How to distinguish from a bad mood
- Duration: symptoms last at least 2 weeks almost every day, most of the day
- Anhedonia - loss of pleasure from what used to please; key feature
- Impaired functioning: work, studies, relationships, everyday life suffer
- Mood changes little depending on external events
- Physical symptoms are added: sleep and appetite disturbances, fatigue
Ordinary sadness is associated with a specific reason, lasts days, is softened by support and pleasant events and does not deprive a person of the ability to live an ordinary life.
Symptoms
- Depressed mood, melancholy, feeling of emptiness
- Loss of interests and pleasure
- Fatigue, decreased energy even after rest
- Sleep disorders: insomnia or, less commonly, increased sleepiness; typically early awakening at 4–5 am
- Changes in appetite and weight
- Difficulty concentrating and making decisions
- Feelings of guilt, worthlessness, low self-esteem
- Slowness or, conversely, agitation
- Bodily manifestations: headaches, back pain, digestive disorders
- Thoughts about death and self-harm
У мужчин депрессия нередко проявляется не грустью, а раздражительностью, вспышками гнева, злоупотреблением алкоголем и уходом в работу. Из-за этого её распознают позже.
What to exclude
- Гипотиреоз — проверяется ТТГ; частая и полностью обратимая причина.
- Дефицит витамина B12, фолиевой кислоты, витамина D, анемия.
- Побочное действие лекарств.
- Злоупотребление алкоголем и психоактивными веществами.
- Биполярное расстройство — важнейший вопрос: были ли периоды необычно повышенного настроения и активности. От этого зависит выбор лечения.
Treatment
- Psychotherapy, primarily cognitive-behavioral, is a method with proven effectiveness for mild and moderate depression, comparable to medications
- Antidepressants - for moderate and severe depression; the effect develops after 2–4 weeks, not immediately
- The course of treatment after improvement continues for at least 6–12 months - early withdrawal is the main cause of relapse
- Cancellation only gradually and under the supervision of a doctor
- Regular physical activity has a proven antidepressant effect
- Normalization of sleep, limiting alcohol
- For severe and resistant forms - other methods, including hospital treatment
Антидепрессанты не вызывают зависимости и не меняют личность. Неприятные ощущения при резкой отмене — это синдром отмены, а не «ломка»; он предотвращается постепенным снижением дозы.
How to support a loved one
- Do not say “pull yourself together”, “others have it worse”, “just take a break” - this increases the feeling of guilt
- Acknowledge feelings: “I see that it’s hard for you”, “I’m close”
- Offer specific help: go to the doctor together, help with everyday life
- Don't be left alone if you have thoughts of self-harm and seek emergency help.
- Don't expect quick results: treatment takes weeks
- Taking care of yourself too: supporting someone with depression is draining