Atypical depression

The insidiousness of this mental disorder is not even in the difficulty of its diagnosis. A depressed (depressive) state is associated with inhibition, apathy, lack of appetite and dreary sleepless nights. A person who eats with appetite, gains weight, sleeps soundly and for a long time, reacts violently even to trivial events, even with some increasing depression and anxiety, does not look like a victim of depression in the eyes of others, or even in his own eyes. 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 outside their field of vision. Simply because neither they themselves nor their loved ones believe that they need psychiatric help.

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Epidemiology

Statistics show that depressive disorder is the most common mental illness. Every year, approximately 200 million people around the world seek medical help and are diagnosed with depression. It is predicted that one-tenth of the male population and one-fifth of the female population will likely experience some form of depressive episode. It is believed that half of people experiencing depression do not seek medical help because they do not consider themselves ill.

Atypical depression as one of the clinical variants of this mental disorder occurs in every third or fourth depressive patient (approximately 29% of all diagnosed cases of depression). According to research data, the predominant symptoms in patients with atypical depression are those of inversion of vegetative signs - increased sleepiness 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 (hypertouchiness). The last largest group of patients was characterized by the dominance of mood reactivity. The majority of patients in all three groups were women.

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Causes 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 to be a consequence of the imbalance of neurotransmitters - primary messengers that transmit electrochemical impulses between neurons of the brain, as well as to tissues and cells related to the monoamine group. Deficiency of serotonin and/or norepinephrine, as well as dopamine, is assumed to be the basis for the development of depressive disorder. The immediate cause of such an imbalance is unknown. The processes occurring in the brain are too complex, at the current level it is impossible to record reactions occurring at the level of an individual synapse. However, the role of these neurotransmitters in the occurrence of depression and the risk factors that contribute to this are beyond doubt. These include:

• individual emotional-volitional characteristics of the personality;
• hereditary predisposition to increased susceptibility to emotional stress;
• endocrine pathology – decreased thyroid function (hypothyroidism), deficiency of somatotropin (growth hormone);
• taking medications containing hormones, drugs, and some blood pressure lowering drugs;
• infectious diseases affecting the membranes of the brain;
• alcoholism, drug addiction, substance abuse.

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Risk factors

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

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Pathogenesis

The pathogenesis of the disease is based on the study of the action of antidepressants and their use in the treatment of depression, as well as post-mortem determinations of serotonin levels in the brains of deceased patients with depressive disorders.

Patients with primary (endogenous) depression always show a deficiency of monoamines, in addition to this, a decrease in the sensitivity of presynaptic and postsynaptic receptors, which leads to compensation through the acceleration of 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 elevated mood (thymoanaleptic effect); controls the level of aggression; controls impulsive desires; regulates the feeling of satiety and hunger, alternation of periods of sleep and wakefulness; provides an analgesic effect;
• norepinephrine – carries out, so to speak, mental accompaniment of stress, activates the waking nervous system, suppressing the sleep centers; includes stress-induced insensitivity to pain; participates in increasing the level of motor activity, cognitive processes, regulates many other motivational processes and biological needs.
• dopamine – produced during positive experiences, ensures the development of psychological motivation for various types of activities.

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

Hypercorticism is constantly detected in patients with depressive disorders. The secretion of cortisol fluctuates during the day, its largest part is released in the pre-dawn and morning hours, then it decreases and from 10-11 pm until the middle of the night the hormone is not produced at all. In patients with depression, the normal rhythm is disrupted - 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 cortisol secretion - corticotropin-releasing factor. Most scientists, however, prefer the monoamine hypothesis, considering hypersecretion of cortisol as a symptom, not a pathogenetic link. However, the connections between monoamines and glucocorticoids are quite complex. If it is proven that norepinephrine inhibits the production of hormones, and its deficiency leads to hypersecretion of glucocorticoids, then the data on the relationship between cortisol and serotonin are ambiguous. A number of studies confirmed that various stressors led to a decrease in serotonin levels and hypercorticism. But in other studies, serotonin stimulated the production of cortisol.

It is obvious that nowadays all the pathogenetic links that trigger the mechanism of depression have not yet been identified, there are actually many more of them. The starting point can be a combination of monoamine deficiency with the pathopsychological personality specificity of the patient. Depressive disorder occurs with pathological functioning of the hypothalamic-pituitary-adrenal, as well as the limbic system, which coordinates impulses sent to the hypothalamus, and its impulses are transmitted to the hippocampus 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.

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Symptoms atypical depression

Until now, experts have not come to a conclusion as to what type of mental disorder an atypical depressive episode should be classified: either to interpret it as a type of dysthymia – a chronic, less pronounced, but longer-lasting (at least two years) form of depression; or as a mild form of bipolar affective disorder with more subtle symptoms, that is, a vague version of manic-depressive psychosis.

The first signs, characteristic of this particular form of neuropsychiatric disorder, look like this:

• an immediate situational reaction, and after positive events and even memories of them, the patient feels a sharp improvement in his condition;
• the patient and those around him begin to notice a craving for food that was previously not typical for this individual (this could be too frequent snacks or, on the contrary, rare but very plentiful ones, 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 daytime sleepiness that 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, an emotional outburst, tears;
• complains of paresthesia of the extremities - tingling, numbness, leaden 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 in general: decreased sexual desire, fatigue, weakness or, conversely, abnormal arousal, pain syndromes that are not relieved by painkillers - migraines, toothache, heart pain, stomach pain, as well as digestive disorders.

There are no specific external signs that indicate that a person has depression, however, certain behavioral characteristics may indicate the likelihood of a depressive disorder. People around you should pay attention to the fact that a person they know well constantly looks very worried; when talking, he constantly looks away; has become noticeably more inhibited - speaks slowly with long pauses, as if remembering words and constantly thinking, or, conversely, abnormally excited. Depression is given away by an untidy appearance, illogical actions and reasoning, self-flagellation or belligerence and defiance, tearfulness and an invariably sad appearance, 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 in based on 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 by the set of points are interpreted as follows: normotypics 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 condition, 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 on the appropriate scale, indicating the severity of mental pathology. Patients who score up to 10 points are considered healthy, from 10 - sick. Those who score 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. Mood reactivity prevails, which is expressed in its improvement in response to events assessed by the patient as positive. The disorder itself develops as a recurrent type, i.e. episodes of depression are periodically repeated, however, manic episodes with an amnestic component, delusions and hallucinations are absent. Periodic agitation and hyperactivity are possible, immediately following depression, which can be assessed as 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.
2. Inversion of vegetative disorders prevails, manifested by an excellent appetite with a preference for a high-calorie diet up to frank gluttony and drowsiness (sleep "falls" mainly during the day; sometimes the patient has a very hard time waking up in the morning, which is not associated with lack of sleep). In this case, atypical depression develops as a bipolar disorder with a significant disturbance of activity and mood. The disease typically develops at an earlier age, frequent depressive periods are replaced by mild manic ones, a pronounced picture leads to more frequent requests for psychiatric help. The disease proceeds as an alternation of diametrically opposed episodes with persistent symptoms of drowsiness and overeating during the depressive stage. The intervals of mood corresponding to the norm become shorter or the pathology from the very beginning proceeds continuously without intervals of enlightenment. Recurrent course of atypical depression with a predominance of sleep and food intake disorders was practically not noted.
3. Prevalence of sensitivity to rejection is expressed in hypertrophied touchiness with the perception of any remark or behavioral change of others towards oneself. The patient's reactions are expressed by hysteria, outbursts of rage, obvious (aggression, avoidance) or hidden (cold, hostile attitude towards the supposed offenders and "enemies") rejection. Patients experience difficulty in building interpersonal connections 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) alternate 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 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 in adolescence and youth. The severity of the disease increases from the first type to the third. For a disease that occurs as a bipolar mental disorder, early diagnosis and a much larger number of polar episodes (depressive and hypomanic) in the anamnesis 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, occurring for about half an hour (sometimes more), usually during moments of psycho-emotional 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 assumed that about half of depressive patients consider themselves healthy and do not seek medical help.

The consequences of depressive disorder are:

• indifference to appearance, excess weight and related diseases;
• loss of vital energy, ability to work;
• 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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Diagnostics atypical depression

Domestic psychiatry interprets the term atypicality as a deviation of symptoms, their discrepancy with classical ideas about depression - inhibition 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 singled out as an independent nosological unit, it is attributed to other depressive episodes.

In the DSM-4 (Diagnostic and Statistical Manual of Psychiatry of the American Psychiatric Association), atypical depression is singled out as an isolated syndrome. Diagnostic criteria for atypical depression are named. An obligatory sign 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 organic causes of the patient's complaints. For this purpose, tests for thyroid hormones, somatotropic hormone levels, and cortisol levels may be prescribed. Classic diagnostic tests may be prescribed that indicate the patient's general health condition - clinical blood and urine tests.

To assess the objective and subjective severity of the pathology, the patient will be tested according to Hamilton and Beck; other tests may be used.

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

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

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Differential diagnosis

Differential diagnostics, carried out after all possible examinations, allows us to distinguish depression from a normal physiological reaction to a stressful situation, as well as to exclude patients with severe chronic pathologies, schizophrenia and other congenital and acquired neuropsychiatric diseases, those who abuse psychotropic substances, and those who take certain medications.

Treatment atypical depression

Depressive disorder with atypical features is usually subject to 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), which are 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 for parallel therapy with other drugs.

In atypical depressions with elements of apatoabulia and asthenic complaints, a non-selective monoamine oxidase inhibitor with psychostimulating action, Nialamide, can be prescribed. The drug irreversibly blocks the enzymatic activity of MAO and prevents the cleavage of amino groups from norepinephrine and serotonin molecules, promoting their accumulation in the brain. It is used in combination with psychotherapy. Contraindicated in sensitized patients, in states of agitation and pronounced suicidal intent, as well as in patients with heart failure, blood vessels, cerebral circulation, liver and kidneys. Causes excitation of the central nervous system, dyspeptic phenomena, 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). Taken orally, starting with 25-50 mg once or twice a day, gradually increasing the dose (every two or 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 treatment-resistant depression it can reach 800 mg. Sometimes drip infusions are used. In combination with Nialamide, other MAO inhibitors and tricyclic antidepressants are not prescribed; treatment with them can be started after two weeks. Enhances the effect of barbiturates, painkillers, and hypotensive agents. A tyramine-free diet should be followed.

Currently, preference is given to selective reversible monoamine oxidase inhibitors, as less toxic drugs. Their representative is Moclobemide. The pharmacological action of this drug is similar to the previous drug, unlike the irreversible inhibitor, which forms stable bonds with the enzyme and completely blocks it, Moclobemide temporarily deprives monoamine oxidase of 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 levels. It is used for various depressions, does not have a calming effect, but normalizes sleep. It causes the same side effects as the previous drug, which usually disappear after stopping the intake. Contraindicated in case of intolerance, acute disorientation in space, is not prescribed in pediatric practice, pregnant and lactating women, people prone to suicide. At the beginning of treatment, a single dose of 100 mg is taken three times a day after meals, after achieving a therapeutic effect, the dose is reduced to 50 mg. 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 adjustment. It is not combined with the use of alcoholic beverages. But other antidepressants can be taken immediately after stopping Moclobemide.

In atypical depression, especially in people with suicidal tendencies, antidepressants from the serotonin reuptake inhibitor group have a good therapeutic effect. They help improve mood, normalize sleep, eliminate fear and the feeling of uselessness. Although at the same time, these same drugs (like all antidepressants) can lead to excessive excitement and exacerbation of suicidal tendencies in case of overdose or prolonged uncontrolled use. Drugs with the active ingredient fluoxetine, such as Prozac, selectively bind serotonin receptors, thereby promoting its accumulation in the synaptic cleft and prolonging the stimulating effect of serotonin. The patient's anxiety and restlessness decrease, the feeling of fear decreases, and mood improves. May cause vasculitis, hot flashes, hypotension, atrial fibrillation, enlargement of the arteries, indigestion, pain along the esophagus; from the nervous system and psyche, a lot of side effects inherent in depression; genitourinary disorders, idiosyncrasy and severe allergic reactions, serotonin syndrome. Prozac can be used to treat pregnant patients, its teratogenicity has not been identified. If the mother is prescribed the drug in the third trimester, then the behavior of the newborn is observed for the first time. It is better for nursing mothers not to use it, since it penetrates into breast milk.

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

Interacts with many medications, so if it is necessary to combine it with any medication, caution should be exercised. Prozac is absolutely incompatible with oral antipsychotics Pimozide and Thioridazine, after stopping the use of which a time interval of at least 5 weeks is maintained. It is prohibited to combine it with MAO inhibitors. This also applies to St. John's wort-based products, including homeopathic ones. After stopping the use of drugs that inhibit the enzymatic activity of monoamine oxidase, a time interval of at least two weeks is maintained. During therapy with serotonin reuptake inhibitors, alcoholic beverages and alcohol-containing drugs are not consumed.

In atypical depression, one of the symptoms is hypersomnia. The production and level of the sleep hormone melatonin (a derivative of serotonin) also does not reach the normal level. In addition to sleep and wakefulness disorders, this entails other disorders, in particular, eating disorders. In case of major atypical depression with prevailing symptoms of hypersomnia and hyperphagia, the doctor may prescribe the antidepressant Valdoxan. The active substance of this drug, agomelatine, has an affinity for melatonergic (MT₁ and MT₂) and serotonergic 5-HT₂ⅽ receptors, while not blocking others - α- and β-adrenergic receptors, benzodiazepine, histamine-, dopamine- and cholinergic. Agomelatine particularly actively stimulates the release of dopamine and norepinephrine in the prefrontal cortex of the brain, without changing 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 necessary for good rest. In patients taking this drug, the frequency of libido disorders decreases. It does not have a hyper- and hypotensive effect, does not affect the heart rate, does not cause addiction. The biological availability 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 indications, and nursing mothers are advised to stop breastfeeding. It is not used in pediatrics and is not prescribed to patients with liver dysfunction. Contraindicated in individuals sensitized to the components, as well as - suffering from lactase deficiency. Particular caution should be exercised when prescribing to patients with suicidal tendencies. At the beginning of treatment, it is not recommended to perform work involving the use of complex and dangerous mechanisms.

Patients with depressive episodes are prescribed short-term therapy with the drug from one and a half to two months at 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, allergic reactions and undesirable effects from the digestive organs, especially the liver, nervous and other systems, are not excluded. During treatment, patients are periodically given liver tests: before the start of therapy, and then - at intervals of three weeks, one and a half, three and six months.

It is not combined with alcohol and drugs that have a toxic effect on the liver, inhibiting the enzymatic activity of CYP1 A2. It interacts with many drugs, so if combined use is necessary, caution is required.

Antidepressants are the main group of drugs for depressive disorders, correcting the level of neurotransmitters and promoting the restoration of impaired processes occurring in the brain. Their effect does not manifest itself immediately, but at least after a week. In addition to antidepressants, the patient may be prescribed neuroleptics, normothymics (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, excluding products containing tyramine, which neutralizes the effect of the drug. The consequences of such a combination can be migraine, hypertensive crisis and intracranial hemorrhage.

Tyramine is a trace amino acid that is formed in aged protein products. It is found in large quantities in aged cheeses, smoked and pickled foods, canned and fried meat, fish, alcohol, and in smaller quantities in plant foods – bananas, nuts, soybeans, and beans. Cottage cheese, brine, and processed cheeses are allowed.

Dietary nutrition for atypical depression has several goals: firstly, to ensure effective use of drugs, secondly, to prevent weight gain, thirdly, to improve mood with the help of nutrition and saturate the body with necessary vitamins and microelements. When the patient does not take antidepressants, products containing tyramine are not contraindicated, they contribute to weight loss, improve mood and metabolism. Animal fats are limited 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) predominate in the menu.

When depressed, you should not rely on sweets, coffee, cocoa, black tea, sweet carbonated drinks. And if you can eat a few pieces 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, psychotherapy and physiotherapy.

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

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

Physiotherapy treatment in addition to medication and/or psychological assistance has a noticeable therapeutic effect. In the treatment of depression, various methods are used: 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 plan. It is aimed not only at achieving a therapeutic effect, but should also instruct the patient to follow all the doctor's recommendations, not to violate the regimen and to undergo all prescribed courses and procedures on time, motivate the patient to be treated until complete recovery and not to quit treatment at the first noticeable signs of improvement. Only a comprehensive approach and the correct selection of methods based on careful diagnostics is the key to successful treatment of atypical depression.

Folk remedies

A good alternative to antidepressants are the recommendations of traditional healers. In combination with psycho- and physiotherapy, herbal treatment, provided that the individual wishes to recover and return to a full life, can be very effective. However, a thorough diagnosis and identification of all factors that influenced the development of depressive disorder must be a mandatory condition. If medications are still necessary, then after consultation with a specialist, drug therapy can be supplemented with traditional remedies.

The following can be used as tonic herbal adaptogens:

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 hematopoiesis, strengthens blood vessels, stimulates brain activity, relieves fatigue and increases performance. Contraindicated for patients with hypertension, tachycardia, excessive excitability and insomnia. As a stimulant, an alcohol tincture of ginseng root is used, for which dried crushed roots (50 g) should be poured with ½ liter of vodka (if tolerated, 50 g of honey can be diluted in it). The product is infused for three weeks in a warm place, protected from direct sunlight. From time to time, it is recommended to shake the container with the tincture. The tincture is measured out with a teaspoon and taken orally before meals.
2. Golden root or Rhodiola rosea – restores lost strength, including sexual interest, calms and simultaneously stimulates the central nervous system. Golden root normalizes blood pressure, however, hypertensive patients with uncontrolled increases in blood pressure should refrain from this remedy. The stimulating effect of this plant is lower than that of ginseng, in addition, it can be useful for hypothyroidism and diabetes. A tonic tincture is also prepared with alcohol, for which 50 g of dried and ground roots are poured with two glasses of high-quality vodka. The remedy is infused for two weeks at room temperature, protected from direct sunlight. From time to time, it is recommended to shake the container with the tincture. At first, take five drops before three meals. Then gradually increase the number of drops taken, stopping at 20 drops.
3. Maral root or leuzea contains carotene, inulin, vitamin C, alkaloids, flavonoids and essential oils. The use of preparations made from this plant for medicinal purposes activates vital forces, increases efficiency, normalizes mood, sleep and appetite. Depression goes away, interest in life in all its manifestations returns, blood supply to muscle tissue and metabolism improve, which promotes motor activity and parting with excess weight. Tinctures on alcohol are mainly used as tonics. It is prepared from maral root in a proportion of 15 g of the plant component in dried and crushed form per 100 g of vodka. The remedy is infused for two weeks at room temperature, protected from direct sunlight. From time to time, it is recommended to shake the container with the tincture. Take 20 drops before morning and evening meals. Maral root is also taken in powder form, dried and finely ground, then thoroughly mixed with honey in the proportion: one part powder to nine parts honey. Dose one tablespoon three times a day. Evening intake is carried out no earlier than two hours before bedtime. It is not recommended for hypertensive patients and glaucoma.
4. St. John's wort (perforated) is rich in B vitamins, tocopherol, ascorbic acid and carotene, contains essential oils, choline, flavonoids and traces of alkaloids. Everyone knows its anti-inflammatory and disinfectant effect, however, not everyone knows that this plant is a powerful natural antidepressant. Hypercin and hyperforin, which are part of this herb, provide it with an antidepressant effect. Based on it, the pharmaceutical industry of Germany produces the drug Gelarium Hypericum, indicated for the treatment of depressive disorders. St. John's wort does not have contraindications for medicinal antidepressants, in addition, it stimulates the gastrointestinal tract, does not cause drowsiness and inhibition, which is valuable in the treatment of atypical depression. An alcohol tincture is best suited for treating this condition: it is prepared with vodka in a ratio of 1:7, and with alcohol 1:10, and left to infuse 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 the tincture are diluted in ¼ glass of water and drunk throughout the month. When taking medications containing St. John's wort, you need to protect your skin from sunlight, and hypertensive patients should also be careful. Women taking oral contraceptives should take into account that St. John's wort reduces their effectiveness. Long-term use can cause attacks of excitement up to manic episodes. St. John's wort is not compatible with antidepressants, anesthetics and antibiotics.

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

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Homeopathy

Certainly, the most effective homeopathic therapy will be prescribed individually. A homeopathic doctor, having listened to the patient's complaints, will conduct a detailed interview with him, which will cover all aspects of the patient's character and habits, his preferences in food, leisure, relationships with others, and the specifics of his condition. In severe cases, communication with the patient's relatives is necessary. As a result of the clinical picture compiled, a drug will be prescribed, constitutional (in most cases) or symptomatic. The goal of homeopathic treatment is to restore the equilibrium state of the human nervous, immune and endocrine systems, thus ensuring his recovery. Homeopathy does not deny the need to use psychotherapeutic practices and is quite compatible with them.

Almost all drugs are used in the treatment of depressive disorders, depending on the constitutional characteristics of the patient and his symptoms. Hypericum perforatum (common 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 better on good-natured plethoric patients who prefer loose-fitting clothes, women of this type are flirtatious, the main feature is an instant change of mood. Arsenicum album (white arsenic) as a constitutional remedy for rational, calculating, demanding of themselves and others, while prone to melancholy, tearful and restless. Belladonna (Belladonna) is prescribed to 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 from their use are incomparable with the effects of antidepressants.

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

• Valeriana offiсinalis (valerian) – has a relaxant effect on both the nervous and vascular systems;
• Humulus lupulus (common hops) – eliminates increased excitability;
• Crataegus (hawthorn) – tones the heart muscle, optimizes heart function, expands the lumen of the coronary arteries, has an antihypertensive effect;
• Hyperiсum perforatum (St. John's wort) - activates metabolism in neurons, tones cerebral vessels, stabilizes blood flow;
• Melissa officinalis (lemon balm) – increases resistance to stress factors, relieves attacks of overexcitement;
• Chamomilla reсutita (chamomile) – has a moderate calming effect, strengthens the immune system, relieves swelling and inflammation, normalizes the digestion 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 excitation and depression of the nervous system, have a moderate anticonvulsant effect.

Contraindicated for patients sensitized to the ingredients of the homeopathic complex and children under two years of age. Pregnant and lactating women should use only as prescribed by a doctor.

The 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 spoon of clean water and drink, holding them in the mouth while taking. Dosage: 2-5 full years - five drops; 6-11 full years - 10 drops; from 12 years - 15-20 drops. The standard course is a month, continuation of treatment is possible only after consultation with a doctor.

Ignatia Gommacord is used for psychosomatic pathologies, including depressive disorders. The composition includes two components: plant - beans of St. Ignatius (Ignatia), and animal - musk of the musk deer (Moschus), in several dilutions.

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

Contraindicated for patients sensitized to the components and children under two years of age. Pregnant and lactating women should use only as prescribed by a doctor.

The 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 spoon of clean water and drink, holding it in your mouth while taking it. Dosage: 2-5 full years - five to seven drops; 6-11 full years - from seven to ten drops; from 12 years - ten drops. The standard course is a month, continuing the intake is possible only after consulting a doctor.

Nervoheel is a complex of homeopathic dilutions of several substances of plant, animal and mineral origin, which have an antidepressant effect and also relieve increased excitability and muscle spasms.

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

• Ignatia (St. Ignatius beans) – eliminates depression, inhibition, anxiety, mental instability, muscle spasms;
• Sepia officinalis (the contents of the ink sac of the 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, depressed mental state;
• Acidum phosphoricum (phosphoric acid) – restores the emotional, intellectual, neuropsychic sphere and physical activity;
• Zincum isovalerianicum (valerian-zinc salt) – relieves hypochondriacal syndrome, convulsions and tremors in the limbs; normalizes sleep;
• Psorinum-Nosode (scabies nosode) – stabilizes control over emotions, mental reactions; relieves migraine-like, stomach and other pains.

Contraindicated for patients sensitized to the components. No age restrictions. Pregnant and lactating women should use only on doctor's prescription.

The rules for taking sublingual tablets are similar to the previous drugs. Children aged 0-2 years are given half a tablet; three years and older - a whole one. Three times a day, the last time immediately before bedtime no more than 15-20 minutes.

Prevention

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 minor troubles "get on our nerves" and we lose the ability to enjoy achieving our goals. Even routine tasks can bring pleasure, because they are necessary for us and our loved ones.

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

Positive thinking allows you to 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 emotional stressors in interpersonal relationships in all spheres of life.

Avoid harmful addictions that lead to intoxication - drugs, alcohol, medication; give preference to positive emotions and try to exclude negative ones; refuse self-isolation and expand your social contacts; be intolerant of violence - such simple general rules will help to significantly reduce the risk of depressive disorder.

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

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Forecast

In cases where atypical depression is not a symptom of a psychiatric illness, the prognosis for recovery is always favorable. The duration of treatment depends entirely on timely seeking of help, the patient's awareness of his condition, the desire to recover, and the severity of the pathology.

Untreated depression can be fatal, the condition worsens, and a constantly depressed mood can lead to thoughts of suicide and attempts to implement them.

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