How to treat depression?

Depression

The information in this section should not be used for self-diagnosis and self-medication. In the case of pain or other exacerbations of the disease, diagnostic tests should only be prescribed by the doctor who is treating you. Your physician should be consulted for diagnosis and proper treatment.

The criteria for a depressive episode are a daily and major part of the day decrease in mood that differs significantly from a person’s usual state for two weeks or more, an obvious decrease in interests and enjoyment of activities usually associated with positive emotions, increased fatigue and motor lethargy.

To the above symptoms may be added the following:

• decreased attention span;
• impaired appetite;
• insomnia;
• decreased self-esteem;
• thoughts of guilt;
• suicidal thoughts.

1. Psychogenic depression develops as a reaction to psychotraumatic events.
2. Endogenous depression is caused by changes in the levels of hormones and neurotransmitters.
3. Exogenous depression occurs under various somatic diseases, as a result of brain damage and use of psychoactive substances.
4. Latent (“masked”) depression manifests itself in the form of a somatic illness.

When diagnosing it, it is important to rule out the presence of any organic illnesses. After all, such depression has many manifestations, with which patients consult therapists, cardiologists, neurologists, etc. However, examinations do not reveal any organic pathology.

The most common form of such depression is cardiac. Patients feel excruciating pain in the heart area, palpitations, weakness, dizziness, but when undergoing cardiological examination no abnormalities are detected.

The abdominal variant is also common, with pain in any part of the abdomen, nausea, and decreased appetite.

The cutaneous variant is characterized by redness and changes in skin sensitivity, the appearance of eczematous rashes, increased sweating, itching, often localized (for example, itching only the palms or shins).

Causes of exogenous depression may be craniocerebral trauma, neuroinfections, tumor and vascular diseases of the brain (atherosclerosis, strokes and cerebral infarcts), atrophic processes.

Psychogenic depression occurs after exposure to psychological trauma, which is an individually significant stressful event.

Endogenous depression occurs as an independent illness, but can also accompany bipolar disorder, which is characterized by the alternation of phases of mania, depression and mental stability.

Somatic diseases that can lead to depression are divided into groups.

1. Cardiac abnormalities: myocardial infarction, arterial hypertension, chronic heart failure, arrhythmias.
2. Endocrine disorders: diabetes mellitus, hypo- and hyperthyroidism.
3. Gastrointestinal disorders: cirrhosis of the liver, colitis, etc., leading to impaired absorption and detoxification of harmful substances.
4. Rheumatic diseases: rheumatism, systemic connective tissue diseases, arthritis, etc. are accompanied by severe pain and require long-term treatment.
5. New growths, especially malignant ones.

Specific features of the postpartum period contribute to the development of this condition: hormonal readjustment of the body occurs (concentration of female sex hormones decreases), the volume of circulating blood decreases.

The deterioration of health after childbirth, problems during breastfeeding, and changes in appearance also have a considerable influence. Depression develops in 10% of first-born women from the second to the sixth month after childbirth and presents symptoms typical of all depressions: motor lethargy, worsening of mood, tearfulness, changes in appetite. A feature of postnatal depression is a woman’s decreased interest in the child, irritation from the need to care for him or her. It is very important to diagnose this condition and undergo treatment, since it is the child who suffers in the first place.

What doctors should you go to when depressed?

In most cases, when depressed patients seek help from a general practitioner, cardiologist, endocrinologist, gastroenterologist depending on the cause of their complaints. Many patients avoid seeking help from a psychiatrist or psychologist. However, specialists in psychiatry and psychology not only diagnose the causes of depression but also help to cope with it.

Diagnosis of depression A doctor of any specialty can suspect depression. However, depression can only be diagnosed by a psychiatrist, who will conduct an interview and analyze the data obtained. To exclude organic pathology in masked and exogenous depression, depending on the symptoms, the doctor may prescribe a complex of laboratory and instrumental examinations:

• clinical blood test;

Synonyms: Full blood count, FBC. Full blood count, FBC, Complete blood count (CBC) with differential white blood cell count (CBC with diff), Hemogram. Brief description of the study Clinical blood count: total.

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, psychoneurologists and psychotherapists differ from each other, how different patients select therapy, what is the danger of refusing to take medication, when pills and other drugs become dangerous, how these drugs work, why you should not drink Corvalol and Valokordin, as well as self-medicate.

Where to Run

One of the reasons why very few patients with depression in our country still go 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, they are often confused about them,” confirmed Svetlana Minskaya, psychiatrist and 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. These are essentially “renamed” (so that people don’t get scared) psychiatrists. You can also go to them with symptoms of depression.

Why run

In some cases, depression that has kept a person from living a normal life for years can be “eliminated” very, very quickly. “I have seen more than once how people with fairly severe depression, against which they quit their jobs, lay all day on the couch and caused the very real hatred of relatives, starting treatment, literally in a month and a half completely transformed. – 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 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 common 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.

However, mild and even moderate depression sometimes really “goes away” with age, a change of lifestyle, or, if the depression was reactive, when the psychotraumatic situation is eliminated. 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 their life problems – told 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 first it is very important to tell the person in detail what his illness is, to explain how the medications work, and so on.

“In general, the very explanation of how the medications 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 disregard 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 other

The main medication for depression is, as it is easy to guess, an antidepressant. Since on the biochemical level, depression is an abnormal metabolism of neurotransmitters (serotonin and noradrenaline), 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 medication-neuroleptics, which will reduce the “heat” of depressive thoughts.

About the dangers of self-medication

Since people very rarely go to the doctor with melancholy and anxiety, but to survive somehow, a variety of “improvised means” are often used – 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.

Not only are we not talking about trying to pick up an antidepressant or other type of medication yourself, but we strongly advise against it. Depression is a case where “folk medicine” and “common sense” can be the enemy of the patient, and there should be no room for ego 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 emergence and development of this neurophysiological phenomenon, is it caused by human evolution (maybe it is a payment for some abilities unique to the animal world), what the world science has learned about depression in recent years and in what direction the pharmacological developments are moving.