"A whole range of conditions": the chief psychiatrist of Moscow - about the danger of depression and methods of its treatment

- Georgy Petrovich, according to WHO statistics, about 5% of the adult population of the planet suffers from depression.

What is this disorder?

What are its symptoms?

- In the current international classification of diseases ICD-10, depression occurs simultaneously in different sections.

For example, in the section on affective disorders or mood disorders.

Previously, such mental health disorders were called "manic-depressive psychosis", in this case, mania means a painfully high mood.

This is when the patient experiences alternately the phase of painful excitement, then the phase of depression.

Today, such a syndrome is called bipolar affective disorder, since the word “manic” was decided to be abandoned due to negative associations.

There is also recurrent depression - that is, a recurrent, recurrent painful decrease in mood.

It is these depressions that are the most severe, they are often accompanied by persistent beliefs about the meaninglessness of life, which pushes the patient to suicidal behavior.

Recurrent depressions are the most difficult to treat and sometimes require very active therapy, up to electroconvulsive therapy, which is widely used in Northern Europe.

- At the same time, there is still an opinion that depression is supposedly a frivolous disorder.

 How serious is this disease

- Recurrent depression is not a condition that can be taken lightly or somehow romanticized.

In the mind of the patient, everything takes on an exclusively negative connotation - the past, the present, and the future, there is no light.

A person lives with a constant feeling of strong guilt, this is a very painful condition.

• Chief freelance psychiatrist of Moscow, head physician of the Psychiatric Clinical Hospital No.

  ON.

  Alekseev DZM "Georgy Kostyuk

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With depression, as a rule, thinking and motor activity slow down, mood decreases.

However, it happens that this happens unevenly - for example, the mood is not reduced so much or even slightly increased, but there is a sharp mental and motor retardation.

It also happens vice versa, and a set of these combinations creates a whole range of states.

It is especially dangerous when motor activity remains at the same level, and the mood drops sharply - this opens up the patient the opportunity to realize suicidal ideas.

The fact is that motor inhibition often saves patients from such actions - they simply do not have the strength to realize anti-vital thoughts.

A person in severe depression sometimes cannot even get out of bed.

Such conditions are not associated with external causes and are, as psychiatrists used to say, "endogenous in nature."

Of course, it is necessary to treat depression, otherwise the disease can end very sadly.

At the same time, there is another large group of patients who suffer from anxiety-depressive disorders.

These are neurotic, stress-related, somatoform diseases, which already belong to a different category of the ICD and manifest themselves much more easily than recurrent depression and bipolar disorder.

Such depressions are largely caused by external factors, and the number of people suffering from them can vary greatly depending on the circumstances.

Under normal, calm conditions, about a quarter of the European population suffers such conditions during the year - such statistics were previously collected by WHO.

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- Are there any markers by which a person can suspect that he has an anxiety-depressive disorder?

- The intensity of the manifestations can be very different, but in general this is a condition that is characterized by a decrease in mood, irritability, sometimes apathy, fatigue, inability to concentrate, worsening sleep.

Sleep deserves special attention, because, on the one hand, it is the most powerful regulator of our state, which helps us cope with depression, but, on the other hand, it is the very first and most sensitive indicator of the state of the body.

In depression, sleep disturbance is often accompanied by disturbing thoughts that a person scrolls through his head while lying in bed.

At the first stage, you should try to normalize your regimen, give up alcohol, spend less time on social networks, etc. Communication with relatives and friends can play a very beneficial role.

This does not mean that you need to pour out negativity on them, but care, trusting relationships, conversation - all this is very important and helps a lot.

There is nothing strange in this, because professional psychotherapy is, as a rule, also a conversational practice: with the help of prompting questions, a specialist helps a person to speak out.

But if all of the above does not help, then you need to seek professional help.

It is not necessary to immediately go to a psychiatrist, because there are also medical psychologists and psychotherapists who can work with such conditions.

- What causes, besides stress, can cause depression?

Especially if we talk about its most severe forms.

For example, are there psychological, personal prerequisites for this disease, or is genetics to blame?

- If we are talking about severe forms of depression, then in this case heredity really plays a role.

People whose parents suffered from depression may also develop such disorders.

This pattern can be traced at the level of population genetics.

However, molecular methods have not yet been able to find the “depression gene”, although many genes associated with this disease have been discovered.

Therefore, in this case, we can talk about polygenic risk.

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As for anxiety-depressive disorders, they are more associated with resistance to stress, which is determined by human psychology.

Drawing an analogy, you can compare anxiety with inflammation.

If the tissues are physically damaged, then inflammation will occur, and the psychological impact leads to anxiety.

In both cases, we are dealing with a defensive reaction.

Returning to depression, I note that a person's super-strong anxious response to some external factors can destroy not only the psyche, but also cause physical ailments.

Such severe anxiety is accompanied by hormonal changes, the release of adrenaline and other mediators that greatly affect the body.

Of course, how a person reacts to problems is related to his personality type.

There are people with pronounced anxiety traits.

There are those who look for the cause of failure in their actions, and there are those who always place the blame on others.

Anxiety-depressive state often becomes the basis for the development of other disorders, including addictive behavior - alcoholism, drug addiction, gambling addiction, etc. In addition, this condition significantly complicates the treatment of any diseases - cardiovascular, pulmonary, and many others.

There is a whole range of psychosomatic diseases, in the genesis of which a person's mental state plays an important role.

These are bronchial asthma, peptic ulcers, and dermatitis, and even some arthritis ...

What happens during depression in the brain?

Is the biochemistry of this process known?

- Partly known.

So, it is already clear that the leading role in this case is played by such a neurotransmitter as serotonin.

However, upon closer examination, it turns out that we do not know exactly how these processes proceed.

Because there are drugs that block the reuptake of serotonin by neurons: this means that the neuron that released the serotonin molecule will not be able to take it back, as it usually does, and the concentration of serotonin in the brain will increase.

Such drugs really help patients with depression.

But at the same time, drugs with the opposite effect, which, on the contrary, increase the reuptake of serotonin, have a similar effect.

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- Now more and more people are talking about such a phenomenon as postpartum depression.

What are its features and dangers?

- The main feature of postpartum depression is that it manifests itself mainly in relation to the child.

What it is connected with, we can only guess for now - of course, a high load on the body during pregnancy plays a role.

The main danger here is that a woman is always very ashamed of this disorder - how to tell her husband, relatives that she does not feel anything in relation to her own newborn child?

She understands that this is not normal, but she cannot tell anyone about it - accordingly, she does not receive help, she falls into a very dangerous trap.

With regard to new mothers, both doctors and loved ones should be especially sensitive, because postpartum depression can lead to tragic consequences.

And of course, people need to be told more about the fact that such a state is possible.

First of all, it is important to inform husbands, as well as other relatives.

How much has the treatment of depression advanced in recent years?

“Unfortunately, it cannot be said that there have been serious breakthroughs in this area lately.

Although, of course, there are new drugs with a more complex principle of action.

But interestingly, when one of the most effective drugs for depression was compared in a study with a placebo, it turned out that the drug had an effect in 80% of cases, and dummy pills - in 60%.

This goes to show how important the psychological aspect is when we talk about treating disorders like depression.