Causes and types of manifestations of somatized depression

Each of us has repeatedly heard stories about incredible fortitude. When doctors announce a “diagnosis-sentence”, but a person does not despair, fights for his health and, despite all the sad forecasts, defeats the disease. Such seemingly miracles happen solely due to fortitude, self-confidence and incredible determination. But, unfortunately, there are not very happy stories. It happens that the power of the spirit affects a person negatively. In this case, various disorders and ailments begin, physical health suffers, although in fact deep, hidden depression dominates.

Somatized depression occurs atypically, hiding under the guise of somatic or vegetative complaints.

More than a bad day

How can you tell that this is depression and not just a bad and sad period? You need to ask yourself a few questions about the events in your life.

What is somatized depression, symptoms and treatment, you will learn today from this article.

Are you sad about something that happened at work? Are there problems with your life partner? There may only be isolated moments of sadness, but if you feel hopeless, realize that you want to cry for no reason, and if you are empty inside for more than two weeks, it could be an episode of somatized depression.

Psychosomatic aspects of depression

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

MEDICATION CORRECTION

DEPRESSION

CLINICAL CLASSIFICATION OF ANTIDEPRESSANTS

First-line antidepressants for use in general clinical practice

(A.B. Smulevich)

• Selective serotonin reuptake inhibitors (SSRIs): fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram
• Reversible monoamine oxidase type A inhibitor (MAOI-A): pyrazidol
• Selective norepinephrine reuptake blocker (SNRB): mianserin
• Selective serotonin norepinephrine reuptake inhibitor (SNRI): venlafaxine, Ixel
• Selective serotonin reuptake stimulator (SSRES): tianeptine (Coaxil)

PSYCHOSOMATIC ASPECTS OF DEPRESSION

MEDICATION CORRECTION

DEPRESSION

Second-line antidepressants for use in general clinical practice

(Smulevich A.B.)

• Monoamine oxidase inhibitor (MAOI): nialamide
• Reversible inhibitor of monoamine oxidase type A (MAO-A): Aurorix
• Selective reversible norepinephrine uptake blocker (SRRB): ludiomil
• Tricyclic antidepressants (TCAs): amitriptyline, imipramine, clomipramine

Second line antidepressants

PSYCHOSOMATIC ASPECTS OF DEPRESSION

MEDICATION CORRECTION

DEPRESSION

Effect of antidepressants and tranquilizers on symptoms of depression

PSYCHOTHERAPY FOR DEPRESSION

The practical application of psychotherapy requires a certain stage-by-stage approach.

Goal of the initial stage

– establish a therapeutic partnership with the patient and support him in the process of further treatment.

Necessary

Reveal the meaning of psychotherapeutic intervention

• Explain to the patient the essence of his disorder, the advisability of hospitalization or out-of-hospital treatment, the significance of certain life events in the development of the disease state
• Involve the patient's family in the therapeutic process

PSYCHOSOMATIC ASPECTS OF DEPRESSION

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

Goals of the main stage of psychotherapy

• Relief (mitigation) of guilt and despair
• Restoring Hope
• Protection from self-destructive behavior
• Interpretation of the meaning (meaning) of depression

Types of psychotherapy used

for depression

• Cognitive therapy
• Interpersonal therapy
• Behavioral therapy
• Short-term dynamic therapy
• Family therapy

PSYCHOSOMATIC ASPECTS OF CARDIOVASCULAR SYSTEM DISEASES

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

PSYCHOSOMATIC ASPECTS OF DISEASES

OF CARDIO-VASCULAR SYSTEM

CARDIAC ISCHEMIA

Coronary heart disease (CHD)

is one of the most pressing problems of modern medicine. According to statistics, IHD is the leading cause of death in many countries around the world. In Russia, about 350 men and 130 women aged 30 to 69 years die from ischemic heart disease per 100,000 people every year.

Psychosomatic relationships in patients with coronary artery disease are traditionally considered within the framework of two approaches.

Psychocentric. Emphasizes the role of acute and chronic mental stress, as well as various characteristics of the patient’s mental state in the occurrence, clinical picture, course and prognosis of coronary artery disease. Among the latter, constitutional characteristics of personality are considered, interpreted within the framework of the concept of alexithymia, specific “personality profiles,” behavioral type “A,” as well as comorbid mental disorders with coronary artery disease (affective, anxious-phobic, etc.).

Somatocentric. Studies the influence of the clinical features and course of coronary artery disease on the patient’s subjective perception of his disease and the uniqueness of mental disorders, the manifestation of which is associated with somatic diseases (somatogenies and psychogenic conditions associated with somatic suffering - nosogenic reactions).

You want to isolate yourself

Are you actively and joyfully leaving your home? Do you think that a short conversation with someone you know is too difficult? Are you socially isolated when a friend wants to "drag" you out of the house? The fact that you don't want to communicate with friends is a sign of depression. A support group is not just a healthy way to protect yourself from it, but also a very important factor in leading a fulfilling life. Somatized depression, treatment and symptoms will now be easy and understandable for you.

What is postpartum depression

Postpartum depression

• genetic (episodes of depression in close relatives);
• obstetric (pathology of pregnancy and childbirth);
• psychological (increased vulnerability, past psychological trauma and depressive states);
• social (absence of a husband, conflicts in the family, lack of support from the immediate environment);
• economic (poverty or the threat of a decline in material well-being after the birth of a child).

Postpartum depression is said to occur when at least one of the following symptoms is observed:

• emotional depression, sleep and appetite disturbances persist for several weeks after childbirth;
• signs of depression reach significant depths (the mother in labor does not fulfill her duties towards the child, does not participate in the discussion of family problems, etc.);
• fears become obsessive, ideas of guilt towards the child develop, and suicidal intentions arise.

You are more irritable than usual

Depression can also manifest itself in symptoms of irritability. Those who have a relaxed lifestyle may argue with their loved ones without realizing that depression is speaking for them. This leads to a sharp decrease in stress tolerance.

People diagnosed with depression are likely to act stupid, nervous, or even aggressive.

Symptoms of the disease

Agitated depression manifests itself with a range of symptoms. In addition to the usual signs characteristic of depression (apathy, melancholy, sleep and appetite disturbances, headaches, etc.), this form of depression also has special symptoms:

1. At the initial stage of the disease, loved ones should be wary of the fact that the patient begins to experience and voice constant anxiety: it seems to him that some kind of misfortune will happen to him or his loved ones. This anxiety may be pointless, or it may have clear images, for example, “someone will get hit by a car,” “they will kill me,” etc. At the same time, there are no real threats to the life and health of the patient or his loved ones.
2. The patient's speech consists of short, repeated phrases, rather monotonous, on the same disturbing topic. There may be repeated utterance of the same alarming phrase - “anxious verbigeration.”
3. A state of motor agitation is also observed, which expresses itself in restlessness, frequent changes of posture, and constant walking.
4. With mild agitation, the patient may wring his fingers; in more severe conditions, frantic excitement and self-torture may occur, even to the point of attempting to kill himself. This syndrome is called melancholic raptus.
5. Very often this disease is accompanied by various forms of delusion - delusions of accusation and self-blame, delusions of ruin, Cotard's delirium, etc.

If you don't like it anymore

If you no longer enjoy going out with your friends, having fun in your free time, or having sex with your partner, you may be suffering again from a disease called masked somatization depression. If you have been diagnosed with depression in the past and now notice that your feelings for your spouse or children have cooled, or that your hobbies and work do not bring you as much satisfaction as before, it is time to talk to your doctor. Treatment of somatized depression and reviews of this method will be provided to you by your doctor.

Symptoms of depression can return at any time.

Causes of depression

The causes of depression can be divided into two groups: biological and psychological. If the former predominate, they speak of endogenous depression, i.e. caused by internal biological reasons. These are considered to be disturbances in the production and absorption of neurotransmitters such as serotonin and dopamine. It is worth noting that, despite the fact that a number of sources emphasize the lack of connection between traumatic events and endogenous depression, this is not entirely true: exacerbations of endogenous depression often occur against the background of certain provoking events of a psychogenic nature. Psychological stress acts in some cases as a trigger mechanism that contributes to the implementation of a biological predisposition. Let us add here that depression is a disease that has a hereditary predisposition. The presence of a person suffering from depression in the family indicates an increased risk of developing this disorder in blood relatives.

In the case of a predominance of psychological factors in the development of a depressive state, it is customary to speak of psychogenic or reactive depression. We are talking about reactive depression when the development of a depressive state was preceded by traumatic circumstances. Such circumstances may include the death of a loved one, divorce, job loss, or changes in financial situation. Depression in this case is a reaction to changes in life situations. I would like to add here that the development of psychogenic depression is not always preceded by clearly defined stressful events. When seeking psychological help, a person is not always able to formulate what was the starting point for the deterioration of his condition. Moreover, a depressed state and dissatisfaction with oneself, relationships, and life in general can develop against the background of seemingly complete well-being. Thus, in practice, there are cases when symptoms of depression first appeared against the backdrop of great success, personal and professional: a rapid rise in career, a successful and happy marriage. This state of affairs ceases to be strange when we refuse to understand the emotional life of patients only as a reflection of certain external, objective events, and consider and take into account the inner world of a person with all its complexity and inconsistency. Upon closer examination, success and achievement are often associated with feelings of guilt and anxiety. The unconscious meanings of certain external events have a much greater influence on our lives than we are accustomed to think.

The feeling of futility torments you

Old ideas and feelings of disgust and hatred directed at your loved one may reappear. They may hide with self-criticism, which usually increases as a depressive episode approaches. A positive mentality can turn into concentration problems with a deep focus on your failures and shortcomings.

You may blame yourself for situations that are out of your control or think that everything bad that happens is your fault.

Discussing this with a therapist can help improve your self-confidence.

Treatment

Drug treatment of this disease (as well as any form of depression), first of all, involves taking antidepressants.
They help to significantly reduce the symptoms of melancholy, apathy, relieve emotional stress, normalize vitality, sleep and appetite. This disease is treated by a psychotherapist or psychiatrist. Based on the symptoms of the disease, he will select exactly the antidepressant that is suitable for this patient. For example, for severe anxiety, a specialist may prescribe pyrazidol, and for symptoms of lethargy and apathy, melipramine or paxil. The duration of admission and the necessary concomitant treatment are also determined by the doctor. Depression is considered a disease of the soul. However, it affects not only the human psyche. Somatic depression occurs in patients who experience a number of physical illnesses. Disturbances in the functioning of the body appear in parallel with mental disorders and intensify along with any disease. Disturbances in the functioning of the digestive system, various types of headaches and a feeling of pressure in the chest are common. The pain of depression is very strong, even unbearable for the patient. Patients with somatic depression complain of various ailments in many organs of the body.

Do you feel exhausted?

The fact that you feel slower in your movements or think that you can no longer concentrate on the tasks in front of you is a serious sign of depression.

Problems appear gradually - one morning you have a very difficult time deciding what you want to wear, another day you cannot make a choice about what to eat. Or it’s very difficult for you to respond to work email. All these little things can become obstacles in everyday life. The core element of depression is a depressed, sad, seemingly unreasonable mood that is present most of the time. In children and adolescents, this condition may be irritability rather than sadness. A person suffering from depression feels sad, desperate, discouraged, and powerless.

It may also manifest itself as a noticeable decrease in interest in all or almost all activities. All areas of life can be affected. Some people report that they are no longer interested in hobbies or activities that they previously considered enjoyable or fun.

They retreat socially and increasingly neglect normal activities that were previously considered enjoyable. For example, they don’t go to the cinema, don’t shop, don’t read, don’t play with children, don’t play tennis, and so on.

A change in body weight of more than 5% over a month is a symptom that is usually ignored - it can be significant weight loss or weight gain.

A depressed person often says “I don’t care now”, “I’m not interested in this anymore.” During depression, sleep may be disrupted. Insomnia is very common. People wake up at night and cannot fall asleep. Sleep is considered unapproachable and painful, regardless of its length.

Also interesting is information about the disease somatized depression in Desyatnikov’s variants.

Desyatnikov explains such syndromes of latent depression as: drug addiction, obsessive-phobic, agripnic (with sleep disorders), hypothalamic (vegetative-visceral, vasomotor-allergic, pseudo-asthmatic).

Changes in motor behavior, body apathy, or psychomotor slowness may also occur. Depression can manifest itself in the inability to sit quietly: you want to walk, twitch your hands, rub your hands, and involuntarily touch clothes. Psychomotor penetration of problems is present in movements of speech, thought or body.

Somatized depression as a psychosomatic disorder is considered by many specialists, doctors and analysts.

Fatigue or lack of energy dominates - even the smallest tasks seem to require significant effort. There is a feeling of worthlessness, excessive or inappropriate guilt. For example, excessive concern about guilt due to minor events in the past. An overly negative assessment of a loved one. Depressed people especially complain of problems with memory or concentration even when performing easy tasks, resulting in a decreased ability to think, focus, or make decisions.

Negative thoughts, death, or thoughts of suicide often occur in people with depression and can be just a 1-2 minute shortcut to actually planning to commit suicide. Globally, about 800 thousand people commit suicide every year, a significant proportion of them suffering from depression. Moreover, for every person who commits suicide, there are ten or more people they know who have attempted suicide.

Other symptoms may also be noted:

• headache;
• abdominal pain;
• joint pain;
• anxiety;
• panic attacks;
• excessive worries about your physical health;
• phobias;
• difficulties in intimate relationships;
• low libido;
• abuse of alcohol or other substances.

Diagnosis of somatic disorder

Half of patients with depression talk only about somatic complaints; in 20%, affective symptoms, psychological or cognitive, can be identified. This is a big difficulty in making a diagnosis. If there are patients with a chronic somatic disease, then up to 30% of them also suffer from a depressive disorder. Older people and females are at greater risk. Research shows that anxiety disorders are more common in women. But this only applies to somatic depression; in pure depression the ratio is equal. In women it occurs 1.5 times more often, and starts from a young age.

In such a disease, it is not always possible to achieve complete remission. A reduction in symptoms can be achieved by 50% with antidepressant therapy. But anxiety may persist, and the patient may also experience pain. These are the most common signs that remission is incomplete. There is a direct connection between somatic pain and attacks of depression. The stronger the pain, the longer and stronger the episodes of depression.

Pain is associated with functional impairment and, accordingly, a general deterioration in well-being, inability to work and frequent visits to doctors. Patients with chronic pain combined with signs of depression are more likely to think about suicide.

I don't know if my sadness is important

We all have different problems or too high expectations that we didn't have before, but that doesn't mean we're depressed. However, depression or a depressive episode is a combination of several emotional, physical, behavioral and cognitive symptoms. And if you are experiencing sadness, irritability and other symptoms in your life, then you should consult a specialist as soon as possible!

If the number of symptoms is present for most of the day/almost every day/at least two weeks from the onset/have now appeared or are clearly worse than the person's previous condition/significantly impair the person's social, occupational or other areas of functioning. For some people, this dysfunction may not be as obvious, may be communicated by the person concerned, or may be noticed by others.

Depression can be cured and can also be controlled through psychotherapy. Depression is a condition that often goes undiagnosed, and those who suffer from it are often stigmatized and convinced that it is not a real problem. In fact, depression can affect anyone, from young to old, and it is one of the most common diseases in the world.

Depression in spring

Spring depressed mental states are of an endogenous nature, but do not fall under the definition of severe medical pathologies. They talk about asthenic syndrome, which manifests itself as:

• avitaminosis;
• drowsiness;
• lack of appetite;
• causeless sadness;
• feeling of hopelessness;
• prostration.

A prolonged period of cold weather and short daylight hours help weaken the production of hormones, including neurotransmitters. Oxygen starvation, climatic, astronomical factors, physical inactivity are the prerequisites for a decrease in vitality in the spring. Both men and women are susceptible to it. But they can cope with depression on their own.

Sleep and wakefulness, music, aromatherapy, a week's vacation will become an effective medicine. Experiencing joyful moments in life works better than pills.

Risk group

The same factors that provoke the appearance of the classic version of depression are responsible for the occurrence of this disease: a decrease in hormonal concentrations is observed in the body and disruptions occur in the process of transmitting signals from the sensory organs to the brain.

First of all, this applies to hormones such as dopamine or serotonin, which prevent the patient from receiving positive emotions from life and current events.

This contributes to a loss of interest in hobbies and everything that made a person happy before. Modern medicine still does not know why some people have a tendency to such conditions, while others do not.

However, there are certain factors that can trigger depression under certain circumstances:

• Hereditary factors and genetic predisposition. One of the reasons for the reduced concentration of neurotransmitters in the brain is sometimes due to corresponding heredity, if at least one of the relatives had a similar problem. There is still debate about this theory and experts cannot come to a consensus, but it cannot be denied that pathology most often occurs in people whose relatives suffered from various mental illnesses.
• Hormonal imbalances are a common problem in which the synthesis of various hormones is disrupted. This may be caused by a disruption in the functioning of the endocrine system or individual internal organs, a long course of taking hormonal-type pharmacological agents, pregnancy, the postpartum period, or age-related changes in the female body.
• Emotional turmoil and too frequent exposure to various stressful situations. In this case, the synthesis of cortisol and adrenaline increases in proportion to the decrease in the synthesis of serotonin or dopamine; the systematic nature of this process can lead to hormonal changes in the body.
• The presence of events that cause serious trauma to mental health. This can be any life situation that leads to severe emotional upheaval, the most common cases are the following: betrayal of a loved one, forced separation, dismissal from work, termination of personal relationships.
• Deterioration of the immune system, acute lack of vitamins and minerals, lack of a complete and balanced diet, prolonged fasting, systematic lack of sleep and other similar factors can provoke a general deterioration in an individual’s health. This leads to disruptions in the central nervous system, a person loses the ability to withstand stressful events, and this often leads to the onset of depression.

Diagnostic measures

It is difficult to identify hidden depression in the early stages of its development. The patient either does not seek medical help or visits doctors with complaints of digestive disorders, high blood pressure, etc. In the absence of medical supervision, he may miss changes in emotional background and cognitive functions. A characteristic feature of masked depression is the lack of effectiveness of the therapy for somatic diseases.

During the conversation with the patient, the doctor finds out his lifestyle, work activities, hobbies and interactions with other people. Somatovegetative signs, which are closely related to changes in mood and time of day, are also assessed. The Latent Depression Test assesses the severity of bodily symptoms.

An external examination of the patient is carried out in order to detect existing somatovegetative signs and concomitant diseases. Electroencephalography and computed tomography or magnetic resonance imaging of the brain are recommended. These methods are aimed at studying the state of the central nervous system and identifying possible organic causes of mental disorders.

How to recognize the enemy?

I must immediately make a reservation that there are no clear criteria for diagnosing masked depression.

It helps to establish a diagnosis that somatovegetative symptoms usually do not fit completely within the framework of the disease that they imitate, and doctors of non-psychiatric specialties, as a rule, notice this, and also pay attention to the failure of treatment of the suspected somatic disease

The most difficult thing to detect is the actual disturbed mood. The doctor must be able to identify the various signs of depression present in the clinic of such an illness.

They suggest the idea of ​​masked depression - the frequency of appearance of somatovegetative and mental disorders, the presence of a history of unclear somatic disorders, erased, classic depressive or manic phases, the suddenness of the onset and disappearance of attacks of the disease, the seasonal occurrence of attacks of the disease - mainly in the autumn-spring period, which is typical and other classic types of depression. Data on the lack of effect from somatic therapy and a positive reaction to treatment with antidepressants can be of great help in diagnosis.

general information

Latent depression is a psychological disorder that is expressed primarily in physical manifestations. The symptoms of larval, somatized depression are similar to diseases of the internal organs. Most often these are disorders in the functioning of the gastrointestinal organs, as well as vegetative-vascular dystonia.

Doctors also call this type of depression “depression without depression,” since its main symptoms are physical, and not psychological, as in a normal disorder.

The disease was known back in the 19th century, but nowadays psychotherapists are increasingly diagnosing it. This is explained by the fact that people have become more attentive to their mental health and are more often seeking medical help. But due to its similarity to other somatic diseases, latent depression is not always diagnosed on time, and therefore the patient does not receive the necessary timely treatment.

6% of the population of Russia and other developed countries has signs of depression. 70-75% of them do not seek medical help, since the disease is mild and does not lead to symptoms noticeable to others. Masked or hidden depression ranks 4th in the structure of depressive disorders and is rarely detected in the initial stages of development.

Women are more often affected. Mostly residents of large cities are affected. Depression is rarely detected among the rural population. This is due to chronic stress, which is more common among urban residents.