Depression: The Plague Of The 21st Century

2024 Author: Harry Day | [email protected]. Last modified: 2024-01-15 16:05

Author: Ekaterina Sigitova

Aside where the days are cloudy and short

a tribe will be born that does not hurt to die.

(Petrarch)

Nothing pleases, the days slip through your fingers like sand, the world is seen through a cloudy veil, you don't want to get up, and eat, and sleep, just cry, cry, cry …

Sound familiar?

Today, the reality is that when you use the word "depression" in a company or in private conversation with a friend, you are likely to meet an understanding look. This, in fact, a medical term has firmly taken its place in the active vocabulary of modern man. Even too firmly - to the place and out of place, at the slightest blues, we decide that we are depressed, and intensely pity ourselves.

This "medal", of course, has two sides. With one of them, the scientific name allows people not to be ashamed of their experiences, and to receive the necessary “kitchen psychotherapy”. On the other hand, the word “depression” is used so much in different senses and in different contexts that others may not believe in a real, serious illness, considering complaints to be whining and lack of will.

The statistics of the incidence of depression every year changes towards more and more sad numbers. If, before 1916, depression occurred in less than 1% of the population; then from 1916 to 1950 their prevalence was already 2-5%; and after 1950 the incidence of depression reached 12% -14%. According to WHO data for 2006-2008, approximately 15% of the world's population is currently suffering from depression.

Well, in the era of world wars, there was no time for such “nonsense” as depression, and over a century the number of “sufferers” increased 15 times? Not certainly in that way. The increase in morbidity is associated not only with a high level of unemployment, characteristics of social life and stress, but also with more advanced diagnostic methods, as well as the fact that modern people are no longer so shy about going to doctors.

It can be different, green and red

Back in Ancient Greece (330 BC), Hippocrates described such a phenomenon as melancholy, referring to this term as a bad mood. After him “melancholy” was studied by many scientists, in particular, Areteus of Cappadocia, Robert Burton, Théophile Bonet, François Bossier de Sauvage, Jean Bayarget, and, finally, Emile Kraepelin, who, in fact, suggested using the term “depression”.

Despite the large number of scientific papers on the topic, there is currently no consensus on the causes, mechanisms of development and types of depression. The American Psychiatric Association's fourth edition of the Diagnostic and Statistical Classification of Mental Disorders (DSM-IV, 1994) provides information on many types of depression. Why did it happen? The fact is that a huge range of depressive manifestations complicates the diagnosis and gives rise to many interpretations and hypotheses.

For example, only within the framework of a biological theory, the following causes of depression are assumed: genetics, a deficiency of neurotransmitters in the brain, electrolyte metabolism disorders, seasonal changes in daylight hours, etc. And psychological theories assign a significant role in the development of depression to such resounding phenomena as “learned helplessness” (Martin Seligman) and “wrong conclusions from the surrounding reality” (Aaron Beck).

If we talk about classifications, then depression is usually classified according to the severity (mild, moderate and severe). They are also divided according to “internal” or “external” causes of occurrence (for example, reactive and autonomous, endogenous and exogenous, neurotic and psychotic, somatized and “true” depression).

Cross-cultural studies of the prevalence and structure of depression in different countries have revealed many interesting facts. In particular, a study conducted in 1981 by the US National Center for Health Statistics on a sample of 18.5 million.healthy people, found that the symptoms of depression are more pronounced in the poor; African Americans and Hispanics; women; people with low levels of education and income; divorced and single people. According to several scientific works of later years, depressions are more common in Western countries than in Eastern ones, due to differences in worldview and philosophy of life; in eastern countries, depressions often take on a somatized form.

However, not everything is so simple: differences in culture, language and communication characteristics of the subjects quite strongly distort the results, because, for example, feelings of guilt, low self-esteem and lack of life motivation are not always regarded as symptoms of depression.

It is believed that not everyone experiences depression. They are more susceptible to people with a certain personality structure: anxious, suspicious, active and fussy, with demonstrative character traits - they have a slightly higher chance of encountering depression than most.

Gender differences in the structure of the incidence of depression are difficult to present unequivocally: since men are less likely to visit doctors and less often admit that they have any symptoms, currently about 70% of patients with depression are women.

Whether people or dolls

How to determine that this is exactly depression, with which you need to go to a specialist, and not just a period of melancholy, self-pity, or PMS?

This is what is written in the International Classification of Diseases 10th revision (ICD-10). You are depressed if you have experienced 3 or more symptoms every day in the past 2 weeks or more, such as:

apathy, lack of will and motivation for action.

You wake up - you don't want anything. If you don't wash, you are lazy, you don't eat or smoke, you just don't remember about it. You walk from corner to corner and do not notice how time flies. One fine evening I realized that I have been like this for 20 days. I didn't notice them. (Lena, 27 years old)

Feelings are disgusting. It seems that you live, move, eat, sleep, study - but at the same time you … do not live. All sensations are like through a thick layer of gray cotton wool. (Arina, 35 years old)

difficulty concentrating, memory.

I come to work two hours late. The scattered attention is scary, I confuse the words - instead of a polyclinic - a hairdresser, I forget even at work some things, which in a normal state is not typical for me. (Anna, 37 years old)

In general, I began to forget everything, some details about work, sometimes I could not even remember some conversation the next day. (Jeanne, 31 years old)

an inability to enjoy anything.

I sincerely did not understand conversations about studies, clothes, cosmetics, Eurovision, the girl of “that guy”, the “big wash” program. I didn't understand when the head girl told me something about the open session and the absences. They all seemed to speak Chinese. (Olga, 26 years old)

Nothing pleases - no food, no socializing, no cinema - nothing. (Taisiya, 39 years old)

decreased self-esteem, self-doubt, difficulties in communicating with people.

From scratch, at work, there is a constant feeling that everyone is up in arms against, that they do not appreciate, do not respect, do not like. I hated the whole world, felt how THEY ALL wish me harm. (Alina, 25 years old)

I could not talk to anyone, because after a minute I was literally beginning to break, and hysterics began: what are they all talking about when I feel so bad !!! (Natasha, 31 years old)

The world is disgusting, there is so much dirt and pain in it, I am a failure, mediocrity, I can’t and don’t know how, no one loves, it seems that everyone mocks me, I hate people, if someone from my acquaintances behaves positively, I want them everyone was burnt in hell - how can they rejoice if I'm so awful? (Tamara, 30 years old)

thoughts of guilt, self-deprecation.

In the morning you wake up and think: I won't get up, I will lie there, just lie, I won't go anywhere, I won't eat, I won't think. I needed somewhere? Ah, I won't go … You sleep, falling through, wake up in the middle of the night, and some thoughts like, everything is wrong, why do I live, maybe it's better not to eat, not to move? (Olesya, 28 years old)

dark and pessimistic vision of the past, present and future.

I don't want anything - not even the best; it seems that nothing will bring deliverance from this state; everything is bad, hopeless; even if there is heaven on Earth, I don't care; even the fulfillment of a cherished dream, it seems, will not bring anything (Alla, 31 years old)

The movie is not funny, the book is uninteresting, etc. I do not want to communicate. All fools. And why are they so cheerful? From stupidity, apparently. (Arina, 35 years old)

I remember the complete blackness of thoughts and a complete refusal to filter those thoughts. That is, you are thinking something really scary - about yourself, about your loved ones - and no inclinations to give yourself over the head that you even allow yourself to think about this. (Taisiya, 39 years old)

Like a step in the middle of a mountain - there are still many kilometers of road ahead, but you are already tired, as the devil knows what, and you definitely cannot get there. (Olga, 36 years old)

a desire to harm or kill yourself.

I didn't want to live anymore. But in the Russian language, unfortunately, there is no word that would mean NOT to live, but would not at all mean DIE. (Olga, 26 years old)

I really, really want to die. Constant sluggish thinking about what could be done to die - you can buy a rope … Or you can pills … (Arina, 35 years old)

disturbed sleep.

I want to sleep all the time, so I would sleep and sleep like a marmot (Alla, 31 years old)

Sleep disturbed, constant nightmares, sleep paralysis. (Irina, 28 years old)

She fell asleep calmly, woke up at 2 am and that's it until the morning. (Maria, 30 years old)

At night I woke up at 4 - and I don't sleep anymore, but in the afternoon I start to fall. Even if there is an opportunity to sleep 20 hours a day, there is no feeling of “rest”. (Elvira, 40)

I could sleep two, three days in a row. Sleep until you have a headache from excess sleep. Get up to the toilet and go to bed again. (Arina, 35 years old)

I fell asleep very badly, because all the time I was replaying my “troubles” in my head and there was always an internal dialogue. (Natasha, 31 years old)

She walked like a zombie with glass eyes, ate whatever, constantly wanted to sleep, but could not. Even if I fell asleep for an hour at 3 o'clock, the dream was still some kind of superficial, I heard everything and even continued to think about something in this pseudo dream. (Angela, 42)

decreased appetite.

Eat. But no pleasure. In fact, there is no appetite, much less hunger - but I want to chew, structures time, distracts. (Elvira, 40)

The appetite was normal. Food alone is not fun. Eat here and eat … Or do not eat … (Arina, 35 years old)

I don't remember anything about food, everything was on autopilot. (Natasha, 31 years old)

It is also worth paying attention to the daily (so-called circadian) rhythm of life - fluctuations in the intensity of various biological processes associated with the change of day and night. Normally, the mood in the morning should be better than in the evening. With depression, the rhythm is disturbed: a new day begins with an early, at 3-5 am, awakening, it is full of "black" thoughts, by the evening the state stabilizes a little. Often people in depression "addicted" to painkillers and alcohol in order to somehow alleviate the condition

I wanted to drink every evening. With alcohol it was easier, as if the heaviness from the soul went away a little. (Jeanne, 31 years old)

I sat down tightly on painkillers (like Nurofen), barely got off afterwards (Nadezhda, 39 years old)

I got hooked on solpadein - a terrible thing! Drank for over a year - brrr … (Evgeniya, 26 years old)

Quite often, with depression, constipation, weight fluctuations, and menstrual irregularities occur. Characterized by indifference to the environment, apathy, decreased memory and interest in everything. It so happens that people who are depressed stop taking care of themselves.

I came home, took off only my shoes and outerwear, and immediately went to bed. Then she woke up and left in the same (!!!) attire. Sometimes I didn't even wash my face. (Olga, 26 years old)

A couple of times I fell straight into bed and slept in clothes, barely drag yourself into the shower, shave with disgust or nothing. (Elvira, 40)

I haven't washed my hair for a month. (Ekaterina, 28 years old)

Fake toys

Let's take a look at some of the common types of depression and their features.

Somatized depression

This is a disorder in which bodily symptoms come to the fore, while the psyche is left unattended, although mood disturbances and other manifestations of depression are present. Previously, this depression was called masked (from the word "mask"). Patients complain of weight changes, hand tremors, respiratory distress, insomnia or drowsiness, sweating, libido disturbances, dizziness, palpitations and chest pains, constipation or diarrhea, etc. It is believed that patients with this type of depression account for up to 25% of the general practitioner visits, and about 60-80% of them are never recognized and do not reach psychiatrists.

Statistics show that this type of depression is more common among people of middle and high income, with a high standard of living and education, and of pre-retirement age.

The criterion for this type of depression is that the patient's complaints do not "fit" into any known bodily illness, patients find it difficult to find a description of their feelings, this is accompanied by pronounced anxiety and tension.

Reactive depression

This is a depression that developed after a mental trauma: loss of loved ones, rape, disability. It is believed that there are several phases during an acute psychogenic reaction: acute, subacute, the phase of compensation and adaptation. Reactive depression develops in about half of bereaved people and often lasts 6-12 months or more. Normally, the feeling of grief dulls somewhat 2-3 months after the injury. If 4-6 months or more have passed, and the emotions are the same intense, then this is a reason for contacting a specialist.

Depression caused by bodily illness

There was a high incidence of depression in patients with the following diseases:

- dysfunction of the ovaries (especially polycystic), thyroid gland (including subclinical), diabetes mellitus;

- diseases accompanied by severe pain (for example, rheumatoid arthritis, trophic foot ulcers, angina pectoris)

- oncological diseases (including still undetected and painless, at relatively early stages)

- diseases occurring with a clear threat to life (identified oncological, chronic renal failure, multiple sclerosis, etc.)

- some autoimmune and neurological diseases;

- diseases of the gastrointestinal tract;

- skin diseases that appear on large surfaces, with a chronic course and itching as a symptom.

Medication-induced depression

The “gray list” includes drugs such as reserpine, chlorpromazine, haloperidol, oral contraceptives, beta-blockers, clonidine and others. This does not mean that taking these drugs is unnecessary or dangerous. Just be mindful of yourself during the course of your treatment.

Postpartum depression

It arises, as the name implies, in a young mother after the birth of a child. Postpartum depression affects about 14% of mothers and 10% of fathers (data from the Norfolk School of Medicine, published in the journal Pediatrics in 2006). It is caused not only by neuroendocrine disorders, but also by fatigue, lack of sleep, negative experience of childbirth, child characteristics, mother's expectations, feelings of low self-esteem and self-esteem, low level of social support. The myths of society and the media equate motherhood with a happy pastime, which leads to a violation of the delicate balance in the woman's psyche.

Medication, psychotherapy, educational programs, self-help groups, and alternative therapies (herbs, diet, massage, phototherapy) are used to treat this group of depression. The cure in the first 4-8 weeks is achieved in 67% of mothers.

Read on the website: DEPRESSION

Go away, old woman, I'm in sorrow

The paradox is that often people who are depressed, either do not understand what is happening to them, and therefore deny the need for professional help; or the state of self-pity is so pleasant and has so many secondary benefits that it takes a very long time to get to the doctor.

All weekend I revel in my grief: cried and slept, slept and cried. She did not eat anything, for a long time she did not want to drink sedatives in order to suffer from her own. (Marina, 31 years old)

The state is gray, no bursts. There was no feeling that I was depressed. I did not think about it at all, and such words did not arise. (Maria, 30 years old)

I had thoughts of going to the doctor or just complaining to someone. And they were always interrupted by an outlandish reasoning, which then seemed to me to be the crown of logic (also, apparently, a consequence of depression): “How can someone help me if I cannot help myself ?!” (Arina, 35 years old)

You constantly whine to your friends, you want them to feel sorry for you and share your melancholy when they get scared and start shouting "go to the doctor!" - you take offense at them that they do not understand that you no longer need to see a doctor, that your life is over, and all that remains is to survive in this state. Yes, you revel in your condition. (Taisiya, 39 years old)

I didn't understand that something was wrong with me. It seemed to me that this hopelessness is absolutely normal, now it will always be so. And from this I only wanted to die, because I did not see a way out. (Tamara, 30 years old)

It was terribly offensive that none of my friends was trying to somehow stir me up, help me. It was terrible for myself, some kind of hypersensitivity. (Jeanne, 31 years old)

Nevertheless, only a specialist (psychiatrist or psychologist) can say with certainty whether it is time for you to take pills, or you can still “shake yourself off”, pulling yourself out on your own, like Munchausen. Therefore, when you feel that something is amiss, do not hesitate to appeal. Depression is not only unpleasant, but also dangerous - you cannot correctly assess your condition, you have a reduced reaction and work opportunities, and, no matter how scary it sounds, depression can lead to suicide. In terms of the number of suicides, depression confidently “holds” the third place after addictions and psychosis. But up to 90% of depressive episodes can be completely cured.

Unfortunately, many people in Russia are afraid of visiting a psychiatrist, fearing that they will be “registered” and stigmatized for life. As a result, a huge number of myths associated with psychiatrists and psychotropic drugs are widespread. Many people independently “prescribe” antidepressants and tranquilizers to themselves, although, probably, they would hardly treat their heart or stomach. This is not true. A normal doctor will not treat a healthy person, but will send him home with relief - he already has enough patients. But he will not miss severe depression, prescribe treatment, and thereby save you from further deterioration, and your relatives from anxiety. Self-medication in case of depression is very dangerous: an incorrectly selected drug or its dose will not only not have a therapeutic effect, but can also harm.

Antidepressants are now the standard treatment for depression. There are 37 trade names of this group of drugs registered in Russia.

Many drugs, if they are not adhered to and are not monitored, are addictive. In particular, it is now believed that one in 20 US citizens takes Prozac. There was even such a term "Prozac generation", designating the modern American nation. And a 2007 Australian study found that the most commonly used drug class among Australians was antidepressants.

That is why antidepressants can only be prescribed and prescribed by a psychiatrist, belong to the “B” list of pharmaceuticals, and are dispensed in pharmacies by prescription. Antidepressants of the latest generations have a fairly selective effect and a minimum of side effects (for example, dry mouth, yawning, slight fluctuations in weight - not such a big price to pay for the opportunity, figuratively speaking, to breathe deeply).

They need to be taken for at least 6 months. It so happens that the first prescribed antidepressant is not suitable: in this case, after 2-3 weeks of therapy in an adequate (that is, corresponding to the severity of depression) dose, the drug can be changed or a second one can be added. Sometimes this is done more than once until a completely suitable and working treatment regimen is selected.

Abroad, in particular in the United States, electroconvulsive therapy (ECT) is widely used to treat depression. Its efficiency is about 50%.

Psychotherapy can be a treatment for mild (sometimes moderate) depression. In more serious cases, a preliminary "preparation" of the patient with antidepressants is required, and psychotherapy will already be an auxiliary, albeit very effective method. They use such areas of psychotherapy as rational, cognitive, gestalt therapy, psychoanalysis, body-oriented methods, etc. In general, the process is aimed at informing the patient about the disease, finding the causes and better ways to cope with them, withdrawing negative emotions into the external environment, responding to painful situations.

If there are some “irreparable” reasons for depression (for example, a seriously ill relative, financial losses, loss of loved ones, unsuccessful marriage, etc.), it still needs to be treated. It often happens that medications and psychotherapy help a person who is unsuccessfully trying to punch through a wall with his head, “see” windows and doors.

Described are the antidepressant effects of yoga and meditation, sunlight (natural or from powerful light lamps), dark chocolate, bananas and oatmeal (they contain the "happiness substance" serotonin)

What follows from this? Should live

You should not be upset ahead of time if you begin to notice any of the symptoms in yourself. Sometimes depression can be stopped and even avoided.

As a means of "prevention" of depression, we can recommend the following:

1) regular exercise and activity … "They may be the most potent natural antidepressant," writes naturopathic physician Michael Murray in Natural Prozac Substitutes.

2) good nutrition rich in omega-3 fatty acids, tryptophan and vitamin B6 (Omega-3 - rapeseed oil, flaxseed, salmon, sardines, tuna, raw (not fried) nuts, eggs; tryptophan - milk, eggs, poultry (especially turkey), almonds; vitamin B6 - meat, animal liver, chum salmon, beans, cereals (buckwheat, millet), wheat flour, yeast).

3) getting enough sleep. Sleep deprivation in the brain decreases levels of serotonin and other neurotransmitters, and the body is depleted, which can predispose to the development of symptoms of depression.

4) protect yourself from shocks and disappointments. For example, don't watch horror movies. During the difficult times of the Great Depression, films with a bad ending were even officially banned from showing in America, and the concept of a happy end appeared.

5) regular examination for somatic diseases and timely treatment. Particular attention should be paid to the thyroid gland, menstrual cycle, and diseases of the digestive system. In particular, practice shows that after correcting the level of thyroid hormones, the symptoms of depression disappear without a trace in 25-30% of patients.