How to deal with morning depression. Morning depression: what to do? Why does depression get better in the evening?

They would be happy to rejoice, but depression prevents them. Let us cure depression - and they will stop being depressed, and a good mental disposition of the patient is the key to the success of any therapeutic treatment.

MAIN SYMPTOMS

Body system

Disease

Endocrine system

Diabetes mellitus, thyrotoxicosis, Cushing's disease, Addison's disease

Cardiovascular and respiratory systems

Coronary heart disease, bronchial asthma, chronic circulatory failure, chronic cardiopulmonary failure

Digestive system

Peptic ulcer and duodenal ulcer, enterocolitis, hepatitis, cirrhosis, cholelithiasis

Joints and connective tissue

Systemic lupus erythematosus, rheumatoid arthritis, scleroderma

Pernicious anemia

Oncological diseases

Cancer, sarcoma, disseminated carcinomatosis

The immune system

Gynecological pathology

Myoma of the uterus

Genitourinary system

Chronic pyelonephritis

Organs of vision

Glaucoma

Whoever is not allowed to be deeply mistaken is content with a trifle.

L. L. Krainov-Rytoe

To be wise is to know what to ignore.

William James

DEPRESSION

Symptoms of depression are categorized as “major” and “minor”. What is the difference between them? The main symptoms of depression are seen in everyone who suffers from depression, albeit to varying degrees. Additional symptoms only complement, diversify, color the picture of the disease - in each specific case, some of them are present, and some are not. We will, of course, start with the main symptoms of depression. However, before that, a small disclaimer. Doctors, by their common agreement and understanding, diagnose depression only if the symptoms below have been observed in a person for more than two weeks in a row.

So, obligatory symptoms of depression these are:

decreased mood, feeling of despondency, depression, melancholy;

loss of interest, ability to experience pleasure;

decreased energy, activity, increased languor.

Let's examine them in order.

The main symptom of depression is low mood, by and large it does not exist at all. The world seems gray and empty, and the sense of meaninglessness of what is happening catches up such melancholy that at least get into the loop. A person's sleep is disturbed, appetite decreases (often to a complete disgust for food), he loses weight and literally melts before our eyes. Internal stress can be unbearable, or complete apathy can begin. Former joys seem meager, pleasure - something mysterious and unattainable. A person suffering from depression, either unsuccessfully tries to occupy himself with something, hoping to somehow get rid of painful thoughts, or goes to bed and does not want to do anything. He may become angry and irritable, he may cry for days on end, or he may not cry at all, but this makes him even worse. Thoughts swarm in my head, revolve around one topic - life failures, disappointment in work or family, some of them begin to have various physical ailments. Such is the close-up of depression.

Decreased mood, feelings of despondency, depression, melancholy

Mild depression.If we have depression that developed against the background of acute or chronic stress, that is, neurotic depression, then our mood, as a rule, decreases moderately. We begin to look at life pessimistically, do not experience the former feeling of joy, and more and more - fatigue. More often in this case, the mood decreases by the evening, when all the things have already been done and the person, without being distracted by anything, gives himself up to the power of depressive arguments about how bad everything is, unlucky, stupid, etc.

As a rule, with such depression, a person experiences anxiety, it is difficult for him to relax, stupid thoughts about some upcoming troubles constantly creep into his head. Somewhere indeep in his soul, he still believes that everything will end happily, that the problems will be resolved, but his statements on this score will be very mean.

Medium depression.If insince depressive genes come into play, then our mood drops very significantly, especially at night and in the morning (some improvement occurs in the afternoon, but it can be difficult in the evening). In fits "tearfulness may appear, and attempts to cope with it are not always successful.

A person in this state begins to feel burdened by life, does not want to get better, does not believe in the possibility of improvement, and often thinks that the only way out or the right step is to commit suicide. Anxiety here, as a rule, is very high, strong internal stress does not give a person peace, despite the fact that there seems to be no strength whatsoever. It is almost impossible to cheer such a person, he ignores any optimistic remarks from others, sometimes, however, with an ironic smile.

Severe depression.If our depression, God forbid, came out of nowhere at all, without serious stress, for no reason, as if by itself, most likely it is a depression of a genetic nature. Decreased mood in this case is manifested, as a rule, by depression, melancholy is felt literally as physical pain. At the same time, the person himself often does not consider his mood to be depressed, he simply does not think that this may have any significance against the background of the general hopelessness and senselessness of his existence.

Anxiety may not be felt at all, but it may seem outrageous, sometimes such patients say that they seem to be squeezed in some kind of grip and either they themselves will be crushed, or they will not stand the grip. They have an expression of sorrow on their faces, the corners of the mouth are lowered, the upper eyelid is broken at an angle in the area of \u200b\u200bthe inner third, on the forehead there is a characteristic fold, the posture is hunched over, the head is down. Suicidal intentions are quite clear.

The worst thing is to feel that you are an addition to your own furniture.

V.O. Klyuchevsky

Literary testimony:

"The circle of my powerlessness has closed ..."

These words conclude the story "Ruth" from the book "The Fall" by an amazing modern writer Lilia Kim about a young, suddenly widowed woman. The state of her heroine perfectly reflects a person's mental confusion, when his anxiety becomes depression, and depression becomes anxiety:

“My life ended with the last breath of Chileon. I hung between that light and this, unable to be in any of them. Life had never been more meaningless, but I still lacked the heart to commit suicide, perhaps partly because Chileon's last words were, "Please live happily." He was very fond of asking me about some incredibly complicated little thing.

Don't worry, you are still young, you have no children. You will still get married. I made repairs in your com-

here you are. It will be necessary to agree to transport things, - my mother makes plans for my life.

I only heard: "You have no children" and burst into tears. My mother began to calm me down, but her face is annoyed that I don't understand how she thought of everything well and arranged it.

I don’t want to live! I don't want to live anymore! Mama! Do you hear! I, your daughter, do not want to live! - a cry is heard inside me, continuing with a hysterical echo, turned into a black hole left over from my soul, into which I am sinking more and more.

To clean one thing, you have to stain something else; but you can stain anything you want without cleaning anything.

Lawrence J. Peter

Loss of interest, ability to experience pleasure

Scientifically, this symptom is called "anhedonia" (loss of a sense of pleasure), in a simple way - this is when you do not want to do anything, there is only strength to lie and look at the wall. The processes of inhibition in the brain prevailed over the processes of arousal: a person suffering from depression is not only not happy with anything, but also not impressive. What used to be a pleasure now seems insipid, empty, stupid. However, the severity of depression and the severity of this symptom varies greatly.

Mild depression.In the case of a depressive neurosis, of course, we can become interested in something, although the circle of our interests will be significantly reduced, and the interest that arises will quickly disappear. The feeling of pleasure seems to be smoothed out and disappears earlier than usual. This is especially clearly realized in the sexual sphere — there is no desire, I don’t want to, I don’t carry away. But if you look more closely, you will notice that there are no interesting programs on television, and fascinating books have disappeared, and work is a yoke, and rest is a whirlpool. Of course, there are still some pleasures, but there is little pleasure in them, little. A characteristic feature is the patient's loss of interest in his appearance, women, for example, stop using cosmetics or do it completely automatically, that is, out of habit, and not out of a desire to please and impress.

Medium depression.If a person has mixed depression - from stress and from genes, then all his interest is limited to the topic of painful experiences. If he is worried about the situation at work, then he will be fixed on some of its nuances - relations with the boss, with partners, colleagues. Moreover, it is painful, selective, as if besides these several problems in his life there is nothing at all.

People suffering from this form of depression remain passive, a kind of neutrality, even when those around them actively express joy or interest. The feeling of loss of pleasure encompasses the widest possible layers (food loses its taste, the world seems to be "gray", etc.). This experience becomes painful, painful, there are constant comparisons of themselves with normal people: "Why are they happy? .. What could be interesting for them in this?" Ultimately, such a person comes to the conclusion that he himself is "not fit for anything"

has changed a lot, does not look like himself at all, "has become different."

Severe depression.If depression in a person is genetic, then the loss of interest and pleasure can even come to a complete rejection of any activity. Patients' statements about this sound frightening, they wonder how it is possible to experience interest and pleasure at all. They may ask the doctor: “Can you be happy about something? What ?! " What used to give pleasure, delight or interest now seems meaningless, absurd, absurd, monstrous. Such a person may have the feeling that he has never experienced pleasure or interest at all in his life. This depression can change not only our sense of the present, not only our ideas about the future, but even our memories of the past.

Decreased energy, activity, increased fatigue

The predominance of processes of inhibition over processes of arousal, of course, also affects the activity of people suffering from depression - this queen of depression and melancholy. Having fallen into the grip of depression, we not only get tired quickly, we often cannot at all get involved in any purposeful activity; and if we do begin to do something, it will be purely automatic, detached, without a sense of belonging.

Mild depression.In the case of a depressive neurosis, we will look tired and twitched, outsiders may say that we are somehow too passive. Our anxiety, however, will not allow us to completely “surrender”. It is possible that she will even make us too active and energetic, but only in attacks. Braking, however, wins every time, though perhaps not immediately.

Medium depression.With moderate severity of depression, passivity acquires the features of stiffness. A person rarely changes posture, his facial expressions are poor and monotonous. It can be seen that he moves with difficulty, thinks about the question for a long time, cannot always gather himself to answer fully and clearly. With such depression, a person often complains of fatigue, but this is not just fatigue, he is "tired of life", "everything weighs on him", "no strength, complete decline", etc. He gets tired of talking, reading, watching TV: “I can’t figure it out,” “I don’t understand what they are talking about,” “I’m losing the thread.” However, it would be a mistake to believe that this is precisely about fatigue. In the brain of a person suffering from such depression, there is simply not enough excitement, it is quickly suppressed by inhibition.

Severe depression.A person with severe genetic depression may have activity

caused only by an attack of anxiety. At times there is agitation, intense excitement, accompanied by aimless actions. The rest

time it resembles a deflated ball, it seems that life has left him. It's not just lethargy, it's crushing. The movements of such patients are slow, extremely stingy, they are performed only when absolutely necessary, the so-called "depressive stupor" can develop. Patients speak quietly and with difficulty, instantly get tired of communication or any other activity.

Space is finite, according to modern astronomers. This is a very comforting thought - especially for those who can never remember where they put something.

Woody Allen

ADDITIONAL SYMPTOMS OF DEPRESSION

Additional symptoms of depression, although called additional, sometimes cause a person even more suffering than the main symptoms of the disease. The fact is that both a depressed mood, a loss of a sense of pleasure, and general passivity are difficult to "internal development", and depression is, first of all, internal suffering when we think and change our minds about some of our misfortunes.

In addition, the main symptoms of depression, oddly enough, are more difficult to notice than some of its particular manifestations. You may notice that you have lost weight, that you feel insecure or suffer from sleep disturbances. However, it is much more difficult to understand that your mood is low if it has been consistently decreased over several months.

Additional symptoms of depression ta kovs:

difficulty concentrating if necessary, keeping attention;

decreased self-esteem, the emergence of a sense of self-doubt, ideas of guilt and self-deprecation;

dark and pessimistic vision of the future,

ideas or actions of self-harm and suicide;

sleep disorders (more often early morning awakening);

appetite changed (in any direction);

decreased libido (sex drive);

somatic complaints without organic causes; and hypochondriacal mood.

Let's consider them in order.

Difficulty concentrating when necessary, keeping attention

In order to keep attention on some business for a long time, the brain must form the necessary dominant. But how to form a dominant, for example, for watching a TV show, if your whole brain is subject to depression and, accordingly, is under the dominion of a depressive dominant? Yes, it's hard enough. In fact, the only possible source of excitement in the brain of a person suffering from depression is painful and fatal thoughts about the meaninglessness and inconsistency of life.

With depressive neurosis, we focus on our own pessimistic experiences. With depression of moderate severity, a person communicates with us as if through some kind of wall - he is fenced off, focused on something else, as if he is hardly distracted from what he is doing the rest of the time. It seems that at times he "turns off" and loses the thread of the conversation. When communicating with a person who has become a victim of genetic depression, there is a feeling that he is completely somewhere in a completely different world, from which we hear only some echoes and scraps of phrases. The reasons for these impressions are that the very act of such a conversation cannot occupy and captivate a person suffering from severe depression.

Loneliness is bad because so few people can stand themselves.

Laszlo Felek

Decreased self-esteem, occurrence

feelings of self-doubt, ideas of guilt and self-deprecation

Being in a state of depression, we begin to think about the failure of the world around us - it is "bad", "unfair", "cruel", "stupid"; or about our own inconsistency, that we ourselves are "bad", "stupid", "are not capable of anything", "are to blame for everything and everyone." Moreover, because of our depression, we really cannot cope with stress, do work that requires concentration of attention, enthusiasm, etc. So it is quite easy to find arguments in favor of our insolvency, and blaming ourselves for anything at all is not difficult at all, because ideal people do not exist, and doing business and avoiding mistakes is impossible. So you can always consider yourself a "bad mother" or "useless father", "an ungrateful child or comrade."

However, the feeling of guilt that develops in depression, according to various studies, is more characteristic of Americans. Russians, on the other hand, experience feelings of guilt in a very peculiar way, they often feel awkward or ashamed. However, as the depression deepens, guilt really begins to compete with self-deprecation, although it does not completely replace it.

A person suffering from depression can ascribe to himself a variety of vices, consider himself the culprit of various misfortunes and crimes, call himself a "criminal who ruined people's lives." At the same time, as "evidence", he will remember some minor blunders and mistakes that, in a state of depression, will seem to him terrible and monstrous.

Avoid making final and irrevocable decisions when you are tired or hungry.

Robert Heinlein

A gloomy and pessimistic vision of the future

In a sense, it is simply difficult for a person with a depressive disorder to think about the future, it does not appear in him - there is neither energy, nor strength, nor desire for this. He, by and large, lacks the desire to live in order to think about the future, especially since any uncertainty scares, and to frighten a person who is in depression means to aggravate his condition, once again emphasizing its role of “anxiety absorber”. In combination with a self-deprecating assessment, all prospects really seem futile to a person.

The fact that everything will be bad is only a judgment; it becomes a symptom of the disease only in cases when such a conclusion begins to determine a person's behavior. This symptom is especially typical for depressive reactions to acute and severe stress, depressive neurosis that developed against the background of a chronic traumatic situation, as well as in the classic forms of manic-depressive psychosis.

Ideas or actions for self-harm and suicide

In suicidology, the science of suicide, there are several options for suicidal behavior:

suicidal thoughts (which, in principle, being an abstract judgment, can arise against the background of relative mental health);

suicidal intentions (a clear desire to commit suicide when the patient deliberately thinks through the possible options for suicide);

suicidal actions (direct attempts at suicide, preparation for suicide);

and finally, suicide itself (suicide). A person suffering from depression usually does not regret having to give up his life. On the contrary, he sees in suicide a deliverance from suffering. And it is held back, on the one hand, by a natural unwillingness to experience physical pain, and on the other hand, by thoughts of loved ones. However, if a person thinks that he only interferes with his loved ones, and his inner, mental pain is unbearable, these obstacles cease to protect his life.

Fortunately, with severe depression (due to the severity of inhibition processes), patients, as a rule, lack the internal strength to form specific plans for suicide, and even more so for their implementation. Sometimes this can create the illusion of a relatively good condition of the patient, while in fact it speaks of his prohibitive severity.

In any case, if a person develops depression, you need to remember about the risk of a similar outcome of this disease, take his corresponding statements seriously and understand that in reality he does not want to mortify himself, this is what his depression wants, and it is very persistent.

Sleep disturbances

During the development of depression, certain chemical processes occur in the human brain, namely, a decrease in the amount of substances that play a primary role in the transmission of nerve impulses from one nerve cell to another. One of these substances is serotonin. And here's the trick ... The fact is that this substance (more precisely, its lack) plays a significant role in the development of depression, and its lack has an extremely adverse effect on the state of our sleep. This is why so often a depressed person turns to the doctor not because of their depression directly, but because of sleep disorders.

Sleep disorders can be very different, which I described in detail in the book "Remedy for insomnia", published in the series "Express Consultation". Here we will clarify only a few important details. Sleep problems are quite peculiar for people with depression. A person can toil all day, experiencing unbearable drowsiness, but all his attempts to fall asleep are in vain. It seems paradoxical, but in fact there is nothing strange about it. Just what he perceives as drowsiness is to a large extent only the general lethargy, characteristic of a depressed patient. And his sleep is disturbed due to the lack of serotonin caused by depression itself.

However, patients with severe genetic depression often fall asleep well, but wake up early in the morning, before the alarm clock, and always with a sense of anxiety and inner tension. By the evening they "disperse" somewhat and feel better. Apparently, in a day, depression is partly overcome due to the constant influx of excitement into the brain from activities and other events performed by a person. At night, the amount of these irritations decreases, and the brain again finds itself in its painful, semi-inhibited state. As a result, sleep becomes superficial, extremely sensitive, anxious, dreams seem to a person not natural and spontaneous, but “made”. In the morning he may think that he has not slept at all, feel overwhelmed, tired, with a heavy head.

There is, however, another explanation for these depression-specific sleep disorders. Since anxiety is an emotion, it is localized in the deep layers of the brain, and during sleep, mainly the "upper" part of it falls asleep. Apparently, this is why people suffering from depression often fall asleep quite well, but after 3-5 hours of sleep they suddenly wake up, as if from an internal impulse, feel vague anxiety and anxiety. That is, the lower layers of the brain wait until the upper layers of it fall asleep, and then the anxiety that is always hidden behind depression suddenly breaks out. After waking up like this, it is usually difficult to fall asleep, and if sleep returns, it becomes superficial and disturbing.

With a depressive neurosis, on the contrary, the process of falling asleep is often more difficult: a person is spinning in bed, cannot find a place for himself, cannot lie down, at times wants to get up and start doing something. He constantly thinks that he cannot fall asleep, and the next day he will feel bad. Such reasoning, of course, significantly postpones his sleep, which is in no way consistent with anxiety. It is possible, by the way, against the background of depression and nightmares, as well as night awakenings associated with them.

One way or another, but the symptom of sleep disturbance, although located here almost at the very bottom of the list, is one of the most significant signs of depression. It is almost impossible to imagine depression without sleep disturbances. And therefore, if you sleep well, then, fortunately, you should not apply for a diagnosis of depression, at least not yet.

"Heavy sleep, who is depressed by grief."

Russian proverb

I think, therefore, I cannot sleep.

Laszlo Felek

Literary testimony:

"All kinds of dangers"

In my book How to Get Rid of Anxiety, Depression and Irritability, I told the story of Konrad Lorenz - an outstanding researcher of animal behavior, No belevsky Prize and generally a wonderful person. How are you it is clear that he also suffered from a rather severe depression, which, however, was expressed in him mainly mi sleep. This is what he writes about it in his famous book Beyond the Mirror.

“When I, as it usually happens to me, wake up for a while at very early hours, everything unpleasant that I have had to face lately comes to my mind. I suddenly remember an important letter that should have been written long ago; it occurs to me that this or that person did not behave towards me the way I would like; I find errors in what I wrote on on the eve, and above all in my mind, all the transport possible dangers which I must immediately prevent tit. Often these sensations besiege me so strongly that I, taking a pencil and paper, write down the message that I remember. dangers and newly discovered dangers, so that they are not be. After that, I fall asleep again, as if calmed down; and when I wake up at the usual time, all this heavy and threatening seems to me no longer so gloomy nym, and also come to mind effective safety measures that I immediately begin to take. "

It remains to be noted that this truly legendary brow the century suffering from depression did not succumb and did not break under her onslaught. He fought all his life (as can be seen from this passage from his book) for his mental health, for his right to live a happy and fulfilling life, which causes him even more respect than even his really brilliant discoveries in the field of animal psychology.

With a full belly, it's hard to think, but loyal,

Gabriel Laub

Change in appetite

When we say that appetite in depression can change in any direction, it probably seems strange. Io if you know how our body works, then this is even logical. Indeed, in a person suffering from depression, appetite can both increase and disappear. Loss of appetite, on the one hand, is explained by the predominance of inhibition processes over excitation processes in the brain, since those centers of the brain that are responsible for the feeling of hunger also fall under the inhibition.

On the other hand, the autonomic nervous system is involved - that part of the human nervous system that is responsible for the regulation of bots of all internal organs of the body. Anxiety strengthens the autonomic nerve division noy system, which submitted it works the food system rhenium (this is the so-called"Sympathetic division" of the autonomic nervous system). If the body is in anxiety, then it selectively enhances the work of only those organs that are necessary for a living being to escape from danger - the work of the heart is activated, blood pressure rises, the rhythm of breathing changes, etc. The stomach is not needed to escape and attack , and therefore during these periods, his work is simply suspended.

A person who develops acute depression (for example, as a reaction to severe stress) can lose up to 10 kg in one month. And the number of lost kilograms, in a sense, can be considered as a criterion for the severity of a depressive disorder.

However, the increase in body weight in depression, paradoxically, we also owe this second of the two described mechanisms. Here a kind of collision arises. If a person suffering from depression and being in a state of anxiety still manages to eat something, then the following situation may arise. The food it absorbs acts on the corresponding receptors, which leads to the activation of the brain centers responsible for digestion. The initiative, as they say, comes from below.

Activation of the parasympathetic division of the autonomic nervous system (which is the antagonist of the sympathetic division, which is activated by anxiety) reduces sympathetic influences. Blood, figuratively speaking, flows to the stomach, the heart rate decreases, blood pressure normalizes, and this automatically leads to a decrease in anxiety. Thus, food intake can become a kind of defense mechanism to reduce anxiety. It becomes easier for a person, and such a reflex is formed in his brain: if you eat, you feel better.

As a result, a person suffering from depression, sometimes gaining up to two to three dozen kilograms in six months, may go to the doctor with complaints of gut, and not depression. And it should not be surprising that the usual time for gorge attacks in such patients is at night, when anxiety threatens to wake up and disrupt sleep. Moreover, as their favorite "food anti-anxiety drugs" they use bakery products that can quickly swell in the stomach and thus have a maximum effect on the corresponding receptors, as well as traditional irritants of digestive activity - spices, seasonings or, for example, lemon.

Finally, one cannot do without a desire to please oneself: a person tries to cheer himself up by leaning on food. Soon, as depression develops and the ability to feel pleasure becomes less, the corresponding goal can no longer be achieved in this way. But the person continues to chew "on the machine", ostensibly distracted from heavy thoughts.

Ignore minor flaws; remember: you also have large ones.

Benjamin Franklin

If you read the inscription "buffalo" on an elephant's cage, do not believe your eyes.

Kozma Prutkov

A case from psychotherapeutic practice:

Pancakes with lemon

Now I remember one very remarkable case from psychotherapeutic practice. Diseases, generally speaking, rarely give rise to fun, and depression even more so, but my patient herself talked about what happened with humor (despite the depressive decrease in mood, people with a good sense of humor do not lose humor, however, it gets very specific - cold-ironic - color). So ...

A sweet plump woman of forty-three years old appeared on the threshold of my office. Appearance she did not betray her as a depressed patient. She looked more like a healthy Russian woman who came down from the pages of Nekrasov's myth-making about our people: "She will stop a galloping horse, she will enter a burning hut!"

After we met her, I asked: "What, in fact, brought you to me?" She, already rosy-cheeked, flushed even more, looked down and said a strange: "Pancakes". “Pancakes ?! - I was surprised. - With this and a psychotherapist? However, my surprise was short-lived. Within ten minutes everything fell into place - my patient came to the right place.

However, I will not retell the whole story, but I will tell only about one symptom of depression: a change in appetite in any direction, in this case - upward. The situation looked like this here. Every night, at the fourth hour of sleep, at exactly two o'clock in the morning, this charming lady woke up, as if from some kind of inner impulse. Anxiety, usually activating us to fight or flee, caused her to immediately get up and start doing something to keep herself busy.

And my patient had a tough ritual for this case: she went to the kitchen and started ... What would you think? Yes, cook pancakes! After baking a kilogram of pancakes, she sat down at the table and began to drink tea with pancakes. “And tea,” she made a reservation with surprising and at the same time comic seriousness, “must be with lemon!” Further, having eaten "from the belly," she felt the pleasant sweetness of the dream rolling over her and gently swam back into bed. By four o'clock in the morning she was already asleep like a baby. However, six months later, this "baby" found himself two dozen extra pounds.

Well, why did she turn to a psychotherapist? Of course, in order to reduce weight! What did the psychotherapist find with her? Given the title of the book, it is understandable: depression. Indeed, this woman had a classic symptom of early awakenings (if she went to bed not at ten, as she did, but at twelve, she would wake up at the classic time for depression - at four or five in the morning). These early awakenings, as expected, were accompanied by attacks of anxiety, and this, if we recall the physiology, is the result of the activation of the sympathetic division of the autonomic nervous system.

And then what should have been called the "classical defense mechanism" occurred, to which this patient of mine resorted absolutely unconsciously. What did she do? To begin with, she went to the kitchen and spent her overwhelming anxiety on active "useful" activities: beating dough and then juggling pancakes - this is a serious physical activity that can absorb the excess internal tension that distinguishes anxiety. At the same time, she had to carefully monitor so that the dough whipped well, the pancakes did not burn, and she herself did not burn. In short, all this forced her to switch from internal experiences to external activities, which naturally seriously reduces the level of anxiety10.

Then she proceeded to the "highlight" of the program: she began to absorb lush, fatty pancakes, washed down with tea, "always with lemon." Carbohydrates (and pancakes are primarily carbohydrates) are quickly absorbed by the body, pancakes themselves, swelling in the stomach, press on its walls, lemon causes such salivation that Pavlov's dog never dreamed of. In short, this sweet woman, unaware of it herself, did a great thing: in all possible ways and forcibly activated the parasympathetic division of her autonomic nervous system.

You feel bad in the morning, but better in the evening. Slightly better or noticeably better, but still not as bad as in the morning. Longing, hopelessness, sadness subside a little. Finally, you get a respite for your business, daily worries. You switch to the here-and-now and act. But behind these deeds lies a strong fear, fear of repetition. You seem to be looking forward to a new repetition of the cycle "bad in the morning - good in the evening." An annoying expectation that prevents you from quietly enjoying your evening "letting go". You are anxiously awaiting the morning. Bad, bad cycle. Ugly swing.

Let's take a closer look, however, to them more closely. As I wrote in the previous article, an emotionally bad morning is the beginning of the day for a person who is insecure and blames himself for the horrors that are happening to him. By evening, the same person, due to the inevitable movement in the stream of affairs - even if he is in the ward of a psychiatric hospital - moves from his fears and the stream of thoughts about his worthlessness to what can be felt, measured, touched, done. That is, he or she begins to feel by the totality of the results of their deeds that they can at least somehow manage their lives. And the feeling of hopelessness, melancholy, constitutional for depression, recedes. The question is: who actually rides on this swing? The same person? Yes, one and the same. Whose thoughts and emotions are these? Only him. That is, the switching occurs in his own stream of thoughts and feelings. Doctors say - wait for the antidepressants to work and forget about it altogether! There is nothing, they say, to analyze! Aha, how! Considering the low effectiveness of antidepressants - according to data announced at one of the medical conferences in Zaporozhye, their effectiveness does not exceed 40% on average - many may not wait. Especially those who have been counting on them for a long time.

The fact is that behind this swing there is a real choice - the choice of your feelings and thoughts. This choice is made almost unconsciously, but it is still made. And it is done every day. ... More precisely, these are our beliefs, our views on how the world works. If in him I am the only god, the one who controls everything, then the experience of many people says that really they will not succeed. Never. This choice is choosing some form of control over your life. If I say to myself: I can’t do anything, I don’t believe in myself, then this is nothing but a certain belief in myself. Belief in yourself as weak and infirm. Although, in fact, I want to see myself different. But true faith is faith in yourself as incapable and worthless. There are images of failure and loss behind it. If we see such images, then no other emotional reaction can be expected from us. Then we begin to swing in the morning on the familiar swing.

However, neuropsychologists are well aware that our brain does not care whether it sees a picture or in reality finds itself in the described situation. He perceives reality, as K. Frith writes in his book "Brain and Soul", only as his own fantasy, that is, a model of the world. A terrible model creates terrible feelings. If we assume that the model or picture of who we are changes, well, at least slightly, then the reaction will be different. In her book Fear ... But Act, Susan Jeffers writes about a simple exercise that proves it:

“From Jack Canfield, co-author of the Chicken Soup for the Soul book series and president of Self-Esteem Workshops, I learned a great way to demonstrate the benefits of positive over negative thinking. I often use this technique in my practice. I ask someone to stand up and face the class. After making sure that the person has no problems with hand mobility, I ask the volunteer to clench his hand into a fist and extend his hand to the side. Then, standing facing him, I try to lower his arm with my outstretched hand, and I ask my assistant to resist with all his might. It was extremely rare for me to succeed on the first attempt to lower his hand.

Then I ask him to relax and lower his hand, close his eyes and repeat to himself ten times the negative statement: "I am a weak and worthless being." I ask him to really feel the essence of this statement. When my assistant repeats this ten times, I ask him to open his eyes and extend his hand again. I remind you that he again needs to resist with all his might. And here I am already able to lower his hand immediately! Everything looks as if the forces have left him.

You need to see the expression on the faces of my volunteers when they find that they cannot resist my pressure, and that's it. Sometimes, some asked me to repeat the experiment. "I just wasn't ready!" They repeated in a plaintive voice. We tried again, and again the same thing was repeated - the hand went down sharply, almost showing no resistance. At this moment, the confusion on the faces of my "experimental" was the most genuine.

Then I ask the volunteer to close their eyes again and repeat the positive affirmation ten times: "I am a strong and worthy person." Again, I ask my assistant to feel the content and meaning of these words. Again he reaches out and prepares to resist my pressure. To his surprise (and to the surprise of others), I cannot bend his arm. It becomes even less pliable than the first time I tried to lower it. If we continue to alternate positive and negative statements, the result is always the same. I can drop my hand after a negative statement, and I am not able to do so after a positive statement.

By the way - for those who read these lines with a skeptical smile - I tried to conduct this experiment, not knowing which ones are strong, negative ones are weak. I left the room, and the class decided whether the statement was positive or negative. And we always got the same thing: strong words - a strong hand, weak words - a weak hand.

This is a stunning demonstration of the power of the words that we use. Positive words make us strong, negative ones weak. And does not matter, believewe are told or not. The very fact of pronouncing them makes our inner "I" believe in them. Everything looks as if our inner “I” does not know what is true and what is not. It does not analyze, but simply reacts to what is offered to it. When the words "I have no strength" are broadcast, it instructs our entire being: "He wants to be weak today." When the words “I am full of strength” come in, the instruction for our body looks like this: “He wants to be strong today” (pp. 66-67).

It turns out that a simple change in the internal dialogue from the sad-sad "I am not good for anything" to "I can" changes the whole thing and leads to a different form of emotion ?! Well, of course, I'm not so naive as to assume that a depressed person will start feeling better just by saying such a phrase and will immediately return to a good mood. Of course not. How many years did it take for you to program yourself to be sad? How many years did you develop as a person who, deep down, carried such a reaction to circumstances like depression? Twenty? Thirty? Fifty five? I'm talking about a person in a prison of depression, at least admitting that his depression is in his mind, in his head. That she is part of his way of thinking, not someone else's, but his own. And that means he can change it. And one day get rid of depression.

The swing "bad morning - a little better evening" is a choice of emotions through the images of yourself and the world around you. These images are formed very early, in childhood. Sometimes depression is an indicator of what kind of childhood a person had. But at some point, it became the property of the person himself. Childhood has passed, but the images remain. The voices of parents or other loved ones remained. As they say, "the mother carries the child for a whole year in herself, and then he carries her all his life." Angry, demanding or sometimes drunken voices of parents, grandmothers, grandfathers, brothers, sisters. And all this can be changed. Change because for a second to admit that this is all mine. That it is in my mind, in an internal dialogue, in my head. This is my head and I am responsible for it, not my parents.

We can learn to choose our own emotions by choosing images of what the world we live in and who we are. We may one day choose whether to be depressed or not.

Is it true that with depression there can be no good mood at all?

No, it's not quite there. Sometimes bright and joyful events (a party with friends, a date, a holiday, a trip) give an experience of elation and pleasure, but when the event passes, everything returns to square one. First of all, the fact that a depressed mood persists is important. aboutmost of the time - day, week, month.

In addition, experts say that short-term mood elevations occur with atypical depression. So pay attention, first of all, to the depth of the experience of depression and depression.

I often feel better in the evenings. I feel toned and have time to do a lot. Does this mean that I am not depressed, but simply lazy and weak-willed?

It is impossible to make a diagnosis in absentia, as well as to refute it. But for depression, evening improvement is very characteristic. For two or three hours, a person seems to return to normal, and in the morning he again experiences despondency and fatigue. If we are talking about anxiety-depressive disorder, the opposite picture may be observed - improvement in the morning.

My relatives often tell me that if I did hard physical labor, I would quickly recover. That all my depression comes from thinking too much. This is true?

There is no evidence that hard physical work cures depression, just as the habit of "thinking a lot" provokes it. Depression is treated with psychotherapy and antidepressants, and nothing else. But in the process of treatment, feasible physical activity in the gym (or walking on the street) really improves the condition.

Sometimes it seems to me that there is simply not enough joy in my life. If more good things happened to me, I would not live in depression.

I don’t know if you really have depression (you may be healthy and really lack positive emotions), but we already know that a large number of stressful events predispose to this disease. And then a vicious circle turns out: the lost ability to rejoice leads to the avoidance of familiar and favorite forms of activity, which in turn increases melancholy.

When I read about the symptoms of depression, it seems to me that everything is not so bad for me. But in fact, I am far from the norm - the mood is not right, I do not want anything. What happened with me?

Only a doctor can give a reasoned answer to your question after talking with you. I can only mention dysthymia, a sub-depressive condition in which depressed mood, low self-esteem, and an inability to enjoy pleasure persist for a long time. Dysthymia also requires treatment.

Is it true that antidepressants make you fat?

No, it’s not.

Do they cause addiction?

If I start taking antidepressants, will I be a completely different person?

Antidepressants do not affect the personality in any way and, therefore, do not change anything in a person. But they effectively remove symptoms and give strength for fruitful psychotherapy.

If I am already diagnosed with depression and am not on treatment, will it get worse?

Depression is often reported to be chronic, with each subsequent episode being more prolonged and more severe if untreated. Russian psychiatrists also claim that once it starts, a depressive episode, if left untreated, does not go away in 40% of cases even after a year.

Can depression be cured to the end - so that it never recurs?

Yes, you can. This requires not only antidepressants, but also full-fledged psychotherapy, during which you will begin to understand and hear yourself much better than before, and in addition, learn how to help yourself. This means that even if individual symptoms of depression make themselves felt (and none of us is immune from difficult situations that provoke this disorder), you can quickly and effectively stop them at the very beginning, preventing the development of the disease.

How long and how often will I have to see a psychologist?

Each person is unique, and therefore it is impossible to predict in advance how long it will take him to cope with depression. This will depend on many factors, including the severity of the disease, and its duration, and life history, and attitude to psychotherapy, and the willingness or unwillingness to work independently. But it is better to count on several months of therapy with one visit per week.

Is depression always accompanied by weight loss?

No. With depression, both weight gain and no change in this indicator can be observed.

Why do some people get fat when depressed?

There are several possible reasons. For example, atypical depression causes an increased craving for fast carbohydrates. This disorder is also usually accompanied by a decrease in activity, including motor activity - a person sits at home more, refuses walking and sports. Improvement in the evening hours can provoke late dinners. In addition, for many people with depression, food remains almost the only source of pleasure - no wonder they want to eat more than usual.

I read that people with depression sleep little and wake up early. But I want to sleep all the time and am ready to do it 12 hours a day. Why is this so?

Sleep disturbance in depression is not always insomnia and early awakenings. Rather, it is more appropriate here to say that sleeping habits are changing. For example, there is an increased need for sleep, often combined with the feeling "no matter how much I sleep, I still don't get enough sleep." Scientists cannot yet give an exact answer why this is so, but it can be said with precision that as you recover, you will return to your norm.

When I look back, I see a continuous series of failures. It seems to me that I will never get out of this state, no matter how much you treat me.

Depression is insidious in that it forms a very unpleasant and painful vision of one's own life - its past, present and future. It is important to understand this point and deliberately refrain from making any assessments until the disorder has receded. Now the most important task for you is maximum activity in search of specialists who will help you, and active cooperation with them. And you will think about your past later, when you recover.

What is cognitive therapy for depression?

Cognitive psychotherapy is a scientific approach that has proven to be highly effective, allowing you to cope with an illness in a few months. It is based on working with thoughts and beliefs, which experts have found have a huge impact on our feelings and actions. This approach is recommended for those who are committed to a quick fight against depression and to cooperate with a psychologist “on an equal footing”, since it assumes the most active position of the patient himself.

If you have not found the answer to your question, you can write to me by mail or at the reception. ©

Everyone is very fond of the word "depression" now. Some even know exactly what it is, but knowledge alone is not enough to make such a diagnosis.

This article is a kind of test for whether you have depression and whether you need to seek help with this problem. As you read the text, mark the points on the piece of paper for the symptoms that you noted in yourself, then calculate the sum of the points and read the interpretation of the results at the end of the article.

30 symptoms of real depression

Let's divide all symptoms into three groups. The first one - "worth" of 3 points, that is, the most indicative symptoms, the second - 2 points, the third - 1 point.

"Three-point" symptoms

Symptom # 1: Loss of pleasure in life, anhedonia. Previously loved by the patient activities that brought him pleasure, now seem meaningless and can even cause disgust.
Symptom # 2: Depersonalization - loss of adequate self-perception. The patient begins to perceive his own "I", his body as something sharply negative.
Symptom # 3: Derealization is a change in the perception of the world. In the case of depression, the reality appears to be gray, cold: "I'm in my cold little hell."
Symptom # 4: Self-aggression, self-harm, suicidal thoughts and attempts.
Symptom # 5: The patient sees the future in exclusively gloomy tones, he does not see prospects, life seems finished.
Symptom # 6: Severe anxiety syndrome may be present. This is an unreasonable, irrational (as psychiatrists sometimes jokingly say - "existential") anxiety, from which the patient cannot find a place for himself. A person rushes about restlessly, reflexively presses his hands to his chest or throat, groans.
Symptom # 7: The condition worsens in the morning and improves in the evening.

Symptom # 8: The patient stops responding to events that previously caused him a vivid emotional response. For example, a mother may stop worrying if her son stays with friends longer than usual, although she used to go crazy with anxiety.
Symptom # 9: A depressed person is constantly self-deprecating, feeling guilty, even if it is unfounded.
Symptom 10: Patients often look out the window or at the light source when talking - this is a very characteristic sign of depression, which is the first to catch the eye on examination.
Symptom 11: For patients with depression, a special posture is characteristic, the so-called "posture of submission", a kind of gesticulation directed towards oneself, lowered corners of the mouth and a specific sweet upper eyelid hanging at the outer corners of the eyes.
Symptom 12: Both subjective and objective deterioration in mental activity, pseudodementia. Patients often think they are starting to develop something like Alzheimer's. This is facilitated by the availability of information resources on the Internet and some similarity of the clinic of severe depression with this pathology.

"Two-point" symptoms

Symptom 13: Difficulty concentrating, subjective feeling of difficulty remembering.
Symptom 14: Decreased appetite, especially in the morning. By the evening, appetite may return to normal. At the same time, patients often refuse their usual food and eat only sweet or other high-calorie carbohydrate foods.
Symptom 15: Weight loss, which is sometimes significant. On the other hand, this is not a permanent symptom, since it happens, and vice versa, if the patient eats a lot of carbohydrate foods, more often in the evening, when the condition improves and appetite is restored.
Symptom number 16: From the moment of the onset of the disease, patients begin to wake up several hours earlier than usual, but, as a rule, do not get up, waiting for the morning in bed.
Symptom 17: You may experience insomnia or even a feeling that the desire for sleep is not appearing at all. Unlike a similar symptom in manic disorders, here insomnia is very burdensome for the patient.
Symptom # 18: Hypochondria appears - thoughts about existing diseases in the patient. Even if they are not there, the patient will find their symptoms, and, in the end, they may well actually appear. Senestopathies are also characteristic - non-existent discomfort in the internal organs.
Symptom 19: The speech of patients with depression is often slow, they can translate any conversation into their own problems, memories from the past.
Symptom # 20: Quiet voice, long pauses between words. The voice loses all directivity (commanding intonation).

Symptom # 21: The patient cannot immediately, clearly and clearly formulate his idea. In the worst case, he generally says that no ideas have occurred to him for a long time.
Symptom 22: Self-esteem drops sharply, self-confidence disappears, even if there are no objective reasons for this.
Symptom # 23: A feeling of inferiority, self-inferiority, which is very painful for the patient, may arise. This feeling is directly related to the ideas of self-blame, so characteristic of any depression.
Symptom # 24: Lethargy, the desire to be alone, if possible.

"One point" symptoms

Symptom 25: Decreased sex drive. This symptom does not occur in all patients, since another option is also possible - sexual satisfaction sometimes somewhat relieves the state of anxiety, in which case libido remains normal or even increases (this, of course, is not typical for severe depression).
Symptom # 26: Sometimes self-hatred can develop in patients into aggression towards others. This symptom is most common during adolescence.
Symptom # 27: Dark, nightmarish dreams that patients remember well and then over and over again can scroll in their thoughts.
Symptom # 28: Time seems endless, it is very difficult for the patient to wait.
Symptom number 29: Patients with great difficulty force themselves to get out of bed in the morning. With severe depression, a person may even simply not do this, not paying attention to the fact that they need to do some business.
Symptom 30: Patients stop caring for themselves, pay less attention to themselves than before.

Interpreting Results

Calculate the total number of points and determine which of the four groups you belong to.

A. Group 1, 50-66 points, or at least three signs worth 3 points: You have a serious affective disorder that is unlikely to be post-stress or related to a life event. You are absolutely shown to see a psychiatrist as early as possible to correct your condition. In your case, you need treatment with a suitable group of antidepressants, sedatives, normalization of your lifestyle and, of course, individual psychotherapy.

B. Group 2, 30-49 points: you have many signs of depression, and this is most likely it. Also, your condition may be a manifestation of dysthymia if it lasts more than a month, but in this case, dysthymia is severe. You should definitely contact a psychiatrist with an additional specialization as a psychotherapist in order to comprehensively correct your condition with the help of psychotherapy and medicines.

C. Group 3, 11-29 points: perhaps you are just a very impressionable person and react sharply to any unfavorable circumstances. Your condition can hardly be called depression, at most - hypothyroidism, but you can turn to a psychotherapist or medical psychologist who will definitely help you get rid of your problem.
D. 4 group, 0-10 points: most likely, you have no depression at all, and you do not need to worry.

Many people have developed morning depression in recent years. Quite often in the morning it becomes hard to wake up, even a cup of coffee cannot help to get out of the state of somnambulism, life seems gray and boring, work is just awful, and personal life is once and for all failed.

And such a negative state of mind should be fought without fail, because otherwise the whole day may go down the drain, and then these days will become habitual, and soon a person may forget that he once felt peace and joy.

Traditionally, this state of mind is exacerbated in the fall and spring. And the autumn and winter weather in itself evokes sad reflections and evokes an association with boredom, emptiness and death.

Such a diagnosis as depression denotes a mental disorder characterized by a feeling of melancholy, low mood, a feeling that life is over.

In some cases, this condition is characterized by inhibition of movements, slow thinking, in some cases, excessive excitement. Appetite may be impaired, libido decreased, sleep disturbance observed.

It should be remembered that in some cases, at the initial stage, depression can be overcome by adopting some good habits.

You need to remember that it is you who are now the center of the universe, and it depends on you what your life will become.

First of all, in order to have an excellent mood and well-being in the morning, you should sleep as much as possible. In this case, you should sleep in a row for at least eight hours. It is with healthy sleep that mental and physical health begins.

Try to be positive in the morning. You should stretch, then yawn, pull your hands and feet back and forth, and then you need to rotate them.

The next step to awaken the body is to massage and blink. You need to blink with effort, quickly. Then you need to circle your palm over the hips, chest, stomach. It is also necessary to massage the head a little in a circular motion, as well as the ears, which have almost all the nerve endings.

Then you should go to the window, open it and get some fresh air. In this case, you need to exhale through the mouth, inhale through the nose. You need to breathe deeply so that the air reaches the lower parts of the lungs.
Such breathing exercises allow the brain and heart to receive enough oxygen - and the depression will recede.

The shower should be cool, but you should not immediately make ice water, as this will be stressful for the body. The water should be gradually made colder.

Also, a good auto-training will be the opportunity to express your concerns. To do this, you can take a regular sheet of paper and write down all your negative thoughts. Then you need to think about what you have written, remember the moments of happiness and joy in the past, and realize that life itself is beautiful.

In addition, one can imagine a situation that is much worse than the current one, and thus it is possible to realize that many problems can in fact be solved.

Depression is a mental disorder that is accompanied by feelings of longing, apathy, and a negative attitude. Morning depression occurs in many people. This may be due to the changing seasons, for example, very often there is an autumn or spring blues. A person can become moody and return to normal mental balance, or they can fall into deep depression. There can be many reasons for this. If after a week or two a person does not return to his normal life, then he needs professional help.

Clinical picture

It is important to remember that depression is a serious medical condition that requires treatment.

Like any disease, depression has its own symptoms. The main signs of a depressive state are:

In addition to emotional symptoms, there are physical signs of depression that can manifest in a wide variety of symptoms. Depression can cause a variety of medical conditions. Insomnia, loss of appetite, disturbances in the functioning of the gastrointestinal tract, headaches, decreased libido, nervousness, malfunctioning of the cardiovascular system and many other pathologies may indicate the development of a depressive state in a person.

Depression treatment

The approach to dealing with depression must be comprehensive. The patient can independently try to restore mental balance using all the means known to him that brought him joy. If such therapy will not bring results for a long time, it is better for the patient to start taking medications, the choice of which should be made by the doctor. Self-selection of drugs is prohibited, because there are many contraindications and side effects. Treatment should be carried out strictly under the supervision of a specialist.

Prevention

Morning depression can occur simply as a sign of systematic lack of sleep. A busy working day, constant stressful situations, unhealthy diet and lack of food also contribute to the development of mental disorders.

The first method of dealing with a depressive state in the morning should be sound sleep, which is at least 8 hours. After waking up, the patient will benefit from a contrast invigorating shower. The contrast should not be too sharp; it is better to start with slightly cool or warm water.

Eating a good, balanced diet will help improve your well-being. Lack of vitamins can significantly reduce performance. Physical activity will be helpful. For example, regular gymnastics in the morning or jogging in the morning will help to improve blood circulation, metabolism and the production of all the necessary hormones. A fulfilling sex life is also an integral part of the prevention of depression.

It is important that the sick person has the opportunity to do what they love, which gives him joy. The support of relatives and loved ones greatly contributes to the patient's recovery. It is desirable that communication brings the patient positive emotions.

Finally

It should be remembered that there is no universal cure for depression. Some patients cannot get rid of depression for years. It is important that the patient himself understands the need for treatment and makes efforts. A quick cure for depression is almost impossible, so the patient and his loved ones should prepare for a long recovery period.

With any type of depression, sleep is disturbed: a depressed psyche causes a sleep disorder, and vice versa, chronic lack of sleep leads to a depression.

By According to statistics, sleep is disturbed in 83% - 100% of people susceptible to this disease. Patients reasonably complain about, the duration of which is not much less than that of healthy people, but its structure is thoroughly disorganized.

Common features of sleep for depression:

• falling asleep is difficult and tiring,
• night awakenings are more frequent and prolonged than in a normal healthy state,
• superficial sleep stages prevail over deep sleep stages,
• rapid eye movements in paradoxical sleep are more frequent,
• the fourth stage of the slow phase of sleep is twice as short as usual,
• rapid (paradoxical) sleep is supplanted by drowsiness,
• an electroencephalogram in REM sleep registers sleep spindles, and in wakefulness - delta waves inherent in deep sleep,
• earlier awakenings in the morning.

Depression, depending on the cause, is subdivided into endogenous and reactive:

• Reactive - triggered by a traumatic situation
• Endogenous - by internal causes.

With endogenous depression

a person falls asleep safely, but suddenly wakes up at night and spends the rest of it in a gloomy state, languishing with a vague and very heavy feeling of fear, guilt, melancholy and hopelessness. This mood can trigger suicidal thoughts.

Patients complain about the lack of normal rest, the head is constantly busy with thoughts. Apparently these thoughts are the "thoughts" of superficial sleep. Normal falling asleep gradually also goes wrong and the patient has to use.

Wakefulness in them is replaced by prolonged drowsiness with frequent awakenings, or immediately by rapid sleep. In the morning they doze or stay awake, while healthy people sleep REM sleep and dream.

In depression, the picture of sleep demonstrates increased activity of awakening mechanisms and suppression of the fourth phase of slow wave sleep. With a severe degree of the disease, paradoxical sleep occurs more often than usual, but due to repeated awakenings it cannot be fully realized.

After treatment, he returns to normal, but the fourth stage often does not return and sleep remains superficial.

It should be noted that endogenous depression is the most severe of 59 types of depression. This is due to hereditary factors and metabolic disorders.

Latent depression

Latent or disguised (bodily) depression is often not diagnosable. However, early morning awakening, "broken sleep", decreased vitality and expression of active emotions are characteristic symptoms even in the absence of a painful mood.

The main complaint with this form of the disease is. The name is fully justified - depression is masked by physical ailments, often severe.

Seasonal depression

This type of disease has a seasonal orientation: it manifests itself with a reduction in daylight hours in autumn and winter in people prone to this, more often in women. Seasonal depression affects 5% of the world's population.

Typical symptoms:

• increased morning and daytime sleepiness,
• overeating, craving for sweets. As a result, an increase in body weight.
• the duration of sleep, compared with the summer period, is increased by 1.5 hours,
• the night's sleep is incomplete and does not bring rest.

Sleep patterns for various depressive syndromes

Dreary depression characterized by:

• loss of energy at the end of the day (feeling akin to a hangover),
• difficult falling asleep, lasting about an hour, accompanied by painful thoughts and bitter thoughts,
• light sleep, control over the outside world does not weaken, which does not give a feeling of rest,
• very early awakening (2-3 hours earlier than usual),
• unwillingness to get up after waking up, the patient lies for a long time with his eyes closed,
• broken state after lifting.

Such abnormal sleep increases the feeling of despair and oppressive pain, it does not bring a feeling of freshness and relaxation. As a result, wakefulness is sluggish, often with headaches.

Apathetic depression:

• waking up later than usual by 2 - 3 hours,
• constant sleepiness - morning and afternoon,
• the boundaries between wakefulness and sleep are blurred.

Patients are ready to spend the whole day lying in bed, calling sleepiness laziness. Sleep does not bring proper rest, but it is not considered a problem.

Anxious depression:

• drowsiness is reduced,
• disturbing thoughts cause long sleep,
• shallow sleep, restless dreams,
• frequent awakenings, sudden awakenings are possible, accompanied by sweating and shortness of breath from unpleasant sleep.
• Early awakenings (1 hour -1.5 earlier than usual).

Most of the patients complain that sleep does not bring rest.

The nature of dreams for various depressions

In any type of depression, REM sleep, which is responsible for dreaming, is disrupted. This affects the character and plots:

Dreary state - rare dreams are painful, gloomy and monotonous, filled with stories about an unsuccessful past life.

Apathetic state- rare, isolated dreams are poorly remembered and poor emotionally.

Anxiety -plots change frequently, events are fleeting, directed towards the future. Dreams are filled with catastrophic events, threats and persecution.

CLASSIFICATION OF CAUSES OF SLEEP DISORDERS
(proposed A.M. Wein, an outstanding Russian sleep doctor, and K. Hecht, a German scientist)

1. Psychophysiological.
2. Insomnia in neuroses.
3. With endogenous mental diseases.
4. With the abuse of psychotropic drugs and alcohol.
5. When exposed to toxic factors.
6. With diseases of the endocrine system (diabetes mellitus, for example).
7. Organic brain diseases.
8. Diseases of the internal organs.
9. As a consequence of syndromes that occur during sleep (sleep apnea).
10. As a consequence of the violation of the cycle "wakefulness-sleep" (suffering of owls and larks, shift workers).
11. Shortened sleep, constitutionally conditioned (Napoleon and other short-sleepers. True, it is a stretch to refer them to sleep deprivation).

Used materials from the book by A.M. Wayne's "Three-thirds of a Life".

For relaxation, I propose to see how beautiful our Earth is.

Elena Valve for the Sleepy Cantata project.

“I absolutely do not want to get out of bed in the morning. I don’t want to go to work, the mood is lousy, I don’t want to communicate with anyone ”

“I don’t want to eat anything, I lost weight, I think all the time that I’m a failure. Colleagues say they value me at work, but I am sure that I am about to be fired. "

“My head often hurts, everything has become completely uninteresting. I began to sleep badly.
I can't understand what's wrong with me "

What unites these people? All of them, in one form or another, suffer from depression. Now this word can be heard very often, but what is depression really?

What is depression?

First of all, depression is a disease. But how do you tell depression from just being in a bad mood?

In a state of depression, a person's mood is lowered for a long time, what used to be enjoyable and interesting ceases to be so. Physical weakness appears, sleep is often disturbed and appetite disappears, weight decreases. Ideas of guilt arise, the future looks bleak, self-esteem and self-confidence are diminished.

Not every depression in mood is depression. For a diagnosis, this condition must last at least 2 weeks. In a chronic course, periods of depression can last for 6 months or more. The depressive state varies greatly in severity: from depressed mood to severe depression in which a person cannot get out of bed. Depression is often combined with anxiety; this is the so-called anxiety depression.

Sometimes a person does not feel depressed at all, but instead complains of bodily symptoms - heart pains, migraines, skin and gastrointestinal tract diseases. This happens when a person does not know how to react to a situation with the help of their emotions.

What is the cause of depression?

"It all started for me for no reason, like everything in life was normal, and suddenly - depression"

In fact, depression doesn't happen without a reason. It's just that in some cases, the reasons for it are obvious - some kind of serious life shock (divorce, loss of a loved one, loss of work), and in others, depression occurs for no apparent external reason. But even in this case, there are reasons.

Scientists now believe that depression is caused by a combination of factors. In some patients with depression, genetic factors play a role, i.e. a predisposition to depression can be inherited. But it is not the depression itself that is transmitted, but only the predisposition. If you have a predisposition to depression, this means that it can manifest itself only under certain adverse circumstances. Psychological factors play an important role in the development of depression, in particular, upbringing, family environment, and severe stress during childhood (for example, separation from parents).

An important factor in the development of depression is the particular style of thinking that contributes to depression.

Thinking traits that contribute to depression

“I have been working for the company for 3 years. He rose to the head of the department. But I feel like a complete failure, because I set myself the goal of becoming a deputy director ... "

“I failed the interview. It seems to me that people like me are not hired "

Let's take a closer look at some of the thinking patterns that can lead to depression.

• Perfectionism. You are sure that you should achieve only the best results in everything. People with depression are rarely satisfied with what they do because they set very high standards for themselves. Perfectionism forces them to work with overexertion, which causes severe exhaustion and constant anxiety about the result.
• Black and white thinking. You think on the principle of "all or nothing" - "If I did something by half, then I did not do anything", "Either I won or I lost." This way of thinking is very dangerous, because it does not allow a person to see intermediate options for the development of events.
• Catastrophization. When some minor nuisance occurs, it seems to you that a disaster has occurred. "If my child gets a grade at school, it means that he will not be able to study!" Catastrophic thinking is very anxiety-provoking and energy-consuming.
• "I should". You constantly tell yourself that you have to: be a good husband / wife, parent, employee, always keep up with everything, not get angry with other people ... The list goes on and on. The so-called "tyranny of obligation" does not allow a person to enjoy life and take time for himself.

These are not all thoughts that contribute to the development of depression. Anyone has many of them, but they take up most of the time in patients with depression. Psychotherapy can help combat these thoughts and develop more realistic thinking.

How can depression be treated?

If you are suffering from depression, the first thing you should do is see a psychiatrist. Unfortunately, very often in our country, people are accustomed to referring to psychics and fortune tellers rather than to medical specialists. Only a psychiatrist can correctly diagnose you and decide if you suffer from depression.

Depression is treated like with psychotropic drugs - antidepressants, prescribed by a doctor, and with the help of psychotherapy (it can be carried out by a psychotherapist or clinical psychologist). In severe depression, antidepressant treatment is essential. in this state, thoughts of suicide and attempts at suicide are not uncommon. It is best when antidepressant treatment is accompanied by psychotherapy. In milder forms, psychotherapy alone can be dispensed with.

"The doctor prescribed antidepressants for me, but I am very afraid to take them, I heard that they are addicted to drugs, and they also make you very fat"

Antidepressants are medications for depression. There are many types of antidepressants now. Modern antidepressants are much more easily tolerated by patients and have fewer side effects. Only a psychiatrist should prescribe and stop antidepressants. He will also tell you about the peculiarities of taking and acting on these drugs.

The belief that antidepressants cause drug addiction is a big misconception. With proper treatment under the supervision of a psychiatrist, this does not happen. It is very important that you are in constant and regular contact with your doctor. Don't be afraid to ask questions about your medication, how the drug works, and side effects. The various side effects of antidepressants are relatively easy to deal with and reversible.

"I started taking antidepressants, I drank for three days, no result - I quit"
"When I got better, I dropped the pills and everything started again," - this is often heard from patients. The fact is that antidepressants begin to act gradually, accumulating in the body and the full effect appears after about 2 weeks. You can not independently cancel antidepressants and change the dose yourself.

Do not think that you will have to drink these medicines all your life. With the right treatment, you will be able to manage without them over time. But at the same time, you must tune in to a long process of treatment. It's also important to understand that there can be some ups and downs in the treatment of depression. If you feel worse for a while, despite taking antidepressants and psychotherapy, do not despair. Such periods are associated both with external circumstances and with the individual action of the antidepressant. Talk to your doctor so that he can change the treatment regimen as needed. If you are undergoing psychotherapy, do not be afraid to tell the therapist about the deterioration in order to develop further strategies.

What is psychotherapy?

What is psychotherapy? To put it simply, psychotherapy is a word heal. A psychotherapist helps a person to independently understand what his feelings and actions are dictated by. Precisely on their own, because many people have a wrong idea of \u200b\u200ba psychotherapist as a person who will give specific instructions on how to live correctly. In fact, advice can be given by many, but they rarely make life easier, since they are most often based on the experience of the advisor. And the role of the psychotherapist is completely different - he creates conditions in which a person makes decisions himself, begins to better understand what is really behind his problems.

The most recognized and widespread throughout the world are two types of psychotherapy - psychoanalytic psychotherapy and cognitive-behavioral psychotherapy.

Psychoanalytic psychotherapy is the oldest form of psychotherapy in use today. One of the main ideas of this type of psychotherapy is the existence of an unconscious sphere of the psyche. Thoughts and desires that are unacceptable to us are often not realized by us. For example, you cannot understand why, for no apparent reason, you have a strong dislike for someone. This person may remind you of someone significant to you, but this similarity is not recognized. Until you remember who you are really angry with, it will be difficult to get rid of the irritation.

Relationships are another important target of psychoanalytic therapy. They are often built on the experience of previous relationships (early childhood experiences are especially important). Most often, in adults, memories of childhood are greatly distorted and their connection with current relationships is not obvious. Moreover, it is very difficult to grasp some repetitive stereotypes in the relationship of an adult. For example, some women are constantly involved in close relationships with men with alcoholism. During psychotherapy, these stereotypes are realized and their connection with past experience is established.

Psychoanalytic therapy - a long procedure. It can last for several years with a frequency of two to five times a week. There are relatively short-term forms - 1-2 sessions per week for several months to a year.

Cognitive Behavioral Therapy - a younger direction in psychotherapy. The main idea of \u200b\u200bCBT is the dependence of a person's emotions and behavior on his thoughts.

All people have so-called automatic thoughts. These are thoughts that come to our minds automatically and are not disputed by us. For example, a patient says that her mood deteriorated badly after her boss looked at her. After analyzing this situation, it turned out that an automatic thought flashed through her, “If the boss looked at me, then he is not happy with me!”, And it was she who spoiled the woman's mood.

If you learn to catch these thoughts, check their correctness (“What does it say that my boss is unhappy with me?”), And challenge, then you can get a powerful means of regulating your own emotional state. Behind automatic thoughts are deep beliefs about oneself, about people, about the world around them, which are formed in childhood and are often not realized. You can also work with them, being aware and changing, if necessary. In CBT, a system of homework and behavioral exercises is widely used. CBT is shorter-term than psychoanalytic therapy (20-40 sessions once a week).

What happens if depression is not treated?

"Bad mood, you think that now every trifle is being treated or something", "You are a man, pull yourself together, why are you mocking?" - this can be heard all the time. Many people suffering from depression do not seek help because they believe that it is a shame that they have to cope with problems on their own. This is a very big mistake. Why?

• firstly, depression is difficult to cope with on your own, and advice to pull yourself together will not help here. Seeking help is not a weakness; on the contrary, you need to have a lot of courage to admit your problems and fight them. Seeing a specialist is your first step towards recovery. Turning to a specialist, you make a conscious choice in favor of health.
• secondly, depression without treatment leads to dire consequences:
  • People who have not received treatment for depression for many years may lose their jobs, lose friends. Also, they often have family problems, up to the destruction of the family.
  • If a person has suffered from depression for many years without receiving any help, their treatment may be more difficult and longer.
  • Alcoholism can be a dangerous consequence of depression without treatment. According to some reports, up to half of people with alcoholism are diagnosed with depression, but have never received appropriate treatment. Alcohol has a short-term antidepressant effect. But over time, it only intensifies depression, not to mention the emergence of alcohol dependence.
  • Finally, the most dangerous consequence of depression without treatment is suicide attempts. If you have suicidal thoughts, see a psychiatrist immediately.

Can you work when you are being treated for depression?

“The doctors diagnosed me with depression. I decided not to work, because overexertion, stress at work is harmful to me. I have been sitting at home for two years, sadness "

“I decided to fight depression. I thought that if I worked harder, there would be no time to think about nonsense. Loaded myself with work, but realized that I could not cope "

So after all, which is more correct - to work or not? In fact, for a person suffering from depression, moderate activity is essential.

It is very important to try to entertain yourself, go to the store, walk, meet friends, even if it does not bring the former pleasure. The following paradoxical principle is important here - "I will have to live with depression for a while." This means that you do not have to wait until you are fully recovered in order to start doing something. Many patients say: "When I feel that I have recovered, then I will move mountains, and now I am not capable of anything." It is not right. You need to start trying to do some business, being in a state of depression.

If you are undergoing treatment for mild to moderate depression, you may well be able to work. But it is very important to adjust your work schedule. Avoid unrealistic deadlines and rush jobs. Try not to work overtime. Do not try to cope with depression by loading yourself with a lot of things. This can lead to rapid exhaustion and worsening of your condition. It is important to understand that depression is not a time for big changes and decisions. Give yourself permission to take small steps.

If you are undergoing treatment for severe depression and cannot work, do not despair. Let your treatment be your job for a while.

In any case, discuss work-related issues with your doctor or psychotherapist.

Can you help yourself on your own?

As mentioned above, depression is a disease that specialists treat. And your first task is to find those who will provide you with qualified assistance. But you must understand that without your efforts, the results of treatment will be much worse or appear slower. So what can you do to ease depression treatment?

1. Observe the daily routine
   • It sounds corny, but proper sleep and rest patterns are very important for improving your condition. Try to go to bed and get up in the morning at the same time.
   • Avoid taking sleeping pills on your own (without the recommendation of your doctor). Although sleeping pills can help you fall asleep quickly, this sleep is different and less beneficial for you. If you take sleeping pills uncontrollably, increasing the dosage, after a while you will not be able to do without them.
   • Don't go to bed too early. If you have been going to bed at one in the morning all your life, do not try to fall asleep at 22.00.
   • Try not to sleep for more than 20 minutes during the day to avoid disturbing your night's sleep.
2. Go about your daily activities

   Often people in a state of depression completely stop doing their daily activities, to the point that they stop taking care of themselves. And the longer they do not engage in daily activities, the less confidence they have that they can handle life. As already mentioned, begin to act in small steps, without waiting for the end of the depression.

   • Start doing things that brought you pleasure - read magazines, go for walks, pursue your own hobby. An important principle - do it even if you do not get the same pleasure as before.
   • Engage in self-service. Take a shower, do at least a minimum exercise. Try to cook your own food at least occasionally. Even if you are severely depressed, doing your daily activities will help you feel able to cope with them. An important principle is not to ask too much of yourself.
3. Maintain communication

   Yes, when a person is experiencing depression, communication can be difficult. However, if you keep in touch with people, your healing process will go faster. You will feel that you are not alone and you will be able to find someone who will understand you.

   • Do not hide from loved ones that you suffer from depression. Try asking them for support. The constant mask of good mood and the fear of appearing weak take away your strength and increase depression
   • Try to stay in touch with your friends. The principle already mentioned is also important here - do so, even if it does not bring the former pleasure yet. Try to take an interest in their life, this will help you break away from the constant fixation of your own problems.
4. Avoid alcohol, drugs and stimulants

   As already mentioned, alcohol brings temporary relief, but then only worsens depression and ruins your life. The same thing, only more so for drugs. It is also important to limit your caffeine intake because Excessive stimulation of the nervous system can result in increased depression.

One well-known psychotherapist when asked a patient "Who is recovering from depression?" answered: "He who is being treated gets well." Remember this principle, and you can return to normal life.

Kochetkov Ya.A., Moscow Research Institute of Psychiatry
Scientific and Methodological Center for Psychoendocrinology
psyend.ru/pub-depress.shtml

There are many types of depression. Some types of depression are characterized by diurnal variations associated with worsening symptoms at certain times of the day.

Depression in the morning - causes

Doctors don't know the exact cause of morning depression, but there are many factors. Because morning depression occurs around the same time every day, doctors often associate it with an imbalance in a person's circadian rhythm. Hormonal changes can affect your circadian rhythm. One of these hormones is melatonin, which causes drowsiness.

Some people who do not have symptoms of clinical depression often experience mood swings throughout the day.

Research shows that imbalances in circadian rhythm, sleep quality, and light intensity can lead to mood changes, especially in depressed patients.

In addition to changes in the body's natural rhythms, several other factors can contribute to morning depression and depressive disorder. These factors include:

• a family history of depression;
• drug or alcohol addiction;
• medical conditions such as sleep disturbance, chronic pain, anxiety, and ADHD;
• recent life changes, such as divorce or loss of a loved one;
• injury.

Symptoms of morning depression

Symptoms of depression can include feelings of helplessness, sadness, and hopelessness, and they can get worse in the morning. The general term for this diurnal variation is morning depression.

Daytime depression means symptoms appear at about the same time every day. For some, these symptoms appear in the evening.

Symptoms of depression can include decreased or no pleasure in exercising. Symptoms may subside during the day.

Other symptoms include:

• depressed mood lasting most of the day;
• significant weight loss or decreased appetite;
• sleepiness during the day;
• anxiety;
• tiredness or feeling of lack of energy;
• feelings of worthlessness or excessive guilt
• difficulty concentrating, thinking, or making decisions;
• repetitive thoughts of death, suicide, or self-harm.

In addition, a person with morning depression may notice the following symptoms:

• it is difficult for him to wake up in the morning;
• physically difficult to get out of bed;
• difficulty thinking, especially in the morning;
• difficulty doing normal morning tasks, such as dressing and brushing your teeth.

In a person with morning depression, these symptoms diminish or disappear during the day.

Depression in the morningdiagnostics

To diagnose depression, the doctor must ask the person about the symptoms. He may ask questions about changes in mood, sleep, weight, and appetite. The doctor will try to determine how long these symptoms last, get better, or get worse.

The doctor will also try to rule out others possible reasonssuch as a health condition that can cause similar symptoms. Hypothyroidism is one example.

Certain medications can also lead to mood changes and depression symptoms, so your doctor will ask you about the medications you are taking.

Depression in the morningtreatment

There are many treatments for depression, such as:

Psychotherapy

This treatment helps a person recognize negative thinking patterns and learn positive behaviors.

Drug treatment

Antidepressants, mood stabilizers, and antipsychotics.

Exercises

Regular exercise, especially outdoors, can reduce symptoms of mild to moderate depression.

Transcranial brain stimulation

Brain stimulation techniques such as electroconvulsive therapy and repetitive transcranial magnetic stimulation can reduce symptoms of severe depression.

Some people also take advantage of alternative therapies, including acupuncture, meditation, and yoga. While they can help people feel better and maintain good mental health, they should not replace treatment for major depressive disorders.

When treatment is carried out, the person must change habits to help manage the symptoms.

Prevention of morning depression

Positive changes can include:

Improving sleep hygiene

A person can improve sleep quality by darkening the bedroom, keeping the temperature cool, and eliminating distractions such as cell phones, computers, and televisions.

Preparing for the next morning in the evening

Preparing clothes and items for work or school, and preparing breakfast in advance can make the morning easier.

Get enough rest

Going to bed and waking up at the same time can help relieve symptoms.

It's important to wake up earlier or adjust your work schedule to reduce stress in the morning.

Using light signals

Light can tell the body that morning has come and it is time to wake up.