Major depressive disorder

Consultation via Skype or WhatsApp is available.

If short-term episodes of bad melancholy mood are repeated from time to time, we can talk about recurrent or recurring depression. The term “recurrent” implies a return to a previous state or periodicity of some state. Between depressive periods, a person’s mood returns to normal. He can work actively and enjoy life until the next return of the disease.

Recurrent depression is dangerous due to complications, since each subsequent episode is more difficult to bear than the previous one. It can become chronic or complicated by the development of bipolar affective disorder. With this disease, a person’s periods of bad mood and apathy are replaced by episodes of activity and vigorous activity.

People with depressive disorder rarely go to the doctor, as they perceive the manifestations of the disease as a difficult period of life, after which everything will be fine again. But mental illness worsens over time, resulting in the inability to live a normal life.

Only contacting a specialist will help cope with the disease and prevent its recurrence.

Features of the course

Periodic schizophrenia has a lot in common with affective psychoses. It occupies a borderline position in the classification of schizophrenia and affective disorders. The favorable course of the disease and the development of pronounced affective disorders at the time of the attack brings recurrent schizophrenia closer to manic-depressive psychoses, but the occurrence of catatonic and delusional disorders makes it possible to consider this pathology as a form of schizophrenia. In the specialized literature you can find the following names for recurrent schizophrenia: atypical variant of manic-depressive psychosis, schizoaffective psychosis. Quite often this pathology is called the third endogenous disease.

The recurrent form of schizophrenia is characterized by several types of attacks, each of which has psychopathological features. But they have one thing in common: affective disorders develop against the background of an attack. The patient may experience depressive, manic or mixed states. Sensual delirium can take various forms, up to oneiric stupor. Catatonic disorders may also occur.

Experts identify the following types of attacks of periodic schizophrenia:

1. Manifest. This type of attack is typical for young people; their number may vary. In some patients, attacks occur regularly and quite often (approximately every 2–3 years), while in other patients, attacks occur several times throughout life (in old age and adolescence). The number of people who have suffered just one attack in their entire life is 30% of the total number of patients. Such attacks can occur spontaneously or as a result of exposure to a provoking factor (intoxication, various somatic diseases, childbirth in women, etc.). Shortly before the first manifest attack occurs, the patient experiences mild affective disorders. Such fluctuations usually do not affect a person’s performance and productivity. When the disease enters the initial period, the severity of affective fluctuations increases, against their background somatopsychiatric depersonalization may develop. The patient may experience bliss, be in a high mood, strive for vigorous activity, but after some time his condition changes dramatically. The period of emotional uplift is replaced by lethargy, a significant decrease in the level of activity, and inactivity. In this state, a person greatly exaggerates the significance of small conflicts that occur in reality. Sleep problems arise, manifested by painful insomnia or particularly vivid dreams. Very often, patients are visited by a premonition of some kind of incident; they feel as if they are going crazy.
2. Oneiric-catatonic. This type of attack of periodic schizophrenia is characterized by the emergence of involuntary fantasies that arise at a certain stage in the development of the attack. The patient vividly imagines flights to distant planets, terrible wars, world catastrophes, travel, etc. A feature of periodic schizophrenia is that a person retains the ability to correctly navigate the environment and perceive the world around him. A state gradually develops in which the individual completely detaches himself from reality, plunging into fantastic experiences (oneiric clouding of consciousness).
3. Depressive-paranoid. Such attacks are most often accompanied by increased anxiety; sensory delirium is based on the idea of ​​​​condemnation or persecution. In the acute phase of a depressive-paranoid attack, oneiric episodes rarely occur. Attacks of this nature tend to last longer than others.
4. An affective attack does not develop as harmoniously as other types of attacks characteristic of recurrent schizophrenia. The intensity of affect increases gradually; the attack is characterized by the presence of mixed states and the absence of the classical affective triad. The clinical picture of the disease often changes; during an attack, acute delusional ideas are replaced by oneiroid or catatonic symptoms.

Each of the described types of recurrent schizophrenia has its own psychopathic characteristics, but they all develop according to one general pattern. The first stage of an attack

with the development of affective circle disorders. When the attack enters the second stage, the patient experiences acute sensory delirium. The third stage is characterized by the presence of oneiric stupefaction. Whether an attack belongs to a particular type is determined by the dominant symptom of the disease. If oneiroids come to the fore, then the attack is called oneiroid-catatonic, the predominance of affective disorders suggests the development of an affective attack, etc.

An attack of recurrent schizophrenia can last for several months; there are cases where the attack lasted several years. Prolonged attacks are most often depressive.

Regardless of the duration of attacks and the frequency of their occurrence, with periodic schizophrenia, pronounced personality changes do not occur, as happens with other types of illness.

Features of the course of recurrent schizophrenia largely depend on the age of the patient. If the first attack of the disease occurs before the age of 25, then it will be characterized by the presence of oneiric-catatonic disorders. In the future, their intensity will be noticeably reduced.

Subsequent attacks may stop their development at the stage of staging, when the patient perceives the world around him as a theatrical action, or acute delirium. Attacks that occur later are manifested only by affective disorders.

If recurrent schizophrenia develops in a patient over 25 years of age, then oneiric-catatonic states usually do not develop. The attacks are affective in nature or accompanied by acute delirium.

Treatment of recurrent depression

Only contacting a psychotherapist or psychiatrist allows you to make a correct diagnosis and assess the severity of symptoms. Treatment is selected individually. It depends on how the episode progresses, how often they occur, and how many months they last.

Pharmacotherapy

Antidepressants are prescribed only when necessary. The dose and medication are selected taking into account your medical history and health status. Typically the duration is several months. The use of pharmacotherapy can speed up the healing process and minimize the possibility of recurrent episodes.

Psychotherapeutic techniques

Conducting psychotherapy helps to identify negative attitudes in the patient’s thinking and replace them with more positive, constructive ones. The patient learns to see the connection between life events and his emotional experiences. This helps to become aware of your feelings and express them “without going into a depressive state” (or these skills help subsequently reduce the depth of the depressive state).

For recurrent depression, treatment includes drug preventive or remission maintenance therapy. It is recommended in the following cases:

• in chronic or severe forms of the disease;
• if depressive episodes last more than 4-6 months;
• the intervals for complete recovery are reduced;
• the debut occurred at a young or old age.

The practical experience of the doctor is of great importance, since recurrent depression must be able to be distinguished from other mood disorders. The sooner a person seeks help, the easier it will be to cope with the disease.

Symptoms and causes of development

Researchers around the world are still arguing about the causes of schizophrenia. But the leading role in the development of the recurrent form of this pathology is assigned to heredity. Almost all patients suffering from recurrent schizophrenia have close relatives whose medical histories contain mental disorders or psychopathy.

There is an opinion that this form of schizophrenia occurs in hyperthymic individuals. In schizoids, recurrent schizophrenia is extremely rare.

Most often, attacks occur spontaneously, only in some cases provoking factors have been identified. These can include severe somatic illnesses, various stressful situations; in women, an attack can begin in the postpartum period.

The main symptoms of recurrent schizophrenia are oneiric, catatonic and affective manifestations, as well as delusions. Disorders of the affective circle can be accompanied by depression or mania (elevated mood, the opposite of a depressive state), catatonic manifestations are stupor and agitation.

A classic attack of recurrent schizophrenia with its typical course manifests itself as follows:

• the initial stage of the attack is characterized by emotional disturbances. A person experiences sudden mood swings, the desire to create is replaced by complete apathy. Against this background, autonomic disorders arise;
• Then the attack moves into the staging stage. At this moment, a person is still able to perceive reality holistically, but it begins to seem to him that there is some kind of idea going on around him. Delusional ideas begin to arise that he is surrounded by actors, and an unknown screenwriter is directing them;
• the development of acute delirium is the next stage of the attack. Most often, delusional ideas are antagonistic in nature. The patient mentally divides the people around him into forces of evil and good. He is sure that they are constantly fighting among themselves. A sick person may also have delusional ideas about his own superiority and develop delusions of grandeur;
• the peak of the attack is characterized by the occurrence of oneiric stupefaction. From the outside, the patient may seem inhibited; he remains motionless for a long time, frozen in one position, and stops reacting to others. All his thoughts at this time are occupied with fantastic experiences, in which he is an active participant;
• when the strength of the attack begins to fade, the leading symptoms again become disorders of the emotional circle.

As mentioned above, after an attack of recurrent schizophrenia, a high-quality remission occurs. In some cases, mood disorders may be observed, but they are not pronounced.

Emotional disturbances during the period of remission do not prevent a person from leading his usual lifestyle, working or studying.

Anatomy of the disorder

Recurrent disorder occurs when depression is not a one-time event, but occurs repeatedly. An example of a recurrent depressive disorder is depression that always occurs during certain seasons, such as the so-called winter depression.

Unlike chronic depression, recurrent depressive disorder is characterized by changing phases, so-called depressive episodes, mostly without symptoms. Psychiatrists also differentiate recurrent depressive disorder from bipolar disorder: in this case, depression also occurs repeatedly, but they alternate with euphoric mood states. If this really happened before, then a diagnosis is made - bipolar recurrent affective disorder.

Depression usually strikes more than once in a lifetime. For many people, it can become a chronic or lifelong illness with several relapses. On average, most people have four to five episodes during their lifetime.

Causes of recurrent depression

The main causes of depression can be endogenous, that is, medical, neurological, psychological or exogenous (the disease is caused by social factors). These include, for example, stressful life events such as divorce, grief, stress, anxiety or personality disorders. Age also plays a decisive role. Recurrence is possible after an asymptomatic phase, even after several years or decades.

Almost everyone who has had at least one episode of depression is susceptible to relapse. Several clinical trials also suggest that people may be genetically preset to experience recurrent depressive disorder.

Description of symptoms

Symptoms of recurrent depressive disorder can be both mental and physical . Psychiatric symptoms include:

• unhappy, depressed, desperate mood;
• severe internal anxiety, nervousness and stress;
• problems with attention and concentration;
• thoughtfulness;
• significantly reduced ability to make decisions;
• interest in hobbies and activities is lost;
• pangs of conscience and guilt;
• high sensitivity to criticism;
• lack of self-esteem;
• thoughts of suicide.

Physical symptoms of recurrent depression:

• sleep disturbances, especially in connection with falling asleep;
• nightmares;
• feeling unwell in the morning;
• loss of appetite and weight, in other cases weight gain;
• feeling as if the head is slightly squeezed in a vice;
• pressure in the chest, heavy and wheezing breathing;
• cardiopalmus;
• trembling, cold feet and hands;
• fluctuations in blood pressure and dizziness;
• gastrointestinal problems such as nausea, vomiting, heartburn, flatulence, constipation, rare diarrhea;
• inability to make decisions and a general lack of interest in life.

Diagnosis and treatment

The difficulty in diagnosing this form of schizophrenia is due to its similarity with manic-depressive psychosis. In addition, circular schizophrenia can also have a recurrent form. This type of pathology is characterized by the presence of only a symptom of the affective circle; there are no personality defects in circular schizophrenia, and outside of an attack the person does not have any negative symptoms.

To make a diagnosis, the doctor carefully examines the patient's medical history and performs tests specifically designed to identify this type of schizophrenia. Specialists are faced with the task of not only distinguishing periodic schizophrenia from manic-depressive psychosis and other pathologies, but also eliminating the possibility of faking the symptoms of patients.

There are very common cases where criminals want to avoid imprisonment in this way. For this purpose, the following types of research are carried out:

1. MRI and CT help to identify or exclude organic brain damage, tumors of various natures and other pathologies that manifest symptoms similar to periodic schizophrenia.
2. An EEG will detect temporal lobe epilepsy.
3. A blood test is carried out to detect traces of psychotropic drugs that can lead to confusion and the development of delusional ideas.

But the main method of diagnosis still remains long-term observation of the patient and assessment of his behavior.

Drug treatment is reduced to the use of drugs with a sedative effect. Antipsychotics may be prescribed to patients in whom the attack ceases to develop at the stage of acute fantastical delusions or acute paranoid. At the moment of recovery from an attack, when the leading manifestations of the disease are disorders of the affective circle, the patient may be recommended normatives, antidepressants and drugs aimed at eliminating attacks of mania.

Therapy methods that are commonly called “stress” are widely used. First of all, this is emotional stress psychotherapy. The patient receives some kind of emotional shock, after which changes occur in his soul. The main objective of this method is to reconsider the patient’s attitude towards himself, his illness, others, etc.

During the period of remission, special attention is paid to the prevention of attacks. Preventive medications can prevent their onset. With the help of social workers, psychotherapists and psychologists, patients with a recurrent form of schizophrenia maintain family, work and close friends.

Relapse Prevention

When giving lectures on schizophrenia, experts warn that each new attack of the disease worsens the patient’s condition. The quality of remissions decreases, there is an increase in the risk of self-harm, the patient is increasingly isolated from society, and his self-esteem decreases. Therefore, maintenance therapy between attacks and prevention of relapses of the disease are of great importance.

The imminent development of an attack may be indicated by changes in daily routine or behavior, inadequacy of emotions (their complete absence or excess), difficulties in performing daily activities. If you notice similar signs of an attack in a sick relative, then you need to provide him with a calm environment. Avoid sudden changes in your daily life, eliminate stress factors.

A relapse of the disorder can be triggered by various emotional shocks, excessive physical exertion, colds and infectious diseases, overheating and intoxication.

It is not recommended for patients with a recurrent form of schizophrenia to travel to other countries, since changes in time zone and climatic conditions are also stressful factors.

Quite often, patients with periodic schizophrenia and other types of this disease abuse alcohol and drugs. In this they seek salvation from depression and loneliness. But such dependencies only make the situation worse. The use of narcotic drugs reduces the patient’s sensitivity to drug treatment; this group of patients more often requires hospitalization and has a higher risk of developing suicidal tendencies.

Family members must understand that their relatives with schizophrenia require long-term treatment. Sick people are not able to do large amounts of housework, they have limited opportunities to communicate with other people, so you should not overload them emotionally and physically. But excessive care and low demands also harm the patient’s condition. Try to be as patient and polite as possible towards him, and involve the sick relative in family affairs.