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 treatment. In this article, we will examine in detail such a phenomenon as a depressive episode. We give him a characteristic, consider the classification of stages. Be sure to touch on the causes, symptoms, manifestations, diagnosis, treatment and prevention of the condition.
What is it
A depressive episode is an affective disorder that is characterized by certain cognitive, emotional, and somatic disorders. 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 little effort, he doesn’t want to do anything, because all the activity seems boring, of the same type, and the outside world and human relations are ugly and gray.
Among the additional manifestations of a depressive episode, one can single out reduced attention and concentration, a low level of self-esteem, loss of self-confidence, gloomy pessimistic moods, loss of faith in a "bright future", poor sleep, and decreased appetite. The most serious consequences are self-flagellation, thoughts of suicide.
Duration is determined by specialists for a period of more than 2 weeks.
Classification of the disorder
Consider the depressive episode according to ICD-10 (International Classifier of Diseases of the tenth revision). In this directory, it is assigned the code F32.
According to the ICD, a depressive episode is divided into three stages (depending on the number of symptoms detected in the patient, the severity of their manifestation):
- Light degree (32.0). 2-3 symptoms of the disease are pronounced. The condition is practically indistinguishable from mild sadness, internal mental stress, irritability. A mild depressive episode, of course, brings the patient a certain emotional discomfort, but, in general, does not interfere with ordinary life and work.
- Medium (32.1). In a person, four or more symptoms of the condition are expressed. A depressive episode of an average degree 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. A condition brings suffering to a person. Especially vivid are thoughts about one’s own uselessness, worthlessness, abandonment. Pseudo-psychotic symptoms may occur. The patient often thinks about how to take his own life. Psychosis can and does not match the mood. In severe cases, it ends with hallucinations and delirium.
Reasons for the condition
Let's figure out what can cause the development of a depressive episode. Among the most likely reasons, experts distinguish the following:
- Genetic. These are abnormalities affecting the eleventh chromosome. However, polygenic types of disorder are also noted.
- Biochemical. The fault of the state will be a violation of the activity of metabolism of neurotransmitters. In particular, it is a deficiency of catecholamines and serotonin.
- Neuroendocrine. A depressive episode of a moderate degree can be the result of a disturbed rhythm of the limbic, hypothalamic, pituitary systems, pineal gland. All this will affect the production of melatonin, releasing hormones. It is believed that the process is associated with daylight photons. 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 persons are not immune:
- People aged 20-40 years of both sexes.
- Those who have low social status.
- People who survived a divorce, a break 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 characteristic personal qualities: a tendency to empty feelings, melancholy, anxiety at the slightest occasion, and so on.
- Overly responsible and conscientious people.
- Persons prone to homosexuality.
- The postpartum period in women.
- Having sex problems.
- Persons suffering from chronic loneliness.
- For some reason, they have lost social contacts.
- For a long time experiencing a stressful situation.
- With certain moods cultivated in the family: a sense of one’s own helplessness, worthlessness, uselessness, etc.
Direct symptoms of the condition
Recall that the number of manifestations observed in a patient characterizes the complexity of his condition. For example, a depressive episode of a severe degree is almost the entire list below.
Patients themselves note the following:
- Decreased attention span. Inability to focus on anything for a long time. Subjectively, this is felt as a deterioration in the storage of information, a low degree of development of new knowledge. This is often noted by schoolchildren and students, persons working in the intellectual sphere.
- Reduced physical activity. 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 disguise a state that comes to hatred of oneself.
- Anxiety. This symptom of a depressive episode does not occur in each of the patients.
- Typical improvement in emotional well-being in the evening.
- Decreased self-esteem, the appearance of self-doubt. It appears as a specific neophobia. Such a sense of self estranges the patient from society, contributes to the formation of a complex of his own inferiority. Such a protracted state in old age often leads to pseudo-dementia, deprivation.
- Thoughts on own insignificance and uselessness. Self-flagellation, self-abasement often lead to auto-aggression directed against oneself, self-harm, thoughts of suicide.
- Pessimistic moods. The patient sees the future invariably in joyless and gloomy tones. In the present, he also represents the outside world insensitive and cruel.
- Violation of the regime of wakefulness and rest. The patient complains of insomnia, it is difficult for him to get out of bed in the morning. Cannot fall asleep for a long time, sees disturbing, gloomy dreams.
- Decreased appetite. There is some improvement in the evening. Internally pulls go from protein to carbohydrate foods.
- Misconceptions about time. It seems to drag on painfully long.
- Conflict with own "I". A person ceases to care for himself, he has depressive depersonalization, senestopathic and hypochondriacal experiences.
- Speech is slow, straying from any topic to their own experiences and problems. Sometimes it’s hard for a patient to formulate their own thoughts.
Symptoms on examination
Both a severe depressive episode and a moderate, qualified specialist can determine with a direct examination of the patient:
- A person constantly looks out the window or at another source of light.
- Gesture is turned on your own body. A man often presses his hands to his chest.
- With alarming manifestations, the patient constantly strives to touch his own throat.
- The characteristic pose of submission.
- Veragut fold is visible in the facial expressions, the corners of the mouth are lowered.
- With alarming symptoms, gestures are accelerated.
- The person’s voice is low and quiet. Pauses big pauses between words.
Indirect symptoms
The non-specific manifestations of a depressive episode of an average, severe and mild degree are as follows:
- Dilated pupils.
- Constipation
- Tachycardia.
- Reduced skin turgor.
- Increased fragility of hair and nails.
- Acceleration of involutive changes (a person seems older than his age).
- Restless legs syndrome.
- Psychogenic shortness of breath.
- Hypochondria is dermatological.
- Pseudo-rheumatic, cardiac syndrome.
- Dysuria is psychogenic.
- Somatic disorders of the digestive tract.
- Dysmenorrhea and amenorrhea.
- Chest pain (the patient complains of a "stone on the heart, in the soul").
- Uncertain headaches.
Possible complications
What is the danger of a depressive episode? In the absence of treatment, this condition can easily degenerate into one of social phobias: fear of being in a public place, losing a loved one, and becoming useless to anyone. Such decadent moods sometimes lead to suicide or attempts to reduce one’s life, to do harm to oneself in every way.
If untreated, some patients try to find a solution in alcohol, drugs, excessive smoking, an independent decision to take sedative or even psychotropic drugs.
Important points in the diagnosis
To correctly determine the severity of a depressive episode, a specialist should first pay attention to the following manifestations:
- The ability to focus attention, switch it from subject to subject.
- Self-esteem, degree of self-confidence.
- Self-flagellation, thoughts of one's own guilt.
- Gloomy and pessimistic moods.
- Ideas or even actions that relate to self-harm, suicide attempts.
- Impaired sleep and appetite.
- Duration of the condition (depressive episode lasts more than two weeks).
- The patient has organic brain damage.
- The fact of taking psychotropic drugs or drugs.
- The absence of a history of conditions that could directly lead to a similar manifestation.
Diagnostics Basics
On the basis of what does a specialist detect the development of a depressive episode? Important components here will be the collected history, immediate complaints of the patient, the clinical picture that looms up during the examination, when talking with the patient.
Of great importance in some cases (depressive syndrome is extremely similar to Alzheimer's disease in the elderly) are also examinations: neuropsychological, computed tomography, EEG.
Treatment
The traditional treatment for a depressive episode consisted of the administration of euphoric doses of novocaine, nitrous oxide inhalation. Today, more effective and comprehensive therapy is used:
- Prescription of antidepressant drugs: tetra-, tri-, bi-, monocyclic MAO inhibitors, L-tryptophan, serotonin reuptake inhibitors.
- In order to potentiate (accelerate, activate) the effect of the above drugs, auxiliary drugs can be prescribed: lithium preparations, anticonvulsants, thyroid hormones, atypical antipsychotics and others.
- Phototherapy.
- Monolateral ECT on the nonprincipal (non-dominant) cerebral hemisphere.
- Sleep deprivation (at some points it will be comparable to electroshock therapy).
- Behavioral, group, cognitive therapy.
- Complementary psychomethods - art therapy, hypnotherapy, meditation, acupuncture, magnetic therapy, etc.
Condition Prevention
Today, there are no specific behavioral methods that would completely protect themselves from depressive episodes in the future. Experts suggest following typical recommendations for a healthy lifestyle:
- To refuse from bad habits.
- Lead an active lifestyle, engage in physical exercises, training, sports, spend more time in the fresh air, and go outdoors.
- Do not avoid reasonable loads, not only physical, but also intellectual.
- Maintain a proper diet that does not cause metabolic disturbances in the body.
- Work on your own mental attitude: comprehend new hobbies, areas of activity, be open to new acquaintances. Additional work on your own self-esteem, self-acceptance or a specific life situation.
- Elimination of diseases, the result of which may be prolonged depression.
- Avoid stressful situations, learn how to cope with nervous strain. Engage in activities that increase stress resistance.
- Devote time to communication, activities that bring you positive emotions.
Some special diet should not be made. Specialists only note that nutrition should be complete and varied, saturated with essential vitamins, trace elements, nutrients. In particular, these are nuts, bananas, broccoli, seafood, cereals (especially buckwheat and oatmeal).
Now for the lifestyle. It should include activities and activities associated with increased production of norepinephrine and dopamine by the body, which block decadent moods. To do this, you need systemic physical activity, listening to dynamic music and any other pastime that is positive 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 and psychotherapeutic treatment. Its complications can lead to mental disorders, the emergence of addictions and even suicide.