Endogenous depression - Causes, symptoms and treatment. MF.

Depression -( Latin depressio depression, oppression, synonym: depression, melancholia) - a condition in which a person is continuously marked by a depressed mood, a decrease in mental and motor activity.

The frustration of such a plan does not lead to an intellectual defect and a grave violation of social adaptation, but it is worth remembering that about 10% of people suffering from depression commit suicide. That is why the depressive syndrome should be treated by a doctor. However, in our country it is considered shameful to address a doctor-psychiatrist( and in severe cases such patients are engaged in it).The fear that "he will register, the neighbors will thumb to show," "they will heal there, then become real mad" covers the real danger of the consequences of depression. Meanwhile, from depression nobody is insured. Let's try to figure out who gets in its network first.

There are quite certain risk groups: they are people aged 20-40 years, men after or during the divorce period, single women( especially in the postpartum period), the presence of suicidal facts in the gynaeological tree, teenagers who lost parents after 11 years. Also -people who have suffered severe or chronic stress, experiencing problems of sexual satisfaction, homosexuality, a decline in the social class. Thus, a fairly wide range is obtained. And the above 10% of their number, it's not so little.

Take a closer look at the nearest surroundings and be on your guard if someone from your family or friends starts to complain about bad sleep, appetite, depression. Sometimes you can hear direct statements about the unwillingness to live, the sense of worthlessness of existence, depression, weakness. Expressed in scientific terms, one can see hypobulia( decrease in the volitional component), hypnosis( decrease in volume and stability of attention).there is no strong-willed effort to memorize information. Reduced the instinct of self-preservation, food, sexual instincts. There is a devaluation of his life. Suicide risk is high at the "exit" of depression, when the affect remains, but disinhibition appears, hypobulosis disappears. The patient has the opportunity to organize suicide.

Many people suffer from "matte" depressions, i.e.not strongly pronounced. These depressions are most dangerous for suicidal risk. It is important to pay attention to the presence of tears - if they are not, the condition is regarded as severe. As soon as tears appear, the condition improves. It is useless to talk with patients in serious condition, to cheer and dissuade the patient, especially since this can lead to the opposite result. Characteristic for such people and the feeling of "slowed down the flow of time."

Endogenous depression( unipolar affective disorder) is a consequence of impaired brain function, nervous and endocrine system.

Unequivocally clinical case, its development does not depend on external causes and the appearance is not a consequence of any life-threatening traumatic events. But sometimes there are facts that can mislead the experts. Most often, endogenous depression leads to:

- a deficiency of endogenous amines - have antioxidant properties( antioxidant) that simulate and generate oxidative processes in the body, thus preventing it from deteriorating very quickly.
- a decrease in the level of norepinephrine, which is synthesized from dopamine for the most part in the adrenal cortex, is similar in its properties to epinephrine. Responsible for our wakefulness and our activity, in stressful situations, provides an immediate reaction like "hit or run", increases concentration, increases heart rate, raises the pressure of
- a decrease in the level of serotonin that affects motor activity, vascular tone, and other propertiessimilar to adrenaline.

Endogenous depression can be observed in diseases of the thyroid gland or adrenal glands, cardiovascular diseases, neurological disorders.

Thus, endogenous depression is a deeper violation of mental and physical activity than all other types of depression. Man does not perform the simplest tasks associated with self-service, the use of physical force. Often such patients experience a sense of guilt, think about suicide with a tendency to realize.

In the case of development of endogenous depression, psychotherapy is ineffective. Patients are severely depleted mentally and physically in order to work with the therapist and carry out his tasks. This clinical case requires unconditional treatment from a psychiatrist and, if necessary, placement in a medical hospital.

Statistics say that 50% of patients suffering from monopolar depression are trying to commit suicide, 15% percent still manage to complete the plan. Endogenous depressive episode lasts about 6 months, but there are deviations, plus minus two months. Often patients recover completely when they manage to connect the disease with any somatic( bodily) disorder and eliminate the cause, and sometimes goes into a chronic form and need to take maintenance treatment with antidepressants for life.

If you notice anything similar to yourself or your loved ones, contact a psychotherapist or psychiatrist. Depression can be treated if it is not started.

Diagnosis of depression

In parallel with the conversation aimed at identifying the causes of the disease( stressor, psycho-traumatic situation and other circumstances of the patient's life), the doctor can prescribe a survey aimed at identifying a disease that simulates or provokes endogenous depression. These may include blood diseases, anemia, changes in hormone levels, occupational hazards, etc.

Survey methods relating directly to depression also do not carry anything terrible in themselves. For example, apply:

1. Carroll test - dexamethasone test - while controlling the level of cortisol in the urine and blood after giving dexamethasone.

2. Coarse disturbances of sleep phases are monitored( REM - the phase that occurs after 90 minutes is normal, "creeps forward" with endogenous depression).Similarly - with depression, biorhythms are disturbed - night concentration of urine, body temperature is increased.

Treatment of endogenous depression

Treatment includes the proper selection of medications, long-term antidepressant therapy and corrective psychotherapy aimed at smoothing the character traits that provoke the development of the disease. To begin with, eliminate organic diseases that could lead to depression, and if any - treat them.

Biological methods for treating depression directly are as follows:

1. Phototherapy( exposure to bright light, or vice versa - darkness - but the latter method is less common).
2. Deprivation( deprivation) of sleep either by 12 or 36 hours. Cycle - within a month. Deprivation is very effective, but unstable, so it is combined with antidepressants.
3. Medicines. Principles of drug therapy are as follows: monotherapy + long-term treatment( 2 months -purchasing, 6 months-fixation of the result, year-remission formation).Use antidepressants.

With all antidepressant medications, a "serotonin shock" is possible, so you should carefully select the dose. Do not prescribe antidepressants yourself, the doctor will choose the best dosage for you.

When subdepressions are used, citalopram is a drug from a group of selective blockers for re-uptake. This drug "register" is lower than classical antidepressants, but it is well tolerated.

Classic complications in taking antidepressants - atony of the bladder( detrusion - difficulty in releasing urine), dyspeptic disorders, weight gain, potency disorders, tachycardia, visual impairment.

The doctor and myself can be helped. To him - to alleviate the task, to himself - to cure as soon as possible. What is desirable before visiting a doctor: Sleep! Lack of sleep breaks the rhythms and phases of sleep, and they are already "knocked down".

It is desirable to eat is simple and balanced, there is no special diet, but it is not worth overloading the pancreas. It is known that in the overwhelming number of cases, women "depress" depression, and men "wash down".That's it to drink and then you can not - often there is a rapidly emerging mental and physical dependence, while the clinical manifestations of alcoholism come to the fore. Dependence in this case is formed ten times faster than not in depression. Just try to change the interior of your home - more light colors, "air" curtains, rather than heavy curtains, bright colors.

Depression, regardless of the underlying cause, recur, especially in women( 1/3 for 1 year, 2/3 - 3 years).In children, depression in the classical form can be seen after 10 years.

More in the article "Treatment of depression" & gt; & gt;

In the practical work of a doctor, the following situations may occur.

- The patient is in an extremely depressed state, including stupor, refuses food, physically noticeably weakens. The primary task of the doctor is to get the patient out of a state that threatens his life. Unfortunately, none of the drugs known to us does not have the ability to quickly and without much harm to the patient withdraw it from a state of severe depression. We recommend, without losing precious time searching for a particular medicine, in such cases immediately apply electroconvulsive therapy, and then, depending on the circumstances, continue the same method of treatment or go on to pharmacotherapy. The experience of treatment of depression in our country testifies to the effectiveness of intensive psycho-pharmacotherapy in such cases. Electroconvulsive therapy is usually used later, when resistance to antidepressants is revealed.

- If the patient is depressed, hypobulic, but there are no manifestations of stuporosis, pharmacotherapy should begin with the appointment of antidepressants that have an activating action - monoamine oxidase inhibitors or tachytymoleptics( desipramine, nortriptyline, etc.).

- Sometimes the initial stage of psychosis manifests as agitation and a strong affect of fear. Here, sedative and relieving antidepressants - amitriptyline and trimeprimine are useful;if necessary, then in combination with some neuroleptics: levomepromazine, chlorprotixen, thioridazine. With sharply expressed agitated involutionary depression, we consider it right to start electroconvulsive therapy without delay, if there are no direct somatic contraindications. Antidepressants are slow, and waiting is not always advisable.

- The most characteristic symptoms of endogenous depression are vital anguish, despair, depression. In these cases, treatment begins with the appointment of drugs that raise the mood: imipramine, melitracene, etc. Methods of application of drugs. In those cases, when a rapid and massive psychotropic action( stupor, agitation, etc.) is shown, the dose of the drug should be rapidly increased. It is most reliable to begin treatment with injections: they do not cause sharply pronounced side effects. The effect of the medication appears between the 5th and 20th day, although a later manifestation of this effect is not ruled out. The interval depends on the individual characteristics of the patient, as well as on the dose of the medication, which are determined by age, sex, depth of depression and duration of the disease. Children and the elderly are prescribed smaller doses. During the first day, the dose of the drug( 25-75 mg) is divided into three doses: the latter should be timed to the afternoon, i.e., 16-17 hours to avoid disturbance of sleep. Doses increase gradually to an average of 200 mg, but not more than 300 mg. This applies to all types of antidepressant drugs. 2. As the patient's condition improves, the dose is reduced to about 100 mg per day.

The question of the duration of treatment after the complete disappearance of psychopathological symptoms remains controversial.

Antidepressant therapy should last about 6 months, that is, as long as the spontaneous resounding of the phase of the disease lasts. Considerations are based on the fact that in schizophrenia and endogenous depression, antidepressants do not affect the disease itself, but only its symptoms are removed. So, the disappearance of depressive phenomena does not mean the elimination of depression. Therefore, premature cessation of treatment conceals the risk of a new attack. But there is an opinion that antidepressant therapy not only eliminates symptoms( i.e., symptomatic action), but also shortens the very phase of the disease( pathogenetic effect), which is characteristic for the onset of true remission even after short-term treatment. It is especially important in the preparation of the treatment regimen to provide for a cautious( not sharp) reduction in the doses of the medication, especially a sudden cessation of treatment is dangerous. Often the patients themselves realize the onset of a true and lasting improvement in their health. To these estimates of patients, the attending physician should always listen. The beginning of radical improvement is the moment when patients express complaints related to disorders of the autonomic nervous system, characteristic of the disease itself.

Therapy for Endogenous Depression

Modern psychopharmacology has so expanded the possibilities of treating endogenous depression that traditionally used psychotherapy has lost its relevance and has moved to the background. More and more often it is possible to observe how not only general practitioners, but also psychiatrists are limited to the simple appointment of antidepressants, completely ignoring the psychotherapeutic component of the therapeutic process. At the same time, psychotherapy optimizes treatment, improves the effectiveness of pharmacotherapy. Practice shows that psychotherapy for depression is dynamic and multifaceted. It can vary depending on the clinical picture of the disease, the patient's response to his condition, the stage of treatment. In this communication, we will focus only on some of its aspects.

As a rule, in addition to the depressive disorders proper, a sudden reaction to depersonalization is noted in patients. They are discouraged by their change, they are confused, they try to explain this by external circumstances, they constantly face a misunderstanding of others, often giving them wrong advice: "Get ready, pull yourself together, change the situation," etc. In the classical depressive triad, patients are usually concentrated on intellectual retardation and incomprehensible loss of interest for them. When anxiety is worried, they are worried about constant and poorly explaining anxiety, aimed at their own condition, and on various, even insignificant events. With masked depression, patients who are tired of endless somatoform disorders first of all ask the doctor to help them understand these feelings, advise some additional examinations, complain about insufficient qualification of specialists who are unable to diagnose them correctly.

The psychotherapeutic session at the first reception begins with an explanation to the patient that his condition is fully understood by the doctor. Knowing in detail the structure of the depressive syndrome, the doctor builds a conversation so that the patient is surprised whence the doctor knows those disorders that he has not yet managed or forgot to tell. The patient feels that they have finally realized that his condition is not unique, but it is well known that he does not need to conduct any more endless examinations. It immediately calms down, and contact with it is fully established. Taking into account the personality of the patient, his condition, intellectual and educational levels, the doctor determines the expediency of explaining the essence of the disease and the mechanism of action of drugs in rational psychotherapy. In some patients, this optimizes the healing process, in others - the overload of information on the background of intellectual inhibition can cause a negative reaction. In all cases, clear, optimistic language should be used, for example: "All such depressions pass, your condition is curable", etc.

The modern treatment of endogenous depression in the vast majority of cases is carried out using psychotropic drugs. This necessarily requires psychotherapeutic support. Where drugs cause side effects, for example, dry mouth, constipation, drowsiness, disruption of accommodation, it is necessary to warn the patient about this, to calm down, to say that the first reaction of the body to the drug is usually a reaction to the side effect that the therapeutic result comes later.

Psychotherapy takes on special significance in cases of prolonged depressive phases lasting more than 6, 12, and sometimes considerably more months. Most often, this is a shallow depression, more likely a hypothyroidism that arose after long, sometimes perennial periods of hypertension with high intellectual, creative, business activity, which the patient considers his norm. Such a contrast in a state subjectively increases the depression. Emotional and intellectual dullness plunges the patients into despair. The problem is aggravated by the fact that such "matte" depressions are often resistant to pharmacotherapy. The doctor has a long time, patiently choose drugs and doses. It should be borne in mind that these patients do not tolerate side effects caused by drugs: complain of increasing lethargy, weakness, inhibition. In long psychotherapeutic sessions, the main emphasis is on maximizing the use of the slightest improvements in the state for social and labor adaptation of the patient. Thus, the so-called "windows" are important. They arise due to the classical diurnal rhythm of depression, and due to short-term improvements caused by medications. Usually patients who are tired of the monotonous state, they do not notice, becauseeagerly waiting for a full exit from depression. The task of the therapist is to persuade the patient that, without waiting for the final recovery, actively participate in life during these "windows".For example, when they appear in the afternoon, transfer all important things closer to the evening, use these gaps for an active life. Such short-term improvements allow the doctor once again to convince the patient of the curability of his condition: once lumens have appeared, then his opinion that he is incurable is erroneous. Sometimes it helps to maintain a diary, where the patient records fluctuations in his condition, calculates the amount done in a day, a week, etc. It turns out that objectively, his state is better than he thinks. It should also be taken into account that the smooth mood achieved by treatment often does not suit such a patient. He will consider himself healthy, stop showing depressive complaints only when his condition again becomes hypertensive.

Practice shows that such classical techniques as hypnosis and auto-training are not only ineffective in severe endogenous depression, but can even have a bad effect on the patient's condition. This is due to the fact that with psychomotor retardation the patient is not able to concentrate attention on the words of the doctor, can not provoke the corresponding sensations and gives a negative reaction to it. This effect is particularly pronounced in anxious depression. Endogenous anxiety can worsen when the therapist tries to cause muscle and emotional relaxation.

Family therapy is very desirable in the treatment of endogenous depression. This is especially important in cases where the clinical picture is somewhat blurred, not very pronounced, accompanied by irritability of the patient, externally inadequate behavior, sometimes with alcohol abuse. Close patient needs to explain the true reason for such a change, which basically consists in the patient's reaction to his mental disorganization. Understanding of the mechanism of the disease by relatives contributes to a positive correction of their behavior towards the patient. In particular, they can be recommended not to try to "hinder" the patient, entertain them by visiting crowded places, etc. When psychomotor retardation, emotional dullness, staying in a crowded circle often causes deterioration.

The following are the most important elements.

- The action of psychopharmacological agents is relatively slow and impatience is harmful and unjustified, the patient must understand this. The patient should also understand the nature of some possible phenomena accompanying the treatment, so that he does not interpret them hypochondriacally.

- A gentle mode is required. It is important that the hours of classes and rest alternate depending on the day's fluctuations in the mood of the patient.

- We should not insist on the rapid inclusion of the patient in the life of the collective of the department or involve it in labor or in another activity, since melancholic hypoblasia and inability to make decisions are painful obstacles for the patient to any manifestation of activity.

- There is no need to demand from the patient frequent and detailed reproduction of his delusional experiences, and not to rush to refute their logical arguments, since attempts of this kind push patients to find new arguments to prove the plausibility of his delusional products.

- In a conversation with a patient, it is necessary to avoid topics related to his duties of a public and family nature, as well as not to address the issues of his profession and vocation.

- Activation of the patient should be carried out gradually, as the motor inhibition decreases and the strong-willed functions become stronger. The trust of the patient and the doctor is very important. The doctor should inspire the patient that he trusts him, is convinced that he will not encroach on his life, since this alone can awaken the patient's sense of responsibility to the doctor;thus making unnecessary and inappropriate attempts by logical arguments to persuade a patient to abandon suicidal intentions.

Relative to patients with melancholy, it is useful to use the following two methods. One of them is a multiple explanation to the patient that, no matter how severe the suffering caused by his morbid condition, the disease itself proceeds according to the inherent regularities. I can give some examples. So, an easy, seemingly infectious disease can take an undesirable, even fatal character. At the same time, there are diseases that cause minor suffering, but have a bad outcome. The sickness of the patient, no matter how prolonged and whatever suffering causes, sooner or later must end in complete recovery.

Another device is an appeal to the patient's honor and the requirement of a promise that he will show patience throughout the treatment that he will share with the doctor when despair begins to increase especially. This psychotherapeutic approach, which has long been applied to all patients suffering from melancholia, as a rule, had a positive effect, which was later noted by the patients themselves. If patients are prone to hypochondriacal experiences, it is necessary to warn them about side effects caused by the medicines used.

To which doctors to contact if depression occurs:

- Psychologist
- Psychiatrist
The endocrinologist, cardiologist, neurologist, and surgeon may be needed.