Do i need to see a therapist for depression

1. A person may not notice how far things have gone

The first time I went to the doctor at the age of 34, when several events happened at the same time: the child got two in the quarter, I was called to school for dressing, my husband and I had a fight, I lost a job that didn't pay me for the last two months. And I cried all the time. I just couldn't stop crying. I cried at home when I was brushing my teeth, I cried on the subway on my way to work, I cried on the escalator. I also cried at work. It made my life very difficult and I couldn't stop crying.

I asked my friends to find a doctor for me and went to surrender to a psychiatric dispensary. There she received her diagnosis and her first prescription. There I learned that my depression is endogenous, hereditary. I think the first depressive episodes were in childhood and adolescence, but I just didn’t understand why I was constantly feeling so bad and wanting to die. I have since learned to live with my depression and keep it under control.

Depression is often associated with weakness, so people endure it and don't go to the doctor. And the symptoms get worse.

It's like gaining weight: size 42 gradually increased to size 52. A person who has not seen you for a long time will say: “Wow, how you have changed.” So the symptoms of depression most often appear and intensify gradually, day after day.

Usually the first time a person comes to us in the most difficult condition. This is a 100% rule. On the second and subsequent visits, no one comes in such a serious condition as the first, because they already know what is happening. I have a patient who initially required medical treatment because he had an advanced condition. The second time, no medication was needed, there was enough psychotherapy to cope. He has learned to determine these states himself, he knows what to do.

Signs of depression must be sufficiently persistent to be diagnosed with depression. Everyone can spend the day in bed. We all get in a bad mood from time to time, we can spend the weekend without getting out of bed, but a walk, rest or a good event changes our mood. There may simply be no appetite for a couple of days, and when these symptoms last longer than two weeks, and changes in the external situation do not affect them, then this is depression.

2. Relatives cannot objectively assess the severity of a person's condition

Almost all depressed patients say that they are not understood at home: “ They tell me that I am lazy, I don’t want to control myself, I make up everything ”. You need to take seriously the feelings of a person who says that he is ill.

I had a patient whose mother believes that the best remedy for depression is to clean the floor in the whole apartment.

Washing floors can help if a person is a little sad and anxious, not when depressed. But if a person does not get up for 2-3 days, does not wash, does not brush his teeth and does not go outside, then mopping the floor will not help him.

It will be good if relatives can create conditions for a depressed person to start talking about his experiences. And when a person says: “ I feel bad. It seems to me that my life does not make sense ”, and they answer him:“ Pull yourself together ”, the person closes, he will not tell anything. You need to say: “ I see that you feel bad. Do you want to talk to me? Do you want to go for a walk? Is there anything I can help you with? » If a person refuses, then there is no need to insist. Contact may not take place immediately, sometimes you need to wait, just be there.

My patients say: “Those who have not experienced such a state will not understand. Let them at least not advise what to do.

The offer “If you want, I will come and cook soup for you” is valuable for a depressed person. But teachings and advice - no.

3. Not every depression can go away on its own

There are two types of depression. Depression, which is provoked by some external factors, is called reactive . Reactive depression, as a person has coped with the condition or the external situation has changed, can pass by itself. The duration of reactive depression is very dependent on the individual. It happens (usually this happens after the death of a parent), people come to us only after 3-4 years. That is, a person is in a subdepressive state, then his condition is worse, then better.

There is endogenous depression that comes from within. Endogenous depression rarely resolves on its own. It can escalate, subside, and escalate again. But usually it doesn't go away on its own. The causes of endogenous depression are the lack of neurotransmitters (serotonin, norepinephrine, dopamine).

Many are confused by the fact that in psychiatry the main method of research is conversation. How can a doctor just tell me what disease I have? They just talked to me.

Yes, there are many types of tests now, but they are used more for research purposes than for diagnosis. Separately, without a general clinical picture, such studies are not indicative.

4. Only a doctor can recognize some conditions

There was no loss of energy, so at first I did not think about depression, but I was tormented by a feeling of depression, which did not allow me to sleep, eat, or communicate. For eight months it got worse and worse, and at some point it became clear that it would not go away on its own. I turned to a specialist, he prescribed pills, it became easier.

Depression can be hidden, invisible to others. For us psychiatrists, one of the most difficult types of depression is “ironic depression”. When a person does not say: “I’ll go out the window now” or “I feel bad”, and when he has an ironic mask on his face. The person smiles, and to the question: “How are you?” he answers with restraint that everything is fine with him, ironically refers to his oppressed state. A person with ironic depression is dangerous in terms of committing sudden suicides.

But don't take the blame for unnoticed depression. In fact, it is impossible for a non-specialist to recognize some states. Relatives of our patients blame themselves for not noticing changes in a person. But they didn't notice because they never experienced these problems.

5. Sometimes a person needs help to get to the doctor

Someone comes to the doctor himself, someone is brought by relatives. Someone asks relatives to bring him. Our patients often say that they were going to see a specialist for six months, but still could not decide. A relative can offer help: “Do you want me to go to the doctor with you?” Sit in line, stand next to me, just for the sake of support. This is very valuable for a depressed person.

6. Postpartum depression: it is very serious and will not go away on its own.

A woman with postpartum depression is immediately visible. The mother of the newborn is very involved in it. The woman was expecting that she would give birth to a child, there was a joyful premonition, and after the birth she suddenly lay down and could not get up. Or suddenly anxiety sets in. Postpartum depression is difficult to confuse with something. The state changes suddenly: CLICK, and it became like this.

The worst thing is that there are those who really go out the window. If you suspect a woman has postpartum depression, you need to grab her in an armful and take her to the doctor.

There are women who endured the most difficult period, 2-3 months, and somehow managed on their own, but many still have some rudimentary symptoms - some have obsessive states, some have fears, some are afraid going out. Postpartum depression leaves a mark, someone will have fears and anxieties, and someone's husband may leave.

Another argument in favor of antidepressants. They allow to reduce social losses to a minimum. Maintain quality of life. After all, due to illness, a person can lose his job, family, friends.

7. Antidepressants really help

Psychiatric intervention improves the quality of life, antidepressants are a temporary measure, it allows you to survive the acute period without loss. In my practice, I often encounter those people who take medication and return to normal life. There is no dependence on antidepressants. It is a myth. There is no physical dependence on antidepressants. And psychological dependence can arise from anything, from shopping, from your favorite cups of coffee.

Now the level of development of psychopharmacology is such that it allows you to choose a medicine in most cases, the patient will not notice the side effects of this medicine. A “vegetable”, inhibited state that everyone is afraid of, severe sedation, etc. is either a necessary moment in the treatment of severe conditions, or a short period at the beginning of treatment. It is important to discuss everything with the doctor, tell him about your symptoms so that he can adjust the treatment.

There are three groups of antidepressants: sedatives - those that calm, stimulants - for those who cannot get out of bed, and drugs of a balanced type.

When a person in depression cannot sit still, his head is constantly spinning with different thoughts, then we, doctors, make a choice in favor of sedatives. If we see lethargy, apathy, drowsiness, fatigue in our patient, he does not have the strength and desire to live, we prescribe stimulating antidepressants. But most often we use antidepressants with a balanced effect, in which there is both, which even out the condition.

Usually we wait 7-10 days for the result, during which time the drug accumulates in the blood. As a rule, after this we see a reduction in symptoms: their decrease or disappearance. The patient comes to us a week later and says that he has become much calmer.

In general, in psychiatry, everything does not happen quickly. But when the condition improves, the person feels it. You can't confuse this with anything.

8. Due to depression, you will not be registered with the PND and will not be reported to work that's why it functions every other time and is always ready to hang, slow down. I couldn’t go anywhere except work, sometimes I see an interesting event in the evening, I have to go after work, and at the end of the working day I sit and I can’t get up from my chair, raise my hand. He began to fall on the streets, sometimes in dangerous places, once he fell on the tram tracks. There were also thoughts of suicide.