Depression – symptoms, and treatment

Depression is not a disease that can be overcome by willpower. It is a slowly debilitating and disabling mental illness caused not only by life’s problems but also by nutritional deficiencies that we may not be aware of for a long time. An improperly formulated diet, persistent weight loss, and eating disorders can cause symptoms of depression. It’s worth knowing, and in addition to psychological help, you should also look for dietary support to help you boost your levels of vitamins and other nutrients that are key to your brain.

Definition of disease. Causes of the disease

According to the World Health Organization (WHO), depression is a common mental illness characterized by persistent sadness and loss of interest in activities that normally give pleasure, inability to perform daily activities, accompanied feelings of guilt, and decreased self-esteem for 14 or more days.

Signs of depression: indecision, impaired concentration, psychomotor retardation or agitation, sleep disturbances, and changes in appetite and weight.

In psychology, depression (from Latin depression – suppression) is defined as an affective state characterized by a negative emotional background, a change in the motivational sphere, cognitive (associated with cognition) representations, and general passivity of behavior.

It is important to distinguish depression as a clinical illness from a depressive reaction to a psychologically understandable situation, where each of us experiences a depressed mood for several minutes or hours in connection with a subjectively significant event. About 16% of people experience depression at least once in their lifetime. [1]

It has been observed that women are significantly more likely to be diagnosed with depression, probably because women are subject to greater neuroendocrine changes. This is due to several physiological characteristics of the female body – the menstrual cycle, postpartum, or menopause, during which the psycho-emotional state can range from normal to clinically delineated depression. In addition, depression is more often detected in women due to their gender, social, and psychological characteristics – for example, it is easier for women to talk about their emotional state.

Men are usually less likely to seek help from a psychiatrist or psychotherapist as they are hindered by social stereotypes: men must be rational, strong, and “real men don’t cry.” In contrast, depressive states in men are directly related to addictive behaviors (alcoholism, drug addiction, gambling, extreme sports).

Significantly increases the risk of developing a depressive disorder in the following cases:

• in old age, because they lost the point of living (when they retired);
• when adult children grow up and leave their parents in a child-centered family (the “empty nest” syndrome);
• at the loss of a loved one.

The biopsychosocial model of how depression develops is widely accepted today. This model says that social, psychological, and biological factors can all cause depression.

Social factors leading to depression:

• Loss, betrayal, divorce, and other types of domestic violence can cause both short-term and long-term stress;
• loss or change of job;
• high psycho-emotional stress in professional activities;
• retirement;
• economic crises;
• political instability in the country.

Psychological causes of depression:

• as a trait of temperament, the tendency to get stuck on bad experiences;
• non-adaptive coping strategies in overcoming stressful situations.

Biological causes of depression:

• neurobiological;
• immune;
• endocrinological changes in the body, such as pregnancy, the postpartum period, menopause, hypothyroidism, or hyperthyroidism;
• Authorization of the body as a result of severe infectious diseases.

Symptoms of depression

How does a person feel when depressed:

1. There is a depressed mood, despair, melancholy, a feeling of hopelessness, low mood for a long period.
2. Fatigue and fatigue increase as a result of chronic or small loads.
3. Decreased interest and ability to enjoy things that used to bring satisfaction.

In addition, signs of depression include:

• decreased ability to concentrate;
• low self-esteem and self-doubt;
• feelings of guilt and a tendency to self-abasement;
• a pessimistic and gloomy outlook on the future;
• psychomotor retardation or agitation;
• sleep disorders;
• changes in appetite and weight.

Recurrent thoughts of death and suicide and suicide attempts are dangerous symptoms of depression.

The thinking of a person suffering from depression is characterized by the presence of irrational ideas and cognitive errors:

1. Excessive self-criticism or unreasonable guilt – thoughts about your worthlessness, loss of self-confidence, low self-esteem, a tendency to self-blame.
2. A negative vision of the present is a feeling of the meaninglessness of existence, the hostility of the surrounding world and people.
3. A negative future vision is expecting problems, new shocks, failures, and suffering.

The pathogenesis of depression

Based on the available studies, it has been proven that disturbances in neurotransmitter activity in the neurons of the limbic system of the brain play a key role in the development of depression – the release and interaction with receptors of the postsynaptic gap of such mediators as serotonin, noradrenaline, dopamine, acetylcholine, histamine, etc.

What Happens in the Body During Depression

The lack of serotonin is manifested in increased irritability, aggression, sleep disturbances, appetite, sexual activity, and a lowering threshold of pain sensitivity. A decrease in norepinephrine concentration in the brain’s neurons leads to increased fatigue, impaired attention, apathy, and a decrease in initiative.

Dopamine deficiency is manifested in a violation of motor and mental activity, a decrease in satisfaction from activities (from food, sex, rest, communication), and a loss of interest in cognition and learning.

Therefore, the drug approach in the treatment of depression consists in prescribing antidepressants that regulate the release and interaction of neurotransmitters with receptors of neurons in the limbic system.

Classification and stages of development of depression

In the International Classification of Diseases of the 10th revision (ICD-10), depression is classified according to the severity and type of course.

Types of depression by severity:

• light;
• moderate;
• Severe depression without/with psychotic symptoms.

With mild to moderate depression, a person, as a rule, remains able to work, although the quality of life decreases. Severe depression is characterized by the presence of typical symptoms of depression: low mood, decreased interest and pleasure in activities, increased fatigue, impaired ability to work, and suicidal tendencies may be present [4].

By flow type: 

• depressive episode;
• recurrent (recurring) depressive disorder;
• chronic mood disorder.

Up to 30-35% of patients have a chronic form of depression, with a duration of depressive disorder of two or more years.

Also, in psychiatry, it is customary to distinguish between depression by origin :

• Endogenous (manic-depressive psychosis) – implies an unreasonable onset, a hereditary predisposition to the development of the disease, alternation of depressive and manic states;
• exogenous – develops under the influence of acute or chronic stress factors;
• Somatogenic – associated with somatic, including organic pathology ( myocardial infarction, stroke, traumatic brain injury, oncological diseases, etc.).

The American DSM-5 classification takes into account the phenomenological features of depressive disorder.

These include depressive symptoms:

• with anxiety distress;
• with mixed features;
• with melancholic features;
• with atypical features;
• with psychotic features
• congruent and incongruent mood;
• with catatonia (movement disorders);
• with seasonal patterns (only applies to recurring episodes).

The seasonal affective disorder is a type of depression associated with the changing seasons that starts and ends around the same time each year. In most people with this type of disorder, symptoms begin in the fall and continue into the winter months, less frequently in the spring or early summer [19].

Complications of depression

All over the world, the economic losses due to disability and the cost of treating people with depression are high.

The coexistence of depression with somatic pathology (arterial hypertension, coronary heart disease, bronchial asthma, diseases of the gastrointestinal tract, oncology, autoimmune disorders) aggravates the course of somatic diseases; In contrast, the severity of the pain syndrome increases, somatic disorders become chronic, resulting in increased mortality from the main diseases.

Why is depression dangerous?

One of the most serious problems is the high probability of suicide in depression (8%). At the same time, up to 60% of the total number of suicides are people suffering from depression. [5] [6]

Therefore, timely diagnosis and adequate medical assistance to people suffering from depression are important.

Diagnosis of depression

A large proportion of patients with depression due to fear of the stigma of mental illness [7] and an abundance of physical manifestations (somatic “masks”) – headaches, dizziness, pain and heaviness in the chest, fatigue, indigestion – first of all, seek advice from a polyclinic network to general practitioners, where they can undergo examination for a long time and ineffective treatment because they do not receive adequate assistance. [8] [9] [10]

In the United States, where the number of psychiatrists is quite large, 50% of patients with symptoms of depression turn to primary care specialists, while only 20% go to psychiatrists [8]. In the United Kingdom, general practitioners treat many patients with depression, and only 10% go to psychiatrists. [11]

Examination for depression

Timely access to a psychiatrist and psychotherapist helps to establish the correct diagnosis of depression and choose effective treatment.

In the diagnosis of depression, clinical scales are used – the Hamilton depression scale, the Zang scale, Beck, etc., [12] [13] [14] that determine the presence and severity of depression and its manifestations.

Unfortunately, there are still no accurate laboratory tests and studies that could show which mediator imbalance led to the development of depression in a particular patient.

Differential diagnoses of depression

Depression is differentiated:

• with mood disorders caused by organic disorders of the brain;
• affective disorders in the structure of schizophrenic disorders;
• bipolar affective disorder (in addition to depressive phases, mania occurs in the structure of the disease).

Treatment for depression

Depressive disorders of mild severity may respond well to psychotherapeutic treatment.

Supportive care for depression

The doctor observes patients 1-2 times a week until the condition improves. During the appointment, the doctor supports the patient, gives the necessary explanations, and monitors progress. A meeting in the doctor’s office can be supplemented by talking with the patient on the phone. The doctor should explain to the patient that depression is not a feature of mood and character but a serious disease caused by biological disorders and needs treatment, in which the prognosis is favorable.

Also, the doctor should encourage the patient to expand daily and social activities, such as walking more often in the fresh air or joining an art circle. The doctor needs to convey to the patient the understanding that the disease is not his fault, that negative thoughts are only a part of this condition, and they will soon pass [20].

Medical therapy for depression

In moderate and severe depression, psychopharmacotherapy (antidepressants) and psychotherapy are more effective.

Today, serotonergic antidepressants and the so-called dual-acting antidepressants (affecting the exchange of serotonin and norepinephrine) are widely used. They are used for three months or more (the average duration of therapy is 6-12 months).

Antidepressants should be taken under the supervision of a physician and, despite long-term use, usually do not lead to dependence and are well tolerated.

If depression is not treatable, has become chronic, and is prone to recurrence, antidepressant therapy can be supplemented with other psychotropic drugs – tranquilizers, antipsychotics, and anticonvulsants.

In addition to outpatient treatment of mild and moderate depression, severe depression is subject to treatment and observation in a hospital setting.

Psychotherapy in the treatment of depression

In the psychotherapy of depression, cognitive-behavioral psychotherapy is proven to be effective and fast-acting, aimed at changing irrational beliefs and depressogenic patterns of behavior of patients, and psychodynamic psychotherapy (psychoanalytic, existential psychotherapy, Gestalt psychotherapy), focused on working through deep feelings and traumatic early experience, is widely used. Patient, the formation of adaptive functioning in the present [15] [16].

Electroshock therapy for depression

Electroshock therapy (ECT), due to the presence of a wide list of contraindications, adverse reactions, and complications, is of limited use. But in cases of severe depressive disorder and drug resistance, ECT can be used and is proving effective [20].

Phototherapy for depression

Phototherapy is used to treat the seasonal affective disorder in clinics specializing in such therapy. In this case, powerful artificial light sources are used with an exposure regime of 10,000 lux for 30 minutes twice – in the morning and the evening. 

How to get rid of your depression

In the case of a depressive reaction to a stressful situation or mild depression, you can not consult a doctor since the manifestations of depression do not lead to maladaptation. It will help a person if he is distracted from a stressful situation and plunges into work or a hobby. Support from a close environment or a visit to a psychologist can also alleviate the condition. But if the condition is delayed, aggravated, and leads to social maladaptation, then, in this case, the help of a specialist is needed – a psychiatrist, a psychotherapist.

What to do if a loved one has depression

From a close environment for a person suffering from depression, sincere support, empathy, sympathy, and an offer to resort to the help of a specialist will be important.

Prevention

A significant proportion of patients do not receive adequate improvement from antidepressant therapy and have resistance or poor tolerability of drug treatment. [17] In these cases, non-drug methods of biological therapy are an alternative (for example, electroconvulsive therapy is often used abroad for resistant depression) and psychotherapy. [18] 

Without adequate treatment, a depressive disorder has a high risk of recurrence, aggravation of the course, and the appearance of a suicidal mood in a patient.

Prevention of depression are:

• reduction of stress loads;
• Normalization of the sleep-wake mode (insomnia is one of the provoking factors of depression);
• proper nutrition;
• exclusion of alcohol abuse, nicotine, and other addictions;
• Systematic sports (with a sports load in the human body, endogenous opiates are released in greater quantities – enkephalins and endorphins, substances that provide a good mood and vigor and reduce pain);
• communication with friends and relatives;
• Engaging in pleasant and interesting activities that create a positive emotional background.

Bibliography

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