Depression and their types

Depression (Latin depressio – suppression, oppression.)
1) mood, characterized by a sense of inadequacy, a sense of despair, a decrease in activity or reactivity, pessimism, sadness and associated with these symptoms; normal, relatively short-lived and frequent ; 2) mental disorder, the main signs of which are persistent long-term (at least 2 weeks) decreased mood, a feeling of melancholy, sensation hopelessness. As a rule, it is accompanied by motor retardation (sometimes excitement), slow thinking, anxiety, ideas of self-blame, sleep disturbance (early morning awakening), impaired appetite, decreased libido.
A reluctance to communicate and accept help from is characteristic . In some patients, complaints of physical health problems (weight loss, constipation, arterial hypertension, palpitations, pain in the chest, head, abdomen, joints or back) come to the fore . Meet as extremely severe (melancholy) and relatively mild (dysthymia) options. Severe D. poses a great danger due to the high probability of suicide. D. is not considered an independent disease, but acts as a manifestation of many mental illnesses (manic-depressive psychosis, schizophrenia, intoxication, alcoholism, diseases caused by mental trauma, etc.).
Roughly in equal proportions observed cases of AD, associated with stress, severe psychological loss (reactive AD), and emerging unjustly against a background of psychological comfort (endogenous DA). In any case, D. is considered as a very favorable disorder, since it responds well to treatment, sometimes goes away spontaneously. Endogenous D. is prone to repeated attacks. For treatment, psychotropic drugs (antidepressants), electroconvulsive therapy and psychotherapy are used. In accordance with the law of the Russian Federation, the diagnosis and treatment of mental disorders is carried out by a psychiatrist. The complexity and versatility of the problems of depression is determined, on the one hand, by its involvement in many forms of disorders of higher nervous activity, and, on the other hand, by a wide variety of manifestations of depressive conditions (degree of severity, nature of the course, duration, impact on work ability, etc.). Due to the large differences in forms and manifestations, special attention should be paid to the diagnosis of depression. The importance of a thorough differential diagnosis, taking into account the individual characteristics of the development of higher nervous activity, is in the first place and the role of age and the importance of personality characteristics should be taken into account. Many consider depression as a kind of disease of civilization, emphasizing the large role of stress factors in its occurrence, which is unreliable in the cause-and-effect chains of depression development. Depression can occur and when endogenous psychoses, as well as a result of somatic and cerebro-organic disorders including the presence of effects of stress, as the background factor. Even in the diagnosis of the depressive state itself, certain difficulties arise due to the large number of atypical, somatized, masked (hidden) forms of depression. The organization of therapeutic measures for depressive states is often limited to either the use of antidepressants and tranquilizers, or psychotherapy, which often leads to an increase in depressive attacks, their transition to the opposite manic phase, or to the appearance of erased (hidden) depressions. Depressive affect is one of the forms of a person’s emotional response, differing from natural emotions by a significantly longer duration and possible suicidal risk, as well as often in combination with a number of other psychopathological phenomena. How and any other emotional state of depression is made up of three components: – the subjective experience of negative affect and symptoms of its expression in behavior, facial expressions, gestures; – certain shifts in the internal environment of the body, which depend on the constitutional and personal characteristics of the individual; – pathogenetic mechanisms underlying the disease (emotional disturbance). It is these mechanisms that determine the originality of depression (its modality, severity, additional psychopathological symptoms, nature of the course , etc.) in each individual case, as well as the specificity of depressive states. Obviously, in those cases where there is a hereditary predisposition to depression (that is, endogenous weakness of some links of the regulatory system), for the onset of the disease , a less significant effect of the psychogenic factor on these links is required . On the contrary, where there is no hereditary burden , for the onset of depression requires a longer and more intense pressure on the regulatory systems, and the onset of the onset of the disease seems more likely in old age. The so -called “monoamine” hypothesis of the pathogenesis of depression has the greatest recognition . It boils down to the fact that with endogenous depression there is a deficiency in the brain of norepinephrine or serotonin. As you know, norepinephrine and serotonin play the role of mediators in the central nervous system and, which is especially important, in those parts of the brain that are involved in the formation of emotions, instinctive behavior, urges, as well as autonomic and neuroendocrine regulation. The effectiveness of the regulation of the endocrine system in patients with depression is assessed using special techniques using diagnostic tests and drugs. This drug suppresses signals from the brain and pituitary gland that cause the adrenal cortex to release cortisone and allows you to check how the brain and pituitary gland respond to feedback. In psychotic depression, the drug is unable to suppress the secretion of steroids, although patients have no noticeable adrenal or pituitary abnormalities. Types of depression 20-35% of people suffering from depression are not in a position to lead a normal life. For others, periods of depression are followed by periods of normal well-being. In the third strongest depression downs alternate with incredible lifts mood. Below are descriptions of the most common types of depression. Clinical depression When depression is severe enough to require treatment, it is called clinical. As symptoms worsen, they talk about severe depression. Such conditions are still episodic in nature. Dysthymia addition to episodic depression, dysthymia there – depression, which is protracted, again and again repeated for a long time. If a person with dysthymia develops symptoms of clinical depression, they are referred to as double depression. Bipolar Disorder This condition, also known as manic-depressive syndrome, is characterized by sudden, unexplained changes in very bad and very good moods. Scientists believe the cause of this disorder is a lack of certain substances necessary for the functioning of the brain. With the help of medicaments bipolar disorder is treated in 80% of cases. Seasonal depression The reason for this depression lies not only in the person himself, but also in the environment. According to scientists, some people suffer more than others from a lack of natural light. Treatment for this type of depression is based on providing the person with the required level of lighting. Who fall into depression?    

Women, compared to men, are almost 2 times more likely to suffer from clinical depression. The incidence of bipolar disorder is gender independent. Depression affects people from different ethnic groups equally.
Depression is more common in people aged 25–40. This disease is especially widespread among people born after 1945. Perhaps this is due to social factors (an increase in the number of single-parent families, changes in social roles, the influence of stress). However, depression affects people of all ages, even children. Experts believe that 2% of children and 4–8% of adolescents face this problem. She also does not bypass the people of the older generation.
Depression often affects people with a hereditary predisposition to the disease.
Often, depression accompanies other illness, mental disorders, alcohol and drug addiction.
Marriage can be both positive and negative in terms of the development of depression. Compared to single people, people with a long-term partner are less likely to suffer from clinical depression. On the other hand, depression often develops in those who are unhappy with their partner. Men who are happily married are the least likely to suffer from depression.

Classification of types of depression based on its causes Until now then in psychiatry continue to divide depression into two main categories, which introduced the XIX century psychiatrist Paul Moebius: endogenous and exogenous depression. The first is associated with a hereditary predisposition and is the result of some constitutional violation, the second is associated with life events and is an understandable, but nonetheless excessive response to some stressful event. Hanel distinguishes three categories of depression:  

psychogenic depression. Psychogenic depression refers to those forms of depression that – in a broad sense – were caused by the environment, for example, some problems that existed in childhood, or associated with acute experiences of grief or loss. The number of people with this form of depression is increasing. endogenous depression – based on a hereditary predisposition; organically determined depression or somatogenic – arises as a result of somatic diseases and ailments and manifests itself in combination with them. If the initial disease (main) disease is successfully treated, then the depressive state is also alleviated.

Types of endogenous depression, manic-depressive psychosis in the present time it is diagnosed as a bipolar disorder. The disease manifests itself in two different poles – depressive and manic. In bipolar disease , two types are distinguished . Type 1 – as with over time are shown manic and depressive phases. Type 2 – when with the passage of time manifested depressive phases and hypomania, but none of them is entirely formed delusions. Most often, the first manifestation of the disease occurs before the age of 30. Depressive phases occur much more often than manic ones. Bipolar disorders occur in 1% of adults. If we add lighter forms with hypomania, then they reach 5%. Monopolar diseases are more common , in which only depressive phases occur, but manic phases do not occur. Manic-depressive psychosis is based on a genetic predisposition. Disguised (hidden) depression In the 1970s . professor of psychiatry has formulated the concept of latent depression. “ Masked depression means a state in which the depressive element itself is absent … There are no typical signs of depressive thinking, and patients complain only of somatic ailments: palpitations, stabbing pains in the heart, a feeling of tightness in the chest, lack of enthusiasm, powerlessness, exhaustion, loss energy, insomnia, lack of appetite, weight loss, loss of sex drive and potency. There are also complaints of dizziness, pain, constipation, shortness of breath. Patients feel sick physically, not mentally. ” In the specialized literature, you can find the concept of “depression with a smile.” This means that the patient’s external facial expressions do not coincide with his real state of health, with his internal state. These people do not want (consciously or unconsciously) to show others what is really in their souls. “Depression with a smile” was first discovered in Thailand. Prenatal and postpartum depression in women Pregnancy, childbirth and the time after them can be a period of “biological crisis” for women . “Depression can show itself even during pregnancy.” There are several forms of violations:

short-term bad mood “crying days” appear 3-5 days after childbirth in about 25-30% of women. “Crying days” are associated with hormonal changes, mood swings are observed, after a few days it stabilizes;
postpartum depression occurs in the first months after childbirth in 10-15% of mothers. Postpartum depression is combined with emotional lability and reflections on the child and motherhood. Highlighted psychosocial risk factors that increase the risk of depression after childbirth:

a partner who is not able to adequately support a woman,

lack of support from the social environment;
stress and anxiety during childcare.

in the first weeks after childbirth, psychosis is found in 1-2% of women.
Seasonal Depressions Typical seasonal (seasonally related ) depression occurs regularly throughout the year, most often around fall. Symptoms of seasonal depression:

the time when it begins: regularly at about the same time (more often in autumn – in winter);
signs of depression weaken by spring, do not appear during the summer period (with an increase in the length of the day);
a strong need for sleep (with other types, they sleep less than usual);
increased appetite (with other types of loss or decrease in appetite);
in women it appears 4 times more often than in men;
this type of depression is mainly associated with exposure to light.

Psychogenic depression
Psychogenic depression is depression caused by psychological causes. Psychological reasons can be different. We believe that they can be classified according to the level of personality development. We refer to psychogenic depression as anaclitic, psychotic, narcissistic and neurotic depression. Reactive depression or grief can be viewed as an emotional state that occurs in response to traumatic circumstances.

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