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Anxiety and depressive disorders in women

Vasyuk Yu.A.

Yuri Alexandrovich Vasyuk presented an overview report on the topic of anxiety and depressive disorders in women and the possibility medical correction depression.

Ivashkin Vladimir Trofimovich, Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

I will now give the opportunity to make a message to Professor Yuri Alexandrovich Vasyuk. "Anxiety and depressive disorders in women".

Yuri Alexandrovich Vasyuk,doctor of medical sciences, professor:

Good afternoon, dear colleagues.

Today we will talk about anxiety and depressive disorders in women and the possibilities of their drug correction.

First of all, it is necessary to recall the definition of depression. As you know, depression is characterized by a state of low mood, depression, sadness, a decrease or loss of interest in any activity, a decrease in activity.

If current trends continue, by 2020 depressive disorders will take the second place (after coronary heart disease) among all diseases in terms of the number of years lost due to disability.

Speaking about the epidemiology of depression, it would probably be very revealing to reflect the situation that has developed in such a rich and prosperous country as the United States.

It is known that currently in this country 10 million people suffer from clinically significant depression. Another 20 million have adjustment disorders. The economic burden of depression in the United States is $83 billion.

Great Britain is also no less prosperous country. Even the concept of "the phenomenon of the iceberg of depression" has been introduced. Its essence lies in the fact that only a third of patients with depression turn to doctors. Only a third of the applicants are diagnosed with an affective disorder. This part of the patients is prescribed adequate treatment.

The total cost of depressions in the UK is more than 15 billion pounds. 65% of patients with depression are the result of insufficient diagnosis and untimely correction. 65% of depressed patients have suicidal ideas, 15% of them commit suicide.

Speaking about the risk factors for depression, we can recall quite a lot of adverse circumstances. Anxiety disorder in anamnesis, unfavorable heredity, deficiency social support, postpartum period, drug or alcohol addiction, severe somatic diseases, elderly age, low socioeconomic status. But a special place in this list is occupied by the female gender.

Risk factors for mental disorders in premenopausal women. In fact, there are quite a few disorders. But it is necessary to note the most significant of them. First of all, it is:

• - stressful life events:
• - divorce;
• - childlessness;
• - loss of social security;
• - the presence of mental disorders in history;
• - low level of education;
• - postpartum period, premenopause, oophorectomy, luteal phase of the menstrual cycle.

We will try to briefly discuss all of these conditions.

The so-called "women's depression". This is premenstrual syndrome (PMS). It is characterized by depression in combination with somatic disorders (vegetovascular and neuro-endocrine).

Premenstrual dysphoric disorder - the same, but in combination with pathocharacterological manifestations (up to suicidal thoughts, affective lability).

If we talk about epidemiology, it should be noted that in the population the frequency of PMS is 30 - 70%, depending on age. In mentally ill women, the frequency of PMS is 100%.

The clinical criteria for this syndrome are reduced to the following key positions:

• - PMS occurs 2-14 days before menstruation and disappears with its onset or in the first days of menstruation;
• - it is a complex of vegetative-vascular, metabolic-endocrine and mental disorders;
• - in the premenstrual period, there is an increase in aggressiveness, suicidal activity, the frequency of delinquency and suicidal attempts.

Postpartum depression is also a fairly common situation.

Manifestation or recurrence of endogenous depression. Usually, postpartum depression occurs 10 to 12 days after an uncomplicated delivery without an external cause. The clinical picture is characterized by classic depressive manifestations, anxiety and an atypical form (tearful).

Separately allocate neurotic depression. It manifests itself before childbirth (stress, fear of childbirth) or after childbirth (psychogeny associated with the family and the child). The clinic of neurotic depression is manifested by astheno-depressive and anxious-depressive symptoms.

Another type of depression in women is associated with menopause. Her options are:

• - climacteric depression;
• - psychogenic depression;
• - endogenous depression;
• - involutive depression;
• - depression in surgical menopause.

The emotional-affective syndrome is known to be characterized by:

• - decrease in mood;
• - loss of interest in one's own personality and in the environment;
• - unmotivated anxiety;
• - suspiciousness, anxiety;
• - feeling of inner tension;
• - Anxious fears for one's health, etc.

Asthenic syndrome is very well known to all of us. There is no need, perhaps, to dwell on it for a long time. Suffice it to recall such key manifestations as fatigue, decreased activity, increased vulnerability, resentment, excessive sensitivity, mood lability, tearfulness and irritability.

Somatovegetative disorders occur in almost every second or third woman on an outpatient appointment. This is a heartbeat, arrhythmia, discomfort in the left half of the chest, fluctuations blood pressure(BP), feeling short of breath, dyspeptic disorders, chills, trembling, sweating.

Finally, dissomnic disorders (or sleep disorders). They are manifested in women by an increase in the time to fall asleep, frequent nocturnal awakenings, a low subjective assessment of the quality of sleep, and the so-called sleep apnea syndrome.

A fairly large part of depression in women is occupied by depressive disorders during surgical menopause. The frequency of these disorders (according to some authors) reaches 60 - 80% of cases. But most of the literature indicates the detection of this syndrome in 40 - 45% of patients.

The clinical picture is characterized by a combination of affective (anxious, melancholy, apathetic, dysphoric) and somato autonomic disorders(which we just talked about).

For the treatment of affective disorders of the depressive spectrum, the optimal is combination therapy. Small doses of antidepressants may be used in the treatment of these conditions.

Diagnosis of depression in concomitant somatic pathology. This is a very important point. I would like to draw your attention to the main clinical manifestations. Targeted search for the most significant symptoms depression:

• - yearning;
• - sleep disturbance;
• - feelings of guilt, low self-esteem;
• - suicidal ideas / thoughts about death;
• - the frequency of manifestation of painful symptoms.

This allows in most cases to suspect the presence of a depressive syndrome.

Evaluation of the dynamics of these symptoms (especially the improvement in the background of taking antidepressants) is a direct indication of its presence. In doubtful cases, ex juvantibus treatment is carried out.

It should be noted that, as a rule, depression is masked somatic manifestations. Clinical manifestations of most somatic diseases, which are also characteristic of depression:

• - weakness, fatigue;
• - headache;
• - tachycardia, chest pain;
• - feeling of shortness of breath, tachypnea;
• - arthralgia, myalgia;
• - loss of appetite;
• - constipation, abdominal pain;
• - urination disorder;
• - decreased libido;
• - Disorders of the menstrual cycle.

Very wide range of clinical manifestations. It is very difficult to suspect the presence of an anxiety-depressive disorder with such a spectrum of manifestations.

But if the clinician has such suspicions, it is necessary to use widely available, very simple tools for detecting depression: subjective and objective scales.

Subjective scales: Beck depression questionnaire (BDI), Zung scale.

Objective scales: Hamilton anxiety and depression scales, Montgomery-Asberg scale.

I will not stop your attention on the technology of using these tools. It is described in detail in the literature. A list of questions, answer options, each of which has a certain number of points. Their summation makes it possible to suspect the presence of depression.

(Slide show).

On this slide, a fairly characteristic appearance of a woman with a depressive disorder. Notice the dull look, downcast face. Appearance speaks volumes.

Treatment strategy for depressive disorders menopause reduced to symptomatic treatment, the use of phytoestrogens, hormone replacement therapy, antidepressant therapy, psychotherapy.

Cognitive therapy or psychotherapy is a very important component complex treatment, not an alternative pharmacological treatment, but very actively increases its efficiency. It is aimed at changing self-esteem. The most important thing is to develop emotional self-regulation skills that allow patients to endure difficult stressful situations without sinking into depression.

Even in ancient times, philosophers noted: Man of sense he will never complain about anything, because he understands well that real grief does not come from what happened to him, but from the fact that he thinks unreasonably about what happened. About his attitude towards this stressful situation to the possibility of self-regulation.

Of course, antidepressants are the drugs of first choice. Their common property is a positive effect on emotional sphere, accompanied by an improvement in general and mental condition and, in particular, an improvement in mood.

The therapeutic effect of antidepressants (it must be remembered) develops gradually. It appears, as a rule, within 2-4 weeks from the start of therapy.

unwanted effects. Unfortunately, there are quite a few of them. This:

• - sedative effect (in some medicines especially classic, tricyclic antidepressants);
• - orthostatic hypotension;
• - high potential for drug interactions (especially sedatives, hypnotics, antiarrhythmics, antihypertensive drugs. Most of these drugs are prescribed for patients with cardiac pathology);
• - weight gain is also an undesirable effect of antidepressants (with long-term use of tri- and tetracyclic antidepressants);
• - slow development of the therapeutic effect, the need for dose titration;
• - necessity gradual decline dose of the drug at the end of treatment.

Anxiety and anxiety disorders are a satellite companion of depressive disorders. Anxiety is a feeling of anxiety, nervousness, tension, agitation, foreboding of trouble, internal tension. All these components of anxiety are well known not only to doctors, but also to most of our patients.

The severity of anxiety in stressful conditions ranges from mental discomfort without a clear understanding of the causes of anxiety to the appearance of symptoms of psychological maladaptation of the individual.

Anxiety disorder is a group of neuroses associated with unreasonable and destabilizing feelings of fear and tension for no apparent reason.

We often hear the phrase "anxiety-depressive disorder." They usually accompany each other. If we talk about the symptoms of anxiety, they can be conditionally divided into mental and somatic.

The former include tension, inability to relax, restless thoughts, bad forebodings and fears, irritability and impatience, difficulty concentrating and sleep disturbances.

Somatic include hot flashes or colds, sweating, palpitations, shortness of breath, "lump in the throat", dizziness and headache, trembling, a feeling of "goosebumps", disorders of the gastrointestinal tract, urination disorders, sexual disorders. Very common clinical manifestations.

IN developed countries Anxiety disorders are found in 10-20% of the population.

According to " National Study concomitant diseases» 25% of the world's population has experienced some form of anxiety disorder at least once in their lifetime. Their prevalence among general medical practice is several times higher than in the general population.

I would like to draw your attention to the fact that women suffer from anxiety disorders 2 times more often than men. The cause of these disorders: life, home, husband, child, work.

The medical and social significance of anxiety disorders is very high. They are characterized by the duration of the course, a tendency to recurrence.

Somatization of psychopathological disorders is very frequent occurrence. Patients with anxiety symptoms are 6 times more likely to visit a cardiologist, 2.5-3 times more likely to visit a rheumatologist, 2 times more likely to visit a neurologist, urologist, ENT doctor. According to the data in the literature, a gastroenterologist is consulted 1.5 times more often than in the general population.

The deterioration in the prognosis of concomitant somatic pathology is also a very important component of medical and social disorders. A significant decrease in the quality of life and working capacity, impaired social functioning is a very important medical and social aspect of anxiety disorders.

Speaking of drug therapy used to treat anxiety, you must first turn to tranquilizers (or anxiolytics - anti-anxiety drugs). They are classified into benzodiazepine and non-benzodiazepine ("Afobazol" ("Afobazol"). In addition, the use of antidepressants and herbal preparations.

Undesirable effects of benzodiazepines:

• - sedative and hypnotic effects;
• - the phenomenon of "behavioral toxicity";
• - paradoxical reactions;
• - systemic side effects;
• - the formation of mental and physical dependence, the development of the effect syndrome (rebound effect);
• - high potential for intercellular interaction (especially when combined with a class of drugs with beta-blockers, adrenomimetics, calcium antagonists, ACE inhibitors and ethanol).

Reception is contraindicated at serious illnesses of cardio-vascular system, kidney and liver.

Quite actively used in our time herbal preparations. In particular, "Persen" ("Persen"). It is not by chance that I fixate on this drug, because one of the questions that came to me is related to the desire of the listeners to discuss the issue of the evidence base of Afobazol, Persen and antidepressants.

Weaknesses of herbal preparations:

• - low efficiency- the anxiolytic effect is very weak, as a rule, only when a pronounced sedative effect is achieved;
• - they (in particular, for "Persen") are characterized by the presence of a hypnosedative effect in daytime;
• - individual sensitivity of patients;
• - a large number of side effects that limit the use of the drug (nausea, epigastric pain, dry mouth, abdominal pain, flatulence, diarrhea or constipation, anorexia, anxiety, fatigue, headache);
• - a large number of plant components in combined preparations (which are quite popular in our country), unfortunately, significantly increases the risk of allergic reactions.

St. John's wort is highly recommended in a wide range of practical activities. But it affects the isoenzymes of the cytochrome P450 system and can interact with many drugs metabolized by this particular enzyme. Most of us are like that. At least in cardiology.

Weaknesses of barbiturate-containing drugs ("Corvalol" ("Corvalolum"), "Valocordin" ("Valocordin"), "Valoserdin" ("Valoserdin").

High toxicity. It is manifested by depression of the respiratory and vasomotor centers, a decrease in myocardial contractility and vascular smooth muscle tone.

These drugs are addictive, require higher doses, and are associated with withdrawal symptoms that can lead to complete insomnia, physical and mental dependence.

In most parts of the world, these drugs are not available over the counter. You simply will not be able to enter any of the EU countries with this drug. In most parts of the world, phenobarbital is not used as an anti-anxiety and hypnotic for many years.

The availability of the combined drugs that I mentioned often leads to their uncontrolled use. There are more problems than positive effects.

A few words about "Afobazole". The systemic effects of the new generation anxiolytic "Afobazol" are associated with a vegetotropic effect. "Afobazole" increases heart rate variability under stress, tone n. vagus, which contributes to a better adaptation of the cardiovascular system to stress.

Intravenous administration of "Afobazole" does not cause changes in blood pressure, cardiac output and contractile function of the intact heart.

With occlusion and reperfusion of the coronary artery, Afobazole has an antirhythmic and antifibrillatory effect.

The pharmacodynamics of this drug is due to the fact that it has an anxiolytic effect, not accompanied by a hypnosedative effect. Anxiolytic effect occurs on the 5th-7th day from the start of treatment. The maximum effect - by the end of the 4th week of treatment.

What are the features of "Afobazol". Drug dependence is not formed and withdrawal syndrome does not develop. There are no muscle relaxant properties and a negative effect on memory and attention indicators, cognitive disorders.

To the question that I received: what is the evidence base for antidepressants and Afobazol?

A lot of research has been done with this drug. The format of our meeting does not allow me to dwell on many of them in detail. But I will try to do it.

IN Science Center obstetrics and gynecology and perinatology, an open clinical study was conducted. 56 patients with uterine myoma and a control group - 32 healthy women. It has been shown that anxiety symptoms are detected in 72% of patients with uterine myoma and mastopathy. You see, what a large percentage of affective disorders.

Afobazole reduced sympathetic influences, restored compensatory and adaptive response mechanisms, and reduced the frequency of emotional and disturbing symptoms in these patients by 2.5 times. Afobazole was well tolerated.

Another open, non-comparative clinical trial was conducted at the First Moscow Medical Institute (Perinatal Center) and City Clinical Hospital No. 29 in Moscow. It studied the effect of "Afobazole" on PMS in women with autonomic disorders.

Results. The appointment of "Afobazol" was associated with a decrease in the severity of vegetative disorders. The most pronounced effect was observed with sympathicotonia. The maximum effect is by the end of the 4th week. The effect persisted for two weeks after completion of therapy.

Another open non-comparative clinical trial. It included women with psychopathological climacteric disorders. Appointed "Afobazol". Its effect was compared with other psychotropic drugs ("Diazepam" ("Diazepam"), "Mebikar" ("Mebicarum").

It was shown that the normalization of mood against the background of the use of "Afobazole", the disappearance of anxiety disorders, emotional lability, a decrease in depressive manifestations were noted already on the 5-6th day of therapy.

In comparison with Diazepam, Afobazole more often stopped or significantly weakened psychopathological manifestations. climacteric syndrome within the asthenic variant. More often than Mebicar, it stopped the manifestation of anxiety and depressive disorders.

Also in the group of patients treated with "Afobazol", there was a decrease in vegetative-vascular manifestations already in the second week, the disappearance of lethargy, fatigue, asthenic manifestations. Normalization of sleep in most patients.

The use of "Afobazole" in the treatment of anxiety and depressive disorders in surgical menopause. A very important group of patients was studied in an open, non-comparative, controlled study. It included women with surgical menopause.

It was shown that treatment with "Afobazole" (20 mg/day for three weeks) led to an improvement in well-being, mood, a decrease in the frequency of headaches, and a decrease in disorders of the gastrointestinal tract and respiratory organs.

Side effects are not registered.

Indications for use are already clear from what I said:

• - anxiety states: generalized disorders, adaptation disorders, as a pre-depressive state in patients with various somatic diseases. Also for dermatological, oncological diseases;
• - sleep disturbances associated with anxiety;
• - cardiopsychoneurosis;
• - PMS;
• - alcoholic withdrawal syndrome;
• - to alleviate the withdrawal syndrome when quitting smoking.

Contraindications:

• - individual intolerance;
• - period of pregnancy or lactation;
• - childhood.

Side effects of "Afobazole":

• - increased individual sensitivity;
• - possible allergic reactions;
• - rarely - headache;
• - does not cause addiction;
• - does not cause drowsiness;
• - does not affect the concentration of attention and memory (can be used by people whose activities require increased attention and quick response).

The scheme of application of "Afobazole" is quite well known. 1 tablet 3 times a day for 2-4 weeks. If necessary, the dose can be increased to six tablets per day, and the course of treatment is prolonged up to three months.

Speaking about the benefits, once again I would like to emphasize a very high security profile. Convenient release form. Low potential of intercellular interaction.

(Slide show).

A completely different face: glowing bright eyes, a smile! Full of energy, cheerful woman.

Questions and answers

In the remaining 2 minutes I will try to answer the questions I received.

? Whether there is a non-drug treatment depression?

Undoubtedly. We have already said that non-drug treatment is rational psychotherapy. Enough effective method. It should be noted that it is used not as an alternative, but as an addition to psychopharmacotherapy. Only then can a sufficiently good effect be achieved.

? Does Hormone Replacement Therapy Reduce Depression in Menopausal Women?

Certainly. I spoke about it. The format of our meeting does not allow me to dwell on this in detail. But in consultation with a gynecologist-endocrinologist, it can significantly increase the effectiveness of the treatment of these patients. Naturally, the appointment of hormone replacement therapy.

? Does depression in men matter less, both socially and economically?

The question is philosophical. But psychiatrists, psychoneurologists, psychotherapists believe that depression in women still develops more often. In my opinion, there is no need to prove it for a very long time. This is an obvious fact.

? When are antidepressants indicated?

The question is rather difficult. I have already spoken about the use of scales in testing patients. When you gain a certain number of points (more than 20), it is advisable to consult a psychiatrist. It must be borne in mind that in our country the number of psychiatrists is about 10 thousand people. The number of patients with anxiety-depressive disorders…

45% of patients of all somatic patients on an outpatient appointment have an anxiety-depressive disorder. 25% of them have clinical manifestations that require correction. Psychiatrists, therapists, cardiologists have agreed that when using modern antidepressants in small doses, with a moderate regimen, depression can be treated with antidepressants and non-psychiatrists.

It is difficult to say in a nutshell about prescribing antidepressants. This is a separate issue.

Thank you for attention.

Vladimir Ivashkin: Thank you very much, Yuri Alexandrovich.

(0)

He is aware of his condition and is critical of it.

Anxiety disorders, according to the international classification of diseases, are divided into 5 groups, one of which is referred to as mixed anxiety-depressive disorder, which will be discussed.

Competition between anxiety and depression

The name already hints at the fact that this type of disorder is based on 2 conditions: depression and anxiety. However, none of them are dominant. Both conditions are pronounced, but it is impossible to make a single diagnosis. Either anxiety or depression.

It is only characteristic that, against the background of depression, anxiety increases and takes on enormous proportions. Each of these conditions amplifies the effect of the other syndrome. Reasons for some fears and anxieties are present, but very insignificant. However, a person is in an enduring nervous overstrain, he feels a threat, a lurking danger.

The insignificance of the factors that cause anxiety personality disorder is combined with the fact that in the patient's value system the problem grows to a cosmic scale, and he does not see a way out of it.

And eternal anxiety blocks an adequate perception of the situation. Fear generally prevents thinking, evaluating, making decisions, analyzing, it simply paralyzes. And a person in this state of spiritual and volitional paralysis goes crazy with hopelessness.

Sometimes anxiety is accompanied by unmotivated aggressiveness. Huge internal tension, which is not resolved in any way, provokes the release of stress hormones into the blood: adrenaline, cortisol, they prepare the body for fight, rescue, flight, defense.

But the patient does none of this, remaining in a potential state of anxiety and restlessness. Can't find a way out active actions, stress hormones begin to purposefully poison the nervous system, from this the level of anxiety grows even more.

A person is taut like a bowstring: muscles tense, tendon reflexes increase. He seems to be sitting on a barrel of gunpowder, terribly afraid that it will explode and still does not move. Maybe depression overshadows anxiety and prevents the unfortunate person from taking steps to save. In a specific case, salvation from a state that kills him.

• thundering heartbeats, which are clearly felt in the head;
• the head, naturally, is spinning;
• hands and feet tremble, there is not enough air;
• a feeling of "drying" of the mouth and a coma in the throat, a fainting state and the impending horror of death complete this picture.

Panic attack in anxiety disorders

Anxiety-depressive disorder, which is combined with panic attacks, is common.

Anxiety neurosis, simply put, fear, can always go to its extreme degree - panic. Panic attacks have over 10 symptoms. Less than 4 signs do not give grounds for making a diagnosis, and four or more - this is directly a vegetative crisis.

Symptoms that indicate the development of PA:

• palpitations, pulse and general pulsation of blood vessels, the condition is felt as if something is pulsating in the whole body;
• severe sweating (sweat hail);
• shaking chill with trembling of arms and legs;
• a feeling of lack of air (it seems that you are about to suffocate);
• choking and shortness of breath;
• sensations of pain in the heart;
• severe nausea with urge to vomit;
• severe dizziness (everything "rides" before the eyes) and fainting;
• violation of the perception of the environment and self-perception;
• fear of insanity, feeling that you are no longer able to control your actions;
• sensory disturbances (numbness, tingling, cold hands and feet);
• flushes of heat, waves of cold;
• Feeling like you could die at any moment.

Panic attacks with anxiety depressive syndrome occur when anxiety in this mixed disorder is more pronounced than depression. The presence of panic allows a more accurate diagnosis.

The peculiarity of these attacks is that they are always associated with a certain phobia. Panic is a state in which horror is combined with a feeling of impossibility to escape from it. That is, there are insurmountable obstacles for escape.

For example, panic attacks can suddenly occur on the street, in a store, in a market, a stadium (fear of open spaces). An attack can also occur in an elevator, subway, train (fear of closed spaces).

Attacks are short (from a minute to 10), are long (about an hour). They can be either single or cascading. They appear a couple of times a week, but sometimes the number of attacks may be less, or may be twice the usual rate.

Causes of Anxiety and Depressive Disorders

Anxiety depression can be caused by the following causes and factors:

1. Strong short-term stress, or chronic, taking the form of an illness.
2. Physical and mental overwork, in which a person "burns out" from the inside.
3. A family history of such disorders.
4. A long, serious illness, a grueling struggle with which is equated to the question "to live or not to live."
5. Uncontrolled intake of drugs of the group of tranquilizers, neuroleptics, antidepressants, or anticonvulsants.
6. "The roadside of life" is a state in which a person feels "excluded" from life. This happens with the loss of a job, unsustainable debts, the inability to provide yourself with a decent standard of living, more and more failures in finding a job. The result is a state of hopelessness and fear for one's future.
7. Alcoholism and drug addiction, which deplete the nervous system, destroy brain cells and the body as a whole, which leads to severe somatic and psychosomatic disorders.
8. age factor. Pensioners who do not know what to do with themselves, women during menopause, adolescents in the period of the formation of the psyche, men who are in a “midlife crisis”, when you want to start life anew and change everything in it: family, work, friends, yourself.
9. Low level of intelligence, or education (or both). The higher the intellect and level of education, the easier a person copes with stress, understanding the nature of their occurrence, a transient state. In his arsenal there are more means and opportunities to cope with temporary difficulties, without launching them to the extent of psychosomatic disorders.

Side and inside view

Anxiety depressive disorder has characteristic outlines and symptoms:

• complete or partial loss of a person's skills to adapt to the social environment;
• sleep disturbances (night awakenings, early rises, long falling asleep);
• identified provocative factor (losses, losses, fears and phobias);
• appetite disturbance (poor appetite with weight loss, or, conversely, “jamming” of anxiety and fears);
• psychomotor agitation (erratic motor activity: from fussy movements to "pogroms") along with speech arousal ("verbal eruptions");
• panic attacks are short or prolonged, one-time or repeated;
• suicidal ideation, suicide attempts, committed suicide.

Establishing diagnosis

When establishing a diagnosis, standard methods and an assessment of the clinical picture are used.

• Zung scale - a test for determining depression and the Beck Depression Inventory are used to determine the severity of a depressive state;
• the Luscher color test allows you to quickly and accurately analyze the state of the individual and the degree of his neurotic deviations;
• The Hamilton scale and the Montgomery-Asberg scale give an idea of ​​the degree of depression, and based on the test results, the method of therapy is determined: psychotherapeutic or medication.

Assessment of the clinical picture:

• presence of anxiety depressive symptoms;
• the symptoms of the manifestation of the disorder are an inadequate and abnormal response to a stressor;
• time of existence of symptoms (duration of their manifestation);
• the absence or presence of conditions under which symptoms appear;
• the primacy of symptoms of anxiety and depressive disorders, it is necessary to determine whether the clinical picture is a manifestation of a somatic disease (angina pectoris, endocrine disorders).

The path to the "right doctor"

An attack that happened for the first time is usually not regarded by the patient as a symptom of the disease. It is usually written off as an accident, or they independently find a more or less plausible reason that explains its occurrence.

As a rule, they try to determine in themselves internal illness that caused these symptoms. A person does not immediately get to the destination - to a psychotherapist.

A trip to the doctor begins with the therapist. The therapist sends the patient to a neurologist. The neurologist, finding psychosomatic and vegetative-vascular disorders, prescribes sedatives. While the patient is taking medication, he actually becomes calmer, disappear autonomic symptoms. But after stopping the course of treatment, the attacks begin to recur. The neuropathologist makes a helpless gesture and sends the sufferer to a psychiatrist.

The psychiatrist relieves not only from attacks for a long time, but also from any emotions in general. Intoxicated with heavy psychotic drugs, the patient is in an off state for days, and looks at life in a sweet half-asleep. What fears, what panic!

But the psychiatrist, seeing "improvements", reduces lethal doses of antipsychotics, or cancels them. After some time, the patient turns on, wakes up and everything starts all over again: anxiety, panic, fear of death, an anxiety-depressive disorder develops, and its symptoms only get worse.

The best outcome is when the patient immediately goes to a psychotherapist. A correct diagnosis and adequate treatment will greatly improve the patient's quality of life, but when the drugs are discontinued, everything can return to normal.

Usually there is a consolidation in the mind of cause-and-effect relationships. If a panic attack has overtaken in a supermarket, a person will avoid this place. If in the subway, or in the train, then these modes of transport will be forgotten. Random appearance in the same places and in similar situations can cause another panic syndrome.

The whole range of therapies

Psychotherapeutic help is as follows:

• method of rational persuasion;
• mastering the techniques of relaxation and meditation;
• sessions with a psychotherapist.

Medical treatment

In the treatment of anxiety-depressive disorder, the following groups of drugs are used:

1. Antidepressants (Prozac, Imipramine, Amitriptyline) affect the level of biologically active substances V nerve cells(norepinephrine, dopamine, serotonin). Drugs relieve symptoms of depression. In patients, the mood rises, longing, apathy, anxiety, emotional instability disappear, sleep and appetite normalize, and the level of mental activity increases. The course of treatment is long due to the fact that the pills for depression do not work immediately, but only after they accumulate in the body. That is, the effect will have to wait a couple of weeks. Therefore, paired with antidepressants, tranquilizers are prescribed, the effect of which manifests itself after 15 minutes. Antidepressants are not addictive. They are selected individually for each patient, they must be taken strictly according to the scheme.
2. Tranquilizers (Phenazepam, Elzepam, Seduxen, Elenium) successfully cope with anxiety, panic attacks, emotional stress, somatic disorders. They have a muscle relaxant, anticonvulsant and vegetostabilizing effect. They act almost instantly, especially in injections. But the effect will end sooner. Tablets act more slowly, but the result achieved lasts for hours. The courses of treatment are short due to the fact that the drugs are highly addictive.
3. Beta-blockers are necessary if the anxiety-depressive syndrome is complicated by autonomic dysfunction, they suppress vegetative-vascular symptoms. They eliminate pressure surges, increased heartbeat, arrhythmia, weakness, sweating, tremors, hot flashes. Examples of drugs: Anaprilin, Atenolone, Metoprolol, Betaxolol.

Physiotherapy methods

Physiotherapy is an important part of the treatment of any psychosomatic conditions. Physiotherapy methods include:

• massage, self-massage, electromassage relieves muscle tension, soothes and tones;
• electrosleep relaxes, calms, restores normal sleep.
• electroconvulsive treatment stimulates brain activity, increases the intensity of its work.

Homeopathy and alternative treatment

Herbal medicine is a treatment with medicinal herbs and soothing herbal preparations:

• ginseng - stimulating tincture, or tablet forms of the drug, increases efficiency, activity, relieves fatigue;
• motherwort, hawthorn, valerian have an excellent calming effect;
• lemongrass tincture is a powerful stimulant, which is especially indicated for depression with its ability to awaken apathetic, lethargic, inhibited citizens to an active life.

• gentian grass - for those who are discouraged;
• Arnica Montana - a drug that eliminates both depressive and anxiety symptoms;
• Hypnosed - removes insomnia, strong excitability;
• Elm leaves and bark - increases endurance, relieves fatigue.

Syndrome prevention

In order to always be psychologically stable, the following conditions must be observed:

• do not dwell on negative emotions;
• organize a “health zone” around you, that is: give up nicotine, alcohol, eat right, move actively, do feasible sports;
• do not overwork either physically or mentally;
• get enough sleep;
• expand your "comfort zone": communicate and meet people, travel, visit clubs of interest;
• find an activity for yourself that will captivate you with your head and leave no room for anxious thoughts and depressive states in it.

Far reaching consequences

When ignoring pathological symptoms you can purchase a set of bodily and mental ailments:

• an increase in the number and duration of panic attacks;
• development of hypertension, cardiovascular diseases;
• violation of the functions of the digestive system, the development of peptic ulcer;
• the occurrence of cancer;
• the development of mental illness;
• fainting and convulsive syndromes.

The quality of life of patients, their professional skills, and marital relations also suffer greatly. Ultimately, all this can lead to the fact that a person ceases to somehow interact with society and acquires a fashionable disease - social phobia.

The saddest and irreversible complication is the situation when a person commits suicide.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

How does anxiety-depressive syndrome manifest itself?

Anxiety-depressive syndrome is one of the neuroses, which manifests itself in feelings of anxiety, blues, melancholy and depression. This disorder is treatable if the person is aware of their problem and sees a doctor. Such an ailment can be treated not only by a psychiatrist, now cardiologists, psychotherapists, and neuropathologists are also doing this.

The reasons for such a neurosis are troubles in personal life, in the professional field, unpleasant life events that have become a severe trauma for the psyche. But you should not postpone contacting a specialist, it is better to fix the problem in the early stages, when it is much easier and faster to cure it.

Symptoms of the disorder

Anxiety-depressive syndrome, symptoms, its treatment is carried out depending on the clinical manifestations and the stage of development of the pathology. signs this disorder in many ways similar to those of other neurological disorders Therefore, diagnosing such a condition is sometimes quite difficult. The main symptoms of the disorder are:

1. Feeling of inferiority, which is accompanied by guilt, low self-esteem.
2. The appearance of suicidal thoughts and inclinations.
3. Rapid or labored breathing.
4. Tachycardia, chest pain.
5. Weakness, fatigue.
6. Frequent headaches, sometimes quite intense.
7. Sleep disorders.
8. Longing, depression, tearfulness.
9. Decreased sex drive.

Also, in addition to the listed signs, problems with stools, urination, and many other symptoms are sometimes noted that a person does not even associate with psychological problems.

But before real troubles, there is no feeling of fear, only vague feelings of danger appear. This creates a vicious circle. The feeling of constant anxiety provokes the production of adrenaline, which contributes to the appearance nervous excitability and anxiety.

All symptoms of neurosis are divided into 2 large categories. These include clinical signs and vegetative manifestations. TO clinical signs can be attributed:

1. Permanent drastic changes in an emotional state.
2. Increased restlessness and constant feeling of anxiety.
3. Constant sleep problems.
4. Constant worries about relatives, the expectation that something negative will happen.
5. Regular stress, anxiety, which does not allow you to fall asleep normally.
6. Rapid fatigue, weakness.
7. Deterioration of concentration of attention, speed of thinking, ability to work, perception of new information.

Vegetative signs include:

1. Frequent increased heartbeat.
2. Shiver.
3. Feeling of a lump in the throat.
4. Increased sweating, the appearance of moisture in the palms.
5. Flushes of heat or chills.
6. Frequent urination.
7. Violations of the stool, the appearance of pain in the abdomen.
8. Myalgia, muscle tension.

Neurosis is often accompanied by depression. To make such a diagnosis, it is necessary to collect common symptoms that last for weeks or even months.

Who has an increased tendency to neurosis?

Women are the main risk group. This is due to greater emotionality, receptivity, responsibility for both the family and career. If a woman does not know how to relax and relieve emotional stress, she is prone to neurosis. Factors provoking aggravation of the condition include changes in hormonal background, period of bearing a child, menstruation, postpartum period, menopausal changes. Risk factors for the onset of the disorder include:

1. Lack of work. During this period, there is an acute sense of being thrown out of the working world, the inability to provide for oneself on one's own, the constant search for work, which is futile. Stress provokes the appearance of the first sign of disorder.
2. Narcotic substances and alcoholic beverages. Such addictions destroy a person's personality, leading him to permanent depression. And constant depression provokes a search for a way out, which a person is looking for in a new dose. So a vicious circle is formed, it is often impossible to break it without recourse to outside help.
3. Bad heredity. It has been proven that in children of mentally ill people this disorder appears more often.
4. Advanced age. During this period, a person acutely feels the loss of his social significance in connection with retirement. Children have grown up, they have their own families, they feel less need for parents, friends and soulmate leave, there is less and less communication. Such people need constant support, their involvement in the lives of their children and grandchildren, they must feel their importance.
5. Serious somatic diseases. A severe form of depression is often provoked by the appearance of an incurable disease in a person.

Therapy for the disorder

After staging accurate diagnosis the specialist prescribes complex treatment. It consists in taking medications that are combined with psychotherapy. The psychological impact in this neurosis is aimed at raising self-esteem, increasing control over one's emotions, developing stress resistance, and fighting depression.

Drug therapy consists in the use of tranquilizers, anti-anxiety drugs, herbal preparations. The main thing is to visit a specialist who will conduct competent therapy, it is unacceptable to self-medicate and make diagnoses on your own.

Often the doctor prescribes antidepressants and tranquilizers. They contribute to the regulation of vegetative processes in the body, normalize and streamline them. Such drugs help to calm the nervous system, improve the quality of sleep, and regulate the concentration of stress hormones in the blood. Such complex therapy is very effective. Treatment lasts at least a month.

In addition to medical treatment, it is also necessary to visit a psychologist. The likelihood of developing an anxiety-depressive syndrome increases if a person is constantly experiencing any stress very hard, if he is not used to solving problems, but tends to keep everything in himself and silently endure if the state of affairs does not suit him.

Behavioral psychotherapy in this case will be the best addition to drug treatment, enhance its effectiveness and help get rid of the problem faster.

The main thing is that a person himself understands his problem and strives to solve it.

If he learns to live fully and deal with frequent emotional stress, he will be able to overcome the disorder.

Anxiety-depressive disorder

It is known that depression is an actual problem in people of the 21st century. It develops due to high psycho-emotional stress associated with the accelerated rhythm of life. Depressive disorders significantly reduce the quality of human life, so you need to learn how to observe personal mental hygiene.

Causes of Anxiety Disorder

The anxiety-depressive syndrome belongs to the group of neuroses (ICD-10), and is accompanied by various kinds of physical and mental disorders. The most common causes of depression are:

• hereditary predisposition to depression;
• many stressful situations;
• organic changes in the state of the brain (after bruises, injuries);
• prolonged anxiety and depressive symptoms;
• deficiency in the body of serotonin and essential amino acids;
• taking barbiturates, anticonvulsants and estrogenic drugs.

Symptoms of a disease of the nervous system

The main symptom of an anxiety-depressive disorder is constant groundless anxiety. That is, a person feels an impending catastrophe that threatens him or his loved ones. The danger of an anxious and depressive state lies in a vicious circle: anxiety stimulates the production of adrenaline, and it pumps up negative emotional stress. Patients who have this personality disorder complain of lack of mood, systematic sleep disturbance, decreased concentration, accompanied by chills and muscle pain.

postpartum depression in women

Many women experience anxiety-depressive symptoms immediately after childbirth, which is called childhood sadness. The condition lasts from several hours to a week. But sometimes depression and anxiety in young mothers takes severe form which can last for months. The etiology of anxiety is still not exactly known, but doctors name the main factors: genetics and hormonal changes.

Types of depressive disorders

Anxiety differs from true fear in that it is a product of an internal emotional state, subjective perception. The disorder manifests itself not only at the level of emotions, but also by body reactions: increased sweating, heart palpitations, and indigestion. There are several types of this disease, which differ in symptoms.

generalized anxiety

With this syndrome, the patient experiences chronic anxiety, not knowing the cause of the condition. Manifested anxious depression fatigue, disruption of the digestive tract, restlessness, insomnia. Often, a depressive syndrome is observed in people with panic attacks or alcohol addiction. Generalized anxiety-depressive disorder develops at any age, but women suffer from it more often than men.

anxiety-phobic

It is known that a phobia is medical name exaggerated or unrealistic fear of an object that does not pose a danger. The disorder manifests itself in different ways: fear of spiders, snakes, flying on an airplane, being in a crowd of people, sharp objects, bathing, sexual harassment, and so on. With anxiety-phobic syndrome, the patient has a persistent fear of such a situation.

mixed

When a person has several symptoms of depression for a month or more, doctors diagnose mixed anxiety-depressive disorder. Moreover, the symptoms are not caused by the use of any drugs, but worsen the quality of the social, professional or any other sphere of the patient's life. Main features:

• thought retardation;
• tearfulness;
• sleep disturbance;
• low self-esteem;
• irritability;
• difficulty concentrating.

Diagnosis of depressive disorders

Questioning remains the main method of diagnosing depression in a patient. The identification of symptoms of depression is facilitated by a trusting atmosphere, a sense of empathy, and the doctor's ability to listen to the patient. Also in the practice of psychotherapy, a special scale of depression and anxiety HADS is used to determine the level of pathology. The test does not cause difficulties for the patient, does not take much time, but gives the specialist the opportunity to make the correct diagnosis.

Treatment of anxiety-depressive syndrome

The general strategy for the treatment of anxiety and depressive disorders is to prescribe a complex of drugs, homeopathic remedies, herbal remedies and folk recipes. Of no small importance is behavioral psychotherapy, which greatly enhances the effect of drug therapy. The complex treatment of anxiety-depressive syndrome also includes physiotherapy.

Preparations

Drug treatment helps to get rid of depression-anxiety disorder. There are many types of drugs with psychotropic effects, each of which affects its clinical symptoms:

1. Tranquilizers. Powerful psychotropic medications used when other treatments for depression have failed. They help to get rid of internal tension and panic, reduce aggression, suicidal intentions.
2. Antidepressants. Normalize the emotional state of a person with obsessive-compulsive disorder ( obsessive states) to prevent exacerbation.
3. Antipsychotics. Assign with inadequate emotions of the patient. Drugs affect the area of ​​the brain that is responsible for the ability to perceive information and think rationally.
4. Sedatives. Sedative medicines, which are used to eliminate nervous tension, normalize sleep, reduce the level of excitability.
5. Nootropics. They affect areas of the brain to increase efficiency, improve blood circulation.
6. Alpha and beta blockers. Able to turn off receptors that respond to adrenaline. Increase blood glucose levels, sharply narrow the lumen blood vessels regulate vegetative processes.

Psychotherapeutic methods

Not every person with an anxiety-depressive disorder needs medication or hospitalization. Many psychiatrists prefer to treat depression in children and adults with psychotherapeutic methods. Specialists develop a variety of methods, taking into account gender characteristics, adapted to different social groups. Some patients are more suited to single consultations, while others show excellent results with group treatment.

Cognitive Behavioral Therapy

Anxiety disorder can be treated with cognitive behavioral therapy. It is used to treat a wide range of depressive symptoms, including addiction, phobias, and anxiety. During the course of treatment, people identify and change their destructive thought patterns that affect their behavior. The goal of therapy is that a person can take control of any concept of the world and interact positively with it.

Hypnosis

Sometimes the effect of hypnosis on a patient with a depressive disorder is the most effective therapeutic method. Thanks to modern trance techniques, negative attitudes and perceptions of reality change in a person. With the help of hypnosis, patients quickly get rid of gloomy obsessive thoughts, chronic depression. Anxious personality disorder in a person passes, he receives a powerful boost of energy and a long-lasting feeling of inner satisfaction.

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Depressive and anxiety disorders

Anxiety The issue of raising the awareness of doctors on the diagnosis and treatment of common psychopathological disorders - depression and anxiety - is becoming more and more relevant every day.

IN modern conditions, given the significant prevalence of these psychopathological disorders, especially among patients with somatic pathology, and the emergence of new, safer antidepressants, the diagnosis and treatment of mild and moderate depression in most countries of Europe and North America is carried out by first-line physicians, as well as internists, cardiologists, neurologists , gastroenterologists, etc., 80% of antidepressants in Western Europe, the USA and Canada are not prescribed by psychiatrists.

The International Psychiatric Association and the International Committee for the Prevention and Treatment of Depression have introduced educational program on the diagnosis and treatment of depressive disorders, which has been implemented in many regions. In 1998 this program was started in Russia, in 2002 the materials were published in Ukraine. Over the past years, the number of scientific publications on this issue in Ukraine has been increasing, but practical implementation remains insufficient. There is also no national training program for specialists. Most doctors note the importance of this problem, but do not consider themselves competent in surveys of the diagnosis and treatment of depression. Therefore, it is especially important for doctors of all specialties to master the skills of diagnosing and treating depressive and anxiety disorders.

Depression is divided into: psychogenic, endogenous and somatogenic. Psychogenic depressive disorders occur as a consequence or under the influence of psychological and stressful causes. Endogenous depressive disorders are those depressions that develop in schizophrenia and manic-depressive psychosis. Somatogenic depressive disorders are observed in various somatic diseases (cardiovascular, endocrine, gastrointestinal tract, etc.). Depression can also occur in case of intoxication of the body, infectious diseases, drug addiction and alcoholism. Quite often in clinical practice so-called latent depressions are observed, when the actual depressive symptoms are masked as a violation in the work of various organs and systems, persistent headaches, changes in sleep and are not recognized by the patient as such.

According to the World Health Organization, from 10 to 20% of the world's population during their lives note the occurrence of clinically pronounced depressive conditions. According to the results of epidemiological studies, every eighth inhabitant of our planet needs specific pharmacotherapy in connection with depressive states. In 60% of cases, as a rule, in case of insufficiency or inadequate therapy, repeated depressive episodes occur. Nearly half of people with depression do not see a doctor, and about 80% are treated by internists and general practitioners.

The development of depressive disorders is associated with a violation of the metabolism of the main neurotransmitters: serotonin, norepinephrine and dopamine in the central structures of the brain (limbic system), which are involved in assessing the emotional significance of information that enters the central nervous system (CNS) and forms the emotional component of human behavior. The two-way causal relationship of depression with the state of internal organs and somatization of symptoms of depression can be explained by the close relationship of the central structures and the cerebral cortex with the centers of the autonomic nervous system and endocrine regulation.

Depression is diagnosed in 20% of patients with coronary heart disease (CHD), in 30-50% of patients after myocardial infarction and in 30-50% after a stroke. The importance of influencing psycho-emotional factors was confirmed in the INTERHEART studies, where their contribution to the risk of developing acute myocardial infarction was not inferior to diabetes and smoking. Over the past few decades, the relationship between depression and prognosis in patients with coronary artery disease has been studied in more than 60 international prospective studies. It was found that severe depression in patients with angiographically confirmed coronary heart disease is the most significant isolated predictor of coronary events throughout the year. The mortality rate of patients who have a history of myocardial infarction and suffer from depression is 3-6 times higher than in people without signs of depression. In the case of depression, patients often do not follow the recommendations of doctors regarding treatment. Considering important role depressive disorders in patients with coronary artery disease, the American Heart Association developed and introduced in 2008 the Depression and CHD Guidelines for Screening and Treatment, which focuses on the need for screening to identify individuals with CHD and depression who require additional treatment . In addition, results from the ENRICHD study showed that a group of depressed patients who had an acute myocardial infarction and received serotonin reuptake inhibitors had a 42% reduction in the incidence of death or recurrence of myocardial infarction compared with the rate in patients with depression who did not antidepressants were prescribed.

In most patients, the manifestation of depression is closely associated with anxiety disorders. Anxiety is a normal reaction of the human body to adverse life factors. But if it occurs without a reason or in severity and duration exceeds the real significance of the event and worsens the patient's quality of life, then this condition is regarded as pathological.

Anxiety disorder is characterized by manifestations of internal tension, inability to relax and concentrate. Characteristic are constant internal tension and increased sweating. Patients show increased anxiety during the performance of daily work and make pessimistic forecasts, they, in most cases, have difficulty falling asleep. Phobias, or fears, are also manifestations of anxiety disorders. The results of epidemiological studies show that anxiety disorders occur in 25% of the population throughout life.

Symptoms of anxiety disorders are diagnosed in 10-16% of patients who turn to general practitioners. According to the results of modern scientific research an increased risk of cardiovascular complications was noted in patients with anxiety disorders. Among the mechanisms being considered, the main role belongs to an increase in the level of serotonin-mediated platelet reactivity in patients with coronary artery disease and comorbid anxiety (the existence of independent correlations between anxiety and platelet function has been proven). At the same time, platelet reactivity was significantly higher in patients with a combination of depression and anxiety than in patients with depression alone or in individuals without pathopsychological disorders.

A significant spread of anxiety and depressive disorders is also characteristic of patients with pathology of the digestive tract. Depression is often diagnosed with diseases of the digestive tract, such as functional dyspepsia, functional biliary disorders, irritable bowel syndrome, in case of chronic diffuse liver diseases of various origins (viral hepatitis, alcoholic disease liver, cirrhosis of the liver, hepatic encephalopathy), as well as in patients who are treated with interferons. Comorbid anxiety and depressive disorders are also characteristic of other gastroenterological diseases. Thus, according to the results of the American national survey, peptic ulcer of the stomach and duodenum is associated with an increase in the frequency of generalized anxiety by 4.5 times, panic attacks - by 2.8 times. Determined that elevated level anxiety is associated with increased healing time for peptic ulcers. According to different authors, depression is detected in 35-50% of patients with peptic ulcer. More than 20% of patients with pathology of the digestive tract require the appointment of antidepressants. Comorbid anxiety and depressive disorders are also common in other chronic diseases: endocrinological ( diabetes, hyperthyroidism, hypothyroidism, etc.), pulmological (chronic obstructive pulmonary disease), rheumatic (rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis), oncological, neurological (stroke, Parkinson's disease, etc.), especially in the case of their joint course in the elderly age. Depressive disorders also require attention in young patients, as well as in women after childbirth.

Diagnosis of anxiety and depressive disorders

The main method of diagnosing depression and anxiety remains questioning the patient. The identification of psychopathological disorders is accompanied by a trusting atmosphere of communication between the doctor and the patient, mutual understanding and a sense of empathy, as well as effective feedback (the ability to listen, discuss, clearly pose questions). Methodical materials The World Psychiatric Association "Educating Physicians in Mental Health Skills" defines the main aspects of the communication style of doctors, which are associated with assessing the emotional state of the patient:

1. Establish good eye contact
2. Clarify patient complaints
3. Make comments with empathy
4. Notice the patient's verbal and non-verbal cues
5. Do not read medical records during a conversation
6. Control the patient's excessive talkativeness

In the clinical settings “Depression: Helping Depression in Primary and Secondary Care” developed by NICE (National Institute for Health and Clinical Excellence – National Institute for Health and Clinical Excellence, UK) for depression screening, it is recommended to ask two questions: “You often noted reduced mood, sadness, or hopelessness over the past month? and "Have you often noticed a lack of interest or pleasure in things that you normally enjoy over the past month?" For anxiety screening, you can use the questions: "Do you feel restless, tense and anxious most of the time during the last month?" and “Do you often have feelings of internal tension and irritability, as well as sleep disturbances?”.

Main signs of a depressive episode

1. Depressed mood, obvious in comparison with the patient's usual norm, is noted almost daily and most of the day, especially in the morning hours, the duration of which was at least 2 weeks, regardless of the situation (the mood can be depressed, melancholy, accompanied by anxiety, anxiety, irritability, apathy , tearfulness, etc.).
2. Significant reduction (loss) of interest and pleasure in activities that were usually associated with positive emotions.
3. Unmotivated decrease in energy and activity, increased fatigue during physical and intellectual stress.

Additional signs of a depressive episode

1. Decreased ability to concentrate, inattention.
2. Decreased self-esteem, self-confidence.
3. The presence of ideas of guilt and humiliation.
4. A gloomy and pessimistic vision of the future.
5. Suicidal fantasies, thoughts, intentions, preparations.
6. Sleep disorders (poor sleep, insomnia in the middle of the night, early awakening).
7. Decrease (increase) in appetite, decrease (increase in body weight).

To define a mild depressive episode, it is sufficient to state at least two main and two additional symptoms. The presence of two main symptoms of depression in combination with three or four additional symptoms indicates moderate depression. Identification of all three main symptoms of depression and at least four additional ones indicate severe depression. It should be borne in mind that due to various depressions, the risk of suicide is possible. If a patient has suicidal manifestations, a psychiatric consultation is necessary.

Particular difficulties arise during the diagnosis of "masked depression", which can manifest itself functional disorders internal organs (hyperventilation syndrome, cardioneurosis, irritable bowel syndrome), algia (cephalgia, fibromyalgia, neuralgia, abdominalgia), pathocharacterological disorders (alcoholism, drug addiction, antisocial behavior, hysterical reactions).

The scientific literature systematizes other emotional disorders that clearly appear in the onset of depression:

1. Dysphoria is a gloomy, grouchy-irritable, angry mood with increased sensitivity to any external stimuli. Sometimes it is embittered pessimism with caustic captiousness, at times with outbursts of anger, swearing, threats, constant aggression.
2. Hypothymia is a persistently depressed mood, which is combined with a decrease in the overall activity of mental activity and behavioral motor activity.
3. Subdepression is a persistently lowered mood, which is combined with a decrease in the overall activity of mental activity and behavioral motor activity. The most characteristic components are somatovegetative disorders, reduced self-esteem and identification of one's condition as painful.

In the ICD-10, anxiety disorders are presented under Panic Disorder (F41.0), Generalized Anxiety Disorder (F41.1) and Mixed Anxiety and Depressive Disorder (F41.2).

The main symptom of panic disorder is recurring attacks of severe anxiety (panic), which is not limited to a specific situation or any specific circumstances, and, as a result, become unpredictable. The dominant symptoms are: sudden palpitations, chest pain, suffocation, dizziness and a feeling of unreality (depersonalization or derealization). Many patients feel fear of death, lose self-control. Anxiety and fear are so strong that they literally paralyze the will of the patient. A panic attack usually lasts for several minutes; the condition gradually (from 30 minutes to 1 hour) normalizes. But after that, the patient remains afraid of a new attack. A panic attack must be differentiated from paroxysmal tachycardia, atrial fibrillation and angina pectoris.

Generalized anxiety disorder is characterized by manifestations of internal tension, inability to relax and concentrate. In this case, also characteristic are the constant internal trembling, increased sweating, frequent urination. Patients show increased anxiety during daily activities and make pessimistic predictions, they have difficulty falling asleep. Phobias, or fears, are also manifestations of an anxiety disorder. Mixed anxiety and depressive disorder is diagnosed when both anxiety and depression are present.

To diagnose comorbid anxiety and depressive disorders in clinical practice, a large number of rating scales and questionnaires have been developed. For screening studies, the Hospital Anxiety and Depression Scale (HADS) is widely used. The scale was proposed by A.S. Zigmond and R.P. Snaith in 1983 and includes 14 statements, 7 of which correspond to depressive (D) and 7 to anxiety (T) disorders, which are counted separately.

Full Name _________________________________________________

This questionnaire is designed to help your doctor understand how you are feeling. Read each statement carefully and choose the answer that best fits how you felt over the past week. Check the circle that is in front of the answer you have chosen. Don't think too long on each statement, as your first reaction will always be the most correct.

I feel tension, I feel uneasy

From time to time, sometimes

I don't feel at all

What brought me great pleasure and now makes me feel the same way

It's probably like that

To a very small extent this is so.

It's not quite right

I feel fear, it seems that something terrible is about to happen

Yes, the fear is very strong.

This is true, but the fear is not very strong

Sometimes but it doesn't bother me

I don't feel at all

I am able to laugh and see in this or that event funny

Probably so

To a very small extent this is so.

It's not like that at all

Fussy thoughts swirling in my head

Most time

From time to time and it's not that often

I feel energized

I don't feel at all

Almost all the time

I can easily sit down and relax

Probably so

It seems to me that I began to do everything very slowly

Almost all the time

I feel inner tension or trembling

I don't feel at all

I don't care about my appearance

I don't spend enough time on it

It seems to me that I began to devote less time to this

I take care of myself the way I used to

I feel restless, I constantly need to move

Probably so

To some extent it is

I don't feel at all

I believe that my activities (activities, hobbies) can bring me a sense of satisfaction

Just the way it usually is

Yes, but not as much as before

Significantly less than usual

I don't think so at all

I have a sudden feeling of panic

Doesn't happen at all

I can enjoy an interesting book, radio or TV program

HADS evaluation criteria: 0-7 points - normal; 8-10 points - subclinically expressed anxiety / depression; 11 or more - clinically significant anxiety / depression

For questioning a patient, it is not necessary to give rating scales (4th and 5th columns of the table) and evaluation criteria

Patients diagnosed with clinically significant anxiety or depression should be referred for psychiatric consultation. Consultation with a psychiatrist is also required by patients with depression and the presence of suicidal thoughts. In case of insufficient effectiveness of antidepressant therapy for 1-1.5 months, as well as in the presence of a history of depression, which required treatment by a psychiatrist. In the case of subclinical anxiety or depression, treatment may be prescribed by a general practitioner (internist).

Treatment of anxiety and depressive disorders in therapeutic practice

In accordance with clinical guidelines developed by NICE "Depression: Depression Management in Primary and Secondary Care", "Treatment of Depression in Adults (Main Edition)", guidelines of the American Heart Association "Depression and Coronary Heart Disease: Recommendations for Screening and Treatment" and scientific developments of Ukrainian specialists , treatment of mild and moderate depressive and anxiety disorders can be carried out by primary care physicians.

In accordance with the NICE Clinical Guidelines, patients with mild depression can be treated without prescription of antidepressants in the case of a self-help program, which consists of the provision of appropriate written materials, a sleep management program and computer-assisted cognitive behavioral therapy, followed by an assessment of the patient's condition. In our country, such programs have not yet received much distribution in clinical practice. In order to increase the information content and involve patients in the treatment, the Leaflet "Anxiety and depressive disorders" has been developed.

Treatment of patients with comorbid anxiety and depressive disorders should be built taking into account the difficult relationship between the somatogenic and psychological components. In most cases, it is advisable to combine drugs for the treatment of a somatic disease with the prescription of drugs to eliminate depressive and / or anxiety disorders. It is important to use drugs, the effectiveness and safety of which has been proven from the standpoint of evidence-based medicine, to explain to the patient at an accessible level that in order to recover, it is necessary to normalize the biochemical processes in the nervous system that are disturbed by the disease, chronic stress, psychotraumatic situations, etc. it is necessary to discuss the treatment plan with the patient, point out the importance of adherence to the drug regimen, and also warn that the clinical effect develops gradually. Most patients adequately perceive a logically based approach to prescribing drugs that affect the psycho-emotional sphere. In some cases, it is useful to involve family members in complex psychotherapeutic rehabilitation.

The main groups of pharmacological drugs that are used in therapeutic practice are II generation antidepressants (serotonin reuptake inhibitors), tranquilizers, drugs of other pharmacological groups.

The main indications for prescribing antidepressants in diseases of the digestive tract are comorbid anxiety and depressive disorders in patients with functional disorders digestive tract, chronic diffuse diseases liver, persistent pain in chronic pancreatitis, obesity and eating disorders. Patients who have suffered a myocardial infarction, patients with arterial hypertension, coronary artery disease and neurocirculatory dystonia require special attention. It is advisable to prescribe antidepressants in case of detection of signs of other chronic diseases (stroke, diabetes mellitus, osteoarthritis, etc.).

Antidepressants

When choosing an antidepressant for outpatient treatment, it is necessary to take into account safety, tolerability, the risk of interaction with other drugs, the absence of an effect on performance, the positive effect of previous antidepressant treatment. In accordance with the requirements of evidence-based medicine, serotonin reuptake inhibitors are considered the drugs of choice for the treatment of patients with symptoms of depression and anxiety. They do not show cardiotoxic effects, do not cause physical or mental addiction. The clinical effect of antidepressant therapy appears 1-3 weeks after the start of treatment. If there is no clinical effect of the antidepressant for 4-6 weeks, a psychiatrist's consultation and replacement with another drug is necessary.

In the initial period of antidepressant use, the patient should visit a doctor at least once every 2 weeks and pay attention to possible side effects of treatment, which in most cases go away on their own. To achieve a positive therapeutic effect, the frequency of visits to the doctor should be once every 6-12 weeks. The duration of treatment with antidepressants is 6-12 months. In the case of stopping treatment immediately after achieving a clinical effect, the likelihood of relapse increases significantly. Elderly people in cases of recurrent depressive episodes, as well as in the presence of chronic depression in the past, should be recommended long-term (at least 3 years) or lifelong prescription of antidepressants.

When prescribing antidepressants of the serotonin reuptake inhibitor group, it is necessary to take into account their features:

Fluoxetine is an antidepressant with a stimulant effect. Enhances the effect of analgesic drugs. Recommended for depression of various origins, panic fears and bulimia nervosa, premenstrual dysphoric disorder. The advantage is the absence of a sedative effect. Possible side effects: hyperexcitability, dizziness, increased convulsive readiness, allergic reactions. The positive effect most often manifests itself after 5-10 days, the maximum - in a day, stable remission - after 3 months. In the case of anxiety-depressive disorders, it is advisable to prescribe Fluoxitine simultaneously with benzodiazepine tranquilizers during the first week, which makes it possible to achieve a sedative effect without the complications characteristic of tricyclic antidepressants.

Paroxetine is a balanced antidepressant. Produces both antidepressant and anxiolytic action. But keep in mind that this is one of the least selective serotonin reuptake inhibitors (it partially affects the reuptake of norepinephrine and blocks muscarinic receptors, which causes a sedative effect). Possible side effects: nausea, dry mouth, irritability, drowsiness, excessive sweating, sexual dysfunction.

Sertraline - does not have a sedative, stimulant and anticholinergic effect. Possible side effects: diarrhea, dyspepsia, drowsiness, hyperhidrosis, dizziness, headache, allergic reactions.

Citalopram. The advantage of this drug is the speed of the therapeutic effect (5-7 days of treatment). Possible side effects: dry mouth, drowsiness, hyperhidrosis, dizziness, headache, allergic reactions.

Escitalopram is a representative of the group of serotonin reuptake inhibitors with maximum selectivity. Installed over high efficiency Escitalopram versus citalopram in patients with moderate depression. The drug has little effect on the activity of cytochrome P450, which gives it advantages in the case of a combined pathology that requires polypharmacotherapy.

Promising in general medical practice is the use of the melatonergic antidepressant Agomelatine, which has a pronounced antidepressant effect and a unique additional advantage - the rapid recovery of the disturbed sleep-activity cycle and an excellent tolerability profile. Agomelatine improves the quality and duration of sleep and does not cause daytime sleepiness, which is important for patients who continue to work. In the case of a predominant sleep disorder, the drug has a significant clinical advantage.

Ademetionine – (-) S-adenosyl-L-methionine is an active methionine metabolite that contains sulfur – natural antioxidant and an antidepressant, which is produced in the liver. A decrease in the biosynthesis of Ademetionine in the liver is characteristic of all forms of chronic liver damage. The antidepressant activity of Ademetionine has been known for over 20 years and it is considered as an atypical antidepressant stimulant. Used to treat depression, alcoholism and drug addiction. Rather rapid development and stabilization of the antidepressant effect (during the first and second weeks, respectively), are characteristic, especially when administered parenterally at a dose of 400 mg / day. Combining the antidepressant and hepatoprotective effect is advantageous when the drug is prescribed to patients with diseases of the digestive tract.

tranquilizers

Tranquilizers (from lat. tranquillo - to calm), or anxiolytics (from lat. anxietas - anxiety, fear). In addition to the actual anxiolytic, the main clinical and pharmacological effects of tranquilizers are sedative, muscle relaxant, anticonvulsant, hypnotic and vegetostabilizing. Classical representatives of this group are benzodiazepines, which enhance GABAergic inhibition at all levels of the CNS and have a pronounced anti-anxiety effect, which allows significant progress in the treatment of anxiety states of various etiologies. However, in the process of accumulating clinical experience with the use of classical benzodiazepines (chlordiazepoxide, diazepam, finazepam, etc.), more and more attention began to be paid to the side effects of these drugs, which often negates their positive effect and leads to the development of serious complications. Therefore, drugs of this group, including their rapid clinical effect, should be used on an outpatient basis for the treatment of panic attacks. But, when prescribing benzodiazepines, first of all, it is necessary to take into account the possibility of drug dependence, so the course of treatment should be limited to two weeks.

Prospects for the treatment of comorbid anxiety disorders are associated with the use of new generation anxiolytics (Etifoxin, Afobazole).

Etifoxine is an anxiolytic that acts as a direct GABA mimetic. It has a number of advantages compared to benzodiazepines, since it does not cause drowsiness and muscle relaxation, does not affect the perception of information, does not lead to addiction and the development of a withdrawal syndrome. In addition to anxiolytic, it has a vegetative-stabilizing effect and improves sleep. The drug can be used in Everyday life. Its effectiveness is more pronounced when prescribed in the early stages of anxiety disorders. Etifoxine can be used simultaneously with antidepressants, sleeping pills and cardiological drugs.

Afobazol is a derivative of 2-mercaptobenzimidazole, a selective anxiolytic that has a unique mechanism of action and belongs to the group of membrane modulators of the GABA-A-benzodiazepine receptor complex. The drug has an anxiolytic effect with an activating component, which is not accompanied by hypnosedative effects, does not have muscle relaxant features, and does not have a negative effect on memory and attention. During its application, it does not form drug addiction and the withdrawal syndrome does not develop. Reduction or elimination of manifestations of anxiety (concern, apprehension, awe, irritability), tension (tearfulness, anxiety, inability to relax, insomnia, fear), autonomic disorders (dry mouth, sweating, dizziness), cognitive impairment (difficulties during concentration attention) are observed on the 5th-7th day of treatment. The maximum effect is achieved at week 4 and lasts an average of 1-2 weeks after the end of the course of treatment. Afobazole is especially indicated for persons with predominantly asthenic features in the form of a feeling of increased vulnerability and emotional lability, a tendency to emotionally stressful situations. The drug does not affect the narcotic effect of ethanol, enhances the anxiolytic effect of Diazepam.

The "atypical tranquilizers" include Mebicar, Phenibut trioxazine, etc.

Mebikar is a daytime tranquilizer-adaptogen of wide application, which, in addition to nxiolytic, has a nootropic, antihypoxic and vegetostabilizing effect. The effectiveness of the drug in patients with arterial hypertension and coronary artery disease has been proven. Possible side effects: dyspeptic manifestations, allergic reactions, hypothermia, lowering blood pressure.

Phenibut improves GABAergic neurotransmitter transmission, which causes a nootropic, anti-asthenic and vegetative-stabilizing effect. Possible side effects: nausea and drowsiness. Caution should be given to patients with erosive and ulcerative lesion digestive tract.

Drugs of other pharmacological groups

Glycine belongs to the amino acid-regulator of metabolic processes. It is an inhibitory neurotransmitter, increases mental performance, eliminates depressive disorders, increased irritability, and normalizes sleep. Can be used by the elderly, children, adolescents with deviant behaviors. In alcoholism, it not only helps to neutralize toxic products of ethyl alcohol oxidation, but also reduces pathological craving for alcohol, prevents the development alcoholic delirium and psychosis.

Magne-B6 - original drug, which is a combination of the trace element magnesium and peredoxin, which potentiate each other's action. Apply in case of psycho-emotional stress, anxiety, chronic mental and physical overwork, sleep disorders, premenstrual and hyperventilation syndrome. Can be given as monotherapy or in combination with other drugs. Does not interact with alcohol, is used to treat alcohol hangover.

Phytopreparations

The use of phytopreparations in the treatment of patients with depressive and anxiety disorders is not regulated by the Clinical Guidelines, which meet the criteria of evidence-based medicine. Therefore, it is advisable to prescribe appropriate modern antidepressants/anxiolytics to patients with a diagnosed depressive and/or anxiety disorder. But phytopreparations can be used to prevent stress-induced psychopathological conditions and autonomic disorders.

In folk medicine, soothing herbs such as valerian, dog nettle, hawthorn, mint, hops and some others have long been used, which are called phytotranquilizers. On their basis, a large number of phytopreparations, widely represented on the pharmacological market, have been developed. Traditionally, tinctures of valerian, hawthorn, etc. are used.

Anxiety disorders are a group of neurotic disorders with diverse symptoms. The disease has psychogenic roots, but there are no changes in the person's personality. He is aware of his condition and is critical of it.

Anxiety disorders, according to the international classification of diseases, are divided into 5 groups, one of which is referred to as mixed anxiety-depressive disorder, which will be discussed.

Competition between anxiety and depression

The name already hints at the fact that this type of disorder is based on 2 conditions: depression and anxiety. However, none of them are dominant. Both conditions are pronounced, but it is impossible to make a single diagnosis. Either anxiety or depression.

It is only characteristic that, against the background of depression, anxiety increases and takes on enormous proportions. Each of these conditions amplifies the effect of the other syndrome. Reasons for some fears and anxieties are present, but very insignificant. However, a person is in the imperishable, feels a threat, lurking danger.

The insignificance of the factors that cause anxiety personality disorder is combined with the fact that in the patient's value system the problem grows to a cosmic scale, and he does not see a way out of it.

And eternal anxiety blocks an adequate perception of the situation. Fear generally prevents thinking, evaluating, making decisions, analyzing, it simply paralyzes. And a person in this state of spiritual and volitional paralysis goes crazy with hopelessness.

Sometimes anxiety is accompanied by unmotivated aggressiveness. Huge internal tension, which is not resolved in any way, provokes the release of stress hormones into the blood: adrenaline, cortisol, they prepare the body for fight, rescue, flight, defense.

But the patient does none of this, remaining in a potential state of anxiety and restlessness. Having not found a way out in active actions, stress hormones begin to purposefully poison the nervous system, from which the level of anxiety grows even more.

A person is taut like a bowstring: muscles tense, tendon reflexes increase. He seems to be sitting on a barrel of gunpowder, terribly afraid that it will explode and still does not move. Maybe depression overshadows anxiety and prevents the unfortunate person from taking steps to save. In a specific case, salvation from a state that kills him.

• thundering heartbeats, which are clearly felt in the head;
• the head, naturally, is spinning;
• hands and feet tremble, there is not enough air;
• a feeling of "drying" of the mouth and a coma in the throat, a fainting state and the impending horror of death complete this picture.

Panic attack in anxiety disorders

Anxiety-depressive disorder, which is combined with the usual case.

The ancient Greek god Pan always appeared suddenly and out of nowhere, and terrified people so much that they, not choosing a way to retreat, rushed away. The terrible god Pan served to have the disorders called panic attacks named after him.

Anxiety neurosis, simply put, fear, can always go to its extreme degree - panic. have more than 10 symptoms. Less than 4 signs do not give grounds for making a diagnosis, and four or more - this is directly a vegetative crisis.

Symptoms that indicate the development of PA:

Panic attacks in anxiety-depressive syndrome occur when anxiety in this mixed disorder is more pronounced than depression. The presence of panic allows a more accurate diagnosis.

The peculiarity of these attacks is that they are always associated with a certain phobia. Panic is a state in which horror is combined with a feeling of impossibility to escape from it. That is, there are insurmountable obstacles for escape.

For example, panic attacks can suddenly occur on the street, in a store, in a market, a stadium (fear of open spaces). An attack can also occur in an elevator, subway, train (fear of closed spaces).

Attacks are short (from a minute to 10), are long (about an hour). They can be either single or cascading. They appear a couple of times a week, but sometimes the number of attacks may be less, or may be twice the usual rate.

Causes of Anxiety and Depressive Disorders

Anxiety depression can be caused by the following causes and factors:

Side and inside view

Anxiety depressive disorder has characteristic outlines and symptoms:

• complete or partial loss of a person's skills to adapt to the social environment;
• (night awakenings, early rises, long falling asleep);
• identified provocative factor (losses, losses, fears and phobias);
• appetite disturbance (poor appetite with weight loss, or, conversely, “jamming” of anxiety and fears);
• (erratic motor activity: from fussy movements to "pogroms") along with speech excitement ("verbal eruptions");
• panic attacks are short or prolonged, one-time or repeated;
• suicidal ideation, suicide attempts, committed suicide.

Establishing diagnosis

When establishing a diagnosis, standard methods and an assessment of the clinical picture are used.

Standard methods:

• Zung scale- The depression test and the Beck Depression Inventory are used to determine the severity of the depressive state;
• Luscher color test allows you to quickly and accurately analyze the state of the individual and the degree of his neurotic deviations;
• Hamilton scale and Montgomery-Asberg scale gives an idea of ​​the degree of depression, and based on the results of the test, the method of therapy is determined: psychotherapeutic, or medication.

Assessment of the clinical picture:

• the presence of anxiety and depressive symptoms;
• the symptoms of the manifestation of the disorder are an inadequate and abnormal response to a stressor;
• time of existence of symptoms (duration of their manifestation);
• the absence or presence of conditions under which symptoms appear;
• the primacy of symptoms of anxiety and depressive disorders, it is necessary to determine whether the clinical picture is a manifestation of a somatic disease (angina pectoris, endocrine disorders).

The path to the "right doctor"

An attack that happened for the first time is usually not regarded by the patient as a symptom of the disease. It is usually written off as an accident, or they independently find a more or less plausible reason that explains its occurrence.

As a rule, they try to determine the internal illness that provoked such symptoms. A person does not immediately get to the destination - to a psychotherapist.

A trip to the doctor begins with the therapist. The therapist sends the patient to a neurologist. The neurologist, finding psychosomatic and vegetative-vascular disorders, prescribes sedatives. While the patient is taking medication, he, in fact, becomes calmer, vegetative symptoms disappear. But after stopping the course of treatment, the attacks begin to recur. The neuropathologist makes a helpless gesture and sends the sufferer to a psychiatrist.

The psychiatrist relieves not only from attacks for a long time, but also from any emotions in general. Intoxicated with heavy psychotic drugs, the patient is in an off state for days, and looks at life in a sweet half-asleep. What fears, what panic!

But the psychiatrist, seeing "improvements", reduces lethal doses, or cancels them. After some time, the patient turns on, wakes up and everything starts all over again: anxiety, panic, fear of death, an anxiety-depressive disorder develops, and its symptoms only get worse.

The best outcome is when the patient immediately goes to a psychotherapist. A correct diagnosis and adequate treatment will greatly improve the patient's quality of life, but when the drugs are discontinued, everything can return to normal.

Usually there is a consolidation in the mind of cause-and-effect relationships. If a panic attack has overtaken in a supermarket, a person will avoid this place. If in the subway, or in the train, then these modes of transport will be forgotten. Random appearance in the same places and in similar situations can cause another panic syndrome.

The whole range of therapies

Psychotherapeutic help is as follows:

• method of rational persuasion;
• mastering the techniques of relaxation and meditation;
• sessions with a psychotherapist.

Medical treatment

In the treatment of anxiety-depressive disorder, the following groups of drugs are used:

Physiotherapy methods

They are an important part of the treatment of any psychosomatic conditions. Physiotherapy methods include:

• massage, self-massage, electromassage relieves muscle tension, soothes and tones;
• relaxes, calms, restores normal sleep.
• electroconvulsive treatment stimulates brain activity, increases the intensity of its work.

Homeopathy and alternative treatment

Herbal medicine is a treatment with medicinal herbs and soothing herbal preparations:

• ginseng- stimulating tincture, or tablet forms of the drug, increases efficiency, activity, relieves fatigue;
• motherwort, hawthorn, valerian have an excellent calming effect;
• lemongrass tincture- a powerful stimulant, which is especially indicated for depression with its ability to awaken apathetic, lethargic, inhibited citizens to an active life.

• gentian grass - for those who are discouraged;
• Arnica Montana - a drug that eliminates both depressive and anxiety symptoms;
• Hypnosed - removes insomnia, strong excitability;
• Elm leaves and bark - increases endurance, relieves fatigue.

Syndrome prevention

In order to always be psychologically stable, the following conditions must be observed:

Far reaching consequences

If pathological symptoms are ignored, a set of bodily and mental ailments can be acquired:

• an increase in the number and duration of panic attacks;
• development of hypertension, cardiovascular diseases;
• violation of the functions of the digestive system, the development of peptic ulcer;
• the occurrence of cancer;
• the development of mental illness;

The quality of life of patients, their professional skills, and marital relations also suffer greatly. Ultimately, all this can lead to the fact that a person ceases to somehow interact with society and acquires a fashionable disease - social phobia.

The saddest and irreversible complication is the situation when a person commits suicide.

The issue of increasing the awareness of physicians regarding the diagnosis and treatment of common psychopathological disorders - depression and anxiety - is becoming more and more relevant every day.

In modern conditions, given the significant prevalence of these psychopathological disorders, especially among patients with somatic pathology, and the emergence of new, safer antidepressants, the diagnosis and treatment of mild and moderate depression in most countries of Europe and North America is carried out by first-line physicians, as well as therapists, cardiologists, neurologists, gastroenterologists, etc., 80% of antidepressants in Western Europe, the USA and Canada are not prescribed by psychiatrists.

The International Psychiatric Association and the International Committee for the Prevention and Treatment of Depression have introduced an educational program for the diagnosis and treatment of depressive disorders, which has been implemented in many regions. In 1998 this program was started in Russia, in 2002 the materials were published in Ukraine. Over the past years, the number of scientific publications on this issue in Ukraine has been increasing, but practical implementation remains insufficient. There is also no national training program for specialists. Most doctors note the importance of this problem, but do not consider themselves competent in surveys of the diagnosis and treatment of depression. Therefore, it is especially important for doctors of all specialties to master the skills of diagnosing and treating depressive and anxiety disorders.

Depression is divided into: psychogenic, endogenous and somatogenic. Psychogenic depressive disorders occur later or under the influence of psychological and stressful causes. Under endogenous depressive disorders imply those depressions that develop in schizophrenia and manic-depressive psychosis. Somatogenic depressive disorders observed in various somatic diseases (cardiovascular, endocrine, gastrointestinal tract, etc.). Depression can also occur in case of intoxication of the body, infectious diseases, drug addiction and alcoholism. Quite often in clinical practice, so-called latent depressions are observed, when the actual depressive symptoms are masked as a violation in the work of various organs and systems, persistent headaches, sleep changes and are not recognized by the patient as such.

According to the World Health Organization, from 10 to 20% of the world's population during their lives note the occurrence of clinically pronounced depressive conditions. According to the results of epidemiological studies, every eighth inhabitant of our planet needs specific pharmacotherapy in connection with depressive states. In 60% of cases, as a rule, in case of insufficiency or inadequate therapy, repeated depressive episodes occur. Nearly half of people with depression do not see a doctor, and about 80% are treated by internists and general practitioners.

The development of depressive disorders is associated with a violation of the metabolism of the main neurotransmitters: serotonin, norepinephrine and dopamine in the central structures of the brain (limbic system), which are involved in assessing the emotional significance of information that enters the central nervous system (CNS) and forms the emotional component of human behavior. The two-way causal relationship of depression with the state of internal organs and somatization of symptoms of depression can be explained by the close relationship of the central structures and the cerebral cortex with the centers of the autonomic nervous system and endocrine regulation.

Depression is diagnosed in 20% of patients with coronary heart disease (CHD), in 30-50% of patients after myocardial infarction and in 30-50% after a stroke. The importance of influencing psycho-emotional factors was confirmed in the INTERHEART studies, where their contribution to the risk of developing acute myocardial infarction was not inferior to diabetes and smoking. Over the past few decades, the relationship between depression and prognosis in patients with coronary artery disease has been studied in more than 60 international prospective studies. It was found that severe depression in patients with angiographically confirmed coronary heart disease is the most significant isolated predictor of coronary events throughout the year. The mortality rate of patients who have a history of myocardial infarction and suffer from depression is 3-6 times higher than in people without signs of depression. In the case of depression, patients often do not follow the recommendations of doctors regarding treatment. Given the important role of depressive disorders in patients with coronary artery disease, the American Heart Association developed and introduced in 2008 the Depression and CHD Guidelines for Screening and Treatment, which emphasizes the need for screening to identify individuals with CHD and depression who require additional treatment. In addition, results from the ENRICHD study showed that a group of depressed patients who had an acute myocardial infarction and received serotonin reuptake inhibitors had a 42% reduction in the incidence of death or recurrence of myocardial infarction compared with the rate in patients with depression who did not antidepressants were prescribed.

In most patients, the manifestation of depression is closely associated with anxiety disorders. - a normal reaction of the human body to adverse life factors. But if it occurs without a reason or in severity and duration exceeds the real significance of the event and worsens the patient's quality of life, then this condition is regarded as pathological.

anxiety disorder characterized by manifestations of internal tension, inability to relax and concentrate. Characteristic are constant internal tension and increased sweating. Patients show increased anxiety during the performance of daily work and make pessimistic forecasts, they, in most cases, have difficulty falling asleep. Phobias, or fears, are also manifestations of anxiety disorders. The results of epidemiological studies show that anxiety disorders occur in 25% of the population throughout life.

Symptoms of anxiety disorders are diagnosed in 10-16% of patients who turn to general practitioners. According to the results of modern scientific research, an increased risk of cardiovascular complications in patients with anxiety disorders has been noted. Among the mechanisms that are considered, the main role belongs to an increase in the level of serotonin-mediated platelet reactivity in patients with coronary artery disease and comorbid anxiety (the existence of independent correlations between anxiety and platelet function has been proven). At the same time, platelet reactivity was significantly higher in patients with a combination of depression and anxiety than in patients with depression alone or in individuals without pathopsychological disorders.

A significant spread of anxiety and depressive disorders is also characteristic of patients with pathology of the digestive tract. Depression is often diagnosed in diseases of the digestive tract such as functional dyspepsia, functional biliary disorders, irritable bowel syndrome, in the case of chronic diffuse liver diseases of various origins (viral hepatitis, alcoholic liver disease, cirrhosis of the liver, hepatic encephalopathy), as well as in patients who treated with interferons. Comorbid anxiety and depressive disorders are also characteristic of other gastroenterological diseases. Thus, according to the results of the American national survey, peptic ulcer of the stomach and duodenum is associated with an increase in the frequency of generalized anxiety by 4.5 times, panic attacks - by 2.8 times. It has been established that an increased level of anxiety is associated with an increase in the healing time of peptic ulcers. According to different authors, depression is detected in 35-50% of patients with peptic ulcer. More than 20% of patients with pathology of the digestive tract require the appointment of antidepressants. Comorbid anxiety and depressive disorders are also common in the case of other chronic diseases: endocrinological (diabetes mellitus, hyperthyroidism, hypothyroidism, etc.), pulmological (chronic obstructive pulmonary disease), rheumatic (rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis), oncological, neurological ( stroke, Parkinson's disease, etc.), especially in the case of their joint course in the elderly. Depressive disorders also require attention in young patients, as well as in women after childbirth.

Diagnosis of anxiety and depressive disorders

The main method of diagnosing depression and anxiety remains questioning the patient. The identification of psychopathological disorders is accompanied by a trusting atmosphere of communication between the doctor and the patient, mutual understanding and a sense of empathy, as well as effective feedback (the ability to listen, discuss, clearly pose questions). The methodological materials of the World Psychiatric Association "Educating Physicians in Mental Health Skills" define the main aspects of the communication style of doctors, which are associated with the assessment of the patient's emotional state:

1. Establish good eye contact
2. Clarify patient complaints
3. Make comments with empathy
4. Notice the patient's verbal and non-verbal cues
5. Do not read medical records during a conversation
6. Control the patient's excessive talkativeness

In the clinical settings "Depression: help with depression at the stage of primary and secondary care" developed by NICE (National Institute for Health and Clinical Excellence - National Institute for Health and Clinical Excellence, UK) for depression screening, it is recommended to ask two questions: "You often noted reduced mood, sadness, or hopelessness over the past month? and "Have you often noticed a lack of interest or pleasure in things that you normally enjoy over the past month?" For anxiety screening, you can use the questions: "Do you feel restless, tense and anxious most of the time during the last month?" and “Do you often have feelings of internal tension and irritability, as well as sleep disturbances?”.

Main signs of a depressive episode

1. Depressed mood, obvious in comparison with the patient's usual norm, is noted almost daily and most of the day, especially in the morning hours, the duration of which was at least 2 weeks, regardless of the situation (the mood can be depressed, melancholy, accompanied by anxiety, anxiety, irritability, apathy , tearfulness, etc.).
2. Significant reduction (loss) of interest and pleasure in activities that were usually associated with positive emotions.
3. Unmotivated decrease in energy and activity, increased fatigue during physical and intellectual stress.

Additional signs of a depressive episode

1. Decreased ability to concentrate, inattention.
2. Decreased self-esteem, self-confidence.
3. The presence of ideas of guilt and humiliation.
4. A gloomy and pessimistic vision of the future.
5. Suicidal fantasies, thoughts, intentions, preparations.
6. Sleep disorders (poor sleep, insomnia in the middle of the night, early awakening).
7. Decrease (increase) in appetite, decrease (increase in body weight).

To define a mild depressive episode, it is sufficient to state at least two main and two additional symptoms. The presence of two main symptoms of depression in combination with three or four additional symptoms indicates moderate depression. All three major symptoms of depression and at least four additional symptoms indicate severe depression. It should be borne in mind that due to various depressions, the risk of suicide is possible. If a patient has suicidal manifestations, a psychiatric consultation is necessary.

Particular difficulties arise during the diagnosis of “masked depression”, which can manifest itself as functional disorders of internal organs (hyperventilation syndrome, cardioneurosis, irritable bowel syndrome), algia (cephalgia, fibromyalgia, neuralgia, abdominalgia), pathocharacterological disorders (alcoholism, drug addiction, antisocial behavior , hysterical reactions).

The scientific literature systematizes other emotional disorders that clearly appear in the onset of depression:

1. Dysphoria- gloomy, grouchy-irritable, angry mood with increased sensitivity to any external stimuli. Sometimes it is embittered pessimism with caustic captiousness, at times with outbursts of anger, swearing, threats, constant aggression.
2. hypothymia- persistently lowered mood, which is combined with a decrease in the overall activity of mental activity and behavioral motor activity.
3. subdepression- persistently lowered mood, which is combined with a decrease in the overall activity of mental activity and behavioral motor activity. The most characteristic components are somatovegetative disorders, reduced self-esteem and identification of one's condition as painful.

In the ICD-10, anxiety disorders are presented under Panic Disorder (F41.0), Generalized Anxiety Disorder (F41.1) and Mixed Anxiety and Depressive Disorder (F41.2).

main feature panic disorder are recurring attacks of severe anxiety (panic), which are not limited to a specific situation or any specific circumstances, and, as a result, become unpredictable. The dominant symptoms are: sudden palpitations, chest pain, suffocation, dizziness and a feeling of unreality (depersonalization or derealization). Many patients feel fear of death, lose self-control. Anxiety and fear are so strong that they literally paralyze the will of the patient. A panic attack usually lasts for several minutes; the condition gradually (from 30 minutes to 1 hour) normalizes. But after that, the patient remains afraid of a new attack. A panic attack must be differentiated from paroxysmal tachycardia, atrial fibrillation and angina pectoris.

generalized anxiety disorder characterized by manifestations of internal tension, inability to relax and concentrate. In this case, constant internal trembling, increased sweating, and frequent urination are also characteristic. Patients show increased anxiety during daily activities and make pessimistic predictions, they have difficulty falling asleep. Phobias, or fears, are also manifestations of an anxiety disorder. Mixed anxiety and depressive disorder is diagnosed when both anxiety and depression are present.

For diagnostics comorbid anxiety and depressive disorders in clinical practice, a large number of rating scales and questionnaires have been developed. For screening studies, the Hospital Anxiety and Depression Scale (HADS) is widely used. The scale was proposed by A.S. Zigmond and R.P. Snaith in 1983 and includes 14 statements, 7 of which correspond to depressive (D) and 7 to anxiety (T) disorders, which are counted separately.

Hospital Anxiety and Depression Scale (HADS, 1983)

Date of completion__________________ Full Name _________________________________________________ This questionnaire is designed to help your doctor understand how you are feeling. Read each statement carefully and choose the answer that best fits how you felt over the past week. Check the circle that is in front of the answer you have chosen. Don't think too long on each statement, as your first reaction will always be the most correct.
Statement	Answer options	Patient response	Number of points	Scales: depression (D), anxiety (T)
I feel tension, I feel uneasy	Constantly Often From time to time, sometimes I don't feel at all	○	3 2 1 0
What brought me great pleasure and now makes me feel the same way	This is true It's probably like that It's not quite right	○	3 2 1 0
I feel fear, it seems that something terrible is about to happen	Yes, the fear is very strong. This is true, but the fear is not very strong Sometimes but it doesn't bother me I don't feel at all	○	3 2 1 0
I am able to laugh and see in this or that event funny	This is true Probably so To a very small extent this is so. It's not like that at all	○	3 2 1 0
Fussy thoughts swirling in my head	Constantly Most part of time From time to time and it's not that often Only sometimes	○	3 2 1 0
I feel energized	I don't feel at all Very rarely Sometimes Almost all the time	○	3 2 1 0
I can easily sit down and relax	This is true Probably so Rarely is it I can't at all	○	3 2 1 0
It seems to me that I began to do everything very slowly	Almost all the time Often Sometimes Not at all	○	3 2 1 0
I feel inner tension or trembling	I don't feel at all Sometimes Often Often	○	3 2 1 0
I don't care about my appearance	This is true I don't spend enough time on it It seems to me that I began to devote less time to this I take care of myself the way I used to	○	3 2 1 0
I feel restless, I constantly need to move	This is true Probably so To some extent it is I don't feel at all	○	3 2 1 0
I believe that my activities (activities, hobbies) can bring me a sense of satisfaction	Just the way it usually is Yes, but not as much as before Significantly less than usual I don't think so at all	○	3 2 1 0
I have a sudden feeling of panic	Often Often enough Rarely Doesn't happen at all	○	3 2 1 0
I can enjoy an interesting book, radio or TV program	Often Sometimes Rarely Very rarely	○	3 2 1 0
HADS evaluation criteria: 0-7 points - normal; 8-10 points - subclinically expressed anxiety / depression; 11 or more - clinically significant anxiety/depression For questioning a patient, it is not necessary to give rating scales (4th and 5th columns of the table) and evaluation criteria

Patients diagnosed with clinically significant anxiety or depression should be referred for psychiatric consultation. Consultation with a psychiatrist is also required by patients with depression and the presence of suicidal thoughts. In case of insufficient effectiveness of antidepressant therapy for 1-1.5 months, as well as in the presence of a history of depression, which required treatment by a psychiatrist. In the case of subclinical anxiety or depression, treatment may be prescribed by a general practitioner (internist).

Treatment of anxiety and depressive disorders in therapeutic practice

According to the NICE Clinical Guidelines Depression: Management of Depression in Primary and Secondary Care, Management of Depression in Adults (Main Edition), American Heart Association Guidelines Depression and Coronary Heart Disease: Recommendations for Screening and Treatment and scientific developments of Ukrainian specialists, the treatment of mild and moderate depressive and anxiety disorders can be carried out by first-line doctors.

In accordance with the NICE Clinical Guidelines, patients with mild depression can be treated without prescription of antidepressants in the case of a self-help program, which consists of the provision of appropriate written materials, a sleep management program and computer-assisted cognitive behavioral therapy, followed by an assessment of the patient's condition. In our country, such programs have not yet received much distribution in clinical practice. In order to increase the information content and involve patients in the treatment, the Leaflet "Anxiety and depressive disorders" has been developed.

Treatment of patients with comorbid anxiety and depressive disorders should be built taking into account the difficult relationship between the somatogenic and psychological components. In most cases, it is advisable to combine drugs for the treatment of a somatic disease with the prescription of drugs to eliminate depressive and / or anxiety disorders. It is important to use drugs, the effectiveness and safety of which has been proven from the standpoint of evidence-based medicine, to explain to the patient at an accessible level that for recovery it is necessary to normalize the biochemical processes in the nervous system, disturbed by illness, chronic stress, psychotraumatic situations, etc. it is necessary to discuss the treatment plan with the patient, indicate the importance of adherence to the drug regimen, as well as warn that the clinical effect develops gradually. Most patients adequately perceive a logically based approach to prescribing drugs that affect the psycho-emotional sphere. In some cases, it is useful to involve family members in complex psychotherapeutic rehabilitation.

The main groups of pharmacological drugs that are used in therapeutic practice are II generation antidepressants (serotonin reuptake inhibitors), tranquilizers, drugs of other pharmacological groups.

The main indications for prescribing antidepressants in diseases of the digestive tract are comorbid anxiety and depressive disorders in patients with functional disorders of the digestive tract, chronic diffuse liver diseases, persistent pain syndrome in chronic pancreatitis, obesity and eating disorders. Patients who have suffered a myocardial infarction, patients with arterial hypertension, coronary artery disease and neurocirculatory dystonia require special attention. It is advisable to prescribe antidepressants in case of detection of signs of other chronic diseases (stroke, diabetes mellitus, osteoarthritis, etc.).

Antidepressants

When choosing an antidepressant for outpatient treatment, it is necessary to take into account safety, tolerability, the risk of interaction with other drugs, the absence of an effect on performance, the positive effect of previous antidepressant treatment. In accordance with the requirements of evidence-based medicine, serotonin reuptake inhibitors are considered the drugs of choice for the treatment of patients with symptoms of depression and anxiety. They do not show cardiotoxic effects, do not cause physical or mental dependence. The clinical effect of antidepressant therapy appears 1-3 weeks after the start of treatment. If there is no clinical effect of the antidepressant for 4-6 weeks, a psychiatrist's consultation and replacement with another drug is necessary.

In the initial period of antidepressant use, the patient should visit a doctor at least once every 2 weeks and pay attention to possible side effects of treatment, which in most cases go away on their own. To achieve a positive therapeutic effect, the frequency of visits to the doctor should be once every 6-12 weeks. The duration of treatment with antidepressants is 6-12 months. In the case of stopping treatment immediately after achieving a clinical effect, the likelihood of relapse increases significantly. Elderly people in cases of recurrent depressive episodes, as well as in the presence of chronic depression in the past, should be recommended long-term (at least 3 years) or lifelong prescription of antidepressants.

When prescribing antidepressants of the serotonin reuptake inhibitor group, it is necessary to take into account their features:

fluoxetine- an antidepressant with a stimulating effect. Enhances the effect of analgesic drugs. Recommended for depression of various origins, panic fears and bulimia nervosa, premenstrual dysphoric disorders. The advantage is the absence of a sedative effect. Possible side effects: irritability, dizziness, increased convulsive readiness, allergic reactions. The positive effect most often manifests itself after 5-10 days, the maximum - after 21-28 days, stable remission - after 3 months. In the case of anxiety-depressive disorders, it is advisable to prescribe Fluoxitine simultaneously with benzodiazepine tranquilizers during the first week, which makes it possible to achieve a sedative effect without the complications characteristic of tricyclic antidepressants.

Paroxetine- antidepressant of balanced action. Produces both antidepressant and anxiolytic action. But keep in mind that this is one of the least selective serotonin reuptake inhibitors (it partially affects the reuptake of norepinephrine and blocks muscarinic receptors, which causes a sedative effect). Possible side effects: nausea, dry mouth, irritability, drowsiness, excessive sweating, sexual dysfunction.

Sertraline- does not have a sedative, stimulating and anticholinergic effect. Possible side effects: diarrhea, dyspepsia, drowsiness, hyperhidrosis, dizziness, headache, allergic reactions.

Citalopram. The advantage of this drug is the speed of the therapeutic effect (5-7 days of treatment). Possible side effects: dry mouth, drowsiness, hyperhidrosis, dizziness, headache, allergic reactions.

Escitalopram- a representative of the group of serotonin reuptake inhibitors with maximum selectivity. Escitalopram was found to be more effective than citalopram in patients with moderate depression. The drug has little effect on the activity of cytochrome P450, which gives it advantages in the case of a combined pathology that requires polypharmacotherapy.

Promising in general medical practice is the use of a melatonergic antidepressant agomelatine, which has a pronounced antidepressant effect and a unique additional advantage - the rapid recovery of the disturbed sleep-activity cycle and an excellent tolerability profile. Agomelatine improves the quality and duration of sleep and does not cause daytime sleepiness, which is important for patients who continue to work. In the case of a predominant sleep disorder, the drug has a significant clinical advantage.

Ademetionine - (-) S-adenosyl-L-methionine- an active metabolite of methionine, which contains sulfur - a natural antioxidant and antidepressant, which is formed in the liver. A decrease in the biosynthesis of Ademetionine in the liver is characteristic of all forms of chronic liver damage. The antidepressant activity of Ademetionine has been known for more than 20 years and it is considered as an atypical antidepressant - stimulant. Used to treat depression, alcoholism and drug addiction. Rather rapid development and stabilization of the antidepressant effect (during the first and second weeks, respectively), are characteristic, especially when administered parenterally at a dose of 400 mg / day. Combining the antidepressant and hepatoprotective effect is advantageous when the drug is prescribed to patients with diseases of the digestive tract.

tranquilizers

tranquilizers (from lat.tranquillo- soothe), or anxiolytics (from lat.anxietas- anxiety, fear). In addition to the actual anxiolytic, the main clinical and pharmacological effects of tranquilizers are sedative, muscle relaxant, anticonvulsant, hypnotic and vegetostabilizing. Classical representatives of this group are benzodiazepines, which enhance GABAergic inhibition at all levels of the CNS and have a pronounced anti-anxiety effect, which allows significant progress in the treatment of anxiety states of various etiologies. However, in the process of accumulating clinical experience with the use of classical benzodiazepines (chlordiazepoxide, diazepam, finazepam, etc.), more and more attention began to be paid to the side effects of these drugs, which often negates their positive effect and leads to the development of serious complications. Therefore, drugs of this group, including their rapid clinical effect, should be used on an outpatient basis for the treatment of panic attacks. But, when prescribing benzodiazepines, first of all, it is necessary to take into account the possibility of drug dependence, so the course of treatment should be limited to two weeks.

Prospects for the treatment of comorbid anxiety disorders are associated with the use of new generation anxiolytics (Etifoxin, Afobazole).

Etifoxine is an anxiolytic that acts as a direct GABA mimetic. It has a number of advantages compared to benzodiazepines, since it does not cause drowsiness and muscle relaxation, does not affect the perception of information, does not lead to addiction and the development of a withdrawal syndrome. In addition to anxiolytic, it has a vegetative-stabilizing effect and improves sleep. The drug can be used in everyday life. Its effectiveness is more pronounced when prescribed in the early stages of anxiety disorders. Etifoxine can be used simultaneously with antidepressants, sleeping pills and cardiological drugs.

Afobazole- a derivative of 2-mercaptobenzimidazole, a selective anxiolytic that has a unique mechanism of action and belongs to the group of membrane modulators of the GABA-A-benzodiazepine receptor complex. The drug has an anxiolytic effect with an activating component, which is not accompanied by hypnosedative effects, does not have muscle relaxant features, and does not have a negative effect on memory and attention. During its use, drug dependence is not formed and withdrawal syndrome does not develop. Reduction or elimination of manifestations of anxiety (concern, apprehension, awe, irritability), tension (tearfulness, anxiety, inability to relax, insomnia, fear), autonomic disorders (dry mouth, sweating, dizziness), cognitive impairment (difficulties during concentration attention) are observed on the 5th-7th day of treatment. The maximum effect is achieved at week 4 and lasts an average of 1-2 weeks after the end of the course of treatment. Afobazole is especially indicated for persons with predominantly asthenic features in the form of a feeling of increased vulnerability and emotional lability, a tendency to emotionally stressful situations. The drug does not affect the narcotic effect of ethanol, enhances the anxiolytic effect of Diazepam.

TO "atypical tranquilizers" belong to Mebicar, Phenibut trioxazine, etc.

Mebicar- a daytime tranquilizer-adaptogen of wide application, which, in addition to nxiolytic, has a nootropic, antihypoxic and vegetostabilizing effect. The effectiveness of the drug in patients with arterial hypertension and coronary artery disease has been proven. Possible side effects: dyspeptic manifestations, allergic reactions, hypothermia, lowering blood pressure.

Phenibut - improves GABAergic neurotransmitter transmission, which causes a nootropic, anti-asthenic and vegetative-stabilizing effect. Possible side effects: nausea and drowsiness. Caution should be given to patients with erosive and ulcerative lesions of the digestive tract.

Drugs of other pharmacological groups

Glycine belongs to the amino acid-regulator of metabolic processes. It is an inhibitory neurotransmitter, increases mental performance, eliminates depressive disorders, increased irritability, and normalizes sleep. Can be used by the elderly, children, adolescents with deviant behaviors. In alcoholism, it not only helps to neutralize the toxic products of ethyl alcohol oxidation, but also reduces the pathological craving for alcohol, prevents the development of alcoholic delirium and psychosis.

Magne-B6- an original preparation, which is a combination of the microelement magnesium and peredoxin, which potentiate the action of each other. Applied in case of psycho-emotional stress, anxiety, chronic mental and physical fatigue, sleep disturbances, premenstrual and hyperventilation syndrome. Can be given as monotherapy or in combination with other drugs. Does not interact with alcohol, is used to treat alcohol hangover.

Phytopreparations

The use of phytopreparations in the treatment of patients with depressive and anxiety disorders is not regulated by the Clinical Guidelines, which meet the criteria of evidence-based medicine. Therefore, it is advisable to prescribe appropriate modern antidepressants/anxiolytics to patients with a diagnosed depressive and/or anxiety disorder. But phytopreparations can be used to prevent stress-induced psychopathological conditions and autonomic disorders.

In folk medicine, soothing herbs such as valerian, dog nettle, hawthorn, mint, hops and some others have long been used, which are called phytotranquilizers. On their basis, a large number of phytopreparations, widely represented on the pharmacological market, have been developed. Traditionally, tinctures of valerian, hawthorn, etc. are used.

They arise as a result of high voltage, which has been acting on the human body for a sufficiently long period of time.

The human autonomic nervous system is designed in such a way that it can withstand loads of a certain strength and amplitude. Overload makes itself felt by breakdowns and disorders of the neurotic spectrum.

It is necessary to consider the main types of anxiety disorders that can cause panic attacks.

Types of Anxiety Disorders

1. Generalized anxiety disorder.

At the heart of this subspecies of neurosis lies a persistent anxiety that has become dominant in the patient's life. Usually, chronic anxiety is accompanied by a number of somatic symptoms: headaches with nausea and dizziness, fussiness and nervousness, a vague expectation of some kind of misfortune and an inability to relax, forget about disturbing factors even for a while. Clinical manifestations are anxiety, tension and pathological activity. The disorder develops in the form of panic neurosis or obsessive-compulsive disorder.

2. Anxiety-depressive disorder.

In psychiatry, it is also called astheno-depressive syndrome. It is based on two cornerstones at once: anxiety and depression. Restless thoughts, vague images that threaten the well-being of the patient, torment him against the background of a general reduced emotional tone. Panic attacks are a natural development scenario in the absence of treatment. At the beginning of work with a patient, a clinical interview helps the doctor to see the whole picture and determine the depth and strength of the disease state.

3. Obsessive-compulsive anxiety disorder.

With this type of neurosis, patients suffer from obsessions and thoughts - the so-called obsessions. The content of obsessions is gloomy, depressing. These are thoughts about death, a catastrophe or the end of the world, about leaving a family or cheating on a spouse, about a miscarriage (in pregnant women). Trying to get rid of yourself negative thoughts, neurotic patients invent arbitrary actions that have no everyday meaning, are of a ritual nature, the purpose of which is to prevent the materialization of obsessions. These actions are called compulsions.

Types of panic attacks

Against the background of anxiety disorders, patients now and then manifest panic attacks. The most common types of panic attacks are spontaneous, specific, and situational.

Spontaneous panic attacks

Spontaneous panic attacks are characterized by the fact that they appear out of the blue. It is difficult for a psychotherapist to establish the cause, to track the trigger that set the panic in motion. The person does not know why he had an attack.

Spontaneous panic attacks are not uncommon in generalized anxiety disorder. They happen often, suddenly and for no reason. Rather, there is a reason: this is an old, basic feeling of anxiety, which has taken root in inner life person. Anything, any image seen can stir up a layer of anxiety, and it, like a swamp, immediately sucks a person into a maelstrom of horror and panic.

Also, spontaneous panic attacks can occur in obsessive-compulsive and anxiety-depressive disorders.

situational panic attacks

The easiest way to identify the cause of a situational panic attack, as it usually lies on the surface.

A situational attack is always preceded by a trigger event. For example: there was an explosion in the subway when a young woman Yu. was driving home from work. She was descending on the escalator when a crumpled train arrived at the station ... The woman felt fear, panic, suffocation and quickly went upstairs. The next day, she asked her boss for a day off. A day later, Y. took the subway to work. Suddenly, a bearded man with a backpack entered her car. When the train ended up in the tunnel, Y. had a seizure. Subsequently, the panic attacks recurred. Y. required psychotherapy sessions before she was able to use the subway again.

Situational panic attacks are not uncommon in anxiety-depressive disorders, especially in cases where depression is exogenous rather than endogenous (due to external events, and not internal, physiological or hormonal changes). However, in cases of generalized and obsessive-compulsive anxiety disorders, this type of panic attack is not uncommon.

Specific panic attacks

Finally, specific or conditionally situational panic attacks are always provoked by a chemical or biological factor. It can be: alcohol, drugs, poisoning, menstruation in women. This type Panic attacks occur regardless of the presence or absence of an anxiety disorder. However, if we are not talking about chemical effects, but about physiological changes, especially in a woman caused by menstruation, pregnancy or menopause, then it is possible that specific attacks of this type are a signal for the onset of one or another neurotic disorder of the anxiety-phobic spectrum.

Panic attacks as companions of anxiety disorders

Panic attacks are unhappy companions of anxiety disorders, aggravating the already unenviable situation of the patient. They occur against the background of neurosis more intense and painful than panic attacks in a person who can conditionally be called healthy. All symptoms are exacerbated, tachycardia and arrhythmia are very pronounced, there is profuse sweating, severe trembling, vomiting, diarrhea and a long period of weakness with exhausted lying in bed after an attack.

The first panic attacks in an anxiety disorder serve as a signal to the neurotic: he is seriously ill! Panic attacks cause fear, depression, anxious expectation of subsequent attacks. The patient's life is now dominated by panic attacks. If the patient realizes that he is suffering from a neurotic disorder, then a panic attack informs him that he does not have a neurosis, but a much more severe one. mental illness! Possibly manic-depressive psychosis.

Treatment of anxiety disorders today is carried out with medication (drugs) or non-drug (psychotherapeutic) means.

In orthodox domestic medicine, until relatively recently, preference was given to drug therapy. Today to psychotropic drugs in the treatment of panic attacks are treated with much more caution.

A psychiatrist in the treatment of anxiety disorders prescribes drugs in a balanced way to avoid the patient getting used to them. And cancel them in stages, according to the scheme, by reducing the dosage.

In case of panic attacks in domestic traditional medicine, tranquilizers are usually prescribed (primarily phenazipam), as well as barbiturates (corvalol, valocardin, which is banned almost all over the world). Well, if the doctor guesses to prescribe to the patient an herbal collection containing anti-panic ingredients: St. John's wort, valerian, mint, lavender, angelica in various combinations. However, any herbal preparations have a delayed effect, and therefore most doctors consider them ineffective in such a situation.

Antidepressants are usually prescribed for anxiety-depressive disorder. Most patients become highly addicted to them. Yes, and the effect of these drugs is "accumulative": first, a certain dose must accumulate in the body, that is, several days of administration must pass, and then the result begins to appear. In the case of panic attacks, when a patient who is relying on medication wants a quick result, antidepressants are ineffective. In addition, effective in depression, they can only increase the panic state.

The mildest of the antidepressants is Negrustin, but it is also recommended to be used in cases where a neurotic disorder is caused by external causes (an accident occurred, someone died).

The dosage of drugs for anxiety disorders depends on the severity of the patient's condition, on the intensity of panic attacks and on the general tone of the patient. It should be noted that there are patients who, even with the most unpleasant neurotic symptoms, refuse to take medication, fearing addiction and dependence on drugs for life. These patients have to choose other methods of treatment.

There are also doctors who believe more in the power of psychotherapy, in word healing and psychotechniques, than in "miracle pills." By the way, the most progressive psychotherapists claim that there is no need for drugs.

Psychotherapy offers a rich, decades-old arsenal of remedies for panic attacks. These are cognitive-behavioral, and positive, and gestalt therapy, and existential analysis, and psychoanalysis, and art therapy.

It is worth dwelling in more detail on such a method as Viktor Frankl's logotherapy (which means "healing with a word" in translation). Frankl assures: the word carries a healing power. Words penetrate into the subconscious and have an impact at the deepest level, affecting the substructures of the personality that are invisible to no one and not known to anyone.

This principle is based on healing with the use of autogenic training.

Mantras for treating panic attacks

IN last years the treatment of panic attacks with the help of mantras is increasingly coming to the fore. There are many mantras, among them there are several popularized to such an extent that they can be easily found on the Internet. The mantra called "So-ham" is especially famous. (Inhale - “So”, exhale - “Ham”). It is performed quite simply. the main task- hear the vibration of air in your sound, merge inhalation and exhalation, and both sounds together.

In addition to the deep impact on the human body as a whole, which is attributed to the mantra as a unique ritual, it normalizes breathing and distracts a person from the symptoms of panic. And distraction techniques are the most effective method of overcoming a panic attack.

Mantra treatment lends itself well not only to panic attacks themselves, but also to anxiety disorders as such. In the future, having mastered a few mantras, it will be possible to move on to meditation and yoga techniques, which will certainly help change consciousness, clear the mind of disturbing thoughts and forever get out of the power of neurosis.