Depression is a disease known since ancient times. People suffering from it have always had a hard time living - not only because of their own melancholy, but also because of society’s attitude towards the problem: if before the patient was suspected of being possessed by the devil, in our times depression is often considered a manifestation of laziness and weakness. Scientists, fortunately, think differently and, moreover, successfully treat this disease. T&P explain how real depression differs from the usual blues and what to do if someone close to you suffers from it.
Poor people
“Depression” is a relatively new term, it appeared only in the 19th century. However, the disease itself has existed for more than the first millennium. It is mentioned in ancient texts from Mesopotamia, Babylon, Egypt and China. In those days, the cause of depression (as well as other mental disorders) was considered to be human possession by demons. The treatment, accordingly, was exorcism sessions: the patients were beaten, tied up, and starved.
In Ancient Greece during the time of Hippocrates, healers, following the legendary doctor himself, were sure that melancholy (as depression was previously called) was caused by an excess of “black bile” - one of the main body fluids. To treat this condition, Hippocrates recommended the use of bloodletting, baths, exercise and diet.
The next important step forward was taken during the time of Plato: philosophers of that time came to the conclusion that the cause of mental illness could be childhood experiences and problems in the family. However, it was not possible to advance further than this idea in those days - after another half a millennium, the dark ages came, which did not promise anything good for the mentally ill.
St. Augustine, who lived at the very beginning of the Dark Ages, stated that despondency and depression are punishment for sins, and the symptoms of severe clinical depression are signs of demonic possession (yes, again). They were treated for “demons” in much the same way as in ancient times - with the help of punishments with which patients were supposed to atone for their sins. But the gradual decrease in the influence of the church by the 17th–18th centuries did not bring anything good to patients with depression: the era of reason and rationalism explained the disease “progressively” - as a lack of self-discipline and indulgence in laziness. However, this does not mean at all that medicine condoned “laziness” - depression was treated with torture, designed to distract patients from their harmful lack of composure.
By the middle of the 19th century, a fashion for hysteria began in Europe - it was explained by many diseases in women, from depression to sexual dysfunction. The popularity of hysteria has led to the emergence of a huge number of different methods of treating it - from hypnosis and water procedures to quite medieval practices such as burning the skin with acid to distract the patient from the disease. In the 20th century, depression began to increasingly appear as a separate diagnosis in medical practice, but even today the attitude towards it is ambivalent - the myth that it is not a disease at all, but a lack of motivation, connivance and laziness, is still alive.
Vadim, 50 years old, car mechanic
Of course, this is a whim. Who suffers from depression? For some reason, they are mostly quite wealthy people, their work is not too hard. Hard workers who work hard at the machine or fell wood don’t suffer from such nonsense. They would feed their family and get a good night's sleep. Our clerks are more likely to suffer from depression because they wash their pants in the office all day long and do nothing. They simply have too much time to really delve into themselves and understand that life has not been a success. What can you think of out of boredom! The second type of depressive is the rich Pinocchio. I have everything: a car, a dacha, and a beautiful wife, but I’m not happy! And why all? Yes, because it’s fashionable now to mope, go to a psychologist, take antidepressants. This fashion came to us from the West, and we immediately picked it up, like any foreign crap.
What is depression
Today it is common to call depression anything, even endless sadness about the absence of your favorite type of tea in a cafe. Doctors, however, have their own opinion on this matter. Depression in its classic form (also called clinical depression or major depressive disorder) has four main symptoms, and none of them are at all similar to what people normally feel when separated from their favorite drink.
1) Decreased mood. This is not just sadness, but a feeling of melancholy and hopelessness that is literally physically felt. If depression is caused by events in the outside world (then it is called reactive), it is basically impossible to escape from depressing thoughts, despite all the cheerful advice from friends “not to get hung up on.” If depression is endogenous (that is, caused not by external factors or other diseases) and there seems to be no reason for sadness, then life simply ceases to be enjoyable entirely, completely.
2) Impaired cognitive function - simply put, problems with thinking. Firstly, thoughts become very slow and clumsy, and secondly, it is noticeably harder to think them than before - they either scatter or get confused, and it is impossible to put them together. And finally, thirdly, thoughts always revolve around one thing. Either around the cause of reactive depression, or, with endogenous depression, around one’s own sins, shortcomings, mistakes, character flaws. One way or another, quite often depressed people come to the conclusion that they are to blame for all their (and sometimes other people’s) troubles, and things won’t get any better, which means life no longer has meaning. This is why depression is such a dangerous risk for suicide.
3) Motor retardation. It becomes as difficult to move as it is to think, even one expression often freezes on the face - according to friends, people with depression seem to age several years at once.
4) Disturbances in the functioning of various body systems. Symptoms of depression also include loss of appetite, insomnia, weight loss (even if there are no problems with appetite), general weakness and constant fatigue, disturbances in the gastrointestinal tract, decreased libido and menstrual irregularities in women.
In addition to clinical, “major” depression, there is also “minor” depression - when the patient has at least two of the listed symptoms, but their number or severity does not reach full clinical depression. It happens that this condition lasts for several years - in this case, the doctor diagnoses “dysthymic depression”. Its cause is often some traumatic event in the past, already half forgotten, but still pressing.
Correctly diagnosing depression is not always easy, because in addition to cases “just like in the textbook,” there are also patients who do not have any characteristic signs of depression at all, for example, there is no depression or sadness. But instead of it (or some other symptom), other disorders are added. Such depressions are called atypical. Simple atypical depressions include those that include grumpiness (the term “grumpy depression” actually exists in medical reference books), anger, a tendency to be ironic, cry, etc. But if, in addition to the characteristic features of depression, the patient also has hallucinations or delusions , doctors talk about complex atypical depression (also called psychotic).
And finally, in addition to unipolar depression, when the patient’s mood is more or less consistently bad or not at all, there is also bipolar disorder (formerly called manic-depressive psychosis), in which periods of depression are replaced by episodes of impressive elation.
Myth #6: “Are you depressed? Go to a hospice and see real suffering."
This myth is a typical example of a moralistic judgment. The suffering of a person with depression can be unbearable. Many patients tell their doctors that they are willing to endure the physical pain rather than the excruciating numbness they experience.
Why are moralistic judgments and advice dangerous for depression? A person already blames himself for everything, exposes himself to condemnation even without demands from the outside.
And then friends and relatives come with the words: “You have a daughter, think about her!” or cheerful calls: “Come on, are you small?”, which do not help, but often contribute to suicide due to feelings of guilt.
Vladimir Lvovich Levi, who once worked with us at the First Medical Institute in the Korsakov Clinic, owns the phrase: “Depression is a state in which it is easier to unload a carload of bricks than to pick up a telephone.” It's hard to answer the phone. Any communication is painful.
And why all?
If we talk about exogenous depression, then the reasons for their occurrence (at least the first-order reasons) include all sorts of traumatic events that happened to the patient, various diseases (primarily neurological, such as epilepsy and dementia, and endocrine, for example, diabetes) , traumatic brain injuries, taking certain medications, lack of sunlight, severe stress.
The situation is more complicated with endogenous, “causeless” depression. There is no clear answer to the question of what goes wrong at the moment when a person becomes depressed. But there are hypotheses about this. The leading theory today is the monoamine theory. According to it, depression begins due to a deficiency in the body of two substances - serotonin and (or) norepinephrine (they are precisely monoamines). The first of them, among other things, is responsible for the feeling of joy, the second is called the “mediator of wakefulness”; it is actively produced during stressful reactions and in situations where it is necessary to gather oneself and act.
The problem may be not only in the actual lack of these substances, but also in disturbances in their transmission from neuron to neuron. The development of Prozac and some other popular antidepressants is based precisely on this theory - their work comes down to increasing the amount of monoamines or correcting problems with their transmission. However, not everything is smooth here. Critics of the monoamine theory say that if depression depended only on serotonin levels, then antidepressants would help immediately after taking them, and not after a month of treatment, as is actually the case. In addition, research suggests that when serotonin levels decrease, not everyone develops depression. From these premises a separate “stress theory” grew. According to her, the effect of antidepressants is not due to their influence on the level of serotonin in the body, but to the stimulation of neurogenesis - the birth of new nerve cells. These processes in certain areas of the brain continue throughout life, and stress can disrupt them. A couple of weeks of taking antidepressants corrects the situation, and thus depression can be overcome. The “stress theory” today is no longer considered an explanation of the origin of depression, but as a hypothesis about the mechanism of action of some antidepressants, it is taken quite seriously.
Myth No. 5: “People shouldn’t be put on antidepressants, it’s dangerous”
This phrase can often be heard from doctors of other specialties. Not psychiatrists, but, for example, therapists. So, in case of serious depression, the patient must be prescribed antidepressants, otherwise his condition may worsen greatly. Moreover, the course of treatment will take at least six months for the disease to go away. Modern antidepressants, no matter how many people, even doctors, fear and demonize them, are no more dangerous than the medications that therapists use in their practice.
Happy pill
Of course, a conversation about the treatment of depression should begin with a story about antidepressants. They are divided into two large groups - stimulating and sedative. The former are used when symptoms of lethargy and fatigue predominate, the latter - for depression accompanied by anxiety. Choosing the right antidepressant is a complex task, since it is necessary to take into account the type of depression, its severity, the patient's expected response to a particular drug, as well as the potential for the development of mania in patients with bipolar disorder. The wrong choice of drug can result not only in aggravation of the condition, but also in suicide - stimulant antidepressants can give the patient exactly the strength that he lacked to end his hateful life. Actually, this is why it is better not to conduct personal experiments with these drugs.
Patients with depression are often recommended to undergo a course of psychotherapy - however, soul-saving conversations mainly show their effectiveness in reactive depression. They treat endogenous drugs, according to studies, in much the same way as placebos.
In general, the range of remedies recommended for mild forms of depression is quite wide: physical activity, light therapy, acupuncture, hypnosis, meditation, art therapy, etc. Most of these methods have no evidence base at all, but some (including physical activity and light therapy) do. Unfortunately, with severe endogenous depression, all this does not work. However, there is treatment for such cases too.
Electroconvulsive therapy shows the best results (much better than antidepressants, for example). This is not at all a continuation of the centuries-old history of treating depression with torture: the patient is given pain relief and a drug to relax the muscles, after which controlled convulsions are induced using an electric current. As a result, chemical changes occur in the brain that lead to improved mood and well-being. After approximately 5–10 sessions, 90% of patients experience significant improvements (antidepressants help in approximately 60% of cases).
Oleg, 49 years old, bank employee
When I was in college, I had a friend. Now I don’t remember what happened to him, whether it was unhappy love or something else, but he began to experience real depression. He could not get out of bed for days. He just lay silently, turned to the wall, skipped lectures, did not want to communicate with anyone. We were very young then, it seemed to us that he was showing off so much, or trying to attract attention to himself. Like, he likes to play the role of such a knight of a sad image, only he slightly overdoes it with sadness. We laughed at him and tried to prove that his behavior did not seem funny or mysterious to anyone. We scolded him and tried to cheer him up somehow. But he didn't care. He just asked to be left alone.
And over time, we got tired of messing with him. We stopped paying attention to him. It seemed to us then that if we stopped reacting to his “quirks,” sooner or later he would get tired of “fooling around.” So, he wasn't tired of it. He swallowed some pills and wanted to die. Fortunately, he was saved, but he was treated for quite a long time. And that’s when I got really scared and realized that depression is serious. If the ambulance had arrived a little later, the person would have died. And we didn't help at all. They only made things worse for him. It was necessary to sound the alarm, look for a specialist, but due to our youth and stupidity, we simply decided to wait until he came out of the image of a sad clown. But in the case of depression, such a position can lead to real tragedy.
Irina, 39 years old, designer
It seems to me that this is not a disease after all. A person drives himself into this state. After all, if you start to think that everything is bad around you, that there is no money, that the children are not studying well, and that your husband is not paying attention, your mood will inevitably deteriorate. And then the person gets so used to the role of such an unfortunate person, offended by life, that he simply cannot part with this mask. He is more accustomed to suffering than to rejoice. After all, in order to find a reason for a good mood, to please others, you need to work hard.
But reasons for sadness have long been found, and in order to sit with a pouty expression on your face, you don’t need to make any effort. So it is much easier to be a pessimist than to be an optimist. This is probably why it is difficult for people to get rid of depression. It's easier for them with her. They explain their reluctance to make any efforts to make life better by depression. It’s easier to sit and complain about life than to look for a new job, a new man, improve family relationships, and so on. In general, everyone is the creator of their own mood. And if a person likes his depression, no doctor will help him.
