Depression is a mood disorder, that is, a complex of mental disorders associated primarily with the emotional sphere. This disorder is characterized by various emotional disorders in which people experience anguish, anxiety, guilt, anhedonia, that is, the loss of the ability to experience pleasure, or apathy – a state where a person does not experience either negative or positive emotions. In addition, depression is characterized by certain disorders in the field of thinking. For example, people with depression may find it difficult to concentrate, to carry out targeted mental activity, which is associated with concentration. In a depressed state, people have difficulty making decisions. They have dark thoughts about themselves, about the world around them, about people.
Depression has such physiological manifestations as sleep disturbances, intestinal functions, sexual needs. In patients with depression, the general energy tone is disturbed, they feel tired. With somatisation depression, the person experiences discomfort in the body. If you look at such a person, then in his behavior one can observe passivity, avoid contact with people, refusal from entertainment. Depression is often accompanied by increasing abuse of alcohol or other psychoactive substances that are used to improve mood.
Manifestations of melancholia have been described in Antiquity. Hippocrates introduced the terms “mania” and “depression.” At the end of the 19th century, the German psychiatrist Emil Kraepelin, the founder of the school of Crepelin, first described manic-depressive psychosis. Later they began to distinguish unipolar and bipolar forms of depressive disorder. In modern concepts, manic-depressive psychosis is called bipolar disorder. In addition, we can talk about the so-called neurotic depression, which can be exposed to people who do not suffer from mental illness, but have psychological difficulties that predispose to depression. Manic-depressive psychosis was described long ago, and now this concept is considered obsolete. In the modern world, the diagnosis of a depressive episode is more common, which can have varying degrees of severity.
Causes of Depression
Current views on depression are described in terms of biopsychosocial models. The causes of depression are never unambiguous. The biological factors of depression are confirmed by genetic studies, but the contribution of genetic factors is generally low. Neurochemical studies show that people prone to depression have impaired metabolism of neurotransmitters that contribute to the interaction between nerve cells and the passage of electrical impulses.
The psychological causes of depression can be summarized in two main directions. First of all, these are violations of self-esteem and self-esteem — introjective variants of depression, in which a person has a certain idea of his own “I” as unworthy of love and respect. In connection with this, various variants of compensatory behavior are formed. For example, this may be expressed in such a personality trait as perfectionism. In this situation, a person can accept himself only when he is perfect, other people evaluate him ideally, and the products of his activity have no flaws. If the life and activity of a person is aimed at confirming a good attitude towards oneself, exhaustion depression occurs. That is, if all activity is aimed at achieving results, a person loses psychic energy, which is formed through experiencing positive emotions: joy, pleasure, interest. Such mechanisms of depression are more common in men.
Another direction in understanding the psychological causes of depression is problems in intimate relationships. When a person needs another person to feel alive and able to adapt to reality, he is inclined to merge with another person and to minimize the distance. In such cases, the person experiences himself through another person. This tendency to depend on relationships is fraught with depression. In such a relationship, the partner often feels strangled. He does not leave space, leaning too close to him. Such relationships often fall apart, and the person who needs this merger feels it as a loss of himself. People describe this experience as follows: “It’s as if I don’t exist if the other one leaves me.” Such dependence often leads to depression, because man does not have the power of the ego, which allows him to live autonomously.
In addition, depression has social mechanisms. There is a certain cultural influence that affects the severity of depression in a particular culture. In northern cultures, the incidence of depression is higher than in southern and eastern ones. Here comes to the fore the cult of success, rationality, well-being, which is implanted through the media and parenting. In the process of growing up, people introject, that is, take in, into their worldview, the idea that they need to have a certain list of achievements in order to be good. The mechanisms of social comparison are activated, and when a person compares himself with other people, and the comparison is not in his favor, it is fraught with depression. In addition, people pay a lot of attention to the achievements in relation to their own physicality: what should be the body, to be socially acceptable, and what should be done with this body to be accepted in society.
Manifestations of depression
Tosca can be felt physically, in the form of squeezing in some parts of the body. Most often, people talk about squeezing in the chest. There is the concept of vital angst when a person feels that something is bad, but does not understand what is concrete. He does not survive the loss, does not suffer from separation from a loved one, but experiences a state of life longing. Patients with this symptom often say that they are simply ill, complain of depressed mood.
Anxiety is a feeling of internal tension, an expectation of something negative. Anxiety often accompanies depression, but can manifest itself. For depression, anxiety can occur in addition to depression and depressed mood.
Guilt feelings and a general tendency to self-accusation are characteristic of people with low self-esteem. There is a connection between low self-esteem and depression. Guilt feelings, as a rule, are associated with personalization, that is, thinking error, in which a person often takes bad events on his own account, and considers good events as the result of external causes.
Anhedonia is a condition in which a person cannot experience the pleasure of something that has pleased him before. For example, a patient with depression says that he would have given half his life for a fishing trip, but now he does not even want to think about it. This is a consequence of anhedonia, a distance from everything that used to be touched.
People most often experience apathy through their own passivity. Apathy is the most severe manifestation of depression, because this condition is difficult to treat with psychological methods. When a person is apathetic, he does not touch anything emotionally, either in a bad or in a good way. In a state of apathy, a person wants to lie in bed, he has no emotions, nothing encourages him, no motive. In this case, the person has due. For example, he says to himself that he must get up, make breakfast, feed the children, but this is experienced as pressure, an obligation, and not as a goal or desire. Most often, people understand that they have apathy when they want nothing but to stay in bed.
Sleep and appetite. Emotions are psychological phenomena that have a large physiological, somatic component. They have a cognitive component at the level of experience: before we feel something, we interpret what is happening. When the emotional state is unfavorable, the functions of the autonomic nervous system are disturbed, which controls the internal organs. A person experiences a variety of physiological symptoms: appetite disturbances in one direction or another, sleep disturbances. Internal stresses make sleep superficial or impede entering sleep.
Behavior. At the level of behavior, depression manifests itself in passivity, avoidance of contacts, refusal from entertainment, gradual alcoholization or substance abuse.
In addition, emotions affect thinking. On the other hand, thinking affects emotions. In some people, depression develops due to biochemical mechanisms that do not depend on his personality. For example, a person from childhood knows that his mood is worse in the morning, and that after lunch, his mood improves. When a person feels a severe emotional state, he has an unconscious need to substantiate this state cognitively. A person has a need to think about the bad. Thinking can also affect emotions. The mechanisms of cognitive therapy of depression are based on the fact that with the help of a psychotherapist a person works on these thinking errors that are inherent in depressive thinking. He becomes aware of these errors at the cognitive level.
Forms of depression
One form of depression is bipolar disorder. It manifests itself as a mood disorder that proceeds with a phase flow. Phases are periods of time that last for weeks or months. Moreover, in bipolar disorder, the phase of depression replaces the phase of mania. Mania is characterized by a positive mood. In this state, a person is full of plans, sleeps little, does not analyze obstacles, commits rash acts.
In bipolar disorder, significant coefficients of the genetic contribution are observed. In neurotic depression, the genetic contribution is lower, and psychosocial factors play a more significant role. With such a disorder, there is no phase of mania, disturbed thinking and reality testing, delusions or hallucinations. Treatment of neurotic depression is more dependent on psychotherapeutic procedures.
Another form of depression is unipolar depression, that is, a depressive episode. It can have three degrees of severity: mild, moderate, and severe. This condition lasts at least two weeks. If the depressive episode is repeated, then the diagnosis changes from a depressive episode to a recurrent depressive disorder, that is, to a periodically pop-up depression. A person can suffer depression once in a lifetime, and can suffer from it twice a year.
In addition, there are such forms of mood disorders as cyclothymia and dysthymia. These are personality characteristics rather than illness. Dysthymia is a property of a person to remain in a gloomy mood, to have a pessimistic picture of the world, but at the same time to function all his life, never addressing psychiatrists. The intensity of depressive symptoms in dysthymic low, but lasts for years.
Cyclothymia is dysthymia with the presence of phases in which the dysthymic phase gives way to a good mood phase and so on. The difference from bipolar disorder is that it is a characteristic associated with a person’s worldview and personality. You can talk about cyclothymic or dysthymic personality. Such depression takes a lifetime if the person does not specifically work on it. And this does not radically restrict his ability to live. But when there is a real clinical depression, a person is limited in life activity. Often he cannot work due to the fact that he cannot concentrate, get out of bed, he has no mental tone, but there is a strong longing.
Treatment of depression
There are several psychotherapeutic areas for the treatment of depression. In particular, psychoanalysts work with depression. They are more focused on the analysis of early losses and injuries. One of the most effective is cognitive-behavioral therapy for depression, the author of which is Aaron Beck. Beck’s concept is called depression cognitive therapy. The basic theoretical premise is that a person has negative basic beliefs, ideas about himself, the world, and his future, which keep him inside the depressive pit.
A person follows a compensatory strategy of behavior in that he should like everyone and should not be mistaken. These behavioral strategies lead to exhaustion or frustration. In cognitive therapy, there are a number of techniques that are designed to correct these basic beliefs. First, more superficial beliefs are corrected. A person learns to recognize these thinking errors. When he tests this in his life, basic beliefs also begin to be corrected, too. He begins to accept himself as he is, ceases to depend on the opinions and assessments of others, allows himself to make mistakes and to treat them adequately. Beliefs are corrected, and the life situation begins to be interpreted through the prism of other beliefs and a worldview that is more adaptive.
In addition, depression is treated with medication. It is known that half of the inhabitants of the United States take antidepressants. In Russia, this practice is also common, but far fewer people turn to psychiatrists. The history of Soviet psychiatry in the Soviet period is rather repressive. There are prejudices in people’s minds.
Depression should be treated comprehensively. If a person treats depression with antidepressants, the mechanisms of psychological coping with emotions do not mature. As a result, sooner or later he attacks the same rake.
Frequency of depression
According to statistics, depression occurs more often in women than in men. This is due to the fact that women as a whole have a more delicate nervous organization and there are cyclical hormonal changes. The most vulnerable age range is after 45 years. In old age, depression is associated with anxiety. There are predictions that in the 21st century depression will take the second place after cardiovascular diseases for reasons of disability. In general, in Western countries, this is indeed a social disaster.
The effect of depression on physical health
There are two mechanisms of the effect of depression on physical health. First, there is somatization, in which it is not about physical health, but about the symptoms that a person experiences as a violation of physical health. Often, when a person is depressed, there are so-called psychalgia, that is, pain in different parts of the body. In this case, medical research does not lead to any results. But a person suffers systematically from the body: he may have a bad headache or, for example, a knee; besides, there are stomach or heart pains.
Another mechanism is the effect of depression on health, on changes in body tissues that are associated with depression. By itself, depression does not cause damage to internal organs. But a person who is depressed often leads an unhealthy lifestyle. Having a dark look at the state of things in life, he may not go to the doctors or, conversely, turn too often. The physiological, biochemical components of depression are not fully understood. As for psychology, there are also many white spots, in particular in the description of family and cultural mechanisms of depression. Scientists are trying to understand why, for example, in the southern countries patients with depression are less than in the north, but at the same time in India more than all over the world.