Menopause, mood swings and depression: how to stay in control

Medical information is reliable Checked by Shaidullin Renat Flyurovich

Depression is a disease of our time, as the disorder is called at the everyday level. Every day the number of recorded cases is growing; according to statistics, about 20% of the population of countries with a good standard of living suffers from it. The disease is serious; when the first signs appear, you should contact a specialist. Treatment of depression will help you return to normal life, get rid of apathy and bad mood, and increase your ability to work.

The difficulty of therapy is that patients are very little aware of the causes of the disorder and its consequences. Prolonged mental and physical illness is often mistaken for bad character, whims, and constant dissatisfaction, so they do not pay attention to it. The condition does not go away on its own; you need the help of a specialist. At Dr. Isaev’s Clinic, the patient is not only prescribed a therapeutic course, but also relapse prevention is carried out, information is provided about the preconditions for the disorder and ways to avoid them.

Signs of Depression

Under certain circumstances, this condition can occur in every person, regardless of gender, age and social status. Depression is a type of mental illness accompanied by a persistent decrease in mood. A person remains in this state for more than two weeks continuously; he experiences a decrease in memory and concentration, loss of interest in life, and retardation of movements. In the absence of timely treatment, the patient loses the ability to live and work fully for many months and even years, and the possibility of attempting to commit suicide cannot be ruled out.

Depression causes

According to statistics, about 90% of diagnoses are made to people who are in a state of chronic stress or experiencing acute psychological trauma. The body cannot cope with this influence of external factors on its own, the psyche fails, depressive episodes are a kind of defensive reaction.

Conditions arising due to severe psychological trauma are considered reactive. They can be triggered by the following events in the patient’s life:

• disability due to health and absence of serious illnesses;
• detection of a malignant tumor;
• conflicts at work, constant tension in relationships with colleagues;
• serious illness of a close relative;
• death of a loved one;
• divorce from your beloved spouse;
• retirement;
• rapid decline in financial levels;
• moving to another city and other factors that can be a real shock for a person.

Depression is not always formed on the basis of negative events. Sometimes the disease occurs when an important life goal is achieved, when a person experiences great success. The patient gets what he wanted. He suddenly loses the meaning of life, he no longer needs to make every effort for a specific result. The situation is aggravated if there are no other life goals at this moment.

A separate category includes depressive neurosis, which develops against a background of constant stress. In this case, it is not always possible to establish the specific cause that became the trigger for the pathology. The patient describes his life as a chain of constantly recurring failures that haunt him every day.

A depressive state of the psychogenic type is more typical for women, while older people suffer from the disease more often than young people. In our society, there are two extreme poles of financial well-being - poverty and wealth. This social scale causes a person to feel dissatisfied with himself if he constantly approaches the first category.

Additional provoking factors will be:

• pessimistic outlook on life;
• low self-esteem, constant self-flagellation;
• loss of parents, loved ones, friends;
• emotional violence against a person;
• physical aggression that the child experienced at an early age;
• predisposition to drug addiction and alcoholism;
• lack of support from others, their indifference towards the person.

Each of these factors in itself is not dangerous; if desired, a person can easily ignore it or seek help from a psychotherapist. If there are several of them, the situation becomes more complicated, the experiences become more intense and acute. In this case, drug treatment may be required.

For example, in a teenager, the period of growing up is associated with intensive growth of all organs and systems; pregnancy and menopause in women are accompanied by hormonal storms. This is fertile ground for the development of a melancholic mood and ever-increasing dissatisfaction with oneself. During these periods, experiences take on a negative connotation; the world around often seems hostile and indifferent.

Organic brain lesions, as well as physical diseases, are classified into a separate category. Cerebrovascular accidents, strokes and heart attacks, traumatic brain injuries, coronary heart disease, and stomach ulcers are also among the sources of depression listed by experts. Against the backdrop of the development of such diseases, depression manifests itself clearly and clearly.

Russian Academy of Medical Sciences RESEARCH CENTER FOR MENTAL HEALTH DEPRESSION (from hope to confidence). (INFORMATION FOR PATIENTS AND THEIR FAMILIES)

MOSCOW 2008

Oleychik I.V. — Candidate of Medical Sciences, Leading Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States © 2008, Oleychik I.V. © 2008, NCPZ RAMS The vast experience accumulated by humanity and reflected in many literary works convincingly shows that sadness (sadness, blues) has always walked side by side with people, being one of the natural human emotions. None of us are immune from failure, illness, breakup, loss of loved ones, or financial collapse. Every person can face something inevitable and inevitable, when it seems that life loses its meaning and despair becomes limitless. However, normally, sadness, melancholy and melancholy, as natural reactions to events traumatic to the psyche, weaken over time and the person’s condition normalizes without special treatment. The situation is different with depression, which is a mental disorder that differs from natural physiological reactions in its greater intensity, special severity of experiences and persistence of manifestations. True depression rarely goes away on its own, requiring persistent, sometimes long-term treatment. Depressive state (from the Latin word depressio - suppression, oppression) is a disease that concerns not only the individual specific sick person, but is also a significant burden of modern society, since it is spreading more and more widely in the world, causing enormous damage to the health of the population and the state. economy. Moreover, this applies to all countries, regardless of their level of social development. Every year, at least 200 million people worldwide suffer from depression. It is possible that these rates are even higher because most victims of depression do not seek help because they do not realize the severity of their condition. Scientists have calculated that almost every fifth person who has reached adulthood experiences at least one episode of depression during their lifetime. In the most general sense, a depressive state is one of the possible forms of a person’s response to the influence of stress factors. In some cases, depression can be triggered by external negative influences, for example, mental trauma, excessive educational or work overload, infection or other serious somatic illness, traumatic brain injury, changes in hormonal levels, which is especially important for the female body, regular taking certain medications, such as hormones, blood pressure lowering drugs, or abusing alcohol or other drugs. In other cases, depressive states develop as a manifestation of mental illnesses in which the main influence is heredity or characteristics of the nervous system (cyclothymia, dysthymia, manic-depressive psychosis, schizophrenia, etc.). If, based on the description of depressive symptoms contained later in our brochure, you realize that you have indeed developed a depressive state, do not fall into despair, do not “try to pull yourself together”, remember that depression is not a manifestation of weakness of will or character, on the contrary, weakening of volitional qualities is one of the main symptoms of depression. Depression is the same disease as rheumatism, arthritis or hypertension; it responds well to treatment, resulting in complete recovery almost always. You should not blame yourself for the occurrence of depression; it does not indicate either your guilt, or your weakness, or the possible development of a more severe mental pathology. Below we will tell you about the symptoms of depression, which can be extremely varied.

Manifestations of depression

Manifestations of depression can be very different. Depressive states can manifest themselves as disturbances in almost all aspects of mental life: mood, memory, will, activity, which is expressed in the appearance of sadness, sadness, mental and muscular retardation, lasting at least 2 weeks. A depressed mood during depression can manifest itself as mild sadness, melancholy, or boundless despair. It is often accompanied by a feeling of melancholy, unbearable heaviness in the soul, with excruciating pain in the chest, a feeling of hopelessness, deep depression, hopelessness, helplessness, despair and uncertainty. At the same time, the patient is completely immersed in his gloomy experiences, and external events, even the most joyful ones, do not affect him, do not affect his mood, and sometimes even worsen the latter. A constant “companion” of a depressive mood is also anxiety of varying severity: from mild anxiety or tension to frantic excitement and violence. Anxiety and bad mood arise at the mere thought of having to make a decision or change your plans due to suddenly changed circumstances. Anxiety can also manifest itself at the physical (bodily) level in the form of belching, intestinal spasms, loose stools, frequent urination, shortness of breath, palpitations, headaches, increased sweating, etc. The picture of depression is complemented by the disappearance of desires, interests, pessimistic high assessment of everything around him, ideas of his own low value and self-blame. A deficiency of vital impulses manifests itself in patients with a variety of symptoms - from lethargy, physical weakness to a state of weakness, loss of energy and complete impotence. Where an important decision is required, a choice between various options, human activity is greatly hampered. Those suffering from depression are well aware of this: they complain that insignificant everyday tasks, small issues that were previously resolved almost automatically, take on the meaning of complex, painful, insoluble problems. At the same time, a person feels that he has begun to think, act and speak slowly, notes suppression of drives (including food and sexual instincts), suppression or loss of the instinct of self-preservation and the absence of the ability to enjoy life, up to complete indifference to what he previously liked , evoked positive emotions. People suffering from depression often feel “stupid,” “mentally retarded,” or “weak-minded.” Thinking during depression becomes viscous, painful, requires special efforts, one mental image is hardly replaced by the next. The sick person is oppressed by a feeling of his own intellectual inadequacy and professional collapse. Depressed patients have difficulty describing their painful experiences to the doctor. Only after recovering from depression, many of them say that their mood at that moment was low, their thinking was slow, all their undertakings (including treatment) seemed in vain, and the years they had lived were empty and useless. However, at the time of the first visit to the doctor, they could not explain this due to the almost complete absence of thoughts in their heads, “paralysis of thinking.” With depression, there are also often complaints of memory loss, which is why those suffering from it assume that they have “Alzheimer’s disease,” “schizophrenia,” or “senile dementia,” which is not true. These complaints are especially common in depression that develops in adolescence. A typical story Alexey, 18 years old, a 1st year student at a technical university, describes his condition during depression: “Since childhood, I was interested in technology and modeling, could read specialized literature for hours, won school and regional olympiads in mathematics and physics. After finishing school, my dream came true - I passed the exams to a prestigious university with flying colors. Then it seemed to me that the whole world was at my feet, I was flying with happiness “as if on wings.” In September I happily started studying. At the beginning, everything worked out well, but after 2 months I began to notice that it was becoming more and more difficult for me to assimilate what I read, I could not remember the simplest text, and could not solve problems that I had previously “clicked like nuts.” Trying to achieve success by brainstorming for hours or drinking several cups of coffee led to the fact that I completely stopped thinking about anything. It seemed to me that I had “completely and irreversibly become stupefied.” At night I cried, wrapped in a blanket and thought about how best to commit suicide. Fortunately, I met a senior student in the library and shared my problems with him. My new friend said that he had experienced something similar and advised me to contact a psychiatrist at the student clinic. After an examination, I was diagnosed with “adolescent depression” and was sent for treatment to a specialized medical center. After 2 months, I felt completely healthy, returned to my studies and caught up with my classmates.” Depression can also be accompanied by real failures: for example, a decrease in academic performance, quality of work, family conflicts, sexual dysfunction and their consequences for personal relationships. As a rule, the significance of these failures is exaggerated and as a result, a false sense of the irreparability of what happened, the “collapse of all hopes” arises. Another generally recognized danger of depression is the possibility of suicidal thoughts, which often lead to suicide attempts. The condition of a person suffering from depression can suddenly deteriorate sharply, which occurs either without clear external reasons, or under the influence of traumatic situations or unpleasant news. It is in these hours, and sometimes even minutes, that a fatal decision is made. Factors that increase the risk of suicide in depression are past suicide attempts, the severity and duration of the depressive state, the presence of anxiety in its structure, prolonged insomnia, loneliness or alienation in the family, alcohol and drug abuse, job loss and sudden changes in lifestyle, as well as suicides among relatives. Typical story Evgeniy E., 35 years old, leading manager of the company. Almost all my life my career was on an upward trajectory; my goals were clear, clear and achievable. The marriage was extremely harmonious, two beloved children grew up. He devoted almost all his time to the affairs of the company, occasionally, once every 1-2 months, he escaped with his family out of town, to the dacha. He often didn’t get enough sleep, stayed late at work, took assignments home, and was deeply worried about the company’s affairs. Gradually, irritability, fatigue, insomnia, difficulty concentrating appeared, and more and more often he suffered a “fiasco” in his intimate life. Thoughts arose that life had been lived in vain, that it was a “chain of tragic mistakes” that led to a dead end. I began to believe that the choice of work, friends, family was wrong, for which now “there is a reckoning.” Analyzing the past years for a long time, I found more and more evidence and examples of my “duplicity, hypocrisy, insincerity, etc.” I realized that the only way to solve all problems is to voluntarily die. At the same time, he believed that by this act he would free his family from the “burden”, “loser”, “loser”. I decided to lock myself in the garage and poison myself with car exhaust fumes. However, by chance, in a semi-conscious state, he was discovered by an employee of a garage cooperative. He explained what happened as an “accident.” The thought of dying did not leave the patient. I decided to shoot myself with a gas pistol, which I had long ago acquired for self-defense. After being shot in the mouth, he was taken to the Research Institute named after him in serious condition. Sklifasovsky, from where he was discharged a week later. The alarmed wife, suspecting something was wrong, decided to consult her husband with a psychiatrist. He was admitted to the clinic. He agreed to this only out of respect for family relationships; he himself believed that treatment by psychiatrists was completely useless, because... his situation is hopeless and no medicine will help here, but will only “stupefy” his psyche. However, after two weeks of taking a modern antidepressant, the patient’s point of view changed. Everything began to look not so bleak and unpromising, interest in work and in life in general returned, I began to feel more cheerful, more energetic, and an interest in intimate life appeared. I took work to the clinic and called up my colleagues. After two months of treatment, he completely returned to his normal life. I recalled with bewilderment my thoughts about failure, the collapse of life, and suicide. I took the drug prophylactically for about six months, then, on the doctor’s recommendation, I gradually reduced the dose and stopped taking it. Over the next two years, her condition remained stable, career growth continued, and another child was born. Depression is also characterized by sleep disturbances, which occur in approximately 80% of patients. As a rule, these are early awakenings with the inability to fall asleep, lack of feeling of sleep, difficulty falling asleep. These disorders, as well as restless sleep with unpleasant dreams, are often the very first symptoms of incipient depression. If the depression is not deep, it is sometimes difficult to recognize it. This is due to the fact that people are ashamed to tell others about their problems and admit their “weaknesses.” Quite often, especially in Russia, depressive states are masked by alcohol abuse (“vodka cures”). In addition, often patients suffering from depression, in order to “shake themselves up”, “throw themselves into all kinds of troubles”, engage in casual sex, get involved in gambling or extreme sports, go to serve under contract in “hot spots”, lead an idle lifestyle with constant attendance at entertainment events. People around them, relatives who do not have psychiatric knowledge, often accuse them of debauchery, drunkenness, riotous lifestyle, and parasitism. Meanwhile, this behavior is a kind of “cry for help,” an attempt to fill the spiritual emptiness brought by depression with new acquaintances and impressions. Depressive states can occur in mild forms that are easily treatable, but at least a third of depressions are more severe. Such depressions are characterized by: - ​​ideas of guilt, sometimes reaching the level of delirium, i.e. unshakable conviction in their sinfulness, low value (patients consider themselves great sinners, believe that because of them all relatives and Humanity will die, that they are “moral monsters” from birth, allegedly deprived of the foundations of morality and a sense of empathy for other people that they have no place on earth. They find in their past numerous “confirmations" of the above, they believe that the doctor and other patients are aware of these sins and express contempt and indignation with their facial expressions and gestures, but in words, “they are hiding, denying the obvious.” This must be remembered both by the patients themselves and their loved ones in order to prevent the impending threat in time: remove all firearms, piercing and cutting objects, ropes, strong medicines and poisonous substances. household liquids, close windows or shutters, do not let the patient go anywhere alone.If these ideas become persistent and cannot be dissuaded, you must urgently seek advice from a psychoneurological institution or call a psychiatrist at home. - mood swings during the day: in typical cases, the patient, upon waking up, immediately feels melancholy. Sometimes, even before he fully awakens, through his sleep he experiences a painful premonition of the difficult coming morning. In the evening, my health improves somewhat. - the patient may experience a feeling of unmotivated hostility towards loved ones, friends, constant internal dissatisfaction and irritation, which makes him unbearable for the family. - for a number of people suffering from depression, constant doubts, fear for the health and well-being of loved ones, obsessive, i.e. come to the fore. ideas about the misfortunes and troubles of family members that arise against one’s will. A typical story: Dmitry Petrovich, 58 years old, teacher. “After minor troubles at work, I began to feel strange anxiety and agitation. Unpleasant thoughts came into my head that I had done something wrong at work, which is why I double-checked everything many times and went home later than everyone else. But even at home, the anxiety did not go away: as soon as a daughter or wife lingered for even half an hour, terrible pictures of road accidents or violence were drawn in the imagination. I fell asleep only in the morning, got up exhausted and felt drowsy all day. I took valerian and corvalol, but it practically didn’t help. At work they hinted if I should take a vacation. Friends advised me to see a neurologist, but he did not find his pathology and referred me to a psychiatrist. I was diagnosed with anxiety depression. After a course of outpatient treatment, I completely came to my senses.” — in many cases, depression is characterized by unpleasant sensations in the body, disturbances in the activity of internal organs in the absence of objective signs of true somatic, i.e. non-mental illness. At the same time, many patients constantly note pain and internal discomfort. Some complain of headaches, pain in the stomach, joints, and lower back, others complain of intestinal disorders: constipation, indigestion, irritation of the colon, while others pay attention to a decrease in libido and potency. Women often experience painful and irregular periods. Approximately 50% of people suffering from depression complain of such physical ailments when visiting a doctor, without mentioning the depressed mood or state of mind that underlies the depression. Experiencing chronic pain or other unpleasant sensations in the body, patients may not realize that they are suffering from depression, even with severe melancholy, considering the latter a reaction to painful bodily discomfort. — some patients are convinced that they have some rare and difficult to diagnose disease and insist on numerous examinations in general medical institutions. Doctors call this condition masked (hidden) depression, in which a person may experience pain in the head, limbs, chest, abdomen and any other parts of the body, he may be haunted by anxiety, he may suffer from insomnia or, on the contrary, sleeping too much. - Patients may experience disturbances in the cardiovascular system, itchy skin or lack of appetite. And all these are manifestations of depression. - the pathological sensations that patients experience with such depression are quite real, painful, but they are a consequence of a special mental state, and not an internal disease. It must be remembered that the frequency of latent depression exceeds the number of overt ones many times. - with such depression, patients, as a rule, have a changed attitude towards food: they can go without food for a long time and not feel hungry, and when they sit down at the table, they eat only 1-2 spoons - they have neither the strength nor the desire for more . — a sign of depression can be a weight loss of more than 5 kg. within a month. In some people, especially women, appetite during depression, on the contrary, increases, sometimes reaching the level of painful hunger, accompanied by severe weakness and pain in the epigastric region. In some cases, food is taken in excess due to an increased desire for sweets or attempts to distract oneself from painful thoughts by eating frequently. Thus, we see that depression is a disease with many different manifestations that do not go away on their own, requiring special, sometimes long-term, medical intervention. Therefore, if the symptoms described above appear, you must seek help from a psychiatrist who will prescribe and monitor antidepressant treatment.

TREATMENT OF DEPRESSIVE DISORDERS

By now we can say: the vast majority of cases of depression respond well to treatment. According to modern views, effective treatment of depression consists of a combination of pharmacotherapy, psychotherapy and, if necessary, other types of treatment. At the same time, the main role in therapy, of course, belongs to antidepressants - drugs specially designed for the treatment of various types of depression. The creation of antidepressants is based on the discovery of scientists that depression develops as a result of a disruption in the mechanism of biochemical transmission of nerve impulses in parts of the brain responsible for mood, behavior, response to stress, sleep and wakefulness, appetite and some other functions. To ensure coordination of the work of all these functional units, the brain sends special “commands” to them in the form of chemical impulses transmitted from the processes of one nerve cell (neuron) to the processes of another. This transmission is carried out with the help of chemical intermediaries (neurotransmitters), which, having transmitted the signal, partially return to the original neuron. This process is called transmitter reuptake. Thanks to it, the number of transmitters in the microscopic space between the processes of neurons (in the so-called synaptic cleft) decreases, which means that the necessary signals are transmitted worse. As numerous studies have shown, mediators of different structures, in particular norepinephrine and serotonin, are involved in the transmission of signals that ensure the normal functioning of the nervous system. The first of them has a general activating effect, maintains the level of wakefulness of the body and takes part in the formation of adaptive reactions, and the second has a main antidepressant effect, controls impulsive actions, anxiety, aggressiveness, sexual behavior, falling asleep, feeling of pain, which is why it is called serotonin sometimes a “good mood” regulator. A decrease in the amount of transmitters in the synaptic cleft causes symptoms of depression; an increase, on the contrary, prevents their appearance. The ability of some drugs to increase the concentration of neurotransmitters in the synaptic cleft in one way or another allows them to be used as antidepressants. Nowadays, antidepressants are used in Russia, which can be roughly divided into 4 generations based on the time of their creation. The first antidepressants to find widespread clinical use were drugs with a tricyclic structure: amitriptyline and imipramine. They have a fairly powerful effect on most depressive conditions by blocking the reuptake of both norepinephrine and serotonin. However, the real clinical effect of these drugs is significantly offset by their undesirable side effects, which sharply reduce the quality of life of patients during treatment. Side effects of tricyclic antidepressants arise due to the nonspecificity of their effects on receptor structures. Acting in addition to the serotonin and norepinephrine system and on other neurotransmitters (acetylcholine, histamine, dopamine), these antidepressants cause side effects such as urinary retention, dry mucous membranes, constipation, rapid heartbeat, fluctuations in blood pressure, confusion, tremors, sexual dysfunction functions, weight gain. In such cases, it is necessary to prescribe other drugs to correct side effects or reduce the therapeutic dose of drugs, which naturally affects the effectiveness of the antidepressant effect. It has been observed that up to 50% of patients refuse to take tricyclic antidepressants due to severe side effects. For the same reason, doctors are increasingly less likely to prescribe these drugs to patients on an outpatient basis. The situation was somewhat improved by the introduction into practice of second generation drugs - tetracyclic antidepressants, which, along with the ability to block the reuptake of norepinephrine and serotonin, could also affect some other receptors. Being analogues of tricyclic compounds, these drugs have comparable antidepressant activity, but unlike their predecessors, they are safer because they are much less likely to cause unwanted side effects. In addition to antidepressant, mianserin (lerivon) has a clear sedative, anti-anxiety and hypnotic effect. Maprotiline (Ludiamil) has a mild, balanced antidepressant effect. In general, these drugs can treat mild to moderate depression, but are ineffective in patients with severe depression. Today, third generation antidepressants such as fluoxetine (Prozac), fluvoxamine (fevarin), paroxetine (Paxil), sertraline (Zoloft), citalopram (cipralex) and some other drugs that selectively affect the serotonin metabolism system have received widespread recognition today. , preventing its reuptake in the synaptic cleft. Based on the mechanism of action, these antidepressants are combined into the group of selective serotonin reuptake inhibitors. In addition to treating depression, they are used to correct eating disorders, level out panic disorders, so-called social phobias, various obsessive states and chronic pain symptoms. These drugs have gained popularity due to the possibility of once-daily dosing, the accompanying anti-anxiety effect, the presence of a psychostimulant component and a small number of side effects. In addition, they have little toxicity and are well tolerated by elderly patients. However, some researchers note their lack of effectiveness in the treatment of severe forms of depressive conditions, probably associated with selective activity in relation to only one neurotransmitter - serotonin. It should be noted that in recent years, some American scientists have associated the use of these drugs with an increased risk of suicide, which, however, has not been proven. Considering the high frequency of side effects in some of the above drugs and the insufficient antidepressant activity in others, psychopharmacologists have taken the path of developing more effective antidepressants - fourth generation drugs that selectively block the reuptake of both serotonin and norepinephrine, without affecting other neurotransmitters. system and having minor side effects. Three drugs currently meet these requirements: milnacipran (Ixel), duloxetine (Cymbalta) and venlafaxine (Effexor). Their antidepressant activity in the treatment of patients with severe and moderate depression has been confirmed in a number of specially conducted studies, which have simultaneously shown that these drugs are well tolerated. It should be noted that in mild depressive states, antidepressants of plant origin (negrustin, gelarium hypericum, deprim, etc.) can be effective, but there is no reliable data guaranteeing their effectiveness. The opinion of a number of doctors that all depression can be treated with herbs or, say, acupuncture should be considered unfounded. For extremely severe depression that does not go away despite the use of the most powerful antidepressants, electroconvulsive therapy (ECT) can be effective, but this situation is extremely rare and requires careful justification by a committee of doctors and the consent of the patient. An important additional role in antidepressive therapy, especially with concomitant anxiety, is played by tranquilizers - anti-anxiety drugs, such as Xanax, phenazepam, diazepam, nitrazepam, atarax, etc. Drugs that, when taken systematically, can prevent mood swings in various depressive disorders include so-called mood stabilizers or mood stabilizers - lithium preparations, carbamazepine, valproic acid salts, lamotrigine, topiramate. When taken systematically, in most patients, the clinical manifestations of depression either completely disappear or become rare and mild, not requiring hospitalization and not significantly affecting the ability to work. Antipsychotics play a significant role in the treatment of some forms of depression. These include both traditional drugs - fluanxol, triftazin, eglonil, teralen, neuleptil, sonapax, and atypical antipsychotics that are gaining increasing recognition among doctors: seroquel, solan, zeldox, rispolept, abilify, serdolect and others. In drug therapy for depressive conditions, an unconventional, strictly individual approach is used, with the obligatory provision of fruitful cooperation between the patient and the doctor. Otherwise, there may be a violation of medical recommendations regarding the doses and regimen of taking medications. The patient’s faith in the possibility of recovery, the absence of prejudice against the “harm” caused by psychotropic drugs, and systematic adherence to the doctor’s prescriptions largely contribute to the achievement of therapeutic success. Drug treatment for depression takes time. You should not expect a complete cure in the first days of taking the drug. It must be remembered that all modern antidepressants begin to act on depressive symptoms no earlier than 1-2 weeks after the start of treatment. Cancellation of an antidepressant, as well as its prescription, should only be carried out by a doctor. Cancellation is usually made no earlier than 6 months after normalization of the mental state. Even after all symptoms of depression have completely disappeared, do not rush to stop taking the drug yourself, as there is a risk of exacerbation of the disease. Therefore, doctors recommend continuing to take an antidepressant for a certain period of time. A common mistake is premature discontinuation of medications soon after a significant improvement in the condition or due to “forgetfulness.” To avoid this, try to include taking the drug in the list of daily urgent tasks - for example, store it in the bathroom and take it after performing hygiene procedures. When planning a trip, calculate exactly how many tablets you need for the entire period you are away from home. Disruption of therapy is fraught with serious troubles. Psychotherapy for patients with depressive conditions, carried out along with drug treatment, involves various systems of influence, including individual conversations, family and group therapy, etc. An important element of social rehabilitation is participation in mutual support groups for patients who have suffered from depression. This allows other patients to feel helped in understanding their problems, to realize that they are not alone in their misfortune, and to see opportunities for personal participation in rehabilitation activities and in public life.

Depression symptoms

For each person, signs of depression can manifest themselves differently, it all depends on the stage and form of the pathology. Symptoms occur at different levels, affecting all aspects of the emotional sphere and behavioral reactions of the patient.

Emotional manifestation:

• deep depression is accompanied by a loss of the ability to experience simple human feelings (anger, joy, surprise, fear);
• there is no interest in surrounding events and people;
• those activities that previously evoked pleasant emotions are of no interest to the patient at all;
• a person is dissatisfied with himself, his appearance;
• lack of self-confidence, low self-esteem;
• constant feeling of guilt, even if the objective reason for this is not determined;
• the patient often blames himself for everything, without necessarily saying it out loud;
• increased irritability, nervousness;
• depressed and depressed mood;
• often falls into despair;
• the patient is characterized by melancholy and suffering;
• the feeling of internal tension increases;
• a subconscious expectation of trouble arises;
• increased anxiety even in the absence of any reason.

Fears about the health of loved ones are constantly present in depressed patients. They understand that they cannot do or change anything in this situation. Anxiety is also associated with fears of appearing stupid or ineffective in the eyes of the public. Going to a psychiatric clinic is the first step on the path to recovery.

The manifestation of the disease at the physical level is expressed in the following:

• sleep disturbance (constant daytime sleepiness or insomnia);
• complete loss of appetite or uncontrolled eating;
• decreased libido, sexual needs cease to interest the patient;
• disruption of the functioning of the gastrointestinal tract (constipation or diarrhea);
• increased fatigue and chronic fatigue;
• decreased energy level, exhaustion, feeling of lack of strength.

Even with ordinary physical or intellectual stress, general weakness of the body, unpleasant sensations in the body and pain of varying intensity occur.

Behavioral symptoms of depression:

• it is impossible to involve a person in any activity that involves the implementation of a certain algorithm of actions;
• he refuses entertainment;
• There is a tendency towards solitude and avoidance of social contacts.

A depressed state can change the intensity of cognitive processes:

• there are difficulties when trying to concentrate on any subject;
• concentration suffers;
• the patient experiences problems if he needs to make some decision and cannot rationally “weigh” the risks;
• he constantly doubts whether he is doing the right thing, turning over the situation in his head, and in the end he never comes to a definite opinion;
• constantly thinks about his own helplessness, insignificance for others;
• thinking is slow, which is very noticeable to others;
• in severe cases, thoughts of suicide occur, and the likelihood of committing it is high.

If there are two or more symptoms from this list, and they are observed in the patient for 2 weeks or more, the doctor may diagnose depression. The selection of effective treatment depends on which type of disorder the patient has:

• Dysthymia.

This is a mild variant of the disease, which begins in adolescence and is formed against the background of intrapersonal conflicts, problems with parents, and constantly changing hormonal levels. People around him believe that this is a manifestation of a difficult character; such a person is called a melancholic or a pessimist.

• Depressive episode.

This condition arose in the patient for the first time in his life; it did not have time to develop into a severe form. A short-term but memorable case of total sadness, exhaustion, lack of interest in everything that was happening.

• Bipolar affective disorder.

Characterized by alternating moments of bad mood and pathological joy, the patient’s life is constantly between these two poles. He seems to float on the waves of mood, constantly moving from one peak of emotions to another.

• Recurrent depressive disorder.

These episodes recur every few years, after which they may go away on their own. The pathology must be treated in a psychiatric center for a long time with the help of psychotherapy and periodic courses of medications.

Etiology of the disease

The classification of depression according to the current edition of the manual of mental disorders involves division into the following groups:

• major depressive disorder;
• chronic depressive disorder;
• depressive disorder with specified or unspecified etiology: premenstrual disorders, depression due to health problems, consequences of taking psychoactive drugs.

Most cases of depression have a clear age link: adolescence or age 20-30 years. Due to mental characteristics, women are more prone to depressive symptoms; the exact reasons for this phenomenon have not yet been established. Some depressive symptoms occur in 30% of patients seeking medical help. Less than 10% of those who apply show signs of deep depression that require competent medical intervention.

The state of demoralization associated with unpleasant incidents in the patient’s life differs significantly from clinical depression. There are a number of characteristic signs indicating temporary psycho-emotional difficulties that disappear within a few days without specific treatment:

• deterioration in mood manifests itself in outbreaks and is not permanent or protracted;
• as events change, a person’s mood improves and his mental state returns to normal;
• low mood can alternate with fun and stable well-being;
• The patient does not have suicidal thoughts, feelings of self-hatred, or feelings of worthlessness.

If the patient is prone to depression due to demoralization, individual signs of major depression may be observed. But even they do not allow us to talk about a disease that requires immediate help.

Depression scale

If a patient has doubts about the state of his health, and he is sufficiently informed in matters of mental disorders, it will not be difficult during self-diagnosis to determine the presence of a depressive episode.

The 21-item Beck Depression Inventory is used for this purpose. It contains several statements, in each of them you need to select only one option. This phrase should reflect the thoughts and feelings of a person at the current moment as accurately as possible.

You need to answer questions as truthfully as possible and be sincere with yourself. As a result, it is necessary to calculate the total number of points; the lower their number, the lower the likelihood of depression.

If you have alarming results on the Beck scale, you should contact a specialist; you can make an appointment at Dr. Isaev’s Clinic any day. This should be done immediately if you are experiencing panic attacks due to nervous exhaustion.

Course of manic-depressive psychosis

According to studies, the course of MDP in 70% of cases occurs in shallow affective phases, deterioration develops only in 30%. The disease manifests itself at strictly specific intervals, for example, exacerbations can be associated with the seasons, or timed to coincide with certain events in a person’s life. If the course manifests itself as bipolar disorder, then there may be dual phases, alternating with slight clearings. Variation can also occur when a depressive state is replaced by enlightenment, then a manic phase begins and stabilization occurs again.

Most often, chronic depression appears in adulthood. The duration often varies in the range of 10-15 years. But we should not exclude the possibility that a person will be able to get out of this state. Depression is often called “frozen” when the state in the same pore persists for a certain time.

Depression in men

Constitutional differences between the male and female body lead to the fact that mental disorders have different manifestations. This condition in a man is often unnoticeable to those around him; the patient tries to appear joyful and cheerful, telling everyone about the absence of problems.

The depressive triad, characteristic of men, is expressed as follows:

• anhedonia – the ability to experience pleasure and joy is reduced or absent;
• changes in thinking processes - new, sometimes absurd, judgments arise, negativism and pessimism predominate;
• motor retardation, slowness.

One of the reasons for the development of the disease in the stronger sex is erectile dysfunction. Decreased libido, lack of attraction to the opposite sex, fear of being ridiculed by a partner causes a feeling of slight dissatisfaction with oneself, and then turns into a severe form, accompanied by a feeling of one’s own helplessness and insignificance, the man does not feel strong and self-confident.

Personality and character change

The character, as it were, adapts to this neurosis, to this situation. A person begins to change, and those around him regard this change as a change for the worse, not for the better.

The character becomes prickly, sometimes unbearable, extremely selfish, self-centered, requiring increased attention, hysterical forms of behavior appear, manifestations of explosiveness when a person turns into a powder keg, igniting from every spark that arises for the most random reason. Or the character becomes hyper-anxious, suspicious, when every little thing begins to frighten, and in every case, in every non-standard, emergency situation, panic appears.

Both the first and the third options for transforming neurosis significantly reduce the number of quality days of life and are absolutely not worth it, because neurosis is, in general, a functional disorder that can and should be completely reduced. You can get out of it by returning to your normal, mental, pre-neurotic state.

Depression in women

There are several factors that lead to the development of depression in women. Among them are the following categories:

• Biological

The disorder develops slowly and gradually under the influence of changes in the body. Increased nervous excitability, decreased levels of norepinephrine or serotonin, and hormonal imbalance lead to pathology. The situation is aggravated if the body lacks vitamins, microelements and other useful substances.

• Social

This group of factors is associated with frequent stress, bad habits, polluted environment, increased physical and emotional activity. The female body is weaker than the male; it is not able to withstand such loads for a long time. The psyche is depleted, various unfavorable states arise, including depressive ones.

• Interpersonal relationships

Psychotraumatic events that occur in a woman's life can cause this disorder. Among them are:

• death of a loved one;
• long-term separation or complete breakup of relationships;
• lack of understanding on the part of relatives;
• constant dissatisfaction with your appearance, excess weight or physical characteristics;
• professional dissatisfaction.

The combination of these factors threatens an increase in symptoms and a gradual deterioration in a woman’s health.

The lack of joy in life radically changes the patient’s character; he becomes melancholic, constantly dissatisfied with himself and his loved ones, and makes complaints about everyone, even if there is no reason for this.

Additional risk factors

Among the factors that increase the risk of depression are biological (fertility, heredity), characteristics of interpersonal interaction and specific personal characteristics. In addition, if a woman is exposed to increased stress for a long time or is a single mother, this further increases her chances of developing symptoms of depression.

Additional risks include:

• Family experience of mood disorders.
• The presence of a mood disorder in a woman in adolescence or early youth.
• Loss of a parent in childhood.
• Loss of family, friendly support or threat thereof.
• Intense or prolonged psycho-emotional stress (possibly dismissal, problematic interpersonal relationships, separation or divorce).
• Violence experienced in childhood or recently: physical and/or sexual.
• Certain medications.

In addition, some are susceptible to developing postpartum depression, as well as so-called seasonal affective disorder, depending on the time of year.

Postpartum depression

After the pregnancy period has been successfully overcome and a woman gives birth to a child, she may experience a different range of feelings and sensations on the physical level. Postpartum depression is an atypical mental disorder that can be dangerous for the new mother and her environment.

It is important to understand that childbirth represents enormous stress for the psyche and a great test for the body. Psychological assistance is necessary for the patient in case of serious deviations from the norm. This condition occurs during the first 3 months after birth and can be mild or severe.

Among the provoking factors, experts identify:

• excessive physical exertion associated with caring for a newborn;
• the pregnancy was difficult or unwanted;
• inability to breastfeed;
• financial difficulties;
• dysfunction of the nervous system, which began even before birth;
• conflicts with a partner (separation, quarrels, infidelity);
• moral exhaustion of the body;
• unjustified expectations of a young mother;
• lack of help at home from close relatives.

This disorder can be distinguished from others by a number of specific signs. The doctor diagnoses and prescribes medications; self-medication in this case threatens to worsen the condition. Among the symptoms characteristic of women are:

• Regular complaints of excessive fatigue, lack of energy, loneliness. This is accompanied by mood swings, euphoria is often replaced by causeless sadness, and outbursts of anger occur that the woman is unable to control. She often cries, becomes hysterical, and does not respond to attempts to calm her down.
• Panic fear. Usually it concerns the health of the newborn, the mother has fears that he may suddenly die or something will happen to him. A gloomy vision of the future becomes dominant, the imagination draws terrible pictures of events that could happen in a few hours or days. Articles about accidents and illnesses read on the Internet are automatically “tried on” to oneself.
• The feeling of guilt does not leave a woman; even the smallest failure plunges her into a world of fear and self-flagellation.
• Provoking conflict. Often a young mother throws tantrums every day for any reason, she becomes grumpy, and she herself looks for reasons to quarrel with her husband or loved ones. People around them attribute these symptoms to whims and bad character, so they do not respond to them in a timely manner.

Depressive disorder and menopause

By analogy with other periods of a woman’s life, during menopause there is a close relationship between hormonal levels, physical manifestations and emotional reactions and experiences. Among the physical symptoms, the most common are hot flashes or chills, excessive sweating, dry skin, excess weight gain and a number of others. Mental symptoms include irritability, sleep disturbances, tearfulness, headaches and migraines. These symptoms, together with increased anxiety, cause depression. Most often, menopause begins after 45 years of age, but due to the characteristics of a particular organism (for example, surgical removal of the ovaries), it can begin earlier.

Depression test

The psychological tools that psychiatrists, psychologists and psychotherapists use in their work have certain specifics. These can be tests, questionnaires, questionnaires, projective techniques. The difficulty lies in the correct interpretation of the material received from the patient.

It is strictly not recommended for patients to use their own intuition and information on the Internet. The patient may misdiagnose himself and prescribe medications that are not required in his case.

Moreover, most tranquilizers, antidepressants and other strong drugs are available only with a doctor's prescription. The use of dubious remedies will not only not help, but will also aggravate the situation and increase the level of intensity of symptoms.

In addition to tests, Dr. Isaev’s clinic performs diagnostics using modern equipment, which can be used to determine the presence of concomitant diseases. In some cases, treatment must begin with them, since such pathologies complicate the clinical picture.

How to get out of depression

Psychologists advise to be attentive to your body, at the first signs of depressive episodes, try to help yourself before visiting a doctor. It is important to follow these rules:

1. There is no need to avoid a bad state and mood and hate yourself for it. The patient must accept himself as he is at a particular moment. This is a normal phenomenon that occurs under the influence of external and internal factors. Depression must be fought, but this must be done gently, without putting strong pressure on the psyche.
2. Redirecting focus to another activity. Reading books, riding a bike, going to the gym, swimming, and changing the environment helps a lot. If finances and time allow, you can go on a trip, see many interesting and new places, in this case the apathy often goes away on its own. Perhaps the person simply lacked impressions.
3. You need to get rid of the fear of losing your positive emotions. Manifestations of joy, euphoria, and pleasure should be enjoyed at the moment they appear, and not constantly replay bygone times in your thoughts.
4. Communication with new people, interesting contacts. You can go to an exhibition, cinema or theater, meet interesting interlocutors, let others help. There is no need to be afraid of being rejected or not needed; in most cases, such experiments end successfully.
5. The psychotherapist will recommend meditations that can be used when the first symptoms of depression approach. Such techniques help develop a sense of inner integrity.
6. Normalization of sleep and rest patterns. An exhausted body needs help first. A full eight-hour sleep helps restore its reserves and promotes inner peace.

How can a woman cope with menopausal symptoms?

• Eat healthy foods and maintain moderate but regular exercise (workout is effective in controlling anxiety levels).
• Get involved in a creative activity, find an interesting hobby that will guide you towards pleasant achievements.
• Find a technique that can balance your mental state: this could be meditation, certain relaxation breathing techniques, yoga (other techniques, strategic self-help for anxiety).
• Try to keep the air in the bedroom at a cool temperature, which will help prevent sweating during sleep and, as a result, sleep disturbances.
• Seek emotional support from friends, close family, or professional help as needed.
• Maintain family relationships, communicate in different interest groups, strengthen friendships with other people.
• Follow your doctor's instructions regarding taking vitamins, dietary supplements, minerals and other medications prescribed to you.
• During periods of frequent hot flashes, give preference to loose-fitting clothing.

Treatment of depression

If a person cannot cope with his condition on his own, he needs the help of a psychotherapist. Treatment of depression involves the use of various techniques aimed at relaxing the nervous system, calming down, and increasing self-esteem.

If the patient does not realize what is happening to him, hypnosis sessions are recommended. Immersion in a trance and precise adherence to the doctor’s commands makes it possible to travel back to childhood or adolescence, to determine the place and time when the psychological trauma was inflicted. In some cases, the patient requires consultation with a neurologist or psychiatrist if he develops other pathologies against the background of a depressive disorder.

Neurotic conditions

At this age, in addition to depressive disorders, neurotic conditions are also quite common - here we are talking about the so-called psychogenic adaptation reactions.
We are talking about those social clashes and cataclysms that await almost every person who has reached this age. There is a very interesting psychological phenomenon here. On the one hand, a person who has reached a certain level in his development, at 35–40 years old, feels like a king, the master of the situation. He really deserves to feel this way, he really sees how he is superior to the still green and inexperienced youth in this or that matter.

At the same time, he sees how he is significantly more active than older people, who, although more experienced, are much slower in their thoughts, decisions, actions; they are old-fashioned, do not always keep up with some modern innovations, and so on.

Feeling like the master of the situation, a person enters into quite tough competition with his peers. In this competition, unfortunately, spears are often broken and people's destinies are broken.

In this competition, which does not necessarily look like an open war with swords drawn, very often it can be some kind of behind-the-scenes conflicts, intrigues in a professional team or, again, in some social group.

In this tension, which is experienced by a person who works very actively and takes an active life position, the adaptation mechanisms of psychological defense very often break down. They stop working. What used to always save you, what you could previously rely on, stops working, and then neurotic disorders begin

.

These patients also often come to the attention of a psychiatrist, but more often even a psychologist, and in their painful state we see a lot of anxiety disorders of the autonomic nervous system.

Questions and answers

Is it possible to get rid of a bad mood on your own with the help of antidepressants?

We categorically do not recommend prescribing medications yourself. This is done by the doctor based on examination of the patient. Many medications have a number of contraindications, which the patient himself may not be aware of.

How long does it take to treat depression?

This is an individual indicator, it all depends on the form of the disease and its stage.

How common is depression during menopause?

Research shows that between 8 and 38 percent of women going through menopause experience mood changes. Premenopausal women are twice as likely to suffer from depression than women who have not yet entered perimenopause.

It is clear that a history of depression makes menopausal women more susceptible to developing it. Women who have experienced PMS or postpartum depression are at greater risk of depression during menopause than women who have not experienced postpartum depression.

It's not surprising that women with a particularly long transition to menopause find themselves more prone to depression than women with a shorter transition, especially if they also experience other unpleasant menopausal symptoms.