Atypical depressive disorder. Symptoms of atypical depression. How to deal with depression

Atypical depression is a separate type of psychoemotional disorder characterized by a combination of typical depressive symptoms and some specific signs. The leading manifestations of atypical depression: emotional reactivity, excessive appetite, weight gain, increased drowsiness.

Despite the fact that today atypical depression is a widespread disorder, an unambiguous cause of its occurrence and an accurate prognosis of its development have not been established. Conducted scientific research put forward several versions about its nature. Some experts attribute atypical depression to a subtype of dysthymia, while another group of scientists believe that this ailment is a mild variant of bipolar disorder. The lack of a unified understanding of the nature of the disease and sufficient clinical data on the mechanisms of development create a certain difficulty in the diagnosis of pathology, its differentiation from other depressive disorders and its treatment.

The International Classifier of Diseases (ICD-10) classifies atypical depression under the heading "other depressive episodes" and recommends that diagnosis be guided by the presence of somatic symptoms that do not have organic causes. According to DSM-IV, the diagnosis of atypical depression can be made if the patient has emotional reactivity (increased susceptibility of the subject to external stimuli), combined with at least two of the following manifestations:

• increased appetite;
• increase in body weight;
• pathological drowsiness;
• sensations of heaviness in the lower extremities;
• significant disruption of social activity as a result of an increased reaction to interpersonal problems.

Atypical depression: causes

Among the putative risk factors in the formation of atypical depression, experts identify several leading causes.

Biological factors

• Disruption of the balance of chemical active substances in the brain - neurotransmitters (norepinephrine, serotonin, dopamine).
• Genetic predisposition - the likelihood of contracting depressive disorders, inherited.
• Taking certain pharmacological drugs (steroids, narcotic pain relievers, some antihypertensive drugs).
• Malfunction of the endocrine system, leading to hormonal imbalance.
• Infectious viral diseases affecting the brain.
• Some long-term chronic ailments, for example: cancer.
• Alcohol abuse, use of drugs or toxic substances.

Psychological factors

• Features of the emotional-volitional sphere of the personality.
• Exposure to both single and chronic stressors.
• Forced stay in critical situations, for example: imprisonment.
• An individual's sudden need for outside help, for example, with a disability.
• Features of childhood and adolescence (domestic violence).
• An interpersonal conflict that led to the formation of an inferiority complex or a guilt complex.

Atypical depression: symptoms

A peculiar distinguishing feature of the disease from other depressive forms is the patient's immediate reaction to a change in the situation. Individuals with this disorder are characterized by extreme volatility and variability of mood, polymorphism, mobility and richness of the emotional sphere. Their mood reflects the content of specific situations, therefore, with positive changes in life (both objective and "fantasy"), the state of most patients improves.

Among the specific manifestations of the disease:

• Excessive need for food;
• Rapid weight gain;
• Pathological daytime sleepiness;
• Excessive night sleep
• Intense response to external stimuli
• Feeling of heaviness, paralysis in the limbs.

Along with the above signs, atypical depression can be accompanied by a variety of somatic symptoms, including:

• Feeling tired, decreased performance, decreased energy potential.
• Motor retardation or anxious agitation.
• Unreasonable persistent pain, not amenable to drug treatment: headache of a pressing, aching character, disorders of the digestive tract, discomfort in the region of the heart.
• Decreased sexual function.

Atypical depression: treatment

In the treatment of atypical depression, specialists resort to the appointment of antidepressants - MAOIs (monoamine oxidase inhibitors), for example: phenelzine, pheniprazine. The therapeutic efficacy of drugs in this group significantly exceeds the action of TCAs (tricyclic antidepressants). According to recent studies, a higher efficiency of the use of MAOIs has been established in comparison with the use of SSRIs (selective serotonin reuptake inhibitors), but this information requires more detailed study.

When using MAOIs, it is necessary to take into account their relatively high toxic effects and cumulative capacity. Treatment with these antidepressants is carried out under close medical supervision. A pronounced therapeutic effect occurs on average 2-3 weeks after the start of the course of treatment. It is worth considering that monoamine oxidase inhibitors disrupt the chemical process for the breakdown of tyramine, therefore it is recommended to follow a special diet that excludes cheese, wines, nuts, and chocolate.

Psychotherapy methods act as an additional tool in the treatment of atypical depression and are used to educate patients in new ways to respond to stressful events, familiarize themselves with relaxation techniques and get rid of stress.

Proven traditional medicines used as tonic adaptogens for atypical depression include:

• ginseng root;
• rhodiola rosea;
• leuzea;
• lure;
• Chinese lemongrass;
• eleutherococcus;
• aralia; rosemary;
• pulmonary gentian.

These "green pharmacy" products are allowed to be used together with the use of pharmacological preparations.

- This is a difficult to treat type of depression, accompanied by changes in body weight, excessive sleepiness and feelings of anxiety. With this type of depression, there are fewer symptoms than in classic cases, and those who have already suffered the classic form of the disease earlier are susceptible to it.

Researchers are considering the possibility that atypical depression is a mild form of bipolar disorder, better known as manic-depressive psychosis. Patients with this diagnosis are less likely than others to suffer from constant and sudden mood swings.

Contrary to the name, atypical depression is fairly common, but it can go undiagnosed in most cases. The reason for this may be not only a medical error, but also the dismissive attitude of patients towards various manifestations of the disease - they may not even pay attention to some of its symptoms, considering them seasonal or associated with some kind of physical ailment.

Symptoms of atypical depression

One of the main distinguishing features of atypical depression is the almost instantaneous response of mood to what is happening around. This means that the person feels better immediately after something good happens, while other forms of depression do not.

In addition to analyzing mood swings, it also takes into account the fact how much drowsiness is increased, or, conversely, there is oversleeping. Symptoms of atypical depression can also include persistent overeating, which can trigger weight gain. Attention is also paid to what is the patient's reaction to refusal, how it affects the ability to work and communicate in society. And the last - whether the patient has a feeling of burden and paralysis, as well as heaviness in the limbs, popularly known as the "feeling of lead".

To begin with, the doctor must make sure that these symptoms have no physical cause. For this, an analysis of the level of hormones can be carried out. It should be remembered that atypical depression can bring with it many comorbidities. For example, low levels of hormones produced by the thyroid gland can be the cause of a bad mood or weight gain.

Causes of atypical depression

It is generally accepted that the cause of depression lies in a chemical imbalance in our brain. Dopamine, norepinephrine and serotonin are among the important elements that play a role in maintaining balance in a stable state.

Despite the fact that the causes of depression are not fully understood, risk factors include:

• heredity factor
• great emotional distress (for example, the death of a loved one, separation from family, divorce, as well as moving, graduating from school, university)
• social conflicts
• various types of violence (both physical and emotional)
• diagnosis of a serious illness (cancer, HIV, heart disease, etc.)
• exclusion from the familiar environment, loss of connection with family, exile

Treatment methods

For symptoms of atypical depression, the first treatment suggested by your doctor is likely to be antidepressant medication. The most effective antidepressants in the treatment of this type of depression are antidepressants, including monoamine oxidase inhibitors, but doctors are in no hurry to prescribe them because of their poor interaction with the food consumed.

Taking such drugs, patients should adhere to a strict diet, consume less carbohydrates and fats, and almost completely eliminate foods rich in tyramine. Smoked meat can be found among such products; meals that include a combination of different products (for example, pizza); sauerkraut; beer; soy and products containing it; products that are not stored according to the rules, or that have lain in the refrigerator for more than two weeks; yeast extracts, etc. Alcohol consumption should also be limited (for example, wine no more than one hundred grams per day). It is also recommended to reduce the amount of caffeine intake.

At the end of the course of treatment, doctors advise adhering to a similar diet for another three to four weeks, since an increase in tyramine levels during this period can cause headaches, increased blood pressure, vision problems, nausea and vomiting, restlessness and other changes in consciousness.

It should be noted that, in contrast to more classical depressions, old types of antidepressants, such as, for example, tricyclic antidepressants, practically do not act on atypical depression.

In addition, antidepressants actively interact with many over-the-counter medications. These include weight management and weight loss supplements; preparations for colds, as well as antipyretic; for the treatment of the common cold (nasal drops and sprays); against cough; pills and inhalers for asthma; natural doping (ginseng, ephedra and others).

Alternative treatments

Treatment with hormones can also give a positive result. The combination of certain antidepressants and drugs for anxiety syndromes (including benzodiazepines) may help treat depression associated with anxiety syndrome. Treatment with such drugs must be strictly controlled, as they can be addictive.

Antidepressants such as selective inhibitors, which are designed to increase serotonin levels in the body, can also be used. These drugs act on the basis of serotonin or norepinephrine, and among them the most common are Prozac, Luvox, Zoloft, Lexapro, Paxil, Celexa.

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The insidiousness of this mental disorder is not even the difficulty of diagnosing it. A depressed (depressive) state is associated in all with lethargy, apathy, lack of appetite and dreary nights without sleep. A person who eats with appetite, recovers, sleeps soundly and for a long time, reacts violently even to trivial events, even in the presence of some growing depression and anxiety, does not look in the eyes of others, and his own, as a victim of depression. Especially in the initial stages of the development of a mental disorder. Atypical depression belongs to affective disorders characterized by special symptoms, so most patients, according to psychiatrists, remain out of their field of vision. Simply because neither they themselves, nor their loved ones believe that they need psychiatric help.

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ICD-10 code

F32 Depressive episode

Epidemiology

Morbidity statistics show that depressive disorder is the most common mental illness. Every year, approximately 200 million people worldwide seek medical attention and are diagnosed with depression as a result of testing. One tenth of the male population and one fifth of the female population are predicted to be highly likely to experience some form of depressive episode. It is believed that half of people experiencing depression do not see a doctor because they do not consider themselves sick.

Atypical depression as one of the clinical variants of this mental disorder occurs in every third or fourth depressed patient (approximately 29% of all diagnosed cases of depression). According to studies in patients with atypical depression, the prevailing symptomatology is the inversion of autonomic signs - increased drowsiness and eating disorders. This type was typical for younger patients with early manifestation of the disease. The next most common group was dominated by sensitivity to rejection (hypersensitivity). The last group of patients in terms of number was characterized by the dominance of mood reactivity. The majority of patients in all three groups were women.

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Causes of atypical depression

The etiology of most mental disorders is still under study, depression is no exception. In modern psychiatry, the so-called monoamine theory prevails, in which depressive disorders, including atypical ones, are considered as a consequence of an imbalance in neurotransmitters - primary mediators that transmit electrochemical impulses between neurons in the brain, as well as to tissues and cells belonging to the monoamine group ... Deficiency of serotonin and / or norepinephrine, as well as –dopamine, has been suggested as the basis for the development of depressive disorder. The immediate cause of this imbalance is not known. The processes occurring in the brain are too complex, at the present level it is impossible to fix the reactions occurring at the level of an individual synapse. However, the role of these neurotransmitters in the onset of depression and the risk factors that contribute to this are not in doubt. These include:

• individual emotional and volitional characteristics of a person;
• hereditary predisposition to increased susceptibility to emotional stress;
• endocrine pathology - decreased thyroid function (hypothyroidism), growth hormone (growth hormone) deficiency;
• taking medications containing hormones, drugs, certain drugs that lower blood pressure;
• infectious diseases affecting the lining of the brain;
• alcoholism, drug addiction, substance abuse.

Risk factors

At risk are people who have experienced depression at an early age, severe stress, one-time or chronic - victims of physical or psychological violence; suffering from a serious incurable disease; those who have lost a dearly beloved loved one; suddenly changed life stereotypes.

Pathogenesis

The pathogenesis of the disease is based on the study of the effect of antidepressants and their use in the treatment of depression, as well as on postmortem measurements of serotonin levels in the brains of deceased patients with depressive disorders.

In patients with primary (endogenous) depression, a deficiency of monoamines is always revealed, in addition, a decrease in the sensitivity of presynaptic and postsynaptic receptors, which leads to compensation by accelerating the circulation of monoamines, as a result of which their supply is depleted, which leads to hypersecretion of cortisol.

The functions of monoamine neurotransmitters are distributed as follows:

• serotonin - provides an increase in mood (thymoanaleptic effect); controls the level of aggressiveness; directs impulsive drives; regulates the feeling of satiety and hunger, the alternation of periods of sleep and wakefulness; provides anesthetic effect;
• norepinephrine - carries out, so to speak, mental accompaniment of stress, activates the waking nervous system, inhibiting sleep centers; includes stress-induced numbness to pain; participates in increasing the level of motor activity, cognitive processes, regulates many other motivational processes and biological needs.
• dopamine - produced during positive experience, provides the development of psychological motivation for various types of activities.

There is no doubt that these neurotransmitters are actively involved in the development of depression. However, it is assumed that there are several more complex and related mechanisms. Violation of the biomolecular interaction of norepinephrine and serotonin is far from the only process that triggers the development of pathology.

In patients with depressive disorders, hypercortisolism is constantly found. The secretion of cortisal fluctuates during the day, most of it is released in the predawn and morning time, then it decreases and from 22-23 hours until the middle of the night the hormone is not produced at all. In patients with depression, the normal rhythm is disturbed - cortisol is also produced at night, due to which its excess is formed. The central link in the regulation of hormone production is the hypothalamus, which produces a catalyst for the secretion of cortisol - corticotropin-releasing factor. Most scientists, however, prefer the monoamine hypothesis, considering the hypersecretion of cortisol as a symptom rather than a pathogenetic link. However, the links between monoamines and glucocorticoids are complex. If it is proved that norepinephrine inhibits the production of hormones, and its lack leads to hypersecretion of glucocorticoids, then the data on the relationship of cortisol with serotonin are ambiguous. Several studies have confirmed that a variety of stressors led to decreased serotonin levels and hypercortisolism. But in other studies, serotonin stimulated cortisol production.

It is obvious that today all the pathogenetic links that trigger the mechanism of depression have not yet been identified; in fact, there are much more of them. The starting point can be the combination of monoamine deficiency with the pathopsychological personality of the patient. Depressive disorder occurs with the pathological functioning of the hypothalamic-pituitary-adrenal system, as well as the limbic system, which coordinates the impulses sent to the hypothalamus, and its impulses are transmitted to the hippocampus, which is responsible for the emotional response. Dysfunction of the reticular formation leads to a deficiency of adrenergic neurotransmitters and a decrease in the biological tone of the brain mechanisms that control mood.

Symptoms of atypical depression

Until now, experts have not come to the conclusion to what type of mental disorders to attribute an atypical depressive episode: whether to interpret it as a type of dysthymia - a chronic, less pronounced, however, more prolonged (at least two years) form of depression; or - as a mild form of bipolar disorder with more smoothed symptoms, that is, a vague version of manic-depressive psychosis.

The first signs characteristic of this particular form of neuropsychic disorder are as follows:

• instant situational reaction, and after positive events and even memories of them, the patient feels a sharp improvement in his condition;
• the patient and his environment begin to notice a craving for the absorption of food, which was not previously characteristic of this individual (it may be too frequent snacks or, on the contrary, rare, but very abundant, preference is given to sweets, pastries, chocolates), which entails a sharp weight gain;
• the patient becomes a lover of sleep, regularly wakes up late, complains of drowsiness in the daytime, which is not associated with previous lack of sleep;
• begins to show inadequate sensitivity to negative comments about his actions, to refusals and disagreement with his opinion - the reaction looks like hysteria, emotional outburst, tears;
• complains of paresthesia of the extremities - tingling, numbness, lead heaviness.

In addition to the five main symptoms that distinguish atypical depression from other types of depressive disorders, there may be others that are characteristic of this pathology as a whole: decreased sexual desire, fatigue, weakness, or, conversely, abnormal arousal, pain syndromes that cannot be stopped by pain medications - migraines, toothache, heart, stomach pain, as well as - digestive disorders.

There are no specific external signs that indicate the presence of depression in a person, however, certain behavioral characteristics may indicate the likelihood of a depressive disorder. Others should pay attention to the fact that a person they know well has a very worried look; when talking, he constantly looks away; became noticeably more inhibited - speaks slowly with long pauses, as if remembering words and constantly thinking, or, conversely, abnormally excited. Depression gives out an untidy appearance, illogicality of actions and reasoning, self-flagellation or belligerence and challenge, tearfulness and an invariably sad look, sometimes a person freezes for a long time in complete immobility.

The stages of the disease are classified according to the Hamilton scale - an objective assessment of the severity of the patient's condition is given, regardless of the type of depression. It is used by specialists, is not intended for self-diagnosis, is filled out on the basis of a conversation with the patient and his relatives and is considered a serious diagnostic classifier. The answers are assessed on a four-point scale, the first 17 answers according to the set of points are interpreted as follows: normotypes will score from zero to seven points; a patient who scored from eight to 13 points is diagnosed with a mild stage of the disease; the average corresponds to 14-18 points; the following intervals 19-22 and 23 and more indicate a severe stage and a very severe advanced disease.

For self-assessment of the state, the Beck test questionnaire is used, which takes into account the cognitive-affective signs of depressive disorder and its somatic manifestations. The answers are assessed according to the appropriate scale, which indicates the severity of mental pathology. Patients who scored up to 10 points are considered healthy, from 10 - sick. Those who scored more than 30 points are diagnosed with an extremely severe stage of the disease.

According to the dominant symptoms, the following types of atypical depression are distinguished, in which:

1. The reactivity of mood prevails, which is expressed in its improvement in response to events, assessed by the patient as positive. The disorder itself develops as a recurrent one, that is, episodes of depression are periodically repeated, however, manic episodes with an amnestic component, delusions and hallucinations are absent. Possibly intermittent agitation and hyperactivity immediately following depression, which can be judged to be hypomania. The severity of this type of atypical depression is the mildest, the level of adaptation of such patients is the highest compared to the following types of disorder below.
2. Inversion of vegetative disorders prevails, manifested by excellent appetite with a preference for a high-calorie diet up to overt gluttony and drowsiness (sleep "piles up", mainly during the day; sometimes it is very difficult for the patient to wake up in the morning, which is not associated with lack of sleep). In this case, atypical depression develops as a bipolar disorder with significant impairment of activity and mood. The development of the disease at an earlier age is characteristic, frequent depressive periods are replaced by mild manic ones, a pronounced picture leads to more frequent referrals for psychiatric help. The disease proceeds as an alternation of diametrically opposite episodes with persistent symptoms of drowsiness and overeating during the depressive stage. The intervals of mood corresponding to the norm are getting shorter, or the pathology from the very beginning proceeds continuously without intervals of enlightenment. There was practically no recurrent course of atypical depression with a predominance of sleep and food intake disorders.
3. The prevalence of sensitivity to rejection is expressed in hypertrophied resentment with the perception of any remarks or behavioral changes in others. The patient's reactions are expressed by hysteria, outbursts of rage, explicit (aggression, avoidance) or hidden (cold, hostile attitude towards the alleged offenders and "enemies") rejection. Patients experience difficulty in building interpersonal relationships and social adaptation. This type of disorder is characterized by a recurrent type of course, in which severe melancholic depressive episodes (provoked by individually intolerable situations) are interspersed with affective stages. In the dynamics of observations of such patients, a decrease in the amplitude of bursts of excitement is clearly traced. The lowest level of adaptation was observed in patients with atypical depression with a dominant sensitivity to rejection.

The first and third types of atypical depression manifest at a more mature age from 30 to 45 years, while the manifestations of the second are first encountered already in adolescence and adolescence. The severity of the disease increases from the first to the third. For a disease proceeding as a bipolar mental disorder, early diagnosis and a much larger number of polar episodes (depressive and hypomanic) in history are characteristic than for the recurrent type, which is characterized by a longer course.

The so-called "lead paralysis" - heaviness in the limbs with paresthesia, which occurs for about half an hour (sometimes more), usually at moments of psychoemotional stress or without the influence of a provoking factor, is equally often observed in patients with all types of disease.

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Complications and consequences

The consequences and complications of depression can be fatal - according to statistics, approximately 15% of people suffering from depressive disorders commit suicide. Unfortunately, it is estimated that about half of depressed patients consider themselves healthy and do not seek medical help.

The consequences of a depressive disorder are:

• indifference to appearance, overweight and related diseases;
• loss of vital energy, performance;
• alcohol and drug addiction;
• difficulties in interpersonal relationships at work and at home;
• social phobia and isolation from society;
• exacerbation of existing diseases and premature death;
• suicidal thoughts and their implementation.

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Diagnosis of atypical depression

Russian psychiatry interprets the term atypicality as a deviation of symptomatology, its inconsistency with the classical ideas about depression - lethargy in the affective, intellectual and volitional spheres (depressive triad). These symptoms are also present, but fade into the background. In ICD-10, atypical depressive disorder is not isolated as an independent nosological unit, it is referred to as other depressive episodes.

In DSM-4 (American Psychiatric Association's Diagonal and Statistical Manual of Psychiatry), atypical depression is isolated as an isolated syndrome. Diagnostic criteria for atypical depression have been identified. A mandatory symptom of this disease is mood reactivity. Optional and serving as additional criteria, the so-called optional symptoms are: drowsiness, overeating and associated weight gain, "lead paralysis" and heightened emotional susceptibility to rejection.

After interviewing the patient, the doctor will try to exclude the organic causes of the patient's complaints. For this, tests for thyroid hormones, growth hormone levels, and cortisol levels may be prescribed. Perhaps the appointment of classical diagnostic tests that speak about the general state of health of the patient - clinical studies of blood and urine.

To assess the objective and subjective severity of the patient's pathology, they will be tested according to Hamilton and Beck, other tests can be used.

Instrumental diagnostics of patients with atypical depression includes computed and magnetic resonance imaging, electroencephalography and interval cardiometry, which determine the rate of extinction of the galvanic skin response after stress.

Computed tomography is not very informative, however, sometimes depressed patients have dilated cerebral ventricles. Magnetic resonance imaging in patients with atypical depression developing as bipolar disorder revealed the presence of bright white spots in the white matter localized around the ventricles of the brain. An electroencephalogram can detect changes in the bioelectrical activity of the medulla.

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Differential diagnosis

Differential diagnosis, carried out after all possible examinations, makes it possible to distinguish depression from a normal physiological reaction to a stressful situation, and also to exclude patients with severe chronic pathologies, schizophrenia and other congenital and acquired neuropsychiatric diseases, substance abusers, taking certain medications.

Treatment for atypical depression

Depressive disorder with atypical features usually requires long-term treatment. Tricyclic antidepressants are ineffective in this case. Thymoanaleptic therapy is carried out with drugs that inhibit the enzymatic activity of monoamine oxidase (MAO inhibitors), or selectively block the reuptake of serotonin (SSRI antidepressants), especially relevant if the patient has suicidal intentions. The drug is selected individually, taking into account the type of depressive disorder with atypical symptoms, the presence of concomitant diseases in the patient and the need to simultaneously conduct therapy with other drugs.

For atypical depressions with elements of apato-abulia and asthenic complaints, a non-selective monoamine oxidase inhibitor with a psychostimulating effect can be prescribed Nialamid... The drug irreversibly blocks the enzymatic activity of MAO and prevents the cleavage of amino groups from the molecules of norepinephrine and serotonin, contributing to their accumulation in the medulla. It is used in combination with psychotherapy. Contraindicated in sensitized patients, with states of agitation and expressed suicidal intentions, as well as in patients with insufficiency of the heart, blood vessels, cerebral circulation, liver and kidneys. Causes excitement of the central nervous system, dyspeptic symptoms, hypotension, delayed emptying of the bladder. It is not recommended to take the drug at night (the last time the drug is taken at 17.00). It is taken orally, starting from 25-50 mg once or twice a day, gradually increasing the dose (every two to three days by 25-50 mg) until the therapeutic effect is achieved. Then the dose is gradually reduced. The average daily dose is 100-200 mg, in cases of depression resistant to therapy, it can reach 800 mg. Sometimes drip infusion is practiced. In combination with Nialamide, other MAO inhibitors, tricyclic antidepressants are not prescribed, treatment with them can be started after two weeks. Strengthens the effect of barbiturates, pain relievers, antihypertensive drugs. A Tiramine-free diet should be followed.

Currently, selective reversible monoamine oxidase inhibitors are preferred as less toxic drugs. Their representative is Moclobemide... The pharmacological action of this agent is similar to the previous drug, in contrast to an irreversible inhibitor, which forms stable bonds with the enzyme and completely blocks it, Moclobemide, temporarily deprives monoamine oxidase activity, then the unstable compound is destroyed and the active component of the drug is eliminated from the body, and the enzyme activity is restored to normal level. It is used for various depression, does not have a sedative effect, but normalizes sleep. Causes the same side effects as the previous drug, which usually go away after you stop taking it. Contraindicated in case of intolerance, acute disorientation in space, not prescribed in pediatric practice, pregnant and lactating women, persons prone to suicide. At the beginning of treatment, a single dose of 100mg is taken three times a day after meals, after reaching a therapeutic effect, the dose is reduced to 50mg. The maximum daily dosage is 600 mg. The effect of ibuprofen or opium derivatives from combined use with Moclobemide increases, and cimetidine inhibits its breakdown, so the dosage of the drugs requires correction. It is not combined with the use of alcoholic beverages. But other antidepressants can be taken immediately after you stop taking Moclobemide.

In atypical depression, especially in persons with suicidal tendencies, antidepressants from the group of serotonin reuptake inhibitors give a good therapeutic effect. They help to improve mood, normalize sleep, eliminate feelings of fear and feelings of uselessness. Although at the same time the same drugs (like all antidepressants) can lead to excessive agitation and exacerbation of suicidal tendencies in case of overdose or prolonged uncontrolled use. Preparations with the active ingredient fluoxetine, such as Prozac, selectively binds serotonin receptors, which contributes to its accumulation in the synaptic cleft and prolongs the stimulating effect of serotonin. The patient's level of anxiety and anxiety decreases, the feeling of fear decreases and his mood rises. May cause vasculitis, hot flashes, hypotension, atrial fibrillation, increased arterial lumen, indigestion, pain along the esophagus; on the part of the nervous system and psyche, there are a lot of side effects inherent in depression; disorder of the genitourinary sphere, idiosyncrasy and serious allergic reactions, serotonin syndrome. Prozac can be used to treat pregnant patients, its teratogenicity has not been identified. If the mother is prescribed a drug in the third trimester, then at first the behavior of the newborn is monitored. It is better for nursing mothers not to use it, as it passes into breast milk.

The daily requirement of patients with depressive disorders is 20 mg, with hyperphagia, the dose is increased to 60 mg per day.

It interacts with many drugs, so caution must be exercised if it is necessary to combine it with any medicine. Prozac is absolutely incompatible with the oral antipsychotics Pimozide and Thioridazine, after discontinuation of which, a time interval of at least 5 weeks is maintained. It is forbidden to combine it with MAO inhibitors. This also applies to remedies based on the herb St. John's wort, including homeopathic ones. After stopping the intake of drugs that inhibit the enzymatic activity of monoamine oxidase, maintain a time interval of at least two weeks. During therapy with serotonin reuptake inhibitors, do not drink alcohol and alcohol-containing drugs.

In atypical depression, one of the symptoms is hypersomnia. The production and level of the sleep hormone melatonin (a serotonin derivative) also does not reach the normal level. In addition to disturbances in sleep and wakefulness, this leads to other disorders, in particular, eating disorders. For atypical major depression with prevailing symptoms of hypersomnia and hyperphagia, the doctor may prescribe an antidepressant Valdoxan... The active substance of this drug, agomelatine, has an affinity for melatoninergic (MT₁ and MT₂) and serotonergic 5-HT₂ⅽ receptors, while not blocking others - α- and β-adrenergic receptors, benzodiazepine, histamine-, dopamine- and cholinergic. Agomelatine is especially active in stimulating the release of dopamine and norepinephrine in the prefrontal area of ​​the cerebral cortex, without altering the content of extracellular serotonin. The drug does not negatively affect the ability to remember and does not interfere with the ability to concentrate on any action. It synchronizes the intervals of wakefulness and sleep, normalizes its structure and duration, which is necessary for good rest. In patients taking this drug, the incidence of libido disorders is reduced. It does not have a hyper- and hypotensive effect, does not affect the heart rate, does not cause dependence. The bioavailability of agomelatine is reduced in smokers and in male patients in relation to women. Teratogenicity of the drug has not been identified, but pregnant women are prescribed only for vital reasons, while lactating women are advised to stop breastfeeding. It is not used in pediatrics and is not indicated for patients with hepatic dysfunction. Contraindicated in persons sensitized to the components, as well as in those suffering from lactase deficiency. Particular care should be taken when prescribing to patients with suicidal tendencies. At the beginning of treatment, you should not perform work involving the use of complex and dangerous mechanisms.

Patients with depressive episodes are prescribed short-term drug therapy from one and a half to two months with a daily dosage of one or two tablets (25-50 mg). In severe forms of the disease (more than 24 points according to Hamilton), it is prescribed individually. For prophylactic purposes, one or two tablets are dosed per day.

Valdoxan is well tolerated by patients, however, both allergic reactions and undesirable effects from the digestive system, especially the liver, nervous and other systems, are not excluded. During treatment, patients are periodically subjected to liver function tests: before starting therapy, and then at intervals of three weeks, one and a half, three and six months.

Does not combine with alcohol and drugs that have a toxic effect on the liver, inhibiting the enzymatic activity of CYP1 A2. Interacts with many medications, so care must be taken if combined use is required.

Antidepressants are the main group of drugs for depressive disorders, correcting the level of neurotransmitters and helping to restore disturbed processes in the brain. Their effect does not appear immediately, but at least after a week. In addition to antidepressants, the patient can be prescribed antipsychotics, normotimics (mood stabilizers), nootropics, sedatives. They are selected by the doctor individually, depending on the clinical picture and the course of the disease.

When taking antidepressants (MAO inhibitors), you need to adjust your diet by excluding foods containing tyramine, which neutralizes the effect of the drug. The consequence of this combination can be migraine, hypertensive crisis and intracranial hemorrhage.

Tyramine is a trace amino acid found in aged protein foods. Most of it is found in aged cheeses, smoked meats and pickles, canned and fried meat, fish, alcohol, less of it in plant foods - bananas, nuts, soybeans and beans. Cottage cheese, pickled and processed cheeses are allowed to be consumed.

Diet food for atypical depression pursues several goals, firstly, to ensure the effective use of drugs, secondly, to prevent weight gain, and thirdly, to improve mood through nutrition and saturate the body with the necessary vitamins and microelements. When the patient is not taking antidepressants, products containing tyramine are not contraindicated, they can help to reduce weight, improve mood and metabolism. Fats of animal origin limit up to 10% of all fats in the daily diet, the rest should be vegetable fats and unsaturated fatty acids, 30% should be protein products, plant foods (vegetables, fruits and cereals) prevail in the menu.

With depression, do not lean on sweets, coffee, cocoa, black tea, and sugary carbonated drinks. And if you can eat a few slices of dark chocolate, then Coca-Cola and other similar drinks should be excluded.

Treatment of atypical depression can be long-term, combining medication, vitamin therapy, psychotherapeutic and physiotherapeutic treatment.

Vitamins in the treatment of depression are of exceptional importance. You should try to include in the menu foods containing B vitamins, ascorbic acid, carotenoids, vitamins E and D, zinc, calcium, magnesium, tryptophan, unsaturated fatty acids, glycine. The doctor may prescribe the intake of vitamin and mineral complexes, fish oil.

A balanced diet, taking vitamin supplements in combination with drug-free methods, individual or group psychotherapeutic trainings can help cope with mild to moderate depression without the use of antidepressants.

Physiotherapy treatment, in addition to drug and / or psychological assistance, has a noticeable therapeutic effect. Various methods are used in the treatment of depression: transcranial magnetic stimulation, electrical procedures, light therapy, music therapy, color therapy, balneotherapy.

Psychotherapy is mandatory for depressive disorders and is always included in the treatment regimen. It is aimed not only at achieving a therapeutic effect, but also should instruct the patient to follow all the doctor's recommendations, not violate the regimen and complete all prescribed courses and procedures on time, motivate the patient to be treated until complete recovery and not quit treatment at the first noticeable signs of improvement. Only an integrated approach and the correct selection of methods based on a thorough diagnosis is the key to successful treatment of atypical depression.

Traditional treatment

A good alternative to antidepressants is the advice of traditional healers. In combination with psycho- and physical therapy, herbal therapy, provided the individual wants to recover and return to a fulfilling life, can be very effective. However, a prerequisite should be a thorough diagnosis and identification of all factors that influenced the development of a depressive disorder. If drugs are still necessary, then after consultation with a specialist, you can supplement drug therapy with folk remedies.

As tonic herbal adaptogens, you can use:

1. Ginseng root - improves memory and vision, stabilizes the nervous system, has an anesthetic and immunomodulatory effect, tones the entire body, participates in metabolic processes, normalizes blood formation, strengthens blood vessels, stimulates brain activity, relieves fatigue and increases efficiency. Contraindicated in patients with hypertension, tachycardia, overly excitable and suffering from insomnia. An alcoholic tincture of ginseng root is used as a stimulant, for which dried crushed roots (50 g) need to be poured into ½ liter of vodka (you can dilute 50 g of honey in it if tolerated). The remedy is infused for three weeks in a warm place, protected from direct sunlight. It is recommended to shake the container with the tincture from time to time. The tincture is measured with a teaspoon and taken orally before meals.
2. Golden root or Rhodiola rosea - restores lost strength, including sexual interest, soothes and at the same time stimulates the central nervous system. Golden root normalizes blood pressure, however, it is better for hypertensive patients with uncontrolled rises to refrain from this remedy. This herb has a lower stimulant effect than ginseng and may be beneficial for hypothyroidism and diabetes mellitus. The tonic tincture is also prepared with alcohol, for which 50 g of roots dried and crushed on a coffee grinder are poured with two glasses of high-quality vodka. The agent is infused for two weeks at room temperature, protected from direct sunlight. It is recommended to shake the container with the tincture from time to time. First, take five drops before three meals. Then the number of drops taken is gradually increased, stopping at 20 drops.
3. Maral root or leuzea - ​​contains carotene, inulin, vitamin C, alkaloids, flavonoids and essential oils. The use of drugs prepared from this plant for medicinal purposes activates vitality, increases efficiency, normalizes mood, sleep and appetite. Depressed state goes away, interest in life in all its manifestations returns, blood supply to muscle tissue, metabolism improves, which contributes to physical activity and parting with excess weight. Basically, alcohol tinctures are used as tonic. It is prepared from the maral root in the proportion of 15 g of the plant component in dried and crushed form per 100 g of vodka. The agent is infused for two weeks at room temperature, protected from direct sunlight. It is recommended to shake the container with the tincture from time to time. Take 20 drops before morning and evening meals. Maral root is also taken in powder form, dried and ground finely, then thoroughly mixed with honey in the proportion: one part of powder to nine parts of honey. Dose in a tablespoon three times a day. An evening reception is held no earlier than two hours before bedtime. It is not recommended to take hypertensive patients and glaucoma.
4. St. John's wort (perforated) - rich in B vitamins, tocopherol, ascorbic acid and carotene, contains essential oils, choline, flavonoids and traces of alkaloids. Everyone knows its anti-inflammatory and disinfecting effect, however, not everyone knows that this plant is a powerful natural antidepressant. Hypercine and hyperforin, which are part of this herb, provide it with an antidepressant effect. On its basis, the pharmaceutical industry in Germany produces the drug Gelarium Hypericum, indicated for the treatment of depressive disorders. St. John's wort has no contraindications for medicinal antidepressants, in addition, it stimulates the gastrointestinal tract, does not cause drowsiness and lethargy, which is valuable in the treatment of atypical depression. For the treatment of this condition, an alcoholic tincture is best suited: it is prepared with vodka in a ratio of 1: 7, and with alcohol 1:10, left to insist for at least three days at room temperature, protecting it from direct sunlight. It is recommended to shake the container with the tincture from time to time. Before three doses, 10-12 drops of tincture are diluted in ¼ glass of water and drunk for a month. While taking drugs containing St. John's wort, you need to protect the skin from the sun's rays, and hypertensive patients should also be careful. Women taking oral contraceptives should be aware that St. John's wort reduces their effectiveness. Long-term use can cause bouts of arousal up to manic episodes. St. John's wort is not combined with antidepressants, anesthetics and antibiotics.

All of the above herbal tonics are not suitable for pregnant and lactating women.

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Homeopathy

By far the most effective therapy with homeopathic remedies will be individually prescribed. A homeopathic doctor, after listening to the patient's complaints, will conduct a detailed interview with him, in which all aspects of the patient's character and habits, his food preferences, leisure time, relationships with others, and the peculiarities of his condition will be touched upon. In severe cases, it is necessary to communicate with the patient's relatives. As a result of the drawn up clinical picture, a drug will be prescribed, constitutional (in most cases) or symptomatic. The goal of homeopathic treatment is to restore the equilibrium state of the nervous, immune and endocrine systems of a person, thus ensuring his recovery. Homeopathy does not deny the need to use psychotherapeutic practices and is fully compatible with them.

In the treatment of depressive disorders, almost all drugs are used, depending on the constitutional characteristics of the patient and his symptoms. Hypericum perforatum (St. John's wort) is prescribed to apathetic and at the same time irritable patients, suffering from headaches, forgetful, sensitive to cold. Arnica (arnica) works best on good-natured, full-blooded patients who prefer loose cut clothes, women of this type are flirtatious, the main feature is an instant change in mood. Arsenicum album (white arsenic) as a constitutional remedy for rational, calculating, demanding of themselves and those around them, while prone to melancholy, whining and restless. Belladonna (Belladonna) is prescribed for intellectually developed, nervous and impressionable patients.

Pharmaceutical multicomponent preparations produced in homeopathic dilutions can also be included in treatment regimens. In addition, the side effects of their use are not comparable to those of antidepressants.

Valerian Heel indicated for various neuropsychiatric disorders, including depressive syndrome. The drug does not have a direct sedative effect, but carries out an indirect effect by connecting the limbic system of the brain, limiting the excitatory stimulus through the receptors of γ-aminobutyric acid. The pharmacological properties of the drug determine the spectrum of its action:

• Valeriana offiсinalis (valerian) - has a relaxant effect for both the nervous system and the vascular;
• Humulus lupulus (ordinary hops) - eliminates increased excitability;
• Crataegus (hawthorn) - tones the heart muscle, optimizes heart function, expands the lumen of the coronary arteries, has an antihypotensive effect;
• Hypericum perforatum (St. John's wort) - activates metabolism in neurons, tones up cerebral vessels, stabilizes blood flow;
• Melissa officinalis (lemon balm) - increases resistance to stress factors, relieves bouts of overexcitation;
• Chamomilla reсutita (chamomile pharmacy) - has a moderate sedative effect, strengthens the immune system, relieves swelling and inflammation, normalizes the digestive process;
• Acidum picrinicum (picric acid) - provides a nootropic effect;
• Avena sativa (common oats) - promotes adaptation and recovery, strengthens the immune system;
• Bromides (Kalium bromatum, Ammonium bromatum, Natrium bromatum) - normalize the balance of excitement and depression of the nervous system, have a moderate anticonvulsant effect.

Contraindicated in patients and children under two years of age who are sensitized to the ingredients of the homeopathic complex. Use for pregnant and lactating women only as directed by a doctor.

Drops are taken sublingually at least 20 minutes before breakfast, lunch and dinner, or an hour later. You can dissolve the recommended number of drops in a spoonful of clean water and drink, holding it in the mouth while taking. Dosage: 2-5 full years - five drops each; 6-11 full years - 10 drops; from 12 years old –15-20 drops. The standard course is a month, the continuation of admission is possible only after consulting a doctor.

Ignacy Gommacord it is used for psychosomatic pathologies, including depressive disorders. The composition includes two vegetable components - the beans of St. Ignatia (Ignatia), and the animal - musk of the musk deer (Moschus), in several breeds.

The combination of these components reduces depression, anxiety, fear, tearfulness, increases emotional and mental stability. The patient stops neurotic spasms and pains, a nervous tic, in particular in women, menstrual disorders of a neurotic nature stop. The drug has a moderate sedative effect and activates metabolic processes in nerve cells.

Contraindicated in patients who are sensitized to the components and in children under two years of age. Use for pregnant and lactating women only as directed by a doctor.

Drops are taken sublingually at least 20 minutes before breakfast, lunch and dinner, or an hour later. You can dissolve the recommended number of drops in a spoonful of pure water and drink, holding it in the mouth. Dosage: 2-5 full years - five to seven drops each; 6-11 full years - from seven to ten drops; from 12 years old - ten drops. The standard course is a month, the continuation of admission is possible only after consulting a doctor.

Nervoheel a complex of homeopathic dilutions of several substances of plant, animal and mineral origin, which has an antidepressant effect, as well as relieves hyperexcitability and convulsive muscle contractions.

The active substances contained in a combination of substances have the following properties:

• Ignatia (beans of St. Ignatius) - eliminates depression, lethargy, anxiety, mental instability, convulsive contractions of the muscles;
• Sepia officinalis (contents of the ink sac of cuttlefish) - normalizes the process of going to sleep and its quality, reduces the excitability of the nervous system, restores vital activity;
• Kalium bromatum (potassium bromide) - improves the quality of night rest and the ability to remember; relieves attacks of unreasonable fear, depression of the psyche;
• Acidum phosphoricum (phosphoric acid) - restores emotional, intellectual, neuropsychic and physical activity;

Prophylaxis

Depression, like any disease, is easier to prevent than to cure, and in fact it is not as difficult as it seems.

It is impossible to avoid stressful situations, but it is quite possible to increase your resistance to them with the help of mental self-regulation. Every day, all sorts of small troubles "spoil our nerves" and we lose the ability to rejoice in the achievement of our goals. Even routine tasks can be enjoyable, because they are necessary for us and our loved ones.

An optimal daily routine, adequate physical activity, and a healthy diet increase our resistance to stress and reduce the likelihood of depression.

Positive thinking makes you feel much more confident and better, and is the key to mental health.

Compliance with universal moral principles in all spheres of life, the habit of adhering to social behavioral norms will eliminate most of the emotional stressors in interpersonal relationships in all spheres of life.

Avoid harmful addictions leading to intoxication - narcotic, alcoholic, medication; give preference to positive emotions and try to exclude negative ones; give up self-isolation and expand your social contacts; intolerant of violence - these simple general rules can significantly reduce the risk of a depressive disorder.

If you feel that you cannot cope on your own, seek help from a psychotherapist.

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Atypical depression is a widespread psychiatric disorder, a type of major depression characterized by complex treatment and special characteristics. This depressive state is inherent in those people who previously suffered from classic depression. Psychiatrists believe that atypical depression is a mild form of bipolar disorder (). This mental disorder can develop in combination with other diseases: with hypothyroidism, in the presence of growth hormone deficiency syndrome

Atypical causes depression

The causes of atypical depression are: a violation of the chemical balance in the brain (serotonin, norepinephrine and dopamine); genetic factor (geneticists see a violation of the connection between chromosome 18 and 4); endocrine balance disorders, as well as water and electrolyte metabolism; loss of a loved one, interpersonal conflicts and the resulting feeling of guilt; violence (emotional, physical, sexual); important events (job loss, relocation, graduation from an educational institution - school, institute; retirement); , stroke, cancer, HIV; alcohol abuse, as well as drugs; expulsion from social groups; voluntary self-isolation

Atypical depression symptoms

The symptomatology of atypical depression is an instant reaction to an event (joy or sadness); sudden mood swings, increased drowsiness (up to 14 hours a day), doing nothing, loss of all interests and emotions, loss of a sense of reality, constant overeating, sensitivity to refusal of any requests or deeds, feeling of burden and heaviness in the limbs, manifestation of excitement and anger

Atypical depression treatment

How to get out of depression on your own without doctors? Getting rid of depression must begin with establishing the cause of the onset and the desire of the sick person to find a way out of depression. A good remedy for depression is compulsory attending psychotherapeutic sessions and following all the doctor's prescriptions. Disorders detected at an early stage are treated more successfully and faster, so do not waste time. And in an advanced form, a mental disorder can be successfully treated with antidepressants such as monoamine oxidase inhibitors and selective (iprazide, iproniazid, isoniazid and others), but they have a bad side effect. Therefore, in order to avoid this negative moment, it is necessary to strictly adhere to the diet prescribed by the doctor. A feature of this diet is to limit the intake of foods rich in tyramine. And this is smoked meat, salami sausages, raw smoked meat, pizza, sauerkraut, beer, soy and expired products. The tyramine found in these foods inhibits the effects of monoamine oxidase and amino acids. The very onset of the disease is attributed to adolescence and all treatment of a mental disorder is based on taking antidepressants and psychotherapeutic sessions. Psychological help for depression, and this is family and group psychotherapy, gives a positive result, but subject to training for a long time (up to two years). Family psychotherapy is aimed at restoring family relationships, and group psychotherapy provides opportunities for establishing individual and group relationships in society. And thanks to psychotherapy, which corrects deep changes in character, a gradual recovery of the patient begins.

How to deal with depression

The best way to fight is to prevent the relapse of depressive conditions. Prevention includes a healthy lifestyle, adherence to all regimes, exercise, daily walks, favorite work, avoidance of conflict situations, a variety of leisure activities with pleasant moments. Even if depressive states come, the person will find the strength to recover faster. Remain calm when stressful situations arise, do not blame yourself for what is happening, analyze the situation and live with good thoughts on.

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