From the author: From the author’s website Several years ago I wrote an article “Depression through the eyes of a psychologist.” I wanted to summarize my work experience, share it with fellow psychologists and psychotherapists, and most importantly, with people who are faced with this disease, confused and scared, as well as with their relatives and friends, who are no less confused and scared. The article was about endogenous depression, the occurrence of which is not caused by any tragic or stressful events in a person’s life (although stress can serve as the last straw), but is associated with a disruption in the functioning of the mediators of the central nervous system and insufficient production of the hormones serotonin, norepinephrine and dopamine ). To put it more simply, a person has everything wonderful in life, a good family, work and friends, but he cannot be happy, he is sad, toils, blames himself for all the troubles and cannot get out of this state. Since then, the article has taken on a life of its own, it walks around the Internet, and I receive letters. People write about themselves or their loved ones, asking for advice. Recently, responding to another letter, I thought it was time to write a sequel, answering the most frequently asked questions. I hope that this article will also be useful. So, depression. You suspect you have depression. You may have read several medical or psychological articles and found similar signs in yourself. Maybe they took the Beck Depression Inventory. Or someone from your circle told you that he had the same thing, and then the doctor diagnosed depression and prescribed treatment. And now you are confused. You feel bad, painful, have little strength and are in a bad mood and depressive thoughts almost all the time. But at the same time, you are very scared and don’t know what to do. Go to the doctor - where? To which? What if it’s not depression, but some kind of schizophrenia? What if they put you in a closed ward and inject you with strong drugs, and then give you a certificate with which you cannot get a job? These thoughts make you feel even worse. People around you advise you to pull yourself together and not become limp, but you can’t think of anything else. Only about what a weak-willed and useless rag you are, and how bad everything is. Stop. If this condition lasts more than two weeks, and nothing changes and does not get easier, it is better to take care of yourself. How to do this? I know that I read by people from different countries with different medical care systems. But I believe that in most states the procedures are more or less similar. Therefore, I allow myself to give general advice. If you are afraid to go to the doctor, if you still doubt whether it is depression, if you do not know which way to approach treatment, go to a private psychotherapist. Look for someone who works with depression and has experience and a reputation in the field. Someone who can recognize it and diagnose it. At the first stage, this is the specialist you need. The fact is that there are many diseases that give symptoms similar to depression: endocrine, oncological, autoimmune. An experienced specialist will be able to recognize differences in symptoms and guide you along the right path.Next. Suppose it is still depression, and it requires treatment. Most likely, your therapist will refer you to a psychiatrist to prescribe medications for you. And he himself will engage in psychotherapy with you. Perhaps, being a psychiatrist himself, he will combine these processes. I know doctors who deal only with drug treatment and send their patients for therapy to fellow psychologists. I know people who do both. I think both of these options work and each specialist decides for himself what to do. What should you pay attention to? First, contact with a doctor. I often hear “I don’t like doctors.” You don't have to love him! And they don't have to love you. For love there are relatives and friends. But we must treat them with respect and attention. And there should be at least minimal trust and affection. You will be working with this doctor for quite a long time, and it would be good if the upcoming visit does not cause youpanic, disgust, anxiety and fear. Find a doctor with whom you can collaborate! Treatment of depression (and other diseases) is not a passive process. Secondly, but this point is very important - take treatment seriously and responsibly. Most likely, when prescribing antidepressants, your doctor will tell you how they work and what to look for. You can ask yourself. Often doctors do not want to scare the patient and advise not to read the description of side effects. I think they're right. In depression, sensitivity to all bodily ailments is already heightened (this is often another symptom), and close attention to them can only get in the way. But if you are an anxious and suspicious person, ask what you should be afraid of, what to pay attention to, and what you can tolerate. Know that the effect of all antidepressants is prolonged, i.e. the effect of them will not appear immediately, but over time, and accumulates, this is normal, this is how it should be! Unfortunately, many people, not feeling any improvement the day after taking the pills, and not waiting for it a week later, become disappointed and quit taking them. This is not true. In the best case, you will feel a little better in two to three weeks; you need to wait and endure this time, as well as possible side effects from medications. Agree with your doctor when you can contact him, find out in what cases you should not endure. Some people are lucky and the first prescribed antidepressants begin to work quickly and well, while others have to change medications for a long time and select them. Don't blame yourself, don't blame the doctor. Even an ordinary antipyretic affects people differently, it helps one quickly, another more slowly, and in a third it can even cause allergies. What can we say about such complex medications as antidepressants? Collaborate with your doctor, look for the right options together. Actually, that’s why I’m writing about privately practicing psychiatrists - they can devote more time to patients. Doctors in clinics and hospitals, unfortunately, are busier and cannot make appointments and be in touch as often; they have a different work schedule. Let’s continue. The medications are selected, they work, you feel better. The symptoms of depression decreased and then completely disappeared, you feel cheerful and strong. And the thought creeps into my head - why am I taking these pills? I’m already well, I’ve recovered, why endure side effects and injections of pride (I’ve seen very few people who weren’t worried about having to take antidepressants. Here are pills for blood pressure, for cholesterol, for high acidity - please, no problem. But antidepressants are a terrible shame and disgrace, weakness of will and cowardice. Probably, somewhere in the depths of my soul there is a hope that I could control this unfortunate reuptake of serotonin and norepinephrine, I just need to pull myself together and try. , and the general attitude towards depression is the same) Well, I’ll continue. The person gets better, he feels healthy and with a decisive gesture he throws the medicines in the trash. Or he is not decisive and does not throw them away, but simply forgets to take them. Please do not do this! Please discuss with your doctor! Believe me, the doctor also wants to see you healthy and cheerful, he will rejoice at your recovery and be proud of his professionalism. I have heard the opinion that doctors are in cahoots with pharmacists and it is in their selfish interests to keep you on pills for life. I don't think that's true. Depression, unfortunately, is a very common disease; one person who has recovered will be replaced by the next person who is ill, forgive the cynicism. It's good that pharmacists are working and coming up with new medicines. Many of the dramas and tragedies of the past would not have happened if those suffering from depression had had the option of treatment. So, I ask you again - do not stop taking your medications without permission. Talk to your doctor, he will draw up a plan for you, according to which you will calmly and correctly reduce the dose of antidepressants - under his supervision. When discontinuation occurs abruptly, treatment must be!2016