Treatment of masked depression ✯ Psychotherapy clinic

The difficulty in treating masked depression lies in its diagnosis. Unfortunately, this form of depression is very difficult to diagnose and only a very competent doctor is able to correctly assess a person’s condition. This form of depression is often defined by doctors as hidden depression.

To diagnose masked or hidden depression, it is necessary to look for signs other than signs of sadness and depression. Read the article to the end and you will learn how depression can hide, put on the mask of a wide variety of diseases.

In this regard, therapy for masked depression is unable to achieve its main goal. Our specialists have extensive experience in clinical and differential diagnosis. It is also worth noting that in our clinic the patient is examined by several specialists and for each a medical consultation is held free of charge. This eliminates the possibility of an erroneous diagnosis.

If a person undergoes a full course of treatment for latent depression, strictly following all the doctor’s instructions, then he gets rid of it.

It is difficult to help someone who does not admit his illness, someone who will not talk about his state of mind. It is a daunting task to throw a lifeline to those who deny possible help. And yet, we must strive to understand and help those who live with it.

Perhaps you have heard of the mind-body connection? About how the power of the mind can affect the condition of your body?

If you feel depressed, you can feel it in your own body - your body may hurt, your bones may ache, various organs may ache, and your head may be pounding from a migraine.

Brain Clinic specialists treat masked depression using individually adapted methods. The concept of these techniques is an organic synthesis of the principles of restorative medicine, therapy, psychotherapy, neurology and psychiatry. Therefore, we will be able to establish an accurate and complete diagnosis and treat hidden depression with maximum effect.

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What is masked depression?

Masked depression revolves around the concept of mind and body.

This type of depression does not manifest itself in the form of classic depression, it is hidden behind various somatic diseases. Adults may complain of constant fatigue and pain (other unpleasant sensations in the body). Many doctors cannot find any reason in the form of diseases of internal organs or other somatic diseases. In children and adolescents, masked depression may manifest itself in the form of aggression or behavioral disturbances. Such children are referred to a psychologist, but the main problem remains unnoticed. Therefore unsolved.

Similarities and differences

Usually people have a clear understanding of depression. A person tends to think that a sure sign of depression is a feeling of helplessness and hopelessness, difficulty getting out of bed, sadness, a sharp drop in mood, apathy, lack of interest in anything, a depressed state and other signs that are closely related to mood, and this happens every day. That's all there is to recognizing depression, right?

Many people believe that depression is easily identified when it manifests itself as constant sadness. In fact, symptoms of depression can take many subtle forms.

Chances are, if you are reading this article, you have a feeling that something is not quite right with you. You may find that you are very tired all the time and all you need to do is get a good night's sleep.

However, masked depression often appears as something completely different and can cause insomnia, forgetfulness, and an inability to enjoy normal activities, pain or discomfort anywhere, memory loss, decreased or absent sexual satisfaction or desire, fatigue, and much more. much more.

Causes

In most cases, the disease develops after sudden changes that were unfavorable. These include:

Marriage breakdown.
Dismissal from work.
Parting with a loved one.
Moving.
Completion of studies.

Family problems and conflicts also play an important role. With an unstable emotional background in a family where there is no understanding and difficult living conditions, there is a high risk of developing hidden depression. At the same time, a person himself cannot do anything. He will lead his usual lifestyle, try to resist the environment, but depression will affect his physiology.

Difficulties in diagnosis

Masked depression - “in the mask” of somatic diseases.

The difficulties of treating masked depression begin with its diagnosis; it is more difficult to identify than ordinary depression with its classic triad: decreased mood, slowed thinking, slowed motor activity. The symptoms of masked depression are not typical. Depression can be hidden in several directions, “in a mask.”

Such manifestations of depression are called masked depression, otherwise they can be called larved or hidden depression.

As a rule, in most cases, general practitioners often incorrectly diagnose the somatic complaints of patients, because patients always complain only about somatic symptoms, not to mention their internal experiences, and most practitioners do not know that such symptoms belong to depression. Typically, masked depression is mild, but tends to develop into chronic forms. Without proper treatment, over time, patients often become worse and this can trigger the manifestation of more serious disorders, such as a suicide attempt, which can end successfully. The exact cause of the development of masked depression still remains not entirely clear, but according to the results of many functional studies (these data are very important in the diagnosis of hidden forms of depression), practicing medical specialists are well aware of the mechanisms of development of such conditions. And carrying out differential diagnosis from somatic pathology is also important and should be inseparable from a full diagnostic procedure.

“Diagnosing masked depression in children and older people is very difficult because they don’t say, ‘I’m depressed. They are more likely to attribute their condition to physical illness, to what they feel - pain in different parts of the body, memory problems, poor sleep, changes in appetite, says Dr Anne Fabini, head of geriatrics at the Cambridge Health Alliance.

Older people, particularly older men, display their depression in unusual ways. In older men, depression may manifest itself as increased irritability more often than women. Thus, the grumpy old man stereotype may be a sign of a depressed old man. A new report from the Centers for Disease Control and Prevention shows that depression is more common among women (10.7% of adult women) than men (7.7% of adult men). And although depression tends to peak between the ages of 45 and 64, it can appear at any point in a person's life.

Frequent complaints with masked depression

sleep problems,
lack of energy,
fatigue,
problems with concentration or memory,
loss of appetite,
pain or discomfort in various parts of the body,
pains that don't go away
therapists and other doctors do not find diseases that could be the cause of the complaints expressed.

Severe depression. Causes and symptoms

This is how the stage of depression, which has turned into a form of mental disorder, is designated. It is also called clinical depression or major depressive disorder (Major Depression). Unlike moderate depression, the fundamental symptom here is a long period of illness, during which bad mood, apathy, pessimism, and decreased self-esteem are observed. In the physiological aspect, symptoms such as sleep and appetite disorders, asthenia, and lethargy may be present. In extreme cases, it paralyzes the mental, mental, and motor spheres of human activity. In essence, the reasons for the development of severe depression remain the same and are endogenous in nature: stress or psychological trauma, changes in living conditions, abuse in childhood or adolescence, serious illness, taking medications, as well as a number of biological factors. Against the background of these symptoms, with major depression, a person’s immunity decreases, which is a prerequisite for the development of infectious diseases. In general, there is an imbalance in the functioning of the entire body. By and large, major depression is the main symptom of melancholic psychosis, which also belongs to the cluster of mood disorders. It is not subject to self-regression and is a form that requires the mandatory intervention of specialists and the prescription of drug therapy.

Treatment of masked depression

More often than not, patients do not like to take conventional antidepressants due to various side effects and fear of these drugs. Therefore, in the treatment of masked depression, we recommend using very small doses of drugs in combination with herbal drugs and special psychotherapy.

Due to misconceptions about the disease, many patients of different ages are more inclined to take a wide variety of medications than to meet with a psychotherapist or psychiatrist.

However, it has been found that many antidepressants prescribed in conventional regimens are generally ineffective. This is especially true for older people. They can delay treatment for months and years. The risk of side effects with standard therapy for masked depression is significantly greater.

Research from the International Center for Disease Control and Prevention has shown. An adequate combination of medications in small doses and psychotherapy is most effective.

Example of complaints

As an example, we will describe a fairly common option for trying to treat masked depression and contacting us with complaints. The man went through many doctors several times. At the time of treatment, he did not consider his illness to be related to a change in mental state.

I am 25 years old, female. I’ve been sick for 5 years now, I don’t know why. Before this illness I had very little pain. And only a cold. She didn’t fall, didn’t hit herself, there were no surgeries. I have always been active and healthy. It all started with the fact that I was very cold, and because of this, cramps began in my fingers, then periodic weakness in my legs, as if my legs were giving way on their own. I even fell several times and couldn’t get up. When they lifted me up, it was as if nothing had happened, she even ran calmly. Later this weakness spread to the whole body and began to intensify. Now I have: weakness in my arms, hands, fingers, my shoulders are heavy and don’t listen to me well. I practically don’t go outside because I have terrible weakness in my legs, sometimes to the point of trembling. I need qualified help, but I still can’t figure out which doctor. Over the past 5 years, I have lost a lot of weight and lost weight; I have no appetite. I’m scared to go out alone and I can’t. My eyelids did not droop, I swallowed well, but the feces became somehow soft, unformed, and smelled strongly. There are constipation or disorders that alternate, a feeling of bloating, as if inflated from the inside. A feeling of heaviness, slight pressure in the solar plexus area, and I often feel slightly nauseous. I have been to many different doctors, but everyone gives different diagnoses. First they diagnosed multiple sclerosis, then myopathy, later myasthenia gravis, lumbar ischialgia, and osteochondrosis. Other doctors talk about irritable bowel syndrome, the presence of worms, bulbitis, gastrodenitis, pancreatitis, reflux. I went to all the doctors, went through all the examinations 2-3 times. But they still can’t diagnose me. No treatment helps. Plasmapheresis, hormones, a bunch of injections, pills, manual therapy, acupuncture, homeopathy. Zero reaction. The latest diagnosis is myopathic-myasthenic syndrome. Every doctor finds something, and I start another useless treatment. I even saw an oncologist, but the doctor, after listening to me, told me to go to a psychiatrist because I was depressed. But I don’t feel apathy and I don’t have tearfulness, I can laugh normally. It seemed to me that he just wanted to get rid of me. However, my condition is getting worse every time and I am very scared that nothing helps. Can I do some more tests? No one in our family had anything like this. As a child, I was bitten by a tick, but the doctors did a test and said it wasn’t the cause. What tests can be done, where to go? I have a child, I want to live!

Signs, manifestations, symptoms of depression

Signs of the disease can be divided into four groups.

emotional disturbances: decreased mood, lack of ability to worry,
disturbances of mental functions: slowing down of the pace of thinking, impaired attention,
a feeling of insignificance, uselessness, ideas of self-blame, gloomy and negative thoughts about the meaninglessness of life, a pessimistic interpretation of the past, present and future, which can lead to suicidal attempts;
decreased motor activity and behavioral disturbances: decreased performance, passivity, refusal to communicate, reclusiveness;
physiological manifestations: eating disorders (usually loss of appetite), intestinal dysfunction, constipation, loss of libido;

Therapy problems

The main problem in the treatment of masked depression is the lack of competent and complete diagnosis. Carrying out differential diagnosis at a medical consultation in the case of non-typical or not clear symptoms should be the rule. In most cases, patients do not receive adequate treatment for masked depression because the doctor cannot find the true cause of the person's complaints.

This is due to the fact that the patient does not feel or complain about psychological or mental problems. Many specialists cling to minor physiological changes, considering them the cause of complaints. Doctors often forget or do not want to admit that in every case of visiting a doctor there is a high degree of probability of the psychogenic origin of the patient’s complaints. Therefore, most people do not receive the necessary treatment for masked depression.

Many doctors do not refer patients for consultation with a psychotherapist or psychiatrist for a more detailed diagnosis. However, people themselves, when they are advised to consult a specialist in higher nervous activity, perceive the advice negatively. Very often, not understanding the problem, not feeling complaints about impaired nervous activity, they are biased towards such recommendations.

Treatment of masked depression in the clinic

Treatment of masked depression in our clinic is always tailored individually and complex therapy is recommended. We are very careful in choosing drug therapy. Unfortunately, without the use of drugs, therapy will not be sufficient or effective. However, without a specially selected psychotherapeutic program, the result in the treatment of masked depression will not be complete and will not last as long. Therefore, we recommend using both drug therapy and psychotherapy in adequate combination.

In addition, we always associate the treatment of masked depression with somatic manifestations. We take into account the opinion of doctors of related specializations, for example: a therapist, a gastroenterologist, a cardiologist, etc.. With prolonged courses of the disease and attempts at all kinds of “treatment,” completely obvious somatic changes in the body can be observed. This often requires the inclusion of correctors and additional medications to alleviate the person’s general condition.

Our methods of treating masked depression are radically different from standard and generally accepted technologies. Our experience in the treatment of disorders of higher nervous activity shows that for most people in modern conditions, different solutions and approaches are required. We have created unique techniques that have become significantly more effective in the fight against nervous system disorders.

By combining the methods of rehabilitation medicine, neurology, therapy, psychotherapy and psychiatry, we were able to achieve a significant improvement in the quality of the treatment process and the treatment of masked depression became more effective.

How to treat hidden depression

It has been proven that the pathogenetic basis of depression is a disturbance in the metabolism of serotonin, dopamine and norepinephrine, therefore an individually selected antidepressant in an adequate dosage is the basic therapy for latent depression, which can be superimposed on psychotherapy: cognitive, behavioral (behavioral), psychodynamic, etc.

Competent psychotherapy changes the way of thinking in a positive direction, helps to identify true psychotrauma, and removes negative behavioral symptoms such as avoidance of entertainment, a monotonous lifestyle, and the desire for excessive solitude.

Possible complications

If you do not pay attention to the treatment of masked depression, it begins to grow, causing the manifestation of new somatic symptoms, and becomes more complicated. Scientific evidence shows that if masked depression is left untreated or not treated correctly, it is associated with an increased risk of developing early-onset dementia.

Often masked depression can cause the development of addiction (drugs, alcohol, smoking cigarettes, strong tea and coffee, food, etc.). For example, it is not uncommon to hear: “I just need a drink to relax a little. Yes, well, today one glass does not help, because... the tension is very high. I need a little more. It's OK".

When depression is masked, it becomes difficult for others and the person themselves to understand and acknowledge what is going on behind these surface manifestations.

How does masked depression manifest itself?

Changes in weight, sleep or appetite problems. These signs can be confusing because, depending on the individual, they can take very different, sometimes bizarre, forms. Some want to sleep all the time, while others may experience insomnia.
Physical symptoms that do not go away. Fatigue, headaches, back pain, digestive disorders, chronic pain, menstrual problems, potency problems, sexual disorders.
Feeling of anxiety.
Increased excitability, irritability.
Forgetfulness or difficulty concentrating.
Pessimistic outlook on life.
Feelings of guilt or helplessness.
General apathy and lack of interest or pleasure in one's activities.
The emergence of thoughts of suicide.
Compulsive (uncontrollable by reason or will) purchases and actions.
Increased alcohol consumption.
Eating disorders.
Hyperactivity, absorption in work.

Russian Academy of Medical Sciences RESEARCH CENTER FOR MENTAL HEALTH DEPRESSION (from hope to confidence). (INFORMATION FOR PATIENTS AND THEIR FAMILIES)

MOSCOW 2008

Oleychik I.V. — Candidate of Medical Sciences, Leading Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States © 2008, Oleychik I.V. © 2008, NCPZ RAMS The vast experience accumulated by humanity and reflected in many literary works convincingly shows that sadness (sadness, blues) has always walked side by side with people, being one of the natural human emotions. None of us are immune from failure, illness, breakup, loss of loved ones, or financial collapse. Every person can face something inevitable and inevitable, when it seems that life loses its meaning and despair becomes limitless. However, normally, sadness, melancholy and melancholy, as natural reactions to events traumatic to the psyche, weaken over time and the person’s condition normalizes without special treatment. The situation is different with depression, which is a mental disorder that differs from natural physiological reactions in its greater intensity, special severity of experiences and persistence of manifestations. True depression rarely goes away on its own, requiring persistent, sometimes long-term treatment. Depressive state (from the Latin word depressio - suppression, oppression) is a disease that concerns not only the individual specific sick person, but is also a significant burden of modern society, since it is spreading more and more widely in the world, causing enormous damage to the health of the population and the state. economy. Moreover, this applies to all countries, regardless of their level of social development. Every year, at least 200 million people worldwide suffer from depression. It is possible that these rates are even higher because most victims of depression do not seek help because they do not realize the severity of their condition. Scientists have calculated that almost every fifth person who has reached adulthood experiences at least one episode of depression during their lifetime. In the most general sense, a depressive state is one of the possible forms of a person’s response to the influence of stress factors. In some cases, depression can be triggered by external negative influences, for example, mental trauma, excessive educational or work overload, infection or other serious somatic illness, traumatic brain injury, changes in hormonal levels, which is especially important for the female body, regular taking certain medications, such as hormones, blood pressure lowering drugs, or abusing alcohol or other drugs. In other cases, depressive states develop as a manifestation of mental illnesses in which the main influence is heredity or characteristics of the nervous system (cyclothymia, dysthymia, manic-depressive psychosis, schizophrenia, etc.). If, based on the description of depressive symptoms contained later in our brochure, you realize that you have indeed developed a depressive state, do not fall into despair, do not “try to pull yourself together”, remember that depression is not a manifestation of weakness of will or character, on the contrary, weakening of volitional qualities is one of the main symptoms of depression. Depression is the same disease as rheumatism, arthritis or hypertension; it responds well to treatment, resulting in complete recovery almost always. You should not blame yourself for the occurrence of depression; it does not indicate either your guilt, or your weakness, or the possible development of a more severe mental pathology. Below we will tell you about the symptoms of depression, which can be extremely varied.

Manifestations of depression

Manifestations of depression can be very different. Depressive states can manifest themselves as disturbances in almost all aspects of mental life: mood, memory, will, activity, which is expressed in the appearance of sadness, sadness, mental and muscular retardation, lasting at least 2 weeks. A depressed mood during depression can manifest itself as mild sadness, melancholy, or boundless despair. It is often accompanied by a feeling of melancholy, unbearable heaviness in the soul, with excruciating pain in the chest, a feeling of hopelessness, deep depression, hopelessness, helplessness, despair and uncertainty. At the same time, the patient is completely immersed in his gloomy experiences, and external events, even the most joyful ones, do not affect him, do not affect his mood, and sometimes even worsen the latter. A constant “companion” of a depressive mood is also anxiety of varying severity: from mild anxiety or tension to frantic excitement and violence. Anxiety and bad mood arise at the mere thought of having to make a decision or change your plans due to suddenly changed circumstances. Anxiety can also manifest itself at the physical (bodily) level in the form of belching, intestinal spasms, loose stools, frequent urination, shortness of breath, palpitations, headaches, increased sweating, etc. The picture of depression is complemented by the disappearance of desires, interests, pessimistic high assessment of everything around him, ideas of his own low value and self-blame. A deficiency of vital impulses manifests itself in patients with a variety of symptoms - from lethargy, physical weakness to a state of weakness, loss of energy and complete impotence. Where an important decision is required, a choice between various options, human activity is greatly hampered. Those suffering from depression are well aware of this: they complain that insignificant everyday tasks, small issues that were previously resolved almost automatically, take on the meaning of complex, painful, insoluble problems. At the same time, a person feels that he has begun to think, act and speak slowly, notes suppression of drives (including food and sexual instincts), suppression or loss of the instinct of self-preservation and the absence of the ability to enjoy life, up to complete indifference to what he previously liked , evoked positive emotions. People suffering from depression often feel “stupid,” “mentally retarded,” or “weak-minded.” Thinking during depression becomes viscous, painful, requires special efforts, one mental image is hardly replaced by the next. The sick person is oppressed by a feeling of his own intellectual inadequacy and professional collapse. Depressed patients have difficulty describing their painful experiences to the doctor. Only after recovering from depression, many of them say that their mood at that moment was low, their thinking was slow, all their undertakings (including treatment) seemed in vain, and the years they had lived were empty and useless. However, at the time of the first visit to the doctor, they could not explain this due to the almost complete absence of thoughts in their heads, “paralysis of thinking.” With depression, there are also often complaints of memory loss, which is why those suffering from it assume that they have “Alzheimer’s disease,” “schizophrenia,” or “senile dementia,” which is not true. These complaints are especially common in depression that develops in adolescence. A typical story Alexey, 18 years old, a 1st year student at a technical university, describes his condition during depression: “Since childhood, I was interested in technology and modeling, could read specialized literature for hours, won school and regional olympiads in mathematics and physics. After finishing school, my dream came true - I passed the exams to a prestigious university with flying colors. Then it seemed to me that the whole world was at my feet, I was flying with happiness “as if on wings.” In September I happily started studying. At the beginning, everything worked out well, but after 2 months I began to notice that it was becoming more and more difficult for me to assimilate what I read, I could not remember the simplest text, and could not solve problems that I had previously “clicked like nuts.” Trying to achieve success by brainstorming for hours or drinking several cups of coffee led to the fact that I completely stopped thinking about anything. It seemed to me that I had “completely and irreversibly become stupefied.” At night I cried, wrapped in a blanket and thought about how best to commit suicide. Fortunately, I met a senior student in the library and shared my problems with him. My new friend said that he had experienced something similar and advised me to contact a psychiatrist at the student clinic. After an examination, I was diagnosed with “adolescent depression” and was sent for treatment to a specialized medical center. After 2 months, I felt completely healthy, returned to my studies and caught up with my classmates.” Depression can also be accompanied by real failures: for example, a decrease in academic performance, quality of work, family conflicts, sexual dysfunction and their consequences for personal relationships. As a rule, the significance of these failures is exaggerated and as a result, a false sense of the irreparability of what happened, the “collapse of all hopes” arises. Another generally recognized danger of depression is the possibility of suicidal thoughts, which often lead to suicide attempts. The condition of a person suffering from depression can suddenly deteriorate sharply, which occurs either without clear external reasons, or under the influence of traumatic situations or unpleasant news. It is in these hours, and sometimes even minutes, that a fatal decision is made. Factors that increase the risk of suicide in depression are past suicide attempts, the severity and duration of the depressive state, the presence of anxiety in its structure, prolonged insomnia, loneliness or alienation in the family, alcohol and drug abuse, job loss and sudden changes in lifestyle, as well as suicides among relatives. Typical story Evgeniy E., 35 years old, leading manager of the company. Almost all my life my career was on an upward trajectory; my goals were clear, clear and achievable. The marriage was extremely harmonious, two beloved children grew up. He devoted almost all his time to the affairs of the company, occasionally, once every 1-2 months, he escaped with his family out of town, to the dacha. He often didn’t get enough sleep, stayed late at work, took assignments home, and was deeply worried about the company’s affairs. Gradually, irritability, fatigue, insomnia, difficulty concentrating appeared, and more and more often he suffered a “fiasco” in his intimate life. Thoughts arose that life had been lived in vain, that it was a “chain of tragic mistakes” that led to a dead end. I began to believe that the choice of work, friends, family was wrong, for which now “there is a reckoning.” Analyzing the past years for a long time, I found more and more evidence and examples of my “duplicity, hypocrisy, insincerity, etc.” I realized that the only way to solve all problems is to voluntarily die. At the same time, he believed that by this act he would free his family from the “burden”, “loser”, “loser”. I decided to lock myself in the garage and poison myself with car exhaust fumes. However, by chance, in a semi-conscious state, he was discovered by an employee of a garage cooperative. He explained what happened as an “accident.” The thought of dying did not leave the patient. I decided to shoot myself with a gas pistol, which I had long ago acquired for self-defense. After being shot in the mouth, he was taken to the Research Institute named after him in serious condition. Sklifasovsky, from where he was discharged a week later. The alarmed wife, suspecting something was wrong, decided to consult her husband with a psychiatrist. He was admitted to the clinic. He agreed to this only out of respect for family relationships; he himself believed that treatment by psychiatrists was completely useless, because... his situation is hopeless and no medicine will help here, but will only “stupefy” his psyche. However, after two weeks of taking a modern antidepressant, the patient’s point of view changed. Everything began to look not so bleak and unpromising, interest in work and in life in general returned, I began to feel more cheerful, more energetic, and an interest in intimate life appeared. I took work to the clinic and called up my colleagues. After two months of treatment, he completely returned to his normal life. I recalled with bewilderment my thoughts about failure, the collapse of life, and suicide. I took the drug prophylactically for about six months, then, on the doctor’s recommendation, I gradually reduced the dose and stopped taking it. Over the next two years, her condition remained stable, career growth continued, and another child was born. Depression is also characterized by sleep disturbances, which occur in approximately 80% of patients. As a rule, these are early awakenings with the inability to fall asleep, lack of feeling of sleep, difficulty falling asleep. These disorders, as well as restless sleep with unpleasant dreams, are often the very first symptoms of incipient depression. If the depression is not deep, it is sometimes difficult to recognize it. This is due to the fact that people are ashamed to tell others about their problems and admit their “weaknesses.” Quite often, especially in Russia, depressive states are masked by alcohol abuse (“vodka cures”). In addition, often patients suffering from depression, in order to “shake themselves up”, “throw themselves into all kinds of troubles”, engage in casual sex, get involved in gambling or extreme sports, go to serve under contract in “hot spots”, lead an idle lifestyle with constant attendance at entertainment events. People around them, relatives who do not have psychiatric knowledge, often accuse them of debauchery, drunkenness, riotous lifestyle, and parasitism. Meanwhile, this behavior is a kind of “cry for help,” an attempt to fill the spiritual emptiness brought by depression with new acquaintances and impressions. Depressive states can occur in mild forms that are easily treatable, but at least a third of depressions are more severe. Such depressions are characterized by: - ideas of guilt, sometimes reaching the level of delirium, i.e. unshakable conviction in their sinfulness, low value (patients consider themselves great sinners, believe that because of them all relatives and Humanity will die, that they are “moral monsters” from birth, allegedly deprived of the foundations of morality and a sense of empathy for other people that they have no place on earth. They find in their past numerous “confirmations" of the above, they believe that the doctor and other patients are aware of these sins and express contempt and indignation with their facial expressions and gestures, but in words, “they are hiding, denying the obvious.” This must be remembered both by the patients themselves and their loved ones in order to prevent the impending threat in time: remove all firearms, piercing and cutting objects, ropes, strong medicines and poisonous substances. household liquids, close windows or shutters, do not let the patient go anywhere alone.If these ideas become persistent and cannot be dissuaded, you must urgently seek advice from a psychoneurological institution or call a psychiatrist at home. - mood swings during the day: in typical cases, the patient, upon waking up, immediately feels melancholy. Sometimes, even before he fully awakens, through his sleep he experiences a painful premonition of the difficult coming morning. In the evening, my health improves somewhat. - the patient may experience a feeling of unmotivated hostility towards loved ones, friends, constant internal dissatisfaction and irritation, which makes him unbearable for the family. - for a number of people suffering from depression, constant doubts, fear for the health and well-being of loved ones, obsessive, i.e. come to the fore. ideas about the misfortunes and troubles of family members that arise against one’s will. A typical story: Dmitry Petrovich, 58 years old, teacher. “After minor troubles at work, I began to feel strange anxiety and agitation. Unpleasant thoughts came into my head that I had done something wrong at work, which is why I double-checked everything many times and went home later than everyone else. But even at home, the anxiety did not go away: as soon as a daughter or wife lingered for even half an hour, terrible pictures of road accidents or violence were drawn in the imagination. I fell asleep only in the morning, got up exhausted and felt drowsy all day. I took valerian and corvalol, but it practically didn’t help. At work they hinted if I should take a vacation. Friends advised me to see a neurologist, but he did not find his pathology and referred me to a psychiatrist. I was diagnosed with anxiety depression. After a course of outpatient treatment, I completely came to my senses.” — in many cases, depression is characterized by unpleasant sensations in the body, disturbances in the activity of internal organs in the absence of objective signs of true somatic, i.e. non-mental illness. At the same time, many patients constantly note pain and internal discomfort. Some complain of headaches, pain in the stomach, joints, and lower back, others complain of intestinal disorders: constipation, indigestion, irritation of the colon, while others pay attention to a decrease in libido and potency. Women often experience painful and irregular periods. Approximately 50% of people suffering from depression complain of such physical ailments when visiting a doctor, without mentioning the depressed mood or state of mind that underlies the depression. Experiencing chronic pain or other unpleasant sensations in the body, patients may not realize that they are suffering from depression, even with severe melancholy, considering the latter a reaction to painful bodily discomfort. — some patients are convinced that they have some rare and difficult to diagnose disease and insist on numerous examinations in general medical institutions. Doctors call this condition masked (hidden) depression, in which a person may experience pain in the head, limbs, chest, abdomen and any other parts of the body, he may be haunted by anxiety, he may suffer from insomnia or, on the contrary, sleeping too much. - Patients may experience disturbances in the cardiovascular system, itchy skin or lack of appetite. And all these are manifestations of depression. - the pathological sensations that patients experience with such depression are quite real, painful, but they are a consequence of a special mental state, and not an internal disease. It must be remembered that the frequency of latent depression exceeds the number of overt ones many times. - with such depression, patients, as a rule, have a changed attitude towards food: they can go without food for a long time and not feel hungry, and when they sit down at the table, they eat only 1-2 spoons - they have neither the strength nor the desire for more . — a sign of depression can be a weight loss of more than 5 kg. within a month. In some people, especially women, appetite during depression, on the contrary, increases, sometimes reaching the level of painful hunger, accompanied by severe weakness and pain in the epigastric region. In some cases, food is taken in excess due to an increased desire for sweets or attempts to distract oneself from painful thoughts by eating frequently. Thus, we see that depression is a disease with many different manifestations that do not go away on their own, requiring special, sometimes long-term, medical intervention. Therefore, if the symptoms described above appear, you must seek help from a psychiatrist who will prescribe and monitor antidepressant treatment.

TREATMENT OF DEPRESSIVE DISORDERS

By now we can say: the vast majority of cases of depression respond well to treatment. According to modern views, effective treatment of depression consists of a combination of pharmacotherapy, psychotherapy and, if necessary, other types of treatment. At the same time, the main role in therapy, of course, belongs to antidepressants - drugs specially designed for the treatment of various types of depression. The creation of antidepressants is based on the discovery of scientists that depression develops as a result of a disruption in the mechanism of biochemical transmission of nerve impulses in parts of the brain responsible for mood, behavior, response to stress, sleep and wakefulness, appetite and some other functions. To ensure coordination of the work of all these functional units, the brain sends special “commands” to them in the form of chemical impulses transmitted from the processes of one nerve cell (neuron) to the processes of another. This transmission is carried out with the help of chemical intermediaries (neurotransmitters), which, having transmitted the signal, partially return to the original neuron. This process is called transmitter reuptake. Thanks to it, the number of transmitters in the microscopic space between the processes of neurons (in the so-called synaptic cleft) decreases, which means that the necessary signals are transmitted worse. As numerous studies have shown, mediators of different structures, in particular norepinephrine and serotonin, are involved in the transmission of signals that ensure the normal functioning of the nervous system. The first of them has a general activating effect, maintains the level of wakefulness of the body and takes part in the formation of adaptive reactions, and the second has a main antidepressant effect, controls impulsive actions, anxiety, aggressiveness, sexual behavior, falling asleep, feeling of pain, which is why it is called serotonin sometimes a “good mood” regulator. A decrease in the amount of transmitters in the synaptic cleft causes symptoms of depression; an increase, on the contrary, prevents their appearance. The ability of some drugs to increase the concentration of neurotransmitters in the synaptic cleft in one way or another allows them to be used as antidepressants. Nowadays, antidepressants are used in Russia, which can be roughly divided into 4 generations based on the time of their creation. The first antidepressants to find widespread clinical use were drugs with a tricyclic structure: amitriptyline and imipramine. They have a fairly powerful effect on most depressive conditions by blocking the reuptake of both norepinephrine and serotonin. However, the real clinical effect of these drugs is significantly offset by their undesirable side effects, which sharply reduce the quality of life of patients during treatment. Side effects of tricyclic antidepressants arise due to the nonspecificity of their effects on receptor structures. Acting in addition to the serotonin and norepinephrine system and on other neurotransmitters (acetylcholine, histamine, dopamine), these antidepressants cause side effects such as urinary retention, dry mucous membranes, constipation, rapid heartbeat, fluctuations in blood pressure, confusion, tremors, sexual dysfunction functions, weight gain. In such cases, it is necessary to prescribe other drugs to correct side effects or reduce the therapeutic dose of drugs, which naturally affects the effectiveness of the antidepressant effect. It has been observed that up to 50% of patients refuse to take tricyclic antidepressants due to severe side effects. For the same reason, doctors are increasingly less likely to prescribe these drugs to patients on an outpatient basis. The situation was somewhat improved by the introduction into practice of second generation drugs - tetracyclic antidepressants, which, along with the ability to block the reuptake of norepinephrine and serotonin, could also affect some other receptors. Being analogues of tricyclic compounds, these drugs have comparable antidepressant activity, but unlike their predecessors, they are safer because they are much less likely to cause unwanted side effects. In addition to antidepressant, mianserin (lerivon) has a clear sedative, anti-anxiety and hypnotic effect. Maprotiline (Ludiamil) has a mild, balanced antidepressant effect. In general, these drugs can treat mild to moderate depression, but are ineffective in patients with severe depression. Today, third generation antidepressants such as fluoxetine (Prozac), fluvoxamine (fevarin), paroxetine (Paxil), sertraline (Zoloft), citalopram (cipralex) and some other drugs that selectively affect the serotonin metabolism system have received widespread recognition today. , preventing its reuptake in the synaptic cleft. Based on the mechanism of action, these antidepressants are combined into the group of selective serotonin reuptake inhibitors. In addition to treating depression, they are used to correct eating disorders, level out panic disorders, so-called social phobias, various obsessive states and chronic pain symptoms. These drugs have gained popularity due to the possibility of once-daily dosing, the accompanying anti-anxiety effect, the presence of a psychostimulant component and a small number of side effects. In addition, they have little toxicity and are well tolerated by elderly patients. However, some researchers note their lack of effectiveness in the treatment of severe forms of depressive conditions, probably associated with selective activity in relation to only one neurotransmitter - serotonin. It should be noted that in recent years, some American scientists have associated the use of these drugs with an increased risk of suicide, which, however, has not been proven. Considering the high frequency of side effects in some of the above drugs and the insufficient antidepressant activity in others, psychopharmacologists have taken the path of developing more effective antidepressants - fourth generation drugs that selectively block the reuptake of both serotonin and norepinephrine, without affecting other neurotransmitters. system and having minor side effects. Three drugs currently meet these requirements: milnacipran (Ixel), duloxetine (Cymbalta) and venlafaxine (Effexor). Their antidepressant activity in the treatment of patients with severe and moderate depression has been confirmed in a number of specially conducted studies, which have simultaneously shown that these drugs are well tolerated. It should be noted that in mild depressive states, antidepressants of plant origin (negrustin, gelarium hypericum, deprim, etc.) can be effective, but there is no reliable data guaranteeing their effectiveness. The opinion of a number of doctors that all depression can be treated with herbs or, say, acupuncture should be considered unfounded. For extremely severe depression that does not go away despite the use of the most powerful antidepressants, electroconvulsive therapy (ECT) can be effective, but this situation is extremely rare and requires careful justification by a committee of doctors and the consent of the patient. An important additional role in antidepressive therapy, especially with concomitant anxiety, is played by tranquilizers - anti-anxiety drugs, such as Xanax, phenazepam, diazepam, nitrazepam, atarax, etc. Drugs that, when taken systematically, can prevent mood swings in various depressive disorders include so-called mood stabilizers or mood stabilizers - lithium preparations, carbamazepine, valproic acid salts, lamotrigine, topiramate. When taken systematically, in most patients, the clinical manifestations of depression either completely disappear or become rare and mild, not requiring hospitalization and not significantly affecting the ability to work. Antipsychotics play a significant role in the treatment of some forms of depression. These include both traditional drugs - fluanxol, triftazin, eglonil, teralen, neuleptil, sonapax, and atypical antipsychotics that are gaining increasing recognition among doctors: seroquel, solan, zeldox, rispolept, abilify, serdolect and others. In drug therapy for depressive conditions, an unconventional, strictly individual approach is used, with the obligatory provision of fruitful cooperation between the patient and the doctor. Otherwise, there may be a violation of medical recommendations regarding the doses and regimen of taking medications. The patient’s faith in the possibility of recovery, the absence of prejudice against the “harm” caused by psychotropic drugs, and systematic adherence to the doctor’s prescriptions largely contribute to the achievement of therapeutic success. Drug treatment for depression takes time. You should not expect a complete cure in the first days of taking the drug. It must be remembered that all modern antidepressants begin to act on depressive symptoms no earlier than 1-2 weeks after the start of treatment. Cancellation of an antidepressant, as well as its prescription, should only be carried out by a doctor. Cancellation is usually made no earlier than 6 months after normalization of the mental state. Even after all symptoms of depression have completely disappeared, do not rush to stop taking the drug yourself, as there is a risk of exacerbation of the disease. Therefore, doctors recommend continuing to take an antidepressant for a certain period of time. A common mistake is premature discontinuation of medications soon after a significant improvement in the condition or due to “forgetfulness.” To avoid this, try to include taking the drug in the list of daily urgent tasks - for example, store it in the bathroom and take it after performing hygiene procedures. When planning a trip, calculate exactly how many tablets you need for the entire period you are away from home. Disruption of therapy is fraught with serious troubles. Psychotherapy for patients with depressive conditions, carried out along with drug treatment, involves various systems of influence, including individual conversations, family and group therapy, etc. An important element of social rehabilitation is participation in mutual support groups for patients who have suffered from depression. This allows other patients to feel helped in understanding their problems, to realize that they are not alone in their misfortune, and to see opportunities for personal participation in rehabilitation activities and in public life.