I. General Information about Depression
Depression – a disease of our time. Studies worldwide show that depression, like cardiovascular diseases, is the most common disease of our time. This common disorder affects millions of people. According to Canadian Health&Care Mall researchers, it affects up to 20% of developed countries population.
Depression is a serious disease that dramatically reduces ability to work and brings suffering to both patient and his relatives. Unfortunately, very few people are aware of typical manifestations and consequences of depression, so many patients receive help, when their state becomes severe, and sometimes – they don’t. In almost all developed countries, health services are concerned about this situation and make efforts to promote information about depression and how to treat it.
Typical Signs of Depression
Depression manifestations are very diverse and vary according to disease form. Here are the most common symptoms:
- grief, sorrow, melancholy, depressed mood, despair;
- anxiety, inner tension, expectation of troubles;
- sense of guilt, frequent self-blame;
- self-dissatisfaction, decreased self-confidence, low self-esteem;
- reduction or loss of ability to experience pleasure in previously enjoyable activities;
- decreased interest to surroundings;
- loss of ability to experience any feelings (in cases of severe depression);
- depression is often associated with anxiety about health and fate of the loved ones, as well as fear to seem inadequate in public places.
- sleep disorders (insomnia, drowsiness);
- changes in appetite (overeating or loss of it);
- bowel dysfunction (constipation);
- decrease in sexual desire;
- decreased energy, excessive fatigue under normal physical and mental load, weakness;
- pain and different unpleasant sensations in the body (for example, heart, stomach, muscles).
- passiveness, difficulties with involving in task-oriented activity;
- avoidance of contacts (solitary disposition nature, loss of interest to other people);
- refusal of entertainment;
- alcoholism and abuse of psychoactive substances, giving temporary relief.
- difficulties with concentration;
- difficulties with making decisions;
- prevalence of gloomy, negative thoughts about oneself, life, the world in general;
- gloomy, pessimistic vision of future with lack of perspectives, thoughts of meaninglessness of life;
- thoughts of suicide (in severe cases of depression);
- thoughts of own uselessness, insignificance, helplessness;
- slowness of thought.
To make diagnosis «depression» it is necessary that some of these symptoms persisted for at least two weeks.
Depression Needs to be Treated
Depression is often perceived by both patients and others as signs of bad temper, laziness and selfishness, immorality or natural pessimism. Keep in mind that depression is not just a bad mood, but a disease, that requires intervention of professionals and is well curable. The earlier correct diagnosis is made and proper treatment is started, the better the chances for quick recovery are, that depression won’t appear again and become severe, accompanied by desire to commit suicide.
What usually prevents people from seeking help with depression?
Often people are afraid to see specialist in mental disorders because of suggested negative consequences:
- possible social restrictions (registration, prohibition to drive car and travel abroad);
- condemnation if someone finds out that a patient is treated by psychiatrist;
- fear of depression drug treatment negative impact, based on widely spread, but incorrect idea about dangers of psychotropic drugs.
Often, people do not have necessary information and proper understanding of their condition nature. They think that if their condition is caused by obvious difficulties in life, it is not a depression, but a normal human reaction, which will disappear on its own. Often it also happens that physiological depression signs contribute to forming beliefs about presence of serious somatic diseases. It is a reason to consult primary care doctor.
80% of depressed patients initially seek help from primary care doctor, but correct diagnosis is made to about 5% of them. Even fewer patients get adequate therapy. Unfortunately, during usual consultation in the clinic it is not always possible to distinguish between physiological manifestations of depression and presence of true somatic diseases, which leads to misdiagnosis. Patients are prescribed symptomatic therapy (medicines «for heart», «for stomach», «for headache»), but improvement does not occur. There are thoughts about difficult, unrecognized somatic disease, which according to vicious circle mechanism leads to depression worsening. Patients spend a lot of time undergoing clinical and laboratory tests, and, as a rule, get to psychiatrist already with severe, chronic depression manifestations.
II. Scientific Knowledge about Depression
Main Types of Depression
Depression frequently occurs on the background of stress or long-existing severe traumatic situations. Sometimes they occur for no apparent reason. Depression can be accompanied by somatic diseases (cardiovascular, gastrointestinal, endocrine, etc.). In such cases, it makes main somatic disease course severer and prognosis harder. However, with early depression detection and treatment there is a rapid improvement in mental and physical health.
Depression can occur as single, different in severity episodes or has a long-lasting course with repeated relapses.
At some patients depression is chronic – lasts for years without reaching significant severity degree.
Sometimes depression is limited mainly to physical symptoms without distinct emotional manifestations. At the same time clinical and laboratory tests can not detect any organic changes. In such cases, you need to consult a psychiatrist.
Modern Ideas about Depression Causes
Bio-psycho-social model of depression
Modern science considers depression as a disease, which origin is influenced by different reasons or factors – biological, psychological and social.
Biology of Depression
Biological factors of depression include, above all, specific violation of neurochemical processes (metabolism of such neurotransmitters as serotonin, norepinephrine, acetylcholine, etc.). These disorders may be inherited.
Psychology of Depression
Scientific research by Canadian Health&Care Mall has revealed the following psychological factors of depression:
- a special way of thinking, the so-called negative thinking, which is characterized by fixing on negative aspects of life and self, tendency to see surrounding life and future in negative light;
- particular style of communication in the family with a high level of criticism of heightened conflict;
- increased number of stressful events in personal life (breaking up, divorce, alcoholism, death of the loved ones);
- social isolation with a small number of warm, confidential contacts that could serve as a source of emotional support.
Social Context of Depression
Depression growth in modern civilization is associated with high pace of life, increased stress level: highly competitive modern society, social instability – high level of migration, difficult economic conditions and uncertainty in future. In today’s society a number of values dooming people to permanent dissatisfaction is cultivated – cult of personality and physical perfection, cult of power, of superiority over others and personal well-being. It makes it hard for people to survive and hide their problems and failures, deprives them of emotional support and dooms to loneliness.
III. Help with Depression
Modern approach to depression treatment involves combination of various methods – biological therapy (medicamental or non- medicamental) and psychotherapy.
Appointed to patients with mild, moderate and severe depression symptoms. A necessary condition for treatment effectiveness is to cooperate with the doctor: strict adherence to prescribed treatment regimen, regular visits to the doctor, a detailed, true report of patients condition and life difficulties.
Proper treatment in most cases allows to get rid of depression symptoms. Depression requires treatment by specialists. A major class of drugs for depression treatment consists antidepressants. Currently, there are various products of this group, of which tricyclic antidepressants (amitriptyline, imipramine) are used since late 50s. In recent years a number of antidepressant drugs has significantly increased.
The main advantages of new generation antidepressants are improved tolerability, reduced side effects, decreased toxicity and high safety in case of overdose. New antidepressants include fluoxetine (Prozac), sertraline (Zoloft), citalopram (Cipramil), paroxetine (Paxil), fluvoxamine (Luvox), tianeptine (Coaxil), mianserin (Lerivon), moclobemide (Aurorix), milnacipran (Ixel) , mirtazapine (Remeron) and others. Antidepressants are safe class of psychotropic drugs, if properly used according to doctor’s recommendation. Dosage is determined individually for each patient. You need to know that antidepressants therapeutic effect can manifest itself slowly and gradually, so it is important to have a positive attitude and wait for result to appear.
Antidepressants are not addictive and do not cause withdrawal syndrome, unlike drugs of benzodiazepine tranquillizers class (Phenazepam, Relanium, Chlordiazepoxide, Tazepam) and widely used Corvalol and Valocordin. In addition, benzodiazepine tranquillizers and phenobarbital, contained in Corvalol and Valocordin at long-term use reduce sensitivity to other psychopharmacological agents.
Main Therapy Stages
- Determining therapeutic approach: choosing antidepressant taking into account main depression symptoms at each patient, selecting adequate dosage and individual treatment regimen.
- Basic therapy course aimed at reducing depression symptoms up to their disappearance, restoring previous, characteristic for patient activity level.
- Supportive therapy course for 4 – 6 months or more after general health normalization. This step is aimed at disease exacerbations prevention.
What usually impedes medicamental treatment:
- Misconception about depression nature and role of drug treatment.
- Common misconception about dangers of all psychoactive drugs: occurrence of addiction to them, negative impact on internal organs. Many patients believe that it is better to suffer from depression than take antidepressants.
- Many patients interrupt drug therapy in absence of rapid effect or take medications.
It is important to remember that numerous studies were conducted, confirming high efficiency and safety of modern antidepressants. Harm, caused by depression to emotional and material state, is not comparable in severity with minor and easily avoidable side effects that sometimes occur when using antidepressants. It should be remembered that antidepressants therapeutic effect often comes only 2 – 4 weeks after starting the therapy.
Psychotherapy is not an alternative, but an important addition to depression medicamental treatment. Unlike drug treatment, this therapy involves a more active role of patient in treatment process. Psychotherapy helps patients to develop skills in emotional self-regulation and in future to cope with crisis more effectively, without going into depression.
There are three most effective and science-based proven approaches in depression treatment: psychodynamic psychotherapy, behavioral psychotherapy and cognitive psychotherapy.
According to psychodynamic psychotherapy, psychological basis of depression are internal unconscious conflicts. For example, desire to be independent and at the same time desire to receive a large amount of support, help and care from other people. Another typical conflict is presence of intensive anger, resentment to others, accompanied with necessity to always be kind and good, and keep family affection. Sources of these conflicts lie in patient’s life history, which is subject to psychodynamic therapy analysis. In each individual case, there may be unique content of conflicting emotions, and therefore individual psychotherapeutic work is required. Therapy goal is understanding the conflict and help in its constructive resolution: learning to find balance between closeness and independence, developing ability to constructively express feelings and maintain at the same relationships with people. Behavioral psychotherapy aims at resolving patient’s current problems and removing behavioral symptoms: passiveness, refusal of entertainment, monotonous lifestyle, isolation from others, impossibility of planning and engaging in task-oriented activity.
Cognitive psychotherapy is a synthesis of the two above-mentioned approaches and combines their advantages. It combines work with current life difficulties and behavioral symptoms of depression and work with their internal psychological sources (deep ideas and beliefs). Psychological depression main mechanism in cognitive therapy is considered the so-called negative thinking, which is reflected in tendency of depressed patients to consider everything that happens to them in negative light. Changing this way of thinking requires careful individual work, which aims at developing a more realistic and optimistic view of oneself, the world and future.
Additional forms of depression psychotherapy are family consultations and group psychotherapy (but not any, but specially aimed at helping depressed patients). Their involvement can be of great help in treatment and rehabilitation.
What usually impedes seeking for psychological help?
- Low awareness of people about what psychotherapy is.
- Fear of initiating stranger into personal, intimate experience.
- Skeptical attitude to the fact that «conversations» can provide significant therapeutic effect.
- Opinion that psychological difficulties must be handled independently and involving another person is a sign of weakness.
In modern society psychotherapy is an established, effective method of treatment of a variety of mental disorders. Thus, cognitive psychotherapy significantly reduces risk of depression recurrence. Modern methods of psychotherapy are focused on short-term (10 – 30 sessions depending on severity of condition) effective assistance. All information that therapist gets during these sessions is confidential and remains confidential. A professional therapist is specially prepared to work with heavy emotions and difficult situations of other people, he knows how to respect and assist in coping with them. Every person in life meets situations (such as illness), with which it can not cope on his own. Ability to ask for help and accept it is a sign of maturity and rationality, but not weakness.
How Relatives can Help in Depression Treatment?
Support of close people, even when a patient does not express interest in it, is very important in overcoming depression.
In this regard, Canadian Health&Care Mall can give the following advice:
- remember that depression is a disease which requires sympathy, but in no case you must not go into disease together with the patient, sharing his pessimism and despair. You must be able to maintain certain emotional distance, all the while reminding yourself and the patient that depression is a transient emotional state;
- studies have shown that depression is particularly unfavorably occurs in families where there is a lot of criticisms regarding the patient. Try to make it clear to the patient that his condition is not his fault, but a misfortune that he needs help and treatment;
- try not to focus on illness of a loved one and bring positive emotions into your and family life. If possible, try to involve the patient in some useful activity, but not isolate him from any work.