Causes and stages of depression: how it manifests itself, signs of the syndrome, consequences

Etiology of the phenomenon

Life in modern society is complex and stressful, which always puts pressure on a person and affects his mental health. With the current pace of life, especially in big cities, there is a constant lack of time, especially for rest. The result is exhaustion of the nervous system.

An infantile personality, if it is impossible to get everything at once, falls into despair; others worry if there is no prospect of getting what they want at all. Provoking factors are:

• death of loved ones;
• betrayal and betrayal;
• dismissal;
• divorce;
• conflicts at work and much more.

For the development and establishment of depression, a combination of 3 factors must be present:

1. Psychological - influence of personality type. 3 types are more prone to depression: statothymic personality - people are exaggeratedly conscientious, hardworking and neat; melancholic personality - people with high demands on themselves, pedantry, and a desire for constancy; hypothymic personality - people with an anxious personality, who constantly worry about anything or empathize, and are not confident in themselves. Often the psychological factor can be expressed in the desire for perfection with a high level of aspirations. With a predisposition to depression, fairness is always of fundamental importance, and if it is not there, this becomes a trigger factor.
2. Biological - hormonal disorders, head injury, seasonal fluctuations, side effects of drugs, chronic diseases.
3. Social - long-term stress, poor relationships with employees, conflicts in the family and educational institution, lack of warmth and affection in the family, abuse, humiliation, migration and urbanization, sudden changes in life. Then depression, helplessness, and despair begin to predominate among the emotions.

A person blames himself for all failures. He begins to engage in self-flagellation, considering himself incapable of anything.

The patient’s performance decreases, which can lead to job loss, narrow social circles, lead to alcoholism, etc.

A person becomes even more isolated on his failures. A vicious circle is created with no end in sight. Everyone's experiences are expressed differently, which is why depression is so multifaceted. In most cases, it is diagnosed by taking an anamnesis and based on the patient’s subjective story.

There are also many tests and scales to identify depression - this is the work of a psychologist. If the above triad of symptoms lasts less than 2 weeks, this is only a normal human reaction to unfavorable circumstances.

The essence of the problem

Depressive mood manifests itself in despondency, loss of joy (anhedonia). There are many types of pathology, they differ in causes, sensations and symptoms, duration, etc.

According to WHO statistics, today every 10th person over 40 suffers from depression, with 65% being women. And after 65 years - already every fifth. It is also noted that up to 40% of adolescents under 16 years of age often suffer from a similar condition, which often leads to suicide.

Any depression is conventionally divided into stages or phases. There are no clear boundaries between them; they smoothly transform into one another. Only a specialist can distinguish them. Numerous attempts have been made to divide this condition into stages of depression - into 2, 3, 5 stages.

More often, a depressive state is the body’s response to a traumatic situation and circumstances. This type of depression has 4 or 5 stages.

This also includes depression, which occurs when a person cannot find a way out of the current life situation. This is already a legacy from childhood, when a certain model of behavior was imposed on the child.

But such conditions can also arise for no apparent reason - these are endogenous depressions, which are most often observed in mentally ill patients.

Negation

The first phase is rejection. At first the person does not believe that what happened is possible. He may perceive the incident as a mistake, someone’s prank, or a joke.

The person is convinced that this is not really happening, that it is just a “haze”. Patients begin to question the professionalism of health workers and the reliability of the examination.

At this stage, people strive to find a better clinic, turn to doctors who are more competent, in their opinion, and may even consult with psychics, traditional healers, or “grandmothers.”

The brain of a terminally ill person refuses to recognize information about the inevitability of the end of its existence. In order to save themselves, people are trying to find various strategies for an unconventional approach to curing a fatal illness, resorting to traditional medicine, and abandoning the classical directions of traditional therapy.

Psychology interprets the stage of depression as denial as a person ignoring everything that happens to him. This stage is considered quite dangerous, since people renounce the events that happened both externally and internally, which means denying their own emotions, sensations, feelings, thoughts, desires, doubts. Such behavior is dangerous because such actions are biased, because he does not have all the information.

At the same time, denial is considered a key stage of depression, since it protects the patient from severe anxiety and possible shock. In fact, this stage protects a person from unforeseen madness.

The stage in question is usually characterized by a short course and is replaced by anger.

Risk group

Each of us can experience depression at certain times in our lives. However, recent research has shown that there are certain social groups that are more susceptible to depressive disorder.

These include:

• children exposed to violence;
• people over 45 years old;
• participants in hostilities;
• creative individuals.

Teenagers and people with low self-esteem are also at risk.

For many women, depression can manifest itself after 40 years of age due to hormonal changes caused by menopause.

Diagnostics

It is important to remember that others will not be able to help you get rid of the disorder, so you should definitely seek help from a psychotherapist.

Determining the presence of the disease is carried out using special scales and questionnaires, thanks to which it is possible not only to establish the final diagnosis (depression), but also to assess the seriousness of the situation.

In some cases, it may be necessary to study the bioelectrical activity of the brain (electroencephalogram) and hormonal studies.

Stages of depression

The peculiarities of the course of each type of disorder make it possible to distinguish 5 stages of the development of the disease only for psychogenic depression. A severe emotional shock in a person with a healthy psyche triggers the process of gradual acceptance of the grief that has occurred.

First stage

A period of sharp denial of what happened. The initial stage, the first in which a person convinces himself that what happened did not happen to him. The patient maintains his usual lifestyle, there are no classical signs of pathology, but irritation arises at people trying to point out the problem.

Second stage

Awareness of what happened requires a search for the culprit, which provokes the development of acute resentment, increased irritability, and rage. Often at this stage the patient begins to look for shortcomings in himself, finds them and becomes convinced of his own inadequacy, which reduces self-esteem. Signs of the disease include attacks of rage, embitterment, and uncontrollable mood swings.

Third stage

This depressive phase is characterized by complete emotional and psychological exhaustion. The patient feels in a hopeless situation and perceives every attempt to change something as obviously hopeless. The person has already understood what happened, accepted it, but understands that he cannot cope on his own. The third stage is characterized by the desire to make deals with oneself, loved ones, God, even a psychiatrist. Treatment becomes possible only at this stage.

Fourth stage

In the absence of the necessary help from a specialist, an awareness of the acute hopelessness of the situation begins to prevail, a feeling of hopelessness, which provokes changes in the patient’s psychology, pushing him to abuse alcohol, drugs, and gambling. The patient constantly feels sorry for himself, limits his social circle as much as possible, and has problems at work, even threatening to be fired. In severe cases, an acute reluctance to communicate with others can provoke the development of a speech disorder.

Fifth stage

The last stage is characterized by accepting what happened and defining a new life direction. Restoring the ability to enjoy the world around us and perceive its beauty is possible only after completing the process of psychological perception of reality.

Condition classification

When depression occurs, the stages are as follows:

1. Rejection stage (mild). A feeling of anxiety appears, which the person attributes to poor health and mood. Symptoms are rare and most people around them do not notice them. A person is able to switch himself to the positive; he has control over his emotions. If desired, a person can cope with such symptoms on his own.
2. The receiving stage (moderate) is more noticeable to others. The patient becomes aware of his own condition. A person withdraws into himself, is constantly sad, loses his appetite, decreases his productivity and productivity, and has problems falling asleep. The patient is haunted by dark thoughts and becomes tearful. Provocative behavior in the team is noted.
3. Corrosive stage (severe). Apathy and calmness are replaced by aggression and self-aggression. A person can cause physical harm to himself or others. Detachment and indifference arise. The patient does not leave the room and stops taking care of himself. Eating disorders are noted.

   

4. The last, 4th degree is very severe. A person loses the ability to independently cope with his thoughts, he has a desire to end everything at once. The risk of suicide increases. If the cause of depression is schizophrenia, delusional ideas of various contents arise. Hallucinations may occur. The psyche is destroyed. In this case, treatment can only be inpatient.

How to identify depression

Depression can be identified by many signs, they are divided into physical and psychological.

Physical signs of depression:

1. Headache.
2. Stomach upsets.
3. Insomnia or drowsiness.
4. Lack of appetite or, conversely, overeating.
5. Lack of sexual interest.
6. Apathy, weakness.

Psychological signs of depression:

1. Unreasonable feelings of guilt.
2. Dissatisfaction with oneself, irritation.
3. Low self-esteem, melancholy.
4. Feeling of trouble, anxiety.
5. Depressed mood.
6. Lack of interest in favorite things.

Separately, we can highlight social characteristics:

1. Conflicts with others.
2. Alcohol abuse.
3. Reluctance to communicate with people.

Demoralization and grief

The term “depression” is often used to describe a low or depressed mood that results from troubles (eg, financial troubles, natural disasters, serious illness) or loss (eg, death of a loved one). However, the terms “demoralization” and “grief” are more appropriate for such conditions.

Negative feelings of demoralization and sadness, unlike depression, have a wave-like course that are typically tied to thoughts or reminders of the triggering event, pass when circumstances or events improve, may be interspersed with periods of positive emotion and humor, and are not accompanied by predominant feelings inferiority and self-hatred. Depressed mood usually lasts a few days rather than weeks or months, and suicidal thoughts and long-term loss of social functionality are much less likely.

However, events and stressors that cause demoralization and grief can trigger an episode of major depression, especially in predisposed people (for example, those with a history of major depressive episodes or family members).

Symptoms

The clinical picture is assessed on a case-by-case basis. In general, there is a group of violations.

The first and main manifestations of the pathological process are the so-called big triad.

Apathy

A feeling of not wanting to do anything. Sufferers often lie on the bed or sit and spend their time aimlessly. This is not simple laziness, it is the inability to do anything, because there is neither the desire nor the strength to act. Restoring normal activity is only possible with treatment of the underlying disease.

Anhedonia (lack of positive emotions)

Emotional emptiness, a feeling of hopelessness, sadness, melancholy, sadness, this is how patients describe their own condition. On the other hand, it is possible that the other extreme is present. This is the complete absence of any emotional background, icy calm without reaction to external and internal stimuli. This situation is even more difficult to endure and is extremely painful for the patient.

Inhibition of all reactions

Both mental and reaction to stimuli. Therefore, at such times, it is strictly contraindicated for those suffering to drive a car; coordination is also impaired, and to engage in work that requires a quick reaction. For example, in production.

In addition to the main triad, there are so-called optional signs. They can be assessed using the Hamilton scale, which describes the complete symptomatic complex most accurately and completely.

• Insomnia

For daytime sleepiness. Sleeping usually suffers. As soon as the patient goes to bed, drowsiness disappears as if by hand. An option with normal falling asleep, but frequent early awakenings is also possible. Which also ruins your night's rest. The intensity of insomnia also depends on the degree of depression. The more difficult the process. The worse things are with sleep. Temporary medication correction is required.

• Guilt

The diagnosis causes a vague feeling of personal guilt. When a psychotic component, voices, is added, this feeling intensifies and reaches the extreme. May lead to suicide attempt.

• Critical decline in performance

Asthenic symptoms of depression put an end to typical daily activities. I have neither the strength nor the desire to fulfill my professional duties. When adolescent depression occurs, schooling suffers. Academic achievement is falling sharply. The realities of a modern school do not discriminate based on health status, so it makes sense to limit school activities at times.

• Suicidal tendencies

Suicidal attempts with depression are extremely rarely deliberate. A person acts under the influence of a momentary impulse or an impulse that lasts very little. In the second case, he still manages to prepare. Usually this is a very real desire to end one’s life, not demonstrative, as happens with hysterics. However, most sufferers then regret the attempt, so we can talk about attempting suicide as a random, episodic problem. It is eliminated as depression regresses, everything returns to normal after therapy.

• Feelings of different types of anxiety

This is usually mental anxiety. An internal feeling of something unpleasant, vague fears that something should soon happen to him or his loved ones (usually to him). Judgments are inadequate, but do not reach delirium and remain within the framework of the conventional mental norm.

• Excitation

Neuropsychic and motor. Occurs infrequently. Agitation is the opposite of apathy. However, the patient does not last long. Walking around the room, rocking back and forth while sitting. These are manifestations of anxiety. But the depressive state takes over and the patient lies down or calms down his own activities. Again falls into apathy and lethargy.

• Asthenia

Weakness, increased fatigue. The sufferer is constantly lethargic. Unable to perform daily activities. He cannot even carry out household chores, let alone perform professional duties. Asthenia accompanies a person throughout the entire period of existence of the pathological process.

• Also somatic manifestations

Gastrointestinal. By type of constipation, diarrhea, alternation of one and the other. According to research, the reason for this unusual manifestation of the disorder lies in the disruption of the normal production of neurotransmitters.

• Hypochondria

Searching for symptoms of a non-existent disease. Usually fatal. Be it cancer, heart attack, stroke and others. Rarely does a patient have enough strength to go to doctors. Usually these are just statements regarding your condition. But quite revealing.

• Sexual deviations

Not persistent. Temporary. Accompanied by a drop in sexual desire and libido. Representatives of the stronger sex have impotence, the inability to ejaculate during sexual intercourse. In women, anorgasmia and sexual coldness prevail. Reluctance to have sexual contact, regardless of temperament.

Typical signs of depression include a gradual loss of criticism of one’s own condition. A patient in serious condition does not recognize himself as sick and believes that everything is formally in order. This is a relatively rare phenomenon, typical of advanced forms of the pathological process.

Anxiety disorders

Anxiety can be different: with phobias a person is afraid of something specific, with panic attacks he experiences acute but short-lived attacks of horror. Chronically elevated levels of anxiety for multiple reasons are called generalized anxiety disorder. And obsessive-compulsive disorder (OCD) forces a person to perform strange rituals in order to “protect” himself from all kinds of threats. There is an opinion that religious rituals and superstitions are also a type of OCD.

A psychiatric diagnosis is made in cases where a person is unable to cope with negative emotions that make normal life impossible: due to obsessive fears, he stops going to school, cannot cope with work, and destroys relationships one after another. Therefore, say to the anxious person: “Stop worrying, there is no reason for this!” — it doesn’t make the slightest sense.

Constant anxiety affects your physical health, causing muscle tension. Therefore, patients are plagued by severe pain for no apparent reason in the heart, stomach, and migraines.

In most cases, extreme anxiety can be reduced with the help of antidepressants and tranquilizers. Psychotherapy also helps. What definitely doesn’t help is studiously avoiding any scary situations. If anxiety is not dealt with, it will take over more and more spaces. And in the end it will put the victim at a dead end, when he cannot even decide to leave his apartment.

Causes of depression

There are a number of reasons that contribute to the appearance of depression. Typically, depression is the sum of social, psychological and biological aspects. Much less common are cases where only one cause contributes to the appearance of the disease.

Facts that often influence the appearance of depression: characteristics of a person’s life, conditions of early development, heredity.

The likelihood of depression becomes higher in the case of a difficult childhood, when the growing individual is exposed to mental or any other violence. This also applies to abandoned children. Also, the disease can be the result of too difficult or sad events, lack of sunlight in winter, or hormonal imbalances.

Common cause of depression: physical illness. For example, Parkinson's disease or thyroid dysfunction. Some patients notice symptoms of depression after taking medications, alcohol, or drugs.

Adoption

The last stage is acceptance. Here, depressive moods lose ground, giving way to peace. There is a reassessment of one’s own existence, new goals are outlined that revive the desire to live.

As a rule, people, having experienced the above stages of depression, become as if empty, exhausted, as a result of which they perceive their own death as liberation from suffering. Here comes humility with circumstances, forgiveness of grievances, analysis of existence, idealization of some life events and personal achievements, and rethinking of values. People are beginning to experience the joy of existence again.

The search for the guilty has been relegated to the margins, and experience has emerged in experiencing difficult everyday situations. By accepting the situation, a person begins to appreciate what he has anew.

The duration of the phase under consideration is individual.

The stages of depression, in particular acceptance, are characterized by the following behavior:

– requests to loved ones for forgiveness;

– awareness of the inevitability of existence;

– taking responsibility;

- talking about the consequences.

Types of depression

So, what are the types of depression?

Bipolar disorder

It is sometimes also called "Manic Depression". Expressed in mood swings. A serious form of depression. It can only be treated with medication and under the supervision of a psychiatrist. In many cases, it stays with the person forever. Symptoms: strange behavior, unhealthy focus on a topic.

Severe and moderate depression

The primary diagnosis is determined using a questionnaire. The scores obtained give an idea of ​​the severity of the disease. In severe cases, antidepressants are used.

Major Depression

Five or more of the following symptoms were present during the same 2-week period and represent a change from previous functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure:

• Depressed mood most of the day, almost every day, both self-reported and observed by others
• Decreased interest or enjoyment in all or most activities most of the day, almost every day
• Significant weight loss not related to diet, weight gain, or decreased or increased appetite almost every day.
• Insomnia or hypersomnia almost every day.
• Psychomotor agitation or inhibition almost every day.
• Fatigue or loss of energy almost every day.
• Feelings of worthlessness or excessive or inappropriate guilt almost every day.
• Decreased ability to think or concentrate almost every day.
• Recurrent thoughts of death, recurrent suicidal thoughts without a concrete plan.

In addition, these symptoms:

• Cause functional impairment (eg, social, occupational)
• They are not better explained by substance abuse, drug side effects, or other mental or physical illnesses.

The DSM-5 has 3 severity levels for major depression:

• Mild: minor if any symptoms are greater than the number needed to diagnose major depression with minor functional impairment
• Moderate: more than necessary symptoms to diagnose depression of greater intensity and moderate impairment of functioning
• Severe: many more symptoms than required to diagnose depression with intense functional impairment; Psychotic features such as hallucinations or paranoia may be present.

Persistent depressive disorder

This diagnosis includes and expands on the currently unused diagnosis of dysthymic disorder. The patient has major depressive disorder or 3 or 4 dysthymic symptoms, including depressed mood, for 2 years. The disorder may be less severe than major depressive disorder. Dysthymic symptoms are as follows:

• Depressive state
• Change in appetite
• Sleep change
• Low self-esteem
• Weakness
• Decreased concentration
• Hopelessness.

Dysthymia

Also known as chronic depression. Accompanied by a bad mood for two or more years. Over time, it becomes more difficult to recognize, but it is treatable.

Psychotic depression

Severe clinical depression accompanied by psychosis. May be characterized by lapses and confusion in consciousness, hallucinations.

Depression with anxiety disorder

An anxiety disorder often appears in parallel with a depressive state. It is difficult to separate them due to the similarity of symptoms.

Seasonal affective disorder

Appears mainly in the winter months. Symptoms are similar to regular depression, but begin during the cold season. The peak occurs during the period when sunlight is at its minimum. It goes away by spring.

Atypical depression

Contrary to the name, it is widespread. The symptoms are similar to ordinary depression, but alternate with bouts of joy.

In menopause

This type of disorder occurs in women undergoing menopause and is accompanied by fear of old age and loss of intimacy with older children.

Hormone replacement therapy helps with this disorder. Movement, yoga, and meditation are suitable as additional treatment. Good options can be viewed on the channel:

Postpartum depression

Appears after childbirth. About 15% of women who have recently given birth are affected by it. Its symptoms may appear in a mother-to-be who is still pregnant. Symptoms: tearfulness, mood swings, apathy.

Bargain

Stage of depression: comprehension comes at the third stage. The individual begins to feel that all hardships can be easily eliminated if one takes decisive and competent action. For example, if the turning point is caused by a break in the relationship, then the person makes active attempts to restore what was lost (arranges “unexpected” meetings, can blackmail with children, material support). Moreover, each such “test of the pen” brings even more shocks and disappointments.

At the stage of depression under consideration, a person, trying to transform the current circumstances in any way, uses all kinds of methods. So, for example, when diagnosed with an incurable illness, a person will finally decide to take care of himself: he will eat only healthy foods, do exercises, sincerely believing that such activities will contribute to healing.

The bargaining depression stage is characterized by the following typical manifestations:

– prayers to the Almighty, manic begging for a successful outcome;

- search for omens, signs of fate, frantic belief in omens, superstitions;

– visiting witches and psychics in the hope of getting help;

– a combination of mutually exclusive acts (going to fortune tellers, visiting churches);

– disappointment in classical methods of therapy, search for unconventional methods. At this stage, people often cannot soberly evaluate their own actions, and they are also not inclined to listen to the reasonable advice of loved ones.

Individuals tend to perform active, feverish actions, frantically trying to transform the situation. Later, when the affect has passed, people are amazed at themselves, but precisely at that time, the brain seems to be clouded.

Features of depression in older people

In old age, people are plagued by many diseases that bring discomfort to everyday life. They have difficulty hearing, often feel lonely and unwanted. Over the course of a lifetime, the nervous system has become exhausted and now the slightest irritant can lead to real depression.

The main difference between depression in an elderly person is the replay of a past life in the head. Pensioners recall the events of long ago, regretting, slipping into melancholy and despondency, turning into mental disorder.

Older people are constantly plagued by anxiety, although it is less common in depressed young people.

Differences between depression in men and women

Denial, anger, bargaining, depression and acceptance in psychology

The difference in the disease will answer the question of what it is - depression in representatives of different sexes. Girls are more susceptible to emotional disturbances; in men, depression affects their health. In many ways, these people experience the disease in the opposite way:

• For example, women are deeply sad, approaching an apathetic mood, men become overly hot-tempered and aggressive.
• Women often blame themselves for problems that arise; men tend to pass the blame on to everyone rather than admit the fact that they could have made a mistake.
• The girls are tense, they are excited, scared and helpless. Young men become suspicious, their distrust of others increases significantly.
• Surprisingly, depressed women avoid conflicts; men can provoke them.
• Representatives of the fairer sex become slow and nervous, men are also restless, but constantly on edge.
• Women tend to complain when men do not allow such weakness.

If you have been in a state of mental exhaustion for a long time, all these symptoms are not necessarily present or absent in a certain type of person. Some depressed men seek support because they have a nature of self-defense, when women become unbearable, toxic, but at the same time unhappy.

Anger

At this stage of depression, awareness of the problem occurs, which generates anger. After confirming the reality of the problem, the person begins to get angry, not understanding why this happened to him or to his loved ones.

The affect continues, but the patient begins to understand what is happening, which gives rise to a frenzied reaction in him. A surge of adrenaline awakens aggressive behavior, as well as the desire to find the culprits. People can choose God, fortune, doctors, fate, themselves as the culprit.

They are also angry and irritated by subjects in better circumstances. It seems to them that this has never happened to anyone before, no one realizes the full burden of the loss, and no one wants to provide all possible help.

Such anger often causes harm to the angry person himself, as well as to those around him. At the same time, they are unable to restrain the indignation rushing out inside. Therefore, it is necessary to try to correct these outpouring emotions, for example, with the help of work, sports, which contributes to the release of energy, thereby weakening anger.

The stages of depression, in particular anger, are found in the following manifestations:

- searching for those to blame for what happened;

– self-deprecation;

– grumbling about fate, fate, God, the environment that allowed a negative event to happen;

– abuse of alcohol-containing liquids or narcotic drugs;

– self-destruction and bitterness;

– causing harm to the environment (if the individual has an unstable psyche).

The most important thing in the process of overcoming the stage of anger-denial depression is not to cause irreparable damage to social relationships. In psychology, the above two stages are essential during the passage of a crisis.

Step-by-step diagnostic approach

Anamnesis

Patients may present with a history of depression, anxiety, irritability or apathetic mood, anhedonia, weight changes, changes in libido, sleep disturbances, psychomotor problems, loss of energy, excessive feelings of guilt, poor concentration, and suicidal ideation. Patients often have a personal or family history of depression. Some, but certainly not all, have experienced recent stress, trauma or loss, or have underlying health conditions.

In older patients, depression may present as decreased self-care, psychomotor retardation, irritability, and apathy. Also, as a result of depression, these patients may experience significant cognitive impairment (memory deficits).

Screening for depression

Commonly used screening tests include the Guide for the Assessment of Mental Disorders in General Practice (PRIME-MD) and the Patient Health Questionnaire-9 (PHQ-9) for adults in primary care and the Edinburgh Postnatal Depression Scale for postnatal depression. The US Preventive Services Task Force recommends that adult screening in primary care have systems to ensure that positive screening results are followed by an accurate diagnosis, effective treatment, and close follow-up.

Study

There are no defining signs of depression on physical examination, although most patients will have decreased emotional responses, as well as a dull gaze, furrowed eyebrows, psychomotor slowing, speech latency, and expressions of guilt or self-blame. Physical examination and cognitive screening may be useful in ruling out common conditions that are often confused with depression (eg, hypothyroidism, dementia) and in looking for common diseases (including obesity, cancer, stroke).

Diagnosis of depression

To ensure diagnostic accuracy, clinicians should apply DSM-5 criteria to all patients suspected of having depression or who have a positive screening test for depression. Determining whether an episode is mild, moderate, or severe, with or without psychosis, forms the basis for the choice of treatment.

• Criteria for major depression: According to DSM-5, five or more depressive symptoms, including depressed mood or anhedonia, for at least 2 weeks.

For patients with dementia who may not recognize or describe symptoms due to cognitive impairment, clinical assessment is important for case identification and can be supported by the use of various diagnostic tools. Specific structured diagnostic assessments for older adults are available and should be used instead of PRIME-MD or PHQ-9: for example, the Geriatric Depression Rating Scale, or for older adults with cognitive impairment, the Cornell Depression Rating Scale for Dementia. [Cornell Scale For Depression in Dementia] Clinicians can use the PHQ-9 to assess the current severity of depression and subsequent response to treatment.

Tests

Simple laboratory tests should be performed during diagnosis and treatment to rule out other causes of depressive symptoms. Initial tests include thyroid function testing, a metabolic panel, and a complete blood count. Serum vitamin B12 and folic acid levels, as well as 24-hour urinary cortisol, can also be informative (and, if elevated, indicate Cushing's disease).

A.S. Tiganov

In the classification of depression, common in Russian psychiatry, it is customary to distinguish simple and complex depression, but these classifications are built on the principle of the predominance of certain disorders in the picture of depression. While the structure of depression often contains various types of disorders included in classifications into various types of conditions. The study of the psychopathological picture made it possible to identify seven main syndromic types of depression: melancholic, anxious, anesthetic, adynamic, apathetic, dysphoric, senesto-hypochondriacal, as well as complex depression with the development of delusions, hallucinations, and catatonic disorders in their structure. The presented typology of simple depression does not exhaust the entire variety of depressive syndromes and is relative, which is due to the fact that, along with the classic pictures of monomorphic depression, there are conditions that are difficult to attribute to a specific type of depression due to the polymorphism of the main manifestations of the depressive syndrome. Complex depression, which includes senesto-hypochondriacal depression and depression with delusions, hallucinations and catatonic disorders, are distinguished by significant polymorphism and depth of positive disorders, variability, which is associated with the appearance in the clinical picture of the disease of elements that are outside the framework of obligate disorders. The study of prolonged depression has shown that they can have a monomorphic structure if the condition does not change its psychopathological picture for a long time and polymorphic with the development of various types of depressive states in the picture of depression. In contrast to prolonged depression, chronic depressive conditions are characterized not only by prolongation, but also have a number of psychopathological features characteristic of this type of condition, manifested by disharmony of the triad and dissociation between various affective complaints and a rather monotonous appearance and behavior of patients. Further research and analysis of each of the identified variants of the conditions under study may help create a continuous typological continuum of endogenous depressions from the simplest and mildest to the deepest and most complex.

The classification of depressions, acknowledged in Russian psychiatry, usually distinguishes them as simple and complex ones. However, these classifications are structured according to the principle of which forms of mental disturbances prevail in the picture of depressions. At the same time, the structure of depressions frequently contains diverse forms of disturbances, which at times are included in the classifications of different types of disorders. A study of the psychopathological pictures permitted to distinguish 2 groups of depressive states: simple and complex. In accordance with the features of affective disturbances, which was possible to observe, seven basic syndromal types of depressions could be distinguished: melancholic, anxious, anesthetic, adynamic, apathical, dysphoric, coenesto-hypochondriacal, as well as complex depressions with a development of delusions, hallucinations, catatonic disturbances in the structure of the syndrome. The proposed typology of simple depressions does not exhaust the entire variety of depressive syndromes and is only a relevant one. This may be explained by the fact, that along with classical pictures of monomorphic depressions, there are conditions, which are difficult to attribute to definite types of depressions, due to the polymorphism of the basic symptoms of the depressive syndrome. Complex depressions, to which coenesto-hypochondriacal depressions and depressions with delusions, hallucinations and catatonic disturbances are related they are characterized by significant polymorphism and a depth of positive disturbances, variability of the symptoms. This may be explained by an appearance in the clinical picture of elements, which are beyond the framework of obligatory disturbances. A study of protracted depressions has demonstrated that they may have a monomorphic structure, if the condition during a long period of time does not change its psychopathological and polymorphic picture. Chronic depressions unlike protracted depressions are characterized not only by a prolonged development, but by some psychopathological features, so inherent to these states. These features may be expressed by a dysharmonic triad and a dissociation between the diverse affective complaints and a monotonous appearance and behavior of the patients. A further study and an analysis of each of the singled out variants perhaps could facilitate a creation of a continuous typological continuum of endogenous depressions from the most simple and mild ones up to deep and complex depressions.

The problem of depression has occupied a significant place in the work of many foreign and domestic clinicians over the past decades. Such interest is caused by an increase in the proportion of weight of patients with affective pathology observed in psychiatric institutions and the appearance of a large number of hidden, erased, atypical forms, as well as modifications of “classical” depressive patterns, the emergence of previously undescribed depressions.

The increase in the number of affective, in particular, depressive states is associated with a number of factors: an increase in the number of affective disorders, the pathomorphism of mental illnesses, which are increasingly acquiring a paroxysmal course, which is usually accompanied by the development of affective disorders. A clearer diagnosis of affective disorders plays an important role in identifying depression.

Historically, from the time of E. Kraepelin until recent years (P. Kielholz), the most authoritative researchers followed the path of dividing depression into psychogenic, depression in manic-depressive psychosis and organic (E. Kraepelin (14) - psychogenic, endogenous and somatogenic (P. Kielholz (12)).

In modern psychiatry, the discussion in the field of taxonomy of depression comes down to the opposition of biologically determined - endogenous and psychosocially understood - reactive depressions.

Obviously, one cannot completely agree with the opinion of a number of researchers [6,7,19] about the autonomy and insensitivity to environmental factors of endogenous depression. The frequent provocation of exogenous moments of endogenous depressions and the pathoplastic influence of external factors at certain stages of the development of endogenous depressions are known.

The classical concept of endogenous depression assumes the autochthonous development of a triad of depressive states.

Currently, there are a large number of classifications built on different principles and having ambiguous theoretical and practical significance.

One of the most traditional is the classification of P. Kielholz [12], which is based on the nosological principle; they highlight organic, symptomatic, schizophrenic, cyclical, neurotic and reactive depressions, however, the author passes over in silence syndromological conditions that are characteristic and most typical for individual nosological forms.

Most modern classifications essentially repeat Kielholz's classification.

The recently widespread classification of depression in France by P. Pichot [17] divides the latter into primary, which includes endomorphic and exomorphic depression, and secondary, the occurrence of which is associated with somatogenic factors, alcoholism and schizophrenia.

In the classifications of depression common in our country, it is customary to distinguish between simple and complex depression, however, these depressions are one or another disorder, while the structure of depression often contains various types of disorders, which the authors of these classifications include in various types of conditions.

Difficulties in defining and classifying depression are associated with assessing the depth of depression, the degree of severity of its individual components, the presence of radicals of different types of depression and only the relative predominance of one of them in the condition of patients, as well as the uneven severity of various manifestations of depression.

Research material.

In order to create a syndromic classification of depression, 1220 patients were studied using the clinical-psychopathological method. Special cards were compiled that took into account gender, age, order of attack (primary or repeated), duration, diagnosis, patient complaints, clinical descriptive and detailed qualifying definition of the syndrome, and its dynamics. For more than half of the patients, follow-up information was also analyzed.

In the vast majority of cases (990 out of 1220 observations) we were talking about depressive disorders within the framework of endogenous diseases (schizophrenia, MDP). About 2/3 were women, 1/3 were men. The age of the patients studied ranged widely from 18 to 64, but the vast majority of them (about 80%) were young and middle-aged.

Systematics of depression.

The study of the psychopathological picture made it possible to distinguish two groups of depressive states: simple and complex (see Scheme 1). In accordance with the characteristics of affective disorders within the existing observations, seven main syndromic types of depression could be distinguished: melancholic, anxious, anesthetic, adynamic, apathetic, dysphoric, senesto-hypochondriacal, as well as depression with the development of delusions, hallucinations, and catatonic disorders in their structure.

As is known, in the clinical picture of depression, the indicator of the severity of the lesion is mainly the actual affective components of the syndrome.

Depressive disorders, the psychopathological picture of which was limited mainly to hypothymic disorders or disorders of the anergic pole, were generally distinguished by structural simplicity and insignificant polymorphism of psychopathic and neurosis-like manifestations, while senesto-hypochondriacal depression, as well as depression with delusions, hallucinations and catatonic disorders could be assessed how complex.

Thus, simple depressions can include melancholic, adynamic, anesthetic, dysphoric, anxious and apathetic.

Melancholic depression.

A study of melancholic depression (126 observations) showed the psychopathological heterogeneity of these conditions.

A variant of melancholic depression is manifested by states where, along with depression, vital melancholy with retrosternal or epigastric localization, daily mood swings, ideas of self-blame, self-reproach, complaints about the difficulty of concentrating, the impossibility of concentration, there were motor disturbances that sometimes took on the character of substuporous states, which corresponded to the classic melancholic syndrome in its entirety of expression, described within the framework of circular depression.

A feature of another variant of melancholic depression, at the height of the state indistinguishable from the one described above, was the absence in the initial stage of depression, melancholy, and decreased mental and physical activity characteristic of melancholic depression. There was a predominance of indifference, lack of interest, feelings of weakness, lethargy, and increased fatigue. Ideational inhibition was expressed in vagueness of thinking, difficulty concentrating thoughts, and less often - depressive monoideism; motor retardation was manifested by motor adynamia. A common symptom was reflection with reasoning, low self-esteem, and a dysphoric overtone. There were no depressive ideas of self-blame observed. Subsequently, depression and a subjective feeling of low mood increased. Melancholy, diurnal fluctuations, ideas of inferiority and self-blame, motor and ideational inhibition.

At the developed stage, the psychopathological picture of these variants corresponded to the picture of classical melancholia; with features manifested by both the lack of expression of the triad and the presence of “additional features”, such as an adynamic-dysphoric shade.

A study of melancholic depression has shown that their structure is largely related to the age of onset; If the classic variants are characteristic of middle age, then at a young age the initial periods of these types of depression have their own characteristics and are characterized by reflection, pronounced dysphoric disorders, apathetic manifestations with the subsequent development of states close to classic melancholic.

The study of this group of depressions also made it possible to identify shallow melancholy depressions with neurosis-like and psychopathic-like and apathetic disorders, as well as more complex depressive states, polymorphic in their psychopathological structure, where, along with varying degrees of severity of the components of the depressive triad, psychopathic-like ones were also observed; neurosis-like and senesto-hypochondriacal disorders.

Among anxious depressions (162 observations), both inhibited and agitated depressions were observed.

For inhibited depression

anxiety largely determines the picture, coloring other manifestations of depression. Daily fluctuations, usually regular, with the greatest severity of affective disorders in the first half of the day; in especially severe cases, there is no relief in the evening. In the depressive triad, motor inhibition is expressed, the pace of thinking does not change, and ideational inhibition is also manifested by the anxious and melancholy content of thinking. Anxiety is felt physically by patients, which allows us to talk about its vital nature. There are also feelings, ideas of self-blame and inferiority, suicidal thoughts, and physical signs of depression. With anxious-melancholic depression, the picture of the condition is dominated by motor excitation in the form of agitation, the patients’ speech is accelerated, nihilistic delirium occurs, and often Cotard’s syndrome occurs.

Anesthetic depression research

(146 observations) also revealed their heterogeneity: along with purely anesthetic depressions, anxiety-anesthetic and melancholy-anesthetic depressions are distinguished.

For anxiety-anesthetic

Depression is characterized by agitation, external manifestations of anxiety, ideation disorders in the form of influxes and confusion of thoughts, inverted nature of circadian rhythm fluctuations in the absence of ideomotor inhibition, suicidal thoughts, ideas of self-blame, feelings of low mood, as well as somatic manifestations of depression. In the evening hours, patients experience short-term increases in anxiety, which are often combined with neurotic symptoms. A feature of anxiety-anesthetic depression is the presence in their picture of a variety of depersonalization disorders that go beyond the scope of mental anesthesia (a feeling of automation of one’s own actions, the unreality of the perception of one’s own “I”, a feeling of duality), mental anesthesia, which appears within the framework of anxiety-anesthetic depression, poorly differentiated sensations of internal emptiness . Dissociation of the components of the triad is characteristic of anxiety-anesthetic depression of moderate severity: a combination of emotional inhibition with the absence of ideomotor inhibition or even with ideomotor excitation.

For dreary-anesthetic

depression is characterized by a feeling of melancholy with precordial localization, regular daily fluctuations, ideas of self-blame and self-deprecation, suicidal thoughts and intentions, somatic signs of depression, as well as adynamic disorders in the form of a feeling of physical, or, less commonly, so-called “moral” weakness. Anesthetic manifestations are represented by a feeling of loss of feelings, which is regarded by patients as evidence of their real emotional alteration, which is often the main plot of ideas of self-accusation.

With purely anesthetic

depressions, in which anesthetic disorders are the most significant manifestation when other symptoms of depression are erased, ideomotor inhibition is absent or slightly expressed, and there are no diurnal mood swings. Somatic signs of depression. A number of patients have depersonalization and adynamic disorders, a depressive worldview is formed, as well as interpretive hypochondriacal delusions. The plot of delirium consists of anesthetic disorders, interpreted by patients as manifestations of certain somatic diseases. Mental anesthesia manifests itself in the form of consciousness of the inferiority of various forms of emotional life.

Adynamic depression

— states in which weakness, lethargy, impotence, impossibility or difficulty in performing physical or mental work while maintaining impulses, desires, and desire for activity come to the fore (128 observations). In the so-called ideation variant, manifestations of adynamia prevail over pronounced depressive affect, mood is reduced, and ideas of inferiority occur, the plot of which consists of adynamic disorders. Somatic signs of depression include mild sleep and appetite disturbances. Adynamia is expressed in complaints about the lack of “moral strength,” “mental exhaustion,” “mental impotence,” and poor intelligence. In the triad, ideational inhibition dominates over motor inhibition.

The psychopathological picture of the second, so-called motor variant of adynamic depression, is dominated by a feeling of weakness, lethargy, muscle relaxation, and powerlessness.

The affective radical is represented by depression with a feeling of inner restlessness and tension. Somatic signs of depression are clearly expressed: sleep disorders, appetite disorders, weight loss. Ideas of inferiority are noted, the plot of which is determined by the characteristics of adynamia.

The third option, conventionally called combined, is represented by depression with symptoms of ideational and motor adynamia. Depression is of an alarming nature, there is a feeling of melancholy that is of an uncertain nature, and pronounced somatic disorders are noted. There are no clear daily fluctuations, and ideas of self-blame are uncharacteristic. Ideas of one's own inferiority are accompanied by a feeling of self-pity; adynamia is manifested by a lack of physical and moral strength, and the inability to do any work.

Apathetic depression (10 observations), in the picture of which the foreground is the impossibility or difficulty of performing mental or physical activity as a result of the lack of desire and desire for any type of activity, a decrease in the level of motivation and all types of mental activity. There is no noticeable decrease in mood; there are no melancholy, anxiety, ideas of self-blame, or somatic signs of depression.

Possible development of apathetic-melancholic

depression, accompanied by low mood with a feeling of melancholy, ideas of self-blame, and suicidal thoughts. Manifestations of apathy are assessed by patients as a flaw, as one of the most severe disorders. There is an inverse relationship between the intensity of apathy and the severity of the melancholy radical of depression; Some patients, along with melancholy, experience episodes of anxiety, while the nature and severity of apathy does not change. The disharmony of the depressive triad is manifested by the predominance of ideational inhibition over motor inhibition.

Apato-adynamic

depression is one of the types of apathetic depression. Melancholy is not typical in these cases. Ideas of self-blame and inferiority are noted, the plot of which consists of the actual manifestations of apathy; as the intensity of apathy decreases, the intensity of depressive ideas also decreases. Anxiety of the nature of vague “internal restlessness” and tension occurs extremely rarely.

The disharmony of the triad is manifested by a significant predominance of motor retardation over ideational retardation.

Somatic signs of depression are characterized by loss of weight, loss of appetite, and, less commonly, sleep disturbances.

Dysphoric depression is a condition characterized by its occurrence against a background of low mood, irritability, anger, and often aggression, accompanied by destructive tendencies (124 observations). Often, objects and phenomena that shortly before did not attract the patient’s attention and did not bother him become a source of irritation. If there are no reasons to show irritation, patients provoke a conflict situation. Irritability is accompanied by anger, swearing, insulting others; Quite often, patients develop a feeling of hatred, which is subsequently interpreted as the result of a constellation of factors (lack of family, frequent hospitalizations) that contribute to the emergence of a feeling of inferiority.

In a number of patients, at the time of development of dysphoria, a feeling of internal mental tension prevails with a constant expectation of an impending catastrophe.

Behavior during the period of dysphoric depression can be different: in some patients, aggression and threats towards others, destructive tendencies, and obscene language predominate; in others, the desire for solitude associated with hyperesthesia and “hatred of the whole world” predominates; in others, the desire for vigorous activity , which is untargeted and often absurd in nature.

Pictures of dysphoric depression rarely define the condition as a whole; most often they develop in the structure of melancholic and adynamic depression.

Neurosis-like manifestations, often found in the picture of depression of the six types described, are in the nature of obsessive fears and doubts about the correctness and completeness of one’s actions, hypochondriacal fears and, as a rule, reveal an external connection with the real situation. Complaints of fatigue and irritability are common; patients exhibit increased sensitivity to noise, bright light, and loud conversations of others.

It is easy to see that the presented typology of relatively simple depressions not only does not exhaust the entire variety of depressive syndromes, but is also largely relative; This is primarily due to the fact that, along with the classic pictures of monomorphic depression, there are conditions that are often difficult to attribute to a specific type of depression due to their significant variability and polymorphism of the main manifestations of the affective syndrome.

Complex depressions, which include senesto-hypochondriacal depression, as well as depression with delusions, hallucinations and catatonic disorders (240 observations), are distinguished by significant polymorphism and depth of positive disorders, variability and polymorphism and depth of positive disorders, variability of psychopathological manifestations, which is associated with the appearance in clinical picture of elements outside the framework of obligate disorders.

In the clinical picture of hypochondriacal depression, affective disorders themselves recede into the background and hypochondriacal manifestations become leading: complaints of unpleasant, painful sensations in various parts of the body, sometimes of extremely pretentious, bizarre content, a feeling of somatic distress, anxious concerns about one’s health, fear near death. Patients seek confirmation of their thoughts from internists and self-medicate. As the disease progresses, hypochondriacal fears and obsessive thoughts acquire an overvalued and delusional character and completely take over consciousness (hypochondriacal-nihilistic version of Cotard's syndrome).

In depression, in the clinical picture of which there are hallucinatory, delusional and catatonic disorders, along with depression, melancholy, increasing anxiety, fear, there are “voices” of a threatening or imperative nature, the belief in the influence of various devices or hypnosis, in persecution with from colleagues, colleagues and even close relatives; sick, confused, helpless, afraid of being poisoned, spoiled, bewitched. At the same time, some patients express ideas of guilt, damage, ruin, impending punishment, and expect the death of themselves or those close to them.

In a number of cases, for a relatively short period of time, acute sensory delirium occurs with false recognitions, staging, delusions of metamorphosis, and episodes of oneiric disorder of consciousness.

In a significant number of observations, depressive disorders take on the character of melancholic paraphrenia with varying degrees of fantastic delusional experiences from “mundane” interpretations to mystical constructions.

In the structure of depressive-delusional states, a high proportion is occupied by catatonic disorders, ranging from mild manifestations (paramime, negativism) to severe stupor.

As is known, the ratio of affective disorders proper and disorders that go beyond the obligate symptoms of depression are interpreted ambiguously: if some authors consider disorders of the non-affective range as independent of affective disorders [13, 19], then others [17] qualify more severe psychopathological formations as primary in relation to affective disorders.

Dynamics and typology of protracted and chronic depression.

Along with the described simple and complex depressions, which exhaust the structure of an attack of the disease, protracted depression was also studied (95 observations with a disease duration of 2 to 25 years, age from 20 to 75 years, mostly women).

In recent years, more and more publications on protracted and chronic depression have appeared in the literature, which radically changes the idea of ​​depression as a purely phase disease with a favorable outcome (8, 16, 19).

Attempts to find out the cause of the protracted course of depression have led some researchers to the conclusion that the prolonged nature of the disease is often a consequence of drug pathomorphosis (11), however, the description of prolonged psychoses in general and affective states in particular in the past does not allow us to take this position unambiguously.

The study of prolonged depression has shown that they can have both a monomorphic and polymorphic structure with the development of various types of depressive states (3, 4).

In only one fifth of the cases, a relatively uniform picture of the condition was observed, despite the long-term course of the disease: in the majority, the disease was characterized by extreme variability and a change in various types of depressive disorders throughout the course of the disease.

The clinical picture of monomorphic depression (adynamic, anesthetic, dysphoric, senesto-hypochondriacal or anxiety) is characterized by relative simplicity, low variability, insignificant dynamics of individual manifestations, and uniformity of the picture throughout the entire course of the disease. For a relatively short period, within the existing disorders, rudimentary disorders characteristic of another type of depression arose.

A variable polymorphic clinical picture of prolonged depression was observed both in patients with relatively shallow psychopathological disorders and in patients with a picture of the disease defined by deep psychopathological disorders.

In case of relatively shallow psychopathological disorders in the structure of protracted, variable depression, inhibited, adynamic, anesthetic and senesto-hypochondriacal, anxiety states were observed, replacing each other without a certain sequence.

Depressive states were distinguished by pronounced atypia, erasure of actual affective disorders, and the predominance of motor disorders such as adynamia.

In the dynamics, there were short-term mixed states, fluctuations in the intensity of the main manifestations of depression: a simplification of the structure of depression due to the reduction of dysthymic disorders was often noted.

The chronification of depression that occurred 2.5-3 years later was accompanied by an increase in monotony and monotony of psychopathological disorders at the level of adynamic, anesthetic, and hypochondriacal disorders.

In patients with a variable clinical picture and deep psychopathological disorders during the attack, the state changed from simple hypothymia to complex conditions with delusions, hallucinations, and catatonia. After 3-3.5 years, the picture of the disease became stereotypical, and the features of monotony and uniformity increased.

The problem of chronic depression remains relevant today: according to L. Ciompi, GR Lai (1969) (10), chronic depression, accompanied by a high level of social maladjustment and resistance to therapy, accounts for about 30% of the total number of depressions.

Although a significant number of studies have been devoted to the study of chronic depression (1, 2, 9, 15), there is no consensus on the psychopathological criteria for the structure of these conditions.

A study of chronic depression (85 observations with a duration of affective disorders from 2 to 17 years) indicates the existence of a number of common psychopathological properties that unite these conditions.

These include the disharmony of the depressive triad, characterized by a combination of low mood and motor inhibition with monotonous verbosity with difficulty concentrating; hypomanic “windows”; dissociation between the intensity and variety of complaints of an affective nature and the outwardly calm, monotonous appearance and behavior of patients; hypochondriacal coloration of ideas of self-accusation. Obsessive nature of suicidal thoughts with awareness of their alienness; the presence of symptoms of the neurotic register - senestopathic, obsessive-phobic, as well as vegetative-phobic paroxysmal states.

Typologically, chronic depression is divided into melancholic, depersonalization and hypochondriacal.

It must be emphasized that chronic depression in most cases develops in the picture of bipolar affective psychoses.

In conclusion, it should be emphasized once again that although the presented typology of “major” endogenous depression is largely static, it reflects the psychopathological fact of the predominance of certain disorders in the picture of depression and makes certain amendments to the existing classifications of depression.

Further research and analysis of each of the identified types of affective disorders will help create a typological continuum of endogenous depressions from the simplest and mildest to the most complex and deep.

Bibliography.

1. Vovin R.Ya., Aksenova I.O. Prolonged depression. L 1982.
2. Nuller Yu.L., Mikhalenko I.N. Affective psychoses. L. 1988.
3. Pchelina A.L. J. Neuropathol and Psychiatrist 1979; 12:1708-1712.
4. Tiganov A.S., Pchelina A.L. Prolonged endogenous depression. Materials of the IV Soviet-Finnish Symposium on Depression Problems. M 1983; 19-20.
5. Shamanina V.M., Romel T.E., Kontsevoy V.A. and others. In the book: Depression, clinical issues, psychopathology and therapy. Moscow-Basel 1970.
6. Akiskal H. Am J Psychiat 1983; 140:11-20.
7. Angst J., Perris C. Arch Psychiat Nervenarzt 1968; 210:373-386.
8. Bochik HJ, Broszio D. et al. In: Panze F. Problematik Therapie und Rehabilitation der chronischen endogenen Psychosen. Stuttgart 1967; 263-276.
9. Cameron PM Psychiat J Univ. Ottawa 1989; 14; 2:397-402.
10. Ciompi L., Lei G.P. Ed. H. Huber Berne et Stuttg., 1969; 119.
11. Helmchen H. Pharmacopsychiat Neuro-Psychofarmakol 1974; 7; 3:125-155.
12. Kielholz P. Depressive Zustande, Erlennung Bewertung, Behandlung. Berlin, Stuttgart, Wien 1972.
13. Klein D., Taylor E., Dickstein S. J Affect Dis 1988; 14:25-33.
14. Kraepelin E. Psychiatrie. Leipzig 1909-1915; 7:1-4.
15. Kruger E. Nitzsche M., Kuhl J. et al. Psychiat Neurol Med Psychiat 1988; 54:341-355.
16. Petrilowitsch N. Fortsch neur Psychiat 1964; 32:561-579.
17. Pichot P. A Century of Psychiatry. Paris 1983.
18. Seivewright N., Tyrer P. In: Burton R., Akiskal H. Dysthimic Disorder. London 1990; 24-36.
19. Weitbrecht H. Wien Z Nervenheilk 1967; 24; 4:265-281.

Scheme 1. Nosological classification of depressive conditions according
to P. Kielholz
Scheme 2. Taxonomy of depression .

1

2

How to get rid of depression

Remedies for the disease depend on the stage of depression. At first, herbal infusions will help: chamomile, lemon balm and mint, St. John's wort and valerian, fresh air and rest. In case of prolonged depressive states, you need to seek the help of specialists. The doctor will prescribe medication and also consider methods such as light therapy or magnetic stimulation. Remember, these types of treatments are only allowed under the supervision of a doctor.

Medication

In most cases, the patient is prescribed antidepressants, less often mood stabilizers, tranquilizers or anxiolytics. Antidepressants are divided into two groups, differing in chemical formula and expected effect:

1. First-generation antidepressants are a powerful remedy that is used only in severe cases, since side effects affect the cardiovascular system and gastrointestinal tract. Currently, this type is used only as a last resort.
2. Second generation antidepressants are used for mild to moderate cases because they are less effective. But the low effectiveness hides the almost complete absence of side effects.

Vitamins

Treatment of depression and stress will be much more effective when taking vitamins that promote the production of hormones in the body that normalize the emotional background. In addition, they give energy. With the help of vitamins, the work of brain cells is activated, the functioning of the nervous system is regulated, irritability and stress are relieved. With vitamin deficiency, a person is more prone to drowsiness and has difficulty concentrating on certain tasks and everyday activities. Also, a lack of vitamins provokes iron deficiency anemia.

With the help of psychotherapy

Psychotherapy techniques can be used either separately or in conjunction with medications. An individual program is selected for each patient depending on the severity of depression. Psychotherapy helps prevent relapses and restore mental health.

Classical psychotherapy

Psychotherapists, who are called upon to work through the root causes of the disease, identify injuries, and then influence the patient with cognitive behavioral therapy, will help fight the signs of the disease.

Hypnosis for depression and anxiety

If severe or hidden depression has been diagnosed, methods of influencing the subconscious are turned to in order to awaken positive basic beliefs about the importance of a person in the world, increase self-esteem, teach decision-making, and allow mistakes to be made.

Light therapy

Sometimes, medical conditions are not necessary for light therapy treatment. Light can also be used at a household level to treat seasonal affective disorder. We are talking about seasonal depression, which some also call winter blues.

People with a completely normal state of mind can suffer from this type of depression. Reason: lack of sunlight. This causes some people to become depressed from October to April. Symptoms: reluctance to go out or communicate with loved ones, apathy, slowness. In the Scandinavian countries, light therapy has become quite widespread due to the fact that in the autumn-winter period, daylight hours often last less than five hours. This method of struggle has a pronounced antidepressant effect.

Transcranial magnetic stimulation (TMS)

The patient who attended the session is wearing a device similar to a bathing cap. A coil is brought to it, through which a current flows, creating a powerful magnetic field around it. Many people know from physics lessons that if there is any conducting medium in a magnetic field, then an electric current is induced there. In this situation, such a conducting medium can be called the brain. This organ consists of many neurons interacting with each other using electrical impulses. During the period of depression, disturbances occur in electrical interaction processes, and thanks to TMS these processes can be normalized.

Social therapy

The patient who is unlucky enough to contract such an illness is provided with social therapy. The point is to involve third parties in treatment who would not just control the patient’s behavior, but motivate the patient to recover.

Electroconvulsive therapy

When the disease becomes irreversible, electric shock is used. Its task is to reboot the brain. It has proven to be an effective treatment for a number of mental illnesses.

People often wonder what depression is. Depressive syndrome can be a reflection of some physical illness or a response to a side effect of medications. In addition, it is acceptable in the form of a reaction to a fatal life event; as an example, it is customary to cite the death of a loved one, which in itself is unsettling. The disease consists of several stages, but all of them can be treated in a variety of ways.

Treatment with folk remedies

Various herbal decoctions have a positive effect on the nervous system, helping in the fight against stress and depression. A simple decoction of chamomile or mint may help improve your condition. If you think such recipes are ineffective, then act comprehensively.

Ideal option: change of scenery. If funds allow, go to an unfamiliar country or city for a few days. It is desirable that this be a picturesque and colorful place.

If you don’t have this opportunity, then treat yourself to walks in the fresh air more often, even if you have no desire to go outside at all. Watch positive films, read interesting literature - take your mind off depressing thoughts in every possible way.

Principles of treatment

Therapy is carried out only by a specialist. Medications include antidepressants, tranquilizers, and antipsychotics, if necessary. Treatment is most often outpatient. It must be borne in mind that when a patient undergoes therapy, motor activity is the first to be restored. Slow thinking and depressed mood still persist, and it is during this period that the patient may commit suicide.

Psychotherapy is gaining great importance. For mild depression, aromatherapy, sunbathing, relaxation, and walking can help. For some people, depression can develop depending on the season. This often happens in autumn and winter, when daylight hours are reduced. Then they talk about autumn blues, winter melancholy, etc. In this case, light therapy or phototherapy helps a lot.

Sleep deprivation has a positive effect. In this case, the body restarts the rhythm of sleep and wakefulness and other biological “counters.” This allows you to restore normal sleep and increase the production of serotonin and endorphins. And, of course, any patient needs social therapy: praise, approval, attention and support.

Forecasts, prospects for life and healing

The forecasts are generally favorable. Much depends on the stage of the disorder, the personality and psychotype of the sufferer. Recovery from the condition is observed in 60% of patients in the first 3 months, in 90% after 6 months or a year. This is a good result. In the absence of positive dynamics, it makes sense to carry out treatment in a comprehensive way, using techniques aimed at combating resistant forms of the disorder.

How long does depression last without treatment?

For an indefinitely long time. The issue of therapy is key when assessing the prospects for recovery and prognosis. It makes sense to start therapy as quickly as possible.

Without proper help, the consequences of depression are severe. This is, at a minimum, constant chronic fatigue, autism, withdrawal from social interactions, the most severe complication is a suicide attempt. Possibly successful.

Is it possible to avoid depression?

Prevention does not provide a 100% guarantee that depression will not occur in the future. Possible prevention methods include:

1. Taking vitamins. Hypo- and avitaminosis increase the risks of the pathological process.
2. Avoiding stressful situations. As much as possible.
3. Mastering relaxation techniques. Relaxation. Standard methods of counting, distraction, and working through conflict situations are used. There are many options, it is better to consult a psychotherapist.
4. Creating a favorable emotional climate at home. It makes sense, if necessary, to also reconsider the nature of professional activity. The issue is decided at the discretion of the patient.
5. Proper nutrition. With enough vitamins. Especially in spring and autumn. Support with nutritional supplements and vitamin-based medications is required. But in moderation, so as not to provoke excessive vitaminization.

Stage 3

The most dangerous, “corrosive” stage of the disorder. The body retains vital functions while remaining autonomous. Pathological processes are launched in the human mental sphere. Along with dominant indifference and noticeable detachment from the world, a person is driven by aggression, the patient completely loses the ability to manage and control his behavior. In the third stage of depression, an individual is capable of causing harm and physical injury not only to himself, but also to others. A person ceases to identify himself with a person and completely loses the meaning in life. At this stage, suicidal thoughts predominate. Memory loss, manic-depressive psychosis, schizophrenia are a small part of what happens to a person at the third stage.

Patients in this condition cannot do without the serious participation of a psychiatrist, taking antidepressants and other medications. Almost all people with stage three depression are registered in psychiatric hospitals and prescribed an intensive course of therapy. Moreover, it takes a considerable period of time to bring the patient out of this state and return to normal life.

Depression.info - content below

Prevention

To protect yourself from depression, you need to follow simple rules. Do not disturb your sleep and rest patterns, play sports. Be sure to follow a balanced diet, because depression is often caused by a lack of B vitamins. Remember, a good mood is the key to psychological health. Train your body to produce the necessary hormones: dopamine, seratonin, endorphin. To do this, eat bananas, chocolate and red fish, spend more time in the sun and with your loved ones.

Sleep disorders in depression

Sleep disturbance is one of the earliest symptoms of depression, and also one of the most common. According to epidemiological studies, various sleep disorders are observed in 50–75 percent of patients with depression. Moreover, these can be not only quantitative changes, but also qualitative ones.

Manifestations of sleep disturbances in depression are:

• difficulty falling asleep;
• interrupted sleep and frequent awakenings;
• early morning awakenings;
• decreased sleep duration;
• superficial sleep;
• nightmares;
• complaints of restless sleep;
• lack of a feeling of rest after waking up (with normal sleep duration).