Clinical depression treatment: read in all the details

Recurrent Depressive Disorder

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Recurrent depressive disorder is characterized by recurrent episodes of mood decline and decreased thinking and motor activity, each lasting from two weeks to six months (possibly more). Periods of full health (intermissions) are observed between episodes of depression.

The person cannot work, and sometimes tries to withdraw by any means. Therefore, it is necessary not only to see a therapist, but also to do it as soon as possible.

In the dynamics of the disease, there are no manias – periods of elevated mood and physical and mental activity. This distinguishes recurrent depression from bipolar affective disorder.

Recurrent disorder is caused by a disorder of the metabolism of noradrenaline, dopamine, serotonin, through which nerve cells – neurons – conduct impulses and transmit information. The cause of these disorders has not been established. There is evidence of genetic causes of the disease, the theory of damage at the neuronal level with the formation of foci of activity similar to epilepsy, the theory of disorders of sleep and wakefulness rhythms.

Symptoms and Signs of Recurrent Depressive Disorder

The psychotherapist evaluates the degree of severity of the manifestations of the current episode and establishes its degree of severity.

At a mild degree of severity, the patient can still perform social functions – work, maintain social relations and manage the household. Moderate severity allows doing this with difficulty, and the capacity for work, motor and thinking activity is limited. With a severe degree, even basic needs are met with difficulty – the person does not get out of bed, does not eat or drink, and the suicidal risk is maximal.

During each relapse of depression, the patient may show the following signs :

  • poor ability to concentrate – patients have a hard time making decisions and taking responsibility, both large-scale (production, personal) and minimal (what to wear, what to eat);
  • Negative evaluations of the past, present and especially the future;
  • feeling of hopelessness – can be blunted during the day due to the fact that the patient is distracted by daily activities and temporarily not fixated on negative emotions and thoughts
  • decreased or increased appetite;
  • insomnia with early awakening and inability to fall asleep again, or increased sleepiness, where the patient wakes up sleep-deprived and constantly wants to sleep regardless of the time and quality of sleep
  • a general lack of vitality and strength;
  • decreased self-confidence and self-esteem;
  • decreased sex drive.

A psychotherapist or psychiatrist together with a clinical psychologist diagnoses recurrent depressive disorder.

Recurrent depressive disorder meets the criteria of classic depression in its symptoms. It is based on the depressive triad, which was put forward by the German psychiatrist Emil Kraepelin at the turn of the 19th and 20th centuries:

  1. Decline in mood.
  2. Decrease of motor activity.
  3. Deceleration of thinking activity.

These signs should significantly affect the patient’s personal and professional life.

Melancholic and anxious depression

In classical psychiatry, it is customary to distinguish melancholic and anxious depression, although these forms are not limited to the disorder.

Melancholic depression is the most severe form. Patients experience “vital” longing – it is described as physical pain in the soul, chest, neck, and head. The person lies in bed facing the wall for days, stops talking, stops taking care of themselves. He has no pleasure in anything, even in things he used to love very much. He has persistent suicidal thoughts, which only the general collapse of strength prevents him from realizing.

Suicidal thoughts and intentions can be hidden from others, therefore with depression it is necessary to see an experienced therapist.

Anxiety depression is expressed in hypochondriacal ideas (presentiment of nonexistent illnesses), anxiety due to negative future scenarios, expressed vegetative-somatic manifestations – palpitations, cognitations, cold sweats, digestive disorders.

Diagnosis of recurrent depressive disorder

The diagnosis is made by a psychotherapist or psychiatrist. To confirm the diagnosis, it is necessary to:

  1. Clinical-anamnestic examination – the doctor identifies the patient’s symptoms and collects detailed information about his or her life.
  2. Pathopsychological examination – performed by a clinical psychologist; he evaluates personality characteristics and describes abnormalities in thinking, attention, memory, and motivation.
  3. Consultation of a candidate or doctor of sciences, a consilium of specialists – in complicated cases, when symptoms are poorly treated or the diagnosis is doubtful.
  4. Laboratory and instrumental methods for diagnosing the disorder have not yet been developed.

To exclude organic and endogenous diseases (schizophrenia, schizotypal disorder) and prescribe adequate therapy, Neurotest, Neurophysiological test system, EEG are used.

Treatment of recurrent depressive disorder

A combination of pharmacotherapy and psychotherapy is used, the treatment itself is divided into a cupping, stabilizing and supporting stages. Read more in this article about the treatment of recurrent depressive disorder.

When properly diagnosed and appropriately treated, the prognosis is favorable.

Depression – symptoms and treatment

What is depression? Causes, diagnosis and treatment methods will be discussed in an article by Dr. Elena Gennadievna Magonova, a psychotherapist with 21 years of experience.

The article by Elena Magonova was written by the literary editor Yelena Berezhnaya and the scientific editor Sergey Fedosov.

Definition of the disease. Causes of the disease

According to the WHO definition, depression ( depression ) – it is a common mental illness, which is characterized by enduring sadness and loss of interest in what usually brings pleasure, the inability to perform everyday activities, accompanied by feelings of guilt, decreased self-esteem for 14 days or more.

Signs of depression: feelings of indecision, impaired concentration, psychomotor retardation or agitation, sleep disturbances, changes in appetite and weight.

In psychology, depression (from Latin depressio – suppression) is defined as an affective state characterized by a negative emotional background, changes in the motivational sphere, cognitive (cognition-related) ideas and general passivity of behavior.

It is important to distinguish depression as a clinically pronounced illness from a depressive reaction to a psychologically understandable situation, when each of us experiences a lowered mood for a few minutes or hours in connection with a subjectively significant event. About 16% of people have experienced depression at least once in their lifetime. [1]

It has been observed that women are reliably more likely to be diagnosed with depression, which is likely due to the fact that women are subject to greater neuro-endocrine changes. This is due to a number of physiological features of the female body – the menstrual cycle, postpartum or menopause, during which the psychoemotional state can fluctuate from normal to clinically outlined depression. In addition, women are more likely to be diagnosed with depression due to their gender, social, and psychological characteristics – for example, women find it easier to talk about their emotional state.

Men usually seek help from a psychiatrist or psychotherapist less often because they are hindered by social stereotypes: men should be rational, strong, “real men do not cry”, and depression in men is directly related to addictive behaviors (alcoholism, drug addiction, gambling addiction, extreme sports).

The risk of developing a depressive disorder increases significantly in the following cases:

  • In old age due to loss of meaning in life (retirement);
  • when in a child-centered family, adult children grow up and leave their parents (the “empty nest” syndrome);
  • the loss of a loved one.

Nowadays, the biopsychosocial model of depression development, according to which the causes of depression are social, psychological and biological provoking factors, is generally accepted.

The social factors that lead to depression are:

  • Acute and chronic stress (loss, infidelity, divorce, various forms of domestic violence);;
  • loss or change of employment;
  • high psycho-emotional stress in professional activity;
  • retirement;
  • economic crises;
  • political instability in the country.

Psychological causes of depression:

  • A tendency to get stuck in the experience on unfavorable events as a property of temperament;
  • maladaptive coping strategies in coping with stressful situations.

Biological causes of depression:

  • Neurobiological;
  • immune;
  • endocrinological shifts in the body (pregnancy, postpartum period, menopause, hypo- or hyperthyroidism);
  • asthenization of the body as a result of severe infectious diseases.

If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!

Symptoms of depression

How a person feels when depressed:

  1. There is a depressed mood, despondency, sadness, a feeling of hopelessness, low moods for a long period of time.
  2. Increases fatigue and tiredness as a result of habitual or minor exertion.
  3. Interest and ability to enjoy things that used to bring satisfaction decreases.

In addition, signs of depression include:

  • decreased ability to concentrate;
  • low self-esteem and insecurity;
  • feelings of guilt and a tendency to self-deprecation;
  • gloomy and pessimistic visions of the future;
  • psychomotor retardation or agitation;
  • sleep disturbances;
  • changes in appetite and weight.

Recurrent thoughts of death and suicide, suicide attempts are a dangerous symptom of depression.

The thinking of the person suffering from depression is characterized by the presence of irrational notions, cognitive errors:

  1. Excessive self-criticism or unwarranted guilt – thoughts of worthlessness, loss of self-confidence, lowered self-esteem, a tendency to self-blame.
  2. Negative vision of the present – sensation of senselessness of existence, unfriendliness of the surrounding world and people.
  3. A negative vision of the future – expectation of problems, new shocks, failure and suffering.

Pathogenesis of depression

On the basis of available studies it is proved that in the development of depression the key role is played by disorders of neurotransmitter activity in the limbic neurons of the brain – the release and interaction with the postsynaptic receptors of mediators such as serotonin, noradrenaline, dopamine, acetylcholine, histamine, etc. changes.

What happens in the organism during depression

Lack of serotonin manifests itself as increased irritability, aggression, problems with sleep, appetite, sexual activity, decreased threshold of pain sensitivity. A decrease in the concentration of noradrenaline in the neurons of the brain leads to a feeling of increased fatigue, impaired attention, apathy, and decreased initiative.

Dopamine deficiency manifests itself in impaired motor and thinking activity, decreased satisfaction from activities (from eating, sex, recreation, communication), loss of interest in learning, learning.

Therefore, the medication approach in treating depression is to prescribe antidepressants that regulate the release and interaction of neurotransmitters with the receptors of the limbic system neurons.

Classification and stages of depression

The International Classification of Diseases, 10th Revision (ICD-10) classifies depression by severity and type of course.

Types of depression by severity:

  • mild;
  • moderate;;
  • severe depression without/without psychotic symptoms.

With mild and moderate depression, the person usually remains able to work, although quality of life is reduced. Severe depression is characterized by the presence of typical symptoms of depression: low mood, decreased interest and enjoyment of activities, increased fatigue, impaired ability to work, suicidal tendencies may be present [4].

According to the type of course:

  • Depressive episode;
  • Recurrent depressive disorder;
  • Chronic Mood Disorder.

Up to 30-35% of patients have a chronic form of depression, with a duration of the depressive disorder of two or more years.

It is also common in psychiatry to distinguish depression according to its origin :

  • Endogenous (manic-depressive psychosis) – implies a gratuitous onset, hereditary predisposition to develop the disease, alternation of depressive and manic states;
  • exogenous – develops under the influence of acute or chronic stressors;
  • somatogenic – associated with somatic, including organic pathology (myocardial infarction, stroke, craniocerebral trauma, cancer, etc.).

The U.S. DSM-5 classification takes into account the phenomenological features of depressive disorder.

These include depressive symptoms:

  • With anxiety distress;
  • with mixed traits;
  • with melancholic features;
  • with atypical features;
  • with psychotic features,
  • congruent and incongruent moods;
  • With catatonia (movement disorders);
  • with seasonal patterns (refers only to recurrent episodes).

Seasonal affective disorder is a type of depression associated with the changing seasons, beginning and ending at about the same time each year. Most people with this type of disorder have symptoms in the fall and continue through the winter months, less frequently in the spring or early summer [19].

Complications of depression

Worldwide, the economic losses due to the disability and treatment costs of people with depression are great.

The coexistence of depression with somatic pathology (arterial hypertension, coronary heart disease, bronchial asthma, gastrointestinal diseases, oncology, autoimmune disorders) aggravates the course of somatic diseases, with the severity of pain syndrome increasing, somatic disorders become chronic, resulting in increased mortality from the underlying disease.

What is the danger of depression?

One of the most serious problems is the high probability of suicide in depression (8%). At the same time, of the total number of suicides, up to 60% are those who suffered from depression. [5] [6]

This is why timely diagnosis and adequate treatment care for people suffering from depression is so important.

Diagnosis of depression

A large proportion of depressed patients, due to fear of the stigma of mental illness [7] and the abundance of physical manifestations (somatic “masks”) – headaches, dizziness, chest pain and heaviness, brokenness, digestive disorders – first seek consultation in the outpatient clinic network with general practitioners, where they may undergo lengthy examination and ineffective treatment, because they are not adequately helped. [8] [9] [10]

In the United States, where the number of psychiatrists is quite large, 50% of patients with symptoms of depression go to primary care specialists, while only 20% go to psychiatrists [8]. In the United Kingdom, a large proportion of depressed patients are treated by general practitioners, with only 10% going to psychiatrists. [11]

Screening for depression.

Seeing a psychiatrist and psychotherapist in a timely manner helps to establish a proper diagnosis of depression and to select effective treatment.

In the diagnosis of depression, clinical scales are used – Hamilton Depression Scale, Zang Scale, Beck Scale and others, [12] [13] [14] that determine the presence and degree of depression and some of its manifestations.

Unfortunately, there are still no precise laboratory tests and studies that can show which mediators’ imbalance led to the development of depression in a particular patient.

The differential diagnosis of depression

  • with mood disorders caused by organic brain disorders;
  • Affective disorders in the structure of schizophrenic disorders;
  • Bipolar affective disorder (in addition to depressive phases, mania occurs in the disease structure).

Treatment of depression

Depressive disorders of a mild degree of severity can lend themselves rather well to psychotherapeutic treatment.

Supportive treatment for depression

Until the condition improves, the doctor observes patients once or twice a week. During the visit, the doctor supports the patient, gives the necessary explanations and monitors the progress. A meeting at the doctor’s office can be supplemented by talking to the patient on the phone. The doctor should explain to the patient that depression is not a personality or mood disorder but a serious illness that has biological problems and needs to be treated and that the prognosis is good. The doctor should also try to encourage the patient to be more active in daily life and social activities, such as getting outdoors more often or enrolling in an art class. It is important for the doctor to make the patient understand that the illness is not his fault, that negative thoughts are only part of the condition, and that they will pass soon (20).

Medication therapy for depression

For moderate to severe depression, a combination of psychopharmacotherapy (antidepressants) and psychotherapy is more effective.

Today, serotonergic antidepressants and so-called dual-action antidepressants (affecting the metabolism of serotonin and noradrenaline) are widely used, which are used from 3 months and longer (the average duration of therapy is 6-12 months).

Taking antidepressants should take place under the supervision of a doctor and, despite long-term use, usually does not lead to dependence and is fairly well tolerated.

If depression does not respond to treatment, has passed in the chronic form, is prone to relapses, therapy with antidepressants can be supplemented by other psychotropic agents – tranquilizers, neuroleptics, anticonvulsants.

In addition to the outpatient treatment of mild and moderate depression, severe depression must be treated and monitored in a hospital setting.

Psychotherapy for the treatment of depression

Cognitive behavioral psychotherapy, aimed at changing patients’ irrational beliefs and depressogenic patterns of behavior, and psychodynamic psychotherapy (psychoanalytic, existential psychotherapy, Gestalt psychotherapy) aimed at working through the patient’s underlying experiences and traumatic early experiences, forming adaptive functioning in the present is provably effective and fast-acting in the psychotherapy of depression [15] [16].

Electroconvulsive therapy for depression

Electroconvulsive therapy (ECT) has limited use due to a wide list of contraindications, adverse reactions and complications. But in cases of severe depressive disorder and resistance to drug treatment, ECT can be used and proves to be effective [20].

Phototherapy for Depression

Phototherapy is used in the treatment of seasonal affective disorder in clinics specializing in such therapy. In this case, powerful artificial light sources are used with an irradiation mode of 10,000 lux for 30 minutes twice – morning and evening. 

How to get rid of depression on your own

In the case of a depressive reaction to a stressful situation or with depression of a mild degree of severity, it is possible not to go to the doctor, because the manifestations of depression do not lead to disadaptation. It helps if the person is distracted from the stressful situation and immersed in work or hobbies. The support of a close environment or a visit to a psychologist can also alleviate the condition. But if the condition drags on, gets worse and leads to social disadaptation, then specialist help is needed – a psychiatrist or psychotherapist.

What to do if a loved one suffers from depression

From those close to the person suffering from depression, sincere support, empathy, sympathy, and an offer to enlist the help of a specialist will be important.

Prognosis. Prevention

A large proportion of patients do not receive adequate improvement from antidepressant therapy, are resistant, or have poor tolerance to medication. [17] In these cases, non-drug biological therapies (e.g., electroconvulsive therapy is often used abroad for resistant depression) and psychotherapy are alternatives. [18]

Without adequate treatment, depressive disorder has a high risk of relapse, aggravation of the course, and the appearance of suicidal tendencies in the patient.

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