Depression: how does the brain turn off joy?
There are many myths and misconceptions associated with depression, which can be dangerous for those who have lost their joy for life and really suffer from heavy thoughts. Psychiatrists who specialize in treating this illness are rarely consulted, and if they do, they are usually not the first choice.
Vladislav Chupeev, psychiatrist and psychotherapist at the Eating Disorders Research Center, in an interview with the Laba project debunked myths about depression and antidepressants, told about the need to go to specialists and treatment methods.
1. Everyone loves to discuss depression, for example, over drinks. But what do we really know about it? Worldwide today, more than 300 million people suffer from depression. It is one of the most common mental illnesses and the leading cause of disability in the world, according to the World Health Organization (WHO).
According to these figures, about 800,000 people commit suicide each year because of depression, and it is the second leading cause of death among young people from 15 to 29 years. In addition, depressive conditions affect performance and most importantly, quality of life.
2. So it’s not just a bad mood? No, it’s a very real illness. And a serious one at that. Most scientific theories suggest that depression is caused by a lack of neurotransmitters, the universal “messenger substances” that transmit signals in the brain from one nerve cell to another. That’s why depressed people see the world in dark colors – literally. Neurotransmitters are involved in vision, hearing, and the formation of tactile and temperature sensations.
Without these substances, information that reaches the brain is distorted, favorite activities cease to please, music is heard differently. In addition, concentration and memory function decreases: when depressed, it becomes more difficult to remember something good.
The theory of the connection between depression and neurotransmitters has a lot of indirect evidence, but so far it has no indisputable proof. That’s because neurotransmitters are very small. It’s expensive and difficult to track them down in the body and study them well.
3.So what happens in depression? Depression is made up of many symptoms among which the main ones are: apathy – a persistent decrease in motivation, anhedonia – a lack of pleasure from what used to bring it, and a decrease in energy (asthenia).
Another signal of depression is anxiety. It is the body’s universal “flag” that lets you know: something is going wrong. Each of these symptoms is the result of an imbalance of neurotransmitters in the brain cells, primarily serotonin. If the symptoms persist for 3-5 weeks, it’s definitely time to see a psychiatrist.
4. Maybe you should just rest and the depression will go away? No. With mild to moderate depression, the best treatment is the opposite. You need to get out of bed, socialize with people and exercise. The problem is that doing these things when depressed is completely unnecessary.
Severe episodes of depression are characterized by the development of apathy. Sometimes, this is the body’s last resort to protect itself from a suicide attempt: no energy for anything at all.
5. That sounds scary! But how do you not get to that point? Changes happen gradually, so it is difficult to pay attention to them. Depression is characterized by decreased concentration, poor memory, but these factors are the most difficult to observe: in a depressed state, it is difficult to adequately assess oneself.
More important are changes in the quality of life. These include sleep disorders (you do not sleep as well as you did six months ago), changes in appetite in any direction, changes in personal hygiene, lack of desire to take care of yourself, compulsive feelings of guilt and sadness, indifference to your favorite hobby, books, movies, music. These changes are a sign of a biochemical “breakdown,” that very lack of neurotransmitters.
If we are talking about feelings of helplessness, self-loathing and the desire to harm yourself, you need to see a doctor as soon as possible. When such thoughts persist for 2 weeks – there is nothing more to wait for, further will be worse.
6. Going to the doctor for depression? Are you laughing? If you come to the psychiatrist, immediately put him in the hospital! No, not right away. Only those who pose a real danger to themselves or others can be involuntarily admitted to psychiatric hospitals. That is, if you were removed from a window while trying to commit suicide, or if you tried to cut up others with a knife, or brought yourself to exhaustion (body mass index less than 17), then there are grounds for hospitalization.
In any other case, the final decision rests with the patient. The main thing is that heavy thoughts do not form into a concrete and gloomy plan, which the person is ready to carry out now. If such thoughts can be distracted within a day, such a patient will not be admitted to the hospital.
7. I do not believe it! It is easy to get into the mental hospital for nothing! In Russia any admission to a hospital is connected with a pile of papers, so it is impossible to get there “for nothing”. There are strict criteria for being admitted to a psychiatric hospital: risk to others or yourself, or being brought to such a risk without assistance. For depression, these risks include obsessive suicidal thoughts or suicide attempts in the past few months.
If the patient is in this condition, hospitalization is the answer. There, under the supervision of doctors, the person will be able to cope with a severe condition in a few weeks.
Sometimes doctors may actually involuntarily hospitalize a patient – if he or she is in a high-risk group. For example, he recently tried to commit suicide and does not show positive dynamics, i.e. his condition is getting worse.
But even in this case, the patient is given a choice: he or she can refuse to be hospitalized. Without written consent, a person can only be taken to the hospital for 72 hours, then a medical board is assembled and its decision goes to court.
Such a procedure requires a lot of work from doctors, so it is resorted to only in case of a real threat to life.
Of course, a psychiatric hospital is not the most fun place on the planet, especially for a severely depressed person. But fortunately, reality is far from the fantasy of Hollywood screenwriters. Doctors don’t walk around the ward with a taser or a prepared syringe.
They try to reduce the patient’s risks as much as possible, help to cope with the crisis and stabilize the condition so that the person can gradually return to a normal rhythm and enjoy life again.
8. Are you saying that psychiatric patients are dangerous? Patients in psychiatric hospitals are mostly a danger only to themselves. The local staff closely monitors their condition.
On average in the population, 1 person in 100 has a psychiatric diagnosis – this figure does not change depending on gender, region or ethnicity (the exception is older men – they have a higher risk of suicide).
9. Maybe it is enough to talk to a psychologist after all? Of course, it is possible not to go to surgery if you broke your leg. The body itself can heal the fracture. But it’s better to put a cast on it. The help of a psychiatrist is needed in order to cope with the problem more quickly: so there are fewer risks to health and life.
A psychiatrist is a specialist with a medical degree. Only he can diagnose depression and prescribe a treatment regimen. A psychologist does not do this. With clinical depression and compulsive overeating, a psychologist helps solve the problem systemically.
By the way, the list of psychiatrist’s prescriptions include not only antidepressants, but also the same work with a psychologist. When they are combined, the best results are achieved: antidepressants help to gain strength, and psychotherapy helps to find the cause of depression.
10. Okay, then how do you choose an adequate psychiatrist? The same way you choose any other doctor. A good recommendation can come from friends who have already been to such a specialist and you have seen them get better.
The only clearly defined criterion is the doctor’s willingness to be in touch and answer questions. It is important that the specialist can be supportive if side effects of the medication show up. These are not threatening, but sudden dizziness, drowsiness, and nausea can really scare you.
In addition, it is not always possible to choose an antidepressant that is right for you the first time. At a critical moment, the specialist will be able to take the necessary measures: to calm you down, to change the drug therapy, to explain what is going on.
11. Tell then about the pills. If the psychiatrist prescribes medication, will I become a “vegetable”? Taking a medication never causes you to move from the animal kingdom to the plant kingdom. The “vegetable” myth comes in part from the side effects of neuroleptics developed nearly half a century ago. But to a much greater extent this condition is caused by the course of schizophrenia left untreated. That is, we are not talking about depression in this context at all.
A number of severe mental illnesses, if left untreated, take away a person’s unique personality traits year after year, leaving a deep mark on the psyche. Medications, on the contrary, help to slow this process down, helping to maintain a high level of quality of life for as long as possible.
12 Then explain how antidepressants work! The nervous system works by transmitting nerve impulses from one cell of the brain or spinal cord (neuron) to another using neurotransmitters. These mediating substances are released into the space between neurons, which triggers the signal transmission cascade to the next cells. The neurotransmitters are then captured back, broken down into their building blocks, and reassembled to re-transmit the impulses.
Nerve impulse transmission is altered in depression because the amount of neurotransmitters is reduced. This prevents the creation of a complete nerve impulse. Hence, anxiety arises. Antidepressants can be used to restore the natural functioning of the nervous system.
Drugs for depression work in different ways. Previous generations of drugs, such as monoamine oxidase inhibitors (MAOIs), block the destruction of neurotransmitters in nerve cells. Now they are rarely used because of their severe side effects and high toxicity.
They have been replaced by more modern drugs: selective serotonin reuptake inhibitors (SSRIs), that is, drugs that prevent the uptake of a particular neurotransmitter.
SSRIs help form a complete nerve impulse. Gradually increasing the dosage helps the nervous system return to “pre-crisis levels.”
13. Are all antidepressants horrible drugs? During the treatment of depression, a person gets used to nothing but a good mood, normal sleep and the absence of anxiety. So not all psychotropic drugs are drugs, although this opinion is extremely common.
The myth of addiction is related to the presence of withdrawal syndrome in psychiatric drugs: a set of side effects that occur when a person does not stop treatment in a timely, most often involuntarily, ruminative ruminative ruminative ruminative ruminative ruminative ruminative ruminative and RPT in general.
Many people believe that if antidepressants cannot be combined with alcohol, they can be painlessly discontinued for a while, but this is not true. All psychiatric drugs have a cumulative effect. Once discontinued, the drug remains in the bloodstream for up to several weeks, during which time it can enter into unpredictable interactions with alcohol. Then the symptoms of intoxication are superimposed on the drug’s withdrawal symptoms, which can lead to life-threatening conditions.
But that doesn’t mean you have to take antidepressants for the rest of your life. Initial stabilization of the condition occurs after about a month.
During this time, the dosage of medication builds up to the therapeutic dosage, which is always higher. Small doses at first are needed in order to reduce the number of side effects. A full course of drug therapy lasts from six months to 1.5 years. In most cases, treatment takes 7 to 10 months.
14. And here I have a friend who was taking antidepressants, but then the depression came back and it got worse. Could this also happen? It can happen for several reasons. The most common is stopping treatment early without consulting your doctor. It is important to complete the course to the end: untimely withdrawal from medication causes withdrawal syndrome and leads to the recurrence of depression. Symptoms of the disease in such a case are often more severe than at the beginning.
However, it can also get worse after a fully completed course of antidepressant treatment. Medications are not the only component of recovery. They help to cope with the current state of depression, but do not rule out the possibility of a relapse. The key to a stable emotional background can only be behavioral psychotherapy. It is necessary to spend time on this.
15. What to do if a loved one needs help from a psychiatrist? If you feel that the person needs help, but does not consider it possible or necessary to go to a specialist, it is possible to offer your own help and go to the doctor together, literally “taking him by the hand and leading him. If you meet strong resistance – there is a high probability that it is not the person who is talking to you, but his or her illness.
Depressed people can often be afraid to admit to themselves that the situation is out of control.
The best option is not to confront, but to ask questions. Does the person consider what is happening to him or her to be healthy? Is there anything you can do to help? Indeed, going to a specialist may not solve all problems, but it is still worth trying.
Modern psychiatry, unlike what it had 30 years ago, has a wide range of pharmacological tools, even for severe illnesses such as schizophrenia or bipolar affective disorder.
So with drug therapy, depression can be beaten. The main thing is not to be afraid to go to the doctor and not to quit treatment halfway through.
How to get a person out of depression
Drug use causes irreversible harm to health and is life threatening!
Depression is an illness that requires treatment. It is important to notice its symptoms in time and help the person to see a doctor. Sometimes you need help from loved ones, sometimes you need help for yourself. Let’s try to understand in what situation the person needs help and how to do it correctly.
How to understand what is going on
If a person has a bad mood, it does not mean that he has depression. An important characteristic of the condition is the duration of the condition. It should last from 2 weeks or longer.
Depressive disorder is not only a lowered mood, but also a negative assessment of oneself, one’s future, and one’s surroundings. A person in such a state is lethargic, drowsiness appears, the desire to move decreases, attention and memory suffer, and libido drops. What used to bring pleasure no longer does. The person stops taking care of themselves: they dress slovenly, they don’t observe the rules of hygiene. It is not uncommon for such people to have no emotions at all. Sometimes suicidal thoughts arise on the background of the loss of the meaning of existence.
If a person has at least one of the symptoms, and the condition lasts more than 2 weeks, they need help.
By no means always does depression arise in response to a traumatic life event from the immediate past. If there were no serious shocks, but disturbing symptoms have appeared, this is a 100% reason to see a specialist.
What you need to do
First of all, you need to understand that depression will not go away by itself. A person needs help. It is not just sadness or laziness, but a serious illness.
The second thing to remember is not to devalue the person’s experience. No one tells a patient with diabetes to get it together, stop suffering and start producing insulin. A person with depression doesn’t need that kind of advice, either. He can’t get his body to produce the right amount of neurotransmitters. He really has a hard time doing normal things: going to work, playing with his children, socializing with people. These activities won’t bring him relief, and the advice won’t do him any good.
But it is not worth watching in silence how the life of a loved one passes by, either. It is necessary to gently talk to the person about how he feels, how he feels. Express understanding and sympathy.
Good phrases to use when communicating with a person who has a depressive disorder are:
- “I understand that this is hard for you. “;
- “How can I help you?”;
- “You’re just tired, it happens.”
- “It’s no big deal, you can get help.”
- “It happens a lot, it’s not your fault. “.
It is important not to devalue the person’s feelings or deny that a problem exists. You have to gently lead them to believe that seeing a specialist will make a difference. It’s not shameful, it’s not scary, it’s normal. After all, when a person has a stomach ache, he goes to a gastroenterologist. And if the psyche is sick, it’s worth seeing a therapist.
Disperse the person’s fears about going to the doctor:
- Depression is not included in the list of diseases for which psychiatric registration is carried out, which is enshrined in the law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision” № 3185-1.
- A patient’s diagnosis is protected by medical confidentiality, so it will not be disclosed to third parties, including the employer or employees of the educational institution.
- The latest generation antidepressants are not addictive.
- If more serious medications are needed, they will be taken under the strict supervision of a physician who will not allow addiction to develop.
The main thing that needs to be conveyed is that treating depression is necessary and it is normal.
First aid for depression
Before going to a specialist, it is only possible to help a person if the depressive state is provoked by a traumatic event that happened very recently. It is necessary to allow the feelings to happen: crying if sad, screaming in the woods or in the field, hitting objects prepared in advance if there is anger.
A person must understand that all of his or her feelings and emotions are normal.
His feelings need to be lived through and expressed, otherwise they will get stuck deep inside, which will aggravate the situation. People close to them must support and create the conditions for expressing pain in a way that suits the person.
A traumatic situation is not necessarily something bad. Any sudden change in life can provoke a depressive disorder: the birth of a child, a new position, a job change, etc.
If the symptoms occur against a background of general well-being in life, only the help of a specialist can help. Often people do not realize that something is wrong with them, because everything is fine, there have been no sudden changes or traumas, their life is fine. Such a condition is dangerous because no one notices the problem, but it can lead to tragic consequences. A person with this type of depression should definitely be seen by a specialist.