Why does depression come and how to be, if you have run out of strength: says an experienced psychiatrist.
How to recognize a dangerous condition in its early stages? What to do if you can not change the circumstances of life, and “hold on” no longer have the strength? How to save yourself and your loved ones? Maxim Marachev, a Yellmed expert in mental health, answered these and other questions.
Education: First Moscow State Medical University named after I.M. Sechenov. Academic degree: Candidate of Medical Sciences. Work: Deputy Medical Director of the Neurocentre for Medical and Psychological Correction and Rehabilitation Specialization: diagnostics and correction of depression, fears, anxiety, panic, mood swings and personality disorders; identification and selection of therapy for various types of sleep disorders.
Depression has been called the plague of the 21st century. WHO experts put it in second place among the causes of death by 2020, with cardiovascular disease in first place. And indeed, today you can hear everywhere: “I’m depressed”, “I’m depressed”, “I don’t want anything”…
– Maksim Pavlovich, can you tell from one look of a person that he is depressed? Or do we carefully disguise devastation?
– Depression does have outward signs which can be noticed during a conversation: speech and movements of a person are slowed down, he may look sad, emaciated, such a person seems as if he’s “empty” inside. But for a diagnosis, this is not enough: it is necessary to identify such characteristic symptoms as thoughts of own failure, self-blaming, lack of interest in activities which used to bring pleasure, sleep disorders, appetite and others.
In addition, it is necessary to exclude other disorders, so without a detailed questioning, and sometimes, as in the case of hypothyroidism, which has a clinical picture similar to depression, without laboratory tests, it is impossible to do.
– Why has depression become the “plague” of our time?
– It is unlikely that the “incidence” of depression itself has changed by our time. Rather, doctors and patients have begun to pay more attention to this condition, know more about it, but we can also say that depression has become “fashionable”.
One in two people who seek help from mental health professionals, especially psychologists, utter the word “depression” when citing the reason for their initial visit.
At the same time, attitudes toward psychiatry and mental disorders are gradually changing, although this process is far from complete. While in the century before last it would not have occurred to most people to complain to a doctor about a bad mood, now, as psychiatric care strives to be open and patient-centered, modern safe treatments are emerging and more and more people are going to the doctor in search of a better quality of life.
– They say depression doesn’t happen overnight. They say it’s the result of accumulated worries, stresses. At what point does it all “shoot out” – and a person becomes depressed?
– Scientifically speaking, all mental disorders are caused by abnormalities in the brain. This means that symptoms of depression do not appear until pathological changes occur in the brain: connections between different parts of the cortex change, the balance of neurotransmitters such as serotonin, noradrenaline and dopamine is disturbed, hormonal shifts occur, for example in adrenal gland function.
Such changes can be triggered by a stressful situation, because the body reacts to everything with certain physiological processes. And sometimes these changes occur spontaneously – and depression develops without provoking factors.
Genetics plays no small role in the development of this condition. We know that not all people, faced with a succession of stresses in life, suffer from depression. This means that on a basic, neurobiological level, there are flaws that come to light in times of stress with a deficiency of neurotransmitters, which leads to the development of depression.
– Does depression have degrees of severity?
– The doctor always determines the degree of severity of depression, it affects the choice of treatment tactics and the expected prognosis. If individual symptoms are detected and they are moderate in severity, it is possible to do without medication, for example, with psychotherapy.
If there are many symptoms and they are so severe that they interfere with work, threaten life and health of the patient, including when suicidal ideation occurs, prescription of drug therapy is a priority, and in some cases hospitalization is necessary.
– Why are some people more prone to depression and some less so?
– The propensity to develop a mental disorder, particularly depression, is determined by the interaction of many different factors. These include heredity, the specific mental-emotional background of a particular person, and the environment in which he grew up and is. A multifactorial understanding of the basis for the development of depression in psychiatry is called the “biopsychosocial approach”.
– How does a person know he or she is depressed and not a trivial fatigue or bad mood? By what signs?
– The diagnosis of depression is made by a doctor, based on specific criteria that are described in modern classifications. For example, a depressed mood must persist for at least two weeks. In addition to this criterion, at least four others must be present, among which are impaired appetite, loss of interest and pleasure, impaired memory and concentration, lethargy, fatigue, and self-blaming.
However, along with these criteria, there are a large number of questions, the answers to which play a fundamental role in the diagnosis of depression. Therefore, only a psychiatrist can definitively make a diagnosis, differentiate it from other possible causes of feeling unwell and formulate recommendations.
– During depression, do all people have suicidal thoughts, or does it depend on the person?
– No, not everyone has suicidal thoughts. Their occurrence depends on the person and on the severity of depression. Many people’s life values don’t allow them to think about suicide, but even they are not immune from such thoughts if the severe condition lasts a long time. The presence of suicidal thoughts of any content, whether it is a true desire to end one’s life or only an imaginary way out of a difficult situation, unequivocally indicates the need to help the person.
A big problem is suicidal behavior among adolescents, which often hides not a true desire to leave life, but a cry for help, a need for attention from, for example, “perpetually busy” parents.
– Depression – is it always a reason to see a psychiatrist or psychologist? By the way, which specialist should you go to?
– Mental disorders are just as necessary to be monitored and treated by a doctor as bodily illnesses are. The difference between a psychiatrist and a psychologist is that the psychiatrist has a medical background and has the right to prescribe pharmacological drugs.
A psychologist can also help with depression if he knows the techniques of psychotherapy. It is preferable to turn to a psychiatrist to assess the severity of the condition and refer to a psychologist if the patient is indicated for this type of care. In turn, a competent psychologist, having seen during an appointment that the patient’s condition is too severe, will always recommend referral to a psychiatrist.
– Is depression a common problem in Russia?
– Depression is one of the most common mental disorders. According to global statistics, depression affects between 8 and 12 percent of the population. Statistics for Russia give smaller numbers, about 5 percent.
Around the world, doctors say that the true prevalence of depression is much higher: according to some studies, it reaches up to 40 percent, but patients rarely seek help for themselves.
– Many like to self-medicate, buying over-the-counter remedies on the advice of friends. Is this the way out?
– Yes and no. On the one hand, with mild manifestations of individual depressive symptoms, a person may need some additional support, which they often get by purchasing, for example, herbal sedatives or supplements. This may be enough to feel able to overcome temporary stress.
On the other hand, when it comes to the symptoms of depression specifically, this approach does not justify itself and can lead to a deepening of symptoms and a progressive deterioration in quality of life. The problem is that it can be difficult to distinguish the severity of manifestations on their own, but over time, almost everyone who understands the severity of their ill health finds the right specialist, namely a psychiatrist, and an acceptable type of treatment for themselves.
– How do depressive states affect our bodies? What somatic illnesses do people usually deal with?
– The processes in the brain associated with the development of depression inevitably affect the body as a whole.
Depression has many somatic manifestations, from sleep disturbances and lack of appetite to such unobvious effects as an exacerbation of ulcer disease or skin conditions.
It is not uncommon to see masked depression – when the main manifestation of the disorder is somatic symptoms, such as pain. In such cases, after careful examination, it is impossible to find a physical cause, and prescription of antidepressants has a good effect.
– If a person comes out of a depressive state, what is the chance that they will return to it?
– There is a chance. It is definitely higher than for those who have never before sought help for symptoms of depression. However, this probability is significantly reduced by proper medication administration, which follows the doctor’s recommendations for duration, which is often about a year, and the dosing regimen.
The more depressive episodes there were, the higher the probability of recurrence. In this case, it makes sense to talk about preventive medication.
Along with medications, other methods have proven effective in the prevention of relapses. These include: psychotherapy – cognitive-behavioral, psychodynamic, existential-analytical approaches; brain stimulation – transcranial magnetic stimulation.
The course of the disorder is very individual: the patient can suffer seasonal exacerbations or react heavily to minor events, or can have only a few episodes during so-called “critical periods” – childhood, adolescence and old age.
– Is the propensity for depressive states more dependent on individual mental traits or external factors?
– Adhering to the biopsychosocial approach, in which depression is viewed as a multifactorial illness, we cannot talk about more or less priority factors. Each case is unique and contains a different set of causes and predispositions.
It is worth noting that the criteria for depression are often found in individuals with severe somatic illnesses. High rates of depression are found in patients with cardiovascular pathology – especially after sudden, acute events such as a heart attack or stroke, in those with long-term ongoing autoimmune diseases – multiple sclerosis, ulcerative colitis and others, and certainly in people with cancer pathology.
– How do you take control of your own condition if you know you are prone to depression?
– Patients who have already had a depressive episode are advised to take maintenance therapy for some time to maintain the effect. Thereafter, we advise monitoring your condition and seeing a doctor if symptoms reappear. This will prevent the condition from deepening and in the early stages, not to lead to an exacerbation.
– How effective is the treatment of depressive manifestations in hospitals?
– The modern vector of development of psychiatry around the world is directed away from psychiatric inpatient care. Preventive measures are being strengthened by better informing the population – the so-called psychoeducation. The possibilities of outpatient services are expanding, in which the patient can receive all the necessary help, staying at home, surrounded by close people, whose role in the improvement of the condition is very great.
Inpatient care is needed only for those patients whose condition needs to be closely monitored due to high suicide risk, behavioral problems that are difficult to correct, life-threatening conditions such as long-term starvation or deliberate refusal to sleep at night, but these cases are quite few if we are talking about the entire population as a whole.
– What challenges does the psychiatrist face when prescribing medication therapy?
– Treatment of depression is done according to clinical guidelines. For each method of treatment and drug that goes into the guidelines, the effectiveness must be confirmed by scientific research. Including studies of which medications help prevent recurrent episodes, doctors recommend taking them after discharge.
The difficulty is that long-term therapy is often indicated for mood disorders, and many patients are not psychologically prepared for this.
The two most common myths about psychopharmacotherapy and psychiatry are “they will make me a vegetable” and “I will be addicted to drugs. These two ideas have nothing to do with the real picture of what’s going on, but it’s these that have to be dealt with first and foremost.
– Can depression become chronic? In that case, would the person have to take periodic antidepressants?
– There is a separate diagnosis for cases where symptoms of depressive disorder persist for several years – dysthymia. This condition is more difficult to treat, but there are also effective pharmacological and psychotherapeutic approaches to it.
According to the recommendations, even if a depressive episode was the only one and lasted for several months, which is not much by the standards of depression, supportive therapy after recovery should be taken for at least six months. More severe and long-term conditions may require medication for several years.
It is also the case that the patient has had several major depressive episodes, each of which severely disrupted all aspects of life, and each time they sought help, medication was prescribed with a positive effect, but each time, some time after their withdrawal, the symptoms of severe depression reappeared. In such cases, it was advisable to use medication therapy for a long time, without a definite period for its cancellation. And the task of the doctor-psychiatrist is to assess the condition and tolerability of medications, to control general health indicators – ECG, BP, blood analysis – once or twice a year. With such an approach and observing the balance of efficacy and tolerability, drug therapy can continue indefinitely.
– Can frequent depression provoke mental illness?
– Depression is a mental disorder; its frequent recurring episodes are quite distressing for people. We cannot definitely say that the frequency of depressive episodes increases the risk of developing other psychiatric pathology. But we can say that along with depression, of course, other psycho-emotional disorders can occur. The most common include symptoms of anxiety, substance abuse and personality disorders.
– How does social media affect people prone to depression? Do they help or do they make things worse?
– There are a lot of mental health self-education projects on social media right now. Groups are created where patients share useful information and support each other.
On the other hand, in social networks, it’s easy to run into people who promise help or create the illusion of community, but actually pursue completely different goals and can only do harm.
In general, information accessibility in itself is harmless. The opportunity to find a lot of information on the issue of interest – rather a blessing, the whole thing is how to use it, while not getting confused in a large array of sometimes contradictory data.
– Sometimes people create a nervous situation for themselves, they reach for the sources of stress, then complain, get depressed. Only it gets easier – again find a lot of stressful situations. Why is this happening?
– From the outside the situation may look like this, but the person himself feels it differently, and it is inappropriate to blame him for “looking for problems”. We all “find ourselves in stressful situations,” but if this happens often and leads to conditions such as depression, this is a reason to see a psychotherapist or psychiatrist.
Certain personality traits increase the likelihood of conflict behavior, social instability and related mood disorders. A psychotherapist works with these features.
– If a person has a low tolerance for stress, how can he or she organize his or her life in order to minimize the risk of developing depression?
– There is a concept of “psychoprophylaxis” – measures to preserve mental health. We are talking about reasonable organization of lifestyle – diet, sleep, work and rest, work on yourself, which would allow to establish harmonious relationships with others and avoid problems in interpersonal communication.
The difficulty is something else: people rarely think about prevention in moments of intense busyness and a high rhythm of life.
For many, the recommendation “avoid stress” will cause rather a smile, and it must be said not unreasonably, as no one has an understanding of how to do it.
Perhaps the main advice that can be given is: never forget about yourself. If you take timely care of your physical and psychological comfort, the work of mental health professionals will be much less.
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Lack of vitality, unwillingness to get out of bed, bad moods for a long time and even unwillingness to live are all signs of depression. A depressed state has a bad effect on a person’s health and overall well-being. That is why it is so important to get medical help from a specialist in time.
How to determine the presence of depression?
Pathology can appear after experiencing stressful situations. If the disorder is absent, after the resolution of the problem, good mood returns to the person. But when the cause is eliminated, and the person does not leave apathy, depression and loss of strength, it is necessary to seek help from a specialist. The ability to work may also decrease.
It is possible to identify the presence of depression on your own, but self-treatment even at an early stage of development is not worth it. This should be done by a doctor, since self-treatment can only make things worse.
Depression in women is often postpartum, as their life changes dramatically, and sleepless nights add to fatigue. Hence, breakdowns and apathy appear.
When the pathology is in its neglected form, the person has the following symptoms of depression – not only bad moods and powerlessness, but also persistent disorders of the nervous system. There are also symptoms such as: a significant decrease in self-esteem, disadaptation in society, despondency and loss of interest in any events.
On the physiological level, appetite changes, intimate needs and energy decrease, sleep and intestinal functions are impaired (constipation, weakness, fatigue during physical as well as intellectual exertion are observed), body pain (heart, muscle, stomach area).
Signs of depression such as loss of interest in other people, tendency to frequent seclusion, refusal of entertainment, use of alcohol and psychotropic substances are noticeable in the patient.
The mental signs of depression include difficulty concentrating, concentrating, making decisions, slow thinking, a pessimistic view of the future with an absence of perspective and thoughts about the meaninglessness of their existence, suicide attempts, because of their uselessness, helplessness, insignificance.
Causes of depression
The onset of the disorder is not influenced by age category or social affiliation. Most often, depression occurs against a background of stressful negative situations, with constant failures – then the person falls into despair at the inability to somehow influence the course of events.
But in addition to the social factor, severe psychological trauma can lead to the development of depression, such as the collapse of the family, the death of a loved one, a serious illness that affects not only the patient himself, but also his relatives. In this case, depression is referred to as reactive depression.
The likelihood of depression increases with changes in hormonal background: during adolescence, after childbirth, at the onset of menopause, as well as in old age. Can be reflected in the emotional and physical level.
Another factor is brain lesions and somatic pathologies. Often depression affects patients who have had a stroke, suffer from chronic lack of blood circulation in the brain, after a brain injury.
Causes of depression can manifest itself as a result of the side effects of medications (benzodiazepines, corticosteroids). Often this condition disappears on its own after withdrawal of the medication taken.
Types of depressive states
Neurotic – often affected by people with low self-esteem, insecure, straightforward. They constantly experience a sense of injustice, and apathy arises from this.
Clinical – poor mood, loss of energy, problems with appetite and sleep. It is not uncommon to see a tendency toward suicide. Such a clinical picture can last at least 2 weeks.
Vegetative – manifested by signs such as tachycardia, blood pressure fluctuations, tinnitus.
Psychogenic – develops after severe psychological trauma – divorce, loss of a loved one, dismissal from work, betrayal, etc. It is accompanied by mood swings, anxiety, and oversensitivity.
Masked – often the illness manifests itself surreptitiously. Apathy, seclusion, and decreased interest in life may appear only as negativity and fatigue accumulate.
Asthenic – the condition manifests itself as fatigue, sleep disturbance, emotional instability due to accumulated difficulties, stress, physical and psychological strain.
Postpartum – it usually occurs 10-14 days after delivery. The young mother has a heightened sense of anxiety for the baby, and constant lack of sleep and fatigue further aggravate the situation. In addition, the mother’s condition is also affected by hormones.
Somatogenic – seizures occur due to disorders in the endocrine system, the formation and growth of neoplasms of both benign and malignant nature.
Alcoholic – depression is accompanied by the excessive use of alcoholic beverages. The post-drinking state is accompanied by uncontrollable craving for alcohol and the development of a withdrawal syndrome during alcohol withdrawal.
Bipolar – the patient’s euphoria is replaced by a depressive, manic disorder. But in the period between these phenomena, caused by various factors: stress, loss of means of popularity, etc., the person lives a normal life and does not show the symptoms of the illness.
How does depression develop in stages?
First, the patient has a depressed state, which he himself writes off to fatigue, a hard work week, taking alcoholic beverages and other reasons. At the same time, he wants to get away from others and at the same time is afraid of being alone.
Then there is the stage of acceptance: there comes the realization of the dangerous condition, the problem worsens, the intensity of negative thoughts increases, the organism and the immune system malfunction.
The third stage – in the absence of adequate therapy, the patient loses control over himself, aggression increases.
Diagnosis and treatment of depression
To identify the disease, experienced specialists use short questionnaires – screening tools to identify symptoms: anxiety, anhedonia (loss of enjoyment of life), suicidal tendencies. Thanks to this, it is possible to determine whether the patient has chronic depression, the symptoms and treatment of depression, its form and degree of severity.
To fully understand the picture of the disease, the doctor needs to familiarize himself with the symptoms that point to depression, and not another psychological disorder.
The following specialists may be consulted to treat depression:
Psychiatrist – treatment of depression with hypnosis, drugs acute mental pathologies – schizophrenia, mental retardation, epilepsy, as well as other, less severe ailments – neuroses, depression alcoholism, drug addiction, etc.
Psychotherapist – treatment takes place through special therapy, which involves explaining, talking, finding solutions to problems with the patient.
Psychologist – counsels the patient, can not prescribe medications and examinations. Clinical psychologists use modern test methods to identify the problems that caused the psychological disorder.
The main areas of therapy in treatment are psychotherapy, pharmacotherapy, and social therapy.
The necessary condition for the effectiveness of treatment is noted cooperation and trust in the doctor. It is important to strictly follow the prescribed therapy regimen, visit the doctor regularly, and give a detailed report of your condition.
Medications for the treatment of depression
To treat the disorder, antidepressants are used for anxiety depression or when the pathology is accompanied by lethargy. Antidepressants are prescribed directly by the doctor and are not recommended to take them independently. The effect of many antidepressants is manifested two weeks after intake, their dosage for the patient is determined individually.
In bipolar depression, treatment of depression with insomnia is used. While it has a negative effect on a healthy person, in a patient with a psychological disorder, sleep deprivation, on the contrary, brings the psyche back to normal.
A moderate or mild form of depression requires the prescription of mild, natural-based (herbal) medications.
Where can I be examined and treated for depression in Krasnoyarsk?
If you or your loved ones have detected signs of an emotional disorder, it is necessary to immediately contact a specialist. Since the depressed state can lead to dangerous consequences:
Isolation from society
deterioration of appearance
low efficiency or its complete absence
Visit the private clinic “Medunion” in Krasnoyarsk for examination and treatment of depression. Our phone number for an appointment is +7 (391) 202-95-54.