Anxiety depressive disorder taking medications. What is the difference between anxiety and depressive disorder and how to treat it. Visual vector: changing anxiety to love

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

International Psychiatric Association and International Committee Prevention and Treatment of Depression introduced an educational program on the diagnosis and treatment of depressive disorders, which was implemented in many regions. In 1998, this program was started in Russia, and in 2002, materials were published in Ukraine. Over the past years, the number of scientific publications on this problem in Ukraine has been increasing, but practical implementation remains insufficient. There is also no national program for training specialists. Most doctors note the significance of this problem, but do not consider themselves competent in diagnosing and treating 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 arise as a consequence or under the influence of psychological and stressful causes. Under endogenous depressive disorders refers to those depressions that develop in schizophrenia and manic-depressive psychosis. Somatogenic depressive disorders observed in various somatic diseases (cardiovascular, endocrine, gastrointestinal tract and 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 depression is observed, when the actual depressive symptoms are masked as a disruption in work different organs and systems, persistent headaches, changes in sleep and is not recognized by the patient as such.

According to the World Health Organization, from 10 to 20% of the world's population report the occurrence of clinically significant depressive conditions throughout their lives. According to the results of epidemiological studies, every eighth inhabitant of our planet needs specific pharmacotherapy in connection with depressive conditions. In 60% of cases, as a rule, in case of insufficiency or inadequate therapy, repeated depressive episodes occur. Almost half of patients with depression do not go to doctors, and approximately 80% are treated by internists and general practitioners.

The development of depressive disorders is associated with impaired metabolism of the main neurotransmitters: serotonin, norepinephrine and dopamine in central structures ah of the brain (limbic system), which take part in assessing the emotional significance of information that enters the central nervous system (CNS) and forms the emotional component of human behavior. Bilateral cause-and-effect relationship between depression and the condition internal organs and somatization of depression symptoms can be explained by the close relationship between 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 stroke. The importance of influencing psychoemotional factors was confirmed in the INTERHEART studies, where their contribution to the risk of acute myocardial infarction was not inferior to diabetes mellitus and smoking. Over the past few decades, the relationship between depression and prognosis in patients with coronary artery disease has been examined 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 over the course of a year. The mortality rate of patients who have a history of myocardial infarction and suffer from depression is 3-6 times higher than in persons without signs of depression. In cases of depression, patients often do not follow doctors' recommendations regarding treatment. Given the important role of depressive disorders in patients with coronary heart disease, the American Heart Association developed and introduced in 2008 the “Depression and IHD: Screening and Treatment Guidelines,” which emphasizes the need for screening to identify individuals with IHD and depression who require additional treatment. However, the results of the ENRICHD study showed that in the group of patients with depression who suffered an acute myocardial infarction and received serotonin reuptake inhibitors, there was 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 manifestations of depression are closely related to anxiety disorders. - normal reaction the human body to unfavorable 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 daily work and make pessimistic forecasts; in most cases, they 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 consult general practitioners. According to the results of modern scientific research, an increased risk of cardiovascular complications has been noted in patients with anxiety disorders. Among the mechanisms being considered are 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 persons without pathopsychological disorders.

A significant prevalence of anxiety and depressive disorders is also typical for patients with pathologies 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 illness liver, liver cirrhosis, hepatic encephalopathy), as well as in patients undergoing interferon therapy. Comorbid anxiety and depressive disorders are also characteristic of other gastroenterological diseases. Thus, according to the results of an American national survey, gastric ulcers and duodenum is associated with an increase in the frequency of generalized anxiety by 4.5 times, panic attacks- 2.8 times. It has been found that increased levels of anxiety are associated with increased healing time for peptic ulcers. According to various authors, depression is detected in 35-50% of patients with peptic ulcer disease. More than 20% of patients with pathologies of the digestive tract require antidepressants. Comorbid anxiety and depressive disorders are also common in the case of 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 when they occur together 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 for 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(ability to listen, discuss, clearly pose questions). Methodological materials World Psychiatric Association "Training doctors in skills in the field of mental health» identify the main aspects of the communication style of doctors that are associated with assessment emotional state patient:

1. Establish favorable eye contact
2. Clarify patient complaints
3. Make comments with sympathy
4. Notice the patient's verbal and nonverbal cues
5. Do not read medical history notes during a conversation
6. Control the patient's excessive talkativeness

In the clinical guidelines "Depression: care for depression in primary and secondary care" developed by NICE (National Institute for Health and Clinical Excellence - National Institute Health and Clinical Improvement, UK) to screen for depression, it is recommended to ask two questions: “Have you frequently reported low mood, sadness, or feelings of hopelessness over the course of last month? and “During the past month, have you often noticed a lack of interest or pleasure in things that usually bring you pleasure?” Questions that can be used to screen for anxiety include: “Have you felt restless, tense, and anxious most of the time over the past 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 observed almost every day and most of the day, especially in the morning, the duration of which was at least 2 weeks regardless of the situation (the mood can be depressed, sad, accompanied by anxiety, concern, irritability, apathy , tearfulness, etc.).
2. Significant decrease (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 and self-confidence.
3. 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 (difficulty falling asleep, insomnia in the middle of the night, early awakening).
7. Decreased (increased) appetite, decreased (increased) body weight.

To determine a mild depressive episode, it is enough to state at least two main and two additional symptoms. The presence of two main symptoms of depression in combination with three to four additional symptoms indicates moderate depression. All three core symptoms of depression and at least four additional symptoms indicate severe depression. It should be taken into account that due to various types of depression there is a possible risk of suicide. If suicidal symptoms are detected in a patient, consultation with a psychiatrist is necessary.

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

IN scientific literature other emotional disorders that clearly arise at the onset of depression have been systematized:

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

In ICD-10, anxiety disorders are classified under the headings “Panic disorder” (F41.0), “Generalized anxiety disorder” (F41.1) and “Mixed anxiety and depressive disorder” (F41.2).

The main feature panic disorder are repeated 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, choking, dizziness and a feeling of unreality (depersonalization or derealization). Many patients feel the fear of death and lose self-control. Anxiety and fear can be so strong that they literally paralyze the patient’s will. A panic attack usually lasts several minutes; the condition gradually (from 30 minutes to 1 hour) normalizes. But after this, the patient remains afraid of a new attack. A panic attack must be differentiated from paroxysmal tachycardia, atrial fibrillation and an attack of angina.

Generalized anxiety disorder characterized by manifestations of internal tension, inability to relax and concentrate. In this case, the constant internal tremors, increased sweating, frequent urination. Patients exhibit increased anxiety during daily activities and make pessimistic forecasts and have difficulty falling asleep. Phobias, or fears, are also manifestations of an anxiety disorder. A diagnosis of mixed anxiety and depressive disorder is made 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. The Hospital Anxiety and Depression Scale (HADS) is widely used for screening studies. 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.

Patients diagnosed with clinically significant anxiety or depression should be referred for consultation with a psychiatrist. Patients with depression and suicidal thoughts also require consultation with a psychiatrist. 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 cases of subclinical anxiety or depression, treatment may be prescribed by a general practitioner (GP).

Treatment of anxiety and depressive disorders in therapeutic practice

In accordance with NICE clinical guidelines Depression: care for depression in primary and secondary care, Treatment of depression in adults (core edition), American Heart Association guidelines Depression and ischemic disease heart: recommendations for screening and treatment" and scientific developments of Ukrainian specialists, treatment of mild and moderately severe 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 the prescription of antidepressants if a self-help program is provided, which consists of the provision of appropriate written materials, a sleep regulation program and computer-assisted cognitive behavioral therapy, followed by assessment of the patient's condition. In our country, such programs have not yet become particularly widespread in clinical practice. In order to increase information content and attract patients to participate in treatment, a leaflet “Anxiety and depressive disorders” was developed.

Treatment of patients with comorbid anxiety and depressive disorders should be structured 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 somatic illness with the prescription of drugs to eliminate depressive and/or anxiety disorders. It is important to use drugs whose effectiveness and safety have 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 that are disturbed by the disease, chronic stress, psychotraumatic situations, etc. it is necessary to discuss a treatment plan with the patient, point out the importance of adherence to the medication regimen, and also warn that the clinical effect develops gradually. Most patients adequately perceive a logical approach to prescribing drugs that affect the psycho-emotional sphere. In some cases, it is useful to involve family members in comprehensive psychotherapeutic rehabilitation.

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

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

Antidepressants

When choosing an antidepressant for outpatient treatment it is necessary to take into account safety, tolerability, risk of interaction with other drugs, lack of effect on performance, positive effect previous treatment with antidepressants. In accordance with the requirements of evidence-based medicine, serotonin reuptake inhibitors are considered as the drugs of choice for the treatment of patients with symptoms of depression and anxiety. They do not exhibit 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 from an antidepressant for 4-6 weeks, it is necessary to consult a psychiatrist and replace it with another drug.

During the initial period of using antidepressants, the patient should visit the doctor at least once every 2 weeks and pay attention to possible side effects treatments, which in most cases go away on their own. To achieve 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. If treatment is stopped immediately after achieving a clinical effect, the likelihood of relapse increases significantly. Elderly persons in cases of repeated 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 from 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 different origins, panic fears And bulimia nervosa, premenstrual dysphoric disorders. The advantage is the absence of sedation. Possible side effects: increased excitability, dizziness, increased convulsive readiness, allergic reactions. The positive effect most often appears 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 Fluoxetine simultaneously with benzodiazepine tranquilizers during the first week, which makes it possible to achieve sedative effect without complications characteristic of tricyclic antidepressants.

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

Sertraline- has no sedative, stimulating or 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. 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 combined pathology that requires polypharmacotherapy.

The use of a melatonergic antidepressant is promising in general medical practice. Agomelatine, which has a pronounced antidepressant effect and a unique additional benefit - fast recovery disrupted sleep-activity cycle and excellent tolerability profile. Agomelatine improves the quality and duration of sleep and does not cause daytime drowsiness, which is important for patients who continue to work. In the case of predominant sleep disturbance, the drug has significant clinical benefit.

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

Tranquilizers

Tranquilizers (from lat.tranquillo- calm down), or anxiolytics (from lat.anxietas- anxiety, fear). In addition to the anxiolytic effect itself, the main clinical and pharmacological effects of tranquilizers are sedative, muscle relaxant, anticonvulsant, hypnotic and vegetative stabilizing. Classic representatives of this group are benzodiazepines, which enhance GABAergic inhibition at all levels of the central nervous system and have a pronounced anti-anxiety effect, which makes it possible to achieve significant success in the treatment of anxiety conditions 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 serious complications. Therefore, drugs in this group, including their rapid clinical effect, are advisable to use on an outpatient basis for the treatment of panic attacks. But when prescribing benzodiazepines, it is first 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 (Etifoxine, Afobazol).

Etifoxine- 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, and does not lead to addiction and the development of 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 cardiac medications.

Afobazole- a 2-mercaptobenzimidazole derivative, 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 and does not have muscle relaxant features, negative influence on indicators of memory and attention. During its use, drug dependence does not form and withdrawal syndrome does not develop. Reducing or eliminating symptoms of anxiety (preoccupation, bad feelings, fearfulness, irritability), tension (tearfulness, anxiety, inability to relax, insomnia, fear), autonomic disorders (dry mouth, sweating, dizziness), cognitive impairment (difficulty concentrating attention) is observed on days 5-7 of treatment. The maximum effect is achieved at 4 weeks and lasts for 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 and enhances the anxiolytic effect of Diazepam.

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

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

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

Drugs of other pharmacological groups

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

Magne-B6 - original drug, which is a combination of the microelement magnesium and peroxin, which potentiate each other’s action. Used in cases of psycho-emotional stress, anxiety, chronic mental and physical fatigue, sleep disturbances, premenstrual and hyperventilation syndrome. Can be prescribed as monotherapy or in combination with other drugs. Does not interact with alcohol, used to treat alcoholic hangover syndrome.

Herbal remedies

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

In folk medicine, such soothing herbs, like valerian, dog nettle, hawthorn, mint, hops and some others, which are called phytotranquilizers. Based on them, a large number of herbal medicines have been developed, which are widely represented on the pharmacological market. Traditionally, tinctures of valerian, hawthorn, etc. are used.

In psychology, it is customary to consider any state in which a person is a reaction of the body, which is aimed at maintaining its emotional and mental balance. That is why even reactions such as anxiety and fear, leading to depression, are not considered harmful, since they can often speak of a protective way of the psyche. However, these conditions require treatment if a person cannot eliminate them through his own volitional efforts.

Despite the fact that anxiety can perform a protective function - to protect a person from dangers, it can also interfere. In psychology, there are many types of anxiety disorders. To some extent, they are associated with depression, which comes to a person who is constantly worried.

Every day an individual experiences different feelings and... Emotions are the body’s reaction to specific stimuli. Emotional excitement is a sign of deviation from the norm, because it is considered normal when a person feels balanced and calm.

Anxiety is a condition that completely takes over a person. There is no need to talk about the benefits or harms of anxiety. Depending on the reasons for which it arose, anxiety is beneficial or harmful. For example, occurring as a result before something that has not yet happened is harmful. It forces a person to “slow down” himself so that an unwanted event does not materialize. What if a person is worried about an upcoming interview? A person cannot but go for it, otherwise he will not receive the post for the desired position.

The benefits of anxiety appear when a person has already found himself in a situation that threatens him with something. Then it is recommended not to control your sensations, which can save your life.

Anxiety is an almost natural state of modern man. At every step the individual may be in danger, which is reinforced by various internal fears accumulated over a lifetime. However, only adapting to the world around us can reduce a person's anxiety level, especially if he notices that his approach to life is working. If this adaptation does not occur, then anxiety will turn into depression, which in psychology is called anxiety.

What are depression and anxiety?

It is common to distinguish between anxiety and depression. However, psychologists know that they are often interconnected. What are depression and anxiety? Depression is permanent state in which a person resides. Anxiety is an emotion that manifests itself in response to some external stimulus.

It is noteworthy that all people can be in an anxious state. However, not everyone experiences depression.

• There is anxiety as a reaction to some irritant that worries or frightens. As soon as the irritant stops bothering you, the anxiety gradually goes away.
• There is anxiety as a character quality. In this case, a person becomes anxious not only when something bothers him, but also when real danger does not exist.

In the second case, we can talk about the development of depression as natural state for an anxious person. The term “depressive personality” is already used here. This often manifests itself in those who also have people in their family environment who are prone to depression and anxiety.

Unfortunately, there are no instrumental methods for identifying depression and anxiety. These conditions are marked on the body as follows:

1. With depression, the level of cortisol in the blood plasma rises.
2. With anxiety, blood flow to the vessels of the forearm increases.

Other ways to identify these conditions are only by talking with the patient, collecting anamnesis, taking test questionnaires, etc. Relatives are also interviewed to obtain objective and detailed information about the person. Psychiatrists are interested in the following points:

• Has the person changed recently? The important aspects here are:

1. Social passivity.
2. Helplessness.
3. Changing interests.
4. Dependence on others.
5. Changing the way you speak.
6. Other topics for conversation appeared.

• Has your dream changed?
• Has there been a problem with concentration?
• Does the person have difficulty doing normal work?

Anxiety and depression are not static conditions. Over time, their symptoms may change. Thus, anxious depression can develop into panic, obsessive-compulsive or anxiety disorder.

Anxious depression is accompanied by delusional ideas that are based on self-blame and punishment. A person blames himself for all troubles, and also begins to fantasize about what punishment he will suffer for them. Often the punishment is very exaggerated or unrealistic. However, this occurs under the influence of anxiety, the more of which, the worse the depression becomes.

Anxiety and depression often occur in older people. Their crazy ideas provoke feelings of uncertainty, hopelessness, helplessness, which leads to the idea of ​​impoverishment. A person wants to repent in advance in order to avoid difficult situations and not face real punishment.

Symptoms of anxious depression are:

• Statements of guilt, suicidal ideation, manic delusions.
• Mania, replaced by crime and alcohol consumption.
• Slow and tense speech with long pauses.
• Frozen facial expressions.
• Slow movements.
• Melancholy in the first half of the day, anxiety in the second.
• Loss of interests and feelings of pleasure.

From the physiological side, the following signs of anxious depression appear:

1. Sleep disturbance.
2. Fussiness, difficulty concentrating.
3. Appetite disorder.
4. Loss of energy and physical weakness.
5. Impaired attentiveness.
6. Heartbeat.
7. Irritability.
8. Dry mouth.
9. Decreased activity and fatigue.
10. Tremor.
11. Tension.
12. Suicidal thoughts or actions.
13. Slowness or agitation of speech or movements.
14. Dizziness.
15. Decreased sexual desire.

Fear, anxiety and depression

Depression can arise not only from anxiety, but also from fear. If anxiety is a reaction to some kind of danger, then fear is a state that constantly accompanies a person. What is meant by fear that leads to depression? Reaction to the consequences of imaginary actions that a person may commit in the future and be punished for them.

What is fear? Why are people afraid? A lot of modern people’s fears are connected not with a real threat, but with certain expectations of unpleasant events. If earlier people did not bother themselves with fears, but were afraid only when something really threatened them, now people are afraid of everything and everyone, constantly experiencing stress.

Fear is the idea of ​​possible failures in the future. A person does not want to fail in the future, so he is worried, afraid, worried. Why is this happening? Because from childhood, parents teach their children to worry about the result they expect to receive. The child is worried about what grade he will receive. Most likely, he would not care if this assessment did not influence the behavior of his parents, who would praise or scold him.

And this behavior is formed in childhood, when parents teach their children to worry about the results of their actions. On the one hand, it is necessary to accustom the child to the fact that every action is followed by a certain result. But on the other hand, it comes to the point that the child is praised for a good result, and punished for a bad one. So the child learns to worry about the results of his actions, because after that he will either be loved or hated.

This kind of fear is an acquired phenomenon. Real fear is associated only with a real threat that occurs to a person in currently. And all the other fears that this moment a person is not threatened, but only appears in his imagination, are far-fetched and unnecessary. And only the person himself chooses whether to be afraid of something that does not really threaten him, or not to expose himself to stress.

If a person does not give in to his imaginary ideas about what can happen to him, then he begins to act. If a person succumbs to his own fears, then they fill him, limiting him in the space of possibilities and actions. A person chooses not to act so as not to be punished. However, this does not relieve him of fear, anxiety for the future and depression due to dissatisfaction with life.

If you are afraid, then the fear will not go away. If you overcome your own fear, then you will have to face difficult tasks and problems that separate a person from success.

Treatment of anxiety and depression

However, a person may already be so immersed in his own emotional states that he is no longer able to fight them. Treatment of anxiety and depression in this case can no longer be done without the help of specialists. If a more in-depth study of the conditions is necessary, then you should consult a doctor.

To eliminate anxiety, anti-anxiety medications are prescribed:

• Tizercin.
• Amitriptyline for depression.
• Seduxen 30 mg intravenously.
• Anxiolytics.
• Prozac (Fluoxetine).
• Incazan.
• Petilil (Desipramine).
• Cefedrine.
• Moclobemide (Aurorix).
• Sydnofen.
• Bethol.

An alternative treatment option for those who do not wish to resort to medications and cognitive behavioral therapy is exercise. Physical activity helps a person to escape from his imaginary ideas and stop worrying about trifles. It’s good if a person plays his favorite sport.

Physical health is not affected by anxiety and depression. However, the psyche suffers significantly, which begins to include various ways to protect itself. Here you cannot do without the help of specialists. The sooner treatment begins, the better.

Bottom line

If a person does not leave his condition without consideration, then the outcome can be positive. Directing all efforts to eliminate anxiety and depression will allow you to get rid of conditions that significantly prevent a person from expressing himself and achieving any success. Anxiety and depression affect life expectancy only if a person has thoughts of suicide.

You should get rid of the fear that is in a person’s head. A person is afraid of what might happen to him. But why be nervous if it hasn't happened yet? A person is afraid of the future that he draws for himself in his head. But this future may or may not happen. It all depends on what he will do:

1. If he is afraid, he will provoke the creation of a “terrible” future.
2. If he is not afraid, he will act according to the situation and achieve his goal.

It is not fear that should guide you, but you - your fear. And this should manifest itself in the understanding that fear is a picture from the future that you have drawn for yourself. In other words, you expect something scary and bad to happen, but it hasn't happened yet. What if it doesn't happen? It turns out that you wasted your energy, nerves, and time. Don't paint scary pictures of the future for yourself. Be afraid only of what is already happening. And it’s better, of course, not even to be afraid of this.

Don't be afraid of what has already happened. This is a thing of the past. You don't need to be afraid of this. Don't be afraid of what will happen in the future because it hasn't happened yet and may not happen. Why waste your nerves on something that may not happen? Don't be afraid of the present, even if it really frightens you. Try to maintain your composure. This will make you a strong person.

Fears are in your head. You are painting a terrible picture of the future, which has not yet happened and may not happen at all. So, why waste fear and waste time in the present moment when you can be happy?

The modern world often presents us with surprises in the form of daily stress, high emotional and mental stress, coupled with deficits in live communication and positive emotions. A person has forgotten how to rejoice in what has been achieved and has lost the ability to restore internal reserves.

It is not surprising that the psyche cannot stand it. And depression occupies the leading place among disorders. At the same time, at the first manifestations of symptoms, neurologists and psychotherapists usually talk about a depressive disorder, which can develop into a disease called depression.

Anxious depression occupies one of the leading places among all other depressions

Indeed, today there are a lot of them. At the same time, the classification is constantly updated. Depending on the type of reaction to external influences today there are:

• Hysterical;
• Alarming;
• Hypochondriacal;
• Melancholic.

Today we are interested in anxious depression, because it occurs very often in medical practice.

Conditions change - the disease changes

Today, depression and anxiety are concepts that are difficult to separate from each other. Therefore put correct diagnosis and only a qualified doctor can select treatment. Although if we consider classic version course of depression, then anxiety is not at all the main symptom. This is more of an optional or additional feature.

But in modern world psychotherapists are faced with the fact that typical course disorders, with its characteristic low mood, practically do not occur. But anxiety depression is being diagnosed more and more often. This specific disorder, which manifests itself in a special way.

Only a qualified doctor can choose the right treatment for anxiety depression

Diagnostic features

There is a certain circle of people who are most predisposed to mild forms of anxiety. This means that under unfavorable circumstances, they have every chance of earning a serious disorder. It is extremely important to carry out the diagnosis in such a way that there is no error in diagnosis. However, there are no laboratory or instrumental methods that allow you to do this. To understand the patient, you must talk to him personally.

Anxiety and depression are very often accompanied by delusions. This does not indicate a clouding of reason, but it leaves an imprint not only on the life of the person himself, but also on his loved ones. A sick person is convinced that all his “crimes,” often very exaggerated, will have to be answered. This manifestation is not a sign of depression. What is more important here is the level of anxiety, which changes throughout the entire period of the disease.

Periods of exacerbation and remission

The stronger the tension, the more pronounced the fear, anxiety and depression. Therefore, if you have a responsible event coming up that will also require a serious investment of effort, then you should think about whether it’s worth taking on. The period of exacerbation is especially pronounced if, having given 100%, you failed. A person is overcome by delusional ideas: “I am guilty and deserve punishment.”

Anxiety contributes to depressive ideas filled with personal low value. Moreover, the stronger it is, the more pronounced the depression becomes. There is a feeling of hopelessness and fear of the future. In this case, the disease proceeds like a sinusoid. Periods of mania and lighter streaks occur.

The stronger the tension, the more pronounced the anxiety, fear and depression.

Symptoms, or what to expect for the patient

To make it clearer to the reader what we are talking about today, we want to delve deeper into the term anxious depression. Symptoms are the most obvious manifestation of the disorder that we can observe with the naked eye. If we consider all the symptoms separately, we get the following list:

• Tendency to be overly apprehensive. Indecision becomes characteristic of a person. He tries to carefully weigh every decision, but still cannot decide to choose one option without resorting to outside help.
• The future is seen in the darkest light, expectations are only pessimistic.
• Self-esteem sharply decreases, the patient evaluates himself as completely worthless.
• There is concern and anxiety.
• The further you go, the more the feeling of weakness manifests itself; you want to constantly lie at home and not go out anywhere.
• Relatives note that the patient begins to show increased irritability and wariness.
• At the same time, difficulties in concentrating develop, the person notes a complete emptiness in the head. Parallel to what a person feels constant fatigue, he notes sleep disturbance. This is primarily difficulty falling asleep.

The patient's experiences are truly unenviable. They are filled with threatening dangers. Patients wait every minute for an imaginary or really threatening, but many times exaggerated misfortune. Patients are very worried that they may become seriously ill and die. They watch carefully with their bodily sensations and fixate on the slightest discomfort, regarding it as a sign of a fatal illness.

With anxious depression, anxiety about any reason is clearly manifested

Additional component, fear

We have already said that a person constantly feels insecure about tomorrow, as well as fear of unexpected and unforeseen events. It is this fear that determines the course of anxious depression; it permeates every day. Anxiety just goes off scale at any thought that it’s time to get down to business and make a decision.

As the condition worsens, the intensity of thoughts about an imminent catastrophe increases. Anxiety and fear reaches its climax and is accompanied by anguish of horror with confusion, a feeling of hopelessness, and an inability to find a way out. In this case, the distinctive features are the tendency of patients to exhibit pronounced motor agitation with biting their lips and wringing their hands. A person in this condition complains of sweating, palpitations, chest pain and discomfort in the abdominal area. At the same time, patients usually moan, wail, and repeat that they cannot stand it.

Progression of deterioration

This usually doesn't happen suddenly. The condition is slowly deteriorating against the background of debilitating insomnia. Patients note that the pre-dawn hours become completely unbearable. It is at this time that negative experiences reach their utmost severity and can result in a sudden attack of frenzied despair with suicidal actions. Yes, anxious depression often ends in attempts to commit suicide. Therefore, if you suspect a similar disorder in a loved one, then try to convince him to seek help.

Attacks of despair are especially common in the pre-dawn hours

Treatment

As you can see, this disorder is quite serious, and therefore it is extremely important to select effective therapy in a timely manner. To implement it, it is necessary to use a whole range of methods, which together make it possible to defeat such a formidable disease as anxious depression. The treatment is quite slow, so it is important to be patient. There are four groups of methods for working with this disorder:

• Methods of general biological influence. These may be immunomodulators, physiotherapy, swimming and much more.
• Drug therapy. The prescription of medications is strictly individual. For anxious depression, the patient may be prescribed not only antidepressants, but also tranquilizers. They allow you to relieve the disturbing effect.
• Physiotherapy or heat treatment. These methods are usually prescribed in the active phase of the disease to stabilize the condition. For severe anxiety depression, electroconvulsive therapy may be prescribed.
• Herbal medicine, soothing and sleep-normalizing herbs.
• Psychotherapy and psychocorrection. This is a huge complex of psychotherapeutic measures that are aimed at correcting distorted thinking, leveling the feeling of helplessness and doom.

Calming herbs help in many situations

Instead of a conclusion

Any emotional disorder– this is not a reason to close yourself off from the world, and anxious depression is no exception. You are not alone in your problem; there are hundreds of other people living with the same symptoms on earth.

Perhaps the only difference between you is that they have already turned to specialists for help, and you have not yet. Psychologists, psychotherapists and neurologists work precisely to bring back the joy of life to people.

The number of variants of mental disorders, including mood disorders, is of course, and all the main types of combinations have long been described in the scientific literature. No matter how unique a certain case may seem, we can say with confidence that something similar has already happened. Behind the amazing variety of symptoms lies the dull monotony of their practical expression. Some disorders so steadily walk around the world hand in hand that they even deserve to be highlighted in their combination. individual species complex states. An example of these are phobic anxiety disorders (according to ICD-10 - category F40) and mixed anxiety and depressive disorder (F41.2). Considering that the word “anxiety” in its various forms permeates all reference books on psychiatry, and everyone understands something different by this, in the minds of ordinary people, and not burdened by knowledge in the field of psychotherapy and psychiatry, confusion arises. It is understandable because all people experience a feeling of strange anxiety from time to time, as well as because it can be expressed in a variety of ways. However, different in nature are anxious personality disorder, sometimes called avoidant or avoidant personality disorder, and generalized anxiety disorder. Mentioning anxiety in both cases does not mean that it is the same and entails the same consequences in life and in terms of treatment.

Most personality disorders, including anxiety, are characterized by a constant desire for social withdrawal

For correct understanding to arise, two things must be understood.

1. A diagnosis in psychiatry is not made just like that. This is followed by a specific treatment regimen. Again, time-tested and shown to be effective in most cases.
2. Psychiatry does not deal with anything that is not related to psychiatry, but works primarily with psychoses. Even neuroses are of interest mainly when they show signs of something else that resembles psychosis.

Let's take alcoholics for example. Where to direct a person with his devils that arise at the moment of alcoholic delirium? If there are no obvious signs of psychosis, then go to narcology. It will lie there for a couple of weeks and the devils will disappear. But something else can be traced in a person, he has some kind of “carnivorous” delirium, more symptoms, the psyche is bizarrely stuffed with them, sometimes with the same diagnosis, but in mental asylum, well, they will already have a look there, that’s why the examination chambers exist, to look.

Why is all this said? We all know how many phobias there are in the world. It seems that some citizens are afraid of clowns, dogs, spiders. They are afraid of everything... For the most part, it’s all about psychotherapists. The concept of “phobia” in psychiatry takes on a slightly different connotation. Basically, these are fears that are in one way or another connected with hypochondria, but in this matter the expression agoraphibia and social phobia should be serious. All this may or may not be associated with panic attacks. As for all other phobias, the dominant role is played by the form of their expression.

Fear that seems harmless at first glance, such as the fear of spiders, can also be related to psychiatry. But try going to a psychiatrist with some harmless problem. Tell them that you are afraid of dogs or have a fear of pain, spiders, mice. And he or she will start asking about voices in the head or in the walls, in the damp ground. Don't be surprised - this is a specially designed questionnaire for the first interview of a prospective patient. So... If a psychiatrist determines that you do not have productive symptoms, we are talking about delusions and hallucinations, and the negative ones do not go beyond the limit, then... Maybe not to psychotherapists or neuropsychiatrists, but he will simply send you to hell. For the fear of spiders to be of interest to psychiatry, they need to hang from the ceiling right above the bed, burrow into the head, body, crawl out of the refrigerator and fill the entire space. Then these are “spiders” from the industry, otherwise it’s not interesting.

Any diagnosis in psychiatry is not made just like that; it is necessarily followed by treatment

That is why in the ICD the F40 category is decorated with agoraphobia, social phobias and “others”. This is the traditional designation for anything that can have the same destructive potential. The author made a little joke and exaggerated about the spiders that have taken over everything. Productive symptoms there may not be. Just imagine the life of a person who has a panic attack as soon as he leaves the house. This is F40.01 Agoraphobia with panic disorder. The attacks can be something like a panic attack, but the panic can also be purely psychotic, without the specter of somatic problems. He leaves the house, and his legs give way from fear. You can't live like that! But when it is impossible to live like this in any way, then the patient ends up in the diocese of psychiatry.

Anxiety-phobic disorder: symptoms

It’s better to call it anxiety-phobic disorder phobic anxious. It is the phobia that comes first in this drama. Anxiety is a kind of evidence base phobias. Consider the case of agoraphobia. No one is afraid of streets and squares, parks and forests, collective farm markets and shopping centers. The patient experiences something at the level of self-identification problems.

And this is a completely rational feeling. When leaving the apartment, a person sees bills in the mailbox, and even summonses. It goes further, and then... They seduce with advertising, scare with terrorism, cheat, criticize, scold. Everyone is under some kind of social pressure. Let's add to this the gopniks on the streets, tyrant bosses at work. All this presses, presses... At a certain moment, the strength runs out, and you want to hide in your shell. And here a period of irrational transformation of the rational arises. negative reaction. The awareness that we live in a world of predators, and that there are only hostile entities around, is not a reason to be afraid of the space outside the walls that create illusory protection. In fact, the walls of your apartment don’t protect you either. Well, take the renovation project in Moscow. Now the walls are here, if someone needs them, the walls will be there. Yes, and you can enter through any door if those who need to enter enter. The patient understands this perfectly well, but he hides behind the gestalt, which evokes in him associations that allow him to most fully identify himself. Something reminiscent of “I’m in the house”, which we said as children while playing tag. In the crowd, in the city, outside the walls, he is afraid to live, and not just to be physically present. That is why phobic anxiety disorders are represented by two main types - agoraphobia and social phobia.

Anxiety-phobic disorder is accompanied by feelings of fear and anxiety, and such feelings arise during any event in a person’s life

The main sign is this. The person goes about his daily activities and feels relatively well. So he cooked the food, read the news on the Internet, wrote some comment on the social network. Everything is fine, nothing portends trouble. But for some reason he needs to leave the apartment at about 11 am. The very thought of this makes you feel worse. Heart palpitations begin strange feeling mild derealization-depersonalization, shortness of breath occurs or symptoms of hyperventilation appear. A person, like a child, begins to prepare for a long time for going out into the world. And all this preparation is full of eccentricities. To the point where he wonders if he bent over too much when putting on his shoes - the pressure will rise now.

Everyone expresses this differently. The author, may he be forgiven for his boldness, thinks that in this whole “circus” a cunning tangle can be traced - according to a small symptom from all the suitable syndromes. There is an element of obsessive-compulsive disorder, because everyone comes up with their own ways to “fight” this condition. 90% of them are of a ritual nature. Maybe it’s like this - a person has come far enough, he’s walking through the world on his feet, and suddenly he’s afraid that he didn’t take validol or nitroglycerin with him. At the same time, everything is fine with his heart at this moment. But he is convinced that it will be bad and only his “favorite” pills could save him. The point is not in them, of course, but in the fact that they play the role of a talisman and become part of the ritual of salvation.

Some symptoms are hidden behind others. For example, an anxiety-phobic disorder with panic attacks forces all attention to be directed to the attacks themselves - crises, attacks, with all their paraphernalia. However, a careful analysis will show that, to some extent, mental automatisms are also present. Sometimes not in any way, but are directly obvious. A person frankly perceives his thoughts as not so, alien. But all this is drowned in the formulation “depersonalization,” although in essence it is Kandinsky-Clerambault syndrome. Hence the legendary tin foil hats, which the heroes of American films about agoraphobics love to sport. There is a lot of nonsense in this kind of movie, but the trend is captured correctly. This is not the main symptom in the case of such a disorder, but there may be a feeling of “audibility” of thoughts by others, and a feeling of autonomy of thinking.

Anxiety-phobic disorder: treatment

It all depends on what goals the patient sets for himself. Only he, even if his relatives persuaded him to install them. Here is a rough outline of the ideal picture. A physically ill person, even if he is sick with something, does not at all prevent him from living within four walls. Just six months ago he was active and was constantly running back and forth. Suddenly agoraphobia began, as a type of phobic anxiety disorder. Albeit with elements of panic disorder. The ideal therapy is no therapy at all. He got up and went - went to visit some public place, ate in a cafe, wandered around the park and returned home alive and well. Have you had panic attacks? Yes, so what?.. The patients themselves at a certain stage understand perfectly well that this is dancing with ghosts. He didn’t pay attention to the ghosts and... He didn’t fall, didn’t break anything, didn’t lie in the bushes with his heart stopped. The chimera turned out to be just a chimera.

With anxiety-phobic disorder, social phobia, nosophobia, panic and other disorders occur

Not everyone is a hero in this world? Let's say... It's good to cling to anxiety in order to relieve it. It's good that she exists. What is she really? It is a subjective way of increased mental activity. Yes, there - in the depths of the brain at this moment the metabolism is clearly at a very high level. Chemical and electrical signals rush through certain parts of the brain as if there is a strong thunderstorm going on there. It can be suppressed, but you need to press carefully. The main way to pacify mental activity is with antipsychotics. But in in this case This is not entirely necessary, or rather, completely unnecessary. An antidepressant with anti-anxiety effect is quite sufficient. They are needed primarily because, we repeat, there are few heroes. Antidepressants don't fundamentally change anything. A month-long course does not cure, it only relieves symptoms, but during this time a person manages to live as if there is no panic, fear, mistrust of his body, restores social connections and the ability to live an ordinary life.

Psychotherapy for anxiety-phobic disorders is a set of measures aimed at making reality become a fairy tale, and not vice versa. A person experiences very real discomfort because of something that does not exist. Be it agoraphobia, social phobia or something related to imaginary somatic diseases or conditions. If you do not pay attention to the entire complex, then the likelihood that he will retreat is much greater.

Anxiety and depression at the same time

And, since we started talking about antidepressants, another type of combined disorder is mixed anxiety and depressive disorder. This can be called generalized anxiety disorder and depression occurring at the same time. However, the symptoms of both do not prevail over each other. Anxiety comes to the fore because it is brighter and makes you pay more attention to yourself.

Depressive personality disorders also occur with anxiety

Unlike bipolar affective disorder When the phases of mania and depression alternate, everything happens at once. In this case, there are enough symptoms to diagnose both disorders. However, since this is not so rare, and it is not entirely correct to make a bunch of diagnoses, this “melange” has been an autonomous nosological unit for many years.

Mixed anxiety-depressive disorder: symptoms

Anxiety is not associated with anything specific and is not a fear of anything. A person experiences only a vague feeling, and it is far from always associated with danger as a factor in the catastrophe. For example, one patient said that he woke up at 5 am. It seemed to him that he had not done something, that he had done something wrong, that he had done little, that all this would end badly. And his work was related to computers. He could immediately throw himself into work, checking something, redoing something, doing something to drown out the incomprehensible feeling of excitement that vibrates inside.

There are psychotic symptoms, this most vague feeling of anxiety, and vegetative ones - rapid heartbeat, sweating, even irritable stomach or rectal syndrome.

Depression manifests itself in the same way as always and is diagnosed according to general criteria.

A person experiences anxiety not before something specific, but just like that, for no apparent reason.

It is characteristic that all the symptoms of the disorders described above can also appear as a reaction to stress, but then they must be classified under another diagnosis “disorder.” adaptive reactions" Then disturbances in the emotional sphere and subjective distress are explained primarily by some obvious event - the loss of a loved one, emigration to another country, etc.... In this case higher value psychotherapy acquires.

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 called mixed anxiety-depressive disorder, which will be discussed.

Anxiety versus depression

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

The only characteristic is that against the background of depression, anxiety increases and takes on enormous proportions. Each of these conditions enhances the effect of the other syndrome. There are reasons for some fears and anxieties, but they are very minor. However, man is in an imperishable nervous overstrain, feels threatened, lurking in danger.

The insignificance of the factors that cause an anxious 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 adequate perception of the situation. Fear generally prevents you from thinking, evaluating, making decisions, analyzing, it is simply paralyzing. And a person in this state of spiritual and volitional paralysis goes crazy from hopelessness.

Sometimes anxiety is accompanied by unmotivated aggressiveness. Enormous 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 nothing of this, remaining in a potential state of anxiety and restlessness. Having not found a way out through active actions, stress hormones begin to purposefully poison the nervous system, which causes the level of anxiety to grow even more.

A person is taut like a bowstring: muscles tense, tendon reflexes increase. It’s as if he’s sitting on a keg of gunpowder, terribly afraid that it will explode and still doesn’t move. Maybe depression overshadows anxiety and prevents the unfortunate person from taking measures to save himself. In a specific case - salvation from a condition that is killing him.

• thunderous heartbeats that are clearly felt in the head;
• the head, naturally, is spinning;
• arms and legs are shaking, there is not enough air;
• the feeling of a “drying out” mouth and a lump in the throat, a faint state and the impending horror of death complete this picture.

Panic attack with anxiety disorders

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

Anxiety neurosis, simply put, fear, can always develop into its extreme degree - panic. Panic attacks have more than 10 symptoms. Less than 4 signs do not provide grounds for making a diagnosis, but four or more are a direct vegetative crisis.

Symptoms that indicate the development of PA:

• rapid heartbeat, pulse and general pulsation of blood vessels, the condition is felt as if something is pulsating throughout the body;
• heavy sweating (hail sweat);
• shaking chills with trembling of arms and legs;
• feeling of lack of air (it seems that you are about to suffocate);
• choking and gusty breathing;
• sensations of pain in the heart;
• severe nausea with the urge to vomit;
• severe dizziness (everything is “moving” before your eyes) and lightheadedness;
• impaired perception of the environment and self-perception;
• fear of madness, the feeling that you are no longer able to control your actions;
• sensory disturbances (numbness, tingling, cold hands and feet);
• hot flashes, cold waves;
• feeling like you could die at any moment.

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

The peculiarity of these attacks is that they are always associated with a specific phobia. Panic is a state when horror is combined with the feeling of being unable to escape from it. That is, there are insurmountable obstacles to escape.

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

The attacks can be short (from a minute to 10), or long (about an hour). They can be either single-shot or “cascade”. They appear a couple of times a week, but sometimes the number of attacks can be less, or can be twice the usual rate.

Causes of anxiety and depressive disorders

Anxious depression can be caused for the following reasons and factors:

1. Severe short-term stress, or chronic, taking the form of illness.
2. Physical and mental fatigue, in which a person “burns out” from the inside.
3. A family history of similar disorders.
4. A long-term, serious illness, the grueling struggle with which is equated to the question of “to live or not to live.”
5. Uncontrolled use of drugs from the group of tranquilizers, antipsychotics, antidepressants, or anticonvulsants.
6. “The edge of life” is a state in which a person feels “excluded” from life. This happens with the loss of a job, unbearable debts, the inability to provide oneself with a decent standard of living, and more and more failures when looking for work. The result is a state of hopelessness and fear for your 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 don’t know what to do with themselves, women during menopause, teenagers in the period of mental development, men who are in a “midlife crisis” when they want to start life anew and change everything in it: family, work, friends, themselves.
9. Low level of intelligence or education (or both). The higher the intelligence and level of education, the easier a person copes with stress, understanding the nature of their occurrence, a transitory state. He has more tools and opportunities to cope with temporary difficulties without triggering them to the point of psychosomatic disorders.

A look from the outside and from the inside

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 (waking up at night, getting up early, taking a long time to fall asleep);
• identified provoking factor (losses, losses, fears and phobias);
• loss of appetite (poor appetite with weight loss, or, conversely, “eating” anxiety and fears);
• psychomotor agitation (disorderly motor activity: from fussy movements to “pogroms”) along with speech agitation (“verbal eruptions”);
• panic attacks are short or long, one-time or repeated;
• tendency to thoughts of suicide, suicide attempts, completed suicide.

Establishing diagnosis

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

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

Clinical picture assessment:

• presence of anxiety and depressive symptoms;
• symptoms of the disorder are an inadequate and abnormal reaction to a stress factor;
• duration of symptoms (duration of their manifestation);
• the absence or presence of conditions under which symptoms appear;
• the primacy of the 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 occurs 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 to explain its occurrence.

As a rule, they try to determine internal disease, which provoked such symptoms. A person does not immediately get to his destination - to a psychotherapist.

A trip to the doctors begins with a therapist. The therapist transfers the patient to a neurologist. The neurologist, having found psychosomatic and vegetative-vascular disorders, prescribes sedatives. While the patient takes medication, he actually becomes calmer and vegetative symptoms disappear. But after stopping the course of treatment, the attacks begin to recur. The neurologist throws up his hands and sends the sufferer to a psychiatrist.

A psychiatrist provides permanent relief not only from attacks, but also from any emotions in general. Stupefied by heavy psychotic drugs, the patient is in a switched-off state for days, and looks at life in a sweet half-sleep. What fear, what panic!

But the psychiatrist, seeing “improvements,” reduces the 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 worsen.

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

Usually, cause-and-effect relationships are consolidated in the mind. If a panic attack occurs in a supermarket, the person will avoid this place. If in the subway or on a train, then these types of transport will be forgotten. Accidental appearance in the same places and in similar situations can cause another panic syndrome.

The whole range of therapy methods

Psychotherapeutic assistance consists of the following:

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

Drug treatment

The following groups of medications are used in the treatment of anxiety-depressive disorder:

1. Antidepressants (Prozac, Imipramine, Amitriptyline) affect the level of biological active substances in nerve cells (norepinephrine, dopamine, serotonin). The drugs relieve symptoms of depression. Patients' mood improves, melancholy, 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 anti-depression pills do not act immediately, but only after they accumulate in the body. That is, you will have to wait a couple of weeks for the effect. Therefore, tranquilizers are prescribed in combination with antidepressants, the effect of which becomes apparent within 15 minutes. Antidepressants are not addictive. They are selected individually for each patient and must be taken strictly according to the regimen.
2. Tranquilizers (Phenazepam, Elzepam, Seduxen, Elenium) successfully cope with anxiety, panic attacks, emotional stress, somatic disorders. They have a muscle relaxant, anticonvulsant and vegetative stabilizing effect. They act almost instantly, especially in injections. But the effect will end faster. The tablets act more slowly, but the results achieved last for hours. Treatment courses are short due to the fact that the drugs are persistently addictive.
3. Beta-blockers are necessary if the anxiety-depressive syndrome is complicated autonomic dysfunction, they suppress vegetative-vascular symptoms. They eliminate pressure surges, increased heartbeat, arrhythmia, weakness, sweating, tremors, and hot flashes. Examples of drugs: Anaprilin, Atenolone, Metoprolol, Betaxolol.

Physiotherapy methods

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

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

Homeopathy and traditional treatment

Herbalism is treatment with medicinal herbs and soothing herbal mixtures:

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

• gentian herb - for those who are depressed;
• Arnica Montana is a drug that eliminates both depressive and anxiety symptoms;
• Hypnosed – relieves insomnia, severe excitability;
• Elm leaves and bark – increases endurance, relieves fatigue.

Prevention of the syndrome

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

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

Far-reaching consequences

If you ignore pathological symptoms, you can acquire a set of physical and mental ailments:

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

The quality of life of patients, their professional skills, and marital relationships also suffer greatly. Ultimately, all this can lead to a person stopping somehow interacting with society and acquiring a fashionable disease - social phobia.

The saddest and irreversible complication is a situation when a person takes his own life.

This section was created to take care of those who need qualified specialist without disturbing the usual rhythm of your own life.

How does anxiety-depressive syndrome manifest?

Anxiety-depressive syndrome is one of the neuroses that manifests itself in feelings of anxiety, melancholy, melancholy and depression. This disorder is treatable if a person recognizes his problem and consults a doctor. Such an illness can be treated not only by a psychiatrist; now cardiologists, psychotherapists, and neurologists are also involved in this.

The causes of such neurosis are troubles in personal life, in the professional field, unpleasant events in life that have become severe injury for the psyche. But you should not delay contacting a specialist; it is better to eliminate 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 stage of development of the pathology. The signs of this disorder are in many ways similar to those of other neurological disorders, so diagnosing this condition is sometimes quite difficult. The main symptoms of the disorder are:

1. A feeling of inferiority, which is accompanied by guilt and low self-esteem.
2. The emergence of suicidal thoughts and tendencies.
3. Rapid or difficult breathing.
4. Tachycardia, painful sensations in the sternum.
5. Weakness, increased fatigue.
6. Frequent headaches, sometimes quite intense.
7. Sleep disorders.
8. Melancholy, depression, tearfulness.
9. Decreased sexual desire.

Also, in addition to the listed signs, problems with stool, 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 sensations of danger appear. This creates a vicious circle. The feeling of constant anxiety provokes the production of adrenaline, which contributes to the appearance of 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 sudden changes in an emotional state.
2. Increased restlessness and constant feeling of anxiety.
3. Constant problems with sleep.
4. Constant worries about relatives, the expectation that something negative will happen.
5. Regular tension and anxiety that prevent you from falling asleep normally.
6. Fatigue, weakness.
7. Deterioration in concentration, speed of thinking, ability to work, and perception of new information.

TO vegetative signs can be attributed:

1. Frequent heartbeat.
2. Shiver.
3. Feeling of a lump in the throat.
4. Increased sweating, moisture in the palms.
5. Hot flashes or feeling of chills.
6. Frequent urination.
7. Abnormal bowel movements, abdominal pain.
8. Myalgia, muscle tension.

Neurosis is often accompanied by depression. To make such a diagnosis, a collection of common symptoms, which last for several weeks or even months.

Who has an increased tendency to neurosis?

The main risk group is women. This is due to greater emotionality, sensitivity, responsibility for both family and career. If a woman does not know how to relax and reset emotional stress, she is susceptible to neurosis. Factors that provoke aggravation of the condition include changes in hormonal levels, the period of gestation, menstruation, postpartum period, climacteric changes. Risk factors for the disorder include the following:

1. Lack of work. During this period, there is an acute feeling of being thrown out of the working world, the inability to provide for oneself, and the constant search for work that is fruitless. Stress provokes the appearance of the first signs of disorder.
2. Drugs and alcoholic drinks. Such addictions destroy a person’s personality, leading him to constant depression. And constant depression provokes a search for a way out, which a person seeks in a new dose. This creates a vicious circle that is often impossible to break without seeking 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 significant other leave, communication becomes less and less. Such people need constant support, involvement in the lives of their children and grandchildren, they need to feel important.
5. Serious somatic illnesses. A severe form of depression is often triggered by a person developing an incurable disease.

Therapy for the disorder

After making an accurate diagnosis, the specialist prescribes comprehensive treatment. It consists of taking medications that are combined with psychotherapy. The psychological impact of this neurosis is aimed at raising self-esteem, increasing control over one’s emotions, developing stress resistance, and combating depression.

Drug therapy consists of the use of tranquilizers, anti-anxiety drugs, and herbal preparations. The main thing is to visit a specialist who will provide competent therapy; it is unacceptable to self-medicate and diagnose yourself.

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

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

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

The main thing is that the person himself understands his problem and strives to resolve 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 a pressing problem among people of the 21st century. It develops due to high psycho-emotional stress associated with accelerated rhythm life. Depressive disorders significantly reduce the quality of human life, so you need to learn to maintain personal mental hygiene.

Causes of Anxiety Disorder

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

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

Symptoms of nervous system disease

The main symptom of 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-depressive state lies in a vicious circle: anxiety stimulates the production of adrenaline, which intensifies negative emotional tension. Patients who have this personality disorder complain of lack of mood, systematic sleep disturbances, decreased concentration, accompanied by chills and muscle pain.

Postpartum depression in women

Many women immediately after childbirth experience anxiety and depressive symptoms, which are 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 the anxiety state is still not precisely 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 emotional level, but also by body reactions: increased sweating, rapid heartbeat, and indigestion. There are several types of this disease, differing in symptoms.

Generalized anxiety

With this syndrome, the patient chronically experiences anxiety without knowing the cause of the condition. Anxious depression manifests itself as fatigue, gastrointestinal dysfunction, motor restlessness, and insomnia. Depressive syndrome is often 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.

Anxious-phobic

It is known that a phobia is the medical name for an exaggerated or unrealistic fear of an object that does not pose a threat. The disorder manifests itself in different ways: fear of spiders, snakes, flying on an airplane, being in a crowd of people, sharp objects, swimming, sexual harassment, etc. With anxiety-phobic syndrome, the patient develops 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 taking any medications, but worsen the quality of the patient’s social, professional or any other area of ​​life. Main features:

• slow thinking;
• tearfulness;
• sleep disturbance;
• low self-esteem;
• irritability;
• difficulty concentrating.

Diagnosis of depressive disorders

The main method for diagnosing depression in a patient remains questioning. 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 HADS depression and anxiety scale is used to determine the level of pathology. The test does not cause any 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 medications, homeopathic remedies, herbal remedies and folk recipes. It is also important behavioral psychotherapy, which greatly enhances the effect of drug therapy. The complex treatment of anxiety-depressive syndrome also includes physiotherapy.

Drugs

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

1. Tranquilizers. Powerful psychotropic medications used when other treatments for depression have not worked. They help get rid of internal tension and panic, reduce aggression and suicidal intentions.
2. Antidepressants. They normalize the emotional state of a person with obsessive-compulsive disorder (obsessive states), and prevent exacerbation.
3. Neuroleptics. Prescribed for inappropriate emotions of the patient. The drugs affect the area of ​​the brain that is responsible for the ability to perceive information and think rationally.
4. Sedatives. Sedative medications that are used to relieve nervous tension, normalize sleep, reduce the level of excitability.
5. Nootropics. They affect areas of the brain to increase performance and improve blood circulation.
6. Alpha and beta blockers. Able to turn off receptors that respond to adrenaline. They increase the level of glucose in the blood, sharply narrow the lumen of blood vessels, and regulate vegetative processes.

Psychotherapeutic methods

Not every person with anxiety-depressive disorder needs medication therapy or hospitalization. Many psychiatrists prefer to treat depression in children and adults using psychotherapeutic methods. Experts are developing a variety of techniques, taking into account gender characteristics, adapted to different social groups. Some patients are better suited to one-on-one consultations, while others show excellent results when treated in a group setting.

Cognitive behavioral therapy

Anxiety disorder can be cured with cognitive behavioral therapy. It is used to get rid of wide range depressive symptoms, including addiction, phobias, anxiety. During treatment course people identify and change their destructive thinking patterns that influence 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, a person’s negative attitudes and perception of reality change. With the help of hypnosis, patients quickly get rid of gloomy obsessive thoughts, chronic depression. A person’s anxious personality disorder goes away, he receives a powerful charge of energy and a lasting feeling of inner satisfaction.

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Depressive and anxiety disorders

Anxiety The issue of increasing doctors' awareness of 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 spread of these psychopathological disorders, especially among patients with somatic pathology, and the emergence of new, safer antidepressants, diagnosis and treatment of mild and moderate depression in most countries of Europe and North America is carried out by first-line doctors, 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 on the diagnosis and treatment of depressive disorders, which has been implemented in many regions. In 1998, this program was started in Russia, and in 2002, materials were published in Ukraine. Over the past years, the number of scientific publications on this problem in Ukraine has been increasing, but practical implementation remains insufficient. There is also no national program for training specialists. Most doctors note the significance of this problem, but do not consider themselves competent in diagnosing and treating 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 arise as a consequence or under the influence of causes of a psychological and stressful nature. Endogenous depressive disorders mean 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 cases of intoxication of the body, infectious diseases, drug addiction and alcoholism. Quite often in clinical practice, so-called latent depression is observed, when depressive symptoms themselves are masked as a disruption in the functioning 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 report the occurrence of clinically significant depressive conditions throughout their lives. According to the results of epidemiological studies, every eighth inhabitant of our planet needs specific pharmacotherapy in connection with depressive conditions. In 60% of cases, as a rule, in case of insufficiency or inadequate therapy, repeated depressive episodes occur. Almost half of patients with depression do not go to doctors, and approximately 80% are treated by internists and general practitioners.

The development of depressive disorders is associated with a disturbance in the exchange 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 cause-and-effect relationship of depression with the state of internal organs and the somatization of symptoms of depression can be explained by the close relationship of the central structures and 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 stroke. The importance of influencing psychoemotional factors was confirmed in the INTERHEART studies, where their contribution to the risk of acute myocardial infarction was not inferior to diabetes mellitus and smoking. Over the past few decades, the relationship between depression and prognosis in patients with coronary artery disease has been examined 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 over the course of a year. The mortality rate of patients who have a history of myocardial infarction and suffer from depression is 3-6 times higher than in persons without signs of depression. In cases of depression, patients often do not follow doctors' recommendations regarding treatment. Given the important role of depressive disorders in patients with coronary heart disease, the American Heart Association developed and introduced in 2008 the “Depression and IHD: Screening and Treatment Guidelines,” which emphasizes the need for screening to identify individuals with IHD and depression who require additional treatment. However, the results of the ENRICHD study showed that in the group of patients with depression who suffered an acute myocardial infarction and received serotonin reuptake inhibitors, there was 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 manifestations of depression are closely related to anxiety disorders. Anxiety is a normal reaction of the human body to unfavorable 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 features include constant internal tension and increased sweating. Patients show increased anxiety during daily work and make pessimistic forecasts; in most cases, they 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 consult general practitioners. According to the results of modern scientific research, an increased risk of cardiovascular complications has been 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 persons without pathopsychological disorders.

A significant prevalence of anxiety and depressive disorders is also typical for patients with pathologies 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 administer interferon therapy. Comorbid anxiety and depressive disorders are also characteristic of other gastroenterological diseases. Thus, according to the results of an 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, and panic attacks by 2.8 times. It has been found that increased levels of anxiety are associated with increased healing time for peptic ulcers. According to various authors, depression is detected in 35-50% of patients with peptic ulcer disease. More than 20% of patients with pathologies of the digestive tract require 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 if they occur together 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 for 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). Methodological materials of the World Psychiatric Association “Training doctors in mental health skills” define the main aspects of the communication style of doctors, which are associated with assessing the emotional state of the patient:

1. Establish favorable eye contact
2. Clarify patient complaints
3. Make comments with sympathy
4. Notice the patient's verbal and nonverbal cues
5. Do not read medical history notes during a conversation
6. Control the patient's excessive talkativeness

In the clinical guideline “Depression: care for depression in primary and secondary care” developed by NICE (National Institute for Health and Clinical Excellence - National Institute for Health and Clinical Excellence, UK) to screen for depression, it is recommended to ask two questions: “Have you often noted decreased mood, sadness or hopelessness over the past month? and “During the past month, have you often noticed a lack of interest or pleasure in things that usually bring you pleasure?” Questions that can be used to screen for anxiety include: “Have you felt restless, tense, and anxious most of the time over the past 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 observed almost every day and most of the day, especially in the morning, the duration of which was at least 2 weeks regardless of the situation (the mood can be depressed, sad, accompanied by anxiety, concern, irritability, apathy , tearfulness, etc.).
2. Significant decrease (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 and self-confidence.
3. 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 (difficulty falling asleep, insomnia in the middle of the night, early awakening).
7. Decreased (increased) appetite, decreased (increased) body weight.

To determine a mild depressive episode, it is enough to state at least two main and two additional symptoms. The presence of two main symptoms of depression in combination with three to four additional symptoms indicates moderate depression. All three core symptoms of depression and at least four additional symptoms indicate severe depression. It should be taken into account that due to various types of depression there is a possible risk of suicide. If suicidal symptoms are detected in a patient, consultation with a psychiatrist is necessary.

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

The scientific literature has systematized other emotional disorders that clearly arise at 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 pickiness, at times with outbursts of anger, cursing, threats, and constant aggression.
2. Hypotymia 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 low mood, which is combined with a decrease in overall mental activity and behavioral motor activity. The most characteristic components are somatovegetative disorders, decreased self-esteem and identification of one’s condition as painful.

In ICD-10, anxiety disorders are classified under the headings “Panic disorder” (F41.0), “Generalized anxiety disorder” (F41.1) and “Mixed anxiety and depressive disorder” (F41.2).

The main symptom of panic disorder is repeated 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, choking, dizziness and a feeling of unreality (depersonalization or derealization). Many patients feel the fear of death and lose self-control. Anxiety and fear can be so strong that they literally paralyze the patient’s will. A panic attack usually lasts several minutes; the condition gradually (from 30 minutes to 1 hour) normalizes. But after this, the patient remains afraid of a new attack. A panic attack must be differentiated from paroxysmal tachycardia, atrial fibrillation and an attack of angina.

Generalized anxiety disorder is characterized by symptoms of internal tension and an inability to relax and concentrate. In this case, constant internal trembling, increased sweating, and frequent urination are also characteristic. Patients exhibit increased anxiety during daily activities and make pessimistic forecasts and have difficulty falling asleep. Phobias, or fears, are also manifestations of an anxiety disorder. A diagnosis of mixed anxiety and depressive disorder is made when both anxiety and depression are present.

A large number of rating scales and questionnaires have been developed for the diagnosis of comorbid anxiety and depressive disorders in clinical practice. The Hospital Anxiety and Depression Scale (HADS) is widely used for screening studies. 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 matches how you felt last week. Check the circle next to the answer you have chosen. Do not think too long about each statement, since your first reaction will always be the most correct.

I feel tense, I feel uneasy

From time to time, sometimes

I don't feel it at all

Something that brought me great pleasure and now gives me the same feelings

That's probably true

To a very small extent this is true

That's not entirely true

I feel afraid, it seems like something terrible might happen

This is true, 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 it at all

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

That's probably true

To a very small extent this is true

It's not like that at all

Fussy thoughts are spinning in my head

Most part of time

From time to time and not that often

I feel cheerful

I don't feel it at all

Almost all the time

I can easily sit down and relax

That's probably true

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 it at all

I don't take care of my appearance

I don't spend enough time on this

I think I've started devoting less time to this

I take care of myself the same way as before

I feel restless, I constantly need to move

That's probably true

To some extent this is true

I don't feel it at all

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

Exactly as usual

Yes, but not to the same extent 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 television program

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

For patient questionnaires, rating scales (4th and 5th columns of the table) and evaluation criteria should not be given.

Patients diagnosed with clinically significant anxiety or depression should be referred for consultation with a psychiatrist. Patients with depression and suicidal thoughts also require consultation with a psychiatrist. 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 cases of subclinical anxiety or depression, treatment may be prescribed by a general practitioner (GP).

Treatment of anxiety and depressive disorders in therapeutic practice

In accordance with NICE Clinical Guidelines Depression: Care for Depression in Primary and Secondary Care, Treatment of Depression in Adults (Core Edition) and American Heart Association guidelines Depression and Coronary Heart Disease: Recommendations for Screening and Treatment and scientific developments of Ukrainian specialists, treatment of mild and moderately severe 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 the prescription of antidepressants if a self-help program is provided, which consists of the provision of appropriate written materials, a sleep regulation program and computer-assisted cognitive behavioral therapy, followed by assessment of the patient's condition. In our country, such programs have not yet become particularly widespread in clinical practice. In order to increase information content and attract patients to participate in treatment, a leaflet “Anxiety and depressive disorders” was developed.

Treatment of patients with comorbid anxiety and depressive disorders should be structured 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 somatic illness with the prescription of drugs to eliminate depressive and/or anxiety disorders. It is important to use drugs whose effectiveness and safety have 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 a treatment plan with the patient, point out the importance of adherence to medication regimen, and also warn that the clinical effect develops gradually. Most patients adequately perceive a logical approach to prescribing drugs that affect the psycho-emotional sphere. In some cases, it is useful to involve family members in comprehensive psychotherapeutic rehabilitation.

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

The main indications for prescribing antidepressants for 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 if signs of other chronic diseases are detected (stroke, diabetes, 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, and the positive effect of previous treatment with antidepressants. In accordance with the requirements of evidence-based medicine, serotonin reuptake inhibitors are considered as the drugs of choice for the treatment of patients with symptoms of depression and anxiety. They do not exhibit cardiotoxic effects and 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 from an antidepressant for 4-6 weeks, it is necessary to consult a psychiatrist and replace it with another drug.

During the initial period of using antidepressants, the patient should visit the 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. If treatment is stopped immediately after achieving a clinical effect, the likelihood of relapse increases significantly. Elderly persons in cases of repeated 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 from the serotonin reuptake inhibitor group, it is necessary to take into account their features:

Fluoxetine is 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 sedation. Possible side effects: increased excitability, dizziness, increased convulsive readiness, allergic reactions. The positive effect most often appears after 5-10 days, the maximum effect occurs every other day, and stable remission occurs after 3 months. In the case of anxiety-depressive disorders, it is advisable to prescribe Fluoxetine 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 effects. But it must be borne in mind that this is one of the least selective serotonin reuptake inhibitors (partially affects the reuptake of norepinephrine and blocks muscarinic receptors, which causes a sedative effect). Possible side effects: nausea, dry mouth, excitability, drowsiness, excessive sweating, sexual dysfunction.

Sertraline does not have a sedative, stimulant or 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 member of the group of serotonin reuptake inhibitors with maximum selectivity. Escitalopram has been 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 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 - rapid restoration of the disrupted sleep-activity cycle and an excellent tolerability profile. Agomelatine improves the quality and duration of sleep and does not cause daytime drowsiness, which is important for patients who continue to work. In the case of predominant sleep disturbance, the drug has significant clinical benefit.

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

Tranquilizers

Tranquilizers (from Latin tranquillo - to calm down), or anxiolytics (from Latin anxietas - anxiety, fear). In addition to the anxiolytic effect itself, the main clinical and pharmacological effects of tranquilizers are sedative, muscle relaxant, anticonvulsant, hypnotic and vegetative stabilizing. Classic representatives of this group are benzodiazepines, which enhance GABAergic inhibition at all levels of the central nervous system and have a pronounced anti-anxiety effect, which makes it possible to achieve significant success in the treatment of anxiety conditions 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 in this group, including their rapid clinical effect, are advisable to use on an outpatient basis for the treatment of panic attacks. But when prescribing benzodiazepines, it is first 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 (Etifoxine, Afobazol).

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, and does not lead to addiction and the development of 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 cardiac medications.

Afobazole is a 2-mercaptobenzimidazole derivative, 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, has no muscle relaxant properties, or a negative effect on memory and attention. During its use, drug dependence does not form and withdrawal syndrome does not develop. Reducing or eliminating symptoms of anxiety (preoccupation, bad feelings, fearfulness, irritability), tension (tearfulness, anxiety, inability to relax, insomnia, fear), autonomic disorders (dry mouth, sweating, dizziness), cognitive impairment (difficulty concentrating attention) is observed on days 5-7 of treatment. The maximum effect is achieved at 4 weeks and lasts for 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 and enhances the anxiolytic effect of Diazepam.

“Atypical tranquilizers” include Mebicar, Phenibuta trioxazine, etc.

Mebicar is a widely used daytime tranquilizer-adaptogen, which, in addition to nxiolytic, has nootropic, antihypoxic and vegetative stabilizing effects. The effectiveness of the drug in patients with arterial hypertension and coronary artery disease has been proven. Possible side effects: dyspeptic symptoms, allergic reactions, hypothermia, decreased blood pressure.

Phenibut improves GABAergic neurotransmitter transmission, which causes a nootropic, antiasthenic and vegetative stabilizing effect. Possible side effects: nausea and drowsiness. It should be prescribed with caution to patients with erosive and ulcerative lesions of the digestive tract.

Drugs of other pharmacological groups

Glycine belongs to the amino acids that regulate metabolic processes. It is an inhibitory neurotransmitter, increases mental performance, eliminates depressive disorders, increased irritability, and normalizes sleep. Can be used by elderly people, children, teenagers with deviant forms of behavior. In case of 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 is an original drug, which is a combination of the microelement magnesium and peroxin, which potentiate the effect of each other. Used in cases of psycho-emotional stress, anxiety, chronic mental and physical fatigue, sleep disturbances, premenstrual and hyperventilation syndrome. Can be prescribed as monotherapy or in combination with other drugs. Does not interact with alcohol, used to treat alcoholic hangover syndrome.

Herbal remedies

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

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