Very often depression is accompanied by chronic diseases. It is considered, that one third of all patients with serious medical problems suffers from a depression. Thus after infarction it is observed by 40 – 65% of the patients, by ischemic disease – 20%, after the stroke – from 10 to 27%, by diabetes and rheumatoid arthritis – from 20 to 30 %.

It is natural, that chronic diseases cause the disturbance of daily routine, especially if there is no possibility to continue the work. In this case symptoms` appearance may be imperceptible for others and patient itself, that’s why it is necessary to know such symptoms in order to take appropriate measures. There are some of them.

• The constant state of depression, sadness, anxiety, nervousness or indifference.
• The inability to enjoy life or its positive moments.
• Loss of weight and appetite
• Insomnia, early awakening or on the contrary, drowse in the morning
• Impatience
• Reduction of vital power and chronic tiredness
• Feeling of helplessness and pessimism
• Feeling of own otioseness and unjustified guilt
• Difficulties with concentration, memory and with taking decisions
• Recurrent suicidal thoughts

If you notice some of these symptoms by your relatives, discuss with a doctor what measures can be taken. The specialist in fundamental illness (for example in diabetes or arthritis) can not often to diagnose the depression himself, but he should connect the patient with a psychiatrist. In many cases qualified treatment of depression can relieve clinical the course of arthritis or recover health after infarction.

In case of unimportant depression doctors recommend psychotherapy like a first stage of the treatment. Among them the most efficient is Cognitive Behavioral Therapy, CBT. It helps the patient to recognize negative ideas and some behavioral reactions and replace them with positive. Usually the course of treatment is not very long – about 10-20 weeks, and is defrayed by medical insurance. Quite often psychotherapy goes with drug therapy, which yields tangible results, especially by acute form of a depression.

The most commonly are used the class of selective serotonin reuptake inhibitors (SSRI). This group includes:

• citalopram (Celexa)
• escitalopram (Lexapro)
• fluvoxamine (Luvox)
• fluoxetine (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)

An other class of antidepressants (SNRI) is also connected with a heightened content of serotonin and norepinephrine in the brain – venlafaxine (Effexor) and duloxetine (Cymbalta). So-called tricyclic antidepressant, previously widely used for depression treatment, now are not recommended for people elder 65 because of their side effects, particularly their abilities to cause cardiac arrhythmias.

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.