Masked Depression

The hidden course of depression, the tendency to hide under the mask of diseases of various internal organs is one of the most characteristic features of modern depression. Somatization of depression is especially characteristic of those cultures where recognition and expression of emotional states is unacceptable (Cadoret R., 1980).

According to medical literature, hidden options make up between 30 and 80% of all depressive disorders. At the same time, it should be borne in mind the frequent combination of depression with a neurotic state, with the so-called. somatized disorders. In the presence of such conditions, a mild depressive episode is noted in 40% of cases, moderate – in 46%, severe – in 14%.

At the same time, the allocation of masked depression can be interpreted as an extension of the disease. In some cases, masked include depression with sleep disturbances and depression with impulse disorders (anorexia, bulimia, sexual disorders).

If depression is hidden under the mask, it is usually combined with alexithymia, that is, with the inability of the patient to accurately describe their feelings and sensations. The alexithymia level is more pronounced in gastrointestinal and respiratory disorders. In this case, patients may not be aware of the depressive disorder and not clearly identify their emotions. Sometimes they are convinced that they have a rare and difficult to diagnose disease and insist (assuming the physician’s incompetence) on numerous examinations in non-psychiatric medical institutions. However, with active questioning, it is possible to identify a tendency to diurnal fluctuations in mood changes in the form of unusual sadness prevailing in the morning, despondency, indifference and detachment from the surroundings, with excessive fixation on their bodily sensations.

To date, many masks of depression, personality traits, the role of various factors in their origin remain unclear. Also not developed a question about the so-called. somatic depressive equivalents, i.e. disorders of internal organs that completely replace depressive states. The usual masks of depression are pains with fuzzy descriptions in different parts of the body, a feeling of weakness, sleep disturbances, changes in appetite, cardiovascular disorders, etc.

In most patients, there is often marked fatigue, loss of interests and feelings of pleasure. In 84% of cases in the subjective perception of patients with latent depression, complaints of increased fatigue are noted. They associate their depression with unpleasant sensations from the internal organs. At the same time, somatic equivalents of depressed mood in the form of functional disorders of organs and systems prevail in the clinical picture, changes in the vegetative system, while mood changes hidden by somatic symptoms remain in the background and can be detected only with an appropriate study. Most subjectively masks of depression are disorders of the stomach and intestines.

As a specific personality trait in patients with latent depression, there is a tendency to attribute functional disorders of the internal organs to a specific cause. Such models are especially characteristic of patients with gastrointestinal disorders.

One of the most common in all-medical practice “masks” of depressions, which occur in 50% of patients, is persistent pain. Chronic pain as a mask of depression can occur in almost any part of the body. Most often, the doctor has to deal with headache, pain in the back, in the region of the heart or abdomen, pain in the joints. In the latter case, it manifests itself in a variety of pain syndromes, and pain, as a rule, is observed at least at two points. According to Russian scientists, the frequency of depression in these cases reaches 80%. According to the views of American researchers with painful depression, patients complain of pain associated with at least four organs or parts of the body.

local_offerevent_note February 18, 2019

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