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Depression: How Joy Is Disabled in the Brain?

Everybody loves to discuss depression, for example, while drinking. But what do we really know about her?

More than 300 million people worldwide suffer from depression today. It is one of the most common mental illnesses and the leading cause of disability worldwide, according to the World Health Organization (WHO).

According to these data, depression causes about 800 thousand people to commit suicide every year, and this is the second leading cause of death among young people aged 15 to 29 years. In addition, depressive conditions affect performance and, most importantly, the quality of life.

So it's not just a bad mood?

No, this is a very real disease. Moreover, it is serious. Most scientific theories suggest that depression is caused by a lack of neurotransmitters — universal “messengers” —that transmit signals in the brain from one nerve cell to another. Therefore, people with depression see the world in dark colors - literally. Neurotransmitters are involved in the work of the organs of vision, hearing, the formation of tactile and temperature sensations.

Without these substances, the information that reaches the brain is distorted, the favorite activities cease to please, the music is heard differently. In addition, concentration and memory function decrease: in a depressed state it becomes more difficult to remember something good.

The theory of the relationship between depression and neurotransmitters has a lot of indirect evidence, but so far it has no conclusive evidence. This is because neurotransmitters are very small. Tracking them in the body and thoroughly examining them is expensive and difficult.

So what happens with depression?

Depression consists of many symptoms, among which the main ones: apathy - a persistent decrease in motivation, anhedonia - a lack of pleasure from what brought him before, as well as a breakdown (asthenia).

Another signal of depression is anxiety. This is a universal "flag" of the organism, which makes it clear that something is going wrong. Each of these symptoms is the result of an imbalance in neurotransmitters in the brain cells, primarily serotonin. If symptoms persist for 3-5 weeks, it's time to see a psychiatrist.

Maybe you just need to relax and the depression will pass?

No. For mild to moderate depression, the opposite is the best treatment. You need to get out of bed, communicate with people and play sports. The problem is that you absolutely do not want to do this with depression.

For severe episodes of depression, the development of apathy is characteristic. Sometimes - this is the last way of the body to defend itself against a suicide attempt: there is no strength at all for anything.

Sounds scary! And how not to bring it to such a state?

Change is gradual and difficult to notice. Depression is characterized by a decrease in concentration, poor memory, but these factors are the most difficult to observe: in a depressed state it is difficult to adequately assess oneself.

The most important thing is changes in the quality of life. These include sleep disorders (you don't sleep as well as six months ago), a change in appetite in any direction, changes in personal hygiene, a lack of desire to take care of yourself, obsessive guilt and sadness, indifference to your favorite hobby, books, films, music ... These changes are a sign of biochemical breakdown, the very lack of neurotransmitters.

When it comes to feelings of helplessness, self-loathing, and self-harm, see your doctor as soon as possible. When such thoughts persist for 2 weeks, there is nothing more to wait, further it will be worse.

Seeing a doctor for depression? Are you laughing? If you come to a psychiatrist, they will immediately put you in a psychiatric hospital!

No, not right away. Only those who pose a real danger to themselves or others can be hospitalized involuntarily in psychiatric hospitals. Those. if you were removed from a window while trying to commit suicide, or you tried to cut others with a knife, or you have brought yourself to exhaustion (body mass index less than 17), then there are grounds for hospitalization.

In any other case, the final decision remains with the patient. The main thing is that heavy thoughts do not form into a specific and gloomy plan, which a person is ready to carry out right now. If such thoughts can be distracted within 24 hours, such a patient will not be admitted to the hospital.

So what happens with depression?

I don’t believe it! It's easy to get into a psychiatric hospital just like that!

In Russia, any admission to a hospital is associated with a heap of papers, so it is impossible to be there “just like that”. There are strict criteria for admission to a psychiatric hospital: risk to others or to oneself, or leading to such a risk without assistance. For depression, these risks include obsessive thoughts of suicide or attempted suicide in the past few months.

If the patient is in this condition, hospitalization is a way out. There, under the supervision of doctors, a person will be able to cope with a serious condition in a few weeks.

Sometimes doctors can indeed involuntarily hospitalize a patient - if he is in a high-risk group. For example, he recently tried to commit suicide and does not demonstrate positive dynamics, that is, his condition worsens.

But even in this case, the patient is given a choice: he can refuse hospitalization. Without written consent, it is possible to take a person to the hospital only for 72 hours, then a medical commission meets and its decision goes to court.

Such a procedure requires a lot of labor from doctors, therefore, they resort to it only in case of a real threat to life.

Of course, a mental hospital is not the funniest place on the planet, especially for someone with severe depression. But, fortunately, the reality is far from the fantasy of Hollywood scriptwriters. Doctors do not walk around the ward with a shocker or a prepared syringe.

They try to minimize the patient's risks as much as possible, help to cope with the crisis and stabilize the condition so that a person can gradually return to his usual rhythm and enjoy life again.

Are you saying that mental hospital patients are dangerous?

Patients in psychiatric hospitals are predominantly a danger only to themselves. Local staff closely monitor their condition.

On average in the population, 1 out of 100 people have a psychiatric diagnosis - this figure does not change depending on gender, region and nationality (with the exception of older men - they have a higher risk of suicide).

Maybe it's enough to talk to a psychologist after all?

Of course, you don't need to go to surgery if you break your leg. The body itself can heal the fracture. But it is still better to apply a plaster cast. So the help of a psychiatrist is needed in order to cope with the problem faster: this way there are fewer risks to health and life.

A psychiatrist is a specialist with a medical education. Only he can diagnose depression and prescribe a treatment regimen. A psychologist doesn't do that. With clinical depression and compulsive overeating, the psychologist helps to solve the problem systemically.

By the way, the list of psychiatrist's appointments includes not only antidepressants, but also the same work with a psychologist. When they are combined, the best results are achieved: antidepressants help to gain strength, and psychotherapy - to find the cause of depression.

Well, how then to choose an adequate psychiatrist?

Just like you choose any other doctor. A good recommendation can be given by friends who have already visited such a specialist and you have seen that they feel better.

The only clearly defined criterion is the doctor's willingness to be in touch and answer questions. It is important that the specialist can support if side effects of the medication appear. There is no threat in them, but sudden dizziness, drowsiness, nausea can really scare you.

In addition, it is not always possible to find an antidepressant that is right for you the first time. At a critical moment, a specialist will be able to take the necessary measures: calm down, change drug therapy, explain what is happening.

how then to choose an adequate psychiatrist?

Then tell us about the pills. If a psychiatrist prescribes medication, will I become a "vegetable"?

Taking a drug never leads to a transition from the animal kingdom to the plant kingdom. The vegetable myth stems in part from the side effects of antipsychotics developed nearly half a century ago. But to a much greater extent, this condition is caused by the course of schizophrenia, left untreated. That is, the speech in this context is not at all about depression.

A number of severe mental illnesses, if left untreated, take away the unique traits of a person's personality year after year, leaving a deep mark on the psyche. Medications, on the other hand, slow down this process, helping to maintain a high level of quality of life for as long as possible.

Then explain how antidepressants work!

The work of the nervous system is carried out by the transmission of nerve impulses from one cell of the brain or spinal cord (neuron) to another with the help of neurotransmitters. These messenger substances are released into the space between neurons, which triggers a signaling cascade to the next cells. Then neurotransmitters are captured back, broken down into constituent blocks and assembled again to re-transmit impulses.

The transmission of nerve impulses in depression is altered, since the number of neurotransmitters is reduced. This prevents the creation of a complete nerve impulse. Hence anxiety arises. It is possible to restore the natural functioning of the nervous system with the help of antidepressants.

Medications for depression work in different ways. Older drugs, such as monoamine oxidase inhibitors (MAOIs), block the destruction of neurotransmitters in nerve cells. Now they are used quite rarely due to pronounced side effects and high toxicity.

They were replaced by more modern drugs - selective serotonin reuptake inhibitors (SSRIs), that is, drugs that prevent the seizure of a particular neurotransmitter.

SSRIs help form a complete nerve impulse. A gradual increase in dosage helps the nervous system return to "pre-crisis levels."

Are all antidepressants terrible drugs?

During the treatment of depression, a person gets used only to a good mood, normal sleep and lack of anxiety. So not all psychotropic drugs are drugs, although this opinion is extremely common.

The addiction myth is associated with the presence of withdrawal syndrome in psychiatric drugs: a set of side effects arising from untimely, most often unauthorized, termination of the course of treatment for rumination syndrome, rumination syndrome and RPD in general.

Many people believe that if antidepressants cannot be combined with alcohol, then they can be painlessly given up for a while, but this is not the case. All psychiatric drugs are cumulative. After stopping the intake, the drug remains in the blood for up to several weeks, during which it can enter into unpredictable interactions with alcohol. Withdrawal symptoms are then superimposed on the symptoms of intoxication, which can lead to life-threatening conditions.

But this does not mean that you will have to take antidepressants for the rest of your life. The initial stabilization of the condition occurs in about a month.

During this time, the dosage of drugs is increased to the therapeutic one, it is always higher. Small doses are needed at first in order to reduce the number of side effects. A full course of drug therapy lasts from six months to 1.5 years. In most cases, treatment takes 7 to 10 months.

But I have a friend who drank antidepressants, but then the depression returned, and it got worse. Can the same happen?

This may be for several reasons. The most common is the early termination of treatment without consulting a doctor. It is important to complete the course to the end: untimely refusal of drugs causes withdrawal syndrome and leads to the recurrence of depression. The symptoms of the disease in this case are often more severe than at the very beginning.

However, it can get worse even after a fully completed course of antidepressant treatment. Medicines are not the only ingredient in recovery. They help to cope with the current depressive state, but in no way exclude the possibility of relapse. The key to a stable emotional background can only be behavioral psychotherapy. It takes time.

What to do if a loved one needs the help of a psychiatrist?

If you feel that a person needs help, but does not consider it possible or necessary to go to a specialist, you can offer your own help and go to the doctor together, literally "take the hand and take it away." If you meet strong resistance, it is highly likely that it is not the person who is talking to you, but his illness.

Depressed people can often be scared to admit to themselves that the situation is spiraling out of control.

The best option is not to confront, but to ask questions. Does the person consider what is happening to him healthy? Is there anything you can do to help? Indeed, going to a specialist may not solve all the problems, but it is still worth trying.

Modern psychiatry, unlike what it had 30 years ago, has a wide range of pharmacological tools, even for serious illnesses such as schizophrenia or bipolar disorder.

So, with the help of drug therapy, depression can be overcome. The main thing is not to be afraid to go to the doctor and not to quit treatment halfway.

By:Dr. Lindsay Chester

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