Help for depression: looking at it from all angles

How to treat depression correctly?

Depression is a psychiatric disorder that can occur for several reasons: heredity, chronic stress, unpleasant and tragic events, a difficult life situation. Depression can vary in manifestation and severity, as a rule doctors prescribe medication therapy in combination with psychotherapy.

Under conditions of constant stress, anyone can develop depression. It is a psychiatric illness that is not as harmless as it seems and needs proper and timely diagnosis and treatment. The therapy process should be comprehensive and include psychotherapy and medication. For successful treatment, it is very important for the psychiatrist to establish a trusting relationship with the patient. In the process of treatment, antidepressants are used, in more severe cases – tranquilizers. It is important to make the patient understand that he or she has no reason to feel guilty and that people often feel depressed.

How to treat depression correctly?

I. GENERAL INFORMATION ABOUT DEPRESSION

Depression is a disease of our time Studies all over the world show that depression, like cardiovascular disease, is becoming the most common ailment of our time. It is a common disorder that affects millions of people. According to various researchers, it affects up to 20% of the population of developed countries. Depression is a serious illness that sharply reduces the ability to work and brings suffering to both the patient and his loved ones. Unfortunately, people are very little aware of the typical manifestations and consequences of depression, so many patients are treated when the condition takes a long and severe form, and sometimes – not at all. In almost all developed countries, health care services are concerned about this situation and make efforts to disseminate information about depression and its treatment.

Depression is a disease of the whole body. Typical signs of depression include

  • * Moodiness, anguish, depression, despair
  • * Anxiety, internal tension, anticipation of trouble
  • * irritability
  • * guilt, frequent self-blaming
  • * dissatisfaction with oneself, diminished self-confidence, low self-esteem
  • * diminished or lost ability to experience pleasure in previously pleasurable activities
  • * loss of interest in the environment
  • * loss of ability to experience feelings of any kind (in cases of major depression)
  • * depression is often combined with anxiety about the health and fate of loved ones and fear of appearing inadequate in public places
  • * sleep disorders (insomnia, drowsiness)
  • * changes in appetite (loss or overeating)
  • * intestinal disorders (constipation)
  • * decreased sexual urges
  • * loss of energy, increased fatigue during normal physical and intellectual activity, weakness
  • * pain and a variety of discomfort in the body (e.g., in the heart, stomach, muscles)
  • * passivity, difficulty engaging in purposeful activity
  • * avoidance of contacts (tendency to remain isolated, loss of interest in other people)
  • * refusal of entertainment
  • * alcoholism and abuse of psychoactive substances that provide temporary relief
  • * difficulty concentrating, concentrating
  • * difficulty making decisions
  • * the prevalence of gloomy, negative thoughts about oneself, about one’s life, about the world in general
  • * gloomy, pessimistic vision of the future with a lack of perspective, thoughts about the meaninglessness of life
  • * thoughts of suicide (in severe cases of depression)
  • * the presence of thoughts about one’s own uselessness, insignificance, helplessness
  • * slowness of thought

Depression needs to be treated

Depression is often perceived both by the patient and others as a manifestation of bad character, laziness and selfishness, promiscuity or natural pessimism. It should be remembered that depression is not just a bad mood (see manifestations above), but an illness that requires specialist intervention and is fairly well treatable. The earlier the correct diagnosis is made and the correct treatment begun, the better the chances are of a quick recovery, of depression not recurring and not taking a severe form accompanied by the desire to commit suicide. What usually prevents people from seeking help for depression? Often, people are afraid to see a mental health professional because of perceived negative consequences: possible social restrictions (being placed on the register, prohibited from driving or traveling abroad); judgment if someone finds out that the patient is being treated by a psychiatrist; fear of the negative effects of medication for depression, which are based on widely held but incorrect beliefs about the harms of psychotropic drugs. Often people don’t have the right information and misunderstand the nature of their condition. They think that if their condition is related to understandable difficulties in life, it is not depression, but a normal human reaction that will pass on its own. Often it also happens that physiological manifestations of depression contribute to the formation of the belief that there are serious somatic diseases. This is a reason to see a therapist. 80% of patients with depression initially seek help from general practitioners, with about 5% of them being correctly diagnosed. An even smaller number of patients receive adequate therapy. Unfortunately, at a routine outpatient clinic visit, it’s not always possible to distinguish between the physiological manifestations of depression and the presence of a true somatic illness, leading to an incorrect diagnosis. Patients are prescribed symptomatic therapy (heart medications, “for the stomach,” for a headache), but there is no improvement. There arise thoughts of a severe, unrecognized somatic illness, which by the vicious circle mechanism leads to depression getting worse. Patients spend a lot of time performing clinical and laboratory examinations and, as a rule, end up at the psychiatrist with severe, chronic manifestations of depression.

II. SCIENTIFIC KNOWLEDGE OF DEPRESSION

Basic types of depression Often depression occurs against a background of stress or long-lasting severe traumatic situations. Sometimes, they occur for no apparent reason. Depression can accompany somatic diseases (cardiovascular, gastrointestinal, endocrine, etc.). In such cases, it significantly aggravates the course and the prognosis of the underlying somatic disease. However, with timely detection and treatment of depression, there is a rapid improvement in mental and physical well-being. Depressions can occur in the form of single, different in severity episodes of illness, or proceed over a long term in the form of repeated exacerbations. In some patients, depression has a chronic character – it continues for many years, but does not reach a significant severity. Sometimes, depression is limited to mainly bodily symptoms, without distinct emotional displays. At the same time, clinical and laboratory examinations may not reveal any organic changes. In such cases, consultation with a psychiatrist is necessary. Current understanding of the causes of depression Biopsychosocial model of depression Contemporary science views depression as a disease in which different causes or factors – biological, psychological, and social – contribute to its origins.

Biology of Depressions

The biological factors of depression primarily include specific disorders of neurochemical processes (metabolism of neurotransmitters such as serotonin, noradrenaline, acetylcholine, etc.). These disorders, in turn, may be hereditary.

The psychology of depression.

  • * A specific style of thinking, the so-called negative thinking, which is characterized by a fixation on the negative aspects of life and one’s personality, a tendency to see life and one’s future in a negative light
  • * a specific style of communication in the family with an increased level of criticism and heightened conflict
  • * an increased number of stressogenic life events in the personal life (separation, divorce, alcoholization of close people, death of close people)
  • * social isolation with few warm, trusting contacts that could serve as a source of emotional support

The social context of depression

The growth of depression in modern civilization is associated with a high rate of life, an increased level of stress: the highly competitive nature of modern society, social instability – high levels of migration, difficult economic conditions, the uncertainty about the future. Modern society cultivates a number of values that condemn people to constant dissatisfaction with themselves – the cult of physical and personal perfection, the cult of power, superiority over other people and personal well-being. This forces people to take great pains to conceal their problems and failures, deprives them of emotional support, and condemns them to loneliness.

III. HELP FOR DEPRESSION

The modern approach to treating depression involves a combination of different methods – biological therapy (medication and non-medication) and psychotherapy.

Medication therapy

Prescribed for patients with mild, moderate and severe manifestations of depression. The necessary condition for effective treatment is cooperation with the doctor: strict observance of the prescribed therapy regimen, regular visits to the doctor, and a detailed, frank report about one’s condition and difficulties in life.

Antidepressants.

Proper therapy can get rid of the symptoms of depression completely in most cases. Depression requires treatment by specialists. The main class of medications to treat depression are antidepressants. Currently, there are various drugs in this group, of which tricyclic aptidepressants (amitriptyline, melipramine) and have been used since the late 50s. In recent years, the number of antidepressants has increased significantly. The main advantages of the new generations of antidepressants are improved tolerability, reduced side effects, reduced toxicity and high safety in case of overdose. Newer antidepressants include fluoxetine (Prozac, Profluzac), sertraline (Zoloft), citalopram (Cipramil), paroxetine (Paxil), fluvoxamine (Fevarin), tianeptine (Coaxil), mianserine (Lerivon), moclobemide (Aurorix), milnacipran (Ixel), mirtazapine (Remeron), etc. Antidepressants are a safe class of psychotropic medications when used correctly according to a doctor’s recommendation. The dose of the drug is determined individually for each patient. It is necessary to know that the therapeutic effect of antidepressants may appear slowly and gradually, so it is important to have a positive attitude and wait for its appearance. Antidepressants do not cause withdrawal symptoms, unlike drugs of the benzodiazepines class tranquilizers (phenazepam, Relanium, Ellenium, Tazepam, etc.) and are widely used in our country Corvalol, Valokordine. In addition, benzodiazepine tranquilizers and phenobarbital, which are part of Corvalol and Valokordina, decrease sensitivity to other psychopharmacological drugs during long-term use.

The main stages of therapy are.

(1) Determination of treatment tactics: choice of antidepressant, taking into account the main symptoms of depression in each patient, selection of an adequate dose of medication and an individual treatment regimen. 2. Conducting a main course of therapy, aimed at reducing the symptoms of depression, up to their disappearance, and restoring the patient’s previous level of activity. 3. Conducting a maintenance course of therapy for 4-6 months or more after the general normalization of the condition. This stage is aimed at preventing an exacerbation of the disease. What usually interferes with medical treatment: 1. Misconceptions about the nature of depression and the role of medication. 2. Common misconceptions about the unconditional harm of all psychotropic medications: the emergence of dependence on them, the negative effects on internal organs. Many patients are sure that it’s better to suffer from depression than to take antidepressants. 3. Many patients discontinue taking medications when they do not have a quick effect, or take them irregularly. It is important to remember that there have been numerous studies confirming the high effectiveness and safety of modern antidepressants. The damage caused by depression to a person’s emotional and material well-being is not comparable in severity to the minor and easily correctable side effects that sometimes occur with antidepressants. It should be remembered that the therapeutic effect of antidepressants often comes only after 2 to 4 weeks after the start of treatment.

Psychotherapy

Psychotherapy is not an alternative, but an important adjunct to medication treatment of depression. Unlike drug treatment, psychotherapy assumes a more active role of the patient in the treatment process. Psychotherapy helps patients develop skills of emotional self-regulation and subsequently cope more effectively with crisis situations without sinking into depression. Three approaches have proven to be the most effective and scientifically grounded in treating depression: psychodynamic psychotherapy, behavioral psychotherapy and cognitive psychotherapy. According to psychodynamic therapy, the psychological basis for depression is internal unconscious conflicts. For example, the desire to be independent and a simultaneous desire to receive a great deal of support, help and care from other people. Another typical conflict is the presence of intense anger and resentment of others, in combination with the need to always be kind and good and to maintain favor with relatives. The sources of these conflicts lie in the patient’s life history, which becomes the subject of analysis in psychodynamic therapy. Each individual case may have its own unique content of conflicting experiences, and therefore individual psychotherapeutic work is necessary. The goal of therapy is awareness of the conflict and assistance in its constructive resolution: learning to find a balance between independence and closeness, developing the ability to express one’s feelings constructively and to maintain relations with people at the same time. Behavioral psychotherapy is aimed at resolving the patient’s current problems and removing behavioral symptoms: passivity, refusal of pleasures, monotonous lifestyle, isolation from others, inability to plan and engage in purposeful activity. Cognitive psychotherapy is a synthesis of both of the aforementioned approaches and combines their advantages. It combines work with the actual life difficulties and behavioral symptoms of depression and work with their inner psychological sources (underlying ideas and beliefs). Cognitive psychotherapy considers so called negative thinking, which is expressed in the tendency of depressed patients to view everything that happens to them in a negative light, as the main psychological mechanism of depression. Changing this way of thinking requires careful individual work aimed at developing a more realistic and optimistic view of oneself, the world and the future. Additional forms of psychotherapy for depression are family counseling and group psychotherapy (but not any form, but specifically aimed at helping depressed patients). Their involvement can be of significant help in treatment and rehabilitation. What usually prevents one from seeking psychotherapeutic help? 1. People’s low awareness of what psychotherapy is. 2. Fear of exposing an outsider to personal, intimate experiences. 3. skepticism that “talking” can have a noticeable therapeutic effect. 4. 4. the notion that psychological difficulties must be dealt with independently and that resorting to another person is a sign of weakness. In modern society, psychotherapy is an established and effective method of providing help for a variety of mental disorders. For example, a course of cognitive psychotherapy significantly reduces the risk of recurrence of depression.

Modern methods of psychotherapy focus on short-term (10-30 sessions, depending on the severity of the condition) effective help. All the information the psychotherapist receives during sessions is strictly confidential and remains confidential. Professional psychotherapists are specially trained to work with the difficult experiences and difficult life situations of others, they know how to respect them and provide assistance in coping with them. Everyone has situations in life (such as illness) with which they cannot cope on their own. The ability to seek and accept help is a sign of maturity and rationality, not weakness.

Neurotic depression

Depression is a mental health disorder in which there is a prolonged lowered mood combined with feelings of hopelessness, meaninglessness of life, lethargy and irritability. This condition occurs as a response to a number of biological, psychological and social factors, too severe, difficult events and experiences.

There are 2 types of depression – neurotic and psychotic. As defined by psychiatrists, the neurotic type of depression is characterized by apathy, insomnia and anxiety. The disease most often occurs in straightforward and rigid personalities, with a sense of duty, uncompromising.

  • Predisposing factors for the development of neurotic depression are:
  • severe stressful situations;
  • mental trauma in childhood;
  • upbringing mistakes of parents;
  • the use of alcohol or drugs;
  • functional disorders of the nervous system;

unfavorable genetic predisposition.

People with the above-mentioned factors of depression are at risk. Most often, depressive disorder is caused by external factors, rather than by hormonal disturbances. Psychotraumatic incidents (for example, sudden stress or prolonged living in unfavorable conditions) play a crucial role.

What kinds of mental disorders there are

  • Depressive neurosis is accompanied by the following disorders
  • Astheno-neurotic type – manifested by exhaustion of the nervous system, prolonged fatigue;
  • The anxious-phobic type – is manifested by inexplicable attacks of panic, anxiety and fear;
  • Anxiety-depressive type – characterized by a combination of anxiety attacks and emotional depression;

Hypochondriacal type – is characterized by the prevalence of discomfort feelings, due to which the patient constantly looks for nonexistent illnesses.

In contrast to psychotic, in the course of a neurotic disorder there is no lesion of mental functions of the person. Therefore, the patients maintain normal perception of the world. However, disturbances in the course of thought are noticeable and there may be some somatic symptoms. The patient is able to critically perceive his own condition.

What are the forms of depression

  1. Every healthy person has some level of anxiety. It is necessary in order to effectively adapt to reality and challenges in society. The development of neurotic depression leads to various pathological states in a person:
  2. The reactive form of neurotic depression occurs as a result of external factors.
  3. The personal form of depression is formed since childhood, depends on personality traits, the presence of conflict situations.
  4. Non-endogenous depression is formed gradually, against the background of certain events.

Non-psychotic depression is not combined with disorders of perception of the world. It usually remains sober and reasonable.

Depressive states are also distinguished by their degree of severity. In masked, or latent depression, symptoms are mildly expressed. The condition of patients is described as mental suffering. The mood is usually depressed. Patients are bothered by painful sensations in the chest.

In the dysthymic and dysbulic form, the symptoms of obsessive-compulsive neurosis increase. Previously existing character traits are sharpened; pessimism predominates in thinking.

In the cyclothymic stage, there are attacks of melancholy and unmotivated sadness. Self-perception changes within a day. Somatic disorders become acute.

Signs of depression and nervous exhaustion

  • Nervous exhaustion has a characteristic triad. It includes:
  • Depression of the emotional sphere;
  • suppression of cognitive abilities;

weakened psychomotor skills.

  • The main mental and physical symptoms are:
  • persistent headache;
  • abnormal heart rhythm;
  • feeling of discomfort in the chest area;
  • respiratory disorders, shortness of breath or choking sensation;
  • digestive disorders, diarrhea or constipation;
  • appetite disorders;
  • Insomnia or drowsiness at night;
  • anxiety;
  • feeling of impending danger, which appears at any time of the day;
  • irritability;
  • suicidal thoughts;
  • appearance of auto-aggressive behavior;
  • decreased or complete absence of sex drive;
  • tunnel thinking (monotonous; the person sees only what is under his/her eyes, does not recognize mistakes)
  • negative assessment of what is happening in the world;

social alienation.

Be warned: there is no ICD-10 definition for neurotic depression. Depending on the prevailing symptoms, the pathology in question is mainly classified as recurrent depression or dysthymia.

Consequences of a neurotic disorder

Depression at first does not impair a person’s ability to work and his social connections. At first, he is still working hard. Such performance is associated with the activation of an escape mechanism from a stressful or psychotraumatic situation.

However, symptoms of depression gradually increase, and after several years, the quality of the patient’s life is noticeably worse. Personal, educational and social spheres suffer, and the person becomes more and more withdrawn.

The illness can traumatize into a neurotic personality disorder. The patient has a risk of developing drug addiction. Individuals with depression are more likely to commit suicide 70 to 80 percent of the time. Statistics cite staggering data: more than 90 percent of people who die by suicide suffered from depression.

One proven symptom of depression is suicidal ideation. This concept refers to a person’s consciousness of planning and committing suicide.

Treatment and Prevention of Depression

There has been some recent progress in the diagnosis and treatment of depression. Applying for medical help at the right time speeds up recovery and prevents the pathology from worsening. Unfortunately, not always the patient starts treatment in time. In a number of cases he starts treatment when he sees that he cannot cope with the problem by his own strength. To begin therapy, the patient must be active himself, which is problematic because his strength is exhausted. In this situation, the help of family and friends is important.

A psychiatrist, psychotherapist, or neurologist diagnoses and treats this disease. Treatment involves a combination of psychotherapy techniques and the prescription of medications. Medications are needed to relieve acute symptoms. Psychotherapy is prescribed in order that the patient become aware of the causes and mechanisms of his/her illness. In addition, consultations with a psychologist teach the person to react appropriately to stress. This helps prevent the development of depression.

Typically, depression does not have a single cause, so there can be many ways to treat this condition. When treating depression, non-pharmacological methods are preferred. A psychotherapist may recommend breathing and relaxation training. In some cases, it is recommended to attend group classes.

If neurotic depressive disorder has mild symptoms, the doctor may prescribe a patient tonic agents and multivitamins. They stimulate the work of the central nervous system. However, you must remember that all medications should not prescribe themselves: from this, the condition of the body may worsen even more. In addition, an excessive amount of vitamins is not safe for a person. Antidepressants that are taken without a doctor’s permission can lead to severe poisoning.

The most important way to prevent a depressive disorder is to be able to achieve physical relaxation and relieve emotional tension. A person needs to adhere to a normal sleep, work and rest routine. Meals should be regular. At the first symptoms of depression, it is necessary to see a doctor immediately: delaying treatment is fraught with the development of dangerous symptoms.

Early treatment of depression is the key to a speedy recovery.

Psychologist answers to common questions

How is neurosis different from depression

These are 2 different mental disorders that have a similar mechanism of formation. In some cases, the symptoms of these disorders may be similar. However, there are also differences. During depression, a person has no positive emotions, a feeling of hopelessness and gloom prevails.

At the same time, during neurosis, a certain uncertainty, anxiety and tension prevail. During neurosis, a person thinks quickly, which is not the case with depression. Moreover, a certain lethargy is noticeable in depression.

How to overcome fears

  • To combat feelings of fear, it is recommended to do an exercise. First, a person should think about the situation that causes anxiety or fear. Subsequently, it is necessary to answer these questions:
  • What thoughts arise when I am overcome with feelings of fear;
  • What is the worst thing that could happen in this situation?
  • How can I explain the situation in a different way?

how I might have dealt with these situations before.

Psychologists have a rich set of training techniques for dealing with fear and anxiety. At the first pronounced signs of neurotic depression you should immediately see a psychiatrist.

Here you can take a Beck test for depression

Author of article

Mikhail Ivanovich Skvira

Graduated from Educational Establishment “State State Medical University” with a degree in “medical business”. Clinical psychologist, master’s degree in psychology, from 2016 to 2018 the leading specialist in the UH “GOCPB” to work with alcohol dependence method “Edelweiss”, the author of articles and publications. Awarded a commendation for many years of fruitful work in the health care system. Work experience: 18 years

  • I am very nervous, I break down even at the child, I sit at home, I do not communicate with anyone, my boyfriend does not help, I can not turn to anyone for help to listen to, to support, I do not want anything, stomach pain about a month, thoughts of death. I had a headache today after the breakdown, my heart was pounding, my chest hurt, I felt nauseous and dizzy, every day in tears.
  • Victoria Naumova

18.09.2022, 10:15

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