Causes
Varieties
Danger
Treatment
Causes
Depression (from lat. depression — suppression, oppression) is a mental disorder characterized by a pathologically low mood with a negative, pessimistic assessment of oneself, one's position in the surrounding reality and one's future. People in this state usually lose the ability to experience joy, there is melancholy, anxiety, irritability, indecision, and pessimism up to a sense of the meaninglessness of life. At the level of the body, motor retardation, sleep and appetite disturbances, weakness, decreased sexual desire, metabolic disorders and various ailments often appear.
According to medical statistics, about 100 million inhabitants of our planet annually show signs of depression that require professional help. This condition has become one of the leading causes of ill health and disability in the Western world, and by 2020, depression may be second only to coronary heart disease among the leading causes of disability.
Acute stress associated with the loss of a loved one or an important relationship is one of the main reasons for the development of depression over the next year. Chronic stress caused by unresolved intra- and interpersonal conflicts, the inability of patients to openly, spontaneously and at the right time to express their negative emotions also leads to this state. Over time, this gives rise to hopelessness, helplessness, impotence, leads to passivity and suppression of activity. Therefore, depression means the demolition of the previously established strategy of psychological defense in a difficult life situation.
Depression that develops as a result of stressful life events and the experiences caused by them is called reactive depression, since it occurs as a reaction to some external event. In other cases, when the obvious cause of this disease cannot be found, depression is called endogenous - “occurring from within the body”, although, in our opinion, only an intrapersonal conflict deeply repressed into the subconscious can be unidentified. Also, depression can occur as a secondary concomitant condition in severe organic (somatic) diseases.
Scientists have found that the prerequisites for the onset of depression in adults are created during pregnancy, childbirth and in childhood as a result of frequent or prolonged deprivation of vital needs - care, nutrition and love. Childhood trauma, physical or sexual abuse can also be a risk factor for depression in adulthood, especially in response to additional stress.
That is why only pharmacological treatment of depression is only a temporary suppression of symptoms. A deep, systemic psychotherapy is needed, aimed at working through all stages of the patient's life that contributed to the formation of a depressive state, as well as finding a way out of the current state, solving subjectively intractable problems and teaching new life strategies.
Simplifying the complex medical classification, depression can be roughly divided into three types:
- simple - melancholic, anxious, apathetic;
- complex - depression with obsessions, delusions, suicidal ideation;
- hidden (masked, larved).
Since latent depressions are especially difficult to detect, they most often underlie bodily diseases. Psychologists believe that the bodily symptoms manifested in such patients are a defense against intense emotion (the so-called affect), which, due to personal attitudes and character traits, is not allowed into consciousness, as a result of which suppressed, repressed depression develops.
In this case, the classic signs of clinical depression may be mild or even absent, and patients usually do not realize their depressive state, so it is also called asymptomatic depression or dolor occultus - "hidden pain".
Unmanifested, or subthreshold depression, which representatives of the so-called norm do not notice in themselves (that is, ordinary people who are not patients of psychiatrists and psychotherapists), can cover a quarter of the population, as studies have shown on "mentally healthy" residents of megacities. According to other data, the frequency of such latent depressions exceeds the number of explicit ones by 10-20 times, and from 1/3 to 2/3 of all patients seen by generalists, as well as by narrow specialists, suffer from depression, masked hypochondriacal or somatized symptoms.
Our center has developed proprietary diagnostic techniques for the timely detection of latent depression.
Depression significantly affects the quality and prospects of a patient's life. It can lead to a decrease in professional status, a forced change of job, the breakup of a family, and even complete disability.
Depressive and anxious reactions, being typical and most common mental reactions to stress, in turn contribute to various pathological somatic conditions, which therefore can also be classified as psychosomatic.
Today, a number of scientists consider the complexity and significance of psychosomatic relationships in medicine, and, accordingly, all psychosomatic complaints (or at least most of them) as a manifestation of latent depression. The famous Spanish psychiatrist López Ybor Sr. was firmly convinced that psychosomatic disorders in many cases are depressive equivalents. According to V. Reef, depression, anxiety and somatic disorders are so related to each other that they can be attributed to a single disorder.
This is due to the fact that the psychological rejection of the future, the loss of faith and optimism lead to a weakening of the immune defense and the appearance disease dominants. Studies have also shown that depression is an independent risk factor for coronary heart disease and is associated with its severe course, is fraught with a high incidence of coronary events and increased mortality from heart disease.
Moreover, hopelessness and depression are closely associated with the occurrence of cancer. Thus, a twenty-year observation of 2018 employees of the Western Electric Company (USA) revealed a relationship between depression and cancer mortality. Another epidemiological study involved 4825 elderly people. It was found that those who suffered from depression for four years had an 88% increase in cancer mortality. Researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore followed 3,177 patients diagnosed with depression for 24 years. They found a higher risk of developing cancer overall and a statistically significant increase in the risk of developing breast cancer.
Such psychological mechanisms of cancer development are discussed in detail in the book by the director of the "Expio" center, candidate of medical sciences V. L. Matrenitsky "Carcinogenic mind».
Also, depression can manifest itself in eating disorders (overeating and being overweight or, conversely, exhaustion), insomnia, alcoholism and drug abuse.
Another serious danger is that depressive hopelessness is fraught with suicidal thoughts and even attempts. The risk of suicide is especially high when depression is combined with a chronic somatic or neurological disease.
The presence of depression in any somatic disease, especially cancer, is a serious aggravating factor that worsens the prognosis of treatment and contributes to the recurrence of the disease. In particular, studies show that depressed cancer patients have reduced numbers of immune killer cells, poorer quality of life, and shorter survival compared to non-depressive patients. Dutch scientists in 2013 found that in almost all forms of cancer, the life expectancy of depressed patients is halved.
On the other hand, the reduction of depressive symptoms in cancer patients contributes to their better survival. We have developed a comprehensive programAnticancer“, during which depression is significantly reduced in oncological diseases and their psychological causes are eliminated.
Therefore, timely diagnosis and treatment of depression can save the patient's health and life, even if the symptoms are still minor!
It is now becoming increasingly clear that traditional antidepressants have practically exhausted their potential. In recent decades, psychopharmacology has failed to introduce new breakthrough drugs for psychiatry, and approval of new drugs for the treatment of mental illness by the US Food and Drug Administration (FDA) has decreased from 13 in 1996 to one in 2016.
The classic antidepressants currently on the market are ineffective, require weeks of chronic use to relieve symptoms, and many of those suffering from depressive disorders do not achieve complete remission. Alternative drugs such as tricyclic antidepressants are associated with a greater risk of side effects, including weight gain, gastrointestinal disorders and urinary retention, sexual dysfunction and cardiovascular problems. And in general, the effectiveness of these drugs has recently been questioned. Thus, in 2010, in the reputable medical journal JAMA data published that many popular antidepressants in most cases (for mild or moderate depression) work no better than conventional placebos. In 2023 study showed that the effect of antidepressants is comparable to the effect of physical activity in the form of running.
In search of new treatment options for depression beyond antidepressants, scientists turned their attention to the medical drug ketamine, which has been widely used throughout the world as an anesthetic and short-acting pain reliever for more than 40 years. Even a single injection of ketamine has been found to typically produce significant and rapid antidepressant effects in patients with persistent depression that is refractory to other medications.
In March 2019, the US Drug Administration (FDA), an example for most other countries, approved the use of ketamine for the treatment of depression, and in December 2019 the European Commission did so. According to Ronald Duman, professor of psychiatry and neurobiology at Yale University, “The discovery of the rapid therapeutic effect of ketamine in the treatment of treatment-resistant depression is the greatest breakthrough in the scientific study of depression in the past half century.”
This statement is due to the fact that today depression is becoming increasingly resistant to antidepressants. According to statistics (for example, a 2021 study published in the Journal of Clinical Psychiatry), almost a third of patients “fail” to first-line therapy—the effect of prescribed antidepressants is absent within 1-3 months after starting treatment. This condition is called treatment-resistant or drug-resistant depression (more). Ketamine therapy is one of the few alternatives in the treatment of this disease. In 2020, a study was conducted (Basso et al.) comparing the effectiveness of ketamine and electroconvulsive therapy (considered a treatment of last choice for treatment-resistant depression). Their effectiveness has been established to be similar, but ketamine simultaneously improves brain function, while ECT, on the contrary, worsens it.
Overall, ketamine therapy is by far the most advanced and effective treatment for depression (for a review, see Alnefeesi et al, 2021).
Our center uses advanced methods of treating depression (including resistant and postpartum) without antidepressants, many of which are carried out by us for the first time in Ukraine - such as transcranial electrical stimulation of the brain, ketamine therapy, vagus nerve stimulation, stellate ganglion blockade and others ( cm. methods).