Atypical Depression

The insidiousness of this disorder of the psyche is not even in the difficulty of its diagnosis. Depressed (depressed) condition is associated in everyone with retardation, apathy, lack of appetite and dreary nights without sleep. A person who eats with appetite, gets better, sleeps hard and long, reacts violently even to trifling events, even with some growing depression and anxiety, does not look in the eyes of others, and even his own, a victim of depression. Especially in the initial stages of the development of mental disorders. Atypical depression belongs to affective disorders characterized by special symptoms, so most patients, according to psychiatrists, remain outside their field of vision. Simply because neither they, nor their loved ones, consider that they need psychiatric help.

[1], [2], [3]

Epidemiology

The morbidity statistics show that depressive disorder is the most common among the mental disorders. Every year, approximately 200 million people in the world seek medical help, and as a result of the survey, they are diagnosed with depression. According to forecasts, one-tenth of the male population and the fifth female are most likely to face a variant of the depressive episode. It is believed that half of people who are depressed do not go to the doctor, because they do not consider themselves to be sick.

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

[4], [5], [6], [7], [8],

Causes of the atypical depression

The etiology of the majority of psychiatric disorders has been studied to the present day, depression is no exception. In modern psychiatry, the so-called monoamine theory is prevalent, in which depressive disorders, including atypical disorders, are viewed as a consequence of the imbalance of neurotransmitters, the primary mediators transmitting electrochemical impulses between neurons of the brain, and also to tissues and cells belonging to the group of monoamines . Deficiency of serotonin and / or norepinephrine, as well as dopamine is assumed to be the basis for the development of a depressive disorder. The immediate cause of this imbalance is not known. The processes occurring in the brain are too complicated, at the present level it is impossible to fix the reactions occurring at the level of a single synapse. However, the role of these neurotransmitters in the onset of depression and the risk factors that contribute to this are not in doubt. These include:

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

[9], [10]

Risk factors

People at risk are those who survived depression at an early age, severe stress, whether they are single or chronic, who are victims of physical or psychological violence; suffering from a serious incurable disease; lost a loved one dearly loved; suddenly changed life stereotypes.

[11], [12]

Pathogenesis

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

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

The functions of monoamine neurotransmitters are distributed as follows:

• serotonin - provides mood enhancement (thymoanaleptic effect); controls the level of aggression; leads impulsive drives; regulates the feeling of satiety and hunger, alternation of periods of sleep and wakefulness; provides an analgesic effect;
• norepinephrine - carries, so to speak, the mental accompaniment of stress, activates the wakeful nervous system, depressing the sleep centers; includes stress-induced insensitivity to pain; participates in increasing the level of motor activity, cognitive processes, regulates many other motivational processes and biological needs.
• dopamine - is produced during a positive experience, provides the development of psychological motivation for various activities.

The fact that these neurotransmitters are actively involved in the development of depression is not in doubt. However, it is assumed that there are several more complex and related mechanisms. Violation of the biomolecular interaction of norepinephrine and serotonin is not the only process that triggers the development of pathology.

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

It is obvious that in our days all the pathogenetic links that trigger the mechanism of depression have not yet been identified, they are in fact much more. The reference point can serve as a combination of a deficiency of monoamines with the pathopsychological personal characteristics of the patient. Depressive disorder occurs with the pathological functioning of the hypothalamic-pituitary-adrenal, as well as the limbic system, which coordinates the impulses sent to the hypothalamus, and its impulses are transmitted to the hippocampus responsible for the emotional response. Violation of the function of the reticular formation leads to a deficit of adrenergic neurotransmitters and a decrease in the biological tone of the brain's mechanisms controlling the mood.

[13]

Symptoms of the atypical depression

Until now, specialists have not come to the conclusion of what kind of mental disorders include atypical depressive episode: whether to interpret it as a kind of dysthymia - a chronic less pronounced, however, a longer (at least two years) form of depression; or - as an easy form of bipolar affective disorder with a more flattened symptomatology, that is, a blurred version of manic-depressive psychosis.

The first signs, characteristic precisely for a given form of neuropsychic disorder, look like this:

• instant situational reaction, and after positive events and even memories of them, the patient feels a sharp improvement in his condition;
• the patient and his environment begin to notice the craving for food intake, which was not characteristic of the individual before (it can be too frequent snacks or vice versa, rare but very plentiful, preference is given to sweets, pastries, chocolates), which entails a sharp set of weight;
• the patient becomes an amateur to sleep, regularly wakes up late, complains of drowsiness during the day, which is not related to the previous lack of sleep;
• begins to show inadequate sensitivity to negative comments about his actions, to refusals and disagreement with his opinion - the reaction looks like a hysterical, emotional explosion, tears;
• complains of paresthesia of the limbs - tingling, numbness, leaden heaviness.

In addition to the five main symptoms, which distinguish atypical depression from other types of depressive disorders, there may be other, characteristic for this pathology in general: a decrease in sexual desire, fatigue, weakness or, on the contrary, abnormal agitation, pain syndromes not stopped by anesthetic drugs - migraine, dental, cardiac, stomach pain, and also - digestive disorders.

There are no specific external signs indicating the presence of depression in a person, however, certain behavioral features may indicate the likelihood of a depressive disorder. The surrounding people should pay attention to the fact that a person familiar to them always has a very worried look; when talking, he constantly looks away; became noticeably more inhibited - speaks slowly with long pauses, as if recalling words and constantly thinking, or, conversely, abnormally excited. It gives a depressed untidy appearance, illogical actions and reasoning, self-flagellation or belligerence and challenge, tearfulness and invariably sad look, sometimes a man stops for a long time in complete immobility.

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

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

The dominant symptoms are the following atypical depression, in which:

1. The reactivity of mood prevails, which is reflected in its improvement in response to events that the patient evaluates as positive. The disorder itself develops as a recurrent one, that is, episodes of depression periodically recur, however, manic episodes with an amnestic component, delirium and hallucinations are absent. Perhaps periodic excitement and hyperactivity, following immediately after depression, which can be estimated as hypomania. The severity of this type of atypical depression is the easiest, the level of adaptation of such patients is the highest in comparison with below the following types of disorders.
2. The inversion of vegetative disorders, manifested by an excellent appetite with a preference for a high-calorie diet, up to overt eating and drowsiness prevails (the sleep "piles", mainly in the afternoon, sometimes it is very difficult for a patient to wake up in the morning, which is not related to lack of sleep). In this case, atypical depression develops as a bipolar disorder with a significant disturbance of activity and mood. Characteristic of the development of the disease at an earlier age, frequent depressive periods are replaced by mild manic, a pronounced pattern leads to more frequent calls for psychiatric care. The disease occurs as an alternation of diametrically opposite episodes with persistent symptoms of drowsiness and overeating during the depressive phase. The mood intervals corresponding to the norm become shorter or the pathology proceeds continuously from the very beginning without any gaps of enlightenment. The recurrent course of atypical depression with a predominance of disturbances in sleep and eating was practically not noted.
3. The prevalence of sensitivity to rejection is expressed in hypertrophied resentment, with the perception of any remark or behavioral change of others in their address. The patient's reactions are expressed by hysterics, outbursts of rage, obvious (aggression, avoidance) or concealed (cold, hostile attitude towards the alleged offenders and "enemies") rejection. Patients have difficulty in building interpersonal connections and social adaptation. For this type of disorder is characterized by a recurrent type of flow, in which severe melancholic depressive episodes (provoked by individually unbearable situations) are interspersed with affective stages. In the dynamics of observations of such patients, the amplitude of the excitation bursts is clearly traced. The lowest level of adaptation was observed in patients with atypical depression with a dominant sensitivity to rejection.

The first and third type of atypical depression manifest in a more mature age from 30 to 45 years, whereas the manifestations of the second occur for the first time in adolescence and adolescence. The degree of severity of the disease increases from the first species to the third. For the disease, proceeding as a bipolar mental disorder, early diagnostics and a much greater number of polar episodes (depressive and hypomaniacal) in the anamnesis are characteristic, than for the recurrent type, which is characterized by a longer duration.

The so-called "lead paralysis" - the severity in the extremities with paresthesia phenomena, which occurs about half an hour (sometimes more), usually at times of psychoemotional stress or without the influence of a provoking factor, is equally common in patients with all types of disease.

[14], [15]

Complications and consequences

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

The consequences of a depressive disorder are:

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

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

Diagnostics of the atypical depression

Domestic psychiatry treats the term atypical as a deviation of symptoms, its inconsistency with the classical ideas of depression - inhibition in the affective, intellectual and volitional sphere (depressive triad). These symptoms are also present, but recede into the background. In ICD-10, an atypical depressive disorder is not isolated into an independent nosological unit, it is referred to other depressive episodes.

In DSM-4 (a diagonomic and statistical manual on psychiatry of the American Psychiatric Association), atypical depression is isolated in an isolated syndrome. The diagnostic criteria of atypical depression are named. A mandatory feature of this disease is the reactivity of mood. Optional, and optional criteria, so-called, optional symptoms are: drowsiness, overeating and associated weight gain, "lead paralysis" and an aggravated emotional susceptibility to rejection.

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

To assess the objective and subjective severity of the pathology of the patient tested by Hamilton and Beck, other tests can be used.

Instrumental diagnosis of patients with atypical depression includes computer and magnetic resonance imaging, electroencephalography and intervalcardiometry, which determine the rate of extinction of the skin-galvanic reaction after stress.

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

[21], [22], [23]

Differential diagnosis

Differential diagnosis, conducted after all possible examinations, makes it possible to distinguish depression from a normal physiological response to a stressful situation, as well as to exclude patients with severe chronic pathologies,  schizophrenia  and other congenital and acquired neuropsychic diseases that abuse psychotropic substances that take certain medications.

Treatment of the atypical depression

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

With atypical depressions with elements of apato-abulia and asthenic complaints, a non-selective monoamine oxidase inhibitor with psycho-stimulating action of Nialamides can be prescribed  . The drug irreversibly blocks the enzymatic activity of MAO and prevents the elimination of amino groups from the molecules of noradrenaline and serotonin, contributing to their cumulation in the brain substance. It is used in combination with psychotherapy. Contraindicated for sensitized patients, with agitation and expressed suicidal intentions, as well as for patients with heart failure, blood vessels, cerebral circulation, liver and kidneys. It causes excitation of the central nervous system, dyspepsia, hypotension, delayed emptying of the bladder. It is not recommended to take the drug at night (the last time the drug is taken at 5 pm). Accepted orally, starting at 25-50 mg once or twice a day, gradually increasing the dose (every two to three days by 25-50 mg), until the therapeutic effect is achieved. Then the dose is gradually reduced. The average daily dose is 100-200 mg, in cases of resistant to depression therapy it can reach 800 mg. Sometimes drip infusions are practiced. In combination with Nialamide, other MAO inhibitors, tricyclic antidepressants, are not prescribed, treatment can be started two weeks later. Increases the effect of barbiturates, painkillers, hypotensive drugs. Beztraminovuyu diet should be observed.

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

In atypical depression, especially in persons exhibiting suicidal tendencies, antidepressants from the group of serotonin reuptake inhibitors give a good therapeutic effect. They contribute to improving mood, normalizing sleep, removing feelings of fear and feeling unnecessary. Although these same drugs (like all antidepressants) can lead to excessive excitation and aggravation of suicidal tendencies in case of overdose or long uncontrolled use. Preparations with an active component of fluoxetine, such as  Prozac, selectively binds serotonin receptors, which contributes to its accumulation in the synaptic cleft and prolongs the stimulating effect of serotonin. The patient's anxiety and anxiety level decreases, the feeling of fear decreases and the mood rises. May cause vasculitis, hot flashes, hypotension, atrial fibrillation, increased arteries clearance, digestive disorders, pain along the esophagus; from the side of the nervous system and the psyche a lot of side effects inherent in depression; disorder of the genitourinary sphere, idiosyncrasy and serious allergic reactions, serotonin syndrome. Prozac can be used to treat pregnant women, teratogenicity is not revealed. If the mother is prescribed the drug in the third trimester, the first time observed the behavior of the newborn. Breastfeeding mothers should not use it, as it penetrates into breast milk.

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

Interacts with a variety of drugs, so if you need to combine it with any medicine, you need to exercise caution. Prozac is absolutely incompatible with oral antipsychotics Pimozide and Thioridazine, after discontinuation of which they maintain a time interval of at least 5 weeks. It is forbidden to combine it with MAO inhibitors. This applies to funds based on St. John's wort, homeopathic including. After stopping the use of drugs that inhibit the enzymatic activity of monoamine oxidase, the time interval is maintained for at least two weeks. During therapy, serotonin reuptake inhibitors do not consume alcoholic beverages and alcohol-containing medicines.

With atypical depression, hypersomnia is one of the symptoms. The production and level of the melatonin sleep hormone (serotonin derivative) also does not reach the norm. In addition to violations of sleep and wakefulness, this entails other disorders, in particular, eating disorders. With a large atypical depression with prevalent symptoms of hypersomnia and hyperphagia, a doctor may prescribe an antidepressant  Valdoxan. The active substance of this drug, agomelatine, has an affinity for melatoninergic (MT₁ and MT₂) and serotoninergic 5-HT₂ⅽ receptors, while not blocking others - α- and β-adrenergic receptors, benzodiazepine, histamine, dopamine and cholinergic. Agomelatine is particularly active in stimulating the release of dopamine and norepinephrine in the prefrontal zone of the cerebral cortex without altering the content of extracellular serotonin. The drug does not affect the ability to remember negatively and does not interfere with the ability to focus on any action. It synchronizes the intervals of wakefulness and sleep, normalizes its structure and duration, which is necessary for proper rest. In patients taking this drug, the frequency of violations of libido is reduced. Does not have hyper- and hypotensive effect, does not affect the pulse rate, does not cause dependence. The bioavailability of agomelatine is reduced in smokers and in male patients in relation to women. Teratogenicity of the drug is not revealed, but pregnant women are prescribed only for vital indications, nursing is advised to stop breastfeeding. It is not used in pediatrics and is not assigned to patients with hepatic dysfunction. Contraindicated to persons sensitized to components, and also - suffering from lactase deficiency. Particular care should be taken when appointing patients with suicidal tendencies. It is not necessary at the beginning of the treatment to perform work related to the use of complex and dangerous mechanisms.

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

Valdoxane is well tolerated by patients, however, allergic reactions and undesirable effects on the part of the digestive organs, especially the liver, nervous and other systems, are not ruled out. During treatment, patients are periodically made liver tests: before the start of therapy, and then - with an interval of three weeks, one and a half, three and six months.

It is not combined with alcohol and drugs that have a toxic effect on the liver, inhibiting the enzymatic activity of CYP1 A2. Interacts with many medications, therefore, if combined therapy is necessary, care must be taken.

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

Taking antidepressants (MAO inhibitors), you need to adjust your diet, excluding from it products containing tyramine, neutralizing the effect of the drug. The consequence of this combination may be migraine, hypertensive crisis and intracranial hemorrhage.

Tyramine is a trace amino acid that is formed in aged products of protein origin. Most of it is contained in aged cheeses, smoked foods and pickles, conservation and fried meat, fish, alcohol, less in plant foods - bananas, nuts, soy and beans. Cottage cheese, pickled and melted cheeses are allowed to be consumed.

Dietary nutrition in atypical depression pursues several goals, first, to ensure the effective use of drugs, secondly, to prevent weight gain, thirdly, to improve mood through nutrition and saturate the body with the necessary vitamins and trace elements. When a patient does not take antidepressants, products containing tyramine are not contraindicated, they contribute to weight loss, improve mood and metabolism. Fats of animal origin limit up to 10% of all fats in the daily diet, the rest should be vegetable fats and unsaturated fatty acids, 30% should be protein products, vegetable food (vegetables, fruits and cereals) prevails in the menu.

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

Treatment of atypical depression can be long, combining medicamental methods, vitamin therapy, psychotherapeutic and physiotherapy treatment.

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

Balanced nutrition, intake of vitamin preparations in combination with drug-free methods, individual or group psychotherapeutic trainings can help to cope with mild and moderate depression without the use of antidepressants.

Physiotherapeutic treatment in addition to medicinal and / or psychological care has a noticeable therapeutic effect. In the treatment of depression, various methods are used: transcranial magnetic stimulation, electroprocedures, light therapy, music therapy, color therapy, balneotherapy.

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

Alternative treatment

A good alternative to antidepressants are the recommendations of alternative healers. In combination with psycho-and physiotherapy, herbal therapy, provided that the individual desires to recover and return to full-fledged life, can be very effective. However, a prerequisite must be a thorough diagnosis and identification of all factors that affect the development of a depressive disorder. If medications are still necessary, then after consulting a specialist, drug therapy can be supplemented with alternative means.

As toning plant adaptogens, you can use:

1. The root of ginseng improves memory and vision, stabilizes the nervous system, has an anesthetic and immunomodulatory effect, tones up the entire body, participates in metabolic processes, normalizes blood formation, strengthens blood vessels, stimulates brain activity, relieves fatigue and increases efficiency. Contraindicated in patients with hypertension, tachycardia, overly excitable and suffering from insomnia. As a stimulant, alcoholic tincture of the ginseng root is used, for which the dried ground roots (50 g) need to be poured ½ liter of vodka (you can dilute 50 g of honey with it). Infused for three weeks in the heat, protected from direct sunlight. From time to time, a container with a tincture is recommended to shake. Tincture is measured with a teaspoon and taken inside before eating.
2. Golden root or rhodiola rosea - restores lost strength, including sexual interest, soothes and simultaneously stimulates the work of the central nervous system. The golden root normalizes the pressure, however, hypertensive patients with uncontrolled upsides should abstain from this remedy. The excitatory effect of this plant is lower than that of ginseng, in addition it can be beneficial for hypothyroidism and diabetes. Toning tincture is also prepared for alcohol, for which 50 g dried and grinded on a coffee grinder, the roots are poured with two glasses of quality vodka. Infused for two weeks at room temperature, protected from direct sunlight. From time to time, a container with a tincture is recommended to shake. Take first five drops before three meals. Then gradually increase the number of drops taken, stopping at 20 drops.
3. Maral root or levsea - contains carotene, inulin, vitamin C, alkaloids, flavonoids and essential oils. Drug use for medicines prepared from this plant activates vitality, increases efficiency, normalizes mood, sleep and appetite. The depressed state goes away, interest in life in all its manifestations returns, blood supply of muscle tissue, metabolism improves, which promotes motor activity and parting with excess weight. Basically as tonic tinctures on alcohol are used. From the root of the root it is prepared in the proportion of 15 g of the vegetable component in dried and crushed form per 100 g of vodka. Infused for two weeks at room temperature, protected from direct sunlight. From time to time, a container with a tincture is recommended to shake. Take on 20 drops before the morning and evening meals. Maral root is also taken in the form of a powder, dried and finely grinded, then thoroughly mixed with honey in the proportion: one part of the powder into nine pieces of honey. Dosage on a tablespoon three times a day. Evening reception is conducted no earlier than two hours before bedtime. It is not recommended to take hypertensive patients with glaucoma.
4. St. John's wort (perforated) - rich in B vitamins, tocopherol, ascorbic acid and carotene, contains essential oils, choline, flavonoids and traces of alkaloids. Everyone knows its anti-inflammatory and disinfecting effect, however, not everyone knows that this plant is a powerful natural antidepressant. Hypercine and hyperforin, part of this herb, provide it with an antidepressant effect. On its basis, the pharmaceutical industry of Germany produces the drug Gelarium Hypericum, shown for the treatment of depressive disorders. St. John's wort has no contraindications to medicinal antidepressants, it also stimulates the work of the gastrointestinal tract, does not cause drowsiness and inhibition, which is valuable in the treatment of atypical depression. To treat this condition, alcoholic tincture is best suited: on vodka it is prepared in a proportion of 1: 7, and for alcohol 1:10, leave for at least three days at room temperature, protecting from direct sunlight. From time to time, a container with a tincture is recommended to shake. Before three meals, 10-12 droplets of tincture are diluted in ¼ cup of water and drunk for a month. During the intake of preparations containing St. John's wort, you need to protect the skin from the effects of sunlight, and caution should be exercised in hypertensive patients. Women taking oral contraceptives should consider that St. John's wort reduces their effectiveness. Long-term use can cause fits of excitement until manic episodes. Do not combine St. John's wort with antidepressants, anesthetics and antibiotics.

All the above tonic herbal remedies are not suitable for pregnant and lactating women.

[24], [25], [26]

Homeopathy

Undoubtedly the most effective therapy of homeopathic remedies will be appointed individually. A homeopathic doctor, having heard the patient's complaints, will conduct a detailed interview with him, which will cover all aspects of the character and habits of the patient, his preferences in eating, leisure, relationships with others, and peculiarities of the condition. In severe cases, you need to communicate with the patient's relatives. As a result of the compiled clinical picture, a drug will be prescribed, constitutional (in most cases) or symptomatic. The goal of homeopathic treatment is to restore the equilibrium state of the nervous, immune and endocrine system of a person, thus ensuring his recovery. Homeopathy does not deny the necessity of using psychotherapeutic practices and is quite compatible with them.

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

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

Valerian Heel is  shown for various neuropsychic disorders, including depressive syndrome. The drug does not have a direct sedative effect, but mediates the effect by connecting the limbic system of the brain, limiting the stimulus stimulus through the receptors of γ-aminobutyric acid. Pharmacological properties of the drug determine the spectrum of its action:

• Valeriana offisinalis (valerian) - has a relaxing effect for both the nervous system and vascular;
• Humulus lupulus (hops) - eliminates the increased excitability;
• Crataegus (hawthorn) - tones the heart muscle, optimizes the heart, expands the lumen of the coronary arteries, has antihypertensive action;
• Hypericum perforatum (St. John's wort) - activates metabolism in neurons, tones the cerebral vessels, stabilizes the blood flow;
• Melissa officinalis (Melissa) - increases resistance to stress factors, stops overexcusations;
• Chamomilla reсutita (chamomile pharmacy) - has a mild sedative effect, strengthens the immune system, relieves swelling and inflammation, normalizes the process of digestion;
• Acidum picrinicum (picric acid) - provides a nootropic effect;
• Avena sativa (oats common) - promotes adaptation and restoration, strengthens immunity;
• Bromides (Kalium bromatum, Ammonium bromatum, Natrium bromatum) - normalize the balance of excitation and inhibition of the nervous system, have a moderate anticonvulsant effect.

Contraindicated sensitized to the ingredients of the homeopathic complex for patients and children up to two years. Pregnant and lactating women should be used only as prescribed by the doctor.

Drops are sublingually no less than 20 minutes before breakfast, lunch and dinner or an hour later. You can dissolve the recommended amount of drops in a spoonful of clean water and drink, holding up in the mouth when taking. Dosing: 2-5 full years - five drops each; 6-11 full years - 10 drops; from 12 years, 15-20 drops. The standard course is a month, continuation of admission is possible only after consulting a doctor.

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

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

Contraindicated in patients and children up to two years of age who are sensitized to the components. Pregnant and lactating women should be used only as prescribed by the doctor.

Drops are sublingually no less than 20 minutes before breakfast, lunch and dinner, or an hour later. You can dissolve the recommended amount of drops in a spoon of clean water and drink, delaying when taken in the oral cavity. Dosing: 2-5 full years - five to seven droplets; 6-11 full years - from seven to ten drops; from 12 years - ten drops. The standard course is a month, continuation of admission is possible only after consulting a doctor.

Nervocheel  complex of homeopathic dilutions of several substances of vegetable, animal and mineral origin, which has antidepressant effect, and also - arresting increased excitability and convulsive muscle contractions.

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

• Ignatia (beans of St. Ignatius) - eliminates depression, inhibition, anxiety, instability of the psyche, convulsive contractions of the musculature;
• Sepia officinalis (contents of an ink bag of cuttlefish) - normalizes the process of going to sleep and its quality, reduces the excitability of the nervous system, restores vitality;
• Kalium bromatum (potassium bromide) - improves the quality of night rest and the ability to memorize; seizes the attacks of unreasonable fear, the oppressed state of the psyche;
• Acidum phosphoricum (phosphoric acid) - restores the emotional, intellectual, neuro-psychic sphere and physical activity;
• Zincum isovalerianicum (Valerian-Zinc Salt) - Cures hypochondriac syndrome, convulsive attacks and trembling in the limbs; normalizes sleep;
• Psorinum-Nosode (nosode scabies) - stabilizes control over emotions, mental reactions; it stops migraine, stomach and other pains.

Contraindicated in patients who are sensitized to the components. There are no age restrictions. Pregnant and lactating women should be administered only by medical prescription.

The rules for taking sublingual tablets are similar to the previous ones. Dosage children 0-2 full years in a half tablet; three years and older - for the whole. Three times a day, the last time just before bedtime no more than 15-20 minutes.

Prevention

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

It is impossible to avoid stressful situations, but it is quite realistic to increase one's resistance to them with the help of psychic self-regulation. Everyday all sorts of minor troubles "spoil our nerves" and we lose the ability to rejoice at the set goals. Even routine things can bring pleasure, because they are necessary for us and our loved ones.

Optimum daily routine, feasible physical activity, healthy nutrition increases our stress resistance and reduces the likelihood of depression.

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

Observance of universal moral principles in all spheres of life, the habit of adhering to social behavioral norms will allow to exclude the majority of emotional stressors in interpersonal relationships in all spheres of life.

Avoid harmful addictions leading to intoxication - narcotic, alcoholic, drug; prefer positive emotions and try to exclude negative ones; to abandon self-isolation and expand their social contacts; intolerant of violence - such simple generic rules will help to significantly reduce the risk of depressive disorder.

If you feel that you are not coping on your own, ask a psychotherapist for help.

[27], [28], [29], [30]

Forecast

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

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

[31], [32],