How to get out of depression

Posted on March 9, 2021  in Uncategorized

Depression is one of those disorders that have recently become more common in the practice of psychiatrists around the world.     

The fast pace of life, the lack of a normal alternation of work and rest, psycho-emotional stress and much more are some of the reasons provoking the growth of this disease. This is especially true for residents of large cities.   

In addition, this diagnosis is also “popular” at the present time. This fact causes a large number of speculations among pseudo-healers (representatives of alternative medicine, psychics, etc.), and just people who are ready to give various kinds of recommendations, but are very far from medicine.       

This is a very harmful tendency, since many are captivated by delusions that it is enough to normalize their daily routine, do something that gives pleasure, just relax and sit in silence, as the disease itself will recede.    

K Unfortunately, this is not so.  

Depression is an affective disorder prone to progression, affecting not only the emotional, but also the physical condition of a person. In addition, it is also deadly: about 70 % of people suffering from depression have thought or tried / sometimes successfully / attempted suicide. According to WHO forecasts, by 2030 this particular disease may break records and become the main cause of death in the world, giving way to the prevailing cardiovascular and diseases and oncology today .               

That is why the question of how to get out of depression has the only unequivocally correct answer: see a doctor.   

This disorder is treated by doctors – psychiatrists or psychotherapists. But you need to understand that in domestic medical practice, only a specialist with a higher medical education can be a real psychotherapist. Beware of offers from “just psychotherapists”, people who have completed additional courses in any psychotherapeutic area after receiving any higher education (even psychological) .        

The bottom line is that high-quality treatment of depression often requires a combination of psychotherapeutic assistance with the use of pharmacology (antidepressants), and only a doctor with special knowledge can choose the right drug, its dosage.   

It is also almost impossible to get out of depression on your own (just as it is impossible to get out of tuberculosis on your own , for example, or appendicitis).   

The main signs that should make you pay attention are: 

  • yearning,
  • reduced mood background,
  • despondency,
  • unwillingness to communicate,
  • melancholy,
  • decreased efficiency at work, 
  • anhedonia (inability to enjoy the things that gave him before),  
  • decreased libido (sex drive),
  • indifference, vision of life (present, past and future) in black.  

It often happens that being in a depressed state, the person himself is unable to see a doctor. And here his relatives and close people must certainly help him: to persuade, to invite a specialist at home, to start a course of treatment with all his might.     

In the event that there are / even once / statements about the death , or attempts (preparation) for this – inpatient medical care must be provided immediately!       

There are situations when the salvation of our family and friends depends on an attentive attitude to their condition. Depression is where procrastination can really cost your life. At the same time, this disease is quite treatable, you can get out of depression, you just need to be in time.       

Chronic fatigue and depression

Posted on March 3, 2021  in Uncategorized

At the present time, when the pace of life, especially in big cities, is that there is practically no possibility to stop and make a break, doctors are increasingly faced with the phenomenon of the so-called chronic fatigue.     

Its main symptom, which in turn is one of the signs of depression, is a feeling of loss of energy and high fatigue. But, unlike depression, which is included in the group of affective disorders, it is affect (that is, emotions) that suffer less in chronic fatigue syndrome. On foreground muscle weakness, constantly feel tired, not passing without even looking at the long sleep and rest.                   

Chronic fatigue syndrome, in contrast to depressive disorders, was described for the first time relatively recently. He is diagnosed in mainly from residents of large cities.     

In domestic medical practice, CFS was described for the first time in 1991 , at the same time the researchers identified several groups of the population, especially susceptible to this condition. These include the liquidators of the Chernobyl accident and the residents of contaminated areas, patients after surgery (most often – cancer after chemo – and radiation therapy), people with chronic inflammatory diseases. And the last category includes people with high material wealth, more often they are businessmen forced to work a lot, in whose life there are a lot of emotional stress and little physical activity.             

In world practice, viral infections (herpes simplex, Epstein-Bar), immune disorders are considered hypothetical reasons for the development of chronic fatigue syndrome, and some experts tend to believe that this is one of the forms of depression with an atypical course.      

Both diagnosis and treatment of CFS are very difficult. So, first of all, during the examination, you will need to differentiate it from other diseases with similar symptoms. A treatment called the most diverse, since it does not to completely clear the causes of this condition. In mainly high-calorie diet is recommended, orderly daily routine to always to sleep hygiene, vitamins and restorative physio -Procedures. In general, the treatment of this ailment most often comes from work with the most pronounced symptoms. Such symptomatic treatment is able to “extinguish” the most alarming and difficult manifestations, but, unfortunately, it is not able to work with the cause.                  

Thus, the question of the relationship between CFS and depression remains unclear . Some sources note that depression can often accompany this phenomenon, and therefore consider it necessary to use antidepressants. However, there is still no conclusive evidence of the effectiveness of antidepressant use in suspected CFS.        

In any case, remember that normally a healthy person needs 6 to 8 hours of sleep per day to fully recuperate. And after even a short vacation, we should feel refreshed. If this is not the case, if you constantly feel tired for a long time , consult a doctor.               

Stress and depression

Certain adrenal hormones are released in response to stress. They reduce the proliferation of dentate gyrus progenitor cells in the adult hippocaptus . Many corticosteroids reduce the formation of granular nerve cells by inhibiting stem cell division.

NMDA receptors are involved in the realization of the effects of corticosteroids, their blockade prevents the negative effects of corticosteroids. Any violation of neurogenesis develops depression. The hippocampus and prefrontal area may atrophy in depressed patients. When treated with fluoxetine, an antidepressant, the content of new cells in the dentate gyrus increases, and inhibition of serotonin synthesis leads to a decrease in the processes of neurogenesis in the hippocampus .

The microstructure of the hippocampus changes with irradiation, which also leads to an increase in the functioning of microglia and changes in vascularization .

TMS and antipsychotics in the treatment of depression

In the treatment of depression , intermittent transcranial theta stimulation is used for one to three minutes as an additional method of treatment in patients with this disease.  

Some studies have shown that blocking the dopamine D2 receptor alters the therapeutic effect of intermittent theta stimulation.  

An analysis of the case histories of 105 patients with depression, resistant to drug treatment, showed that dorsolateral prefrontal intermittent theta stimulation had a positive result with additional intake of drugs from the antipsychotic group.

Causes of depression

Previously, scientists and doctors believed that neurotransmitters – monoamines, in particular serotonin, dopamine, norepinephrine – play a role in the genesis of depression . This hypothesis arose under the influence of the results of research on antidepressants, but today two more mediators deserve attention – glutamate , which regulates excitation processes, and gamma- aminobutyric acid (GABA), the main mediator of inhibition.

This is supported by evaluations of the effects of ketamine, amantadine , lamotrigine, and anticonvulsants on the severity of depression. These drugs act on the NMDA (N – methyl – D – aspartate ) glutamate receptors. 

The factors that provoke stress play an important role in the development of depression, especially the stress factor is important in the first episode of depression. A person’s predisposition to the effects of stress factors depends on disorders in the regulation of the hypothalamic-pituitary-adrenal system.

Some researchers have found elevated levels of the adrenal hormone cortisol in a large number of depressed patients who have not yet received drug therapy. Moreover, the level of cortisol did not decrease after the administration of dexamethasone. This effect formed the basis for the creation of the dexamethasone test, which was introduced into clinical practice. It detects endogenous depression.

Disturbances in the regulation of the hypothalamic-pituitary-adrenal system occur primarily at the level of secretion of corticotropin- releasing hormone (CRH), which promotes the secretion of adrenocorticotropic hormone (ACTH). A decrease in the level of CRH secretion in patients with high CRH values ​​reduces the production of ACTH by the pituitary gland and subsequently cortisol. A decrease in CRH secretion occurs in response to the introduction of synthetic CRH.

The remissions that occur after episodes of depression can be traced by the dexamethasone test. 

Adults who have suffered severe psychological trauma in childhood are vulnerable to stress, which means to the development of depression, since they have impaired regulation of the hypothalamic-pituitary-adrenal system. Such patients have a tendency to be hyperactive, especially during critical periods of brain development, and a predisposition to depression throughout life, especially in the presence of stress. Numerous changes in the hypothalamic-pituitary-adrenal system, leads to an increase in the secretion of glucorticoids , which leads to structural and functional changes in the limbic system in patients with depression. Antidepressant therapy leads to a decrease in the proliferation of cells in the limbic system of the brain. The modern approach to the genesis of depression does not exclude the role of neuroplasticity in the development of depression. The role of hereditary factors in the development of depression was also noted. 

Medicines that provoke the appearance of depression

Drugs that can cause depression include:

  • oral contraceptives;
  • antimicrobial drugs (ampicillin, evaferents , azithromycin, streptomycin, tetracycline ); 
  • anticonvulsants ( leviracetam, vigabatrin, topiramate );
  • immunomodulators (alpha interferon, steroids, cyclosporine );
  • antihypertensive drugs (beta-blockers, methyldopa , reserpine, flunarizine );
  • psychotropic drugs ( levodopa , metaclopramide , amantadine , sedative hypnotics, phenothiazine , disulfiram );
  • medicines used in oncology ( vinblastine vincristine );
  • barbiturates;
  • antihistamines;
  • psychoactive substances (amphetamine, cocaine).

Focused Ultrasound Treatment for Depression

Ultrasound examination is not only a diagnostic method for imaging human organs and systems. It can be used as a method of focused treatment of mood disorders. The use of ultrasound as a therapeutic agent depends on the frequency parameters and the type of equipment. In addition, ultrasound facilitates the delivery of a drug across the blood- brain barrier to specific brain structures. 

Thus, ultrasound can be one of the means of neurostimulation .

The use of low-intensity and low-frequency ultrasound as a stimulator of neural networks ultimately leads to the activation of neurons through the influence on the sodium- calcium channels of the cell membrane. ( Tyler with et al , 2008).  

Other possibilities and ways of achieving a similar effect in a non-invasive way remain problematic.

Herbal medicine for mental illness

Before the era of pharmacotherapy, mental illness was treated with herbs. Herbal medicine has its own advantages and disadvantages. At this time, there are about thirty drugs, which are based on medicinal herbs. They are used to treat many mental illnesses: obsessive- compulsive syndrome, bipolar, somatoform , psychotic, phobic , seasonal affective disorders, depression, anxiety.

 Medicinal herbs used in psychiatry

Medicinal herbsMental illness
Rhodiola rosea (pink root of Rhodiola rosea , golden root )Depression
Hypericum perforatum (St. John’s wort, Hypericum ordinary )Depression
Scutellaria lateriflora ( skullcap bicolor _Anxiety disorders
Piper methysticum ( kava )Panic, phobic , OCD
Crocus sativus (saffron)Depression
Zizyphus jujuba ( unabi , chappy , Chinese date)Anxiety disorders
Crocus sativus (saffron)Depression

Researchers have found that more than twenty phytopreparations have epigenetic, endocrinological, neurochemical effects . 

 There is evidence for the use of St. John’s wort for treating major (major depression) and kava for treating anxiety disorders.

Representative data indicate the effectiveness of St John’s wort and kava in treating depression and anxiety. But there is not enough evidence to support the use of other drugs in treating mental illness.  

The integration of medicinal herbs with synthetic psychotropic drugs is of great interest for practical medicine. But it is also necessary to study the safety issues when using St. John’s wort and kava . 

 Treatment with medicinal herbs for mental illness is a direction that needs to be developed in practical health care.

Neurochemical processes in depression

At the moment about 30 mediators have been found. Dopamine , norepinephrine, and serotonin are involved in the pathogenesis of depression . Norepinephrine is active in the limbic system and hypothalamus. He is responsible for the reaction to stress, memory processes, physiological drives, emotions. Serotonin is responsible for the human emotional sphere. The connections between neurons are plastic and depend on personality traits, stress, hereditary factors, past experience. The transfer of impulses from one neuron to another is carried out using mediators. When transmitting an impulse ,    transition of an electrical impulse into a chemical signal. Mediators accumulating in the axon are released from it and through the synapse are supplied to another neuron. Mediators have a tropism for different types of receptors. After the transfer of information from one neuron to another neurotransmitter is released from the receptor, it is returned into the synapse. There it is incorporated into the transmitting neuron, or is destroyed by monoamine oxidase . The pathogenesis of depression is associated with a decrease in the sensitivity or density of the postsynaptic serotonergic and noradrenergic systems. According to the theory of S.N. Mosolova        the leading theory is the monoamine theory. The theory postulates that depression develops in due to a lack of dopamine, norepinephrine, serotonin.  

 In the late 70s of the twentieth century, the serotonergic theory of the origin of depression was developed . Based on this theory, serotonin has been considered as a neurotransmitter responsible for improving mood. He was also responsible for aggressiveness, sleep-wake cycle, appetite.

 In the 1950s, the catecholamine theory of depression was formulated . The concentration of norepinephrine in the cell is under the control of presynaptic adrenergic receptors . Stimulating these receptors inhibits the release of norepinephrine and decreases neurotransmission .     

The blockade of these receptors by antidepressants leads to an increase in the release of norepinephrine. Studies of the reticular formation of the brain have shown that antidepressants have a psychostimulant effect. Medicines in this group improve wakefulness, enhance perception, memory, thinking, and increase concentration. According to this theory, endogenous depression is caused by a decrease in the concentration of catecholamines, in particular norepinephrine, in different parts of the brain. The activity of the noradrenergic system is assessed by the concentration in the urine of MOFEG (3-methoxy-4-hydroxyphenylethylene glycol).   

 In patients with depression with low MOFEG positive therapeutic effect was observed by desipramine and imipramine .    

Dopamine deficiency may play a role in the development of depression.

Dopamine takes part in the regulation of the motor sphere, is responsible for the formation of certain behavior, and has a psychostimulating effect. This theory is supported by the ability of L-DOPA to promote increased activity. 

Endorphins are to neuropeptides having a dual function -mediatora and hormone. Endorphins are responsible for a person’s sensitivity to pain, which is why their reduced amount in dysthymia leads to pain intolerance in people with depression.  

Various neurochemical processes leading to depression are targeted by drugs. 

Infection and depression (hypothesis)

Infectious agents such as herpes simplex virus, cytomegalovirus can cause mental manifestations that can be diagnosed as schizophrenia or bipolar disorder. 

In 1907, the American psychiatrist Henry Cotton tried to treat mental illness, fighting various infections in the human body – he removed carious teeth and tonsils. Despite the fact that his views and methods were flawed, already in the 21st century there is a growing body of evidence that viruses and bacteria, and the associated inflammation, are correlated with some mental illness. Some scientists believe that depression is an infectious disease. Even outwardly, patients with depressive disorders look like infectious patients. They look tired, do not want to get out of bed, lose their appetite. In many eastern countries, patients with depression, first of all, complain of physical illness.

Some brain infections, such as Toxoplasma gondii , cause emotional disturbances, mimic mental illness, or cause mental health problems. The same is characteristic of the Epstein- Barr virus , Bourne disease, herpes viruses, herpes zoster, chickenpox.

The experience of the clinic of Doctor of Medical Sciences V.L. Minotko shows that mental illness requires high-quality microbiological and virological laboratory diagnostics. It should include microscopy, RPHA, ELISA, determination of markers of the state of the mucous membrane, cytokine profile and other indicators of inflammation, as well as neuroimaging . Laboratory research should be combined with careful medical history and clinical studies to identify chronic infectious diseases.