Depression and dementia: two sides of the same coin?

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Depression is a common companion to many illnesses. It can also manifest itself as a separate disease. Medical care for this pathology often requires the use of medications. Treatment of depression with drugs is carried out in combination with psychotherapy, acupuncture, and physiotherapeutic methods.

The most modern methods of therapy are used to remove patients from this condition.

Magnetic stimulation

Transcranial magnetic stimulation works by applying electromagnetic fields directly to the patient's brain. In this case, stimulation of brain zones occurs using fields of different frequencies selectively, that is, only to those zones that are responsible for the development of depression. This method is not suitable for those patients whose EEG showed abnormal brain activity.

Treating depression without pills: truth or myth?

In addition to standard methods of treatment (pharmacotherapy), there are also non-drug methods of influence. They are less common, but have their place in the treatment of adaptation reactions and mild subdepressive states. Also, these techniques are used in combination with medications in the treatment of severe and prolonged depression, which is difficult to treat with medication.

Sleep deprivation

Sleep deprivation is a special type of treatment for depression. Even in the era of Antiquity, it was noted that after a sleepless night, a depressed person again became sociable and cheerful. And in the 70s of the last century, Swiss psychiatrist Walter Schulte discovered the healing properties of sleep deprivation.

The essence of the technique is that a person should not sleep for a day. He goes about his day as usual and then stays up all night. It is not recommended to take psychostimulants, caffeine or energy drinks. It is important to combine passive and active activities. That is, spending the entire night in front of the TV or book is highly undesirable. You need to do physical exercise or walks.

The next day the person is also awake. He may experience episodes of drowsiness, which must be combated with physical activity. Then the patient goes to bed. Thus, a patient with depression is in an active state for 36-38 hours, that is, one and a half days. The effect is usually observed immediately, but it does not last long. Therefore, 7-8 sessions of sleep deprivation are carried out twice a week, after which they can be reduced to once. The method is effective in the treatment of depression of both endogenous and psychogenic nature.

Some people find it difficult to understand the paradox of treating depression by further depleting the body through insomnia. Indeed, with a prolonged lack of sleep, a person may experience symptoms of psychosis: delusions, hallucinations, illusions, etc. As is known, this method was used during the Inquisition and World War II for the purpose of exhausting prisoners or interrogating criminals. However, psychotic symptoms occur when there is a chronic lack of sleep. Here, deprivation is carried out periodically, the emphasis is on cyclicality and normalization of the daily routine.

Lack of sleep is recognized by our neuroendocrine system as an existential threat, on par with hunger, hypothermia, injury, etc. A stressful situation stimulates the adrenal glands to produce adrenaline and cortisol. The first produces a quick effect, the second – long-lasting. An increase in their concentration leads to the activation of the body's forces: motor and mental activity accelerates, mood improves (even euphoria), vascular tone and blood pressure increase, metabolic reserves are activated (gluconeogenesis is triggered - the production of glucose from fats and amino acids). The production of serotonin, a hormone responsible for mood, is also normalized. At the same time, physical activity complements the effectiveness of sleep deprivation.

A similar effect was described by the Austrian psychiatrist W. Frankl during his stay in a concentration camp. He noted that people suffering from neuroses before the war were cured of their disorders while in captivity, where they were exposed to inhuman living conditions. A stressful situation changes the neurotransmitter processes that exist in depression.

Naturally, many would want to treat depression without drugs. However, the sleep deprivation method has its limitations. For people suffering from arterial hypertension, diabetes mellitus, renal failure, cancer and other severe somatic diseases, such treatment is contraindicated.

Non-drug treatment for depression: phototherapy (light therapy)

Phototherapy (light therapy) is a technique based on regular exposure of the patient to sunlight or artificial light.

This method was originally used to treat seasonal depression. In the human body in autumn and winter, the amount of the sleep hormone – melatonin – increases. It is derived from serotonin (the good mood hormone). Quantitative fluctuations of both hormones are interrelated. High levels of melatonin inhibit the production of serotonin. In those patients who suffer from depressive disorder, this provokes the onset of seasonal exacerbation. Mood and performance decline, anxiety and melancholy appear. Regular exposure to light reduces the amount of melatonin in the blood and stimulates the body's functioning, and accordingly, the symptoms of depression are leveled. This was proven in a 1999 study by Lee and Chan.

However, phototherapy is not used as an independent method, but in combination with antidepressants. Their combined effect produces the best effect.

It is correct to use white fluorescent lights for the procedure. Every morning, the patient should sit in front of a 10,000 lux light source for 30-40 minutes for 2-3 weeks. At lower light levels (2500 lux), the duration of the procedure can be increased to 2 hours (Lam and Levitt 1999). During the procedure, a person can listen to relaxing music.

Before carrying out phototherapy, you should definitely consult with a psychiatrist and ophthalmologist. If there are contraindications, the procedure is replaced by daily walks.

Regular exposure to daylight, fresh air and physical activity will be a good prevention of autumn-winter depression.

Gymnastics and massage

These non-drug treatments for depression are especially effective if the cause of depression lies in psychological trauma. Therapeutic massage and gymnastics, as well as meditation and breathing exercises, increase the delivery of oxygen to the brain, reduce the level of stress hormone in the blood, normalize sleep, and eliminate feelings of internal anxiety and tension.

It is worth noting that treatment of depression without medications can only be effective if it is used in combination with other methods of therapy and correctly selected by a specialist.

Psychiatrist, Kazak Alexander Alexandrovich

Authorship and editing of the text:
Head of the Department of Psychiatry and Narcology of the Alkoklinik MC, psychiatrist-narcologist Popov A.G., psychiatrist-narcologist Serova L.A.
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How do drugs work?

The transmission of impulses in the nerve tissues of the brain, which regulate mood and emotions, occurs with the help of special compounds - mediators. Violation of the content of mediators leads to the formation of a depressive state. Antidepressants are practically non-addictive and have the ability to regulate and normalize the balance of mediators, which causes a decrease and complete disappearance of painful manifestations. The doctor’s task is to determine the required group of antidepressants and select the most suitable drug for the patient. During the treatment process, the specialist closely monitors the person’s condition and adjusts the dose, and sometimes changes the medication.

Drugs that cause depression

A wide range of medications can affect your mood and lead to depressive symptoms. This list may include the following medications:

• Benzodiazepines (alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), and temazepam (Restoril) to treat anxiety and insomnia. Benzodiazepines are central nervous system depressants. These medications can accumulate in the body, causing depression as a side effect of use medicines.

• Antibiotics (levofloxacin (Levaquin) and ciprofloxacin (Cipro).
• Painkillers (oxycodone (OxyContin) or fentanyl (Abstral).
• Corticosteroids (prednisone (Deltasone) and triamcinolone (Aristocort).
• Beta blockers (metoprolol (Lopressor) and carvedilol (Coreg)
• Statins (simvastatin (Zocor) and pravastatin (Pravachol)
• Anticholinergic drugs (dicyclomine (benthyl)
• Anticonvulsants (gabapentin (Neurontin) and topiramate (Topamax).
• Ironically, two medications sometimes prescribed for severe depression may cause it: aripiprazole (Abilify) and quetiapine (Seroquel).

What should you do if you suspect your depression is caused by medications?

• If you suspect that a medicine you are taking is causing depression, tell your doctor about your symptoms.
• If you have just started a new medication, be aware of any symptoms that occur. Keep a diary and note the day, time and signs of new symptoms - mood swings or insomnia. Monitor for new symptoms for a month. With most medications, depression as a side effect of the medication usually occurs within the first weeks or months of starting or even stopping the medication.
• Report new symptoms immediately. The doctor will change the dosage or prescribe a new medicine.
• Remember also that depression has many causes, and it is not always the fault of medications. Therefore, it is important to talk to your doctor.

Source: Is your medication making you depressed? / Harvard Health Letter - October 2020 - https://www.health.harvard.edu/drugs-and-medications/is-your-medication-making-you-depressed

Medicines that may cause depression

The development of drug-induced depression is possible as a result of taking the following drugs:

• medications that lower blood pressure and cardiovascular medications, such as reserpine, clonidine, anaprilin, verapamil, apressin, nifedipine;
• some cardiac glycosides, such as digoxin and antiarrhythmic drugs, such as procainamide;
• antibacterial drugs - ethionamide, isoniazid, antifungal drug amphotericin B;
• hormonal therapy can also trigger a depressive disorder; you should pay attention to taking prednisone, hydrocortisone, anabolic steroids, and oral contraceptives that contain estrogen and prohexin.

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Taking medications that are aimed at lowering cholesterol levels in the blood - cholestyramine, pravastatin - also contributes to the appearance of signs of depressive disorder.

Note 1

Interferon preparations have a pronounced depressogenic effect, the action of which prevents the proliferation of viruses in the body and stimulates the functioning of the human immune system.

Also, various psychotropic substances and long-term use of large doses of antipsychotics, such as chlorpromazine, risperidone, haloperidol, can provoke the occurrence of depressive disorder in a person. This group of drugs also includes tranquilizers - seduxen, phenazipam, diazepam.

Symptoms of depression after taking medications

Depression, as a side effect of taking medications, most often occurs in people:

• with a history of severe depressive disorder;
• previous episodes of depression;
• family history of depression;
• previous episodes of depression after taking medication.

Symptoms of drug-induced depression are the same as for any depression:

• feeling hopeless, irritable, anxious, or angry;
• loss of interest in work, family, or once enjoyable activities, including sex;
• constant fatigue;
• sleep problems;
• pain, cramps, or digestive problems;
• problems fulfilling responsibilities at work, family, or other important activities;
• increase or decrease in appetite or weight.

Diagnosis of drug-induced depression

To accurately diagnose the onset of drug-induced depression in a person, it is necessary to make sure that taking a particular drug and the occurrence of obvious symptoms of a depressive disorder are truly interrelated. A thorough examination and questioning of the patient about the peculiarities of his use of medications and the timing of the onset of nervous disorders is necessary. It is also necessary to pay attention to whether the patient is taking several groups of medications at the same time.

It is also advisable to determine the concentration of this drug in the blood plasma.

To avoid the development of a depressive disorder, it is necessary, if possible, to stop taking this medication for a drug that is similar in action, but does not have a pronounced depressogenic effect. If the symptoms of depression disappear, it can be concluded that the patient actually suffered from a medicated form of depression.