Alcoholic depression: how to recognize and get out of the vicious circle

Causes

Apathy itself is usually a symptom of some disease. The cause of this condition may be:

• depression;
• schizophrenia;
• diseases of the central nervous system;
• dementia;
• HIV;
• brain tumor;
• alcoholism;
• addiction;
• endocrine disorders.

In addition, the following can provoke the appearance of apathy:

• some medications (sleeping pills, tranquilizers, antidepressants, oral contraceptives, etc.);
• stress and strong emotional experiences;
• overwork and lack of rest.

Alcohol depression: why it develops

Anxiety and depression are constant companions of alcohol addiction. High blood alcohol levels reduce serotonin levels. This leads to a general deterioration in health and depression . When drinking ethanol, the production of norepinephrine increases, and a sharp decrease in this hormone of aggression leads to a feeling of depression, loss of strength, weakness, and apathy.

The absorption and breakdown of alcohol in the body is much more active than the removal of toxic substances that pose a danger. Acetaldehyde (a product of ethanol oxidation) is concentrated in large quantities in the cerebral cortex. This leads to insufficient nutrition of neurons, which causes cells in the cerebral cortex to die.

Various drinks containing alcohol are powerful triggers of mental disorders. While they provide short-term bliss, they later lead to increased symptoms of depression. It has been proven that drinking ethanol directly affects depression. Depression increases cravings for alcohol, and excessive use leads to anxiety, depression, or mania .

Treatment and prevention

To cure apathy, it is necessary to accurately determine its cause. The treatment program and its duration will depend on the root cause. Sometimes, if apathy appears against a background of stress and overexertion and it lasts for a short time, it will be enough for a person to rest well in a calm environment.

A treatment program for apathy may include:

• psychotherapy;
• physiotherapy;
• physical exercise;
• medications.

To prevent apathy, it is necessary to avoid stress, follow a work and rest schedule, get enough sleep, take daily walks in the fresh air, and watch your diet. Vitamin and mineral complexes will be useful. You should also limit your alcohol consumption and give up other bad habits.

If you notice that you have lost your “thirst for life” or that your favorite activities no longer bring you joy, consult a doctor. Medical specialists will make a diagnosis and suggest a course of treatment. It should be remembered that apathy can be a symptom of a serious illness that requires immediate treatment. Contact the SM-Clinic for qualified medical care for you and your loved ones.

What does apathy look like: symptoms and signs

Apathy deprives a person of interest in life, desires and motivation. The absence of these important stimuli has a detrimental effect on behavior and performance. A low energy level will interfere with both daily routine tasks and taking on new challenges.

Important

Over time, despite the actual deterioration of the condition, patients talk less and less about their problem, but go deeper and deeper into it.

Emotions become dulled, which is why everything that usually aroused interest no longer gives an emotional response. Attacks of apathy deprive you of interest in almost all aspects of life. A person may be indifferent when long-awaited events occur, or when meeting new people. It is difficult to make an effort even to solve personal problems. Accumulated problems at work and in personal life only aggravate the situation, because apathy is one of the ways the psyche isolates itself from a difficult situation and overexertion.

At first, when the manifestations have not reached their maximum, people may express similar complaints: “I have some kind of apathy, I don’t want anything,” “I’m tired of everything, I can’t concentrate, I have no desire.” Over time, despite the actual deterioration of the condition, patients talk less and less about their problem, but go deeper and deeper into it. If your loved one complains to you about painful feelings, you should not ignore these words - the person may need help.

The main signs of apathy:

• decreased or absent aspirations and motivation;
• changes in emotions and behavior: decreased interest in life, communication, previous hobbies and new events, difficulties in performing current tasks, lethargy, lethargy, poor concentration, decreased mental functions, etc.;
• impact on quality of life: changes in behavior negatively affect professional success and personal life;
• changes in behavior are not associated with drug and alcohol use.

Clinically significant is the presence of these signs in a person for four weeks. However, if you notice apathy in yourself or a loved one, which lasts less but causes significant discomfort and interferes with life, do not delay contacting a specialist. A professional will quickly help you understand the situation and understand whether it is just a bad mood, fatigue, or a condition that requires correction in order to prevent complications.

Diagnostic measures that can be carried out in a person with complaints of apathy:

1. Consultation with a psychiatrist-psychotherapist
2. Pathopsychological examination: helps more deeply
3. explore mental functions such as thinking, attention and memory. The method helps to detect disorders in the early stages and prevent the occurrence of severe manifestations
4. Laboratory and instrumental techniques to confirm
5. diagnosis: Neurotest, Neurophysiological test system, EEG, CT, MRI of the brain (if organic pathology is suspected)
6. Consultation with related specialists (neurologist)

Mental Health Clinic - We Can Help

Psychologists at our clinic will conduct a professional psychological diagnosis of your condition. In a confidential conversation with a psychotherapist, you will find the true motives of your actions and be able to cope with your problems. An experienced specialist will conduct psychological training with you so that in the future you will be able to manage your emotions, know how to get out of depression on your own, feel more confident and be able to cope with life’s difficulties and problems yourself.

Alcoholic depression and its varieties

There are two types of alcoholic depression:

1. A temporary disorder caused by drinking large doses of alcohol. The result is intoxication of the body;
2. Severe state of apathy after heavy drinking.

The temporary disorder does not last long and passes quickly: it often begins after drinking a large dose of alcohol and is found in conjunction with a hangover. Along with terrible health, a person feels guilt, depression and repents for what he has done. The ongoing processes of ethanol breakdown contribute to a decrease in blood sugar, which causes fatigue, muscle weakness, decreased concentration and depressed mood. Very often these factors are accompanied by excessive anxiety and irritation. A lack of magnesium causes nervousness, rapid heartbeat and chills.

In most cases, this type of depression goes away in a short period of time, without requiring any medical attention.

Disorder after binge drinking is a more complex case: it resolves with complications and requires medical intervention. Alcoholic depression, the treatment of which is necessary, in this case begins after long-term use of alcohol. In the first few days (2–5) after stopping drinking alcohol, it is accompanied by withdrawal syndrome .

Physically, depression is burdened by somatic disorders: tremors of the limbs, convulsions, hyperactivity, and other factors of withdrawal syndrome. In this case, the person feels a psychological crisis (there are no positive emotions). He loses the ability to receive pleasure, there is no purpose and meaning in life. A person suffering from alcoholic depression sees the world as gloomy and is oppressed by a feeling of uselessness and uselessness.

For many, affective disorder is severe, with bad consequences.

What are the dangers of severe depression?

1. Behavior changes. From simply avoiding their usual activities to changing their lifestyle, people with depression end up in sects and extremist organizations. From stopping self-care to attempting suicide.
2. Loss of usual social connections: dismissal from work, family breakdown, loss of friends. What has formed around a person over the course of life, forming his environment, is destroyed by severe depression.
3. General exhaustion: dystrophy, weight loss, metabolic disorders.
4. The development of psychosomatic diseases: cachexia (weight loss), skin rashes, asthma attacks, gastrointestinal disorders (constipation, diarrhea), temperature regulation disorders, excessive sweating, hypotension or hypertension and many other disorders.

Depression in late life

The prevalence of depression in the population of older age groups is, according to various researchers, from 9 to 30%

.
It is important that mild and moderate depressive disorders occur almost 10 times more often than severe depressive conditions requiring inpatient treatment in geriatric departments of psychiatric hospitals. Late age is considered to be the peak age in relation to the incidence of depressive disorders in patients of general somatic practice. This figure varies among different authors from 15 to 75%, indicating a significant accumulation of late-life depression among patients of general practitioners. It is known that older people especially rarely use psychiatric help, not only because they themselves avoid visiting such specialists and do not go to a psychiatrist “until the last minute.” This often occurs due to the prevailing “ageism” in the views of some medical workers, who habitually attribute mental symptoms to manifestations of either irreversible age-related changes or somatic diseases. It is clear that it is precisely the non-severe forms of late-life depression that remain unrecognized, perhaps the most treatable and prognostically favorable. The negative consequences of under-detection of depression in the elderly and elderly boil down to the following: – increased risk of suicide; – worsening symptoms of depression; – chronification of the condition, increasing need for long-term inpatient treatment; – deterioration in the quality of life of the patients themselves and those from their immediate environment; – decreased possibility of social adaptation in everyday life; – negative impact of depressive mood on the manifestations of somatic illness; – limitation of the possibility of treating somatic pathology due to low compliance of elderly depressed patients (non-compliance with diet, medication regimen, refusal of treatment, sometimes for suicidal reasons); – reduction in life expectancy of depressed patients with myocardial infarction, coronary heart disease and other diseases. With rare exceptions, depressed patients from groups of elderly patients in polyclinics and somatic hospitals are not registered at a psychoneurological dispensary and usually do not come to the attention of a psychiatrist, although their complaints and general condition contain signs that direct the doctor to identify depression. In this case, the general criteria for depressive disorder (ICD-10) are quite applicable. The main symptoms
should include: – persistent depressed mood (every day and most of the day, for at least 2 weeks);
– loss of the ability to rejoice, to be interested in something, to experience pleasure (anhedonia); – increased fatigue and decreased energy. Additional symptoms of depression include: – low self-esteem, weakened self-confidence; – self-reproach, self-abasement; – excessive or inadequate feelings of guilt; – difficulty concentrating, focusing attention, doubts, hesitations, indecision; – recurring thoughts about death, unwillingness to live, suicidal thoughts and intentions; – objective signs of psychomotor retardation or anxious agitation (agitation); – sleep and appetite disturbance. Diagnosis of severe depression includes 3 main and 5 (at least) additional symptoms - criteria. For mild and moderate depression, there must be 2 main and at least 3-4 additional symptoms. Following diagnostic criteria is, of course, necessary in the diagnostic process. But in practice, it is important to take into account the peculiarities of the manifestations of depression, which are caused by late age and make it difficult to identify these disorders. In geriatric practice, the most common are shallow depressions, moderately severe and mild, but their symptoms are more difficult to identify and interpret, that is, the very severity of the clinical manifestations of depression in these cases makes it difficult to identify them in a timely manner and does not contribute to an unambiguous interpretation. Difficulties in recognizing depression in older people are also due to the fact that patients themselves are less likely to define depression as a mental disorder, remember and compare it with similar episodes. At least one third of patients view depression not as a disease, but as a psychological problem. Another problem, relating primarily to mildly expressed depression of late age, is the significant prevalence of so-called “atypical”, “somatized” or “masked” depression. According to WHO, half of elderly depressed patients in general somatic practice suffer from masked depression. When diagnosing masked depression in late age, the following supporting signs are used: – identification of symptoms of depression; – signs of cyclicality of somatoneurological symptoms in the current state and in history, daily fluctuations; – premorbid personality traits, reflecting characteristics of reactivity, hereditary factors; – discrepancy between complaints and objective somatic status; – discrepancy between the dynamics of disorders and the course and outcome of a somatic disease; – lack of effect of “general somatic” therapy and positive response to psychotropic drugs. At a later age, the most common are cardiovascular and cerebral-vascular “masks” of depressive disorders
under the guise of coronary artery disease and arterial hypertension. A connection between chronic pain syndrome and depression has been noted. Apparently, the most specific “mask” for late age is the impairment of cognitive functions in so-called “pseudo-dementia” depression. The phenomenon of somatization of depressive disorders in late life does not remove the importance of the problem of the combination of depression and somatic diseases. Depressive symptoms themselves (main and additional) show distinct age-related characteristics. Late-life depression is primarily anxiety depression. Anxiety may not have a specific content, but is more often accompanied by various fears, and first of all, for one’s health and future. Anxious depressed mood is sometimes recognized as a painful state of health. Patients often complain of painful internal anxiety with a feeling of trembling in the chest, stomach, and sometimes in the head. Daily mood swings are characterized not only by worsening in the morning, but also by increased anxiety in the evening. The loss of the ability to rejoice and take pleasure, always heard in complaints, is perceived by patients as age-related changes in the psyche, as well as a feeling of lethargy, weakening of motivation and decreased activity. Depressive pessimism contains experiences of fear of loss of independence, characteristic of late age, for fear of becoming a burden. Thoughts about not wanting to live arise with depression of any severity, including shallow ones. At the same time, the appeal to the doctor and the search for help continue; in some cases, prohibitive techniques are developed, and religious views on the topic of the sinfulness of suicidal thoughts and actions are updated. However, it should be borne in mind that, in addition to known methods, elderly depressed patients can carry out suicidal intentions by refusing proper nutrition, the necessary diet, effective treatment, taking life-saving medications or regular maintenance therapy. And only after depression has passed, these changes in well-being begin to be regarded as symptoms of the disease. Similarly, cognitive dysfunctions tend to be temporary. During periods of depression, elderly patients often complain of poor memory, mistaking problems with concentration for manifestations of forgetfulness and deterioration of intelligence. The preservation of mnestic-intellectual capabilities is confirmed by the performance of special tests, as well as the reverse dynamics of complaints and disorders as a result of treatment with antidepressants. Late-life depression has different etiopathogenesis.

Main nosological groups

represent: – endogenous affective diseases (bipolar and unipolar depressive disorders, cyclothymia, dysthymia); – psychogenic depression (disadaptation reactions); – organic depression; – somatogenic depression; – iatrogenic depression. Endogenous depression of the psychotic level (involutional melancholia) is manifested by a syndrome of anxious-delusional depression with motor restlessness and ideational excitation with the experience of fear, delusional ideas of condemnation, punishment, death, hypochondriacal ideas, suicidal thoughts and actions. In these cases, emergency hospitalization is indicated.

Endogenous depression of a non-psychotic level accounts for at least 20% of depressive disorders

detected in elderly general practice patients. A depressive state can be a single episode of the disease and end in complete remission. Recurrence of depressive phases is more common. At a later age, there are frequent cases of prolonged depression at a subpsychotic level with exacerbations in the form of clinically more pronounced disorders (“double depression”). Attacks of the disease often develop with a seasonal dependence, but the influence of provoking factors cannot be ruled out. Psychogenic depression in late life represents a large group of conditions caused by exposure to mental trauma. The period of aging is called the age of loss. The experience of loss after the death of loved ones and the fear of loneliness constitute the main content of depressive reactions of maladaptation of varying degrees of severity and duration. Unfavorable changes in life (loss of ability to work, financial collapse, a sharp deterioration in the health of one’s own or those in one’s immediate environment) can act as stress factors. Importance is given to personal predisposition in people prone to strong attachment and pronounced dependence on others, as well as in people prone to hyperreaction to stress. In old age, risk factors for the development of psychogenic depression are multiple losses, lack of adequate social support, and age-related decrease in the ability to adapt to reality. An uncomplicated reaction of loss is characterized by a feeling of grief, longing for the deceased, a feeling of loneliness, crying, sleep disturbance, thoughts of one’s own uselessness. More complex and protracted psychogenic depression includes symptoms such as feelings of guilt, self-reproach or a tendency to blame circumstances, thoughts of death, a painful sense of worthlessness, psychomotor retardation, and persistent functional disorders (somatovegetative). Characterized by alarming fears for the future. The duration of depressive reactions of maladjustment ranges from several months to 1–2 years. Organic depression of late age, in contrast to functional (endogenous, psychogenic) depression, is caused by damage to the brain, its substance or vascular system, and irreversible damage to neurotransmitter mechanisms. Cerebrovascular disease is characterized by so-called vascular depression with asthenic and anxious symptoms, tearfulness, lability of the state with fluctuations in the severity of depressive symptoms (“flickering symptoms”), mild cognitive disorders, which worsen during the period of depression and are reduced after the depression has passed. Vascular depression often develops after cerebrovascular accidents (post-stroke depression). In these cases, along with the reactive mechanism for the development of depression, a close connection was found with the localization of the lesion in the left hemisphere. A high susceptibility to depressive disorders is found in diseases such as Parkinson's disease, Huntington's chorea, and progressive supranuclear palsy. Brain tumors (left temporal lobe) are manifested by endoform depression with an acute feeling of melancholy, anxiety, and suicidal tendencies. Diagnosis of depression is complicated by the fact that the symptoms of neurological disease and depression are difficult to differentiate due to common manifestations (hypokinesia, psychomotor retardation, somatic complaints), however, the use of antidepressant therapy along with basic therapy somewhat improves the course and prognosis of neurological diseases.

Depression in Alzheimer's type dementia

may be a clinical manifestation of the onset of the disease.
Often, depressive reactions to loss (the death of a spouse) are the reason for the first visit to the doctor. Further observation reveals instability and disactualization of depressive experiences and reveals memory disorders (for example, it is discovered that the patient does not remember the exact date of death of a loved one) and other symptoms of Alzheimer's type dementia. Depressive reactions to the initial manifestations of mnestic-intellectual decline have a different nature. In these cases, suicidal thoughts and attempts may occur. With further progression of dementia, depressive disorders as clinically defined conditions disappear, but individual depressive symptoms may persist, often difficult to distinguish from the spontaneity of dementia patients and the manifestations of their own cognitive deficit. The importance of identifying these depressive states is important not only for the early diagnosis of mild dementias, but in relation to adequate antidepressant therapy. Timely treatment not only alleviates the condition of patients with initial manifestations of dementia and improves their quality of life, but, in addition, the use of antidepressants with serotonergic and noradrenergic action is justified from the point of view of participation in replacement therapy for neurotransmitter deficiency. Somatogenic depression
in late age is especially common in patients in somatic hospitals and primary health care institutions. In severe somatic illnesses, depression is observed three times more often than in mild and moderate somatic disorders. Depression often occurs after the onset of a somatic illness, but sometimes precedes the identification of the first signs. The closest association of depressive disorders was found with oncohematological pathology, coronary heart disease and its complications (myocardial infarction), chronic respiratory diseases, diabetes mellitus, and damage to the visual organs. Depression develops as a stressful reaction to the diagnosis of a disease (somatopsychogeny), and may also be associated with the effect of hospitalization. Depressive disorder is a symptom (sometimes the first or early) of a number of somatic diseases (hypothyroidism, anemia, vitamin deficiency, hypercalcemia, rheumatoid arthritis, peptic ulcer, chronic renal failure, hepatitis and cirrhosis of the liver, pancreatic carcinoma, etc.). Symptomatic depression usually has a picture of asthenic depression, in some cases anxiety predominates, and as the somatic condition worsens, adynamia, lethargy, indifference to the environment, and indifference increase.

Iatrogenic depression

. There is an idea (not fully proven) about the connection between the occurrence of depression and long-term use of certain medications. This is one of the types of iatrogenic depression. Another type of iatrogenicity is depressive reactions to erroneous or careless medical opinions. It is accepted that depressive states can be caused or provoked by prolonged use of medications prescribed for another reason. It is assumed that this is not actually an affective illness, at least not related to major depression. The list of drugs that have depressogenic properties to one degree or another exceeds 120 items. It should be borne in mind that iatrogenic depression is associated with long-term use of medications. The fact that depressive symptoms disappear when they are discontinued may support this connection. In geriatric practice, the doctor’s focus on the possibility of developing depression should take place when using the following groups of drugs: – psychotropic drugs (haloperidol, risperidone, etc.); – antihypertensives (rauwolfia alkaloids, propranolol, verapamil, nifedipine); – cardiac glycosides (digoxin); – class 1 antiarrhythmic drugs (novocainamide); – hormonal agents (glucocorticoids, anabolic steroids); – antacids (ranitidine, cimetidine); – lipid-lowering (statins, cholestyramine); – antibiotics; - chemotherapeutic agents. In the context of such frequent polypharmacotherapy in elderly patients, the problem of iatrogenic depression is becoming increasingly relevant, however, the doctor should not be guided by information about the depressogenic properties of drugs when prescribing treatment, but keep them in mind when identifying symptoms of depression during long-term (many months, sometimes many years) of their use.

Treatment of elderly patients with depressive disorders

The management and treatment of elderly patients with depressive disorders are the responsibility of a psychiatrist. Patients with severe manifestations of depression are subject to inpatient treatment. For moderately severe depression, treatment is often carried out in a day hospital or on an outpatient basis. For mild manifestations of depression, treatment can be carried out in general somatic institutions (hospital, clinic). The prescription of antidepressant therapy and dynamic monitoring are carried out by a psychiatrist, while cooperation with an internist and his full awareness of the treatment being carried out is necessary. Close constructive cooperation between an internist (geriatrician) and a psychiatrist ensures more rational management of this category of patients, taking into account the characteristics of the course and treatment of mental and somatic illness. The combined use of drug treatment and psychotherapy is advisable. The role of the latter increases as the severity of depression decreases and in remission. The process of drug therapy is a complex maneuver between taking into account clinical indications and the desire to avoid possible side effects and complications, the risk of which is known to increase in elderly and senile patients. The most general rules

are: – the principle of monotherapy;
– use of lower doses of drugs (2–3 times) than prescribed for young and mature patients; – starting treatment with minimal doses; – slow rate of dose increase; – mandatory consideration of somatic contraindications (glaucoma, prostate adenoma, heart rhythm disturbances); – taking into account the compatibility of an antidepressant with other medications prescribed for somatic diseases. Antidepressants of balanced action
with high thymoleptic potential and, at the same time, anxiolytic properties are optimal for the treatment of late-life depression The choice of drugs for the treatment of depressive disorders must be made taking into account side effects, i.e. preference should be given to drugs with a weak orthostatic effect (doxepin, nortriptyline), minimal anticholinergic effect (desipramine, trazodone, MAOIs), and less pronounced sedative properties (nomifensine).

Tricyclic antidepressants

(TAD) are still often used to treat mild and moderate depression.
Despite the fact that no superiority in the clinical effectiveness of second-generation antidepressants compared with TAD was found, the absence and much less severity of side effects constitutes their advantage when prescribing treatment for the elderly and elderly. For somatized depression, the use of nomifensine
.
In addition, the drug is especially preferable for outpatient gerontopsychiatric practice due to the fact that, in comparison with TAD, it acts faster and causes fewer side effects. Among other non-tricyclic antidepressants, the clinical effectiveness and safety of mianserin
and
doxepin
.
The possibilities of using MAO inhibitors (selective) for the treatment of depressed elderly and senile patients are being considered in a new way. Their use is considered especially effective for atypical depression with the properties of reactive lability. Among antidepressants prescribed to the elderly, the use of drugs with a selective focus of action, such as fluoxetine
, which has a selective blocking effect on serotonin reuptake, is justified.
Antidepressants of this group (fluoxetine, paroxetine, fluvoxamine, etc.) are inferior in effectiveness to TAD, but act faster and cause fewer anticholinergic effects, although they can increase anxiety and cause sleep disturbances. It is optimal to take the medication once a day. Mirtazapine
is highly effective in the treatment of moderate and severe depression .
Due to its specific binding to receptors, mirtazapine has virtually no anticholinergic, antiadrenergic and serotonergic (typical of serotonin reuptake inhibitors) side effects, which is especially important for the geriatric population of depressed patients. The advantages of this drug are determined by the speed of onset of the antiadrenergic effect from the second week of treatment, anti-anxiety properties, and the ability to achieve improved sleep without the use of night tranquilizers. Compared with TADs and serotonin reuptake inhibitors, mirtazapine is much better tolerated in old age (does not increase blood pressure and does not cause cardiac arrhythmias), however, the presence of glaucoma and benign prostatic hyperplasia is a contraindication. Among the modern antidepressants, the prescription of which is justified in elderly and senile patients, is paroxetine