A lot is said about depression, but are these messages getting through to society? What approach to disease do we represent as a nation? Is it still so difficult for us to ask for help? These and other questions are answered by psychiatrist dr hab. n. med Agata Szulc.
Doctor, depression is already a civilization disease or not yet?
It is definitely a civilization disease. It has even been calculated that it is the first reason to be dismissed from work in Poland. It is one of the most common diseases that leads to work failure. Not heart disorders or other infections, just depression.
From your observations, how has the approach to depression changed over the years? So far, I meet with comments such as "come on, smile", "go to the gym". Does society continue to do so?
Fortunately less and less. Depression is already one of the most tamed mental illnesses. We do not like to use the words "mental illness" because they have bad connotations. Depression is more "tame". There are many different information campaigns, there are many interesting activities, for example: Faces of depression.
Many famous people talk openly about depression, about their problems, about what they experienced. In fact, sometimes patients come and say: “My family told me to go on vacation. I went on vacation, and the disease went with me ”- these are the words of the patient. This is not temporary fatigue or a temporary bluff. Now there is a lot of talk, autumn, bad weather and chandra. Chandra is a transitory state, short-lived, easily succumbing to cheering stimuli - I will drink hot tea, read a book, rest and it will pass me by. Depression over tea, pulling together, or going to the gym does not respond.
If a patient comes and is referred for therapy, he should focus on drugs first or on talking to a psychologist?
This is a very individual matter. Some patients, and this is clearly visible now, come and say that they want to recover quickly because they cannot cope at work. There is no problem with drugs either, because if you use antidepressants, they start working after about 2 to even 6 weeks of continuous use. It is not fast either. Often, on the other hand, it is clear that this depression is relatedwith various life problems, with interpersonal conflicts. Then we often tell the patient that therapy would be indicated as a concurrent treatment. Sometimes, in milder forms of depression, psychotherapy is enough.
When patients come to you, they immediately know that it is depression, or, for example, say that they feel unwell. What do you hear from them most often?
Most often, the first saying is "I can't cope anymore", "I'm having a hard time", "I'm crying, I can't concentrate". Sometimes these are somatic symptoms and the patient has the diagnosis behind him and has prepared results that did not indicate anything, because it is not about physical problems. Sometimes depression manifests itself as headaches, chest pains, and heart problems, which patients interpret as endangering their he alth. Then it turns out that nothing was found. Cognitive problems are often associated with this disease. Difficulty concentrating, studying or working - these are often the first symptoms.
How is it with these faces of depression? Is depression a chronic sadness or is there a patient who at first glance looks smiling, everything is fine and says that he has been unable to concentrate for several weeks.
Most often it is sadness, because we associate depression with sadness or as we call it - low mood. The depressed mood required for depression to be diagnosed must last for most of the day for at least two weeks. We stick to these two weeks, but often it is a month or two or more. In addition, anhedonia, i.e. the inability to feel pleasure, is an important symptom. Patients may not feel depressed, but they are actually enjoying nothing. I often hear from people with depression that what they once enjoyed doing today does not interest them at all. Some people may become irritable. This means that patients, in the company of people with whom they formerly felt well - today feel irritated. We think irritability - especially in men - is not depression. Symptoms such as irritability, nervousness, sometimes aggression appear, but verbal and impulsive, which is associated with anxiety. Depression is not necessarily a depressed mood.
Recently I read this sentence "The first symptoms of depression appear already in childhood". Is it true or false?
There is a group of people who say that such problems begin in childhood, but then it is associated with trauma. With some childhood problems, such as physical, mental or sexual violence. It may be, but it is not necessarily a rule. The age when the first symptoms appear is approx.30 years. Depression may get worse over time. A typical feature of depression is that women get sick more often and theories differ. Mainly mentioned are social, biological and physiological factors. In fact, we women experience different hormonal states throughout our lives. Depression can start during pregnancy or after giving birth. The menopausal period is also a risky moment, where depression during menopause occurs in about 30% of women, so that's quite a lot. The incidence of depression is estimated from 5-15% in society. In addition, women are more likely to have the social consent to be a little sad and emotional. It is the man who has to hold on, he must be tough, of course he does not go to the doctor, and to see a psychiatrist at all. Unfortunately, men often drown their depression in alcohol, which is a big problem.
Another thing that I read recently - indeed women suffer from depression more often, but men commit suicide more often. Where does this phenomenon come from?
It's true. Women even more often attempt suicide, but the effect of this is much smaller than in men. In men, the main risk factor for suicide - apart from the male sex - is alcohol and psychoactive substance addiction. Now these addictions are mixed up and it's not that someone just drinks alcohol and someone smokes marijuana. Not. Women, however, despite the fact that the percentage of women addicted to alcohol and other substances increases, they become addicted much less frequently. Addiction is a big risk factor for suicide, and of course there are also many biological factors.
Then maybe let's discuss one such biological factor.
When we talk about biology, testosterone hormones are not very "aggressive", but in combination with, for example, alcohol, they increase the tendency to impulsiveness. A very important trait in suicide is impulsivity. This is what research shows. Most suicides are impulsive, "something is pushing me at this point and I can't help myself." Such people immediately reach for pills and medications, which is also related to the fact that men are generally more impulsive.
Children and teenagers depressed. When is it simply mutiny and when is it a real threat? How can a parent deal with this? How can he recognize it?
Problems of children and adolescents are very often related to the family - almost always, in fact. Not necessarily with some pathology, but with some family system that does not function properly. Psychotherapy is the first treatment for children and adolescents, medications are sometimes needed. How to tell the difference? This is a very good question. It should never be taken lightlyno symptoms. Sad moods should always be taken seriously. Whenever possible, it's best to consult a psychologist to begin with and take your thoughts of suicide seriously. Sometimes an attempted suicide shows up and seems to be for show, but it's not true. Any attempted suicide should be taken seriously. Unfortunately, I have seen too many cases where someone theoretically was to be saved, but was not. There is so much talk about it now that it seems that parents should also pay attention to it.
Depression has been known since antiquity, so we will probably never get rid of this problem. What can we as a society do to prevent depression from developing?
Ideally, our entire society should take care not only of physical but also mental he alth. Education to catch the early symptoms of the disease, so as not to ignore them and not be ashamed to go to a psychiatrist. Patients often have the notion that the psychiatrist is terrible, sitting and waiting to be tied up in a straitjacket, locked up in the hospital and left behind. We try to help like all doctors. There is a lot of action about depression and I have the impression that they have made their way into society a bit, that some attention is paid to it, that people rarely say "get a grip", "don't be surprised", but "maybe you'd better go to the doctor, I will go with you if you are afraid ”. Loneliness is a factor that increases the risk of depression and suicide. It is known that widowers more often than widows commit suicide and suffer from depression. We also do not notice suicidal tendencies or thoughts in the elderly, because we think that if an elderly person does not want to eat, they have no appetite - because they do not have, but the underlying thoughts may appear "maybe I could starve myself to death like this. ”- which also happens. The action of people who have the courage to say “I am ill and I have survived it is also great. I can tell you how it was. Not everyone has such courage and this should also be respected.
Is it that we can all get depressed or are there any biological conditions?
It is undoubtedly genetics. The tendency to depressive disorders has a genetic basis. Depression is not simply inherited. It is more complicated. A family history of depression increases your risk of developing the disease. As in all diseases there is so-called "Risk group". For the disease to become active, stress is needed, i.e. cortisol. If we have innate mental resilience, because there is such a thing, stress will not throw us off balance. If a person is susceptible enough stress is enough to trigger depression.
Expert
prof. dr hab. n. med. Agata Szulc -psychiatrist, head of the Psychiatric Clinic of the Medical University of Warsaw From the beginning of her professional career, she has been associated with the Medical University of Bialystok, and since 2013 with the Medical University of Warsaw. Currently, he is the Head of the Psychiatric Clinic of the Faculty of He alth Sciences of the Medical University of Warsaw. She is the author of numerous scientific publications. The main area of her research is neuroimaging in psychiatry, especially in schizophrenia, and more recently in bipolar disorder. The results of the research conducted so far indicate that the use of modern methods of neuroimaging may have real practical significance in the future in the diagnosis, prognosis of the results of antipsychotic treatment, as well as in the diagnosis of people prone to developing psychosis.