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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.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

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Depression

Russian Academy of Medical Sciences
SCIENTIFIC CENTER FOR MENTAL HEALTH









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









nine0003




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. nine0003 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. nine0003 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. nine0018

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. nine0003 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. nine0003 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. nine0018

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. nine0003 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. nine0018

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. nine0003 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. nine0003 - 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. nine0018

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. ” nine0018

- 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. nine0003 - 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. nine0003 - 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 . nine0003 - 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. nine0018

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. nine0003 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. nine0003 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. nine0003 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 frequently. 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. nine0003 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. nine0003 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. nine0003 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. nine0003 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. nine0003 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. nine0003 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. nine0003 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. nine0018

“We were taught not to whine”: how to accept and overcome depression

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Video caption,

Awkward questions: what does it mean to live with depression?

Many people live with depression for years without realizing it. Everyone has autumn blues, bad days, self-doubt, but depression is not just a bad mood. nine0136

In modern society, this is one of the most common mental disorders, in the worst cases ending in premature death. According to the latest WHO estimates, more than 300 million people worldwide suffer from depression.

The BBC Russian service talked to people who have experienced depression about the stereotypes and myths associated with it, as well as about how to overcome this disease.

Image caption,

Sasha Mashin was diagnosed with clinical depression and fully recovered within a year. Yana Mandrykina overcame depression 9 within a year0018

Stereotypes about depression

"Depression doesn't exist. Psychotherapists invented it to make money"

Zhenya Golomuz: I have changed enough psychotherapists and I can say that many of them really use depression to make money. They increase the number of sessions, make them come twice a week, supposedly one session is not enough. But there are also decent people, they really understand your problem, because very often they themselves went through depression before becoming psychotherapists. As in any profession, there are charlatans among psychotherapists and psychiatrists. nine0018

Irina Urnova: I had a psychotherapist who started doing things that should not be done. He started belittling my problems, saying that my problem is not a problem. We stopped dating.

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"It's a disease of selfish"

Sasha Machine: Rather, it is a disease of perfectionists. It often happens to those people who are trying to achieve a cool result in some kind of activity.

Kirill Cheremisov: I know a lot of selfish people who don't get sick. On the contrary, during depression you do not love yourself, but in order to recover, you need to love. One of the points of psychotherapy, psychoanalysis and other techniques is to develop self-love.

Photo caption,

Anastasia Tropp (left) had several periods of depression, the longest one lasting a year and a half. Zhenya Golomuz (right) was clinically depressed for almost two years and recovered from it for three years

"Stop feeling sorry for yourself. Do something useful!"

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Zhenya Golomuz: I am always doing something useful, I am constantly helping people. If I don’t benefit people, I figure out how to benefit people, because it really helps in life. nine0018

Kirill Cheremisov: We were taught not to whine. This is a weakness. You have to be strong. Boys shouldn't cry. You need to feel sorry for yourself. This is fine. Why not?

Kristina Butaeva: We must admit this. Yes, I do feel sorry for myself at the moment. Why should I stop doing this?

Sasha Mashin: Imagine that you broke your leg. And you say to yourself: dude, pull yourself together, you're not a rag. A real man. Depression is not laziness in you. This is a disease that requires professional treatment. nine0018

Yana Mandrykina: By the way, I broke my leg this year. It would have been strange if I hadn't called an ambulance.

Vera Kornakova: I want you to be sorry, but you cannot accept this concern for yourself.

Irina Urnova: And this care is never enough. She is annoying. Everything is not right.

Photo caption,

Vera Kornakova (left) suffered from depression twice, of which she was hospitalized once. Irina Urnova (right) has borderline personality disorder

"You've become so boring, you can't go out anywhere!"

Zhenya Golomuz: You need to be able to explain depression to people, because it seems to them that nothing is visible, nothing hurts, which means that everything is in order with you. And why are you even lying on the bed again? The concert is great, let's go for a drink.

Irina Urnova: I had friends and acquaintances who said: "You are dragging me down with you." Perhaps it was, it was hard for them, but it does not help. For friends of those who are depressed, I would advise either to help or to move away altogether. nine0018

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"Stop pretending. You have to pull yourself together!"

Zhenya Golomuz: Stop pretending - that's the worst thing you can say, because at some point it began to seem to me that maybe I'm actually pretending? Maybe I'm really a lazy pig? nine0018

Kristina Butaeva: These phrases devalue a person's feelings. Wait, I just wanted to tell you that I am really weak at this moment. Why don't you want to admit it? From the phrase "be strong" in a state of depression, you become weaker. On the outside you can't confess, but on the inside you're helpless. Such phrases drive.

Kirill Cheremisov: Of course they do. They make it even weaker, as if they are saying: you should be ashamed. These are all models of behavior imposed by society that prevent you from understanding your condition. nine0018

Sasha Mashin: Chemistry in the head is changing - some substances have become less, others have become more. You can no longer help yourself. You need to change this chemistry by contacting a doctor. It's impossible to take control of yourself. There is no chance for this.

Vera Kornakova: Many people think that you are pretending, but this is due to a lack of understanding of what is happening. The degree of empathy in a person is not such as to feel what is wrong with you.

Image caption,

Kristina Butaeva recovered from depression thanks to her work with a specialist. Kirill Cheremisov managed to cope with depression in 9 years0018

"This is weakness, be strong! There are people who are much worse"

Zhenya Golomuz: I had my first episode of depression at the age of 14. I came home and said: I have depression. My parents say to me: Zhenya, are you completely crazy? Here, read "Robinson Crusoe", he was much worse. He was generally alone, but you have everything: an apartment, a cool school, English from morning to evening. Depression is definitely not for the weak, because to admit that you have depression, you need to be super strong. nine0018

Kristina Butaeva: At the very beginning, it was embarrassing to whine, it was embarrassing to admit to myself. After all, life goes on. And I would like to say: I'm sad now. But you are so expected to smile when you go somewhere or participate in a party. We have to comply, and there is great disharmony in this. For the first time, I could only have a nap with a specialist. Finally I was able to say: I feel bad, yes!

Kirill Cheremisov: Yes, there are starving children in Angola, and this factor should work, but it doesn't. nine0018

Anastasia Tropp: Many of my friends still don't know that I had depression. For some reason, I was so ashamed to tell my friends that I was in this state. I was embarrassed to dump my problems on them. When they found out, they made round eyes and said that I had thought of something.

Living with depression: a personal experience

How does it happen?

Zhenya Golomuz: You stop going to work, then you stop leaving the room, getting out of bed, then you stop rolling over, then you just look into the pillow. Friends say: "Zhen, you could write what is bad." But I couldn’t, because communication takes a lot of strength and energy, it’s really hard to do. nine0018

Kirill Cheremisov: Constant physical fatigue and emotional exhaustion. In the morning you wake up, having slept, but you are broken and do not want anything. In the evening you come home from work barely alive. The only thing you want to do is turn off the light, lie down on the couch and turn off your phone.

Kristina Butaeva: Feeling the bottom. A wide black streak in life. Several times I caught myself thinking that it could not be worse. But it gets worse. Then I admitted to myself that I could no longer fight. Fatigue from the struggle overcame. nine0018

Yana Mandrykina: You drive and cry in the car and don't understand the reason. The condition was such that now it would crash somewhere and that's it. And I also worked all the time, about 24 hours a day. Sometimes I slept a little.

Irina Urnova: There is no special meaning in life. No need to get up in the morning, no need to go to bed earlier or later. There is no need to invent, do something, set some goals.

Vera Kornakova: An infinitely long sleep that does not bring peace. Pain that is not relieved by painkillers. And panic attacks. nine0018

Sasha Mashin: I had a concert and I couldn't figure out what to do, what to play. Everything goes out of focus, you can't focus on anything. There is a growing feeling that something is not right. I didn't have the strength to show any emotion. Cry? No strength to cry. You make a lot of claims. There is a void. It's like your brain has been de-energized. It takes a lot of time to admit that something is wrong with you. That is the problem - why people do not seek help. They think: well, that's something with the mood, somehow things are not going well. nine0018

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What is the worst thing about depression?

Zhenya Golomuz: I don't know. What's worse than the fact that you just can't get up?

Kristina Butaeva: Expectation from people. I think my depression dragged on because I honestly believed that help should come from outside. Well, now they will see how bad I am. I have a running line on my forehead. nine0018

Kirill Cheremisov: To despair and start thinking that it is impossible to get out of this state.

Yana Mandrykina: Stop appreciating life.

Sasha Mashin: During clinical depression, a lot of people come to the conclusion that ending their life is perhaps the only way to end the suffering they are experiencing. And the suffering is intense. At times you feel an ax that sticks out in your chest, a tearing sensation. And you're willing to do anything to make this feeling end. Perhaps that is why they think that the soul is in the chest. The worst thing is not knowing what is happening to you. nine0018

Anastasia Tropp: Probably, when your call for help will be answered with ridicule or a frivolous attitude. If you need a person, and the person distances himself, it is very difficult. It might get you into a loop.

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Antidepressants

Zhenya Golomuz: This is horror, horror, horror! Because you become a little bit of a vegetable, but at the same time a functioning vegetable. If you have to get up because they stopped paying salaries and it’s time to earn some money, then antidepressants are the best thing to go out into the world. I do not recommend it on a regular basis, because you stop getting any pleasure from life, but at least you exist with them.

Yana Mandrykina: In Russia, this is just some kind of barrier. I had it too, because it is generally accepted that if you start taking antidepressants, then it means finally cuckoo. In fact, properly selected antidepressants return to normal life. What's the difference - weak or strong? Happy! Or live in fear. This is some kind of Soviet stereotype, like "guys don't cry." nine0018

Sasha Mashin: If you are thinking about a window or a chandelier, then this is absolutely the situation when you need to take antidepressants. But you don’t need to prescribe medicines to yourself, this should be done by a doctor.

Irina Urnova: I heard the statement that any fool can take a pill, I heard more than once. People are afraid to eat pills and there is a resource that cannot be replenished simply by rest, it must be replenished at the chemical level.

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Video caption,

Colors against depression: how makeup helped restore self-confidence

Can depression be cured?

Kirill Cheremisov: According to statistics, people who seek treatment for depression, 80-90% of them are cured. There are many techniques, great statistics. In my opinion, the most effective is psychoanalysis and cognitive therapy. If it's a severe case of illness where you can't function normally, then antidepressants and some additional medication. nine0018

Kristina Butaeva: It is important not to diagnose yourself. You'll have to try different paths. In meditation, I was strongly thrown in different directions, and I understood that I could not cope on my own. My way was - a conversation with a specialist. There was a feeling that I was alone in the room and talking to myself out loud, but she sat in front of me and periodically asked the question "why?"

Sasha Machine: He is being treated. Although a person who has experienced depression once, the chances of a repeat are seriously increased. But in this case, the problem is not to cure it, but to know what happened to you and seek help. Therefore, even if this happened again, you no longer panic, but write a message to your doctor. Literally a week and you're fine. nine0018

Yana Mandrykina: I agree. You can break your leg several times in your life. You will treat her every time, not selectively.

Zhenya Golomuz: Personally, I have never seen someone completely cured. It's always that kind of Alcoholics Anonymous club.

Why were you depressed?

Anastasia Tropp: This is the biggest secret. It comes from nowhere, and you don't understand at all what it could be connected with. This is a paradox, because you look at everything and want to slap yourself in the face and say: kamon, why did you arrange all this? I changed my lifestyle when I went on maternity leave and all my surroundings began to perceive me as a mother. And my old social history seemed to cease to exist for other people. For me it was a big crisis, but now everything has passed. nine0018

Kristina Butaeva: It is generally accepted that good emotions should be shared. We consider them good because our parents told us it was right. When you experience bad emotions - aggression, stress, it feels like you don't know how to express them. Getting angry is uncomfortable. You forbid yourself, you say - I'm normal, adequate, everything is in order, I read smart books. For example, take the feeling of resentment. You want to complain, but it is not clear to whom. The husband offers to pull himself together, a friend has a lot of problems at work. And it seems that the whole world is not up to you. nine0018

Kirill Cheremisov: You can't be angry with your parents, with your relatives - that's bad. You can't be angry with a child. And you hide these emotions deep down, and they accumulate. No one has ever taught us psychology how to deal with stress. Over time, you drive yourself into this state. I had a long enough stress. Anxiety causes depression, depression causes anxiety. And now you are already lying at the bottom and thinking: why did this happen to you? nine0018

Yana Mandrykina: There were a lot of prerequisites for this. And the final trigger was the loss of friends in a disaster. This shock worked for the acute phase. I may have had a sluggish phase and then a shocking event kicked in.

Sasha Mashin: I seem to have an endogenous history and it's not about the way of thinking, but partly about genetics. There were uncomfortable conditions, but the clinical case was three years ago. He was triggered by an obsession with living in another country. And I was so focused on this thought ... I was very scared to try it and at the same time I really wanted to, because it would bring incredible results in my professional career. And these scales are a constant comparison: what is there and how is it here. What happens if I go, and if I don't? This is the state that started the process. nine0018

Irina Urnova: I am not diagnosed with bipolar disorder or manic-depressive psychosis, but I always balance between hypomania and depressive episodes - the so-called borderline personality type. In hypomania (also called atypical depression), you are alert all the time: you don’t need to sleep, you don’t need to eat, everything is fine anyway. Then this state passes and exhaustion sets in. The trigger was the death of my father and then studying abroad, where I was alone. There began a serious condition. Everyone copes with the death of a loved one differently, but many try to get through it faster and do not let themselves grieve. nine0018

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How did you manage to get out of depression?

Anastasia Tropp: Willpower. You take the will into a fist and try your best.

Zhenya Golomuz: My friends suddenly realized that I needed help. They came up with a system where one person called in the morning, the other drove to work. Therapy, pills and sports helped. Now I do not go in for sports at all, I do not take pills. Routine and reactive psychotherapy helps. As soon as you realize that it starts to cover, you remember that you need to do 12 squats, buy tickets to Europe, somewhere warm. nine0018

Kirill Cheremisov: After I confessed to myself that I was depressed, it was very difficult to tell anyone about it. But relatives understood and believed. And working with a specialist helped.

Kristina Butaeva: A conversation with a specialist and identification of a resource - I need life, I need myself, and then everyone else. And when all this becomes necessary, it helps to overcome.

Sasha Mashin: In my case it was friends who convinced me that I needed to talk to a doctor. I started treatment. It is believed that after the start of medication, somewhere in two weeks it becomes easier. I literally felt better within a week. Three weeks later I was already playing concerts. Although it seemed that everything was over in this life. I fully recovered in six months. In total, it took a year. I had clinical depression when I could not eat, wash, get out of bed. Interestingly, after the treatment, my assimilation of new information increased many times over and my working capacity increased many times over. There are people who are in a sluggish depressive state and think that their life just somehow does not add up and their mood is not very good. This is also a type of depression. There are many types of depression. nine0018

Yana Mandrykina: My friend helped me, she gave me the phone number of her doctor, who diagnosed and prescribed the right treatment. Moreover, he diagnosed not only by conversation, but conducted clinical studies. After all, treatment is not only properly selected drugs, but also a regimen, nutrition, lifestyle.

Vera Kornakova: The first time I did not ask for help, I was afraid to go to a psychiatrist.

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