Alcoholic depression – the affective frustration arising at the people having alcoholism. Usually proceeds from 2 weeks to 1 month. The maximum expressiveness of symptomatology is usually observed during development of an abstinence syndrome. This state quite often arises after an exit from alcoholic psychosis, can develop in the periods of hard drinkings and remissions also. Is followed by decrease in mood, melancholy, feeling of guilt, uselessness and uselessness. Suicide thoughts and actions are possible. The diagnosis is exposed on the basis of the anamnesis and clinical manifestations. Treatment – medicamentous therapy in combination with psychotherapy.
The depression at alcoholism was described by Bleyler in 1920 under the name "alcoholic melancholy". The subsequent researches confirmed as existence special depressive and subdepressions at alcoholics, and difficult, diverse communications between alcoholism and depressive frustration. Frequency of development of a disease and expressiveness of symptomatology directly correlates with duration and weight of alcoholism. Patients of middle and advanced age suffer from depressive frustration more often than young people. Most of patients – people are more senior than 40 years.
The average duration of a depression at alcoholism fluctuates from 2 weeks to 1 month. In hard cases symptoms can remain within a year and more. Duration of a disease depends on psychoemotional features, traits of character, features of the constitution and a condition of an organism of patients. Women suffer more often than men, however at men the depression proceeds heavier and more often is complicated by attempts of a suicide. Aggravation of a male depression is promoted by the fact that men at development of a disease seldom ask for medical care. At alcoholism experts in the field of narcology, psychotherapy and psychiatry are engaged in treatment of a depression.
Reasons of development of an alcoholic depression
Depression at alcoholism – a multifactorial disease. The whole complex of circumstances among which – changes of the general metabolism, violation of work of receptors of a brain, change of the personality, characteristic mental and somatic disorders, uncontrollable thirst for alcohol, the abstinency phenomena leads to its development at the termination of reception of alcoholic drinks, social and household problems. Narcologists constantly should face the alcoholic depression developing in different clinical situations.
The alcoholic depression is a part of simptomokompleks of a syndrome of deprivation, sharp alcoholic intoxication, hard drinking and uncontrollable thirst for alcohol. The abstinence syndrome becomes the most common cause of emergence of depressive frustration. Sincere sufferings of patients are provoked by the expressed physical and psychological discomfort and social problems in combination with the pathological need for alcohol.
Several attacks of a depression arise at the patients undergoing treatment for alcoholism in specialized clinics. At initial stages of therapy at such patients "the sobriety phobia" - the expressed fear of a possibility of life without alcohol develops. This stage is followed by the peculiar grieving caused by alcohol loss. The second wave of a depression is usually observed before an extract of patients from a hospital, at a stage when the person does not suffer from intoxication consequences any more. Into the forefront the melancholy for alcohol and psychological problems acts.
Sometimes depressive frustration develop against the background of remission when the person feels lost, incapable to fit in, "dropped out" of a normal rhythm of life and a social environment, suffering from change of habitual patterns of behavior, forced to solve the numerous problems which arose in the period of alcoholism without having for this purpose rather external support and internal reserves. Such depressions can become the reason of failure and further alcoholization of the patient.
It is necessary to consider that in development of alcoholism a certain value has a premorbidny background. Even prior to the use of alcoholic drinks many patients have the increased tendency to mood swings, development of asthenic states, depressive neurosis, subdepression and various boundary frustration. In process of development of alcoholism this tendency is aggravated and made heavier because of secondary psychoemotional and personal changes.
Symptoms and differential diagnosis of an alcoholic depression
Depression symptoms at alcoholism are usually expressed moderately. Heavy affective frustration are observed rather seldom. The mood is constantly lowered, the patient suffers from feeling of emptiness and senselessness of existence. There is a feeling of loss of paints, characteristic of depressive frustration, emotional dullness of the world. Such perception causes depression and alarm. The angedoniya develops – the person loses ability to rejoice, cannot derive pleasure.
Psychological changes are combined with motor and intellectual block. Gait and the movements are slowed down, the voice becomes silent, monotonous. A mimic variety disappears, on a face of the patient sad expression almost constantly remains. The patient a considerable part of time stays in a condition of a divergence, with a delay answers questions, experiences difficulties in attempt to understand others thought or the instruction. It is heavy to it to think and formulate statements.
Hallucinations and nonsense usually are absent. Often there are supervaluable ideas of own guilt, uselessness, uselessness, fatal impracticality and discrepancy. Tendency to self-abasement and self-accusation is observed. The future is represented sad, hopeless, unpromising. Some patients consider some own previous actions as serious crime. Many patients have thoughts of suicide, attempts of a suicide are possible. Sometimes (mainly at elderly patients) the alcoholic depression is combined with the increased uneasiness.
The alcoholic depression is differentiated with other depressive frustration and states including separate symptoms of a depression. Unlike depressive frustration, "the drunk grief" is not followed by feeling of dullness of the world and loss of ability to feel various emotions. This state arises on "an emotional wave" and passes within several hours, occasionally – several days.
Separate elements of a depression are quite often observed at an abstinence syndrome, but, unlike the real alcoholic depression, disappear after abstention from reception of alcohol within 1-3 days. Reactive depression at alcoholics develops against the background of the heavy injuring events (the death of the relative, a divorce etc.), at an alcoholic depression similar events in the recent past of patients are absent. Alcohol intake can provoke an exacerbation of other mental diseases (a psychogenic depression, a depressive phase of bipolar affective disorder) therefore at emergence of affective symptomatology in patients with alcoholism careful collecting the anamnesis is necessary.
Treatment and the forecast at an alcoholic depression
Treatment of a depression at alcoholism is performed in the conditions of a narcological hospital. In the course of treatment use medicines, psychotherapy and non-drug techniques. To patients appoint antidepressants (usually – SIOZS, tritsiklichesky antidepressants or MAO inhibitors). At the increased uneasiness and sleep disorders conduct short-term courses of medicamentous therapy with use of hypnotic drugs and tranquilizers (diazepam, a fenazepam, a tazepam etc.). In parallel perform dezintoksikatsionny therapy and give psychological assistance.
At early identification and timely hospitalization the forecast at an alcoholic depression in most cases rather favorable. Single depressive episodes, as a rule, are quickly stopped, suicide intentions disappear, working capacity is restored (if it was not broken owing to other diseases). However, if the patient continues to take alcohol, similar states can repeat and be aggravated in process of development of alcoholism.