Evidence-Based Resources About Opioid Overdose

Fact Sheet:

Using Naloxone to Reverse Opioid Overdose in the Workplace: Information for Employers and Workers | CDC (PDF | 785 KB) – This fact sheet helps employers understand the risk of opioid overdose and provides guidance about establishing a workplace naloxone program.

Tips for Teens: The Truth About Opioids | SAMHSA – This fact sheet for teens provides facts about opioids. It describes short- and long-term effects and lists signs of opioid use. The fact sheet helps to dispel common myths about opioids. Access sources cited in this fact sheet.

Toolkits:

Medication-Assisted Treatment (MAT) for Opioid Use Disorder in Jails and Prisons: A Planning and Implementation Toolkit | National Council of Behavioral Health – Developed by the National Council of Behavioral Health, this guide provides correctional administrators and healthcare providers tools for implementing MAT in correctional settings.

Opioid Overdose Prevention Toolkit | SAMHSA -This toolkit offers strategies to health care providers, communities, and local governments for developing practices and policies to help prevent opioid-related overdoses and deaths. Access reports for community members, prescribers, patients and families, and those recovering from opioid overdose.

Evidence Reviews/Guidebooks:

Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States | CDC (PDF |  11.5 MB) – This CDC document reviews evidence-based strategies to reduce overdose. It explains why these strategies work, the research behind them, and examples of organizations that have put these strategies into practice.

Use of Medication-Assisted Treatment in Emergency Departments | SAMHSA – This guide examines emerging and best practices for initiating medication-assisted treatment (MAT) in emergency departments.

Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings | SAMHSA -This guide focuses on using medication-assisted treatment for opioid use disorder in jails and prisons and during the reentry process when justice-involved persons return to the community.

Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders | SAMHSA – This guide reviews ways that telehealth modalities can be used to provide treatment for serious mental illness and substance use disorders including opioid overdose among adults.

Treatment Improvement Protocols/Manuals:

TIP 63: Medications for Opioid Use Disorder | SAMHSA – This Treatment Improvement Protocol (TIP) reviews the use of the three Food and Drug Administration (FDA)-approved medications used to treat OUD—methadone, naltrexone, and buprenorphine.

Advisory: Opioid Therapy in Patients With Chronic Noncancer Pain Who Are in Recovery From Substance Use Disorders | SAMHSA – This advisory addresses screening and assessment tools, nonpharmacologic and nonopioid treatment for chronic pain, and the role of opioid therapy in people with chronic noncancer pain and SUDs.

Overdose Prevention & Naloxone Manual | HRC – This Harm Reduction Coalition (HRC) manual outlines the process of developing an Overdose Prevention and Education Program that may involve a take-home naloxone component.

Websites:

SAMHSA

Other federal websites

Visit the EBPRC for additional information, including Treatment Improvement Protocols, toolkits, resource guides, clinical practice guidelines, and other science-based resources.

Identifying anxiety, depression signs – Mayo Clinic Health System

What is stress, and what happens when we aren’t able to cope well with stress? Stress can present itself after being fired from a job, going through a divorce or losing a loved one. Even getting married, transitioning to a new job or having a baby can cause stress.

Many people look to define stress as either good or bad, when in reality it’s neither. Stress is an event we view as out of our control and typically occurs outside our daily routines. How we react shapes our ability to cope with these and other similar events in the future. When individuals struggle to cope with stressful situations, depression and anxiety become more noticeable.

According to the World Health Organization, anxiety disorders are the most common mental illness in the U.S., affecting more than 40 million adults (18.1 percent of the population) every year.

The most common anxiety disorders include excessive fear or anxiety of:

• Specific phobias
  • Animals — spider, cats, dogs
  • Natural environment — heights, storms, water
  • Blood-injection injury — needles, invasive medical procedures
  • Locations — airplanes, elevators, enclosed places
• Social anxiety disorder — being around other people
• Generalized anxiety disorder — worry about many things

It’s common for those struggling with anxiety disorders to also struggle with depression or vice versa. Close to 10 percent of the world’s population suffers from anxiety and depression. However, while anxiety and depressive disorders are highly treatable, only a small percent of affected individuals receive treatment.

HOW ARE STRESS, ANXIETY AND DEPRESSION CONNECTED?

Anxiety and depression can be caused by a number of things, including:

• Genetics
• Environmental exposure
• Personality
• A life event

EARLY SIGNS OF ANXIETY AND DEPRESSION

An early warning sign for anxiety and/or depression occurs when someone begins avoiding things they once enjoyed. Other warning signs for anxiety include:

• Shakiness
• Increased heart rate
• Tightness in the chest and/or rapid breathing
• Racing thoughts

Meanwhile, warning signs for depression include:

• Isolating oneself
• Frequently thinking negative thoughts
• Reoccurring feelings of sadness

TIPS TO COPE WITH ANXIETY AND DEPRESSION

Diaphragmatic and square breathing techniques. Diaphragmatic breathing involves taking a deep breath from your diaphragm. Your stomach should expand as you breathe in. Square breathing techniques involve taking a deep breath in for five counts, holding this deep breath for five counts, exhaling for five counts and finally holding for five counts before repeating. The entire time should be spent focusing on your breath versus the stressful event.

Challenging your thoughts and changing your thoughts. This involves not placing judgment on situations, good or bad, and recognizing that while situations do occur, it’s important to acknowledge what you’re feeling and identify what’s in your control. Your primary areas of control are acknowledgement of your emotions, feelings and your reaction to stressful situations.

• Ask yourself:What am I feeling?
• What are these emotions?
• How would I like the situation to turn out?

Then, identify small, specific goals to get to your desired outcome. If you fail to acknowledge your emotions and feelings and attach a negative thought to a situation, the outcome of that situation will result in avoidance and increased anxiety.

Instead, challenge yourself to find the positive in a potential situation and acknowledge whatever emotions and feelings the situation reveals. Doing so increases the likelihood you’ll be able to cope effectively with a stressful situation.

ADVANCED SIGNS OF ANXIETY AND DEPRESSION

Advanced signs of generalized anxiety disorder include:

• Excessive worry occurring more days than not for at least six months
• Distress or impairment in social, occupational or other important areas of functioning
• Feeling restless
• Fatigue or frequently feeling tired
• Difficulty concentrating
• Irritability
• Muscle tension
• Sleep disturbances (difficulty falling or staying asleep)

Advanced signs of a major depressive disorder include:

• Feeling down or depressed most of the day, nearly every day
• Diminished interest in activities you once enjoyed
• Significant changes in your weight (increased or decreased)
• Difficulty with sleep (insomnia or hypersomnia)
• Fatigue or frequently feeling tired
• Difficulty concentrating
• Recurrent thoughts of death over at least a two-week period
• Impairment in social, occupational or other important areas of functioning

WHEN TO SEEK PROFESSIONAL HELP

It’s best to talk to a professional health care provider when:

• You find it difficult to function in your daily life
• You no longer participate in activities you once enjoyed
• You find it difficult to get out of bed

TREATMENT FOR ANXIETY AND DEPRESSION

Treatment can include outpatient psychotherapy (talk therapy, cognitive behavioral therapy, dialectical behavioral therapy), outpatient medication management and potentially inpatient mental health hospitalization. Additional treatment may include changing your exercise or eating habits, utilizing social supports, avoiding the use of alcohol and recreational drugs, and/or joining a support group.

WHY IT’S IMPORTANT TO ADDRESS YOUR MENTAL HEALTH

It’s important for people to address their mental health in order to live a life that’s fulfilling. Acknowledging and treating your mental health helps create resilience. It also teaches you to better cope so when a similar situation occurs, you are equipped to handle it.

Stressful situations are going to happen. How we react can determine how it impacts us. There are many resources available in regard to anxiety, depression and stress. Please contact your health care provider to answer any questions you have.

Jolene Hanson is a licensed independent clinical social worker at in Mankato, Minnesota.

For the safety of our patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a non-patient care area where social distancing and other safety protocols were followed.

Depression (major depressive disorder) – Symptoms and causes

Overview

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living.

More than just a bout of the blues, depression isn’t a weakness and you can’t simply “snap out” of it. Depression may require long-term treatment. But don’t get discouraged. Most people with depression feel better with medication, psychotherapy or both.

Depression care at Mayo Clinic

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Symptoms

Although depression may occur only once during your life, people typically have multiple episodes. During these episodes, symptoms occur most of the day, nearly every day and may include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so even small tasks take extra effort
• Reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches

For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.

Depression symptoms in children and teens

Common signs and symptoms of depression in children and teenagers are similar to those of adults, but there can be some differences.

• In younger children, symptoms of depression may include sadness, irritability, clinginess, worry, aches and pains, refusing to go to school, or being underweight.
• In teens, symptoms may include sadness, irritability, feeling negative and worthless, anger, poor performance or poor attendance at school, feeling misunderstood and extremely sensitive, using recreational drugs or alcohol, eating or sleeping too much, self-harm, loss of interest in normal activities, and avoidance of social interaction.

Depression symptoms in older adults

Depression is not a normal part of growing older, and it should never be taken lightly. Unfortunately, depression often goes undiagnosed and untreated in older adults, and they may feel reluctant to seek help. Symptoms of depression may be different or less obvious in older adults, such as:

• Memory difficulties or personality changes
• Physical aches or pain
• Fatigue, loss of appetite, sleep problems or loss of interest in sex — not caused by a medical condition or medication
• Often wanting to stay at home, rather than going out to socialize or doing new things
• Suicidal thinking or feelings, especially in older men

When to see a doctor

If you feel depressed, make an appointment to see your doctor or mental health professional as soon as you can. If you’re reluctant to seek treatment, talk to a friend or loved one, any health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you’re having suicidal thoughts:

• Call your doctor or mental health professional.
• Call a suicide hotline number — in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). Use that same number and press “1” to reach the Veterans Crisis Line.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

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Causes

It’s not known exactly what causes depression. As with many mental disorders, a variety of factors may be involved, such as:

• Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain, but may eventually help pinpoint causes.
• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. Recent research indicates that changes in the function and effect of these neurotransmitters and how they interact with neurocircuits involved in maintaining mood stability may play a significant role in depression and its treatment.
• Hormones. Changes in the body’s balance of hormones may be involved in causing or triggering depression. Hormone changes can result with pregnancy and during the weeks or months after delivery (postpartum) and from thyroid problems, menopause or a number of other conditions.
• Inherited traits. Depression is more common in people whose blood relatives also have this condition. Researchers are trying to find genes that may be involved in causing depression.

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Risk factors

Depression often begins in the teens, 20s or 30s, but it can happen at any age. More women than men are diagnosed with depression, but this may be due in part because women are more likely to seek treatment.

Factors that seem to increase the risk of developing or triggering depression include:

• Certain personality traits, such as low self-esteem and being too dependent, self-critical or pessimistic
• Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems
• Blood relatives with a history of depression, bipolar disorder, alcoholism or suicide
• Being lesbian, gay, bisexual or transgender, or having variations in the development of genital organs that aren’t clearly male or female (intersex) in an unsupportive situation
• History of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder
• Abuse of alcohol or recreational drugs
• Serious or chronic illness, including cancer, stroke, chronic pain or heart disease
• Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)

Complications

Depression is a serious disorder that can take a terrible toll on you and your family. Depression often gets worse if it isn’t treated, resulting in emotional, behavioral and health problems that affect every area of your life.

Examples of complications associated with depression include:

• Excess weight or obesity, which can lead to heart disease and diabetes
• Pain or physical illness
• Alcohol or drug misuse
• Anxiety, panic disorder or social phobia
• Family conflicts, relationship difficulties, and work or school problems
• Social isolation
• Suicidal feelings, suicide attempts or suicide
• Self-mutilation, such as cutting
• Premature death from medical conditions

Prevention

There’s no sure way to prevent depression. However, these strategies may help.

• Take steps to control stress, to increase your resilience and boost your self-esteem.
• Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
• Get treatment at the earliest sign of a problem to help prevent depression from worsening.
• Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.

Feb. 03, 2018

Mental Health Conditions: Depression and Anxiety | Overviews of Diseases/Conditions | Tips From Former Smokers

What Is Depression?

Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, you may be depressed. Symptoms of depression include:¹

• Feeling sad or anxious often or all the time
• Not wanting to do activities that used to be fun
• Feeling irritable‚ easily frustrated‚ or restless
• Having trouble falling asleep or staying asleep
• Waking up too early or sleeping too much
• Eating more or less than usual or having no appetite
• Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
• Having trouble concentrating, remembering details, or making decisions
• Feeling tired‚ even after sleeping well
• Feeling guilty, worthless, or helpless
• Thinking about suicide or hurting yourself

The following information is not intended to provide a medical diagnosis of major depression and cannot take the place of seeing a mental health professional. If you think you are depressed‚ talk with your doctor or a mental health professional immediately. This is especially important if your symptoms are getting worse or affecting your daily activities.

What Causes Depression?

The exact cause of depression is unknown. It may be caused by a combination of genetic, biological, environmental, and psychological factors.² Everyone is different‚ but the following factors may increase a person’s chances of becoming depressed:¹

• Having blood relatives who have had depression
• Experiencing traumatic or stressful events, such as physical or sexual abuse, the death of a loved one, or financial problems
• Going through a major life change‚ even if it was planned
• Having a medical problem, such as cancer, stroke, or chronic pain
• Taking certain medications. Talk to your doctor if you have questions about whether your medications might be making you feel depressed.
• Using alcohol or drugs

Who Gets Depression?

In general‚ about 1 out of every 6 adults will have depression at some time in their life. ³ Depression affects about 16 million American adults every year.⁴ Anyone can get depressed, and depression can happen at any age and in any type of person.

Many people who experience depression also have other mental health conditions.^1,5 Anxiety disorders often go hand in hand with depression. People who have anxiety disorders struggle with intense and uncontrollable feelings of anxiety, fear, worry, and/or panic.¹ These feelings can interfere with daily activities and may last for a long time.

NIMH » Depression

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medications, psychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you.

Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.

You may have heard about an herbal medicine called St. John’s wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH Psychotherapies webpage.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

• ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
• Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
• Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
• ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
• ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.

Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:

• Try to be active and exercise.
• Set realistic goals for yourself.
• Try to spend time with other people and confide in a trusted friend or relative.
• Try not to isolate yourself, and let others help you.
• Expect your mood to improve gradually, not immediately.
• Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
• Continue to educate yourself about depression.

How to Cope With Anxiety and Depression

Symptoms of Anxiety and Depression

According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the standard classification of mental disorders used by mental health professionals in the United States, anxiety and depression can share several common symptoms, including, but not limited to:

• Being easily fatigued
• Difficulty concentrating or mind going blank
• Irritability
• Sleep disturbance (difficulty falling or staying asleep; restless, unsatisfying sleep)

Other signs that a person may suffer from both anxiety disorder and depression include:

• Constant, irrational fear and worry
• Physical symptoms like rapid heartbeat, headaches, hot flashes, sweating, abdominal pain, and/or difficulty breathing
• Changes in eating, either too much or too little
• Persistent feelings of sadness or worthlessness
• Loss of interest in hobbies and activities
• Inability to relax
• Panic attacks

Can Anxiety and Depression Be Treated Together?

Yes. No one has to suffer from anxiety disorder or depression, and certainly not both. People with anxiety disorder should speak with a psychiatrist, therapist, or other healthcare professional about their symptoms and start treatment as soon as possible. If you suspect you have both anxiety and depression, Connolly recommends getting a thorough evaluation from a psychiatrist as a first step. “It’s really crucial for people with both [anxiety and depression] to have a good assessment to rule out bipolar disorder,” she says.

• Cognitive Behavioral Therapy (CBT) CBT focuses on teaching people to challenge their negative thoughts to use coping skills and relaxation techniques to reduce stress. CBT is not only an established treatment for anxiety and depression, it is also the best studied psychotherapy for treating pain, per Harvard Health.
• Interpersonal Psychotherapy (IPT) IPT focuses on the connection between onset of symptoms and current interpersonal problems, such as unresolved grief, relationship disputes, and social isolation or withdrawal.
• Antidepressant Medication Antidepressants include selective serotonin reuptake inhibitors (SSRIs), such as Celexa (citalopram), Prozac (fluoxetine), (Lexapro (ecitalopram), Paxil (paroxetine), Zoloft (sertraline). SSRIs are often used in conjunction with CBT and other forms of psychotherapy for more severe anxiety and depression. Serotonin and norepinephrine reuptake inhibitors (SNRIs), which include Cymbalta (duloxetine),  Effexor (venlafaxine), and Pristiq (desvenlafaxine), are other options.
• Exercise Getting exercise can also help ease symptoms of both depression and anxiety, although why isn’t entirely clear, per the Mayo Clinic. One reason may be that exercise releases feel-good chemicals in the brain that enhance you sense of well-being. Another may be that it distracts you from your worries, fears, and other negative thoughts. Whatever the reason, walking for as little as 10 minutes may alleviate symptoms, the ADAA notes.
• Relaxation Techniques Mindfulness meditation — a way of training your mind to slow down racing thoughts, let go of negativity, and calm both your mind and body by sitting quietly and focusing on your breathing — can ease symptoms of both anxiety and depression and improve quality of life, according to a large research review published in March 2014 in JAMA Internal Medicine.

Important: If you or someone you know needs help coping with anxiety or depression, call the National Suicide Prevention Lifeline at 800-273-TALK (8255). The Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they text to 741741.

Anxiety – What you need to know

The notes here on the different kinds of anxiety and are not meant to give a diagnosis. But you might find them useful if, when you see a doctor, psychologist or counsellor they use these terms. 

There are different kinds of anxiety disorders, but these are the most common:

Generalised Anxiety Disorder (GAD) is when people worry about a number of things, on most days for six or more months. It usually affects young adults, and women more than men. The anxiety is about a wide range of situations and issues, not just one specific event. It can be hard to control it and finds its way into all parts of daily life.

Phobias are extreme and irrational fears about a particular thing. The can be so great that the person goes to great lengths to avoid it, even if it’s harmless. For example social phobia is fear of being judged or embarrassed in public, even in everyday situations like when eating, speaking at work or making small talk.  Another type is agoraphobia, often thought to be a fear of open spaces. It is also a fear of being closed in, or away from a safe place or person who makes you feel safe. It can be extremely disabling and frightening, and can leave people unable to leave their home.

Obsessive Compulsive Disorder (OCD) is when a person has unwanted, intrusive, persistent or repetitive thoughts (whakaaro), feelings, ideas, or sensations (obsessions) which cause anxiety. So they then carry out actions to reduce the anxiety or get rid of those thoughts. For example, the person may be afraid of germs and try to relieve the anxiety through repeated hand washing or avoiding touching things like door knobs. They may know these thoughts (whakaaro) are unreasonable but be unable to stop them. When OCD is severe and left untreated, it can be very distressing, and get in the way of work (mahi), school (kura) and normal life at home. 

Post-traumatic Stress Disorder (PTSD) is a reaction to a highly stressful event outside the range of everyday experience when a person feels very unsafe or threatened. These are unusual experiences such as war, violent attack (verbal, physical or sexual) or a natural disaster. The symptoms usually include irritability, anxiety, flashbacks, repeated nightmares, and avoiding situations that might bring back memories of the event. 

Panic Disorder is when a person has panic attacks. These are intense feelings of anxiety along with the kind of physical symptoms and overwhelming sensations you would have if you were in great danger, like a pounding heart, feeling faint, sweating, shaky limbs, nausea, chest pains, breathing discomfort and feelings of losing control. The symptoms rise and peak rapidly. The effects can be so severe that people experiencing panic attacks can believe they are dying. Despite being frightening and very uncomfortable they are not life threatening. 

Visit the Anxiety New Zealand site or the Small Steps Anxiety page for more info on these and other kinds of Anxiety Disorders.

Anxiety and Depression – About Palliative

Contents

The causes of depression and anxiety can be different

Diagnosis of depression

Treatment of anxiety and depression

Dosage and interaction with other drugs

Refractory depression and anxiety

British doctor Fragment Bruce Cleminson’s Introduction to Palliative Care on the diagnosis and treatment of anxiety and depression. The full version of the book is available here.

People with terminal illnesses tend to be prone to anxiety and depression. After examining 46 studies on the topic, Gotopf and co-authors found that about 15% of patients with advanced stage of cancer suffer from major depressive disorder diagnosed by psychiatrists. At the same time, according to estimates of the incidence of depression according to the Hospital Anxiety and Depression Scale (HADS) , the average prevalence of severe depression in the last stage of cancer is 29%.

Treatment of depression is important not only because depression increases the patient’s mental distress,
but also because it aggravates pain and other symptoms. Studies in Canada, Australia and the United Kingdom show that these countries have a lower percentage of patients with fatal illnesses who suffer from anxiety and depression. Given the limited life span of patients with incurable diseases, it is important to identify depression early, as it lowers the patient’s quality of life and worsens symptoms.In addition, treatment for depression takes time to be effective.

So how can you help a patient suffering from anxiety and depression?

The causes of depression and anxiety can be different

The causes of anxiety and depression can be normal and understandable, or they can be pathological. Anxiety and depression can be associated with an incurable illness of the patient or with one of the aspects that are also directly related to the disease. On the other hand, they may have nothing to do with cancer at all.

If the patient has ever had symptoms of depression, inquire about the previous
treatment, whether it was effective, and what, in the patient’s opinion, may be effective this time.
Depression and anxiety can be associated with difficulties in relationships with other people, or it is a personality trait of the patient, or a recurrent mental problem. Perhaps the patient is more sad than depressed, he gets used to the idea that he has an incurable disease and that his life will be shorter than he imagined.

The only way to find out the cause is to talk to the patient. Knowing the cause of anxiety and depression can help guide appropriate treatment.

Diagnosis of Depression

First we need to talk to the patient and then perhaps his family and friends. We need to understand how the patient is feeling and why he is feeling it. This will allow us to find out if he suffers from depression and anxiety or not. The only way to identify these disorders is to screen for depression at the first screening and use the following questions as screening tools: “Are you feeling depressed?” or “Do you feel interested in your daily activities?”

“Communication is only part of the problem” Doctor Anna Sonkina on how to teach doctors to communicate with patients on an equal footing and persuade an anti-vaccine to supply the vaccine

If you think that anxiety and depression may occur, ask the patient some or all of the following
questions: how did the states of anxiety and despondency begin? was there any event that triggered this? what are the facilitating and exacerbating factors? how does the patient sleep? are there any significant physical symptoms? Has the patient previously had depression and anxiety? does his family support him? perhaps someone died recently in the family? Does the patient believe in God? if so, how and how much does it help him?

Treatment of anxiety and depression

1. To begin with, we must turn to factors that can be leveled: pain, insomnia, and communication difficulties.

2. We need to support the patient emotionally and give him time to cope with the sadness. We
need to find out what is behind his anxiety and help to understand the reasons.

3. Consideration should also be given to non-drug treatment. In the case of an anxiety disorder, this can include relaxation techniques and meditation. For depression, this can include psychological counseling, cognitive behavioral therapy, and self-help books.

4. Drug therapy.

Treatment for anxiety

First-line drugs are symptomatic treatment, for example beta-blockers, if this is not enough, then you need to add SSRIs, if that is not enough, you can try benzodiazepines.

Treatment for depression

SSRIs, mirtazepine, and tricyclic antidepressants may help, but we must remember ourselves and warn the patient and family that the effects of these drugs are not immediate. After 2 weeks, the dose of antidepressant will need to be adjusted if the effect is insufficient, and after 4 weeks, a second drug may need to be added.

5. If the patient does not improve or is suicidal, or has had a poor response to therapy in a previous episode of depression, psychiatric advice should be sought.

Some features of dosing and interaction with other antidepressant drugs when prescribing them to patients with incurable diseases

At a late stage of an incurable disease, especially in elderly patients who are losing weight, with multiple organ failure, the recommended doses of drugs should be reduced, and possibly even stop treatment, as there is a high risk of side effects.

In case of incurable diseases, especially in old age and when the patient is losing weight, his organs do not work as well as before, and the dose of medications must be reduced. If side effects appear, you should stop taking medications if possible.

Example

Five stages of experiencing illness How to support and cope with a loved one with cancer

A hospice patient in his 70s is depressed and does not sleep well.After talking with him, the doctor recommended taking antidepressants. Unfortunately, the doctor started with the normal adult dose of amitriptyline – 75 mg at bedtime – and the patient soon became disoriented and drowsy. The next day, the head of the department conducted an examination. On his recommendation, the patient did not take this drug at all for several days, and then resumed taking it with very low doses. He did not have any side effects, and after about a week, his sleep improved, he felt an improvement in his mood.

It should be remembered that antidepressants and phenothiazine major tranquilizers interact poorly, sometimes very seriously, with tramadol and cause serotonin intoxication, which can be fatal.

Once we have assessed the patient’s condition and mapped out a treatment regimen, we need to draw up a treatment plan with the patient.

It is necessary to discuss with the patient:

1) our impression of his symptoms of anxiety and depression;
2) treatment options.You should listen to the patient’s opinion, find out his fears and doubts about the treatment. Draw up a treatment plan together. Set a date for the next check-up to assess if the scheme is working; if not, you have to start again.

This approach, when we first of all discuss everything with the patient and carefully listen to his opinion, asserts his autonomy, focuses on the fact that the patient always has a choice, and even if he poses a danger to himself or others, we do not we can insist that he stick to what we think is most appropriate in the given situation.The doctor and patient should discuss and agree on treatment.

Refractory depression and anxiety

Depressive disorders and anxiety cause mental and physical suffering. Treating a patient with the methods described above can alleviate his condition. However, some types of depression and anxiety cannot be treated by either a general practitioner or a psychiatrist.

If a patient has a long-term prognosis of life – from several months to several years – it is necessary to continue treatment for depression, as we would do with a healthy person, seeking advice from a specialist psychiatrist.

However, if the patient’s condition does not offer hope for a long life prognosis and further interventions will only exacerbate suffering, depression and anxiety, it may be worth discussing sedation as a way to combat psychological discomfort. The regimen may include sedation for a short period (for a couple of days) or episodes of sedation throughout the day. For example: sleeping in the morning and waking up for dinner, sleeping in the afternoon, waking up in the evening for the arrival of family members. The patient may prefer drug sedation to persistent anxiety.

If sedation is your choice, it is important to discuss all issues with the patient and colleagues, as this 90,023 period is always ethically and emotionally difficult for everyone.

If a decision is made to use sedatives, the patient’s approval must be obtained and the strategy must be explained to the family. Some patients decide to say their last words to relatives before falling asleep.

Conclusion

Depression and anxiety can be difficult to cope with, but by dealing with these symptoms
will help the patient and family.You will improve the quality of his life in the last days, and therefore, soften memories and help relatives cope with the loss.

References

1. Hotopf M. et al. Depression in advanced disease: a systematic review. Part 1. Prevalence and case finding // Palliative Medicine. 2002. Vol. 16.P. 81–97.
2. Rayner et al. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis // Palliative Medicine. 2011. Vol.25 (1). R. 36–51.
3. Wilson K.G. et al. Depression and anxiety disorders in palliative cancer care // Pain Symptom Management. 2007. Feb. Vol. 33 (2). R. 118-129.
4. O’Connor M. et al. The prevalence of anxiety and depression in palliative care patients with cancer in Western Australia and New South Wales // Medical Journal of Australia. 2010. Sep. Vol. 6. No. 193 (5 Suppl). R. 44–47.
5. Mitchell.A.J. et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies – Lancet – Published Online.2011.19 Jan.

Modern methods of diagnosis and treatment of affective disorders (anxiety, depressive) in terms of neurochemical disorders.

Depression, as a type of mental disorder, is an extremely urgent problem in the modern world.

Depressive disorders, according to the World Health Organization, affect more than 264 million people worldwide from all age groups.

About 800,000 people die each year from suicide, the second leading cause of death among people aged 15-29.

Depression is the cause of disability (in European countries) – permanent disability with adverse social consequences.

At the same time, it is not only a medical and social problem; the impact of depressive disorders on the economy is also of no small importance. It is estimated that treating depression has a significant economic effect in the form of restoration of the working capacity of the population, allowing you to receive $ 5 for every dollar invested.

So what is depression and how is it different from being in a bad mood?

The brain is responsible for mental activity. All the complexity and uniqueness of mental, emotional and behavioral activity is contained in just two processes. In the process of excitation and inhibition of brain cells. It should be noted that the process of inhibition of brain cells is active and certain costs are required for its implementation, the use of special substances, neurotransmitters with an inhibition effect. These processes of excitation are realized by neurotransmitter systems. Neurotransmitters are biologically active chemicals through which an electrochemical impulse is transmitted from a nerve cell through the synaptic space between neurons to another nerve cell or other cells (muscle, glandular). The main neurotransmitter systems are distinguished: dopaminergic system, noradrenergic system, serotonergic system, cholinergic system, GABAergic system, excitatory amino acid system: glutamate and asparate, histamine system, glycine system, neuropeptide system, carboline system.These neurotransmitter systems carry out a complex interaction with each other, self-regulate and control the work of not only the brain, but also the whole organism. In the event of a failure, imbalance in neurotransmitter systems, various mental illnesses develop, including those of the affective register (depressive, anxious).

As defined by WHO, “ Depression is a common mental disorder characterized by discouragement,

Loss of interest or joy, guilt and low self-esteem, sleep or appetite disturbances, lethargy and poor concentration.

These problems can become chronic or recurrent and have a significant impact on human capacity

to cope with the challenges of everyday life. In its most severe form, depression can lead to suicide.

Most cases of depression can be treated with medication and psychotherapy “.

From the point of view of psychiatry, in the classical, traditional sense, the concept of “depressive triad” is used to diagnose a depressive state.The father of modern psychiatry, German psychiatrist Emil Kraepelin, described it in 1899 as follows:

1. Hypotimia (depressed mood, depression)
2. Ideatorial lethargy (decreased mental activity)
3. Motor retardation (decreased motor activity)

Symptoms should last two weeks or more. In the case when one or two symptoms are not expressed or are manifested in another way, for example, anger, instead of depression, or motor disinhibition, instead of lethargy, we can talk about atypical variants of depression. In the case of unexpressed symptoms, in some cases, after conducting a thorough clinical examination of the patient and analyzing additional symptoms, it is possible to identify erased, somatized (simulating other bodily diseases) forms of depression. Of course, both erased and somatized forms of depression require timely, adequate treatment by a psychiatrist. Unfortunately, such patients often come to the attention of doctors of other specialties and cannot be recognized. According to domestic researchers, among patients who applied for outpatient care to a physician, depression can be diagnosed in 40.5% of those who applied, including severe depression in 9.5%.Often, such patients are treated for a long time, without the desired effect, by physicians, therapists, neurologists and doctors of other specialties. Many patients are afraid to seek psychiatric help, mistakenly considering treatment by a psychiatrist socially unacceptable, thus wasting invaluable time and the opportunity to receive timely treatment.

What causes depressive, anxiety disorders, how to diagnose and treat them?

Depression and anxiety disorders are considered to be polyetiological diseases, that is, they have several causes.For all the variety of reasons, they can be divided into two main groups: biological and socio-psychological.

Biological reasons are that the morphological substrate of diseases are changes in the central nervous system, namely its pathology. The synthesis of neurotransmitters, their transport is impaired, the plasticity of the nervous tissue is reduced, a decrease or increase in blood flow in the areas of the brain responsible for the formation of emotions, the phenomenon of demyelination, and dystrophy of brain cells is often found.A significant influence on the emotional sphere is exerted by diseases accompanied by atrophy of the cerebral cortex, for example, Alzheimer’s, Pick’s disease, etc., as well as the consequences of traumatic brain injuries. Modern methods of neuroimaging, such as MRI, functional MRI, CT, SPECT, PET, etc., in some cases record these disorders in the brain, and in some cases they do not or carry general non-specific information. It should be noted that the most modern research methods aimed at diagnosing functional disorders of the brain, such as PET, functional MRI, are expensive and inaccessible.

Socio-psychological reasons are that the higher nervous activity of a person, such as intelligence, memory,

attention, thinking and even in many respects emotions, from the point of view of neuropsychology, are the product of social interaction

(family, school, communication through the second signaling system).

A person is a product of society, a personality is formed by means of

communication with society, lives in it.In the case of personally significant stressful experiences, for example, the death of a relative,

serious illness, catastrophe, natural disaster, long-term hard work, etc. ,

states of depletion of the neurotransmitter systems of some and overexcitation of others.

Thus, both biological and socio-psychological factors play a role in the development of anxiety and depressive disorders. In the case of the predominance of biologically factors, one speaks of an “organic” cause of the development of a depressive, anxiety disorder, which is confirmed by neuroimaging methods.In this case, depressive disorders usually develop. In the case of a predominance of severe stress, personally significant experiences, reactive anxiety states are more often diagnosed.

Of course, biological and socio-psychological factors have a mutual influence, interact and form mutually reinforcing pathogenetic connections. For example, severe stress, or a lot of stress (the so-called superposition of stress), causes depletion of inhibitory neurotransmitters, overexcitation of activating neurotransmitters, and it is often difficult to treat such a patient using psychotherapy alone.

At the same time, biological factors such as impaired blood circulation in the brain, demyelination of cells, phenomena of gliosis (cell death) not only affect the areas of the brain responsible for emotions (hypothalamus, amygdala, cingulate gyrus, parahippocampal gyrus), but also serve as a factor that reduces the adaptive capabilities of mental activity in the face of stressful situations.

____________________________________________

It is better to entrust the diagnosis of depressive, anxiety disorder to a psychiatrist.The psychiatrist conducts a structured clinical interview with the patient, where, by questioning the patient, if possible, questioning his environment, clarifies complaints, assesses the state of consciousness, cognitive-mnestic sphere, emotional state, behavior, and psycho-productive phenomena. Such an interview is called a clinical-psychopathological research method. Medical documentation, the results of neuroimaging research methods are being investigated. Additionally, special standardized clinical questionnaires are used: Hamilton Scale, Hospital Anxiety and Depression Scale, Beck’s Questionnaire, etc.American scientists from IOWA State University Clark and Wilson have proposed a “Questionnaire for symptoms of anxiety and mood disorders” for this purpose.

____________________________________________

Measurement and Components Model	Symptoms
1. General distress
1) Alarm	Feeling of tension or slight excitability, feeling of discomfort, feeling of fear, nervousness, agitation, irritability.
2) Depression	Depression, despondency, lack of desires, sadness, hopelessness, self-disappointment.
3) Mixed state	Anxiety, focus on problems, dissatisfaction, confusion, irritability.
2. Anhedonia and positive affect
Loss of interests	Feeling unattractive, detached from others, a sense of inhibition, additional efforts are required to start any business.
Overly elated mood?	Real happiness, real life, optimism, feeling overwhelmed with energy, pride in oneself.
3. Somatic alarm
Alarm excitation	Dizziness, trembling hands, difficulty swallowing, shortness of breath, chest pain.

This questionnaire helps to see the area where the greatest disturbances, namely: the area of ​​general distress, hedonic disturbances or somatic anxiety.Knowing the clinical effects that accompany disturbances in a particular neurotransmitter system, a psychiatrist can choose a treatment taking into account the pathological process. Medical treatment of depressive and anxiety disorders is carried out with special drugs that affect the neurotransmitter systems of the brain. Different drugs have different pharmacological effects; a drug is selected whose profile of action coincides with the necessary therapeutic effect on the disturbed mechanisms of neurotransmitter transmission.

However, the appointment of drug therapy does not deny the importance of psychotherapeutic intervention. The methods of psychotherapy, psychocorrection effectively complement the ongoing therapy, serve the purposes of resocialization, significantly accelerate the process of recovery or the onset of remission.

List of references

1. https://www.who.int/ru/news-room/fact-sheets/detail/depression
2. Time to deliver: report of the WHO Independent High-level Commission on Noncommunicable Diseases
3. Nuriev I.T. Clinical and epidemiological study of depressive disorders among patients of the general somatic network // Vyatka medical bulletin. 2005. No. 1. URL: https://cyberleninka.ru/article/n/kliniko-epidemiologicheskoe-issledovanie-depressivnyh-rasstroystv-sredi-patsientov-obschesomaticheskoy-seti (date of access: 02.08.
4. Shamrey Vladislav Kazimirovich, Trufanov Gennady Evgenievich, Abritalin Evgeny Yurievich, Korzenev Arkady Vladimirovich Modern methods of neuroimaging in psychiatric practice // Russian Psychiatric Journal.2010. No. 2. URL: https://cyberleninka.ru/article/n/sovremennye-metody-neyrovizualizatsii-v-psihiatricheskoy-praktike (date accessed: 02.08.
5. StahI S.M. Essential psychopharmacology. Neuroscientific basis and practical applications. 2 ed. Cambridge Unuversity Press. New York. 2008.-601P.

Artist: Tebenkov Grigory Gennadievich, psychiatrist, psychiatrist, narcologist.

90,000 Airborne alarm – Newspaper Kommersant No. 238 (6959) dated 25.12.2020

Psychologists of the Russian Academy of Sciences named the main socio-psychological consequences of the coronavirus pandemic in Russians. Among them are depressive disorders, increased technophobia, and a decrease in the level of trust in the state and other social institutions. All this was typical of our society, experts say, but the pandemic has accelerated the processes. Of the positive consequences, researchers note a possible increase in the population’s literacy in the field of medicine and respect for doctors.

The Laboratory of Social and Economic Psychology of the Institute of Psychology of the Russian Academy of Sciences has summed up the results of research on the socio-psychological consequences of COVID-19.Scientists have come to the conclusion that every third resident of Russia in 2020 complained of symptoms of depressive disorder. Psychologist, medical communication and stress expert Anna Khasina suggests that in reality the data may be even higher.

According to her, in the spring, experts expected that by the end of the year every second inhabitant of the planet would develop post-traumatic stress disorder, which would manifest itself with anxiety and depression.

At the same time, according to Mrs. Khasina, the number of Russians who seek psychological help has changed insignificantly, however, the “number of suffering people” has increased and the “quality of suffering” has worsened: “Much more people worry, the average Russian’s sleep is much worse, more food disorders, the situation with alcohol is aggravated, with aggression, we can see this even at the everyday level.There are many calls to neurologists, cardiologists, gastroenterologists with stress-associated diseases, and in the next six months there will be even more, because the healthcare system does not react and does not change. ”

Among the reasons for concern, the fear of using digital technologies has grown the most, says Timofey Nestik, head of the social and economic psychology laboratory at the Institute of Psychology of the Russian Academy of Sciences.

Thus, the use of digital technologies to spy on citizens and manipulate public opinion in 2019 worried 56% of respondents, and in 2020 71% of respondents spoke about such fears. Even before the pandemic, Russians had a low level of awareness of new technologies, says Alexander Chulok, director of the Center for Scientific and Technological Forecasting of the ISSEK NRU HSE. “According to our monitoring, in 2019 Russia was in third place from the bottom among the three dozen EU countries in terms of the level of digital skills – between Bulgaria and Poland,” says Mr. Chulok. “At the same time, the pandemic has significantly accelerated the digitalization process. We ourselves have given our personal data to a limited number of video communication services and programs.In other words, there was a social contract: privacy versus security. The pandemic acted as a catalyst for these processes, but they were inevitable, and there is no point in being afraid of them. ”

In addition, 67% of Russians have lost confidence that the state “will help in a difficult situation.” Timofey Nestik explains that the level of trust in the authorities and social structures in our society has always been low. At the beginning of the year, only one in three Russians trusted the state, the expert says.“The decline has intensified due to the contradictory position of the authorities: inconsistency in decisions on restrictive measures, a stake on fear rather than trust, unwillingness to show empathy,” continues Mr. Nestik. “Fortunately, the measures to support the population that were taken later, in the summer , slightly improved the situation, but confidence in the state remains low, at the level of 20% ”.

Willingness to be vaccinated is closely related to the level of trust in the authorities and the health care system.

According to the Levada Center, only a third of Russians (36%) agree to be vaccinated against coronavirus as part of free and voluntary vaccination. According to other estimates, the scientist clarified, about half of the country’s residents are ready to be vaccinated, but if they are confident in the safety of the vaccine: “Now a lot depends on the extent to which we consider ourselves able to control the situation, how much we trust the authorities, doctors, scientists . .. In addition, the idea of ​​how others will behave is of great importance. “According to him, a call to protect loved ones could motivate people to get vaccinated – throughout the first wave, until September, the fear of personal infection decreased, while the fear for loved ones remained steadily high.

The fear of the future is also connected with the crisis of social trust. According to a survey conducted by the Higher School of Economics, more than a third of Russians (37%) fear losing their jobs amid the coronavirus pandemic. The second most common fear is that they will no longer be paid salaries and pensions (21%).“We had a very short planning horizon before, the pandemic only exacerbated the feeling of uncertainty and uncertainty about the future,” says Mr. Nestik. “But most Russians are optimistic about the long-term future. Our research shows that the resources of resilience during a pandemic are empathy for others, trust and faith in one’s ability to influence the situation. ”

Russian psychologists expect from the pandemic and delayed consequences. In particular, a reassessment of values ​​and the previous way of life, a decrease in trust in the state, an increase in anxiety and the level of psychological traumatization.Of the positive consequences, researchers note a possible increase in the population’s literacy in the field of medicine and respect for doctors, an increase in awareness and an increase in social responsibility.

Natalia Kostarnova

90,000 Scientists have figured out how the brain switches from anxiety to depression

An international team of scientists has discovered possible molecular mechanisms for switching the brain from anxiety to depression. In the future, this discovery may lead to the creation of new, more effective drugs for the treatment of human mental disorders.The work was published in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry.

A group of scientists from Russia, China, the Netherlands and Brazil tested the hypothesis that there is a mechanism in the brain that is responsible for the conjugation of disparate symptoms into a single disease. Thus, the symptoms of depression – decreased appetite or depressed mood – can occur in many people, but only a few specific symptoms combine to form a disease. As an experimental model in the study of anxiety states, mice are often used under conditions of chronic social stress.Two males are planted in a cage, where they start to fight, after which they are separated by a transparent partition with holes through which they can feel each other, but cannot contact. They are left for a whole day, and then the manipulations are repeated for many days in a row – as a result, “winners” and “losers” appear, the state of which is of interest for the study of anxiety and depression. According to the model, after about 10 days, the “vanquished” develop a state of anxiety, and after 20 days, depression.

Scientists wondered how one pathology passes into another, and suggested that unique genes may be responsible for this. Such switch genes cannot be detected by classical methods, because they are not responsible for any symptom, but only for switching one pathology to another. To experimentally prove the hypothesis, the scientists performed genome-wide screening of mouse brain gene activity in two key areas: the prefrontal cortex, which is responsible for long-term planning and social behavior, and the hippocampus, which is responsible for memory.

“Our discovery is this: we found out what happens on day 15 in a model of transition from experimental anxiety to depression-like state in mice. At this point, molecular mechanisms in the brain that are not associated with neurotransmitters (as in anxiety) or inflammation (as in depression) begin to activate in the brain. These mechanisms are associated with the cellular skeleton and astrocytes, the side glial cells in the brain that are increasingly associated with mental illness.Thus, we have shown that when in mice one pathology of the brain turns into another, unique cellular mechanisms are activated, in fact acting as a “switch”, which can launch the vector of pathogenesis either in one direction (anxiety) or in another (depression) direction. ” , – said the head of the study, leading researcher at UrFU and professor at St. Petersburg State University Alan Kaluev.

Approximately 70% of people with chronic anxiety may experience depression over time. At the same time, traditional antidepressant therapy helps 30–40% of people.The number of diagnosed cases is growing every year, and fundamentally new drugs for depression do not appear. Therefore, the mechanisms discovered by scientists can become a target for the creation of fundamentally new classes of psychotropic drugs.

Autumn depression – prevention of seasonal blues, signs of illness

Blues, anxiety, loss of interest in life.

How to distinguish between decreased mood, laziness, despondency

from clinical symptoms of mental disorder-depression?

1. “Autumn” depression is not a mental disorder, but a psychological state characterized by a decreased emotional mood, pessimistic views on current events, and a loss of a sense of the joy of life.
2. Quarantine and social isolation, in which we are now forced to be in order to contain the spread of the coronavirus pandemic.

Factors leading to depression

1. Lack of serotonin (the hormone of joy) – associated with a deficiency of vitamin D produced in human skin under the influence of ultraviolet radiation.
2. Oxygen starvation – due to a sedentary lifestyle
3. Daily stresses (some have enormous workloads, others have redundancies or temporary suspension of work; change in their daily routine; lack of understanding of the “whole picture of the coronavirus pandemic”)

Signs of anxiety depressive state

Decreased mood, constant feeling of anxiety, the future seems gloomy and hopeless, there is always a feeling of impending disaster.

On the part of the body: rapid heartbeat, pressure surges, increased sweating, upset stomach and intestines, loss of appetite, a sharp decrease in body weight, headaches, sleep disorders (insomnia, frequent nighttime awakenings), lethargy.

Do you need expert advice?

So how can you support yourself during this difficult period?

Adjust diet

1. include more vegetables and fruits of bright colors, dried fruits, legumes, bananas, dairy products that contain useful vitamins and minerals, or take vitamin and mineral complexes
2. Avoid foods that increase anxiety as much as possible, such as caffeine (including energy drinks), alcohol (which aggravates anxiety and depression), nicotine (cigarettes may seem to be soothing, but nicotine is actually a powerful stimulant) …

It is important to increase physical activity

1. go in for sports (with an open window, on a balcony or loggia, so that there is an influx of fresh air).
2. to recall your favorite activities, hobbies, mastering something new, for which there was not enough time before.
3. revise your wardrobe, rearrange furniture in the house.
4. maintain social contacts through calls and correspondence with friends and family.
5. Maintain a “Notebook of Joy”, in which you need to write down at least five pleasant and joyful events that happened to you during the day every day (this will not be easy, since we usually remember mostly bad things).Over time, it will become an exciting experience for you and teach you to look at your life in a new way.

Learn to Relax

• Master Meditation Techniques
• take a warm bath before going to bed (this helps to fill the familiar “heat deficit” for many, and therefore has a calming effect), preferably with the use of fir essential oil
• Normalize sleep: try to go to bed at the same time, ventilate the room before going to bed, do not watch action films and programs in the evening.

If the measures taken have not brought visible changes for the better, the mood is still bad, negative thoughts are pursuing, it is better to consult a psychotherapist (personally or remotely) who can determine the cause of your condition, ways to eliminate it, and if necessary adequately and competently prescribe drug therapy.

Regular psychotherapy (behavioral, emotional-figurative) and learning to understand yourself will help you! Take care of yourself, give yourself time and attention!

A calm and happy person is the best gift for our loved ones!

Sboeva Elena Mikhailovna

Doctor-psychotherapist of the highest category

Make an appointment

Found a mechanism in the brain that is responsible for “turning on” depression

Scientists have discovered a unique mechanism in the brain that is responsible for “switching” anxiety to depression, and by suppressing which, you can heal mental illnesses and physical ailments caused by them (for example, obesity ).

A genetically determined molecular mechanism has been found in mice, as reported in an article for Progress in Neuro-Psychopharmacology & Biological Psychiatry.

The research team, headed by UrFU researcher, professor of St.

For the experiment, a pair of male mice are placed in a cage. Individuals begin to conflict, fight for dominance. After 15 minutes, they are separated by a transparent partition with holes: that is, opponents see and hear each other, continue to hate, but cannot attack. The next day, the separator is again removed for a quarter of an hour, and the males again converge in a duel.

“As a rule, the winner is determined already in the first rounds. A chronically losing” loser “develops anxiety syndrome after ten days.On the twentieth day, depression is already observed, which corresponds to the “classic” clinical picture: after all, in about 70 percent of patients with mental disorders, anxiety just precedes depression, “says Professor Kaluev. (determines social behavior) and the hippocampus (memory and emotions), the scientific group found: “switching” occurs on the 15th day of the experiment, when brain genes are specifically “activated” that are responsible for the activity of the cytoskeleton (cellular skeleton) and brain astrocyte cells.

Back in the early 1970s, the American psychogeneticist Irving Gottesman put forward a theory: any complex disease-syndrome is greater than the simple sum of its components.

“Compound pathology is more dangerous than its constituent symptoms individually, but by breaking the” thread “, we dismember the very” necklace “of the disease, its complex syndrome into scattered” beads “- symptoms, which are much easier to analyze and suppress”, – explains Alan Kaluev.

At the same time, using his terminology, “beads” are studied in detail by modern genetics, but the “threads” connecting them are still outside the scope of attention of big science.

As a result of the above studies on mice, for the first time, it was possible to empirically confirm the existence of a genomic mechanism, which in itself has nothing to do with anxiety and depression syndromes, but connects them.

Following the logic, we can assume that such mechanisms can be involved in the “switching on” of any other, and not necessarily mental, diseases. “For example, obesity is known to contribute to depression. It is possible that by breaking the thread, we can ‘tear’ one disease from another and thus enhance therapy for both disorders,” says the professor.

Scientists have discovered a possible mechanism for switching brain pathology from anxiety to depression

In experiments on mice, a group of researchers from Russia, China, the Netherlands and Brazil, led by scientists from St. Petersburg State University, discovered possible mechanisms for switching brain pathology from a state of experimental anxiety to depression. In the future, this discovery may lead to the creation of new, more effective drugs for the treatment of mental disorders in humans. The results of the work have been published in the prestigious international journal Progress in Neuro-Psychopharmacology and Biological Psychiatry.

In their study, the scientists proceeded from the hypothesis that there may be a special mechanism in the brain that is responsible for the conjugation of disparate symptoms into a single disease.

A disease is more complex than a collection of symptoms. For example, symptoms of depression – decreased appetite or depressed mood – can occur in many people. And only a few symptoms combine to form a disease – depression. We assumed that there must be some kind of “link”, that is, molecular mechanisms mediated by specific brain genes that “bring together” such diseases, combine symptoms, but do not cause symptoms themselves, ”said the head of the study, head of the laboratory of biological psychiatry at the Institute of Translational Biomedicine. St. Petersburg State University Professor Alan Kaluev .

By studying mental disorders, researchers try to understand which gene in the brain is responsible for a particular symptom. C57BL / 6J mice in a chronic social stress model are often used as an experimental model. This experimental model, created in the 1980s in Novosibirsk, is made in this way: two male mice are put in the same cage, where they begin to fight, after which they are separated by a transparent partition with holes through which they can feel each other, but cannot. contact.They are left in this state for the whole day, and then the manipulations are repeated for many days in a row – as a result, “winners” and “losers” appear clearly, the state of which is of interest for the study of anxiety and depression.

According to the classical model of chronic social stress, if the defeated are stressed every day in this way, then in about 10 days they develop a state of anxiety, but depression does not arise at this stage. If you continue to stress them, then after 20 days these animals have a pronounced depressive state, and they no longer have anxiety.It turns out that in 10 days of fights “mouse” anxiety is caused, one brain pathology. And in 20 days – already depression. The question we asked: what will happen in the middle of this interval – for example, on the 15th day? This is the place where one pathology begins to turn into another. If you imagine a train at a fork – it can go left or right, then the gauge switch, the relay – is this 15th day. This “relay” itself does not cause anxiety or depression. However, this switch in the brain may be responsible for its own unique genes, – explained Alan Kaluev.

As noted by the professor, these genes-“switches” cannot be detected by classical methods of genetics, because they are not responsible for any symptom, nor for anxiety, nor for depression, but only hypothetically “switch” one pathology to another. To experimentally prove the hypothesis, the scientists performed genome-wide screening of mouse brain gene activity in two key areas: the prefrontal cortex, which is responsible for long-term planning and social behavior, and the hippocampus, which is responsible for memory.

Our discovery is as follows: we found out what happens on the 15th day in the model of the transition from experimental anxiety to depression-like state in mice. At this point, molecular mechanisms in the brain that are not associated with neurotransmitters (as in anxiety) or inflammation (as in depression) begin to activate in the brain. These mechanisms are associated with the cellular skeleton and astrocytes, the side glial cells in the brain that are increasingly associated with mental illness.Thus, we have shown that when in mice one pathology of the brain turns into another, unique cellular mechanisms are activated, in fact acting as a “switch”, which can trigger the vector of pathogenesis either in one direction (anxiety) or in another (depression) direction, – explained Alan Kaluev.

The scientist also noted that in about 70% of people with chronic anxiety, this disease with continued stress can turn into depression. At the same time, traditional antidepressants do not always work effectively: only about 30–40% of people, according to Alan Kaluev, respond to therapy, and the majority either does not respond at all, or reacts in a weak form.At the same time, he stressed, the number of detected cases is growing every year, and fundamentally new drugs for depression have not appeared over the past half century.

Therefore, it seems to me that stopping depression is a very important clinically important task. And since existing antidepressants are not always effective, the question arises – how can we stop this rushing train of brain pathology? If he’s already on the path of depression, can we slow him down? Or maybe, as an alternative, it makes sense to hit on this “switch” of the track? Then the mechanisms we discovered can become a new target for the creation of fundamentally new classes of psychotropic drugs, the professor added.

He also emphasized that the data obtained on mice confirm the results of recent studies: in the human brain in an anxiety-depressive state, astrocytes and cellular skeletal mechanisms play an important role – processes associated with the internal skeleton, scaffold, cell shape, as well as local cellular mechanisms … In the future, the researchers plan to test their hypothesis on humans, and in the long term – to understand how exactly it is possible to act on the “switch” and stop depressive disorder at its very beginning.

Colleagues from the Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, the Ural Federal University, the Institute of Experimental Medicine of the V.A. M. Sechenov, Research Institute of General Pathology and Pathophysiology, Russian Scientific Center for Radiology and Surgical Technologies named after Academician A.M. Granova, Research Institute of Physiology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, Institute of Medicine and Psychology, Novosibirsk State University, as well as researchers from the School of Pharmacy at Southwestern University (China), Paso Fundu University (Brazil) and Maastricht University (Netherlands).

The project is supported by the grant of the Russian Foundation for Basic Research No. 16-04-00851.

SPbSU Press Service

Photo courtesy of the laboratory of prof. N. N.Kudryavtseva (Institute of Cytology and Genetics SB RAS, Novosibirsk)

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