Mental health

According to the World Health Organization, in 2020 depression will become the leading cause of death and disability among the female population, and the second cause of death, after cardiovascular disease, among the overall population. About 450 million people worldwide suffer from depression, and more than two-thirds of suicides are committed by persons who are severely depressed.

As a series of psychophysical disorders depression is a condition characterized by mood disorder. Feeling of sadness, anxiety, exhaustion and fatigue is occasionally experienced by everyone, but this kind of mood passes after several days. Depression is more than sadness and despair; it lasts at least a week and completely takes over your life. Depression is present most of the time, and all things that usually could lift the spirits no longer have a positive impact. For a person who suffers from depression the way of thinking changes. The world is seen differently, usually in a negative light. This affects the family and professional life, so it can cause social isolation. It can be hidden behind a sense of exhaustion, and it is often masked by other disorders, such as chronic anxiety or an eating disorder.

Causes of depression

Depression may occur due to loneliness, severe illness, after bereavement, difficult living conditions, reduced movement, and it can also be the result of the genetics. The science has not been able to explain why it exactly occurs. According to recent theories, it is considered that the occurrence of depression is associated with a decrease in the activity of some neurotransmitters, serotonin, norepinephrine and dopamine, which have a natural antidepressant function. Another important factor for the development of depression is excessive secretion of stress hormones, like cortisol. Chronic stress changes the function of the brain, so the depression can be explained by the many harmful effects of stress accumulation.

The main symptoms of depression are:

• Lack the joy, intense sadness, self-pity, bouts of crying
• Fear, anxiety, worry, anguish
• Sensitivity, vulnerability, irritability
• Loneliness, apathy
• Impaired concentration and memory disorders
• Insomnia or great need for sleep
• Fatigue, exhaustion, lack of energy
• Significantly decreased or increased appetite
• Somatic pains that have no physical cause
• Thoughts of death and wishes to die, or suicide planning

Treatment

The first step in treating depression is the correct diagnosis. The diagnosis of depression is not difficult to set up, because it is very simple to establish the symptoms on the basis of the discussion with the patient. It is futile to expect that depression will be cured by willpower and positive thinking. It happens rarely, because the patients have lost the will and optimism, and are unable to gain them back. The most important thing is to visit the general practitioner on time, and s/he will decide whether it is necessary to consult a psychiatrist and what kind of therapy should be applied - antidepressants, psychotherapy or both.

The treatment of depression is conducted in three stages:

1. treatment of acute episodes
2. stabilization of the treatment
3. prevention of recurrence of depressive episodes

In the first phase are used antidepressants, with or without psychotherapy. In the second phase psychotherapy - combined with pharmacotherapy is the primary method. The third stage involves prophylactic treatment.

Which antidepressants are available today?

It is essential to know that antidepressants are very similar to each other because they have antidepressant and anxiolytic effects that are achieved equally fast, but we can distinguish between them based on side effects. On the other hand, the administration regimen can vary according to whether they are given one or more times a day.

For the treatment of depression the new generation of antidepressants is used. For example, fluoxetine (Prozac, Flusetin), sertraline (Zoloft, Asentra), paroxetine (Paxil, Paroxal),escitalopram (Lexapro, Elicea) and citalopram (Celexa, Starcitin), the so-called SSRIs (serotonin reuptake inhibitors: a type of antidepressant that is characterized by the ability to increase the concentration of serotonin in the synaptic cleft; TCAs (tricyclic antidepressants), MAOIs (Monoamine oxidase inhibitors), NaSSAs (Noradrenergic and specific serotonergic antidepressants), SNRIs (Serotonin and norepinephrine reuptake inhibitors) etc.

If one of the drugs is prescribed and it has not reached the desired effect, or if the intensity of the accompanying side effects is so serious that it cannot be tolerated, the patient should immediately contact the doctor who will help him by choosing another drug. Please note that the chances of achieving successful treatment with the first prescribed antidepressant are about 60%. Therefore, you should not give up, but continue the treatment until the withdrawal of the symptoms of the acute phase, which is the first goal. The next goal is "stabilization of the treatment".

Stabilization of the treatment

In the phase called "Stabilization of the treatment", it is important that:

1. Antidepressant is administered until further notice, 6 months to a year or longer, and that the dose is adjusted. Some drugs are given at the same dose as before, others are reduced to about two-thirds, or about half the dose, and the doctor will decide about it after considering many factors.
2. Conditions for psychotherapy are improving, and it is advised to select a method according to personality and capacities of the patient (cognitive-behavioral therapy in most Western countries is considered psychotherapy of choice for the treatment of depression!), according to the circumstances and the objectives. The psychiatrist will advise the patient about the steps that can be implemented.

Finally, when the effects of medicamentous and psychotherapeutic treatment stabilize, the most important is to prevent the appearance of the next episode - "prevention of recurrence of depressive episodes"

Prevention of recurrence of depressive episodes

If a person has been feeling well and has stopped taking the medication, there is still a risk for the occurrence of new episodes, especially in stressful situations; if a person begins to worry, sleep less, eat, smoke or drink more, s/he can be prescribed a preventive therapy.