Masked depression

Between a third and half of patients who first go to the clinic are actually physically healthy. What they mistake for somatic illness is actually masked depression. How to deal with it?

Masked depression is depression characterized by an atypical picture. Not a bad mood, violation of interests, lethargy symptoms come to the fore with this disease. A person may complain of a violation of the cardiovascular system: tachycardia, arrhythmia, heart pain. Or problems with the gastrointestinal tract: constipation, diarrhea, bloating. It happens that the patient is concerned about shortness of breath, respiratory failure. A very common mask of depression is headache, abdominal pain, back pain, and itching.

A person turns to doctors of various specialties – one, another, third. They do not find any pathology or abnormalities in the work of organs that could explain these symptoms. And it’s good if someone suspects a masked depression and directs the patient to a psychiatrist.

That is, it is a psychosomatic disease? What we call “nervous”?

 Not certainly in that way. With a psychosomatic disease, there really is a pathology or impaired functioning of the organs. It exacerbates when a person has some kind of mental disorder or in a situation of stress. Worried – the pressure jumped. He survived stress – a stomach ulcer opened. With masked depression, the body is healthy. But a person experiences pain, discomfort, impaired function.

And how to understand: do you really have a somatic disease or is it a masked depression?

First of all, you need to make sure that you are physically healthy. If you come to the doctor with complaints of pain, organ malfunction, then the first thing you will be referred to is a specialist who deals with this problem: cardiologist, gastroenterologist, neurologist. And only if the doctors, having completed all the tests and examinations, come to the conclusion that everything is in order with your internal organs, you can suspect a masked depression.

How does a therapist recognize this disease?

Patients with usual depression, as a rule, first of all complain of a lowered mood, loss of interest, a feeling of longing, guilt. With masked depression, all this is revealed only with active questioning. A person with this disease may not be aware that his mood has somehow changed recently. But if you ask him, for example: “Do you enjoy your favorite activities?”, Perhaps he will think about it and discover that he is not.

But this is a little strange: how can a person not feel that he is depressed? That the world has lost its color, that I don’t want anything, no strength for anything …

Often masked depression affects people with a specific character. There are, for example, special personalities – alexithimics, who find it difficult to describe their emotional and physical state in words. If a typical patient answers the question: “How exactly does it hurt?” gives a lot of characteristics of his pain – “cuts, stabs, shoots, crushes, burns, achs”, then the alexithimicist will say: “It just hurts. Do not know how”. Such people may not realize that their mood has decreased. In addition, they associate any disease with somatic disorders.

People with hyperthymic depot are also prone to masked depression – those who almost always have high moods. Persons prone to mood swings also have a predisposition to masked depression.

There are social reasons that lead to the fact that the disease will develop precisely in this scenario. For example, if a person lives in an environment where it is believed that psychiatrists are studying something that does not actually exist. That depression is a blues, and you just need to pull yourself together. With such a person, a true disease can also go to the somatic level.

In addition, in children and adolescents, depression very often appears under the mask. The child is unlikely to complain about low mood. Most often, he has somatic symptoms: either his head hurts, then his stomach, then he feels sick, then his temperature rises. There are, of course, other signs of depression: inactivity, refusal to play, sleep disturbance, appetite. At the age of 3-4 years, children can stop talking, do not ask questions and do not answer them. But parents often do not notice this or do not attach importance. As a rule, a child’s depression is caused by a situation in the family: conflicts between father and mother, birth of a younger brother or sister, death of loved ones.

In adolescents, depression manifests itself in the form of aggressive behavior, a desire to conflict, to fight. This is for boys. Girls most often have tearfulness, moodiness, attempts to attract attention to themselves.

What are the most unusual masks of depression you have encountered?

 For me, this form was … a patient’s toothache. More precisely, pain in the lower jaw. The man went to the dentists for a long time, they conducted all kinds of examinations. And only when he came to us and we began to question him, it turned out that this was a masked depression.

Sometimes this disease manifests itself in the form of craving for alcohol. This is especially common in men. Some of them do not understand that the reason for their internal discomfort is a decrease in mood. They feel that something is wrong with them … Depression can be suspected if such an attraction to alcohol is seasonal: in the winter and summer, a person does not drink, but in the spring or autumn applies.

And what, can it still be saved from alcoholism?

Yes, when it comes to secondary alcoholism, when a person was thus “treated” for depression. In the case when a physical dependence on alcohol has not yet formed, he can be helped without the help of narcologists ..

How is masked depression treated?

Just like usual, with antidepressants. Any disease is a violation of the biochemical background, metabolic processes in the body. Depression is no exception. This is not a whim, not a lack of will, not laziness and not spiritual licentiousness.

Depression is a disease in which the mediator metabolism is disturbed in the brain. This has already been proven by science. And to get rid of the problem, it is necessary with the help of drugs to restore the biochemical balance in the body.

Now they are using a new generation of antidepressants – Lexapro, which have a minimum of side effects. Another thing is that these drugs do not act immediately, but after 10-14 days. But, unfortunately, not everyone has the patience to wait for these moments. And the patient stops taking the drugs, deciding that they do not help him. Now we are looking for new antidepressants that would begin to act faster.

But those who continue treatment get rid of both pain and low mood. Pain most often goes away earlier, in any case, its intensity decreases. But finally, the patient recovers only after 6-8 weeks of taking antidepressants.

Is it possible for a person to suspect a masked depression?

Of course. If something bothers you, you have addressed your problem to one, another, third doctor and they say that you are in good health, go at least to a psychotherapist. Especially if you notice a decrease in mood, a lack of interest in your favorite activities for more than two weeks. Do not allow the possibility of mild or moderate depression to expand into severe options. Do not be afraid of psychiatrists – they can really help in this case.

local_offerevent_note March 25, 2020

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