Depression is no longer just a buzzword in the modern world. Everyone knows that this term hides a serious problem, a mental disorder that requires some kind of treatment. In this article, we will analyze in detail such a phenomenon as a depressive episode. We give it a description, consider the classification of stages. We will definitely touch on the causes, symptoms, manifestations, diagnosis, treatment and prevention of the condition.
What is this
A depressive episode is an affective disorder characterized by certain cognitive, emotional, and somatic disturbances. In a patient, it manifests itself in the form of a bad mood, loss of vital interests, decreased energy, activity, increased fatigue and a general loss of joy in life. In other words, a person gets tired even after a slight effort, he does not want to do anything, because all activities seem boring, of the same type, and the outside world and human relations are unsightly and gray.
Among the additional manifestations of a depressive episode, one can distinguish a reducedattention and concentration, low self-esteem, loss of self-confidence, gloomy pessimistic moods, loss of faith in a "bright future", poor sleep, reduced appetite. The most serious consequences are self-flagellation, suicidal thoughts.
Duration is determined by specialists for more than 2 weeks.
Disorder classification
Consider a depressive episode according to ICD-10 (International Classification of Diseases, Tenth Revision). In this reference book, it is assigned the code F32.
According to the ICD, a depressive episode is divided into three stages (depending on the number of symptoms identified in the patient, the severity of their manifestation):
- Mild degree (32.0). 2-3 symptoms of the disease are pronounced. The state is practically indistinguishable from mild sadness, internal mental stress, irritability. A mild depressive episode, of course, brings the patient some emotional discomfort, but, in general, does not interfere with normal life, work activities.
- Medium degree (32.1). A person has four or more symptoms of the condition. A moderate depressive episode will already prevent a person from leading a normal life, doing business.
- Severe without psychotic manifestations (32.2). Most of the identified symptoms are expressed. The state brings suffering to a person. Thoughts about their own uselessness, uselessness, abandonment are especially vivid. Pseudopsychotic symptoms may appear. The patient often thinks about taking his own life. Psychosis may or may not fit the mood. In severe cases, it ends in hallucinations and delusions.
Reason for condition
Let's look at what can trigger a depressive episode. Among the most likely causes, experts identify the following:
- Genetic. These are anomalies that affect the eleventh chromosome. However, polygenic types of the disorder are also noted.
- Biochemical. The fault of the condition will be a violation of the activity of the exchange of neurotransmitters. In particular, it is a deficiency of catecholamines and serotonin.
- Neuroendocrine. A moderate depressive episode may be the result of a disturbed rhythm of the limbic, hypothalamus, pituitary systems, and the pineal gland. All this will be reflected in the production of melatonin, releasing hormones. It is believed that the process is associated with photons of daylight. They indirectly affect the complex rhythm of the body, sexual activity, the need for food, sleep and wakefulness.
Risk groups
Both from a moderate depressive episode, and from more severe manifestations, these categories of people are not insured:
- People aged 20-40 of both sexes.
- Those who have low social status.
- People who survived a divorce, a breakup with a loved one, family, friends.
- Those who had relatives in the family who committed suicide ("family suicide").
- Everyone who was very worried about the death of loved ones.
- Having characteristicpersonal qualities: a tendency to empty feelings, melancholy, anxiety at the slightest provocation, and so on.
- Overly responsible and conscientious people.
- Homosexual persons.
- The postpartum period in women.
- Having sexual problems.
- Persons suffering from chronic loneliness.
- Those who lost their social contacts for some reason.
- Stressed for a long time.
- With certain moods cultivated in the family: feelings of helplessness, worthlessness, uselessness, etc.
Direct symptoms of the condition
Recall that the number of manifestations noted in a patient characterizes the complexity of his condition. For example, a severe depressive episode is almost all of the list below.
The patients themselves note the following:
- Decrease in concentration. Inability to focus on anything for a long time. Subjectively, this is felt as a deterioration in the memorization of information, a low degree of mastering new knowledge. This is often noted by schoolchildren and students, persons working in the intellectual field.
- Reduced physical activity. The symptom can manifest itself up to lethargy, stupor. Some patients rate it as laziness.
- Aggressiveness and conflict. It is noted in adolescents and children who in this way try to mask a state that comes to self-hatred.
- Anxiety. This symptom of a depressive episode does not occur in everyone.patients.
- Typical improvement in emotional well-being by evening.
- Lower self-esteem, the appearance of self-doubt. Manifested as a specific neophobia. Such a sense of self alienates the patient from society, contributes to the formation of a complex of his own inferiority. Such a protracted condition in old age often leads to pseudo-dementia, deprivation.
- Thoughts about your own insignificance and uselessness. Self-flagellation, self-deprecation often lead to auto-aggression directed against oneself, self-harm, thoughts of suicide.
- Pessimistic sentiments. The future is seen by the patient invariably in bleak and gloomy colors. In the present, he also presents the world around him as insensitive and cruel.
- Violation of the mode of wakefulness and rest. The patient complains of insomnia, it is difficult for him to get out of bed in the morning. Cannot sleep for a long time, sees disturbing, gloomy dreams.
- Loss of appetite. There is some improvement in the evening. Internally pulls to switch from protein to carbohydrate food.
- Misconceptions about time. It seems to drag on for an excruciatingly long time.
- Conflict with own "I". A person stops caring for himself, he develops depressive depersonalization, senestopathic and hypochondriacal experiences.
- Speech is slow, strays from any topic to one's own experiences and problems. Sometimes it is difficult for the patient to formulate his own thoughts.
Symptoms on examination
Like a severe depressivean episode, or a moderate one, a qualified specialist can also determine by direct examination of the patient:
- A person constantly looks out the window or at another light source.
- Gesturing towards your own body. The person often presses his hands to his chest.
- In anxiety manifestations, the patient constantly strives to touch his own throat.
- Characteristic submission posture.
- Veragut's fold is visible in the facial expressions, the corners of the mouth are lowered.
- Gestures are accelerated for anxiety symptoms.
- The voice of a person is low and quiet. Puts long pauses between words.
Indirect symptoms
The non-specific manifestations of a moderate, severe and mild depressive episode are as follows:
- Dilated pupils.
- Constipation.
- Tachycardia.
- Reduced skin turgor.
- Increased fragility of hair and nails.
- Acceleration of involutive changes (person seems older than his age).
- Restless legs syndrome.
- Psychogenic shortness of breath.
- Dermatological hypochondria.
- Pseudo-rheumatic, cardiac syndrome.
- Dysuria psychogenic.
- Somatic disorders of the digestive tract.
- Dysmenorrhea and amenorrhea.
- Chest pain (the patient complains of "a stone in the heart, in the soul").
- Unspecified headaches.
Possible Complications
What is the danger of a depressive episode? This condition can easily regress if left untreated.one of the social phobias: fear of being in a crowded place, losing a loved one, becoming useless. Such decadent moods sometimes lead to suicide or attempts to commit suicide, to harm yourself in every possible way.
If left untreated, some patients try to find a solution in alcohol, drugs, excessive smoking, self-decision to take sedatives or even psychotropic medications.
Important points in diagnosis
To correctly determine the severity of a depressive episode, the specialist should first look for the following manifestations:
- The ability to focus attention, switch it from subject to subject.
- Self-esteem, the degree of self-confidence.
- Self-flagellation, thoughts of one's own guilt.
- Gloomy and pessimistic.
- Ideas or even actions that relate to self-harm, suicide attempts.
- Violation of sleep and appetite.
- Duration of condition (depressive episode lasts more than two weeks).
- The patient has organic brain damage.
- The fact of taking psychotropic drugs or drugs.
- No history of conditions that could directly lead to such a manifestation.
Basics of diagnosis
On the basis of what does a specialist detect the development of a depressive episode? The important components here will be the collected anamnesis, the patient's immediate complaints, the clinical picture that emerges during the examination, during a conversation with the patient.
Great value inin some cases (depressive syndrome is extremely similar to Alzheimer's in the elderly) also have examinations: neuropsychological, computed tomography, EEG.
Treatment
Traditional treatment of a depressive episode consisted of the introduction of euphoric doses of novocaine, inhalations of nitrous oxide. To date, more effective and complex therapy is used:
- Prescription of antidepressants: tetra-, tri-, bi-, monocyclic MAO inhibitors, L-tryptophan, serotonin reuptake inhibitors.
- To potentiate (accelerate, activate) the action of the above drugs, auxiliary drugs can be prescribed: lithium preparations, anticonvulsants, thyroid hormones, atypical antipsychotics and others.
- Phototherapy.
- Monolateral ECT on the non-dominant hemisphere of the brain.
- Sleep deprivation (at some points it will be comparable to electroshock therapy).
- Behavioral, group, cognitive therapy.
- Complementary psycho-methods - art therapy, hypnotherapy, meditation, acupuncture, magnetic therapy, etc.
Condition Prevention
Today, there are no specific methods of behavior that would allow one hundred percent to secure oneself from depressive episodes in the future. Experts suggest following typical guidelines for a he althy lifestyle:
- Refuse harmfulhabits.
- Keep an active lifestyle, exercise, workout, sports, spend more time outdoors, go to nature.
- Do not avoid reasonable loads, not only physical, but also intellectual.
- Observe the right diet, which does not cause metabolic failures in the body.
- Work on your own mental attitude: learn new hobbies, areas of activity, be open to new acquaintances. Additional work on your own self-esteem, self-acceptance or a certain life situation.
- Elimination of diseases that may result in prolonged depression.
- Avoid stressful situations, learn to cope with nervous strain. Engage in activities that increase resilience.
- Dedicate time to communication, activities that bring you positive emotions.
No special diet should be made. Experts note only that nutrition should be complete and varied, saturated with essential vitamins, microelements, and nutrients. In particular, these are nuts, bananas, broccoli, seafood, cereals (especially buckwheat and oatmeal).
Now for the lifestyle. It should include classes and activities associated with increased production of norepinephrine and dopamine by the body, blocking decadent moods. This requires systemic physical activity, listening to dynamic music and any other positive pastime for you.
A depressive episode is often perceived by the patient and the people around him as a whim, laziness, excessive irritability, tearfulness. However, this is a serious problem that requires not only personal restructuring, but also medical, psychotherapeutic treatment. Its complications can lead to mental disorders, addictions and even suicide.
