Recurrent depressive disorder is a symptom complex that manifests itself in recurring episodes of depression without recorded cases of high spirits and hyperactivity similar to mania. The prevalence of this disease among the world's population is about two percent of the total population.
Medical history
Information about depression as a disease appeared recently. During the time of Hippocrates, melancholy was associated with the predominance of “black” bile in the body. Of course, the diagnostic methods were gradually improved, and already by the Middle Ages, theologians came to the conclusion that people who are discouraged are obsessed with the devil. Accordingly, they tested on the poor the whole arsenal of means for conducting the rite of exorcism. Holy water, prayer, strict fasting and even torture were used.
Fortunately, the Renaissance came, and with it received a second life and such basic sciences as medicine, physics, mathematics. A scientific approach was encouraged. Since that time, neurology and psychiatry began to consider low mood as a recurrent depressive disorder. The history of the disease goes back many centuries. Different approaches to solving the problem were proposed, but so far it has not been able to cure it.
Development reasons
It is rather difficult to specify the cause of the disease. An exclusively individual approach to assessing symptoms and collecting history is needed here. To do this, write a medical history of psychiatry. Recurrent depressive disorder can be caused both by internal imbalance of hormones and by external causes - psychological trauma, neuroinfection, severe intoxication, head injury (traumatic brain injury). The first episode can be triggered by traumatic circumstances, but the subsequent phases already appear on their own, not related to what is happening in the surrounding space.
Pathogenesis
As a rule, a person reaches adulthood when he is diagnosed with recurrent depressive disorder. Symptoms appear after forty years and can last from three months to a year, and light intervals should be at least eight weeks. The older the patient, the higher the likelihood that the disease will become chronic. The duration of the attack is directly proportional to the length of the disease, sometimes it takes on a seasonal character.
Big symptoms
In psychiatry, there are concepts such as primary and secondary symptoms. They combine in various combinations, forming a recurrent depressive disorder. ICD 10 gives clear criteria for diagnosing this disease:
- depressive mood (lack of positive emotions);
- decrease in interest in previously pleasant things or actions, lack of satisfaction from the work done;
- weakness, lethargy, increased fatigue.
Minor symptoms
In addition to at least one main symptom, there should be several minor ones. They are present in almost all mental patients, and not only in patients diagnosed with recurrent depressive disorder. ICD indicates the following characteristics:
- low self-esteem;
- guilt, self-condemnation and self-accusation;
- suicidal mood;
- decreased attention and concentration;
- hopeless description of the future;
- violation of sleep and appetite.
Diagnostics
A psychiatrist should collect a thorough medical history of the disease not only from the patient, but also from his relatives in order to have a complete picture of the number, frequency and nature of the attacks. Often the patient does not remember when he had the first signs of depression, but his relatives can indicate if not an exact, then at least an approximate date. Recurrent depressive disorder manifests itself in at least two episodes of mood decline, which last more than two weeks. They should be separated by time in light intervals (when the symptoms are completely absent). The doctor does not exclude that the patient may have a manic state, even if there is a significant length of treatment for depression. In this case, the diagnosis changes to
BAR (bipolar affective disorder).
In medical records, recurrent depressive disorder is indicated by the code F.33, indicating the type of current condition, as well as the nature of previous episodes. If there is such information.
Severity
- A mild degree includes two main and two additional symptoms. In addition, it may be accompanied by somatic disorders that exacerbate the course of the disease. Allocate:
- a mild degree with minor somatic manifestations;
- mild with severe somatic diseases. - Moderate severity is placed in the presence of two main and three to four auxiliary symptoms. And just like in a mild degree, somatic disorders are present.
- Severe depressive disorder implies the presence of all major symptoms and at least four secondary symptoms. Usually all of the above are present. A complication of this degree is the presence of psychogenic signs, such as delirium, hallucinations, stupor.
Recurrent depressive disorder must be distinguished from schizoaffective disorder and organic mental changes. In the first case, in addition to depression, there are still symptoms of schizophrenia, and in the second, there is the main disease that will be detected during laboratory and instrumental diagnosis.
Treatment
In order to prescribe therapy, you must first have a complete picture of the patient's body. This is done in the process of registration of the patient in the appropriate hospital. In this sense, recurrent depressive disorder was no exception. Its treatment consists in taking antidepressants and antipsychotics, as well as sleeping pills. Use sleep deprivation or ECT (electroconvulsive therapy) if the disease is resistant to medical intervention. Group and individual psychotherapy helps.
It is impossible to make this diagnosis at home, based only on fragmentary knowledge and indirect symptoms. This should be done by a specialist.
The need for quality assistance
In most cases, a person cannot correctly assess the complexity of the process that happens to him. It seems to him that this is just a bad mood, spleen and fatigue, nothing more. In fact, changes affect deep biochemical levels of regulation that require correction to restore mood.
The second problem that prevents patients from seeking help on time is their weak character, lack of criticism of their condition and moral strength to make a decision. This exacerbates the picture of depression.
In this regard, it becomes clear why the help of a professional, provided in a timely manner, can minimize the harm caused to a person by a recurrent depressive disorder. The forecast in this case can be considered favorable. Ignoring the symptoms only exacerbates the situation and puts the disease in a chronic form.
The disease significantly affects the social connections of a person. He may lose his job, family and friends. Get hurt or even commit suicide. Therefore, patients should not console themselves with the illusions of sudden healing, but you need to go to a doctor who can correctly assess a person’s condition and prescribe him appropriate treatment. The success of therapy depends not only on the actions of the doctor, but also on whether the patient wants to recover or not. Often, psychosomatic problems go away only under the influence of conversations with a psychiatrist, even without medication.
Prevalence
At least once in a lifetime, each of us experienced a state of depression. But hardly anyone bothered to go to the doctor on such an insignificant occasion. Nothing hurts, and okay. In developed countries, depression is one of the main causes of disability. This diagnosis is more common among residents of large cities, because in the “human anthill” you can feel lonely like nowhere else. Crowding, poor ecology, permanent stress, excessive demands on oneself and the desire to succeed will certainly put pressure on the human psyche, causing it to experience overload. The fact that people living in cities more often decide to go to the doctor and find out their diagnosis plays a role.
Somatic, especially neurological diseases exacerbate depression. Persistent headaches or heartaches can prompt a person to think about an imminent demise. An overly strict upbringing, stress and trauma in early childhood, and episodes of domestic violence play a large role. Heredity also plays a role. So, if close relatives have fixed conditions such as BAR, schizoaffective disorder or depression, then the likelihood of it in offspring is much higher.