Introduction
A person with depression may feel distant from their feelings and, as a result, experience disruptions in how the body functions as well as the mind. Doctors base the diagnosis on a conversation with the patient and an examination of his behavior and condition. Depressive disorders may be influenced by feelings, society or problems with organs and systems. Depressions may be managed by using antidepressants with psychotherapy and, if required, supplemented with other psychiatric medications.
Depression can be caused by different factors.
Various factors can lead to the development of a depressive disorder, whether biological, psychological, linked to medicine or social.
Risk factors
Things that can increase the risk of cancer are known as risk factors.
• Having mental disorders or suicide in her ancestors weighed on me.
• Starting factors and origins of depression and anxiety disorders.
• Having many chronic diseases, problems with addiction to drugs and alcohol.
• Experiencing challenging situations, fewer friends and social support.
Pathogenesis of depression
Women are more prone to depression and their episodes become more serious and frequent.
Besides, they are marked by hormone changes throughout the reproductive cycle (pre-menstrual phase, pregnancy, childbirth and menopause).
Sleep disorders caused by limited sleep or changes in sleeping patterns (such as when working night shifts and taking many long-distance flights).
The causes of depression
When depression develops, malfunctions occur in the brain structures and also in the neuroendocrine (hypothalamus and pituitary, for example) along with the neurochemical (noradrenergic, dopaminergic, serotonergic, etc.) systems. The balance between neurotransmitters and their receptors can be affected by certain factors, including their production, breaking down and receptor activity. Neurotransmission-related problems are responsible for the appearance of the disease symptoms.
Because serotonin level affects the body, changes in it can result in tachycardia, rapid breathing, problems with the gut, increased sweating, discomfort in the chest and similar symptoms. If the level of catecholamines in the brain changes, apathy, negative thoughts and feelings, lack of pleasure and poor performance results.
If ACTH or BDNF levels change in the hypothalamic-pituitary system or brain-based neurotrophic factor, a person is more likely to become fatigued, unsteady during stress and have less confidence in themselves. In depression, when there are too few endogenous opioid receptors, the pain perception of the patient lowers.
There are different types of depression.
Since there are many forms of depression, they cannot be organized into one category, yet they are categorized by how severe they are as simple or complex depressions.
Simple depressions
• Melancholic depression involves having a continuous low mood, feeling physically weak and a decrease in mental speed.
- Anxious depression is characterized by increased anxiety against the background of a depressed mood, constant expectation of some kind of trouble, restless behavior, psychomotor agitation, fussiness. The extreme degree of anxious stress is agitated depression, in which the patient rushes about, moans, shouts out words, and may harm himself, make suicidal attempts.
- Anesthetic depression is absolute indifference, internal emptiness.
- Adynamic depression – hypodynamia, slow movements, poor facial expressions, such patients may not get out of bed for hours.
- Apathetic – weakening of all emotions, the patient is lethargic, indifferent to everything and everyone.
- Dysphoric – occurs with a predominance of an angry-melancholy mood, dissatisfaction with others, patients are characterized by expressions of anger, rage, aggression.
Complex depressions
- Senesto-hypochondriac depression
- Depression with delusions, hallucinations and catatonic disorders.
By the severity of symptoms
- Mild – mild is characterized by mild clinical manifestations with one symptom dominating.
- Moderate severity – occurs with moderately expressed clinical symptoms, decreased social activity and performance.
- Severe – characterized by the dominance of some symptom (melancholy, apathy, anxiety, restlessness), manifestation of suicidal thoughts, noticeable disturbances in social communication, inability to work, psychotic manifestations in the form of obsessive ideas of guilt and illness.
By etiology
- This kind of depression arises when there are neurotransmitter faults and is often inherited; it is common in moderate or severe cases, makes the person more prone to suicide and displays strong daily and seasonal changes. It can cause delusions that the person blamed themselves, wanted to destroy themselves or experienced hallucinations. Patients like this lack the ability to carefully assess what is happening to them.
- Psychogenic (neurotic) and reactive depressions occur as a result of mental trauma. Psychogenic depression is characterized by mild clinical manifestations, the absence of suicidal thoughts, psychotic disorders. Reactive depression occurs with severe depressive manifestations and a high suicidal risk, while the patient cannot adequately assess his condition.
- Organic and somatogenic depressions develop against the background of severe neurological and somatic diseases.
These include
- Parkinsonism
- multiple sclerosis
- acute cerebrovascular accident
- brain tumors
- diseases of the endocrine (diabetes mellitus, Addison’s disease, thyrotoxicosis)
- cardiovascular and pulmonary systems (bronchial asthma
- coronary heart disease, heart failure , atrial fibrillation
- chronic pulmonary and cardiac insufficiency)
- diseases of the digestive system (ulcer and gallstone disease, hepatitis, cirrhosis)
- diseases of the joints and connective tissue (rheumatoid arthritis, systemic lupus erythematosus)
- oncological diseases (cancer, sarcoma, etc.)
- diseases of the immune system (AIDS).
- These forms are often manifested by weakness, increased fatigue, tearfulness, they can be accompanied by increased anxiety, outbursts of irritability.
- Alcoholic depression is a serious illness with a high suicidal risk. It is characterized by tearfulness, isolation, anxiety & hypochondriacal symptoms with aggravation of manifestations during the period of abstinence.
- Drug-induced (iatrogenic) depression – occurs under the influence of drugs: neuroleptics (used in the treatment of mental disorders), antibiotics, cardiac glycosides, some antihypertensives (reserpine), hormonal and lipid-lowering drugs, alpha-interferons (in the treatment of hepatitis).
- Depressions associated with the reproductive cycle in women. These include premenstrual syndrome, depressive syndrome of pregnancy, sadness of mothers after childbirth syndrome and postpartum depression. Characterized by the appearance of sadness, a feeling of hopelessness, tension, anxiety, tearfulness, mood lability, difficulty concentrating, increased fatigue, drowsiness and changes in appetite.
Symptoms of Depression
Depression is characterized by the presence of the classic triad of clinical symptoms:
- In hypothymia, a person always feels depressed for most of the day, lacking emotional expression..
- motor retardation, manifested in the form of increased fatigue, difficulties in normal daily activities (slowing down, inability to start or finish), impoverishment of facial expressions, monotony of postures, up to immobility (stupor).
- ideational inhibition, consisting of slow thinking and pauses before monosyllabic answers.
“Depressive states are characterized by fluctuations in condition during the day with exacerbation of symptoms in the morning. Insomnia and frequent awakenings, along with the loss of appetite and a drop in weight due to lack of menstruation, are the usual signs of eating disorders. Pain (cardiac, headache, abdominal), shortness of breath, a feeling of heaviness in the chest, nausea, vomiting, dry mouth may also occur.”
Such patients often neglect the rules of personal hygiene, look sloppy, older than their age. They are characterized by awkwardness or slowness of movements. They can lie in bed for days, turning away from the wall, ready to cry at any moment or immerse themselves in their thoughts and do not notice anything around them. The speech of patients is quiet, slow, phrases are scanty and depressive, when talking they avoid the gaze of the interlocutor.
Depressed people lack emotional reactions to events that would normally bring them joy. They are characterized by ideas of their own worthlessness and guilt, recurring thoughts of self-harm, death, and suicide.
Diagnosis of depression
To establish a diagnosis, a thorough anamnesis is collected and the patient is questioned (about the onset of the disease, the frequency of exacerbations, the presence of circadian rhythm . In the presence of masked depression, objective instrumental studies are carried out to identify violations of psychosomatic correlations (when the manifestations of somatovegetative disorders do not correspond to the severity and nature of the disease).
Inspection and survey
The main criteria for diagnosing depression are:
- prolonged depression of mood (more than two weeks) without connection with any situation;
- decrease, loss of interests and anhedonia (loss of ability to receive pleasure);
- decreased activity and increased fatigue.
When conducting diagnostics, signs of positive and negative affectivity are taken into account. Signs of positive affectivity are:
- Melancholy, manifested by a feeling of oppression in the chest, combined with depression and despair.
- Unreasonable anxiety, restlessness with a feeling of internal tension.
- Intellectual retardation, manifested by difficulties with concentration.
- An abnormal circadian rhythm in which one feels worst in the early morning and improves in the evening.
- Ideas of inferiority, which consist of blaming oneself for worthlessness and inferiority.
- Suicidal thoughts with ideas of a fatal outcome.
- Hypochondriacal ideas associated with the hypertrophy of the danger of an existing or imaginary disease.
Signs of negative effectiveness:
- A painful numbness in which a person is unable to experience hatred, love, compassion and other feelings.
- Depressive devitalization, accompanied by a lack of desire for life, loss of sleep, appetite, and sexual desire.
- Apathy, manifested by indifference and lethargy.
- Dysphoria, consisting of demonstratively violent behavior towards others.
- Mental dissatisfaction – anhedonia.
Rating scales
Special assessment scales (Hamilton, Zung, etc.) are used to identify depressive symptoms. Psychometric assessment scales are one of the methods for making a diagnosis, screening patients for depression, and assessing the dynamics of the condition during treatment. They are a list of statements corresponding to certain clinical symptoms. After filling out the scale, the information is analyzed using a key and the results are interpreted by a specialist.
Differential diagnosis of depression is carried out with the following conditions:
- with other mental disorders, since patients with signs of psychosomatic symptoms require observation by a psychiatrist and more intensive treatment in a hospital setting;
- with hypochondriacal sensitive personality development;
- with mood disorders due to somatic diseases;
- with reactions of grief and loss;
- with dementia in old and senile age.
Treatment of depression
The choice of type, duration and intensity of treatment for depressive conditions depends on the severity and type of pathology.
Antidepressants
Antidepressants, which belong to the class of psychotropic drugs, are used for treatment. The effectiveness of therapy is affected by the correctly selected type of drug, as well as the method of administration, dosage and compliance with the regimen.
The choice of a drug is made taking into account the general condition of the body, the presence of concomitant diseases, and possible side effects. The effect of treatment develops gradually, usually within a week. If there is no effect, then the dose is first increased to the maximum.
Combination therapy
If there is no further positive result, monotherapy is replaced by combination therapy, i.e. the combined use of several psychotropic drugs. Most often, no more than two drugs are prescribed to avoid unpredictable combined effects, as well as side effects.
Combination of antidepressants is possible with the following types of psychotic drugs:
- antipsychotics (neuroleptics) that reduce agitation for the treatment of depression with ideomotor agitation, as well as with a predominance of negative affectivity.
- anxiolytics (tranquilizers) to relieve anxiety, emotional stress, fear and normalize sleep in mild anxiety, anesthetic and hypochondriacal depressions, as well as in mixed forms.
- nootropics to improve thought processes and brain resistance to hypoxia in asthenic and adynamic depression.
- psychostimulants that activate physical and mental activity and reduce fatigue and drowsiness.
Most often, psychotropic drugs are prescribed orally in tablets, capsules, drops or pills. This method is the most convenient and safe, but requires compliance with the frequency of administration and dosage, depends on the intake of food and other drugs.
When the therapeutic effect is achieved, the drug is discontinued gradually to prevent deterioration of the condition and withdrawal syndrome.
Psychotherapy
In addition to antidepressants, combined therapy for depressive states includes psychotherapy, which helps reduce anxiety, distract from fears and motivate for the treatment process and herbal medicine. Psychotherapy for some forms of depression can be used as a pathogenetic (main) method of treatment.
Phytotherapy
Phytotherapy is used in a limited way, positive results are observed only in mild forms with minimal depression. It is more often used in cases of poor tolerance of psychotropic drugs by elderly people, individual intolerance (allergies).
Herbal preparations can be sedative and stimulating. In case of increased irritability and sleep disorders, sedative herbal medicines based on valerian, motherwort, hawthorn, hops, peony, etc. are indicated. If asthenic disorders predominate in the clinic, then herbs with a stimulating effect are used (schisandra, ginseng, chamomile, eleutherococcus, rosea rhodiola).
Supportive therapy
Prevention of depression relapses consists of long-term (up to 9 months) maintenance therapy (taking medications in low doses) after the disease has been relieved. This becomes vital if depression has occurred in the patient’s history or if the disease takes a long time to develop. Additional preventive measures include: giving up bad habits, following a work and rest schedule, allocating enough time for sleep, daily physical activity, and playing sports.
Thus, depression is polymorphic in its manifestations, but is successfully treated with sufficient patient motivation and properly selected therapy. Social support and timely access to qualified help are also very important for such patients.
Prognosis for depression
The prognosis for depression is ambiguous. While antidepressants are useful for some patients, others either do not notice any effect, endure unpleasant reactions or are resistant to the drugs.
Without treatment, depression can have a tendency to frequent relapses, severe progression, and even suicidal tendencies.
Prevention of depression
There is no specific prevention for depression, however, it is important to try to ensure a normal psychological background, for which it is recommended:
- Reduce stressful situations as much as possible
- Establish a rest and sleep routine
- Eat right
- Reduce the amount of mental stimulants – coffee, alcohol and cigarettes
- Pay attention to regular physical activity
- Communicate with loved ones
- Get yourself a hobby
How to get out of depression?
You can get out of depression with the help of a competent specialist – he will select a comprehensive treatment plan, monitor the results and adjust the therapy plan if there is no result.
How long does postpartum depression last?
This is a very individual moment. It can be different, for some it can last from a few days, for others it can last a year. It is important to pay attention to this condition and consult with a competent doctor, a woman really needs help and support during this period.
Can you die from depression?
Unfortunately, suicide attempts are made against the background of such a condition.
How to help yourself with depression?
Surround yourself with loved ones, devote time to physical activity, eat tasty food and rest. This is what you can do on your own.
Still, contacting a doctor is important in addition to the medications.
