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I. GENERAL INFORMATION ABOUT DEPRESSION 

Depression is a disease of our time 

Studies around the world show that depression, like cardiovascular disease, is becoming the most common ailment of our time. It is a common disorder that affects millions of people. According to various researchers, up to 20% of the population of developed countries suffers from it .     

Depression is a serious illness that dramatically reduces the ability to work and brings suffering to both the patient himself and his loved ones. By Unfortunately, very few people are aware of the typical symptoms and effects of depression, so many patients care is provided when the state takes a long and severe, and sometimes – and not at all turns. In almost all developed countries, health services are concerned about the situation and are making efforts to promote information about depression and how to treat it.                 

Depression is a disease of the whole organism. Typical signs of depression 

The manifestations of depression are very diverse and vary depending on the form of the disease. Let’s list the most typical signs of this disorder:   

Emotional manifestations

• Longing, suffering, depressed, depressed mood, despair
• Anxiety, feeling of inner tension, anticipation of trouble
• Irritability
• Feelings of guilt, frequent self-accusations
• Self- dissatisfaction, decreased self-confidence , decreased self-esteem 
• Decreased or lost ability to experience pleasure in previously enjoyable activities   
• Decreased interest in the world around you 
• Loss of the ability to experience any feelings (in cases of deep depression) 
• Depression is often combined with anxiety about the health and fate of loved ones, as well as fear of appearing insolvent in public      

Physiological manifestations

• Sleep disturbances (insomnia, drowsiness) 
• Appetite changes (loss or overeating)
• Bowel dysfunction (constipation)
• Decreased sexual needs
• Decreased energy, increased fatigue during normal physical and intellectual exertion, weakness 
• Pain and various discomfort in the body (for example, in the heart, in the stomach, in the muscles)     

Behavioral manifestations

• Passivity, difficulty in engaging in purposeful activity 
• Avoidance of contact (tendency to be alone, loss of interest in other people)  
• Refusal of entertainment 
• Alcohol and substance abuse that provide temporary relief  

Thought manifestations

• Difficulty concentrating, concentrating
• Difficulty making decisions
• The predominance of gloomy, negative thoughts about yourself, about your life, about the world in general    
• Gloomy, pessimistic vision of the future with a lack of perspective, thoughts about the meaninglessness of life  
• Thoughts of suicide (in severe cases of depression)   
• Having thoughts about your own uselessness, insignificance, helplessness 
• Slow thinking

For the diagnosis of depression, it is necessary that some of the listed symptoms persist for at least two weeks. 

Depression needs to be treated

Depression is often perceived by both the patient and others as a manifestation of bad character, laziness and selfishness, promiscuity or natural pessimism. It should be remembered that depression is not just a bad mood (see manifestations above), but a disease that requires the intervention of specialists and responds well to treatment. The earlier the correct diagnosis is made and the correct treatment is started, the greater the chances for a quick recovery , that the depression does not recur again and does not take on a severe form, accompanied by the desire to commit suicide.              

What usually prevents people from seeking help for depression?  

Often people are afraid to see a mental health professional because of the perceived negative consequences:  

• Possible social restrictions ( registration, ban on driving and traveling abroad)    
• Condemnation if someone finds out that the patient is being treated by a psychiatrist  
• Fears the negative impact of drug treatment, based on which are widely used, but not the accurate understanding of the dangers of psychotropic drugs    

People often do not have the necessary information and misunderstand the nature of their condition. It seems to them that if their condition is associated with understandable life difficulties, then this is not depression, but a normal human reaction that will pass on its own. It often happens that the physiological manifestations of depression contribute to the formation of beliefs about the presence of serious somatic diseases. This is the reason for contacting a general practitioner.             

80% of patients with depression initially seek help from a general practitioner, and about 5% of them are correctly diagnosed . Fewer patients receive adequate therapy. K Unfortunately, in the normal admission to the clinic is not always possible to distinguish between physiological manifestations of depression and the presence of a true physical illness that leads to the formulation of misdiagnosis. Patients are prescribed symptomatic therapy (medicines “for the heart”, “for the stomach”, ” for headaches”), but there is no improvement . Thoughts arise about a serious, unrecognized somatic illness, which, by the mechanism of a vicious circle, leads to an aggravation of depression. Patients spend a lot of time on clinical and laboratory examinations, and, as a rule, come to a psychiatrist with severe, chronic manifestations of depression.                    

II. SCIENTIFIC KNOWLEDGE ABOUT DEPRESSION 

The main types of depression

Depression often occurs against a background of stress or long-term severe traumatic situations. Sometimes they occur for no apparent reason. Depression can accompany somatic diseases (cardiovascular, gastrointestinal, endocrine, etc.). In such cases, it significantly complicates the course and prognosis of the underlying somatic disease. However, with timely detection and treatment of depression, there is a rapid improvement in mental and physical well-being.        

Depression can occur in the form of single, different in severity episodes of the disease or proceed for a long time in the form of repeated exacerbations.   

In some patients, depression is chronic – it lasts for many years without reaching significant severity.     

Sometimes depression is limited mainly to bodily symptoms without distinct emotional manifestations. At the same time, clinical and laboratory examinations may not reveal any organic changes. In such cases, it is necessary to consult a psychiatrist.    

Modern understanding of the causes of depression 

Bio- psycho-social model of depression.

Modern science considers depression as a disease, the origin of which is contributed by different causes or factors – biological, psychological and social.     

The biology of depression

The biological factors of depression include, first of all, specific disorders of neurochemical processes (exchange of neurotransmitters such as serotonin, norepinephrine, acetylcholine, etc.). These disorders, in turn, can be hereditary.    

The psychology of depression

Scientific studies have identified the following psychological factors for depression:

• A special style of thinking, the so-called. negative thinking, which is characterized by fixation on the negative sides of life and one’s own personality, a tendency to see in a negative light the surrounding life and one’s future    
• A specific style of communication in a family with an increased level of criticism, increased conflict  
• An increased number of stressful life events in personal life (separation, divorce, alcohol abuse of loved ones, death of loved ones) 
• Social isolation with few warm, trusting contacts that could serve as a source of emotional support  

The social context of depression

The growth of depressions in modern civilization is associated with a high pace of life, an increased level of its stressfulness : high competitiveness of modern society, social instability – a high level of migration, difficult economic conditions, uncertainty about the future. In modern society, a number of values ​​are cultivated that condemn a person to constant dissatisfaction with himself – the cult of physical and personal perfection, the cult of strength, superiority over other people and personal well-being. This makes people feel bad about their problems and failures, deprives them of emotional support and condemns them to loneliness.                

III. HELP FOR DEPRESSION

The modern approach to the treatment of depression involves a combination of various methods – biological therapy (medication and non- medication) and psychotherapy.       

Drug treatment

Medication is prescribed for patients with mild, moderate, and severe depression. A prerequisite for the effectiveness of treatment is cooperation with a doctor: strict adherence to the prescribed therapy regimen, regular visits to the doctor, a detailed, frank report about your condition and life difficulties.      

Antidepressants

Correct therapy can in most cases completely get rid of the symptoms of depression. Depression requires specialist treatment . The main class of drugs for the treatment of depression are antidepressants. At present there are different products of this group from their tricyclic aptidepressanty (amitriptyline, imipramine ), and have been used since the late 50 ‘s. In recent years, the number of antidepressants has increased significantly.           

The main advantages of new generation antidepressants are improved tolerance, reduced side effects, reduced toxicity, and high overdose safety. By the newer antidepressants are fluoxetine ( Prozac , profluzak ), sertraline ( Zoloft ), citalopram ( tsipramil ), paroxetine ( Paxil ), fluvoxamine ( Luvox ), tianeptine ( tianeptine ), mianserin ( lerivon ), moclobemide ( auroriks ), milnacipran ( Ixel ) , mirtazapine ( Remeron ), etc. Antidepressants are a safe class of psychotropic drugs when used correctly according to a doctor’s recommendation. The dose of the drug is determined individually for each patient. You need to know that the therapeutic effect of antidepressants can manifest itself slowly and gradually, so it is important to be positive and wait for it to appear.        

Antidepressants do not cause addiction and the development of a withdrawal syndrome, in contrast to drugs of the class of benzodiazenine tranquilizers (phenazepam, Relanium , Elenium, tazepam, etc.) and corvalol, valocordin, widely used in our country. In addition, benzodiazepine tranquilizers and phenobarbital, which are part of Corvalol and Valocordin, with prolonged use, reduce sensitivity to other psychopharmacological agents.             

The main stages of therapy

• Determining the treatment strategy: choosing an antidepressant with view of the main symptoms of depression in each patient, the selection of adequate dose and individual treatment regimen     
• Carrying out the main course of therapy aimed at reducing the symptoms of depression until they disappear, restoring the patient’s previous level of activity     
• Conducting a maintenance course of therapy for 4-6 months or more after the general normalization of the condition. This stage is aimed at preventing the exacerbation of the disease.     

What usually interferes with drug treatment:

• The misconception about the nature of depression and on the role of drug treatment   
• A common misconception about the unconditional harm of all psychotropic drugs: the emergence of dependence on them, a negative effect on the state of internal organs. Many patients believe that it is better to suffer from depression than to take antidepressants.    
• Many patients discontinue use if there is no immediate effect or take medication irregularly 

It is important to remember that numerous studies have been carried out confirming the high efficacy and safety of modern antidepressants. The damage caused by depression to a person’s emotional and material well-being is not comparable in severity with the minor and easily eliminated side effects that sometimes occur with the use of antidepressants. It should be remembered that the therapeutic effect of antidepressants often occurs only 2-4 weeks after the start of administration.       

Psychotherapy

Psychotherapy is not an alternative, but an important adjunct to medication for depression. In contrast to drug treatment, psychotherapy assumes a more active role of the patient in the treatment process. Psychotherapy helps patients to develop skills of emotional self-regulation and in the future to cope more effectively with crisis situations without sinking into depression.            

In the treatment of depression, three approaches have proven to be the most effective and scientifically based: psychodynamic psychotherapy, behavioral psychotherapy and cognitive psychotherapy.   

According to psychodynamic therapy, the psychological basis of depression is internal unconscious conflicts. For example, a desire to be independent and at the same time a desire to receive a large amount of support, help and care from other people. Another typical conflict is the presence of intense anger, resentment towards others, combined with the need to be always kind, good and to maintain the location of loved ones. The sources of these conflicts lie in the patient’s life history, which becomes the subject of analysis in psychodynamic therapy. In each individual case, it may be its unique content of conflicting emotions, and therefore require individual psychotherapeutic work. The goal of therapy is to recognize the conflict and help in its constructive resolution: to learn to find a balance of independence and intimacy, to develop the ability to express feelings constructively and maintain relationships with people. Behavioral psychotherapy is aimed at resolving the patient’s current problems and relieving behavioral symptoms: passivity, refusal of pleasures, monotonous lifestyle, isolation from others, inability to plan and engage in purposeful activity.                        

Cognitive psychotherapy is a synthesis of both of the above approaches and combines their advantages. It combines work with actual life difficulties and behavioral symptoms of depression and work with their internal psychological sources (deep ideas and beliefs). As the main psychological mechanism of depression in cognitive psychotherapy is considered the so-called. negative thinking, which is expressed in the tendency of depressed patients to view everything that happens to them in a negative light. Changing this way of thinking requires careful individual work that aims to develop a more realistic and optimistic view of ourselves, the world and the future.                    

Additional forms of psychotherapy for depression are family counseling and group psychotherapy (but not any, but specifically aimed at helping depressed patients). Their involvement can be of significant assistance in treatment and rehabilitation.         

What usually hinders seeking psychotherapeutic help? 

• Low awareness of people about what psychotherapy is 
• Fear of a stranger’s initiation into personal, intimate experiences 
• Skeptical about the fact that “talking” can have a tangible healing effect 
• The notion that you need to cope with psychological difficulties yourself, and turning to another person is a sign of weakness    

In modern society, psychotherapy is a recognized, effective method of helping with various mental disorders. Thus, a course of cognitive psychotherapy significantly reduces the risk of recurrence of depression. Modern methods of psychotherapy are focused on short-term (10-30 sessions, depending on the severity of the condition), effective help. All information that the psychotherapist receives during the session is strictly confidential and remains secret. A professional psychotherapist is specially trained to work with difficult experiences and difficult life situations of other people, he knows how to respect them and help in coping with them. In each person in life there are situations (eg, such as an illness), with whom he did not can cope on their own. Learning to ask for and accept help is a sign of maturity and rationality, not weakness.                            

Helping people close to you to overcome depression 

The support of loved ones, even when the patient does not express interest in her, is very important in overcoming depression.  

In this regard, the following advice can be given to relatives of patients:  

• Remember that depression – a disease in which the need sympathy, but not in koem case can not sink into the disease with the patient, sharing his pessimism and despair. You need to be able to maintain a certain emotional distance, all the time reminding yourself and the patient that depression is a transient emotional state         
• Studies have shown that depression is especially unfavorable in those families where a lot of criticism is made about the patient. Try to make it clear to the patient that his condition is not his fault, but the misfortune that he needs help and treatment        
• Try not to focus on the illness of a loved one and bring positive emotions into your life and into the life of your family. If possible, try to involve the patient in some kind of useful activity, and not remove him from business .