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Introduction
In the etiology of mental disorders, biological methylation processes play a key role. The main source and effective donor of methyl groups in the central and peripheral nervous system is ademethionine (heptral “) – an active sulfur-containing metabolite of methionine, a natural antioxidant and antidepressant that is formed in the liver in an amount of up to 8 g / day and is present in all tissues and body fluids, and most of all – in places of education and consumption, i.e. in the liver and brain.
In this regard, two particularly important biochemical processes in the liver are the synthesis of methionine and S-adenosyl-L-methionine by methylation of homocysteine. The enzymes S-adenosyl-methionine-synthetase and methionine-adenosyl-transferase (MAT) are involved in the formation and functioning of ademetionine. The latter is encoded on two genes – MAT1A and MAT2A, catalyzing the formation of SAM, and only MAT2A expression is associated with faster cell proliferation.
The circular DNA of human SAM synthetase includes 3217 nucleotides encoding a protein of 395 amino acid residues with a molecular weight of 43 647 daltons. In the messenger RNA of the human genome, a single region is responsible for the coding of this protein, and the structural features of the liver-specific S-adenosylmethionine synthetase gene in humans and rats turned out to be quite similar.
The idea of ​​using SAM as an independent drug (MP) is based on qualitative and quantitative correlations of the severity of mental and somatic disease states in humans and animals with the doses and content of SAM in normal or pathologically altered target tissues of the body.
The purpose of this information and analytical review is more pragmatic and consists in generalizing and comparing the observed clinical efficacy and safety of Heptral with existing drugs prescribed for the same indications. The most important and recognized of these indications are exogenous and endogenous depression, alcohol withdrawal, liver disease and arthralgia.
Sources of information
1. Medical and biological data of the Internet (Medline, Pubmed, etc.).
2. Thematic abstract journals of VINITI RAS.
3. Systematic reviews of the Cochran library (Oxford, UK) for 1984-2000.

Heptral – an antidepressant The
relative harmlessness of Heptral made it possible to assess its effect on the vital signs of healthy people. In particular, the heart rate and the concentration of adrenaline in the plasma of healthy subjects moderately decreased against the background of daily administration of 400 mg of heptral for a week as well as under the influence of MAO inhibitors, but the plasma MHPG level did not depend on the intake of heptral. An increase in the level of adrenaline when changing the position of the body from horizontal to vertical was easily stopped by taking Heptral, which indirectly confirms that it has antidepressant properties.
A statistical generalization (meta-analysis) of the results of 19 comparative clinical trials involving 498 depressed patients of varying severity made it possible to establish a reliable, 38-60%, increase in the antidepressant activity of heptral over placebo activity and the coincidence of its intensity with the antidepressant effects of standard tri- and heterocyclic drugs – imipramine, desipramine, amitriptyline and others with almost complete absence of their inherent side effects.
In standard clinical trials, Heptral was statistically significantly superior in efficacy to placebo and tricyclic antidepressants in recurrent endogenous and neurotic depression resistant to amitriptyline, differing from them in the ability to interrupt relapses and in the absence of side effects.
Almost all researchers note a more rapid development and stabilization of the antidepressant action of heptral (weeks 1 and 2, respectively) compared to standard drugs, especially with parenteral administration. In particular, in an open multicenter clinical study of 195 depressed patients, remission occurred after 7-15 days of parenteral administration of heptral at 400 mg / day, and when combined with tricyclic antidepressants, the effects were much faster and more pronounced than when combined with placebo. It should be noted that with an exacerbation of depressive symptoms, the level of ademetionine in the blood and tissues decreases, which requires an increase in dosages.

Heptral with withdrawal symptoms
The experience of testing and using heptral for alcohol withdrawal and opium addiction is apparently quite limited, since there are no English-language publications on this topic in available Internet databases. The following are the main results of two domestic clinical trials of Heptral, conducted in the Department of Clinical Psychopharmacology of the Research Institute of Narcology of the Ministry of Health of the Russian Federation (Director of the Research Institute, Corresponding Member of the Russian Academy of Medical Sciences, Prof. N. N. Ivanets) and at the Central Research Institute of Gastroenterology and the 17th Narcological Hospital in Moscow .
1. Heptral for alcohol withdrawal
Stopping the habitual consumption of alcohol is fraught with fatal complications. Clinically, alcohol withdrawal is manifested by tremors, hallucinations, seizures and delirium, infectious and somatic diseases and injuries. Symptoms appear after a few hours and gradually disappear within 2-3 days. Alcoholic delirium usually develops in 5-10% of cases after 3-4 days and also includes trembling, agitation, confusion, loss of orientation and a sharp increase in autonomic activity – fever, tachycardia and profuse sweating; lethality is about 5%. Convulsive seizures are quite rare, occur 12-48 hours after alcohol withdrawal and are usually generalized; their number is small and they are stopped by conventional drugs.
The aim of the study was to study the hepatotropic effect and effectiveness of Heptral in the treatment of depressive disorders and pathological craving for alcohol (with alcohol withdrawal syndrome) in an open-label study.
Examined 20 alcoholic men 30-60 years old with a disease duration of 6-25 years, 12 of them – with hereditary burden. All patients were diagnosed with stage II alcoholism: with a predominance of the pseudo-bore form – in 14, a constant form against a background of high tolerance – in 6 patients.
All of them had diagnostic criteria for stage II alcoholism: primary pathological craving for alcohol, a pronounced symptom of “loss of control”, maximum alcohol tolerance, fully formed alcohol withdrawal syndrome (AAS) – morning intoxication, altered patterns of intoxication combined with amnesia during the period of intoxication, aggravation premorbid character traits, adverse social and somatic consequences of the disease.
AAS was accompanied by the usual somatovegetative and psychopathological disorders. The severity of AAS was regarded as mild in 6 and moderate in 14 patients, with a Hamilton score of at least 14 points, which was a criterion for inclusion in the study along with a pathological attraction to alcohol and liver pathology. All patients had an enlarged liver, 17 were diagnosed with alcoholic fatty hepatosis, and 3 had chronic alcoholic hepatitis.
Heptral was prescribed in 2 parenteral bottles (800 mg) for 2 weeks. and then 1 tablet (200 mg) 4 times a day for the next 2 weeks. Along with Heptral, vitamins of groups B and C were prescribed and, if necessary, antihypertensive drugs (magnesium sulfate) and benzodiazepines (only at night) in the first 2 days.
Results. The therapeutic effect was noted on days 2-4 of treatment. Fear and anxiety disappeared, irritability decreased, asthenia decreased and physical condition improved, blood pressure returned to normal, appetite appeared, tremor and hyperhidrosis disappeared. By the end of the week, mood was leveled, sleep was restored, depressive symptoms decreased by 60-70%, and after 4 weeks depressive disorders were completely stopped. Craving for alcohol decreased on average by the 10th day. On the scale of general impression, the results were assessed as significant improvement within the framework of depression and as moderate – in relation to craving for alcohol and hepatotropic action (a trend towards positive dynamics of liver function and a decrease in its size). The drug was well tolerated and there were no side effects, complications or addiction to it.
In the instructions for the use of heptral, it is recommended to prescribe it for intrahepatic cholestasis induced by liver lesions of various origins, cirrhotic and precirrhotic conditions, encephalopathies of secondary genesis, depressive syndromes (including secondary) and with withdrawal syndrome.
Heptral is contraindicated in case of individual hypersensitivity to it, in the first two trimesters of pregnancy and lactation. In cirrhotic and precirrotic conditions associated with hyperazotemia, heptral oral administration should be carried out under medical supervision and nitrogen level control. Heptral is not recommended for children without strict indications. No interactions of heptral with other drugs were observed and no clinical cases of overdose were noted.
2. Heptral for opiate withdrawal
Under the observation were 20 male patients 17-38 years old with a diagnosis of “opium addiction of the 2nd degree, withdrawal symptoms” and with a disease duration of 1-22 years; in 50% of cases, the course of drug addiction was aggravated by taking diphenhydramine (1-2 tablets per drug injection). Treatment consisted of administering Heptral intravenously, 800 or 1600 mg / day in the first 14 days and 1600 mg / day in tablets for the next 14 days. We observed an improvement in the functional state of the liver and stimulation of microsomal oxidation processes, expressed in increased clearance and accelerated elimination of the marker preparation of antipyrine. The reverse development of clinical manifestations of abstinence and a distinct antidepressant effect was also noted.

Heptral is a hepatoprotector
Most of the etiological factors of intrahepatic cholestasis inhibit the activity of S-adenosylmethyl synthetase and reduce the production of S-ademethionine, which is accompanied by a violation of biochemical processes in hepatocytes – transmethylation and trans sulfidation. As a result, they decrease: the content of phospholipids, the activity of Na + K + -ATPase and other carrier proteins, membrane fluidity, capture and excretion of bile components, cellular reserves of thiols and sulfates (glutathione, taurine, etc.), which have a pronounced antioxidant effect and are the main substances in detoxification of endogenous and exogenous xenobiotics. Deficiency of these products leads to cytolysis of hepatocytes in cholestasis of any genesis.
The clinical manifestations of cholestasis are quite the same, these are:
1. excessive intake of bile elements in the blood;
2. a decrease in the amount or absence of bile in the intestine;
3. The effect of bile components on liver cells and tubules.
Regurgitation of bile into the blood induces pruritus, jaundice, xanthomas, xanthelasmas, darkening of urine, and systemic lesions:
acute renal failure;
the development of ulcers, erosions and bleeding in the stomach;
increased risk of endotoxemia and septic complications.

At the same time, a deficiency of bile in the intestine is fraught with steatorrhea and malabsorption syndrome, a deficiency of fat-soluble vitamins, and impaired bone mineralization. An excess of bile components leads to necrosis of hepatocytes and tubules and to liver cell failure, and with prolonged cholestasis cirrhosis forms with the development of ascites, edema, and hepatic encephalopathy. Often cholestasis (for example, drug) is asymptomatic and its only manifestation is the results of biochemical liver tests.
The etiological effect on cholestasis is problematic, and most patients are prescribed pathogenetic and symptomatic treatment. Heptral is the drug of choice in most cases for the following mechanisms and causes of cholestasis:
Decreased fluidity (permeability) of the basolateral and / or canalicular membrane of hepatocytes during pregnancy, alcoholic and medicinal liver damage.
Inhibition of Na + K + -ATPase and other membrane carrier proteins in drug and / or bacterial liver damage.
Destruction of the cytoskeleton of hepatocytes, impaired vesicular transport in viral, alcoholic and drug hepatitis, cirrhosis, endotoxemia, sepsis, benign recurrent cholestasis.
Violation of the integrity of the tubules (membranes, microfilaments, cellular compounds) under the influence of drugs, oral contraceptives, bacterial infections, Beiler’s disease.

Clinical trials:
1. In an open clinical trial, heptral treatment of alcoholic liver diseases (34 people) for 14 days with an intravenous drip of 800 mg / day, and in the next 14 days, 400 mg / day 2 times inside (tablets) led to the disappearance of signs depression, improvement of biochemical and physical (liver density) indicators.
2. Treatment of 23 patients with chronic hepatitis C with interferon a2 was accompanied by the development of cholestatic and depressive syndromes. Signs of cholestasis were manifested in the first 3 months of treatment and especially clearly in patients with cirrhotic transformation of the liver. The inclusion of Heptral in the complex of therapy helped to timely stop depressive and cholestatic phenomena and to conduct a full course of antiviral therapy with interferon a2.
3. In the treatment of 8 patients with medicinal lesions of the liver, an improvement in the general condition and normalization of liver tests were observed.
4. Heptral was prescribed to 32 patients with chronic diffuse liver diseases and intrahepatic cholestasis, 16 of whom had primary biliary cirrhosis. During the first 16 days of phase I of treatment, Heptral was injected intravenously at 800 mg / day, and in the next 16 days – 1600 mg / day. Most patients showed a pronounced positive effect – the symptoms of asthenia, skin itching, jaundice, as well as a statistically significant normalization of biochemical parameters disappeared. In patients with primary biliary cirrhosis, there is a tendency to lower cholesterol and bilirubin in the blood. With repeated courses, heptral tolerance and a lack of resistance to its positive effect were noted.

Heptral – an analgesic
Osteoarthrosis is a degenerative joint disease characterized by progressive catabolic loss (“wear”) of articular cartilage due to an imbalance between the synthesis and degradation of cartilaginous proteoglycans, followed by bone growths along the edges of the articular surfaces. It mainly develops in the elderly, but can occur at any age, especially as a result of trauma, chronic inflammatory diseases, and congenital joint defects. Most often, the distal and proximal interphalangeal joints of the hands, the hip and knee joints, the cervical and lumbar spine are affected. Spondyloarthrosis sometimes leads to narrowing of the spinal canal (caudogenic intermittent claudication), pain in the legs and buttocks when standing or walking. It is accompanied by severe bone and muscle pain.
The goal of therapy is to relieve pain and prevent disability. The use of non-steroidal anti-inflammatory drugs (NSAIDs) can provide short-term pain relief, but with prolonged use, harmful side effects (eg, gastric bleeding) develop and cartilage loss increases. The empirical use of Heptral in osteoarthritis has led to analgesia comparable to NSAIDs with no side effects, as well as to stimulation of proteoglycan synthesis and partial regeneration of cartilage tissue.

Conclusion The
possibilities of heptral, alone and in combination with other drugs, in the treatment of depressive disorders are far from exhausted. As already noted, in the available Internet databases there are no English-language publications on the treatment of heptral withdrawal symptoms, and in a random sample of 18 domestic articles, only non-steroidal anti-inflammatory drugs were used in the treatment of arthralgia. There is a further study of the effectiveness of Heptral in the treatment of affective disorders, inhibition of prolactin secretion, etc. Pharmacokinetics has not been studied at all, although the relationship of the antidepressant efficacy of ademetionine with its concentration in blood and tissues appears explicitly or implicitly in many studies, which suggests the possibility of searching for optimal treatment regimens among existing … So far, it has been possible to find out that its transport through the villi of preparations of the human placenta proceeded rather slowly, like passive diffusion of L-glucose, and was accompanied by non-enzymatic conversion to a metabolite of an unknown structure. The transport of melatonin and its antipyrine marker drug proceeded most rapidly, while vitamin E diffused 10 times slower than L-glucose and ademethionine, but its non-racemic free forms were much faster. Measurable concentrations of ademetionine after parenteral administration were found in CSF in patients with senile dementia, which gives hope for new possibilities in the treatment of this and other neurodegenerative diseases with heptral.

Anxiety is an integral part of the clinical picture of mental, neurological and somatic disorders. Being a clinical phenomenon of psychopathological manifestations, it is closely related to other symptoms and, as a rule, to the greatest degree determines the level of psychosocial maladaptation.

Central to a series of anxiety-phobic disorders is panic disorder. Over the course of a lifetime, 10-20% of the population will experience one or more panic attacks. Panic attacks – an unexpectedly arising and quickly, within a few minutes, growing symptom complex of vegetative disorders (vegetative crisis – palpitations, chest tightness, a feeling of suffocation, lack of air, sweating, dizziness), combined with a feeling of impending death, fear of loss of consciousness, loss of control above oneself. The duration of panic attacks is variable, with an average of about 30 minutes. In 2.7% of the population, panic attacks are combined with agoraphobia. Social phobias (fear of shame and confusion in the presence of other people) affect 3-5% of the population. Specific phobias (fear of certain diseases, specific objects, situations, actions) are more common than social ones; patients, according to various sources, comprise 5-12% of the population. Generalized anxiety disorder occurs in 2-5% of the population. These people become disabled very quickly, and in most cases they do not immediately fall into the field of vision of psychiatrists, moving from a local doctor to a neuropathologist and other specialists. In the beginning, the diagnosis of vegetative-vascular dystonia is most often made, then diencephalic crises.

According to our data, the incidence of clinically significant depression among inpatient therapeutic patients is 31.5%, depressive disorders are divided into three groups: psychogenic – 46.1%, somatogenic – 36.4%, endogenous – 17.5%. At the same time, about 35% of patients in outpatient practice with unclear somatic diagnoses also suffer from larvae (somatized) depression.

Somatized depression, disguised as somatovegetative disorders, often lead to errors in diagnosis. Deterioration of the patient’s mental state, markedly reducing stress tolerance, leads to deterioration of the somatic state and, accordingly, improper treatment of the patient.

The adaptive role of anxiety is characterized by a number of physiological shifts that prepare the body for a quick response to danger: the release of adrenaline increases, the sympathetic system is activated, resulting in an increase in blood pressure, an increase in blood flow in the muscles and brain, and blood glucose levels increase in order to create the most favorable for these systems. conditions for activity.

These and other physiological changes are clearly adaptive in nature, but they, with excessive strength and duration, can be the cause of somatic disasters and diseases: heart attack, stroke, hypertensive crisis.

Given the nature of neuroendocrine reactions, anxiety can be defined as a mental component of stress. An inadequately severe anxious reaction to a traumatic situation can occur if the person has a low threshold for anxious response. A possible reason for this may be the insufficient activity of the GABA-ergic system and, in particular, the GABA-benzodiazepine receptor complex. In another type of anxiety disorder, panic attacks, patients have a reduced GABA content in the occipital lobe of the cerebral cortex (A. Goddard et al., 2001) and there is a genetically determined change in benzodiazepine receptors. This is why benzodiazepine tranquilizers are not effective enough in treating panic disorder.

The drugs of choice in these cases are selective serotonin reuptake inhibitors (SSRIs). SSRIs – a group of drugs that are heterogeneous in chemical structure. These are one-, two- and multicyclic drugs with a common mechanism of action: they selectively block the reuptake of serotonin only, without affecting the uptake of norepinephrine and dopamine,
and do not affect the cholinergic and histaminergic systems. The true “champion” in serotonin-positive effect is paroxetine, which has the most balanced effect. The advantage of paroxetine, compared with tricyclic antidepressants, which are most often used by general practitioners, is its safety for patients with somatic and neurological pathology, the elderly. Paroxetine can also be used on an outpatient basis.

An increasing amount of data shows that paroxetine, as a dual-action drug (anxiety and depression), has inherited high efficacy and good tolerance (minimum side effects) from previous generations of antidepressants, it acts against a wider range of symptoms of anxiety and depression.

The mechanism of action of paroxetine is based on its ability to selectively block the reuptake of serotonin (5HT) by the presynaptic membrane, which is associated with an increase in the free content of this neurotransmitter in the synaptic cleft and an increase in the serotonergic effect in the central nervous system, which is responsible for the development of the thymoanaleptic (antidepressant) effect. Paroxetine has low affinity for m-cholinergic receptors, a- and b-adrenergic receptors, as well as for dopamine, 5HT1-like, 5HT2-like and histamine H1 receptors.
The main components of the profile of the psychotropic activity of paroxetine are antidepressant and anti-anxiety effects with a moderate stimulating (activating) effect. In the series of serotonergic drugs, paroxetine is the most powerful and one of the most specific serotonin reuptake blockers.

Paroxetine has therapeutic efficacy even in those patients who did not respond adequately to previous standard therapy. The patient’s condition improves within 1 week after the start of treatment. Taking paroxetine in the morning does not adversely affect the quality and duration of sleep. Moreover, with effective therapy, sleep should improve. During the first few weeks of taking paroxetine, it improves the condition of patients with anxiety or depressive disorders of various origins. Paroxetine has minimal side effects. Treatment with paroxetine is characterized by low severity and rarity of unwanted symptoms, which determines the good tolerance of the drug and the willingness of patients to take paroxetine for a long time as maintenance therapy.

Thus, we can say that, having a pronounced thymoanaleptic effect, paroxetine is a balanced antidepressant and equally reduces both symptoms of anxiety and lethargy.

Despite the numerous studies and the diversity of the concepts of schizophrenic reactions (SR), there is still no unity of views on the clinical boundaries of this concept, and the research criteria for reactive states, the atypia of which is due to the inclusion of procedural manifestations, are still a subject of discussion. The existing disagreements to a certain extent reflect the position of the SR in ICD-10, in which psychogenias of this circle can be classified in the diagnostic sections “Schizotypal disorder” – F21 and “Acute and transient psychotic disorders” – F23. At the same time, in order to classify non-psychotic level SRs to the first of these diagnostic categories, it is not necessary to have a connection with traumatic influences (only in the domestic version of the classification, SRs in this understanding are distinguished by a separate heading – F21.2). At the same time, section F23, which includes, as a priority, the association of psychopathological disorders with stress, does not include disorders whose severity does not reach the degree of acute psychosis (within this category, “Acute polymorphic psychotic disorder” – F23.1; “Acute schizophrenic-like psychotic disorder “- F23.2).
The concepts of the development of psychogenias in schizophrenia, the origin of which dates back to the beginning of the 20th century, were based on the assumption of the existence of a special type of reactive lability, which is formed under the influence of an endogenous process. There was even a separate type – “reactive schizophrenia” [Berze J., 1929], in which, as a result of the impact of mental trauma, a latent schizophrenic process manifests itself as “schizophrenic-psychotic processing of experiences”. Further studies of psychogenias in procedural diseases are based on the idea of ​​the existence of prerequisites in the form of increased readiness for reactions depending on the stage of schizophrenia. It was established that the greatest vulnerability to stressful effects is observed mainly in the initial and post-process periods. In the acute phase of the process, the condition of patients is less affected by psycho-traumatic events [Kantorovich N.V., 1967], while special sensitivity to stress during stabilization can be due to a pathologically altered “soil” with the formation of pseudopsychopathy [Melekhov D.E., 1934] …
As a result of a targeted study of psychogenias in low-grade schizophrenia, A.B. Smulevich (1987), along with SRs that occur simultaneously with the manifestation or entail an exacerbation of the endogenous process, highlighted a variant in which SRs, preferred for patients with residual pseudopsychopathic conditions, are not associated with exacerbation of schizophrenia. According to the author’s observations, this type of SR develops in patients with residual pseudopsychopathic conditions.
It should be emphasized that if the idea of ​​schizophrenia (or schizoidia) as a necessary condition for the formation of SR, which has developed since the time of E. Bleuler [1920], does not cause any particular controversy, then the one put forward in the few works of domestic authors [Melekhov DE, Chernoruk V. G., 1933], not all researchers share the point of view about the possibility of such reactions “on the basis” of personality disorders, not only schizoid, but also of other types.
At the same time, this possibility can be considered in the analysis of modern concepts of schizotypal and borderline personality disorders (PD). Although schizotypal PD largely corresponds to the characteristic of latent schizophrenia in the traditional sense, and borderline one combines deviations, the main features of which are impulsivity with inconstancy of interpersonal relationships, inability to adequately assess reality, affective instability with episodes of dysphoria, irritability, anxiety, tendency to auto-aggressive behavior and disorders drives, their common characteristic is increased vulnerability to psychogenic influences, which is realized by atypical depressive states, obsessive, dissociative disorders and “brief psychotic episodes” or “mini-psychoses” [Kernberg OF, 1967; Gunderson JG, 1975; Paris J., 1999].
This interpretation of SR as clinical structures identified not only by signs of psychogenic provocation and the presence of schizophreniform symptoms contributes to the development of optimal approaches to the treatment of such conditions.
Some of these approaches were developed on the basis of data obtained in the course of a study devoted to the analysis of therapy in patients hospitalized for SR in the clinic of borderline mental pathology and psychosomatic disorders (headed by Academician A.B.Smulevich) of the National Center of the Russian Academy of Medical Sciences.
In the studied patients, a reactive state was verified, which arose against the background of a diagnosis of schizophrenia established in accordance with ICD-10 (“residual” – F20.5, “latent” – F21.1) or PD (“schizotypal personality disorder” – F21.8, ” paranoid personality disorder ”- F60.0,“ borderline type of emotionally unstable personality disorder ”- F60.31). Acute or prolonged mental trauma preceded psychogenesis in the studied sample, in response to which a depression of moderate or mild severity was formed, the content of which was determined by the psychogenic (catatomic) complex. Along with hypotension, other psychopathological disorders (anxiety-obsessive, dissociative, hallucinatory-paranoid) that were heterogeneous with respect to affective ones were also recorded in the clinical picture.
The results of the study allow us to assert that when choosing a method of therapy for SR, it is necessary to take into account, on the one hand, the level of psychopathological disorders (neurotic-psychotic, and on the other hand, interaction with personality (ontogenetically or procedurally determined – psychopathy / pseudopsychopathy) pathology.

Two types of reactions schizophrenic
Depending on the level of psychopathological disorders and comorbid structure constitutional or acquired (residual schizophrenia) personal pathology are two main types of shunt reactor distinguished:
1. SR arising in patients with borderline, schizotypal (including latent schizophrenia) or paranoid RL occurring with the formation of transient psychotic episodes (mini-psychoses) of the type of “outbreaks of hereditary deviants” and are closely interrelated with the psychopathic structure that was formed in the period preceding mental trauma.
2. SRs arising in patients with residual schizophrenia within the framework of a persistent pseudopsychopathic state, proceeding with the formation of psychopathologically homogeneous disorders of a predominantly neurotic level, which are realized within the resources of a personality altered by a progressive endogenous process without the addition of symptoms of more severe registers.

The first type of SR
In the first type of SR, reactive states, although they have the basic signs of true psychogeny, i.e. arise in connection with objectively significant stressful influences (death of loved ones, betrayal, divorce, loss of work), and the psychogenic complex remains relevant throughout the reactive state, differ in a number of significant features.
The clinical picture of reactive states of this type is determined by the combination of a shallow (hysterically dysphoric or anxious) depression of psychogenic content with patho-characteristic (impulsiveness, demonstrativeness, explosiveness) and polymorphic subpsychotic disorders. A characteristic feature of the latter part of the cases is the coexistence of dissociative disorders (pseudodementia, magical thinking, delusional fantasizing), catatimically charged imagery and hallucinations of the imagination, reflecting a traumatic situation, and psychologically irreducible deceptions of perception (calls, haptic, olfactory hallucinations). In other cases (in individuals of a paranoid warehouse with an unshakable conviction of their own rightness, perseverance, determination to achieve a goal, uncompromisingness), in the process of developing psychogeny, the homonymous to obligate properties of the RL are unstable, unsystematized delusions overlap with the anxiety-obsessive form polar with respect to the structure of the RL “Madness of doubt.”
Such reactions are reversible, do not show a tendency to a protracted course (their duration does not exceed several months) and are not accompanied by an exacerbation of the endogenous process with an increase in negative changes in the schizophrenic type.

Therapeutic approaches for type I SR The
therapeutic approaches for this type of SR correspond to the characteristics of both psychopathological disorders that determine the structure of the reaction as a whole (affective – reactive depression), and optional subpsychotic formations.
As a rule, combined therapy is carried out (antidepressants in combination with antipsychotics), and due to the fact that in the clinical picture throughout the pathological reaction the most stable component is hypotension, the main place in the treatment regimen is given to antidepressants, which is consistent with data from other authors. Preferred drugs of the group of selective serotonin reuptake inhibitors (SSRIs), prescribed in high doses (fluoxetine 60-80 mg / day; fluvoxamine 300 mg / day). The appropriateness of using SSRIs is explained in the literature [Coccaro EF, 1996; Paris J., 1999] not only with a favorable tolerance profile and a wide therapeutic range of doses for this group, but also with high lethal doses, which ensures their safety in patients with a risk of impulsive suicidal behavior.
Given the affective instability, the propensity of patients with this type of reaction to repeated depressive conditions, the use of normotimics (carbamazepine, lithium carbonate) is justified.
Subpsychotic manifestations in the picture of psychogenicity are stopped by neuroleptics. At the same time, the corrective effect of the agent of this class on pathocharacterological disorders is also used. Traditional antipsychotics are prescribed taking into account the transient nature of the hallucinatory-paranoid register disorders and the flotating nature of anxiety-obsessive manifestations in low doses (a series of controlled studies have shown the effectiveness of non-injection forms of chlorpromazine [Leon NF, 1982] and haloperidol [Sebran G., Siegel S., 1984]). However, our own observations confirm that given in the modern literature [Khousam HR, Donnely NJ, 1997; Szygethy EM, Schulz SC, 1997] information on the preference of atypical antipsychotics (risperidone 4-6 mg, quetiapine 150-400 mg).
In a number of cases (with the predominance of psychopathic and / or paranoid symptoms over affective ones), monotherapy with neuroleptics of a new generation, which is not inferior in effectiveness to combined treatment, can be carried out.

The second type of SR
With SR of the second type (as opposed to the first), the acquired reactive lability inherent in patients ensures the pathogenicity of even objectively insignificant traumatic events. A pathological reaction is characterized by a dissociation between the minimum force of stress (minor office conflict, family troubles, problems with passing exams or paperwork) and the severity of the response to it. The reactive formations formed at the same time are characterized by relative simplicity, stereotype and a small range of psychopathological manifestations, limited mainly by disorders of the affective and neurotic levels.
Corresponding in the psychological understanding to “refusal reactions” or avoidance, SR according to clinical manifestations can be classified as hysterical, hypochondriacal, asthenic and anxious, which are based on doubts about the ability to cope with habitual activities, associated with real failure.
Shallow psychogenically caused psychopathological disorders are accompanied by the actualization of litigious tendencies, diffuse ideas of attitudes aimed at the “offenders”, “troublemakers”. In some cases, such conditions can persist for months, while in others they can be transient and undergo reduction within a few days even without medication.

Psychopharmacotherapy in type 2 SR
The role of psychopharmacotherapy in this type of SR is relatively small in comparison with type 1 psychogenias. Therapeutic tactics are based on the clinical picture of the reactive state, taking into account the comorbid manifestations of the schizophrenic defect. The main means of stopping psychogenic formations, accompanied, as is typical of “refusal reactions”, confusion in front of everyday difficulties, fear of being left unattended and unsupervised, painful fears and anxiety symptoms, are tranquilizers. At the same time, the treatment adapts to the clinical features of SR: to influence asthenic symptoms, it is necessary to add nootropics and / or small doses of neuroleptics with activating properties (trifluoperazine 3-5 mg, sulpiride 100-200 mg); in cases where the clinical picture of psychogenia is characterized by hysterical or hypochondriacal (neurotic hypochondria) disorders, the effect of tranquilizers can be enhanced with neuleptil in daily doses of 5-10 mg.
Social measures aimed at changing or resolving the situation that contributed to the emergence of a reactive state also have a healing effect. The psychotherapeutic effect of this type of SR is achieved even by the fact of hospitalization, which helps isolate the patient from the traumatic situation.

In recent years, in psychology, much attention has been paid to the study of certain pronounced mental states: stress, anxiety or anxiety (anxiety), rigidity (tendency to perseveration) and, finally, rustration. True, foreign researchers often avoid the terms “conditions” in relation to these phenomena, but in fact it is about states that under certain conditions leave a mark on the entire mental life for a while or, if we speak the language of biology, are integral reactions of the body in his active adaptation to the environment.
The problem of frustration is posed in terms of theoretical discussion and, to an even greater extent, is the subject of experimental research conducted on animals and people (more often on children). Despite the large number of works published on the topic of frustration, there is still a lot of obscurity in this topic. It is no accident that doubts are even expressed about the need for the concept of frustration, since the phenomena it covers are diverse and can be explained without resorting to this concept. So, in particular, Reed Lawson raises the question in the book “Frustration. Development of a scientific concept ”[18; 58, 60]. ‘This book is an attempt to show the modern setting and various solutions to this problem. In the book, in addition to a large generalizing article by the specified author under the heading “Searches and Arguments”, eight articles by various authors expressing a different approach to frustration are given.
There are difficulties in understanding the very term “frustration”. If we turn to the philology of this term, then frustration means disorder (of plans), destruction (of plans), that is, it indicates some kind of traumatic situation in a certain sense of the word, in which failure is suffered. As we will see below, the philology of the term is close to the widespread, though not widely accepted, understanding of frustration. Frustration should be seen in the context of the broader problem of endurance in relation to life difficulties and reactions to these difficulties.
IP Pavlov spoke many times about the difficulties of life that cause unfavorable conditions of the cerebral cortex. In one of the clinical environments, he made a characteristic confession: “In general, life is always unpleasant, continuous difficulty, and this difficulty makes itself felt when the nervous system has already been knocked down. We must consider that life is always difficult ”[3; 213]. In another clinical environment, Pavlov said that “difficult life situations cause either extreme agitation or depression” (3; 555). But difficulties in life can be divided into two categories. There are difficulties that are quite surmountable, although tremendous efforts are often required to overcome them. As Ushinsky pointed out, every work is associated with difficulties. These are often the difficulties, the overcoming of which is one of the conditions for the mental development of a person and his mastery of professional qualifications. When they talk about perseverance, they mean that character trait that is expressed in the struggle with difficulties, in overcoming obstacles. The concept of frustration does not apply to such difficulties, and if it does, it only applies to those cases when completely surmountable difficulties are subjectively perceived as insurmountable, when a person surrenders to them.
Other difficulties in life are among the insurmountable, or, carefully speaking, almost insurmountable (some difficulties that are insurmountable at the present time, for example, in the fight against cancer, will probably be overcome in the future). Researchers of frustration study those difficulties that are truly insurmountable obstacles or barriers, barriers that stand in the way of achieving a goal, solving a problem, and meeting a need.
But can all the insurmountable difficulties in life be reduced to barriers that block the intended action? MI Kalinin, in one of his conversations with high school students, talked about life pricks, disappointments and adversities, which require firmness to endure. character [1; 197]. Indeed, there are life difficulties, often arising unexpectedly as one or another kind of adversity or misfortune, which can be called barriers or barriers only conditionally, since they impede well-being, happiness.
The phenomena of frustration are most studied in relation to the barriers to activity, and therefore in the future we will focus on precisely such situations when the activity is blocked due to insurmountable obstacles, although the scope of frustration cannot be limited to such situations. There are ambiguities as to what to attribute the term frustration to: to an external cause (situation) or to the reaction it causes (mental state or individual reactions). In the literature you can find another use of the term. It would be expedient, in the same way as distinguishing stress – a mental state from a stressor – its causative agent, similarly distinguishing between a frustrator and frustration – an external cause and its effect on the body and personality. Although the term frustration in the literature is of little use, we will use it in the following exposition, using the term frustration – mainly to indicate the state provoked by the frustration. Such use of words prevents confusion in concepts and corresponds to the essence of the matter.
Referring to the definitions of frustration available in the literature, one can proceed from its definition given by S. Rosenzweig, a prominent researcher of this problem in the United States, according to which frustration “takes place when the body encounters more or less insurmountable obstacles or obstructions on the way to the satisfaction of any – or a vital need “(24; 379-388). Apparently, here frustration is viewed as a phenomenon that occurs in the body, in its adaptation to the environment. But a person is a social being, a personality, and therefore the considered definition, which limits frustration to biological interpretation, is completely insufficient.
According to the definition given by Brown and Farber [8], frustration is the result of conditions under which the expected reaction is either prevented or inhibited. Lawson, interpreting the position of these authors, explains that frustration is a conflict between two tendencies: the one that belongs to the type of connection “goal-reaction”, and the one that arose under the influence of interfering conditions [18; 31]. Brown and Farber emphasize the contradictions that arise from the action of frustrators, and it is this contradiction that explains the emotionality, which usually distinguishes reactions in these situations. Ardently supporting these authors in an effort to distinguish between an external cause and the state caused by it, Childe and Waterhouse [9], in contrast to Brown and Farber, recommend to call frustration only the fact (Event) interference, studying its effect on the activity of the organism, but do not lead to such word usage of any developed justifications. Based on the concept of frustration as a mental state, we give it the following definition: frustration is a person’s state expressed in the characteristic features of experiences and behavior and caused by objectively insurmountable (or subjectively understood) difficulties that arise on the way to achieving a goal or solving a problem. As applied to animals, the definition is as follows: frustration is a state of an animal, expressed in characteristic reactions and caused by difficulties that arise on the way to meeting biological needs. The need for two definitions is dictated by the fact that an animal is a biological creature, and a person is a public one, and frustration has different significance and different causes in humans and animals, although there is much in common in this state, as provoked by “barriers” that block activity. There are attempts to elevate the phenomenon of frustration to the rank of completely regular phenomena that necessarily arise in the life of the organism and personality. Thus, Mayer [19] believes that the behavior of an animal or a person depends on two potentials. The first of these is the “repertoire of behavior”, determined by heredity, developmental conditions and life experience. The second potential is constituted by selective or selection processes and mechanisms. They, in turn, are subdivided into those acting with motivated activity and those arising from frustration. The former function when the activity is aimed at achieving a goal based on appropriate motives, one of which (very important) is the satisfaction of needs. In such cases, behavior is always the path to solving the problem. Quite different electoral processes and mechanisms take place during frustration: while motivated and purposeful behavior is distinguished by variability, constructiveness or maturity and “exercise in freedom of choice”, the unfocused behavior characteristic of frustration is characterized by destructiveness, rigidity, and immaturity. There is doubt as to whether frustration can be considered unjustified. If by it we understand how this is wanted, for example, by Childe and Waterhouse, an external reason (barrier or obstruction), then one of two things is possible: either this barrier is overcome, and in this case the behavior will be not only motivated, but also reasonably motivated, or the barrier causes inappropriate, and sometimes, indeed, destructive behavior. But even then it cannot be said that behavior is not motivated by anything and does not pursue any goal. The mere fact that it is attributed to selective forms of behavior indicates that it has its own motivation.
Although the concept of frustration is used in the arsenal of Freudianism, it cannot be considered necessarily associated with it. The problem of the barrier that blocks activity is posed by Kurt Lewin without the direct influence of Freudianism. Many psychologists who conduct a large experimental work on frustration are not Freudians at all. In particular, it would be ridiculous to suspect Freudian researchers of frustration conducting experiments on animals – and there are many of them.
The work on frustration carried out from the standpoint of Freudianism and neo-Freudianism should be categorically rejected. These positions are based on the fantasy of the struggle between “id” (unconscious but powerful drives), “ego” (personality with its psyche) and “superego” (principles of behavior, social norms and “values”). This struggle is full of frustration, understood as suppression by “censorship”, which is a function of the “superego,” the drives that a person has been obsessed with since childhood and which are significant (neo-Freudian) or fully (in Freud’s) sexual nature. Freudianism belittles the role of consciousness and the specific social conditions of human development. Instead of vital needs, conscious purposeful actions, Freudianism puts in the foreground some kind of “subsoil” fatal forces, which supposedly determine the behavior of a person doomed to constant frustration, since the “superego” resists the manifestations of “id”.
Particularly vicious are the attempts to use the doctrine of frustration in its Freudian interpretation to explain social phenomena, attempts to take it into the arsenal of social psychology. So, for example, in the book of Dollard, Dub, Miller, Mauer and Sears “Frustration and Aggression” [13], even such phenomena as war are reduced to the drama of infringement of personal desires, requests and hopes. L. Berkovits [7] considers the aggression arising in social relations to be nothing more than a manifestation of frustration – a conflict between a person with his violently asserting instincts and the environment, considered “in general” as something unchanging and hostile to a person. The anthropologist B. Malinovsky [21] ascribes to the natives a susceptibility to frustration in the form of aggression, as if inherent in them by nature. With this “discovery”, he tries to explain the struggle of the natives with the colonialists, leaving aside the specific conditions of enslavement and exploitation that encourage the indigenous population to rebel against colonial oppression.
Meyer in his article “The Role of Frustration in Social Movements” [20] draws on the phenomena of frustration as an explanation of the relationship between countries. He, for example, declares: “We were more afraid of Russia because we were afraid of its goals more than the frustrations of Japan and Germany.” At the same time, it would be wrong to associate all works on social psychology carried out abroad with Freudianism and, in particular, with frustration in its Freudian interpretation. So, in the large collective work “Current Problems in Social Psychology” [15], which contains articles by 51 authors, Freudianism and psychology occupy an insignificant place, and frustration is mentioned only occasionally. This, of course, does not mean that social psychology in the United States, which does not take the position of Freudianism, does not have very significant shortcomings, and, in particular, in the psychologicalization of the driving forces of social development. The influence of behaviorism is very strongly manifested in the USA in works on frustration. Lawson explicitly states: “In short, the interest in frustration as an internal state, from a behavioristic point of view, distorts the problem, makes it a pseudo-problem” [18; 7]. The existence of what is called the inner world of a person, the existence of consciousness, direction as a system of attitudes and experiences by behaviorism is either denied or recognized as something not worthy of scientific study. However, the requirement of objectivity in psychology does not mean a denial of the inner world of a person, but an incentive to cognize it by the most objective methods, which include not only experiment, but also observations, as well as a verbal report, which always includes some elements of self-observation. The behaviorist position impoverishes the study of frustration, simplifies and sometimes distorts this complex phenomenon, socially determined in humans.
II
Usually, frustration is studied as a reaction to those stimuli or those situations that can be called frustrators. If by reaction we mean everything that is provoked by a frustrator in an animal or a person, including a mental state, then one cannot object to this. But speaking of frustration as a reaction, foreign researchers usually mean the movements and actions performed, not taking into account the fact that the same movements and actions in the psychological sense can be ambiguous. Often a very strong and deep experience of frustration is weakly expressed externally, it seems to go deep, just as in the case of grief some people do not cry, outwardly remain calm, and yet they can feel grief. stronger than those people who in similar cases shed profuse tears.
It is characteristic that psychologists who object to the study of mental states in frustration, nevertheless, are forced to talk about them, and even the same Lawson, among the “dependent variables” allocated to him during frustration, calls “changes in imagination and emotionality”. The mental state caused by a frustrator undoubtedly depends on the type of this frustrator. S. Rosenzweig [24; I51] identified three types of such situations. He attributed privation to the first, i.e. lack of the necessary means to achieve a goal or satisfy a need. As an illustration of “external deprivation”, i.e. cases when the frustration is outside the person himself, Rosenzweig brings a situation where a person is hungry and cannot get food. An example of internal deprivation, that is, with a frustrator rooted in the person himself, is a situation when a person feels attraction to a woman and at the same time realizes that he himself is so unattractive that he cannot count on reciprocity. The second type is deprivation. Examples: death of a loved one; the house in which they lived for a long time burned down (external loss); Samson, losing his hair, which, according to legend, was all his strength (inner loss).
The third type of situation is conflict. Illustrating a case of external conflict, Rosenzweig gives an example of a man who loves a woman who remains faithful to her husband. An example of an internal conflict: a man would like to seduce his beloved woman, but this desire is blocked by the idea of ​​what would happen if someone would seduce his mother or sister.
The above typology of situations that cause frustration raises great objections: the death of a loved one and love episodes are placed in one row, conflicts that relate to the struggle of motives, to states that are often not accompanied by frustration, are unsuccessfully highlighted. It’s not at all good to call conflict cases when a person encounters an external insurmountable barrier on his way. According to this logic, one should speak, for example, about the state of conflict with a turbulent river, which turned out to be an insurmountable obstacle for a person. But leaving these remarks aside, we must say that the mental states of loss, deprivation, and conflict are very different. They are far from identical with various losses, hardships and conflicts depending on their content, strength and significance. With all this, we believe, it is still possible to single out some typical states that are often found under the action of frustrators, although they manifest themselves each time in an individual form. First of all, it is necessary to indicate those cases when frustrations do not cause frustration. In the literature, they are often referred to as tolerance, i.e. patience, endurance, the absence of heavy experiences and harsh reactions, despite the presence of frustrators.
There are different forms of tolerance.
The most “healthy” and desirable should be considered a mental state, characterized, despite the presence of frustrators, calmness, prudence, readiness to use what happened as a life lesson, but without much complaint about oneself, which would already mean not tolerance, but frustration.
Tolerance can be expressed, however, not only in a completely calm state, but also in a certain tension, effort, and containment of undesirable impulsive reactions.
Finally, there is a tolerance of the type of flaunting with accentuated indifference, which in some cases masks carefully concealed anger or despondency.
Tolerance can be nurtured. In the experiment of Keister and Epdegref [16], children practiced solving problems according to the so-called method of successive approximation, in which the difficulty of the problems gradually increases. Children trained in assessing the difficulty of tasks and as a result, they developed a “sober”, calm attitude, even to insoluble tasks.
Dewitz [12] showed by his experiment that children accustomed to behave calmly and play amicably with other children in their usual conditions showed less aggressiveness in frustration than children brought up in a less calm environment.
Tolerance regarding barriers that can be called reasonable and necessary is mandatory. The term tolerance in this case is not even adequate. It is not about “enduring” these barriers, but about recognizing all their necessity and usefulness, considering them to be good for oneself and experiencing frustration rather when these barriers are insufficient (for example, in the so-called “loose” collective or in a classroom where the teacher cannot provide discipline).
What are the mental states in those cases. ”When there is no tolerance, but there is frustration?
It should be said from the very beginning that these states are different and depend on different reasons, the significance of their action, habits to them, the individual characteristics of the subject play an important role; the same frustrator can cause completely different reactions in different people. In American literature, there is a very common tendency among the reactions to a frustrator to highlight aggression. There is an attempt to interpret any aggression as frustration. For example, Miller, Mauer, Oak, and Dollard — the workers at the Institute of Human Relations at the University of Iels, [22] stand at this position. One of the articles of these authors says: “The student of human nature should be told that when he sees aggression, he should suspect whether there is frustration here, and that when he sees interference with the habits of an individual or group, one should be wary of whether all other aggression ”[22; 337]. Although these authors reject the accusation that they reduce all frustration to aggression, they emphasize aggressive reactions to frustration so much that their theory of frustration is usually called the theory of frustration – aggression. We believe that there is no reason to consider aggression as the only reaction to frustration. But this form of reaction is observed very often.
What is meant by aggression?
According to the direct meaning of the word, it is an attack on one’s own initiative with the aim of seizing. When talking about frustration, the term aggression is given a broader meaning. We are talking about a condition that may include not only a direct attack, but also a threat, a desire to attack, hostility. The state of aggression can be outwardly pronounced, for example, in pugnaciousness, rudeness, “cockiness”, or it can be more “hidden”, having the form of latent ill will and anger. Outwardly seeming aggressive reaction may actually not be the same, for example, when the student, as they say, “gives back”. A typical state in the so-called aggression is characterized by an acute, often affective experience of anger, impulsive disorderly activity, malice, and in some cases a desire to “take evil away” on someone and even on something. Roughness is a fairly common manifestation of aggression.
IP Pavlov gives such an example of an aggressive breakdown in himself: “When the experiment did not go, but the experiment was done by the assistant, then the devil knows what words I made at his address, which I would never have allowed, I threw the tools etc.” [3; 179]. In one of the clinical environments, there is a case when a friend asked Pavlov to wake him up, and when Pavlov fulfilled this request, a friend, a quite “decent” man, threw a pillow at him [3; 365].
In both examples, loss of self-control, anger, and unnecessary aggressive actions come to the fore. Pupils who “failed” in the exam, sometimes without making any open aggressive actions, at the same time, show anger, a desire to transfer the blame to innocent people, more often to an “unfair”, “picky” teacher, and sometimes “to comrades and even parents who seemed to interfere with their proper preparation for the exam.
Attempts to link aggression with a certain level of personality development should be rejected, as G. Anderson, for example, did. [4; 13]. He proposed to distinguish six levels of personality development. The highest level – socially holistic behavior – is characterized by submission, recognition of dominance. This is followed by a level called “avoidance of dominance” and differing, apparently, in its formal recognition, if you want to find some workarounds. The third level is characterized by aggression, hostility, anger.

Many people are susceptible to spring depression. At first glance, spring and depression, words with the opposite meaning and can’t stand nearby. This period is closely associated with nature awakening after a long winter hibernation. It seems that the mood should only improve.

There is no consensus on the factors that cause spring depression. But doctors and other specialists have one conviction – the changes are guilty. The discrepancies are only in the details: some believe that the body’s resources have dried up after winter and it is necessary to replenish them. Others argue that the body goes into an energetic phase and requires more sun energy. Still others say that human biorhythms are to blame.

So what if you suddenly find yourself in the net of spring depression? Now they talk a lot about healthy proper nutrition – of course, you need to add more fresh vegetables and fruits to the diet, for leading a healthy lifestyle, it is important regardless of the time of year.

It is important to reverse the negative train of thought and rebuild yourself in a new way. The most effective solution is to actively engage in sports, but this requires a serious attitude and time. By the beginning of classes, spring may end.

Hiking is recommended as a good alternative. Generally speaking, this type of load is very useful and most suitable. And in the case of depression, with its help you can immediately get a lot of benefits in the form of:

• Soft workload • Positive emotions from singing birds and blooming plants. • Blue sky and bright sun. • Fresh impressions 

Fresh impressions are extremely important in any depressed and depressive states. They help distract from all the negative, and capture completely. So we are arranged – the new is more interesting, even if it is not at all different from the old.

Therefore, you can add other sources of new things to walks – a new hobby, new acquaintances, trips to nature for the weekend. A walk in new clothes and a new acquaintance at this time especially helps. With prolonged and prolonged depression, some medicinal plants that have a stimulating effect can help . 

This is enough for the spring depression to recede. And it will help to finish off a lot of fresh air and light. The room where we spend most of the time should be well lit and ventilated.

And finally, do not forget about the smile – in this case, the spring depression will recede irrevocably.

The high incidence of certain diseases in the winter is the result of adverse weather conditions and prolonged stay indoors.

As well as weakening of general immunity, and weakened resistance of the skin and mucous membranes to seasonal viruses, bacteria and allergens.

Among the most common diseases in the winter, of course, one should name the epidemic of respiratory diseases and flu, the risk of heart attacks and bone fractures in slippery streets also increases.

An increase in the incidence of seasonal acute respiratory infections (from the common cold, flu, bronchitis to potential complications such as inflammation of the ear and lungs) and exacerbations of existing diseases such as asthma, chronic bronchitis, autoimmune skin diseases, rheumatic diseases, herpes fever and herpes, especially , in older and immunocompromised people.

In winter, diseases of the urogenital system (inflammation of the prostate, ovary, bladder and kidneys) in both sexes caused by light clothing are also more common.

However, this list of health problems has not yet ended, because in the winter many of us jump over well-known holiday stress, and after the holidays, we are usually worried about depression.

Doctors remind that it is important for health to dress in clothes that keep warm, wrap yourself in a warm scarf, wear a hat, gloves and warm boots.

Many people recover quickly from stress, but some develop stressful depression after stressful situations. Scientists have found an explanation for this difference – it turns out that everything depends on the physiology of the brain.

Scientists at the Scripps Research Institute (USA) set out to find out the cause of the difference in people’s responses to stress. They came to the conclusion that clinical depression after stress may be the result of too intense activity of the GPR158 orphan receptor.

As the experts found, receptors are called orphans, for which there are no compounds (ligands) capable of binding to them. Scientists conducted an experiment in mice suffering from chronic stress and found that animals with an excess of GPR158 had a whole series of signs of depression.

“GPR158 affects key signaling pathways associated with mood regulation in the brain area called the prefrontal cortex,” the authors of the project noted.

According to them, in animals in which GPR158 activity was suppressed, not only depression did not develop, their stress resistance was generally the highest. Scientists believe that things can be the same for people.

This finding will help develop a drug for the treatment of depression, the effect of which will be based on suppression of the GPR158 receptor. 

Immediately after giving birth, many women begin to feel such a strong euphoria that they seem ready to love the whole white world. However, this mood does not last long. Absolutely different sensations come to replace: suddenly a state of anxiety and inexplicable irritability, then aggressiveness and causeless tearfulness rolls over. It would seem that a woman should have received exclusively positive emotions from the state of motherhood, but there it was ….

Anxiety, depression, fatigue, irritability, panic attacks, a sense of unreality of what is happening, poor sleep, loss of appetite and libido, helplessness in household chores, loss of love for your baby are all signs of a fairly common postpartum depression. And its consequence is that a woman ceases to experience joy from her own motherhood, ceases to monitor her appearance, avoids communication, and may even become addicted to drugs or alcohol.

Three types of postpartum crises are distinguished, these are:
postpartum spleen, which appears during the first few days after birth, when you want to cry, there is a feeling of oppression, insecurity, fear, self-doubt;

mild depression, which is accompanied by attacks of helplessness, loneliness, fear, and lasts from several days to a week;

chronic depression: bouts of anxiety, fear, when ordinary activities seem completely unbearable. Such depression develops during the first three months after childbirth and can persist for a whole year, and sometimes even three to four years.
By the way, modern medicine today considers depression as a natural reaction of the body to childbirth and motherhood. Therefore, a young mother should be mentally prepared in advance for the fact that after the birth of her baby, her feelings may become somewhat unstable and rapidly change in different directions: from joy to despair and vice versa. Their relatives should be warned about this so that they do not perceive such a state solely as the vagaries of a spoiled lady and help a woman survive this period as easily and quickly as possible.

So, you are under stress. What to do?

Remember that the onset of motherhood will require you to review the entire lifestyle,
as a result of which you will simply have to adapt to a lot. And if earlier, for example, you could not have imagined a day without a morning newspaper and regularly watching television programs, then with the appearance of a baby in your house you will have to forget about all this: you simply will not have time for this. And in order not to feel divorced from the whole world, listen to the radio (you can do this by doing any housework), and you will always be sufficiently informed about the most significant events taking place in politics, culture, and music.

Try to prioritize and do not try to keep the house in the same state; you simply don’t have enough strength to maintain an impeccable cleanliness. Encourage yourself that chaos reigned in your once so tidy house – a temporary phenomenon.

Do not forget that you just need to find time to be alone with yourself, to wander around the shops, look at a girlfriend or go to the beauty parlor to find balance and connection with the outside world. Therefore, do not be shy to at least occasionally ask your loved ones to sit with your child and do not take into account what
people think about you.

No less important for you after childbirth and rest. Try to set certain hours for rest, preferably if they have a daytime nap. In the event that you do not want to sleep, just relax, close your eyes and do not communicate with anyone at this time. Have a cup of mint or chamomile tea. These herbs have soothing properties. And limit your intake of caffeine, which increases nervousness.

While the baby is sleeping, read a good book. Reading is one of the best ways to avoid stress. Rent a comedy cassette. Laughter perfectly relieves stress.

Turn off your phone and take a hot bath with aromatic oils. Turn on pleasant music and ask your husband to give you the massage necessary to relieve muscle tension and improve your mood. And in order to enhance relaxation, add a few drops of aromatic oil to the massage oil.
The soothing properties are ylang-ylang, sandalwood, lemon, orange, lavender and chamomile oils. By the way, often a similar massage session can turn into a wonderful intimate love scene.

Take time to do gymnastics. It has already been proven that if you do gymnastics during the period of depression, then the emotional state improves much faster. And regular gymnastics reduces stress, fatigue, aggressiveness and depression, gives vigor and uplifting. In addition, exercises distract from everyday worries. Performing them, you can at least temporarily forget about your problems.

Often, the cause for depression can be the feeling that you have become a housewife. In this case, hire a nanny or send the child to a day nursery, and you immediately go to work. And most importantly – do not hesitate to consult a psychologist, no one will consider you abnormal. Remember that if you do not understand what is bothering you now, then it will be much more difficult to do this.

Why are about half of young women so depressed during the best period of their lives? This is the paradox of postpartum depression, for which experts must find the final solution and find out the problem. rapidly decreasing levels of estrogen and progesterone after childbirth can unleash depression, in the same way that hormonal exposure before menstruation can cause a similar reaction. The fact that the susceptibility to the effects of hormones is different in different women can explain why half suffer from postpartum depression, despite the fact that all women experience similar changes in hormone levels. There are many factors of a different kind that are likely to be involved in the onset of postpartum depression, which occurs around the third day after birth, but it can also occur in every period after birth during the first year. Postpartum depression is more likely to occur in women who give birth many times than the first time.

Change of position in the family. Your child is now number one star. Guests are more interested in the child than in your state of health (this change will accompany you as well at home). The pregnant princess now plays the role of Cinderella in the postpartum period.

Homecoming. It is not an unusual thing to oppress and overwork caused by duties that you must fulfill (especially when you have many children and you do not have enough extra help).

Fatigue. Overfatigue with difficult childbirth, too little sleep in the hospital in connection with caring for a child often overlaps with the feeling that you have not yet matured to motherhood.

Frustrated by the child. The child is so small, so red, so fat, without expression. Unlike smiling children from the advertisements you saw. The whole adds to depression.

Frustrated by childbirth or oneself. If in your case some unrealistic dreams of childbirth have not come true, then you may feel unhappy that it is your fault.
Feeling of fracture. Childbirth is a great event for which you were preparing, which you expected and now everything is behind us.

Lack of competence. Young mothers may ask themselves: “Why do I have a child if I am not able to take care of him?”

Location to your old self. Carefree life ended, the opportunity to make a career. All this went irrevocably after the birth.

Dissatisfaction with one’s appearance. You used to be fat and pregnant, now only fat. You cannot bear the wearing of things that you wore during pregnancy, but nothing else suits you.

Unfortunately, a little can be said about postpartum depression, perhaps the only thing is that it does not last very long, about 48 hours for most women. Therefore, it does not require treatment, except in those cases in which depression is prolonged. Below are ways to overcome postpartum depression.
If depression appears in the hospital, persuade the husband to order dinner for two and try to have lunch with her husband.
If the visits annoy you, then limit them. If they give you satisfaction, ask for a more frequent visit.
If staying in the hospital is so annoying, ask for an earlier discharge home.
Overcome fatigue by accepting the help of others, do not do things that may wait, rest when your child is sleeping.
Use the time of feeding to discharge, take care and, or feed the baby lying in bed or sitting in a comfortable chair with legs up.
Use a lactating mother’s diet to stay healthy and fit.
Avoid sugar (especially when combined with chocolate), as it can act as a factor in causing depression.
Allow me to persuade myself to take food outside the house, if this is not possible, then allow me to help myself, that is, let my husband prepare food or order food. Dress elegantly, create a mood, as is the case in restaurants with candlelight and light music.
Take care of your appearance. Look good and you will feel good. A whole day walking in a bathrobe, not
combed, can lead anyone to feel unwell. In the morning, before your husband goes to work, take a shower, comb your hair and do makeup. Buy yourself some pretty thing.
Get out of the house. Go for a walk with the baby, or if you can leave the baby with someone, get out yourself.
A set of physical exercises will help you drive away postpartum sadness, as well as get rid of sagging, which can increase your depression.
If you think that society will have a good effect on this “misfortune” of yours, then meet with the young mothers you know and share your feelings. If you do not have close women who have recently given birth, then try to establish new contacts (in the park, in the pool, with those women with whom you attended courses before childbirth), and whenever possible, meet as often as possible.
If your “trouble” requires treatment alone, then take care of this. although depression feeds on loneliness, some scholars deny this, precisely in relation to postpartum depression.
When guests visit you and sympathize with you, avoid them, as this only worsens your condition.
Do not treat your husband too cold. Consent in the postpartum period is immensely important for both of you (the husband may also succumb to postpartum depression, and may need you just like you do)

Postpartum depression extremely rarely requires pharmacological treatment. The need for this applies to one in a thousand women. If your depression lasts more than two weeks and is additionally accompanied by insomnia, a lack of appetite, a sense of hopelessness, and even thoughts of suicide, aggression against a child, consult a doctor.

The fact that you do not suffer from postpartum depression does not mean that this problem does not concern your family. Studies show that if a wife suffers from this type of depression, the husband is not at risk, while at the same time when the wife feels great, the possibility of depression in fathers / husbands dramatically increases. Therefore, make sure that your husband does not suffer from low mood (depression).

Immediately after giving birth, many women begin to feel such a strong euphoria that they seem ready to love the whole white world. However, this mood does not last long. Replace completely different sensations: suddenly a state of anxiety and inexplicable irritability, then aggressiveness and causeless tearfulness rolls over. It would seem that a woman should have received exclusively positive emotions from the state of motherhood, but it wasn’t there ….

Anxiety, depression, fatigue, irritability, panic attacks, a sense of unreality of what is happening, poor sleep, loss of appetite and libido, helplessness in household chores, loss of love for your child are all signs of a fairly common postpartum depression. And its consequence is that a woman ceases to experience joy from her own motherhood, ceases to monitor her appearance, avoids communication, and may even become addicted to drugs or alcohol.

Three types of postpartum crises are distinguished, these are:
postpartum spleen, which appears during the first few days after birth, when you want to cry, there is a feeling of oppression, insecurity, fear, self-doubt;

mild depression, which is accompanied by attacks of helplessness, loneliness, fear, and lasts from several days to a week;

chronic depression: bouts of anxiety, fear, when ordinary activities seem completely unbearable. Such depression develops during the first three months after childbirth and can persist for a whole year, and sometimes even three to four years.
By the way, modern medicine today considers depression as a natural reaction of the body to childbirth and motherhood. Therefore, a young mother should be mentally prepared in advance for the fact that after the birth of her baby, her feelings may become somewhat unstable and rapidly change in different directions: from joy to despair and vice versa. Their relatives should be warned about this so that they do not perceive such a state solely as the vagaries of a spoiled lady and help the woman survive this period as easily and quickly as possible.

So, you are under stress. What to do?

Remember that the onset of motherhood will require you to reconsider your entire way of life,
as a result of which you will simply have to adapt to a lot. And if earlier you, for example, could not have imagined a day without a morning newspaper and regularly watching television programs, then with the appearance of a baby in your house you will have to forget about all this: you simply will not have time for this. And in order not to feel divorced from the whole world, listen to the radio (you can do this by doing any housework), and you will always be sufficiently informed about the most significant events taking place in politics, culture, and music.

Try to prioritize and do not try to keep the house in the same state; you simply don’t have enough strength to maintain an impeccable cleanliness. Encourage yourself that chaos reigned in your once so tidy house – a temporary phenomenon.

Do not forget that you just need to find time to be alone with yourself, to wander around the shops, look at a girlfriend or go to the beauty parlor to find balance and connection with the outside world. Therefore, do not be shy to at least occasionally ask your loved ones to sit with your child and do not take into account what
people think about you.

No less important for you after childbirth and rest. Try to set certain hours for rest, preferably if they have a daytime nap. If you do not want to sleep, just relax, close your eyes and do not communicate with anyone at this time. Have a cup of mint or chamomile tea. These herbs have soothing properties. And limit your intake of caffeine, which increases nervousness.

While the baby is sleeping, read a good book. Reading is one of the best ways to avoid stress. Rent a comedy cassette. Laughter perfectly relieves stress.

Turn off your phone and take a hot bath with aromatic oils. Turn on pleasant music and ask your husband to give you the massage necessary to relieve muscle tension and improve your mood. And in order to enhance relaxation, add a few drops of aromatic oil to the massage oil.
The soothing properties are ylang-ylang, sandalwood, lemon, orange, lavender and chamomile oils. By the way, often a similar massage session can turn into a wonderful intimate love scene.

Take time to do gymnastics. It has already been proven that if you do gymnastics during the period of depression, then the emotional state improves much faster. And regular gymnastics reduces stress, fatigue, aggressiveness and depression, gives vigor and uplifting. In addition, exercises distract from everyday worries. Performing them, you can at least temporarily forget about your problems.

Often, the cause for depression can be the feeling that you have become a housewife. In this case, hire a nanny or send the child to a day nursery, and you immediately go to work. And most importantly – do not hesitate to consult a psychologist, no one will consider you abnormal. Remember that if you do not understand what is bothering you now, then it will be much more difficult to do this.