If one day you woke up and realized that life is a meaningless and stupid thing, if you feel that nothing can be fixed, because the future has no prospects, if you no longer have an interest in it , what recently gave you pleasure, then... maybe it will pass tomorrow, or maybe not. And if this condition has been going on for some time, think: “What’s happening to me!?” I. GENERAL INFORMATION ABOUT DEPRESSION Definition Depression (from the Latin deprimo - “to press”, “to suppress”) is a mental disorder characterized by the “depressive triad” ": decreased mood and loss of the ability to experience joy (anhedonia), disturbances in thinking (negative judgments, a pessimistic view of what is happening, etc.), motor retardation History Depression, which has spread and acquired such great social significance in our time, is known to doctors since. from the time of antiquity, Hippocrates described in detail under the name “melancholy” conditions that are very reminiscent of our today’s definition of depression, and even recommended treatment - within the capabilities of ancient medicine, of course. Treatment of depression according to Hippocrates consisted of prescribing opium tinctures and warm cleansing enemas (Hippocrates paid attention). the fact that severe depression is often accompanied by constipation, and attached great importance to this), psychological support (it was recommended to “encourage and cheer” the patient), long warm baths, massage and drinking mineral water from one of the famous springs in Crete (as it turned out later, already in the time of Paracelsus, this water contained a large amount of bromine, magnesium and lithium ions - that is, it could really help with depression). Hippocrates also drew attention to the dependence of the condition of many depressed patients on the weather and time of year, to the seasonal frequency of depression in many patients, to improve the condition of some patients after a sleepless night. Thus, he came close to discovering the therapeutic effects of sleep and sunlight deprivation (phototherapy), although he did not make it. The Ebers Papyrus, one of the most important medical treatises of ancient Egypt, also contains a short description of depression. Although the information on the papyrus is full of ritual rites and intricate recipes for exorcising disease-producing demons, it also indicates long practice and observation. Depression is a disease of our time. Research from all over the world shows that depression, like cardiovascular diseases, is becoming an inevitable attribute of modern society. According to WHO forecasts, in the near future depression will take second place in prevalence after cardiovascular diseases. According to various researchers, up to 20% of the population of developed countries suffers from it. For example, it is known that more than half of US residents take antidepressants and tranquilizers. This dynamic, of course, is not encouraging. Every psychiatrist and psychotherapist is familiar with a depressed patient: he suffers from loss of strength, loss of a sense of pleasure in life, insomnia, unpleasant thoughts, and inability to concentrate on current activities. There are also more complex (masked) types of depression, when it “hides” under the guise of other diseases (headaches, gastrointestinal pain, heart pain, etc.). Depression is a disease of the whole body. Typical signs of depression: Symptoms of depression are very diverse and vary depending on the form of the disease. Let's list the most typical signs of this disorder: Emotional manifestations - symptoms of depression: melancholy, suffering, depressed, depressed mood, despair, anxiety, feelings of internal tension, anticipation of trouble, irritability, guilt, frequent self-recrimination, dissatisfaction with oneself, decreased self-confidence, decreased self-esteem, decreased or loss of the ability to experience pleasure from previously pleasant things activities, decreased interest in the environment, loss of the ability to experience any feelings (in cases of deep depression)Physiological manifestations of sleep disturbances (insomnia, drowsiness) changes in appetite (loss or overeating) impaired intestinal function (constipation) decreased sexual needs decreased energy, increased fatigue during normal physical and intellectual stress, weakness, pain and various unpleasant sensations in the body (for example, in the heart, in areas of the stomach, in the muscles) Behavioral manifestations: passivity, difficulty engaging in purposeful activity, avoidance of contacts (tendency to solitude, loss of interest in other people) refusal of entertainment, alcoholism and abuse of psychoactive substances that provide temporary relief. Mental manifestations, slowness of thinking, difficulty making decisions, difficulty concentrating, concentrating, predominance of gloomy, negative thoughts about yourself, about your life, about the world in general, a gloomy, pessimistic vision of the future with a lack of perspective, thoughts about the meaninglessness of life, anxiety about the health and fate of loved ones, the presence of thoughts about your own uselessness, helplessness, fear of appearing incompetent in public places, thoughts of suicide (in severe cases) For To make a diagnosis of depression, it is necessary that some of the listed symptoms persist for at least two weeks. Depression is often perceived both by the patient himself and by others as a manifestation of bad character, laziness and selfishness, promiscuity or natural pessimism. It should be remembered that depression is not just a bad mood (see manifestations above), but a disease that requires the intervention of specialists and is quite treatable. The sooner the diagnosis is made and treatment is started, the greater the chances of a quick recovery and that depression will not recur and will not take a severe form, accompanied by a desire to commit suicide. What usually prevents people from seeking help for depression? It often happens that the physiological manifestations of depression contribute to the formation of beliefs about the presence of serious somatic diseases. This is a reason to contact a general practitioner. 80% of patients with depression initially seek help from general practitioners, and the correct diagnosis is made in approximately 5% of them. Even fewer patients receive adequate therapy. Unfortunately, during a regular appointment at a clinic, it is not always possible to distinguish between the physiological manifestations of depression and symptoms of a somatic illness, which affects the diagnosis. Patients are prescribed symptomatic therapy (medicines for the heart, stomach, and head), but there is no improvement. Thoughts arise about a serious, unrecognized somatic illness, which, through a vicious circle mechanism, leads to worsening depression. As a recent study showed, identifying cases of depression by general practitioners is difficult because in almost half (43%, California) of cases, patients try to keep silent about symptoms of depression. Many people are afraid of being prescribed antidepressants and their side effects; some believe that keeping emotions under control is their own business, and not the doctor’s concern; there are also concerns that a mention of a case of depression will end up in the medical record and somehow become known to the employer; finally, some are afraid of being referred to a psychiatrist for treatment (registration, ban on driving and traveling abroad). II. SCIENTIFIC KNOWLEDGE ABOUT DEPRESSION. Main types of depression. Depression often occurs against the background of stress or long-term 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 significantly complicates the course and prognosis of the underlying somatic disease. However, with timely identification and treatment of depression, there is a rapid improvement in mental and physical well-being. Depression can occur in the form of single episodes of illness of varying severity or occur over a long period of time in the form ofrecurring exacerbations. In some patients, depression is chronic, lasting for many years without reaching significant severity. Sometimes depression is limited mainly to physical symptoms without clear emotional manifestations. However, clinical and laboratory examinations may not reveal any organic changes. In such cases, consultation with a psychiatrist is necessary. Modern ideas about the causes of depression. If we talk about the causes of depression, today the most recognized are biopsychosocial models that reflect the interrelationship of biological, psychological and environmental factors in the genesis of depressive disorders. Biological causes consist of disruption of biochemical processes in the body (metabolism of neurotransmitters such as serotonin, norepinephrine, acetylcholine and etc.). These disorders, in turn, can be hereditarily determined; Psychological - in the distortion of the image of “I” and ideas about the world around the depressed patient; Scientific research has revealed the following psychological factors of depression: a special style of thinking, the so-called. negative thinking, which is characterized by a fixation on the negative aspects of life and one’s own personality, a tendency to see the life around us and one’s future in a negative light; a specific style of communication in the family with an increased level of criticism, increased conflict; an increased number of stressful events in personal life (separations, divorces, alcoholism of loved ones, death of loved ones) social isolation with a small number of warm, trusting contacts that could serve as a source of emotional support Environmental - in the increased stress of modern life, excessive demands on the individual from society, the imposition of a “cult of success” on him. Cross-cultural research shows that cultures that prioritize success and high achievement have much higher rates of depression than societies where success is not a cult. III. HELP FOR DEPRESSION The modern approach to the treatment of depression involves a combination of various methods - biological therapy (drug and non-drug) and psychotherapy. Drug treatment of depression. Prescribed to patients with mild, moderate and severe symptoms of depression. A necessary condition for the effectiveness of treatment is cooperation with the doctor: strict adherence to the prescribed therapy regimen, regular visits to the doctor, a detailed, frank report about your condition and life difficulties. Proper therapy can, in most cases, completely eliminate the symptoms of depression. The main class of medications for treating depression are antidepressants. The main advantages of new generations of antidepressants are improved tolerability, reduced side effects, reduced toxicity and high safety in case of overdose. Antidepressants do not cause addiction and the development of withdrawal syndrome, unlike drugs from the class of benzodiazepine tranquilizers (phenazepam, Relanium, Elenium, Tazepam, etc.) and Corvalol and Valocordin, widely used in our country. In addition, benzodiazepine tranquilizers and phenobarbital, which are part of Corvalol and Valocordin, with long-term use reduce sensitivity to other psychopharmacological agents. Main stages of therapy. 1. Determining treatment tactics for depression: choosing an antidepressant taking into account the main symptoms of depression in each patient, selecting an adequate dose of the drug and an individual treatment regimen.2. Carrying out the main course of therapy aimed at reducing symptoms of depression until they disappear, restoring the patient’s previous level of activity.3. Carrying out a maintenance course of therapy for 4-6 months or more after general normalization of the condition. This stage is aimed at preventing exacerbation of the disease. It is important to remember that numerous studies have been conducted confirming the high effectiveness and safety of modernantidepressants. The toll depression takes on a person's emotional and material well-being is not comparable in severity to the minor and easily treatable side effects that sometimes occur with antidepressant medications. It should be remembered that the therapeutic effect of antidepressants often occurs only 2-4 weeks after starting treatment. Psychotherapy. Unlike drug treatment, psychotherapy involves a more active role for the patient in the treatment process. Psychotherapy helps patients develop emotional self-regulation skills and subsequently cope more effectively with crisis situations without falling into depression. In the treatment of depression, three approaches have proven to be the most effective and scientifically proven: psychodynamic psychotherapy, behavioral psychotherapy and cognitive psychotherapy. According to psychodynamic therapy, the psychological basis of depression is internal unconscious conflicts. For example, the desire to be independent and the simultaneous desire to receive a large amount of support, help and care from other people. Another typical conflict is the presence of intense anger, resentment towards others, combined with the need to always be kind, good and maintain the goodwill of loved ones. The sources of these conflicts lie in the patient's life history, which becomes the subject of analysis in psychodynamic therapy. Each individual case may have its own unique content of conflicting experiences, and therefore individual psychotherapeutic work is necessary. The goal of therapy is awareness of the conflict and assistance in resolving it constructively: learning to find a balance of independence and intimacy, developing the ability to express one’s feelings constructively and at the same time maintaining relationships with people. Behavioral psychotherapy is aimed at resolving the patient’s current problems and relieving behavioral symptoms: passivity, refusal of pleasure, monotonous lifestyle, isolation from others, inability to plan and engage in purposeful activity. Cognitive psychotherapy. The so-called depression is considered as the main psychological mechanism of depression in cognitive psychotherapy. negative thinking, which is expressed in the tendency of depressed patients to view everything that happens to them in a negative light. Changing this way of thinking requires work that is aimed at developing a realistic view of yourself, the world and the future. What usually prevents you from seeking psychotherapeutic help? 1.Low awareness of people about what psychotherapy is. 2. Fear of introducing a stranger to personal, intimate experiences. 3. Skeptical attitude towards the fact that “talking” can give a tangible healing effect. 4. The idea that you need to cope with psychological difficulties yourself, and turning to another person is a sign of weakness. In modern society, psychotherapy is a recognized, effective method of helping with various mental disorders. All information that the psychotherapist receives during the session is strictly confidential and remains confidential. Every person has situations in life (for example, such as illness) that he cannot cope with on his own. The ability to ask for help and accept it is a sign not of weakness, but of personality maturity. What to do if someone close to you suffers from depression? The support of loved ones, even when the patient does not express interest in it, is very important for overcoming depression. Be attentive to his complaints. Avoid flat and comforting statements or trivial encouragement. Emphasize the immediate nature of the depressive state, instilling hope for the end of depression. Do not call for manifestations of the patient’s will, do not tell him: “you must pull yourself together,” you could if you wanted,” etc. Do not allow the patient to feel helpless and guilty. Do not call for virtues such as faith or a sense of responsibility. Release.