Despite the fact that the word “depression” (depressia – from the Latin. Deprimo – press, suppress) has been used in medicine for more than two hundred years, it does not have a clear definition. In the middle of the 17th century, the term “depression,” according to the Oxford Dictionary, in the broad sense of the word meant an oppressed, depressed state of mind, “a depressed state of mind” (Solomon E., 2004).
Historians of medicine note that the ancient Greek word “melancholia” (from the Greek melas – black and chole — bold) and the medieval word “acedia”, which meant depressed, lethargy and laziness, gradually gave way to describe the state of prolonged grief, despondency and fear. place the concept of “depression.” It should be noted that in the medical literature until the 30s of the 20th century, the term “depression” was almost not used; they spoke of melancholy as phaseanic-depressive psychosis or a condition characterized by depressed mood.
Depression can be defined as a painful condition characterized by a fairly long-lasting depressed mood, disturbed thinking, physical activity, and a change in motivations. Phrases such as “impaired thinking”, “impaired motor activity” or “changing motivations” sound rather vague and probably cannot be used as definitions of the term. At the same time, it is impossible to speak unequivocally about slow thinking and weakened motor activity as permanent and typical symptoms of depression – in this state there are also disturbing, anxious thoughts, and motor agitation caused by anguish affect. The change in motivation may also be different, but in the latter case, it is usually caused by a loss of interests and the ability to enjoy some activity. Also for depression characterized by a number of somatic symptoms (decrease or, less often, increase in body weight, sleep disturbance, weakness, disorders of the autonomic nervous system, etc.), the diversity of which also makes it difficult to define the term. Based on the foregoing, it can be concluded that, according to most scientists, the concept of “depression” unites a heterogeneous group of affective disorders and conditions characterized by different susceptibility to various treatments.
Speaking of depression, it is necessary to use the term “hypothymus” with caution (literally – “reduced emotionality”). According to a number of scientists, hypothymia can be one of three types of mood in healthy people (along with syntimia and euthymia), when the mood is weak, but not pathologically reduced.
In psychiatry, depression is included in the group of affective disorders, which are usually understood as prolonged emotional states that affect all manifestations of the mental sphere and include depression or heightened mood (mixed states are also permissible). The term “affective disorder” is now gradually giving way to a more precise concept of “mood disorder”, which is characterized as a fairly stable emotional state (affect usually refers to short-term, fairly pronounced emotions).
Disorders of the depressive spectrum include a group of conditions that are united by the presence of a depressive syndrome of varying severity, which is considered as the phenomenological basis or core, often masked by the accompanying symptoms: anxiety, obsessive states, asthenia, etc.
In the presence of depression and anger in the structure, they speak of dysthymia (dysthymia from the Greek. Dys and thymos, literally – “disturbed sensuality”) – a mood disorder characterized by depression, anxiety, gloom, discouragement, anger, frustration. Dysthymic disorder (previously – depressive neurosis) is a prolonged, with a tendency to chronic course, mild depression.
With dysphoria (dysforia – from the Greek. Dys and fora – passion, impulse; literally – “annoyance, irritation, feeling unwell”), in addition to depressed mood, irritability, hostility, anger, anger, gloominess occur. In this case, a grumpy-irritable mood is combined with an increased sensitivity to any external stimulus and is accompanied by a special internal stress. Usually in a state of dysphoria, patients are quite aggressive.
In everyday life, people often talk about depression, meaning by this word the state of despondency, depression and depression. However, the sad mood that occurs in a person due to any problems, from a medical point of view can not be called a mental disorder. Sadness passes without special treatment, it is commensurate with its experiences with the incident, is not pronounced and does not affect the normal course of life, not to mention the absence of pathological changes from human organs and systems. Close to the meaning of “sadness”, the word “sadness” in psychology is a generalized form of personal response to an unfavorable situation in which a person finds himself. Some short-term episodes of bad mood can occur on days off from work, when a person is alone, occur on the anniversary of the tragic events, in women – before menstruation.
Let us dwell on some definitions that most often arise in the framework of depression: anguish, anxiety, and apathy.
Under the melancholy is understood the painful experience of hopelessness, the feeling of “heartache”, boredom, the general depression that is unusual for a person, which is sometimes difficult to express in words. In Russian, the following expressions are used to describe depression: restraint of the spirit, languor of the soul, painful sadness, anxiety, anxiety, fear, boredom, grief, sadness, grief. In the figurative expression of K. Schneider, melancholy can be compared with “a stone block thrown into the river of life and delaying its flow.” With deep anguish, there is a pressing tension, similar to physical pain, constriction behind the sternum (“auricular” anguish). Depression, characterized by deep sadness, “psychic anesthesia”, painful sensations in the chest, depressed inclinations (food and self-defense instinct), is called “vital depression” (depressia vitalis, from Lat. Vita – life).
The emotion of sadness is experienced as sadness, gloom, spleen, a feeling of emptiness and loneliness. At the same time, it is known that a person, despite the mental pain caused by sadness, endures it much easier than fear or any other negative emotion (Tomkins S., 1968).
Anxiety – experiencing a vague danger, a threat directed to the future. Unlike anxiety, fear is the experience of an immediate, specific threat. Related words: anxiety, bustle, confusion, excitement. Anxious depression (depressia timida, from the Latin. Timidus – “timid, anxious”) is a painful expectation of unhappiness, when anxiety noticeably prevails over the feeling of depression or apathy.
Apathy is characterized by a lack of motivation for activity, impossibility or difficulty of mental or physical activity (it is easier to perform the usual activity). In the XIII century in some way they opposed apathy (acedia) and sadness (tristia), believing that the latter, unlike the first, is not a sin, but, conversely, returns a person to God and repentance. In a state of apathy, there are no desires and aspirations, interest in the surrounding is lost. For a patient in apathy, everything seems empty, bland, meaningless and unnecessary. To determine the state with the predominance of lethargy, apathy, indifference, general decline in vitality, the term “adynamic depression” is used. Depression, accompanied by motor arousal, is called agitated (depressia agitata, from the Latin. Agito – “set in motion, excite”).
The current International Classification of Diseases (ICD-10) states that a diagnosis of depression can only be made if there are at least two of the following symptoms: decreased mood for most of the day; loss of interest and the ability to enjoy what is usually pleased; feeling of loss of energy and fatigue.
Additional signs of depression include: deterioration of the ability to concentrate, reduced self-esteem and self-confidence, the emergence of thoughts about his own fault and worthlessness, disruption of activity with anxious agitation or retardation, a tendency to suicide, sleep disturbance of any type, loss of appetite and weight. According to the views of most psychiatrists, to ascertain depression, it is necessary that such a condition lasts at least two weeks.