Depression. Part II: how to treat it and how not to treat it
Continuation of the literacy about depression, from which the reader will learn how psychiatrists, psychologists, neuropsychologists and psychotherapists differ from each other, how different patients select therapy, what is the danger of refusing medication, when pills and other drugs become dangerous, how these drugs work, why you should not drink valor and valokordin, as well as self-medicate.
Where to Run
One of the reasons why very few depression patients in our country still get to a specialist is that almost no one has a clear understanding – and what, in fact, a specialist is needed here?
“People, first of all, are afraid of all those whose profession name contains the root “psycho”, and secondly – often confused about them, – confirmed Svetlana Minskaya, psychiatrist, psychotherapist. – If very briefly, the gradation is as follows: a psychiatrist is a doctor. He has a medical education and can prescribe medication. His field of expertise is a variety of psychopathological conditions (i.e. deviations from the norm), which include depression. A psychologist, on the other hand, is not a doctor. He has a humanitarian education; he “treats” only with words, and mostly with situational problems of healthy people; as a rule, he does not work with pathologies. Meanwhile, very often people with depression go to a psychologist. More precisely, psychologists can work with depression, for example, using cognitive-behavioral therapy; however, having found out his client has symptoms of depression, the psychologist has to refer him also to a psychiatrist. In practice, unfortunately, it does not occur in all cases – the psychologist, due to lack of medical training, is not always able to “calculate” symptoms indicating that the person needs exactly medical aid.
The biggest confusion is with psychotherapists. The fact is that until recently, a psychiatrist, or a doctor of any other specialty, or a psychologist could obtain the “badge” of psychotherapy in our country. Today, this is the prerogative of psychiatrists. Further, it is very important to keep in mind that psychotherapy is not a direction in medicine, but a method of treatment. Psychiatric treatment is “addressed” to the symptoms of illness, while psychotherapeutic treatment is addressed to the personality of the patient. In general, the most correct answer to the question “who to go to with depression?” would be “to a psychotherapist, who is a psychiatrist by main specialty. By the way, there are also psychoneurologists in polyclinics. In essence, these are “renamed” (in order to keep people from being afraid) psychiatrists. You can also go to them with symptoms of depression.
In some cases, depression, which for years had not allowed a person to live normally, can be “eliminated” very, very quickly. “I have seen more than once how people with rather severe depressions, against which they quit their jobs, lay on the couch all day long and caused the very real hatred of their relatives, after starting treatment, were completely transformed in just a month and a half. – said Dmitry Martynyuk, psychiatrist, psychiatrist-drug therapist. – But, of course, this is not always the case. Some people need two weeks, some need two months, some need six months. There are very resistant depressions in which treatment can take several years. But even if it takes some time to see results, treatment is still necessary. It should be remembered that there are different degrees of depression, and if severe states are not treated, the consequences can be not only disadaptation and low quality of life, but also suicide. A sad example from practice: a very young man, who came to me with rather severe depression, was forbidden by his father to take prescribed medications, motivated by the popular statement “pills are for pussies, my son should be strong”. As a result, his son committed suicide–and it was not a matter of weakness, of course, but of illness. If he had continued to receive treatment, this story might have ended differently.
Of course, mild to moderate depression sometimes “goes away” with age, lifestyle changes, or, if depression is reactive, when the traumatic event is removed. However, the key word here is “sometimes. So if the thought “maybe I have depression?” already visited – go to the doctor in any case.
Another thing is that few people can independently determine that he is depressed. “Much more often people come to me simply as a psychotherapist, with some of his life problem – said Svetlana Minskaya. – Depression is detected in the process of the conversation.
How is it treated
Depression can be treated in two ways: with medication and through psychotherapy. However, there is no one-size-fits-all “right” treatment. First, because depression differs in types, degrees of severity and clinical presentation – in different cases, either anxiety, or depression or some other condition can be in the foreground. Secondly, because, as clichéd as it sounds, everyone is different, and in this case it is a very significant factor.
“In principle, some depressions can be treated with psychotherapy alone, without the prescription of psychotropic drugs,” explained Dmitry Martynyuk. – But this applies mostly to mild depressions, and such treatment takes a very long time. Most often, a combination of medications and psychotherapy is used. In what proportions depends on the individual patient. For example, if a person “does not believe in your pills”, the emphasis is on psychotherapy. At the first visit with a depressive episode, medications are most often prescribed, and at the beginning it is very important to tell the person in detail about what kind of illness he or she has, to explain how the medications work and so on.
“In general, the very explanation of how the drugs work and what depression is, is already psychotherapy,” added Svetlana Minskaya. – In addition, by establishing contact with the patient and informing him or her, compliance, that is, adherence to the treatment plan, increases. The person will not neglect the recommendations, will be less likely to skip taking medications, and so on. Separately, I would like to note that a conscientious psychiatrist will never limit himself to writing a prescription – he will certainly talk to the patient. If this does not happen – this, in general, is a serious signal that it is worth looking for another doctor.
The selection of medications also takes place on an individual basis. “Because medications must not only help, but also not harm, the doctor takes into account many factors, including those not directly related to the symptoms of the disease,” explained Svetlana Minskaya. – Additionally to objective disease pattern and patient’s complaints, a patient’s age and gender, presence of concomitant diseases (not only mental), allergies to any medications or products, taking other drugs (no matter if the doctor prescribed them or chose them independently), lifestyle, bad habits, and even occupation and income level are taken into consideration”.
Antidepressants and others
The main drug for depression becomes, as it is easy to guess, an antidepressant. Since on the biochemical level, depression is an improper metabolism of neurotransmitters (serotonin and norepinephrine), respectively, the task of antidepressants is to normalize it. These drugs regulate the release of serotonin and noradrenaline into the synaptic cleft, as well as their reuptake and the activity of the MAO enzyme that destroys them. There are many groups and subgroups of antidepressants, many of which can, despite different mechanisms of action, produce the same effect. “From a practical point of view, we can distinguish antidepressants of the “old generation,” the so-called tricyclic, and antidepressants of the latest generation, affecting either serotonin reuptake or MAO activity. – told Svetlana Minskaya. – They differ mainly in the frequency and nature of side effects. The tricyclic ones are characterized by their more frequent occurrence, and not so much in the mental area, as in the somatic one: difficulty in urination, constipation, impaired visual focus and so on. Subsequent generations of antidepressants can have mental side effects, such as increased anxiety at the start of treatment, or temporary insomnia. All of these can be easily remedied by adding small doses of other psychotropic medications.”
If necessary, tranquilizers – anti-anxiety medications – are prescribed in addition to antidepressants. Depending on the patient’s complaints, the doctor may prescribe a nighttime tranquilizer (commonly such drugs are called hypnotics) or a daytime tranquilizer, which will allow the patient to distract himself from anxiety and concentrate during wakefulness. In addition to reducing anxiety, tranquilizers can regulate symptoms related to the autonomic nervous system – such as the “stone in the chest” feeling that often accompanies depression.
Another type of medication often prescribed for depression are nootropics. These substances normalize the functioning of the cerebral cortex, improve memory and mental performance in general, and may also reduce the side effects of other psychotropic drugs.
In some cases, the doctor may also prescribe drugs-neuroleptics, which can reduce the “heat” of depressive thoughts.
About the dangers of self-medication
Since people very rarely go to the doctor with melancholy and anxiety, and somehow it is necessary to survive, the course is often used a variety of “improvised means” – from alcohol to over-the-counter drugs.
“In our country it is very popular to take drugs for nerves such as Corvalol, Valokordin or Valoserdin. – warned Svetlana Minskaya. – They are all sold without a prescription and seem harmless, time-tested. In reality, these drugs are intended only for a single use – they contain a potent substance phenobarbital, taken which almost instantly feels relief of mind, and in large doses – a sleeping effect. Dependence and psychological addiction to this substance develops very quickly. And few people know that phenobarbital strongly accelerates the work of liver enzymes, which subsequently leads to intoxication when taking regular therapeutic doses of other drugs, and as a consequence – to the destruction of the liver.
About trying to pick up your own antidepressant or any other type of medication, we not only do not talk about, but strongly advise against it. Depression – this is a case where “folk medicine” and “common sense” can be the enemies of the patient, and there should be no place for self-love and frivolity. It can be said that depression is both harder and easier than is commonly thought. It is heavier because it is a serious illness from which you cannot get rid of it by willpower or cavalry charge. It is easier because modern medicine has a good understanding of this phenomenon, at least on a practical level, and in most cases there is every chance to change depression into the normal proportion of joy and grief.
In the third part of this article we will look at depression from an academic point of view: what is the mechanism of its emergence and development, is it caused by human evolution (maybe it’s a payment for some abilities unique to the animal world), what has world science learned about depression in recent years and in what direction are pharmacological developments moving.
Treating depression without antidepressants
Quite often in people’s lives there are situations that knock out the rut, when everything does not go according to plan, does not work out. A person becomes frustrated, sad, grieving, and thinks he or she is depressed. In most cases, however, this is not the case. Only a doctor can diagnose a depressive disorder.
So what is depression, what are its causes, symptoms and treatment?
Let’s try to understand this in our article.
What is depression?
Do not think that it is just a bad mood or apathy. If you are moping and gloomy, it does not mean that depression takes place. In fact, it is an illness that is characterized by serious changes in the biochemical processes of the human brain. Signs of the illness may persist for more than two weeks, whereas normal frustration or sadness disappears much sooner. If severe depression is not treated promptly, the condition drags on for years and develops into a hard-to-cure chronic form. It is not uncommon that a person does not even realize that they are sick. It is important to understand that treatment of neuroses and depressions is necessary and should be handled by a specialist with extensive experience in this field.
What is clinical depression and why does it require treatment? The disease develops because the production of certain neurotransmitters in the brain, which are responsible for receiving positive emotions, is disturbed. The disease makes a person apathetic, he rarely has a good mood, most often there is a pessimistic attitude.
Causes and symptoms
The causes of the development of this disease can be regular stress, psychotraumas, various unpleasant situations and events, problems in relationships with loved ones, the opposite sex, psychological violence in childhood or in adulthood. However, such deviation in the psycho-emotional state is not only a consequence of trauma, it is also various changes at the physical level. In particular, patients have a lack of vitamin D, iron and some other trace elements and biologically active substances.
In addition, the development of the disease is largely influenced by hormonal disorders and diseases of the endocrine system. Quite rarely, the disorder occurs as a side effect of taking medications, but it is usually prescribed in the instructions. Vitamin D deficiency is associated with a lack of sunshine, and in the fall and spring, many people develop an exacerbation of mental disorders.
Will the depression go away, or is it permanent?
If the disease has lasted for quite some time, many people begin to fear that they will never be able to get rid of it. Is this true? If the illness is in a mild form, it is possible to cope with it yourself. A person sooner or later will experience a traumatic situation, reevaluate it, change the attitude toward the event and recover. In some cases, the use of medications leads to a bad mood, but after their withdrawal the condition normalizes. Any psychiatrist, psychologist or psychotherapist will tell you that treatment for depression is necessary. It will allow the person to get rid of intrusive thoughts and find more positive thinking, which will improve the quality of life, and possibly its duration.
Without treatment for depression in women and men, the disease will progress, exacerbating the psychoemotional state and becoming the cause of mental abnormalities, especially for people of age. But for young people, too, the disease does not go away without a trace. Do not fight it alone, share your problems with family and friends, look at them from the outside, listen to advice, go to the doctor for treatment of panic attacks, moderate and severe depression.
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Types of disorder
With the right methods, medications and therapy plan, the disorder can be managed and cured regardless of the stage and duration of development. If the disorder is caused by a lack or deficiency of certain vitamins and substances in the body, the person’s condition normalizes as soon as the balance is restored. When treating endogenous or psychogenic depression, a special comprehensive therapy is necessary. In the first case, the illness is caused by a mental malfunction, and in the second – by traumatic events.
For example, the death of a spouse can be taken by an elderly woman close to her heart, the loss of the person with whom she lived hand in hand is very traumatic, which can cause not only the development of neuroses, but also dementia. In this case, doctors recommend treating depression in women in a clinic.
No less dangerous and postpartum depression treatment, which is very important for the young mother. During pregnancy and after childbirth a huge number of changes occur in a woman’s body. Not everyone immediately accustomed to the new role, some are afraid of the piled up responsibility, some are not confident in the support of the spouse. As a result, there are mental disorders, panic attacks, groundless fears, and breakdowns.
Today, specialists often provide treatment for bipolar depression. This disorder is getting younger every year, but it should not be confused with a number of other abnormalities. Bipolar disorder is often confused with heightened emotionality. If you feel the symptoms of this illness, call the clinic, today it is possible as a treatment for depression in a hospital in Moscow and undergo therapy as an outpatient.
Treatment of anxiety-depressive disorder without antidepressants
Many people do not want to go to the doctor because they think that only drug treatment of depression with antidepressants is possible. They have heard about the side effects and high risk of drug addiction, as well as various myths about the harms of these medications. The dangers of antidepressants are greatly overestimated. You should not think that in modern medicine there are only drugs and pills to treat depression. Fearing the often far-fetched consequences, people turn to homeopathy for help, which, of course, will not give any result except as a placebo.
Today there are completely different and varied methods of treating depression, in many cases it is possible to do without medication. As a rule, pills are not even the basis of treatment, but supportive therapy for psychotherapy. If you go to the doctor in time and begin effective treatment of depression in Moscow, you can do without drugs.
- Withdrawal from binge drinking
- Consultation with a narcology doctor
What methods for treating anxiety-depressive disorder without pills exist?
It is possible to treat depression with sleep, hypnosis, physical exercises and activities, with psychotherapy sessions with a specialist, relaxation practices, breathing exercises, relaxation, compliance with a certain daily regime. If a person cannot follow the recommendations, they have no strength, they do not cope, you should immediately consult a doctor. Most likely, if the above methods are ineffective in this case, pharmacological therapy is necessary.
What are the dangers of antidepressants for the human body?
Are antidepressants dangerous to health? People are afraid of these drugs as well as antibiotics. There are a lot of myths around these drugs. How dangerous are antidepressants in reality? First of all, you should understand that no doctor will not prescribe you a strong drug without indications for this.
Modern drugs affect the human body quite gently, bringing patients a huge benefit and bringing recovery much faster. The medications affect the production of the necessary neurotransmitters and make up for the lack of serotonin and endorphins. As a result, the patient begins to feel many times better in just a couple of weeks than before the start of therapy.
However, the positive effects of the pills do not appear immediately; over the course of several weeks, the person’s body adapts, which causes some side effects. Often they cause patients to stop taking the medication, as they feel that their condition is only getting worse. However, you should be prepared for the fact that they are not magic pills, which will help to get rid of a serious illness overnight. Most medications have a cumulative effect.
A competent specialist knows in what dosage you need to take a particular drug. Most often, the dose increases gradually as the body becomes accustomed to it, which is why the expected effect will be absent at the beginning of therapy. It is important for patients to stay in touch with their doctor to let him know about any changes. If your health condition worsens, let your doctor know. If you follow the recommendations, the medications will only bring benefits and a significant improvement in well-being.
Dependence on antidepressants – myth or truth?
It is impossible to say unequivocally that medications for depression are evil. But the fact that they are completely harmless, too. Medicine is not standing still, as well as pharmacology. Medications are constantly being improved and perfected. Today, those drugs that caused drug addiction and posed a real threat to health due to side effects are long in the past. The latest generation medications are much safer than their predecessors.
In some cases, patients have to take medications for years, not because they become addicted, but because the treatment plan and indications require it. Most often, however, when referring to specialists in the early stages of the disease, the use of medications is not required, or a short course of administration is necessary. Gradually the dosage is reduced to zero, which prevents the development of drug dependence. A person gradually gets used to living without medication.
However, the truth is that despite the ban on the over-the-counter sale of most such pills, some people bypass the law and buy them illegally. Why do they do it? The fact is that some drugs can still be addictive if overdosed and used over a long period of time. Among the most common pharmacy drugs are Lyrica and Fluoxetine (Prozac). When used inappropriately, for recreational purposes, the drugs can cause dependence, which you can get rid of only with the help of a narcology doctor.
Do not self-medicate, increase the duration of use and dose, it may lead to undesirable consequences and side effects. If you feel that you cannot stop taking the drug, call your doctor. He or she will be able to help you get rid of your addiction.
Is it possible to get rid of depression once and for all?
Is it realistic to cure anxiety-depressive disorder? This question cannot be answered unequivocally in the affirmative. The disease can progress in different ways, have many related diseases of varying severity. Each individual case should be considered individually. In most cases, depressive disorder can be treated, but the risk that the illness will return or stay forever cannot be ruled out. It is very important to monitor any changes and contact a psychotherapist immediately if necessary and if there is a visible deterioration.
Avoiding a relapse can be helped by following your doctor’s recommendations and taking preventive measures. It is necessary to get into the habit of doing sports, exercise, or at least gymnastics in the morning. Remember that no one will take care of you but you. Forget about smoking and alcohol, bad habits only provoke depression. It’s important to observe your sleep regime, as sleeping less than eight hours leads to negative processes in the central nervous system and has an unwanted influence on your mind. Avoid stress if possible.
What can a doctor do for you?
In our country, there is a great distrust of doctors. It affects low level of medicine in regions, lack of financing, low salaries of doctors and with it the negligent attitude towards their work. Of course, there are good and bad doctors and clinics, if you do not trust budget institutions, go to a private center.
If you have symptoms of the disorder, you should immediately contact a psychotherapist. The specialist will be able to quickly recognize the disease, diagnose and take tests, examine the patient and make an individual plan of psychopharmacological treatment. The clinical psychologists at our center are also able to diagnose depressive disorder. Quite often our patients suffer from alcoholic depression caused by prolonged alcohol abuse. “Healthy Youth Center” has all possibilities, experience and necessary resources in order to eliminate all symptoms of the disease and normalize the psycho-emotional state of the patient.
Many people are afraid of psychologists. “Am I crazy?” – can often be heard from patients. However, neuroses and depressive states do not mean that a person is mentally ill, and he will be put in a mental hospital and put on record. When you go to a private center, people are treated completely anonymously. Even if you go to a state clinic, you will not be registered as a patient. Specialists are not entitled to disclose the diagnosis and give information about the patient’s condition to third parties, as it is a medical secret. A person can go through the treatment process with complete peace of mind. Quite often an experienced doctor will only need to conduct psychotherapy sessions in order to achieve a stable remission. Personal communication with the doctor and following his recommendations is all that is needed for a speedy recovery. Do not prescribe your own medication, it can end badly.
If you feel the growing symptoms of depression, do not wait for a miracle and live with it for years, there is a way out, modern techniques and the latest drugs will help to cope with the disease. Doctors will help restore the joy of life, even with chronic pathology.