people. Yes, most people can already identify themselves with depression and are trying to find ways to get rid of it. But is depression really depression? In order to find out whether a person really suffers from depression, it is necessary to undergo a diagnostic course. Diagnosis of the disease is carried out by an experienced doctor, who, at the first complaints, begins with simple questions about the mood and thoughts of the patient. Next, they move on to tests, on the basis of which the doctor becomes

known picture of the disease. If, nevertheless, the doctor reveals a suspicion of depression, then a series of procedures are carried out to examine the patient, which make it possible to exclude other similar diseases. So, the diagnosis includes: Checking the physical condition: weight, height, pressure and pulse. Laboratory tests: it is necessary to donate blood for analysis to identify abnormalities. Psychological research: a visit to a psychotherapist who talks about the symptoms and finds out the cause of the disease. Also, based on this, the doctor finds out the presence of thoughts about suicidal tendencies, which is important in diagnosing depression. After an appropriate diagnosis is made, it is necessary to immediately proceed to the treatment of depression.

How to get rid of depression?

First steps in treating depression

1. Learn more about depression and how to treat it on our website. Check what symptoms you have, read about existing methods treatment, you can read about what you might discuss with your doctor.
2. Contact a specialist - a psychotherapist. It will help you determine if you have depression and how you can manage it.
3. Talk to relatives or friends. Depression could alienate you from them. Close people can support you during this period and help you find a specialist for the disease. You don't have to be alone with depression. After talking with loved ones, you will feel better.

Contacting a specialist

Depression distorts a person's perception of life and can cause shame, fear, and guilt that a person suffers from it. Many people silently suffer through depression. Some are ashamed or afraid to admit their feelings; others deceive themselves by downplaying the symptoms, treatment of the disease is delayed.

Remember that one of the manifestations of depression is a feeling of hopelessness. It may be hard for you to believe that anything can help you, but in the vast majority of cases, depression is treatable.

After you tell what is happening to you, you can ask a psychotherapist:

• "Do you think I have depression?" (after all, even if you have some of the symptoms described above, only a doctor can make an accurate diagnosis)
• What do you think causes depression?
• What should be done to get rid of depression?
• Do I need to consult with any other specialists? (depression is often combined with neurological pathology) If yes, could you recommend someone?
• Do I need to take a vacation, relieve some of my responsibilities, somehow change my lifestyle?
• How long can depression last?
• What are the consequences if you do not start treatment right now?
• Which method of treatment is preferred - drug therapy, psychotherapy or a combination of both (combination therapy)?

What else can you do to get rid of depression?

1. Don't make big decisions. Depression can prevent you from making an informed decision, because in depression a person perceives himself and the world around him biased.
2. Try to avoid stress. For a person suffering from depression, even a small load can seem like a heavy burden. Do not overwork yourself even when you feel that you have strength - this can cause a worsening of the condition.
3. Take care of your body. In a state of depression, a person often loses physical strength, feels exhausted. If you feel that you have physical strength - give your body a little physical activity, but do not overdo it - start walking a little or take care of the flowers.
4. Eat regularly and enjoy. If you have an appetite - do not deny yourself delicious food. This will help you bring back the taste for life. When depression is impaired immunity, so try to eat more vitamins.
5. Avoid negative thoughts. If you have a negative thought - try to think of something pleasant, distract yourself with some action - make a cup of tea, listen to the radio or call a friend.
6. Communicate with friends and relatives, even overcoming yourself. Your loved ones can be a source of support. They can help you make decisions or solve problems that you are afraid of not coping with, help with household chores.
7. Feel free to let your therapist know about any concerns or changes in how you feel. The doctor will help to cope with any problem if he knows about it.
8. Do not take alcohol and drugs - they can provoke a worsening of the condition. Try not to abuse sleeping pills

Talk to your loved ones about what is bothering you - they will support you.