Depression is a serious disease that dramatically reduces the ability to work and brings suffering both to the patient and his family. Unfortunately, people are very little aware of the typical manifestations and consequences of depression, so many patients are assisted, when the state takes a prolonged and severe and sometimes is not. In almost all developed countries health services are concerned about the current situation and make efforts to promote information about depression and ways of treating it.
Most often depression develops on the background of long-term stress or traumatic situation. Often depressive disorders are hidden under the guise of a bad mood, character traits. In order to avoid severe consequences, it is important to understand how and why depression occurs.
Studies worldwide show that depression, like cardiovascular disease, is the most common ailment of our time. It is a common disorder that affects millions of people. According to various researchers, from depression affects up to 20% of the population in developed countries.
Causes of Depression
Depressive disorders can appear at any age and representatives of all social groups. This is primarily due to the fact that the values of modern society have a significant pressure on the person. People aspire to social welfare, professional success, visual appeal. If to achieve that is not possible, a person can fall into despair, it is hard to survive failure, and, as a consequence, become depressed. To depressive disorders may also result and severe psychological trauma such as death of a loved one, family breakdown, breakup with a loved one, a serious illness.
In rare cases, depression occurs without any apparent cause. Scientists suggest that in such situations, play a role especially neurochemical processes, in particular, the exchange of neurotransmitters (serotonin, norepinephrine, etc.).
Symptoms of Depression
Emotional manifestations of depression are very diverse. These include anxiety, despair, low self-esteem. A person suffering from depression, experiencing constant fatigue, sadness. He ceases to be interested in what previously brought him joy, becomes indifferent to others.
Changing the behavior of patients. Depression may be suspected if a person loses the ability to purposeful actions, can’t focus. Outgoing and cheerful by nature man, falling into a depression begins to avoid contact with friends, family, “locks herself in the four walls”. There is often attachment to alcohol, narcotic drugs.
Patients with depression also are characterized by some peculiarities of thinking. Thoughts about yourself become negative, the person is fixed on the negative aspects of his life, feels unnecessary, useless, a burden for the relatives. The patient hard to make their own decisions.
In addition to changes in the emotional sphere, for depression is also characterized by physiological (somatic) manifestations. Most often disturbed sleep and wakefulness, insomnia occurs. Appetite may disappear completely or, conversely, to increase and lead to overeating. Patients complain of pain in the heart area, stomach, suffer from constipation. Markedly reduced energy reserves of the body, patients quickly overworked even with a small physical and mental stress. Often there are disorders of sexual sphere.
Symptoms of depression vary depending on the form of the disease. Here are the most typical signs of this disorder:
Emotional Symptoms of Depression
- anguish, suffering, depressed, depressed mood, despair
- anxiety, feelings of inner tension, anticipation of trouble
- feelings of guilt, frequent self-blame
- dissatisfaction, reduced confidence, reduced self-esteem
- reduced or loss of ability to experience pleasure from previously enjoyable activities
- loss of interest in the surroundings
- loss of the ability to experience any sense (in cases of deep depression)
- depression is often associated with anxiety about health and the fate of loved ones, as well as the fear to appear insolvent in public areas
Physical Symptoms of Depression
- sleep disturbances (insomnia, drowsiness)
- changes in appetite (loss or overeating)
- violation of bowel function (constipation)
- reduction of sexual needs
- decreased energy, fatigue under normal physical and intellectual exertion, weakness
- the pain and discomfort varied in the body (e.g. heart, stomach, muscles)
Behavioral Symptoms of Depression
- passivity, difficulties engaging in purposeful activity
- avoidance (tendency to solitude, loss of interest to other people)
- waiver of entertainment
- alcoholism and substance abuse, respite care
Mental Symptoms of Depression
- difficulties in concentration, attention span
- difficulty making decisions
- predominance of dark, negative thoughts about yourself, about your life, about the world in General
- pessimistic view of the future with the lack of prospects, the idea of the meaninglessness of life
- thoughts of suicide (in severe cases of depression)
- having thoughts of uselessness, of insignificance, helplessness
- slowness of thinking
For the diagnosis of “depression” is necessary that some of these symptoms persisted at least two weeks.
Treatment of Depression
Depression is often perceived by patients and others as a manifestation of bad character, laziness and selfishness, promiscuity or natural pessimism. It should be remembered that depression is not simply bad mood (see symptoms above), and the disease which requires the intervention of specialists and is well treatable. The sooner the correct diagnosis is made and correct treatment begun, the better the chances for a quick recovery, that the depression will not happen again and will not take a severe form, accompanied by the desire to commit suicide.
Often people are afraid to consult a specialist in mental disorders because of the alleged negative consequences:
- Possible social restrictions (registration, prohibition on driving vehicles and travel abroad);
- Condemnation if someone finds out that the patient is treated by a psychiatrist;
- Fears of the negative impact drug treatment of depression, rooted in the widespread but incorrect beliefs about the dangers of psychotropic drugs.
Depression and its treatment
Often people do not have the necessary information and misunderstand the nature of his condition. They think that if their condition is due to understandable difficulties in life, depression is not a normal human reaction, which will be held independently. Often it also happens that the physiological symptoms of depression contribute to the formation of beliefs about the presence of serious somatic diseases. This is the reason for going to the doctor-therapist.
80% of patients with depression initially seek care for General practitioners, the correct diagnosis is established in about 5% of them. Adequate treatment gets even smaller number of patients. Unfortunately, the usual reception in the clinic is not always possible to distinguish between physiological manifestations of depression and the presence of a true physical illness, which leads to the formulation of an incorrect diagnosis. Patients are prescribed symptomatic treatment (medicine “for the heart”, “stomach”, headache), but no improvement occurs. Have thoughts of hard, unrecognized physical illness that the mechanism of a vicious circle leading to worsening depression. Patients spend a lot of time on clinical and laboratory tests, and usually get to the psychiatrist already with severe, chronic manifestations of depression.
Pharmacologic Treatment of Depression
Prescribed to patients with mild, moderate and severe manifestations of depression. A necessary condition for the effectiveness of the treatment is the cooperation with the doctor: strict adherence to the prescribed mode of therapy, frequency of doctor visits, detailed, Frank report about his condition and life difficulties.
Anti-Depressants for Depression
Proper treatment allows in most cases to get rid of the symptoms of depression. Depression requires treatment by specialists. The main class of drugs for the treatment of depression is antidepressant medication. Currently, there are various drugs in this group, of which atidepressant tricyclic (amitriptyline, imipramine) and been used since the late 50-ies. In recent years the number of antidepressants has increased significantly.
The main advantages of the new generations of antidepressants are to improve tolerability, reduce side effects, reduced toxicity and high safety in overdose. New antidepressants are fluoxetine (prozac, prilosec), sertraline (zoloft), citalopram (cipramil), paroxetine (paxil), fluvoxamine (Fevarin), tianeptine (coaxil), mianserin (lerivon), moclobemide (aurorix), milnacipran (Ixelles), mirtazapine (remeron). Antidepressants are a safe class of psychotropic medications if properly applied according to doctor’s recommendation. The dose is determined individually for each patient. You must know that the therapeutic effect of antidepressants may occur slowly and gradually, so it is important to positively tune and wait for his appearance.
Antidepressants are not habit forming and development of the syndrome in contrast to drugs class benzodiazepine tranquilizers (Phenazepamum, Relanium, Elenium, Tazepam, etc.).
Main Stages of Therapy for Depression
- Definition of tactics of treatment: the choice of an antidepressant with the main symptoms of depression in each patient, the selection of adequate dose and individual treatment regimens.
- Holding the main course of therapy aimed at reducing symptoms of depression until their disappearance, the restoration of the former characteristic of the patient’s level of activity.
- Maintenance therapy for 4-6 months or more after the overall normalization of the state. This stage is aimed at prevention of exacerbation of the disease.
What usually hinders the conduct of medical treatment:
- Has the wrong idea about the nature of depression and the role of medical treatment.
- Common misconception about the ultimate harm of all psychotropic drugs: the emergence of addiction, negative impact on the condition of the internal organs. Many patients believe that it is better to suffer from depression than taking antidepressants.
- Many patients interrupt reception in the absence of a rapid effect or irregularly taking medication.
It is important to remember that numerous studies conducted confirming the high efficacy and safety of modern antidepressants. The damage of depression emotional and material well-being of a man, according to the severity is not comparable with minor and easily avoidable side effects that sometimes occur with the use of antidepressants. It should be remembered that the therapeutic effect of antidepressants often comes only after 2-4 weeks after starting.
Therapy for Depression
Psychotherapy is not an alternative and an important complement to medical treatment of depression. Unlike medication treatment, psychotherapy involves a more active role of the patient in the treatment process. Psychotherapy helps patients to develop skills of emotional self-regulation in the future to deal more effectively with crisis situations, without sinking into depression.
In the treatment of depression as the most effective and scientifically proven three approaches: psychodynamic psychotherapy, behavioral psychotherapy and cognitive therapy.
According to psychodynamic therapy, psychological basis of depression are internal unconscious conflicts. For example, the desire to be independent and the simultaneous desire to obtain in a large amount of support, help and care from other people. Another typical conflict is the presence of intense anger, resentment towards others, combined with the need to be always kind and good and keep the location close. The sources of these conflicts lie in the history of the life of the patient that becomes the subject of analysis in psychodynamic therapy. In each individual case can have its own unique content conflicting feelings, and therefore requires an individual psychotherapeutic work. The purpose of therapy is awareness of the conflict and assist in a constructive resolution: to learn to find a balance of independence and intimacy, to develop the ability to constructively Express their feelings and maintain a relationship with people. Behavioral psychotherapy aimed at resolving the current problems of the patient and withdrawal behavioral symptoms: passivity, renunciation of pleasures, monotonous lifestyle, isolation from others, inability to plan and engage in purposeful activity.
Cognitive psychotherapy is a synthesis of both of the aforementioned approaches and combines their advantages. It combines work with the relevant life’s difficulties and behavioral symptoms of depression and work with their internal psychological sources (deep beliefs and convictions). As the main psychological mechanism of depression in cognitive psychotherapy is considered the so-called negative thinking, which is reflected in the tendency of depressed patients to consider everything that happens to them in a negative light. Change this way of thinking requires careful individual work, which aims to develop more realistic and optimistic view of themselves, the world and the future.
Additional forms of psychotherapy of depression are family counseling and group psychotherapy (but not any, but specifically aims to help depressed patients). Their involvement can significantly help in treatment and rehabilitation.
Why patients with depression are not treated in the clinic:
- Low level of awareness among people about what is psychotherapy.
- Fear of initiation of a stranger into the personal, intimate experiences.
- Skeptical attitude to the fact that “conversations” can give tangible therapeutic effect.
- Idea that psychological difficulties have to do that, and appeal to another person is a sign of weakness.
In modern society, psychotherapy is a recognized and effective method of care for various mental disorders. Thus, the course of cognitive psychotherapy significantly reduces the risk of recurrence of depression. Modern methods of psychotherapy focused on short-term (10 to 30 sessions depending on the severity of the condition) effective assistance. All the information the therapist receives in the session is strictly confidential and remains confidential. A professional therapist is specially trained to work with hard feelings and difficult life situations of other people, he knows how to respect them and to assist in coping with them. Each person in life there are situations (such as illness) with which he cannot cope on their own. The ability to ask for help and accept it is a sign of maturity and rationality, not weakness.
Advice to relatives of patients with depression:
Support of loved ones, even when the patient does not Express interest in it, it is very important to overcome depression.
- Remember that depression is a disease in which need sympathy, but in any case it is impossible to take in the disease along with the patient, sharing his pessimism and despair. You need to be able to maintain some emotional distance, all the time reminding yourself and the patient that depression is a transient emotional state
- Studies have shown that depression is particularly damaging flows in those families where we do a lot of critical remarks in the address of the patient. Try to make it clear to the patient that his condition is not his fault, but the misfortune that he needs help and treatment
- Try not to concentrate on illness of a loved one and to bring positive emotions in your life and in family life. If possible, try to involve the patient in some useful activity and not to remove him from cases.