Doctors sick note for depression

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SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

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Last Updated: 08/30/2022

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Gloomy season: what to do with the "autumn depression" | Articles

During the "autumn depression" it is quite possible to get sick leave legally, said lawyer Irina Minina. But only under one condition - namely, after passing the appropriate medical examination. Every year, many Russians complain about the "autumn depression", while doctors and psychologists emphasize that seasonal blues should not be confused with a real mental disorder. How to get rid of temporary apathy and why it is normal to be sad in the fall - in the material of Izvestia.

Sick leave for depression

According to Russian law, a sick leave is issued based on the results of an examination of a patient's temporary disability, which is carried out in connection with diseases, injuries, poisoning and other conditions associated with temporary disability - and depression is included in this list, lawyer Irina Minina said the other day .

— If a doctor diagnoses a patient with, for example, depression, which not only affects the psycho-emotional state of a person, but also prevents him from performing work duties, appropriate treatment must be prescribed and a certificate of incapacity for work must be issued for his time. So, when diagnosing depression in a patient, a sick leave certificate can be issued, as in any other disease, only if a number of conditions are met - the patient has a condition in which he is unable to work, as well as the patient undergoes appropriate treatment.

gloomy season

Photo: TASS/Alexander Shcherbak

As the lawyer clarified, the law clearly states how many days a patient can be on sick leave, including depression. Thus, the order of the Ministry of Health of Russia dated September 1, 2020 No. 925n establishes the right of the attending physician, if a patient is diagnosed with an incapacitated condition, to single-handedly issue him a sick leave for up to 15 calendar days inclusive, but, given the features of the diagnosis "depression", a person may need longer treatment.

- If the prescribed treatment has not brought the desired result within 15 days and the attending physician concludes that the patient is still unable to perform his/her work duties, the sick leave may be extended by decision of the medical commission for up to ten months. At the same time, every 15 days the sick leave will need to be extended , - added Irina Minina.

Causes of the "autumn depression"

First you need to understand that depression is a separate type of mental disorder and in this sense it has nothing to do with the weather and season, psychologist, psychotherapist, director of the HSE Center for Psychological Counseling Irina Makarova noted in a conversation with Izvestia. “What the common people call autumn depression, in fact, is not depression in its clinical manifestation, it is such a psychological description of some kind of emotional depression that is temporary,” she noted.

At the same time, the specialist notes, in autumn this condition can worsen not only in people suffering from depression, but also in those who do not suffer from any mental disorders. There are many reasons for this: there is a sharp transition from heat and sun to cold and cloudy weather, it is not very comfortable to go out, vacation ends and, as they say, harsh everyday life begins, but against which a person has to (despite a possibly depressed emotional state) adapt to changing living conditions.

gloomy season

Photo: Izvestiya/Konstantin Kokoshkin

As a rule, in the autumn-winter period, the number of patients always increases, which all experts are well aware of, Sergey Tiunov, a member of the Moscow Association of Psychotherapists and Medical Psychologists, director of the Psychological and Pedagogical Center "Academy of Success", told Izvestiya.

— In addition to purely physiological moments (the body is gradually preparing for winter), the weather factor also influences: the day becomes shorter, more gray colors appear, the sun comes out less and less, so the body, like plants and some animals, simply prepares for winter, - the source of "Izvestia" notes. - Even in people who are healthy in all respects, there is a certain decline, and as for people who have a predisposition to autumn-spring mood swings, here they have an aggravation.

But in what cases does apathy and poor health become a reason to turn to specialists? “Any change in our body is already a kind of wake-up call, even if we are talking about small fluctuations in mood. However, the presence of suicidal thoughts, of course, is a reason to turn to a specialist, emphasizes Sergey Tiunov. - But this does not mean that with any fluctuations in mood, you should immediately run to a psychologist or doctor. In fact, there are practices and methods that can lift your spirits. ”

How to get rid of blues

First of all, you need to understand that the feeling of a certain apathy is quite normal for the autumn period, emphasizes Irina Makarova.

— In the summer we felt good, warm, moreover, in summer people are generally much more physically active than, say, closer to winter. These transitions are tangible for a person: we are moving from a pleasant summer period to a more severe one, and we cannot but feel it. And in this sense, it must be recognized that this is normal, to some extent it is a sign of psychological well-being, mental health, “good” sensitivity and understanding of the changes that are taking place outside.

But how to deal with this feeling? If a person does not have enough warmth purely physically, a good option would be to go to the sauna, but if we are talking about some kind of spiritual warmth, it is worth meeting friends and having a pleasant party, remembering pleasant moments, advises Irina Makarova.

A proper diet can also help, Irina Berezhnaya, a gastroenterologist and nutritionist, noted in a conversation with Izvestia.

gloomy season

Photo: Depositphotos/luminastock

— First of all, at this time of the year we are especially deficient in vitamin D, which is the prevention of any infections. Receptors for vitamin D are found in all cells of the body, and without sufficient levels of this vitamin, not only depression will progress. Now there are a lot of only that ripened vegetables and fruits, so you should definitely include a fresh crop in your diet. Do not neglect a good physical activity - and this will be enough for good health in the fall.

Sergey Tiunov also shared his recommendations. To begin with, the specialist advises adding bright colors to your wardrobe - orange, red colors. “For example, for women it can be some kind of bright scarf, bracelet. This will please not only you, but even your colleagues at school or work can notice it and make a compliment, which also cheers you up, ”he said.

It is a well-known fact that communication with animals and children also brings pleasure, stresses Tiunov. “In addition, you need to communicate with friends - you can call, but better live, go to visit. We forgot what it's like to go for a cup of tea, - the specialist notes. “In general, you need to look at life optimistically, enjoy everything around you and enjoy every day.”

Freelance psychiatrist of the Ministry of Health: “If a Permian has depression, he can take a sick leave” | 59.ru

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All news , April 7, this year was dedicated to depression. According to the World Health Organization, more than 300 million people in the world are currently living with this disease. The journalist of the portal 59.ru spoke with the chief freelance specialist, a psychiatrist of the Perm Territory about why spleen and depression should not be confused, why bananas can not always cheer you up and who is more prone to illness - women or men.

Anatoly Andrusenko, a freelance psychiatrist, has been monitoring the psychological health of Perm residents for more than 20 years

- The simplest definition of depression is a mental disorder, which is based on a decrease in mood. Its typical manifestations are depressed mood that does not depend on circumstances for a long time, anhedonia - loss of interest or pleasure from previously pleasant activities and pronounced fatigue, "loss of strength", characterized by the stability of this state, for example, within a month. The proportion of each of these manifestations of the syndrome determines the difference in the manifestations of depression. Another important property of the disease is its recurrence, cyclicality.

– What causes depression according to science?

– According to modern concepts, a depressive state occurs due to a change in the work of genes that cease to “issue a command” for the synthesis of a number of substances necessary for the normal functioning of certain groups of brain neurons. As a result, these cells undergo degeneration, they reduce their activity or even die.

Approximately 3% of the population of Prikamye are treated by a psychiatrist, that is, more than 90 thousand people

– What are the origins of this disease?

- Several causes of depression can be observed at once. Hence the difficulties of the diagnostic plan. On the one hand, depression can have an organic basis, that is, be associated with damage to brain cells. On the other hand, it can be psychogenic in nature, being a reaction to the pronounced disabling effects of a somatic disease or an unfavorable life situation. In turn, unrecognized depression can be a risk factor for the development of diseases, such as cardiovascular diseases.

– Is it known how many people in the Kama region suffer from depression?

- Last year about 3% of the population of Prikamye applied for psychiatric help, which is more than 90 thousand people. This group includes people with both mild mental disorders and those with severe psychotic-level disorders. The most common are borderline mental disorders - neurotic and adjustment disorders, which include, among other things, mild depression. Severe mental illnesses such as schizophrenia, bipolar affective disorder are much less common. Today, depression is not singled out separately in the statistical forms adopted for reporting. But it should be noted that every fifth inhabitant suffers depression at least once in his life, the risk of development during his life is 15-20%. In Russia, the real number of people suffering from depression is approaching 9millions.

Doctors say: do not confuse sensitivity to changes in the weather and depression

– Is it possible to say that, in fact, depression cannot now be considered an illness on an equal footing with the flu, for example? For example, the local doctor will never issue a sick leave if you call him because of symptoms of depression.

- Depression is a mental disorder and is included in the International Classification of Diseases 10th revision. Thus, a person suffering from depression who seeks medical help is eligible to take a sick leave. To do this, you need to apply for an appointment and get a conclusion from a psychiatrist that your illness interferes with the performance of professional activities and needs treatment. Based on the severity of the patient's condition, the psychiatrist will decide whether to examine him on an outpatient or inpatient basis, what kind of therapeutic program he needs. In the Perm Territory, psychiatric care is available and optimally close to the population. We have a large psychiatric service, represented by an outpatient complex of the regional clinical psychiatric hospital, five zonal regional psychiatric hospitals that provide assistance on a territorial basis, and 42 psychiatric rooms at central district and city hospitals, where district psychiatrists work. Psychiatric care is provided to patients free of charge.

– What are the methods of helping people with depression today?

– There is a popular belief that if a person is in a bad mood, it is better to eat a banana. Indeed, these fruits contain substances that can be indirectly integrated into the metabolism of serotonin in the body (note: serotonin is a neurotransmitter responsible for maintaining mood). True, as a medicine, even with mild depression, they are useless. This ailment needs complex therapy, which includes drugs, psychotherapeutic correction and psychosocial forms of assistance. Now in the arsenal of doctors there are more than 150 types of antidepressants, including modern, latest generations. They have one principle of action, aimed at restoring neurochemical processes in the brain.

Mild depression is the most common - people are often unaware of this disorder

- Are women really more prone to depression than men?

- In general, a lot depends on the constitution, on the genetic predisposition and the conditions in which the formation of a person's personality took place. There is an opinion that in some people a so-called. depressive personality, which is characterized by a depressive worldview. But, in general, it is women, due to more developed emotionality, who are more prone to depression. Women's more attentive attitude to their health also plays a role, which is why women go to doctors more often and do not hesitate to ask for medical help, unlike men. The stronger sex endures to the last and considers going to the doctor an excessive weakness.

– One of the most common types of depression is postpartum depression. Many women today are subject to it. How does science explain the cause of such a syndrome?

- It is believed that 10-15% of women suffer from postpartum depression, but only 3-5% need treatment. Signs of postpartum depression may include feeling overwhelmed, anxious and empty, loss of interest in life, irritability (often for no reason), a feeling of alienation from your own child. Postpartum depression can occur for a variety of reasons. Among the biological ones are hormonal changes, a natural decline in emotions after childbirth, weakness and overwork in the first weeks of motherhood. Psychological reasons include a woman's hereditary predisposition to emotional disorders, a difficult situation in the family, a feeling of disappointment and unpreparedness for the changes that motherhood brings. It is at this time that the support and understanding of loved ones are necessary for both mother and baby.

Do not think that depression is a “contrived disease” – many suffer from it as the most serious illness

– There is an opinion that during the off-season periods, psychological illnesses worsen in people. Many say that they have "spring exacerbation", "spring depression". What might it depend on?

- I wouldn't call it exacerbations. We northerners are characterized by transitions from one seasonal regime to another and the associated mood swings. Such states can be called "spleen", "spleen", but not depression. We are affected by the fact that the body begins to “rebuild” for the spring-summer biological clock, and different body systems do this in their own way, not really trying to coordinate their actions with their “neighbors”. Naturally, the harmony in the body is temporarily disturbed. By spring, the body simply accumulates fatigue associated with a lack of movement, hypoxia (lack of oxygen), a less active lifestyle with more abundant winter nutrition. This fatigue becomes most noticeable in the spring, when it comes into direct conflict with the awakening nature. Involuntarily, we begin to pay more attention to our condition, realizing that we have become too lethargic, irritable and drowsy. By the way, drowsiness for this period is quite natural. The light regime has already changed, the day has become longer, and melatonin (sleep hormone) in the body continues to be produced according to the winter norm. But these changes are transient in nature and do not lead, unlike depression, to illness and disruption of social, domestic and professional adaptation of a person. This is the difference. In order to cope with the “spring blues”, you need outdoor walks and sunlight, proper nutrition and quality sleep.