The Sad Triad Of Depression. When Do You Need Medical Attention? - The Quality Of Life

The topic of depression has become popular in our time. They write, talk, read about the disease. But this does not always improve the understanding of what really is depression, requiring obligatory medical (not psychological!) Help, and what is “depressed mood” or “depressive experiences”. Such states only resemble clinical depression, but in fact they are natural fluctuations in the emotional background for a person

Not a single sadness

In popular articles and programs, only emotional disorders are mentioned, but the point is that it is impossible to define true depression this way. Apathy, hopelessness, mental pain, and even thoughts of suicide can temporarily arise in a person experiencing the trauma of betrayal, financial collapse, loss of loved ones, etc. Changes in the sensory sphere alone do not yet provide a compelling basis for a diagnosis.

In addition to emotions, depression also changes thinking and behavior. That is why a specialist - a psychotherapist or a psychiatrist - makes this diagnosis in the presence of all three integral components of the so-called "classic depressive triad".

1. Decreased mood

This state is experienced extremely dramatically, since it includes almost everything that is meant by longing, sadness, apathy, melancholy, depression, despondency, loss of interests, meanings, and motivation. Self-confidence and self-esteem are catastrophically falling, severe remorse of conscience, feeling of guilt, inferiority, failure, erroneous past actions and decisions made, self-condemnation, self-deprecation and everything else that could be called a pronounced inferiority complex are possible. The limitation of contacts is expressed, the desire for loneliness is emphasized.

Depression is frozen fear

Sigmund Freud

With extreme degrees of depression, there are feelings of mental pain, heaviness in the soul, "a stone in the heart", sensual emptiness, emotional exhaustion, "burnout", loss of the ability to sympathy and empathy. All this leads to thoughts about the meaninglessness of existence, unwillingness to live, contemplating suicide scenarios.

2. Cognitive, or ideational, inhibition

A person simply does not have enough energy to complete mental operations in full. Simply put, in a state of depression, a writer cannot write, an accountant cannot count, a lecturer cannot speak impromptu. At least they cannot do it as freely as they did before the depression. The diagnosis of depression also implies a decrease in the clarity of thinking, a feeling of "fog" in the head, unnaturalness, unnaturalness of what is happening, disconnection from oneself, inability to concentrate attention, properly remember and assimilate information, which inevitably leads to a decrease in creative and intellectual abilities.

In the experiment, this is confirmed by an objectively recorded decrease in the number of associations per unit of time, so it is no coincidence that depressed patients feel that their "thoughts are flowing slowly." With severe depression, complaints of memory loss, a decrease in vocabulary, difficulties in constructing phrases and sentences, a feeling of "dullness" up to fears of impending dementia are often among the first. All this does not have any organic (neurological) basis and completely disappears when overcoming depression.

3. Motor (kinesthetic) lethargy

The more severe the disease, the less mobility. An exception is the so-called agitated depression, in which a person senselessly rushes "from corner to corner", "like an animal in a cage," but these periods are short-lived. Motor retardation manifests itself not only by externally visible inactivity, but above all by an acutely experienced feeling of loss or decrease in volitional abilities, general tone, strength, energy.

Even ordinary daily activities are performed "through force", as if by the strongest inner urge

And this is not laziness at all - a lazy person can always, but does not want to do anything - he already feels good, without a shadow of mental anguish he watches how others perform his duties.

In case of depression, on the contrary, a person wants, but cannot be active, he searches with all his mental strength, but does not find access to the lost volitional resource.

In severe depression, motor retardation reaches the point that patients cease to monitor their appearance, observe hygiene, spend almost all the time lying or sitting, being in a melancholic stupor.

No matter how emotionally a person may suffer, but if, for example, he reports that during a period of difficult experiences he has read all of Dostoevsky or compiled an annual report, then this is not depression at all, since the second component is missing - mental retardation. If he notes that he is “saved by work”, that tasks, assignments and important things can temporarily distract him from painful experiences, then this is not depression at all, since its third component is absent - motor retardation.

A few more signs

We have heard a lot about panic attacks, but few people are aware that with depression there are often the most real "angry attacks" - episodic outbursts of extreme irritation, impatience, up to poorly controlled aggression, which are not characteristic of the person's character and completely stop after recovering from a depression …

With depression, sleep is often disturbed, and not in the form of a violation of falling asleep, as with anxiety neuroses, but in the form of early (at three to six in the morning) awakenings in a very painful emotional state without the ability to fall asleep again.

Is it autumn blues?

According to the WHO, about 8 million Russians suffer from depression. Across the European Region, this figure stands at 40 million. According to the director of the Moscow Psychological Aid Service Nina Petrochenko, in June 2017 about 3,870 Muscovites used the organization's services, which is 14% more than in the same period last year - then 3,400 people applied for support. About 25% of all requests are health complaints. This concept includes both physical and mental states, including depression. In second place is the lack of communication (about 20%). There are many family and marital problems (11-12%).

The daily rhythm of mood is typically "owl": in the first half of the day all the components of the depressive triad are most pronounced, and by the evening and especially towards the night, a person seems to "pace", acquiring a relatively greater activity and clarity of thinking. Among the vegetative, or, as they say, psychosomatic symptoms of depression are constipation of the intestines, headaches, arterial hypertension and dryness of the mucous membranes. The latter may in part determine such a well-known feature of depressed patients as the inability to cry.

Often, the place of the first component of the depressive triad (decreased mood and emotional experiences) is taken by multiple complaints about the state of physical health, a feeling of loss of strength as a result of a severe but unrecognized illness, the belief in the presence of symptoms of somatic pathology with normal examination results. This depression is called somatized, or masked, latent.

In general, there are a lot of options for depression - anxious, apathetic, melancholic, hypochondriacal, reactive, endogenous, recurrent, psychotic, neurotic, latent, somatized, atypical and others.

In no case should you try to diagnose yourself, let alone treat depression. This is the business of a doctor with a medical degree - a psychotherapist or psychiatrist.