Instructions for coming out of depression: a pill, a word and a personal effort
Psychotherapist advice for those who are “covered” with depression: what specialist to turn to first? What helps: a pill or a word, a conversation? Should I be afraid of antidepressants?
Around depression a lot of controversy. Many still consider this disease – “vagaries” and the consequence of a satiated time. About the myths that have developed around the disease, and about what treatments are most effective, we talked with a psychiatrist of the highest category Lyubov Frolova .
Depressive disorders are now found in the list of symptoms and aggravating conditions in half of the diseases on the WHO list. The causes of the disorders vary. In particular, it has been proven that there is a genetic predisposition to depression. This illness can be present in our lives for a few years, or it can last a lifetime. “Everyone in the world at least once, but suffered from a depressive state,” says psychotherapist Lyubov Frolova.
Depression is a serious illness, although many believe that it is banal moping and laziness. In fact, with depression recorded abnormal activity of the brain – this can be seen in brain imaging. The biochemical balance is disturbed, as well as the transmission of impulses between nerve cells. So it’s not just the whims of your loved one. If he has depression – remember: it is an illness, and it must be treated.
There is no such thing as “vegetative vascular dystonia. But depression is.
Man is a very complex organism. “Everything in us is embedded in layers. First – our animal, biological essence – these are instincts. Then there are reflexes and emotions. Then there are moods. Emotion flashed and extinguished, and the mood is the background, it holds for a long time,” says Lyubov Frolova. – Then touches the personality or as people call it – the character. And above all this is our intellectual and logical abilities. And all of this together determines our consciousness. Which is also divided into unconscious, conscious-unconscious and conscious.
Depressive syndrome can occur when different “layers” of our psyche are disordered, the expert explains. “For example, with a personality disorder, when a person’s consciousness is strongly influenced by some character trait, he builds himself some air castles, and the dream does not come true, then the mood begins to change. One thing is piled on top of another, and it entails a decrease in mood. If a person can not find a rational way out of this, it can begin depression.
Depression affects one in six people. Sometimes it is believed that immersed with his head into work, you can get rid of depression on their own. This will help with anxiety, but not with depression. The illness requires treatment by a specialist. By the way, if your loved one is trying to hide from life’s problems at work, it may be one of the signs of depression that has begun.
“During these periods the emotional experience is heightened. The intellect may be calm, but the soul is reeling. Emotions in general are more active and primary. Therefore, a mood disorder, no matter which way it swings, then pulls the intellect,” says Lyubov Frolova. – Depressive disorders affect both motor and intellectual functions. Physical activity or lethargy and mental – everything is interconnected. There is no separate space in our body for physical, mental and emotional, so a depressed person is not lazy, as others accuse him, he is truly unable to move and think: if a depressive disorder is not treated for a long time, it affects physical health”.
As recently as 10 years ago, the World Health Organization added hypertension, coronary heart disease, heart attacks, stomach ulcers, skin diseases, (mostly neurodermatitis), and bronchial asthma to the list of psychogenic diseases.
“These are diseases that have been proven to originate in the mental state. That is, we get nervous for a long time – and the autonomic reactions that always accompany the emotional ones take hold. This changes the structure of blood vessels, then organs, and a disease is formed.
Eight character traits for seven billion people
We have only eight character traits according to the psychiatric classification. Psychologists distinguish 16. “Meanwhile, there are about seven billion people living on earth. And people are never alike,” notes Lyubov Frolova.
The eight character traits :
- Hysterical character (the oldest, is responsible for survival, it is a man-artist, he must be in the spotlight, shine, but can adapt to any conditions).
- Paranoid trait (single-mindedness).
- Pedantry – slowness, thoroughness and thoroughness.
- Anxiety and mistrust (“Have I done the right thing? Have I offended someone?”).
- Excitability (before I thought about it, I already did it.)
- Hyperthymic trait (person-motivator, energizer, leader, but very enthusiastic, fickle; lots of energy, but doesn’t get things done)
- Depressive trait, dysthymic, person-brooding: “everything is bad, nothing will work”).
- Introversion. Low emotionality, but internal fullness. Inherent in people with talent, intellectuals.
Usually we combine three or four to five traits. The combination of all eight traits does not happen, so the ideal personality does not exist in principle. “Some trait usually stands out the most. Let’s say an anxious, anxious person.
but it still has the determination to move him forward, and hysterical trait, not to be afraid of society. All in all, you get a harmonious personality. But if suddenly the anxious and mistrustful trait is much more, the person will doubt his actions and words, feeling anxious at the slightest opportunity.
A hypertensive citizen, for example, combined with purposefulness will be an excellent leader. But here, for example, if he starts to get nervous because of exams or any other problems in life, anxiety will pull on his own vascular dystonia. In fact, there is no such disease, it is a vascular instability due to emotional reactions. If anxiety lasts for a long time, it will seem that he can’t cope with anything. Then disorders of sleep, appetite join, even less energy is left for activity, and depression begins.
Or an introvert: he is a closed person, he already has a limited circle of communication, but if someone also offends him, he will completely cut himself off from society. We will not see his worries, but he will have them.
Who is almost not susceptible to depression are hyperthymes, Pure hyperthymes will just get carried away with another idea and run on. Cyclothymics, people who combine hyperthymic and depressive traits in the same person, are active from spring to fall, and in winter they go into hibernation and ennui.
The hysterical character sharpen their feelings on external beauty. On this basis, they often develop all sorts of disorders: if you are unhappy with your appearance, what kind of mood will you have?
And this is just the most primitive, banal problems, but there are deeper. Every one of us has experienced loss. Divorce. Deaths of loved ones. Disasters. Wars. “In general, depression is a normal reaction to stress. Grief must be experienced, we must come out of the experience with new experiences, renewed. If the personality is not able to overcome grief, the person goes into long-term depression.”
Who to turn to?
You go to a specialist. If a word, a conversation (which is a good place to start) can help you, then you need a psychologist, and if words aren’t enough, you need a psychotherapist. This is already a doctor with experience in psychiatric work. A psychiatrist, on the other hand, appears on the scene in extreme cases: such as suicidal moods, attempted suicide. “Any action in the form of autoaggression or heteroaggression (aggression against oneself or another person) must be dealt with by a psychiatrist,” explains Lyubov Frolova.
Often everything ends in the first stage – with a visit to a psychologist. For some, he helps, but for others, he did not, and the person is generally disappointed in psychological aid. He forms a belief that specialists of this profile are unable to cope with his problem. What is to be done? Here it makes sense to talk about the quality of psychological and psychotherapeutic services in the country. And about the culture of addressing this kind of professionals. Many people do not understand the difference between a psychologist and a psychotherapist.
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“A psychologist treats only with words. A psychotherapist treats with both a pill and a word. A psychiatrist most often uses medication, such specialists are overloaded, dealing with severe problems, and time is short, usually they do not have time to do psychotherapy,” says Lyubov Frolova.
Depression can develop gradually: a bad mood becomes habitual and constant. The person begins to ignore study, work, some holidays and events. Social ties are disrupted. After the beginning of treatment for depression, the condition of most patients improves in 4-6 weeks.
“Society has replaced our mother.”
If the person who is ill has a strong, normal personality, he “survives” his problem with the help of words, a psychologist. The person comes out of the depression and continues to live on, ready to meet a new stress.
The psychotherapist notes that throughout the world, personal maturity is now very much behind the calendar age. We take a long time to mature. “If you compare the conditions of life now and a hundred years ago, they will be much different. At least in the degree of comfort. We don’t walk, we don’t have to plow or grow our own food, but we experience daily encounters with an unprecedented (for the past) flow of information. A person who does not need to exert himself, but who daily receives a powerful dose of information entertainment and irritation, does not grow up. He has a childlike life. Society has replaced our mother.” And any immature personality reacts to stresses in a childlike way. “As a result, the immature personality has a lot of demands, and a deficit of responsibility, especially considering the Russian trend of prolonged parental care. Perhaps parental prolonged hyperopedic care can be explained by the very complicated history of our country, in which human losses numbered in the millions,” explains Lyubov Frolova.
Belief in a magic pill
In any case, you have to admit: the treatment depends on the strength of the stress. “If there is an earthquake and you are in the center of it, everyone understands that there is a need for all kinds of help. But after all, an earthquake, the collapse of the world, can also happen in the figurative sense, in the psychological sense, in your head. You have to try to realize the extent of your defeat. And then go to the doctor, choosing a specialist with medical training. And get ready for medical treatment.
At the same time, medication must be accompanied by psychotherapy, then in 90-95 percent of cases we are waiting for success. “If the treatment is just a pill, that’s 50 percent success. If the treatment is only a word, also 50 percent. Only a combination of factors can help. And success will be in 95 percent, as a doctor I cannot guarantee 100 percent cure,” says Lyubov Frolova.
“But if you read the forums on the Internet, the belief in the magic pill we have almost entirely, in 90 percent of cases, and with any disease. A hypertensive patient comes to the doctor and demands: “Doctor, give me a drug that I was immediately cured and grew 20 years younger,” says the psychotherapist. – And the doctor, from such a patient’s point of view, is a magician. We pass the responsibility onto the doctor. He has to wave a wand, and I should be as good as new. This again comes from social immaturity. The most common request we get is, ‘Doctor, give me hypnosis so I can be cured.
A person may become frustrated with a treatment-not because the doctor or antidepressant is bad, but because the person expects a different treatment. He expects magic. But let’s be realistic: There are no magic pills or magic words.
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There is no addiction.
There is also the fear of treatment with antidepressants. Fear of addiction. But it grows from the same place, says Lyubov Frolova, – from the myth, from the belief in the magic pill: “The patient takes the pills for 5 days, they don’t help him. “I quit the pills, they don’t help,” he says, quits, returns to his usual state, but since he felt at least a little bit of relief, the returned state seems even worse to him. Subjectively. “I was prescribed a bad antidepressant, it has an addictive effect,” hence these thoughts. But in fact, the treatment with medications has to go at least two months. And there are also prolonged stressful situations that last six or six months or a year. Patients come to us who have already been to witches and magicians and other doctors. The longer the depression was before treatment, the longer it takes to recover. About the same period.”
Antidepressants are not addictive. “The trouble is that the vast majority of patients who come to me have already taken a bunch of pills that are just directly addictive. Usually these are tranquilizers. And some people manage to get hold of stimulants, and they cause an addiction and gradually form an addiction. Self-medication is the scourge of our time. The Internet is the doctor in charge. People on the forums “prescribe” to each other – advise drugs, telling where, for example, can buy phenazepam without a prescription – says Lyubov Frolova. – I, as a doctor, prescribe antidepressants, and they do not cause addiction, because they have an entirely different effect. They add a missing neurotransmitter in a given state so that the body itself produces during this time, for example, serotonin in the cells. Then the body gets used to working on its own again, the nerve cells regain their ability to work, and we cancel the medication. Therefore, again, it is important to observe the doctor: antidepressants can be taken only under the supervision of a specialist.
Any medication has side effects. And if you read the summary of the drug – often the opposite. For example, drowsiness and agitation, or constipation and diarrhea. Because foreign pharmaceutical companies have long been working under the control of insurance companies. And if a patient finds any side effect from the medication, and it is not declared in the summary, the client can sue for millions. So it’s reinsurance. And only doctors with extensive clinical experience with antidepressants can tell a client which drug is right for them so there are no side effects.
If the patient comes in for the first time, it also takes a while for the doctor to select the medication. It can be compared to the antibiotic, which is chosen according to the sensitivity of the infection, so that it works. It’s the same with depression in a particular patient. “There are at least 20 neurotransmitters in the head. Some of them are depressogenic, others are mood-enhancing. We don’t need to invent anything – everything we need is inside a person. All we need is to help the organism “work it out. That is why self-treatment is impossible. Internet forums are no different than forums on drive-up benches: “Try it, girlfriend, it worked for me!”
According to a study by the U.S. National Institute of Mental Health, 70% of people who took medication for depression got rid of their symptoms, although it took time. Scientific evidence supports the effectiveness of combining medication with psychotherapy.
By the way, the medicinal effect of antidepressants manifests itself in two weeks after starting to take them. For some, it takes a month or even three months. So those who quit treatment halfway through – just did not wait for the drug to take effect. You need to go to the doctor and say: It doesn’t help. And then the specialist will choose the individual scheme of action of the medicine. This is the doctor’s prerogative.
But remember, medications (as we said) only help half the time. You also need a word. And your effort. Pills alone, without your attempt to overcome the crisis with your own mental resources, will not cope with depression.
Does hypnosis help? “It is a type of psychotherapy. But it’s also one version of a magic wand – in the public perception. “You hypnotize me to be the way I want to be.” Hypnosis is a very crude tool. We put a person into a trance. We either put something in a person’s brain, and we don’t know what it will result in, we don’t know what it will interact with inside him, or we take something out of a person internally,” the doctor explains. – But at the same time, we don’t know if his or her own experiences are coming out of him or her. I use this method very rarely, and on certain patients. It is worth knowing that 30 percent of the population is genetically immune to hypnosis.
One has to be prepared for the triad – the pill, the word, one’s own effort. “The therapist will make you work on yourself. The patient has to work, he is the main assistant to himself, the doctor can only show what possibilities his body has, and already you have to use these possibilities yourself. This, by the way, refers to any disease, all doctors repeat to the patient: must balance the diet, get rid of bad habits, increase physical activity, and physical ailments will decrease, but who does it all? Ask yourself this question.”
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Why can not beat depression on their own
What is the treatment of depression with cognitive-behavioral psychotherapy
Dmitry Kovpak psychotherapist, Ph.
Ilya Kachai musician, philosopher, teacher, clinical psychologist, cognitive behavioral therapist
“Get out of depression on your own” is a very popular request. But is it really possible? If by “on your own” you mean “without pills,” then yes, there are types of depression that are realistic to beat without antidepressants. If “on your own” means without the help of a specialist, then that’s unlikely. The fact is that on your own it is very difficult to break the vicious circle that governs a person’s behavior when depressed.
What is depression?
It is a disorder of the emotional sphere, which is characterized by a lowered mood, loss of interest or pleasure in life (so-called anhedonia), a decrease in the general level of activity, as well as various experiences – feelings of guilt, shame, anxiety and low self-esteem. When depressed, a person is pessimistic about themselves, their position in the world and their future, and this lasts for at least two weeks.
This time criterion allows us to distinguish depression from low mood, which can be associated with objective troubles and difficulties in life and which can self-heal in a couple of days. It should also be noted that depression can be a symptom of certain physical illnesses and a side effect of a number of medications and treatments.
What can be painful with depression
In addition, depression can manifest as pain, loss of appetite, sleep disorders, increased fatigue, decreased libido and poor concentration.
The same fibromyalgia that is often encountered in the practice of neurology is not always a separate disease. The fact is that depression, like anxiety, is accompanied by quite strong bodily tension, which is manifested by algias – pain symptoms and syndromes. Tension in the skeletal musculature can create such chronic pain. Sometimes these are chronic tension headaches, which in 70% reflect an unfavorable emotional state, back pain, abdominal pain, limb pain.
Fibromyalgia (mostly muscle pain), cephalgia (headache), cardialgia (heart pain), abdominalgia (abdominal pain), neuralgia (nerve pain such as intercostal neuralgia) and other algias may reflect anxiety and depression disorders, representing psychosomatic symptoms. Therefore, often after some time, against the background of psycho-emotional relaxation, these manifestations disappear.
What does a depressed person look like
Diagnostic criteria for specialists include the appearance of the person: how he knocked on the door and entered the office; what his gait and what posture he took, sitting in a chair; what are the features of his facial expressions. Often depressed patients have what is called a “depressive mask” with stultifying facial expressions. Quiet and inexpressive speech, poor in intonation and interrupted by long pauses is also possible.
However, agitated depression – when it is difficult for the person to sit still, he or she is constantly fidgeting and changing postures – also occurs. Sometimes there is not enough strength to maintain the same level of neatness: a man may be careless in his clothes, a woman in her makeup, etc. In other words, there are a large number of external signs that specialists pay attention to and use to make a diagnosis.
Who is most likely to suffer from depression
Depression is an extremely common phenomenon. According to statistics, at least one in fourteen people on the planet suffers from clinically pronounced depression. At the same time, people of working age are most susceptible to it. It is believed that women experience depression and seek professional help for this disorder twice as often as men.
Teenage depression is also a frequent phenomenon, largely associated with hormonal restructuring, and most importantly, with an abrupt change of life guidelines and values: children’s ideas change to more adult ones, there are disappointments and existential crises.
Surprisingly, the lowest number of depressions is recorded at college age, when a person has broken free from the pressure of the family environment, but not yet overburdened with work and family problems. However, it is believed that every ten years of life, the risk of depression or exacerbation increases by about one and a half times. By retirement age, more than half of the population suffers from depression.
How a depressed person relates to themselves and the world
Statistically, the vast majority of depression is psychogenic (neurotic) in nature. The most relevant for diagnosing psychogenic depression is Aaron Beck’s cognitive triad, which highlights such key dysfunctional beliefs as a pessimistic assessment of oneself, a negative perception of the present and a negative assessment of one’s future.
Negative self-perceptions are expressed in the fact that a person evaluates himself as inadequate, inferior, defective, sick or deprived, although there are no objective reasons for this. In other words, he or she believes that he or she is bad, that there is something wrong with him or her and that other people will not accept him or her, or believes that he or she is helpless and practically disabled.
A negative attitude about one’s current experience is that one feels that people around one treat one badly, that life is unsightly and meaningless, that values and reality place exorbitant demands on one or present insurmountable obstacles on the way to one’s life goals.
Finally, a negative attitude towards one’s own future manifests itself in the fact that one sees in it an endless series of difficult trials and suffering, believing that one must constantly endure difficulties, disappointments and hardships, behind which failure and a dramatic finale inevitably await.
What prevents one from coming out of depression on one’s own
Dysfunctional negative thinking leads a person to disbelief in his abilities, reduces daily activity, up to complete inactivity, which, in turn, leads to the so-called anhedonia – reduction of satisfaction and pleasure from life and what previously brought them. This suppresses mood and promotes even more negative estimations, reasoning and forecasts.
In parallel, the person develops a negative vision of oneself, which again leads to a decrease in activity due to a feeling of helplessness and hopelessness. Subsequently, compensatory strategies – when the person does not resolve the reasons for the depressed state arising, but tries to compensate for the bad mood with some situational activities – are activated.
If a woman tries to get rid of or at least distract herself from her suffering by, for example, shopping – she buys a lot of unnecessary things, of which “her closets are full but she has nothing to wear anyway,” as a result, this aggravates her condition. As a result, she can blame herself for the “fruitless” time spent, the money spent, etc. This leads to a sense of hopelessness, since, as expected, her shopping has not made her feel better, on the contrary, it has gotten worse. Once again, she is in a depressed mood, beginning a new round of wandering in a vicious circle.
Avoidance is one of the frequently encountered compensatory strategies of behavior, which the person does not always notice, in fact, it seems to him or her that it is a combination of circumstances. However, avoidance can manifest in dozens or even hundreds of different forms, where a person seems to accidentally not do something that makes sense to do.
How depression is treated with cognitive behavioral psychotherapy
Speaking of the psychological measures necessary to avoid falling into depression, we should say about the importance of forming a worldview “anti-depressive” foundation. After all, “I-concept”, or the attitude towards oneself, can be depressogenic: “I am bad, “I am nothing,” “I am a loser”, “I am a loser and an outcast.
The person tries to compensate for these attitudes in one way or another. It is often possible to observe variants of hypercompensation, when he tries to prove to those around him that he is good. In this case the person does not eliminate the cause of the problems in his or her “self-concept. He has only compensatory methods – achievements, with which he tries to reduce the pressure of his inner negative self-perception, but it does not help. A person can become a world champion, a billionaire, a prime minister and still experience tremendous depression, oppression of the core of his personality, of his inner “self-concept. And if it is not understood, it will be very difficult to rebuild it.
In this respect, psychotherapy is built, first of all, on clarification, comprehension and analysis of what one believes in. The worldview foundation, although formed throughout one’s life, can be changed at any moment. True, it is more difficult to do this with each new year, because every belief and skill gradually turns into a mastery, a rigid conviction.
Nevertheless, it is real at any age. Therefore, the prevention of depression on the psychological side is mainly a worldview, and in some cases – a philosophical work on yourself.
Cognitive-behavioral psychotherapy is based on theories of learning and the assumption that human psychological problems are based on errors of thought, cognitive distortions. Therapy focuses on changing a person’s dysfunctional automatic thoughts and biases that affect their perception of life.
In the course of cognitive psychotherapy, he learns to solve accumulated problems and find a way out of situations that previously seemed insurmountable. He re-examines his own system of beliefs and attitudes, his world-view, corrects his thinking and consolidates the corrections with a system of training – behavioral experiments, exercises and assignments.