Masked depression. How to recognize masked depression Masked depression of a neurotic nature symptoms

At least 200 million people are diagnosed with depressive disorders every year. One in ten men and one in four women will suffer from depression in their lifetime.

Depression

ABOUT depression we can talk endlessly. And not only because the relevance of the problem is very high, but also because the variety of its symptoms and manifestations is reminiscent of a woman who often changes clothes, and sometimes puts on a mask so as not to be recognized.

At least 200 million people are diagnosed with depressive disorders every year. One in ten men and one in four women suffers depression throughout your life.

According to some authors, among patients who consulted general practitioners, 68% have symptoms of depression, and in general medical practice, masked depression or other borderline psychopathological conditions occur in 32.9% of patients with an unknown diagnosis.

The interaction between depression and somatic disorders can be viewed from different perspectives.

1. Depression can manifest itself as somatic disorders.

2. Depression may be consequence of severe somatic illness, for example, malignant diseases or stroke.

3. Depression and physical illness can coexist(for example, when HIV infection, with gastritis).

4. Depression may develop due to certain hormonal diseases, such as hypothyroidism, menopause, Cushing's syndrome.

5. Depression can develop when taking certain medicines (for example, antihypertensive and some hormonal drugs).

An abundance of complaints, their unusual combination, which is not typical for the clinical picture of any somatic disease, suggests a masked(hidden, larvinated, somatized) depression.

In this case, somatic symptoms come to the fore, overshadowing the severity of affective depressive disorders. The clinical picture is dominated by vegetative and somatic symptoms, which makes diagnosis very difficult, especially since the characteristic depressive symptoms weakly expressed, erased or completely absent.

These patients are fixated on their experiences and usually do not talk about the symptoms of depression that they have, considering them secondary and insignificant. Moreover, the doctor’s questions about his mood, problems, and lifestyle are often perceived extremely negatively, causing aggression and irritation. Therefore, it is difficult for a non-psychiatrist to diagnose such depression unless he puts aside the somatic complaints presented by the patient and tries to look inside the problem with which the patient came to him, and also looks at it from the other side.

Skills in analyzing “body language” and nonverbal communication will help him with this. Patients with depression are usually casually dressed, their outfit has gray or dark tones, women do not wear makeup, do not have hairstyles or jewelry, they have poor facial expressions and movements, inexpressive and monotonous speech, monosyllabic answers, etc.

But if the doctor can remove the mask hidden by somatic symptoms of depression, then he will see a depressed mood, a pessimistic assessment of the past, present and future, a decreased desire to perform usual work, a loss or decrease in interests and the ability to experience pleasure in activities or events usually associated with positive emotions, a decrease in activity, increased fatigue and decreased energy. And these symptoms, upon careful analysis, arose on the eve of the problems with which the patient came to see a somatic doctor (not a psychiatrist).

Below are the “masks” of depression that prevent a correct diagnosis from being made in time and helping the patient:

eating disorder(usually a decrease or lack of appetite and, as a result, weight loss, less often - “eating” anxiety and depression),

sleep disorder(insomnia or increased sleepiness, frequent awakenings, difficulty falling asleep, early awakening),

pain syndrome, all kinds of pain that have no basis, organic nature (headaches of a diffuse nature, arthralgia - joint pain, myalgia, fibromyalgia - muscle pain, pain in chest, in the abdomen, in the region of the heart, trigeminal neuralgia, facial nerves, intercostal neuralgia, lumbosacral radiculitis, etc.),

autonomic dysfunction (local sweating, marbling or coldness of the extremities, persistent white dermographism, lability of heart rate with a tendency to tachycardia and pain in the heart area, lability of blood pressure), which can be perceived as cardioneurosis with a continuous or recurrent course for > 3 months. or vegetative-vascular dystonia with unpleasant sensations in the heart area, changes in the strength and frequency of heart contractions, tachycardia, extrasystole,

memory impairment, decreased concentration of attention and perception of new information, while intelligence remains unchanged, but patients feel incompetent in performing usual professional and everyday work, solving ordinary issues (in my practice, there were cases when a programmer could not perform basic typing, and a housewife could not could cook food)

functional disorders from other internalorgans(irritable bowel syndrome, hyperventilation syndrome, etc., the manifestations of which are: constipation, flatulence, dizziness, burning sensation, feeling of muscle tension, weakness in the limbs, itchy skin, neurodermatitis, disorder menstrual cycle, erectile dysfunction, decreased libido),

asthenic manifestations(increased weakness, fatigue),

“masks” in the form of psychopathological disorders(obsessions, anxiety disorders, panic attacks, phobic disorders, hypochondriacal phobias - cardio-, cancerophobia, etc., hysterical reactions - a tendency to dramatize the situation, the desire to draw attention to one’s ailments),

“masks” in the form of pathological characteristics disorders(antisocial behavior with conflict, outbursts of aggression, confrontation, drug addiction, substance abuse, gambling, alcohol abuse, auto-aggressive behavior with tendencies to self-harm).

Such patients, as a rule, visit an endless number of different specialists, presenting a lot of various complaints that can also occur with other somatic diseases. They undergo numerous studies that do not confirm either somatic or neurological organic diseases.

These are patients who, despite months of examination by various specialists, do not have a definite diagnosis. They are often treated symptomatically, trying to relieve a specific symptom, but the treatment is ineffective, and patients continue to see doctors, and depression worsens, becomes protracted and more difficult to treat.

Patients drop out of society, bring suffering to loved ones, lose their profession, friends, and skills. Due to the severity of depression, ideas of self-blame may arise in them, and suffering becomes unbearable. We may lose such a patient, since the suicide rate in depression is very high.

But, With information and relevant knowledge, masked depression can be diagnosed in time. And if it is not quite pronounced and is caused by a traumatic situation, you can try to cope with the help of a psychologist or psychotherapist, take a vacation and try to relax where there is a lot of sun, relaxation and various amenities, take sedatives of herbal origin.

This is also not the end if the state of depression does not go away. There is always a way out! Seek help from doctors who are depression specialists. And it’s not scary that they are called psychiatrists. ABOUTThey don’t know what to do to prevent depression from returning. published

On the contrary, people feel pain of a completely different nature, suspecting they have various diseases.

Because of this, neither the patient nor the doctors may not suspect for a long time that the person is suffering from a depressive disorder.

It is important to identify the real reason ailments in order to prescribe effective treatment.

The most common symptoms of masked depression are:

• Vegetovascular dystonia.
• Dizziness, migraines.
• Irritable bowel syndrome.
• Cardylagia, tachycardia, racing blood pressure.
• Cardioneurosis.
• Pain in the muscles, joints, and spine that is not justified by external factors.
• Circadian rhythm disturbances (insomnia, daytime sleepiness, increased sleep duration).
• Eating disorders (bulimia, anorexia, compulsive overeating).
• Mental disorders (obsessive-compulsive disorders, panic attacks, increased anxiety).

A striking feature of latent depression is the frequent change in somatic symptoms, which creates in a person the false feeling that he is developing several different diseases at once.

A sign that a person is developing nominal masked depression is that clinical examinations do not give results. The person is physically absolutely healthy, but symptoms of various diseases continue to appear.

Also, the most important feature of this disease is the lack of improvement in the person’s condition when receiving treatment for the alleged diseases.

Depression is a disease of the 21st century, because modern man pursues many stress factors- failures at work, in the family, constant lack of time. Here you will find tips on how to avoid depression. This information is useful to everyone.

Neck muscle tension as a symptom

There are two options for the occurrence of unpleasant sensations affecting the neck muscles with masked depression:

1. Muscle tension that appears as a result of a depressed state of the body.
2. Symptoms are one of the masks that hides the disease.

In the first case, excessive tension in the neck muscles actually occurs, which leads to cramps, stooping, pain, stiffness of movement, and loss of sexual desire.

In such a situation, physiotherapy (massages, electrical procedures, mud baths) can improve the patient’s condition by achieving muscle relaxation.

When the symptoms are a manifestation of the mask of hidden depression, not only a feeling of muscle tension occurs, but also such false sensations as: heaviness in the neck and back, a feeling of “stiffness” in the joints, bursting, pulling or tightening sensations in the neck muscles. In this case, treatment attempts do not bring results or lead to a worsening of the condition.

Excessive muscle tension is directly related to a person’s psychological state, so when muscle tension appears, pay attention to the traumatic, nervous or depressing situations that have happened to you recently.

Reasons

The main cause of masked depression is a decrease in the level of neurotransmitters: serotonin, dopamine and norepinephrine. The most important factor is disruption of serotonin production. This type of hormone is not only responsible for a person’s mood, but also helps the body regulate pain.

If serotonin levels drop, then depression can manifest itself not only as a decrease in mood, but also as unpleasant or painful sensations in different areas of the body.

Factors causing disruption of neurotransmitter production have not been fully studied.

But there are several reasons why people are at risk:

• Genetic predisposition.
• Congenital pathology of metabolism of various substances (galactosemia, hyperglycemia, protein deficiency).
• Autoimmune diseases (multiple sclerosis, myxedema).
• Vascular pathologies of the brain (aneurysms, damage to the carotid artery, due to traumatic brain injury).

Differences from classic depression

In the case of classical depression, a person has the following symptoms: apathy, suicidal thoughts, guilt, depressed mood (regardless of circumstances), anxiety, anhedonia (loss of interest in activities), pessimism, decreased self-esteem, severe fatigue.

The listed mood disorders are hidden behind physical ailments with masked depression. This makes classic depression a disorder that is easier and quicker to diagnose than latent depression.

If you experience symptoms of classic depression that last more than a month, you should seek help from a doctor. Without proper treatment, depression continues to develop, significantly affecting quality of life.

Subdepressive state or masked depression?

Subdepression is a mild depressive state characterized by a decrease in mood and a feeling of melancholy, which are not as pronounced as in clinical depression.

Subdepression is not a mental illness and is caused by external factors and worries.

In contrast to masked, in which it is the internal functions of the body that are disrupted.

How could this be dangerous?

The basis of the danger is the extremely difficult diagnosis of this disease. The longer the disease remains untreated, the stronger its manifestations. In constant anxiety about the state of health, a person can greatly reduce his mental stability. This can cause the development of neuroses, psychoses, and mood disorders, which will only worsen the patient’s condition.

In addition, passing through large number doctors and constantly receiving different diagnoses, a person will try new treatment methods. Unnecessary use of medications can harm a person’s physical health due to various side effects and then the disease that was just a mask can become a real disease.

Treatment of masked depression

Only complex therapy will help to effectively influence the effectiveness of treatment, which includes two approaches:

1. Drug treatment.
2. Psychotherapy.

The use of antidepressants and sedatives is combined with psychotherapeutic work.

Medicines help relieve symptoms of depression, and a psychotherapist works to identify and eliminate psychological problems caused by external factors. Therapy for masked depression shows positive results quite quickly.

Often the symptoms of the disease disappear within a month after starting treatment. However, doctors often recommend repeating the course of treatment after 3-6 months from the last course.

When treating with a psychotherapist, it will also be useful to take into account the opinion of doctors in related fields (generalist, gastroenterologist, cardiologist), because with a long period of illness and the use of the wrong treatment route, changes in the functioning of the human body are possible.

Masked depression is a mental disorder in which a decrease in mood can occur almost unnoticed, but at the same time signs characteristic of diseases of the internal organs appear. A person suffering from hidden depression is not aware of the mental disorder and is convinced that he has some serious physical illness. The difficulties of treatment begin with diagnosis, since this form is difficult to identify in comparison with the classic one; the danger of the disease lies in its invisibility, mildness and mild symptoms.

Causes

Like classic depression, latent depression occurs as a result of a disturbance in the metabolism of serotonin and a decrease in its level, and this hormone regulates the function of nervous system. An excessively strong reaction of the body to signals from internal organs occurs, the patient notes a deterioration in general well-being. The exact reasons for the decrease in the amount of serotonin in the body have not been established, but it has been revealed that the likelihood of masked depression of a neurotic nature becomes higher in the presence of certain diseases.

Special risk groups

• people who are sensitive to stress and conflict by nature, anxious and suspicious by nature, prone to mood swings, weather dependent;
• a subdepressive state is typical for people with a weak autonomic nervous system, who often experience attacks of dystonia and changes in blood pressure;
• The risk of developing depression increases in those suffering from inborn defects of metabolism, multiple sclerosis, Parkinson's disease and vascular pathologies of the brain.

Symptoms

In most cases, somatized depression is accompanied by sleep disturbances, memory loss, fatigue, anxiety, and decreased or absent sexual satisfaction. However, patients always note the presence of symptoms characteristic of physical diseases.

Taking into account the signs of hidden depression, three main types of the disease can be distinguished.

Cephalgic type, in which the patient complains of headaches, most manifested by emotional disturbances, loud noise, and mental stress. There are problems with concentration and memory, and anxiety. It is difficult for a person to explain in words the general physical condition, it seems that everything hurts. Brain examinations do not yield results, and the patient begins to suspect an incurable disease, which leads to fear and possible panic attacks.

Gastralgic type. The disease is disguised as pathologies gastrointestinal tract. A person complains of heaviness, distension in the abdomen, pain in the stomach, frequent and too noticeable peristalsis (movements) of the intestine, gas, constipation, belching, and possible pain in the hypochondrium. Therapy prescribed by gastroenterologists does not help. As a result, the patient’s fear for his health increases, anxiety states arise, and he fears cancer or ulcers.

Cardialgic type. In this case, depression manifests itself as discomfort in the chest, a feeling of lack of air occurs, disruptions in cardiac activity, tachycardia, tingling in the heart area, and pressure surges are possible. Sometimes it is assumed that this is how vegetative-vascular dystonia manifests itself or that hypertension begins, but treatment does not produce results. A person does not believe in recovery, experiences anxiety, his performance suffers, and an obsessive fear of death arises.

In most cases, the patient’s relatives note his emotional lability (sharp mood swings for no apparent reason), the person becomes conflicted and impulsive, touchy and whiny, irritable.

Methods for treating hidden depression

A misconception about the disease leads to the fact that, instead of coming to see a neurologist, psychotherapist or psychiatrist, a person suffering from a depressive state visits doctors of other specialties and starts taking medications to treat various pathologies. However, even psychotherapy without combining it with medication can help some patients overcome and cope with the disease.

Due to the fact that masked depression occurs due to a decrease in serotonin levels, patients are prescribed antidepressants - drugs aimed at improving the general mental state, reducing apathy, melancholy, anxiety, relieving emotional stress, and increasing mental activity. In some cases, sedatives are prescribed.

The best option would be complex treatment, in which drug therapy is combined with psychotherapy sessions. This approach will help overcome the disease and prevent its recurrence.

Masked (hidden, larvae, vegetative, “depression without depression”) does not manifest itself in the usual way, it is hidden under the “mask” of diseases of the internal organs. In this case, physical discomfort is observed, painful sensations V different parts body, changes in human behavior. There are no symptoms of classic depression - apathy, depression or suicidal thoughts.

Reasons

Like any other depression, masked depression develops due to metabolic disorders, or more precisely, when the amount of the neurotransmitter serotonin, which controls the functioning of the nervous system and regulates mood, decreases. This leads to a super-strong reaction of the body to ordinary impulses from the internal organs, and the patient experiences a feeling of pain and discomfort.

The reasons for the decrease in serotonin levels in the body are not fully understood. It is known that the risk of developing latent depression increases in the presence of certain diseases: inborn defects of metabolism, multiple sclerosis, Parkinson's disease and vascular pathologies of the brain.

Symptoms

The symptoms of hidden depression are very varied, but they are difficult to detect. Depending on the symptoms, the disease is divided into three main types:

• Gastralgic type. The disease manifests itself under the guise of gastrointestinal tract pathologies with the following symptoms: heaviness in the abdomen, a feeling of discomfort, loss of appetite, belching, pain in the hypochondrium, constipation. The patient seeks help from gastroenterologists, but the treatment does not help. Because of this, fear for one's health, fear of cancer and anxiety attacks develop.
• Cephalgic type. Depression is hidden under the “mask” of a neurological disease. The patient complains of headaches, especially severe during emotional disturbances, mental stress, or loud noise. A person cannot express his general physical condition in words; it seems to him that everything hurts. He undergoes all brain-related examinations, but there are no results. The patient suspects an incurable disease, which causes fear.
• Cardialgic type. The disease is hidden behind discomfort in the chest, a feeling of lack of air, a feeling of interruptions in cardiac activity, tingling, changes in pressure, tachycardia. It is assumed that this is VSD or the onset hypertension, but the treatment does not help the patient. The patient stops believing in recovery, performance declines, and fear of death develops.

In most cases, any type of hidden depression is accompanied by sleep disturbances - nightmares, insomnia or hypersomnia.

A person’s character also changes, he becomes touchy, whiny, aggressive, conflictual, and impulsive.

There is no satisfaction from eating, sexual activity and other natural phenomena. The patient tries to attract the attention of others to his illnesses and does not believe in the qualifications of doctors.

Differences from classic depression

Unlike classical depression, with masked depression the patient does not suffer from melancholy and does not fall into an apathetic state. Its manifestations are well hidden under the “outfits” of other diseases.

At the same time, the person is sure that he is suffering from some rare and difficult to diagnose non-psychiatric pathology, and therefore requires numerous examinations. He consults with therapists, gastroenterologists, neurologists and other specialists, but to no avail. As a result, the person begins to suspect doctors of incompetence and goes to another clinic. Most often, such patients see a psychotherapist only after years of examination.

Recognizing the disease is usually difficult, since the patient turns to doctors of a different profile. None serious illnesses however, they are not detected, and minor and common diseases cannot be cured with conventional medicines. Then the patient is referred to a psychotherapist, who, using surveys, determines the diagnosis.

The doctor asks the patient about lifestyle, changes in emotional state, problems in interpersonal relationships and professional activities. It is often discovered that a person has low self-esteem, his views on the future are rather pessimistic, and he does not receive satisfaction from food, entertainment and life in general.

How can this be dangerous?

Masked depression is dangerous due to its invisibility. Sometimes it is not possible to recognize the disease for years, and with the loss of time the patient’s condition only worsens. Over time, depression is accompanied by other mental illnesses, such as anxiety attacks and fear of death from an unknown disease that doctors cannot detect.

Changes in the patient's character spoil relationships with loved ones and colleagues. Quarrels, manifestations of aggression and irritability push a person out of society.

Antisocial behavior also threatens job loss. A predisposition to drug addiction and alcoholism develops.

Treatment

Masked depression is treated with appropriate medications and psychotherapy sessions. Since the main cause of the disease is a lack of serotonin, the patient is prescribed antidepressants. Additionally, sedatives are prescribed. Depending on the psychological state, the patient may be prescribed the following medications:

• Venlafaxine;
• Duloxetine;
• Ipsapirone;
• Ludiomil;
• Mirtazapine;
• Noveril;
• Saroten;
• Flesinoxan.

For severe sleep disturbances, Aponal is prescribed, for pronounced fears, Tavor or another tranquilizer; if the patient is very inhibited, he is prescribed Tofranil (Imipramine) or another antidepressant that stimulates the central nervous system. For latent depression, these drugs give a relatively quick positive result; signs of the disease disappear after 2-4 weeks, but therapy sometimes has to be continued for months until complete recovery.

During psychotherapy sessions, the doctor works on the psychological processing of the conflict that caused depression in the patient. A long-term therapeutic course is indicated, including psychoanalysis, individual and group sessions.

The best treatment will be a combination of medications and psychotherapy sessions. This will allow you to simultaneously cope with the symptoms of the disease and prevent its re-development.

Prognosis and prevention

Correctly diagnosed masked depression is easy to treat. The main thing is to explain to the patient that it is really necessary. After all, a person is convinced that he has another disease and does not want to believe that he needs the help of a psychotherapist.

To prevent the development of latent depression, you should take care of your psychological state - live with positive thoughts, do not give in to despondency, take timely breaks from work, avoid stress and conflicts.

In the video, the psychotherapist talks about the types of depression, including the features of masked depression:

The insidiousness of the disease lies in the fact that a person, in addition to a psychological disorder, experiences physical pain and inconvenience. The effectiveness of treatment depends entirely on the correctness of the diagnosis.

Hidden depression is often hidden behind physical illnesses, which is why it is called somatic. Sometimes a person begins to experience pain symptoms of unknown origin. Scientists claim that the cause of physical illness is a spiritual disorder that manifests itself through diseases of the body. With a correct diagnosis, only a psychotherapist can restore good physical condition and eliminate the symptoms of masked depression.

Symptoms

Symptoms of latent depression most often manifest themselves in the form of psychogenic pain: it can be headache or toothache, discomfort in the joints, cervical migraine. A person may also experience vegetative-vascular disorders: tachycardia, dizziness and heaviness in the body. Signs of hidden depression look like this:

Subdepressive state is not always noticeable to others

People suffering from masked mental disorder do not always show their inner state. First of all, they do this so as not to disturb their loved ones. Patients have learned to hide their condition under the guise of calm and satisfaction with life.

Sudden nervous breakdowns

Somatized depression often gives rise to outbursts of emotions. An always calm person can suddenly burst into tears or scream sharply, for no apparent reason. After such an explosion of emotions, the patient again becomes calm and balanced.

Appetite disturbance

Hidden depression is often accompanied by a complete refusal to eat, or vice versa, increased appetite. Patients with mental disorders very often try to compensate for their worries by changing their taste preferences. Relatives should be wary of a sharp change in gastronomic preferences for no apparent reason.

Insomnia or vice versa, constant sleepiness

Sleep disturbance is a clear sign of depression. A person suffering from this disease can rarely boast of healthy and restful sleep. Patients mainly suffer from insomnia, cannot fall asleep for a long time and then fall into a borderline state between sleep and reality. There are often cases when a person sleeps more than 10 hours a day and does not get enough sleep.

Uncontrolled use of medications

Some people, trying to get rid of a depressed state, begin to take various antidepressants on their own. As a result, the low-grade disorder takes chronic form and more difficult to treat.

Constant mood swings

A person who has just been cheerful and sociable can plunge into heavy thoughts or even cry. People experiencing an internal crisis can experience several mood swings in one day.

Obsessive-compulsive disorder

Masked depression of a neurotic nature is often accompanied by obsessive movements syndrome. A patient with a hidden disorder may tap on the table, count floors in houses, twitch his neck or bite his lips. People who perform repetitive movements are more likely to have internal problems psychological in nature.

Constant search for meaning

A depressed person cannot enjoy a good day or success at work; he is constantly busy thinking about finding the meaning of life. Such thoughts make him sad, thoughts about imminent death only aggravate his depressive state.

Psychosomatic pain

Somatic manifestations of depression are expressed in bodily pain of unknown origin. A complete diagnosis does not answer what caused the health problems. Imaginary radiculitis or headache a prime example of hidden depression. One of the main problems of people experiencing symptoms of somatized depression is that they do not want to admit even to themselves that they need psychological help.

How to get rid of hidden depression

The first step to getting rid of the disease is a consultation with a psychotherapist who will select the right treatment. Somatic symptoms of depression cannot be ignored; this is fraught with serious consequences. The causes of subdepression can be internal and external. TO internal reasons include: low self-esteem, loss of meaning in life, and more. External reasons are financial problems, troubles at work, divorce from a loved one, housing instability, sexual dissatisfaction. If you cannot cope with problems on your own, and communication with friends does not bring the desired result, there is only one way out - seek help from a specialist. A psychotherapist will clearly explain what hidden depression is and help you deal with it on a professional level.

It should begin with a complete diagnosis of the patient. After all pathological diseases are completely excluded, therapy for the hidden disorder begins. In cases of mild illness, the attending physician will recommend non-drug treatment, which includes:

• Psychotherapy, which is carried out in the form of individual or group sessions;
• Light therapy;
• Magnetic and transcranial stimulation and more.

Somatized depression in neglected form treated with tranquilizers and antidepressants. Only the attending physician should draw up a course of treatment, taking into account general condition sick. It is strictly forbidden to take sedatives on your own, as they have a lot of contraindications and can cause complications. If all doctor's recommendations are followed, treatment of latent depression has a favorable prognosis. Getting rid of the disease is not easy, which is why an integrated approach to treatment is so important. Psychological assistance, support from loved ones and, if necessary, drug therapy will allow the patient to look at the world with completely different eyes.

The appearance of the first signs of depression cannot be ignored. There can be many reasons that caused a state of mental discomfort: from loss of meaning in life to financial problems. The first symptoms of an internal crisis are sleep disturbances, lethargy and irritability, loss of appetite, and psychosomatic pain. A timely diagnosis and proper treatment will allow you to get rid of this unpleasant disease and live a full life.

Masked depression

First, let's define what depression is. This is a mental disorder that is very common in the modern world. It is characterized primarily by decreased mood, loss of interest in life, lack of desire to do anything, and inability to experience pleasure. The quality of life deteriorates, melancholy, sadness eat away, life loses its meaning. A sick person can remain in this depressed state for a very long time, without finding a way out.

Depending on the cause of origin, depression is divided into 3 main groups:

1. Endogenous (Arises for no apparent reason, regardless of the situation. The cause is genetic predisposition, changes in the hereditary apparatus. The impetus can be any change in the usual lifestyle.)
2. Psychogenic (The cause is a specific stressful event. First, a “fixation” on it occurs, and then other symptoms are added to this state, as a rule, it goes away after the problem is resolved.)
3. Somatized or masked (Does not manifest symptoms characteristic of this disorder, but imitates non-existent diseases, hides under the guise of a somatic disorder.)

We will pay special attention to this type of depression, clarifying that the terms “hidden” and “larved” also refer to masked depression.

Causes of masked depression and difficulties of diagnosis

External factors can provoke hidden depression, such as: loss loved one, stress, troubles in your personal life. And if there is bad heredity, multiple sclerosis, parkinsonism syndrome, cerebral vascular pathology, then the person is at risk. Impaired metabolism leads to a decrease in the production of the hormone serotonin, which is responsible for regulating mood and pain.

Diagnosing masked depression is incredibly difficult. A person goes from doctor to doctor, takes expensive tests, but there is no effect.

The thing is that in the case of hidden depression, at a doctor’s appointment, the patient does not talk about the symptoms characteristic of depression. He talks about some kind of illness and in the first place is not a bad mood, but very specific dizziness, discomfort in various parts of the body, heart and headaches or intestinal problems, shortness of breath, sleep disturbances, lack of libido. A person is sure that his poor health is due to the presence of an “incurable” disease. Masked depression exhausts the body both physically and emotionally.

There is a very important point here: the symptoms that the patient is talking about do not fit into any one picture of the disease. An attentive doctor, be it a therapist, gastroenterologist, or even more so a psychotherapist, will definitely conduct a detailed survey and pay attention to the manner of speaking and study the medical history and clarify the symptoms.

Subdepressive state

There are subdepressive states when the symptoms of depression are expressed in a fairly mild form. In this case, the person is not yet exhausted by the disease, he is still quite active, but nothing pleases him anymore, there is no “taste of life.”

The state of subdepression usually occurs when some new stage, a new leap in development is expected, a choice needs to be made, but the person does not see which direction to take. And he also doesn’t know what to do in this case. The state of affairs seems deadlocked. Old goals have been achieved, but new goals are not in sight. A crisis comes, a situation when there is no joy, no significance, no pleasure, no incentives for further development.

If a person is sufficiently educated and strong, he can figure this out on his own and do a “reassessment of values,” and if that doesn’t work, then seek help from a doctor at this stage. This condition indicates that something needs to be changed. But what to change and in what direction to move - this is where the doctor will help.

The doctor must be able to distinguish and see the fine line that distinguishes ordinary blues from a depressive state.

Masks of depression

Hidden depression is an insidious disease, dangerous because it is very difficult to discern. What is this disorder disguised as? Here are the most common cases:

• Irritable bowel syndrome: increased anxiety causes rumbling, flatulence, abdominal pain, loose stool. A person is afraid to leave the house because of frequent visits to the toilet, he is afraid that he will not find the toilet on the way or will not have time to reach it
• Vegetative-vascular dystonia: a diagnosis that does not exist. When it is not clear what is happening to the patient and the reasons for what is happening are not clear, this diagnosis is usually made. Pressure surges, dizziness, weakness, fear of fainting, headaches from muscle tension, migraines, tachycardia, the desire to take a deep breath and fear of lack of air
• “Cardiac melancholy” syndrome: aching, stabbing, cutting pain in the chest. A thorough examination will not show structural changes in the heart muscle and blood vessels
• Neuralgic and rheumatic pains
• Insomnia (difficulty falling asleep, light, restless sleep, nightmares and difficulty getting up)
• Pathological drowsiness (you spend more than 10 hours in bed and at the same time feel overwhelmed and exhausted)
• Anorexia (lack of appetite, refusal to eat) and bulimia (bouts of gluttony)
• Mental disorders in the form panic attacks and various phobias

Symptoms of masked depression

If any of the above manifestations are present, but all this occurs against the background of emotional depression, it is worth finding out and identifying the presence of the following symptoms:

• Daily fluctuations in mood and activity (usually in the evening the mood improves, and in the morning sadness, despondency, anxiety sets in), their frequency and recurrence (time, season)
• Pessimistic assessment of one’s future (the view of the world is changing, nothing pleases, everything around is in shades of gray, some things seem absolutely insoluble)
• Difficulty concentrating (there is a feeling that memory is impaired, perception and learning something new becomes problematic)
• Increased level of anxiety (concern, worry, expecting the worst)
• Lack of effect from previously prescribed therapy

Usually the patient talks about this as a secondary manifestation caused by the disease, not realizing that these are signs of hidden depression. This manifestation of symptoms makes it difficult to make a timely diagnosis, and therefore, the severity of the disease can be underestimated.

People have different attitudes towards certain events in life. For some, a quarrel in the family or troubles at work are a normal life situation, but for others it can be stressful and lead to mental trauma. Maximum effort is spent on a minimal event. Unable to relax and get rid of tension in the usual way, a person concentrates on what happened, becomes despondent, rushes to extremes, and makes significant decisions that he regrets. It seems that he has reached a dead end, with nowhere to get vital energy from. There is a masked depression of neurotic origin.

Symptoms of masked depression of a neurotic nature

• Uncontrollable mood swings
• General weakness and weakness
• Tendency to criticize and blame others for your troubles
• The story of the event ends in tears and feelings of self-pity
• A little anxiety
• A clear understanding of the causes of the disease
• Sleep disorder
• Digestive system disorders
• Pain of various etiologies and localizations (headache, heart, joint)

Weak-willed people, quiet and passive, not used to fighting and winning, defending their point of view - this is the category of people who have every chance of ending up in the arms of this insidious neurological disorder. Being in a state of depression with an anxious component, at the moment of its maximum manifestation, a feeling of hopelessness, doom, and despair may arise. And here there is a danger of suicidal thoughts.

The surest way to prevent suicide is timely detection of the disease and timely treatment.

It happens that the disease is not detected and progresses, the person’s character changes greatly. He becomes aggressive, irritable or, on the contrary, withdrawn, detached from others. Social isolation gradually occurs. Why is this dangerous? The fact that at this moment a person seeks relief from his condition in alcohol and drugs, and in return receives worsening depression.

A special risk group is teenagers

Masked depression also occurs in adolescence. The peak of depression occurs in adolescence (15-40% of young people are susceptible to this illness). This manifests itself in the form of a demonstration of disobedience, protest, or, conversely, laziness and tearfulness. Children openly come into conflict with their parents and teachers, they can terrorize those around them with music of a certain direction, or become interested in subcultures or religion.

It is very important to persuade a teenager to visit a psychotherapist. Do not give him conditions and ultimatums, find those the right words who will help you and him get a consultation with a doctor.

Treatment of masked depression

As a rule, depressive conditions are treatable; the main thing here is not to delay in seeing a doctor, and to strictly and carefully follow his instructions. Treatment will depend on the nature of the disease and the severity of the disease, on symptoms, characteristics of the body, the presence concomitant diseases and on the age of the patient.

Hidden (larved) depression is treated using an integrated approach, combining medication and psychotherapy.

Medicines (according to a doctor’s prescription and strictly individually)

1. Antidepressants (reduce and alleviate feelings of depression). Do not be afraid of addiction; new generation drugs will only help the body restore damaged mechanisms and ease the symptoms of depression. There are many names: Luvox, fluoxetine, anafranil, paroxetine, citalopram, etc.
2. Tranquilizers (have a sedative effect, reduce fear, panic and anxiety). There are restrictions on admission: children under 18 years of age, frail elderly people, pregnant and lactating women, those with kidney and liver failure, drivers. Drugs such as: Relanium, tazepam, phenazepam, afobazole, atarax have proven themselves and are often prescribed for the treatment of depressive conditions
3. Nootropic drugs: piracetam, neurobutal, vinpocetine, cerebrolesin (improves memory, activates brain function)
4. Multivitamins

Psychotherapy

Not an alternative to drug treatment, but an important addition that involves the active participation of the patient in the treatment process. In the arsenal of a psychotherapist there are many methods and techniques for treating latent depression, which allow the patient to cope with his internal and external problems and conflicts. The following areas are used: psychoanalysis, cognitive psychotherapy, rational, behavioral, gestalt therapy in groups and individually, as well as light therapy and art therapy. These and other non-drug methods help resolve problems that seem insoluble to the patient.

All together, both medications and psychotherapeutic methods make it possible to realize and overcome internal complexes, relieve affective tension and consider the situation from an angle where it ceases to be a psychological trauma.

It is important to achieve absolute trust in the doctor-patient relationship. The disease is easy to treat, and if you tune in to a positive outcome and actively cooperate with the doctor, the recovery process will go faster.

Signs and treatment of masked depression

A depressive state can be completely invisible to others, but can be felt by a person at the level of physical ailment and even distinct pain in one or another part of the body. In this case, masked depression, or subdepressive state, occurs.

Masked depression. Origin story

Victorian doctors in the 19th century drew attention to a similar illness, accompanied by complex shape exhaustion, calling it “neurasthenia.”

They were unable to determine the medical cause of this condition, because... patients reported symptoms similar to those of mental illness.

Modern medicine defines such neurasthenia as masked depression.

The origin of this type of disorder is not fully understood. However, there is a hypothesis according to which its development is associated with three mechanisms:

1. It reveals pathological changes at the somatic and neurological levels. Thus, the decompensation mechanism is triggered, i.e. physical ailment is corrected due to the emotional state.
2. This type of depression is characterized by a combination of a true somatic illness, for example, bronchial asthma or allergies, with pathogenetic depressive syndrome. Treatment of depression in this case is aimed at completely eliminating the psychosomatic factor and compensatory restoration of the somatic state.
3. It may occur against the background of imitation of somatic changes due to the individual picture of the disease.

In any case, depression of this type develops against an organic background, and therefore is closely related to the somatic state of the human body.

Reasons

The main cause of the occurrence and development of masked depression is a violation of metabolic processes, namely endocrine changes associated with the release of serotonin.

Its main function is to regulate mood and pain, so a decrease in the hormone leads to the fact that a decreased mood is perceived by the body as pain and discomfort in different parts of the body.

In addition, the causes of anxiety are:

• violations of work and rest schedules;
• dissatisfaction with various aspects of life: work activity, interpersonal relationships;
• prolonged physical and mental overload;
• prolonged stress.

The hereditary factor is also important possible complications during the period of perinatal development.

Symptoms

The symptoms of masked depression are primarily associated with pain of varying degrees of intensity and localization.

Experts identify several types of depressive disorders of this nature:

1. Malfunctions in the functioning of biological rhythms: prolonged insomnia or, conversely, constant drowsiness, “inverted mode”, when a person is awake at night and sleeps during the day.
2. A pain mask associated with the appearance of heart, headaches, muscle pain and neurological problems.
3. Disturbances in autonomic and endocrine systems: vegetative-vascular dystonia, anorexia, bulimia, sexual dysfunction.
4. Mental disorders expressed in panic attacks, obsession, various phobias and antisocial behavior.

All of the above signs are characterized by both complex and individual manifestations.

What are the signs of mild depression? Find out from the article.

How to get rid of depression on your own after a divorce? Read on.

Diagnosis and treatment

The effectiveness of treatment for masked depression directly depends on proper diagnosis. Identifying symptoms from the patient himself does not give the desired result, but only increases the duration of diagnosis and immediate treatment.

The doctor prescribes antidepressants and sedatives, leading to an improvement in the condition at the somatic level and the elimination of painful sensations.

Drug treatment also includes the use of multivitamins, immunostimulants and restoratives. Treatment should be comprehensive with an adequate combination medicines and psychotherapy.

For effective treatment and consolidation of a positive result, it is important to take into account the opinion of specialists from related medical fields: therapeutic, gastroenterological and cardiological areas.

Forecast

Correct and timely diagnosis facilitates rapid treatment. According to statistics, every fourth woman and every tenth man experiences a similar depressive state at least once in their life. More than 90% of them make a full recovery.

The difficulty with this disease is that it can last for many years, i.e. a person is treated by a therapist, neurologist, narcologist to no avail, and ends up seeing a psychotherapist when masked depression becomes chronic.

Wearing depressive masks is a painful burden for every person. When faced with such a problem, it is important to tune in to a positive outcome and prevent the reoccurrence of masked depression - a condition that exhausts the human body both physically and emotionally.

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What is masked depression of a neurotic nature?

Masked (larved) depression is a psychiatric term meaning a depressive syndrome that has a hidden course. The disease is similar in symptoms to neurasthenia, when the patient feels a state of extreme fatigue and problems sleeping.

Clinical picture

In the masked form of the disease, the clinical symptoms of depression are mild or do not occur at all. In most cases of subsyndromal depression, apathy, hypothymia, motor and mental retardation are usually relegated to the background and are not recognized by the patient.

In the latent form of the disease, a person does not objectively comprehend the influence of the affective components of depression. The patient does not understand what it is, and is sure that he is developing a difficult to diagnose, and possibly even incurable disease. He visits various specialists in an attempt to find a somatic disease, performs complex diagnostic procedures, and as a result begins to doubt the doctor’s competence.

Most often, patients with larval depression report pain and irregular heart rhythm, lack of air, and problems with sleep. Somewhat less often, they describe a persistent headache that is not responding to medications, dyspeptic symptoms associated mainly with impaired peristalsis (diarrhea, constipation, nausea and flatulence). In some cases, patients note problems with memory and decreased concentration.

Some patients complain of sleep disturbances: intermittency, difficulty falling asleep, nightmares. Sometimes patients notice a change in their appetite: a decrease or, conversely, an increase in the need for food. Complaints of changes in libido or irregular menstruation are also common.

Objectively, patients experience slight retardation, which is often expressed in a slower speech rate. As secondary symptoms, sometimes there is increased sensitivity to bright lighting and loud sounds, but these factors are never dominant, that is, they reduce the patient’s quality of life.

The danger of the masked form of the disease is the secrecy and weakness of depressive symptoms. Without recognizing the pathological condition in a timely manner, you can get severe consequences: the disease can be complicated by the addition of panic attacks and more dangerous depressive disorders.

The progression of larval depression is accompanied by negative personality changes: uncontrollable outbursts of irritability and unmotivated aggression interfere social life person and performance of professional duties. In psychologically immature individuals, social isolation can lead to the formation of painful addictions, such as alcoholism or drug addiction.

Causes of subdepressive state

The main causes of masked depression are hereditary predisposition and physiological and biological factors. Masked depression of a neurotic nature occurs due to a lack of substances that regulate the activity of the central nervous system. A deficiency of neurotransmitters leads to an increased reaction to impulses transmitted from organs, resulting in unpleasant and sometimes painful sensations in the patient.

External factors can trigger a subdepressive state: troubles at work and in your personal life, the death or departure of a loved one. The risk group also includes people with a family history, vascular pathologies of the brain, Parkinsonism syndrome, and multiple sclerosis.

Symptoms of larval depression

Masked depression can have two development options: agripnic, which occurs with sleep disturbances, nightmares, early awakening and is accompanied by heavy lifting, and anorectic, in which dyspeptic symptoms are present: loss of appetite, nausea, constipation or diarrhea, as well as weight loss.

A subdepressive state is characterized by the occurrence of many somatic and mental symptoms, such as:

• depression;
• anxiety and phobias;
• obsessions;
• symptoms of neurasthenia;
• hypersomnia, interrupted sleep, insomnia;
• decreased or increased peristalsis;
• signs of vegetative-vascular dystonia (VGS for short);
• skin itching;
• dizziness;
• lack of appetite or bulimia;
• changes in blood pressure and heart rate;
• pain in the heart area;
• neuralgia of various origins.
• increased aggressiveness, conflict;
• formation of pathological dependencies;
• sexual deviations;
• hysterical reactions aimed at attracting attention.

Often, with masked depression, the patient’s relatives note changes in his character and behavioral disturbances: conflict, impulsiveness, unmotivated aggression, irritability, excessive touchiness and tearfulness. Therefore, it is important to know what signs indicate the disease in order to start treatment on time and prevent its progression.

Treatment of the disease

Treatment of subdepression must be carried out comprehensively, using not only pharmacotherapy, but also psychocorrection methods: behavioral, art therapy, rational, psychotherapy. Psychotherapy sessions help determine psychological reasons latent depression, teach relaxation, self-control and help in the formation of adequate self-esteem.

The main components of pharmacotherapy for masked depression are antidepressants (BP for short), tranquilizers and nootropics, as well as sedatives and vitamin-mineral complexes:

• antidepressants;
• tranquilizers and nootropics;
• sedatives;
• vitamins and minerals.

Antidepressants

The antidepressants of choice in this case should be a group of serotonin and norepinephrine reuptake inhibitors. It includes drugs such as Venlafaxine, Anafranil, Duloxetine. If the patient's leading symptom is motor and mental retardation, then it is advisable to use antidepressants that stimulate the activity of the central nervous system (Imipramine, Melipramine).

Tranquilizers and nootropics

For anxiety conditions, tranquilizers of a number of benzodiazepines (Phenazepam) are prescribed, and when sleep disorders dominate, the following are used effective drugs, as cyclopyrrolon derivatives (Zopiclone).

The drug Phenibut combines the qualities of a nootropic and the anti-anxiety properties of a tranquilizer, which allows it to be used for anxiety conditions without losing the ability for productive mental activity. It is effective in conditions with components of neurosis, which are characterized by mood lability, tearfulness and excessive irritability.

The daily tranquilizer Afobazol has a mild effect, so it can be purchased at a pharmacy without a prescription. The drug is effective for phobias and anxiety, eliminates excessive irritability and tearfulness, and makes it easier to fall asleep.

Sedatives

The use of these drugs helps reduce aggressiveness, irritability, suppress excessive nervous excitement, and normalize the state of HCV. Additionally, sedatives relieve intestinal spasms, improve sleep, normalize heart rate, without having a harmful effect on the brain.

Sedatives based on peony and motherwort have a strong sedative effect, normalize the functions of the central nervous system and HCV, relieve irritability, sleep disturbances and unmotivated anxiety. Medicines containing St. John's wort have not only a sedative effect, but also antidepressant properties. Good effect Combined sedatives also exhibit symptoms.

Vitamins and minerals

As an auxiliary treatment, it is recommended to take long-term courses of vitamin-mineral complexes that contain calcium pantothenate, magnesium, folic acid, and vitamin B6. They help the body fight the effects of stress and support the functions of the nervous system.

Treatment of masked depression using the above groups of drugs can have a positive result within a couple of weeks; quite often the symptoms of the disease disappear after 30 days of continuous treatment. But to avoid relapse, you should not stop drug therapy before the end of the prescribed course (usually 3-6 months).

Causes, symptoms and treatments for masked depression

Masked depression is a condition in which the classic symptoms of depression (low mood, lack of plans for the future, pessimistic mood) are not expressed or absent. What masks does depression wear?

Anxious-phobic mask

Fear of getting an incurable disease for no apparent reason, anxiety about an iron not being turned off (probably), fear of being alone, fear of death and other phobias - all these hypochondriacal phobias can exist on their own, but more often they serve as a mask for hidden depression.

If they have existed in your life for a long time and you have learned to cope with them without harming yourself and your active life, you can ignore minor fears and anxieties. If they appeared not so long ago, but have already brought great discord into your everyday life, if you feel that you cannot cope alone, seek help and begin treatment.

Obsessive behavior

Any person has the right to do strange things. The person knows that his action is absurd, but he repeats it again and again. Wiping the floor in an apartment is a necessary act, but when the dust is washed off 15 times a day, it’s already an obsession. Obsessive movements hide behind them a feeling of unsettlement and depression. Endlessly checking whether the gas or water is turned off, returning home several times to check the lock - these symptoms are characteristic of masked depression.

Hypochondria

It can act as an independent disease, but it can also be another mask for a depressed state of mind. The person becomes very suspicious and is sure that he has a terrible incurable disease (despite the fact that there are no objective signs of the disease).

Neurasthenia

Irritability and fatigue, emotional exhaustion, general weakness are signs of neurasthenia. But neurasthenia itself can be a symptom of masked depression.

Sleep disorders

Insomnia or hypersomnia - any of these manifestations is a violation of human biorhythms. Masked depression is characterized by disturbing sleep with many awakenings. At the same time, getting up in the morning requires great volitional efforts, and the feeling of fatigue does not leave either in the morning or in the evening. A person whose depression is hidden under the guise of sleep disturbances may sleep for days on end and still not feel rested.

Autonomic and endocrine disorders

Vegetative-vascular dystonia is a disease on which all incomprehensible symptoms are usually blamed. Strictly speaking, such a diagnosis international classification there are no diseases. Dizziness, hot or cold flashes, changes in blood pressure, fainting - this set of symptoms can be explained by one of the masks of depression.

Heart pain, stomach pain, joint pain, headache are common masks for this mental disorder. When turning to doctors, a person sincerely feels sick, and when objective studies speak of health, the patient begins to be suspected of being a malingerer. But this is not so - the person is sick, he just needs to contact a neurologist or psychiatrist and receive adequate treatment.

Pathological changes in character

In an effort to get away from a depressed state and low mood, the patient may seek solace in pathological tendencies: alcoholism and drug addiction are a frequent companion to masked depression. Therefore, it is important for toxicologists to find out whether a killing hobby or mood problems appeared first.

Tearfulness, touchiness, and the desire to attract attention through problems with well-being are characteristics of a person susceptible to masked depression. She changes her whole life, subordinating her to her absurd laws. Painful sensations in the cardiovascular system and a rapid heartbeat do not add optimism, but taking pills that lower the heart rate and improve blood pressure is useless; the root cause needs to be treated - masked depression.

Treatment of masked depression

Patients are very often afraid to take antidepressants: many consider the pills to be dangerous to health, disrupt hormonal levels, and are highly addictive. And in general, taking antidepressants means admitting that you are mentally ill. This common misconception is especially problematic when communicating with patients suffering from masked depression. Therefore, their treatment begins with minimum doses antidepressants in combination with herbal sedatives.

Very important!

The diseases described in the article actually exist. Making an independent diagnosis and self-medicating is very dangerous, because only qualified doctors can distinguish the masks of depression from a somatic illness. In one case, only antidepressants can solve the problem, in another - a complex of suitable medications.

If you feel unstable and strange, or observe symptoms that you cannot put into a specific picture, consult a doctor. The sooner a differentiated diagnosis is made, the sooner you can undergo treatment and return to an active normal life.