Depression – symptoms and treatment
What is depression? Reasons for the emergence, diagnosis and treatment methods will be discussed in an article by Dr. Yelena G. Magonova, a psychotherapist with experience of 21 years.
The article by Elena Magonova was written by the literary editor Yelena Berezhnaya and the scientific editor Sergey Fedosov.
Definition of the disease. Causes of the disease
According to the WHO definition, depression ( depression ) – it is a common mental illness, which is characterized by enduring sadness and loss of interest in what usually brings pleasure, the inability to perform everyday activities, accompanied by feelings of guilt, decreased self-esteem for 14 days or more.
Signs of depression: feelings of indecision, impaired concentration, psychomotor retardation or agitation, sleep disturbances, changes in appetite and weight.
In psychology, depression (from Latin depressio – suppression) is defined as an affective state characterized by a negative emotional background, changes in the motivational sphere, cognitive (cognition-related) ideas and a general passivity of behavior.
It is important to distinguish depression as a clinically pronounced illness from a depressive reaction to a psychologically understandable situation, when each of us experiences a lowered mood for a few minutes or hours in connection with a subjectively significant event. About 16% of people have experienced depression at least once in their lifetime. 
It has been observed that women are reliably more likely to be diagnosed with depression, which is likely due to the fact that women are subject to greater neuro-endocrine changes. This is due to a number of physiological features of the female body – the menstrual cycle, postpartum or menopause, during which the psychoemotional state can fluctuate from normal to clinically outlined depression. In addition, women are more likely to be diagnosed with depression due to their gender, social, and psychological characteristics – for example, women find it easier to talk about their emotional state.
Men usually seek help from a psychiatrist or psychotherapist less often because they are hindered by social stereotypes: men should be rational, strong, “real men do not cry”, and depression in men is directly related to addictive behaviors (alcoholism, drug addiction, gambling addiction, extreme sports).
The risk of developing a depressive disorder increases significantly in the following cases:
- In old age due to loss of meaning in life (retirement);
- when in a child-centered family, adult children grow up and leave their parents (the “empty nest” syndrome);
- the loss of a loved one.
Nowadays, the biopsychosocial model of depression development, according to which the causes of depression are social, psychological and biological provoking factors, is generally accepted.
The social factors that lead to depression are:
- Acute and chronic stress (loss, infidelity, divorce, various forms of domestic violence);;
- loss or change of employment;
- high psycho-emotional stress in professional activity;
- economic crises;
- political instability in the country.
Psychological causes of depression:
- A tendency to get stuck in experiencing unfavorable events as a property of temperament;
- maladaptive coping strategies in overcoming stressful situations.
Biological causes of depression:
- endocrinological shifts in the body (pregnancy, postpartum period, menopause, hypo- or hyperthyroidism);
- asthenization of the body as a result of severe infectious diseases.
If you find similar symptoms, consult your doctor. Do not self-medicate – it is dangerous for your health!
Symptoms of depression
How a person feels when depressed:
- There is a depressed mood, despondency, sadness, a feeling of hopelessness, low moods for a long period of time.
- Increases fatigue and tiredness as a result of habitual or minor exertion.
- Interest and ability to enjoy things that used to bring satisfaction decreases.
In addition, signs of depression include:
- decreased ability to concentrate;
- low self-esteem and insecurity;
- feelings of guilt and a tendency to self-deprecation;
- gloomy and pessimistic visions of the future;
- psychomotor retardation or agitation;
- sleep disturbances;
- changes in appetite and weight.
Recurrent thoughts of death and suicide, suicide attempts are a dangerous symptom of depression.
The thinking of a person suffering from depression is characterized by the presence of irrational ideas, cognitive errors:
- Excessive self-criticism or unwarranted guilt – thoughts of worthlessness, loss of self-confidence, lowered self-esteem, tendency to self-blame.
- Negative vision of the present – sensation of senselessness of existence, unfriendliness of the surrounding world and people.
- A negative vision of the future – expectation of problems, new shocks, failure and suffering.
Pathogenesis of depression
On the basis of available studies it is proved that in the development of depression the key role is played by disorders of neurotransmitter activity in the limbic neurons of the brain – the release and interaction with the postsynaptic receptors of mediators such as serotonin, noradrenaline, dopamine, acetylcholine, histamine, etc. changes.
What happens in the organism during depression
Lack of serotonin manifests itself as increased irritability, aggression, problems with sleep, appetite, sexual activity, decreased threshold of pain sensitivity. A decrease in the concentration of noradrenaline in the neurons of the brain leads to a feeling of increased fatigue, impaired attention, apathy, and decreased initiative.
Dopamine deficiency manifests itself in impaired motor and thinking activity, decreased satisfaction from activities (from eating, sex, recreation, communication), loss of interest in learning, learning.
Therefore, the medication approach in treating depression is to prescribe antidepressants that regulate the release and interaction of neurotransmitters with the receptors of the limbic system neurons.
Classification and stages of depression
The International Classification of Diseases, 10th Revision (ICD-10) classifies depression by severity and type of course.
Types of depression by severity:
- severe depression without/without psychotic symptoms.
In mild and moderate depression, a person usually retains the ability to work, although the quality of life is reduced. Severe depression is characterized by the presence of the typical symptoms of depression: low mood, decreased interest and enjoyment of activities, increased fatigue, impaired ability to work, suicidal tendencies may be present .
According to the type of course:
- Depressive episode;
- Recurrent depressive disorder;
- Chronic Mood Disorder.
Up to 30-35% of patients have a chronic form of depression, with a duration of the depressive disorder of two or more years.
It is also common in psychiatry to distinguish depression according to its origin :
- Endogenous (manic-depressive psychosis) – implies a gratuitous onset, hereditary predisposition to develop the disease, alternation of depressive and manic states;
- exogenous – develops under the influence of acute or chronic stressors;
- somatogenic – associated with somatic, including organic pathology (myocardial infarction, stroke, craniocerebral trauma, cancer, etc.).
The U.S. DSM-5 classification takes into account the phenomenological features of depressive disorder.
These include depressive symptoms:
- With anxiety distress;
- with mixed traits;
- with melancholic features;
- with atypical features;
- with psychotic features,
- congruent and incongruent moods;
- With catatonia (movement disorders);
- Seasonal patterns (refers only to recurrent episodes).
Seasonal affective disorder is a type of depression associated with the change of seasons; it begins and ends at about the same time each year. Most people with this type of disorder have symptoms in the fall and continue through the winter months, less often in the spring or early summer .
Complications of depression
Worldwide, the economic losses due to the disability and treatment costs of people with depression are great.
The coexistence of depression with somatic pathology (arterial hypertension, coronary heart disease, bronchial asthma, gastrointestinal diseases, oncology, autoimmune disorders) aggravates the course of somatic diseases, the severity of pain increases, somatic disorders become chronic, resulting in increased mortality from the underlying disease.
What is the danger of depression?
One of the most serious problems is the high probability of suicide in depression (8%). At the same time, of the total number of suicides, up to 60% are those who suffered from depression.  
This is why timely diagnosis and adequate treatment care for people suffering from depression is so important.
Diagnosis of depression
A large proportion of depressed patients, due to fear of the stigma of mental illness  and the abundance of physical manifestations (somatic “masks”) – headaches, dizziness, chest pain and heaviness, brokenness, digestive disorders – first seek consultation in the outpatient clinic network with general practitioners, where they may undergo lengthy examination and ineffective treatment because they are not adequately helped.   
In the United States, where the number of psychiatrists is quite large, 50% of patients with symptoms of depression go to a primary care provider, while only 20% go to a psychiatrist . In the United Kingdom, a large proportion of depressed patients are treated by general practitioners, with only 10% going to psychiatrists. 
Screening for depression.
Seeing a psychiatrist and psychotherapist in a timely manner helps to establish a proper diagnosis of depression and to select effective treatment.
In the diagnosis of depression, clinical scales are used – Hamilton Depression Scale, Zang Scale, Beck Scale and others,    that determine the presence and degree of depression and some of its manifestations.
Unfortunately, there are still no precise laboratory tests and studies that can show which mediators’ imbalance led to the development of depression in a particular patient.
The differential diagnosis of depression
- with mood disorders caused by organic brain disorders;
- Affective disorders in the structure of schizophrenic disorders;
- Bipolar affective disorder (in addition to depressive phases, mania occurs in the structure of the illness).
Treatment of depression
Depressive disorders of a mild degree of severity can lend themselves rather well to psychotherapeutic treatment.
Supportive treatment for depression
Until the condition improves, the doctor observes patients once or twice a week. During the appointment, the doctor supports the patient, gives the necessary explanations and monitors the patient’s progress. An appointment at the doctor’s office can be supplemented by a telephone conversation with the patient. The doctor should explain to the patient that depression is not a personality or mood disorder but a serious illness that has biological problems and needs to be treated and that the prognosis is good. The doctor should also try to encourage the patient to be more active in daily life and social activities, such as getting outdoors more often or enrolling in an art class. It is important for the doctor to make the patient understand that the illness is not his fault, that negative thoughts are only part of the condition, and that they will pass soon (20).
Medication therapy for depression
For moderate to severe depression, a combination of psychopharmacotherapy (antidepressants) and psychotherapy is more effective.
Today, serotonergic antidepressants and so-called dual-action antidepressants (affecting the metabolism of serotonin and noradrenaline) are widely used, which are used from 3 months and longer (the average duration of therapy is 6-12 months).
Taking antidepressants should take place under the supervision of a doctor and, despite long-term use, usually does not lead to dependence and is fairly well tolerated.
If depression does not respond to treatment, has passed in the chronic form, is prone to relapses, therapy with antidepressants can be supplemented by other psychotropic agents – tranquilizers, neuroleptics, anticonvulsants.
In addition to the outpatient treatment of mild and moderate depression, severe depression must be treated and monitored in a hospital setting.
Psychotherapy in the treatment of depression
Cognitive-behavioral psychotherapy, aimed at changing patients’ irrational beliefs and depressogenic patterns of behavior, and psychodynamic psychotherapy (psychoanalytic, existential psychotherapy, Gestalt psychotherapy), aimed at working through patients’ underlying experiences and traumatic early experiences, forming adaptive functioning in the present is provably effective and quick in psychotherapy of depression  .
Electroconvulsive therapy for depression
Electroconvulsive therapy (ECT) has limited use due to a wide list of contraindications, adverse reactions and complications. But in cases of severe depressive disorder and resistance to drug treatment, ECT can be used and proves to be effective .
Phototherapy for Depression
Phototherapy is used in the treatment of seasonal affective disorder in clinics specializing in such therapy. In this case, powerful artificial light sources are used with an irradiation mode of 10,000 lux for 30 minutes twice – morning and evening.
How to get rid of depression on your own
In the case of a depressive reaction to a stressful situation or with depression of a mild degree of severity, it is possible not to go to the doctor, because the manifestations of depression do not lead to disadaptation. It helps if the person is distracted from the stressful situation and immersed in work or hobbies. The support of a close environment or a visit to a psychologist can also alleviate the condition. But if the condition drags on, gets heavier and leads to social disadaptation, then specialist help is needed – a psychiatrist or psychotherapist.
What to do if a close person is depressed
Genuine support, empathy, sympathy and an offer to resort to the help of a specialist will be important for a person suffering from depression from his close environment.
A large proportion of patients do not receive adequate improvement from antidepressant therapy, are resistant, or have poor tolerance to medication.  In these cases, non-drug biological therapies (e.g., electroconvulsive therapy is often used abroad for resistant depression) and psychotherapy are alternatives. 
Without adequate treatment, depressive disorder has a high risk for relapse, a worsening of the course, and the appearance of suicidal tendencies in the patient.
15 Ways to Fight Depression
Self-treatment of depression by itself can defeat mild forms of depression. In more serious cases, “amateur attempts” are inadmissible, a specialist must be supervised, and natural remedies can be a good support for the prescribed measures.
Change your lifestyle
Although therapy and medication are the key methods of controlling depression, much can be done on your own without waiting until medication therapy is necessary. Changing behaviors — physical activity, diet, and lifestyle — can be an effective natural way to overcome depression.
Fighting depression is a war fought day in and day out, not just during those weeks or months when medication is expected to work. Medication is medication, but there are ways to support yourself.
Create a habit.
If you are depressed or have experienced depression, you need to prevent the onset or recurrence of such a condition. Depression knocks a person out of the rhythm of life, depriving him of orientation to the extent that one day begins to imperceptibly flow into another. And this lack of order, in turn, can only worsen depression.
It’s very difficult to wake up in the morning and not have the slightest idea what you’re going to do all day. So a person is boiling “in his own juice” in the power of despondency, hopelessness and heavy thoughts.
A sense of control over what is happening can give a developed habit. Psychologists confirm that it helps, and that the lack of a sense of control makes people feel worse.
1. Exercise. Everyone knows that physical activity improves mood. You don’t need to run a marathon or exhaust yourself with heavy physical activity – it won’t do any good, it won’t lift your mood, and maybe even make it worse. Nor does it matter what type of exercise you choose. These can be specific aerobic exercises that are good for the heart (if, for example, they are recommended by your cardiologist). But a simple half-hour walk for mental health may also be enough.
2. Nutrition. There is no special diet or nutritional regimen “for depression,” but a basic healthy diet in general offers tremendous benefits.
Nutrients are a necessary component in the fight against depression. After all, it is a physiological process, similar to healing from a physical injury. Without the right set of nutrients, medications for depression won’t work effectively enough.
Warning. Consult with your doctor to see if the medications you are taking can cause weight gain. If so, you will need to pay special attention to nutrition. If depression is related to eating disorders (anorexia, compulsive overeating) regular consultations with a specialist are necessary.
3. Sleep. Although sleep problems are a symptom of depression, they can also make it worse. Some people who suffer from depression sleep too much. But many more depressed people suffer from insomnia. Either way, something needs to be done.
Just lying in bed and trying to force yourself to sleep while counting elephants won’t help. Better yet, make a habit of going to bed and getting up at the same time every day. Organize and make it a habit to get healthy sleep.
4. Strive for a goal. Nothing keeps the spirit going like reaching a goal. The challenge is to set realistic goals. You don’t need to set global goals or write a 20-page list of feats. Start with small but realistic tasks, the completion of which will give a sense of small but victory, and therefore a sense of accomplishment.
5. Responsibility. When a person has a hard time on their mind, their natural impulse is to step back, to give up all of their responsibilities at home and at work. This feeling must be fought. A sense of responsibility will not let you lose heart. Just do not need to force events: if you are not ready to go back to work or to study, it is normal. Think about part-time work. If it seems too difficult, consider the possibility of uncomplicated work. But don’t give up – seeing the result of the work done will give you a sense of satisfaction.
6. Relaxation. Don’t think that pleasure or relaxation are things that happen by themselves. The only way to make them happen is to plan them.
Changing the mind.
When a person is depressed, he gets used to seeing the world and himself “in black.” This way of thinking can become habitual and continue for many months after the biological cause of the depression is eliminated.
Automatic negative thoughts are frequent sources of anxiety. These thoughts arise randomly when you encounter a situation that hurts your feelings. They can be related to each other and all together poison your life.
Example: your boss has asked you to rewrite the beginning of a project you are working on. Instead of just rewriting, you start “inventing” the reasons for such an order, “deepening” the problem: what if I am not professional enough? What if I get fired? Further down the chain: “I will remain penniless, I will lose my home, my family will hate me, I am a total loser, why should I live in the world…”…that’s it: within a few seconds you are plunged into complete despair.
How do you deal with automatic negative thoughts?
7. Think about it. At first, it will be very difficult to catch the beginning of this negative chain. After all, these thoughts arise involuntarily. It will be easier to remember the “bad day” and try to understand what happened. How did you go from feeling good in the morning to feeling nasty in the afternoon? What events – and what thoughts – lead you to a depressed state of mind?
By recreating what happened, you will understand what automatic thoughts you are prone to and how they arise. Then, over time, you’ll learn to identify automatic thoughts at the right moment and take control of yourself – stopping them before they get out of hand.
8. Pause. When you find that automatic thinking has “kicked in,” try to pause, switch, and unwind. Breathing exercises, or just a walk in the fresh air will help. Break away for a while from the activity in which these thoughts caught you.
9. Use logic. The next time some problem makes you feel terrible, try using logic as a natural remedy for depression. Depression can make you think disgusting things about yourself, often grotesquely exaggerated. Try to imagine this: is it true that no one likes you? Is there any real evidence? True, you may feel like the dumbest and most hated creature on the planet, but what is the real possibility of that?
Other natural ways to fight depression
In addition to creating habits and changing your mind, there are other natural ways to combat black longing.
10. Reach out to friends and family members. When it’s hard on the soul, people you trust will help. Talk to them about what’s going on with you. Sometimes, realizing that a friend can’t just be your “vest” (it’s emotionally very hard, after all), you’ll need to set aside your feelings for a while. And that’s a good thing – by taking care of your loved one’s emotional health, you’ll take a break from your own worries. You can just enjoy your time together with that person.
11. find support. In addition to relying on friends and family, you can try participating in a psychological support group. Maybe you’ll meet people who really understand what you’re going through and will help you recover.
12. Consult your doctor before taking supplements. Although a huge number of supplements are recommended as remedies for depression, practice suggests that prescribing them on your own is simply dangerous. Always consult your doctor before you start taking a supplement, especially if you are already prescribed any medication.
13. Beware of abuse. Many people trying to cope with depression try to drown it out with alcohol and other substances. It’s no use – you’ll feel even worse after a few hours. If you already have a substance abuse problem, such as alcohol, don’t wait until your depression is over. Get help, otherwise together these problems will “deal” with you even faster.
14. Make a difference. When a person is depressed, he gets as if in a vicious circle, in a rut. Every typical day will go like this: bed, TV, computer. Psychologists believe that in order to get rid of depression naturally need to force yourself to do something different, something completely new. Go to a museum. Grab a book and go read it on a park bench. Enroll in a foreign language course. In general – break the pattern.
15. Don’t ignore serious signs of depression. While using natural ways to fight depression on your own can help, they have their limitations. People have enough resources to help themselves, but these resources are not infinite. And when a person is so immersed in depression that he or she cannot cope with the depressive state on his or her own, with his or her own will, with thoughts that the world would be a better place without him or her, he or she needs urgent professional help.
And one more thing: make time for pleasant things
Experts advise a depressed person to be sure to make time for things you enjoy. You need to do things that entertain you,” they say.
Clearly, when you’re depressed or recovering from depression, entertainment seems impossible. The things you used to enjoy are no longer enjoyable. One of the insidious problems with depression is that it teaches a sense of hopelessness, a denial that there might be something enjoyable in life. It is this feeling that you have to struggle with.
So, as strange as it sounds, you’re going to have to work to have fun. Schedule activities that you used to enjoy. Even if you “really don’t feel like it,” keep going out with friends. Keep going to the movies and playing tennis. Over time, nice things will be like they were again.