Hypothymia

A person is given a great gift by nature – the ability to feel and experience various emotions. Thanks to this gift, we can love and hate, be happy and sad, feel joy or anger. But sometimes, due to certain circumstances, a person can lose the ability to respond to events adequately. In psychotherapy, such conditions are called emotional disorders, when a person’s natural emotions acquire a persistent excessive expression. For example, a consistently low mood, which is characteristic of such a pathological condition as hypothymia, manifests itself in the form of constant melancholy, depression, sadness, a feeling of hopelessness and low self-esteem.

Hypothymia is a complex pathological condition that is often perceived as a temperamental feature. Thus, a melancholy mood can very often be observed in melancholics, for whom the transition from a dreamy-romantic mood to a depressed-depressive one is a normal variant. Rainy and cloudy weather, lack of sunlight or prolonged stay in a darkened room can cause a persistent decrease in mood in melancholics.

But there is one important point that distinguishes melancholy from hypothymia. A ray of light, a funny joke, a positive piece of music and even attention from relatives and friends are enough for a melancholic to bring him back to life. Even such a trifle as a friendly smile or a funny souvenir can change the perception of the surrounding world in a positive direction.

Hypothymia, unlike melancholia, cannot disappear on its own under the influence of sunlight or the positive mood of the people around. It is a pathological condition in which a bad mood completely takes over a person, determining his feelings and actions.

However, hypothymia cannot be called a full-fledged disease. It is usually considered in the context of various mental pathologies. At the same time, it is necessary to understand that even such controversial phenomena as suicide, alcoholism, drug addiction and other forms of addiction are considered pathologies in psychiatry. And against their background, the development of hypothymia is quite logical.

Hypothymia can also be a symptom of more serious mental illnesses. It is considered a structural component of various syndromes (obsessive-phobic, hypochondriacal, dysmorphomanic, asthenic), characteristic of many disorders of the psychoemotional sphere. Since this symptom is not considered specific, it can be observed during an exacerbation of the vast majority of mental pathologies (schizophrenia, cyclothymia, apathy, etc.).

But most often, hypothymia is considered as one of the main diagnostic signs of endogenous depression. We are talking about a depressive state that has no external causes: it is not associated with diseases (for example, hypothymia can be observed in oncology and other severe pathologies not associated with emotional disorders, if a person sees no hope for recovery), it is not preceded by stressful situations and mental trauma. Depression develops as if from within.

This type of pathology is characterized by a triad of symptoms:

• persistent decrease in mood, sadness, melancholy, lack of joy (hypothymia),
• impaired thinking (pessimistic thoughts, negative judgments, skepticism, unjustifiably low self-esteem),
• motor retardation, laziness, lack of attempts to change life for the better.

Depression is necessarily accompanied by a decrease in mood, and in endogenous depression this symptom takes on persistent forms (hypothymia).

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Epidemiology

According to statistics, endogenous depression is observed in 35% of patients with depressive conditions. In half of the cases, patients have a thyroid gland disorder – hypothyroidism. But scientists cannot yet explain the connection between this somatic factor and the development of hypothymia and depression.

In suicidal tendencies, a persistent decrease in mood can be observed both on the eve of a suicide attempt and for a long time after it. Sometimes it is hypothymia that causes repeated attempts to commit suicide.

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Causes hypothymia

The pathogenesis and causes of hypothymia have not yet been fully studied.

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Risk factors

Risk factors can include stressful situations in childhood and adulthood (death of relatives, divorce of parents and lack of established contact with them, car or plane crashes, etc.), as well as an unfavorable political and economic situation in the country, in which the standard of living remains consistently low, and people do not see prospects for its improvement.

Depression can be caused by child abuse, and then childhood experiences result in a problem in adulthood, when a person develops a negative attitude towards both others and themselves.

But all these moments are more characteristic of reactive depression. But in the pathogenesis of endogenous depression, characterized by hypothymia, hereditary and socio-ecological factors are not excluded, which come first.

As for the environmental factor, unfavorable environmental conditions have a negative impact on the health of the immune system. They weaken the defense mechanisms, as a result of which a person becomes more susceptible not only to infectious pathologies, but also to the negative impact of stress. The reaction to various psychological problems is exacerbated, which leads to excessive expression of negative emotions.

Head injuries can also be considered one of the risk factors for the development of hypothymia. Contusions of the temporal parts of the right side of the head can cause the development of melancholy depression, in which the symptom of hypothymia comes to the fore. Contusion of the left temporal lobe can cause anxious depression, where anxiety, worry, and heavy thoughts appear against the background of a decrease in mood. With a contusion of the frontal lobes of the brain, depression borders on apathy (lethargy, indifference to oneself and others, poor facial expressions).

In case of concussion, hypothymia is especially pronounced with all its inherent symptom complex. It is observed in 50% of cases, manifesting itself in the acute period of the disease.

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Symptoms hypothymia

Hypothymia is not considered a separate pathology. It is almost always one of the symptoms of more severe mental disorders or brain injuries. Its manifestations depend on the individual characteristics of a person's personality.

In some, hypothymia manifests itself as mild sadness, melancholy, a feeling of hopelessness and uselessness. Others become so immersed in their experiences that they begin to feel physical discomfort (a feeling of heaviness, squeezing behind the breastbone, pain in the heart, as in cardiovascular pathologies). In the second case, they talk about vital depression or vital (heart) melancholy.

And yet, despite all the diversity of temperaments and character traits, hypothymia can be diagnosed by the presence of the following symptoms:

• a sad mood for 2 or more weeks,
• the absence of a productive reaction to positive stimuli, in other words, it is impossible for a person to regain a good mood and cheerful disposition by any of the usual means,
• weight loss, which is most often observed against the background of poor appetite; however, not everyone loses their appetite, while weight loss is almost always observed,
• problems with night rest: a person either has trouble falling asleep, has nightmares, wakes up 2 or more hours earlier than usual, or sleep is superficial and restless, which does not allow a person to fully rest at night,
• the other extreme is increased sleepiness (a person constantly wants to sleep, sleep for him becomes the best way to escape from difficult thoughts and problems, both real and imaginary),
• decreased speech and motor activity: isolation appears, fixation on one's thoughts and experiences, the person limits his contacts, preferring communication with the computer rather than interaction with people, rarely leaves the house, is silent and sullen at work.

These symptoms can be considered the first signs of hypothymia, but they can also indicate other health problems. Sometimes similar symptoms can be observed in a person who has been ill for a long time or does not feel well, experiences constant pain, has suffered a tragedy, etc. In this case, it is too early to talk about a pathological condition.

If you dig deeper, you can identify other, more specific symptoms that indicate hypothymia:

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Decreased interest in life and thinking abilities

The cognitive sphere suffers first. A person stops being interested in the surroundings: he does not listen to the news, does not read books, does not watch TV, his existing knowledge is enough for him, there is no desire to replenish it. He is so immersed in his state that he even gets used to constant despondency and does not feel the desire to do anything to change the situation.

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Low self-esteem and self-worth

The decrease in speech, motor and mental activity leads to the fact that a person begins to doubt his abilities and capabilities. He considers himself a worthless nobody, and finally gives up.

In severe cases of hypothymia, people lose their significance in their own eyes. They consider themselves useless to anyone (even to themselves and their families), because, in their opinion, they are not capable of living a normal, happy life, they begin to engage in self-blame and self-flagellation, increasingly inclined to the idea of suicide.

Loss of meaning in life

Seeing no prospects for the future, a person begins to live in the present, stops dreaming and making plans. The emerging thoughts about changing something in life immediately fade away under the influence of the false confidence that the mistakes of the past will not allow anything to be corrected. A person lives under the weight of this confidence, which guides his actions.

The appearance of psychosomatic symptoms resembling the clinical picture of cardiac, neurological, and gastrointestinal diseases.

A person may suffer from chest pain and pressure or diffuse abdominal pain syndrome, weakness, lethargy, apathy, and incredible laziness. Sometimes even a change in taste perception is noted. Nausea and constipation, which are most likely neurological in nature, are often among the symptoms of hypothymia.

Emotional disorders

Hypothymia is not considered the only type of emotional disorders when their inadequate manifestation is observed. After all, not only a sad depressed state, but also a consistently elevated mood regardless of the situation is considered a deviation from the norm, however, as are sharp mood swings.

"An optimist for life" is someone who never loses heart and sees the positive side of everything. Whether this is good or bad depends on the person. Optimism itself is not a pathology, but if a person remains happy even during tragic situations, does not see problems where they actually are, and never parts with a carefree, joyful smile, this is already an alarming symptom.

Hyperthymia is a condition that is the opposite of hypothymia in its manifestations. If a patient with hypothymia constantly experiences sadness, anxiety and depression, then with hyperthymia there is a painfully elevated mood for a long time. Such people are always cheerful, no matter what happens, they are full of energy, proactive and show obvious interest in everything in the world, offering their help, but most often limiting themselves to empty words. Life seems to them to be a kind of holiday for the soul. It seems that nothing can upset these people.

People with hyperthymia are fixated not so much on themselves as on their merits, which seem to them to be greater than they actually are. They also focus the attention of others on their achievements and positive personal qualities. Caring for others and offering help is nothing more than proving once again how good, kind, and caring they are.

What people do not like is criticism. Only this can make a person irritable, as a result of which further communication with him becomes impossible. Usually a person with hyperthymia hurries to end the conversation and leave as soon as possible, trying not to hear further statements addressed to him, no matter how good they are.

Despite its apparent harmlessness, hyperthymia is considered a characteristic manifestation of manic syndrome.

The opposite of the above-described conditions is apathy. If hypothymia is dominated by negative emotions, and hyperthymia is dominated by painfully positive emotions without any apparent reason, then apathy is characterized by a virtually complete absence of emotions, indifference, and apathy. At the same time, a person remains indifferent not only to people and events, but also to himself. Such people speak little and actually do not experience any emotions when listening to others.

Apathy, like hyperthymia and hypothymia, is also considered a pathological condition and is related to emotional disorders. It develops most often at the stage of progressive schizophrenia, when the patient goes to extremes in his behavior, is either overly excited, or extremely depressed, or becomes inert to everything in the world. Apathy, like hypothymia, can also be a consequence of damage to the frontal lobes of the brain.

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Complications and consequences

It is worth mentioning right away that no emotional disorder passes without a trace. Even a short-term rise or fall in mood makes adjustments to relationships between people. If a person is happy, he transmits his positive emotions to other people, if he is sad, his loved ones try to console and cheer him up, hoping for a response.

However, in a normal state, a person cannot constantly be in a state of euphoria and good humor. Some situations cause opposite emotions in a person. It is difficult for a healthy person to understand someone who smiles at a funeral or enthusiastically extols his merits to someone who is saddened by his problems.

Hyperthymia can attract people around them up to a certain point, until they encounter a striking discrepancy in emotions, insult to their feelings, inadequate reaction to criticism, up to conflicts. All this brings coldness and detachment into communication. People begin to look askance at a strange, ever-smiling neighbor or employee, and try to avoid communicating with him.

The situation is no better with hypothymia. But in this case, the patient himself begins to limit contacts with relatives, friends, colleagues. He withdraws into his experiences, believing that he can hardly get help from other people. Negative emotions put pressure on the psyche, leading to nervous breakdowns, the extreme manifestation of which is suicidal mood. The person simply loses interest in life, does not see the meaning in it, as well as his value for society.

Patients with apathy also push people away from themselves. Not always does a simple person see a disease in such a strange manifestation of feelings (or rather, their absence), so they simply refuse to communicate with a “soulless and insensitive” creature.

But if a person with hyperthymia is optimistic, charged with positive emotions, shows initiative and noticeable efficiency, which makes him, at least, a valuable worker, then patients with apathy and hypothymia are characterized by decreased efficiency, absent-mindedness, and inability to perform responsible work. It is clear that such employees, if they cause pity, then only at first, in the end, the matter most often ends in dismissal.

Complications of hypothymia include decreased cognitive abilities: memory and attention suffer, and it becomes difficult for a person to concentrate on important work or an event. Logical thinking, the ability to analyze and draw conclusions are significantly weakened, so a person becomes unable to realistically assess the situation and his or her condition, which complicates the treatment of the pathology.

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Diagnostics hypothymia

Hypothymia is a rather difficult condition to diagnose. On the one hand, the symptoms of depression are obvious, but on the other hand, patients have difficulty making contact, are rather withdrawn and silent, so it can be very difficult to determine the cause of this condition.

And it is not the patients themselves who most often seek help, but their relatives, who are concerned about this state of affairs. Usually, this happens far from the initial stage of the disease. After all, a bad mood is not considered a pathology. Anxiety begins when a relative or friend has been in a depressed state for more than one week. At first, everyone offers various sedatives, tries to find out the reason for the "eternal" sadness and cheer up, but when they do not find an explanation for the pathological decline in mood, they begin to sound the alarm.

An experienced psychiatrist, having talked to the patient, will quickly establish a diagnosis, specifying what happened to the mood and how the person is trying to improve it. With hypothymia, a person is unlikely to find a decent answer to these simple questions.

The usual blood and urine tests, as well as specific laboratory studies, are unlikely to help clarify the picture in this case. Some studies (such as OAK and OAM) may be useful only when prescribing drug treatment in severe cases of hypothymia.

Instrumental diagnostics are carried out mainly when there is a suspicion of head trauma or tumor processes. In this case, ultrasound, MRI, CT and other necessary studies are carried out.

If a person complains of a feeling of pressure and pain behind the breastbone, he may be prescribed an electrocardiogram to determine whether these symptoms are associated with pathologies of the cardiovascular system.

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Differential diagnosis

A major role in diagnostic measures is given to differential diagnostics. It is important not only to identify the symptom itself, which is hypothymia, but also to determine the pathology to which it corresponds, especially at the initial stage of the disease, when other symptoms are still absent. Further treatment will depend directly on the identified disease and the severity of its course.

Even if a connection between hypothymia and depression is identified, it is important to determine the type of this depression. If depression has psychological causes (reactive type), the treatment focuses on psychotherapy, but if there are no such causes, the basis of treatment is psychopharmacotherapy (medicinal correction of the condition), and psychotherapy is considered an additional method. If depression is associated with a head injury or malignant processes, then the cause of depression (disease or consequences of injury) is treated first, and then the correction of the condition is dealt with.

Treatment hypothymia

We will not focus on the treatment of hypothymia caused by somatic pathologies, since the choice of drugs for different diseases can differ significantly, and the approach to psychotherapy of such patients is similar to the methods for depression, which we will consider below.

As for endogenous depression, which is characterized by hypothymia, here a place of honor is given to drug therapy. The basis of such therapy is antidepressants, which in turn can have both a stimulating and a sedative effect.

The first are used in cases of deep depression and apathy, which are accompanied by a consistently melancholy mood and anxiety (Fluoxetine, Milnacipran, Desipramine, etc.). Antidepressants with a sedative effect are prescribed if, against the background of a depressed mood, there is an unaccountable anxiety and sullen irritability (Sertraline, Azafen, Coaxil and other drugs).

If depression is mild and the patient only experiences causeless sadness and a depressed mood that prevents him from enjoying life, it is not necessary to prescribe antidepressants. In this case, a good effect can be achieved by using herbal sedatives (tincture of motherwort, valerian, St. John's wort extract, etc.).

It is very important to choose the drug that corresponds to the patient's symptoms, otherwise the condition may worsen. Stimulating antidepressants can increase anxiety and cause suicidal thoughts, and sedatives can provoke a noticeable inhibition of mental reactions, constant drowsiness and an even greater decrease in performance.

It is important to take into account that the lasting effect of taking antidepressants does not occur immediately. Sometimes 2-3 weeks of drug treatment are required before the patient's condition stabilizes (in severe cases, improvement occurs after 1.5-2 months). But this is not a reason to stop treatment. Drug treatment can continue for a very long time until stable remission is achieved.

True, many doctors question the effectiveness of antidepressants in mild forms of depression and hypothymia. They believe that the best effect is achieved by taking sedative herbal preparations and introducing psychotherapeutic methods.

It would be wrong to focus only on medication treatment in case of hypothymia. After all, until the patient realizes his value and learns to manage his emotions, pills will only give a temporary effect. Medications allow to reduce the level of anxiety and prevent suicide attempts, but they are not able to change self-awareness and self-esteem.

All this is the work of a psychologist and psychotherapist, who use various practices in their work to achieve the best effect. But behavioral, cognitive and interpersonal psychotherapy have proven themselves especially well.

The goal of behavioral therapy is to find an activity that would interest the patient, emphasize his value, help to increase self-esteem and become a stimulus in life. In this way, the patient is taught to be more active, self-control and control over his emotions.

Cognitive psychotherapy helps the patient to deal with bad thoughts, anxiety, negative attitudes towards oneself and the world around them, and uncertainty about the future.

Interpersonal psychotherapy looks at the connection between the patient's mood and the social situations that affect it. Patients are taught to avoid frustrations and conflicts with others by working through various situations and ways to get out of them.

In mild to moderate hypothymia, antidepressants are rarely prescribed, with preference given to psychotherapy. In addition to the above methods, family psychotherapy can be used, helping patients to realize their value to their loved ones, teach them to find a common language and the joy of communicating with their loved ones.

It is very important for a psychotherapist to initially aim a person at a positive result, showing that his problem is solvable and that the doctor himself is interested in the patient's speedy recovery. The patient needs to understand that a bad mood should not darken his life, this state of affairs must be fought, paying attention to the bright colors that our life is actually rich in.

Such methods as light therapy (natural light, especially sunlight, can have a positive effect on a person's mood) and zootherapy (communication with animals and caring for them helps to feel needed and simply brings pleasure) can help in this difficult task. Music therapy (cheerful positive melodies always improve the mood, and calm classical music helps to reduce the feeling of anxiety and hopelessness) and dancing (in dance you can express your state and vision of the world, throw off the burden of negative emotions) can also be used.

Correction of physical activity also helps in the treatment of hypothymia. Physical exercises and useful activities help improve metabolism, stimulate the production of beta-endorphins and serotonin, and improve the communication skills of patients. However, this type of therapy is effective only if the patient has a desire to engage in active activities and a desire to overcome the disease.

The ability of color and smell to influence our feelings and emotions allows us to practice such methods as color therapy and aromatherapy in hypothymia. Diet therapy with light food and fasting days are also recommended, because lightness in the stomach means lightness in the whole body, including the head. It is not for nothing that nutritionists recommend giving up heavy food in the evenings, which provokes nightmares. At night - this is restless sleep, and during the day - heavy thoughts.

Patients with hypothymia, rotating in the circle of their negative thoughts and emotions, are in constant nervous tension, therefore, as a way to prevent the recurrence of symptoms after a course of treatment, autogenic training is used. Autogenic training helps patients relax and switch to positive thoughts, and therefore, allows them to get rid of such unpleasant manifestations as insomnia, increased anxiety, tension headaches.

Since hypothymia can be observed in patients with various diagnoses, the approach to treatment will always be strictly individual. And since the treatment of hypothymia is a long process, the treatment regimen may change depending on the results. It is inappropriate, for example, to instill auto-training skills in a patient in the acute stage of the disease, when he cannot relax at all. But when stable positive results are already visible, auto-training will help prevent remission of the disease.

Prevention

Since emotional disorders are often provoked by a person's inability to withstand stressful situations, the first thing to do is to increase your stress resistance. But this should not be done with the help of antidepressants, but by mastering the methods of the same auto-training or yoga. Such classes will allow you to learn how to cope with negative emotions and will contribute to adequate self-esteem.

In order for a person to feel happy, there must be people dear to him in his environment. It is impossible to be truly happy alone or surrounded by those who do not understand and do not appreciate you. At the same time, it is important to find mutual understanding not only in the family, but also at work or among friends. If envy, meanness, intrigue reign in the work team, it is better to change it than to bring things to a nervous breakdown and depression, in which a consistently bad mood is the norm. The same applies to fake friends, communication with whom causes constant discomfort.

As for activities, a person should always have a hobby, thanks to which he can show his abilities, talents and simply the best sides of his personality. This not only increases self-esteem, but also causes respect from others. The ideal option is when a person can prove himself in the professional field, and this brings him satisfaction. If a person has a favorite job, depression, as a rule, does not threaten him.

Taking care of children and the elderly, caring for animals, listening to positive music, and doing creative work help to keep yourself in order. All this helps to increase self-esteem and look at familiar things differently.

If you stick to a daily routine with enough time for rest and work, as well as a balanced diet with a predominance of foods with high nutritional value, this will reduce the risk of emotional disorders and other health pathologies.

And, of course, the key to a healthy life is considered to be physical activity, walks in the fresh air, and giving up bad habits that undermine health.

As for the prognosis, hypothymia in most cases responds well to correction by psychotherapeutic methods even without the use of medications. Usually, this symptom can be dealt with, albeit not so quickly, even in cases of severe depression, although here you can’t do without antidepressants.

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