From the author: Depression is a very multifaceted problem. I decided to systematize knowledge on it in this article. Conflict of professions... Psychiatrists sometimes dislike psychologists because they mind their own business: they take on the treatment of clients with severe mental disorders, in particular with depression. After all, such patients in the early stages of depressive disorder (while they still have strength) come to see a psychologist, and not a psychiatrist. And not everyone really recovers after working with a psychologist. This is dangerous because the client who “didn’t help” loses faith in his cure and lets everything take its course. Or, at best, he still turns to a psychiatrist, but it’s too late, because... time is lost. A person may already be in such a serious condition that he is one step away from committing suicide. In this case, his relatives usually bring him to the psychiatrist. And doctors may no longer have time to help them, suicides happen. Therefore, it is very important for a psychologist not to miss such a patient during diagnosis and to guide him along the right path to recovery. It is necessary to recognize depression in time, which requires drug treatment. So it turns out that the health and, in some cases, the life of such a client often depends on the psychologist. Of course, the correct diagnosis depends on the qualifications of the psychologist himself, knowledge of related psychodisciplines: psychiatry, neurology, endocrinology; as well as his level of responsibility and integrity. In this regard, the qualifications of most psychologists in our country leave much to be desired. They don't know psychiatry! That is why the training course “Psychiatry for Psychologists” is so in demand among psychologists seeking to improve their qualifications. By the way, many psychiatrists are also not qualified and not motivated to help the patient: either due to lack of education (which is strange), or because of emotional and professional burnout, or because of irresponsibility or personal qualities. Well then, what can we say about psychologists who, when receiving their education, did not even study the psychodisciplines necessary for practical work? I'm throwing a stone at my garden, but it's fair! I studied psychiatry only while receiving additional education in “clinical psychology.” And after that, I studied for a long time in practice with the best psychiatrists. I will try to systematize knowledge on depression based on my experience of working with such patients at a private appointment and in a vascular clinic. And also to summarize those sections of psychodisciplines that relate to the topic of depression. A view from above... A big plus in psychiatry is that it has the concept of register syndromes (according to I.A. Kudryavtsev), which are not found in other medical specialties. A register-syndrome is an enlarged nosological unit (individual diseases) compiled into a specific register. One register unites its characteristic syndromes, which have the same origin (pathogenesis). Different registers are needed in order to separate from each other syndromes that have qualitatively different causes. This means that these disorders must be treated pathogenetically in different ways. Diagnostic errors are costly for patients. Sometimes they are also costly for doctors (from inadequacy of position to physical harm to mentally ill patients). There are the following pathopsychological register syndromes: I - schizophrenic (clinical equivalent: schizophrenic psychoses). II - affective-endogenous (clinical equivalents: manic-depressive psychosis and functional affective psychoses of late age, endogenous depression and mania).III—oligophrenic (clinical equivalent: oligophrenia, mental retardation).IV—exogenous-organic (clinical equivalents: exogenous-organic brain lesions - cerebral atherosclerosis, consequences of traumatic brain injury, intoxication encephalopathy, vascular dementia and encephalopathy, consequences of hypertension, etc.). V - endogenous-organic (clinical equivalents: true epilepsy, brain tumors,primary atrophic processes in the brain, Alzheimer's disease (dementia), frontotemporal dystrophy, non-vascular dementia, with Lewy bodies, endocrine diseases). VI - personality-abnormal (clinical equivalents: accentuated and psychopathic personality, caused by abnormal “soil” psychogenic reactions).VII—psychogenic-psychotic (clinical equivalent: reactive psychoses).VIII—psychogenic-neurotic (clinical equivalent: neuroses and neurotic reactions).All mental disorders fit into some pathopsychological register-syndrome. This article is about depression, so I will try to find a place in the registers for depression of various origins. Endogenous (biological) depression fits into the affective-endogenous register-syndrome; neurotic depression - in the psychogenic-neurotic register; post-schizophrenic depression - in the schizophrenic register; vascular, post-stroke, endocrine and drug addiction depression - in the exogenous-organic register; involutional (senile) and epileptic depression - into endogenous-organic; reactive depression and cyclothymia - in personality-abnormal. Within the framework of the affective-endogenous and psychogenic-neurotic register, depression is an axial syndrome that determines the entire nature of the disease. These are basically what psychologists encounter at their appointments. Within other register syndromes, depression develops against the background of other underlying diseases, and is not the leading one in the clinical picture of the disease. And such patients are unlikely to see a psychologist en masse with their complaints. Neurotic depression of the psychogenic-neurotic register is the bread of the psychologist. Well, and a psychiatrist at a private appointment too. It is these types of depressions that are treated with psychotherapy. However, without recognizing biological (endogenous) or somatogenic depression, the psychologist risks losing his professional face and harming the person and his relatives. As you know, clinical depression is dangerous due to suicide. Let's separate the wheat from the chaff... How to recognize endogenous (biological) depression and differentiate it from psychogenic and other types of depression? How to decide: “Should I keep this patient with myself, or transfer him to a doctor for outpatient or inpatient treatment?” Classification table of depression by pathogenesis Endogenous depression Psychogenic depression Somatogenic organic (vascular, endocrine, involutional, drug addiction, epileptic, hypertensive) Somatogenic symptomatic Pathopsychological register-syndrome Affective - endogenous Psychogenic-neurotic Endo- and exogenous-organic Psychogenic-neurotic (in some cases endo- or exogenous-organic) Main diagnostic criterion Arises spontaneously, without an objective reason, as if out of the blue. It can also disappear spontaneously. It occurs due to a metabolic disorder of certain substances in the brain. There is always a certain objective reason. The clinical picture of the development of such depression always corresponds to the criteria of neuroses by K. Jaspers: 1. The condition is always caused by mental trauma.2. A psychogenically traumatic situation is reflected in the clinical picture of the disease and is reflected in the content of its symptoms.3. The condition is related in time to its cause. The presence of a psychoorganic symptom complex (exo- and endogenous): 1. Decreased attention and memory.2. Slowness or acceleration of all mental processes.3. Emotional imbalance.4. Decreased intelligence and sometimes impaired thinking. Caused by disease of internal organs or glands. Somatic illness is the leading one in the clinical picture of the disease. Clinical picture The clinical picture includes the depressive triad according to E. Kraepelin: 1) Hypotymia - a sharp decrease in mood. Emotions can be different. Young people have more melancholy, older people have more anxiety in the clinical picture; 2) Bradyphrenia - severe slowness of thinking (false dementia); 3) Hypobulia - a sharp decrease in volitional.