Endogenous Depression - Causes, Symptoms and Treatment .MF .
Depression - (Latin depressio depression, oppression; synonym:. Depression, melancholia) - a condition in which a person has long marked depressed mood, decreased mental and physical activity.
disorder of such a plan does not lead to the intellectual defect and a gross violation of social adaptation, but it is worth remembering that about 10% of people with depression commit suicide.That is why depressive symptoms should be treated by the doctor.However, in our country it is considered shameful treatment to a psychiatrist (and in severe cases, such patients is engaged in it).The fear that "he will put on the account, the neighbors will show the finger," "they will heal it, and then make a real madman" covers the real risk of the effects of depression.Meanwhile, the depression no one is immune.Let's try to figure out who gets in its network in the first place.
There are well-defined risk groups: people aged 20-40 years, men after divorce or in the period of single women (especially in the postpartum pe
Look to the immediate environment and alert, if someone in your family or friends are beginning to complain of poor sleep, appetite, depression.Sometimes you can hear and direct statement of unwillingness to live, a sense of futility of existence, depression, fatigue.In scientific terminology, can be seen hypobulia (decrease volitional component) gipomneziyu (reduction of volume and stability of attention) - sinceNo willpower to memorize information.Decreased survival instinct, the food, the sexual instincts.There is a depreciation of their lives.Suicide risk is high on the "output" of the Depression, when the affect remains, but there is disinhibition, hypobulia disappears.The patient has the ability to organize suicide.
Many people suffer from "matte" depression, ie,not very pronounced.These depressions are the most dangerous for the suicidal risk.It is important to pay attention to the presence of tears - if they do not, the state is regarded as serious.As soon as there are tears, the condition improves.Chatting with patients in serious condition useless to cheer and reassure the patient can not, especially since it can lead to the opposite result.It is characteristic for these people and the feeling of "slow flow of time."
Endogenous depression (unipolar affective disorder) - a consequence of a violation of brain function, nervous and endocrine systems.
Definitely a clinical case, its development is not dependent on external factors and the appearance is not the result of any traumatic life events.But sometimes there are facts that may mislead the experts.Most often leads to endogenous depression:
- lack of endogenous amines - have antioxidant properties (antioxidant) model and generate oxidative processes in the body and thus do not give him to wear very quickly.
- reducing the level of noradrenaline, which is synthesized from dopamine for the most part in the adrenal cortex, in its property resembles adrenaline.Responsible for our vigilance and our activity in stress situations provides an immediate reaction by the type of "fight or flight", improves concentration, quickens the heartbeat, raises
pressure - decrease in the level of serotonin, which affects motor activity on vascular tone, the remaining propertiessimilar to adrenaline.
Endogenous depression can be observed in diseases of the thyroid gland or the adrenal gland, cardiovascular diseases, neurological rasstroystavh.
Thus, endogenous depression is more profound violation of the mental and physical activities than all other types of depression.A person does not perform simple tasks associated with self-service, use of physical force.Often, these patients feel guilty, thinking about suicide with a trend towards implementation.
In the case of endogenous depression, psychotherapy is ineffective.Patients severely depleted mentally and physically for what would have to work with a therapist and do his job.This case requires the unconditional and treatment by a psychiatrist if necessary placement in a medical hospital.
Statistics say that 50% of patients suffering from unipolar depression attempt suicide, 15% percent still can not complete the plan.Endogenous depressive episode lasts for about 6 months, but there are deviations, plus or minus two months.Most patients recover fully, when it is possible to associate the disease with any somatic (bodily) disorder and eliminate the cause, and sometimes becomes chronic and you need to take maintenance treatment with antidepressants for life.
If you notice something like that in themselves or their loved ones, contact a therapist or psychiatrist.Depression is treatable, if it does not run.
depression parallel with the conversation, aimed at identifying the causes of disease (stress factors, psychotraumatic situation and other circumstances of the patient's life), your doctor may prescribe a survey aimed at identifying the disease, simulating or provoking an endogenous depression.These may be diseases of the blood, anemia, changes in hormone levels, occupational hazards, etc.
survey methods related directly to depression just do not carry anything terrible.For example used:
1.Test Carroll - dexamethasone suppression test - at the same time control the level of cortisol in the urine and blood after the administration of dexamethasone.
2. tracked gross violations of sleep phase (REM -. Phase occurs after 90 minutes in the norm, "crawling forward" with endogenous depression).Just - in depression disturbed biorhythms - increased nocturnal urine concentration, body temperature.
treatment of endogenous depression
Treatment includes proper selection of drugs, long-term treatment with antidepressants and psychotherapy correctional aimed at smoothing the character traits that provoke the development of disease.To begin exclude organic disease which can lead to depression, and if any - treat them.
Biological therapies directly to depression are:
1. Phototherapy (exposure to bright light, or vice versa - darkness - but the latter method is used less frequently).
2. Deprivation (deprivation) or sleep 12 or 36 hours.The cycle - within a month.Deprivation is very effective, but it is unstable, so it is combined with antidepressants.
3. Medicines.Principles of drug therapy are as follows: monotherapy + long-term treatment (2 months -kupirovanie, 6 months - binding result, the year - the formation of remission).Use of antidepressants.
With all the possible usages of antidepressants "serotonin kick" therefore should be carefully selected dose.Do not set yourself antidepressants alone, the doctor will choose your dose is better.
subdepression If citalopram is used - a drug from the group of selective re-uptake blockers.This drug is "register" below the classical antidepressants, but it is well tolerated.
Classic complications of antidepressants - atonic bladder (detruziya - difficulty in discharging urine), diarrheal disorders, weight gain, potency disorders, tachycardia, blurred vision.
doctor and yourself can help.Him - to facilitate the task yourself - quickly recover.What is desirable before the doctor visit: To sleep!Lack of sleep rhythms and breaks the sleep phase, and they are so "shot down."
desirable to eat simple and balanced, there is no special diet, but also overload the pancreas is not necessary.It is known that in the overwhelming number of cases, women are depressed, "seize" and men "washed down".That's just drink something and can not - there is often rapidly emerging psychic and physical dependence, and the clinical manifestations of alcoholism come to the fore.The dependence thus formed is ten times faster than non-depressed.Just try to change the interior of your home - a little more bright colors, "air" curtains instead of heavy drapes, bright colors.
Depression regardless of the root causes of relapse, especially in women (1/3 for 1 year, 2/3 - 3 years).Children depression in the classic form can be seen after 10 years.More
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In practice, the physician may encounter the following situation.
- The patient is in a very depressed state, including stuporous, refuses food, physically weakened markedly.The primary task of the doctor - patient withdraw from such a condition that threatens his life.Unfortunately, none of the known agents is not capable of quickly and without any harm for the patient to withdraw it from the state of severe depression.We recommend not wasting valuable time searching for a particular medicament, in such cases, immediately apply electroshock therapy, and then depending on the circumstances, to continue the same treatment or go to pharmacotherapy.Experience in the treatment of depression in our country testifies to the effectiveness of intensive psihofprmakoterapii in such cases.Electroconvulsive therapy is usually applied later, when revealed resistance to antidepressants.
- If a patient is depressed, gipobulichen, but expressed no stuporoznyh phenomenon, drug treatment should be initiated with antidepressants having an activating effect, - monoamine oxidase inhibitors or tahitimoleptikov (desipramine, nortriptyline, and others.).
- Sometimes the initial stage of psychosis manifested azhitirovannostyu and strong emotion of fear.There are useful sedative and relieves the fear of antidepressants - amitriptyline and trimeprimin;if necessary, in combination with some antipsychotics: levomepromazina, hlorprotiksenom, thioridazine.When pronounced agitated involutional depression we think is right without delay to begin electroconvulsive therapy if there is no direct physical contraindications.Antidepressants are slow, and waiting is not always appropriate.
- The most characteristic symptoms of endogenous depression are vital anguish, despair, depression.In these cases, treatment begins with prescribing, uplifting: imipramine, melitratsen and other route of administration..In those cases, when shown a rapid and massive psychoactive effects (stupor, azhitirovannost and so on. D.), The dose of medication should quickly improve.It is safest to start treatment with injections: they do not cause very pronounced side effects.The action of the drug appears between the 5th and 20th day, although it is possible and a later manifestation of this effect.Interval depends on the individual patient, and also on the dose of the medicament, which are defined by age, gender, duration and depth of depression diseases.Children and the elderly prescribe lower doses.During the first day of the drug dose (25-75 mg) was partitioned into three stages: the latter must be confined to the afternoon time, ie to 16-17 hours to avoid sleep disturbance...The doses are gradually increased on average up to 200 mg, but not higher than 300 mg.This applies to all types of antidepressant medications 2. With the improvement of the patient the dose is decreased to about 100 mg per day.
The duration of the treatment after complete disappearance of psychiatric symptoms remains controversial.
antidepressant therapy should be continued for about 6 months, ie. E. As much as spontaneous otzvuchanie last phase of the disease itself.Observations based on the fact that for endogenous depression and schizophrenia antidepressants have no effect on the disease itself, and only relieve the symptoms.Thus, the disappearance of depressive phenomena does not mean the elimination of depression.Therefore, premature discontinuation of treatment carries the risk of a new attack.But there is a view that antidepressant therapy not only eliminates the symptoms (ie. E. A symptomatic effect), but also shortens the phase of the disease itself (pathogenetic action), which is characteristic of the onset of the true remission even after short-term treatment.It is especially important in the preparation of the treatment regimen provided a cautious (not sharp) reduction of doses of a medicament particularly dangerous sudden discontinuation of treatment.Often the patients themselves are aware of the onset of true and lasting improvements in their health status.These estimates of patients attending physician must always listen.The beginning of a radical improvement when patients express complaints associated with disorders of the autonomic nervous system, characteristic of the disease.
Psychotherapy endogenous depression
modern psychopharmacology is so expanded the possibilities of treatment of endogenous depression, which is traditionally used previously psychotherapy has lost its relevance and moved into the background.Increasingly, you can see how not only general practitioners, but psychiatrists are limited to a simple appointment of antidepressants, completely ignoring the psychotherapy component of the therapeutic process.At the same time optimizing therapy treatment, improves the efficiency of pharmacotherapy.Practice shows that psychotherapy for depression is dynamic and multifaceted.It can vary depending on the clinical picture of the disease, the individual patient's response to their condition, stage of treatment.In this report we will focus only on some of its sides.
As a rule, in addition to the actual depressive disorders in patients with marked response to sudden-onset depersonalization.They discouraged their change, confused, trying to explain this to external circumstances, they are constantly faced with the lack of understanding of others, often giving them wrong advice: "Pull yourself together, pull yourself together, a change of scenery", etc.In the classical triad of depressive patients are usually focused on intellectual retardation and incomprehensible to them losing interest.When anxious depression, and they are concerned about the constant anxiety maloobyasnimaya directed on their condition, and different, even insignificant events.When masked depression sick and tired of the endless somatoform disorders in the first place, asking a doctor to help them understand these feelings, suggest some additional tests, complaining of a lack of qualified professionals who are not able to put them to the correct diagnosis.
psychotherapy sessions at the first reception begins by explaining to the patient what his condition is completely understandable doctor.Knowing in detail the structure of the depressive syndrome, the doctor builds a conversation so that the patient wonders where Dr. disorders known to those of which he has not had time or forgot to tell.The patient feels that he finally realized that his condition is not unique, and it is well known that he did not need endless surveys carried out.He immediately calms down, and contact with it is fully installed.Given the identity of the patient, his condition, intellectual and educational levels, the doctor will determine the usefulness of psychotherapy in a rational explanation of the essence of the disease and the mechanism of action of drugs.In some patients this will optimize the healing process, while others - information overload on the background of intellectual retardation can cause a negative reaction.In all cases, you should use clear wording of optimistic, eg. "All of these are depression, your condition can be cured," etc.
Modern treatment of endogenous depression in most cases carried out using psychotropic drugs.This necessarily requires psychotherapeutic support.Where the drugs cause side effects such as dry mouth, constipation, drowsiness, disturbance of accommodation, it is necessary to warn the patient about this, to reassure, to say that the first reaction to the medication - usually a reaction to a side effect of that therapeutic result occurs later.