Autonomic depression symptoms. Methods of dealing with a nervous tic

Catad_tema Autonomic dysfunction syndrome (ADS) - articles

Autonomic dysfunction associated with anxiety disorders

"Clinical Efficiency" »»

MD, prof. O.V. Vorobiev, V.V. blond
First MGMU them. THEM. Sechenov

Most often, autonomic dysfunction accompanies psychogenic diseases (psycho-physiological reactions to stress, adjustment disorders, psychosomatic diseases, post-traumatic stress disorder, anxiety-depressive disorders), but it can also accompany organic diseases of the nervous system, somatic diseases, physiological hormonal changes, etc. Vegetative dystonia cannot be considered as a nosological diagnosis. It is permissible to use this term when formulating a syndromic diagnosis, at the stage of clarifying the category of a psychopathological syndrome associated with autonomic disorders.

How to diagnose vegetative dystonia syndrome?

Most patients (over 70%) with psychogenic autonomic dysfunction present exclusively somatic complaints. Approximately a third of patients, along with massive somatic complaints, actively reports symptoms of mental distress (feelings of anxiety, depression, irritability, tearfulness). Typically, these symptoms patients tend to interpret as secondary to a "severe" physical illness (reaction to the disease). Since autonomic dysfunction often mimics organ pathology, a thorough physical examination of the patient is necessary. This is a necessary step in the negative diagnosis of vegetative dystonia. At the same time, when examining this category of patients, it is advisable to avoid uninformative, numerous studies, since both ongoing studies and inevitable instrumental findings can support the patient's catastrophic ideas about his disease.

Vegetative disorders in this category of patients have polysystemic manifestations. However, a particular patient can strongly focus the doctor's attention on the most significant complaints, for example, in the cardiovascular system, while ignoring symptoms from other systems. Therefore, the practitioner needs knowledge of typical symptoms to identify autonomic dysfunction in various systems. The most recognizable are the symptoms associated with the activation of the sympathetic division of the autonomic nervous system. Autonomic dysfunction is most often observed in the cardiovascular system: tachycardia, extrasystole, discomfort in the chest, cardialgia, arterial hyper- and hypotension, distal acrocyanosis, waves of heat and cold. Disorders in the respiratory system can be represented by individual symptoms (difficulty breathing, "lump" in the throat) or reach a syndromic degree. The core of the clinical manifestations of hyperventilation syndrome are various respiratory disorders (a feeling of lack of air, shortness of breath, a feeling of suffocation, a feeling of loss of automatic breathing, a sensation of a lump in the throat, dry mouth, aerophagia, etc.) and / or hyperventilation equivalents (sighs, coughing, yawning) . Respiratory disorders are involved in the formation of other pathological symptoms. For example, a patient may be diagnosed with musculo-tonic and motor disorders (painful muscle tension, muscle spasms, convulsive musculo-tonic phenomena); paresthesia of the extremities (numbness, tingling, "crawling", itching, burning) and / or nasolabial triangle; phenomena of altered consciousness (pre-syncope, a feeling of "emptiness" in the head, dizziness, blurred vision, "fog", "grid", hearing loss, tinnitus). To a lesser extent, doctors focus on gastrointestinal autonomic disorders (nausea, vomiting, belching, flatulence, rumbling, constipation, diarrhea, abdominal pain). However, disorders of the gastrointestinal tract often disturb patients with autonomic dysfunction. Our own data suggest that gastrointestinal distress occurs in 70% of patients with panic disorder. Recent epidemiological studies have shown that more than 40% of panic patients have gastrointestinal symptoms that meet the criteria for a diagnosis of irritable bowel syndrome.

Table 1. Specific symptoms of anxiety

It is important to assess the development of autonomic symptoms over time. As a rule, the appearance or aggravation of the intensity of patient complaints is associated with a conflict situation or a stressful event. In the future, the intensity of vegetative symptoms remains dependent on the dynamics of the current psychogenic situation. The presence of a temporary relationship of somatic symptoms with psychogenic ones is an important diagnostic marker of autonomic dystonia. Regular for autonomic dysfunction is the replacement of some symptoms with others. "Mobility" of symptoms is one of the most characteristic features of vegetative dystonia. At the same time, the appearance of a new “incomprehensible” symptom for the patient is an additional stress for him and can lead to an aggravation of the disease.

Vegetative symptoms are associated with sleep disturbances (difficulty falling asleep, light superficial sleep, nocturnal awakenings), asthenic symptom complex, irritability in relation to habitual life events, and neuroendocrine disorders. Identification of the characteristic syndromic environment of vegetative complaints helps in the diagnosis of psychovegetative syndrome.

How to make a nosological diagnosis?

Mental disorders obligately accompany autonomic dysfunction. However, the type of mental disorder and its severity vary widely among patients. Mental symptoms are often hidden behind the "facade" of massive autonomic dysfunction, ignored by the patient and those around him. The ability of a doctor to see in a patient, in addition to autonomic dysfunction, psychopathological symptoms is decisive for the correct diagnosis of the disease and adequate treatment. Most often, autonomic dysfunction is associated with emotional and affective disorders: anxiety, depression, mixed anxiety-depressive disorder, phobias, hysteria, hypochondria. Anxiety is the leader among psychopathological syndromes associated with autonomic dysfunction. In industrialized countries in recent decades, there has been a rapid increase in the number of alarming diseases. Along with the increase in morbidity, the direct and indirect costs associated with these diseases are steadily increasing.

All anxiety pathological conditions are characterized by both general anxiety symptoms and specific ones. Vegetative symptoms are nonspecific and are observed in any type of anxiety. Specific symptoms of anxiety, concerning the type of its formation and course, determine the specific type of anxiety disorder (Table 1). Because anxiety disorders differ primarily in the factors that cause anxiety and the evolution of symptoms over time, the situational factors and cognitive content of anxiety must be accurately assessed by the clinician.

Most often, patients suffering from generalized anxiety disorder (GAD), panic disorder (PR), and adjustment disorder fall into the field of view of a neurologist.

GAD occurs, as a rule, before the age of 40 (the most typical onset is between adolescence and the third decade of life), flows chronically for years with a pronounced fluctuation of symptoms. The main manifestation of the disease is excessive anxiety or restlessness, observed almost daily, difficult to voluntarily control and not limited to specific circumstances and situations, in combination with the following symptoms:

• nervousness, anxiety, a feeling of agitation, a state on the verge of collapse;
• fatigue;
• violation of concentration of attention, "off";
• irritability;
• muscle tension;
• sleep disturbances, most often difficulty falling asleep and maintaining sleep.

GAD is a chronic anxiety disorder with a high likelihood of symptom recurrence in the future. According to epidemiological studies, in 40% of patients, anxiety symptoms persist for more than five years. Previously, GAD was considered by most experts as a mild disorder that only reaches clinical significance when it is comorbid with depression. But the increase in facts indicating a violation of the social and professional adaptation of patients with GAD makes us take this disease more seriously.

PR is an extremely common disease prone to chronicity, manifesting at a young, socially active age. The prevalence of PR, according to epidemiological studies, is 1.9-3.6%. The main manifestation of PR are recurring paroxysms of anxiety (panic attacks). Panic attack (PA) is an inexplicable painful attack of fear or anxiety for the patient in combination with various autonomic (somatic) symptoms.

The diagnosis of PA is based on certain clinical criteria. PA is characterized by paroxysmal fear (often accompanied by a sense of imminent death) or anxiety and/or a sense of inner tension and is accompanied by additional (panic-associated) symptoms:

• pulsation, strong heartbeat, rapid pulse;
• sweating;
• chills, tremor, sensation of internal trembling;
• feeling short of breath, shortness of breath;
• difficulty breathing, suffocation;
• pain or discomfort in the left side of the chest;
• nausea or abdominal discomfort;
• feeling dizzy, unsteady, light-headed, or light-headed;
• feeling of derealization, depersonalization;
• fear of going crazy or doing something out of control;
• fear of death;
• feeling of numbness or tingling (paresthesia) in the limbs;
• sensation of waves of heat or cold passing through the body.

The comorbidity of PR with psychopathological syndromes tends to increase as the duration of the disease increases. The leading position in comorbidity with PR is occupied by agoraphobia, depression, and generalized anxiety. Many researchers have proven that when PR and GAD are combined, both diseases manifest themselves in a more severe form, mutually aggravate the prognosis and reduce the likelihood of remission.

Some individuals with extremely low stress tolerance may develop a disease state in response to a stressful event that does not go beyond ordinary or everyday mental stress. More or less obvious stressful events for the patient cause painful symptoms that disrupt the patient's usual functioning (professional activity, social functions). These disease states have been termed adjustment disorder, a reaction to overt psychosocial stress that appears within three months of the onset of stress. The maladaptive nature of the reaction is indicated by symptoms that go beyond the norm and expected reactions to stress, and disturbances in professional activities, normal social life, or in relationships with other persons. The disorder is not a response to extreme stress or an exacerbation of a pre-existing mental illness. The reaction of disadaptation lasts no more than 6 months. If symptoms persist for more than 6 months, the diagnosis of adjustment disorder is reassessed.

The clinical manifestations of adaptive disorder are highly variable. However, it is usually possible to distinguish between psychopathological symptoms and associated autonomic disorders. It is the vegetative symptoms that make the patient seek help from a doctor. Most often, maladjustment is characterized by an anxious mood, a feeling of inability to cope with the situation, and even a decrease in the ability to function in daily life. Anxiety is manifested by a diffuse, extremely unpleasant, often vague feeling of fear of something, a sense of threat, a feeling of tension, increased irritability, and tearfulness. At the same time, anxiety in this category of patients can be manifested by specific fears, primarily fears about their own health. Patients are afraid of the possible development of a stroke, heart attack, oncological process and other serious diseases. This category of patients is characterized by frequent visits to the doctor, numerous repeated instrumental studies, and a thorough study of the medical literature.

The consequence of painful symptoms is social exclusion. Patients begin to cope poorly with their usual professional activities, they are haunted by failures in work, as a result of which they prefer to avoid professional responsibility, to refuse career opportunities. A third of patients completely stop professional activities.

How to treat vegetative dystonia?

Despite the mandatory presence of autonomic dysfunction and the often disguised nature of emotional disturbances in anxiety disorders, the basic treatment for anxiety is psychopharmacological treatment. Drugs successfully used to treat anxiety affect various neurotransmitters, in particular serotonin, norepinephrine, GABA.

What drug to choose?

The range of anti-anxiety drugs is extremely wide: tranquilizers (benzodiazepine and non-benzodiazepine), antihistamines, α-2-delta ligands (pregabalin), small neuroleptics, sedative herbal preparations and, finally, antidepressants. Antidepressants have been successfully used to treat paroxysmal anxiety (panic attacks) since the 1960s. But already in the 90s it became clear that, regardless of the type of chronic anxiety, antidepressants effectively stop it. Currently, selective serotonin reuptake inhibitors (SSRIs) are recognized by most researchers and practitioners as the drugs of choice for the treatment of chronic anxiety disorders. This provision is based on the undoubted anti-anxiety efficacy and good tolerability of SSRI drugs. In addition, with prolonged use, they do not lose their effectiveness. For most people, the side effects of SSRIs are mild, usually occurring within the first week of treatment and then disappearing. Sometimes side effects can be leveled by adjusting the dose or timing of the medication. Regular use of SSRIs leads to the best results of treatment. Usually, anxiety symptoms stop after one or two weeks from the start of taking the medication, after which the anti-anxiety effect of the drug increases in a graduated manner.

Benzodiazepine tranquilizers are mainly used to relieve acute symptoms of anxiety and should not be used for more than 4 weeks due to the risk of developing an addiction syndrome. Data on the consumption of benzodiazepines (BZs) suggest that they remain the most commonly prescribed psychotropic drug. A sufficiently rapid achievement of an anti-anxiety, primarily a sedative effect, the absence of obvious adverse effects on the functional systems of the body justify the well-known expectations of doctors and patients, at least at the beginning of treatment. The psychotropic properties of anxiolytics are realized through the GABAergic neurotransmitter system. Due to the morphological homogeneity of GABAergic neurons in different parts of the CNS, tranquilizers can affect a significant part of the functional formations of the brain, which in turn determines the breadth of the spectrum of their effects, including adverse ones. Therefore, the use of BZ is accompanied by a number of problems associated with the peculiarities of their pharmacological action. The main ones include: hypersedation, muscle relaxation, "behavioral toxicity", "paradoxical reactions" (increased agitation); mental and physical dependence.

The combination of SSRIs with BZ or small antipsychotics is widely used in the treatment of anxiety. The appointment of small antipsychotics to patients at the beginning of SSRI therapy is especially justified, which allows leveling the anxiety induced by SSRIs that occurs in some patients in the initial period of therapy. In addition, while taking additional therapy (BZ or small antipsychotics), the patient calms down, more easily agrees with the need to wait for the development of the anti-anxiety effect of SSRIs, better adheres to the therapeutic regimen (compliance improves).

What to do in case of insufficient response to treatment?

If therapy is not effective enough within three months, alternative treatment should be considered. Switching to broader-spectrum antidepressants (dual-acting antidepressants or tricyclic antidepressants) or adding an additional drug to the treatment regimen (eg, small antipsychotics) is possible. Combined treatment with SSRIs and small antipsychotics has the following advantages:

• impact on a wide range of emotional and somatic symptoms, especially pain;
• faster onset of the antidepressant effect;
• higher chance of remission.

Among the small antipsychotics, alimemazine (Teralijen) is the most commonly used for the treatment of anxiety disorders. Clinicians have accumulated considerable experience in the treatment of patients with autonomic dysfunction with Teraligen. The mechanism of action of alimemazine is multifaceted and includes both central and peripheral components (Table 2).

table 2. Mechanisms of action of Teraligen

Based on many years of experience in the use of alimemazine (Teralidgen), it is possible to formulate a list of target symptoms for prescribing the drug in the management of anxiety disorders:

• sleep disturbances (difficulty falling asleep) - the dominant symptom;
• excessive nervousness, excitability;
• the need to enhance the effects of basic (antidepressive) therapy;
• complaints about senestopathic sensations;
• gastrointestinal distress, in particular nausea, as well as pain, itching in the structure of complaints. It is recommended to start taking Teraligen with minimal doses (one tablet at night) and gradually increase the dose to 3 tablets per day.

What is the duration of treatment for anxiety disorders?

There are no clear recommendations on the duration of therapy for anxiety syndromes. However, most studies have proven the benefit of long courses of therapy. It is believed that after the reduction of all symptoms, at least four weeks of drug remission should elapse, after which an attempt is made to stop the drug. Too early withdrawal of the drug can lead to an exacerbation of the disease. Residual symptoms (most often symptoms of autonomic dysfunction) indicate incomplete remission and should be considered as a basis for prolonging treatment and switching to alternative therapy. On average, the duration of treatment is 2-6 months.

List of used literature

1. Vegetative disorders (clinic, diagnosis, treatment) / ed. A.M. Wayne. M.: Medical Information Agency, 1998. S. 752.
2. Lydiard R.B. Increased Prevalence of Functional Gastrointestinal Disorders in Panic Disorder: Clinical and Theoretical Implications // CNS Spectr. 2005 Vol. 10. No. 11. R. 899-908.
3. Lademann J., Mertesacker H., Gebhardt B. Psychische Erkrankungen im Fokus der Gesundheitsreporte der Krankenkassen // Psychotherapeutenjournal. 2006. No. 5. R. 123-129.
4. Andlin-SobockiP., Jonsson B., WittchenH.U., Olesen J. Cost of disorders of the brain in Europe // Eur. J. Neurol. 2005. No. 12. Suppl 1. R. 1-27.
5. Blazer D.G., Hughes D., George L.K. et al. Generalized anxiety disorder. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study / eds. Robins L.N., Regier D.A. NY: The Free Press, 1991. P. 180-203.
6. Perkonigg A., Wittshen H.U. Epidemiologie von Angststorungen // Angst-und Panikerkrankung / Kaster S., Muller H.J. (eds). Jena: Gustav Fischer Ver-lag, 1995. P. 137-56.

Autonomic depression is a type of mental disorder, the main symptoms of which are disorders of the autonomic nervous system. This condition requires the obligatory supervision of the attending physician. Symptoms of this type of depression are quite diverse. The disease can occur in people of different ages, genders, social status, professions. If you have symptoms of pathology, you should seek help from a specialist in a timely manner.

Clinical picture

Autonomic depression is characterized by a wide range of different symptoms. This psychosomatic disease provokes multiple manifestations of physical ailments. With typical depression, the patient's mood decreases, he becomes apathetic, and a pessimistic outlook on life prevails. Emotions, if they arise, are negative. The patient loses interest in what is happening around, his self-esteem is significantly reduced, suicidal thoughts may occur.

Autonomic depression is characterized by a predominance of autonomic disorders. The patient has a lot of unpleasant or painful sensations that are not associated with any physical pathologies.

Physical manifestations of a depressive disorder can be not only pain of a different nature, but also dizziness, nausea, digestive upset, excessive sweating, loss of appetite, shortness of breath. The patient constantly feels weakness, quickly gets tired, even minor loads require serious efforts from him. At the same time, sleep disturbances occur, the patient develops insomnia, he is haunted by nightmares. There is a decrease in libido, a change in body weight, both upward and downward (weight loss usually develops).

There may be other symptoms of a vegetative disorder. The most striking manifestations of pathology are panic attacks and a vegetative crisis. These are paroxysmal autonomic disorders. Also, vegetative disorders can manifest themselves in the form of permanent disorders.

Diagnosis

Only a specialist can make a reliable diagnosis. If depression is larvated (occurs in a latent form), then its symptoms resemble many different diseases. After a comprehensive examination of the patient, the diagnosis can be established. It is also important to find out the cause that led to the development of the disease. There can be many reasons for depression.

Treatment of pathology

Treatment of autonomic depression is carried out in a complex manner. Therapy of psychovegetative disorders is carried out with the help of drugs such as antidepressants, tranquilizers, antipsychotics. Vegetotropic agents are also used. Other drugs may be used depending on the indications.

In addition to drug treatment, the patient may be recommended psychotherapy, which, together with medications, will speed up the healing process. Additionally, various physiotherapeutic procedures can be used that help improve the general condition of the body. Useful will be yoga, swimming, breathing exercises, reflexology, breathing exercises. Massage in combination with aromatherapy and regular physical activity will also improve the patient's condition. Proper nutrition also plays a significant role.

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Symptoms of depression

Signs of the onset of depression

• emotional signs;
• mental disorder;
• physiological signs;
• behavioral disorder.

Emotional Signs
Emotional signs of the onset of depression indicate a deterioration in the patient's emotional status and are most often accompanied by a decrease in general mood.

Emotional signs of depression include:

• changeable mood with a sharp change of fun to melancholy;
• apathy;
• extreme despondency;
• depressed, oppressive state;
• a feeling of anxiety, restlessness, or even unreasonable fear;
• despair;
• lowering self-esteem;
• constant dissatisfaction with yourself and your life;
• loss of interest and pleasure in work and the world around you;
• feeling of guilt;
• feeling of worthlessness.

The main signs of a mental state disorder are:

• difficulty concentrating;
• inability to focus on a particular job or activity;
• completing simple tasks over a longer period of time – work that used to be done in a few hours can take a whole day;
• “fixation” on one’s worthlessness – a person constantly thinks about the meaninglessness of his life, only negative judgments about himself prevail in him.

The main physiological signs of depression

Often the first symptoms of depression are expressed in a violation of the behavior of the patient.

The main signs of impaired behavioral status in depression are:

• unwillingness to contact family and friends;
• less often - attempts to attract the attention of others to themselves and their problems;
• loss of interest in life and entertainment;
• sloppiness and unwillingness to take care of themselves;
• constant dissatisfaction with oneself and others, which results in excessive demands and high criticality;
• passivity;
• unprofessional and poor-quality performance of their work or any activity.

Diagnostic signs of depression

Allocate the main and additional diagnostic signs of depression.

The main signs of depression are:

• hypothymia - reduced mood compared to the patient's inherent norm, which lasts more than two weeks;
• a decrease in interest in any activity that usually brought positive emotions;
• increased fatigue due to a decrease in energy processes.

• decreased attention and concentration;
• self-doubt and low self-esteem;
• ideas of self-blame;
• disturbed sleep;
• disturbed appetite;
• suicidal thoughts and actions.

Anxiety and depression

Symptoms of anxiety in depression are:

• feeling of internal tension - patients are in a state of constant tension, describing their condition as "a threat hung in the air";
• a feeling of anxiety at the physical level - in the form of trembling, frequent heartbeat, increased muscle tone, excessive sweating;
• constant doubts about the correctness of the decisions made;
• anxiety spreads to future events - at the same time, the patient is constantly afraid of unforeseen events;
• a feeling of anxiety extends to the events of the past - a person constantly torments himself and reproaches himself.

Vegetative symptoms in anxious depression are:

• tachycardia (rapid heartbeat);
• labile (unstable) blood pressure;
• increased sweating.

Sleep disorders in depression

Symptoms of sleep disturbance in depression include:

• difficulty falling asleep;
• interrupted sleep and frequent awakenings;
• early morning awakenings;
• reduced sleep duration;
• superficial sleep;
• nightmares;
• complaints of restless sleep;
• lack of a feeling of rest after waking up (with normal sleep duration).

Sleep disorders in depression include both insomnia (85 percent) and hypersomnia (15 percent). The former include - a disorder of night sleep, and the latter - daytime sleepiness.

In the dream itself, several phases are distinguished, each of which has its own functions.

Sleep phases include:
1. Non-REM sleep

• drowsiness or theta wave stage;
• sleep spindle stage;
• delta sleep;
• deep dream.

In depression, there is a decrease in delta sleep, a shortening of the short sleep phase, and an increase in the superficial (first and second) stages of non-REM sleep. In patients with depression, the phenomenon of "alpha - delta - sleep" is noted. This phenomenon takes up more than one-fifth of sleep in duration and is a combination of delta waves with alpha rhythm. At the same time, the amplitude of the alpha rhythm is several oscillations less than during wakefulness. It is assumed that this activity in delta sleep is the result of an activating system that prevents the inhibitory somnogenic systems from fully functioning. Confirmation of the relationship between REM sleep disturbances in depression is the fact that delta sleep is the first to recover when coming out of depression.

depression and suicide

The main risk factor is endogenous depression, i.e. depression in the frame of schizophrenia or bipolar psychosis. In second place are reactive depressions, that is, depressions that have developed as a response to trauma or stress.

The main problem of suicide is that many who committed suicide did not receive qualified assistance. This means that the majority of depressive states remain undiagnosed. This group of depressions mainly includes masked depressions and depressions in alcoholism. These patients receive psychiatric care later than others. However, patients receiving medication are also at risk. This is due to frequent and premature interruptions of treatment, lack of support from relatives. In adolescents, certain medications are a risk factor for suicide. It has been proven that second-generation antidepressants have the ability to provoke suicidal behavior in adolescents.

It is very important to suspect a suicidal mood in a patient in time.

Signs of suicidal ideation in patients with depression are:

• slipping of suicidal thoughts in a conversation in the form of phrases “when I am gone”, “when death takes me”, and so on;
• constant ideas of self-accusation and self-abasement, talk about the worthlessness of one's existence;
• severe disease progression up to complete isolation;
• before planning suicide, patients can say goodbye to their relatives - call them or write a letter;
• also, before committing suicide, patients often begin to put their affairs in order - make a will, and so on.

Diagnosis of depression

Questioning a patient with depression

• mental inhibition;
• yearning;
• anxiety and agitation (arousal) or motor retardation (depending on the type of depression).

• apathy;
• anhedonia - loss of the ability to enjoy;
• painful insensibility.

The depressive content complex is:

• ideas of self-accusation - most often in sin, in failures or death of close relatives;
• hypochondriacal ideas - consist in the patient's conviction that he suffers from incurable diseases;
• suicidal thoughts.

Additional diagnostic signs of depression are:

• family history - if among the patient's relatives there were people suffering from a depressive disorder (especially bipolar), or if there were suicides among the next of kin;
• the patient's personality type - anxiety personality disorder is a risk factor for depression;
• the presence of depressive or manic conditions before;
• concomitant somatic chronic pathologies;
• alcoholism - if the patient is not indifferent to alcohol, then this is also a risk factor for depression.

The Beck Depression Scale and other psychometric scales

Psychometric scales for assessing depression are:

• Hospital Anxiety and Depression Scale (HADS);
• Hamilton scale (HDRS);
• Tsung scale;
• Montgomery-Asberg scale (MADRS);
• Beck scale.

Hamilton Scale (HDRS)
It is the most popular and frequently used scale in general medical practice. Contains 23 items, the maximum score for which is 52 points.

The interpretation of the Hamilton scale is:

• 0 - 7 points talk about the absence of depression;
• 7 - 16 points- Minor depressive episode
• 16 - 24 points
• over 25 points

The interpretation of the Zung scale is:

• 25 – 50 - variant of the norm;
• 50 – 60 - mild depressive disorder;
• 60 – 70 - moderate depressive disorder;
• over 70- severe depressive disorder.

The interpretation of the Montgomery-Asberg scale is:

• 0 – 15 - lack of depression;
• 16 – 25 - Minor depressive episode
• 26 – 30 - moderate depressive episode;
• over 31- Major depressive episode.

The interpretation of the Beck scale is:

• up to 10 points- lack of depression;
• 10 – 15 - subdepression;
• 16 – 19 - moderate depression;
• 20 – 30 - severe depression;
• 30 – 62 - severe depression.

Department of Nervous Diseases FPPO MMA them. THEM. Sechenov

URL

Introduction

At the appointment with a general practitioner, patients with depressive syndromes make up more than 30%. This figure is probably even higher for neurological practice. At the same time, it should be taken into account that patients who actively complain of low mood, depression, depression, lack of interest in life usually do not go to a therapist or neurologist, but turn to a psychiatrist in a polyclinic or a neuropsychiatric dispensary. At an appointment with an internist, patients complain primarily of somatovegetative disorders. It is known how difficult it is to diagnose and treat persistent cardialgia, prolonged and "inexplicable" hyperthermia, constant shortness of breath, persistent nausea, exhausting sweating, dizziness, dramatic and frightening autonomic paroxysms or, in modern terminology, "panic attacks" (PA), etc. .d. As a rule, with active and targeted questioning, these patients can identify sleep disturbances, appetite, changes in body weight, decreased libido, constant weakness, fatigue, decreased interest in the environment, and other symptoms that indicate the presence of depressive disorders. Subclinical manifestations of depression in such patients also led to the appropriate terminology: "hidden", "masked", "larved", "atypical", "alexithymic", "depression without depression".

It is known that autonomic disorders of central origin or psycho-vegetative syndromes can manifest themselves in the form of both paroxysmal and permanent disorders.

Paroxysmal autonomic disorders

The vegetative crisis (VC), or PA, is the most striking and dramatic paroxysmal manifestation of the psychovegetative syndrome.

Terminology

The name “vegetative crisis”, traditional for domestic medicine, emphasizes that vegetative symptoms are of primary importance in an attack. In foreign medicine, especially in English, the leading role in vegetative paroxysm is given to emotional and affective disorders (fear, anxiety), which is accordingly reflected in the terms used - "anxiety attacks", "panic attacks".

Diagnostic criteria

The term "Panic Attack" has gained worldwide recognition today thanks to the classification of diseases proposed by the American Psychiatric Association in 1980 (DSM-III). According to the latter, PA is the main manifestation of "Panic Disorders" (PD). Subsequently, this classification was refined and currently in its latest version - DSM-IV - and in the International Classification of Diseases - ICD-10 - the following are adopted criteria for diagnosing PR.

BUT. Recurrence of seizures intense fear or discomfort in combination with four or more of the following symptoms, they develop suddenly and reach their peak within 10 minutes:

- pulsations, strong heartbeat, rapid pulse;

- sweating;

- chills, tremor;

- feeling short of breath, shortness of breath;

- difficulty breathing, suffocation;

- pain or discomfort in the left side of the chest;

- nausea or abdominal discomfort;

- dizziness, unsteadiness;

- weakness, dizziness, faintness;

- feeling of numbness or tingling (paresthesia);

- waves of heat and cold;

- feeling of derealization, depersonalization;

- fear of death;

- fear of going crazy or doing something out of control.

B. The emergence of PA not due to the direct physiological action of any substances(for example, drug dependence or drug use) or somatic diseases (for example, thyrotoxicosis).

AT. In most cases, PA do not occur as a result of other anxiety disorders, such as "Phobias" - "Social" and "Simple", "Obsessive Phobic Disorders", "Post Traumatic Stress Disorders".

Epidemiology

According to statistics, from 1.5 to 4% of the adult population suffer from PR at certain periods of their lives. Among those seeking primary care, patients with PA make up to 6%. The disease debuts most often at the age of 20 - 30 years and is extremely rare before 15 and after 65 years. Women suffer 2-3 times more often than men.

Main clinical manifestations

The criteria required for diagnosing PA can be summarized as follows:

paroxysmal;

Polysystem autonomic symptoms;

Emotional-affective disorders.

Obviously, the main manifestations of PA are vegetative and emotional disorders. Already from the list of symptoms presented above, it can be seen that vegetative symptoms affect various body systems: these are respiratory, cardiac, vascular reactions (central and peripheral), changes in thermoregulation, sweating, gastrointestinal and vestibular functions. An objective examination, as a rule, reveals rises in blood pressure (sometimes to high values ​​\u200b\u200band more often during the first attacks), severe tachycardia, often an increase in extrasystoles, there may be an increase in temperature to a subfebrial or febrile level. All these symptoms, arising suddenly and "for no reason", contribute to the appearance and fixation of another group of symptoms - emotional-affective disorders. The range of the latter is unusually wide. So, a feeling of causeless fear, reaching the degree of panic, usually occurs during the first attack, and then, in a less pronounced form, is repeated in subsequent attacks. Sometimes the panic of the first PA subsequently transforms into specific fears - the fear of myocardial infarction, stroke, loss of consciousness, falling, insanity, etc. In some patients, the intensity of fear (even in the first attacks) may be minimal, but nevertheless, upon careful questioning, patients report a feeling of internal tension, anxiety, restlessness, a feeling that "something will explode inside." In neurological and therapeutic practice, the emotional manifestations of an attack can differ significantly from a typical situation. So, in an attack, the patient may not experience fear, anxiety; it is no coincidence that such PAs are called "panic without panic" or "non-insurance PAs". Some patients experience a feeling of irritation during an attack, sometimes reaching the degree of aggression, in some cases - a feeling of melancholy, depression, hopelessness, report "unreasonable" crying at the time of an attack. It is the emotional-affective symptoms that give the attack such an unpleasant and even repulsive character.

In a large category of patients with PD, the structure of the attack is not limited to the above-described vegetative-emotional symptoms, and then the doctor can detect another type of disorder, which we conditionally called "atypical". They can be represented by local or diffuse pains (headaches, pains in the abdomen, in the spine, etc.), muscle tension, vomiting, senestopathic sensations (sensation of heat, "frostbite", "stirring", "transfusion" of something , "emptiness") and (or) psychogenic (hysterical) neurological symptoms (feeling of "coma in the throat", weakness in the arm or leg, impaired speech or voice, consciousness, etc.).

In the interictal period, patients, as a rule, develop secondary psychovegetative syndromes, the structure of which is largely determined by the nature of the paroxysm. In patients with PA, shortly after the onset of paroxysms, the so-called agoraphobic syndrome develops. "Agoraphobia" literally means "fear of open spaces", but in the case of panic patients, fear refers to any situation that is potentially "threatened" for the development of an attack. Such situations can be being in a crowd, in a store, on the subway or any other form of transport, moving away from home for some distance or being alone at home, etc. Agoraphobia causes appropriate behavior that allows you to avoid unpleasant sensations: patients stop using transport, do not stay at home alone, do not move far from home, and eventually become almost completely socially maladjusted.

The fears of patients with PA may relate to a specific disease, with which, in the patient's opinion, disturbing symptoms are associated: for example, fear of a heart attack, stroke, etc. Obsessive fears force the patient to constantly measure the pulse, check blood pressure, do repeated electrocardiograms, and even study the relevant medical literature. In such cases, we are talking about the development of obsessive fears or hypochondriacal syndrome.

As secondary syndromes, depressive disorders often develop, manifested by a decrease in social activity, interest in the outside world, increased fatigue, constant weakness, decreased appetite, sleep disturbances, and sexual motivations. In patients with demonstrative seizures, as a rule, hysterical personality disorders are detected with clinical manifestations of hysteria in the somatic or neurological sphere.

Permanent autonomic disorders

Permanent vegetative disorders mean subjective and objectively recorded violations of vegetative functions that are permanent or occur sporadically and are not combined with vegetative paroxysms (panic attacks). These disorders may manifest predominantly in one system or be distinctly multisystemic in nature. Permanent vegetative disorders can be manifested by the following syndromes:

In the cardiovascular system - cardiorhythmic, cardialgic, cardiosenestopathic, as well as arterial hyper- and hypotension or amphotonia;

In the respiratory system - hyperventilation disorders: a feeling of lack of air, shortness of breath, a feeling of suffocation, shortness of breath, etc.;

In the gastrointestinal system - dyspeptic disorders, nausea, vomiting, dry mouth, belching, abdominal pain, dyskinetic phenomena, constipation, diarrhea;

In thermoregulatory and sweating systems - non-infectious low-grade fever, periodic "chills", diffuse or local hyperhidrosis, etc.;

In vascular regulation - distal acrocyanosis and hypothermia, Raynaud's phenomenon, vascular cephalgia, lipothymic conditions, heat and cold waves;

In the vestibular system - non-systemic dizziness, feelings of instability.

Autonomic disorders and depression

There is an extensive literature on the relationship between depression and anxiety. This problem is also relevant for PR, since a combination of PR and depression is possible.

When examining a patient suffering from PD, the doctor should be alert to possible endogenous depression, since the risk of suicidal actions requires immediate psychiatric intervention.

According to modern criteria, depression is characterized by a decrease in mood, a decrease or lack of interest or pleasure, combined with a decrease in appetite or an increase in it, a decrease or increase in body weight, insomnia or hypersomnia, psychomotor retardation or agitation, a feeling of fatigue or loss of energy, a feeling of worthlessness, an inadequate feeling guilt, decreased ability to think or pay attention, and recurring thoughts of death or suicide.

For the clinician, the question of the nature of depression is important - is it primary or secondary? To resolve this issue, two diagnostic criteria are important: the time factor and the severity of depressive symptoms. R. Jacob et al. propose to use both criteria and determine which of the disorders occurs without the other in the patient's history. If episodes of depression appeared before PR, and PA appear only during the period of depression, then PR are secondary to depression. If depression appears only in the presence of PR and, as a rule, at a certain stage of their development, then, most likely, we are talking about primary PR and secondary depression.

It was shown that patients with depression with PA had a longer course, were often of an endogenous, agitated type and had a worse prognosis, i.e. their depression was more severe.

There is an opinion that secondary depressions are often found in PR. The following pattern of PR dynamics is considered typical: panic attacks - agoraphobia - hypochondria - secondary depression. In a study by A. Breier, out of 60 patients with AF with PR, depression was detected in 70%, and in 57% of cases it occurred after the first PA. According to some data, secondary depressive fouling is observed in 70 - 90% of cases with a long-term existence of PR.

Since the risk of suicide is high in primary depression, especially its severe (acute) forms, and the use of psychotherapy is also difficult, the differential diagnosis of PR and depression with PA is necessary. If primary depression is suspected, it is necessary to focus on weight loss, pronounced disturbances in concentration and sleep disorders, gross motivational disorders. Secondary depressions have a milder course and usually regress when PR is stopped.

Currently, the pathogenetic relationship between PR and depression is being actively discussed, the reason for which is the frequent combination of PR and depression and the obvious effectiveness of antidepressant drugs in both cases. However, a number of facts refute the assumption of a single disease: first of all, these are different effects when exposed to biological markers. Thus, sleep deprivation improves the condition of patients with major depression and worsens with PR; the dexamethasone test is positive in the first case and negative in the second, the introduction of lactic acid naturally causes PA in patients with PR or in patients with depression in combination with PR, but not in patients suffering only from major depression. Thus, discussing the combination of PR with major depression, it can be assumed that the presence of depression is a factor contributing to the manifestation of PR, although the mechanisms of this interaction remain unclear.

Permanent autonomic disorders also occur in the structure of various affective and emotional-psychopathological syndromes. In most cases, we are talking about depressive disorders (masked, somatized and other variants) or mixed syndromes, among which anxiety-depressive, depressive-hypochondriacal and hysterodepressive disorders dominate. According to A.B. Smulevich et al. , hysterical depression is one of the most common psychogenic reactions, accompanied by severe somatovegetative and hysterical neurological symptoms. Most often, such manifestations of the disease are observed in menopause.

Therapy of psychovegetative disorders

Currently, the following groups of drugs are used in the treatment of vegetative syndromes of both paroxysmal and permanent nature:

Antidepressants (AD);

Tranquilizers (typical and atypical benzodiazepines - ABD);

Small antipsychotics (MN);

Vegetotropic agents.

It has already been proven through many controlled (double-blind, placebo-controlled) studies that the basic drugs in the treatment of autonomic disorders are AD, which are used as monotherapy or in combination with other drugs. It should be emphasized that AD therapy is indicated not only when vegetative disorders are a manifestation of depression, including masked depression, but also when vegetative disorders (permanent and paroxysmal) occur within anxiety and anxiety-phobic disorders, even if no obvious depression is detected (for example, , PR with agoraphobia), in cases of mixed anxiety-depressive and hystero-depressive (a combination of somatoform and depressive) disorders. This position reflects current trends in psychopharmacotherapy, where blood pressure is the leading one, and tranquilizers (mainly typical benzodiazepines) play the role of symptomatic, auxiliary, corrective therapy. The exception is ADB (alprazolam and clonazepam), which in some cases can also be used as basic pharmacotherapy. Antipsychotics are used as additional drugs when combination therapy is needed. Vegetotropic drugs (blockers, vestibulolitics, etc.) are usually introduced into treatment as symptomatic therapy or to correct side effects of blood pressure.

It should be noted that it is advisable to combine the use of any psychotropic drugs with vegetotropic therapy, especially if the drug used in addition has mechanisms of cellular neurotropic effects (neurometabolic cerebroprotection). In particular, the appointment of Vinpocetine (Cavinton) allows, due to these effects, to significantly improve the results of treatment.

Pharmacotherapy of patients with paroxysmal and permanent psychovegetative disorders involves several therapeutic strategies: seizure relief (PA); prevention of recurrence of paroxysms; relief of permanent psychovegetative syndromes.

Cupping PA

Tranquilizers of the benzodiazepine group (Relanium, tazepam, phenazepam, Xanax, etc.) are the most effective means for stopping PA. However, with this symptomatic method of treatment, the dose of the drug must be increased over time, and the irregular use of benzodiazepines and the associated recoil phenomenon can contribute to an increase in PA, progression and chronicity of the disease.

PA Recurrence Prevention

Numerous double-blind, placebo-controlled studies have convincingly shown that two groups of drugs, AD and DBA, are the most effective in preventing PA.

Today, the range of AD effective against PR has expanded significantly and includes at least 5 groups of drugs: tricyclic antidepressants- imipramine (melipramine), amitriptyline (triptisol, nortriptyline), clomipramine (anafranil, hydifen); quadricyclic antidepressants- mianserin (miansan, lerivon); monoamine oxidase inhibitors - moclobemide (Aurorix); antidepressants with an insufficiently known mechanism of action - tianeptine (coaxil, stablon); selective serotonin reuptake inhibitors (SSRIs) - fluoxetine, fluvoxamine (Avoxin), sertraline (Zoloft), paroxetine (Paxil), citalopram (Cipramil).

Of considerable interest is the last antidepressant from this group - citalopram. The high selectivity of the drug and the low potential for interactions, a favorable profile of side effects, coupled with high efficiency, allow us to consider cipramil as the drug of choice for many depressive conditions, in particular, in general somatic and geriatric practice. The presence of citalopram, along with thymoleptic and also a distinct anxiolytic action indicates the possibility of using citalopram in anxiety disorders and, in particular, in panic attacks. Currently, two Russian clinics have already started studying the effectiveness of citalopram in panic disorders.

The most probable is the theory that links the anti-panic efficacy of AD with a predominant effect on the serotonergic systems of the brain. A positive effect can be achieved by using small daily doses of drugs. However, when using blood pressure, especially tricyclic ones, in the first decade of treatment, there may be an exacerbation of symptoms - anxiety, restlessness, agitation, and sometimes an increase in PA. Adverse reactions to tricyclic blood pressure are largely associated with anticholinergic effects and can be manifested by severe tachycardia, extrasystole, dry mouth, dizziness, tremor, constipation, weight gain. The above symptoms can lead in the early stages to a forced refusal of treatment, especially since the clinical effect, as a rule, occurs 2 to 3 weeks after the start of therapy. Significantly fewer adverse reactions are observed when using drugs of the SSRI group. Their better tolerability, the possibility of a single daily intake and the painlessness of rapid withdrawal at the end of treatment have made these drugs leaders in the treatment of PR.

Atypical benzodiazepines include clonazepam (antelepsin, rivotril) and alprazolam (xanax, cassadan). It has been shown that benzodiazepines (both typical and atypical) enhance the action of GABA (g-aminobutyric acid), which is the main inhibitory mediator in the central nervous system. An essential advantage of this group of drugs is the rapid appearance of the clinical effect (3-4 days). There is evidence that in high doses (6-8 mg) alprazolam has an antidepressant effect.

The choice of the drug is determined mainly by the clinical picture of the disease and the characteristics of the drug. If PA has appeared recently and there is no agoraphobic syndrome, then it is advisable to start therapy with ABD. If PA is combined with agoraphobia or other secondary syndromes (depression, phobic syndrome, hypochondria), then AD should be used. First of all, it is recommended to use AD with minimal side effects. In some cases, the combined use of AD and DBA is required, since DBA, firstly, provides an early onset of the clinical effect (almost as early as the 1st week of treatment), and secondly, helps to stop PA before the onset of AD action.

Treatment of permanent psychovegetative disorders

When choosing tactics for the treatment of permanent psycho-vegetative disorders, they proceed primarily from the nature of the emotional-psychopathological syndrome. In the case of depressive disorders, the main, and often the only, drugs are AD. Currently, SSRIs are preferred. When depression is combined with other syndromes, combined therapy is used - a combination of blood pressure with tranquilizers (ABD) or small antipsychotics: melleril (sonapax), teralen, neuleptil, eglonil, chlorprothixene, etaperazine.

Individual selection of pharmacological preparations, the use of small doses, if necessary, a combination with cognitive-behavioral psychotherapy and social adaptation today make it possible to successfully cope with such widespread and socially maladaptive suffering as psychovegetative syndromes.

Profluzak (fluoxetine) – Akrikhin, Russia
Paxil (paroxythene) - SmithKline Beecham, UK
Coaxil (tianeptine) - Servier, France
Cipramil (citalopram) – Lundbeck, Denmark
Vinpocetine (Cavinton) – Gedeon Richter, Hungary

Literature:

1. Vegetative disorders. Clinic. Diagnostics. Treatment. Ed. A.M. Wayne. Medical news agency. M. 1998; 749.
2. ICD-10 International Classification of Diseases (10th revision). Classification of mental and behavioral disorders. WHO/Trans. from English. Ed. Yu.L. Nuller, S.Yu. Tsirkin St. Petersburg. "ADIS" 1994.
3. DSM IV. Diagnostic and Statistical Mannual of mental disorders. Washington 1990.
4. Breier A, Charney D, Heninger C. Agoraphobia with panic attacks. Arch Gen Psychiatry 1986; 43(11): 1029-36.
5. Kushner M.G., Beitman B.D. Panic attacks without fear: an overview. Behav Res Ther 1990; 28(6): 469-79.
6. Vein A.M., Dyukova G.M., Vorobieva O.V., Danilov A.B. Panic attacks. SPb. 1997.
7. Jacob RG, Lilienfeld SO. Panic disorder: diagnosis, medical assessment, and psychological assessment. In: Walker IR, Norton GR, Ross CA (eds.). Panic Disorder and Agoraphobia. Belmont 1991; Part 3: 433-69.
8. Lesser IM, Rubin RT et al Secondary depression in panic disorder and agoraphobia. Arch Gen Psychiatry 1988; 45:437-43.
9. Smulevich A.V., Kozyrev V.N., Syrkin A.L. Depression in somatic patients. M. 1997; 108.
10. Djukova GM, Shepeleva JP, Vorob'eva OB. Treatment of vegetative crises (panic attacks). Neurosci Behav Physiol 1992; 22(4): 343-5.
11. Tesar GE, Rosenbaum JF, Pollack MN et al. Double-blind, placebo-controlled comparison of clonazepam and alprazolam for panic disorder. J Clin Psychiatry 1991; 52:69-76.
12. Wade AG. Antidepressants in panic disorder. Intern Clin Psychopharmacol 1999; 14(Suppl. 2): 13-7.

The most typical somatovegetative manifestations of depression include sleep disorders. Still Aretaeus of Cappadocia in the II century. n. e. described people with depression as "sad, despondent, and sleepless." E. Kraepelin (1910) noted that sleep in such patients is superficial and is accompanied by frequent, prolonged awakenings. J. Glatzel (1973) believed that "broken sleep" or early awakening, along with a decrease in urges and a decrease in the ability to emotional resonance, can be an expression of depression even in the absence of a dreary mood. According to the literature, out of every 500 patients with endogenous depression, 99.6% complain of sleep disorders, and out of 1000 - 83.4%, and in 2% of cases, agryptic manifestations precede other symptoms of the disease.

This obligatory nature of sleep-wake cycle disorders in depression is based on common neurochemical processes. Serotonin, whose mediation disorders play an important role in the genesis of depression, is not only of outstanding importance in organizing deep slow wave sleep, but also in initiating REM sleep. This also applies to other biogenic amines, in particular norepinephrine and dopamine, the deficiency of which is important both in the development of depression and in the organization of the sleep-wake cycle.

Types of sleep disorders

Sleep disorders can be either the main (sometimes the only) complaint that masks depression, or one of many. It is believed that a "broken dream" or early morning awakening, along with a decrease in urges and a decrease in the ability to emotionally resonate, can indicate the presence of depression and in the absence of a dreary mood. Dissomnic disorders (disturbances in the functions of sleep and dreams) are most often manifested by insomnia (intermittent sleep with unpleasant dreams, early awakening with difficult, painful rise requiring volitional effort) or hypersomnia (compensatory lengthening of sleep duration). Hypersomnia is pathological drowsiness. Mild depression is often accompanied by increased drowsiness. Sleep acquires a certain psychological significance for such patients, a kind of dependence on sleep is formed, since at this time, according to them, they “rest” from the painful experiences of the waking state. As depression deepens, hypersomnia gives way to insomnia.

Insomnia is a significant reduction in the norm of daily sleep up to complete insomnia. Sometimes there is a complete lack of sleep for a long time. It should be noted that the complaints of many patients about insomnia are often exaggerated and reflect the fear of insomnia rather than true sleep disturbances: efforts to accelerate the onset of sleep in fact only prevent it. In depressive patients with anxiety symptoms, sometimes there is a fear of sleep (“I will fall asleep and not wake up”), hypnagogic mentism, and vegetative-vascular paroxysms. With the onset of night, the need for sleep in depressive patients may be lost, there is a desire to do something, "sleep does not go."

Sometimes falling asleep can be disturbed in the sense that it comes on suddenly, without a preceding drowsy period: “I fall asleep accidentally, as I turn off, I fall into sleep.” Awakening can be just as sudden. Quite often, falling asleep is accompanied by other disorders: myoclonic jerks, unusual bodily sensations, grinding of teeth (bruxism), a feeling of increase or decrease in the size of the body and its individual parts. Often observed with masked depression "the phenomenon of restless legs" - a feeling of numbness of one or another part of the body, paresthesia, which soon disappear if patients begin to knead, massage the corresponding part of the body. The nature of dreams in depressive patients also changes. As a rule, such painful dreams are characterized by a chaotic and unmemorable change of images. Stereotypically recurring dreams may occur.

Appetite disorders are expressed by nutritional deficiency with a complete loss of hunger up to aversion to food, associated with weight loss, constipation; morning sickness, lack of appetite.

Somatovegetative disorders determine the clinical picture of an affective disorder, "masking" the manifestations of hypothymia itself. The depressive phase in these observations manifests itself as sleep and appetite disorders with objectively recorded isolated monosymptoms or a combination of them. The debut of the disease is sudden - patients accurately date the time of the disappearance of sleep and appetite. Disorders of the sleep process, in contrast to the so-called peristatic variants with a violation of the dynamics of carotid inhibition and its depth, are expressed by the loss of the need for sleep with complete insomnia or a sharp reduction (up to 2-3 hours per day) of its duration. A short, interrupted sleep does not bring rest, awakening is painful, and, despite the feeling of fatigue, there is no drowsiness.

The loss of the need for satiety, like insomnia, occurs suddenly and is manifested by a complete loss of appetite up to aversion to food, intolerance even to the smell of food, urges for nausea and vomiting. Forced refusal to eat, characteristic of depressive anorexia, is accompanied by malnutrition with a significant decrease in body weight that occurs over 1-2 weeks of illness. The depressive affect in these cases is represented by depression with lethargy, internal discomfort, consonant with the “negative tone of vital sensations” and anxious fears about the somatic state, while the feeling of melancholy and ideas of self-blame characteristic of endogenous depression are absent. At the same time, in most patients, a feature characteristic of vital depressions is found - susceptibility to the daily rhythm: the most painful state of health occurs in the morning hours.

The reverse development of an affective disorder is characterized by a reduction in somatovegetative disorders, followed by a reverse development of depressive symptoms. With the repetition of phase affective states, the hypothymic component of the syndrome itself becomes more pronounced - a feeling of vital anguish, mental pain, ideas of low value come to the fore, while somatovegetative disorders are relegated to the background.

Timely diagnosis of autonomic depression is of great practical importance, however, during the initial treatment, it is diagnosed only in 0.5-4.5% of cases (W. Katon et al., 1982), and therefore the doctor "treats" only physical symptoms , especially since patients do not critically evaluate their condition and are extremely negative about the proposal to consult a psychiatrist. However, the longer the patient considers himself a somatic patient and the longer the doctor concentrates on this, the more the patient enters the role of a somatic patient, for him it becomes a “lifestyle”. Patients with poor adaptation at work, a conflict family and difficulties in relationships are most susceptible to this.

According to a number of authors, the presence of somatovegetative disorders (sleep disturbances, loss of appetite) in the clinical picture of endogenous depression serves as a good prognostic factor in terms of the effectiveness of antidepressant therapy. Patients with depression with severe somatovegetative disorders have a higher psychopharmacological lability and greater sensitivity to antidepressants. In this regard, the choice of therapy should minimize the phenomena of behavioral toxicity (lethargy, daytime sleepiness, inhibition of cognitive functions) and possible side disorders, especially autonomic.

Given the fact that in these cases, the most painful manifestations of the pathological condition are agryptic disorders, the choice of drugs to normalize sleep function requires special discussion. Drug treatment of insomnia is primarily provided by the appointment of antidepressants with a sedative effect (amitriptyline - tryptizol, trimipramine - gerfonal, doxepin - sinequan, maprotiline - ludiomil, mianserin - lerivon, etc.) in the evening. If their intake is insufficient, the use of benzodiazepine tranquilizers (diazepines - Valium, Seduxen, Relanium, Sibazone; chlordiazepoxide - Librium, Elenium; Bromazepam - Lexotane; Lorazepam - Ativan, Merlit; Phenazepam) and preparations of that the same groups with a predominant hypnotic effect (nitrazepam - eunoctin; radedorm, reladorm, rohypnol, midazolam - dormicum, triazolam - halcion, flurazepam - dalmadorm, etc.).

However, the use of these medications may be undesirable due to the possibility of side effects that exacerbate autonomic disorders with a sense of bodily discomfort (lethargy, drowsiness in the morning, muscle relaxation, hypotension, ataxia). In case of poor tolerability of benzodiazepines, some antihistamines (diphenhydramine, pipolfen, suprastin), as well as a tranquilizer of the piperazine series hydroxyzine (atarax), a blocker of histamine H1 receptors, which, along with antihistamine properties, has high anxiolytic activity, can be used. Hypnotics of other chemical groups are also shown. Among such medicines, derivatives of cyclopyrrones - zopiclone (Imovan) and drugs of the imidazopyridine group - zolpidem (Ivadal) can be noted. The latter reduce nocturnal awakenings and ensure the normalization of sleep duration (up to 7-8 hours), without causing weakness, lethargy, asthenic manifestations after waking up.

The choice of one or another hypnotic agent should be based on knowledge of the predominant effect of the drug on pre-, intra-, or post-somnic sleep disorders. So, to improve the quality of falling asleep, it is preferable to prescribe Imovan, while Rohypnol and radedorm have a greater effect on the depth of sleep. The normalization of the duration of sleep in the morning is facilitated by the appointment of a drug such as reladorm.

In some cases, antipsychotics with a pronounced hypnotic effect are used: promazine (propazine), chlorprothixene, thioridazine (sonapax), alimemazine (teralen). It is also necessary to exclude the evening intake of psychotropic drugs that can cause insomnia (antidepressants with a stimulating effect - MAO inhibitors, nootropics, stimulants that prevent falling asleep and provoke frequent awakenings).

With vegetative depression, often combined with somatized and psychosomatic disorders, the use of eglonil, befol and noveril is especially indicated, including in combination with vegetotropic phytotranquilizers - novopassit, persen, hawthorn.

Complementary Therapies

Of interest are some non-pharmacological methods that act on the depressive radical and concomitant dyssomnic disorders - sleep deprivation and phototherapy. Deprivation (deprivation) of sleep is the more effective method, the more severe depressive disorders are. Some authors believe that this technique is comparable in effectiveness to electroconvulsive therapy. Sleep deprivation can be an independent method of treating patients with subsequent transition to antidepressants. Apparently, it should be used in all patients resistant to pharmacotherapy in order to increase the possibilities of the latter.

A certain cyclicity of episodes of dysthymia in autumn and winter, alternating with euthymia and hypomania in late spring and summer, has long been identified. In autumn, increased sensitivity to cold, fatigue, decreased performance and mood, preference for sweet foods (chocolate, sweets, cakes), weight gain, and sleep disturbances appear. Sleep lengthens on average by 1.5 hours compared to summer, drowsiness in the morning and afternoon, poor quality of night sleep. Phototherapy (treatment with bright white light) has become the leading method of treatment for such patients, exceeding in its effectiveness almost all antidepressants.

Autonomic depression and its characteristics

Autonomic depression is a type of mental disorder, the main symptoms of which are disorders of the autonomic nervous system. This condition requires the obligatory supervision of the attending physician. Symptoms of this type of depression are quite diverse. The disease can occur in people of different ages, genders, social status, professions. If you have symptoms of pathology, you should seek help from a specialist in a timely manner.

Clinical picture

Autonomic depression is characterized by a wide range of different symptoms. This psychosomatic disease provokes multiple manifestations of physical ailments. With typical depression, the patient's mood decreases, he becomes apathetic, and a pessimistic outlook on life prevails. Emotions, if they arise, are negative. The patient loses interest in what is happening around, his self-esteem is significantly reduced, suicidal thoughts may occur.

Autonomic depression is characterized by a predominance of autonomic disorders. The patient has a lot of unpleasant or painful sensations that are not associated with any physical pathologies.

Physical manifestations of a depressive disorder can be not only pain of a different nature, but also dizziness, nausea, digestive upset, excessive sweating, loss of appetite, shortness of breath. The patient constantly feels weakness, quickly gets tired, even minor loads require serious efforts from him. At the same time, sleep disturbances occur, the patient develops insomnia, he is haunted by nightmares. There is a decrease in libido, a change in body weight, both upward and downward (weight loss usually develops).

There may be other symptoms of a vegetative disorder. The most striking manifestations of pathology are panic attacks and a vegetative crisis. These are paroxysmal autonomic disorders. Also, vegetative disorders can manifest themselves in the form of permanent disorders.

Diagnosis

Only a specialist can make a reliable diagnosis. If depression is larvated (occurs in a latent form), then its symptoms resemble many different diseases. After a comprehensive examination of the patient, the diagnosis can be established. It is also important to find out the cause that led to the development of the disease. There can be many reasons for depression.

Treatment of pathology

Treatment of autonomic depression is carried out in a complex manner. Therapy of psychovegetative disorders is carried out with the help of drugs such as antidepressants, tranquilizers, antipsychotics. Vegetotropic agents are also used. Other drugs may be used depending on the indications.

In addition to drug treatment, the patient may be recommended psychotherapy, which, together with medications, will speed up the healing process. Additionally, various physiotherapeutic procedures can be used that help improve the general condition of the body. Useful will be yoga, swimming, breathing exercises, reflexology, breathing exercises. Massage in combination with aromatherapy and regular physical activity will also improve the patient's condition. Proper nutrition also plays a significant role.

new entries

The information on the site is provided for informational purposes only, does not claim medical accuracy and is not a guide to action. Do not self-medicate. Consult with your physician. The use of materials from the site is prohibited. Contacts | We are on Google+

Depression. Causes, symptoms, treatment of the disease

Frequently asked Questions

The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious physician.

Current Statistics on Depression

• high pace of life;
• a large number of stress factors;
• high population density;
• isolation from nature;
• alienation from centuries-old traditions, which in many cases have a protective effect on the psyche;
• the phenomenon of "loneliness in the crowd", when constant communication with a large number of people is combined with the absence of close warm "unofficial" contact;
• lack of motor activity (it has been proven that a banal physical movement, even ordinary walking, has a positive effect on the state of the nervous system);
• population aging (the risk of depression increases many times with age).

Different Differences: Interesting Depression Facts

• The author of "gloomy" stories Edgar Allan Poe suffered from bouts of depression, which he tried to "treat" with alcohol and drugs.
• There is a hypothesis that talent and creativity contribute to the development of depression. The percentage of depressive and suicidal among outstanding figures of culture and art is much higher than in the general population.
• The founder of psychoanalysis, Sigmund Freud, gave one of the best definitions of depression when he defined pathology as self-directed irritation.
• People suffering from depression are more likely to have fractures. Studies have shown that this is associated with both a decrease in attention and a deterioration in the condition of the bone tissue.
• Contrary to popular belief, nicotine is in no way able to “help relax”, and puffing on cigarette smoke only brings visible relief, in fact, aggravating the patient’s condition. Among smokers, there are significantly more patients suffering from chronic stress and depression than among people who do not use nicotine.
• Addiction to alcohol increases the risk of developing depression several times.
• People suffering from depression are more likely to fall victim to the flu and SARS.
• It turned out that the average gamer is a person suffering from depression.
• Danish researchers have found that paternal depression has a very negative effect on the emotional state of infants. These babies cry more often and sleep worse.
• Statistical studies have shown that overweight children of kindergarten age have a significantly higher risk of developing depression than their peers who are not overweight. At the same time, obesity significantly worsens the course of childhood depression.
• Depressed women have a significantly higher risk of preterm birth and other complications during pregnancy.
• According to statistics, every 8 out of 10 patients suffering from depression refuse specialized care.
• The lack of affection, even with a relatively prosperous financial and social situation, contributes to the development of depression in children.
• Approximately 15% of depressed patients commit suicide each year.

Causes of depression

Classification of depressions according to the cause of their development

• external influences on the psyche
  • acute (psychological trauma);
  • chronic (state of constant stress);
• genetic predisposition;
• endocrine shifts;
• congenital or acquired organic defects of the central nervous system;
• somatic (bodily) diseases.

However, in the vast majority of cases, a leading causative factor can be identified. Based on the nature of the factor that caused the depressed state of the psyche, all types of depressive states can be divided into several large groups:

1. Psychogenic depression, which is a reaction of the psyche to any adverse life circumstances.
2. Endogenous depressions (literally caused by internal factors) are psychiatric diseases, in the development of which, as a rule, a genetic predisposition plays a decisive role.
3. Depression associated with physiological endocrine changes in the body.
4. Organic depression caused by a severe congenital or acquired defect of the central nervous system;
5. Symptomatic depressions, which are one of the signs (symptoms) of a bodily disease.
6. Depression that develops in patients with alcohol and/or drug addiction.
7. Iatrogenic depression, which is a side effect of a drug.

Psychogenic depression

• tragedy in personal life (illness or death of a loved one, divorce, childlessness, loneliness);
• health problems (severe illness or disability);
• cataclysms at work (creative or production failures, conflicts in the team, job loss, retirement);
• experienced physical or psychological abuse;
• economic troubles (financial collapse, transition to a lower level of security);
• migration (moving to another apartment, to another district of the city, to another country).

Much less often, reactive depression occurs as a response to a joyful event. In psychology, there is such a term as “goal achieved syndrome”, which describes the state of emotional depression after the onset of a long-awaited joyful event (admission to a university, career achievement, marriage, etc.). Many experts explain the development of the achieved goal syndrome by the unexpected loss of the meaning of life, which was previously concentrated on one single achievement.

• genetic predisposition (close relatives were prone to melancholy, made suicide attempts, suffered from alcoholism, drug addiction or some other addiction, often masking the manifestations of depression);
• psychological trauma suffered in childhood (early orphanhood, divorce of parents, domestic violence, etc.);
• congenital increased vulnerability of the psyche;
• introversion (a tendency to self-deepening, which, when depressed, turns into fruitless self-digging and self-flagellation);
• features of character and worldview (pessimistic view of the world order, overestimated or, conversely, underestimated self-esteem);
• poor physical health;
• lack of social support in the family, among peers, friends and colleagues.

Endogenous depressions

Hormones play a leading role in the life of the body as a whole and in the functioning of the central nervous system in particular, therefore any fluctuations in the hormonal background can cause serious emotional disorders in susceptible individuals, as we see in the example of premenstrual syndrome in women.

• teenage depression;
• postpartum depression in women in labor;
• depression in menopause.

This kind of depressive states develop against the background of the most complex restructuring of the body, therefore, as a rule, they are combined with signs of asthenia (exhaustion) of the central nervous system, such as:

• increased fatigue;
• reversible decline in intellectual functions (attention, memory, creativity);
• reduced performance;
• increased irritability;
• tendency to hysteroid reactions;
• emotional weakness (tearfulness, capriciousness, etc.).

Changes in the hormonal background cause a tendency to impulsive actions. It is for this reason that “unexpected” suicides often occur in relatively shallow depressive states.

• damage to the cardiovascular system (ischemic heart disease, chronic circulatory failure);
• lung diseases (bronchial asthma, chronic pulmonary heart failure);
• endocrine pathologies (diabetes mellitus, thyrotoxicosis, Itsenko-Cushing's disease, Addison's disease);
• diseases of the gastrointestinal tract (peptic ulcer of the stomach and duodenum, enterocolitis, hepatitis C, cirrhosis of the liver);
• rheumatoid diseases (systemic lupus erythematosus, rheumatoid arthritis, scleroderma);
• oncological diseases (sarcoma, uterine fibroids, cancer);
• AIDS;
• ophthalmic pathology (glaucoma);
• genitourinary system (chronic pyelonephritis).

All symptomatic depressions are characterized by a relationship between the depth of depression and exacerbations and remissions of the disease - with a deterioration in the patient's physical condition, depression worsens, and when a stable remission is achieved, the emotional state normalizes.

Depressions that develop in alcoholism and/or drug addiction can be considered as signs of chronic poisoning of brain cells by neurotoxic substances, that is, as symptomatic depressions.

• antihypertensive drugs (drugs that lower blood pressure) - reserpine, raunatin, apressin, clonidine, methyldopa, propranalol, verapamil;
• antimicrobials - sulfanilamide derivatives, isoniazid, some antibiotics;
• antifungals (amphotericin B);
• antiarrhythmic drugs (cardiac glycosides, novocainamide);
• hormonal agents (glucocorticoids, anabolic steroids, combined oral contraceptives);
• lipid-lowering drugs (used for atherosclerosis) - cholestyramine, pravastatin;
• chemotherapeutic agents used in oncology - methotrexate, vinblastine, vincristine, asparaginase, procarbazine, interferons;
• drugs used to reduce gastric secretion - cimetidine, ranitidine.

• disorders of cerebral circulation (often accompanied by hypertension and atherosclerosis);
• coronary heart disease (as a rule, is a consequence of atherosclerosis and leads to arrhythmias);
• heart failure (often treated with cardiac glycosides);
• peptic ulcer of the stomach and duodenum (usually occurs with high acidity);
• oncological diseases.

These diseases can lead to irreversible changes in the central nervous system and the development of organic depression (impaired cerebral circulation) or cause symptomatic depression (gastric and duodenal ulcers, severe heart damage, oncological pathology).

• patients with a tendency to depression need to select drugs that do not have the ability to suppress the emotional background;
• these drugs (including combined oral contraceptives) should be prescribed by the attending physician, taking into account all indications and contraindications;
• treatment should be carried out under the supervision of a doctor, the patient should be informed of all unpleasant side effects - timely replacement of the drug will help to avoid many troubles.

Symptoms and signs of depression

Psychological, neurological and vegetative-somatic signs of depression

• decrease in the general emotional background;
• inhibition of thought processes;
• decrease in motor activity.

A decrease in the emotional background is a cardinal system-forming sign of depression and is manifested by the predominance of such emotions as sadness, melancholy, a sense of hopelessness, as well as a loss of interest in life up to the appearance of suicidal thoughts.

In addition, a variety of appetite disorders are observed in depressed patients. Sometimes bulimia (gluttony) develops due to loss of satiety, but loss of appetite up to complete anorexia is more common, so patients can lose significant weight.

• tachycardia (increased heart rate);
• mydriasis (dilated pupil);
• constipation.

In addition, an important feature is the specific changes in the skin and its appendages. Dry skin, brittle nails, hair loss are noted. The skin loses its elasticity, resulting in the formation of wrinkles, often a characteristic fracture of the eyebrows appears. As a result, patients look much older than their age.

Criteria for the diagnosis of depression

The main symptoms of depression

• a decrease in mood (determined by the sensation of the patient himself or from the words of relatives), while a reduced emotional background is observed almost daily for most of the day and lasts at least 14 days;
• loss of interest in activities that used to bring pleasure; narrowing the range of interests;
• decreased energy tone and increased fatigue.

Additional symptoms

• decreased ability to concentrate;
• decreased self-esteem, loss of self-confidence;
• delusions of guilt;
• pessimism;
• thoughts of suicide;
• sleep disorders;
• appetite disorders.

Positive and negative signs of depression

• positive symptoms (the appearance of any sign that is not normally observed);
• negative symptoms (loss of any psychological ability).

Positive symptoms of depression

• Longing in depressive states is in the nature of painful mental suffering and is felt in the form of intolerable oppression in the chest or in the epigastric region (under the pit of the stomach) - the so-called precordial or epigastric longing. As a rule, this feeling is combined with despondency, hopelessness and despair, and often leads to suicidal impulses.
• Anxiety often has an indefinite character of a painful premonition of an irreparable disaster and leads to constant timid tension.
• Intellectual and motor retardation is manifested in the slowness of all reactions, impaired attention function, loss of spontaneous activity, including the performance of everyday simple duties, which become a burden to the patient.
• Pathological circadian rhythm - characteristic fluctuations in the emotional background during the day. At the same time, the maximum severity of depressive symptoms occurs in the early morning hours (for this reason, most suicides occur in the first half of the day). By the evening, the state of health, as a rule, improves significantly.
• The ideas of one’s own insignificance, sinfulness and inferiority, as a rule, lead to a kind of reassessment of one’s own past, so that the patient sees his own life path as a continuous series of failures and loses all hope for “light at the end of the tunnel”.
• Hypochondriacal ideas - represent an exaggeration of the severity of associated physical ailments and / or fear of sudden death from an accident or fatal illness. With severe endogenous depressions, such ideas often take on a global character: patients claim that “everything is already rotten in the middle”, certain organs are missing, etc.
• Suicidal thoughts - the desire to commit suicide sometimes takes on an obsessive character (suicide mania).

Negative symptoms of depression

• Painful (mournful) insensitivity - most common in manic-depressive psychosis and is a painful feeling of complete loss of the ability to experience such feelings as love, hate, compassion, anger.
• Moral anesthesia is mental discomfort due to the realization of the loss of elusive emotional ties with other people, as well as the extinction of such functions as intuition, fantasy and imagination (also most characteristic of severe endogenous depressions).
• Depressive devitalization - the disappearance of the desire for life, the extinction of the instinct of self-preservation and the main somatosensory urges (libido, sleep, appetite).
• Apathy - lethargy, indifference to the environment.
• Dysphoria - gloominess, grouchiness, pettiness in claims to others (more common with involutional melancholy, senile and organic depressions).
• Anhedonia - the loss of the ability to enjoy everyday life (communication with people and nature, reading books, watching TV series, etc.), is often recognized and painfully perceived by the patient, as another proof of his own inferiority.

Treatment for depression

What medications can help with depression

The main group of drugs prescribed for depression are antidepressants - drugs that increase the emotional background and return the patient the joy of life.

This group of medicines was discovered in the middle of the last century quite by accident. Doctors used the new drug isoniazid and its analogue, iproniazid, to treat tuberculosis and found that patients' mood improved significantly even before the symptoms of the underlying disease began to subside.

• stimulating effect on the nervous system;
• sedative (calming) effect;
• anxiolytic properties (relieves anxiety);
• anticholinergic effects (such drugs have many side effects and are contraindicated in glaucoma and some other diseases);
• hypotensive effect (lower blood pressure);
• cardiotoxic effect (contraindicated in patients suffering from serious heart disease).

First and second line antidepressants

Prozac drug. One of the most popular first-line antidepressants. It has been successfully used for teenage and postpartum depression (breastfeeding is not a contraindication to Prozac).

• selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Fevarin), citalopram (Cipramil);
• selective serotonin reuptake stimulants (SSOZS): tianeptine (coaxil);
• individual representatives of selective norepinephrine reuptake inhibitors (SNRIs): mianserin (lerivon);
• reversible inhibitors of monoamine oxidase type A (OIMAO-A): pirlindol (pyrazidol), moclobemide (Aurorix);
• adenosylmethionine derivative - ademetionine (heptral).

An important advantage of first-line drugs is the compatibility with other drugs, which some patients are forced to take in view of the presence of concomitant diseases. In addition, even with prolonged use, these drugs do not cause such an extremely unpleasant effect as a significant weight gain.

• monoamine oxidase inhibitors (MAOIs): iproniazid, nialamide, phenelzine;
• thymoanaleptics of a tricyclic structure (tricyclic antidepressants): amitriptyline, imipramine (melipramine), clomipramine (anafranil), doxilin (sinequan);
• some representatives of SNRIs: maprotiline (ludiomil).

Second-line drugs have a high psychotropic activity, their action is well studied, they are very effective in severe depression, combined with severe psychotic symptoms (delusions, anxiety, suicidal tendencies).

In cases where the patient has already successfully taken an antidepressant, doctors usually prescribe the same drug. Otherwise, drug treatment for depression begins with first-line antidepressants.

When choosing a drug, the doctor focuses on the severity and prevalence of certain symptoms. So, in depressions that occur mainly with negative and asthenic symptoms (loss of taste for life, lethargy, apathy, etc.), drugs with a slight stimulating effect are prescribed (fluoxetine (Prozac), moclobemide (Aurorix)).

What drugs can be prescribed additionally in the treatment of antidepressants

In severe cases, doctors combine antidepressants with drugs from other groups, such as:

• tranquilizers;
• neuroleptics;
• nootropics.

Tranquilizers are a group of medications that have a calming effect on the central nervous system. Tranquilizers are used in the combined treatment of depression that occurs with a predominance of anxiety and irritability. In this case, drugs from the benzodiazepine group are most often used (phenazepam, diazepam, chlordiazepoxide, etc.).

• Tablets are best taken at the same time. Depressed patients are often absent-minded, so doctors suggest keeping a diary to keep track of drug use, as well as notes on its effectiveness (improvement, no change, unpleasant side effects).
• The therapeutic effect of drugs from the group of antidepressants begins to appear after a certain period after the start of administration (after 3-10 or more days, depending on the specific drug).
• Most of the side effects of antidepressants, on the contrary, are most pronounced in the first days and weeks of admission.
• Contrary to popular belief, drugs intended for the medical treatment of depression, when taken in therapeutic doses, do not cause physical and mental dependence.
• Antidepressants, tranquilizers, antipsychotics and nootropics do not develop addiction. In other words: there is no need to increase the dose of the drug for long-term use. On the contrary, over time, the dose of the drug may be reduced to the minimum maintenance dose.
• With a sharp cessation of antidepressants, the development of a withdrawal syndrome is possible, which is manifested by the development of such effects as melancholy, anxiety, insomnia, and suicidal tendencies. Therefore, drugs used to treat depression are discontinued gradually.
• Treatment with antidepressants should be combined with non-drug treatments for depression. Most often, drug therapy is combined with psychotherapy.
• Drug therapy for depression is prescribed by the attending physician and is carried out under his supervision. The patient and / or his relatives should promptly inform the doctor about all adverse side effects of treatment. In some cases, individual reactions to the drug are possible.
• The replacement of an antidepressant, the transition to combined treatment with drugs from different groups and the cessation of drug therapy for depression are also carried out on the recommendation and under the supervision of the attending physician.

Do I need to see a doctor for depression?

• depressed mood persists for more than two weeks and there is no tendency to improve the general condition;
• previously helped methods of relaxation (communication with friends, music, etc.) do not bring relief and do not distract from gloomy thoughts;
• there are thoughts of suicide;
• disrupted social ties in the family and at work;
• the circle of interests narrows, the taste for life is lost, the patient "goes into himself."

A person who is depressed will not be helped by advice that “you need to pull yourself together”, “get busy”, “have fun”, “think about the suffering of loved ones”, etc. In such cases, the help of a professional is necessary, because:

• even with mild depression, there is always a threat of a suicide attempt;
• depression significantly reduces the patient's quality of life and performance, adversely affects his immediate environment (relatives, friends, colleagues, neighbors, etc.);
• like any disease, depression can worsen over time, so it is better to consult a doctor in a timely manner to ensure a speedy and full recovery;
• depression can be the first sign of severe bodily ailments (oncological diseases, multiple sclerosis, etc.), which are also better treated in the early stages of pathology development.

Which doctor should be consulted for the treatment of depression

• About complaints
  • what worries more melancholy and anxiety or apathy and lack of "taste of life"
  • whether depressed mood is combined with sleep disturbances, appetite, sexual desire;
  • at what time of the day are pathological symptoms more pronounced - in the morning or in the evening
  • whether there were thoughts of suicide.
• History of present illness:
  • with what the patient associates the development of pathological symptoms;
  • how long ago they appeared;
  • How did the disease develop?
  • what methods the patient tried to get rid of unpleasant symptoms;
  • what medications the patient took on the eve of the development of the disease and continues to take today.
• Current state of health (it is necessary to report all concomitant diseases, their course and methods of therapy).
• Life story
  • past psychological trauma;
  • have had episodes of depression before;
  • past illnesses, injuries, operations;
  • attitude towards alcohol, smoking and drugs.
• Obstetric and gynecological history (for women)
  • whether there were menstrual irregularities (premenstrual syndrome, amenorrhea, dysfunctional uterine bleeding);
  • how the pregnancies went (including those that did not end with the birth of a child);
  • whether there were signs of postpartum depression.
• Family history
  • depression and other mental illnesses, as well as alcoholism, drug addiction, suicide among relatives.
• Social history (relationships in the family and at work, whether the patient can count on the support of relatives and friends).

It should be remembered that detailed information will help the doctor at the first appointment to determine the type of depression and decide on the need to consult other specialists.

How a specialist treats depression

• individual
• group;
• family;
• rational;
• suggestive.

The basis of individual psychotherapy is the close direct interaction between the doctor and the patient, during which the following occurs:

• deep study of the personal characteristics of the patient's psyche, aimed at identifying the mechanisms of development and maintenance of a depressive state;
• the patient's awareness of the features of the structure of his own personality and the causes of the development of the disease;
• correction of the patient's negative assessments of his own personality, his own past, present and future;
• rational solution of psychological problems with the closest people and the surrounding world in all its integrity;
• informational support, correction and potentiation of ongoing drug therapy for depression.

Group psychotherapy is based on the interaction of a group of people - patients (usually in the amount of 7-8 people) and a doctor. Group psychotherapy helps each patient to see and realize the inadequacy of their own attitudes, manifested in the interaction between people, and correct them under the supervision of a specialist in an atmosphere of mutual goodwill.

• suggestion in the waking state, which is a necessary moment of any communication between a psychologist and a patient;
• suggestion in a state of hypnotic sleep;
• suggestion in a state of medical sleep;
• self-hypnosis (autogenic training), which is carried out by the patient on his own after several training sessions.

In addition to medication and psychotherapy, the following methods are used in the combined treatment of depression:

• physiotherapy
  • magnetotherapy (using the energy of magnetic fields);
  • light therapy (prevention of exacerbations of depression in the autumn-winter period with the help of light);
• acupuncture (irritation of reflexogenic points with the help of special needles);
• music therapy;
• aromatherapy (inhalation of aromatic (essential) oils);
• art therapy (therapeutic effect of the patient's fine arts)
• physiotherapy;
• massage;
• treatment with the help of reading verses, the Bible (bibliotherapy), etc.

It should be noted that the methods listed above are used as auxiliary and have no independent value.

• Electroconvulsive therapy (ECT) involves passing an electric current through the patient's brain for a few seconds. The course of treatment consists of 6-10 sessions, which are carried out under anesthesia.
• Sleep deprivation - refusal of sleep for a day and a half (the patient spends the night without sleep and the whole next day) or late sleep deprivation (the patient sleeps until one in the morning, and then goes without sleep until the evening).
• Unloading and dietary therapy - is a long-term fasting (nearby) followed by a restorative diet.

Shock therapy methods are carried out in a hospital under the supervision of a doctor after a preliminary examination, since not everyone is shown. Despite the apparent "rigidity", all of the above methods, as a rule, are well tolerated by patients and have high rates of effectiveness.

What is postpartum depression?

• genetic (episodes of depression in close relatives);
• obstetric (pathology of pregnancy and childbirth);
• psychological (increased vulnerability, psychological trauma and depressive states);
• social (absence of a husband, conflicts in the family, lack of support from the immediate environment);
• economic (poverty or the threat of a decrease in the level of material well-being after the birth of a child).

It is believed that the main mechanism for the development of postpartum depression are strong fluctuations in the hormonal background, namely the level of estrogens, progesterone and prolactin in the blood of a woman in labor.

• emotional depression, sleep and appetite disturbances persist for several weeks after childbirth;
• signs of depression reach a considerable depth (a woman in labor does not fulfill her duties in relation to the child, does not participate in the discussion of family problems, etc.);
• fears become obsessive, ideas of guilt towards the child develop, suicidal intentions arise.

Postpartum depression can reach different depths - from prolonged asthenic syndrome with low mood, sleep and appetite disturbances to severe conditions that can turn into acute psychosis or endogenous depression.

What is teen depression?

• associated with puberty endocrine storm in the body; increased growth, often leading to asthenia (depletion) of the body's defenses;

Depression in adolescence has its own characteristics:

• symptoms of sadness, melancholy and anxiety characteristic of depressive states in adolescents often manifest themselves in the form of gloom, capriciousness, outbursts of hostile aggression towards others (parents, classmates, friends);
• often the first sign of depression in adolescence is a sharp decline in academic performance, which is associated with several factors at once (decreased attention function, increased fatigue, loss of interest in learning and its results);
• isolation and withdrawal in adolescence, as a rule, manifests itself in the form of a narrowing of the social circle, constant conflicts with parents, frequent changes of friends and acquaintances;
• the ideas of own inferiority characteristic of depressive states in adolescents are transformed into an acute rejection of any criticism, complaints that no one understands them, no one loves them, etc.
• apathy and loss of vitality in adolescents, as a rule, is perceived by adults as a loss of responsibility (missing classes, being late, careless attitude to one's own duties);
• in adolescents more often than in adults, depressive states are manifested by bodily pains unrelated to organic pathology (headaches, pains in the abdomen and in the region of the heart), which are often accompanied by fear of death (especially in suspicious adolescent girls).

Adults often perceive the symptoms of depression in a teenager as unexpectedly manifested bad character traits (laziness, indiscipline, spitefulness, bad manners, etc.), as a result, young patients become even more withdrawn into themselves.

• aggravation of signs of depression, withdrawal into oneself;
• suicide attempts;
• running away from home, the appearance of a passion for vagrancy;
• propensity to violence, desperate reckless behavior;
• alcoholism and / or drug addiction;
• early promiscuity;
• joining socially unfavorable groups (sects, youth gangs, etc.).