During the period of depression, suicidal thoughts, suicidal thoughts, which usually indicate the severity of depression, may arise due to the state of depression, depressed self-preservation instinct, intolerable mental pain.
Suicide occurs in 15% of cases of unrecognized mood disorders, and most often happens 4-5 years after the onset of the disease.
In the presence of suicidal thoughts, the patient has a burning desire to severely punish himself, not to burden others with taking care of himself, “not to be a burden to others”. All the patients’ beliefs are that these conditions are temporary, that the experience of those people who have recovered, even their own previous experience should disprove the hopelessness of their situation, most often prove to be in vain. In some cases, the thought arises of the patient’s delusional conviction in the meaninglessness of their existence.
The danger of impulsive suicidal attempts should be kept in mind. Suicidal acts are possible even with shallow depressions, especially in the absence of motor inhibition, with a change in the perception of the surrounding world and one’s own personality. Sometimes it manifests itself in a heightened perception of colors, sounds and sensations: “everything is bright and sharp, everything is distorted in some way”, sometimes, on the contrary, in the sense of dulling what is happening, as if “through dim glass”.
In severe depression, patients are so weak that they do not find the strength to take their own lives, but when they begin to get out of the disease or receive drugs that increase activity, suicide attempts are possible. A sick person can work out a suicide plan in detail and, experiencing temporary relief, make an imaginary impression on others about improving their condition, but the risk of suicide remains high.
The group of high risk of suicide are males of 16-25 and 55-70 years. In the latter case, this risk increases in lonely persons, especially those suffering from severe somatic diseases, as well as in those whose relatives have committed suicide. The premenstrual syndrome and the anniversaries of the tragic events for the patient belong to the suicidally dangerous period for affective disorder. According to the results of many studies, the risk of suicide is also high in people with a low level of cerebrospinal fluid, the main metabolite of serotonin, 5-hydroxyindolecetic acid. After suicide, elevated levels of hydrocortisone and norepinephrine were found in brain tissue.
Patients suffering from affective disorders most often use tricyclic antidepressants and lithium preparations for suicide. Quite often a suicidal attempt is made while intoxicated.
A clinical survey of a patient with suspicion of the possibility of suicide includes questions aimed at identifying a sense of hopelessness, willingness to commit suicide, having a detailed plan for suicide (drawing up a will, arranging your financial affairs, searching for suicide instruments).
Vegetative dysfunction
During depression, various disorders of the vegetative system occur: sweating, fluctuating blood pressure, dry mouth, bowel problems and other disorders.
Depression is accompanied by disorders of the circadian rhythm, hence the increased severity of symptoms of depression at certain times of the day.
Depression disrupts a person’s sexual life. The sexual desire decreases, the erection weakens, the feeling of an orgasm is dulled, the menstrual cycle changes, up to the complete absence of menstruation.
On the part of the digestive system, there is a lack or decrease in appetite, less often – its strengthening (atypical symptom of depression), as a rule, concerning certain products. For many patients, the sense of taste of food disappears; it “becomes like grass.” Weakness makes it difficult to go grocery shopping, cook and eat, and thoughts about food make you feel nauseous. Often there are persistent constipation, flatulence (flatulence), abdominal pain. The patient noticeably loses weight or, on the contrary, begins to eat a lot and get better. Changes in appetite in people suffering from other diseases besides depression (peptic ulcer, hypertension, diabetes mellitus) may complicate the course of the latter.
Observation of the activity of the cardiovascular system demonstrate its disorders such as palpitations and cardiac rhythm disturbances. In patients with depression, the extremities are most often cold, bluish, the pulse is filiform, and its frequency is variable.
Changes in the respiratory system can be observed: feeling of lack of air, feeling of incomplete sigh, breathing often slow.
For depression, various pains are quite typical: headaches (heaviness in the head), pains in the joints, in the lower back, in other parts of the body. At the same time, the perception of pain can be changed, most often due to the lowering of the pain sensitivity threshold.
Sleep disturbance
80% of people suffering from depression, disturbed sleep (insomnia). Various disorders are noted, including the disappearance of the sense of sleep. Difficult falling asleep, sleep is usually superficial, restless, anxious with nightmares.
Patients with depression enter the dream phase much earlier than healthy people, and this fact may indicate a biological susceptibility to depression. The latent period of sleep with rapid eye movement in patients with depression is shortened. Normally, it is about 90 minutes (varying from 70 to 110 minutes depending on the person’s age). Note that the shortening of the latent period to confirm the diagnosis of depression should be confirmed by several studies conducted outside of alcohol intake, other psychoactive substances or drugs. The diagnostic value of sleep studies during depression increases if its features such as an increase in the concentration of rapid eye movements in the first half of the night, an increase in the density of rapid eye movements, a shortening of the delta sleep phase, and awakening in the middle of the night or in the early morning are recorded.
In patients with depression, dreaming is more common in the first half of the night. Frequent symptoms of depression are the absence of a feeling of rest after sleep, the disappearance of naps, or, less commonly, daytime sleepiness (hypersomnia).
Sudden nighttime awakenings are especially typical for depression, as well as early, at three or four o’clock in the morning, and this “terminal insomnia,” due to a violation of the late, fourth phase of sleep (the third and fourth phases in severe depression may be absent completely), is often the onset of relapse bipolar disorder. As you know, dreaming and the deepest, late stage of sleep are especially important for the vital activity of the human body.
Sleep cycles during depression lag behind the daily biorhythms. Drowsiness is especially noticeable in winter in those patients who have seasonal affective disorder.