Can depression cause itching

Why It Happens and What to Do

You’re anxious, and your skin keeps itching. Are these symptoms related?

Though you might not think it, your skin can reveal some of your deepest emotions. Just think about the last time you blushed from embarrassment or felt goosebumps while listening to inspiring music.

Anxiety, in particular, has several ways of showing itself in the physical body: It can cause shaking hands, sweating, butterflies in your stomach, or a lump in your throat.

And for some people, anxiety can cause itchy skin. Feeling itchy from anxiety is called “psychogenic itching.” While this isn’t extremely common, it’s also not rare.

Unlike many other organs in the body, your skin has an immediate reaction to mental stress. Some researchers call it the “brain-skin connection.”

Psychogenic itching, or psychogenic pruritus, occurs when psychological factors trigger or worsen itchy skin.

So, how does this happen?

Research into anxiety and itching says that the brain plays a critical role in the sensation of itching. The brain’s sensory, motor, and emotion-related areas are activated when we’re feeling itchy, and even when we just think about scratching. The central nervous system (CNS), which is responsible for regulating anxiety, is particularly involved.

More research is needed to identify the specific mechanisms behind why anxiety and itching go together. But researchers do know that when the body’s “fight, flight, or freeze” response is activated under stress, it releases a flood of hormones and other chemicals, such as cortisol and adrenaline.

Stress also activates the immune system to release histamine, a compound known to play a role in signaling itch sensations.

In short-term stress, cortisol acts as an anti-inflammatory and helps balance out the histamine levels. However, during chronic stress, the body becomes less sensitive to cortisol, allowing for more inflammation and itching.

When you reduce anxiety, you might find that your itching goes away. In fact, there’s evidence that anti-anxiety medications and psychosocial treatments for anxiety — including cognitive behavioral therapy (CBT) — can have anti-itch effects.

Anxiety and itching can result in a continuous itch-anxiety cycle. Anxiety leads to itching, which in turn leads to more anxiety, and so on.

Psychogenic itching, as well as other types of chronic itching, can significantly affect a person’s mental health and well-being. Many people with chronic itch report that psychological stress is a factor that aggravates their itching.

Research has also shown a link between itching and symptoms of depression. People who report severe depression also report higher itch intensity, compared to people who report low symptoms of depression.

One study found that when people with a chronic itch condition viewed stressful images — such as a snake preparing to strike or a person being pulled from a burning building — their itch severity increased.

In another study, healthy women with no chronic itch conditions reported greater itching sensations due to histamine reactions when they experienced negative emotions from distressing film clips.

You might also have experienced the “contagious itch” phenomenon.

If you see your friend scratching, or you’re reading about itching or watching a movie with a person scratching, it can make you feel itchy too! Everyone can experience this at some level, but it tends to happen to a greater degree among people with neurotic personalities.

Does anxiety make you more itchy at night?

Some people with anxiety-related itching report that their itching is worse at night. Itchy skin at night is also called nocturnal pruritus. While researchers don’t know exactly why this happens, there are a few theories.

First, your body increases blood flow to the skin at night, and your skin tends to retain less moisture — both of which could potentially worsen itchy sensations.

In addition, the body releases fewer anti-inflammatory corticosteroids at night, while releasing higher levels of certain itch-related hormones.

Also, unlike during the day when we have plenty of distractions, lying in bed at night can draw our attention to the sensations in our body, including itchy skin, making it feel more itchy.

Can anxiety cause an itchy scalp?

Some people seem to get an itchy scalp when they have anxiety. Scientists aren’t exactly sure why this happens, but we do know that anxiety increases cortisol levels, which are directly linked to hair follicles.

Internal stressors may also be linked to the growth of bacteria and fungi on the scalp, which can cause it to get dry and flaky, leading to itchiness.

To find out the cause of your itching, your physician or dermatologist will likely take your medical history, give you a dermatological exam, and request any lab tests or biopsies as needed.

If no medical source for the itching is found, your healthcare professional will work with you to explore other causes, which may include psychiatric reasons like anxiety.

According to the International Forum for the Study of Itch (IFSI), psychogenic itching falls into one of six itch categories:

dermatological, caused by a skin condition
systemic, caused by an organ problem
neurological, arising from nerve problems

psychogenic or psychosomatic, linked with psychiatric or psychosomatic conditions
mixed
other

To date, clinical trials haven’t explored the treatments for psychogenic itching. However, experts suggest that the following medications might be useful for relieving psychogenic itch, depending on the symptoms:

hydroxyzine (antihistamine)
tricyclic antidepressants (mainly doxepin)
selective serotonin reuptake inhibitors (SSRIs)
in some cases, antipsychotics and antiepileptics

You might also want to try some home remedies for itch, such as cool packs, wet wrap therapy, and applying moisturizer.

Keeping your anxiety levels to a minimum may also help relieve the itch. Try out some anxiety-reducing activities, like:

CBT methods
deep breathing
meditation
exercise
acupuncture
yoga

If you experience chronic itching, you may benefit from talking with a healthcare professional. Seeing a dermatologist first can rule out skin-related causes.

If you believe anxiety is causing your itching, consider trying some anxiety-reducing activities, such as meditation or yoga.

What You Can Do When They Happen Together

If you have anxiety and itchy skin, it’s possible that you’re dealing with two distinct issues. It’s also possible that these conditions are closely linked.

Anxiety disorders can cause some people to experience itchy skin and itchy skin conditions can lead to anxiety. One can exacerbate the other.

Each can be effectively treated, but it’s important to determine whether the anxiety and itching are connected. Itching due to anxiety is no less real than itching from other causes, but it may take a different approach to treatment.

According to the Anxiety and Depression Association of America, anxiety disorders affect 40 million adults in the United States every year. More than 1 in 5 people experience chronic itch at some point in their lifetime.

It’s difficult to know how many people have anxiety-related itching, or psychogenic itch.

Continue reading to learn more about the association between anxiety and itching, and what you can expect of treatment.

Anxiety, especially if it’s chronic, can affect your health in many ways. Anxiety is related to a number of skin problems. Just think about how a brief moment of embarrassment can cause you to blush or how being nervous can make some people break out in hives.

The weight of mental or emotional stress can also lead to some serious itching.

Your brain is always communicating with nerve endings in your skin. When anxiety kicks in, your body’s stress response can go into overdrive. This can affect your nervous system and cause sensory symptoms like burning or itching of the skin, with or without visible signs.

You can experience this sensation anywhere on your skin, including your arms, legs, face, and scalp. You might feel it only intermittently or it could be quite persistent. The itch can happen at the same time as symptoms of anxiety or it can occur separately.

Even if the cause of your itching is anxiety, serious skin problems can develop if you scratch too much or too vigorously. This can leave you with irritated, broken, or bleeding skin. It can also lead to infection. Not only that, but the scratching probably won’t do much to relieve the itch.

On the other hand, the skin condition and relentless itching may have come first, prompting the anxiety.

You may indeed have two unrelated problems — anxiety plus an itch caused by something else entirely. Depending on your specific symptoms, your doctor may want to investigate some other causes of itchy skin, such as:

allergic reaction
dry skin
eczema
insect bites and stings
psoriasis
scabies
shingles

Most of these conditions can be identified upon physical examination. Itchy skin can also be a symptom of less visible conditions such as:

anemia
cancers such as lymphoma and multiple myeloma
diabetes
kidney failure
liver disease
multiple sclerosis
thyroid problems

That’s why it’s so important to talk to your doctor about:

your medical history, including pre-existing conditions, allergies, and medications
symptoms of anxiety or depression
any other physical symptoms you may have, even if they seem unrelated

This information will help guide the diagnosis.

Treatment depends on the specific causes of anxiety and itching. No matter the cause, unrelenting itching can have a negative impact on your overall quality of life. So, it’s worth seeking treatment.

Aside from your primary care physician, you might benefit from seeing a specialist or perhaps two. A mental health professional can help you learn to manage anxiety, which can alleviate that aggravating itch.

If your skin is seriously affected, you might also need to see a dermatologist.

Psychologists can also help with dermatological problems related to anxiety. This field is called psychodermatology.

Treatment for the itch may include:

corticosteroids or other soothing creams or ointments
oral selective serotonin reuptake inhibitors, a type of antidepressant that may ease chronic itching in some people
light therapy sessions may help get itching under control

Here are some things you can do on your own to help relieve itching:

Use hypoallergenic, fragrance-free moisturizer every day.
Run a humidifier to help keep your skin moist.
Avoid rough clothing, hot baths, harsh sunlight, or anything else that contributes to itchiness.

Try over-the-counter products such as corticosteroid cream, calamine lotion, or topical anesthetics.
When itching is impossible to ignore, put on some gloves or cover your skin to prevent yourself from scratching.
Keep your fingernails trimmed so that if you do scratch, you’re less likely to break the skin.

Since stress can aggravate the itch, you’ll also need to take steps to lower your stress levels. Here are a few things you can try:

acupuncture
deep breathing exercises
meditation
yoga

A therapist can provide behavior modification therapy and other strategies to lessen anxiety. It’s also important to maintain a healthy diet, get plenty of sleep every night, and exercise regularly.

Any underlying medical conditions should also be addressed.

Anxiety and itching are both things that can come and go. If they’re fleeting and not causing any major problems, you may not need to see a doctor. If that’s the case, it’s still a good idea to mention it at your next appointment.

If anxiety and itching are interfering with your ability to function or causing visible skin damage or infection, see your primary care doctor as soon as possible. If necessary, you can get a referral to the appropriate specialist.

Untreated, the cycle of anxiety and itching can repeat over and over, ratcheting up your anxiety level. Frequent scratching can also lead to serious skin issues.

Anxiety and itching can be effectively treated, though. It may take some time, but with professional guidance, you can learn to manage anxiety, ultimately resolving the itch.

Regardless of which came first, anxiety and itching can be connected. With a combination of anxiety management and a good skincare routine, you can break the cycle and potentially rid yourself of persistent itch.

Depression

Russian Academy of Medical Sciences
SCIENTIFIC CENTER FOR MENTAL HEALTH

DEPRESSION (from hope to certainty).
(INFORMATION FOR PATIENTS AND THEIR FAMILIES)

MOSCOW
2008

Oleichik I.V. - Candidate of Medical Sciences, Leading Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States

© 2008, Oleichik I.V.
© 2008, NTsPZ RAMS

The vast experience accumulated by mankind and reflected in many literary works convincingly shows that sadness (sadness, spleen) has always gone side by side with people, being one of the natural human emotions. None of us is immune from failures, illness, breakups, loss of loved ones, financial collapse. Each person can face something inevitable and inevitable, when it seems that life loses its meaning, and despair becomes boundless. However, normally, sadness, sadness and melancholy, as natural reactions to traumatic events, weaken over time and the person's condition returns to normal without special treatment. The situation is different with depressions, which are mental disorders that differ from natural physiological reactions in greater intensity, special severity of experiences and persistence of manifestations. True depression rarely goes away on its own, requiring persistent, sometimes long-term treatment.
A depressive state (from the Latin word depressio - suppression, oppression) is a disease that concerns not only an individual specific sick person, but is also a significant burden of modern society, since it is spreading more and more widely in the world, causing enormous damage to the health of the population and the state. economy. And this applies to all countries, regardless of their level of social development. Every year, at least 200 million people in the world fall ill with depression. Perhaps these figures are even higher, since most victims of depression do not seek help because they are not aware of the painfulness of their condition. Scientists have calculated that almost one in five people who have reached adulthood will experience at least one episode of depression during their lifetime.
In the most general sense, a depressive state is one of the possible forms of a person's response to the impact of stress factors. In some cases, depression can be triggered by external negative influences, for example, mental trauma, excessive educational or work overload, infection or other serious somatic disease, traumatic brain injury, changes in the hormonal background, which is especially important for the female body, regular certain medications, such as hormones, blood pressure medications, alcohol or other drug abuse. In other cases, depressive states develop as a manifestation of such mental illnesses, in which the main influence is heredity or characteristics of the nervous system (cyclothymia, dysthymia, manic-depressive psychosis, schizophrenia, etc. ). If, based on the description of depressive symptoms set out later in our brochure, you realize that you have indeed developed a depressive state, do not fall into despair, do not “try to control yourself”, remember that depression is not a manifestation of weakness of will or character, on the contrary, weakening of volitional qualities is one of the main symptoms of depression. Depression is a disease like rheumatism, arthritis or hypertension, it responds well to treatment, resulting in almost always a full recovery. You should not blame yourself for the occurrence of depression, it does not indicate either your fault, or your weakness, or the possible development of a more severe mental pathology. Below we will tell you about the symptoms of depression, which can be extremely diverse.

Manifestations of depression

Manifestations of depression can be very different. Depressive states can be manifested by a violation of almost all aspects of mental life: mood, memory, will, activity, which is expressed in the appearance of sadness, sadness, mental and muscle retardation, lasting at least 2 weeks. Depressed mood during depression can manifest itself as mild sadness, sadness, and boundless despair. Often it is accompanied by a feeling of melancholy, unbearable heaviness in the soul, with excruciating pain behind the sternum, a feeling of hopelessness, deep depression, hopelessness, helplessness, despair and uncertainty. At the same time, the patient is completely immersed in his gloomy experiences, and external events, even the most joyful ones, do not affect him, do not affect his mood, and sometimes even worsen the latter. A constant "companion" of a depressive mood is also anxiety of varying severity: from mild anxiety or tension to violent excitement, riot. Anxiety and bad mood arise at the mere thought of the need to make some kind of decision or change your plans due to suddenly changed circumstances. Anxiety can also manifest itself on the physical (bodily) level in the form of belching, intestinal cramps, loose stools, frequent urination, shortness of breath, palpitations, headaches, increased sweating, etc.
The picture of depression is complemented by the disappearance of desires, interests, a pessimistic assessment of everything around, ideas of one's own low value and self-blame. Deficiency of vital impulses is manifested in patients with a variety of symptoms - from lethargy, physical weakness to a state of weakness, loss of energy and complete impotence. Where an important decision is required, a choice between different options, human activity is sharply hampered. Depressed people are well aware of this: they complain that insignificant everyday tasks, small issues that used to be solved almost automatically, take on the significance of complex, painful, insoluble problems. At the same time, a person feels that he began to think, act and speak slowly, notes the suppression of instincts (including food and sexual instincts), the suppression or loss of the instinct of self-preservation and the lack of the ability to enjoy life up to complete indifference to what used to be liked evoked positive emotions.
People suffering from depression often feel "stupid", "mentally retarded", "feeble-minded". Thinking in depression becomes viscous, painful, requires special efforts, one mental image is hardly forced out by the next. The sick person is oppressed by the feeling of his own intellectual insolvency, professional collapse. Depressed patients can hardly describe their painful experiences to the doctor. Only after getting out of depression, many of them say that the mood at that moment was lowered, thinking was slow, all undertakings (including treatment) seemed in vain, and the years lived were empty and useless. However, at the time of the first visit to the doctor, they could not explain this because of the almost complete absence of thoughts in their heads, “para-lich of thinking”. With depression, there are also often complaints of memory loss, which is why those suffering from it assume that they have "Alzheimer's disease", "schizophrenia", "senile dementia", which is not true. Especially often these complaints are found in depressions that develop in adolescence.
Typical story
Aleksey, 18 years old, 1st year student of a technical university, describes his condition during depression as follows:
“From childhood, I was fond of technology and modeling, I could read special literature for hours, won school and regional olympiads in mathematics and physics. After graduating from school, my dream came true - I brilliantly passed the exams to a prestigious university. Then it seemed to me that the whole world was at my feet, I flew with happiness "as if on wings." In September, I happily began to study. At the beginning, everything worked out well, but after 2 months I began to notice that it was becoming increasingly difficult for me to absorb what I read, I did not remember the simplest text, I could not solve problems that I used to “click like nuts”. Trying to achieve success through many hours of brainstorming or drinking a few cups of coffee led to the fact that I completely stopped thinking about anything. It seemed to me that I was "finally and irreversibly stupid. " At night I sobbed, wrapped in a blanket and thought about how best to commit suicide. Luckily, I met a senior in the library and shared my problems with him. My new acquaintance said that he experienced something similar and advised me to contact the psychiatrist of the student clinic. After the examination, I was diagnosed with juvenile depression and sent for treatment to a specialized medical center. After 2 months, I felt completely healthy, returned to my studies and caught up with my classmates.

Depression can also be accompanied by real setbacks: for example, a decrease in academic performance, the quality of work, family conflicts, sexual disorders and their consequences for personal relationships. As a rule, the significance of these failures is exaggerated and as a result there is a false sense of the irreparability of what happened, "the collapse of all hopes."
Another generally recognized danger of depression is the possibility of suicidal thoughts, which often lead to suicide attempts. The condition of a person suffering from depression can suddenly deteriorate sharply, which happens either without clear external causes, or under the influence of traumatic situations, unpleasant news. It is during these hours, and sometimes even minutes, that a fatal decision is made. Factors that increase the risk of suicide in depression are past suicide attempts, the severity and duration of the depressive state, the presence of anxiety in its structure, prolonged insomnia, loneliness or alienation in the family, alcohol and drug abuse, loss of work and a sharp change in lifestyle, as well as relatives commit suicide.
Typical story
Eugene E., 35 years old, leading manager of the company.
Almost all my life, my career went “on the ascending”, the goals set were clear, clear and achievable. The marriage was extremely harmonious, two beloved children grew up. He devoted almost all the time to the affairs of the company, occasionally, once every 1-2 months, he escaped with his family out of town, to the country. He often lacked sleep, stayed late at work, took home assignments, and was deeply worried about the affairs of the company. Gradually, irritability, fatigue, insomnia, difficulty concentrating appeared, more and more often he suffered a “fiasco” in intimate life. Thoughts appeared that life was lived in vain, that it is a "chain of tragic mistakes" that led to a dead end. He began to believe that the choice of work, friends, family was wrong, for which now "retribution has come." Analyzing the past years for a long time, he found more and more evidence and examples of his "duplicity, hypocrisy, insincerity, etc." I realized that the only way to solve all problems is to voluntarily leave this life. At the same time, he believed that by this act he would free the family from the “burden”, “loser”, “loser”. I decided, having locked myself in the garage, to get poisoned by the exhaust gases of the car. However, by chance, in a semi-conscious state, he was discovered by an employee of a garage cooperative. He explained what happened as an "accident". The thought of leaving life did not leave the patient. I decided to shoot myself with a gas pistol, which I had long ago acquired for self-defense. After a shot in the mouth, in a serious condition, he was taken to the Research Institute. Sklifasovsky, from where he was discharged a week later. The alarmed wife, suspecting something was wrong, decided to consult her husband with a psychiatrist. He was admitted to the clinic. He agreed to this only out of respect for family relations, he himself believed that treatment by psychiatrists was completely useless, because. his situation is hopeless and no medicines will help here, but will only "stupefy" his psyche. However, after two weeks of taking a modern antidepressant, the patient's point of view changed. Everything began to look not so bleak and hopeless, interest in work and life in general returned, I began to feel more cheerful, more energetic, interest in intimate life appeared. He took work to the clinic, called up colleagues. After two months of treatment, he fully returned to his usual life. With bewilderment, he recalled his thoughts about insolvency, the collapse of life, suicide. He took the drug prophylactically for about six months, then, on the recommendation of a doctor, he gradually reduced the dose and stopped taking it. Over the next two years, the condition remained stable, career growth continued, another child was born.

Depression is also characterized by sleep disturbances, occurring in approximately 80% of patients. As a rule, these are early awakenings with the inability to fall asleep, lack of a sense of sleep, difficulty falling asleep. These disorders, as well as restless sleep with unpleasant dreams, are often the very first symptoms of incipient depression.
If the depression is not deep, it is sometimes difficult to recognize it. This is due to the fact that people are ashamed to tell others about their problems, to admit to "weaknesses". Quite often, especially in Russia, depressive states are masked by alcohol abuse (“vodka heals”). In addition, often patients suffering from depression, in order to "shake themselves up", "throw into all serious", engage in casual sex, are fond of gambling or extreme sports, leave to serve on a contract in "hot spots", lead an idle lifestyle with constant attendance at entertainment events. Surrounding people, relatives who do not have psychiatric knowledge, often accuse them of debauchery, drunkenness, riotous lifestyle, parasitism. Meanwhile, this behavior is a kind of “cry for help”, an attempt to fill the spiritual emptiness brought by depression with new acquaintances and impressions.
Depressive conditions can occur in shallow forms that are easily treatable, but at least a third of depressions are more severe. Such depressions are characterized by:
- ideas of guilt, sometimes reaching the degree of delirium, i.e. unshakable conviction in their sinfulness, low value (patients consider themselves great sinners, believe that because of them all relatives and Mankind will die, that they are “moral freaks” from birth, supposedly deprived of the foundations of morality and a sense of empathy for other people that they have no place on earth They find in their past numerous "confirmations" of what has been said above, they believe that the doctor and other patients are aware of these transgressions and express contempt and indignation with their facial expressions and gestures, but in the words “they hide, deny the obvious. ” Both the patients themselves and their relatives must remember this in order to prevent the impending threat in time: remove all firearms, piercing and cutting objects, ropes, potent drugs and poisonous close household fluids, close windows or shutters, do not let the patient go anywhere alone.If these ideas become persistent and cannot be dissuaded, it is urgent to seek advice from a psychiatrist. neurological institution or call a psychiatrist at home.
- mood swings during the day: in typical cases, the patient, waking up, immediately feels longing. Sometimes, even before full awakening, through a dream he experiences a painful premonition of a heavy coming morning. In the evening, the state of health improves somewhat.
- the patient may experience a feeling of unmotivated hostility towards relatives, friends, constant internal discontent and irritation, which makes him unbearable for the family.
- in a number of people suffering from depression, constant doubts, fear for the health and well-being of loved ones, obsessive ones, come to the fore. arising against the will, ideas about the misfortunes and troubles of family members.

Typical story
Dmitry Petrovich, 58 years old, teacher.
“After minor troubles at work, I began to feel incomprehensible anxiety and agitation. Unpleasant thoughts came into my head that I did something wrong at work, because of which I double-checked everything many times and went home later than everyone else. But even at home, the anxiety did not let go: as soon as the daughter or wife lingered for at least half an hour, terrible pictures of traffic accidents or violence were drawn in the imagination. I fell asleep only in the morning, got up broken and felt sleepy all day. I took Valerian, Corvalol, but it practically did not help. At work, they hinted whether I should take a vacation. Friends advised me to consult a neuropathologist, but he did not find his pathology and sent me to a psychiatrist. I was diagnosed with anxiety depression. After a course of outpatient treatment, I completely recovered. ”

- in many cases, depression is characterized by unpleasant sensations in the body, disturbances in the activity of internal organs in the absence of objective signs of true somatic, i.e. non-mental illness. At the same time, many patients constantly report pain, internal discomfort. Some complain of headaches, pains in the stomach, joints, lower back, others - of disorders in the intestines: constipation, indigestion, irritation of the colon, others pay attention to a decrease in sexual desire and potency. In women, menstruation often becomes painful and irregular. Approximately 50% of depressed people at the doctor's office complain of such physical ailments, without mentioning the depressed mood or state of mind underlying the depression. Experiencing chronic pain or other unpleasant sensations in the body, patients may not realize that they are suffering from depression, even with severe melancholy, considering the latter a reaction to painful bodily discomfort.
- some patients are convinced that they have some rare and difficult to diagnose disease and insist on numerous examinations in general medical institutions. Doctors call this condition masked (hidden) depression, in which a person may experience pain in the head, in the limbs, behind the sternum, in the abdomen and in any other parts of the body, he may be haunted by anxious fears, he may suffer from insomnia or, on the contrary, too much sleep.
- Patients may experience disturbances in the cardiovascular system, skin itching or lack of appetite. All of these are manifestations of depression.
- the pathological sensations that patients experience during such depressions are quite real, painful, but they are the result of a special mental state, and not an internal disease. It must be remembered that the frequency of latent depressions exceeds the number of explicit ones many times over.
- with such depression, patients, as a rule, also have a changed attitude towards food: they can go without food for a long time and not feel hungry, and sitting down at the table, eat only 1-2 spoons - they have neither strength nor desire for more .
- a sign of depression can serve as a weight loss of more than 5 kg. within a month. In some people, especially women, the appetite for depression, on the contrary, increases, sometimes reaching the level of excruciating hunger, accompanied by severe weakness and pain in the epigastric region. In some cases, food is taken in excess due to an increased craving for sweets or attempts to distract oneself from painful thoughts by frequent eating.
Thus, we see that depression is a disease with many different manifestations that do not go away on their own, requiring special, sometimes long-term, medical intervention. Therefore, when the symptoms described above appear, it is necessary to seek help from a psychiatrist who will prescribe and monitor antidepressant treatment.

TREATMENT OF DEPRESSIVE DISORDERS

To date, it can be argued that the vast majority of cases of depression respond well to treatment. According to modern views, effective treatment of depression consists of a combination of pharmacotherapy, psychotherapy and, if necessary, other types of treatment. At the same time, the main role in therapy, of course, belongs to antidepressants - drugs specially designed for the treatment of various types of depression.
The creation of antidepressants is based on the discovery of scientists that depression develops as a result of a violation of the mechanism of biochemical transmission of nerve impulses in the brain regions responsible for mood, behavior, response to stress, sleep and wakefulness, appetite and some other functions. To ensure the coordination of the work of all these functional divisions, the brain sends special "commands" to them in the form of chemical impulses transmitted from the processes of one nerve cell (neuron) to the processes of another. This transmission is carried out with the help of chemical mediators (neurotransmitters), which, after transmitting a signal, partially return to the original neuron. This process is called neurotransmitter reuptake. Thanks to him, the number of mediators in the microscopic space between the processes of neurons (in the so-called synaptic cleft) decreases, which means that the necessary signals are transmitted worse. Numerous studies have shown that mediators of various structures, in particular, norepinephrine and serotonin, are involved in the transmission of signals that ensure the normal functioning of the nervous system. The first of them has a general activating effect, maintains the level of wakefulness of the body and takes part in the formation of adaptive reactions, and the second has the main antidepressant effect, controls impulsive actions, anxiety, aggressiveness, sexual behavior, falling asleep, feeling of pain, therefore serotonin is called sometimes a "good mood" regulator. A decrease in the number of mediators in the synaptic cleft causes symptoms of depression, while an increase, on the contrary, prevents their appearance. The ability of some drugs in one way or another to increase the concentration of mediators in the synaptic cleft allows them to be used as antidepressants.
Now antidepressants are used in Russia, which can be conditionally divided into 4 generations according to the time of creation.
The first antidepressants to find wide clinical use were tricyclic drugs: amitriptyline and imipramine. They have a fairly powerful effect on most depressive states by blocking the reuptake of both norepinephrine and serotonin. However, the real clinical effect of these drugs is significantly offset by their undesirable side effects, which drastically reduce the quality of life of patients during treatment. Side effects of tricyclic antidepressants arise due to the nonspecificity of their effect on receptor structures. Acting in addition to the serotonin and norepinephrine system and other neurotransmitters (acetylcholine, histamine, dopamine), these antidepressants cause side effects such as urinary retention, dry mucous membranes, constipation, palpitations, fluctuations in blood pressure, confusion, tremor, sexual dysfunction. functions, weight gain. In such cases, it is necessary to prescribe other drugs to correct side effects or reduce the therapeutic dose of drugs, which naturally affects the effectiveness of the antidepressant action. It has been observed that up to 50% of patients refuse to take tricyclic antidepressants due to severe side effects. For the same reason, physicians are less likely to prescribe these drugs to patients on an outpatient basis.
The situation was somewhat improved by the introduction into practice of drugs of the second generation - tetracyclic antidepressants, which, along with the ability to block the reuptake of norepinephrine and serotonin, could also affect some other receptors. Being analogues of tricyclic compounds, these drugs have antidepressant activity comparable to them, but unlike their predecessors, they are safer, since they cause unwanted side effects much less often. In addition to the antidepressant, mianserin (lerivon) has a clear sedative, anti-anxiety and hypnotic effect. Maprotiline (Ludiamil) has a mild balanced antidepressant effect. In general, these drugs are able to cure mild to moderate depression, but are ineffective in patients with severe depression.
To date, antidepressants of the 3rd generation, such as fluoxetine (Prozac), fluvoxamine (Fevarin), paroxetine (Paxil), sertraline (Zoloft), citalopram (Cipralex) and some other drugs that selectively (selectively) affect the serotonin metabolism system, have received widespread recognition today. , preventing its reuptake in the synaptic cleft. Based on the mechanism of action, these antidepressants are combined into a group of selective serotonin reuptake inhibitors. In addition to treating depression, they are used to correct eating disorders, level panic disorders, so-called social phobias, various obsessive-compulsive disorders and chronic pain symptoms. These drugs have gained popularity due to the possibility of a once-daily intake, concomitant anti-anxiety effect, the presence of a psychostimulant component and a small number of side effects. In addition, they have low toxicity and are well tolerated by elderly patients. However, some researchers note their lack of effectiveness in the treatment of severe forms of depressive states, probably associated with selective activity in relation to only one neurotransmitter - serotonin. It should be noted that in recent years, some American scientists have associated the use of these drugs with an increased risk of suicide, which, however, is not proven.
Considering the high frequency of side effects in some of the above drugs and the insufficient antidepressant activity in others, psychopharmacologists have taken the path of developing more effective antidepressants - IV generation drugs that selectively block the reuptake of both serotonin and noradrenaline, without affecting other mediators. system and with minor side effects. Currently, 3 drugs meet these requirements: milnacipran (Ixel), duloxetine (Cymbalta) and venlafaxine (Effexor). Their antidepressant activity in the treatment of patients with severe and moderate depression has been confirmed in a number of specially conducted studies, which at the same time showed that these drugs are well tolerated.
It should be noted that antidepressants of plant origin (negrustin, gelarium hypericum, deprim, etc.) can be effective in mild depressive states, but there are no reliable data guaranteeing their effectiveness. The opinion of a number of doctors that all depression can be treated with herbs or, say, acupuncture, should be recognized as unfounded.
For extremely severe depressions that do not improve despite the use of the most powerful antidepressants, electroconvulsive therapy (ECT) can be effective, but this situation is extremely rare and requires careful justification by the commission of doctors and the consent of the patient.
An important additional role in antidepressant therapy, especially with concomitant anxiety, is played by tranquilizers - anti-anxiety drugs, such as Xanax, phenazepam, diazepam, nitrazepam, atarax, etc. Drugs that can, when taken systematically, prevent mood swings in various depressive disorders include so-called mood stabilizers or mood stabilizers - lithium preparations, carbamazepine, valproic acid salts, lamotrigine, topiramate. With their systematic intake in most patients, the clinical manifestations of depression either completely disappear or become rare and mild, requiring no hospitalization and not significantly affecting the ability to work.
Antipsychotics play a significant role in the treatment of certain forms of depression. These include both traditional drugs - fluanxol, triftazin, eglonil, teralen, neuleptil, sonapax, and atypical antipsychotics that are gaining more and more recognition among doctors: seroquel, solian, zeldox, rispolept, abilify, serdolect and others.
In drug therapy of depressive conditions, an unconventional, strictly individual approach is used, with the obligatory provision of fruitful cooperation between the patient and the doctor. Otherwise, there may be a violation of medical recommendations regarding doses and regimens for taking medications. The patient's faith in the possibility of recovery, the absence of prejudice against the "harm" caused by psychotropic drugs, the systematic observance of the prescriptions prescribed by the doctor largely contribute to the achievement of therapeutic success.
Drug treatment of depression takes time. You should not expect a complete cure already in the first days of taking the drug. It must be remembered that all modern antidepressants begin to act on depressive symptoms no earlier than 1-2 weeks after the start of treatment. Cancellation of an antidepressant, as well as its appointment, should be carried out only by a doctor. Cancellation is usually made no earlier than 6 months from the normalization of the mental state. Even after the complete disappearance of all symptoms of depression, do not rush to stop taking the drug yourself, as there is a risk of an exacerbation of the disease. Therefore, doctors recommend continuing to take the antidepressant for a certain period of time. A common mistake is the premature withdrawal of drugs soon after a significant improvement in the condition or due to "forgetfulness". To avoid this, try to include the drug in the list of daily urgent matters - for example, store it in the bathroom and take it after hygiene procedures. When planning a trip, calculate exactly how many tablets you need for the entire period of absence from home. Breaking therapy is fraught with serious troubles.
Conducted along with drug treatment, psychotherapy of patients with depressive states implies various systems of influence, including individual conversations, family and group therapy, etc. An important element of social rehabilitation is participation in the work of mutual support groups for patients who have experienced depression. This allows other patients to feel help in understanding their problems, to realize that they are not alone in their misfortune, to see the possibilities of personal participation in rehabilitation activities and in social life.

How depression affects the human body

March 6, 2018, 2:47 pm

Science

The British scientific journal The Lancet Psychiatry published an article on an eight-year study of patients with severe clinical depression. This work reinforced the idea that the disease is associated with inflammatory processes in the brain.

Researchers at the University of Toronto divided the participants into three groups: some had depression for less than ten years, others for longer, and still others who were healthy. Each was checked on a CT scan to see if their gray matter differed.

Migraine

Migraine is like a regular headache, like an uppercut is like a flick. During an attack, it seems as if a nail was stuck in the eye, hair grows into the head with needles, any sound and light become unbearable. Not surprisingly, one in four people with migraines have depression - a reaction of the psyche to suffering. But apparently, the connection between the two diseases is much more complicated.

Back in 1994, American scientists calculated that depression more than triples the risk of a first migraine. By the age of 33, almost one in two people with clinical depression have a migraine. It turns out that two diseases mutually increase the risks of each other.

True, this does not mean that depression causes migraines. Perhaps they just have a common nature. A 2010 study of distant relatives in the Netherlands points to a possible genetic link between the two diseases. It has also been noticed that migraine sufferers have a low level of serotonin, and one of the causes of depression is just a lack of serotonin. But unlike the statistical association between migraine and depression, these explanations are mere guesswork.

Broken connections in the brain of babies

Depression undermines health, but even worse, it can change the body of a person who has not even been born yet. This has come to light in several studies of pregnant women with depression and their children after birth.

Arthritis

Recent laboratory studies show that inflammation in depression extends throughout the body, not just the brain. Knowing this, scientists from the University of Calgary decided to test whether depression is to blame for the fact that about one in 12 patients with psoriasis develops arthritis.

Psoriasis is a disease in which the skin becomes covered with raised, red, scaly patches. This is due to the fact that the immune system mistakenly attacks skin cells and inflammation begins. But the nature of psoriasis is not fully understood, and one of the mysteries is why inflammation sometimes spreads to the joints and psoriatic arthritis develops.

To test whether there is a link between the diseases, scientists processed more than 73,000 medical records of people with psoriasis. It turned out that those who also had depression had arthritis 37% more often. Two guesses follow from this. Perhaps psoriatic arthritis can be treated with psychotherapy and antidepressants. It is also possible that depression can provoke other inflammatory diseases.