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I. GENERAL INFORMATION ABOUT DEPRESSION 

Depression is a disease of our time 

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

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

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

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

Emotional manifestations

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

Physiological manifestations

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

Behavioral manifestations

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

Thought manifestations

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

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

Depression needs to be treated

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

What usually prevents people from seeking help for depression?  

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

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

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

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

II. SCIENTIFIC KNOWLEDGE ABOUT DEPRESSION 

The main types of depression

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

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

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

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

Modern understanding of the causes of depression 

Bio- psycho-social model of depression.

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

The biology of depression

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

The psychology of depression

Scientific studies have identified the following psychological factors for depression:

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

The social context of depression

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

III. HELP FOR DEPRESSION

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

Drug treatment

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

Antidepressants

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

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

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

The main stages of therapy

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

What usually interferes with drug treatment:

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

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

Psychotherapy

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

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

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

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

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

What usually hinders seeking psychotherapeutic help? 

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

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

Helping people close to you to overcome depression 

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

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

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

Complaints of elderly people suffering from depressive spectrum disorder often revolve around problems with diseases of internal organs, joints, and spine. It is worth paying special attention to the fact that it is very, very difficult to identify depression in old age . In general, it does not belong to the typical “companions” of old age and is not an inevitable consequence of age-related changes.            

In general , if depression manifests itself, then with age , somatic, that is, bodily symptoms , hypochondriacal experiences (excessive attention to one’s health, constant fear of getting sick), fears , anxiety , irritable, maliciously melancholy mood, cognitive impairments come to the fore … In this period of life vividly expressed – wife are manifestations of depression as a negative image of will – present, the difficulty of perception of positive developments. The cause of all failures, including growing physical difficulties, people begin to consider their own failure. In the case of depressive illness in the foreground you can go delusions of guilt and sin.                    

Fears that with age it becomes more difficult to treat depression , which is largely justified and is due to the influence of the vascular factor, on the one hand, and degenerative changes in the cerebral cortex , on the other. Studies show that the effectiveness of treatment for depression, as well as its manifestations, in old and senile , and at a young age is approximately the same. Another thing is that among the mechanisms of the onset of depression, over time, deep, biological factors begin to play an increasing role . This organic changes in the brain and the aging of the cardiovascular system, other related chronic – skie internal diseases, metabolic disorders. Drug treatments can go on the forefront, but there is often need a combination of two antidepressants of different mecha – ma action, active involvement of non-drug therapies .                           

The influence on depression of psychosocial factors , which also contribute to its occurrence and development, cannot be underestimated .    

Among the most common reasons that provoke the onset of depression , – fear of loss of autonomy, lack of social support, loneliness, social isolation, loss of influence and respect, changing living conditions and the usual social ties.    

Especially dangerous in old age are severe mental trauma – the death of a spouse, a change of place of residence (moving to another district, city, country, from a rural area to a city, etc.), and finally, financial collapse, so familiar to most Russian pensioners. That is why in the psychotherapy of the elderly and senile age the support and encouragement of a person is so important – and especially in the family circle, if , fortunately, there is one.   

It would seem that everyone, in fact, knows the main symptoms of depression … However, this is a false impression. It is worth delving a little deeper and getting acquainted with the clinical descriptions of this disorder in more detail – and you will be surprised how complex and varied its manifestations are! And an accurate diagnosis can be made only by knowing all the nuances, sometimes outwardly inconspicuous individual characteristics of these manifestations. And an effective treatment strategy , in turn, is based precisely on a comprehensive knowledge of all the signs of depression .                

When you look closely at someone with depression, you will probably notice that their mood is altered .   

Doctors call depressed mood hypothymia and note that the “bad mood” in depression can have different shades specific to a given mental disorder. 

Indeed, depressed mood is recognized as a classic sign of depression. In all cases of disorder, even the most mild, this symptom occurs most often. 

The spectrum of mood changes can include anxiety, melancholy, apathy and irritability. Emotions close to the feeling of anguish, sadness, and recognized the sadness, to apathy – laziness and indifference, to the dismay – excitement , anxiety and fear.            

“Recognition” of the leading modality of mood: irritability, anxiety, melancholy and apathy is especially necessary for accurate diagnosis of depression and the construction of an optimal treatment regimen.     

Each of the leading modalities of depression has its own spectrum of concomitant somatic and neurological symptoms.  

Constant doubts when making a decision, low self-esteem, and feelings of guilt are quite typical signs of depression. 

It can also manifest itself in an angry, melancholy mood – dysphoria. At the same time, one should not forget that such phenomena as constant dissatisfaction, irascibility, resentment and vulnerability can be permanent attributes of a person’s personality, which were present even before the onset of depression.       

Irritability, anxiety, melancholy and apathy, as a rule, are in close connection with each other, but at some point one of these feelings becomes the leading one. The manifestation of a number of other symptoms depends on this , in particular: the nature of sensations in the internal organs and the degree of change in thinking and perception processes.            

Unbearable melancholy is a hard feeling. In this state, the world for the sufferer looks lifeless and dead. And such a world can no longer bring any joy, no pleasure. This is how anhedonia often develops . This term “covers” the loss of the ability to experience, experience pleasure. The joys of life lose their meaning, what used to please is now indifferent …       

In severe cases, there is “mental anesthesia” – a conscious loss of the ability to any feelings in general. Despite the excruciating mental pain, a person sometimes completely loses the “gift of tears”, but as he recovers, the ability to cry out his sorrows returns to him.      

During depression, initiative clearly weakens, the ability to cope with difficulties decreases , many desires common to people disappear, and the will noticeably weakens. A person begins to constantly complain of fatigue , weakness, which sometimes seem so insurmountable that he no longer has the strength to just get up and go to the doctor. In severe cases, there may be complete passivity, immobility. Obvious changes in behavior and appearance occur.       

With depression, a person, on the one hand, seeks isolation, avoids contact with other people, and on the other hand, on the other hand, seeks sympathy and support from others.       

He strives for loneliness and at the same time is afraid of it, withdraws from communication, hiding his feelings, and at the same time he is glad, even if a short, casual meeting with a person who is ready to at least superficially delve into his problems.          

Attempts to distract the depressed person, to come up with entertainment for him, are usually unsuccessful and often cause the opposite effect. Deep pessimism soon paints the world dark again . Changing the place of stay, contacting a new doctor sometimes only for a short time bring relief, which quickly gives way to disappointment, irritability and the return of other symptoms, even more pronounced.      

Movement during depression is most often slowed down, limited. The sufferer can sit motionless in one place or lie for a very long time . Sometimes there is even a so-called “depressive stupor” – a state of complete immobility.   

Less often, opposite phenomena can occur . So, with melancholy in the elderly and young people, specific excitement can be observed, in which a person does not find a place for himself, rushes about, breaks his hands, groans. The character of a person is noticeable in the manifestations of depression.     

In the period of depression also appears carelessness in dress and in appearance. For a person, a posture with lowered shoulders, a sad expression on the face, lowered corners of the mouth, a look “down”, a fold at the eyebrow, among psychiatrists known as the “Veragut fold”, named after the doctor who described it, become characteristic .      

Statistics shows that 80% of people suffering from depression, on – Rushen sleep . As a rule, a person wakes up early, as if from a sudden jolt. But it may be difficult and falling asleep, sleep usually surfaces – ny, restless anxious, often saturated nightmares. A person sometimes does not feel that he was asleep.        

Phase of dreams in such people comes much earlier than normal, which, in particular, could be evidence of biological predraspolo – field intensity to depression . Dreaming sleep usually occurs in the first half of the night. Common symptoms are lack of sense of relaxation after sleep, do not – the ability to sleep in the daytime, or, on the contrary, expressed daytime sleepiness.         

As you know, the deepest, late stage of sleep is very important for the normal functioning of the body, and in severe depression this stage may be completely absent. Reduction or absence of tre – tey and fourth phases of sleep – sleep Rem-phase – is considered the most accurate diagnostic criteria for depression. In addition, sleep cycles during depression lag behind the circadian rhythm.      

Insomnia is a common symptom and a sure companion of depression.  

The occurrence of sleep disorders can also be caused by diseases of internal organs, endocrine diseases, alcohol abuse , smoking, as well as neurological diseases (migraines, back pain). Insomnia interferes with the restoration of vital energy, as a result of which a person is overworked, mental activity decreases, and the immune system decreases. A person becomes irritable and can blame himself for not being able to keep up with the general rhythm of life. Therefore, if insomnia continues for seven days, you need to seek help.   

People with depression have different assessments of their condition. Not seeing clear reasons for its development, some, including the patient’s relatives, may not recognize depression as a disease, while blaming themselves for lack of will, passivity, and indecision. In these cases, there are frequent attempts to explain the symptoms by psychologically understandable reasons, thoughts are expressed about the presence of bodily diseases. But more often the problem is perceived as a mental one, and with an admixture of ideas of self-accusation: “I got sick because of stupidity, because of a trifle,” “I didn’t need to be treated in the hospital,” “I took the wrong medicine,” “I didn’t get myself together on time” and etc. Characterized by endless searches for the cause of the disease, “archaeological excavations” concerning the past and everything that could be the source of the development of depression. The question is constantly tormented – why did this happen to me?                       

The most dangerous are thoughts of suicide or suicidal thoughts. If they are present, the suffering person has a burning desire to punish himself, no longer burden others with taking care of himself, not be a burden for those around him. Understanding that the state of depression is temporary, that it is possible to recover, like many other “brothers in misfortune”, and even one’s own previous experience in overcoming suffering sometimes does not bring relief … It is known that the state of alcoholic intoxication in these cases often leads to tragic consequences – suicide.                 

A specially constructed clinical conversation of a doctor includes questions aimed at identifying a feeling of hopelessness, a willingness to commit suicide, a detailed plan for committing it (in particular, drawing up a will, putting in order their financial affairs, searching for tools for committing suicide). Do not be afraid to openly ask a person if he has suicidal thoughts . Sometimes this can prevent trouble.           

A common medical mistake by a psychiatrist , usually committed under pressure from a patient with depression and his relatives, is the premature discharge of a patient from a psychiatric clinic , especially if, upon admission to the hospital, he had thoughts of suicide.     

In time of depression there are a variety of vegetative disorders – tive nervous system: sweating, fluctuations in blood pressure, palpitations, dry mouth, fatigue, insomnia , tremor, disorders of intestinal activity and approx. Patients often cold, he did not can keep warm, freezing the tips of the fingers ( maybe this is why depressed patients have a desire to stand for a long time under a hot shower or take a warm bath).         

Depression is accompanied by disturbances in the circadian rhythm. Hence the Wuxi – Lenie severity of the symptoms of depression in a certain time period. Previously it was thought that the symptoms of depression is usually worse in the first sexual – not a single day (80% of patients with depression), but in recent years suggest that the circadian rhythm of depression depends on the individual biological characteristics of the patient man.      

Typically, depression disrupts a person’s sex life . Snee – zhaetsya libido, impaired erection, the sensation of orgasm. In women disrupted menstrual cycle, sometimes monthly fully pre – clearly reduced.   

During the period of depression, the digestive system suffers. Decreases or completely disappears appetite. However, in rare cases, it even intensifies – as a rule, in relation to certain products. It is no coincidence that bulimia is often accompanied by symptoms of depression (a person “seizes melancholy”) and is treated with antidepressants . During depression, many say that ” food has lost its taste”, it becomes like “grass”. The resulting weakness makes it difficult to go to the grocery stores , choose them, cook and eat, and the thought of food even causes nausea.                  

A common symptom of depression, especially in old age – resistant for – pores, flatulence, pain in the abdomen. A person noticeably loses weight or less often, on the contrary, having begun to eat abundantly, he gains weight.    

Changes in appetite in people who, in addition to depression, suffer from bodily diseases – peptic ulcer disease, hypertension, diabetes mellitus – can complicate the course of the latter.   

Heart rhythm disorders – often “on – wet on depression” with the cardiovascular system.   

Sometimes breathing problems arise : a person feels a lack of air, incomplete inhalation. Breathing is slow.  

Frequent companions of depression – a different kind of pain : headache (Chuv – GUSTs heaviness in the head), in the neck, the back, joints, and other frequently encountered in the field of past wounds, traces of the operation. This may be changed and the very perception of pain: she seems stronger, has a special character, it becomes unbearable and the reception for by reducing sensitivity to pain – STI. Note that chronic pain syndrome also successfully treats – Xia antidepressants. 

Atypical depression is a form of depressive disorder characterized by anxiety, excessive sleepiness, increased appetite, and changes in weight. Atypical depression is difficult to treat.   

Symptoms of atypical depression

A diagnosis of this depressive disorder requires at least 5 signs.  

The following symptoms are characteristic of atypical depression:

•  sadness
•  decrease in energy potential
•  feeling of hopelessness and worthlessness 
•  loss of the ability to enjoy activities you love 
•  difficulty concentrating and making decisions  
•  tearfulness
•  irritability
•  excessive sleepiness
•  insomnia
•  pain for no reason
•  toothache
•  digestive disorders
•  low sex drive
•  sexual dysfunction
•  headache
•  changes in appetite
•  weight loss or gain
•  obsessive thoughts of death and suicide  
•  injury to health, attempted suicide

Atypical depression is widespread. Experiments and studies are being conducted to find out if a given depression is a subtype of the mildest type of depression , dysthymia. This type of depression lasts for at least two years. There is also an opinion that atypical depression is a milder form of bipolar disorder, also called a manic-depressive episode.     

Causes of atypical depression

It is believed that the development of atypical depression occurs as a result of a chemical imbalance in the cerebral cortex. The chemical elements neurotransmitters responsible for allowing brain cells to communicate with each other include dopamine, serotonin, and norepinephrine. The causes of atypical depression have not been fully identified. The main causes of atypical depression are distinguished:      

•  grief , loss in life (death of a loved one, separation, divorce) 
•  genetic factor
•  interpersonal incidents, resulting in feelings of guilt  
•  violence (sexual, bodily, or sensual)
•  an important event in life (moving, changing or losing a job, completing school or university, retirement)    
•  serious illness
•  alcohol or drug addiction 
•  leaving the family. 

Treatment for atypical depression

In the treatment of atypical depression, it is recommended to use antidepressants that give quick results. Some drugs can have a negative effect on the body, so you need to follow a special diet.  

Exercise for depression is free, healthy, and absolutely free of any side defects. Exercise has been shown to help prevent potential bouts of depression, as decreased mobility is one of the manifestations of a depressive state.      

Exercises that improve oxygen metabolism (jogging, swimming, riding a bike), and so the heavy lifting can significantly alleviate depression mild or moderate or enhance the effectiveness of the treatment of severe.   

Even a walk can bring tangible benefits. Exercise combined with psychotherapy and / or medication can help you cope with depression much faster. Another point is important here : the effect of exercise can be long-term. So, in the course of the experiments, it was found that people who regularly exercise, even after seven years, reduced anxiety and depression.         

Why is exercise beneficial?

• They distract a person from the experiences typical of a depressive disorder.  
• Exercise for depression increases self-esteem: a sense of accomplishment, winning a round of sports, etc. make a person successful.  
• Exercises involving group / pair activities (dance, aerobics) reduce feelings of isolation.
• Physical activity with access to nature harmonizes the inner state of a person: even a walk in the forest / park or weeding garden beds in the country can give a feeling of satisfaction.    
• On a biological level, physical activity helps release those chemicals ( endorphins ) in the brain that lift your mood and even reduce pain.   

How much time to spend on exercise for depression?

It is enough to do exercises that improve oxygen metabolism only 2-5 times a week for 30-40 minutes. Do not start with such a load right away – increase it gradually. None of the exercises are effective if they feel too hard. You can start simply by walking. Most people with depressive disorder are difficult to get up, so start small.               

Depression responds fairly well to treatment. About 80% of patients who received appropriate effective treatment recovered from depression completely. Non-drug treatment is an essential part of the treatment of this disorder and is usually carried out through psychotherapy. The following methods are used to treat depression without medication:   

•  Cognitive-behavioral psychotherapy – lectures, trainings, assignments, keeping an observation diary, monitoring your state and well-being. With this therapy, a person learns to control his behavior and change it;   
•  Art therapy. Art therapy . This includes drawing, modeling, music, cinema therapy . This method contributes to the displacement of the patient’s experiences; 
•  Body-oriented psychotherapy treats depression through contact with the body; 
•  Transactional analysis – description and analysis of human behavior;  
•  Special breathing exercises;
•  Psychoanalysis. Dealing with experiences related to childhood, mental trauma;  
•  Existential-humanistic psychotherapy. The psychologist helps to characterize your lifestyle, identifies the features of building relationships with others, assists in changing your behavior and lifestyle;   
•  Gestalt therapy – is based on the principles of focusing consciousness on reality;   
•  Neuro Linguistic Programming;
•  Psychological counseling;
•  Hypnotherapy;
•  Light therapy .

Light therapy , aimed at changing the violation of the patient’s biological rhythms , is very effective . Researchers have shown that biological rhythms can be changed by exposure to high-intensity light. It turns out that bright and prolonged exposure to light has a positive effect on the centers of circadian rhythms, there is an inhibition of melatonin secretion in the pineal gland, a change in the concentration of cortisol and ACTH in the patient’s blood, synthesis of catecholamines, and a sympathicotonic and parasympathicotonic effect. Thus, there is a fight against the symptoms of the disease. To obtain the desired therapeutic effect, a room illumination of at least 2600 lux is required . The required illumination is achieved by using incandescent lamps, which are located on the ceiling of the room at a height of about 2.5 m. As a rule, 27 incandescent lamps of 200 W are used. It has been proven that the effectiveness of treatment increases if the walls of the treatment room are painted white or green, with maximum body exposure. Before prescribing this treatment, the patient is thoroughly examined. During the session, patients can freely walk around the room. The positive effect of therapy depends on the intensity of the regulatory function of the cerebral cortex and the stabilization of the activity of the autonomic system. For the treatment of this disorder , special tabletop devices are used.                       

Since depression is very difficult to cope on their own, especially when it comes to these forms of depression as severe. Therefore, if you feel that you are starting to get sick, contact a qualified specialist. The variety of methods allows you to effectively deal with the symptoms of the disorder, and thorough diagnostics contributes to successful treatment.