Depression. An Excerpt From The Book "Stop, Who Leads?" Nominee For The "Enlightener" Award Dmitry Zhukov

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

On the eve of the autumn blues, together with the publishing house Alpina Non-Fiction, we are publishing an excerpt from the book Stop, Who Leads? Biology of human behavior and other animals”nominee for the“Enlightener”award, Doctor of Biological Sciences Dmitry Zhukov.

Man belongs to a biological species, therefore he obeys the same laws as other representatives of the animal kingdom. This is true not only of the processes taking place in our cells, tissues and organs, but also of our behavior - both individual and social. In the book, the author analyzes such issues at the intersection of biology, endocrinology and psychology, and shows, confirming them with examples from medicine, history, literature and painting.

"Everything that does not kill me makes me stronger," said F. Nietzsche. He was wrong: such an impact as an uncontrolled stressful situation does not kill immediately, but makes a person weak and sick, in other words, depressed.

Depression - the most common of the so-called major psychoses (the other two are schizophrenia and epilepsy). Accordingly, the most common mental state that worsens a person's adaptation, reduces his working capacity and is subjectively the most difficult to experience, is a depressive state.

The concept of depression as an independent disease was introduced by the great German psychiatrist Emil Kraepelin. E. Kraepelin described the triad of symptoms of a depressive state, which retains diagnostic value to our time:

• dreary, depressed mood;

• mental and speech inhibition;

• motor retardation.

In other words, depression is characterized by depression of the affective, cognitive and motor functions of the individual. For mania, as for the opposite of depression, this triad is inverted. Mania is characterized by a cheerful mood, as well as mental-speech and motor arousal. Note that the activation of cognitive functions in the manic state is not a fruitful condition. At the same time, one thought “is in a hurry to change another,” leaving speech not for half an hour, but half a second. Moreover, thoughts not only do not follow reasoning, but also arise and disappear rapidly, without a logical connection.

Unlike mania, euphoria is characterized by increased affect, that is, unreasonably good mood, as well as decreased motor and cognitive functions.

Here, we note that the term "mania" is often used unprofessionally to denote delirium, for example, "megalomania", "persecution mania". The use of this term in this case is inappropriate, as is the use of such, for example, a term as "sex maniac". Patients in the manic phase are hypersexual, but not because of painfully high sexual motivation, but secondarily because of increased self-esteem. During a depressive episode, a person's self-esteem is correspondingly reduced.

E. Kraepelin emphasized the great role of the hereditary factor in the development of depressive psychosis. The presence of sick people among a person's relatives significantly increases the risk that frequent subdepressive states are lightning bolts of psychosis, i.e., over time, they will turn into a serious illness. Meanwhile, like any sign, depression occurs under the influence of a combination of genetic and environmental factors. The main environmental factor that influences the formation of depression is uncontrolled stress.

Depression, the symptoms of which were first described in the "Code of Hippocrates", and still represents an important psychiatric problem. Depression affects from 10 to 20% of the population of all countries and cultures, and in a severe form requiring hospitalization - from 3 to 9%. Moreover, about a third of patients are insensitive to any form of treatment, including psychotherapy, drug and electroconvulsive therapy, sleep deprivation, phototherapy, and no longer used lobotomy (brain surgery).

Depressive states represent a heterogeneous group of disorders. But all of them are characterized by three symptoms: low mood, cognitive and motor retardation. In addition, additional symptoms are usually present: ahedonia (loss of interest in all or almost all of the usual activities or lack of pleasure in them); decreased libido; an appetite disorder (increase or decrease); psychomotor agitation or inhibition; sleep disorders; asthenia; ideas of self-blame with feelings of uselessness of existence; suicidal thoughts.

The urgency of the problem of anxiety is evidenced by the fact that the world consumption of anti-anxiety drugs (Valium, Seduxen, Tazepam, Phenazepam, etc.) in 1980-2000. XX century second only to aspirin. It should be emphasized that both depressive and anxiety syndromes are often found in the structure of various mental illnesses. Thus, anxious depression exists as an independent disease, and depressive and anxious states often accompany somatic diseases. Moreover, affective disorders, the degree of which does not reach the level of psychosis, periodically develop in the majority of the population due to the "stress of life".

Classification of depressive conditions

The terms "depression" and "anxiety" are often used synonymously with stress. It is not right. There are significant differences between these concepts

Anxiety - affect arising in anticipation of an undefined danger or unfavorable development of events.

Depression - a syndrome characterized by a combination of three symptoms: low mood, inhibited intellectual and motor activity, i.e., a reduced level of affective, cognitive and motor functions of a person.

With depression resulting from past events, a person is immersed in a bleak present, while with high anxiety, his attention is absorbed by unpleasant or dangerous events that may occur in the future (Fig. 5.6). Anxiety arises with and accompanies stress, and depression is a consequence of chronic stress. Thus, at certain stages of the pathology, increased anxiety is often combined with depressive syndrome.

Depression is a very common mental disorder that can take many forms. Anxiety and other affects may be present in the structure of this disease. There is, for example, "angry depression." There is even agitated depression, in which the patient, despite the depressed mood, is in motor and mental agitation. So the leading symptom of depression is passion disorder - low mood. Attention is drawn to the abundance of synonyms for a depressive state: despondency, melancholy, blues, sadness, grief, dryness, torpor, tightness, hypochondria, melancholy and spleen. Such lexical richness indicates the prevalence of this condition and its significance in the life of Russian people. It is noteworthy that the most common word - despondency - has the Indo-European root nau, which is found in the Old Russian word nav - "dead man". Thus, it is obvious that in the minds of the ancients, depressive states are closely associated with death. This is

confirmed by modern suicide statistics. The overwhelming majority of successful suicidal attempts are made by people in a depressed state.

For a better understanding of the nature of depression, let us consider the classification of depressive states.

Depression are divided according to different criteria. So, reactive depression is isolated if the reason for its occurrence is obvious. If a mental disorder was preceded by upheavals in personal life, natural disasters, serious accidents, etc., it is most likely that the cause of the illness is in this event, that is, the illness is a reaction (sometimes delayed) to a strong sudden impact. More often, a depressive episode develops without an obvious reason, or the reason for it, which the patients themselves indicate, is a very insignificant event. Since the external cause of the disease cannot be established, such depression is called endogenous, that is, having some kind of internal cause.

In fact, endogenous depression also has external causes. Their development is associated with chronic stressful influences constantly acting on a person.

He may not be aware that he is in a state of uncontrollable stress. Many everyday dramas, which sometimes culminate in murders "on the basis of personal hostile relationships," are situations beyond the control of one or all parties. In addition, numerous minor stressful events do not go unnoticed. Their effect accumulates and results in a clinically evident picture. This is "stress plankton - … a microcosm of tiny, but numerous monsters, where weak, but poisonous bites imperceptibly erode the tree of life."

M. Zoshchenko, widely known as the author of funny, albeit very sad stories, suffered from depressive psychosis. Obvious signs of the disease appeared in the writer long before the publication of the "Decree on the magazines" Zvezda "and" Leningrad "", as a result of which he was expelled from the Writers' Union, which, of course, aggravated the course of the disease, but was not its cause. In Before Sunrise, completed in 1944, Zoshchenko goes over the events of his life, trying to explain the frequent bouts of bad mood. Among other things, he recalls his courtship with a woman with whom he only walked the streets for two weeks and who, during a walk, went to a dressmaker, and asked him to wait outside. After some time, the woman went out, and the young people continued to walk. After some time, the hero of the novel found out that the woman was visiting not a dressmaker, but her lover. To his puzzled question, the woman replied that he himself was to blame (we characterize the girl's behavior as redirected activity, see Chapter 4).

Analyzing such events, Zoshchenko tries to convince the reader (and himself) that this and many other similar "small cases" are trifles and they can in no way be the cause of his almost constant ill health, bad mood. As proof, the writer gives various arguments, refers to numerous examples of fortitude, assures that a person's behavior is explained by his will and reason (the first publication of an abridged version of the novel was published under the title "The Tale of the Mind").

Despite all this, including the optimistic author's title of the novel, M. Zoshchenko himself was unable to overcome his constantly progressing illness through rationalization. Thus, numerous unpleasant events, each of which in itself is not a strong mental trauma, due to its large number and, of course, a special mental makeup of the personality, cause severe depression.

One of the arguments against the fact that learned helplessness as a result of uncontrolled stress constitutes an adequate model of endogenous depression is the short duration of the stress exposure used. If painful stimulation with an electric current is used as a stressor - the simplest and therefore widespread stimulation, then the exposure time does not exceed one hour. It is possible that in this case it is indeed more appropriate to interpret the resulting changes in the behavior and physiology of animals as a model of reactive depression, i.e.a form of disorder that develops as a result of short-term but strong exposure. To avoid this fair objection, animal modelers have developed a model of depression resulting from chronic mild stress1.

Under this stress, rats or mice are exposed to one of the following influences daily for four weeks:

• lack of food;

• lack of water;

• tilt of the cage;

• wet litter;

• crowding (the number of animals in the cage is twice as large

usual);

• social isolation (one animal in a cage);

• inversion of the light cycle (the light turns on in the evening and turns off in the morning).

Every week the order of application of influences changes.

If each of these stressors is applied in isolation, that is, if animals are exposed to only one deprivation of water per day or by tilting the cage, then this, of course, will cause stress reactions. But the behavioral and physiological indicators of animals will return to normal in two or three days. However, with chronic application of influences, and in an unpredictable order, animals develop a state of learned helplessness, which can last

a few months.

Endogenous depression is called primary, since there is no clear cause of the disease, more precisely, it cannot be detected. Secondary

refers to depression with an obvious cause. It can be a traumatic event or illness. With any ailment, the mood drops; if it decreases very strongly, then one speaks of depression secondary to a somatic illness.

Distinguishing between primary and secondary depression can be difficult, especially if it is not possible to detect any strong shock that preceded the illness, since primary depression is often accompanied by pain in different parts of the body. Accordingly, they talk about various somatic masks of depression - from cardiovascular to dermatological. These can be complaints of pain and discomfort in the absence of organic changes: psychogenic shortness of breath; psychogenic headache; psychogenic dizziness, movement disorders of psychogenic origin; psychogenic pseudo-rheumatism (complaints of musculoskeletal pain); various complaints of unpleasant and painful sensations in different parts of the area

abdomen; psychogenic disorders in the kidney area, as well as a variety of sexual disorders.

The term "hypochondria", which now means focusing on one's health issues, comes from the Greek hypochondrion - hypochondrium. The old anatomists called the chondroi the thoracic-abdominal septum, believing it to be made up of cartilage. We conclude that the ancient hypochondriacs complained mainly of vague painful sensations in the upper abdomen (Fig. 5.7). Note that the Russian "blues" is a derivative of "hypochondria".

The high frequency of such localization of pain in depression was reflected in the emergence of such a synonym for it as "spleen". This is the English name for the spleen, which is located in the left hypochondrium. In 1606 an Englishman published a book describing his depression, in which he used to spleen as a verb.

The spleen is also associated with such a widespread term as melancholy, which means "the spill of black bile." Opposite the spleen, in the right hypochondrium, lies the liver, a brown organ that secretes bile, which gives the characteristic color to feces. The spleen is dark brown in color, and by analogy with the liver, its secret was called "black bile." Attacks of depression were associated with the spill of black bile. Note that this is a mythical fluid: the spleen does not emit any fluids, blood corpuscles are formed in this organ.

It is interesting that scurvy, such a scourge of travelers of the era of great geographical discoveries, is also one of the somatic (bodily) manifestations of depression. In school, we are taught that a lack of vitamin C in food leads to scurvy, a serious illness in which teeth fall out. In particular, scurvy was very common among members of expeditions. This became especially noticeable when, in the 15th century. long voyages of Europeans to other continents began. Fresh vegetables and fruits - vitamin C-rich foods - quickly ran out, and scurvy broke out among the crews during many months in the open ocean without fresh supplies. One of the forerunners of preventive vitaminization is considered to be Captain James Cook, who in 1768 took sauerkraut on a voyage around the world, which is believed to have prevented the appearance of scurvy in the crew.

In a story like this, almost everything is correct. Indeed, vitamin C is necessary, since it is not synthesized in the human body and must be supplied with food, that is, it is a vital dietary factor. And we willingly eat sauerkraut, lemons with oranges, green onions and black currants even without the doctors' reminders. However, scurvy is caused not by the lack of vitamin C itself, but by a violation of its metabolism in the body, which reduces the synthesis of collagen - a protein of connective tissue and leads to tooth loss. If metabolic processes are impaired, then even with an excess of vitamin C in the diet, scurvy will still develop. And this metabolic disorder often occurs with depression.

As for Captain Cook, then, of course, we will not deny his services to geographical science, sailing and the English crown. But let's pay attention that in the XVIII century. trips around the world were no longer expeditions to the Unknown. Everyone already knew well how long to sail from Europe to America, from Europe to the Cape of Good Hope, from the Cape of Good Hope to Malabar, etc. Sea voyages ceased to be an uncontrollable situation, which they were for the first travelers - Vasco da Gama, Columbus, Magellan. Since the uncontrollability of the situation has significantly decreased, the likelihood of developing depression has dropped significantly. In favor of treating scurvy as primarily a biological marker of depression rather than a lack of vitamin C, in particular, the high incidence of this disease (despite a sufficient amount of vitamin C in the diet) among people experiencing prolonged uncontrolled stress, for example, among prisoners or among participants polar expeditions.

Note that in experiments, the violation of collagen synthesis is used as a biological marker of depression, much more reliable than the results of psychological tests.

The frequency of specific somatic manifestations of depression differs in different social groups and changes over time. This is due to the fact that psychosomatic symptoms, like many mental disorders, are epidemic in nature, due to unconscious imitation.

Somatic disorders in depression are so diverse that an aphorism has developed: "Who knows the clinic of depression, he knows medicine", like the medical aphorism of the 19th century: "Who knows the clinic of syphilis, he knows medicine." Somatic masks for depression are not only varied, but extremely widespread. According to various researchers, from a third to a half of patients who visit a doctor for the first time need to correct their emotional state, and not to treat the heart, liver, kidneys, etc. In other words, painful sensations in different parts of the body to which they complain, are not a consequence of a disease of the organs located there, but a reflection of a primary depressive state.

Meanwhile, from the practical point of view, it is extremely important to establish what caused the patient's depression - a consequence of the disease or the manifestation of symptoms of primary, endogenous depression. In the first case, treatment is prescribed for a specific somatic disorder, and in the second, antidepressant therapy. Various hormonal tests are effectively used to differentiate between primary depression (see below).

According to the severity of the disorder, that is, according to the severity of clinical symptoms, depression can be either psychosis or remain at the level of a neurotic disorder. Without going into the intricacies of various definitions of neurosis and psychosis, we will only say that the border between the two forms of the disease runs along the level of socialization of the patient. With neurosis, he can perform numerous functions of a member of society, communicate with other people and even work, although this is given to him with difficulty and gives difficulties to other people. In psychosis, the patient is excluded from social life and needs hospitalization. In the case of psychotic depression, the patient lies in bed and almost does not respond to external stimuli and internal needs.

Accordingly, the severity of the disorder speaks of affective disorders, if they are pronounced, and dysthymic, if mood disorders are subtle or transient. For example, dysthymic disorders are most common in premenstrual syndrome (see Chapter 3).

The severity of the disease, as a rule, corresponds to the type of course. In the most severe form of depression, periods of decline in the affective, cognitive and motor spheres (depressive episodes) are followed by manic phases. At this time, patients experience a shift in the opposite direction: there is an unmotivated mood elevation, mental and motor excitement. This does not mean that such a period is favorable for mental activity. For manic patients, speech excitement is characteristic, in other words, talkativeness. Mental arousal means that patients cannot concentrate on one subject or activity. Their thoughts jump; having arisen, they do not have time to take shape and logically end, as new ones come to replace them. Manic agitation of the patient is very painful for those around him.

Monopolar depression, in which light gaps are replaced only by depressive episodes, usually proceeds more easily than bipolar, in which light gaps alternate with depressive and manic phases.

Depressive episodes are repeated at different intervals. If they occur exclusively in the autumn-winter period, then the forecast is favorable. Autumn depression is quite easily corrected and, as a rule, does not go beyond mild neurosis. If depressive episodes occur outside of connection with a change in natural light, then the prognosis is less favorable.

As for anxiety, its classification is simpler. Primary anxiety is distinguished, the so-called post-traumatic syndrome, in which a feeling of anxiety is the leading symptom. Secondary anxiety accompanies many situational disorders, which is natural, since a healthy person needs a certain amount of anxiety for the formation of motivation (see Chapter 3). Recall that under stress, anxiety prompts a person or animal to adapt their behavior to changed conditions.

Since depression is often accompanied by increased anxiety, it is extremely important to correctly diagnose anxiety as primary or as secondary, that is, part of the depressive syndrome. For this, the so-called diazepam test is used. Diazepam is an anti-anxiety drug that has no antidepressant activity. If, after taking it, the patient has a decrease in any symptoms or complaints, it means that they were due to anxiety.

Dmitry Zhukov

Doctor of Biological Sciences, Associate Professor in Physiology, Senior Researcher, Laboratory of Comparative Behavioral Genetics, Institute of Physiology. I. P. Pavlova RAS

Alpina non-fiction

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