Depression. Later symptoms can be divided into groups. Symptoms and treatments for chronic depression

Depression is a mental illness. Some people do not take it seriously and call it any mood disorder, without even knowing how dangerous it is and how important it is to make the right diagnosis in time. If you do not seek help in a timely manner and allow the disease to flow into severe or chronic form, then you can face the negative consequences of depression.

Social Consequences

The influence of any disease on the body is purely individual and is associated with such factors as its degree, form, methods of treatment, the patient's attitude to therapy, etc. It is impossible to predict in advance what depression will entail in a particular person. However, there are a number of symptoms and signs that are characteristic of a person who has overcome such mental condition. And they are primarily social in nature.

Dominance of negative emotions.
Lack of desire to learn something new, make acquaintances, etc.
Problems with communication in personal and professional life.
The appearance of previously unnoticed phobias and fears (often, for example, a closed space).
Decreased mental ability.
Irritable attitude towards noise or laughter.
Decreased libido, other problems in sexual life.
Predominance of feelings of hopelessness and helplessness in many situations.
The most serious is the unwillingness to continue life.

Often after therapy, a person for a long time can't bring myself to visit public places, especially entertaining (bars, restaurants, clubs, etc.). This cannot but affect social adaptation. Closedness and uncommunicativeness - frequent consequences depression.

Often during therapy, people become so accustomed to taking medicines, which maintain the level of serotonin in the body (antidepressants), which cannot completely get out of depression on their own. This carries the risk of addiction to drugs.

The patient's condition must also be monitored after his treatment, since at any moment he can lose faith in life and stop seeing any prospects, which often leads to thoughts of suicide. According to some studies, about 40% of people who are in a state of depression are thinking about how to die. Thus, what will happen if depression is not treated is much more dangerous than its very manifestation.

Physical Consequences

It is well known that the mental state of a person is directly related to a number of physical manifestations. Often similar diseases inflict serious blow on general condition sick. Similar health effects of depression typically affect the brain, heart, and nervous system. Among the most common are the following:

The risk of developing thrombosis - a depressive state causes increased emission into the blood of adrenaline, which negatively affects cardiovascular system and often leads to the formation of blood clots.
Insomnia is common symptom depression, which often long time remains after treatment.
Weakening immune system- due to lack deep sleep, the body does not have time to recover and becomes susceptible to various diseases, in addition, an overabundance of the stress hormone affects this.
Reducing the pain threshold - the hormone serotonin makes a person less sensitive to pain, its deficiency (as in a period of depression) - on the contrary, reduces pain threshold, which can even cause causeless pain in various limbs.
Chronic fatigue is a reaction of our body to the unwillingness to do something, to learn something new and to live in general.
Hair loss, brittle nails, whitish skin are a consequence of a decrease in immunity and lack of sleep.

Problems with appearance, especially in women, cause even greater reluctance to change in any way own life, which can either delay the moment of cure, or lead to a relapse after such. They are observed, as a rule, already during the period of depression, but often remain for some time and after, until the body is fully restored from the stress experienced.

Depression is more dangerous for people suffering from any chronic diseases. They, by the way, can become an impetus for its development. In such cases, the patient, along with the symptoms of this mental disorder, has more serious manifestation symptoms of the corresponding disease. And people in a depressed state tend to neglect caring for their health, which can negatively affect their physical condition.

A special role should be given to the problem of alcohol or drug addiction, which often develop against a background of depression and then remain with a person for a long time. false state Have a good mood that cause alcohol, drugs can be compared with the action of antidepressants. Medications treat the symptoms, not the cause of the disease, and therefore cannot be considered as the only direction in the treatment of depression.

Alcohol, cigarettes, drugs and other harmful substances, addictive, have almost the same effect, but with more great harm for good health. As soon as their action stops, the patient again shows the symptoms of the disorder. Similar state I immediately want to stop, which introduces a person into an endless circle of taking certain substances, drugs. Addiction is very difficult to treat, especially against the background of an advanced mental illness, so often in such cases when the patient still seeks help or someone from his environment does, hospitalization and a long stay in the hospital are required for full control over the course of treatment.

Prevention

The most obvious answer to the question of how to avoid harmful effects for health from depression, is to follow the doctor's instructions. But this is where the first problem arises. Most people need a lot of strength to even acknowledge the existence of a mental problem. In our society, it is not customary to talk about such things and, moreover, to turn to a psychotherapist. However, it is these actions that will not allow the transition of the disease to a severe stage.

How depression affects a person's health has already been described above. The consequences are really serious. It is possible to avoid their appearance only when the person himself is set up for a complete cure. Of course, to do this without the help of a specialist, relatives, friends and, last but not least, medical preparations, will be very difficult.

People who still overcome this disease are more prone to relapses. On this basis, they need to be monitored after the end of treatment. These can be individual psychoanalysis sessions with the attending physician or special support groups. The help of the environment also plays an important role. Alone with your thoughts, man prone to development depression, becomes dangerous for him in a state of helplessness, uselessness, etc.

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

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

Depression is often confused with a "bad" mood, but what distinguishes real depression from low spirits?

Typical symptoms of depression:

emotional

Anguish, suffering, oppressed, depressed mood, despair;

anxiety, feeling internal stress, expectation of trouble;

Increased irritability;

Feelings of guilt, frequent self-accusations;

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

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

Decreased interest in the surrounding reality.

Physiological

You note a violation of appetite, sleep / wakefulness;

You have reduced sexual activity and attraction;

Fatigue under normal loads, a decrease in energy tone, a feeling of weakness, loss of strength;

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

Behavioral

Passivity, difficulties in performing purposeful activities;

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

Rejection of entertainment;

Alcoholism, the use of psychotropic substances.

Thought Manifestations

Difficulty concentrating, concentrating;

The dominance of the dark negative thoughts about your life, yourself, those around you;

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

Thoughts of suicide;

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

Slow thinking.

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

Types, causes and treatments for depression

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

What happens if depression is not treated?

Depression is often perceived by both the person himself and his environment as a manifestation of bad character, laziness and selfishness, licentiousness or innate pessimism. Remember that depression is not just Bad mood, but a serious emotional problem, a painful disorder, or even serious disease Therefore, it is important to seek professional help in a timely manner.

What usually prevents people from seeking help for depression?

Possible social restrictions, registration in the PND;

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

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

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

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

How can you help yourself?

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

2) Avoid drinking alcohol, narcotic substances cut down on caffeine.

4) Try to keep in touch with friends and relatives, ask them for support, and not hide under the guise of a good mood. Disguise requires energy and does not improve the condition.

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

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

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

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

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

Medications (antidepressants).
Psychotherapy.

The best solution would be their combination.

Features of treatment in the elderly

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

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

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

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

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

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

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

Features of the treatment of minor and major depression

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

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

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

Treatment of vascular depression

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

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

Possible medicines and therapeutic measures:

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

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

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

Drugs and medicines

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

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

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

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

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

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

Electroconvulsive therapy and magnetic stimulation

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

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

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

Psychological treatments

Until quite recently, the disease was treated mainly with medication. However, today more and more patients prefer, especially if we are talking about mild or medium degree the severity of the disease. Can be used:

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

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

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

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

According to scientists from the World Health Organization, depression is great danger than asthma, angina pectoris, arthritis and diabetes combined. She renders destructive action on relationships between people physical state and financial situation of the individual.

The main danger for patients with depression is very strong state longing and despair, at the peak of which they are even capable of committing suicide. This is especially true in patients with expressed feeling anxiety. According to scientists, every day about 15 people in the world attempt suicide in connection with depressive moods. It is quite natural that this disease is still considered the only condition that entails such great amount unexpected deaths. To prevent such a situation, it is necessary to identify depression on early stage and accept necessary measures for her treatment.

Also, according to American scientists, in people suffering from depression, the risk of developing Parkinson's disease is increased three times, and the likelihood of multiple sclerosis increases five times.

In addition, people suffering from depression may not be able to take advantage of healthy lifestyle lives that provide beneficial effect on the human body. The researchers concluded that depression leads to a decrease in anti-inflammatory effects caused by moderate use alcohol and exercise. This is another danger of depression, which currently affects about one in ten people in the world.

Harm to others

Not only does depression have an incredible harm to the quality of life of an individual, but there are cases when patients in a state of passion commit illegal acts against other people. The most striking example in similar situation is the murder by a person with depression of another person, and the subsequent commission of suicide.

There are several varieties of such phenomena. One of them is the murder of an infant by his mother, suffering from postpartum depression. Another is the murder of a teenager by his parents. This usually happens in families where children are beaten and abused, in connection with which the child decides to take a desperate step. It can also be included here mass extermination family members and other people with subsequent suicide.

What is depression?

Every person from time to time feels lonely, sad or despairing in a difficult situation. It - natural reaction to the negative things that happen to us. However, if longing, sadness or despondency turn into our constant companions, our way of life changes significantly. It is this constant state of intense sadness and depression that is what doctors today call depression.

This disease - the scourge of the 21st century - has actually been known since ancient times. Hippocrates was one of the first to describe depression, giving it the name "melancholia" (in translation - "black bile"). In fact, the state of melancholy today is understood to be somewhat different, namely, a prolonged low mood, which, unlike depression, is not characterized by a strong breakdown and despair. Some famous poets and musicians admitted that being in a state of melancholy gave them the opportunity to dive deeper into the creative process and feel inspired. In a state of depression, this, alas, is impossible.

Depression - this is a set of manifestations (symptoms) that are not limited to only depressed mood. Depression can be defined as changes at the level of biochemistry, life experience and behavior, and the anatomical substrate is the brain. With depression, a lot of negative changes occur in the patient's body, affecting changes in endocrine system(pituitary, thyroid gland, adrenal glands, sex hormones), changes in the neurochemical processes of the body associated with a deficiency of various mediators, primarily norepinephrine, serotonin and dopamine), disorders of the biological rhythms, the so-called circadian rhythms. All this indicates that changes have occurred in the nervous system that have affected the brain. Patients with depression, as a rule, show a lack of activity, they are not energetic and unsociable. And this, in turn, makes others turn away from such patients.

Causes of depression

In the time of Hippocrates, it was believed that in human body contains 4 types of liquids - black bile, yellow bile, blood and phlegm. From here came the first name of depression - melancholia, i.e. the predominance of black bile in the body, allegedly responsible for a depressed mood. DoctorsXIXIt has been believed for centuries that depression is inherited and is due to congenital weakness of character. At the beginning of the last century, Sigmund Freud, as part of his psychosexual theory, called depression as the cause of depression. internal conflict and guilt.

In the middleXXcentury, researchers have identified two types of depression, depending on the causes that caused it. The first - endogenous type - implies the development of depression due to internal factors(diseases, severe heredity, etc.). The second type - neurotic, or exogenous depression - occurs under the influence of external negative events (death loved one, dismissal from work, moving to an unfamiliar city, etc.).

Depression is a complex disorder, and it is not clear what causes it. In modern psychiatry, it is generally accepted that the development of depression, as well as for most other mental disorders, requires the combined action of three factors - biological (heredity), psychological (personality and character traits of a person, striving for excellence with high standards of claims while simultaneously prone to underestimated self-assessment of one's successes and achievements, constant search for the meaning of life and the inability to find it, the need for the support of other people and the desire to realize their expectations, explaining their problems by external causes and the blows of fate that do not depend on the person himself, the inability to relax, stubbornness, pride and pride, which make it difficult to seek help) and social (acute and chronic stress and attempts to cope with it with the help of inadequate psychological defense mechanisms) . Here are some of the most common reasons.

Negative events that happened to a person:

Violence is one of the most heavy factors capable of causing depression. The violence is not only sexual, but also physical (beatings) and emotional (repression, constant insults).
Serious conflicts with friends or relatives, a negative situation in the family.
Death of a loved one, divorce.
Reaching retirement age (especially for women), job loss.
Positive events that caused a strong emotional reaction can also cause depression. New job, marriage, graduating from a university are always associated with serious changes in life - in some cases a person cannot adapt to them, and reacts to changes with depression, the so-called "adaptation disorders".
Serious illnesses and certain medications can also cause depression.
Alcoholism and drug addiction - over 30% of people who are addicted to alcohol or drugs are in a state of depression.
Personal problems, social isolation (including due to other mental illness), social inadequacy can lead to thrill loneliness and depression.
The hereditary factor - according to some data, the presence of depression among family members increases the risk of its development in children.

Is depression dangerous?

Unlike some mental disorders characterized by antisocial behavior, depression is dangerous primarily for the patient himself. In the absence of proper help and treatment, unbearable mental suffering often leads a person to attempt suicide. One in ten people with depression will eventually attempt suicide.

The negative impact of depression on the body extends not only to the nervous system. It increases the risk of developing asthma coronary disease hearts, aggravates the current chronic diseases resulting in frequent deaths of patients with serious illnesses. For this reason, in modern clinics, when treating patients who are forced to stay in bed rest, great attention give them psychological state. It is known that in elderly bedridden patients, it is depression that most often causes death, “aheading” the underlying disease.

Depression has a very serious impact on all areas of a person's life. A decrease in activity entails problems at work, violations in the sexual sphere negatively affect family or love affairs, lack of interest in past hobbies makes life gray and meaningless.