What is a Depressive Episode?
A depressive episode is an affective disorder characterized by emotional, cognitive and somatic disorders, which manifests itself in a decrease in mood, loss of interests and pleasure, a decrease in energy, and, as a result, a decrease in activity and increased fatigue. There is marked fatigue, even with little effort. Among the additional symptoms are also present a reduced ability to concentrate and attention; reduced self-esteem and self-confidence; secondary ideas of self-incrimination; dark and pessimistic vision of the future; ideas or actions aimed at self-harm or suicide; disturbed sleep; reduced appetite.
A depressive episode lasts at least 2 weeks.
According to the number, type and severity of symptoms present, they differentiate:
- Mild depressive episode
- Depressive episode of moderate
- Depressive episode of severe
Causes of a Depressive Episode
- Genetic causes may be abnormalities in chromosome 11, although it is assumed that polygenic forms of the disorder will exist.
- The biochemical cause is the impaired neurotransmitter metabolic activity: serotonin and catecholamine deficiencies.
- Neuroendocrine causes are expressed in impaired rhythm of the functioning of the hypothalamic-pituitary, limbic system and pineal gland, which is reflected in the rhythm of release of releasing hormones and melatonin. These processes are associated with photons of daylight. This indirectly affects the overall rhythm of the body, in particular, the rhythm of sleep / wakefulness, sexual activity, and food.
Risk factors are age 20-40 years, decline in social class, divorce in men, family history of suicides, loss of relatives after 11 years, personality traits with features of anxiety, diligence and conscientiousness, stressful events, homosexuality, problems of sexual satisfaction, the postpartum period, especially in single women. In the pathogenesis of depression, along with genetic factors that determine the level of neurotransmitter systems, it is important to cultivate helplessness in the family during the stress period, which forms the basis of depressive thinking, loss of social contacts.
Symptoms of a Depressive Episode
Patients note a decrease in the ability to concentrate and attention, which is subjectively perceived as a difficulty of remembering and a decrease in success in learning. This is especially noticeable in adolescence and youth, as well as in persons engaged in intellectual work. Physical activity is also reduced to lethargy (up to a stupor), which can be perceived as laziness. In children and adolescents, depression can be accompanied by aggressiveness and conflict, which mask a kind of self-hatred. It is conditionally possible to divide all depressive states into syndromes with the anxiety component and without the anxiety component.
The rhythm of mood changes is characterized by a typical improvement in well-being in the evening. Self-esteem and self-confidence are reduced, which looks like a specific neophobia. The same sensations distance the patient from those around him and heighten his sense of inferiority. With prolonged depression after the age of 50, this leads to deprivation and a clinical picture resembling dementia. There are ideas of guilt and self-deprecation, the future is seen in dark and pessimistic tones. All this leads to the emergence of ideas and actions related to auto-aggression (self-harm, suicide). Sleep / wake rhythm is disturbed, insomnia or lack of feeling of sleep is observed, dark dreams prevail. In the morning the patient hardly gets out of bed. Appetite decreases, sometimes the patient prefers carbohydrate food to protein, appetite can be restored in the evening. Changing perception of time, which seems infinitely long and painful. The patient ceases to attract attention, he may have numerous hypochondriacal and senesthopathic experiences, a depressive depersonalization appears with a negative perception of his own I and body. Depressive derealization is expressed in the perception of the world in cold and gray tones. Speech is usually slowed down with talking about its own problems and past. Attention concentration is difficult, and the formulation of ideas is slow.
On examination, patients often look out the window or at the source of light, gestures with orientation toward their own body, pressing their hands to their chest, with anxious depression to the throat, submission posture, facial expression fold Veragutus, lowered corners of the mouth. When anxiety accelerated gestural manipulation of objects. The voice is low, quiet, with long pauses between words and low directivity.
Indirectly, a depressive episode can be indicated by symptoms such as pupil dilation, tachycardia, constipation, decreased skin turgor and increased fragility of the nails and hair, accelerated involutive changes (the patient seems older than his years), and somatoform symptoms such as: psychogenic shortness of breath, syndrome restless legs, dermatological hypochondria, cardiac and pseudorheumatic symptoms, psychogenic dysuria, somatoform disorders of the gastrointestinal tract. In addition, in depressions, sometimes the weight does not decrease, but increases due to the carbohydrate burden, the libido may also not decrease, but increase, because sexual satisfaction reduces anxiety levels. Among other somatic symptoms, vague headaches, amenorrhea and dysmenorrhea, chest pains and, especially, a specific feeling of “stone, heaviness on the chest” are characteristic.
Diagnosing a Depressive Episode
The most important signs are:
- reduced ability to concentrate and attention;
- reduced self-esteem and self-confidence;
- ideas of culpability and self-deprecation;
- dark and pessimistic vision of the future;
- ideas or actions that lead to self-harm or suicide;
- disturbed sleep;
- reduced appetite.
Depression should be differentiated from initial events in Alzheimer’s disease. Depression can indeed be accompanied by a pseudodementia clinic described by Wernicke. In addition, prolonged depression can lead to cognitive deficits as a result of secondary deprivation. Chronic depression pseudo-dementia is referred to as Puna Van Winkle syndrome. For the distinction have anamnestic information, the data of objective research methods. In depressed patients, typical daily mood swings and relative success in the evening are more often present, their attention is not so grossly disturbed. In mimicry of depressed patients, Veraguta folds, lowered corners of the mouth are noted, and there is no confusion and rare blinking characteristic of Alzheimer’s disease. When depression is also not marked gestural stereotypy. With depression, as with Alzheimer’s disease, progressive involution is noted, including decreased skin turgor, dull eyes, increased fragility of the nails and hair, but these disorders in brain atrophy are more often ahead of psychopathological disorders, and in depression they are noted with a long duration of low mood . Weight loss with depression is accompanied by a decrease in appetite, and in Alzheimer’s disease, appetite is not only not reduced, but can also increase. Patients with depressions react more clearly to antidepressants by increasing activity, but in Alzheimer’s disease, they can increase sustainability and astenisation, giving the impression of overloading patients. Nevertheless, the data of CT, EEG and neuropsychological examination are crucial.
Treatment of a Depressive Episode
Antidepressants are used in treatment: mono-, bi-, tri-, and tetracyclic, MAO inhibitors, serotonin reuptake inhibitors, L-tryptophan, thyroid hormones, monolateral ECT in the non-dominant hemisphere, sleep deprivation. The old methods include in / treatment with increasing euphorizing doses of novocaine, inhalation with nitrous oxide. Phototherapy with fluorescent lamps, cognitive psychotherapy and group psychotherapy are also used.