A complete review of drugs and psychotherapy for severe depression

Causes and symptoms of severe depression

Psychological factors for the occurrence of depressive states include:

1. Prolonged stress. A state of permanent stress is caused by the need to perform unpleasant work, frequent and forced meetings with any person, poverty, conflicts in the workplace and in the family.
2. Mental trauma. The most severe traumas include the death of loved ones, rape, and threats to life. Events from the past can affect a person’s psychological state.
3. Frustration. An unachieved goal can cause frustration, for example, repeated attempts to arrange a personal life or move up the career ladder.
4. An existential crisis associated with the loss of meaning in life.

Physiological causes of severe forms of the disease include:

• exhaustion;
• poor nutrition (lack of some vitamins necessary for the body);
• alcohol poisoning;
• cerebrovascular accident;
• menopause in women.

Signs of severe depression:

1. Deterioration of mood. Deterioration may occur gradually over several weeks and is expressed in loss of interest in the outside world and favorite activities. The patient's sexual desire decreases until it is completely lost. In the morning, you feel unwell (dizziness, nausea).
2. Decreased concentration, absent-mindedness.
3. Guilt. The patient may blame himself for the tragedy that caused the depression, such as the death of a relative. Patients often blame themselves for not achieving anything in life. There is a decrease in self-esteem. The patient claims that he is not capable of anything. There is a desire to punish yourself.
4. Pessimism. A person may have the feeling that nothing good awaits him. Against the backdrop of such thoughts, a desire to commit suicide arises.
5. Increased fatigue, passivity.
6. Loss of appetite. The disorder can manifest itself in complete refusal to eat or bulimia (eating excess food).
7. Lack of emotional reactions to events. A person remains indifferent even in the event of a threat to life.
8. Hallucinations and delusions. These symptoms do not always appear. Unlike schizophrenia, hallucinations and delusions in depression are not fantastic in nature. A patient, for example, may insist that he has some disease and will find signs of it in himself.
9. Impaired motor activity. Movements become slow. Stupor is possible, in which a person can remain in one position for a long time. The opposite can also be observed: motor activity increases and the patient becomes fussy.
10. Sleep disorder (insomnia, poor sleep or constant desire to sleep).

Causes

A state of deep depression can be caused by various factors. They can be psychological or physiological.

The first category of causes of depression includes mental trauma and constant stress. This may not only be moral pressure. For example, physical violence is a serious factor in the onset of major depression. Even after complete rehabilitation of the body, the psyche retains traces of this event. Some psychological traumas can haunt a person since childhood. These may be unfulfilled hopes, loss of meaning in life and other negative phenomena.

Physiological factors of depression include overwork, bad habits (alcoholism, drug addiction), head injuries, unbalanced diet, and irregular sex life. Even a sedentary lifestyle and many other physiological factors can cause mental disorders. Most often, severe depression is caused by several factors. They may belong to different groups.

Treatment of severe depression

If a person shows symptoms of severe depression, not only the patient himself, but also his loved ones should know what to do. The patient is not always aware of his problem. You should not wait for self-healing; you need to contact a clinical psychologist.

The patient may be asked to undergo a medical examination, including urine and blood tests, MRI, EEG, etc.

The examination may reveal:

• disturbances in the functioning of the cardiovascular system;
• neuroinfections;
• intoxication;
• traumatic brain injuries;
• hormonal imbalance.

If these problems are excluded, the patient is prescribed:

1. Psychotherapy. The method may include individual or group counseling. If the cause of depression is problems in the family, the patient’s relatives should take part in the consultations. Non-drug treatment involves the use of classical psychoanalysis, symboldrama, psychodrama and other psychotherapeutic methods.
2. Drug treatment. It includes the use of such groups of drugs as antidepressants (Remeron, Coaxil) and tranquilizers (Nitrest, Nozepam). The selection of drugs and setting the dosage should be carried out by the attending physician.

Treatment of depressive conditions includes 3 phases:

1. Active (lasts about 1 month). By taking medications, the main symptoms of the disease are eliminated, ability to work is restored, and appetite returns.
2. Stabilizing (lasts from 6 to 12 months). The stabilizing stage of treatment is carried out after achieving remission. The patient, under the supervision of a physician, reduces medication intake.
3. Supportive (duration is assigned individually). Doses of drugs in this phase become minimal. The attending physician continues to monitor the patient's condition.

Main symptoms

There are three main symptoms of major depression. They are determined first. The first symptom is an abnormally depressed mood for the person. He remains in this state most of the day. The patient remains in this mood for at least two weeks.

The second main symptom is a clear decrease in joy and interest in one’s activities. Previously, she brought pleasure to the patient. However, now the person has completely lost interest in this matter.

The third main symptom is increased fatigue and decreased vital energy levels. At the same time, the patient’s mood is dominated by melancholy, apathy, and anxiety. If all of these symptoms are present in a person, a doctor may diagnose severe depression.

Disease prognosis

The development of medical science has made it possible to create hundreds of pharmacological agents for the effective treatment of this complex psychological disease. The study of brain processes and the human psyche gives patients today a chance of complete recovery.

Recovery depends on the person himself. Doctors give the following recommendations for restoring health:

• vigorous daily walking (30 minutes per day);
• gymnastics or swimming classes;
• a new hobby or passion;
• communication with family and friends;
• find someone who is worse off and help him;
• spend more time in the fresh air.

Do not delay starting treatment if signs of depression appear. The sooner measures are taken, the easier and more effective the restoration of normal mental processes will be achieved. The best way out of depression is to deal with it promptly and consistently.

Consequences

A sick person is not able to lead a normal life, work, get around himself, take care of himself or someone else. As they say, it exists, but does not live.

This disease places an unbearable burden not only on the person himself, but also on his family and society as a whole. This is why this condition needs treatment. Waiting for a person to come out of severe depression on their own is extremely imprudent. So you can wait for the dangerous consequences of severe depression - a suicide attempt.

Suicide: when is it possible?

As a rule, patients with severe depression are lethargic and lethargic. Despite having suicidal thoughts, they do not have the strength to act on these thoughts.

There are 2 dangerous periods when the chances of committing suicide attempts are highest: the beginning of the disorder and the moment of recovery from it.

At the initial stages of a depressive episode, the mood is already painful, the patient may be visited by various bad thoughts, and motor retardation is not yet very pronounced. During such periods, it is necessary to carefully monitor the person so that he does not do something irreparable.

A similar situation occurs a couple of weeks after the start of treatment. The first symptoms that begin to improve with treatment for severe depression are movement disorders. Negative thoughts, unreasonable feelings of guilt, and a pessimistic vision of the future disappear a little later. During a slight improvement, patients can put into practice everything that they had time to think at the peak of depression. So during this period, maximum control is also necessary not only over the patient’s actions, but also over one’s words, so as not to say anything unnecessary or provoke the person to do something.

Support from loved ones and their care is necessary for depression of any severity, so I recommend reading the article “How to help someone with depression” to know how to support such a person, what you can say in his presence and what you shouldn’t.

Depressive disorder occurs a little differently in women than in men. That’s why I devoted a separate article to this topic.

Why does it occur

Why severe depression occurs in a particular person is one of the first questions a doctor will ask himself when communicating with a patient. Further treatment tactics will depend on this.

The role of genetic, organic and socio-psychological factors in the development of severe depression has been reliably confirmed.

Genetic factors

A significant part of severe depressive disorders are endogenous depressions. The latter arise due to a deficiency in the body of special substances called monoamines, which are involved in the regulation of emotions, cognitive processes, attention, and memory. These are the well-known norepinephrine, serotonin, and dopamine.

The deficiency of these substances does not arise out of nowhere, but is triggered by the action of special genes responsible for the development of depressive disorder.

Depression may be one of the phases of bipolar disorder, a disease with a hereditary predisposition.

Social and psychological factors

Some people are predisposed to depression. They are distinguished by uncompromising, straightforwardness, and an “excessively serious” understanding of the sense of duty. The experiences of such people are affectively rich, but at the same time they tend to inhibit the external manifestation of emotions.

Social factors that can lead to the development of an affective disorder are bereavement (death of a loved one, divorce, separation), lack of social support, when a person has to overcome everything on his own, with no one to expect help from, financial problems, loneliness, various serious illnesses and associated social problems and financial costs.

Organic factors

Depressive disorder can be not only an independent disease caused by genetic characteristics or social problems, but also a secondary pathology, a complication of another nosology.

Brain stroke, Huntington's chorea, Parkinson's disease, thyrotoxicosis, hepatitis, cancer and many other pathologies can be complicated by the development of a depressive episode.