Depressive reactions and depressive neuroses. Reactive depressions

Reactive depression is a disorder that occurs as a specific reaction of the psyche to traumatic events or frequent stressful situations. Psychopathology is quite common, manifested by constant despondency and longing, and is difficult to diagnose, since patients rarely go to a narrow-profile doctor. The disease is dangerous with the risk of complications, therefore, when the first anxiety symptoms should see a psychiatrist.

Reactive depression is more common in women than in men

There are two main types of depression - endogenous and reactive. Endogenous depression develops as a result of any internal malfunctions in the body or psyche. So, the cause can be chronic diseases, endocrine disorders, neuroses and other pathologies. Unlike this type of disorder, reactive depression occurs as a result of external influences on the psyche. Most often, the causes are stress and traumatic events in a person’s life, but not everything is so simple and the causes of reactive depression are not always obvious and can be identified independently.

A few facts about reactive depression:

• 85% of patients with this diagnosis are women of different ages;
• in half of the cases, a depressive disorder is diagnosed 1-2 years after the onset of the first symptoms;
• most patients misinterpret symptoms and seek help from a therapist, although depression is treated by a psychiatrist;
• every year the frequency of reactive depression in patients increases by an average of 1-1.5%.

Pathology can manifest itself at any age. Due to the peculiarities of mental activity, women are more prone to reactive mental disorders than men. Doctors attribute this to the fact that the female psyche can function longer under conditions of constant stress, which leads to exhaustion and the development of depression.

In the ICD-10, this disorder is classified as a depressive episode and is designated by the F32 code.

The main feature of the disease is the patient's obsession with events that traumatize the psyche. So, if the cause of the development of the disease was a tragic event that claimed the life loved one, the patient will constantly return thoughts to this situation, considering it with different sides and analyzing what he could do. The problem is that this way of thinking can eventually become intrusive thoughts or delusional disorder.

The international classification of diseases ICD-10 designates reactive depression with another code - F25.1. This code is used for depressive-type schizoaffective disorder.

Causes of reactive depression

The main reason for the development of this type of depression is a strong emotional experience or a stressful situation that is of personal importance to a person.

The exact causes and mechanism of the development of the disease depends on the form of reactive depression. There are two main types - acute and prolonged reactive depression.

Acute reactive depression is also called short-term depression. It occurs as an instant reaction of the psyche to severe stress or a traumatic event. The cause of this violation is any events that are important for human life. As a rule, the symptoms of acute depression increase rapidly, but the episode lasts no more than 4-5 weeks.

Prolonged reactive depression dangerous pathology the reasons for which are often not obvious. It comes after a long period time after experiencing an event. In other words, a person may be faced with a traumatic situation that will Negative influence on the psyche, but will not cause depression. At the same time, the psyche becomes vulnerable, so any stresses and experiences weaken it. Over time, stressful situations accumulate and depression occurs. The main reason for its development is precisely the psychotrauma that occurred in the past, and stress and other experiences are only aggravating factors.

Another scenario for the development of prolonged depression is multiple minor stresses or life failures. Separately, these events are not considered as psychotraumatic factors. Moreover, a person may dismiss them or not pay due attention. At the same time, constant existence in a state of stress is ordeal for the psyche and nervous system, therefore, over time, leads to the development of reactive depression. On average, episodes of this disorder last from one month to two years.

Risk factors

The loss of a loved one is the most important factor in which reactive depression occurs.

In addition to stress and personal tragedies, reactive depression can be associated with chronic diseases, skull injuries, and disruption of neurotransmitters.

Pathology can be triggered by the action of temporary factors, which include the period of bearing a child, hormonal disruptions in women, the onset of menopause. As a risk factor, a feature of the personality psychotype is considered, as well as genetic predisposition.

The risk of developing reactive depression depends on the severity of stress factors, which is calculated on a special scale developed by psychiatrists specifically for self-diagnosis of patients. This scale takes into account the most common stressful situations, each of them corresponds to the number of points. When assessing the risk of developing depression, events that occurred to a person during last year. If the total score is greater than or equal to 300, the person should apply for qualified help, since such a number of traumatic situations do not pass without a trace and cause mental disorders.

People who are subject to frequent stress are advised to undergo this test regularly. Even if there are no symptoms of depression yet, but the person scored about 250-300 points, it is recommended to consult a psychotherapist or psychiatrist. For example, with the help of psychotherapy, it is possible to restore the psyche and prevent the development of reactive depression.

Symptoms

Psychopathology accompanied by dizziness

Reactive depression is serious condition developing in several stages. First, a shock reaction is observed with the corresponding symptoms, then a depressive affect develops, accompanied by anxiety and dysthymia, followed by apathy, and after - psychomotor retardation and decreased speed of thought. Thus, acute reactive depression begins with a state of psychomotor agitation, then reaches a peak point, after which psychomotor retardation is observed.

In the case of acute reactive depression, about the onset pathological process show the following signs:

• psychomotor agitation;
• feeling of panic, growing anxiety;
• weakness in the muscles of the limbs;
• heart palpitations;
• dizziness;
• hypotension (decrease blood pressure);
• disorientation in space.

These symptoms are much like a panic attack or a panic attack. After some time, these symptoms are replaced by hopeless longing, a sense of hopelessness and futility of all human actions. Next, a person develops despair, a feeling of panic, various phobias suddenly appear. Most often, patients face the fear of death. Acute reactive depression also causes disorders eating behavior, in particular lack of appetite or its sudden increase. If the pathology proceeds with severe anxiety symptoms, there is severe insomnia and chronic fatigue.

Prolonged reactive depression is manifested immediately by depressive symptoms, without previous signs of panic and anxiety. This form of the disorder is characterized by the appearance of typical depressive symptoms:

• yearning;
• tearfulness;
• weakness;
• apathy;
• drowsiness;
• hypochondria;
• asthenic syndrome;
• pathological guilt;
• self-flagellation.

The symptoms of the disorder do not change during the day, which makes it possible to distinguish reactive depression from other types of the disorder, in which the symptoms of the disease decrease in the evening.

Types and features of reactive depression

Depending on the symptoms, there are three forms of reactive depression:

• true;
• anxious;
• hysterical.

True reactive depression is a disorder in which there are predominantly depressive symptoms without signs of anxiety disorder. As a rule, true reactive depression proceeds smoothly, without episodes of deterioration and improvement in the patient's well-being, while lasting no more than 1-3 months.

In anxious reactive depression, the symptoms of an anxiety disorder predominate. In addition to constant melancholy and depressed mood, a person feels increasing anxiety and panic, his phobias become aggravated, and psychomotor agitation is observed. This form of depressive disorder quickly exhausts the psyche and is often accompanied by obsessive thoughts and delusions.

With anxious reactive depression, many need hospital treatment, hospitalization is also indicated in case of suicidal thoughts.

The hysterical form of the disorder is accompanied by hypochondria, tearfulness, and hysterical seizures. As a rule, people who are initially prone to tantrums face this form of pathology.

Why is reactive depression dangerous?

With pathology, without timely treatment, there are problems with sleep

In reactive depression, symptoms and treatment depend on the type of disorder, which only an experienced professional can identify. It is important not to try to treat the pathology on your own, resorting to dubious folk remedies, since a qualified approach allows you to cope with the symptoms in just a few weeks, and inadequate therapy increases the risk of complications.

Psychogenic (reactive) depression can turn into endogenous in the absence of timely treatment. This is due to a malfunction of mood neurotransmitters against the background of exhaustion of the nervous system and mental tension in reactive depression.

Also among the possible complications:

• chronic asthenic syndrome;
• apathy;
• panic attacks;
• anxiety disorder;
• dysthymia;
• sleep disorders.

Asthenic syndrome manifests itself chronic fatigue, lack of physical and mental strength for professional and domestic activities. This violation greatly impairs the quality of human life and is difficult to treat, especially if it becomes chronic.

The general principles of therapy for reactive depression are a combination of drug methods with psychotherapy. Treatment is selected individually for each patient and depends on the characteristics of the course of the disease.

It is important not to try to treat yourself, but to trust a professional, since in case of depression it is necessary to act on its cause, and not just deal with the symptoms. For example, loss of speech in reactive depression can be directly related to the traumatic situation that led to the development of this mental disorder, so treatment should help a person cope with his thoughts and emotional experiences.

Medical treatment

For reactive depression, the doctor prescribes drug therapy eliminating the main symptoms of the disease. For this purpose, tricyclic antidepressants or monoamine oxidase inhibitors are used. If indicated, antidepressants of other groups can be used.

In acute depression, tranquilizers and antipsychotics can additionally be used to cope with stressful effects and reduce the overall emotional tension of the patient.

Additionally, so-called mood stabilizers are used - drugs from the group of mood stabilizers.

Psychotherapy

Psychotherapy in group sessions is good for reactive depression

Quite often, a way out of acute reactive depression can be found with the help of psychotherapy, without resorting to drugs. Such a technique can be used as monotherapy only for true or acute reactive depression, the attacks of which last for a relatively short time.

Practiced treatment methods:

• cognitive-behavioral psychotherapy;
• gestalt therapy;
• art therapy;
• group psychotherapy sessions.

The method is selected individually for each patient. For depression, a course of treatment lasting 3-4 weeks is indicated, no less.

In the case of severe reactive depression, psychotherapy is complemented by drug treatment. How long reactive depression is treated in time depends on the characteristics of the organism and the severity of the symptoms. Generally, drug therapy assigned to a course lasting from 6 months.

Other treatments

The doctor can supplement therapy with the intake of vitamins, physiotherapy, herbal remedies. Vitamins are prescribed in order to speed up the recovery of the nervous system. For this, B vitamins, magnesium preparations, Omega-3-6-9 are recommended. Physiotherapy helps to speed up the healing process - acupuncture, electrosleep, massage, exercise therapy. At home, it is recommended to use aromatherapy.

Traditional medicine is powerless with reactive depression. At home, we can only recommend to adhere to healthy lifestyle life and follow the recommendations of the doctor.

Forecast

With early detection of symptoms and referral to a specialist physician, the prognosis is mostly favorable. This means that one course of treatment is enough to deal with depression. At the same time, some patients may experience relapses of the disease after severe stressful and psychotraumatic situations. In this case, it is recommended to consult a doctor about the appointment. additional drugs or about methods of prevention of exacerbations. Without treatment, the disease can go into a chronic form or the so-called recurrent depressive disorder.

is a severe emotional and psychological state person. This violation occurs in response to various psychotraumatic situations. A characteristic feature of this pathology is a long-term concentration on unpleasant sensations. This state belongs to the category of depressive psychogenic diseases, which are accompanied by psychotic and neurotic reactions, classified as a mood disorder.

Etiology of reactive depression

The primary cause of the development of this pathological condition is the abrupt changes in life that cause a person powerful emotions. Most often, reactive depression develops in traumatic situations, including:

• loss of loved ones;
• divorce;
• lowering social status;
• bankruptcy;
• unexpected illness or injury;
• problems in the sexual sphere;
• sudden job change
• dependence of family members on bad habits;
• conflicts in the family and at work.

At the same time, it is necessary to take into account what may arise against the background of situations that should evoke positive emotions. Such disorders often occur after marriages, receiving long-awaited rewards, promotions, etc.

There are several factors that can contribute to the development of such reactions against the background of positive and negative experiences, in addition, they often aggravate the course. Most often, such disorders occur in people who have constitutional or congenital features of the body.

Acquired factors that contribute to the development of such a pathological condition as reactive depression include chemical dependence, menopause, as well as some chronic infectious diseases. External factors that can create the preconditions for the onset of psychogenic depression include chronic sleep deprivation, a diet with low content nutrients and physical overload. All this leads to physical exhaustion and makes the body more prone to various psychological traumas.

In addition, some personality characteristics may contribute to the emergence similar problem. Often, reactive depressions are diagnosed in people who try to avoid any traumatic situations and abstract from their awareness and problem solving. Among other things, often such violations of the psychological and emotional background are observed in people who deliberately choose and do not want to communicate with other people.

The factors contributing to the aggravation of the course of reactive depression include, first of all, a genetic predisposition to such pathologies. In addition, the violation may occur in more severe forms in people with personality accentuation. It is believed that various food and chemical intoxications aggravate the course of this pathology, hormonal disorders, organic pathologies of the brain and the consequences of traumatic brain injuries.

Symptoms of Reactive Depression

The clinical manifestations of this disorder are extremely diverse. Currently, there are two main forms of reactive depression, depending on the nature of the existing symptomatic manifestations. These include short-term and prolonged depression. Each option has its own flow characteristics and characteristic manifestations. When a patient has short-term reactive depression, symptoms may include:

• state of shock;
• increased sweating;
• sleep disorders;
• loss of appetite;
• tachycardia;
• affective amnesia;
• panic attacks;
• motor retardation;
• anxiety and depressed emotional state.

With this variant of the course, characteristic manifestations persist for no more than 1.5 weeks. After this period, they gradually decline and then completely disappear.

Prolonged psychogenic depression is accompanied by the appearance of symptoms such as:

• tearfulness;
• emotional lability;
• persistent depressed mood;
• decrease in social activity;
• increased fatigue;
• hypochondria;
• obsessive ideas;
• self-accusation.

After a long period, the intensity of symptomatic manifestations may decrease. As a rule, while pathological condition there is a gradual shift discomfort and emotions and switching attention to solving everyday problems and other life situations.

Complications of reactive depression

If the existing psychological tension is not reduced, reactive depression can become a springboard for the development of a number of extremely unfavorable complications. Often in the future, a person develops. In addition, subsequently a person may be tormented by bouts of panic attacks. The depressive process can attach character somatic disorder. The patient may occasionally have suicidal thoughts.

In rare cases, against the background of a condition such as psychogenic depression, melancholia develops. In addition, signs of asthenia may be present for a long period of time. In this case, a person has a significant decrease in physical and mental performance, sleep disturbance, increased irritability and emotional instability. The consequence of such a pathology as psychogenic depression can be dysthymia. This state is characterized by despondency and depression.

Diagnosis of reactive depression

To determine the nature of the problem, the psychiatrist first collects an anamnesis and evaluates the subjective complaints of the patient. The degree of expression is specified clinical picture and the dynamics of the increase in symptoms, their relationship with the traumatic situation. Neurological testing and assessment of depressive disorder according to the Beck scale is performed.

In some cases, visits to other highly specialized specialists. If depression develops against a background of a number of acquired diseases, ultrasound may be required. thyroid gland. Often an electrocardiogram is required. Depending on the indications, an appointment is made biochemical analysis blood and urine. MRI and angiography may be required.

Treatment for reactive depression

In most cases, special therapy for this pathology is not required. At the same time, there are cases when psychogenic depression causes such significant symptomatic manifestations that a person becomes dangerous both for himself and for others. With a short-term reactive depressive reaction, treatment with tranquilizers can be prescribed to reduce the severity of symptomatic manifestations.

Antipsychotics are often used to suppress psychomotor agitation, unreasonable fears and anxiety. Antidepressants and hypnotics are often used to relieve sleep disorders. Psychotherapy is often prescribed to eliminate reactive depression. Working in this area with a specialist allows the patient to rethink and accept the traumatic situation that has taken place in his life.

To get rid of reactive depression faster, patients are advised to devote more time to sleep. Recommended to visit public places, for example, exhibitions or meetings where you can escape from obsessive thoughts. In addition, in order to more quickly eliminate the manifestations of reactive depression, it is desirable to change the situation at least for a while.

Reactive depression (psychogenic depression) refers to a group of protracted depression that occurs after a variety of difficult experiences. These experiences may be associated with the death of loved ones, a severe conflict situation in the family (adultery, divorce), troubles at work, and other reasons.

More often, reactive depression occurs in hysterical people, if they have certain character traits. According to such patients, others should pay more attention to them, that the suffering of other people, in comparison with their experiences, is nothing. Immediately after an accident, the patient usually becomes inhibited, internally indifferent. He has no violent emotional manifestations. The patient "withdraws into himself", becomes silent and withdrawn. The patient has a dreary mood all day. Everything is presented in a gloomy light: past, present, future. Later, a typical and expressive pattern of depressive symptoms develops.

Patients are covered by a pessimistic mood. They are characterized by a critical attitude towards their condition. Often distinctive feature reactive depression is the accusation by the patient of the occurrence of the disease of the people around him.

The patient may sob with groans and wringing of hands, loss of consciousness may occur, a demonstration of suicide attempts appears. Most of the time it's just blackmail. But still, suicide attempts should be given attention. Sometimes the bouts of despair that are characteristic of reactive depression can actually lead to a real desire to end one's life. This is especially often observed in the first weeks of the onset of the disease.

An important role in the emergence and development of reactive states is played by "environmental factors", which weaken the body's resistance to psychotraumatic situations. These factors include: traumatic brain injury, somatic diseases(Alzheimer's disease, cerebral atherosclerosis, traumatic brain injury, etc.), emotional stress, overwork. The development of reactive depression may also be accompanied by pregnancy, the state after childbirth, and age-related crises.

Symptoms of reactive depression:

• Feelings of hopelessness, depression, tearfulness;
• Insomnia or, on the contrary, a person goes to sleep and sleeps for days;
• gastrointestinal disorders;
• Psychosomatic disorders can lead to drug and alcohol abuse;
• Hyperhidrosis and hypertension;
• Hallucinations that reflect the content of the psychotrauma;
• Depression can cause a variety of physical ailments: back and stomach pains, headaches. At the same time, studies do not confirm any physical pathology.

There are two forms of reactive depression:

• open form — in which there are clear signs depressive disorder (lethargy, melancholy mood, etc.);
• dessimulative form - there are no active complaints of melancholy, patients try not to remember the traumatic situation, keep inconspicuously and quietly. Suicidal thoughts and actions in these cases become unexpected for relatives and others.

The prognosis of reactive depressions is favorable. Usually, two to four weeks after the trauma that caused the diagnosis of depression, the symptoms of the disease disappear. The path of recovery alternates with periods of emotional instability, tearfulness, increased mental exhaustion.

But still, in some part of the patients, the course of the disease can take a protracted character. Psychogenic symptoms turn into abnormal personality development with various manifestations of neurosis, neurasthenia and psychosomatic disorders.

Treatment for depression

Reactive depression is sometimes treated more effectively than other types of depression. But it should be remembered that a psychotherapist should treat her. You should be as frank as possible with your doctor, which will help you choose the right course of treatment. Joint work "patient-doctor" will accelerate the exit from a serious condition.

To combat depression, a combination of three types of psychotherapeutic help is used: psychotherapy, psychopharmacology (drug treatment) and social therapy.

Psychotherapy

There are many different psychotherapeutic techniques. All of them are based on attention to the patient, on supporting him at a difficult moment. The advice of a psychologist will teach the patient to properly relate to a traumatic situation, show ways to relieve stress. The attending physician will show how to respond correctly to the appearance of such situations in the future, explain to relatives and friends about the need to help the patient in socio-psychological relations.

Medical treatment

Antidepressants are used to treat reactive psychoses. The choice of the drug, as well as its dosage, depends on the degree of depression and its structure. The most commonly used classic antidepressants: melipramine, amitriptyline, miansan. After the condition improves, the dosage is reduced. With a decrease in the symptoms of depression, the attending physician gradually cancels the use of antidepressants.

Stimulant antidepressants are prescribed for patients with symptoms of lethargy, melancholy and apathy (cypramine, Prozac, Paxil). Antidepressants sedative action prescribed for unaccountable anxiety, increased irritability, with the appearance of suicidal thoughts.

In hysterical states, tranquilizers are used (seduxen, phenazepam). If the patient suffers from insomnia, the doctor may recommend sleeping pills to help regulate sleep.

With strong emotional disorders magnesium metabolism is disturbed. The interaction of calcium with magnesium acts as a tranquilizer, and this relieves psycho-emotional stress. Therefore, the appointment of magnesium preparations is most often mandatory.

In mild cases, various herbal preparations based on St. John's wort, lemon balm, and all kinds of sedative preparations are used.

Helping yourself is very important. Try to cope with the diagnosis of depression yourself.

help yourself

• Sleep more. Sleep is good medicine;
• Don't be alone. If you feel like crying, don't hold back your tears. They will bring relief;
• Have fun and relax. Take a warm bath with foam or medicinal herbs with a calming effect. Go to the theatre, visit beauty salon, walk through the park, forest, shops;
• Postpone making major decisions (job change, divorce, moving) until you get out of a depressive state;
• Go in for sports: visit the pool, sports grounds, do breathing exercises.
• Change the interior and yourself. After all, we are the masters of our mood. It is very important to want to get rid of depression and throw it out of your life.

Close people should support the patient. This will give him a sense of security and confidence. Love, care and attention will help improve general state a patient with reactive depression.

Reactive depression is different in that a person most of his time is focused on the traumatic situation, and from normal reaction grief - by the fact that the experiences of the patient are more vivid, prolonged and excessively intense: a person is deeply immersed in himself, blames himself or others for the situation that has happened, and pays attention to his suffering great amount time. What happened becomes for the consciousness of the patient overvalued idea(idea-fix).

In addition, reactive depression leads to significant impairment psychological functions: somatic and vegetative disorders, behavioral, mood and adaptation disorders. Immediately after the misfortune that has occurred, a person seems to turn to stone, does everything automatically, is constantly silent, does not cry, does not show violent emotional reactions, there is an internal indifference to everything that happens around. And only after a certain amount of time, the true expressive picture of reactive depression is revealed.

The patient has such symptoms as household helplessness, a pessimistic assessment of life, motor and emotional retardation, great weakness, and irritability over trifles, which was not characteristic of him before. Other symptoms: autonomic disorders ( headache, sleep disturbance, dizziness, respiratory failure, etc.), tearfulness, a feeling of hopelessness, hopelessness and depression.

Reactive depression is divided into three types: true depression, anxiety and depression in hysterical personalities. Such a division is somewhat arbitrary, and is largely determined by the characteristics of the human psyche and his attitude to the world around him.

True reactive depression

True reactive depression usually lasts no more than two to three months. If the patient seeks help from specialists in time and receives necessary treatment, then he gradually comes out of a depressive state, and the main symptoms of depression also disappear: emotional instability, inability to have fun, tearfulness, emotional and physical exhaustion. Although flashes of depression and bouts of despair can still be provoked by random associations on early stages treatment.

Anxious reactive depression

Anxious reactive depression manifests itself as follows: the patient begins to imagine that something threatens his work, health or well-being. There are symptoms such as complete immersion in thoughts about the impending disaster, fears, phobias, fearful depression and depression. Asthenovegetative disorders may also appear: sweating, lethargy and weakness. Acute anxiety may be accompanied by increased mobility and activity.

Reactive depression in hysterical individuals

The most common reactive depression among hysterical personalities. Thus, a patient who is prone to hysteria and wants to constantly be in the center of everyone's attention shows such symptoms of depression as deliberate and caricature behavior. A person publicly declares that his grief is so strong that in comparison with him, the experiences and sufferings of other people are zilch.

According to a hysterical personality suffering from reactive depression, members of his family, and in general all the people around him, should treat him with increased attention.

The patient also has symptoms of vegetative disorders: sleep and appetite disorders, endocrine functions. Hysterical reactive depression is dangerous because hysterical personalities are prone to demonstrative attempts to commit suicide. In most cases, such attempts are only a theatrical performance, calculated on the reaction of the public, but it should always be remembered that bouts of despair in a patient can provoke a real suicidal desire. That is why the patient needs qualified treatment and the help of competent specialists.

How to survive this state

Since reactive depression usually develops in direct connection with the occurrence of a super-strong stressful situation, as it normalizes or eliminates, the symptoms of the disorder smooth out and gradually disappear. But sometimes this doesn't happen. What should be the treatment in this case?

Usually, with reactive depression, it is enough to use high-quality psychotherapeutic treatment. In some difficult cases sometimes used and drug treatment: antidepressants and tranquilizers. But, of course, a lot depends on your own attitude towards recovery.

• Eliminate the irritant that causes you negative reactions. If this is not possible, do what usually gives you pleasure.
• Depression "makes" us believe that we have no value, so after a period internal recovery you need to gain faith that this is not true. There are no useless people, direct your energy to finding yourself in this life, and not to self-destruction, no matter how unrealistic and overwhelming the task may seem.
• Set yourself up for positive moments. Yes, that's right - set it up. Losses are often accompanied by finds, and any mistake gives us a new chance to change something in our lives.

If, despite all your attempts, you are unable to cope with a depressive state on your own, seek qualified help from specialists. A good psychotherapist and clinical psychologist in the course of treatment will help you overcome your illness, and rush into the battle called life with renewed vigor.

Reactive depression is an emotional disorder that occurs as a result of some serious stressful situation.

The main reason for the appearance of reactive depression is catastrophic events, global negative changes in human life. Such events are called "blows of fate", they can lead to the appearance of depression even in a person who does not have a predisposition to the development of depressive or other mental disorders.

Among the most common causes reactive depression death of a loved one, breakup with a loved one, divorce, bankruptcy, financial collapse, job loss, litigation.

In connection with the global financial crisis that occurred a few years ago, the number of patients with depressive disorders increased sharply, because many people lost their jobs, could not pay off a bank loan, were left without an apartment, a car.

In addition to the psychotraumatic social factor the hereditary predisposition to the development of affective disorders, constitutional features and age of patients, the presence of somatic and mental diseases (organic brain damage, schizophrenia) matter.

Symptoms

Reactive depression can be short-term (lasts no more than 1 month) and prolonged (its duration is from 1-2 months to 2 years).

short-term depressive reaction

Short-term (acute) reactive depression, as a rule, is directly related to some kind of misfortune. The loss that has occurred is individually significant, reaching the dimensions of a mental trauma.

The onset of symptoms of acute depression may be preceded by transient manifestations of a shock reaction - anxiety, psychogenic amnesia, silence (mutism), motor retardation, or aimless throwing. Hysterical disorders may also occur.

The leading symptoms of acute depression are deep despair, suicidal thoughts, various fears (phobias), sleep and appetite disorders. In most cases, these symptoms are short-lived and disappear fairly quickly. However, some patients at the peak of the disorder commit suicide or self-harm.

Prolonged depressive reaction

Prolonged depressive disorders are associated with a prolonged stressful situation. Symptoms of prolonged reactive depression are most often tearfulness, depression, a pessimistic vision of the future, a weakening of the energy potential of patients, asthenic and hypochondriacal manifestations.

With reactive depression, daily mood swings are not as pronounced as with endogenous depression. In their thoughts, patients constantly return to the events of the misfortune that happened. Patients tirelessly torment themselves that they did not do everything possible to prevent misfortune. Even when the manifestations of a depressive disorder are a little erased, become less acute, the slightest reminder of misfortune can provoke an outbreak of despair. And if in the daytime work helps to distract, then the experienced drama torments the patient for a long time at night, emerges in nightmarish dreams.

Over time, the impact of the stressful situation decreases ("time heals"), and in most cases, depressive disorders completely disappear, leaving no pathological changes. But there are also situations when the primary reactive depressive reaction eventually acquires properties endogenous depression(psychogenically provoked melancholy).

Treatment

Treatment of reactive depression should combine drug therapy and psychotherapy sessions. Medications help to relieve the main manifestations of an affective disorder, and psychotherapy helps to cope with grief.

From medications antidepressants (fluvoxamine, fluoxetine, sertraline) are used together with tranquilizers (diazepam, lorazepam, alprazolam). Thanks to the use of antidepressants, patients' mood improves, autonomic and motor manifestations of depression decrease. Tranquilizers relieve emotional tension, anxiety, fears, sleep disturbances.

Of the psychotherapeutic methods for the treatment of reactive depression, they most often resort to individual or family psychotherapy, cognitive, rational psychotherapy.

Reactive depression is a type of depression that, unlike the endogenous form, develops as a result of severe psychological trauma or constant impact more stress mild nature for a certain amount of time. In the reactive form, the patient's condition is usually stably depressed, and it can be extremely severe.

What it is?

Depression has several various forms, which differ in their provoking reasons, the nature of the course, severity, the presence of other disorders. Reactive depression is one of the most common forms and usually results from external factors, develops quite quickly, almost immediately after a psychological trauma. This form of the disease can occur at any age, it does not depend on gender and other characteristics.

The development of the disease in this case, in addition to the traumatic situation, can be affected by the state of human health in general, the genetic predisposition to disorders of this kind. The most common factors provoking reactive depression include events such as the death of a loved one, getting into an extreme situation that threatens life and health. A reactive depressive disorder can develop due to a constant tense stressful environment at work or school, with the loss of a job.

The most common variant of the disease is reactive depression with mild psychopathological symptoms. Depending on the severity of the manifestations of this disease, various options treatment: from simple psychotherapy with the minimum amount drugs until full hospitalization and quite severe medicines.

ICD-10 code for depressive disorders F30 - F39. In most cases psychiatric illnesses called exactly according to the ICD codes, without mentioning the disease itself.

Important! When diagnosing depression, a differential approach is extremely important, since depressive phases occur in other disorders, which, at the same time, have a completely different origin and development mechanisms.

Reactive depression in children and adolescents

The reactive form of the disorder is quite common in childhood and adolescence. Usually, the development of the disease is influenced by problems at school and at home. If parents suppress their child, use not the most positive methods of education, the family is dysfunctional, the likelihood of a disease increases.

At school, this form of depression may occur due to problems with teachers, excessive workloads for which the child is not ready, if conflict situations with other students.

A child with reactive depression may appear extremely ill-mannered, lazy, aggressive. In children, the symptoms of the disease appear a little more pronounced than in adults. Children often need more help from a therapist to deal with depression.

Important! It should also be taken into account that psychological trauma in childhood may be factors in the development of various psychiatric disorders in adulthood.

Symptoms

Diagnosis is usually based on the presence of the following signs disorders. Almost all of them should be present to one degree or another, while they can have different severity.

1. Symptoms of a shock reaction. These may include anxiety, sometimes without expressed reasons, fast development phobias, mutism, constant feeling of fear. There may be motor retardation or, on the contrary, constant movement, tics. This condition may persist for several weeks.
2. Then the second stage of depression develops. Usually there is increased tearfulness, constant severe fatigue, irritability. Anxiety and constant fear remain, suicidal thoughts and inclinations develop in severe stages, sometimes auditory hallucinations. When depression falls self-esteem, there are thoughts about their own uselessness. Sleep and appetite are disturbed.

These are the main symptoms of this disease. In addition, patients with reactive depression may constantly replay memories of past traumatic events in their heads. Patients may feel guilt, regret, come up with ways that would help to avoid a negative situation, its consequences. The patient's thoughts can constantly revolve around the events that caused the psychotrauma.

Important! But sometimes psychological trauma itself is not fixed in the memory of the patient, so the help of a psychotherapist is required to restore traumatic events in memory and work them out.

Also commonly used differential diagnosis, since similar symptoms can occur with other mental disorders. This requires consultation with a neurologist, conducting various tests and surveys, monitoring the patient's condition for a certain period of time.

How to treat?

Used for therapy various methods corrections. With severe psychological trauma, therapy with a psychotherapist is usually required. It is important to work through the trauma, to understand yourself, working with a psychotherapist will help get rid of fixation on the experience, find ways to solve the problem.

If the condition is extremely severe, various medications may be prescribed to help relieve the main symptoms of depression.

1. Various tranquilizers are commonly used, for example, Diazepam, Phenozepam, Atarax and others. The drug is selected depending on the severity of the symptoms.
2. Antidepressants such as fluoxetine may be used. Such drugs can adversely affect the body if taken irrationally, therefore, they are prescribed exclusively by the attending physician.

In the presence of suicide attempts or extremely intense suicidal thoughts, hospitalization and stay in the hospital may be required. However, in most cases of reactive depression, the symptoms begin to disappear when correct work with a psychotherapist. It also helps to achieve good results combined methods treatment.

Prevention

It is extremely difficult to insure against this disorder, since it is impossible to completely avoid stressful situations that can injure the psyche. However, stress tends to accumulate, so when you get into situations or environments that negatively affect the psyche, you need to urgently get out of them, for example, change your place of work if there is a negative environment.

You also need to deal with the consequences of stress in a timely manner, do not suppress aggression, anger, resentment. You need to be able to release negative experiences, you should pick up suitable techniques work with stress.

Reactive depression is a severe violation of the psychological and emotional state of a person that develops as a reaction to a traumatic event.

Causes of the disease

As the name implies, reactive depression is a reaction to some kind of mental trauma or prolonged exposure to depression. stress loads. In other words, the patient develops a depressive state after a certain event or a number of such situations occurred in his life, which he perceived as negative.

It should be understood that this disease does not develop for some "standard" reasons. How traumatic an event is for the human psyche is determined by many factors - from social to hereditary. In fact, even whether grief or other negatively colored emotions are transformed into depression largely depends on these factors.

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Risk factors

In the presence of predisposing circumstances, the likelihood of abnormal psycho-emotional depression becomes much higher:

1. Belonging to a particular profession. People who, due to professional employment, are often subjected to excessive stress or are forced to bear responsibility for the health and life of other people (doctors, firefighters, law enforcement officials, etc.). In this case, the visible habituation to stresses and resistance to them is in the nature of a “mask”, under which processes constantly occur that weaken the nervous system and depress the psyche.
2. social status. Lonely people are more prone to depression, including reactive depression. According to experts, this is due to the inability to discuss with someone the event that caused mental pain and help yourself to reduce the level of anxiety in the process of speaking out your thoughts.
3. Alcohol addiction. Being the strongest depressant, alcohol negatively affects the human nervous system. In this regard, the degree of psycho-emotional reactions is inadequate to the real state of affairs, and in the presence of any severely traumatic event, emotions completely get out of control.
4. hereditary predisposition. A tendency to psycho-emotional disorders can be transmitted from parents to children, which becomes a risk factor for the development of depressive states for the latter.
5. Features of education. People who grew up in families where the manifestation of emotions is considered weakness, as well as those who have witnessed domestic violence, are more prone to depression.

Important: reactive depression often develops after a traumatic event, which is defined as severe by general standards (financial collapse, divorce, death of a loved one).

But sometimes this condition occurs in response to a negative or tragic development of a situation that is personal for the patient.

It could be a loss pet, the death of an idol with whom a person has never met, etc. Therefore, the assessment of the severity of psychological trauma should not occur in terms of generally accepted standards.

Symptoms of the disease

The symptoms that manifest this kind of mental disorder are quite diverse and variable. But their description is more appropriate to address to the relatives and friends of the patient. This is due to the fact that a person suffering from this condition may not be aware of the changes that have occurred to him. Usually he is aware that after a certain event in his life and worldview something “broke”, but he considers this a natural manifestation of grief, sadness, longing and other negatively colored emotions. And those who are close to the sick person need to see in time the signs that a person close to them needs help.

Symptoms of reactive depression can be divided into general (characteristic of any person suffering from this disease) and individual (due to a number of characteristics of the patient's personality).

Common symptoms include the following:

1. Emotional depression. If we compare emotions and feelings with the colors of the rainbow, then the sufferer from reactive depression sees them through a dense haze. The colors are muted, the manifestations of joy or fun are distorted - the patient develops a skeptical or even cynical attitude towards any positive aspects. He sincerely does not understand the reasons for someone's joy, considering it something unnecessary and even annoying.
2. Changing habitual behavior. The patient ceases to experience pleasure from the activities that he used to like to spend time in, his interests are limited to the traumatic event and everything connected with it. So, if the cause of depression was the death of a loved one from a heart attack, a person may be seriously interested in the methods of treating this disease, mortality statistics, etc.
3. Tearfulness. A person suffering from reactive depression has literally wet eyes. Any, at first glance, meaningless detail, can cause a crying attack in a patient. The same applies to any reminders of a traumatic event, and things, sounds, smells, etc., which only the patient himself associates with a negative or tragic situation, can become a reminder. So, thoughts about the death of a loved one can even be inspired by a doorbell, and the patient explains this as “He (the deceased) never called like that.”
4. External changes that are visible to others. A person suffering from depression is often stooped and the preferred posture is sitting in a chair/armchair with a hunched back. Often, the patient tightly clenches his palms into fists and clenches his jaw, without noticing this, from the outside it looks like an extreme degree of tension.

Individual manifestations of reactive depression directly depend on the type of personality of the patient, and can vary widely:

• a person begins to avoid any form of communication, closes in on himself, and when trying to start a conversation with him, he answers briefly and in monosyllables, does not support a conversation;
• the patient tries at every opportunity to start talking about the event that traumatized him, obviously trying to relive it, and the conversation builds around the expected development of the situation if the circumstances were different (“If I called an hour earlier”, “If I had not then overslept for work, etc.);
• the emotional picture is dominated by a sense of guilt, which is expressed in regrets that nothing has been done that could change the course of events. With a reasoned explanation that the patient is not to blame for what happened, he finds new "points of application" in order to confirm his guilt;
• the patient experiences an irrational fear that the traumatic event will happen again. He is constantly waiting to be told bad news(about someone's death, refusal to hire, etc.).

At long course reactive depression, its symptoms may be accompanied by signs of other health disorders, and not only mental ones. For example, it is not uncommon for people suffering from depression to develop sleep problems ranging from difficulty falling asleep to chronic insomnia. In patients, appetite is reduced or completely absent, gastrointestinal disorders develop (dyspepsia, stool disorders, etc.), there is a decrease in libido, etc. Autonomic disorders are manifested by seizures heavy sweating, episodes of palpitations, etc. Symptoms of reactive depression of a physical nature depend on individual features individual health conditions can vary greatly.

But with all the variety and variability of manifestations, this kind of depression has only two, really “unique” features, by which it is distinguished from other similar conditions:

1. Changes in behavior and emotional state always begin to occur after some event, closely related in time to the onset of change. So, if the loss of a loved one occurred a few months before the onset of the first symptoms of depression, and dismissal from work - a few weeks, then with a high degree of probability it was the second case that provoked the changes. An exception may be situations when, after the first traumatic event (for example, parting with someone), a person did not cease to be subjected to excessive psycho-emotional stress, and one of them (in our example, the loss of a job) played the role of the “last straw”, causing depressive changes.
2. Psycho-emotional reactions and changes in behavior exceed the significance of the event and / or their duration exceeds the duration of normal reactions. This distinguishes reactive depression, for example, from grief. A grieving person after some time (usually 2-3 weeks after the tragic event) accepts the fact of death, comes to terms with it, restores social ties and generally returns to his usual way of life. A patient with reactive depression does not have an adequate assessment of the situation, he fixates on a traumatic event and, figuratively speaking, continues to live in it, neglecting work and family responsibilities and his own health.

Important: the described symptoms can be combined in different ways, and with a long course of depression or suppression of the patient's emotions, they can be completely unnoticeable. Only a specialist is able to distinguish, for example, grief or the natural process of adaptation during financial collapse from depression.

Treatment

In the treatment of this disease highest value has how long a person has been suffering from this condition and from manifestations of psycho-emotional depression.

Let's take a closer look at effective methods.

Medical treatment

Depending on the severity of the symptoms, the following groups of drugs may be prescribed:

1. Antidepressants (Sertraline, Fluvoxamine, etc.), which alleviate the manifestations of depression, increase positive emotions and eliminate the motor symptoms of depression (stiffness, tightness, obsessive repetitive movements, etc.).
2. Tranquilizers (Diazepam, Alprozolam, etc.) reduce the level of anxiety and anxiety, alleviate fears, and improve sleep quality.

For prolonged or severe course such depression and autonomic disorders caused by this, drugs may be prescribed to normalize heart rate, blood pressure, increased appetite, etc.

Important: the selection of drugs, their dosage and the duration of the course of treatment can only be carried out by the attending physician. Of great importance when choosing drugs is the professional and daily activities of the patient. This is due to the fact that a number of medications have a negative effect on the ability to concentrate and are dangerous for people who control vehicle caring for young children and employed in other areas where reduced attention carries with it potential threat for themselves or others.

Psychotherapy

This disease requires integrated approach, and for the fastest possible recovery, it is extremely important to "live" the traumatic event and leave it in the past - something that the patient is unable to cope with on his own.

Invaluable assistance in this matter is provided by psychotherapeutic assistance in the form of individual or group sessions conducted under the supervision and guidance of an experienced doctor.

The general objectives of the classes are:

• elimination of negative feelings about the traumatic event;
• training in methods of controlling fears and anxiety;
• restoration of adequate psycho-emotional reactions;
• return to normal social and personal life;
• training in the rules of psychological hygiene, which allow preventing such a development of the situation in the future.

If necessary, the psychotherapist supplements the general course of psychotherapy coursework and trainings that eliminate the so-called "blocks" that "lock" the problem at the subconscious level. In some cases, with the consent of the patient, hypnotherapy can be used.

Important: psychotherapy is powerful tool treatment for this type of depression. If a medical methods- the "first line of defense", allowing you to quickly eliminate acute manifestations depression, then psychotherapy is the most important stage of treatment, restoring the quality of life of a person and preventing complications of depressive conditions.