The word «depression» means dispirited mood. If more exactly – it is a triad of events in the person’s state: the deceleration of physical, mental and psychical activity. Here we give some common symptoms which have most of patients. There isn’t any power to do something; nothing please you; very usual duties become beyond your strength; you have frequent fits of anger and aggression to entourage; you get into a bad mood even in the mornings; you want to lie in the dark room the whole day, and so on, and so forth. All that includes also a physiology with its symptoms – insomnia, light sleep with anxiety dreams, headaches, pressure changes, pains in stomach and heart.

Do you recognize your state? Do not be frightened. Let’s take a closer look at this «depression», the enemy should be known by sight. For one thing, the physicians do not use the diagnosis «depression». With a word «depressed» we can describe different effects: congruent behavior after bereavement, conflict reactions and neurosis, personalities and of course the disease.

In fact, the disease happens rarer than you think, about by four patients from 100. In this case we are really speaking about mental disease, but not about temporal state. The disease is lasting for years and is treated only with a help of medicaments and under the care of a physician. Other 96 patients who complain about the same symptoms, in all probability have neurotic reaction of varying severity to some life’s circumstances. In this case our mind and physiology are able to cope with some difficulties independently. You should only help. The main thing is to notice signals, which our wise organism is sending long before «avalanche» of stated above symptoms.

We got accustomed to another course of events. We do not pay attention to bad spirits, hoping that everything is going to be alright. You have not let it run itself. The fact is that protracted depression has a good chance to turn into serious disease called «Major depressive disorder». You can not cope with this state alone. And there are some words how does depression originate.

How do we react in such a way? The question is in stress. At that, it isn’t referred to one-time shock, but to so-called “accumulative” stress, which has a lot of small “blows” on our psychology. It may be burned omelet, quarrels with neighbor or with beloved person, or even dissatisfaction with oneself. All our life is a complete stream of these stresses. It affects everybody in spite of the age and social status.

A human – is a cat with nine lives and one of the survivable species, so at the very least it can cope with a number of stresses. But a state of chronic stress is accumulated and from time to time our mind (and after that a whole organism) is failed. It is called neurotic reaction. I can safe say that every person has got under its control just once in his life.

As a matter of fact, all stressful situations may be relatively divided into two types. The first of them is social conditions. In this case we can hardly change something. These conditions are simply thrust. Whether you like it or not, you have to learn how to survive. A research worker of one of the universities in the U.S. has made an investigation where we can see a quite definite connection between ups and downs in the American economy and sickness rate of mental diseases. According to his data, during business depression a number of mentally diseased has been increased up to 150 – 200%. The result of economic recessions leads to inevitable ending – a nervous breakdown. You can observe it by people who are absorbed with a crisis situation. The author writes that these people blame themselves. They believe that they have weak points and they are not able to make progress in this financial race, but in most cases they are only innocent victims of society.

These studies show that the more the American has succeed in this race for subsidiary earnings, the greater are his chances to go mad in case of ill effects. According to statistics, the mental diseases happen during economic dislocations by men of substance, who really have something to lose. All these circumstances cause a constant emotional overload and make neurosis as a norm by a definite number of the population.

There is one more important reason of neurotic depression – it is a morbid tendency to move up the career ladder. Theoretically, a conception about career or careerism is not at variance with morality. Why is it bad that person is trying to be successful or he wants to make his family be independent of financial instability? It is bad when this aim becomes the only important thing for him. Such people have so-called «career disease».It is painful both for careerist and for his relatives, as well as it leads to nervous disorders. They are especially discernible by the overthrow of career plans.

The discrepancy between our production commitments, our interests, personalities and even sportsmanship also causes the development of neurotic reaction. For a long time accumulated negative emotions can lead to neurotic disorders. They also provoke a necessity to be engaged in several things simultaneously (at that, all of them are pressing business) – not having time to concentrate at one thing, a person has to switch over another. In this case you get a broken search order and information analysis, you do not have a satisfaction, because you fail to finish the thing which you have started before. You have quickly to redirect and adapt yourself to new conditions.

The second group of reasons of neurotic disorders is personal relations. Here the first place take emotional experiences concerning loss of near relations, love-affairs, adulteries, intrafamilial disputes, as well as alcohol abuse of one family members. Our lives are full of private reasons of one or another varying severity.

One more cause which has an influence on the development and acuity of neurotic reaction – is peculiarity of our nervous system. These peculiarities are innate, that is why they are not liable to variation. According to reaction type to inductive stimulus we are divided into people with type of strong nervous system and weak nervous system.

The people with strong nervous system have high working capacity, especially if it requires staying-power and purposefulness. They do not lose presence of mind in difficult situations. They are enterprising, persistent and independent. They do not like to complain about the shoals of life, as well as they do not seek support by inner circle. These people have rare nervous breakdowns.

The people with weak type of nervous system, on the contrary, have low working capacity. They are lack decision and always try to avoid responsibility and difficult situations. Usually they tend to inadequacy. They can not defend believes and are easily surrender themselves over to somebody’s influence.

Since the beginning of the twentieth century, researchers have experimented with different substances in order to synthesize the drug which relieves depression symptoms. However all experiments were failed. The first antidepressant was «discovered» in 1957 by a chance, when doctors payed attention to iproniazid, that was used by multimodality therapy of tuberculosis. Except of the main medication’s effect, it was observed and a side effect, which was showed in unusual high spirits by tuberculosis patients. A short time later this medication was used for relief of depression symptoms, especially as the tuberculosis remedy it did not justify itself.

According to the other version, the action of the medication was discovered by Nathan Kline. Moreover his disclosure was also more than accidental – with a help of drug he tried to prove the theory about the location of «ego». During psychoanalytical session Kline has mentioned that some patients have not got former problems any more. Iproniazid was offered for sale, but soon it was turned that it increases the risk of jaundice, so the sale of medications was discontinued.

At the same time in Germany Ronald Kun discovered imipramine. Kun gave his patients different medications in order to build the global classification of mental diseases. The German psychiatrists of that time were completely obsessed with this classification. As in previous cases, medication was «discovered» when patients were elated. In contrast to iproniazid, imipramine still is in the list of official medications of WHO and up to Prozac it was the best selling antidepressant.

When the first antidepressants were discovered, no one could have imagined that just in a few decades, treatment with antidepressants would almost force out other types of depression treatment. According to poll, that took place at the end of the XXth century in the USA, the biggest discovery of the last century will be not the theory of relativity, and not the Internet, but a small capsule of Prozac.

Seasonal affective disorder can have the same symptoms as a depression, which are not connected with the certain season. It may be depressed mood, melancholy, anxious feeling, apathy, joylessness or hopelessness. Rarely these symptoms are more pronounced in the first half of the day, whereas to the evening the state becomes better.

More typical for seasonal affective disorder are considered other symptoms. Patients, suffering from seasonal depressions, parallel with depressed mood, anxious feeling and decreased activity, experience drowse and keen appetite during the whole day. During depression they consume more food which is rich in carbohydrates. They can also put on weight. As a rule, reduces the overall tone, but appears weakness and variety of unpleasant sensations in the body.

Asthenic symptomatology of seasonal affective disorder is following: feeling of weakness, flabbiness, souse and all-overishness. It may be different pains and unpleasant feelings in the body. The mental work decreases, the memory and attention worsen. It is significant that intensity of these symptoms practically do not depend on outside force and quite often they are more pronounced in the morning hours after awakening.

In development of seasonal affective disorder the important role plays metabolic serotonin – biologically active substance, which regulate mood.
Experimental researches have shown that in winter the content of serotonin lower than in summer. The significant regulator of serotonin is melatonin – an active material, which production depends on light quantity.

The classical approach of seasonal affective disorder treatment is light therapy. Besides, it has been proved high efficiency of antidepressants with a specific action on the exchange of serotonin in the brain. Prolonged use of these medicines allows not only cure developed depressive state, but also to prevent their future development. As by other depressions, the essential element of effective treatment is psychotherapy

Depression is a disease state which has characteristic symptoms.

By no means is depression a manifestation of the lack of character. This is a serious disease which is accompanied by violations of all psychological and even physical (sleep, appetite, body weight, etc.) functions of a person. Loss or reduction of strong-willed character – is one of the symptoms of the depression. Therefore, you should not advise the person suffering from depression, «to pull yourself together» – he will not be able to overcome the disease without medical care. Depression significantly affects the efficiency, education, social life, relationships with other people, including next of kin.

Is there a connection between depression and female sex?

It is common knowledge that women suffer from depression more often than men. This fact is confirmed by numerous epidemiological researches from different countries. The frequency of depression by women is 2-3 times higher than by men. In modern medicine female sex belongs to factors, which are predisposed to development of depression.

What is a reason of depression?

In many respects depression is connected with changes in endocrine profile, which take place in the woman organism during childbearing age. So-called genesial (genital) cycle passes a number of stages, starting with a menstruation and finishing with its completion. It includes menstrual cycle, pregnancy, childbirth, premenopausal and climacterical periods. At each of these stages there are a lot of changes in the composition and number of hormones, which are accompanied by physiological changes of all functions of the female body, including the psychological realm. Therefore, such changes of endocrine profile are connected with the increased risk of depression.

How does depression become apparent by women?

How it was stated above, the risk of depression increases at each stage of the reproductive cycle. There are different variants (syndromes) of depression in the clinical medicine, which are typical for every stage of the reproductive cycle, – premenstrual syndrome, pregnant depressive syndrome, postnatal depression during premenopausal and climacterical periods.

Manifestation of depression may be different. Depressed mood can manifest itself both by oppression and apathy, and by hyperirritability, maudlin, anxiety, a sense of internal tension. The change in mood is usually accompanied by a decreased activity, a loss of energy, an easy fatiguability and a distracted attention. Depression in women is often accompanied by a variety of somatic disorders: disturbance of sleep (insomnia or excessive sleepiness), appetite disturbance (decreased or increased appetite). There may appear unpleasant feelings of stress and pain in the mammary glands, headaches, pains in joints and muscles, pains in heart and occasional heartbeats, weakness in the body, fluctuations of blood pressure, etc.

The duration of depressions which associated with the reproductive cycle may be different. Premenstrual depressive syndrome is usually brief, about 2 weeks (1 week before and 1 week after menstruation), but it has recrudescent character with the monthly worsening. Post-natal depressions and menopause depressions may be more protracted and continue several weeks and even months.

How can you treat depression?

Depression – is a curable disease. In case of the correct choice of an appropriate remedy and its dose, the completely eliminate from the depression symptoms is quite possible.

The treatment of depression occurs only with the help of special medicines, which called antidepressants.

The treatment of depression should be ordered only by a doctor. We must remember that every person has its own characteristics of depression, which are connected both with the gravity of the disease and it clinical manifestations. The correct choice of treatment in each case requires the appreciation of multiple characteristics of the patient. Only doctor can correctly identify, evaluate and classify such features. In no case one should not resort to the help of relatives or friends or choose a means of treating independently, on the grounds that some medication helped someone who you know.

This rule must be observed, especially if change of mood is accompanied by a changes of overall health, violations of bodily functions and pains that is most characteristic for depressions which are associated with the reproductive cycle. In such cases, only doctor can properly assess the nature of symptoms, determine the actual state of internal organs and choose medicines that will be not only effective but also safe. It is strongly encouraged to take antidepressants during pregnancy and lactation.

Nowadays there are a lot of antidepressants. All modern medications of this class are effective and safe. However each of them has its own differential characteristics, which connected both with therapeutic action and its dosage.

The treatment of depression takes time. You should not wait for the recovery in the first days of taking the medication. Remember that all modern antidepressants effect the depression no earlier than in 1-2 weeks after beginning the treatment. During this period a doctor also identifies the necessary dosage.

The abolition from the antidepressant, as well as its prescription, should only be ordered by a doctor. Even after the complete disappearance of all symptoms of depression you should continue to take antidepressants for some period of time. It is connected with a risk of worsening depression, which in case of premature abolition of therapy is very high – up to 60-80%. Moreover, the worsening of depression, associated with the premature termination of treatment, usually more difficult responds to treatment. The duration of such additional period of treatment, which aim is preventive measures, determines only doctor on the basis of individual characteristics of each patient.

Remember, even if you decide to stop treatment before the period determined by a doctor, it is necessarily to consult with a specialist.

Many patients experience false alarm regarding constant dependence on antidepressants. Considerable part of patients, suffering from depression, belong to placebo-reactor, i.e. people who are easily susceptible even for pills, which do not contain some active pharmaceutical substances. All just-listed determine heighten interest of such patients in psychotherapy.

The telling argument, testifying the role of psychotherapy in depression treatment, are those experimental data, which show the importance of psychological factors in the formation of therapeutic resistance to medical products. The effective course of psychotherapy in the long term is possibly more useful than pharmacotherapy, because it teaches the patient. The last one acquires the skills to overcome the depression, learns to recognize its approximation and prevents its recurrence. According to the results of many studies, the normalization of endocrine indicators in the therapy of depression is achieved not only in the process of treatment with antidepressants, but also in psychotherapy. The influence of the psychotherapy on endocrine indicators are observed both in the case of its combination with pharmacological therapy, and in the case of using it as the only method of treatment.

In a number of cases, psychotherapy allows patients to adjust to reality with the continuing violations of affection, thinking and attitudes. With an independent therapeutic effect, psychotherapy promotes the optimal collaboration of the patient and physician, raises the efficiency of medical treatment, improves family relationships and professional status of the patient.

Frequent start of depression after acute trauma or prolonged stress leads to a persistent search of psychological reasons of its occurrence. This situation increases the desire of patients to psychological care. However, excessive revaluation of its capacity, unfortunately, can lead to a complete denial of psychotropic substances, formation of resistant and prolonged depression variants, cause her early exacerbations.

In respect to a doctor, the psychotherapy of depression first of all should be aimed at elimination of its symptoms. Some of them are more sensitive to psychotherapy, and other are relatively difficult to its impact. It is generally believed that by severe depressions psychotherapy’s possibilities are more limited than in cases of slight disease.

As psychotherapeutic targets are chosen mood disorders, paralogia, behavioral disorders, motivation and physiological symptoms. Among affective symptoms – are sadness, sense of guilt and shame and especially anxiety.

There are a number of general principles of operation which have a psychotherapist with a patient suffering from depression. Here the doctor’s control over his own feelings regarding to patient is very important, because of the possible sense of futility, anger, excessive fatigue and sympathy. Psychotherapist not only sympathizes with the patient, but he also carefully observes him, keeping some distance. During the therapy doctor should strictly regulates communicating time with patient and maintains the structure of the momentum to recovery. Active statements of the purposeful questions, confidence in the diagnosis, the real hope are basic rules of depression treatment. The studies have shown that hope, which was received from a doctor, is retrospective by patients and taken as an important help in overcoming a depression.

The peculiarity of work with a patient depression is not so much empathy, as understanding the condition, and in particular, the possibility of change of mood. Often patient aspire to «petrify» the psychotherapist by means of his endless waiting for assistance, and the latter makes an error, starting with theoretical explanations and searches of psychological reasons of depression. In fact, the psychotherapist must ensure that the patient drew attention to himself and seek adequate perception of his situation. A particularly undesirable conversation with the patient is about the symptoms of his condition. More important is to emphasize the dependence of the expression of different situations, to talk about the features and relationships with other people. Psychotherapist’s compassion is usually increases by patient the waiting for assistance, an attempt to ease the symptoms lead to its strengthening, consolation – to inconsolable. It is important to bring the patient to the need for self-help, but not comfort him, show him the importance to understand himself as he is.

For depression treatment it were proposed different methods of psychotherapy:

• Psychoanalysis
• Person-centered psychotherapy
• Existential therapy
• Interpersonal therapy
• Cognitive therapy
• Reminiscence therapy
• Projection variations with time
• Relaxation training
• The therapy of social problems and other methods of psychotherapy.
• Including its mixed and eclectic variants.

According to the most researches the most effective method by depression treatment is cognitive therapy, focusing on correct mindset characteristics of patients suffering from depression.

Typical (main) symptoms of depression:

• The mood is bad, depressed, nasty, dismal, “there’s a gnawing in your heart”
• “You are browned off everything”: you put off some plans or for a long time you make yourself for their performance. There is no desire going into the heart of the matter, – you know that you must do it, but you take any measures. The production decisions and business acquaintances you also leave over until tomorrow. You are not interested in something, you do not want to do anything, but you know that you should do it. There is no pleasure like before – “You are past caring.” You couldn’t remember when you were happy.
• You are tired even after unimportant physical exercises, or in the evening you are completely unable. It may be the feeling of constant tiredness. It seems that you have never had a rest. You want to refuse from routine, rather to take a break and muster your strength. However, brief rest does not improve the condition, and amusements fast lose their attraction.

Other symptoms of depression:

1. It is difficult to concentrate in the presence of an irritant (for example, by television, radio, conversation in the next room); because of «parallel» thoughts – «while reading I am thoughtful of others». It becomes difficult to pick words or to catch the meaning of the conversation. While reading books, magazines or commercial papers it is also hardly to find their meaning, you have to reread it once again.
2. After taking a decision, it appears unusual for you indecision, constant doubts in ordinary domestic or well-known professional duties. The self-reliance has disappeared, – «What if I say too much or do something wrong».
3. The critical appraisal of all past life is quite possible. «Everything that I have had in the past is useless. I had to do other things». You experience painful feeling of the «black sheep» in the family and «white crow» in the work. You reproach yourself in filial irresponsible duties or in insufficient care concerning other next of kin.
4. Your mind is filled with sad thoughts, that you are «loser» and you are not able to solve the problems. There is an ascertaining of full professional failure. The dismal and pessimistic vision of the future may be filled with quite concrete life conditions.
5. Sometimes it occurs to you – «Perhaps it would be better to pass away, because everything is bad, nonsensical, the life has lost its meaning since».
6. The sleep disorder is quite varied. This includes difficult falling asleep; reduction of night sleep because of frequent awakenings; the awaking at 3-4 o’clock at night or at 5 in the morning with following sleeplessness. At all kinds of sleep disorders there is no sense of rest in the morning.
7. You have jaded appetite («I can do with one cup of tea during the day»), or you can even have aversion to food’s sort or its smell.

Depression self-testing

In event that you do not get some of three symptoms (main and extra list), so you do not have depressed mood according to ICD-10.

Mild depressive disorder

The presence of 2 typical symptoms of depression and at least 2 symptoms from the list of “a-g”. You are worried about your state. You feel certain difficulties by work performance or by social activity.

Moderate depressive disorder

The presence of 2 typical symptoms of depression and at least 3 symptoms (preferably 4) from the list of “a-g”. There are formidable difficulties in performance of social duties, housekeeping or by continuation of professional activity.

Major depressive disorder

The presence of all 3 typical depressed symptoms or more than 4 from the list of “a-g”. The social and home activities can be very limited or improbable.

If you have a depressed mood in accordance with the criteria, your state may be exacerbated with a number of additional painful displays:

• You want to be alone, shut yourself off from everybody;
• The next of kin notice that you become silent and you stop smiling;
• The relations with relatives and colleagues become complicated with unusual for you irritability and aggression;
• The feeling of weight in the chest, («A weight sits heavy on my heart»), or an ache in the left part of the chest or burning pain behind breastbone.
• It appears unnatural for you slowness in movements, or on the contrary, moving excitement and anxiety, (« I have the heebie-jeebies»).
• During depression the sexual drive may decrease, («I do not even think about it»).
• You feel bad especially in the morning or in the afternoon. By the evening you feel better (typical diurnal rhythm of disturbance mood)
• The attempt to improve your state with a help of alcohol brings only temporary and unstable effect.

In case if you find by yourself or by some member of your family the foundation for depression self-testing, you should seek a psychological help.

Nowadays many men of the street do not know how to treat depression effectively. However, the treatment of the first signs of depression trouble not only them. The effective help for depression is still not only the task of psychiatrists, but also psychotherapists. The successful depression treatment requires a biological therapy, psychotherapy and a number of social measures aimed to improvement of the patient’s status.

The spontaneous recovery by lingering depression is quite uncommon and forms about 10% of all cases. At that, the return of depression happens within the next 2-4 years.

The effectiveness of the depression treatment depends on its clinical presentation and on the adequacy of therapeutic intervention. The biological treatment of depression first of all includes pharmacological therapy. At the same time for the biological treatment of depression may be used: electroconvulsive therapy, sleep deprivation, phototherapy, dietetic therapy, phototherapy, efferent treatment methods and other biological modalities on the patient’s body. Among the pharmacotherapy of depression more often are used antidepressants, however during the therapy of this disease are also spread other medications: tranquilizers, neuroleptics, vitamins, hormones, antioxidants, the lithium, medicines that improve the metabolism in brain cells and influence the immune system.

It should be noted, that antidepressants can also be effective by the treatment of anxiety, impulsive obsessions, migraine, bulimia, vegetative crisis, and even by removal of different pains, because antidepressants usually raise pain threshold. The treatment of depression signs can be conducted with the help of psychotherapy. In order to get rid of depression patients aspire themselves to this form of medical and psychological aid. A great while, depressed patient can’t bring himself to ingestion, and starting the intake of antidepressants, he quite often ceases the pharmacotherapy of depression.

By virtue of helplessness and constant doubts, patients are usually suggestible and while reading the annotations of one or another drug, they easily find by themselves side effects in the first days of the treatment. Besides, depressed patients have functional disorders of internal organs and thereby are really sensitive to some side-effects. Many patients experience a false alarm living in constant dependence on antidepressants. The main part of the patients, suffering from depression, is a placebo – reactors, i. e. people who are easily responsive to even «blank tablets», which generally do not contain any active materials. All aspects listed above determine the heighten interest of such patients in the psychotherapy.

A major argument, which testifies the role of psychotherapy in depression treatment, is the experimental data, which show the importance of psychological factors in the formation of therapeutic resistance of depression to medical products. The effective course of psychotherapy in long-range outlook is likely more useful than pharmacotherapy, because it teaches the patient. The last one acquires the skills of overcoming depression. It learns to recognize its approximation, as well as to prevent its recurrence. According to the results of many studies, the normalization of endocrine indicators during the depression therapy is achieved not only by the process of treatment with antidepressants, but also by psychotherapy. The influence of psychotherapy upon the endocrine indicators is observed both in its combination with psychopharmacological therapy and in the case of its using like a single treatment.

In a number of cases, psychotherapy allows patients to adapt to real life. With an independent therapeutic effect, psychotherapy promotes the optimal collaboration of the patient and a physician. It also improves the efficiency of medical treatment, as well as family relationships and professional status of the patient.

The frequent depression after acute trauma or lingering stress leads to a persistent search of its origin. This circumstance strengthens the patients` aspiration for psychological help. However, an excessive overestimation of its abilities, unfortunately can lead to complete repudiation of psychoactive drugs, as well as to formation of resistant and lingering kinds of depression and to its early exacerbations. For patients the issue how to treat depression remains open.

From the doctor’s point of view the psychotherapy of depression should be primarily aimed at removal of depression symptoms. Some of them are more sensitive to psychotherapy, and other come relatively difficult under its influence. It is assumed that by severe depressions the possibilities of psychotherapy are more limited than in light cases. As targets of psychotherapeutic effects they choose mood disorder, behavioral disorder, motivational and physiological symptoms. Among affective symptoms - is sadness, feeling of guilt and shame and especially anxiety.