Six myths about depression: how to distinguish the disease from the blues and how to escape from it

Severe depression is a mental disorder accompanied by persistent low mood, lethargy, and deterioration of cognitive functions. The disease manifests itself with quite noticeable symptoms. A person experiences a malfunction in the autonomic system, he suffers from insomnia, dizziness, surges in blood pressure and more.

The main danger of severe depression is the appearance of suicidal thoughts and obsessions. The longer they pursue a person, the higher the risk that he will bring them to life.

According to WHO, every second person suffers from a mental disorder at least once in their life. Every year there are more and more such patients. The disease can develop in people of different ages, regardless of their gender.

The ICD 10 revision codes depression as F32. In the international classification of diseases, this pathology is called a “depressive episode.” Its severe form may be accompanied by psychotic symptoms (F32.2) or occur without them (F32.3).

Causes

Severe depression never occurs on its own. Specific causes lead to the disease. Depending on this, the following types of depressive mental disorders are distinguished:

• Psychogenic.
• Endogenous.
• Postpartum.

Each of them will be considered separately.

Causes of psychogenic depression

The main reason for the development of psychogenic depression is the resulting psychological trauma. It can be acute or chronic, namely:

1. Acute psychological trauma. It can be provoked by divorce of spouses, death of a loved one, loss of material assets and similar events.
2. Chronic stress. This reason is more difficult to identify. For a long time, a person may suffer from domestic violence and be dissatisfied with his financial situation. Problems at work, quarrels with colleagues, fellow students, classmates, and rejection of the individual in the team lead to chronic stress. From the outside it may seem that a person has come to terms with these circumstances, but he simply muffles negative emotions. At this time, his neurological reserves are depleted, and severe depression develops.
3. Achieving your goals. Often the cause of depression is dissatisfaction with the result to which a person has been working for a long time. Alternatively, psychogenic disorder may arise from a lack of understanding in which direction to move next when all goals have been achieved.

The longer a person does not receive professional help, the higher the risk of severe consequences. Among them: suicide, alcoholism, drug addiction.

Causes of endogenous depression

An endogenous disorder occurs due to an imbalance of hormones. The disease becomes severe during periods of exacerbation. There are 4 causes of endogenous depression:

• Hereditary predisposition leading to certain characteristics in the production of hormones. If a person has close blood relatives with this disease, the risk of developing severe depression increases.
• Diseases of the endocrine system. A deficiency of serotonin and dopamine leads to a person ceasing to enjoy life.
• Neurological pathologies: neuroses and psychoses.
• The presence of accentuated personal character traits. Hyper-responsibility, increased suspiciousness, and pedantry can cause depression. Any changes in the planned plan, or a discrepancy between expectations and reality can cause severe depression.

Lack of therapy leads to thoughts of suicide. If you do not help the patient in time, depression will end in a suicide attempt.

Causes of postpartum depression

The postpartum form of the disease develops in women after the emergence of a new social role. Mental disorder is aggravated by hormonal changes. The main causes of postpartum depression:

• Hereditary predisposition.
• Hormonal imbalance. An increase in prolactin levels after childbirth, coupled with a decrease in progesterone and thyroid hormones, has a negative impact on a woman’s mental health.
• Irregular daily routine, chronic fatigue.
• The emergence of a new mother status. This places a certain burden of responsibility on the woman.
• Deterioration of relationship with husband.

Severe postpartum depression, if left untreated, leads to persistent delusions and obsessive phobias. A woman may attempt suicide or harm the health of the child.

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.

Symptoms of severe depression

Severe depression can provoke symptoms that are not always correctly interpreted by people around the sick person. Therefore, if you suspect a deterioration in the psychological health of a close relative or friend, you need to focus on the classic triad of signs:

1. A person is always in a low mood.
2. He becomes sluggish and thinks slowly.
3. Motor activity decreases.

If in the past a person was cheerful and cheerful, then due to the developing disease he loses interest in life. He is not interested in household chores, he stops participating in any discussions, and refuses to go to holidays and meetings with colleagues. It is difficult to bring the patient into dialogue; he avoids any conversations. If you still manage to start a conversation, then you can clearly trace a tendency to blame yourself or the people around you for the troubles that happened to you.

Constant conversations about suicide, death or the afterlife should be a reason to contact a psychoanalyst.

Signs of impending severe depression may vary depending on the nature of the illness. Melancholy and hopelessness in the endogenous form of the disease manifests itself in the morning hours. By evening the person begins to feel better. In psychogenic disorder, on the contrary, deterioration occurs in the evening. Many patients indicate that emotional devastation is so strong that they experience it as physical pain.

Patients often develop derealization. It manifests itself in detachment from reality. A person perceives the world around him as fantastic and alien. This leads to refusal to communicate and worsening of the disease.

A severe form of depression can provoke symptoms associated with disruption of the internal organs. In men, potency deteriorates; in women, libido decreases. Lack of sexual desire and problems in intimate life contribute to the progression of the disease.

Other physical manifestations of severe depression include:

• Menstrual dysfunction.
• Lack of appetite.
• Losing weight.
• Insomnia.
• Constipation.
• Cardiopalmus.
• Deterioration of skin condition.
• The appearance of deep wrinkles.
• Brittle nails.
• Hair loss.
• Excessive sweating.
• Headache.
• Dyspnea.
• Retrosternal pain.

Even a person's posture can tell a lot. Patients remain motionless for a long time. They sit or lie like frozen sculptures. The head is always tilted forward, the shoulders are hunched, the elbows rest on the knees. The advanced stage of the disease leads to the fact that a person does not even have the strength to get out of bed. He doesn’t change clothes, doesn’t wash, doesn’t take care of himself. Speech becomes slow. The patient prefers to remain silent and does not answer questions. It is difficult for him to smile and express any emotions other than melancholy.

Psychotic symptoms

Severe depression is accompanied by the emergence of dangerous psychotic symptoms. Among them:

• Hallucinations.
• Panic attacks.
• Delusional ideas and thoughts.
• Severe psychomotor retardation.
• Stupor.

These symptoms are pronounced, causing the person to lose the ability to conduct normal social activities. This condition requires emergency medical attention, as it can have serious consequences.

Psychotic disorders caused by advanced depression often become causes of suicide or lead to health problems such as dehydration or anorexia due to starvation.

Possible consequences

There is no doubt that the worst outcome of a prolonged depressive period is suicide. It is known that about 15% of patients suffering from this disease for a long time attempt to commit suicide; A much larger number thinks about it and plans, but does not dare to follow through.

This is primarily due to the fact that the disease becomes chronic, and this is very exhausting for a person. The patient ceases to believe in the success of treatment for severe depression , and given the lack of strength and apathy, begins to think about the unauthorized cessation of torment.

The risk group includes lonely people, as well as people with a family history of suicide. If the patient is surrounded by many people, then this, paradoxically, can also provoke the person to act rashly: the patient may consider himself a burden or to blame for someone else’s failures.

You should know that serious intentions, in contrast to demonstrative and blackmail attempts to kill oneself, are distinguished by “silence.” As a rule, warning signs may include sudden repayment of debts, a request to forgive for a particular act in the past, as well as gratitude for the help provided to him. The patient may even try to convince others that he is feeling better.

However, much more often a person does not dare to make an attempt on his life. In these cases, prolonged depression can cause damage to the following areas of life:

• Social position, status. A long absence from society can disorient the patient, so it is necessary to help him with adaptation at first.
• Changing worldview. Negativism can become a habit that will prevent the patient from creating connections with people, which will create a vicious circle, since the inability to start a family or make friends can provoke another attack of the disease.
• Prolonged mental stress does not go away without leaving a trace, so people with chronic depression are at high risk of developing other mental pathologies.

In order to understand what to do if you have severe depression, there are a few things you should know. First, the disease can be treated and even the most advanced forms can be kept in remission. Secondly, a person cannot cope alone. The most difficult thing is to convince the patient himself that he needs help. This is especially difficult to do, knowing that in a depressive decline a person has neither the mood, nor the desire, nor the motivation to treat himself.

Diagnostics

If you suspect depression, you should consult a psychiatrist. Identification of the disease begins with collecting anamnesis. Often close relatives of the patient are involved in this process, since his condition does not allow for a high-quality initial survey.

To make a diagnosis, a doctor must identify at least 2 core symptoms of depression and at least 4 additional signs. The detection of at least one psychotic criterion, for example, hallucinations or delusions, becomes the reason for the immediate initiation of treatment in a hospital setting.

To differentiate severe depression and schizophrenia, special psychological studies are carried out, for example, the “Neurophysiological Test System” or “Neurotest”. They are performed by a clinical psychologist. The presence of complaints about poor health is a reason for consultation with a neurologist, endocrinologist, cardiologist or other specialist.

Treatment

Treatment of severe depression is carried out in several stages:

1. The stage of active influence on the body.
2. Maintenance therapy stage.
3. Prevent future episodes of depression.

The presence of suicidal tendencies requires the appointment of anxiolytics (Alprazolam or Phenazepam). Their use is combined with antidepressants, which are selected individually. In the absence of severe clinical manifestations of the disease, the patient can be sent home. However, a specialist is required to monitor his condition daily. Improvement should be expected in 21-28 days.

If there is no effect, then switch to taking tricyclic antidepressants. They can be administered intravenously. In this case, the patient is hospitalized.

After a month of active therapy, the patient’s well-being should improve. This becomes a reason to discontinue anxiolytics. Antidepressants continue to be taken for another 1.5 months.

To cope with psychotic symptoms, antipsychotics are used, including: Quetiapine. Risperidone, Olanzapine and others. They help get rid of hallucinations and delusions.

In addition to antidepressants and tranquilizers, you may need to take hormonal medications. Estrogen and thyroxine preparations help women recover from postpartum depression.

You need to find out what medications the person is taking. It is possible that certain medications will need to be replaced. Some substances can negatively affect the psyche of a patient with depressive syndrome. Particular attention should be paid to women receiving thyroid hormones, as well as older people who, due to their age, take a variety of medications.

Severe depression is not a reason for despair; you can cope with it if you have a clear understanding of what to do next. The patient will not be able to fully resist the disorder on his own; he will definitely need the support of loved ones. They are the ones who should take him to a specialist for an appointment. It doesn’t matter who needs help: a teenager or an adult.

Types of psychotherapeutic assistance

To cope with depression, they resort to various methods of psychotherapeutic assistance. The following areas of therapy have a good effect:

• Hypnosis.
• Gestalt therapy.
• Neurolinguistic programming techniques.
• Art therapy.
• Game treatment.
• Zootherapy.

A clinical psychologist can recommend specially selected books for reading.

Supportive treatments

When a person begins to recover from depression, he will need social support. Friends and close relatives should lend a helping hand. It is possible that the psychologist will suggest attending a specially organized group where the patient will meet people who have similar problems. Group psychotherapy sessions teach people how to express their emotions correctly. A person stops hiding thoughts that bother him. This promotes a speedy recovery.

You should not count on instant results. In the treatment of severe depression, one of the effective medicines is time. The recovery process may be accompanied by relapses and remissions. The duration of therapy is determined by the severity of the disease.

It’s good if after severe symptoms are relieved you have the opportunity to travel. Meeting people, expanding your social circle, positive emotions from a change of environment - all this will benefit a person with a depressive personality type.

Sometimes psychologists recommend having a pet. This method is especially relevant for lonely people with a limited circle of friends. Caring for animals adds worries, makes you forget about anxious thoughts, and realize your own importance.

Physiotherapy

Physiotherapeutic treatment is a prerequisite for the successful restoration of mental functions. Methods are selected on an individual basis. The most effective procedures are:

• Therapeutic and physical training complexes.
• Acupuncture.
• Aromatherapy.
• Light therapy.
• Hirudotherapy.
• Treatment with mud.

Water treatments help cope with anxiety. Therefore, it is useful to visit the pool, go to seaside resorts, and do water aerobics.

Symptoms and danger of suicide

Severe depression is a mental disorder that is found to be caused by a number of factors that affect a person's condition. Regardless of social status and financial situation, gender and age, the majority of potential clients of psychological specialists are susceptible to the disease.

Loss of pleasure from life, a decrease in the energy field, a decrease in activity up to apathy towards everything - this is severe depression, the symptoms of which are ambiguous. Delusional ideas of self-deprecation, which do not always arise according to the logic of guilt, and suicidal tendencies are the accompanying consequences of this condition.

The instinct of self-preservation is suppressed, and unbearable mental pain provokes suicide. It is recommended that if you have such thoughts, you immediately contact specialists and expect that psychologists will determine the reasons based on the client’s symptoms. Suicide does not appear in the first stages of the disease; severe depression develops, according to statistics, after about five years.

Dangerous feelings include:

• the desire to punish oneself for the slightest offenses;
• search for guilt;
• delusional belief about the meaninglessness of existence;
• hallucinations and sleepwalking;
• the desire not to burden relatives with your own presence in their lives;
• increased sense of responsibility;
• exhausting negative thoughts in the head.

Often the client’s physical weakness saves him from suicide, but it is pointless to count on it. Qualified help guarantees improvement in the shortest period of time if severe depression is prevented in the early stages. Often, developing a suicide plan calms a person in this difficult state for years.

It is important to support lonely people, who, according to statistics, are much more likely to commit suicide. Therefore, specialist recommendations should be extended to a wide range of potential clients. Premenstrual syndrome in women and the anniversary of a tragic event must be accompanied by additional attention to a person predisposed to suicide.

Severe depression - what to do? You should immediately contact specialists practicing mental and psychological care. Most often, a deep depressive state develops during the endogenous and bipolar phase of the client’s condition. At this stage, the person’s support and accompaniment to a specialist in the very first months of appointments is required for a quick way out of depression.

Prevention

To prevent the development of severe depression, you should follow these recommendations:

• Exercise. Regular physical activity helps treat depression no worse than medications. During exercise, the body produces joy hormones, which are responsible for a good mood (endorphins, serotonin).
• Be outdoors more often. A half-hour walk is enough to improve your well-being. Meetings with familiar people and casual conversations help to unwind and forget about dark thoughts.
• Eat properly. Priority should be given to products that are sources of complex carbohydrates.
• Allocate at least 8 hours of sleep. Getting adequate rest helps you feel energized throughout the day.
• Avoid stress. You need to analyze exactly what factors can provoke deep emotional stress, and try to exclude them from your life.
• Expand your social circle. It should include people who do not cause negative emotions.
• Plan your future. You need to set goals and strive to achieve them. They can be varied, from buying a new dress to traveling to another country. The main thing is that a person wants to achieve them.

The listed tips should be taken into account not only by those people who have never experienced depression, but also by those who have already coped with an episode of the disease.

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).

Forecast

It is difficult to make an unambiguous prognosis for patients with severe depression. Neurotic disorders often acquire a protracted course. The disease becomes chronic. However, the correct selection of drugs and an integrated approach to treatment can achieve good results.

It is impossible to completely exclude the possibility of relapse. Therefore, family and friends should pay special attention to a person who once suffered an episode of severe depression.