From the author: A little clinical perspective on the problem of depression. Depression. Causes and treatment. Depression is the most common mental illness and is one of the leading causes of temporary disability in the world. According to WHO forecasts, by 2020 it will take first place in terms of incidence. At the same time, half of the Internet “diagnoses” themselves with a state of depression, “being depressed today,” “autumn depression,” etc. But at the same time, according to official statistics, the average time for symptoms to appear before being seen by a psychiatrist or psychotherapist is 7-10 years. Let's understand depression. Depression is a syndrome complex, i.e. a set of symptoms and syndromes. This is not a nosology, not one disease. Depressive syndrome includes three classic manifestations: decreased mood, decreased physical activity, and decreased mental activity. If these symptoms last more than two weeks, it is called depressive syndrome, or simply depression. Not a couple of hours, not a couple of days. In addition to the classic triad, the depressive syndrome often includes the following symptoms and syndromes: Feelings of guilt, self-blame, ideas of low value (“I’m worthless, a loser”). Difficulty in getting pleasure (“nothing makes me happy,” “no taste for life,” “gone.” all the joy"). Reduced self-esteem, self-abasement. Decreased sexual activity and desire (“orgasm is gone,” “I don’t want anyone”). Changes in appetite: increase (“stress eating”) or decrease (“food has lost its taste”). Violation sleep: early awakening, lack of feeling of sleep (“as if I hadn’t slept”). Feeling of meaninglessness, decay, hopelessness. Weakness, fatigue (“no strength for anything”). General malaise, decreased activity of internal organs (constipation). Sometimes, somatic symptoms are leading, and sometimes the only ones, this is especially often the case when a person has difficulty verbalizing emotions (aleksethymia), in which case, the person talks more about physical discomfort (“heavy heart,” “presses on the shoulders,” “ emptiness inside"). Pain (chronic pain not associated with any obvious, organic reasons). Anxiety. Increased alcohol intake (“avoiding the problem”). Depersonalization and derealization (“everything around has changed, it has become gray,” “I gray, boring”). Suicidal thoughts, actions (most typical for moderate and severe depression, for endogenous and organic. More on this below). All of these symptoms are both a consequence and a cause of depression, creating a vicious cycle of depression. Mechanisms of depression: Physiologically, depression is associated with two important parameters of the nerve cell: neuroplasticity and neurochemical activity. Briefly about this. Let's start with the most popular one, with neurochemistry. For a long time it was generally accepted that depression is a consequence of a lack of serotonin in the neurons of the brain. Then, it became clear that almost all neurotransmitters are involved, dopamine, norepinephrine, endorphins, and all, all, all. On this basis, in the treatment of depression, everything that can be used is used (including synthetic cannabinoids). However, a considerable part of the research shows that a change in the metabolism of any neurotransmitter in the brain triggers a nonspecific neuroplaticity system associated with the activation of a gene responsible, in particular, for the synthesis of neuronal growth factor. Those. a change in neurotransmitter exchange for a neuron is local stress at the cellular level; the cell responds to this stress by starting the synthesis of a growth factor, which causes the growth and formation of new synapses and neural connections, which essentially do all the healing work. New connections create new ways for the brain to respond. The researchers note that this is precisely what explains the fact of the delayed effect in the treatment of depression. Genetic mechanisms are associated with the synthesis of proteins and new cellular structures, and this takes time (at least 7 days, more often 14-21). But is it possible to say that disruption of neural connections, death of synapses, or a decrease in overall neuroplaticity is a physiological cause?depression is still difficult. And everything would be fine, but... let’s look at the reasons for the triggering of depression, i.e. why all these processes begin inside the head (changes in neurotransmitters and changes in brain plasticity). Causes of depression: Psychological reason. As a rule, a person reacts psychologically with melancholy, sadness, sadness; these are normal, often necessary ways of reacting. But sometimes these methods are “pumped” excessively, sometimes a person is irrationally sad, sad, and reacts excessively, or where there is no need to react that way. Then we talk about depressive thinking as a way of emotionally reacting to events in life. Neurotic depression. The leading mechanism of neurotic depression is a person’s reaction to frustration. Frustration is the inability to achieve the desired result. The cause of frustration is often psychological trauma and deep-seated beliefs. For example, a young man wants to date and sleep with beautiful women, but every time he has a fear of approach. First, a feeling of frustration arises as a way to show a person the effectiveness of the chosen tactics (the psyche seems to say, you’re doing it wrong), and then depression arises as a way to show that the chosen strategy is wrong (“stop, you’re doing the wrong thing”). In this case, depression will be part of the development of neurosis, part of the development of a personality in a state of so-called. “developmental trauma”, “learned helplessness”. Endogenous depression. It occurs when the cause of a breakdown in the functioning of neurons lies within the neurons themselves, like genetic breakdowns. 3a. Depression within bipolar affective disorder.3b. Depression within schizophrenia. The most important thing here is the presence of these internal causes (hence the name “endogenous”, i.e. having internal origin). In this case, the onset of depression can be completely autonomous, in the form of a biological clock, phases, or provoked by stress, but then continue according to its own internal laws. In schizophrenia, depression can be a consequence of a person’s reaction to an illness, as a consequence of a hallucinatory-delusional syndrome (for example, a woman was delusionally convinced that she was homeless, that she had no housing and reacted to this delusion with depression, sometimes more complex interweavings), or as brain reaction to past psychosis. Very often, endogenous depression occurs with an atypical picture, for example, instead of apathy, there is pronounced, bright anxiety, agitation (agitated depression), or there are no emotional experiences, but somatic symptoms are clearly present (the so-called “masked” depression), etc. Organic depression. In this case, the cause of disruption of the functioning of neurons is damage to neurons due to disease (cerebral atherosclerosis, strokes, injuries, tumors, damage to the endocrine system (hypothyroidism, decreased sex hormones), etc. And of course, often the reasons are mixed, especially often Psychological and neurotic factors are intertwined in such a way that it is sometimes difficult to separate where the neurosis is and where the personality is. In diseases, depression often occurs as a person’s reaction to this disease (catastrophization, for example, in oncology, heart disease). Treatment of depression It is important to exclude an organic cause. depression, so as not to miss a somatic and neurological disease. Although, as a rule, a person turns to a psychotherapist at the very end, one should not forget about this. General therapeutic recommendations. A. Sleep and rest schedule It is often extremely difficult for a person to do anything. - due to illness. But physical inactivity aggravates depression. The movement itself, activity already helps. Sometimes, due to a thinking disorder (“dumbness”), it is difficult for a person to do meaningful work. Let it be any little thing that does not require attention and effort, for example, modeling, drawing. There was a study where people with depression simply moved matches from one box to another, and their mood improved. With depression, it is often worse in the first half of the day, and sometimes the person tries.