From the author: “I have depression” is a phrase familiar to many, which, unfortunately, has become too popular in our difficult times. Whether it is really that harmless is something everyone decides for themselves. And for starters, you can just figure out what is hidden behind this common word “depression”... Dejection is a languid feeling of the spirit caused by impotent anger at fate or at other people. Immanuel Kant Depressive changes in mood, as a normal reaction to troubles and stress, can occur in any person and repeat itself repeatedly throughout life. Only some people easily cope with such experiences, while others are prone to developing more persistent emotional disorders... According to the US National Committee on Mental Health, by 2020 depression will become the second leading cause of disability in the world after cardiovascular diseases. Emotional disorders rank third among the reasons for medical consultations in developed countries and are the main workload for psychiatrists, with women 2–3 times more likely than men to seek help. Over the past ten years, the number of such disorders has increased by 25% - this is a trend persists in the world and in Ukraine. In the general population, almost 30% of adults experience significant depression and anxiety, which adversely affects a person's social functioning. Depression can occur at any time in life, but most often begins between 20 and 50 years, in 50% of patients - around 40 years, in 15% - at 65 years of age and later. A very important aspect of depressive disorders is the risk of suicide. Approximately 2/3 of patients with diagnosed depression are prone to suicide attempts and 10-15% carry them out, for this reason teenage depression is especially dangerous. The reason for untimely detection and treatment of depressive disorders is the fear of psychiatric intervention. Fearing the stigma of being “crazy,” people prefer to suffer rather than seek help from mental health services. Many people simply do not know that there are different types of affective (emotional) disorders and that the symptoms that appear are not always signs of mental illness - in most cases they turn out to be transient, short-term phenomena. But if you have alarming symptoms, timely seeking help will help avoid the development of a more serious disorder. What is depression? First of all, two main groups of depression should be distinguished: endogenous and psychogenic. In our article we will talk about psychogenic depression, when the cause of the disorder is a psychological factor. Modern specialists use the term “depression” to describe a syndrome that includes psychological, emotional, somatoneurological and a number of other clinical manifestations. Depressive syndrome (so-called simple depression) in the most Typically, it is a triad, which consists of a depressed, melancholy mood (hypotymia), slowed thinking and motor retardation. Low mood can have various shades: from feelings of sadness and depression to deep depression or gloomy moodiness. In more severe cases, oppressive, hopeless melancholy predominates, which is often experienced not only as mental pain, but also as an extremely painful physical sensation in the area of ​​the heart, less often in the head or limbs (vital melancholy). Ideation inhibition is manifested by slow, quiet speech, difficulty concentrating, impoverished associations, and a sharp decline in memory. The patients' movements are slow, their facial expressions are mournful, inhibited or frozen, and there is no desire for activity. In severe cases, there is complete immobility, a gloomy numbness (depressive stupor), which can sometimes be suddenly interrupted by a state of melancholic frenzy (raptus). Depressive syndrome is characterized by pronounced somatovegetative disorders in the form of sleep, appetite, and function disorders.gastrointestinal tract (constipation), patients lose weight, their endocrine functions are upset. At outpatient appointments and in the department of borderline conditions, doctors more often have to deal with subdepressive states. Psychological components of subdepression include low mood, pessimism, feelings of unworthiness and guilt. The somatic condition is characterized by difficulty falling asleep, interrupted sleep and early awakening in the morning, anorexia or hyperphagia (overeating) with loss of taste of food, weight loss, fatigue, motor retardation or emotional arousal (agitation), periodic impotence, amenorrhea and decreased libido. To diagnose subdepressive disorder episode, at least three of the following signs must be present (according to G.V. Starshenbaum): 1. Decreased motivation or activity.2.Disturbed sleep.3.Decreased self-esteem or feelings of inadequacy.4.Decreased ability to concentrate.5.Decreased social adjustment.6.Loss of interest or satisfaction in previously enjoyable activities.7.Decreased speech activity.8. A pessimistic vision of the future or gloomy thoughts about the past. In addition to the described forms of depressive syndromes, there are their varieties, due to modifications of the main depressive disorders. There is ironic (smiling) depression, in which a smile is combined with bitter irony over one’s condition with extreme depression of mood and a feeling of complete hopelessness and meaninglessness of one’s existence. Without significant motor and intellectual inhibition, depression develops: with a predominance of tearfulness, incontinence of affect, and a feeling of helplessness - tearful depression; with constant complaints - aching depression; with a feeling of hostility towards everything around him, detachment, irritability and gloominess - grumbling, gloomy depression. If in the picture of depression a significant place is occupied by anxiety, which prevails over the affect of melancholy, and anxious fears, then we speak of anxious depression. But the most dangerous and insidious is the so-called hidden depression. Depression in a mask The insidious nature of this type of depression is already indicated by the presence of a large number of its names : hidden, masked, larved, alexithymic, erased, somatized. Most often it is called somatized or hidden depression - because it is hidden behind the mask of somatic diseases, and that is why it remains unrecognized for many years (if not forever). However, it is the most common and occurs 10 - 20 times more often than overt (ordinary depression), it affects up to 2/3 of all patients in clinics. Patients can be observed for years by a cardiologist with suspected ischemic disease, by a gastroenterologist due to assumptions of a peptic ulcer, from a rheumatologist - due to pain in the joints, from a sex therapist - in connection with periodic impotence, from a gynecologist - with premenstrual tension syndrome and dysmenorrhea, etc. How to recognize such depression and distinguish it from a real somatic disease? First of all, you should pay attention to daily fluctuations in symptoms with greater severity in the morning, like all other manifestations of endogenous depression. Suicidal thoughts are sometimes noted. There is a general feeling of poor health, diffuse, sometimes burning pain in various places (psychalgia), especially fibromyalgia (muscle pain). Patients are also concerned about a feeling of pressure and pain in the head, “in the pit of the stomach” and behind the sternum (“sternal melancholy”), difficulty breathing, high blood pressure, a feeling of pressure in the throat when eating and a readiness to vomit, constipation, pain and tension in the legs , decreased libido and potency, menstrual irregularities, increased fatigue and decreased ability to work, accompanied by self-flagellation. The disease often occurs under the guise of vegetative-vascular (neurocirculatory) dystonia, while vegetative-visceral crises are the equivalent of a depressive-hypochondriacal explosion of despair. To those listed abovein this case, somatohevetative symptoms are supplemented by complaints of dysfunction of various organs and systems, decreased appetite, increased sweating, dry mouth, dizziness and tachycardia. A characteristic feature of masked depression is the frequent change of somatic disorders, in which a person has the impression that he is sick immediately several diseases, as well as severe pain. Something constantly hurts, while the localization of the pain changes all the time: now the head hurts, then the stomach, then the heart. This form of depression is characterized by intermittent sleep with unpleasant dreams, early alarming awakenings in the morning, unusual despondency and difficulty getting up, requiring painful volitional efforts. Patients complain that they do not get enough sleep, since sleep does not bring them a feeling of rest; they are overcome by drowsiness and lethargy during the first half of the day. If sleep disturbances predominate, an agripnic variant of masked depression is diagnosed. A person may not be aware of the emotional manifestations of depression, but he or she has poor facial expressions, a mournful facial expression, and quiet monotonous speech. With targeted questioning, feelings of sadness, inferiority and hopelessness are revealed, sometimes breaking out in tears. Seasonality of exacerbations, indifference, isolation from others and excessive fixation on one’s bodily sensations are noted. Patients are often convinced that they have a rare and difficult to diagnose disease, they insist on numerous examinations, accuse doctors of incompetence, and turn to paramedics. One of the most obvious signs of masked depression is the absence of any clinical evidence of the disease. Tests do not confirm the presence of the disease, the doctor cannot prescribe adequate treatment or it simply does not help, and after the next visit to the doctor the patient receives a referral to a neurologist or even a psychiatrist. Such a denouement is not at all tragic, but, on the contrary, correct, since we are not talking about real diseases, but about their imitation (somatization of mental suffering). Proper psychiatric treatment of masked depression can lead to the complete elimination of psychosomatic symptoms and save a person from many years of suffering and endless visits to doctors. Psychiatry or psychotherapy? In the treatment of depressive disorders, two main directions can be distinguished: psychopharmacological and psychotherapeutic. According to modern views, depression is based on a lack of the neurotransmitter serotonin in the brain, which is involved in the transmission of nerve impulses and ensures vigorous activity, good mood and performance. Therefore, modern drug treatment relies on the use of a new generation of antidepressants - selective serotonin reuptake inhibitors (SSRIs). These drugs are not only highly effective in treating depressive disorders, but also do not have the side effects that previously made taking conventional antidepressants less desirable. The advantage of such psychopharmacological treatment is the fairly rapid disappearance of somatized manifestations of depression: pain and somatovegetative dysfunctions. The use of the second therapeutic direction - psychotherapeutic - should be sequentially step-by-step. In cases of clinically significant depression, treatment must be comprehensive, otherwise the effect will be short-term and unstable. The ideal option for choosing a specialist in this case is a psychiatrist-psychotherapist. In his work he will combine medication and psychotherapeutic treatment. An alternative option for providing assistance to a patient may be the collaboration of a psychiatrist with a psychologist. The doctor carries out diagnostics and prescribes medications, and the psychologist carries out psychotherapeutic work. In cases where there is no need for drug treatment, you can limit yourself to visiting a psychological office. But it must be remembered that it is not. 9-11.