Misconceptions about antidepressants, fear, and lack of causative power that accompany depression often stand in the way of treating a sick person. Depression can effectively "tear" out of life, take away the important life roles performed so far.
Continuous development of the topic of depression in its various aspects can help not only patients but also their relatives, who often unwittingly aggravate the problem of depressive disorders.
Editors Marcelina Dzięciołowska talks to psychiatrist Jolanta Klemens.
A mistaken, stereotypical perception of depression may be the reason for the lack of support from relatives?
- You touched the editor on a fundamental problem. Depression in many circles is still not perceived as a disease, so it is the order of the day for family and friends to intervene: "get a grip", "get a grip" and the like.
These interventions certainly do not help someone with depression.
- On the contrary, they make you feel more guilty.
How to distinguish periodic moods from depression?
- We all experience mood drops, various discounts depending on the weather, the phase of the monthly cycle in women, and what life situations we face. If it is a low mood lasting 2-4 days and then everything returns to normal, it is hardly a depression. If, on the other hand, the drop in mood lasts for more than two weeks - then we can talk about depression. Although the decline in mood often occurs much earlier, we do not equate it with an illness.
Why?
- Because the mood drop itself does not necessarily have to occur. Sleep disturbances, especially waking up at night, may occur. I know from my experience in working with patients that most of them do not see them in the category of sleep disorders. Only when I ask if the patient wakes up from sleep does he answer yes - several or even a dozen or so times during one night. Then it should be clarified whether after such awakening it is easy for the patient to fall asleep or leave the bed.
What do the patients then reply?
- That they even get up several times tobathrooms. Please note that the patient, who is, for example, 36, does not yet have to physiologically run to the toilet. It is also important whether the patient falls asleep immediately after returning to bed - most of them have problems with that. These guiding questions help patients understand the nature of the disease. This is one of the most commonly overlooked symptoms.
What other symptoms are not the same as depression for patients?
- Another symptom is a decrease in psychophysical efficiency. For example, slower performance at work, reflection, checking something repeatedly. The feeling that the patient is insufficiently performing his or her job, that there is nothing worth it, that he or she fulfills worse as a parent, and that a partner in depression is very common. Patients blame this on fatigue.
Such a person will say: "I will rest, take a few days off and everything will be back to normal"?
- If a depressed person says they need to rest, that's pretty good. As a rule, the last thing a depressed person would think about is a vacation, because he feels that he is not living up to expectations, and since he does not, he does not deserve a vacation. He will stay longer at work, he will spend the nights, he will take work home, but all this is very mediocre.
Can such a long-term experience of sleep disorders become a new “normality” for the patient so that he no longer perceives it as a real problem?
- Exactly. Depression develops slowly, it doesn't happen overnight. People use their adaptability to difficult situations.
Can a close partner notice that something is wrong with the other person?
- A signal that something not entirely good is happening may be, for example, that two people in a relationship are starting to drift apart. One of them may not feel like talking, may be constantly tired, or may give up activities she has enjoyed so far. The sexual sphere also disappears, which sometimes arouses suspicions on the part of a he althy partner of betrayal.
What should be done in this case?
- You just need to ask your partner how he is doing and what you can help him with. This "how are you feeling" question provides a platform for conversation. Noticing the problem gives a space for the opening of a person who, due to depression alone, feels guilty that he does not fulfill any of the roles.
This conversation can be especially difficult if the partner is indeed depressed and experiences anhedonia.
- Sometimes depression is diagnosed at such a stage that it's difficult by any meanshelp.
What can we do as relatives, family?
- First of all, seek help from a psychiatrist. It is a disease like any other, and to treat the disease you need a doctor - a person who has completed medical studies. In the further process, we can seek the help of a psychologist, but at the beginning it must be a psychiatrist with whom the problem should be presented and the forms of help discussed. In such a situation, a psychiatrist will most often tell a loved one to bring a depressed person to the office.
This is probably not an easy task. How to tell a loved one to see a psychiatrist? After all, we can hear: "Do you think I'm crazy?"
- Unfortunately, such common ideas are common in society. A very high level of empathy, delicacy and understanding is required here. As people we are whole - it is impossible to separate the body from our head, from emotions, from the psyche. Emotions are something you can't see at first glance. We cannot measure them, but they significantly influence our functioning. I explain this to my patients on the example of love, which can add energy, give wings, but also cut off this energy, to which the body reacts slower, we do not feel like doing anything. Our head center is essential for overall functioning.
Let us assume that the patient is convinced to see a psychiatrist. When is the decision to introduce antidepressants taken?
- If we diagnose depressive disorders, it is tantamount to implementing pharmacotherapy. Depression tears people out of their lives in a very insidious way. If the patient is deprived of vital roles, there is no point in waiting with pharmacotherapy, it should be started immediately.
Do patients fear drug addiction?
- This is of greatest concern to patients. Virtually every first visit is faced with such a question.
Does this fear stop patients from starting pharmacotherapy?
- Yes, it is much easier for the patient to use the advice or help of a neighbor who, for example, recommends pills for better sleep. However, these are medications prescribed to this patient, tailored to her, so using this “neighborly help” may do more harm than good. The doctor has to assess the patient's he alth, what medications he is already taking, what symptoms predominate in depression, and only then selects the medications.
Are anti-depressants really addictive?
- We are in the 21st century, drugs in psychiatry have developed tremendously. I can say with full responsibility that modern drugs are used correctlythey have no right to make the patient addicted. Drugs that have an addictive potential are mostly older generation drugs, but also newer ones with anxiolytic, sedative and / or hypnotic properties, intended for short-term, short-term use (maximum 2 - 4 weeks). Any wise psychiatrist will tell you this at the very beginning. We can adjust the antidepressant to improve the quality of sleep, so that there are no wake-ups, that the sleep phases are preserved, that the patient feels asleep in the morning and has energy to act. We can assure you that if the symptoms for which we have administered the drug pass, then the patient can safely discontinue the drug. There is no addiction here.
What about other concerns? Can antidepressants change a patient's personality?
- No drugs used in psychiatry can change a patient's personality, there is no such possibility. Human functioning is primarily influenced by the disease itself, so much so that in the treatment process we strive for the patient's return to normalcy, a positive attitude to life, and the willingness to embrace various life problems. Medicines will not erase the problem, but they will improve your mood and performance, which will help you regain your strength to deal with problems.
What if the patient does not feel better, let's assume after a few weeks of using the drug?
- By analyzing the patient's he alth, we separate the depressive core and symptoms accompanying depression. Very often these symptoms are sleep disorders and eating disorders. We cannot absolutely promise the patient that it will improve after a week. We set it to the fact that it is a long-term process. After 2-3 weeks, we can expect a noticeable long-term improvement, but the improvement in sleep quality may come faster. It is crucial for the patient to trust us that we can help him. If the mood does not improve, but the patient falls asleep, this is a milestone in the recovery process.
The gradual weight removal from the patient's shoulders certainly contributes to the success of the further treatment process?
- Yes. It is a process lasting several weeks - from the moment the patient first visits the psychiatrist's office to the moment when he or she experiences improvement, when he begins to see that his involvement in everyday life increases, in thinking about what to cook, what purchases to do, etc. When the patient begins to regain himself, the partner begins to regain his loved one, the children begin to regain the parent. Parents are also starting to recover their depressed child.
Recovery from depression - what does the recovery process look like?
-There is an improvement in the main symptoms initially, but the longer a well-chosen treatment lasts, the more benefits the patient receives from it. At a later stage, the quality of cognitive function, i.e. what we call concentration, memory, improves. The patient notices that he is more efficient, that he can focus, that he performs activities faster, etc. At the end, he also notices an improvement in libido, because when a depressed patient does not think about this function, this is the last thing the depressed person thinks about.
If there is an improvement in the patient's mental he alth, this effect must be perpetuated - time for the improvement to stay with the patient permanently, right?
- Yes, there are three cut-off points. The first is when the patient reports. The second is when the selected drugs improve the patient's he alth. The third is when the patient notices that he is feeling very well - patients often say that he is better than before the depression developed. This is the moment when you should take medicines for a minimum of six months at a dose after which the patient felt well. This is the time of treatment consolidation. After these six months, we check how the patient is doing and make a decision about what to do next.
What happens after six months of fixed treatment?
- There are patients who want to end pharmacotherapy, but there are also those who want to stay with these drugs. Then we can lower the dosage. Depressive disorders tend to recur due to the essence of the disorder itself, i.e. imbalances in the amount of serotonin, dopamine and norepinephrine.
What if my depression recurs?
- The patient has to start treatment all over again, but this is not a bad thing. I explain to my patients that you should not be afraid of this, these patients are very sensitive, so they will see a doctor when the first symptoms appear.
How can patients who have gone through this process help?
- People who have gone through depression, have had contact with a psychiatrist, have been treated with antidepressants are more sensitive to signals of depression in people around them. Having sensitivity resulting from their own experiences, they are able to reach people with various mental disorders much more effectively. This is a skill that cannot be learned by anyone who has not had such experience.
Side effects that patients fear - they may or may not occur, right?
- Side effects most often accompanied the drugs of the old generation. They are still availableon our market and contrary to appearances, they are also praised by patients, and it is the patient who is to be satisfied. Newer-generation drugs have fewer and fewer side effects. It is important which drug we choose, as well as its slow introduction, so that the body can get used to the new substance.
What about people who only take antidepressants on a temporary basis?
- If a patient uses irregular treatment, forgets the dosage, or stops taking medications without consulting a doctor, side effects appear due to irregularities in pharmacotherapy and sudden discontinuation of the drug. Following your doctor in this regard is important, although there are also situations, editor, where these symptoms are used to the benefit of the patient.
How is it?
- In the case of some antidepressants, somnolence is an undesirable symptom, and yet a large group of patients with depressive disorders struggle with, for example, insomnia. Knowing this, we as doctors use this drug as a sleep aid. An undesirable symptom is therefore sometimes very desirable in the hands of a specialist who knows how to navigate in the world of pharmacotherapy. It is very important to diagnose the patient and determine what is the problem for them and choose the drug that works best for them.
Proper selection of the drug and the right dose is the key to success. Still, there are cases where standard medications don't work.
- Yes, when the patient does not respond to the first therapy, we add a second drug from a different group. If the patient reacts to a combination of drugs from two different groups, then all is well and we can expect the healing process to come. However, there are cases of drug-resistant depression. According to the latest research, it concerns about 8 percent. all cases of depressive disorders. These are patients who did not respond to two correctly conducted cycles of pharmacotherapy.
What does "correctly conducted cycles of pharmacotherapy" mean?
- It means that we chose the right medicine for the patient, we used it long enough and in the correct dose. If there is no improvement in the patient's he alth, then we are dealing with drug-resistant depression.
Is there anything else you can do in this situation?
- There are green lights for such patients as the newest inhalation treatment for depression has emerged. There are also other medical methods, but non-pharmacological, which complement the treatment of, among others, drug-resistant disorders. We are moving forward all the time and you should not begive up, but look for other therapeutic methods. For a patient who is suffering, who is depressed, who has lost hope, this can be an insurmountable path. Here is a request to relatives to stay with the patient, to give the patient strength, to go to the doctor with him and look for new opportunities.
By getting rid of misconceptions, we have a chance to heal. Oncologists also sound the alarm that it is difficult for society to convince the public that cancer does not have to be a fatal disease - after all, it has been defeated by many.
- It is very unfortunate that people who have no experience spread their view about depression or its treatment to people who have a problem with their mental he alth.
How can it harm people with depression?
- Disseminating such views makes it impossible for people with depression to benefit from the achievements of medicine in the 21st century. The editor referred to oncological diseases in an interesting way, because in their case time is of great importance and what is curable in oncology at the beginning may be incurable after some time. It is similar with depression - if the intervention is initiated early enough, the chances of returning to full fitness are much greater.
Apart from exacerbating depressive disorders, what threatens those who delay?
- If the patient misses this moment, unfortunately - depression is a fatal disease and, if left untreated, it may result in death by suicide. My appeal to people who have a non-medical view of treating depression is that they leave it to themselves and not take responsibility for those who will commit suicide as a result of bad advice, because it is very difficult to live with such a burden.
The conclusion is one - you should consult a depressive disorder with a specialist, not a neighbor. This is a serious matter. Realize that asking for help is not a shame, it is not a sign of weakness. These are basic things that society simply forgets.
- Society either forgets or doesn't know. In the West or in the United States, treating depression, attending a psychotherapist is perfectly normal. It is just beginning to be here.
Is the so-called "Stimulation" may be a factor in causing or aggravating mental disorders?
- If we compare the living conditions at the beginning of the 20th century to those now - 120 years later, the number of stimuli that reaches us per unit of time is incomparably greater, and not much has changed in the programming of our organism.
Fast times,Social media, the flood of information from the radio and television, flashing banners, flashy posters - all these can actually be the cause of the constantly increasing number of cases of depression?
- Even 30 years ago, diseases of the cardiovascular system were in the first place. At the moment, depression is starting to take the lead, it is about to "take the lead". This is what the editor rightly mentioned - these flashing lights, the number of stimuli, our phones that are constantly with us are such a "leash". When sitting in a restaurant, we see that people use telephones instead of talking to each other. Additionally, the sheer volume of negative news that bombards us is something our bodies cannot cope with.
What can we do?
- Serve yourself "moments of silence". Set a time when home cell phones will be turned off, set a day without a TV, radio or computer. It can be extremely difficult these days, especially for young people. Another thing is the matter of calming down - trying relaxation techniques that everyone can adapt individually to their needs. The third thing is to go back to the beginning of our conversation, which is psychotherapy. It is a help which, also from my own experience - and I am not ashamed to talk about it - is the greatest gift a person can make for himself. A good therapist helps to organize what is happening in our whole life, to the past, to childhood, to the developmental age, i.e. adolescence, helps to look at what was and how it influenced our development. Once the psychotherapist will help us to look at it all, destroy our comfort zone developed over the years, then help us rebuild it, but it will be completely different.
Other, which means what?
- First of all, it will be a zone with more insight, with more sensitivity, with a greater understanding of yourself and other people. Since we will be more friendly to ourselves and others, the quality of our life will change and therefore it will have a positive effect on our mental state. Psychotherapy is therefore a good solution, but not in the acute phase of depression, when a person does not reach much, when it is a struggle for survival, and then there is a struggle to return to normal functioning. When the patient returns to him, we offer him a good psychotherapy in the hands of an experienced psychotherapist who has his supervisor, which guarantees safe psychotherapy.
You raised an interesting point here. Someone once told me that I was a good psychotherapistshould, at the patient's request, pass the contact to the supervisor without any problems. That's true? What is the actual role of a supervisor?
- This is a very wise hint. Maybe not necessarily contact, but rather information that the psychotherapist uses this form of professional support. Both doctors and psychotherapists have to constantly train. There is no way to rest on your laurels here. In the case of psychotherapy, the supervisor is a kind of "safety valve", he watches over the correct course of therapy. This person does not have any opinion, but hears what is happening with the patient in the therapeutic process and is able to look at his situation objectively and thus provide very valuable tips.
How does it work in practice?
- During the session with the supervisor, the psychotherapist discusses the given case, this person helps in good patient management, which is why it is so important. The current in which a given psychotherapist works is not so crucial, because each patient needs a different one. At the moment when the therapist destroys our sense of security, when he "peels off the layers of the root", that is, helps to open up emotionally, in this process we come to what is most important, but often also very painful. It is important then that the therapist helps to rebuild the sense of order and security. It is not difficult to demolish it, the trick is to build a "stable structure" on decent foundations.
As a psychiatrist, what would you like to convey to patients suffering from depression?
- Don't be afraid of the psychiatrists. We are medical doctors, warm and empathetic people, we do not judge. Our task is to help you overcome the various turmoil that you face in life. The greatest satisfaction for us is when the patient says: "Thank you, everything is all right now".
Thank you for the interview.
Expert
Dr. Jolanta Klemens, psychiatrist She graduated from the Medical University of Silesia in Katowice and 4-year postgraduate studies in psychotherapy at the Jagiellonian University in Krakow. He has experience in inpatient and outpatient psychiatric treatment. She worked as a consultant in the somatic departments of the Provincial Hospital, General Hospital and BCO in Bielsko-Biała. In the past, he was a court expert at the District Court in Bielsko-Biała in the field of psychiatry and addictions. Since 2004, a lecturer at numerous conferences in Poland. For many years he has been the Plenipotentiary for the He alth of Doctors and Dentists at the Beskidzka Izba Lekarska. Since 2004, he has been running his own medical activity, since 2015 under the name of PSYCHOMedical JolantaClement. The facility employs psychiatrists, psychotherapists, a personal trainer, and a nurse. As part of its activities, it uses the latest therapeutic methods, including pharmacological ones, reserved for use only in a medical facility.
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Marcelina Dzięciołowska Editor for many years associated with the medical industry. He specializes in he alth and an active lifestyle. A private passion for psychology inspires her to take up difficult topics in this field. Author of a series of interviews in the field of psycho-oncology, the aim of which is to build awareness and break stereotypes about cancer. He believes that the right mental attitude can work wonders, therefore he promotes professional knowledge based on consultations with specialists.