Depression. Predepressive state or how the mechanisms of depression are activated

General concept and features of pathology

Latent depression is a psychological disorder that is expressed primarily in physical manifestations. The symptoms of larval, somatized depression are similar to diseases of the internal organs. Most often these are disorders in the functioning of the gastrointestinal organs, as well as vegetative-vascular dystonia.

Doctors also call this type of depression “depression without depression,” since its main symptoms are physical, and not psychological, as in a normal disorder.

The disease was known back in the 19th century, but nowadays psychotherapists are increasingly diagnosing it. This is explained by the fact that people have become more attentive to their mental health and are more often seeking medical help. But due to its similarity to other somatic diseases, latent depression is not always diagnosed on time, and therefore the patient does not receive the necessary timely treatment. A patient can visit specialists for years and be treated for pathologies that do not exist in the body. This is the main insidiousness of a hidden depressive state.

Pitfalls of masked depression

Diagnosing masked depression is quite difficult, so experts classify this disease as very dangerous. A person does not understand what is happening to him, what he is sick with, since he feels only physiological symptoms. He does not consider it necessary to seek psychotherapeutic help, but undergoes examinations by other doctors, suspecting that he has some serious physical pathology.

The number of people suffering from this type of nervous disorder is increasing every year. Mistrust of psychiatrists, a low level of psychological literacy of people and, of course, many social trends can be the reason that a person suffering from depression does not receive timely help.

In order to recognize masked depression as early as possible and seek help in time, you need to become more familiar with the “masks” of this illness.

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Most often, a patient with masked depression complains of the following symptoms, which doctors call “heart melancholy” syndrome: pain in the heart area, lack of air, irregular heart rhythms and sleep disorders.

Also common are long-term headaches that cannot be controlled by medications, and spasms in the gastrointestinal tract associated with peristalsis disorders (diarrhea, constipation, vomiting, flatulence). Sometimes at the appointment, signs of psychological abnormalities are revealed, such as loss of self-respect, strong self-criticism and accusations against oneself, decreased concentration and memory problems.

Some patients complain of lack of sleep, disruption of routine, inability to fall asleep quickly, and interruption of sleep. Others experience changes in their eating habits: their appetite decreases or, on the contrary, they feel constant hunger and the need for food. It happens that women complain of decreased libido and disruptions in the menstrual cycle. A more careful diagnosis reveals a slight slowdown in motor and mental reactions, manifested in inhibited speech. A person may react sharply and intolerantly to bright lights and loud sounds.

The symptoms of the pathology in question resemble manifestations of neurasthenia, a disorder characterized by a combination of irritability and constant fatigue. According to the assumption of some psychiatrists who study masked depression, chronic fatigue has a dominant influence on the onset and development of the disease.

The disease is dangerous because it has no obvious symptoms, it approaches unnoticed and even gently, so to speak. But if the disease is not diagnosed in time and allowed to develop without treatment, then it will be complemented by other mental pathologies: sudden and inexplicable panic attacks, persistent hypochondria and other depressive disorders.

Increasing, masked depression can lead to dramatic changes in a person's character, such as uncontrollable outbursts of rage and rage, which contribute to isolation and alienation, and also interfere with work responsibilities. Emerging new habits of antisocial behavior can make the patient a drug addict, alcoholic and delinquent.

Depression can manifest itself as vegetative-vascular dystonia, arterial hypertension, migraine, cardioneurosis, osteochondrosis, hyperventilation syndrome, dysmenorrhea, skin diseases, irritable stomach syndrome, arthralgia and myalgia. But these diseases are not signs of masked depression. Diagnostic tests prescribed by the doctor do not reveal pathological changes, and medications do not give positive results. A person can be observed by different specialists for many years, but there will be no improvement in his condition.

Symptoms

Masked depressive disorder is difficult to diagnose because its symptoms resemble many other pathologies. The disease masquerades as other diseases. Its main symptom is various pains: in the chest, head, heart muscle and even in the teeth. The pain is painful for the patient, and analgesics do not always help.

Signs of hidden depression:

• increase or decrease in pressure;
• difficulty breathing;
• dizziness;
• increased heart rate;
• appetite disorders - anorexia (refusal to eat) or bulimia (increased feeling of hunger);
• weight fluctuations – weight loss or obesity;
• apathy – a mood of complete indifference;
• sleep disorders - insomnia, nightmares;
• lack of libido – decreased sex drive;
• feeling of anxiety;
• hypochondria – searching for non-existent diseases;
• mood swings.

A whole range of signs may appear, and sometimes two or three are enough to make a diagnosis.

Experts call masks that hide depressive pathology:

• Cardioneurosis is a psychosomatic disorder of the heart;
• osteochondrosis – disorders in articular cartilage;
• vegetative-vascular dystonia – disturbances in the functioning of the cardiovascular system;
• irritable bowel – intestinal disorders;
• skin rashes of unknown cause;
• dysmenorrhea – pain during menstruation that has no obvious cause;
• hyperventilation – lack of air;
• migraine is a severe headache.

A person with hidden depression feels chronic fatigue, does not experience joy from what is happening, and suffers from hopelessness. Symptoms of latent depression manifest themselves very clearly in the morning, and by noon the patient’s mood improves slightly.

The patient may experience sudden mood swings. In some periods it is accompanied by melancholy, which is replaced by sudden irritability or violent emotions. If such behavior is not characteristic of a person’s psyche and is not a feature of his character, this indicates depressive pathology.

Symptoms and signs of masked depression

Masked depression is difficult to recognize under the manifestations of other neurological diseases. Most often it is hidden under the following “masks”:

1. Mental disorders and manifestations of borderline states:

• anxiety-phobic disorders or phobias;
• hypochondria;
• obsessive-compulsive disorder or obsessive behavior;
• neurasthenia.

1. Sleep problems, which manifest themselves in the following symptoms:

• insomnia;
• daytime sleepiness;
• hypersomnia or excessive night sleep.

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1. Autonomic and somatization disorders:

• manifestations of neurocircular dystonia;
• dizziness;
• hyperventilation;
• cardioneurosis;
• irritable bowel syndrome, hypomotor dyskinesia, constipation;
• neurodermatitis;
• anorexia;
• bulimia

1. Various pain syndromes:

• cephalgia;
• cardialgia, tachycardia, blood pressure surges;
• abdominalgia;
• fibromyalgia;
• neuralgia of various origins;
• pseudorheumatic arthralgia.

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1. Disorders in social behavior:

• sexual deviations;
• the formation of various addictions: to drugs, alcohol, games, etc.;
• changes in character and the appearance of impulsiveness, aggressiveness, the desire to create conflict situations;
• the occurrence of hysterical reactions: tearfulness, touchiness, dramatization of situations, the desire to be the center of attention, playing “sick”.

Masked depression is divided into the following clinical types:

1. Agripnic - with frequent interrupted sleep, nightmares, early awakening, combined with difficulty getting up.
2. Anorectic – with nausea at the sight of food, loss of appetite, weight loss, constipation or diarrhea.

The condition of a patient suffering from masked depression is often accompanied by changes in behavior and character: impulsiveness, conflict, irritability, aggressiveness, touchiness and tearfulness appear.

Causes and diagnosis

Often, a depressive state occurs in completely healthy people who are moving up the professional ladder and have a high social status. It often appears when a person achieves certain life goals, for example:

• the birth of a child;
• acquisition of real estate;
• gaining financial independence.

It seems that a person has everything he strived for, but the meaning of life disappears, and the strength for further advancement is lost.

Family problems, lack of family support, and conflicts at work can lead to hidden depression. Depressive pathology can occur in children whose parents divorce.

Any sudden traumatic event can cause illness. This includes layoffs at work, an unexpected move, separation from a loved one, and graduation. Non-recognition in the professional sphere, a long course of any disease also become causes of depressive disorder.

Experts trace the connection between depressive illness and bad habits. A patient experiencing depression wants to share with his loved ones, but no one wants to listen to him. Then the person withdraws within himself and may start smoking, drinking alcoholic beverages in large quantities, or taking drugs. It is important to tell the psychotherapist about all recent life circumstances in order to make a correct diagnosis and prescribe therapy. The psychotherapist carefully examines the patient, observes his behavior and condition, and analyzes recent events.

Hidden depression is always a consequence of the shock experienced. Any pain is considered an important sign suggesting the presence of a disease in a patient. May cause migraine, toothache and neck pain. However, the symptoms do not describe any one somatic disease.

The severity of symptoms depends on the stage of depression. The more advanced the disease, the more symptoms the patient experiences. A mild form of depression shows few symptoms.

Typically, diagnosis begins with a therapist, as the patient complains of various pains. If no pathologies are found, the patient is referred for consultation to a psychotherapist. Not every specialist can instantly identify masked depression. For this reason, the patient often becomes disillusioned with medicine and leaves without the necessary help. In this case, depression may go away on its own over time, or the patient will end up seeing a psychiatrist if the disease worsens sharply.

Forecast

How successful the treatment of depression will be depends on its stage, the presence of physiological manifestations and the correct selection of medications. Depression in its early stages can be easily cured within a few months. If the pathology has bothered a person for more than a year, therapy lasts from 6 months to several years.

Important! Stopping treatment with antidepressants even if there are visible improvements without the recommendations of a psychotherapist is prohibited!

In severe cases, a specialist may prescribe several medications. Depression is not a disease that can be cured on its own. People in this state cannot correctly assess their condition. They do not have medical education to prescribe medications for themselves. In order for the treatment to last not several years, but a couple of months, you need to visit a psychotherapist.

Depression is a serious illness that requires specialist help. You should not try to treat it yourself - this will only negatively affect the general condition of the body, and the wrong selection of medications can lead to unpleasant consequences. Study medical bile for heel spurs using the link.

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Treatment

If you detect signs of a hidden depressive state, you do not need to contact your relatives and friends. A psychotherapist should treat the disease. The pathology cannot be eliminated without medical help. A comprehensive, serious approach to treatment is very important.

The psychiatrist will offer psychiatry sessions that will help the patient eliminate pessimistic moods, restore energy balance, set up a positive attitude towards life and restore joy.

The disease requires long-term treatment; two to three sessions will not be enough. Even if the condition improves, you should complete the full course of treatment.

Depression tends to recur, so after recovery a person needs to be attentive to his psychological state.

In addition to attending psychotherapeutic sessions, the doctor prescribes antidepressants. These medications speed up the healing process, but are not always prescribed. Only severe forms of depression require medication. It is not recommended to purchase them without a doctor’s prescription, since only a specialist can determine which medication the patient needs.

To improve the condition, the following is also used:

• magnetic stimulation;
• art therapy;
• light therapy

Sometimes eliminating the causes that caused it helps to get rid of depression. This could be moving, changing jobs, establishing mutual understanding with relatives.

With proper and timely treatment, the disease can be overcome. In this process, the support of loved ones is very important. As a result, the depression goes away, and the patient again feels the joy of life.

How to treat hidden depression

For this purpose, complex therapy is used, including medications and long-term psychotherapy. Physiotherapy, therapeutic massage and lifestyle changes are of additional importance in treatment.

Use of drugs

The “gold standard” in the treatment of masked depression is the use of antidepressants. This group of drugs normalizes the functioning of neurotransmitter systems in the brain and eliminates the clinical manifestations of pathology. When choosing drugs, you should take into account existing somatic diseases, which may be contraindications to their use.

The main antidepressant drugs used in the treatment of masked depression

Treatment of masked depression is carried out in three stages, each of which is mandatory for all patients.

The first stage is relief therapy aimed at eliminating acute symptoms and achieving remission. The average duration of treatment varies from 1 to 3 months, depending on the severity of symptoms. It is recommended to use antidepressants from the group of selective serotonin reuptake inhibitors, which show the greatest effectiveness and safety when taken long-term. The main drugs: Paroxetine, Fluoxetine, Escitalopram, Sertraline, Maprotiline and Venlafaxine. Additionally, low doses of tranquilizers (Phenazepam, Afobazol, etc.) are selected. At the beginning of therapy, the dosage of drugs is minimal. It increases gradually during treatment until the symptoms of the pathology disappear. If the patient has severe autonomic disorders, then it is possible to use antipsychotics such as Sulpiride or Teraligen.

At the end of the relief treatment, they move on to stabilizing therapy. Its goal is to eliminate the residual effects of depressive disorder. Treatment lasts from 3 to 9 months. The patient uses similar antidepressants in low dosages. It is recommended to use drugs used at the stage of relief therapy. Atypical antipsychotics remain highly effective.

Preventive treatment lasts from 1 year and is aimed at preventing relapses of depressive disorder. Antidepressants, low dosages of carbamazepine and lithium salts are used in therapy.

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Psychotherapeutic assistance

Subdepressive state or masked depression is a mental disorder that requires psychotherapeutic help. In this regard, clinical recommendations for the treatment of the disease necessarily include psychotherapy. It is possible to use its various directions: cognitive-behavioral, psychoanalysis, positive approach, etc.

At the initial stages of treatment, individual psychotherapy is recommended. This allows you to reduce the severity of symptoms and ensure high effectiveness of drug therapy. The specialist teaches the patient how to correctly work with existing symptoms and sensations, accept and adapt them for normal life. Much attention is paid to the patient’s social life to restore contacts with loved ones and friends.

During the preventative therapy stage, it is possible to attend group or family psychotherapy sessions. At the same time, there is an improvement in the socialization of the patient and a reduction in the risk of relapse of a mental disorder in the future.

It is important to note that psychotherapy should not be considered the only method of treatment. All patients with symptoms of depression require the use of antidepressants to quickly restore the normal functioning of neurotransmitter systems in the central nervous system.

Non-drug approaches

Meditation, sleep deprivation and physiotherapy sessions can be used as additional therapy methods. Long-term breathing meditation can improve the balance of neurotransmitters in the brain and stabilize mood. Physiotherapy (electric sleep, galvanization, etc.) has a general strengthening effect on the body.

Sleep deprivation is carried out only in cases of severe depressive disorder and low effectiveness of medications. The method is performed in a medical institution with constant medical supervision of the patient.

The following changes are used as criteria for the effectiveness of complex treatment for latent depression:

• persistent improvement in everyday mood, determined during a survey and using specialized psychological tests (Beck Depression Scale, etc.);
• absence of somatic and vegetative symptoms;
• returning to past hobbies, restoring social contacts;
• improving the standard of living.

When these criteria are reached, the patient is transferred to supportive psychotherapy.

General information about the disease

In recent years, this disease has taken the leading fourth place among severe somatic pathologies that lead to disability or death . If you look at the statistics, more than 6% of the population suffers from depressive disorders, while almost half of these people have hidden depression.

Masked depression is characterized by the fact that the neurological symptoms themselves can sometimes only be examined by a specialist, since their main manifestations are well hidden under the “masks” of somatic disorders. This form of the disease is caused by the following factors:

• 
  hereditary connection;

• gender;
• social position in society;
• personal qualities (anxiety, personality types prone to neurasthenia);
• living conditions.

It is worth noting that this disease is more common in women, people with poor heredity, those who are married and who are passionate about their careers. This disease also predominates among residents of large cities and metropolises rather than those living in provinces or villages.