Reactive depression

Reactive depression is one of the types of psychogenic disorders provoked by extreme shock, commotio animi - a psychotrauma. More than a century ago, in 1913, the great German psychiatrist Karl Theodor Jaspers formulated the main criteria for reactive negative states. This diagnostic triad has not lost its relevance until now, it has been supplemented and improved, but it is considered the basis for all variants of psychogenic disorders, including reactive depression:

1. The reactive state of the psychoemotional sphere is provoked by a mental trauma, acute or chronic.
2. The traumatic factor forms symptoms, clinical manifestations of the condition.
3. The reactive disorder can stop quickly enough, provided the provoking factor disappears.

Depressive psychogenic diseases develop as a complex of neurotic and psychotic reactions, classified as mood disorders. The course of the process is directly conditioned by the personality traits of the person, the specifics and variants of the development of the traumatic event.

[1], [2], [3], [4], [5], [6]

Epidemiology

Epidemiological data concerning nosology - reactive depression, are highly controversial. The collection of information is complicated by many reasons, the main thing in their list are subclinical manifestations of the disease and later recourse to a specialist for help. Most often, patients either try to cope independently with mental shocks, or in the course of chronicization and somatization of depression get to other doctors - gastroenterologist, endocrinologist, cardiologist.

Primary differential diagnosis exists, but it is used by psychiatrists and psychotherapists, rather than general practitioners, who are mostly treated by patients with psychogenic depressive disorder. As a result, eliminating the presented somatic complaints, non-specialized therapy can "hide" typical depressive symptoms for a long time, transforming the acute form of the disease into a latent, latent, prolonged one. These and many other reasons do not allow to make up a complete, reliable epidemiological picture, which clearly classifies and describes the frequency of psychogenic depressions.

According to the latest available information, the statistics of diseases by reactive depression looks like this:

• Women suffer psychogenic emotional disorders more often than males. The ratio is 6-8 / 1.
• 40% of depressive disorders are diagnosed 10-12 months after the onset. More than 45% are determined after unsuccessful therapy of somatic diseases associated with depression
• Only 10-12% of the ill people in a timely manner turn to the specialized help to psychotherapists, neurologists, psychiatrists.
• No more than 20% of patients with signs of reactive depression complain of poor health, most often of a physical nature (gastrointestinal disturbance, cardio-neurological complaints, difficulty breathing, ingestion of food).
• Not more than 30% of all cases of requests for help are recognized by the doctor as manifestations of psychogenic disorder.
• Periodic disorders of the depressive series are recorded in 9% of people who are in the field of vision of specialists.
• Only 22-25% of patients with psychogenic depression receive adequate, specialized medical care.
• More than 80% of patients suffering from a reactive form of depression are treated not by profile, but by general practitioners.
• The prevalence of diagnosed chronic form of psychogenic disorder grows every year. In women, this indicator is 1.5%, for men - 0.5-0.8% per year.

[7], [8], [9], [10], [11]

Causes of the reactive depression

The reactive disorders proceed in various forms, which combine into two large categories:

• short-term reactive depression;
• prolonged, chronic psychogenic depression.

The causes of reactive depression also divide, classify and provoke a specific clinical picture. Common is a single criterion - a psychotraumatic external effect. Paradoxically, the depressive disorder of this series can also be caused by positive events that occur suddenly and rapidly. In 1967, Thomas Holmes and Richard Rahe compiled a special scale in which the causes of reactive depression are located in terms of the significance of events.

 The conditional rating of factors that affects the depth of depression looks like this:

Life Change Units

• Loss, death of a significant person, relative, family member.
• Sudden separation or divorce with a partner.
• Conclusion in prison.
• Unexpected injury or illness.
• Sharp deterioration of financial well-being, loss of material resources.
• Loss of workplace, dismissal.
• Retirement, deprivation of the usual professional circle of communication and activity.
• Illness of a loved one, family member, friend.
• Problems in the sexual sphere.
• Sharp job change, professional activity.
• Conflicts in the family.
• Loans, debts, which accumulate and do not allow to strengthen the financial situation.
• Chemical dependence of family members (co-dependence of the person himself).
• Deterioration of housing conditions, moving to another country, region, locality.
• Conflicts at work, pressure from superiors.
• Lack of social activity, change of the usual social circle.
• Deprivation of sleep.
• Change of food, inability to satisfy food preferences.
• Events that involve judicial actions, minor problems with compliance with legislation.

Also among the causes of psychogenic depressive disorder can be a marriage, reconciliation after a long quarrel, rewarding a high level for personal achievement, starting a study or, conversely, ending the learning process.

Summarizing, all the etiological factors can be called one word - a psychotrauma. It is characterized by intensely colored emotional experience. Shocks can be the leading cause of the reactive state (producing a cause) or a supporting, secondary factor against the background of the already formed, psychogenic base.

 In addition to the Holmes and Rhea scale, there is a classifying division of etiological causes into two groups:

1. Acute, significant psychogenic trauma:
   • shock;
   • situational, depressing;
   • an event that provokes a strong alarm.
2. Chronic psychogenic trauma:
   • long, less intense than extreme events, triggering anxiety;
   • chronic diseases of the person himself or illness of relatives, family members;
   • unfavorable social, economic, family environment, lasting more than six months.

Also, the causes of reactive depression can be existentially significant (the threat of life), such as those that break the notion of the structure of the world - universal principles, or important only for the individual - professional, intimate, relating to family relationships.

[12], [13], [14], [15]

Risk factors

Terminologically, psychogenesis was described as far back as 1894 by Robert Sommer, who formulated criteria and risk factors for the development of hysterical reactions. Subsequently, psychiatrists supplemented provoking causes of both external and internal levels, when pathogenetic and exogenous factors closely intertwined and form a depressive disorder.

Risk factors can be:

• Congenital, constitutional features of the organism.
• Acquired factors - pregnancy, climacteric period, chemical dependence, chronic infectious diseases.
• External causes - deprivation of sleep, lack of food ration, physical overload.

Psychoreactive lability, a predisposition to psychogenic depression in the modern sense are the specific properties of a person, the presence or absence of a coping strategy (the experience of experiencing stress, coping with a traumatic situation).

Overcoming the stressful factor is the ability to maintain a balance between a stressful stimulus and an adequate response to it without compromising one's own emotional resources. The lack of the skill of constructive reactions, psychological flexibility, elasticity leads to negative consequences for the human condition. This can become a trigger mechanism for the development of a chronic form of reactive depression.

Accordingly, personal risk factors are defined as follows:

• The strategy of avoidance, avoiding a stressful situation, the inclusion of automatic mechanisms of psycho-protection (sublimation, projection, rationalization, negation, displacement).
• Intentional social isolation, unwillingness to seek help and receive support.

To aggravate the course of a depressive reaction to stress can also such reasons:

1. Genetic predisposition to depressive states, reactions.
2. Accentuation of features of character.
3. Intoxication, both food and chemical.
4. The age factor is pubertal, menopausal, elderly age.
5. Biochemical disorders of the body, chronic pathology.
6. Craniocerebral trauma, organic pathology of the brain.
7. Constitutional properties of man.
8. Violation of  neurotransmitter  systems of the brain.

The most important for the course of the psychogenic depressive episode are internal-level risk factors that adversely affect the productivity of therapeutic interventions and the prognosis of the disease.

[16], [17], [18], [19], [20], [21]

Pathogenesis

Pathogenetic description of the process of development of reactive states is still the subject of discussions among neurologists and psychiatrists. Historically formed in the last century, the opinion of the hysteroid database was gradually supplemented with information on other disease-provoking factors. Pupils I.P. Pavlova, V.N. Myasishcheva in the middle of the last century have strengthened their opinion that psychogeny is more a deformation of the development of personal qualities, and the constitutional features of a person only add specific clinical signs, but are not fundamental in the etiological sense.

The doctrine of B. D. Karvasarsky, Yu.A. Alexandrovsky and others, not less famous personalities, gave impetus to the profound research of the very concept of psychotrauma as the main source of psychogenic disorders. Pathogenesis, the process of the onset of a depressive acute reaction is described today as a combination of premorbid state, constitutional properties of a person and the specificity of a stress factor. 

In general phrases, the mechanism of reactive depression can be described as a failure of the function of cortex cerebri (cerebral cortex cerebral cortex) due to intense overload, or a disruption in the rhythm of the work of stimulation and inhibitory process. Such a sharp change in habitual functioning leads to a cascade of negatively colored humoral shifts. Adrenal reactions, autonomic symptoms, hyperglycemia, blood pressure jumps, cardiovascular dysfunctions - this is an incomplete list of the consequences of an acute reaction to a sudden traumatic event. If the stress factor is really significant for the internal rating of a person, a sharp restructuring of the pituitary-adrenal complex is also possible. And in combination with features, risk factors, all this can transform an acute depressive state into a chronic neurotic disease, when the adaptive properties of the organism are decompensated and depleted.

[22], [23], [24], [25], [26]

Symptoms of the reactive depression

The clinical picture of psychogenic depressive disorder is very diverse and multifaceted, like all varieties of this category as a whole. It is not by chance that there is an expression that depression has a thousand masks, often hiding behind the symptoms of somatic diseases. The most manifested in this sense is the psychogenic reactive state, which is caused by a specific traumatic event or event. Symptoms of reactive depression depend on its type - a short-term or prolonged form.

1. Short-term reactive depression rarely lasts more than 4 weeks. Its main signs are symptomatology of dissociative disorders
   • shock reactions;
   • mutism;
   • affectogenic amnesia;
   • symptoms of vegetative dysfunction - sweating, tremor, tachycardia;
   • sleep disorders and decreased appetite;
   • attacks of panic attacks;
   • situational suicidal thoughts;
   • motor retardation or vice versa - affective, disorderly movements;
   • anxiety and a depressed psycho-emotional state.
2. Prolonged psychogenic depression, which can last from 1-1,5 months to a year or more:
   • constant depressed mood;
   • emotional lability, tearfulness;
   • apathy;
   • anhedonia;
   • lack of social activity;
   • increased fatigue;
   • asthenia;
   • constant reflection, guilt, self-blame;
   • obsessions (obsessions);
   • hypochondria.

For the reactive form, sharp changes in the level of mood and activity are characteristic, but not to the same extent as in cases of diagnosed endogenous depression. Deterioration of the state is most often activated in the evening and at night, during the day when there are distractions, it is much easier for a person to bear the severity of a trauma. Symptoms of reactive depression are temporarily replaced by external circumstances, daily worries or responsibilities. False relief creates the illusion of victory over the disease, but it is able to hide and return with more painful sensations. That is why it is important to start treatment at the first signs of psycho-emotional discomfort, directly caused by a traumatic event.

First signs

The first manifestations of psychogenic emotional disorder are not always manifested in the clinical sense. A person with a well-developed coping strategy can not outwardly show their experiences and reactions, thereby suppressing them and creating the risk of a chronic process. This is typical for a strong half of humanity, because since childhood, boys are brought up in the spirit of the rule "men do not cry." By hiding the natural reaction, the response to the traumatic factor, the person himself forms the soil for the development of a number of psychosomatic pathologies. And, on the contrary, timely adequate response to a stressful factor greatly facilitates the experience of a difficult period and speeds up the process of getting out of it.

The first signs of reactive depression may be as follows:

• Desire to cry, cry.
• Difficult rhythm of inspiration and expiration.
• Psychomotor, motor affective agitation.
• Freezing, stupor.
• Spasms are muscular, vascular.
• Tachycardia, increased heart rate.
• A fall or a sharp increase in blood pressure.
• Fainting.
• Spatial disorientation.

The most common reaction, typical first signs of an extreme traumatic situation, are physiologically natural manifestations of fear and the mobilization of all resources to overcome it. The intensity range is small - either hyperdynamics, activity, or stupor (hypodynamia). In fact - this is the famous triad "Bey, run, zamri". Trying to control the inherent property of reacting to an intensive, threatening human values factor, is meaningless. This feature needs to be known, taken for granted and, if desired, slightly modified with the help of special exercises. According to statistical data, only 12-15% of people are really capable of showing themselves in cold conditions in an extreme situation, while maintaining a rational view of events.

[27], [28]

Endogenous and reactive depression

Etiologically, the types of depressive disorders are divided into large groups:

• Endogenous.
• Somatogenic.
• Psychogenic.

Each category has specific clinical manifestations, signs that allow to differentiate the species and prescribe adequate therapeutic measures. The most common endogenous and reactive depression. Their main difference is in provoking factors:

• Vital or endogenous depressive disorder develops against a background of visible objective well-being without the intervention of a traumatic factor.
• Psychogenic disorder is always based on a significant traumatic event for a person.

The difference from the species from each other can be represented in this format:

Endogenous and reactive depression

Differences	Psychogenic depression	Vital depression
Genetic factor, heredity	Genetic, hereditary factors are rarely diagnosed	Hereditary factor is present
The presence or absence of a psychotraumatic factor	In the anamnesis there is a clear connection between the psychotraumatic cause and the onset of depression. The prolonged form may not show a linear connection, but with the help of questionnaires, tests it can be found.	Autochthonous development of symptoms, without a clear link to a specific provoking factor. The stress factor can be present as part of the depressive structure, but only as one of the multiple triggers in the initial phase of the development of the condition.
The presence of psychopathological disorders	Accurate reproduction of the psycho-traumatic circumstance.	Reflection of the provoking factor is blurred.
Intensity of depressive symptoms	The intensity of symptoms is related to the level of mental trauma and individual sensitivity of a person.	The relationship between the level of the stress factor and the severity of the symptoms of depression can not be traced. A typical depressive triad (asthenia, intellectual and motor retardation) is not associated with a specific traumatic factor.
Dependence of symptoms on time of day	Deterioration of the condition in the evening and at night.	In the evening and at night, the condition improves slightly.
Preservation of criticism	Criticism and understanding of the soreness of their condition are preserved.	Criticism is often absent.
Presence or absence of inhibitory reactions	Present in the initial phase of the disease.	The inhibition is pronounced.
Vitalization of symptoms, affect	Absent.	Feeling of melancholy, often totalization of symptoms.
Thinking disorders, delusional constructs	Rarely. There is no sense of guilt, there are claims to others, to circumstances. Delusional constructions are found only in the initial phase, they are characterized by specific descriptions associated with the traumatic factor.	Self-incrimination, complexes of inferiority. Bred more often generalized, gradually becoming more complicated.
Behavior	Crying, affective manifestations, fears, anxiety.	Absence of crying, monotony of reactions, isolation.
Dissonance	Problems with sleep, especially in the first phase (falling asleep)	Early, anxious awakening, melancholy mood.
Dependence on the season	Absent.	Typical autumn-spring exacerbations.
Somatic disorders	Reactive depression often develops against the background of chronic diseases.	The combination occurs, but rarely or without an obvious relationship.
Premorbid features	People with paranoid, hypertensive, hysteroid traits are prone to psychogeny.	To the endogenous forms of depression are inclined anxious-hypochondriac persons with an increased sense of responsibility.
Depersonalization	Pronounced weakly.	Typical in the manifestation of emotional coldness, anhedonia.

[29], [30], [31], [32], [33], [34], [35]

Stages

The psychogenic group of depressive disorders is a composite category of species whose stages differ depending on the diagnostic criteria. A common etiological factor is strong, sometimes prohibitive stress, psycho-emotional trauma, which makes it possible to describe the stages of the development of the disease in this way:

• Shock reactions.
• Depressive affect - anxiety, dysthymia.
• Apathy with periods of hysterical manifestations.
• Psychomotor disorders, inhibition.

The last two points are possible with a protracted form of psychogenic depression, which is considered to be the most difficult in therapy and carries the risk of a disease transition into a chronic, endogenous process. Also, to the emotional description of the stages of reactive states provoked by a single stressful event, the classical scheme of experiencing grief approaches. Its author, Elisabeth Kubler-Ross, in 1969, formulated the stages of responding to violent shocks:

1. Stage of total negation.
2. Anger, anger at the external environment, the environment.
3. The stage of bargaining (the illusion of improving the situation when the invented conditions are fulfilled).
4. Actually depressive episode.
5. Stage of humility and acceptance of a traumatic event.

These periods clearly describe the process of living the loss of significant people, extreme events. In general, the clinic of reactive depressive states can be polymorphic, and the stage of depression, depression can start immediately after a trauma. It depends on the individual characteristics, premorbid specific properties of the personality and on the presence of concomitant traumatic circumstances (chronic diseases, negative social conditions and other causes). If a person is already exhausted and deprived of internal psychic resources before a "meeting" with a psychotrauma, his coping strategies are not developed, the stages of affective reactions may be absent initially. In such cases, clinically manifested vital affects (melancholia, apathy, asthenia, intellectual retardation) are observed and there is a risk of suicidal thoughts right up to hysterical attempts to carry out the withdrawal from life. The protracted, protracted form tends to weaken reactive symptoms and experiences, which greatly complicates both differential diagnosis and therapy of the disease.

[36]

Forms

One of the most common and many-sided diseases, depression, has been studied for more than one century. Until now, the classifications, protocols of treatment and the concretization of clinical manifestations change. Types of reactive depression are conventionally combined into two large categories:

• Short-term form.
• Prolonged form.

Without the risk of serious complications, short-term psychogenies occur, they last from 2 weeks to one and a half months, longer protracted states are more experienced and difficult to treat, which in turn are divided into these types:

1. Psychogenic depression with hysteria, explosiveness, demonstrative clinical manifestations.
2. Anxious depression.

Features of the prolonged form are caused by premorbid, when the personality is initially characterized by suspicion, anxiety, and cycloidity.

Types of reactive depressive disorder are classified in this version:

1. True reactive depression, which lasts up to 1 month and is characterized by obvious clinical manifestations.
2. Anxious form of psychogenic depression, when the oppressed state alternates with bursts of activity and leads to asthenia, vegetative disorders.
3. A hysterical kind of reactive disorder, which is characterized by theatrical manifestations of experiences, demonstrative attempts at suicide.

The most productive in terms of the effectiveness of therapy is an open form of psychogeny with a vivid clinical picture. Dessimulative variants of psychogenic depression, when the reactions are "encapsulated" are the most disturbing in terms of the risk of actual suicide.

[37], [38], [39]

Complications and consequences

With the timely application of professional help, the symptoms of reactive depression are completely deactivated. This greatly reduces the consequences and complications for the patient, which can lead to an endogenous form of the disease. Reduction of feelings, if necessary, medical treatment, adequate methods of psychotherapy, help of relatives and social environment - these measures help a person cope with difficulties and super-strong shocks without vitality and exhaustion.

The consequences and complications that can occur with a psychogenic form of depression:

• asthenia;
• vegetative-vascular disorders;
• attacks of panic attacks;
• somatization of depressive process;
• psychogenic melancholy;
• dysthymia;
• suicidal thoughts and attempts to implement them.

Negative supplements to the symptomatology can be "eliminated" subject to trust in specialists, treatment in specialized institutions and complex treatment. Sometimes a visit to a psychologist who owns the testing technique, the detection of a reactive depression clinic, which is able to provide first psychological assistance and, if necessary, divert the patient to a doctor for prescribing drug therapy, is enough.

[40], [41], [42], [43], [44], [45]

Diagnostics of the reactive depression

Diagnosing reactive symptoms is simple enough, especially in the first stage, when clinical manifestations are closely related to the traumatic factor. Moreover, the diagnosis can be projective. If there is a specialist in the place of psycho-traumatic events who know the basic concepts of the consequences of the influence of super-strong stressors, he has the right to presume the variants of the flow of the process and reactions. So, PTSD is a post-traumatic stress disorder, has the property to manifest itself clinically after years. Early preventive treatment, preventive measures and periodic dynamic diagnostics make it possible to minimize the negative consequences of this syndrome. The urgency of educating general practitioners in identifying depressive symptoms is still relevant, given the statistical data and the prevalence of depression worldwide. Diagnosis of the depression clinic, more precisely primary questionnaires and filters, is now being studied by first-level doctors in most countries of Europe and in the US, which makes it possible to prescribe timely preventive treatment and minimize the risk of complications.

Diagnostic protocols of psychogenic disorders differ from each other, depending on the classifiers belonging to a particular school of psychiatry. The basic for all versions is the teaching of Jaspers, which describes a triad of typical features:

• Psychogenic reaction and frustration develops immediately after the action of the traumatic factor.
• Symptoms of the disorder are directly related and depend on the intensity and specificity of the injury.
• The process of the disease is closely intertwined with the relevance and level of the psychotrauma, neutralization of traumatic circumstances in most cases leads to a positive resolution or a decrease in the intensity of the symptoms.

Diagnosis of reactive depression and mood disorder (according to ICD-10) can also be based on three categories of classifiers:

1. Etiological classification.
2. Clinical classification.
3. Pathogenetic classification.

In ICD-10, psychogenic depression is indicated in the section "Mood disorders" in categories F 30-F 39, which makes it possible to diagnose the disease according to the proposed criteria.

The general scheme for diagnosing reactive depression is as follows:

• Interrogation of the patient, collection of anamnesis and subjective complaints.
• Evaluation of the severity of the clinical picture of the disease, the specific dynamics and clarification of the relationship of symptoms with a traumatic factor.
• Testing on the scale of HAMD (Hamilton).
• Assessment of depressive disorder according to the Beck scale.
• According to the testimony, completing the self-evaluation questionnaire Tsung or Eysenck's questionnaire.
• To clarify and differentiate, it is possible to use the NEDRS - a scale for assessing reactive or endogenous depressive disorder.

The patient may be assigned additional studies if the depression develops against the background of previously acquired diseases:

• Ultrasound of the thyroid gland.
• Electrocardiogram.
• MRI or computed tomography by indications.
• UAC and urinalysis, biochemical blood test.

The psychological battery of tests as an element of diagnosis is used only during the therapy, in the second and subsequent stages. It should be taken into account that the reactive form of depressive disorders is very specific, and the filling and passing of multifaceted techniques can only retraumatize the patient.

[46], [47], [48], [49], [50]

Analyzes

To diagnose a reactive depressive episode, analyzes are usually not prescribed. They can be useful only as an addition to the research complex, when the patient suffers a protracted form of psychogeny against the background of already acquired somatic pathologies. In the protocols for diagnosing depression, analyzes are mentioned, but rather this option is suitable for the category of nosology from the so-called "big psychiatry".

What tests can help in diagnosing a reactive type of depression?

• Blood tests to determine the level of thyroid hormones.
• Analysis for the concentration of holotranskobalamin (vitamin B12).
• UAC and general urine analysis.
• A blood test for the assimilation of vitamin B9 (folic acid).

One of the latest advances in medical science has been the longitudinal study of blood of more than 5,000 people for the previously defined symptoms of depression. American scientists have identified biological markers that show the interaction of various structures of the brain and can point to subtle changes in the biochemical process. The list of biomarkers studied:

• Epidermal  Growth  Factor - a protein responsible for the division, regeneration, growth of epidermal cells.
• BDNF is a brain-derived neurotrophic factor. The factor that stimulates the work and development of neurons.
• Resistin is a hormone that activates metabolic disorders.
• Myeloperoxidase, an enzyme, the lack of which weakens the function of phagocytes.
• Apolipoprotein C3 is a gene that participates in the formation of triglycerides, thus indirectly responsible for energy metabolism in the body.
• Soluble tumor necrosis factor receptor 2 receptor from a number of cytokines.
• Glycoprotein alfa-1 antitrypsin, whose level affects the broncho-pulmonary system.
• The lactogenic hormone is prolactin, which is part of the structure of the anterior lobe of the hypophysis.
• Cortisol, regulating carbohydrate metabolism, taking part in the biochemical process of response to the stress factor.

The process of confirming the effectiveness of these analyzes is still ongoing. Perhaps in a few years doctors will have a reliable tool for early diagnosis of reactive depression and other types of depressive disorder.

[51], [52], [53], [54], [55], [56], [57], [58], [59]

Instrumental diagnostics

In the list of additional methods of examination at the first signs of reactive depression, which include standard tests and questionnaires, as well as instrumental diagnostics. The state of internal organs, systems have either a background effect on the course of the depressive process, or they are the primary basis, exacerbating the symptoms of the disease. In addition, the appointment of a certain group of medicines (antidepressants, antipsychotics, sedatives) requires checking the function of the liver, kidneys and digestive tract. Therefore, instrumental diagnostics became not a "curiosity" in the psychiatric diagnostic complex, but rather a norm that ensures the effectiveness of treatment.

Additional diagnostic methods include such purposes:

• MRI, computed tomographic examination of the brain to exclude serious pathologies (tumors, cysts).
• EEG - to study the activity of the electrical process in the brain.
• Ultrasound of the abdominal cavity organs.
• Cardiogram.
• Echocardiography.
• Angiography.
• Ultrasonic dopplerography.
• Electromyography.

Of course, the listed methods are used quite accurately, and only in cases where differential diagnosis requires an extensive examination to specify the form, type and specificity of the depressive disorder.

Differential diagnosis

The diagnosis in the category of "Mood Disorders" under the ICD-10 is not particularly difficult. This is due to a clear linkage of the clinical picture to the primary stress factor. Thus, in the first conversation, by questioning the patient, the doctor can already make initial conclusions and prescribe additional methods of investigation. Differential diagnosis in such cases is conducted between reactive and endogenous forms of depression. Also, more serious nosologies needing specific therapy should be excluded. Sometimes such a survey is conducted in a stationary setting.

What is excluded in the differential diagnosis of reactive depression:

• The reactive paranoid.
• Bipolar disorder.
• Endogenous depression.
• Short-term grief reactions.
• Anxiety disorder.
• Phobic disorders.
• OCD - obsessive-compulsive disorder.
• Schizophrenia.
• Schizoaffective disorder.
• Organic dysfunction of the brain.
• True dementia.
• Dependence on psychoactive substances.

Differential diagnosis is carried out according to the scheme, which takes into account the neurotic and psychotic register, as well as specific signs - seasonality, the presence of the Jaspers triad, the connection with the psychotraumatic cause, persistence and intensity of affect, diurnal fluctuations in symptoms, suicidal tendencies, safety of criticism, vital components of the process.

[60], [61], [62], [63], [64], [65], [66], [67], [68]

Treatment of the reactive depression

If a patient comes to a doctor in an acute period, immediately after a traumatic event, he may be prescribed medication. Psychopharmacology is considered effective in certain clinical symptoms that threaten the general condition of the patient. In the appointment of drugs are taken into account such factors:

• Pathogenetic mechanisms of reactive disorder.
• Degree of severity of clinical manifestations.
• Age of the patient.
• Floor.
• Presence or absence of concomitant somatic pathologies.

Excessively small or, on the contrary, overdoses of the drug can neutralize the therapeutic effect, so it is important for the doctor both diagnostic information and identifying the main feature, the "symptom - the target". Targets for pharmaceutical treatment are specific symptoms:

• Excitation with disturbing manifestations. Agitation.
• Explicit psychosomatic symptoms (acute pain in the GI tract, heart).
• Vegetative symptoms.
• Fear.
• High level of depression (suicide risk).

Acute experiences of the stress factor are removed with such medicines:

• A group of neuroleptics.
• Antidepressants.
• Stabilizers of mood - normotimiki.

Antidepressants are considered classic drugs in the treatment of reactive depression. A properly selected drug in the shortest time, in the initial period of the disease, allows you to achieve a result without obvious side effects and addictive syndrome. A marker of successful appointment is an improvement in mood, a common clinical manifestation within the first two weeks.

Treatment of reactive depression also includes such methods:

• Psychotherapy - course not less than three weeks.
• Physiotherapeutic procedures.
• Dietotherapy.
• Massotherapy.
• Aromatherapy.
• Art therapy.
• Acupuncture, acupuncture.
• Physiotherapy.

An integrated approach to treatment makes it possible to achieve full recovery, in which relapses are practically not encountered.

Psychotherapy in reactive depression

In psychogenic disorders, psychotherapeutic sessions are mandatory. Psychotherapy with reactive depression is effective and brings not only temporary comfort to the patient, but also a therapeutic positive result. Methods and techniques that are used in psychotherapy, for more than a hundred years. Before choosing the most appropriate technique, the therapist conducts additional examinations that determine the vector and duration of the course of therapy:

• Assessment of the level of mental disorders.
• Analysis of personality properties.
• Evaluation of the ability to self-therapeutic work.
• Analysis of the rehabilitation resource and potential.
• Drawing up a psychological portrait of the patient.

Clinical and psychological examinations should not last long, testing and surveys usually fit into one session. Further, psycho-corrective work is carried out using the following methods:

1. CBT is cognitive-behavioral therapy.
2. TKPTT is traumatic focused cognitive-behavioral therapy.
3. Interpersonal therapy.
4. Art therapy.
5. Symboldrama.
6. Gestalt therapy.

The format for the provision of psychotherapeutic care can be different - both individual sessions and visits to group therapy. The group form of help is effective when the members of the group have experienced similar in severity and structure trauma (natural disaster, bitterness of loss of a family member, military actions).

The process of the psychotherapeutic course is accompanied by drug support in cases of manifestations of affective reactions or suicidal attempts. To deny pharmacological assistance in the treatment of reactive disorders is unproductive and even dangerous. Psychotherapy and medications help the patient to maintain their psychostatus and within 3-4 weeks get out of the uncomfortable, severe condition without the risk of complications and chronic illness.

Medicinal treatment

Medicamentous care in psychogenic disorders is applied as mandatory. Medicines are excluded if a person owns an effective coping strategy and reacts adequately to a psychotrauma, reprocessing it independently and competently. Unfortunately, very few such cases are encountered, so medicines are prescribed for 90% of people experiencing severe experiences, reactions and anxiety.

The classical choice of drugs is a group of antidepressants that normalize the level of neurotransmitters. The name and type of medication depends on the stage, type and specificity of reactive depression.

Groups of antidepressants differ in tasks and actions:

1. Monoamine oxidase inhibitors.
2. Tricyclic antidepressants.
3. Selective inhibitors of reverse neuronal seizure (SSRIs).
4. Monoamine receptor agonists.

Also in the treatment are effective tranquilizers, sedatives, neuroleptics, herbal medicine and homeopathy.

Prescribe drugs can only be a doctor - a psychiatrist or psychotherapist, not a psychologist who does not have medical education, not a housemate, and not a pharmacist in a pharmacy. The choice of such a serious medicine is the prerogative of a specialist, taking into account all the features of the disease course and the properties of the patient's body.

The examples given are information, not a recommendation for use.

1. Fluoxetine. A SSRI group medicine that improves mood, neutralizing anxiety and stress. It is prescribed for various depressive conditions, obsessions, neurotic disorders. It is shown to apply a course of up to 4 weeks 1 tablet per day. Contraindications - nephropathies, hepatopathies, diabetes mellitus and epilepsy.
2. Amitriptyline is a drug from the group of tricyclic antidepressants. It is shown in reactive and endogenous depression, it is effective in treating mixed anxiety-emotional disorders, with neuroses. The dosage depends on the condition and age. Scheme of appointment - 25 mg at bedtime once a day, increasing the dose to 3 doses per day for a month. Then the dosage is changed again, reducing it to 1 tablet. The course of the process should be under the supervision of a physician, who will adjust the drug intake.
3. Gidazepam. The drug of the group of day tranquilizers. Has a good anti-anxiety, stabilizing effect for asthenic manifestations of depression, neuroses, psychogenic forms of depression. Removes irritability, improves sleep. Take gidazepam can be up to 3 times a day with a dosage of 0.02 mg. The course of treatment can last up to 2-3 months. Contraindications - pregnancy, hepatopathology, kidney disease, glaucoma.

Please note that the above medicines are only available on special recipes. This indicates not only their effectiveness, but also the inadmissibility of self-treatment.

Vitamins

Traditionally, with all forms and types of depressed mood, when depressed, it is recommended to take a complex of vitamins, including vitamins of group B, as well as ascorbic acid, vitamin E, A, and microelements. This accelerates the process of getting out of the reactive state, strengthens the body's resources and gives strength to the sick person.

Here is an example of the most popular vitamin complexes:

• Multi-tabs In the complex. Includes in the composition of coenzyme vitamin B1, vitamin B6, folic acid, vitamin B2, B12, nicotinamide and pantothenic acid. Take a complex of 1 tablet three times a day for up to one month. The drug has virtually no contraindications, it is prescribed to pregnant women and children from 10 years.
• Neurovitan. The composition includes thiamine, octothiamine, riboflavin, vitamin B6, cyanocobalamin. The complex is suitable for strengthening the nervous system, and is also prescribed for heart disease, diabetes, and immune defenses. The course of admission to 4 weeks, appoint 1 to 3 tablets per day, depending on the age and condition of the patient. Vitamins can be drunk to children, starting from 1 year.
• Milgamma. Neurotropic composition allows to improve nerve conduction, microcirculation of blood. Milgamma is given in injectable or tablet form. The course of treatment lasts up to 1 month. The drug has contraindications - pregnancy, allergic reactions, cardiopathy. Also, it is not prescribed for children under 16 years old.

Physiotherapeutic treatment

Non-drug treatment can have a positive effect in the complex therapy of reactive depression. Physiotherapeutic methods have long been used to alleviate the symptoms of neuroses, mood disorders.

Physiotherapeutic treatment of psychogenic diseases, recommended by official protocols:

• Lateral physiotherapy (light therapy). It is carried out with the help of a specific device and glasses, where each lens is divided in color. On the right - red color, on the left - green - for cupping asthenia, phobias. On the contrary - for the treatment of anxiety conditions, agitation. The course is 6-7 procedures.
• Acupuncture or acupuncture.
• Electrosleep.
• Su-Jok therapy.
• Therapeutic relaxing massage.
• Aromatherapy.
• Galvanic collar for Shcherbak. The method of influence on the central nervous system and the autonomic nervous system.
• Mesodiencephalic modulation (effects of electrical signals on certain areas of the brain).
• Light Aromophonotherapy.
• Baths with relaxing herbal decoctions.

Note that physiotherapy treatment of reactive depression can not be basic, it only complements a wide range of options and speeds up the recovery process.

Alternative treatment

A painful state, anxiety, irritation, anger after the received psychotrauma many try to neutralize independently, applying alternative treatment. This option is sometimes effective, if the reactive depression proceeds quickly, without complicated symptomatic manifestations. Of the safe methods, you can recommend only the simplest tips that are included in the alternative treatment:

• Physical activity is feasible.
• Expansion of the assortment of nutrition towards vitaminization. The more vitamins, microelements the body receives, the more it has the strength and resources to fight the disease.
• Fresh air - daily and as much as possible.
• More sunlight. If weather conditions or a season do not allow you to enjoy the sun, you can apply color therapy. Bright hot hues - red, orange, yellow, can defeat apathy. Blue, blue, light purple - to reduce irritability and agitation.
• Warm baths filled with sea salt or essential oil. An antidepressant is an oil of orange, lavender, pine or fir.
• Aromatherapy. The treatment sessions are virtually free and can be arranged at home. Aromatic oil is enough to apply on the inner fold of the elbows, on the lower part of the nape (closer to the neck). Also, you can use aroma lamps if there is no allergy.

Alternative treatment of depression involves the use of decoctions, herbal infusions. However, phytotherapy can not be considered absolutely safe, the recipe and choice of a medicinal plant should be made by a specialist with knowledge and experience in this field.

[69], [70], [71], [72], [73], [74], [75]

Herbal Treatment

The most famous and respected plant in the treatment of depression is St. John's Wort. Treatment with herbs is impossible without it, and St. John's wort can be used as monotrava, and as part of the phytosboria. Hypericum is the favorite plant of Hippocrates, about which he wrote many centuries ago. Until now, miraculously preserved records with the recipe of those years, which became the basis for the development of pharmacology in general, and the production of drugs for depression in particular.

St. John's wort is an unsafe plant, like all antidepressants produced on the basis of its extract, extract. The therapeutic effect is achieved relatively quickly, but also complications and side effects are possible. An example of the most gentle recipe that needs individual adjustment.

• 1 teaspoon of dried Hypericum flowers are poured into 250 ml of boiling water.
• Insist the broth no more than 5 minutes to a light yellow shade.
• Infusion is taken by 1/3 cup three times a day before meals, for 25-30 minutes.
• Every day, you need to prepare a fresh remedy.
• The course of herbal medicine St. John's wort is 21 days.
• At the slightest sign of adverse adverse events, treatment with St. John's wort should be stopped. It can trigger a drop in blood pressure, allergies.

A medicinal balm can also be effective. It eliminates insomnia, improves the overall psycho-emotional state. The recipe for the decoction is as follows:

• 1 tablespoon of dry leaves and flowers of lemon balm is poured 300ml of cold water.
• The mixture is brought to a boil and boiled for 2-3 minutes.
• The broth is cooled to a warm state and filtered.
• 1 teaspoon of honey is added to the phytotoxic.
• Herbal infusion is used 2-3 times a day, regardless of food intake.
• The course of treatment with melissa can last up to 2 months.

Treatment with herbs, phytogens can supplement the basic therapy, but not replace it completely.

Homeopathy

A set of therapeutic measures to neutralize depressive symptoms may include homeopathy. Studies of the effectiveness of homeopathic remedies continue in the same way as disputes about its legitimacy in principle. There is no reliable information about the effectiveness of non-traditional treatment, although homeopathic doctors actively assert the opposite. However, the patients who were saved by homeopathy also stand up for the protection of alternative methods and assure that their condition has improved without the use of synthetic drugs.

Let us dwell on the fact that homeopathy has the right to exist, at least as an addition to the basic methods of therapy. The list below is not intended for self-treatment and is not a recommendation, it is provided only for reference.

Homeopathy in the treatment of jet depressions:

• Nervochel N. Preparation, the basis of which is the ignition. Ignacy is effective for getting rid of seizures, depression, irritation and insomnia. Also in the composition of the Nervohel are bromide, which obviously has a positive sedative effect, phosphoric acid, dry matter from the bag of cuttlefish, valerian-zinc salt. The drug is administered in the form of tablets, applied 1 tablet three times a day for mild forms of depressive disorder. In more serious situations, experts recommend that the tablet be dissolved every 15 minutes for 1.5-2 hours. The drug has no adverse side effects, it is prescribed for children from 1 year, except for pregnant women and mothers who breast-feed their babies.
• Arnica montana. The agent rather refers to phytotherapy, as it is produced from a plant growing in the Alps. Previously, Arnica was used as a medicine for bruises and bruises. Later the spectrum of its application has expanded, and today homeopathy recommends that Arnica Montana as a drug that improves the emotional state. Contraindications - allergies to components, pregnancy and children under 10 years. Reception - 15-20 drops three times a day for 10 days, if the drug is released in liquid form. The tabulated arnica is appointed by the homeopath, depending on the individual characteristics of the patient.
• Nux vomica, the composition of the drug includes bryony, chilibuha, colocintis, lycopodium. Nux vomica works well with depressive symptoms, insomnia, agitation. The drug is not prescribed for pregnant women and children under 1 year. The dosage is chosen by the doctor, but the instructions have such instructions: adult patients - 10 drops three times a day, daily dose of Nux vomica diluted in water (100 ml). Babies up to a year - 6-9 drops, children from 2 to 6 years - 12-15 drops. The drug should be used one hour after a meal. The duration of the course will be determined by a homoeopathic doctor.

Prevention

Avoid psycho-traumatic events is impossible, so the prevention of development of reactive depression - this is training, acquiring the elasticity of the psyche, the development of coping strategies. In addition, adequately accept the blows of the outside world and correctly respond to stress factors helps to take care of their own resources - both in the physiological and in the psychoemotional sense.

Tips that help strengthen the nervous system, the psyche - this is prevention, which must be dealt with systematically.

• First of all, you should take care of quality sleep. Sleep should last at least 7 hours. In the acute stage of the depressive state, sleep can be prolonged to 10-12 hours. It helps to restore energy and strength.
• Prevention of depressive disorders is an environment. Man is a social being. Support for friends, family and close members of the family - this, at times, and the best medicine, and the first psychological help.
• It is important to allow yourself to express emotions, whether it be grief or despair. The body with the help of lacrimation helps a person to alleviate mental pain. To restrain tears is to suppress an injury, driving it inward.
• Water, air and light. These tips are not new, but they have been effective for many years. This is how our organism works, that instantly reacts gratefully to water, comfortably arranged procedures and to good, pleasant lighting. If possible, you should go to the seaside or take a walk along the river bank. The change in the situation is already therapeutic in itself, and in combination with fresh air is doubly effective.
• All serious, fateful decisions should be postponed for a while, when the body recovers, and an emotional resource appears. The tactic of taking care of yourself is the fulfillment of small, simple, simple things.
• Physical activity. The feasible load, playing sports - these are techniques that are not aimed at strengthening the muscles, but on breathing, which is inevitably activated during the exercise. Breathing techniques are a great way to improve and stabilize the emotional state.

Reactive depression is much easier to prevent, more precisely, to stop at the first stage of development. The best way to do this is to engage in a psycho-hygiene and not forget about prevention.

[76], [77], [78], [79], [80]

Forecast

The prognosis of treatment of reactive depression in most cases can be positive under condition of early treatment to professionals. Independent attempts to get out of a vital impasse can also be crowned with success, but only in the case of psychotrauma with low intensity and degree of significance. Nevertheless, the growth of depressive forms and species, the increasing number of hidden and reactive psychogenies suggests that the problem remains urgent and requires a more careful, serious attitude towards it. Previously, the purely psychiatric task today becomes the number one issue in the literal sense, throughout the world, including WHO.

Timely differential diagnosis, detection, rendering of the first psychological help, support, appointment of adequate therapeutic measures is a complex that allows a person to cope with a psychotraumatic event and manifestations of reactive depression quite successfully. Otherwise, the disease acquires a protracted character, which carries the risk of neuroticism and the transition of the state to a chronic somatic form. Accordingly, this variant of the development of the disease requires a longer treatment process, efforts both on the part of the patient himself and on the part of the doctor. Therefore, even if you independently cope with the first signs of a reactive state, you should visit a psychotherapist, a medical psychologist, for a qualitative study of the trauma and getting rid of its consequences.

[81], [82], [83]