Depression can be the result of a bereavement, such as the death of a loved one, a break in a relationship, or financial loss. However, in our time, people with somatic depression are quite common. This type of depression occurs during the onset of severe diseases of internal organs and can continue even after complete recovery.
Somatic depression is more common in late adolescence, middle age in both men and women, and at retirement age in older people.
What diseases can cause depression:
- osteoarthritis;
- pneumonia;
- heart diseases;
- atherosclerosis (especially cerebral vessels).
In addition, somatic depression can occur against the background of awareness of the severity of the disease and a possible change in the rhythm of life.
Of course, it is difficult not to agree that serious diseases of internal organs will undoubtedly cause fear in everyone, however, only those people who have a mild and suspicious character plunge into depression. Such people in life experience more than others any troubles, and even the most insignificant diseases, exaggerating their danger several times. But, when this type of people finds out about the seriousness of their health problems, depression is inevitable.
Manifestation of symptoms
Somatic depression is also called "masked", as it is hidden behind a number of somatic manifestations, namely, what a person feels during a disease of internal organs and, of course, exaggerating the entire danger.
Some of the many symptoms that can occur during physical depression include:
- sleep problems;
- tension and anxiety;
- irritability, anger, or fearfulness;
- headache, constipation, or upset stomach.
In a person suffering from somatic depression, the mood remains unchanged, but you can notice trembling in the hands, dizziness, chest pain and increased heart rate.
Due to the individuality of each person's body, the symptoms will differ.
How is somatic depression treated?
After all these symptoms, both mental and physical, persist for at least two weeks, the correct action is to seek the advice of a psychologist. Mental health professionals are able to diagnose an illness if symptoms may be associated with depression. It is important to start treatment as early as possible so that the doctor can choose an individual approach just for you.
If the physical symptoms are associated with depression, they should improve with treatment. Antidepressants are one of the treatment options in addition to psychotherapy. To determine which treatment is best, you need to consult with your doctor or other mental health professional. The use of antidepressants helps to regulate hormones such as serotonin in the brain, which greatly relieves the symptoms of somatic depression.
Refers to "Depression"
Depression and antidepressants
Attention: this article is part of a more general article: Depression in which it is used.
Depression - the plague of the 20th century - this is how the media call depression, and the comparison with the most terrible disease of the Middle Ages was not at all accidental: according to forecasts, by 2020, depression will come out on top among other diseases, overtaking today's leaders - infectious and cardiovascular diseases; in the twenty-first century, it is depression that will become the # 1 killer. Already today, more than 50% of all suicides on the planet are committed by people who are depressed .. (See statistics)
"I have depression" - how often do we say these words without thinking about their meaning. What is depression really?
Depression (from the Latin Depressio - depression, oppression) is a psychosomatic state, in the mental sense it is characterized by depression, melancholy, a sad mood, which can be exogenous (as a mental reaction to an unpleasant depressing event) or endogenous (as a low mood, associated with a physiological state). The state of depression is characterized by a negative emotional background, a slowdown in intellectual activity, a change in the motivational sphere and a general passivity of behavior. Subjectively, a person in a state of depression experiences, first of all, heavy, painful emotions and experiences - depression, melancholy, despair. Attractions, motives, volitional activity are sharply reduced. Typical are thoughts about their own responsibility for a variety of unpleasant and difficult events that have occurred in the life of a person or his loved ones. Feelings of guilt for past events and a sense of helplessness in the face of the future are combined with a sense of hopelessness. Self-esteem is sharply reduced. The behavior is characterized by slowness, lack of initiative, a person quickly gets tired, there is a breakdown, and all this leads to a decrease in productivity and even greater depression. It is necessary to distinguish between functional depressive states, which can be observed in healthy people, as a situational reaction to a particular event in life (reactive depression), and persistent clinical depression. With depression, the state of depression can last from several weeks to several months. However, with a prolonged depression, this period can last for years. One of the signs of depression is a lack of hope. During a depression, it seems that this is forever, and the future is drawn in extremely gloomy colors. In fact, it does not exist at all.
Diagnostic signs of depression
The diagnosis is made when there are two main symptoms and at least two additional ones.
The main symptoms are:
Depressed mood, regardless of the circumstances;
- Decrease in intellectual activity;
- Anhedonia - loss of interest or pleasure from previously pleasant activities;
- Severe fatigue, “loss of strength”.
Additional symptoms:
- Pessimism;
- Feelings of guilt, worthlessness, anxiety and / or fear;
- Low self-esteem;
- Inability to concentrate and make decisions;
- Thoughts about death and (or) suicide;
- Unstable appetite, marked decrease or gain in weight;
- Disturbed sleep, the presence of insomnia or oversleeping.
Somatic symptoms of depression
Appearance: facial expressions are not only mournful, but also frozen, the expression of grief is enhanced by the Veragutta fold; bent posture, when walking, the legs drag; the voice is soft, dull with weak modulations or not modulated at all.
Decreased appetite and weight loss. Severe depressive patients, in addition to emaciation, are distinguished by a "hungry smell" from the mouth, coated tongue and pharynx. Constipation is a constant and sometimes very unpleasant and painful somatic manifestation of depression for patients.
Disorders in the sexual sphere: decreased libido, in women, temporary frigidity and cessation of menstruation, in men - a decrease in potency.
Some pain, neurological and muscle disorders are less consistently observed in depression.
A number of unpleasant and painful sensations arising from depression are associated with disturbances in the tone of smooth and skeletal muscles. These disorders include: unpleasant, pulling painful sensations in the neck and back of the head. Similar sensations sometimes arise between the shoulder blades, in the shoulder girdle, in the lower extremities, in the knees, and in the lower legs. Spastic phenomena are not uncommon: as the calf muscles cramp, more often at night, and to such an extent that in the morning the patients continue to feel severe pain, hardening in the calves. With depression, attacks of sacro-lumbar radiculitis often occur.
There are headaches that compress the back of the head, temples, forehead and radiate to the neck, pains that resemble migraines, and pains that resemble neuralgia of the facial nerve. In depression, an algic syndrome is sometimes described, apparently due to a decrease in the threshold of pain sensitivity.
A significant proportion of somatic disorders are more often observed at the onset of an attack of depression or precede it, and are also observed with anxiety (this is especially true for muscle and pain symptoms).
Types of depression
Psychogenic (reactive) depression- psychogenic always arises after painful experiences for the patient, more often acute mental trauma. Although it is believed that the intensity of depressive disorders in these cases is less than in endogenous depression, the risk of suicide in these conditions is quite high. In addition to the signs common to depressions, psychogenic depressions are characterized by a clear connection between the onset, course and completion of an attack with mental "trauma". The behavior and statements of patients are usually associated with a real situation, often the patient exaggerates real life difficulties. Another feature of psychogenic depressions is the great brightness, expressiveness, expressiveness, sometimes even demonstrativeness of emotional manifestations. The severity of vegetative disorders is also characteristic. A variety of stressful situations can lead to depression - from the most difficult to everyday trifles. Death of a loved one, loss of job, conflicts with loved ones, loneliness, unfulfilled dreams. Of course, with the loss of a loved one, longing and sadness are natural, but sometimes their depth and duration is so great that you have to resort to medical help. Less significant events also do not pass without leaving a trace for our psyche - gradually accumulating, they drive a person into a cage of depression.
Depressive reactions can be of various types:
- hysterical
- alarming
- hypochondriacal
- melancholic
Endogenous depression- in a certain percentage of people, depression develops without external reasons against the background of complete well-being. This is the same chronic disease as tuberculosis or hypertension, only it causes not physical, but mental suffering. The causes of endogenous depression are determined by heredity or metabolic characteristics of the central nervous system mediators responsible for emotional responses (physiological causes).
Exogenous or somatogenic depression- arises from reasons external to the brain. This is depression in severe somatic, infectious or endocrine diseases. The main cause of depression is a disturbance in the work of internal organs, chronic intoxication with prolonged infections or in violation of the excretory function of the body, hormonal changes. Other reasons are the restrictions imposed on the person by the disease itself (low mobility, being in the hospital).
Disguised depression- many people do not even suspect that they have depression, because it is often disguised as some kind of somatic illness, and a person has been complaining about the heart or stomach all his life, and the reason lies elsewhere. Such depressions are called masked. Depression is often associated with diseases such as diabetes and cancer.
Dysthymic depression- There is a type of depression called dysthymia. With dysthymia, the symptoms of depression are not so pronounced, and the person lives as if by inertia, boiling for years in the tasteless broth of everyday life. He lives without joy, like an automaton, gradually getting used to this state, considering it the norm. In fact, this condition is also a depression, which you can get rid of.
Cyclic depression- pronounced cyclicality of depressive states depending on the time of year, phases of the moon, time of day, etc. Depression is usually stronger in the morning. Winter is also often the cause of exacerbation of the depressive state. This is due to a decrease in the length of daylight hours and, as a result, a deterioration in mood. That is why depression is much less common in southern latitudes than, say, in Europe or Russia.
Other types of depression:
... In agitated depression, anxiety and motor restlessness predominate: patients rush, groan, do not find a place for themselves ...
In the case of adynamic depression, lethargy, immobility, lack of motivation come to the fore ...
The picture of hypochondriac depression is determined by anxious fears or even a belief in the presence of a serious illness ...
Asthenic depression proceeds with a predominance of lethargy, physical and mental fatigue, concentration disorders, hyperesthesia ...
In hysterical depression, hysterically colored affective disorders prevail, phenomena of exaggerated despair with sobs, convulsions, conversion astasia-abasia, tremors, aphonia and dissociative amnesia, hysterical hallucinations with symptoms ...
Psychopharmacotherapy
Pharmacotherapy for depression is carried out mainly with antidepressants. Antidepressants are a class of psychotropic drugs used primarily to treat depression. In a depressed patient, they improve mood, reduce or relieve melancholy, lethargy, apathy, anxiety and emotional stress, increase mental activity, normalize the phase structure and duration of sleep, and appetite.
Antidepressants are predominantly stimulatory and are used to treat patients with depression associated with lethargy, apathy, and melancholy. Anafranil, melipramine, tsipramil, paxil, prozac are indicated for the treatment of deep dreary or apathetic depression; in subpsychotic depression, petylil, pyrazidol is preferable, which may have a beneficial effect on the anxiety component of depression.
Antidepressants with predominantly sedative action are indicated for anxious depression, unaccountable anxiety, and gloomy irritability. With severe anxiety depression (especially with suicidal thoughts and intentions) amitriptyline is indicated; with shallow depression with elements of anxiety, ludiomil, azafen are prescribed, with poor tolerance of antidepressants and with high blood pressure, coaxil is preferable.
In mild cases, herbal preparations are used: hypericin, St. John's wort.
In cases of severe mental and emotional disorder, magnesium metabolism is disturbed - magnesium is rapidly excreted through the kidneys from the body, while magnesium is needed by the adrenal glands to produce cortisol. In addition, magnesium is involved in the synthesis of all known neuropeptides and provides the activation of glycine. It has been shown that, in combination with calcium, magnesium acts as a natural tranquilizer, relieving psycho-emotional stress.
List of the most common antidepressants
It should be noted that the active ingredients of antidepressants are listed here, and not their trade names. And one more thing: you should not self-medicate, all drugs have pronounced side effects, they are prescribed by a doctor, choosing an individual medicine and dosage during a detailed diagnostic conversation.
Drug-free treatment for depression. Diet, exercise, daily routine and fresh air.
With antidepressants sorted out a little. But are they really needed? Medicines treat rather clinical cases, severe lingering depression, when other means no longer help. The simple recommendations described below will help you not to come to such a life. Everyone knows that the rescue of drowning people is the work of the drowning people themselves. This also applies to those "drowning" in everyday storms. Psychologists believe that in such a situation, a person can only help himself to recover, namely to recover, because depression is a disease that must be treated, just like any other disease (treat in a timely manner to prevent the transition to the chronic stage). Before you go to the psycho atra and ask him to prescribe sleeping pills or antidepressants for you, try to cope with this condition yourself.
Sleep more.
Sleep is the best medicine. As a rule, people who are in a depressed state suffer from insomnia, which further aggravates their condition. For the most useful and longest sleep, ventilate the bedroom well and leave the window open whenever possible. This will provide you with a sufficient amount of oxygen, respectively, you will sleep longer and wake up refreshed. Keep in mind that sleeping on high and soft pillows is not only unhealthy, but also harmful. Try to keep your pillow just above the level of the sheet, as If the head is positioned much higher than the body during sleep, the blood supply to the brain is impaired, which can lead to headaches in the morning.
Try not to be alone.
Have fun.
"Your depression will only worsen if you wander around the house and mope. Our advice is to get out of the house. It doesn't matter what you decide to do, as long as you do something active. Go for a walk, ride a bike, visit friends , read, play chess or take care of the children.American psychologists believe that watching TV not only does not contribute to relaxation, but on the contrary, harms your well-being, so it is better, for example, to take a warm bubble bath, spend an evening at the opera or in a noisy night club ... Do whatever you want and enjoy it!
Don't make big decisions such as moving, changing jobs, divorce, without discussing the problem with close friends or trusted relatives. Try to delay making decisions on important issues until you get out of your depression. You cannot really rely on your decisions now. Delay taking them until you feel better.
Play sports.
Studies show that people who are depressed do better if they exercise regularly. Outdoor activities (jogging, walking, swimming, cycling) can help overcome discouragement. If you are already exercising regularly and are in good physical shape, but in a depressed state of mind, try "exercising to complete physical exhaustion," Dr. Gessel suggests. "This is a good way to relieve tension." Join the gym or the pool and instead of sobbing all evening in front of the TV, watching melodrama and drowning out your feelings with sweets, burn calories, exercising on the machines or swimming in the pool. As a result, instead of eyes swollen from tears and weight gain, you will improve your figure, and this, you see, cannot but rejoice.
Swim more.
At worst, just shower more often, because water has truly unique properties. It seems to wash away negative emotions from you. In addition, shampooing improves blood flow to the brain.
Live for today.
The past troubles are powerless, they can no longer hit you, forget grievances and defeats, do not rebuild wounds, do not remember that which cannot be returned. Do not scare yourself with phantoms of impending troubles - there is only one future, and you can compose a whole hundred misfortunes, most of which will never happen.
Don't overeat or skip food.
Eat a healthy, balanced diet. Feasts have a boomerang effect. You may feel good when you eat, but with the subsequent increase in your waist by a few centimeters, your depression will increase as well. Leave home if you need to fight the urge to eat.
Many medications we take can cause depression.
Depressive states are often accompanied by a lack of appetite, increased sensitivity to the smell and type of food, nausea and vomiting. The following drugs have depressogenic properties: reserpine, raunatin, guanedin (octadine), apressin, clonidine, methyldopa (dopegit) - drugs used for hypertension. Therefore, if possible, refrain from taking medications.
Change the interior.
The surrounding light background greatly affects the mental well-being. Therefore, try to surround yourself with light things, change the wallpaper and generally change the environment in which you are most of the day to a lighter and more spacious one.
Remember, we are the masters of our mood! The main thing is to want to forever part with depression and throw it out of your life. For real.
As you know, from a physiological point of view, depression is caused by a violation of the metabolism of neurotransmitters in the central nervous system ... namely, the metabolism of serotonin and dopamine is disturbed, as a rule. To correct the metabolism in the body, it is not always worth resorting to medications. This can be helped by a special diet, as well as physical activity.
The rake we choose
One of the unpleasant "side effects" of depression is that when things get bad, it is very tempting to somehow force the pleasant sensations in order to enjoy at least something in life. Therefore, a depressed person, "struggling" with his condition, may begin to overeat, abuse alcohol and even use drugs.
So, there is a whole category of successful, many working men who come to a psychologist about "alcohol problems": excessively frequent or emerging drinks that interfere with work. They come precisely because they are not inclined to alcoholism, and "drunkenness" harms the business.
At the very first visit, it turns out that "drunkenness" appeared as a reaction to depression, which the client is trying to "fill". Moreover, this type of "alcoholism" goes away as soon as the symptoms of depression are alleviated (that is, even before the disease is cured).
Why not try to get out of depression this way?
First, it is harmful in itself.
Secondly, both alcohol and overeating affect the metabolism, which during depression is often already disturbed. And, finally, after "orgies" (food or alcoholic), the feeling of guilt remains, and guilt is one of the strongest mechanisms that aggravate depression.
Of course, there is a temptation to say to yourself: "Now, when I feel so bad, I can afford everything." However, our body and our unconscious are no worse than Pavlov's dogs possess conditioned reflexes: if a person is used to keeping himself in check when everything is fine and to come off in full, when something bad happened (“the soul is not good” or really, depression began ) then the body will unconsciously work to receive "encouragement" over and over again. Better to accustom yourself to the opposite: to reward yourself when all is well.
Diet
If we are talking about cyclical depression (that is, if depression returns, for example, every year in spring, autumn, or both spring and autumn), then it is easier to survive it with a special diet.
I must say right away: a diet does not cure, but it often greatly facilitates the condition.
In addition, it works for a healthy metabolism, and does not allow you to get fat. And any woman knows how unpleasant it is to be not just depressed, but a fat woman in depression.
So:
Dry red wine and yellow fatty cheeses should be completely excluded from the diet (but Adyghe, suluguni, chechil cheeses, on the contrary, are very useful).
In the morning, you should eat a portion of oatmeal with dried fruits: dried apricots and dried persimmon and wash it down with cocoa. Two words about cocoa: a large mug in the morning is a great Tao, but the same mug for the night is a friend of insomnia (this is often forgotten).
During the day, you can eat vegetable soup or lean borscht with mushrooms, potatoes or durum pasta, rice with seafood in any quantity.
With seasonal depressions, it is better to limit the consumption of meat and chicken: they can only be used once a week, and mutton is preferable from meat dishes.
For sweet chocolate (black), bananas and green tea with honey.
The only problem is that this diet should be adhered to strictly, and being in depression, the strength to maintain the regime is usually not enough.
Here, by the way, the help of relatives is useful, who usually feel restless and helpless next to a loved one suffering from "it is not clear from what".
Physical exercise
Normally, there is a direct relationship between exercise and an improvement in mood (as well as a decrease in anxiety) (for this there are a number of reasons, starting with the production of endorphins, ending with muscle relaxation and specific normalization of metabolism).
During many psychopathological states, physical activity is also shown (although this is a topic for a separate large text).
The first to discover the effect of physical activity on the treatment of depression was the famous Russian psychiatrist V.P. Protopopov (experts know him from Protopopov's syndrome, which is characteristic of depression). This doctor, who deeply studied depression, determined that the metabolism of patients with depression and patients with diabetes is very similar (which is why diabetics often develop diabetic depression).
One of the ways to normalize metabolism and get a person out of depression is physical activity.
The only problem is that during depression you don't even want to get out of bed. Therefore, convincing a depressed person to do whatever physical activity is as easy as convincing a person who has come from a best friend's funeral to sing a perky song.
I have seen with my own eyes only two cases when the loved ones of a patient with depression succeeded (and another person told me about one more, whose opinion I trust): the result was overwhelmingly beautiful.
But in the general case, it is very difficult to do, and even so as not to drive the one whom he was going to help into complete despair. 5
Endogenous depression is characterized by a number of somatic disorders, which are of great importance in the diagnosis of this disease. First of all, attention is drawn to the very appearance of a patient with a rather strong depression: facial expressions are not only mournful, but also frozen, the expression of grief is enhanced by the Veragutt fold; bent posture, when walking, the legs drag; the voice is low, dull with weak modulations or generally unmodulated. For people who knew the patient before depression, he gives the impression of suddenly aging, which is due to a decrease in skin turgor, the appearance or increase of wrinkles; the patient's gaze becomes dull, the eyes sink, the features become, as it were, erased, sometimes the hair loses its shine, and their loss may increase. With the rapid reduction of depression, sometimes achieved with fast-acting drugs, the brightening and rejuvenation of the face and the entire appearance of the patients are first of all striking.
By far one of the most important and persistent physical symptoms of depression is decreased appetite and weight loss. Before the use of modern methods of therapy, refusal to eat and exhaustion, often reaching the degree of cachexia, were, along with suicides, the main threat to the life of patients. At that time, artificial nutrition was very widely used, but even with its help it was not always possible to successfully combat exhaustion.
The effectiveness and expediency in these cases of the administration of glucose and small doses of insulin are very problematic, since the amount of sugar and the amount and activity of insulin in the blood of such patients are not reduced, but even increased.
Severe depressive patients, in addition to emaciation, are distinguished by a "hungry smell" from the mouth, coated tongue and pharynx. However, even in milder cases, there is almost always a decrease in appetite, more in the first half of the day. Therefore, such patients are easier to feed for dinner or lunch than for breakfast.
Constipation is a constant and sometimes very unpleasant and painful somatic manifestation of depression for patients. In some cases, there is no stool during the week, and conventional laxatives and simple enemas are ineffective, so you have to resort to a siphon enema. In some elderly patients, rectal prolapse occurs due to severe constipation during depression. Constipation negatively affects the general somatic state, and sometimes becomes the object of hypochondriacal experiences. Therefore, in all patients with depression, it is necessary to carefully monitor the stool, constantly resorting to various laxatives and laxatives, and in case of severe constipation - to a combination of stronger laxatives or an enema.
Constipation in depression is associated with colon atony, in part due to increased sympathetic nervous system tone. Tachycardia, mydriasis, dry mucous membranes, especially the oral cavity, are also a consequence of peripheral sympathotonia. The combination of these symptoms, especially together with insomnia and anxiety, often leads to an erroneous diagnosis of thyrotoxicosis. However, the content of thyroid hormone in the blood is not elevated.
Disorders in the sexual sphere are common: a decrease in libido, in women, temporary frigidity and cessation of menstruation, in men - a decrease in potency.
Some painful, neurological and muscle disorders are less constantly observed in depression, which, however, have recently received a lot of attention. A large literature is devoted to them, and to a large extent they are connected with the problem of “hidden”, “masked” or “larvae” depressions and “depressive equivalents”, which is so fashionable in recent years. In addition (which is practically extremely important), these symptoms often lead to an erroneous diagnosis of various somatic diseases and depression viewing. They, capturing the attention of the patient and the doctor, can really "mask" depressive symptoms. A number of unpleasant and painful sensations arising from depression are associated with disturbances in the tone of smooth and skeletal muscles. It is possible that the increased frequency of these phenomena is due to an increase in the number of anxiety-depressive states in which they are usually observed. These disorders include: unpleasant, pulling painful sensations in the neck and back of the head, sometimes they resemble cervical myositis. In some patients, cervical myositis occurs at the onset of depression. Similar sensations sometimes arise between the shoulder blades, and the shoulder girdle, in the lower extremities, in the area of the knees, legs. Spastic phenomena are not uncommon: as the calf muscles cramp, more often at night, and to such an extent that in the morning the patients continue to feel severe pain, hardening in the calves. Sometimes it brings the feet and toes together. In a dream, limbs often go numb and numb. This is probably also associated with increased skeletal muscle tone and impaired venous outflow.
As shown by electrophysiological studies of P. Whybrow, J. Mendels (1969), in depression, changes in muscle tone are determined, which have a central origin.
Painful sensations in depression are obviously of a different nature. Sometimes they are caused by smooth muscle spasms; such pains often mimic the picture of an "acute abdomen" - volvulus, an attack of appendicitis, cholecystitis, etc. More often there are compressive, pressing pain in the heart, as well as behind the sternum, less often in the epigastric region, in the hypochondrium. These sensations are commonly described as a "vital component" of longing (in the precordial area) or anxiety (behind the breastbone). In some cases, these pains are attributed to an attack of angina pectoris, myocardial infarction or acute cholecystitis, as a result of which patients end up in somatic hospitals.
The nature of these pains is not well understood. They tend to arise in areas of the sympathetic plexus and are sometimes relieved or relieved (especially chest pain) by the administration of tranquilizers or alpha-blockers (for example, pyrroxane or phentolamine). Intravenous drip of adrenaline in healthy subjects produces sensations similar to those described by patients with depression. Obviously, the burning sensation along the spine belongs to the same group of phenomena.
With depression, attacks of sacro-lumbar radiculitis often occur. The nature of these pains has been clarified: in depression, as well as in stress, mineral metabolism is disturbed, intracellular sodium accumulates, due to which swelling of the intervertebral cartilage and compression of the nerve roots occur, especially if there are predisposing factors for this, for example, the phenomena of osteochondrosis (Levine M., 1971).
There are headaches that compress the back of the head, temples, forehead and radiate to the neck, pains that resemble migraines, and pains that resemble neuralgia of the facial nerve. However, more often patients complain of "lead severity", "stupefying pressure", "turbidity" in the head.
In depression, an algic syndrome is sometimes described, apparently due to a decrease in the threshold of pain sensitivity. Probably, this is, for example, the origin of excruciating toothache, in which the patient requires and often achieves the removal of several or all of the teeth, and other similar pains. It should be noted that, although such cases are relatively often described in the literature, among the mass of patients with depression, they are extremely rare and can be considered as casuistry.
In patients with endogenous depression, a number of biochemical changes are found: hyperglycemia, which, however, according to the preliminary data of I. G. Kovaleva, is accompanied by high insulin activity, hyperadrenalinemia, increased blood clotting, some hormonal abnormalities, etc.
However, one should pay attention to the fact that a significant part of somatic disorders: muscle pain, spasticity, sciatica, acute headaches and abdominal pain, as well as chest pain and hyperglycemia are more often observed and the onset of an attack of depression or precede it, as well as observed with anxiety (this is especially true for muscle and pain symptoms).
Changes in blood pressure deserve special attention in this respect. It was generally accepted that hypertension is characteristic of depression. This point of view is reflected in many manuals. On the other hand, some patients with depression tend to hypotension. Our joint observations with N.G. Klementova showed that in 17 out of 19 patients (mainly women) with late monopolar depression, who had previously suffered from hypertension with high numbers of pressure and tendencies and crises, during the period of depression, but before the start of treatment, blood pressure decreased significantly, and crises disappeared. Perhaps this fact did not attract attention, since in the first 1 - 2 days after admission to the hospital, the pressure may again increase as a result of emotional stress caused by hospitalization, and later on, the decrease in the th indicators is attributed to the action of psychotropic drugs. On the other hand, in some patients (more often with bipolar MPD), such pressure changes were not observed.
There is a concept among doctors - "difficult" patients, that is, patients who are worth a lot of work to diagnose. Some of them experience pain in the heart, stomach, teeth, others have tried all the remedies for headache, but it remains, others suffer from insomnia or shortness of breath, others suffer from skin rashes, some patients can hardly move - lethargy, weakness interfere.
Thorough modern surveys record complete well-being, or reveal abnormalities so slight that they cannot even be thought of as the source of massive complaints. In the end, diagnoses are made, but the trouble is, treatment, even operations do not help. Pains remain, unpleasant sensations prevail. After the next rounds of examinations and treatments, such patients are "transferred" to the category of "incomprehensible", and then they are sent to a psychiatrist. Or maybe such a delay is forgivable, caused by the fact that psychiatrists are just sitting "without bread", in their part, basically everyone is healthy?
In fact, one in four people in industrialized countries is prone to nervous malaise. Due to temporary disability due solely to nervous stress, the United States loses $ 20 billion annually, 80% of all industrial accidents are caused by it.
Nervous stress- A common cause of mental disorders, from mild depression to chronic mental illness. It has been proven that cardiovascular diseases, collagenoses, gastrointestinal diseases, cancer and damage to the vessels of the brain are in one way or another associated with depression. It is about her that will be discussed.
A person lived, worked, not only experienced satisfaction, joy, pleasure, but delivered all these feelings to others. With the onset of depression, everything becomes dull, the connection with the world is disrupted. In order to somehow stay at the same level, a person turns on reserves, in the end they surrender too. Depression forces you to build relationships with others in a new way, but on a painful basis, and the world and its inhabitants are perceived by a person in a different way.
In turn, the environment does not remain neutral, reacts to the changed brother with a whole spectrum of feelings: from pity and sympathy to irritation and indignation, and sometimes hostility: the microenvironment in which the patient revolves continues to perceive him as a healthy person and naturally makes the same demands on him ... For the patient, this is not an episode, but a painful stereotype of reaction, for he exists in a shell, sees the world through a gray, sometimes gloomy glass of melancholy, comprehends and evaluates the environment inadequately. The very fact of communication is an unbearable burden for him. And this is the constant background for many months.
For some, depression is fatal. This is perhaps the only disease in which life is devalued and there is a desire to leave it. Moreover, such a thought is perceived as a salutary blessing, as the only way out.
Classic depression is characterized by depressed or dreary mood, decreased mental activity, combined with movement disorders and some somatic disorders. Every healthy person must have experienced a state of depression - and more than once. This is a normal reaction to unpleasantness at work, an undeserved insult, or severe grief.
Pathological depression, depression as a disease, is distinguished either by its too long duration and excessive intensity, or by the absence of an objectively significant traumatic stressful situation in the period of a person's life immediately preceding it (depression).
In our case, we will just talk about states that do not manifest themselves in a classical form, we will talk about a variety of masks that the so-called latent depression.
Any disease is the suffering of the whole organism: its physical and mental spheres. In mental illness, bodily (physical) disorders are also observed to one degree or another. With somatic diseases, there is always a deviation in the psyche.
In cases of latent depression, various bodily manifestations come to the fore. Actually depressive disorders, being erased, unexpressed, seem to recede behind the scenes: the somatic curtain of complaints hides depression.
The severity of depressive disorders (despite the most diverse covering facade) is often shallow, but still has its own boundaries.
Recall that true depression is characterized by a depressed, melancholy mood, mental and motor inhibition, a change in somatic tone. If depressive disorders are not pronounced or if there is no motor and mental associative inhibition, then we are talking about incomplete (reduced) depression.
As the center of gravity of the manifestations of depression shifts to the bodily sphere, when somatic symptoms (physical pain, discomfort) come to the fore, and the mental component (mood) fades into the background, then they talk about masked depression.
Finally, somatic disorders fill the entire clinical picture. The physical sounds so bright, powerful and convincing that the mental (depressive) is not detected, not recognized by the patient. Therefore, patients talk only about somatic manifestations, complaining of pain and discomfort, do not notice a reduced, depressed mood. In this case, we are dealing with depressive equivalents.
A purely practical question also arises: is it legitimate to transfer traditional methods of treating depression to masked or depressive equivalents? According to these methods, therapy should be "shock" with increasing doses for the earliest possible elimination of the mental component. But in our case, it is replaced by a somatic one. That is why, in the treatment of these conditions, we have abandoned the maximum doses and switched to the minimum. Practice has confirmed the correctness of this decision.
Such different masks
We want to tell you more about the condition, which has received several names: "latent" depression, "depression without depression", "larvae", "somatic", "smiling", "foggy", in short, in all cases here the mental manifestations of the disease are erased, are hardly noticeable, and physical, bodily - become predominant and obscure the true disease, direct the thinking of the somatic doctor and the patient along the wrong path. As a result, the true root cause of the disease - depressive disorders - is not noticed.
The disease is also called disguised - it hides its face, dresses up in other people's clothes.
Feeling of heaviness, a burning sensation, pressure in the chest, constipation or diarrhea, the formation of a large amount of gas in the intestines (flatulence), dizziness, a feeling of tightness and constriction when breathing, hair loss, a feeling of a lump in the throat - this is not a complete list of complaints of patients suffering from masked depression.
Pain is a very common symptom and is usually accompanied by deep anxiety and tension. They can be localized in any part of the body, usually intensify in the predawn hours, are characterized by possible migration, uncertainty. Patients find it difficult to describe these pains, find it difficult to choose words to convey sensations, emphasizing their painful deep nature, but clearly distinguish them from the sensations of ordinary physical pain. Patients complain: "strangles", "crushes", "bursts", "gurgles", "pulsates". The pains are prolonged, dull, lasting from several hours to several days, months. Less often they have a sharp, stabbing, cutting character - "pricks like an awl", "a stake under the shoulder blade", "like a knife in the chest."
Very often a certain "package" of sensations associated with a specific localization becomes a mask of depression. Then we have to talk either about the abdominal syndrome ("bloating", "vibration" of the stomach, "swelling" of the intestines, constipation or diarrhea), or about the agrypnic syndrome (inability to fall asleep, more often - awakening before dawn). With arthralgic syndrome, patients experience incomprehensible excruciating pain in the joints, spine, feel that there is something extraneous in their body that interferes with walking and, in general, any movement. Painful sensations in the region of the heart - squeezing, aching, nagging pains indicate a cardiac mask.
The increasing psychological and emotional stress against the background of changes in the general reactivity of the body leads to the fact that mental disorders are increasingly masked by bodily disorders. How to evaluate the sound of the somatic (pain, discomfort)? Is it only as a manifestation of the disease? Why is there no such representation of the bodily component in classical depression? Maybe because the body does not need it, because there is an awareness of mental ill-being? When it disappears, the body begins to ring a bell and informs about malfunctions in the "upper floors" of power - in the brain, signals this from the periphery of its cortex with pains and unpleasant sensations. Apparently, there is a biological expediency in this.
I would like to draw particular attention of the reader to the mask of depression, which can be called glossalgic. Glossalgia - diseases of the tongue and oral mucosa; their main symptoms are burning, tingling, rawness, itching, numbness, often combined with pain in the tongue.
In such conditions, both the patient and the doctor face serious difficulties. Depressive disorders (depression, depression, anxiety) are so similar to those accompanying dental diseases that, of course, they are perceived as secondary.
The patient claims that his teeth hurt. He demands to remove them! And often, at the insistence of patients, not only one or two teeth are removed, but all of them. This is the mask of depression!
These patients, by the way, also complain of dry mouth, tingling, tingling, creeping creeps, feeling of "hair on the tongue."
One of the most common variants of latent depression is sexual dysfunctions. They are not only the most persistent, but perhaps the earliest signs of incipient depression. With the growth of depressive manifestations, changes in the sexual sphere are aggravated: the duration of intercourse changes, desire decreases, orgasm dulls.
Patients, not realizing the decline in sexual functions, strive to preserve the previous stereotype of sexual relations, in fact, make increased demands on themselves, and this further aggravates the existing disorders and even more severely traumatizes the psyche.
Headache as a mask of latent depression dominates the manifestations of the cephalgic syndrome. Patients emphasize its stubborn, painful nature, complain of burning, bursting, heaviness, constriction. The exact location of headaches is sometimes difficult to pinpoint.
Along with headache, patients often experience dizziness, imbalance of the body, unsteadiness of gait. "The earth is sinking underfoot", "pulling to the side all the time", "darkness before the eyes."
The abundance of somatic complaints that do not fit into the framework of a specific disease, the absence or transience of organic changes, the ineffectiveness of somatic treatment - all this is enough to suspect latent depression.
Young people have their own problems
While in adults the depressive syndrome has been studied more or less fully, in children such studies are still just beginning. There is still no consensus about the age at which depression may appear. Some authors believe that depressive phases occur even in children under 10 years of age. Other researchers question this. All experts, however, agree that recognizing depression in children is difficult.
Sleep disorders, bouts of tearfulness, agitation, headache, tics in preschoolers may have a depressive origin.
In school-age children, latent depression sometimes takes the form of disobedience, laziness, schoolchildren do not have time to study, run away from home, and enter into conflicts for any reason.
With latent depression in adults and children, functional disorders manifest themselves in different ways. So, respiratory ailments, pain, sweating are not observed in children, but they have manifestations of the disease that are absent in adults suffering from latent depression: enuresis (urinary incontinence is observed in 30% of children), mutism (silence, lack of both response and spontaneous speech with an undisturbed ability to speak and understand someone else's speech), difficulties in communicating with others. Such conditions occurred either for no reason at all, or after minor troubles. The existing disorders often did not take pronounced forms and had diurnal dynamics. Parents usually associated them with overwork.
Everyday life, unfortunately, gives us many examples of an illusory way out of depression: youth's fascination with palmistry, religion, "hard rock", "light and heavy metal."
Of course, I am in no way claiming that the general adherence of modern youth to "rock" indicates that all young men and women are "hidden depressants." However, I have no doubt that it is precisely young people suffering from depression that are the core, the basis of the so-called “difficult”, “unmanageable,” “rockers,” and other restless people, those about whom there has been so much debate lately — acute and contradictory.
The unsightly and socially significant masks of depression are alcoholism and drug addiction. We are not talking about alcoholics and drug addicts in general, but only about those suffering from latent depressive disorders. It is the recurrent depressive and bodily disorders that become the impetus for alcoholism and drug addiction. Yes, latent depression has a lot of manifestations, and the patient needs to describe in detail his feelings, analyze his mental and physical condition, but the main thing for a doctor is to synthesize the collected information and make a diagnosis.
Emotions that don't fade
We (whether we like it or not) give an emotional assessment to all the influences of the social and biological environment, events happening around us, inside the body, and the very first assessment (even before the inclusion of thinking) is always polar: “either-or”. But not everything can be realized. With complete well-being in the body, a person experiences comfort, and failures in his work are accompanied by anxiety, anxiety.
These polar states have a corresponding biochemical support in the form of changes in the sensitivity of brain neurons to biological perulators of its work - mediators or neuropeptides - and are called the capacious word "emotions". The external manifestation of emotions is judged by facial expressions that express a state of satisfaction or suffering. Their internal manifestation can be precisely those pains or discomfort that we talked about above. They are closely related to the biological sign of emotion. If positive emotions cause short-term reactions (blood pressure rises, pulse rate increases), then fear, anxiety, melancholy, low mood (negative emotions), involving the vessels of the heart, brain, smooth muscle organs (stomach, intestines) in the reaction, lead to undesirable , serious consequences. By an arbitrary effort of will, we can prevent an external outburst of emotions - we restrain ourselves. However, the resulting negative emotion (excitement) remains in the central nervous system and spreads to the internal organs. Such "delayed" emotions have two features: the first - they manifest themselves in the form of pains and unpleasant sensations and the second - are overgrown with countless reasons for self-swaying (heightened trace sensitivity) and therefore become almost constant. Even if the negative emotion or their chain passed, they could even be forgotten, but the trace remained.
And this trace is long-term memory, which is always emotional. The negative emotional coloring of life-threatening states leads to the formation of certain cliches-matrices, which subsequently play a double role. On the one hand, they protect, save a person from a possible meeting with danger, reminding him of the corresponding emotional state. On the other hand, emotional traces in the memory of certain painful phenomena become a source of reproduction of the “picture of the disease,” that is, ready-made cliches, under the influence of any negative emotional stimulus, whether or not associated with the suffering suffered. Consequently, the "picture of the disease", its manifestations are ready, they are waiting for some external or internal reason to emerge, appear on display, although the objective indicators of health in a person are the same as in any other, who works a lot and fruitfully and carries the burden of social worries ...
Of paramount importance in the "resurrection" of the disease is the internal hidden accumulation of numerous negative stimuli (emotional, intellectual, etc.), they create a pre-start emotional state, until a certain time does not declare or perceive itself by a person, but this process is unconsciously controlled by memory. In such cases, a very insignificant reason may become a "starter", which launches a long-standing picture of the disease. So, the cause of disturbances in the state of health in the emotional, mental state of a person.
The main signs of masked depression
1. Mandatory presence of mild depression. the inability to rejoice and enjoy life as before, difficulty in communicating with others, the desire for solitude, limited contacts, a decrease in the previously inherent energy and activity, difficulty in making a decision.
2. An abundance of persistent and varied pains and unpleasant sensations, which are of a peculiar nature, which are difficult to describe. Absence or insignificant severity of organic changes that do not explain the nature, persistence and duration of complaints.
3. Disturbance of sleep: reduction of its duration and early awakening. Decreased appetite, weight loss. Changes in the menstrual cycle in women, decreased potency in men.
4. Daily mood swings, improvement during the day.
5. Frequency, waveform of existing somatic, mental disorders. Spontaneity (causelessness) of their appearance and disappearance.
6. Seasonal, most often autumn-spring. the preference for the manifestation of both somatic and mental disorders.
7. Lack of effect from somatic therapy and a positive response to antidepressants.
If you find common patterns in the manifestation of latent depression, try to tell your doctor about them, do not hesitate and do not be surprised if the doctor refers you to a psychotherapist, neuropsychiatrist, psychiatrist for consultation.
Doctor of Medical Sciences V. Desyatnikov.
Repeatedly, each of us has heard stories of incredible fortitude. When doctors voice the "diagnosis-sentence", but the person does not despair, fights for his health and, despite all the sad forecasts, the disease wins. Such seemingly miracles happen solely thanks to the strength of the spirit, self-confidence and incredible dedication. But, unfortunately, there are not very happy stories. It happens so that the power of the spirit affects a person negatively. In this case, various disorders and ailments begin, physical health suffers, although in fact deep, latent depression predominates.
Somatized depression is atypical, hiding under the guise of complaints of the somatic or vegetative plan
Depression is one of the most important problems in modern medicine. Scientists say that by the end of 2020, this ailment will become the main cause of disability, and will also be the second on the list of diseases after cardiovascular diseases. Although this is no small matter, very little time is spent on it. In general medicine, not enough attention is paid to the diagnosis and treatment of such diseases. Determining the number of patients with such a disease has yet to be. Previously, various terms and criteria for depression were used, therefore, a lot of people with a similar problem went unnoticed. Most often, women are sick, men are more resistant to the disease.
The very word "depression" is not entirely relevant. In medicine, it is customary to say "depressive disorders." Doctors divide this concept into:
- unclassified disorders (6 subtypes);
- major depressive disorder;
- dysthymia.
Major depression is more common in psychiatric practice and refers to a rather severe manifestation of the disease.
Latent (somatized) depression is a non-standard disease... It is characterized by many vegetative and somatic complaints, behind which a true ailment is hidden. It belongs to mental disorders. The latter were discovered back in the distant 19th century. In different countries of the world it is called differently, in the CIS countries - "hidden", in England and America - "masked", in Germany - "larvinated" depression. In addition, the common name is "depression without depression."
This disease is not easy to recognize. She can hide behind a wide variety of diseases. It so happens that a patient visits medical institutions for a long time, takes a million tests, undergoes treatment for a variety of ailments from many specialists, but in fact it is necessary to get him out of a depressive state. For example, a person treats diseases of the heart, blood vessels, stomach or intestines, but you need to consult a psychotherapist.
As for the clinical picture, the patient hides his bad mood, melancholy, pessimistic views of others, the inability to rejoice in the future for a number of complaints, which he explains by diseases that have not been identified in him. A person can talk about incomprehensible hot flashes and cold, headaches, sweating, that the whole body aches.
Somatized depression is very difficult to recognize, which is why it is called "latent" depression
Depression symptoms and somatic feelings
Since the disease is complex in nature, the symptoms are very diverse. If the treatment takes place in a hospital, and the ailment has intense and pronounced symptoms, then there are practically no difficulties in making a diagnosis. Mild symptoms are another matter. In this case, the doctor, at the first contact with the patient, is unlikely to be able to correctly determine what happened, to make the correct diagnosis.
Symptoms of depression can be axial as well as secondary. Somatic symptoms fall into the first category and include depressed mood, slow thinking and movement, and fear.
Pain is one of the masks behind depression... They can change their location or appear throughout the body, in addition, analgesics often do not work as they should. Symptoms may be more severe at night or early in the morning. People try to "save" the diseased organ, stop physical activity and create their own daily routine.
The second mask is a change in the "wakefulness-sleep" mode, or in simple words, insomnia... A person, as a rule, does not fall asleep well, sleep is very sensitive and restless. The patient may wake up frequently or suffer from nightmares. Sleep does not allow the body to rest, as a result, a person feels not poured in in the morning, and dreams of a pillow during the day. The most striking symptom of somatized depression is early awakening, which is accompanied by hopelessness, longing and unwillingness to eat.
Nutrition and weight problems are also considered signs of somatic depression. Some patients lose weight very quickly and become anorexic. Others, on the contrary, suffer from uncontrolled overeating, gain excess weight.
Insomnia is one of the clearest signs of somatized depression.
Asthenia is the most common symptom of depression... Somatic sensations: poor performance, which does not depend on the load. It rises after a long break, rest, and even sleep. The patient speaks of absent-mindedness, lack of concentration during work, difficulty in eliminating any problems, as well as fatigue from daily household chores.
The disease hides behind the mask of asthenia and increased anxiety. These signs hide an insidious ailment.
How to diagnose somatic depression (DM)
In order to identify DM, some main signs are used. First of all, the patient should be examined for all his complaints, pains and ailments. It is necessary to establish whether they correspond to the current state of the body, to exclude the effect of "general somatic" therapy, and also to analyze the effect of psychotropic substances on the patient. If medications have a positive effect, it can be assumed that the cause of endless ailments and pains is a depressive disorder.
When a person has recently been in stressful situations, depends on drugs, alcohol and medications, the presence of such an ailment cannot be ruled out. Mild depressive conditions, attempts at suicide, the use of psychotropic drugs, as well as the presence of close relatives with mental disorders can signal that a person is prone to illness. During masked depression, seasonal exacerbations occur (autumn-spring period), the symptoms appear brighter in the morning, in the evening there is an improvement in the general condition of the patient.
Only an experienced specialist can make the correct diagnosis
Treatment methods
"Depression without depression" is a rather insidious disease, it brings a lot of problems not only to the patient, but also to his doctor. Since the doctor often hears stories about poor work of the heart or gastrointestinal tract, it can be quite difficult to identify the true cause of complaints. Moreover, lack of mood, depression is an adequate response of a person to health problems. But affective disorder will eventually make itself felt by false symptoms, which are most likely triggered by a feeling of fear. When, in the treatment of an ordinary disease, the doctor does not see a positive result, it is worth contacting a psychologist or psychotherapist. Only this specialist will help to bring the patient out of the state of depressive disorder, which will qualitatively improve the general physical condition of the patient.
There are two ways to treat an ailment:
- psychopharmacologically;
- psychotherapeutic.
The first method involves the use of a variety of drugs (antidepressants). Psychotherapy uses the methods of cognitive-behavioral therapy.
In addition to the above methods of dealing with the disease, doctors may recommend herbal medicine (herbal treatment).
Since the main symptom of masked depression is sleep problems that complicate the overall course of the disease, the main task of the doctor is to restore sleep and activity. As you know, sleep is the best medicine, it helps to relieve fatigue and reduce irritability. In order to eliminate such problems, the doctor may recommend herbal anti-anxiety medicines that act as sleeping pills. They have no side effects, are well absorbed and are not addictive, unlike conventional sleeping pills.
Treating depression with antidepressants is just one of the treatments prescribed by doctors
Phytopreparations, in addition to the main action, can have a positive effect on intracellular metabolic processes, as well as the state of cells and tissues of the body.
Medical practice has repeatedly proved that certain herbal preparations are most effective for treating somatic depression. For example, herbs that have tranquilizing and antidepressant effects are best suited for treatment.
Additional treatments include massage, meditation, long walks, and exercise and sports. Doing things you love, communicating with pleasant, interesting people have a positive effect on the body.
It is worth remembering that each person has individual symptoms, the disease can manifest itself in different ways. An important factor influencing the course of the disease is the patient's age. Depression is easier for young people than for older people. In spite of everything, it is impossible to close in oneself with one's problem! Remember, it takes time to fully recover. It is necessary to strictly follow the doctor's prescriptions and stubbornly go towards recovery. Do not be afraid to talk about your fears, contact people with a similar problem, support each other, rejoice in positive events, success. Never give up in the fight for both your physical and mental health.
Loading ...