In 1910, E. Reiss singled out psychogenic depressions, considering the main features of all psychogenic diseases on this model. K. Birnbaum (1918) emphasized that the experiences of such patients are “centered” on psychotraumatic circumstances and remain dependent on them throughout the course of the illness.
Yu.V. Cannabih (1929) noted that psychogenic depression can develop in healthy individuals. K. Schneider (1955) considered "neurotic depression" as an independent form of the disease. A. Kilchholtz (1977) noted the nosological commonality of neurotic and reactive depression, highlighting exhaustion depression as one of the variants of reactive depression.
Special constitutional-premorbid personality traits determine the gamut of shades of reactive depression. When it occurs, the features of the psycho-traumatic factor play an important role, which is defined as an irretrievable loss (death of relatives, friends), severe conflict in the family (divorce, adultery) or at work (harassment that strikes at prestige, the threat of "exposure"), etc. .
The clinical picture of reactive depression is characterized by depression, a sense of hopelessness, hopelessness, tearfulness, insomnia, and various autonomic disorders. The consciousness of the sick is completely focused on the events of the misfortune that happened to them, all its circumstances. This theme becomes dominant, takes on the character of an overvalued idea of negative content, the patients are engulfed in complete pessimism. The main plot remains relevant even when the depression drags on and becomes less vivid in itself. Random association can intensify painful memories, depression, even outbursts of despair.
Most often, with the gradual stabilization of reactive depression, depressing memories are repeated in dreams of a "nightmare" nature.
Vital manifestations in reactive depression are not as bright and clear as in cases of endogenous phases. These patients retain a critical understanding and assessment of their condition, a distinctive feature is the direction of the vector of guilt not on themselves, but on others.
Signs of ideational and motor retardation appear mainly only in the early stages of reactive depression. Immediately after the misfortune, the superpowerful stress, the patient, as it were, “petrifies”, does everything automatically, while internally remains indifferent to everything; at the same time, there are no tears, violent emotional manifestations of feelings, “withdrawal into oneself”, silence is noted. And only then does an “expressive” picture of reactive depression develop. The difference from endogenous depression is found in that the intensity of psychogenic depressive manifestations is associated with a specific situation.
In accordance with the prevailing symptoms, one can single out hysterical psychogenic depression with demonstrativeness, explosiveness (P.I. Felinskaya, 1968), anxious depression and truly depressive reactions. It is clear that the special flavor of these variants is associated with individual premorbidity (tantrums, anxious and suspicious, cycloids). The duration of reactive depression usually does not exceed several months, the exit from it is gradual, through the stage of asthenia.
A depressive-paranoid state can develop after severe psychogeny as a reactive psychosis. This condition develops subacutely. In the period of the prodrome, there is a sharpening of personal characteristics, patients experience fear, anxiety, suspicion is noted. In the future, ideas of relationship develop, delusional ideas of persecution with a plot that reflects a psychogenic situation.
With a hallucinatory-delusional manifestation, along with ideas of attitude, persecution, auditory hallucinations arise. Verbal hallucinations are usually true; with prolonged reactive depressive psychosis, pseudohallucinations may occur. The content of auditory hallucinations is closely intertwined with situational conflicts, and is usually threatening.
Depressive-paranoid states proceed, as a rule, for a long time, with recurrent variants, the duration varies from a month to two to three years.
Differential diagnosis of reactive psychoses, including various variants of depression, is carried out with schizophrenia, endogenous depression. Against schizophrenia is evidenced by the absence of personal progression and signs of thought disorders, autism, exit from psychosis with the preservation of all the basic personality traits, adequate emotionality. In addition, in all cases of reactive psychosis, signs of the Jaspers triad are determined.
Endogenous affective psychoses are distinguished by an autochthonous character, the development of a depressive symptom complex, reactive depression is determined by the plot of the psychogeny that took place.
Reactive depression is an emotional disorder that occurs as a result of some serious stressful situation.
The main reason for the appearance of reactive depression is catastrophic events, global negative changes in human life. Such events are called "blows of fate", they can lead to the appearance of depression even in a person who does not have a predisposition to the development of depressive or other mental disorders.
Among the most common causes of reactive depression are the death of a loved one, a breakup with a loved one, divorce, bankruptcy, financial collapse, job loss, litigation.
In connection with the global financial crisis that occurred a few years ago, the number of patients with depressive disorders increased sharply, because many people lost their jobs, were unable to pay bank loans, were left without an apartment or a car.
In addition to the psycho-traumatic social factor, hereditary predisposition to the development of affective disorders, constitutional features and age of patients, the presence of somatic and mental diseases (organic brain damage, schizophrenia) are important.
Symptoms
Reactive depression can be short-term (lasts no more than 1 month) and prolonged (its duration is from 1-2 months to 2 years).
short-term depressive reaction
Short-term (acute) reactive depression, as a rule, is directly related to some kind of misfortune. The loss that has occurred is individually significant, reaching the dimensions of a mental trauma.
The onset of symptoms of acute depression may be preceded by transient manifestations of a shock reaction - anxiety, psychogenic amnesia, silence (mutism), motor retardation, or aimless throwing. Hysterical disorders may also occur.
The leading symptoms of acute depression are deep despair, suicidal thoughts, various fears (phobias), sleep and appetite disorders. In most cases, these symptoms are short-lived and disappear fairly quickly. However, some patients at the peak of the disorder commit suicide or self-harm.
Prolonged depressive reaction
Prolonged depressive disorders are associated with a prolonged stressful situation. Symptoms of prolonged reactive depression are most often tearfulness, depression, a pessimistic vision of the future, a weakening of the energy potential of patients, asthenic and hypochondriacal manifestations.
With reactive depression, daily mood swings are not as pronounced as with endogenous depression. In their thoughts, patients constantly return to the events of the misfortune that happened. Patients tirelessly torment themselves that they did not do everything possible to prevent misfortune. Even when the manifestations of a depressive disorder are a little erased, become less acute, the slightest reminder of misfortune can provoke an outbreak of despair. And if in the daytime work helps to distract, then the experienced drama torments the patient for a long time at night, emerges in nightmarish dreams.
Over time, the impact of the stressful situation decreases ("time heals"), and in most cases, depressive disorders completely disappear, leaving no pathological changes. But there are also situations when the primary reactive depressive reaction eventually acquires the properties of endogenous depression (psychogenically provoked melancholia).
Treatment
Treatment of reactive depression should combine drug therapy and psychotherapy sessions. Medications help to relieve the main manifestations of an affective disorder, and psychotherapy helps to cope with grief.
Of the medications, antidepressants (fluvoxamine, fluoxetine, sertraline) are used together with tranquilizers (diazepam, lorazepam, alprazolam). Thanks to the use of antidepressants, patients' mood improves, autonomic and motor manifestations of depression decrease. Tranquilizers relieve emotional tension, anxiety, fears, sleep disturbances.
Of the psychotherapeutic methods for the treatment of reactive depression, they most often resort to individual or family psychotherapy, cognitive, rational psychotherapy.
Reactive depression is a type of depression that, unlike the endogenous form, develops as a result of severe psychological trauma or constant exposure to milder stresses for a certain amount of time. In the reactive form, the patient's condition is usually stably depressed, and it can be extremely severe.
What it is?
Depression has several different forms, which differ in their provoking reasons, the nature of the course, severity, and the presence of other disorders. Reactive depression is one of the most common forms, it usually occurs as a result of external factors, develops quite quickly, almost immediately after psychological trauma. This form of the disease can occur at any age, it does not depend on gender and other features.
The development of the disease in this case, in addition to the traumatic situation, can be affected by the state of human health in general, the genetic predisposition to disorders of this kind. The most common factors provoking reactive depression include events such as the death of a loved one, getting into an extreme situation that threatens life and health. A reactive depressive disorder can develop due to a constant tense stressful environment at work or school, with the loss of a job.
The most common variant of the disease is reactive depression with mild psychopathological symptoms. Depending on the severity of the manifestations of this disease, various treatment options can be prescribed: from simple psychotherapy with a minimum amount of drugs to full hospitalization and rather heavy drugs.
ICD-10 code for depressive disorders F30 - F39. In most cases, psychiatric diseases are named exactly according to the ICD codes, without mentioning the disease itself.
Important! When diagnosing depression, a differential approach is extremely important, since depressive phases occur in other disorders, which, at the same time, have a completely different origin and development mechanisms.
Reactive depression in children and adolescents
The reactive form of the disorder is quite common in childhood and adolescence. Usually, the development of the disease is influenced by problems at school and at home. If parents suppress their child, use not the most positive methods of education, the family is dysfunctional, the likelihood of a disease increases.
At school, this form of depression may occur due to problems with teachers, excessive workloads for which the child is not ready, in the presence of conflict situations with other students.
A child with reactive depression may appear extremely ill-mannered, lazy, aggressive. In children, the symptoms of the disease appear a little more pronounced than in adults. Children often need more help from a therapist to deal with depression.
Important! It is also worth considering that psychological trauma in childhood can be factors in the development of various psychiatric disorders in adulthood.
Symptoms
When making a diagnosis, attention is usually paid to the presence of the following signs of the disorder. Almost all of them should be present to one degree or another, while they can have different severity.
- Symptoms of a shock reaction. These may include anxiety, sometimes for no apparent reason, the rapid development of phobias, mutism, a constant feeling of fear. There may be motor retardation or, on the contrary, constant movement, tics. This condition may persist for several weeks.
- Then the second stage of depression develops. Usually there is increased tearfulness, constant severe fatigue, irritability. Anxiety and constant fear remain, suicidal thoughts and inclinations develop in severe stages, sometimes auditory hallucinations occur. When depression falls self-esteem, there are thoughts about their own uselessness. Sleep and appetite are disturbed.
These are the main symptoms of this disease. In addition, patients with reactive depression may constantly replay memories of past traumatic events in their heads. Patients may feel guilt, regret, come up with ways that would help to avoid a negative situation, its consequences. The patient's thoughts can constantly revolve around the events that caused the psychotrauma.
Important! But sometimes psychological trauma itself is not fixed in the memory of the patient, so the help of a psychotherapist is required to restore traumatic events in memory and work them out.
Differential diagnosis is also commonly used, since similar symptoms can occur with other mental disorders. This requires consultation with a neurologist, conducting various tests and surveys, monitoring the patient's condition for a certain period of time.
How to treat?
For therapy, various methods of correction are used. With severe psychological trauma, therapy with a psychotherapist is usually required. It is important to work through the trauma, understand yourself, working with a psychotherapist will help get rid of fixation on the experience, find ways to solve the problem.
If the condition is extremely severe, various medications may be prescribed to help relieve the main symptoms of depression.
- Various tranquilizers are commonly used, for example, Diazepam, Phenozepam, Atarax and others. The drug is selected depending on the severity of the symptoms.
- Antidepressants such as fluoxetine may be used. Such drugs can adversely affect the body if taken irrationally, therefore, they are prescribed exclusively by the attending physician.
In the presence of suicide attempts or extremely intense suicidal thoughts, hospitalization and stay in the hospital may be required. However, in most cases, with reactive depression, the symptoms begin to disappear with proper work with a psychotherapist. Combined treatments also help to achieve good results.
Prevention
It is extremely difficult to insure against this disorder, since it is impossible to completely avoid stressful situations that can injure the psyche. However, stress tends to accumulate, so when you get into situations or environments that negatively affect the psyche, you need to urgently get out of them, for example, change your place of work if there is a negative environment.
You also need to deal with the consequences of stress in a timely manner, do not suppress aggression, anger, resentment. You need to be able to release negative experiences, you should choose the appropriate methods of working with stress.
Reactive depression is a severe violation of the psychological and emotional state of a person that develops as a reaction to a traumatic event.
Causes of the disease
As the name implies, reactive depression is a reaction to some kind of mental trauma or prolonged exposure to stress. In other words, the patient develops a depressive state after a certain event or a number of such situations occurred in his life, which he perceived as negative.
It should be understood that this disease does not develop for some "standard" reasons. How traumatic an event is for the human psyche is determined by many factors - from social to hereditary. In fact, even whether grief or other negatively colored emotions are transformed into depression largely depends on these factors.
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Risk factors
In the presence of predisposing circumstances, the likelihood of abnormal psycho-emotional depression becomes much higher:
- Belonging to a particular profession. People who, due to professional employment, are often subjected to excessive stress or are forced to bear responsibility for the health and life of other people (doctors, firefighters, law enforcement officials, etc.). In this case, the visible habituation to stresses and resistance to them is in the nature of a “mask”, under which processes constantly occur that weaken the nervous system and depress the psyche.
- social status. Lonely people are more prone to depression, including reactive depression. According to experts, this is due to the inability to discuss with someone the event that caused mental pain and help yourself to reduce the level of anxiety in the process of speaking out your thoughts.
- Alcohol addiction. Being the strongest depressant, alcohol negatively affects the human nervous system. In this regard, the degree of psycho-emotional reactions is inadequate to the real state of affairs, and in the presence of any severely traumatic event, emotions completely get out of control.
- hereditary predisposition. A tendency to psycho-emotional disorders can be transmitted from parents to children, which becomes a risk factor for the development of depressive states for the latter.
- Features of education. People who grew up in families where the manifestation of emotions is considered weakness, as well as those who have witnessed domestic violence, are more prone to depression.
Important: reactive depression often develops after a traumatic event, which is defined as severe by general standards (financial collapse, divorce, death of a loved one).
But sometimes this condition occurs in response to a negative or tragic development of a situation that is personal for the patient.
This may be the loss of a pet, the death of an idol that a person has never met, etc. Therefore, the assessment of the severity of psychological trauma should not occur in terms of generally accepted standards.
Symptoms of the disease
The symptoms that manifest this kind of mental disorder are quite diverse and variable. But their description is more appropriate to address to the relatives and friends of the patient. This is due to the fact that a person suffering from this condition may not be aware of the changes that have occurred to him. Usually he is aware that after a certain event in his life and worldview something “broke”, but he considers this a natural manifestation of grief, sadness, longing and other negatively colored emotions. And those who are close to the sick person need to see in time the signs that a person close to them needs help.
Symptoms of reactive depression can be divided into general (characteristic of any person suffering from this disease) and individual (due to a number of characteristics of the patient's personality).
Common symptoms include the following:
- Emotional depression. If we compare emotions and feelings with the colors of the rainbow, then the sufferer from reactive depression sees them through a dense haze. The colors are muted, the manifestations of joy or fun are distorted - the patient develops a skeptical or even cynical attitude towards any positive aspects. He sincerely does not understand the reasons for someone's joy, considering it something unnecessary and even annoying.
- Changing habitual behavior. The patient ceases to experience pleasure from the activities that he used to like to spend time in, his interests are limited to the traumatic event and everything connected with it. So, if the cause of depression was the death of a loved one from a heart attack, a person may be seriously interested in the methods of treating this disease, mortality statistics, etc.
- Tearfulness. A person suffering from reactive depression has literally wet eyes. Any, at first glance, meaningless detail, can cause a crying attack in a patient. The same applies to any reminders of a traumatic event, and things, sounds, smells, etc., which only the patient himself associates with a negative or tragic situation, can become a reminder. So, thoughts about the death of a loved one can even be inspired by a doorbell, and the patient explains this as “He (the deceased) never called like that.”
- External changes that are visible to others. A person suffering from depression is often stooped and the preferred posture is sitting in a chair/armchair with a hunched back. Often, the patient tightly clenches his palms into fists and clenches his jaw, without noticing this, from the outside it looks like an extreme degree of tension.
Individual manifestations of reactive depression directly depend on the type of personality of the patient, and can vary widely:
- a person begins to avoid any form of communication, closes in on himself, and when trying to start a conversation with him, he answers briefly and in monosyllables, does not support a conversation;
- the patient tries at every opportunity to start talking about the event that traumatized him, obviously trying to relive it, and the conversation builds around the expected development of the situation if the circumstances were different (“If I called an hour earlier”, “If I had not then overslept for work, etc.);
- the emotional picture is dominated by a sense of guilt, which is expressed in regrets that nothing has been done that could change the course of events. With a reasoned explanation that the patient is not to blame for what happened, he finds new "points of application" in order to confirm his guilt;
- the patient experiences an irrational fear that the traumatic event will happen again. He constantly waits for bad news (about someone's death, about being denied a job, etc.).
With a long course of reactive depression, its symptoms may be accompanied by signs of other health disorders, and not only mental ones. So, it is not uncommon for people suffering from depression to develop sleep problems - from difficulty falling asleep to chronic insomnia. Patients have reduced or completely absent appetite, develop disorders of the gastrointestinal tract (dyspepsia, stool disorders, etc.), there is a decrease in libido, etc. Autonomic disorders are manifested by attacks of severe sweating, episodes of rapid heartbeat, etc. Symptoms of reactive depression of a physical nature depend on individual individual health conditions and can vary greatly.
But with all the variety and variability of manifestations, this kind of depression has only two, really “unique” features, by which it is distinguished from other similar conditions:
- Changes in behavior and emotional state always begin to occur after some event, closely related in time to the onset of changes. So, if the loss of a loved one occurred a few months before the onset of the first symptoms of depression, and dismissal from work - a few weeks, then with a high degree of probability it was the second case that provoked the changes. An exception may be situations when, after the first traumatic event (for example, parting with someone), a person did not cease to be subjected to excessive psycho-emotional stress, and one of them (in our example, the loss of a job) played the role of the “last straw”, causing depressive changes.
- Psycho-emotional reactions and changes in behavior exceed the significance of the event and / or their duration exceeds the duration of normal reactions. This distinguishes reactive depression, for example, from grief. A grieving person after some time (usually 2-3 weeks after the tragic event) accepts the fact of death, comes to terms with it, restores social ties and generally returns to his usual way of life. A patient with reactive depression does not have an adequate assessment of the situation, he fixates on a traumatic event and, figuratively speaking, continues to live in it, neglecting work and family responsibilities and his own health.
Important: the described symptoms can be combined in different ways, and with a long course of depression or suppression of the patient's emotions, they can be completely unnoticeable. Only a specialist is able to distinguish, for example, grief or the natural process of adaptation during financial collapse from depression.
Treatment
In the treatment of this disease, the most important thing is how long a person has been suffering from this condition and from manifestations of psycho-emotional depression.
Let's take a closer look at effective methods.
Medical treatment
Depending on the severity of the symptoms, the following groups of drugs may be prescribed:
- Antidepressants (Sertraline, Fluvoxamine, etc.), which alleviate the manifestations of depression, increase positive emotions and eliminate the motor symptoms of depression (stiffness, tightness, obsessive repetitive movements, etc.).
- Tranquilizers (Diazepam, Alprozolam, etc.) reduce the level of anxiety and anxiety, alleviate fears, and improve sleep quality.
With prolonged or severe course of such depression and autonomic disorders caused by this, drugs can be prescribed to normalize heart rate, blood pressure, increase appetite, etc.
Important: the selection of drugs, their dosage and the duration of the course of treatment can only be carried out by the attending physician. Of great importance when choosing drugs is the professional and daily activities of the patient. This is due to the fact that a number of medications have a negative effect on the ability to concentrate and are dangerous for use by people who drive a vehicle, care for young children and are employed in other areas where a decrease in attentiveness poses a potential threat to themselves or others.
Psychotherapy
This disease requires an integrated approach, and for the fastest recovery it is extremely important to "live" the traumatic event and leave it in the past - something that the patient is unable to cope with on his own.
Invaluable assistance in this matter is provided by psychotherapeutic assistance in the form of individual or group sessions conducted under the supervision and guidance of an experienced physician.
The general objectives of the classes are:
- elimination of negative feelings about the traumatic event;
- training in methods of controlling fears and anxiety;
- restoration of adequate psycho-emotional reactions;
- return to normal social and personal life;
- training in the rules of psychological hygiene, which allow preventing such a development of the situation in the future.
If necessary, the psychotherapist supplements the general course of psychotherapy with coursework and trainings that eliminate the so-called "blocks" that "lock" the problem at the subconscious level. In some cases, with the consent of the patient, hypnotherapy can be used.
Important: psychotherapy is a powerful tool for treating this kind of depression. If medical methods are the “first line of defense”, which allows you to quickly eliminate the acute manifestations of depression, then psychotherapy is the most important stage of treatment, restoring the quality of life of a person and preventing complications of depressive states.
Preliminary remarks on the term "depression". Depression means depressed mood. The word "depressive" can explain various phenomena: adequate behavior after a painful loss, conflict reaction and neurosis, personality structure and illness. Depressive symptoms occur in reactive depression (depressive reaction or depressive conflict reaction), depressive neurosis (neurotic depression), endogenous depression (melancholia), depressive syndrome in schizophrenia or organic psychosis. This will be reported in the relevant chapters. To speak simply of "depression" would be an unforgivable oversimplification. Diagnostic differentiation serves as targeted therapy. "Depression" without a more precise definition does not mean anything. The prevalence of depressive disorders in general is about 4-6%, and in outpatient practice at least 10-20%.
frequency and differentiation. "Normal", or better - adequate to the situation, frustration with sad, overwhelming reasons is defined as depression or deprimirovannost. In reactive depression, the patient is also sad about something lost, lost, or taken away. Reactive depression differs from “healthy” adequate sadness in a pattern of greater intensity and longer duration (with the presence of transient somatic complaints) that occurs after an insurmountable conflict.
The depressive neurosis is directed not at one actual conflict, but at a far-reaching harmonious constellation of conflicts. Depressive character neurosis and depressive personality structure are about the same thing. There are wide transitions to depressive reactions.
Melancholia (or endogenous depression) is distinctly different in origin, symptoms and course from reactive and neurotic depression; we are talking about significantly different mental disorders, but they also occur in such people.
Reactions of sadness. If a person suffers from a severe loss, such as the death of a loved one, then a painful mental process of restructuring occurs. Acute sadness often occurs with somatic complaints and autonomic disturbances such as impotence and exhaustion, especially gastrointestinal disturbances. Mental reactions of sadness include alienation and irritability. Behind the hostility is often a sense of guilt. Like painful sadness, they try to overcome it. But only a correct assessment of loss and sadness, reconciliation with loss can (in the sense of active sadness) lead to overcoming a difficult situation and to a new orientation. It is defined as the work of sorrow "after which the fullness of the Self becomes free and unrepressed again" (Freud).
A pathological or morbid situation of sadness is spoken of when it drags on (often for months or even years).
This is based on various reasons: at first, a forced stay in a society that restrains manifestations of longing, often unbearable loneliness and the absence of a partner for conversation, as well as self-flagellation due to real or imaginary errors in caring for the deceased, the remaining unresolved problems with him, while ambivalent attitudes and repressed aggressiveness play a special role in this; on the other hand, the expressed friendships that broke off so suddenly. In detail, these reactions of sadness are as diverse and diverse as human life situations in general.
With manifestations of normal sadness, patients undergo petrification and encapsulation, they have passivity and loss of interest, sometimes sad or aggressive behavior towards others. The mood disorder is already losing touch with the loss. The morbid reaction of sadness is accompanied by significant autonomic disturbances and corresponding hypochondriacal fears, which in organ selection are often associated with the illness of the deceased (identification tendency). Gastrointestinal psychosomatic disorders can lead to ulcerative colitis. Often alcohol and drug abuse.
The painful reaction of sadness is regarded as a model of the depressive reaction in general. It occurs not only in cases of death, but also in the loss of a loved one due to separation, divorce, etc. For differential diagnosis, it should be borne in mind that deeply experienced losses can also cause other mental illnesses, such as melancholy.
Depressive reactions occur with abrupt changes in life relationships, loss of the usual way of life and a trusting atmosphere (for example, during emigration and flight), as well as when changing the field of activity, after moving, retiring, even after going on vacation. It is not the external situation that is decisive here, but the experience of change, the loss of shelter and uncertainty about the new situation. Often, deep-seated resentment and a crisis of self-esteem lie at the heart of depressive reactions.
Depressive neuroses. The reason why many people end up in a dangerous state as a result of insecurity is clear from their life history, from the theme of painful childhood experiences, and not just because of the loss of an atmosphere of love after parting with their mother or breaking family ties. Lack of warmth, hearth and "broken house" - these are often just overestimated winged words. Just as pathogenic can be the excessive care of anxious parents who tie the child to themselves and protect him from the influence of the outside world, and that is why the formation of independence and stamina is difficult.
This "overprotectiveness" reflects the distrust that expresses the mother's repressed aggressive tendencies towards her child. Thus, a “hothouse” educated person remains dependent and in need of support, and reacts depressively to minor changes. When parents become the only constant support and not the possibility of manifestation of aggressive impulses is brought up, a ban on the manifestation of real feelings in problem situations is fixed. The only thing that is allowed to appear in the mind is fear and guilt.
Depressive neurosis is a character neurosis or personality disorder. With their weak severity, they speak of a depressive personality structure in the sense of persistent mental deviations. Depressive-neurotic development, which (from the point of view of psychoanalysis) begins with the oral phase of development, can lead throughout life to latent depressive mood disorders (neurotic depression). At the same time, actual difficulties are an occasion, not a cause. The depressive-neurotic structure is associated with the development of other disorders, especially drug addiction and anorexia.
Oral fixation in neurotic depression may be a regressive response to leaving this early phase with a primary sense of security. If initial certainty is lacking, bondage and separation anxiety develop, and in later life loss of love and separation (and even separation anxiety) always signifies deep narcissistic resentment. Therefore, aggressive impulses arise in relation to another person who is inflexible in something. Since the neurotic cannot realize his aggression, he transfers it to his own person (in healthy people, the opposite happens - shocks and sadness turn into anger and rage).
Psychoanalytically, self-reproaches and suicidal impulses are interpreted by introjection and auto-aggression: they are based in accusations and murderous impulses against others. The ambivalence between the strong need for attachment and the resulting aggressive behavior is the conflict in neurotic depression.
The concept of borderline personality disorders. Severe depressive neuroses (as well as other neuroses and personality disorders) are designated from psychoanalytic positions as borderline states. This is not so much a new diagnosis (and not cases borderline between neuroses and schizophrenia), but the construction of a model that, in the doctrine of the phases of life, connects early childhood experiences with subsequent painful personal developments: the objects of the world are divided into good and evil (such a split is the concept , which is not equivalent to splitting in the doctrine of schizophrenia), which leads to "an active dissection of contradictory introjection and identification." A certain weakness of the ego is characteristic as “an expression of a general insufficiency with otherwise normal functions of the ego” (Kernberg). This deep psychological construction of the borderline personality organization is applicable not only to depressive neuroses, but (non-specifically and beyond the scope of the diagnosis) to other mental disorders, which is confirmed therapeutically, not to mention the described psychotherapy of severe neuroses. Such patients undergo more protective psychotherapy, mainly psychodynamic-integrative. At the same time, the psychotherapist must act more actively (less strictly in restraint or avoidance), he must rather “build bridges” (Kernberg) for the patient, showing special concern for countertransference. This experience is based in part on the psychotherapy of schizophrenia.
Children often have a chronic, personality-dependent depressive mood disorder. It does not manifest itself in everyday life, in relationships with children, it is covered by inconspicuous behavior, but it is clearly revealed in a number of situations and in projective tests. Most often this is the result of severe deprivation in early childhood.
Classification. According to ICD 10, sadness reactions and other depressive reactions, as well as adjustment disorders, are coded in F43.2, depressive neuroses are coded as dysthymia (F34.1).
Therapy. With reactions of sadness, psychotherapy is indicated, but, of course, only when the sadness becomes strong and the patient is not able to overcome it without outside help. The most important is the close relationship between the patient and the doctor, including as protection against suicidal actions. Empathy with the sad events of the past should be given the main attention, but without their Significance remaining dominant. The task of the therapist (not only a doctor, but also an executor, relatives or friends) is to determine the relationship of the patient with the deceased, talking with him as if with a partner, while in order to debunk the idealized image of the deceased, one can move on to specific problems of later life, give advice and help forge new interpersonal relationships. The latter is also useful for depressive reactions in migrants.
In depressive neuroses, careful analytical psychotherapy is indicated in order to get to the roots of pathological development. At the same time, mood disorders may intensify at first, and suicidal impulses become aggravated. Such patients are particularly sensitive to separation anxiety.
Behavioral therapy, especially in its cognitive direction, is quite successful in depressive neuroses.
Antidepressants are indicated only for deep mood disorders, within the framework of depressive-neurotic conditions. Their therapeutic effect is certain, but less than with melancholy. The same applies to indications at this stage for wakefulness therapy. In severe sleep disorders, tranquilizers can be used for a short time. These types of somatotherapy are not a substitute for psychotherapy, but they can contribute to improvement, especially they help patients in crisis.
The prognosis, despite the high suicidality of patients, is better with depressive neuroses than with other forms of neuroses.
Depression can occur in a person for a variety of reasons. Symptoms of depression may be milder or stronger. There are several forms and types of depression, including: reactive depression, postpartum depression, mild depression, clinical depression and other forms.
Reactive depression or reactive psychosis is a mental disorder that occurs with severe shocks that are emotionally significant for a person. Psychic trauma can be caused by difficult events in a person's life, the so-called blows of fate. Such events include the death of a loved one, breakup (divorce), major troubles at work, dismissal, major material losses. Long-term unpleasant situations, although not so severe that cause constant long-term stress, can also cause the development of reactive (psychogenic) depression. Clinic specialists Rehab Family have extensive experience in dealing with such conditions, and will help to get out of them.
Symptoms of Reactive Depression
When the stress passes, the symptoms of depression also gradually disappear, often without leaving noticeable traces in the human psyche. But neuroendocrine factors can be connected to external factors, and then reactive depression turns into endogenous depression.
Main reactive depression symptoms
Immediately after the misfortune, there are signs of acute depression: severe anxiety, tossing, or vice versa, severe lethargy, intense fear and despair.
In the event of a severe loss or shock, any person will experience, showing certain symptoms. But each person reacts differently to the same life situation. A depressive state can be aggravated by adverse factors, which include: pregnancy, severe injuries, somatic diseases, overwork and emotional overstrain.
Treatment for reactive depression
If a person cannot get rid of disturbing symptoms for a long time, then he needs medical help and, possibly, hospitalization. Experienced clinicians Rehab Family using modern techniques, they will carry out complex treatment, provide support and sympathy, and help find a way out of the situation.
To relieve an acute condition in reactive psychosis, antidepressant drugs are prescribed:
- Antipsychotics to relieve fear and anxiety;
- Normotimics to stabilize mood;
- lithium preparations.
Only a comprehensive treatment of reactive depression, an individual, caring approach to the patient, will give good results and a return to normal life.
With reactive depression, violent manifestations of emotions are not typical. Usually the patient becomes silent and withdrawn.
This disease differs from endogenous depression in that a person completely focuses on a traumatic situation. But with this ailment, the patient's experiences are more intense and prolonged than with ordinary grief.
The patient's thought process is focused on the experienced situation. At the same time, he is overcome by feelings of guilt and remorse. The patient exhausts himself, aimlessly analyzing the situation, restoring the event that happened in the smallest detail.
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Reactive depression is a dangerous disease that can lead to significant impairment of psychological functions. So, against the background of an increase in the disease, the patient develops delusional ideas of persecution.
In some cases, depressive arousal causes a short-term explosion of the "affect of a melancholy state", which is expressed in rolling on the floor, loud sobs, suicidal moods.
Causes
The causes of the development of the disease vary depending on the specifics of the disease.
So, with short-term reactive depression (lasting up to 1 month), the disease occurs immediately or after a short period of time after the tragic events. What happened is extremely negative for the patient, it is perceived by him with high intensity and significantly affects his future life.
Another option for the development of the disease is prolonged reactive depression. The cause is chronic stress. It does not have significant intensity, but it affects the patient for a long time.
Events are not considered by the patient as a total crisis. However, chronic stress entails constant emotional tension, which transforms into apathy, detachment. The disease occurs as one of the elements of overcoming negative stimuli.
To diagnose reactive depression, American researchers created a special scale. With its help, the doctor is able to calculate and make an assumption about the presence of this disease in the patient.
The events included the following:
- death of a loved one;
- divorce;
- illness or injury of the patient himself;
- loss of income;
- large debts;
- illness of a loved one;
- problems with law;
- and others.
Each of them is assigned points. Summing up these figures, experts calculate an individual risk indicator for the last year.
A traumatic situation is not the only reason for the development of the disease. Among other things, the following factors influence:
- heredity;
- character traits of the patient;
- brain diseases;
- somatic diseases.
- reactive depression symptoms
Symptoms of Reactive Depression
In acute and prolonging diseases, not only the causes of development differ, but also the symptoms of manifestation. So, in the first case, the patient has the following symptoms, indicating a further reaction:
- panic anxiety;
- weakness;
- pain in the region of the heart;
- lowering blood pressure;
- dizziness;
- tachycardia;
- increased sweating.
Reactive depression itself is expressed by the following symptoms:
- depressing state;
- insomnia;
- refusal of food;
- feeling of hopelessness of the future;
- the appearance of suicidal thoughts;
- development of phobias;
- auditory hallucinations.
These signs, with timely medical intervention, are eliminated quite easily with the help of psychotherapy. However, if reactive depression is manifested by suicidal behavior and panic attacks, then the patient is prescribed medication.
Prolonged disease is manifested by the following symptoms:
- tearfulness for no reason;
- pessimism;
- self-accusation;
- lack of energy potential;
- depressed mood;
- loss of interest in life;
- motor and emotional retardation.
The disease may also be accompanied by additional symptoms:
- insomnia;
- feeling of hopelessness.
The disease causes pain. The patient has physical ailments, but the examination does not reveal any pathology.
Kinds
Experts distinguish the following types of this disease:
| True |
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| in hysterical faces |
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This division is recognized as conditional and is made in accordance with the characteristics of the human psyche. It also matters the attitude of the patient to the outside world.
Forms
There are two forms of reactive depression. Their main difference is the degree of manifestation of symptoms:
| open |
|
| Dessimulative |
|
Treatment
Methods for correcting reactive depression involves the use of a complex of funds. Among them, the drug effects of drugs and psychotherapy should be noted:
| Medicines |
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| Psychotherapy |
|
How to help yourself
In addition to outside help, the patient himself must try to cope with the depressive state that has arisen. The following recommendations will help you get rid of the disease:
- sleep at least 8 hours a day;
- do not hold back tears, as they will bring relief;
- make changes in life, for example, change the interior, throw away old things;
- try not to be alone, alone with your thoughts;
- exercise;
- refuse to make hasty decisions;
- it is necessary to be distracted from anxious states, to have fun more often.