Depression is one of the most common chronic diseases in the world. It is a serious mental disorder that affects almost 1.5 million Poles. A wave of depression is going through our world, says psycho-oncologist Adrianna Sobol.
Marcelina Dzięciołowska: Depression is an ambiguous term, isn't it?
Psychooncologist Adrianna Sobol:Yes, depression has many faces. There are several subtypes of it, although in common use we describe them incorrectly with the same term. When we talk about depressive disorders, we overuse the word without realizing what it is and how serious it is. Many times I hear from different people: "But I'm sad today, I think I'm depressed."
Unfortunately, we have an ingrained view of depression in culture and language as a temporary bluff that can be treated with a piece of chocolate or by meeting friends. Meanwhile, there is no cure for clinical depression other than pharmacotherapy and psychotherapy. Only the two best coexisting forms, or in some cases one of them, are effective in the process of therapy and preventing future recurrences. Unfortunately, not all of these forms turn out to be effective, because today we know that almost 30 percent. patients struggle with the so-called drug-resistant depression.
When are we talking about drug-resistant depression?
The diagnosis of drug-resistant depression is made when, after two attempts at treatment with standard antidepressants from different groups (using optimal doses and for a specified duration), no improvement in the patient's he alth is observed.
This is definitely a difficult situation, especially as depressed patients often experience suicidal thoughts.
Yes, so we should constantly emphasize that depression is a fatal disease, and in drug-resistant depression it is a particularly common phenomenon. When the patient does not respond in the slightest degree to the classic forms of therapy, we must take into account that he may have increased suicidal thoughts, which often do not subside, but intensify because the patient loses the will to live with subsequent attempts. This indicator in groups suffering from drug-resistant depression is even higher - the risk of committing suicide increases 7 times.
What if the patient does not feeltherapeutic effect?
It is a doubly difficult diagnosis due to the fact that patients actively seek help and are open to it, yet they do not receive it. This only increases helplessness and reduces confidence in traditional therapies and he althcare professionals as well. The need to go through the stages of unsuccessful therapy in order to obtain a definitively confirmed diagnosis is an extremely frustrating moment for the patient.
It often takes months, not years, during which patients constantly ask themselves what to do to help themselves and feel like they used to before the disease started. It should be noted that at that time the vast majority of them are unable to be active in other areas of life. It suffers from interpersonal relationships, professional life, the level of social involvement is reduced to almost zero, and even if it is not, it is caused by great suffering and additional cognitive costs.
How to best treat depression?
The most effective form of treating depression is the combination of individually selected pharmacotherapy and psychotherapy, but when it comes to patients with drug-resistant depression, a revolution has taken place in this area recently.
Please tell me more about it.
There are new drugs available, their way of administration is completely different than the current forms of standard pharmacotherapy. These drugs are administered by the nasal route with simultaneous administration of drugs from the group of SSRIs or SNRIs. This form of treatment is important because its effects are noticeable after 24 hours. This gives hope, especially in the case of patients who want to get a solution after many months of looking for an effective therapy. Unfortunately, such treatment is currently not reimbursed and is relatively difficult to obtain.
What is this drug?
This is esketamine - a ketamine derivative that has so far been used in the treatment of pain as well as in the treatment of depressive disorders. Effective attempts to use ketamine in the treatment of trauma and post-traumatic stress disorder have also been carried out, but there are no recorded indications for its use in clinical practice.
What is the innovation of this solution?
This creates a new possibility for the drug to arrive and to move other mechanisms that are to lead to a quick effect of improving the patient's he alth condition. It acts on areas other than standard drugs (i.e. the area of selective serotonin or norepinephrine reuptake inhibitors), namely the NMDA receptor. Esketamine is an antagonistN-methyl-D-glutamatergic aspartate receptor, which causes a very fast cerebral effect.
I hope that it will help many sick people soon and allow them to return to a better life. But let's go back to depression. The sick person is often left alone in this difficult situation, but there are also cases where not only the sick person suffers.
Depression does not only concern the sick person, it affects the whole family who generally wants to help but does not know how, hence the helplessness. At the very beginning, it should be remembered that it is important to observe the early symptoms of depression and refer a loved one to a specialist. Patients often ignore the first symptoms or simply do not notice them.
So how do you know that these are the first symptoms of depression and not a momentary sadness?
Depressed mood, trouble sleeping, trouble with appetite, redundant reaction, withdrawal, thoughts of giving up, crying, drowsiness, sluggish mode of action - these are all classic symptoms of depression, but you should always be sensitive to the fact that everyone these symptoms may be slightly different and may be masked by some behavior, e.g. workaholism.
When should I see a specialist?
If they persist for more than two weeks, then you should seek help - this is the most important thing. It can be a general practitioner, psychiatrist, psychologist or psychotherapist who will help such a person lead this path of treatment.
People are very afraid to seek outside help.
Unfortunately, many people are afraid to use the help of specialists. There are studies which show that about a third of contacts with doctors are not related to somatic disease at all, but to mental disorders. However, this fear of being stigmatized, of not being able to cope in a world that requires a lot of us, makes us run away from the disease.
And yet, when we have a runny nose or a sore throat, we go to the doctor who recommends pharmacotherapy.
It is the same with the treatment of depression. Patients often hear from their relatives "pull yourself together", "run, it will work," and this is the worst thing a person with depression can hear. It is important to distinguish between sadness and symptoms of depression. Many situations require support. Such psychoeducation is also needed by the families of patients who feel helpless and lost, who do not know how to provide support and where to look for it. This often blocks and delays diagnosis of depression, and you shouldn't be ashamed of seeking help. You have to be proud of yourself that you found the strength to fight for yourself and yoursthe future.
Many patients ask the doctor not to initiate drug treatment, and the doctor often has his hands tied.
It often happens that a patient struggles with a chronic neurological or oncological disease and depression at the same time. In such a situation, she is afraid of this double diagnosis, because she knows that it is another treatment, another fight. The patient is afraid that he will not have the strength to treat the underlying disease. Depression is often a side effect of treatment, not disease. These are situations that generate fatigue, constant exposure to the stressor of visits to the hospital, which is very stressful. Depression in chronically ill patients is often ignored.
Are there situations where the patient does not want to be treated and his relatives come for help?
Absolutely, such situations happen very often, but unfortunately, in the end, it is the patient who has to decide on his own that he wants to receive this help and appear in person, unless his life is in danger and urgent help is needed regardless of his will .
How can we help?
We need to look at this disease in a completely different way, be open to psychoeducation, the ability to pick up the first signals and, above all, to start treatment. The most important thing is not to postpone the moment of starting treatment.
Thank you for the interview.
Expert
Adrianna Sobol, psycho-oncologist, lecturer at the Medical University of Warsaw Psycho-oncologist and lecturer at the Medical University of Warsaw at the Department of Oncological Prevention. He works at the LuxMed Oncology Cancer Hospital in Warsaw. She is a member of the Board of the OnkoCafe Foundation - Together Better, a psychotherapist and founder of the Ineo Psychological Support Center. Has created an online training platform He alth Begins In The Head. Author of numerous publications in the field of psycho-oncology and he alth psychology. Co-author of the book "Tame cancer. Inspirational stories and a guide to emotions" (Znak, 2022). She acts as an expert in television programs, co-creates campaigns and social campaigns. He conducts numerous trainings and workshops in the field of psychology and personal development.
About the author
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. Believes you have the right attitudemental he alth is able to work wonders, therefore it promotes professional knowledge based on consultations with specialists.