Depression – the mental disorder which is shown steady decrease in mood, motive block and violation of thinking. The psychoinjuring situations, somatic diseases, abuse of psychoactive agents, violation of exchange processes in a brain or a lack of bright light (seasonal depressions) can become the reason of development. Frustration is followed by decrease in a self-assessment, social disadaptation, loss of interest in habitual activity, own life and surrounding events. The diagnosis is established on the basis of complaints, the anamnesis of a disease, results of special tests and additional researches. Treatment – pharmacotherapy, psychotherapy.
Depression – the affective frustration which is followed by the strong suppressed mood, negative thinking and delay of movements. Is the most widespread mental disorder. According to the last researches, the probability of development of a depression during life fluctuates from 22 to 33%. Experts in the field of mental health specify that these figures reflect only official statistics. A part of the patients suffering from this frustration or do not see a doctor at all, or pay the first visit to the expert only after development of the secondary and accompanying frustration.
The peaks of incidence fall on youthful age and an after-life. Prevalence of a depression at the age of 15-25 years makes 15-40%, 40 years – 10% are aged more senior, 65 years – 30% are aged more senior. Women suffer one and a half times more often than men. Affective frustration makes heavier the course of other mental disorders and somatic diseases, increases risk of development of a suicide, can provoke alcoholism, drug addiction and toxicomania. Treatment of a depression is performed by psychiatrists, psychotherapists and clinical psychologists.
Approximately in 90% of cases the sharp psychological trauma or a chronic stress becomes the reason of development of affective frustration. The depressions resulting from psychological injuries call jet. Jet frustration are provoked by a divorce, death or a serious illness of the loved one, disability or a serious illness of the patient, dismissal, the conflicts at work, retirement, bankruptcy, sharp falling of level of material security, moving, etc.
In some cases depressions arise "on the roll", at achievement of the important purpose. Experts explain similar jet frustration with the sudden loss of meaning of life caused by lack of other purposes. The neurotic depression (depressive neurosis) develops against the background of a chronic stress. As a rule, in similar cases the concrete reason of frustration does not manage to be established – the patient or finds it difficult to call the injuring event, or describes the life as a chain of failures and disappointments.
Women have psychogenic depressions more often than men, elderly people – are more often than young people. Among other risk factors – "extreme poles" of a social scale (wealth and poverty), insufficient resistance to stresses, the underestimated self-assessment, tendency to self-accusations, a pessimistic view on the world, an adverse situation in a parental family, the physical, psychological or emotional abuse postponed at children's age, early loss of parents, hereditary predisposition (presence of a depression, neurotic frustration, drug addiction and alcoholism at relatives), lack of support in a family and in society.
Rather rare version are the endogenous depressions making about 1% of total of affective frustration. Carry periodic depressions at a unipolar form of maniac-depressive psychosis to number of endogenous affective frustration, a depressive phase at bipolar options of a course of maniac-depressive psychosis, involutional melancholy and senile depressions. Neurochemical factors are the main reason for development of this group of frustration: genetically caused violations of exchange of biogenous amines, endocrine shifts and changes of a metabolism resulting from aging.
The probability of endogenous and psychogenic depressions increases at physiological changes of a hormonal background: in the period of a growing, after the delivery and in the period of a climax. The listed stages are a peculiar test for an organism – during such periods activity of all bodies and systems is reconstructed that affects all levels: physical, psychological, emotional. Hormonal reorganization is followed by increased fatigue, decrease in working capacity, a reversible memory impairment and attention, irritability and emotional lability. These features in combination with attempts of acceptance of own growing, aging or a role of mother, new to the woman, become a push for development of a depression.
One more risk factor are damages of a brain and somatic diseases. Statistically, clinically significant affective violations come to light at 50% of the patients who had a stroke at 60% of the patients suffering from chronic insufficiency of brain blood circulation and at 15-25% of the patients having a craniocereberal trauma in the anamnesis. At ChMT depressions usually come to light in the remote period (in several months or years from the moment of a trauma).
Among the somatic diseases provoking development of affective frustration, experts specify coronary heart disease, chronic cardiovascular and respiratory insufficiency, diabetes, diseases of a thyroid gland, bronchial asthma, stomach ulcer and a duodenum, cirrhosis, rheumatoid arthritis, hard currency, malignant new growths, AIDS and some other diseases. Besides, depressions often arise at alcoholism and drug addiction that is caused as chronic intoxication of an organism, so by the numerous problems provoked by reception of psychoactive agents.
Classification of depressions
In DSM-4 allocate the following types of depressive frustration:
- The clinical (big) depression – is followed by steady decrease in mood, fatigue, vigor loss, loss of former interests, inability to derive pleasure, sleep disorders and appetite, pessimistic perception of the present and future, the ideas of guilt, suicide thoughts, intentions or actions. Symptoms remain within two or more weeks.
- The small depression – a clinical picture not completely corresponds to big depressive frustration, at the same time two or more symptoms of big affective frustration remain within two or more weeks.
- Atypical depression – typical displays of a depression are combined with drowsiness, increase in appetite and emotional reactivity.
- The postnatal depression – affective frustration arises after the delivery.
- Recurrent depression – symptoms of frustration appear approximately once a month and remain within several days.
- Distimiya – the permanent, moderately expressed decrease in mood which is not reaching the intensity characteristic of a clinical depression. Remains within two or more years. Some patients against the background of a distimiya periodically have big depressions.
As the main manifestation serves the so-called depressive triad including steady deterioration in mood, delay of thinking and decrease in physical activity. Deterioration in mood can be shown by melancholy, disappointment, a hopelessness and feeling of loss of prospects. Increase in level of alarm is in certain cases observed, such states are called a disturbing depression. Life seems senseless, former occupations and interests become unimportant. The self-assessment decreases. There are thoughts of suicide. Patients are fenced off from people around. Many patients have a tendency to self-accusation. At neurotic depressions patients sometimes, on the contrary, accuse of the misfortunes of people around.
In hard cases there is hard experienced feeling of full loss of consciousness. On the place of feelings and emotions as though the huge hole is formed. Some patients compare this feeling to intolerable physical pain. Daily mood swings are noted. At an endogenous depression the peak of melancholy and despair usually falls on morning hours, in the second half of the day some improvement is celebrated. At psychogenic affective frustration the return picture is observed: improvement of mood in the mornings and deterioration in the late afternoon.
Delay of thinking at a depression is shown by problems when planning actions, training and the solution of any daily tasks. Perception and storing of information worsens. Patients note that think as though become viscous and slow, any intellectual effort demands a big investment of forces. Delay of thinking is reflected in the speech – patients with a depression become silent, speak slowly, reluctantly, with long pauses, prefer short terse answers.
Motive block includes slowness, sluggishness and constraint of movements. The patients having a depression carry out the most part of time almost not movably, in a sitting position or lying. The characteristic sedentary pose – hunched with the inclined head, elbows lean on knees. Patients with a depression do not find forces in hard cases even to get up, wash and change clothes. The mimicry becomes poor, monotonous, on a face there is a stiffened expression of despair, melancholy and hopelessness.
The depressive triad is combined with vegetative and somatic frustration, sleep disorders and appetite. Typical vegetative and somatic manifestation of frustration is Protopopov's triad including locks, expansion of pupils and increase of pulse. At a depression there is a specific damage of skin and its appendages. Skin becomes dry, its tone decreases, on a face sharp wrinkles because of which patients look appear is more senior than the years. The hair loss and fragility of nails is noted.
The patients having a depression show complaints to headaches, pains in heart, joints, a stomach and intestines, however when carrying out additional inspections somatic pathology either is not found, or does not correspond to intensity and the nature of pains. Typical symptoms of a depression are frustration in the sexual sphere. The sexual inclination decreases significantly or lost. Women stop or have irregular periods, at men impotence quite often develops.
As a rule, at a depression the loss of appetite and loss of weight is observed. In some cases (at atypical affective frustration), on the contrary, increase in appetite and increase in body weight is noted. Sleep disorders are shown by early awakenings. During the day patients with a depression feel sleepy, not well rested. The perversion of a daily rhythm of a dream wakefulness is possible (drowsiness in the afternoon and sleeplessness at night). Some patients complain that they do not sleep at night whereas relatives approve the return – such discrepancy demonstrates loss of feeling of a dream.
Diagnostics and treatment of a depression
The diagnosis is established on the basis of the anamnesis, complaints of the patient and special tests for determination of level of a depression. Diagnosis requires existence of at least two symptoms of a depressive triad and at least three additional symptoms which are among sense of guilt, pessimism, difficulties in attempt of concentration of attention and decision-making, decrease in a self-assessment, a sleep disorder, appetite violation, suicide thoughts and intentions. At suspicion on existence of somatic diseases of the patient having a depression direct to consultation to the therapist, the neurologist, the cardiologist, the gastroenterologist, the rheumatologist, the endocrinologist and other experts (depending on the available symptomatology). The list of additional researches is defined by doctors of the general profile.
Treatment of a small, atypical, recurrent, postnatal depression and distimiya usually carry out on an outpatient basis. At big frustration hospitalization can be required. The plan of treatment is made individually, depending on a look and weight of a depression apply only psychotherapy or psychotherapy in combination with pharmacotherapy. A basis of medicinal therapy are antidepressants. At block appoint antidepressants with the stimulating effect, at a disturbing depression use medicines of sedative action.
Reaction to antidepressants depends both on a look and weight of a depression, and on specific features of the patient. At initial stages of pharmacotherapy psychiatrists and psychotherapists sometimes should replace medicine because of insufficient anti-depressive effect or pronounced side effects. Reduction of expressiveness of symptoms of a depression is noted only 2-3 weeks later after the beginning of reception of antidepressants therefore at the initial stage of treatment by the patient often write out tranquilizers. Tranquilizers are appointed to term of 2-4 weeks, the minimum term of reception of antidepressants makes several months.
Psychotherapeutic treatment of a depression can include individual, family and group therapy. Use rational therapy, hypnosis, gestalt therapy, art therapy etc. The psychotherapy is supplemented with other non-drug methods of treatment. Patients are directed to LFK, physical therapy, acupuncture, massage and an aromatherapy. At treatment of seasonal depressions the good effect is reached at application of a svetoterapiya. At resistant (not giving in to treatment) depressions in some cases use electroconvulsive therapy and a deprivation of a dream.
The forecast is defined by a look, weight and the reason of a depression. Jet frustration, as a rule, will well respond to treatment. At neurotic depressions tendency to a long or chronic current is noted. The condition of patients at somatogenic affective frustration is defined by features of the main disease. Endogenous depressions badly give in to non-drug therapy, at the correct selection of medicines in some cases steady compensation is observed.