Reactive depression

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

1. The reactive state of the psycho-emotional sphere is provoked by mental trauma – acute or chronic.
2. The traumatic factor forms symptoms and clinical manifestations of the condition.
3. Reactive disorder can cease quite quickly, provided that the provoking factor disappears.

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

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Epidemiology

Epidemiological data concerning the nosology - reactive depression, are very contradictory. Collection of information is complicated by many reasons, the main one in their list is subclinical manifestations of the disease and late appeal for help to a specialist. Most often, patients either try to cope with mental shocks on their own, or in the process of chronicization and somatization of depression they get to doctors of other specialties - a gastroenterologist, endocrinologist, cardiologist.

Primary differential diagnostics does exist, but it is used by psychiatrists and psychotherapists, not general practitioners, to whom patients with psychogenic depressive disorder predominantly turn. As a result, by eliminating the presented somatic complaints, non-specialized therapy is able to “hide” typical depressive symptoms for a long time, transforming the acute form of the disease into a latent, hidden, protracted one. These and many other reasons still do not allow us to compile a complete, reliable epidemiological picture that clearly classifies and describes the frequency of psychogenic depressions.

According to the latest available data, the statistics for reactive depression are as follows:

• Women suffer from psychogenic emotional disorders more often than men. The ratio is 6-8/1.
• 40% of depressive disorders are diagnosed 10-12 months after onset. More than 45% are determined after unsuccessful treatment of somatic diseases associated with depression
• Only 10-12% of sick people promptly seek specialized help from psychotherapists, neurologists, and psychiatrists.
• No more than 20% of patients with signs of reactive depression complain of poor health, most often of a somatic nature (gastrointestinal disorders, cardio-neurological complaints, difficulty breathing, swallowing food).
• No more than 30% of all cases of seeking help are recognized by the doctor as manifestations of a psychogenic disorder.
• Periodic depressive disorders are recorded in 9% of people who come to the attention of specialists.
• Only 22-25% of patients with psychogenic depression receive adequate, specialized medical care.
• More than 80% of patients suffering from reactive depression are treated not by a specialist, but by general practitioners.
• The prevalence of diagnosed chronic forms of psychogenic disorders is growing every year. In women, this figure is 1.5%, in men – 0.5-0.8% per year.

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Causes reactive depression

Reactive disorders occur in various forms, which are grouped into two broad categories:

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

The causes of reactive depression are also divided, classified and provoke a specific clinical picture. The common criterion is a single psychotraumatic external influence. Paradoxically, a depressive disorder of this series can also be caused by positive events that occur suddenly and rapidly. In 1967, Thomas Holmes and Richard Rahe compiled a special scale in which the causes of reactive depression are arranged according to the degree of significance of events.

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

Life Change Units

• Loss, death of a significant person, relative, family member.
• Sudden separation or divorce from a partner.
• Imprisonment.
• Unexpected injury or illness.
• A sharp deterioration in financial well-being, loss of material base.
• Loss of job, dismissal.
• Retirement, loss of the usual professional circle of communication and activities.
• Illness of a loved one, family member, friend.
• Problems in the sexual sphere.
• A sudden change of job or professional activity.
• Conflicts in the family.
• Loans and debts that accumulate and prevent you from strengthening your financial situation.
• Chemical dependence of family members (codependency of the person himself).
• Deterioration of housing conditions, moving to another country, region, locality.
• Conflicts at work, pressure from superior colleagues.
• Lack of social activity, change of usual social circle.
• Sleep deprivation.
• Change in diet, inability to satisfy food preferences.
• Events that involve legal action, minor compliance issues.

Also among the causes of psychogenic depressive disorder may be marriage, reconciliation after a long quarrel, high-level awards for personal achievements, the beginning of education or, conversely, the end of the educational process.

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

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

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

Also, the causes of reactive depression can be existentially significant (life-threatening), such that they destroy ideas about the structure of the world - universal human principles, or important only for the individual himself - professional, intimate, concerning family relationships.

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Risk factors

Psychogenia was terminologically described back in 1894 by Robert Sommer, who formulated the criteria and risk factors for the development of hysterical reactions. Subsequently, psychiatrists supplemented the provoking causes of both external and internal levels, when pathogenic and exogenous factors are closely intertwined and form a depressive disorder.

Risk factors may include:

• Congenital, constitutional features of the body.
• Acquired factors – pregnancy, menopause, chemical dependence, chronic infectious diseases.
• External causes – sleep deprivation, poor diet, physical overload.

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

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

Accordingly, personal risk factors are defined as follows:

• Avoidance strategy, escape from a stressful situation, activation of automatic psychological defense mechanisms (sublimation, projection, rationalization, denial, repression).
• Intentional social isolation, unwillingness to seek help and receive support.

The following factors can also aggravate the course of a depressive response to stress:

1. Genetic predisposition to depressive states and reactions.
2. Accentuation of character traits.
3. Intoxication, both food and chemical.
4. Age factor - puberty, menopause, old age.
5. Biochemical disorders of the body, chronic pathologies.
6. Traumatic brain injury, organic pathologies of the brain.
7. Constitutional properties of a person.
8. Disruption of the neurotransmitter systems of the brain.

The most significant for the course of a psychogenic depressive episode are risk factors of the internal level, which negatively affect the effectiveness of therapeutic measures and the prognosis of the disease.

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Pathogenesis

The pathogenetic description of the process of development of reactive states is still a subject of discussion among neurologists and psychiatrists. The historically established opinion of the hysteroid base in the last century was gradually supplemented by information about other factors provoking the disease. The students of I.P. Pavlov, V.N. Myasishchev in the middle of the last century became convinced that psychogenia is to a greater extent a deformation of the development of personal qualities, and the constitutional features of a person only add specific clinical signs, but are not fundamental in the etiological sense.

The teachings of B.D. Karvasarsky, Yu.A. Aleksandrovsky and other equally famous personalities gave impetus to deep research into the very concept of psychological trauma as the main source of psychogenic disorders. Pathogenesis, the process of the origin of an acute depressive reaction is described today as a combination of the premorbid state, the constitutional properties of a person and the specificity of the stress factor.

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

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Symptoms reactive depression

The clinical picture of psychogenic depressive disorder is very diverse and multifaceted, as are all varieties of this category in general. It is no coincidence that there is an expression that depression has a thousand masks, often hiding behind the symptoms of somatic diseases. The most pronounced in this sense is the psychogenic reactive state, which is caused by a specific traumatic fact or event. The symptoms of reactive depression depend on its type - short-term or prolonged form.

1. Brief reactive depression rarely lasts more than 4 weeks. Its main features are the symptoms of dissociative disorders
   • shock reactions;
   • mutism;
   • affectogenic amnesia;
   • symptoms of autonomic dysfunction - sweating, tremor, tachycardia;
   • sleep disturbances and loss of appetite;
   • panic attacks;
   • situational suicidal ideation;
   • motor retardation or, conversely, affective, disordered movements;
   • anxiety and depressed psycho-emotional state.
2. Prolonged psychogenic depression, which can last from 1-1.5 months to a year or more:
   • persistent depressed mood;
   • emotional lability, tearfulness;
   • apathy;
   • anhedonia;
   • lack of social activity;
   • increased fatigue;
   • asthenia;
   • constant reflection, feelings of guilt, self-accusation;
   • obsessions;
   • hypochondria.

The reactive form is characterized by sharp changes in mood and activity levels, but not to the same extent as in cases of diagnosed endogenous depression. Deterioration of the condition most often occurs in the evening and at night, during the day, when there are distracting factors, it is much easier for a person to bear the severity of mental trauma. Symptoms of reactive depression are temporarily displaced by external circumstances, daily worries or responsibilities. False relief creates the illusion of victory over the disease, but it can lurk and return with more painful sensations. This is why it is important to begin treatment at the first signs of psycho-emotional discomfort directly caused by the traumatic event.

First signs

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

The first signs of reactive depression may be the following:

• The desire to cry, to sob.
• Difficulty in the rhythm of inhalation and exhalation.
• Psychomotor, motor affective arousal.
• Freezing, stupor.
• Spasms - muscular, vascular.
• Tachycardia, increased heart rate.
• A drop or a sharp increase in blood pressure.
• Fainting.
• Spatial disorientation.

The most common reaction, the typical first signs of an extreme traumatic situation are physiologically natural manifestations of fear and mobilization of all resources to overcome it. The range of intensity is small - either hyperdynamia, activity, or stupor (hypodynamia). In essence, this is the famous triad "fight, run, freeze". Trying to control the innate ability to react to an intense factor that threatens human values is pointless. This feature must be known, accepted as a given and, if desired, slightly corrected with the help of special exercises. According to statistics, only 12-15% of people are truly capable of acting coolly in an extreme situation, maintaining a rational view of events.

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Endogenous and reactive depression

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

• Endogenous.
• Somatogenic.
• Psychogenic.

Each category has specific clinical manifestations, signs that allow differentiating the type and prescribing adequate therapeutic measures. The most common are endogenous and reactive depression. Their main difference is in the provoking factors:

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

The differences between species can be presented in this format:

Endogenous and reactive depression

Parameters of difference	Psychogenic depression	Vital depression
Genetic factor, heredity	Genetic, hereditary factor is rarely diagnosed	The hereditary factor is present
Presence or absence of a psychotraumatic factor	The anamnesis clearly shows a connection between the psychotraumatic cause and the onset of depression. The prolonged form may not show a linear connection, but it can be detected with the help of questionnaires and tests.	Autochthonous development of symptoms, without a clear link to a specific provoking factor. The stress factor may be present as part of the structure of depression, but only as one of multiple triggers in the initial phase of the condition's development.
Presence of psychopathological disorders	A clear reproduction of a traumatic circumstance.	The reflection of the provoking factor is blurred.
Intensity of depressive symptoms	The intensity of symptoms is related to the level of mental trauma and the individual's sensitivity.	There is no connection or correspondence between the level of the stress factor and the severity of depressive symptoms. The typical depressive triad (asthenia, intellectual and motor retardation) is not associated with a specific traumatic factor.
Dependence of symptoms on the time of day	Worsening of the condition in the evening and at night.	In the evening and at night the condition improves slightly.
Preservation of criticism	Criticism and understanding of the painfulness of one’s condition are preserved.	Criticism is often absent.
Presence or absence of inhibition of reactions	Present in the initial phase of the disease.	The inhibition is clearly expressed.
Vitalization of symptoms, affect	Absent.	A feeling of melancholy, often total vitalization of symptoms.
Thought disorders, delusional constructions	Rarely. There is no sense of guilt, there are claims to others, to circumstances. Delusional constructions are encountered only in the initial phase, they are characterized by specific descriptions associated with the traumatic factor.	Self-accusations, inferiority complexes. Delusions are often generalized, gradually becoming more complex.
Behavior	Crying, affective manifestations, fears, anxiety.	Lack of crying, monotonous reactions, isolation.
Insomnia	Problems with sleep, especially in the first phase (falling asleep)	Early, anxious awakening, melancholy mood.
Depends on the season	Absent.	Typical autumn-spring exacerbations.
Somatic disorders	Reactive depression often develops against the background of chronic diseases.	The combination occurs, but rarely or without obvious connection.
Premorbid features	People with paranoid, hyperthymic, and hysterical character traits are prone to psychogenia.	Anxious and suspicious individuals with a heightened sense of responsibility are prone to endogenous forms of depression.
Depersonalization	Poorly expressed.	Typical in the manifestation of emotional coldness, anhedonia.

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Stages

The psychogenic group of depressive disorders is a collective category of types, the stages of which differ depending on diagnostic criteria. The common etiological factor is strong, sometimes extreme stress, psycho-emotional trauma, which makes it possible to describe the stages of the disease development as follows:

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

The last two points are possible in the case of a protracted form of psychogenic depression, which is considered the most difficult to treat and carries the risk of the disease becoming a chronic, endogenous process. The classical scheme of grief experience is also suitable for the emotional description of the stages of reactive states provoked by a single stressful event. Its author, Elisabeth Kubler-Ross, formulated the stages of reacting to strong shocks in 1969:

1. The stage of total denial.
2. Anger, rage towards the external environment, surroundings.
3. Bargaining stage (the illusion of an improvement in the situation when the invented conditions are met).
4. A depressive episode proper.
5. The stage of resignation and acceptance of a traumatic event.

These periods vividly describe the process of experiencing the loss of significant people, extreme events. In general, the clinical picture of reactive depressive states can be polymorphic, and the stage of depression, oppression can start immediately after a psychological trauma. This depends on individual characteristics, premorbid specific personality traits and the presence of concomitant traumatic circumstances (chronic diseases, negative social environment and other reasons). If a person is already exhausted and deprived of internal mental resources before the “meeting” with a psychological trauma, his coping strategies are not developed, the stages of affective reactions may be absent initially. In such cases, clinically manifested vital affects (melancholy, apathy, asthenia, intellectual inhibition) are observed and there is a risk of suicidal thoughts up to hysterical attempts to commit suicide. The protracted, protracted form tends to weaken reactive symptoms and experiences, which significantly complicates both differential diagnostics and therapy of the disease.

Forms

One of the most widespread and multifaceted diseases, depression, has been studied for centuries. Classifications, treatment protocols and specification of clinical manifestations are still changing. Types of reactive depression are conventionally combined into two large categories:

• Short-term form.
• Extended release form.

Short-term psychogenic states occur without the risk of serious complications; they last from 2 weeks to one and a half months; prolonged reactive states are more difficult to experience and treat, which in turn are divided into the following types:

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

The characteristics of the prolonged form are determined by the premorbid period, when the personality is initially characterized by suspiciousness, anxiety, and cycloidity.

Types of reactive depressive disorder are classified in this way:

1. True reactive depression, which lasts up to 1 month and is characterized by obvious clinical manifestations.
2. An anxious form of psychogenic depression, when a depressed state alternates with bursts of activity and leads to asthenia and autonomic disorders.
3. A hysterical type of reactive disorder characterized by theatrical manifestations of experiences and demonstrative suicide attempts.

The most productive in terms of therapy effectiveness is the open form of psychogenia with a vivid clinical picture. Desimulative variants of psychogenic depression, when reactions are “encapsulated”, are the most alarming in terms of the risk of actual suicide.

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Complications and consequences

With timely seeking of professional help, the symptoms of reactive depression are completely de-actualized. This significantly reduces the consequences and complications for the patient, which can lead to the endogenous form of the disease. Reduction of experiences, if necessary, drug treatment, adequate methods of psychotherapy, help from relatives and social environment - these measures help a person cope with difficulties and extremely strong shocks without vitalization and exhaustion.

Consequences and complications that may occur with psychogenic depression:

• asthenia;
• vegetative-vascular disorders;
• panic attacks;
• somatization of the depressive process;
• psychogenic melancholia;
• dysthymia;
• suicidal thoughts and attempts to carry them out.

Negative additions to the symptoms can be "liquidated" provided that you trust the specialists, contact specialized institutions and undergo complex treatment. Sometimes it is enough to visit a psychologist who knows the testing method, find a clinic of reactive depression, who is able to provide first psychological aid and, if necessary, refer the patient to a doctor to prescribe drug therapy.

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Diagnostics reactive depression

It is quite easy to diagnose reactive symptoms, especially in the first stage, when clinical manifestations are closely related to the traumatic factor. Moreover, diagnostics can be projective. If there is a specialist at the site of psychotraumatic events who has basic concepts about the consequences of the influence of super-strong stressors, he has the right to assume variants of the course of the process and reactions. Thus, PTSD - post-traumatic stress disorder, tends to manifest clinically years later. Early preventive treatment, preventive measures and periodic dynamic diagnostics allow to minimize the negative consequences of this syndrome. The relevance of educating general practitioners in the issues of determining depressive signs is still relevant, given the statistical data and prevalence of depression throughout the world. Diagnostics of the depression clinic, or rather primary questionnaires and filters, are now studied by first-line doctors in most European countries and in the USA, this makes it possible to prescribe timely preventive treatment and minimize the risk of complications.

Diagnostic protocols for psychogenic disorders differ from each other depending on the classifiers' affiliation with a particular school of psychiatry. The basis for all versions is Jaspers' teaching, which describes a triad of typical signs:

• A psychogenic reaction and disorder develops immediately after exposure to a traumatic factor.
• The symptoms of the disorder are directly related to and depend on the intensity and specificity of the trauma.
• The disease process is closely intertwined with the relevance and level of psychological trauma; neutralization of traumatic circumstances in most cases leads to a positive resolution or reduction in the intensity of symptoms.

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

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

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

The general diagnostic scheme for reactive depression looks like this:

• Interviewing the patient, collecting anamnesis and subjective complaints.
• Evaluation of the severity of the clinical picture of the disease, the specificity of the dynamics and clarification of the relationship between symptoms and the traumatic factor.
• Testing according to the HAMD (Hamilton) scale.
• Rating of depressive disorder according to the Beck Depressive Inventory.
• According to the indications, filling out the Zung self-assessment questionnaire or the Eysenck questionnaire.
• For clarification and differentiation, it is possible to use the NEDRS – a scale for assessing reactive or endogenous depressive disorder.

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

• Ultrasound of the thyroid gland.
• Electrocardiogram.
• MRI or computed tomography as indicated.
• Complete blood count and urine tests, blood biochemistry.

The psychological battery of tests as a diagnostic element is used only in the process of therapy, at the second and subsequent stages. It should be taken into account that the reactive form of depressive disorders is very specific, and filling out and passing multi-question methods can only retraumatize the patient.

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Tests

As a rule, tests are not prescribed for the diagnosis of a reactive depressive episode. They can be useful only as an addition to the research complex when the patient suffers from a protracted form of psychogenia against the background of already acquired somatic pathologies. Tests are mentioned in the protocols for diagnosing depression, but this option is more suitable for the category of nosologies from the so-called "big psychiatry".

What tests can help diagnose reactive depression?

• Blood tests to determine thyroid hormone levels.
• Analysis of holotranscobalamin (vitamin B12) concentration.
• Complete blood count and general urine analysis.
• Blood test for absorption of vitamin B9 (folic acid).

One of the latest achievements of medical science was a longitudinal study of the blood of more than 5,000 people for early detection of depression symptoms. American scientists have identified biological markers that show the interaction of various brain structures and can indicate subtle changes in the biochemical process. List of biomarkers studied:

• Epidermal Growth Factor is a protein responsible for the division, regeneration, and growth of epidermal cells.
• BDNF - brain-derived neurotrophic factor. A factor that stimulates the work and development of neurons.
• Resistin is a hormone that activates metabolic disorders.
• Myeloperoxidase, an enzyme whose deficiency impairs the function of phagocytes.
• Apolipoprotein C3 is a gene that is involved in the formation of triglycerides, thereby indirectly responsible for energy metabolism in the body.
• Soluble tumor necrosis factor receptor 2 is a trimeric receptor of the cytokine family.
• Glycoprotein alpha 1 antitrypsin, the level of which affects the bronchopulmonary system.
• The lactogenic hormone is prolactin, which is part of the structure of the anterior lobe of the hypophysis.
• Cortisol, which regulates carbohydrate metabolism and is involved in the biochemical process of response to a stress factor.

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

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Instrumental diagnostics

The list of additional methods of examination at the first signs of reactive depression may include standard tests and questionnaires, as well as instrumental diagnostics. The state of internal organs and systems either has a background effect on the course of the depressive process or is the primary basis that aggravates the symptoms of the disease. In addition, the prescription of a certain group of medications (antidepressants, neuroleptics, sedatives) requires checking the function of the liver, kidneys and gastrointestinal tract. Therefore, instrumental diagnostics has become not a "novelty" in the psychiatric diagnostic complex, but rather the norm, ensuring the effectiveness of treatment.

Additional diagnostic methods include the following appointments:

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

Of course, the listed methods are used quite carefully, and only in cases where differential diagnostics require an extended examination to specify the form, type and specificity of depressive disorder.

Differential diagnosis

Making a diagnosis within the category of "Mood disorders" according to ICD-10 does not present any particular difficulties. This is due to the clear link between the clinical picture and the primary stress factor. Thus, in the first conversation, interviewing the patient, the doctor can already make initial conclusions and prescribe additional research methods. Differential diagnostics in such cases is carried out between reactive and endogenous forms of depression. It is also necessary to exclude more serious nosologies that require specific therapy. Sometimes such an examination is carried out in a hospital setting.

What is excluded in the differential diagnosis of reactive depression:

• Reactive paranoid.
• Bipolar disorder.
• Endogenous depression.
• Short-term grief reactions.
• Anxiety disorder.
• Phobic disorders.
• OCD is an obsessive-compulsive disorder.
• Schizophrenia.
• Schizoaffective disorder.
• Organic disorders of brain function.
• True dementia.
• Dependence on psychoactive substances.

Differential diagnostics is carried out according to a scheme that takes into account the neurotic and psychotic register, as well as specific signs - seasonality, the presence of Jaspers' triad, connection with a psychotraumatic cause, stability and intensity of affect, daily fluctuations in symptoms, suicidal tendency, preservation of criticism, vital components of the process.

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Treatment reactive depression

If a patient comes to a doctor in the acute period, immediately after a traumatic event, he may be prescribed drug therapy. Psychopharmacology is considered effective for certain clinical symptoms that threaten the general condition of the patient. The following factors are taken into account when prescribing drugs:

• Pathogenetic mechanisms of reactive disorder.
• Severity of clinical manifestations.
• Age of the patient.
• Floor.
• The presence or absence of concomitant somatic pathologies.

Excessively small or, on the contrary, superdoses of a drug can neutralize the therapeutic effect, therefore, both diagnostic information and identification of the main sign, the "target symptom", are important for the doctor. Specific symptoms are considered targets for pharmaceutical treatment:

• Excitement with anxiety manifestations. Agitation.
• Obvious psychosomatic symptoms (acute pain in the gastrointestinal tract, heart).
• Vegetative symptoms.
• Fear.
• High level of depression (risk of suicide).

Acute experiences of the stress factor are relieved by the following medications:

• Group of neuroleptics.
• Antidepressants.
• Mood stabilizers – normothymics.

Antidepressants are considered classic means in the treatment of reactive depression. A correctly selected drug in the shortest possible time, in the initial period of the disease, allows achieving results without obvious side effects and addiction syndrome. A marker of the success of the appointment is an improvement in mood, general clinical manifestations during the first two weeks.

Treatment of reactive depression also includes the following methods:

• Psychotherapy - a course of at least three weeks.
• Physiotherapy procedures.
• Diet therapy.
• Therapeutic massage.
• Aromatherapy.
• Art therapy.
• Acupuncture, acupuncture.
• Physiotherapy exercises.

A comprehensive approach to treatment allows for complete recovery, with virtually no relapses.

Psychotherapy for reactive depression

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

• Assessment of the level of mental disorders.
• Analysis of personality traits.
• Assessment of the ability to perform independent therapeutic work.
• Analysis of rehabilitation resources and potential.
• Drawing up a psychological portrait of the patient.

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

1. CBT – cognitive behavioral therapy.
2. TFCBT – trauma-focused cognitive behavioral therapy.
3. Interpersonal therapy.
4. Art therapy.
5. Symbol drama.
6. Gestalt therapy.

The format of psychotherapeutic assistance may vary - both individual sessions and group therapy. Group assistance is effective in cases where group members have experienced traumas similar in severity and structure (natural disaster, grief over the loss of a family member, military action).

The process of psychotherapy is accompanied by drug support in cases of affective reactions or suicidal attempts. Denying pharmacological help in the treatment of reactive disorders is unproductive and even dangerous. Psychotherapy and drugs help the patient maintain their psychostatus and get out of an uncomfortable, severe condition within 3-4 weeks without the risk of complications and chronicity of the disease.

Drug treatment

Medication in psychogenic disorders is used as mandatory. Medicines are excluded if a person has an effective coping strategy and reacts to psychological trauma adequately, processing it independently and competently. Such cases, unfortunately, are very rare, so medications are prescribed for 90% of people experiencing severe experiences, reactions and anxiety.

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

Groups of antidepressants differ in their tasks and actions:

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

Tranquilizers, sedatives, neuroleptics, herbal medicine and homeopathy are also effective in treatment.

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

The examples provided are for informational purposes only and are not recommendations for use.

1. Fluoxetine. A drug of the SSRI group that improves mood, neutralizes anxiety and tension. It is prescribed for various depressive states, obsessions, neurotic disorders. It is recommended to use a course of up to 4 weeks, 1 tablet per day. Contraindications - nephropathy, hepatopathy, diabetes mellitus and epilepsy.
2. Amitriptyline is a drug from the group of tricyclic antidepressants. It is indicated for reactive and endogenous depression, effective in the treatment of mixed anxiety-emotional disorders, neuroses. The dosage depends on the condition and age. The prescription scheme is 25 mg before bedtime once a day, increasing the dose to 3 doses per day for a month. Then the dosage is changed again, reducing it to 1 tablet. The course of the process should be under the supervision of a doctor who will adjust the intake of the drug.
3. Gidazepam. A drug of the daytime tranquilizer group. It has a good anti-anxiety, stabilizing effect in asthenic manifestations of depression, neuroses, psychogenic forms of depression. Relieves irritability, improves sleep. Gidazepam can be taken up to 3 times a day at a dosage of 0.02 mg. The course of treatment can last up to 2-3 months. Contraindications - pregnancy, hepatopathologies, kidney diseases, glaucoma.

It should be noted that the above-described medications are available only with special prescriptions. This indicates not only their effectiveness, but also the inadmissibility of self-medication.

Vitamins

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

Let's give an example of the most popular vitamin complexes:

• Multi-tabs B complex. Contains coenzyme vitamin B1, vitamin B6, folic acid, vitamin B2, B12, nicotinamide and pantothenic acid. Take the complex 1 tablet three times a day for up to one month. The drug has virtually no contraindications, it is prescribed to pregnant women and children from 10 years of age.
• Neurovitan. Contains thiamine, octothiamine, riboflavin, vitamin B6, cyanocobalamin. The complex is suitable for strengthening the nervous system, and is also prescribed for heart disease, diabetes, and decreased immune defense. The course of administration is up to 4 weeks, 1 to three tablets per day are prescribed depending on the age and condition of the patient. Vitamins can be taken by children starting from 1 year.
• Milgamma. Neurotropic composition improves nerve conduction, blood microcirculation. Milgamma is prescribed in injection or tablet form. The course of treatment lasts up to 1 month. The drug has contraindications - pregnancy, allergic reactions, cardiopathy. It is also not prescribed to children under 16 years of age.

Physiotherapy treatment

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

Physiotherapeutic treatment of psychogenic diseases recommended by official protocols:

• Lateral physiotherapy (light therapy). It is performed using a specific device and glasses, where each lens is divided by color. On the right is red, on the left is green - for the relief of asthenia, phobias. On the contrary - for the treatment of anxiety, agitation. The course consists of 6-7 procedures.
• Acupuncture or acupuncture.
• Electrosleep.
• Su-Jok therapy.
• Therapeutic relaxing massage.
• Aromatherapy.
• Galvanic collar according to Shcherbak. Method of influencing the central nervous system and the autonomic nervous system.
• Mesodiencephalic modulation (the effect of electrical signals on certain areas of the brain).
• Light aromatherapy.
• Baths with relaxing herbal infusions.

It should be noted that physiotherapeutic treatment of reactive depression cannot be basic; it only complements a wide range of options and accelerates the recovery process.

Folk remedies

Many people try to neutralize the painful state, anxiety, irritation, anger after the psychological trauma on their own, using folk remedies. This option is sometimes effective if reactive depression proceeds quickly, without complicated symptomatic manifestations. Of the safe methods, only the simplest tips can be recommended, which are included in folk remedies:

• Moderate physical activity.
• Expanding the range of food towards vitaminization. The more vitamins and microelements the body receives, the more strength and resources it has to fight the disease.
• Fresh air - daily and as much as possible.
• Get more sunlight. If the weather conditions or season do not allow you to enjoy the sun, you can use color therapy. Bright hot shades - red, orange, yellow, can overcome apathy. Blue, light blue, light purple - reduce irritability and agitation.
• Warm baths filled with sea salt or essential oil. Orange, lavender, pine or fir oils are considered antidepressants.
• Aromatherapy. Treatment sessions are practically free and can be arranged at home. It is enough to apply aromatic oil to the inner bend of the elbows, to the lower part of the back of the head (closer to the neck). You can also use aroma lamps, provided there is no allergy.

Traditional treatment of depression also involves the use of decoctions and herbal infusions. However, herbal medicine cannot be considered absolutely safe; the recipe and choice of medicinal plant should be made by a specialist with knowledge and experience in this area.

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Herbal treatment

The most famous and respected plant by doctors in the treatment of depression is St. John's wort. Herbal treatment is impossible without it, and St. John's wort can be used as a single herb or as part of a herbal collection. Hypericum is Hippocrates' favorite plant, he wrote about it many centuries ago. Miraculously, records with the recipes from those years have survived to this day, which became the basis for the development of pharmacology in general, and the production of drugs for depression in particular.

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

• 1 teaspoon of dry Hypericum flowers is poured with 250 ml of boiling water.
• Infuse the decoction for no more than 5 minutes until it turns light yellow.
• Take the infusion 1/3 cup three times a day before meals, 25-30 minutes.
• It is necessary to prepare a fresh product every day.
• The course of herbal therapy with St. John's wort is 21 days.
• At the slightest sign of adverse side effects, treatment with St. John's wort should be stopped. It can provoke a decrease in blood pressure, allergies.

Melissa officinalis can also be effective. It eliminates insomnia and improves the overall psycho-emotional state. The recipe for the decoction is as follows:

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

Herbal treatment and herbal infusions can complement basic therapy, but not replace it completely.

Homeopathy

Homeopathy may be included in the complex of therapeutic measures to neutralize depressive symptoms. Research into the effectiveness of homeopathic remedies continues, as do disputes about its legitimacy in principle. There is no reliable information about the effectiveness of non-traditional treatment, although homeopathic doctors actively claim the opposite. However, patients who were saved by homeopathy also defend alternative methods and claim that their conditions have improved without the use of synthetic drugs.

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

Homeopathy in the treatment of reactive depression:

• Nervokhel N. A drug based on ignatia. Ignatia is effective in relieving cramps, depression, irritation and insomnia. Nervokhel also contains bromide, which obviously has a positive sedative effect, phosphoric acid, dry matter from the cuttlefish bursa, valerianic-zinc salt. The drug is prescribed in tablet form, 1 tablet is used three times a day for mild forms of depressive disorder. In more serious situations, experts recommend dissolving the tablet every 15 minutes for 1.5-2 hours. The drug has no negative side effects, it is prescribed to children from 1 year old, the only exceptions may be pregnant women and mothers who breastfeed their babies.
• Arnica montana. The remedy is more likely to be a herbal medicine, as it is made from a plant growing in the Alps. Previously, Arnica was used as a medicine for bruises and contusions. Later, the range of its application expanded, and today homeopathy recommends Arnica montana as a drug that improves the emotional state. Contraindications - allergy to the components, pregnancy and children under 10 years of age. Reception - 15-20 drops three times a day for 10 days, if the drug is released in liquid form. Arnica tablets are prescribed by a homeopath depending on the individual characteristics of the patient.
• Nux vomica, the composition of the drug includes bryonia, chilibuha, colocynthus, lycopodium. Nux vomica works well with depressive symptoms, insomnia, agitation. The drug is not prescribed to pregnant women and children under 1 year. The dosage is selected by the doctor, but the instructions include the following instructions: adult patients - 10 drops three times a day, the daily dose of Nux vomica is diluted in water (100 ml). Babies under one year - 6-9 drops, children from 2 to 6 years old - 12-15 drops. The drug should be used one hour after eating. The duration of the course will be determined by a homeopathic doctor.

Prevention

It is impossible to avoid psychotraumatic events, therefore prevention of reactive depression development is training, acquisition of mental resilience, development of coping strategy. In addition, taking care of one's own resources - both physiologically and psychoemotionally - helps to adequately accept the blows of the outside world and competently respond to stress factors.

Advice that will help strengthen the nervous system and psyche is prevention, which must be done systematically.

• First of all, you should take care of quality sleep. Sleep should last at least 7 hours. In the acute stage of depressive state, sleep can be extended to 10-12 hours. This helps to restore energy and strength.
• Prevention of depressive disorders is the environment. Man is a social being. Support from friends, relatives and close family members is sometimes the best medicine and first psychological aid.
• It is important to allow yourself to express emotions, be it grief or despair. The body, through tears, helps a person to soften the mental pain. Holding back tears is suppressing the trauma, driving it inside.
• Water, air and light. These tips are not new, but have been effective for many years. Our body is designed in such a way that it instantly and gratefully responds to water, comfortably arranged procedures and good, pleasant lighting. If possible, you should go to the seaside or take a walk along the river bank. A change of scenery is therapeutic in itself, and in combination with fresh air it is doubly effective.
• It is better to postpone all serious, fateful decisions until the body recovers and emotional resources appear. The tactics of self-care are doing small, simple, easy things.
• Physical activity. A feasible load, sports activities - these are techniques aimed not at strengthening muscles, but at breathing, which is inevitably activated when doing exercises. Breathing techniques are a great way to improve and stabilize your emotional state.

Reactive depression is much easier to prevent, or rather, to stop at the first stage of development. The best way to do this is to practice mental hygiene and not forget about prevention.

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Forecast

The prognosis for treating reactive depression can be positive in most cases, provided that professionals are consulted early. Independent attempts to get out of a life impasse can also be successful, but only in the case of a low-intensity and low-severity psychological trauma. However, the growth of depressive forms and types, the increasing number of hidden and reactive psychogenias indicate that the problem remains relevant and requires a more attentive, serious attitude to it. What was previously a purely psychiatric task is now literally becoming the number one issue in the entire world, including the WHO.

Timely differential diagnostics, early detection, provision of first psychological aid, support, appointment of adequate therapeutic measures - this is the complex that allows a person to cope with a traumatic event and manifestations of reactive depression quite successfully. Otherwise, the disease becomes protracted, which carries the risk of neurosis and transition of the condition to a chronic somatic form. Accordingly, this variant of the disease development requires a longer treatment process, efforts from both the patient and the doctor. Therefore, even if you independently cope with the first signs of a reactive state, you should visit a psychotherapist, a medical psychologist for high-quality processing of the psychological trauma and getting rid of its consequences.

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