Definition of the disease. Causes of the disease
According to the WHO definition, depression is a common mental illness characterized by persistent despondency and loss of interest in what usually gives pleasure, inability to perform everyday tasks, accompanied by feelings of guilt, and a decrease in self-esteem for 14 or more days. Signs of depression: feeling indecisive, impaired concentration, psychomotor inhibition or agitation, sleep disturbances, changes in appetite and weight.
In psychology, depression (from Lat. depressio-suppression) is defined as an affective state characterized by a negative emotional background, changes in the motivational sphere, cognitive (cognition-related) representations, and general passivity of behavior.
It is important to distinguish depression as a clinically expressed disease from a depressive reaction to a psychologically understandable situation, when each of us experiences a low mood for several minutes or hours due to a subjectively significant event. About 16% of people have experienced depression at least once in their lifetime.
It is noted that women are significantly more likely to be diagnosed with depression, which is probably due to the fact that women are subject to large neuro-endocrine changes. This is due to a number of physiological features of the female body — the menstrual cycle, the postpartum or menopausal period, during which the psychoemotional state can range from normal to clinically defined depression. In addition, women are more likely to be depressed due to their gender, social, and psychological characteristics – for example, it is easier for women to talk about their emotional state.
Men are usually less likely to seek help from a psychiatrist or psychotherapist, as they are hindered by social stereotypes: men should be rational, strong, “real men do not cry”, while depressive states in men are directly related to dependent behaviors (alcoholism, drug addiction, gambling addiction, extreme sports).
Significantly increases the risk of developing depressive disorder in the following cases::
in old age due to the loss of the meaning of life (retirement);
when adult children grow up and leave their parents in a child-centered family (“empty nest” syndrome);
in case of loss of a loved one.
Currently, the biopsychosocial model of depression development is generally accepted, according to which the causes of depression are social, psychological and biological provoking factors.
Social factors leading to depression:
acute and chronic stress (loss, infidelity, divorce, various forms of domestic violence);
job loss or change;
high psycho-emotional loads in professional activity;
political instability in the country.
Psychological causes of depression:
tendency to get stuck in experiences on unfavorable events as a property of temperament;
maladaptive coping strategies for coping with stressful situations.
Biological causes of depression:
endocrinological changes in the body (pregnancy, postpartum period, menopause, hypo – or hyperthyroidism);
asthenization of the body as a result of severe infectious diseases.
Symptoms of depression
How does a person feel about depression:
There is a depressed mood, despondency, melancholy, a feeling of hopelessness, a low mood for a long period.
Increased tiredness and fatigue as a result of habitual or small loads.
Your interest and ability to enjoy things that were previously satisfying decreases.
In addition, signs of depression include:
reduced ability to concentrate;
low self-esteem and self-doubt;
feelings of guilt and self-deprecation;
gloomy and pessimistic vision of the future;
psychomotor retardation or agitation;
changes in appetite and weight.
Repeated thoughts about death and suicide, suicide attempts — a dangerous symptom of depression.
The thinking of a person suffering from depression is characterized by the presence of irrational ideas, cognitive errors:
Excessive self-criticism or unjustified feelings of guilt — thoughts about your own worthlessness, loss of self-confidence, low self-esteem, a tendency to self-blame.
Negative vision of the present — a sense of meaninglessness of existence, malevolence of the surrounding world and people.
Negative vision of the future — the expectation of problems, new shocks, failures and suffering.
Pathogenesis of depression
Based on the available studies, it has been proved that disorders of neurotransmitter activity in neurons of the limbic system of the brain play a key role in the development of depression — the release and interaction with postsynaptic cleft receptors of such mediators as serotonin, norepinephrine, dopamine, acetylcholine, histamine, etc. changes.
What happens in oragnism during depression
Lack of serotonin is manifested in increased irritability, aggression, sleep disorders, appetite, sexual activity, and a decrease in the threshold of pain sensitivity. A decrease in the concentration of norepinephrine in brain neurons leads to a feeling of increased fatigue, impaired attention, apathy, and decreased initiative.
Dopamine deficiency is manifested in impaired motor and mental activity, decreased satisfaction with activities (from food, sex, recreation, communication), loss of interest in learning and learning.
Therefore, the drug approach to treating depression consists in prescribing antidepressants that regulate the release and interaction of neurotransmitters with the receptors of neurons in the limbic system.
Classification and stages of depression development
In the International Classification of Diseases of the 10th revision (ICD-10), depression is classified according to its severity and type of course.
Types of depression by severity:
severe depression without / with psychotic symptoms.
With mild to moderate depression, a person usually remains able to work, although the quality of life decreases. Severe depression is characterized by the presence of typical symptoms of depression: low mood, decreased interest and pleasure from activities, increased fatigue, impaired ability to work, and suicidal tendencies may be present .
By current type:
recurrent depressive disorder;
chronic mood disorder.
Up to 30-35 % of patients have a chronic form of depression, with a duration of depressive disorder of two or more years.
Also in psychiatry, it is customary to distinguish between depression by origin:
endogenous (manic-depressive psychosis) – implies a causeless beginning, a hereditary predisposition to the development of the disease, an alternation of depressive and manic states;
exogenous — develops under the influence of acute or chronic stress factors;
somatogenic — associated with somatic, including organic pathology (past myocardial infarction, stroke, traumatic brain injury, cancer, etc.).
The American DSM-5 classification takes into account the phenomenological features of depressive disorder.
These include depressive symptoms:
with anxiety distress;
with mixed features;
with melancholic features;
with atypical features;
with psychotic traits,
congruent and incongruent moods;
with catatonia (movement disorders);
with seasonal patterns (applies only to recurring episodes).
Seasonal affective disorder is a type of seasonal depression that begins and ends around the same time each year. Most people with this type of disorder develop symptoms in the fall and continue into the winter months, less often in the spring or early summer .
Complications of depression
Worldwide, economic losses are high due to disability and treatment costs for people suffering from depression.
The co-existence of depression with somatic pathology (arterial hypertension, coronary heart disease, bronchial asthma, gastrointestinal diseases, oncology, autoimmune disorders) makes the course of somatic diseases more difficult, while the severity of pain syndrome increases, somatic disorders turn into a chronic form, and as a result, mortality from the underlying disease increases.
What is the danger of depression?
One of the most serious problems is the high probability of suicide in depression (8%). At the same time, up to 60% of the total number of suicides are people suffering from depression.
That is why timely diagnosis and adequate medical care for people suffering from depression is so important.
Diagnosis of depression
A large proportion of depressed patients because of fear of stigma of mental illness and the abundance of physical manifestations (somatic “mask”) – headaches, dizziness, pain or heaviness in the chest, fatigue, digestive disorders, primarily, to seek consultation at the outpatient network of therapists, where for a long time to be screened and ineffective treatment, since it does not receive adequate assistance.
In the United States, where the number of psychiatrists is quite large, 50% of patients with symptoms of depression go to specialists in the primary network, while only 20% go to psychiatrists . In the United Kingdom, the majority of patients with depression are treated by general practitioners, and only 10% go to psychiatrists.
Examination for depression
Timely access to a psychiatrist and psychotherapist helps to establish the correct diagnosis of depression and choose effective treatment.
In the diagnosis of depression, clinical scales are used – the Hamilton depression scale, the Zang scale, the Beck scale, etc., determining the presence and severity of depression and its individual manifestations.
Unfortunately, there are still no accurate laboratory tests and studies that can show exactly which neurotransmitters are unbalanced and have led to the development of depression in a particular patient.
Differential diagnosis of depression
with mood disorders caused by organic brain disorders;
affective disorders in the structure of schizophrenic disorders;
bipolar affective disorder (in addition to depressive phases, mania occurs in the structure of the disease).
Treatment of depression
Depressive disorders of mild severity can respond quite well to psychotherapeutic treatment.
Supportive treatment for depression
Until the condition improves, the doctor sees patients 1-2 times a week. During the appointment, the doctor supports the patient, provides necessary explanations and monitors progress. A meeting in the doctor’s office can be supplemented with a conversation with the patient on the phone. The doctor should explain to the patient that depression is not a particular mood and character, but a serious disease caused by biological disorders and in need of treatment, in which the prognosis is favorable. The doctor should also gently encourage the patient to expand their daily and social activities, such as taking more walks in the fresh air or joining a creative circle. It is important for the doctor to convey to the patient the understanding that the disease is not his fault, that negative thoughts are only part of this condition and they will soon pass .
Drug therapy for depression
For moderate and severe depression, a combination of psychopharmacotherapy (antidepressants) and psychotherapy is more effective.
Today, serotonergic antidepressants and so-called double-acting antidepressants (affecting the metabolism of serotonin and norepinephrine) are widely used, which are used for 3 months or more (the average duration of therapy is 6-12 months).
Taking antidepressants should be done under the supervision of a doctor and, despite long-term use, usually does not lead to dependence, it is well tolerated.
If depression does not respond to treatment, has turned into a chronic form, and is prone to relapse, antidepressant therapy can be supplemented with other psychotropic drugs – tranquilizers, antipsychotics, and anticonvulsants.
In addition to outpatient treatment for mild and moderate depression, severe depression should be treated and monitored in a hospital setting.
Psychotherapy in the treatment of depression
In psychotherapy of depression evidence-based effective and fast is cognitive-behavioral therapy aimed at changing irrational beliefs and depressogenic patterns of behavior of patients, and is widely used psychodynamic psychotherapy (psychoanalytic, existential psychotherapy, Gestalt psychotherapy), focused on a deep study of the experiences and traumatic early experience of the patient, the formation of adaptive functioning in the present .
Electroshock therapy for depression
Electroshock therapy (ECT) is of limited use due to a wide range of contraindications, adverse reactions, and complications. However, in cases of severe depressive disorder and drug resistance, ECT can be used and proves its effectiveness .
Phototherapy for depression
Phototherapy is used in the treatment of seasonal affective disorder in clinics specializing in such therapy. In this case, powerful artificial light sources are used with an irradiation mode of 10,000 lux for 30 minutes twice-in the morning and in the evening.
How to get rid of depression on your own
In the case of a depressive reaction to a stressful situation or with mild depression, you can not consult a doctor, since the manifestations of depression do not lead to maladjustment. It will help a person if they distract themselves from a stressful situation and immerse themselves in work or hobbies. Support from a close circle or a visit to a psychologist can also ease the condition. But if the condition is prolonged, becomes heavier and leads to social maladaptation, then in this case the help of a specialist — a psychiatrist, psychotherapist is necessary.
What to do if a loved one is depressed
From the immediate environment, sincere support, empathy, empathy and an offer to seek the help of a specialist will be important for a person suffering from depression.
A significant proportion of patients do not receive adequate improvement from taking antidepressant therapy, have resistance or poor tolerance to drug treatment. In these cases, non-medicinal methods of biological therapy are an alternative (for example, electro-convulsive therapy is often used abroad for resistant depressions), as well as psychotherapy.
Without adequate treatment, depressive disorder has a high risk of relapse, aggravation of the course, and the appearance of a suicidal mood in the patient.
Prevention of depression are:
reducing stress loads;
normalization of the sleep-wake regime (insomnia is one of the provoking factors of depression);
elimination of alcohol, nicotine abuse, and other addictions;
systematic sports activities (during sports load, endogenous opiates are released in the human body in greater quantities – enkephalins and endorphins, substances that provide a good mood, cheerfulness, and pain reduction);
chat with your friends and family;
engaging in pleasant and interesting activities that create a positive emotional background.