Types of depression: signs, treatment. Clinical depression (major depressive disorder)

Ph.D. A.B. Kholmogorova, Ph.D. T.V. Dovzhenko, Ph.D. N.G. Garanyan

Moscow Research Institute of Psychiatry, Ministry of Health of the Russian Federation

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Good day, dear readers!

In today's article, we will consider with you such a psycho-pathological condition as depression, as well as its causes, symptoms, classification, treatment and prevention. So…

What is depression?

Depression- a mental disorder characterized by despondency (anhedonia, or loss of joy), impaired thinking and motor retardation.

One of the main, and most common causes of depression is, or a long-term traumatic situation for the nervous system. A secondary factor or reason that leads a person to a depressive state is the inability of a person to solve certain situations, to get out of various difficulties. If the main causes of depression are predominantly a problem that has arisen in the present, then secondary factors are a legacy from childhood, when a person, at an early age, along with upbringing, adopts a model of his behavior for the rest of his life.

It happens that depressive disorders are hidden under the guise of a bad mood or character traits, and if these conditions are not separated and efforts are not directed to the treatment of depression, not only the person himself, but also the people around him can suffer from this.

A depressed person is in such a sensual state that constantly repeats - "there is no way out." But it really isn't! There is always a way out, and even the most severe depression can be treated!

According to statistics, depression is present in every tenth inhabitant of the Earth, over the age of 40, and 2/3 of them are women. Further, the older a person is, the worse the picture is, which is apparently provoked by a deterioration in health, social status, aging of the body, sometimes a feeling of uselessness and loneliness, and lack of work. A depressive state is also observed in 5-40% of children and adolescents under the age of 16, and therefore, this generation has a high percentage of suicides.

Depression - ICD

ICD-10: F32, F33
ICD-9: 296

Depression can affect people of any age and gender. The so-called values ​​of modern society can put constant pressure on a person, which can later cause depression. Among such “values” one can distinguish: the desire for social well-being, fame, career advancement, the desire to be attractive, etc. If something cannot be obtained, or not received immediately, a person may fall into despair, and his experiences against this background may provoke the development of a depressive state.

Fertile ground for the development of depression can also be factors such as: betrayal, dismissal, divorce, serious illness or death of a loved one, contempt or ridicule from others, etc.

In rare cases, depression is possible without any cause. In such a situation, the peculiarities of human neurochemical processes (the exchange of neurotransmitters) can be guilty.

Today, in psychiatry, it is believed that the development of depression requires a complex effect on a person of 3 factors: psychological, biological and social.

Psychological factor:

There are 3 personality types that are more prone to developing depression:

• statotimic personality (characteristic: exaggerated conscientiousness, excessive accuracy and diligence);
• melancholic personality (characteristic: pedantry, desire for order, constancy, excessive demands on oneself);
• hyperthymic personality (characteristic: self-doubt, constant worries, low self-esteem).

Biological factor:

• heredity;
• head injuries that led to disruption of brain activity;
• hormonal disorders;
• seasonality of depressive disorder (rain, cold, heat, etc.);
• daily fluctuations, shortening of the REM sleep phase;
• side effects of certain drugs;
• (lack of vitamins in the body).

Social factor:

• chronic stress, frequent stressful situations;
• negative relationships in the family, society (school, work, university, etc.);
• strict measures of education;
• lack of love and affection from parents;
• abuse and harassment;
• significant changes in life;
• urbanization, population migration.

The main signs of depression:

Emotional:

• hopelessness, despondency, constant sadness;
• nervous tension, irritability;
• loss of interest in things that used to give pleasure;
• guilt;
• slow thinking, difficulty concentrating and inability to make decisions;
• anxiety, anxiety, fear;
• unwillingness to communicate with relatives and friends;

Physical:

• • fatigue and feeling of weakness;
  • longing in the form of a stone in the chest or a coma in the throat;
  • sleep disorders;
  • appetite disorders (as a result of which weight gain or loss occurs);

• change in taste sensations;
• distortion of colors and sounds;
• violations of a sexual nature;
• dry mouth;
• increased sweating;
• cardiopalmus;
• pupil dilation.

In severe cases, depression can be accompanied by suicidal thoughts about death.

The presence of several of the above symptoms may indicate the presence of depression. If this is found, it is necessary to consult a psychotherapist.

Important! Some symptoms are characteristic of anxiety and other disorders, so do not self-diagnose or self-medicate!!!

Depression must be distinguished from normal grief, which has an adaptive function. The process of experiencing grief normally takes about 1 year, but if the experience is prolonged in a person, reactive depression may develop.

The number of types of depression is very large, and all of them are diverse in their manifestations.

Here are the most common types of depression:

Dysthymia. In simple terms, dysthymia is a chronic depressive mood. It is characterized by bad mood, fatigue, lack of appetite and sleep. This type of depression can be observed in postpartum depression and manic-depressive psychosis.

Affective insanity. The depressive phase of dysthymia, which is also characterized by a bad mood, slowing down of thinking and speech, loss of appetite. Waking up in the morning, a person feels sadness, anxiety, becomes inactive and indifferent.

postpartum depression. This type is found only in women, based on the name, it is clear that the disease develops in the first months after the birth of a child, it may also be after a miscarriage or the birth of a dead fetus. It is characterized by a deep sense of sadness, hopelessness, loss of joy in life. During this period, it is difficult for a woman to take care of a child.

Important! Do not confuse fatigue after childbirth and postpartum depression !!! Many women feel exhausted and weak after childbirth, suffer, but these feelings exist in parallel with the joy of the appearance of a baby. This type of fatigue goes away a couple of weeks after giving birth, while postpartum depression can last for several months.

depressive reactions. They usually appear with changes in life (moving, retiring, changing jobs, etc.). The main criterion that causes such a reaction is not so much a traumatic external situation as the experience of the changes themselves and uncertainty in the changed conditions. Often, this type of depression is based on an acute crisis of self-esteem and subconscious resentment.

The reaction of sadness. This type is a complex process of painful restructuring of a person after a bereavement. Acute sadness is manifested by irritability, alienation, impotence, exhaustion, upset stomach and intestines. When people react sadly, alcohol and drug abuse is often noted.

Melancholia (endogenous depression). The causes of this type of depression can be both real and fictional. A melancholy person sees himself as a bad person who deserves punishment. It happens that such reproaches can be addressed to another significant person.

depressive neurosis(reactive depressive disorder). This type of depression is also called character neurosis and/or personality depressive disorder. There are several forms of depressive neurosis, which are united by the fact that a person's assessment of reality remains intact, and the symptoms of depression are mild or slightly expressed.

masked depression. The peculiarity of this type of depression lies in its latent course. Only one symptom may be present. Diagnosing this type is extremely difficult.

Bipolar disorder. Characterized by severe mood swings. This is a complex condition in which mania leads to insomnia, hallucinations, nervous breakdowns, disorientation and bouts of paranoia can also be observed.

Seasonal depression. This is a mood disorder that occurs every year at the same time. Often, seasonal depression begins in the fall or winter and ends in early summer. One theory says that insufficient sunlight leads to a decrease in the production of serotonin in the brain, which has a calming and pain-relieving effect. As a result, a lack of serotonin leads to a depressed mood and the manifestation of symptoms such as: fatigue, carbohydrate deficiency and weight gain. It is theoretically possible that this type of depression is also associated with insufficient intake of the required amount and microelements into the body.

Larviated form (somatized). The affect of melancholy is manifested, often there is a syndrome of "heart anguish" and pain in the intestines and stomach. Such somatic disorders are clearly manifested in the morning and are well treated with antidepressants.

anesthetic form. In this form of depression, a person suffers from a lack of experiences. The world around us loses colors and sounds, there is even a feeling that time has stopped.

adynamic form. The main symptom of this type is longing, which is experienced indifferently. The will decreases, the person ceases to take care of himself, experiences a feeling of physical impotence and apathy.

Anxiety depressive disorders (agitated). Manifested by longing, which is replaced by anxiety and fears. People with this kind of depression are always on the lookout for possible trouble. Anxious experiences are blurred and may be inspired by external information. It is also accompanied by speech and motor excitement, a person in the literal sense of the word cannot sit in one place. Melancholic raptus can happen to a person: the patient can start rushing about the street with screams, squeals or lamentations, or roll on the ground. At such moments, he becomes very dangerous for himself and for others.

atypical depression. This disorder is distinguished by increased appetite (resulting in weight gain), increased sleepiness, and increased emotional response to positive events.

Childhood mood disorder. This type is invisible in ordinary life, but clearly manifests itself in certain situations and is detected by special tests. This is a chronic depressive state determined by personality traits. Usually this disorder is the result of severe deprivation experienced by the child in early childhood.

Pseudo dementia. Often found in older people, manifestations resemble a decrease in intellectual activity. The problem of concentration of attention develops, the ability to orientate in space is disturbed, and memory is also impaired. Only a specialist can distinguish this type of depression from dementia.

Stages of depression

Like other diseases, depression has several stages. Each period can last from one week to several months.

1. Rejection stage (light). A person becomes restless, writes off everything to a bad mood and well-being. Loss of interest in past activities and hobbies. Symptoms such as apathy, drowsiness, fatigue, lack of appetite gradually accumulate. Alienation from the world begins, the desire to communicate disappears, but these feelings are accompanied by a fear of loneliness. A person at this stage often finds a way out in excessive consumption of alcoholic beverages, sitting for many hours in computer games, and watching TV for many hours.

2. Receiving stage (moderate). A person begins to understand what exactly is happening to him, refuses to eat, because of this he is rapidly losing weight. Disorders such as insomnia, a violation of the adequacy of thinking, fast incoherent speech, illogical statements and reasoning, there may even be hallucinations appear. A person can no longer cope with negative thoughts on his own, he has a desire to completely end it, which leads to a high risk of suicide attempts.

3. Corrosive stage (severe). At this stage, external calmness is replaced by aggressive behavior, a person no longer wants to control himself, is able to harm himself or others. There is indifference and detachment. The psyche begins to collapse, due to the long-term influence of depression, a person can even get schizophrenia.

Diagnosis of depression

To make a correct diagnosis and prescribe an effective treatment, the doctor conducts a series of tests:

• communication with the patient (gathering information);
• general urine analysis.

There are also special questionnaires and scales for diagnosing depression.

Beck scale. The questionnaire consists of 21 questions with fixed response options. Testing time 20-60 minutes. Invented by an American psychiatrist, bears his name. Used since 1961.

Zung self-reported depression scale. The questionnaire consists of 20 statements, the results of which are determined in 3 scales: depressive experiences, depressive affect, somatic symptoms. Testing time 8-10 minutes. Named after the developer. Used since 1965.

ODS (questionnaire of depressive conditions). The technique is based on the method of pattern recognition, there is also a lie scale. Developed at the Bekhterev Institute.

Edinburgh Postnatal Depression Scale (EPDS). Contains 10 statements with 4 possible answers. Used since 1987 thanks to scientists from Edinburgh and Livingston.

How to get rid of depression? Depending on the stage and type of depression, the characteristics of the body, the presence of concomitant diseases, age and other factors, the treatment of depression may include one or another set of procedures and drugs.

As a rule, the treatment of depression is accompanied by individual correction of nutrition and lifestyle, including physical activity.

Depression of the initial stage, a mild form, can be cured without drugs, with the help of psychotherapy, or mental correction of the patient's behavior and way of thinking. Drug treatment is prescribed for moderate and severe disease, but only in combination with psychotherapy.

Non-drug treatments for depression

Psychotherapy. This is a method of verbal interaction between the patient and the specialist, which allows solving current internal problems, analyzing the current mental state and finding the most appropriate ways to resolve problem situations. The program of psychotherapy is selected individually.

Light therapy. A method of exposure to light of a certain length, which contributes to the production of serotonin (the hormone of good mood), and to adjust circadian rhythms (internal biological clock). Light therapy can even relieve pain.

Transcranial magnetic stimulation. The prototype is electroconvulsive brain stimulation. This method allows non-invasively, using short magnetic pulses, to stimulate the cerebral cortex. Transcranial magnetic stimulation has been used in the treatment of severe depression and has had a measurable effect.

Medical treatment for depression

pharmacological treatment. Drug therapy for depression occurs with the help of various types of antidepressants. They reduce symptoms and reduce suicidal rates.

Important! Medications can only be prescribed by a doctor, after diagnosis. This is due to a large variety of antidepressants, which at the chemical level act on a particular part of the brain, and also cause various reactions.

Types of antidepressants

The human brain is made up of neurons (nerve cells). The transmission of information from neuron to neuron occurs through the synaptic cleft (a small space between neurons) with the help of neurotransmitters (chemical messengers).

To date, science knows about 30 different mediators. Belonging and relation to depression have 3 of them: serotonin, norepinephrine and dopamine.

There is a biological theory that believes that depression develops against the background of a decrease in the concentration of neurotransmitters in synapses. Antidepressants are needed to regulate the concentration of mediators and restore the biochemical background in the brain that has been disturbed.

Tricyclic antidepressants. They were synthesized back in the 50s of the last century. The mechanism of action of this type of antidepressants is based on a decrease in the absorption of norepinephrine and serotonin mediators by brain neurons, as a result of which their concentration in the brain increases. Some drugs in this group have a calming effect, others - stimulating.

The time of onset of the therapeutic effect depends on the specific situation from several days to several months.

Among the side effects most often noted are: lethargy, palpitations, drowsiness, dry mouth, increased sweating, decreased potency, difficult urination, etc.

Among tricyclic antidepressants, one can single out: Azafen, Amitriptyline, Clomipramine, Imipramine, Trimipramine, Doxepin, Dothiepin, Coaxil, Fluoracizine, Nortriptyline, etc.

Monoamine oxidase inhibitors (MAOIs). Antidepressants of this type slow down the action of the enzyme in the nerve endings, thereby preventing the destruction of norepinephrine and serotonin. Often, MAO inhibitors are prescribed to patients who do not have the expected therapeutic effect from taking tricyclic antidepressants, as well as to patients with dysthymia and atypical depression.

The time of onset of the therapeutic effect is several weeks.

Among the side effects most often noted are: sleep disturbances, jumps, weight gain, decreased potency, swelling of the limbs, heart palpitations.

Among the MAO inhibitors can be identified: "Befol", "Melipramine", "Pyrazidol", "Sydnofen", "Tranylcypromine".

Selective serotonin uptake inhibitors. Today, this group of drugs is the most modern class of antidepressants that are used in medicine. Their mechanism of action is associated with blocking the reuptake of serotonin in synapses. As a result, the concentration of the mediator increases. Such drugs act exclusively on serotonin, without affecting other neurotransmitters.

Among the inhibitors of the selective uptake of serotonin, one can single out: Paroxetine, Sertraline, Fluoxetine, Citalopram, Escitalopram.

Compared to other types of antidepressants, serotonin selective uptake inhibitors have fewer side effects that are not pronounced.

other antidepressants. There are also other groups of antidepressants that differ from the above drugs in terms of the mechanism of action and chemical composition: Bupropion, Venlafaxine, Duloxetine, Mianserin, Nefazodone.

Vitamins and minerals for depression:

In the treatment of depression, the following are also actively prescribed:

• omega 3;

Important! Before using folk remedies for the treatment of depression, be sure to consult your doctor!

Carrot juice. Just drink freshly squeezed carrot juice. You can add an apple to the carrot in the juicer. The combination of apple and carrot is not only healthy, but also very tasty.

Peppermint. 1 st. Pour a spoonful of leaves with 1 cup of boiling water, let stand for 1 hour at room temperature and strain. Take 0.5 cups in the morning and evening. A few mint leaves can also be added to regular tea.

Myrtle. Add myrtle flowers to regular tea. Also, rub the myrtle with your hands and inhale its fragrance. You can also put dry myrtle in rag bags and put it in the places where you spend the most time. Taking a bath with myrtle has a very positive effect on the nervous system. Just take a bath with myrtle leaves and flowers, and for the application of myrtle, it can be used both fresh and dry.

St. John's wort. Pour 1-2 teaspoons of dried flowers and herbal parts with 200 ml of boiling water and let them brew for 10 minutes. Drink this tea 2-3 times a day for several months. Before use, brew a fresh decoction for each time. Just keep in mind that St. John's wort can reduce the strength of some drugs, including drugs that are used in the treatment of and.

Chinese lemongrass (schizandra). Grind 10 g of dry schizandra berries and boil in 200 ml of water. Strain and drink instead of tea. For taste, you can add sugar to this remedy or.

In a pharmacy, you can buy a ready-made tincture of Chinese magnolia vine. It is recommended to use 20-30 drops 2 times a day. In severe cases, the norm can be exceeded up to 40 drops at a time.

Passion flower (passiflora). Pour 1 teaspoon of passionflower herb with 150 ml of boiling water. Infuse for 10 minutes, strain and take a glass of infusion shortly before bedtime.

Knotweed (highlander bird). 3 art. Spoons of knotweed grass pour 1 cup of boiling water. Let it brew for 1 hour in a warm place, strain. Take 1-2 tbsp. spoons 3 times a day.

Borago (borage). 1 st. pour a spoonful of borage grass with a glass of boiling water, wrap and leave for 2 hours in a warm place. Strain and take 0.5 cup 3 times a day before meals.

Herbal collection. Mix 2 parts of hop cones, 1 part of flowers, root and lemon balm, pour into a coffee grinder and grind. 2 tbsp. Spoons of the resulting collection, brew 2 cups of boiling water. Insist 15 minutes and strain. Drink sips throughout the day. Leave most of the glass in the evening so that you can sleep better at night. Drink the remedy for 7 days.

Winter swimming. In the treatment of depressive conditions, winter swimming has proven itself very well - bathing and dousing with cold water. Just before using these procedures, be sure to consult your doctor.

God's help

In the modern world, spiritual problems that haunt a person for more than one year can also be the cause of depression, and traditional treatment only leads to relief for a certain period of time. this is especially true if depressive and suicidal issues arose among other family members. In this case, it may be necessary to turn to a priest who can instruct a person, direct him to God. There are many God's calls in the Holy Scriptures, for example, in the Gospel of John (14:27) Jesus told His disciples: "Peace I leave with you, My peace I give you; not as the world gives, I give you. In another place, in Gospel of Matthew (11:28) He said: “Come to Me, all you who are weary and burdened, and I will give you rest.” Therefore, often when people come in prayer to the Lord and ask Him for help, the Lord answers and helps. however, turning to the Lord excludes the sinful behavior of a person, which could lead to depression and other problems in a person’s life.Read the Holy Scriptures, perhaps you will find something in yourself that led to the negative consequences that you currently have.May the Lord It will help you with this.

Prevention of depression

As you know, the disease is easier to prevent than to treat later. There are several rules that will help you always be in a positive vitality:

• observe the regime of work and rest. Sleep at least 8 hours a day, go to bed before midnight, preferably before 22:00;
• lead an active lifestyle, walk, ride a bike and be sure to do exercises in the morning;
• take vitamins, especially in the autumn-winter-spring period;
• eat right, avoid fast food, soda and other things, do not get carried away with flour and confectionery;
• do not withdraw into yourself, do not say bad words, do not speak negatively about yourself and others, love and do good;
• get rid of bad habits (smoking, drinking alcohol, drugs);
• If you have a job with constant nervous tension, think about it, maybe it should be changed? Nerves are more valuable than money!

Which doctor should I consult for depression?

• Psychotherapist

Video about depression (spiritual point of view)

Manic-depressive psychosis is a disease manifested by recurrent depressive and manic phases, usually separated by light intervals.

depressive phase

The depressive phase is characterized by a triad of symptoms: depressed, melancholy mood, inhibition of thought processes, stiffness of movements. A person is sad, gloomy, barely moves, he experiences a feeling of longing, hopelessness, indifference to loved ones and to everything that previously gave him pleasure. A person in a depressive phase sits in one position or lies in bed, answers questions in monosyllables, with a delay. The future seems unpromising to him, life - meaningless. The past is viewed only in terms of failures and mistakes. A person can talk about his worthlessness, uselessness, failure. The feeling of oppressive melancholy sometimes leads to suicidal attempts.

In women who are depressed, menstruation often disappears. With a shallow depression, diurnal mood swings characteristic of MDP are noted: in the morning they feel worse (they wake up early with a feeling of melancholy and anxiety, are inactive), in the evening the mood rises slightly, activity increases. With age, anxiety (unmotivated anxiety, premonition that “something is about to happen”, “inner excitement”) takes an increasing place in the clinical picture of depression. Usually, patients with manic-depressive psychosis understand the changes that are happening to them, evaluate them critically, but they cannot help themselves and suffer greatly from this.

Manic phase

The manic phase is manifested by increased mood, acceleration of thought processes, psychomotor agitation. Everything around seems beautiful and joyful, a person laughs, sings, talks a lot, gesticulates. This phase is characterized by disinhibition of instincts, which can result in promiscuity.

A person in a manic phase often overestimates his abilities, offers his own candidacy for various positions that do not correspond to his level of knowledge and qualifications. Often, such people discover extraordinary abilities in themselves, pretend to be an actor, poet, writer, quit their job in order to be creative or just change their profession. A person in the manic phase has a great appetite, but he can lose weight because he spends too much energy and sleeps a little - only 3-4 hours.

The duration and frequency of depressive and manic states are different: from several days and weeks to several months. Depressive phases are usually longer than mania. Seasonality of relapses is characteristic, more often in autumn and spring. Sometimes the disease is characterized by the occurrence of only depressions (less often only manias), then they speak of a unipolar course of the disease. Treatment of severe forms is carried out in a hospital, with mild manifestations of the disease, treatment is carried out on an outpatient basis.

bipolar affective disorder

BAD is a disease of unstable mood.

One of two and a half diseases of the group of endogenous mental disorders, which also includes schizophrenia.

The outdated name "manic depressive psychosis" is much more descriptive of the yin and yang/west and east/plus and minus of this disease: depression and mania, but it had to be changed due to the lack of yang minus in some patients and the presence of a more accurate name, which does not carry the word “psychosis”, which is terrible for others.

Synonyms: TIR, circular psychosis, cyclophrenia; "bipolar disorder", "BD", "MDI". Not to be confused with a bar where they drink.

The flow of the BAR looks like riding up and down the roller coaster of mood, with periodic hanging on the peaks and bottoms, where you either rejoice beyond measure, or, accordingly, kill yourself. These are serious psychiatric conditions in the form of recurrent long-term episodes of marked mood disturbance that are widespread and associated with disability and mortality. They run the gamut from debilitating depression to rampant mania, leading to relationship breakups, poor performance at work/school, and even suicide. Bipolar disorder usually develops in late adolescence or early adulthood, but often goes unrecognized, and then people suffer for years until they are noticed and treated.

Due to the many variations in the severity of the course and the unspecified origin of bipolar symptoms, the concept of "bipolar spectrum disorders" is often used, including cyclothymia. According to DSM-IV, there are 4 types of such disorders:

The basis of the concept is that there is a low-level mood cycling that may look like a character trait to the observer, but, nevertheless, interferes with the normal functioning of the patient. If a person clearly gives the impression of suffering from some type of bipolar disorder, but does not meet the above diagnostic criteria, then the diagnosis of an unspecified bipolar disorder is made.

Everyone has mood swings: depression, a feeling of tension for a couple of days, and short-term mental ups and downs to the level of euphoria are familiar to everyone, but everything changes when BAD comes.

The classic version of this disorder, when manic and depressive episodes follow each other, is extremely rare - more often there is either underhypomania with depression, or only depression in general.

Depressive phases are much less productive in outward manifestations than manic phases, and last three times as long; they manifest themselves like any other depressions: despondency, depression, lack of interest in the outside world, pessimism and others (), which in the end can lead to not the best consequences without proper therapy: about 50% of patients made at least one suicide attempt () .

It is worth remembering that depression is not like ordinary sadness: a person will refuse any activities, not talk to anyone, sit / lie in one position for a long time, suffering about his worthlessness and meaningless life. In milder cases, there may be a dependence of mood on the time of day, which will improve in the evening, but in general, this condition will last not a week or two, but more than a month.

The catch for doctors and patients is that it is quite difficult to distinguish depression in bipolar (bipolar) from ordinary (unipolar) depression without a clear analysis of the patient's mood in the past, which may well have been hypomanic episodes that he did not remember. Not all antidepressants are suitable for bipolar depression, and mood stabilizers must be used with them so that a successful exit from a depressive state does not provoke mania or a change in the type of disorder to a fast-cycling one (4 or more depressive / manic episodes per year).

If depression can be imagined by anyone, even the strongest person, then it’s more difficult with mania, because the average person associates psychopaths, maniacs (especially sexual ones) and all kinds of affects known from Dontsova’s books with this word.
Bright, active, eccentric - that's how you can describe a man in the stage of mania compared to a light gap. They are euphoric, but at the same time irritable, tactless and intrusive, especially when trying to correct their behavior. If you've ever watched Jack Black movies, then you can imagine it. The topics of one conversation are constantly changing without any particular relationship (“jump of ideas”), emotions are ahead of thoughts, sometimes there are false exaggerations of one’s power, wealth, abilities, up to delusions of grandeur and self-image as a god. In addition to just talking, they impulsively engage in risky activities (gambling, speed driving, drug use, criminal business), without any assessment of the consequences.

A person in a manic phase is not a rapist who runs around with an ax, inarticulate screams and sows panic. He can be called a madman, but the main manifestations of mania are a long-term elevated mood, excessive mental and physical excitement, not due to circumstances or events.
They come with:

It would seem that an ordinary person would be happy to do all this, only now it will be enough for a maximum of a day, and in patients with bipolar disorder this condition lasts a week or more - during such a time you can break a lot of firewood. This condition without treatment can last up to 6 months ().
In contrast to the depressive phase, many people enjoy mania, experiencing euphoria, comparable to the arrival of drugs, which they get addicted to due to this ().

In advanced cases, activity rises beyond the limit, erasing the connection between the level of mood and behavior: frenzied excitement appears (delirious mania), in which, without life-giving therapy, it is possible to win a box from physical exhaustion. It's nice that cases of unipolar mania (without depressive episodes) have not yet been described ().

Everything is the same, but several times weaker. It is easy to confuse a person in hypomania with an active extrovert, and vice versa: they are energetic, work hard, gush with ideas (often meaningless) and annoy everyone; the difference is that extraversion is a character trait that practically does not change over time, and hypomania can increase to mania or alternate with a normal state and depression.

Alternating hypomania (without episodes of mania) and depression is referred to as the disorder of the second, most common, type. BAD II is much more difficult to diagnose than type 1 because hypomanic episodes can simply be periods of elevated mood and successful productivity that people are unaware of and slow to report to doctors. If you've ever quit smoking, you're familiar with the feeling of elation in the first weeks - that's what hypomania is.

In hypomania, productivity and performance really and clearly increase, it is in it that many famous people with BAD find their inspiration ().

Sometimes BAD surprises in the form of simultaneous mania and depression (mixed type): a person is completely sad and hopeless, but at the same time feels an incredible surge of energy (); now this mixed form is referred to as an unspecified disorder (NOS - not otherwise specified).

The term "dysphoric mania" is used to describe patients in whom classic manic symptoms are combined with marked anxiety, depression, or anger. Although these symptoms tend to appear at more advanced stages of the disease and are therefore directly correlated with the severity of the disease, in some patients they present transiently, and then they can be described as "dysphoric", "mixed", "irritable-paranoid", or even " paranoid-destructive."

Cyclothymia

Cyclothymic disorder is now considered as a light version of BAD with chronic numerous episodes of unstable mood, recorded for more than two years in a row, but not up to the level of full-fledged depression or mania (). Often, patients with cyclothymia are presented with the second type of disorder to start, since it is difficult to immediately assess the severity of the phases.

People with an unstable mood will have to suffer until the problem is solved for about ten years - this is the average period between the first episode of the disease and the diagnosis (). As with many other mental disorders, a person with MDP is usually brought in for a consultation by relatives, because manic episodes are pleasant for many patients (and hypomanic ones in general), and in depression they don’t care at all, what kind of doctors are there.

The good news is that with proper selection of drugs, compliance with their use and good psychotherapy, mood can be stabilized for a very long time, or at least reduce the severity of manifestations, even considering that the disease is chronic.

Due to the easy conversion of depression to mania or rapid cycling disorder in the guidelines for the treatment of acute depression in bipolar disorder, the initial use of antidepressants is not recommended, and the use of mood stabilizers is preferred: the first line of therapy includes Quetiapine, Lithium and Valproate.

Manic depression? There is a solution to the problem!

Mental illness. The vast majority of people believe that this problem will not affect them. However, next to us lives a huge number of people suffering from various mental illnesses. And far from always these diseases are pronounced - often, such people are completely adequate in appearance. When receiving the necessary treatment, such people are quite able to lead a full life, work and even have a family and children.

However, relatives of such people should remember that for a normal existence and prevention of an exacerbation of the disease, it is necessary to create the most comfortable psychological conditions and a favorable microclimate in the family for sick people suffering from certain diseases. Stress has an extremely detrimental effect on the psyche of a sick person, so such people should be protected from them as much as possible.

Manic depression: causes of development

What is a manic-depressive syndrome? Or, as it is also called, manic expression? Doctors - psychotherapists characterize this disease as follows: a mental disorder that occurs against the background of undulating psycho-emotional states: depressive (low mood) and manic (excessively excited mood). Between these phases, mental disorders can disappear completely, while the person's personality does not suffer.

Manic-depressive psychosis is a genetically determined disease. Genetic studies of manic-depressive psychosis have confirmed this fact. Simply put, the predisposition to the development of this disease can be inherited. However, please note that this is not about the disease itself, but only about the predisposition to it. And it is not at all necessary that a manic depressive syndrome will make itself felt - it is quite possible that a person will never encounter this disease. A lot depends on the environment in which the child grows and develops - parents must remember this.

Most often, the disease makes itself felt after a person reaches the age of thirty. Moreover, the disease rarely begins immediately in an acute form. As a rule, for some time the sick person himself or his close relatives begin to notice certain precursors of this disease.

First of all, the psycho-emotional background of a person changes to a large extent - it becomes extremely unstable. A person can often be either in an overly depressed or, conversely, overly excited mood. After that, a pronounced phase of the flow of precursors can be observed - the depressed state is replaced by an excited one. Moreover, most often the depressive phases last much longer than the excited ones.

This condition can last from six months to several years. And if the malaise is not detected in a timely manner and the sick person does not receive the necessary help, the precursors will smoothly turn directly into the disease itself - manic-depressive psychosis.

Depressive phase of the disease

Most of the disease occurs in the depressive phase. The depressive phase has three main features that clearly characterize it:

1. Bad mood. A person has a depressed mood all the time, and it is accompanied by a very real physical ailment - weakness, fatigue, lack of appetite.
2. The appearance of speech and physical inhibition. A person is in a state of lethargy - his physical and mental reactions are significantly reduced. A person almost all the time looks sleepy, feels indifference to everything that happens.
3. The appearance of a pronounced intellectual retardation. A person loses the ability to concentrate his attention on any object: reading, writing, working at a computer. Significantly reduced performance.

The thoughts of a sick person acquire an extremely negative connotation. He has a feeling of his own guilt, often completely groundless, self-abasement and self-flagellation become his favorite pastime. All these depressive moods, unfortunately, very often lead to the fact that a person makes suicide attempts.

There are two types of depression - mental and physical. With mental depression, a person is in a depressed psycho-emotional state. In the same case, if there is a bodily form of depression, problems in the work of the cardiovascular system are added to the depressed mood.

In the event that the depressive state is not treated, depression continues to progress: the psychological state of a person continues to deteriorate, speech and motor inhibition increases, in especially difficult situations it can reach a real stupor - complete silence and immobility. A person stops eating, drinking, going to the toilet, understanding and responding to speech addressed to him.

On the part of the physical condition of a sick person, significant deterioration is also noticeable: there is a strong dilation of the pupils, the development of cardiac arrhythmias - tachycardia, bradycardia, arrhythmia. Also, in such patients, the development of spastic constipation, which appears as a result of spasm of the muscles of the gastrointestinal tract, is often noted.

Manic phase of illness

As mentioned above, if a person suffers from a manic-depressive syndrome, the depressive phase is replaced by a manic one. The manic-depressive phase includes the following disorders:

The manic phase has a number of specific features. If the depressive phase is pronounced, then the manic phase, most often, proceeds quite smoothly, not so pronounced. Sometimes only an experienced doctor - a psychotherapist - can notice something wrong. However, as the disease progresses, the manifestations of the manic phase become more pronounced.

The mood of a person becomes overly optimistic, the assessment of reality becomes overly rosy, not corresponding to reality. A sick person may have completely crazy ideas. In addition, motor activity is greatly increased, and the flow of speech becomes almost inexhaustible.

Other features of the course of manic-depressive syndrome

The most common is the classic course of manic-depressive syndrome. However, much less often, but still sometimes doctors - psychotherapists are faced with atypical forms of the disease. And sometimes this fact can significantly complicate the correct and timely diagnosis of manic-depressive syndrome.

So, for example, there is a mixed form of the course, in which manic-depressive psychosis makes itself felt differently. With a mixed form of the course of the disease, some symptoms of one phase are replaced by certain symptoms of the second phase. So, for example, a depressive mood may be accompanied by excessively nervous excitability, but lethargy, both mental and physical, typical of depression, may be completely absent.

The manic stage of the disease can be expressed by an increased emotional upsurge, but at the same time with a pronounced mental and intellectual retardation. The behavior of a sick person may be absolutely normal, or may be completely inadequate.

Also, quite often, doctors - psychotherapists have to deal with the so-called erased forms of manic - depressive syndrome. The most common form of the erased course of the disease is cyclothymia. By the way, according to some doctors - psychotherapists, this form of manic - depressive syndrome in varying degrees of severity is present in as many as 80% of all adults! It is difficult to judge how true the information is, but there is still something to think about.

With this form of the disease, all the symptoms of a manic-depressive syndrome are so lubricated that a sick person can maintain full working capacity. And his family and colleagues do not even know that something is wrong with him. The depressive and manic phases are so erased that, apart from occasional bad moods, they do not make themselves known in any way.

In addition, sometimes with an erased form of manic-depressive syndrome, the disease proceeds with a latent form of depression. It is also almost impossible to detect. Even the sick person himself may not be aware of the reasons for his bad mood, and therefore carefully hide it from others. A very big danger of such latent forms of manic-depressive syndrome lies in the fact that the phase of depression goes unnoticed, and as a result, the likelihood of committing suicide increases significantly.

Symptoms of the classic manic-depressive syndrome

This disease has its own characteristics of the course, which distinguish it from other mental diseases. It is about the typical symptoms of manic-depressive syndrome that will be discussed below. Strictly speaking, the totality of all these symptoms is characterized by one concept - an anxious - depressive state.

A sick person may experience a strong sense of anxiety. More often than not, this concern is unfounded. Either there are still reasons, but the anxiety is too hypertrophied. Moreover, most often patients are worried about the feeling of anxiety for their future and the future of their loved ones. They are afraid that something might happen: someone close to them or they themselves will get hit by a car, lose their job, and the like.

A psychiatrist immediately distinguishes such sick people from those who are in a state of melancholy. Even in their facial expressions, constant anxiety is noticeable: their faces are tense, their gaze unblinking. His whole appearance expresses a feeling of intense tension. And in a conversation with a doctor, people suffering from increased anxiety will not be too frank - rather, they will take a wait-and-see attitude. The slightest careless word can contribute to the fact that a person simply closes in on himself.

Relatives of such a sick person should remember the basic rules of behavior designed to establish contact and alleviate the patient's morale. First, you first need to make sure that you are dealing with a case of increased anxiety. To do this, it is enough to correctly start the simplest conversation with a person - take a pause. And not necessarily too long a pause - about ten seconds is enough.

In the event that a person is in a simple depressive state, he will be silent for as long as he likes. If a person really has an alarming symptom, he will not endure a long pause, be sure to be the first to start a conversation.

During the conversation, observe the behavior of the sick person. As a rule, his gaze is shifty, restless, he has the so-called "restless hands syndrome" - a sick person is constantly fiddling with something: the edge of the clothes, the sheet. As a rule, it is very difficult for such people to stay in the same position for a long time - they get up, walk around the room.

In especially severe cases, a person with an alarming symptom almost completely loses control of himself. There are two extremes into which such a patient may fall. The first extreme is the stage of torpor. At this stage, the patient's anxiety reaches a stage when a person is only able to look at one point in front of him, practically not reacting to any external stimuli.

There is also another extreme, which is less common, only in particularly severe cases. A person begins to feverishly rush around the room, refuse to eat, scream or sob non-stop. In such a case, it is highly recommended to place the sick person in a specialized medical facility. You should not torment yourself with guilt for the fact that you have shifted the care of your loved one to the shoulders of doctors. Believe me, this must be done first of all for his own safety, since in such a state, impulsive attempts to commit suicide are very, very likely.

Treatment for manic depression

Manic-depressive syndrome should never be left without attention and appropriate treatment. Moreover, it should be noted that manic-depressive psychosis is not a mild sleep disturbance, when you can knock out sleeping pills and sleep peacefully until morning. The treatment of manic-depressive syndrome should be occupied only by psychotherapists.

Treatment is carried out in several stages. A sick person is prescribed a course of treatment with pharmacological drugs. Preparations are selected strictly individually, depending on the condition of the sick person - so, if a person has physical or mental lethargy, he is prescribed drugs that stimulate activity. In the same case, if a sick person is dominated by increased excitability, he will be prescribed sedatives.

The prognosis of this disease

So many people who are faced with this disease in one way or another are interested in - what is the forecast of doctors? As a rule, in the event that the manic-depressive syndrome itself is not aggravated by any concomitant disease, the prognosis is quite favorable - a person is able to return to a normal lifestyle.

However, relatives of a sick person should remember that successful treatment of the disease is possible only if it is detected in a timely manner. The later treatment begins, the stronger the irreversible changes in the personality of a sick person occur. So it's better to play it safe and see a doctor for ordinary depression than not to notice the real trouble.

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Manic depression wikipedia

manic depression

Bipolar disorder, also known in the past as manic depression, is a mental illness that causes the sufferer to experience extreme mood swings, from depressed to overly agitated. People with this disease, feeling happy and joyful, abruptly fall into an excessive feeling of sadness and depression, and vice versa. Because manic depression is characterized by a sudden change in mood phases - or mood polarity - it is called bipolar disorder, or bipolar disorder. Between bouts of mood swings, the patient may be in a normal state and mood.

The word "mania" describes the state of the patient when he is in an overly elevated and agitated mood and feels self-confident. These feelings quickly develop into distraction, irritability, anger and even anger. The word "depression" describes the state of depression and sadness of the patient. Because the symptoms are similar, patients are sometimes misdiagnosed with acute depression.

In most patients, attacks of the depressive phase occur much more often than mania.

Who is most likely to get manic depression?

According to the National Institute of Mental Health, about 2 million people in the United States suffer from a disorder such as manic depression. It usually starts at a young age, before the age of 35. If children get sick, then it will proceed in a more complex form and together with attention deficit hyperactivity disorder.

Some studies have shown that manic depression is hereditary, due to its frequent occurrence within the same family.

This disease affects both men and women equally, but women suffer from more frequent episodes of mood swings - that is, bipolar disorder of a cyclical nature. This course of the disease may be due to the fact that women have more frequent changes in hormone levels, impaired thyroid function, and they are more often prescribed antidepressants. Women are also more prone to frequent bouts of depression than mania.

As a result of research, it was found that about 60% of patients with bipolar disorder also suffer from alcohol or drug addiction. In addition, studies have shown that manic depression most often occurs in people with seasonal affective disorder or post-traumatic stress disorder.

What causes manic depression?

It is impossible to say exactly what caused depression or bipolar disorder, but causes include genetic predisposition, changes in brain chemistry, or the environment, such as stress or life changes. More and more research is being done to establish the relationship between these causes and the onset of bipolar disorder, how one can avoid its first attack, and what role these causes play in treatment.

How does manic depression manifest itself?

Manic depression is characterized by mood phases that do not follow a specific order, and depression does not always follow mania. The patient may experience an attack of one phase several times in a row, when suddenly he develops an attack of the opposite mood phase. Changes in the mood phase can occur at intervals of weeks, months, or even years.

The severity of an attack of depression or mania in each case is strictly individual.

Symptoms of mania include:

• Excessive feelings of happiness, optimism and excitement.
• Sudden change of joyful state to irritability, anger and hostility.
• Restlessness.
• Rapid speech and inability to concentrate.
• Increased energy and reduced need for sleep.
• Increasing sexual desire.
• Tendency to draw up grandiose plans and impossible tasks.
• A tendency to make poor judgments, such as the decision to quit a new job.
• Abuse of alcohol or drugs.
• Increased impulsivity.

Manic depression is also characterized by psychopathic attacks, for example, people see or hear things that do not exist, believe in them and it is impossible to convince them otherwise. In some cases, they believe that they have supernatural abilities and powers, or consider themselves God-like.

Symptoms of depression include:

Symptoms of the disease

Unlike other depressive disorders, which are mainly manifested by mood changes and apathy, manic depression causes more serious mental disorders.

This disease is characterized by seasonality and cyclicity, one can speak of bipolar disorder if his mood and behavior quickly and for no apparent reason changes to the opposite - from unbridled fun to periods of deep melancholy and oppression.

In the clinical picture of the disease, 2 phases of the disease alternate:

Most of the time the patient is depressed. At the beginning of the disease, psycho-emotional symptoms of depression predominate: sadness, melancholy, apathy, lack of positive emotions, and so on. The emotional-volitional sphere is disturbed, the patient is constantly in a depressed state, nothing pleases him, does not arouse interest, he has difficulty making decisions, cannot communicate with people, depending on the characteristics of the person’s character, tearfulness, irritability or aggressiveness may prevail.

The attitude and thoughts of the patient change, he sees everything in an exclusively black light, suffers from the realization of his own imperfection, insignificance, feels guilty, fear of the future, life seems bleak and useless.

If the patient is not provided with qualified assistance at this stage of the disease, his condition will worsen and physical symptoms of depression will appear: