Hypothymia

Man from nature is given a great gift - the ability to feel and experience different emotions. Thanks to this gift, we can love and hate, have fun and be sad, experience joy or anger. But sometimes, due to some circumstances, a person may lose the ability to respond to events adequately. In psychotherapy, such states are called emotional disorders, when natural emotions in a person acquire a persistent excessive expression. For example, a stably low mood, which is characteristic of such a pathological condition as hypothyroidism, manifests itself in the form of unchanging depression, depression, sadness, feelings of hopelessness and low self-esteem.

Hypotension - a complex pathological condition, which is often perceived as a feature of temperament. So, a melancholy mood can very often be observed in melancholics, for whom the transition from a dreamy-romantic mood to a depressed-depressive is a variant of the norm. Rainy and cloudy weather, lack of sunlight or prolonged stay in a darkened room in melancholy can cause a persistent decline in mood.

But there is one important point that distinguishes melancholia from hypothyroidism. Melancholic enough light, a jolly anecdote, a positive musical work and even attention from relatives and friends to bring it to life. Even such a trifle as a friendly smile or a funny souvenir can change the perception of the world around in a positive way.

Hypotenia, unlike melancholy, can not disappear by itself under the influence of sunlight or the positive mood of the surrounding people. This is a pathological condition in which a bad mood completely captures a person, conditioning his feelings and actions.

However, a full-blown hypothyroid disease can not be called. Usually it is considered in the context of various pathologies of the psyche. It should be understood that even such controversial phenomena as suicide, alcoholism, drug addiction and other forms of addiction in psychiatry are considered pathologies. And against their backdrop, logical development of hypothyroidism is logical.

Hypotenia can be a symptom of more serious mental illness. So it is considered as 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 with an aggravation of the vast majority of mental pathologies (schizophrenia, cyclothymia, apathy, etc.).

But most often hypothyroidism is considered as one of the main diagnostic signs of endogenous depression. This is a depressive condition that does not have external causes: it is not associated with diseases (for example, hypothyroidism can be observed in oncology and other severe pathologies that are not related to emotional disorders, if a person does not see any hope of recovery), it is not preceded by stressful situations and mental trauma. Depression develops as if from within.

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

• persistent decline in mood, sadness, longing, lack of joy (hypothyroidism),
• violation of mental activity (pessimistic thoughts, negative judgments, skepticism, unreasonably low self-esteem),
• motor inhibition, laziness, no attempts to change life for the better.

Depression is necessarily accompanied by a decrease in mood, and with endogenous depression this symptom acquires persistent forms (hypothyroidism).

[1], [2]

Epidemiology

According to statistics, endogenous depression is observed in 35% of patients with a depressed state. In half of cases, patients have a disruption of the thyroid gland - hypothyroidism. But scientists can not explain the relationship of this somatic factor to the development of hypipathy and depression.

With suicidal inclinations, a persistent decline in mood can be observed both on the eve of a suicide attempt and for a long time after it. Sometimes it is hypothyroidism that causes repeated attempts to commit suicide.

[3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

Causes of the hypothymia

The pathogenesis and causes of hypothyroidism have not been fully investigated. 

[13], [14], [15], [16]

Risk factors

Risk factors can be both stressful situations in childhood and adulthood (death of relatives, divorce of parents and lack of regular contact with them, car or air crash, etc.), and the unfavorable political and economic situation in the country, in which the standard of living remains stably low, and people do not see the prospects for its increase.

Depression can be caused by cruel treatment of the child, and then childhood experiences pour into the problem in adulthood, when a person develops a negative attitude to both the surrounding and to himself.

But all these moments are more characteristic of reactive depression. But in the pathogenesis of endogenous depression, characterized by hypothyroidism, hereditary and socio-ecological factors that come out on top are not ruled out.

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

One of the risk factors for developing hypothyroidism can be considered head trauma. Contusions of the temporal parts of the right side of the head can cause the development of dreary depression, in which the symptom of hypothymia comes to the fore. A bruise of the left temporal lobe can cause an alarming depression, where anxiety, anxiety, and heavy thoughts appear against the background of a decrease in mood. When the frontal lobe of the brain is bruised, depression is bordered by apathy (lethargy, indifference to oneself and others, meager facial expressions).

With concussion of the brain, hypothyroidism is expressed especially clearly with all its inherent symptom complex. It is noted in 50% of cases, manifested in the acute period of the disease.

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

Symptoms of the hypothymia

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

In some, hypothyroidism manifests itself in the form of mild sadness, longing, feelings of hopelessness and uselessness. Others are so immersed in their experiences that they begin to feel physical discomfort (a feeling of heaviness, squeezing behind the sternum, pain in the heart, as in cardiovascular pathologies). In the second case, they speak of vital depression or vital (heart) longing.

And yet, despite all the diversity of temperaments and features of nature, hypothyroidism can be diagnosed by the presence of the following symptoms:

• dreary mood for 2 or more weeks,
• the lack of a productive reaction to positive stimuli, in other words, it is impossible for a person to return to a normal mood and a cheerful mood,
• weight loss, which is most often observed against a background of poor appetite; but the appetite is not lost by everyone, while weight loss is almost always noted,
• problems with night rest: a person either falls asleep badly, sees nightmares, wakes up 2 hours or more earlier than usual time, or sleep has a superficial, restless character that does not allow a person to fully rest at night,
• another extreme - increased drowsiness (people constantly want to sleep, sleep for him is the best way to get away from serious thoughts and problems, both real and imaginary),
• reduction of speech and motor activity: there is isolation, obsession with one's thoughts and experiences, a person restricts his contacts, preferring communication with a computer, rather than interacting with people, rarely leaves home, at work is silent and gloomy.

These symptoms can be considered the first signs of hypothyroidism, but they can also point to other health problems. Sometimes, similar symptoms can be observed by a person who has been ill or unwell for a long time, experiencing constant pain, suffered tragedy, etc. In this case, it is too early to talk about the pathological condition.

If you dig a little deeper, you can identify other, more specific symptoms, indicating a hypotomy:

[21], [22], [23], [24]

Decreased interest in life and thinking abilities

First of all, the cognitive sphere suffers. The person ceases to be interested in others: he does not listen to news, does not read books, does not watch TV, he has enough knowledge of his knowledge, he does not have the desire to replenish him. He is so immersed in his condition that he even gets used to the constant despondency and does not feel like doing something to change the situation.

[25], [26], [27], [28], [29]

Low self-esteem and self-worth

Decreased speech, motor and mental activity leads to the fact that a person begins to doubt his abilities and abilities. He considers himself to be a worthless nonentity, finally drops his hands.

In severe cases of hypothyroidism, 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 able to live a normal happy life, begin to engage in self-blame and self-flagellation, increasingly inclined to the idea of suicide.

Loss of the meaning of life

Without seeing prospects for the future, a person begins to live in the present, ceases to dream and make plans. Emerging thoughts that something to change in life, immediately fade the influence of 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 a clinical picture of cardiac, neurological, gastrointestinal diseases.

A person can be tormented by pain and pressure in the chest or diffuse pain syndrome in the abdomen, weakness, lethargy, apathy, incredible laziness. Sometimes even there is a change in taste perception. Often among the symptoms of hypotension, nausea and constipation occur, which are most likely neurological in nature.

Emotional disorders

Hypotenia is not considered to be the only type of emotion disorder when there is an inadequate manifestation of them. After all, not only a dreary oppressed state, but also a mood that is stable, independent of the situation, is considered a deviation from the norm, however, like sharp mood swings.

"Optimist for life" is talking about those who are never discouraged and in everything sees the positive side. It's good or bad depends on the person. Optimism in itself is not a pathology, but if a person remains happy even during tragic situations, does not see problems where they really are, never part with an unconcerned joyful smile - this is already an alarming symptom.

Hypertymia is a condition reversed by hypothyroidism in its manifestations. If a patient with hypothymia is constantly experiencing sadness, anxiety and depression, then with hypertension, a morbidly uplifting mood is observed for a long time. Such people are always cheerful, whatever happens, they are full of energy, initiative and show a clear interest in everything in the world, offering their help, but most often confining themselves to empty words. Life seems to them a kind of a holiday for the soul. These people, it seems, nothing can upset.

People with hypertension are fixated not so much on themselves as on their merits, which seem to them more than they really are. On their achievements and positive personal qualities they accentuate the attention of others. Caring for others and offering help for them is nothing else than proving once again what kind they are good, kind, caring.

What eli people do not like, so it's critics in their address. Only she can make a person irritable, as a result of which further communication with him becomes impossible. Usually a person with hypertension hastens to finish the conversation and leave as quickly as possible, trying not to hear further statements in their address, however good they may be.

Despite the apparent harmlessness of hypertension is considered a characteristic manifestation of manic syndrome.

The opposite of the states described above is apathy. If hypotymia is dominated by negative emotions, and when hypertension is painfully positive for no apparent reason, then apathy is characterized by almost complete absence of emotions, indifference, indifference. Thus the person remains indifferent not only to people and events, but also to itself. They say such people are few and do not actually experience any emotions, listening to others.

Apathy, like hypertension and hypothyroidism, is also considered a pathological condition and refers to emotional disorders. It develops more often at the stage of progressive schizophrenia, when in his behavior the patient rushes to extremes, or is excessively excited, or extremely depressed, or becomes inert to everything in the world. Apathy, like hypothyroidism, can also be a consequence of the defeat of the frontal lobes of the brain.

[30], [31]

Complications and consequences

It is worth mentioning immediately that no emotion disorder goes away without a trace. Even a brief rise or deterioration of mood makes an adjustment in the relationship between people. If a person is happy, he conveys his positive emotions to other people, if he is saddened, his family tries to comfort him and cheer him up, hoping for a response.

However, in a normal state, a person can not always be in a state of euphoria and complacency. Some situations cause the opposite emotions in a person. It is difficult for a healthy person to understand someone who smiles at a funeral or enthusiastically extols his services to someone who is saddened by his problems.

Hypertension can attract others until a certain point, until they encounter a striking disparity of emotions, an insult to their feelings, an inadequate reaction to criticism, even conflicts. All this introduces coldness and detachment into communication. People start with suspicion to glance at the strange ever smiling neighbor or employee, try to avoid communication with him.

It is no better with hypothetics. But in this case the patient himself begins to limit contacts with relatives, friends, colleagues. He closes in his experiences, believing that he can hardly get help from other people. Negative emotions press on the psyche, leading to nervous breakdowns, the extreme manifestation of which is suicidal mood. Just a person loses interest in life, does not see in it a sense, as, indeed, its value for society.

Repel people and patients with apathy. Not always a simple person in such a strange manifestation of feelings (or rather, their absence) sees the disease, so simply refuses to communicate with the "soulless and unfeeling" creation.

But if a person is optimistic with hypertension, is charged with positive emotions, shows initiative and remarkable efficiency, which makes him at least a valuable worker, then patients with apathy and hypotomy differ in reduced working capacity, absent-mindedness, inability to perform responsible work. It is clear that such employees, if they cause pity, then at first, in the end, the case usually ends in dismissal.

Complications of hypothyroidism are a decrease in cognitive abilities: memory and attention suffer, it becomes difficult for a person to concentrate on an important job or event. Logical thinking, the ability to analyze and draw conclusions significantly weaken, so a person becomes unable to really assess the situation and his condition, and this complicates the therapy of pathology.

[32], [33], [34], [35]

Diagnostics of the hypothymia

Hypotenia is a rather complicated condition in the diagnostic state. On the one hand, the symptoms of depression are obvious, but on the other - patients are hard at making contact, are rather closed and silent, so it can be very difficult to determine the cause of such a condition.

And the help is often turned not by the patients themselves, but by their relatives, 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 in a depressed state is already living for more than a week. First, all offer various sedatives, try to find out the cause of "eternal" sadness and cheer, without finding an explanation for the pathological decline in mood, begin to sound the alarm.

Experienced psychiatrist, after talking with the patient, quickly establish a diagnosis, specifying what happened to the mood and how a person tries to improve it. With hypotomy on these simple questions a person is unlikely to find a worthy answer.

Habituated blood and urine tests, as well as specific laboratory studies are unlikely to help clarify the picture in this case. Some studies (such as OAB and OAM) may be useful except in the appointment of medication in severe cases of hypothyroidism.

Instrumental diagnostics is performed mainly with the suspicion of head trauma or tumor processes. In this case, ultrasound, MRI, CT and other necessary examinations are performed.

If a person complains of a crushing feeling and pains behind the sternum, an electrocardiogram can be prescribed to him to determine if these symptoms are not associated with the pathologies of the cardiovascular system.

[36], [37], [38], [39], [40],

Differential diagnosis

A major role in diagnostic activities is assigned to differential diagnosis. It is important not only to identify the symptom itself, which is hypothyroidism, but 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 detected disease and the severity of its course.

Even if we identify the relationship between hypotension and depression, it is important to determine the type of this depression itself. If depression has psychological causes (reactive appearance), psychotherapy is emphasized in treatment, if there are no such reasons, psychopharmacotherapy (medical correction of the condition) is the basis of treatment, and psychotherapy is considered an additional method. If depression is associated with head trauma or malignant processes, first of all they treat the cause of depression (illness or consequences of trauma), and then they are already engaged in the correction of the condition.

Treatment of the hypothymia

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

As for endogenous depression, for which hypothyroidism is typical, medication is given a place of honor. The basis of such therapy is composed of antidepressants, which in turn can have both a stimulating and sedative effect.

The former are used in case of deep depression and apathy, which are accompanied by a consistently dreary mood and anxiety ("Fluoxetine", "Milnacipran", "Desipramine", etc.). Antidepressants with sedative action are prescribed if unconscious anxiety and sullen irritability are manifested in the background of a decreased mood (Sertraline, Azafen, Coaxil and other preparations).

If the depression is mild, and the patient only has an unreasonable sadness and a depressed mood that does not allow him to enjoy life, antidepressants should not be prescribed. In this case, a good effect can be obtained from the use of sedative preparations on plant basis (tincture of motherwort, valerian, St. John's Wort extract, etc.).

It is very important to choose exactly the drug that corresponds to the patient's symptomatology, otherwise deterioration is possible. Stimulant antidepressants can exacerbate anxiety, and cause suicidal thoughts, and sedatives - to provoke a marked inhibition of mental reactions, constant drowsiness and even greater decline in performance.

It should be borne in mind that the persistent effect of taking antidepressants does not come immediately. Sometimes 2-3 weeks of medication is required before the patient's condition stabilizes (in severe cases, improvement occurs 1.5-2 months later). But this is not a reason to stop treatment. Drug treatment can continue for a very long time until a stable remission is achieved.

However, many doctors question the effectiveness of antidepressants in the case of mild forms of depression and hypothyroidism. They believe that the best effect is achieved through the use of sedative plant drugs and the introduction of psychotherapeutic techniques.

It would be wrong to concentrate on hypothyroidism only on drug treatment. After all, while the patient does not realize his value and does not learn how to control his emotions, the pills will only have a temporary effect. Medications can reduce the level of anxiety and prevent suicide attempts, but can not change self-awareness and self-esteem.

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

The goal of behavioral therapy is to find activities that would interest the patient, emphasize its value, help increase self-esteem and become an incentive in life. Thus, the patient is taught to be more active, to teach self-control and control over his emotions.

Cognitive psychotherapy helps the patient to struggle with bad thoughts, anxiety, negative attitudes towards himself and the world around him, uncertainty about the future.

Interpersonal or interpersonal psychotherapy examines the relationship between a patient's mood and the social situations that affect him. Patients are taught to avoid disappointments and conflicts with other people, working out different situations and methods of getting out of them.

With hypotension of mild and moderate degree, antidepressants are rarely prescribed, giving preference to psychotherapy. In addition to the above methods, family psychotherapy can be used to help patients realize their value for their loved ones, to teach them to find a common language and the joy of communicating with their relatives.

It is very important for a therapist to initially direct a person to a positive result, showing that his problem is solved and that the doctor himself is interested in the soonest recovery of the patient. The patient should be made to understand that a bad mood should not overshadow his life, one must struggle with such a state of affairs, paying attention to the bright colors that our life is actually rich in.

Such techniques as light therapy (natural light, especially sunlight, can positively influence a person's mood) and zootherapy can help in this difficult matter (communication with animals and caring for them help to feel necessary and simply brings pleasure). Music therapy can also be used (gay positive melodies always improve mood, and calm classical music helps to reduce feelings of anxiety and despair) and dances (in dance you can express your state and vision of the world, throw off the load of negative emotions).

Helps in the treatment of hypotension and correction of physical activity. The performance of physical exercises and useful activities contributes to the improvement of metabolism, stimulates the production of beta-endorphins and serotonin, improves the communication skills of patients. However, this type of therapy is effective only if there is a desire for the patient to engage in active activities, striving to defeat the disease.

The ability of color and smell to influence our feelings and emotions makes it possible to practice hypothymia and such methods as color therapy and aromatherapy. It also shows dietotherapy using light food, unloading days, because lightness in the stomach is lightness in the whole body, including the head. It's not for nothing that nutritionists recommend to refuse in the evenings from heavy food provoking nightmares. At night it is a restless dream, and in the afternoon - heavy thoughts.

Patients with hypothyroidism, revolving in the circle of their negative thoughts and emotions, are in constant nervous tension, therefore as a way to prevent recurrence of symptoms after the course of treatment autogenous training is applied. Autotraining helps patients relax and switch to positive thoughts, which means they can get rid of such unpleasant manifestations as insomnia, increased anxiety, tension headaches.

Since hypothyroidism can be observed in patients with different diagnoses, the approach to treatment will always be strictly individual. And since the treatment of hypothyroidism is a lengthy process, the treatment regimen may vary depending on the results. So it is impractical, for example, to instill in the patient the skills of auto-training in the acute stage of the disease, when it is impossible to relax at all. But when there are already persistent positive results, auto-training will help prevent remission of the disease.

Prevention

Since emotional disorders are often provoked by a person's inability to resist stressful situations, first of all, one must increase their stress-resistance. But do it not with the help of antidepressants, but by mastering the techniques of the same auto-training or yoga. Such activities will allow you to learn how to deal with negative emotions and will contribute to an adequate self-assessment.

In order for a person to feel happy, surrounded by his people should be dear to him. It is impossible to be truly happy alone or surrounded by those who do not understand and appreciate you. It is important to find mutual understanding not only in the family, but also at work or in the circle of friends. If there is envy, meanness, intrigue in the work collective, it is better to replace it than to bring the matter to a nervous breakdown and depression, in which a consistently bad mood is the norm. The same applies to fake friends, communication with which 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 aspects of personality. This increases not only self-esteem, but also causes respect for others. Ideal option is the case when a person can prove himself in a professional field, and this brings him satisfaction. If a person has a favorite job, depression usually does not threaten him.

Help to keep themselves in the normal care of children and the elderly, caring for animals, listening to positive music, doing creative work. All this helps to increase self-esteem and take a different look at the usual things.

If you adhere to the regime of the day with enough time for rest and work, as well as rational nutrition with a predominance of products with high nutritional value, this will reduce the risk of emotional disorders and other health pathologies.

And, of course, physical activity, walking outdoors, abandoning bad habits that undermine health are considered the guarantee of a healthy life.

As for the prognosis, hypothyroidism in most cases is well amenable to correction by psychotherapeutic methods even without the use of medications. Usually with this symptom, albeit not so fast, it is possible to cope even in case of severe depression, although here it is not enough to do without antidepressants.

[41], [42], [43], [44], [45], [46],