Neurotic depression: causes, symptoms, treatment, prognosis

Depression is one of the most common forms of reactive conditions. A characteristic feature of this condition is the absence of any perceptible border between norm and pathology.

Mild depression is the most common form of normal universal human experiences: any significant loss in most normal people causes a depressed, melancholic mood, general lethargy, lack of sleep, appetite, tears, etc.

In pathological cases, we are talking mainly about a quantitative increase in the same phenomena. Depressive syndromes include conditions that include an obligate symptom - a decrease in mood from mild sadness, sadness to deep depression, and optional symptoms - a decrease in mental activity, movement disorders, various somatic disorders (cardiac arrhythmias, weight loss, constipation, decreased appetite, etc.).

Depressive triad

Mental symptoms:

- Emotional symptoms: sad, dreary mood (the world seems bleak and colorless), fear, irritability, hopelessness, feelings of inadequacy, feelings of insensibility, inner emptiness, apathy or inner anxiety, indecision, guilt.
- Cognitive symptoms: slow thinking (thoughtfulness), impaired concentration, thoughts about death, gloomy ideas about the future, meaninglessness of life, decreased self-esteem, negative self-image, anticipation of catastrophes, ideas of sinfulness, focus on failure, a sense of failure.

Psychomotor symptoms:

- Psychomotor retardation: excessive facial mimic or lack of it, limited mobility, stupor.
- Psychomotor agitation: constant restlessness, feeling of being driven, thirst for activity.

Somatic symptoms

- Vital disorders: fatigue, powerlessness, lack of energy, lethargy, weakness, feeling of pressure or pain in the heart or stomach, loss of appetite, weight loss, headaches, indigestion, decreased libido.
- Sleep disorders: sleep disturbance, interrupted sleep, early awakening, daily mood swings.
- Vegetative disorders: dry mouth, shortness of breath, dizziness, constipation, heart rhythm disturbances.

One can speak of depression as a syndrome only when there is a more or less constant combination of symptoms in the emotional, cognitive and somatic spheres; as a result of these symptoms, the patient's lifestyle and quality of life are disturbed, depressive syndrome has a protracted course.

Neurotic depression

Neurotic depression is characterized by:

- The prevailing mood is characterized by feelings of grief or fear.
- Decreased vitality - lack of desires and interests.
- Feeling of own inferiority.
- Self-reproach.
- Thoughts about suicide;
- Hypochondriacal complaints (fearing and suspecting serious illness).
- Sleep and appetite disorders.
- Strong dependence on evidence of love and affection.
- The tendency to "cling" to someone.
- Decreased tolerance for frustration at failure.
- Explicit fears.

Depressed patients are characterized by:

- Underestimation of their chances and capabilities, combined with passivity and restraint indecision;
- Allow others to make excessive demands on them, humility.
- Feel uncomfortable in group situations.
- Cannot make demands.
- Lack of initiative.
- Avoid situations of self-affirmation.
- Avoids discussion by withdrawing into oneself.
- Lack of self-confidence and a positive sense of self-worth.
- Remain dependent and even looks for it, fear of independence.
- Seeks the closeness of another person, clings to them. The partner personifies the figure of an "adult", a mother.
- Is looking for security.
- Is afraid of being abandoned - fear of losing the object, fear of losing the love of the object, separation.

Neurotic depression can be a stage in neurosis development.

The syndrome always occurs psychogenically and in its manifestations reflects a traumatic situation. Main components: reduced mood background, not reaching the degree of melancholy. Decreased mood is usually combined with severe emotional lability, often asthenia, mild anxiety, poor appetite, and insomnia.

- Pessimistic attitude is not generalized, but limited to the zone of conflict situation.
- There is a pronounced component of the fight against the disease, the desire to change the traumatic situation.
- There is no mental or motor inhibition, ideas of self-accusation, suicidal tendencies.
- Symptoms are less persistent, somatic disorders are less pronounced, more dynamic and easier to treat than endogenous depression.
- Expressiveness of facial expressions of patients, facial expression is depressed only with the mention of psychotrauma.
- The decrease in self-esteem is less pronounced.
- Depressive affect appears in the form of anxiety-depressive, asthenic-depressive, phobic-depressive and hypochondriac-depressive syndromes.
- Psychological comprehensibility of experiences; reflection of psycho-traumatic pathogenic factors in experiences and statements.

Characteristic traits:

1) Preservation of the basic personality traits,
2) Psychogenic, psychologically understandable occurrence and course;
3) Bouts of unrealistic optimism;
4) An ambivalent attitude towards suicidal thoughts;
5) The presence in the dynamics of the development of the clinical picture of phobias, obsessive and sometimes pronounced hysterical disorders.

Psychotic depression is an acute form of depression in which attacks of psychosis are manifested. It is a more severe form of neurotic depression in which the main symptoms are accompanied by hallucinations, disorientation, or any other type of inability to perceive reality. Psychotic depression occurs in every fourth patient hospitalized with a diagnosis of acute depression.

In addition to symptoms of clinical depression such as feelings of helplessness, worthlessness, and hopelessness, psychotic depression also adds psychosis.

Symptoms of psychotic depression include:

- Nervous elevation,
- Increased anxiety,
- Constipation,
- Hypochondria,
- Suspiciousness,
- Insomnia,
- Intellectual disability,
- Physical immobility,
- Psychosis.

Neurotic depression and endogenous (true) depression: what are the differences?

Although neurotic depression and true (endogenous) depression have many symptoms in common, there are fundamental differences between these diseases.

Differences between neurotic depression and depression

These are the main differences between neurotic depression and true, simple depression, the symptoms and treatment of which largely depend on the cause of its occurrence. At the same time, this disease responds very well to antidepressants (for instance, Imipramine), psychotherapy and auxiliary general health methods (massage, physiotherapy, reflexology, etc.). Provided that treatment is started on time, the prognosis for neurotic depression is favorable. It is possible to achieve complete recovery, prevent relapses and significantly improve the quality of life.

If neurotic depression exists long enough, then it is transformed into a deeper disease - neurotic personality disorder.
Another very important point is that with the persistence of a chronic traumatic situation and the absence of treatment, there is a high risk of the formation of addiction diseases. In this situation, they also act as methods of psychological escape. Most often, the following addiction diseases occur: alcoholism, drug addiction, gambling addiction. It is possible to form either any of them or their combinations.

Neurotic depression occurs when a difficult life situation exists for a long time, which over time begins to seem hopeless and insoluble. Indeed, there are circumstances that cannot be changed. Even then, you can become healthy again and significantly improve your quality of life. This is possible thanks to psychotherapeutic techniques that will help you get out of the influence of a traumatic situation, learn to live in such a way that it does not provoke the development of the disease.

Post by: Samuel Wrangler, M.D., Montgomery, Alabama