What is masked depression? Why is masked or hidden depression dangerous? Masked depression of a neurotic nature symptoms.

The hidden course of depression, the tendency to hide under the guise 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 the recognition and expression of emotional states is unacceptable (Cadoret R., 1980).

According to the medical literature, latent variants account for 30 to 80% of all depressive disorders. At the same time, one should keep in mind the frequent combination of depression with a neurotic state, with the so-called. somatization disorders. In the presence of such conditions, a mild depressive episode is observed in 40% of cases, a moderate one in 46%, and a severe one in 14%.

At the same time, the identification of masked depression can be interpreted as an expansion of the boundaries of the disease. In some cases, masked depression includes depression with sleep disturbances and depression with desire disorders (anorexia, bulimia, sexual disorders).

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

Until now, many masks of depression, personality traits, and the role of various factors in their origin remain unclear. Also, the question of the so-called somatic depressive equivalents, i.e. disorders of internal organs that completely replace depressive states. Common masks of depression are pain with vague descriptions in various parts of the body, a feeling of weakness, sleep disturbances, changes in appetite, cardiovascular disorders, etc.

Most patients often experience severe fatigue, loss of interests and feelings of pleasure. In 84% of cases, the subjective perception of patients with latent depression includes complaints of increased fatigue.

They associate their depression with unpleasant sensations from the internal organs. At the same time, the clinical picture is dominated by somatic equivalents of depressed mood in the form of functional disorders of organs and systems, changes in the autonomic system, while changes in mood hidden by somatic symptoms remain in the background and can only be identified with appropriate research. The most subjectively painful masks of depression are disorders of the stomach and intestines.

A specific personality trait of patients with latent depression is the tendency to attribute functional disorders of internal organs to any specific cause. Such patterns are especially typical for patients with gastrointestinal disorders.

One of the most common “masks” of depression in general medical practice, which occurs in 50% of patients, is persistent pain. Chronic pain, a mask for depression, can occur in almost any part of the body. Most often, the doctor has to deal with headaches, back pain, pain in the heart or abdomen, and joint pain. In the latter case, it manifests itself in a variety of pain syndromes, and the pain is usually noted in at least two points. According to domestic scientists, the incidence of depression in these cases reaches 80%. According to the views of American researchers, in the painful version of depression, patients complain of pain associated with at least four organs or parts of the body.

The insidiousness of the disease lies in the fact that in addition to psychological distress, a person experiences physical pain and discomfort. The effectiveness of treatment depends entirely on the correctness of the diagnosis.

Hidden depression is often hidden behind physical illnesses, which is why it is called somatic. Sometimes a person begins to experience pain symptoms of unknown origin. Scientists claim that the cause of physical illness is a spiritual disorder that manifests itself through diseases of the body. With a correct diagnosis, only a psychotherapist can restore good physical condition and eliminate the symptoms of masked depression.

Symptoms

Symptoms of latent depression most often manifest themselves in the form of psychogenic pain: this can be a headache or toothache, discomfort in the joints, or cervical migraine. A person may also experience vegetative-vascular disorders: tachycardia, dizziness and heaviness in the body. Signs of hidden depression look like this:

Subdepressive state is not always noticeable to others

People suffering from masked mental disorder do not always show their inner state. First of all, they do this so as not to disturb their loved ones. Patients have learned to hide their condition under the guise of calm and satisfaction with life.

Sudden nervous breakdowns

Somatized depression often gives rise to outbursts of emotions. An always calm person can suddenly burst into tears or scream sharply, for no apparent reason. After such an explosion of emotions, the patient again becomes calm and balanced.

Appetite disturbance

Hidden depression is often accompanied by a complete refusal to eat, or vice versa, increased appetite. Patients with mental disorders very often try to compensate for their worries by changing their taste preferences. Relatives should be wary of a sharp change in gastronomic preferences for no apparent reason.

Insomnia or vice versa, constant sleepiness

Sleep disturbance is a clear sign of depression. A person suffering from this disease can rarely boast of healthy and restful sleep. Patients mainly suffer from insomnia, cannot fall asleep for a long time and then fall into a borderline state between sleep and reality. There are often cases when a person sleeps more than 10 hours a day and does not get enough sleep.

Uncontrolled use of medications

Some people, trying to get rid of a depressed state, begin to take various antidepressants on their own. As a result, the low-grade disorder takes on a chronic form and is more difficult to treat.

Constant mood swings

A person who has just been cheerful and sociable can plunge into heavy thoughts or even cry. People experiencing an internal crisis can experience several mood swings in one day.

Obsessive-compulsive disorder

Masked depression of a neurotic nature is often accompanied by obsessive movements syndrome. A patient with a hidden disorder may tap on the table, count floors in houses, twitch his neck or bite his lips. People who make repetitive movements most often have internal problems of a psychological nature.

Constant search for meaning

A depressed person cannot enjoy a good day or success at work; he is constantly busy thinking about finding the meaning of life. Such thoughts make him sad, thoughts about imminent death only aggravate his depressive state.

Psychosomatic pain

Somatic manifestations of depression are expressed in bodily pain of unknown origin. A complete diagnosis does not answer what caused the health problems. Imaginary sciatica or headache is a clear example of hidden depression. One of the main problems of people experiencing symptoms of somatized depression is that they do not want to admit even to themselves that they need psychological help.

How to get rid of hidden depression

The first step to getting rid of the disease is a consultation with a psychotherapist who will select the right treatment. Somatic symptoms of depression cannot be ignored; this is fraught with serious consequences. The causes of subdepression can be internal and external. Internal reasons include: low self-esteem, loss of meaning in life, and more. External reasons are financial problems, troubles at work, divorce from a loved one, housing instability, sexual dissatisfaction. If you cannot cope with problems on your own, and communication with friends does not bring the desired result, there is only one way out - seek help from a specialist. A psychotherapist will clearly explain what hidden depression is and help you deal with it on a professional level.

It should begin with a complete diagnosis of the patient. After all pathological diseases are completely excluded, therapy for the hidden disorder begins. In cases of mild illness, the attending physician will recommend non-drug treatment, which includes:

• Psychotherapy, which is carried out in the form of individual or group sessions;
• Light therapy;
• Magnetic and transcranial stimulation and more.

Somatized depression in its advanced form is treated with tranquilizers and antidepressants. Only the attending physician should draw up a course of treatment, taking into account the general condition of the patient. It is strictly forbidden to take sedatives on your own, as they have a lot of contraindications and can cause complications. If all doctor's recommendations are followed, treatment of latent depression has a favorable prognosis. Getting rid of the disease is not easy, which is why an integrated approach to treatment is so important. Psychological help, support from loved ones and, if necessary, drug therapy will allow the patient to look at the world with completely different eyes.

The appearance of the first signs of depression cannot be ignored. There can be many reasons that cause a state of mental discomfort: from loss of meaning in life to financial problems. The first symptoms of an internal crisis are sleep disturbances, lethargy and irritability, loss of appetite, and psychosomatic pain. A timely diagnosis and proper treatment will allow you to get rid of this unpleasant disease and live a full life.

Masked depression

First, let's define what depression is. This is a mental disorder that is very common in the modern world. It is characterized primarily by decreased mood, loss of interest in life, lack of desire to do anything, and inability to experience pleasure. The quality of life deteriorates, melancholy, sadness eat away, life loses its meaning. A sick person can remain in this depressed state for a very long time, without finding a way out.

Depending on the cause of origin, depression is divided into 3 main groups:

1. Endogenous (Arises for no apparent reason, regardless of the situation. The cause is genetic predisposition, changes in the hereditary apparatus. The impetus can be any change in the usual lifestyle.)
2. Psychogenic (The cause is a specific stressful event. First, a “fixation” on it occurs, and then other symptoms are added to this state, as a rule, it goes away after the problem is resolved.)
3. Somatized or masked (Does not manifest symptoms characteristic of this disorder, but imitates non-existent diseases, hides under the guise of a somatic disorder.)

We will pay special attention to this type of depression, clarifying that the terms “hidden” and “larved” also refer to masked depression.

Causes of masked depression and difficulties of diagnosis

External factors can provoke hidden depression, such as: the loss of a loved one, stress, troubles in your personal life. And if there is bad heredity, multiple sclerosis, parkinsonism syndrome, cerebral vascular pathology, then the person is at risk. Impaired metabolism leads to a decrease in the production of the hormone serotonin, which is responsible for regulating mood and pain.

Diagnosing masked depression is incredibly difficult. A person goes from doctor to doctor, takes expensive tests, but there is no effect.

The thing is that in the case of hidden depression, at a doctor’s appointment, the patient does not talk about the symptoms characteristic of depression. He talks about some kind of illness and in the first place is not a bad mood, but very specific dizziness, discomfort in various parts of the body, heart and headaches or intestinal problems, shortness of breath, sleep disturbances, lack of libido. The person is sure that his poor health is due to the presence of an “incurable” disease. Masked depression exhausts the body both physically and emotionally.

There is a very important point here: the symptoms that the patient is talking about do not fit into any one picture of the disease. An attentive doctor, be it a therapist, gastroenterologist, or even more so a psychotherapist, will definitely conduct a detailed survey and pay attention to the manner of speaking and study the medical history and clarify the symptoms.

Subdepressive state

There are subdepressive states when the symptoms of depression are expressed in a fairly mild form. In this case, the person is not yet exhausted by the disease, he is still quite active, but nothing pleases him anymore, there is no “taste of life.”

The state of subdepression usually occurs when some new stage, a new leap in development is expected, a choice needs to be made, but the person does not see which direction to take. And he also doesn’t know what to do in this case. The state of affairs seems deadlocked. Old goals have been achieved, but new goals are not in sight. A crisis comes, a situation when there is no joy, no significance, no pleasure, no incentives for further development.

If a person is sufficiently educated and strong, he can figure this out on his own and do a “reassessment of values,” and if that doesn’t work, then seek help from a doctor at this stage. This condition indicates that something needs to be changed. But what to change and in what direction to move - this is where the doctor will help.

The doctor must be able to distinguish and see the fine line that distinguishes ordinary blues from a depressive state.

Masks of depression

Hidden depression is an insidious disease, dangerous because it is very difficult to discern. What is this disorder disguised as? Here are the most common cases:

• Irritable bowel syndrome: increased anxiety causes rumbling, flatulence, abdominal pain, loose stools. A person is afraid to leave the house because of frequent visits to the toilet, he is afraid that he will not find the toilet on the way or will not have time to reach it
• Vegetative-vascular dystonia: a diagnosis that does not exist. When it is not clear what is happening to the patient and the reasons for what is happening are not clear, this diagnosis is usually made. Pressure surges, dizziness, weakness, fear of fainting, headaches from muscle tension, migraines, tachycardia, the desire to take a deep breath and fear of lack of air
• “Cardiac melancholy” syndrome: aching, stabbing, cutting pain in the chest. A thorough examination will not show structural changes in the heart muscle and blood vessels
• Neuralgic and rheumatic pains
• Insomnia (difficulty falling asleep, light, restless sleep, nightmares and difficulty getting up)
• Pathological drowsiness (you spend more than 10 hours in bed and at the same time feel overwhelmed and exhausted)
• Anorexia (lack of appetite, refusal to eat) and bulimia (bouts of gluttony)
• Mental disorders in the form of panic attacks and various phobias

Symptoms of masked depression

If any of the above manifestations are present, but all this occurs against the background of emotional depression, it is worth finding out and identifying the presence of the following symptoms:

• Daily fluctuations in mood and activity (usually in the evening the mood improves, and in the morning sadness, despondency, anxiety sets in), their frequency and recurrence (time, season)
• A pessimistic assessment of one’s future (the view of the world is changing, nothing pleases, everything around is in shades of gray, some things seem absolutely insoluble)
• Difficulty concentrating (there is a feeling that memory is impaired, perception and learning something new becomes problematic)
• Increased level of anxiety (concern, worry, expecting the worst)
• Lack of effect from previously prescribed therapy

Usually the patient talks about this as a secondary manifestation caused by the disease, not realizing that these are signs of hidden depression. This manifestation of symptoms makes it difficult to make a timely diagnosis, and therefore, the severity of the disease can be underestimated.

People have different attitudes towards certain events in life. For some, a quarrel in the family or troubles at work are a normal life situation, but for others it can be stressful and lead to mental trauma. Maximum effort is spent on a minimal event. Unable to relax and get rid of tension in the usual way, a person concentrates on what happened, becomes despondent, rushes to extremes, and makes significant decisions that he regrets. It seems that he has reached a dead end, with nowhere to get vital energy from. There is a masked depression of neurotic origin.

Symptoms of masked depression of a neurotic nature

• Uncontrollable mood swings
• General weakness and weakness
• Tendency to criticize and blame others for your troubles
• The story of the event ends in tears and feelings of self-pity
• A little anxiety
• A clear understanding of the causes of the disease
• Sleep disorder
• Digestive system disorders
• Pain of various etiologies and localizations (headache, heart, joint)

Weak-willed people, quiet and passive, not used to fighting and winning, defending their point of view - this is the category of people who have every chance of ending up in the arms of this insidious neurological disorder. Being in a state of depression with an anxious component, at the moment of its maximum manifestation, a feeling of hopelessness, doom, and despair may arise. And here there is a danger of suicidal thoughts.

The surest way to prevent suicide is timely detection of the disease and timely treatment.

It happens that the disease is not detected and progresses, the person’s character changes greatly. He becomes aggressive, irritable or, on the contrary, withdrawn, detached from others. Social isolation gradually occurs. Why is this dangerous? The fact that at this moment a person seeks relief from his condition in alcohol and drugs, and in return receives worsening depression.

A special risk group is teenagers

Masked depression also occurs in adolescence. The peak of depression occurs in adolescence (15-40% of young people are susceptible to this illness). This manifests itself in the form of a demonstration of disobedience, protest, or, conversely, laziness and tearfulness. Children openly come into conflict with their parents and teachers, they can terrorize those around them with music of a certain direction, or become interested in subcultures or religion.

It is very important to persuade a teenager to visit a psychotherapist. Don’t give him conditions and ultimatums, find the right words that will help you and him get a consultation with a doctor.

Treatment of masked depression

As a rule, depressive conditions are treatable; the main thing here is not to delay in seeing a doctor, and to strictly and carefully follow his instructions. Treatment will depend on the nature of the disease and the severity of the disease, on symptoms, characteristics of the body, the presence of concomitant diseases and on the age of the patient.

Hidden (larved) depression is treated using an integrated approach, combining medication and psychotherapy.

Medicines (according to a doctor’s prescription and strictly individually)

1. Antidepressants (reduce and alleviate feelings of depression). Do not be afraid of addiction; new generation drugs will only help the body restore damaged mechanisms and ease the symptoms of depression. There are many names: Luvox, fluoxetine, anafranil, paroxetine, citalopram, etc.
2. Tranquilizers (have a sedative effect, reduce fear, panic and anxiety). There are restrictions on admission: children under 18 years of age, frail elderly people, pregnant and lactating women, those with kidney and liver failure, drivers. Drugs such as: Relanium, tazepam, phenazepam, afobazole, atarax have proven themselves and are often prescribed for the treatment of depressive conditions
3. Nootropic drugs: piracetam, neurobutal, vinpocetine, cerebrolesin (improves memory, activates brain function)
4. Multivitamins

Psychotherapy

Not an alternative to drug treatment, but an important addition that involves the active participation of the patient in the treatment process. In the arsenal of a psychotherapist there are many methods and techniques for treating latent depression, which allow the patient to cope with his internal and external problems and conflicts. The following areas are used: psychoanalysis, cognitive psychotherapy, rational, behavioral, gestalt therapy in groups and individually, as well as light therapy and art therapy. These and other non-drug methods help resolve problems that seem insoluble to the patient.

All together, both medications and psychotherapeutic methods make it possible to realize and overcome internal complexes, relieve affective tension and consider the situation from an angle where it ceases to be a psychological trauma.

It is important to achieve absolute trust in the doctor-patient relationship. The disease is easy to treat, and if you tune in to a positive outcome and actively cooperate with the doctor, the recovery process will go faster.

Signs and treatment of masked depression

A depressive state can be completely invisible to others, but can be felt by a person at the level of physical ailment and even distinct pain in one or another part of the body. In this case, masked depression, or subdepressive state, occurs.

Masked depression. Origin story

Victorian doctors in the 19th century drew attention to a similar illness, accompanied by a complex form of exhaustion, calling it “neurasthenia.”

They were unable to determine the medical cause of this condition, because... patients reported symptoms similar to those of mental illness.

Modern medicine defines such neurasthenia as masked depression.

The origin of this type of disorder is not fully understood. However, there is a hypothesis according to which its development is associated with three mechanisms:

1. It reveals pathological changes at the somatic and neurological levels. Thus, the decompensation mechanism is triggered, i.e. physical ailment is corrected due to the emotional state.
2. This type of depression is characterized by a combination of a true somatic illness, for example, bronchial asthma or allergies, with a pathogenetic depressive syndrome. Treatment of depression in this case is aimed at completely eliminating the psychosomatic factor and compensatory restoration of the somatic state.
3. It may occur against the background of imitation of somatic changes due to the individual picture of the disease.

In any case, depression of this type develops against an organic background, and therefore is closely related to the somatic state of the human body.

Causes

The main cause of the occurrence and development of masked depression is a violation of metabolic processes, namely endocrine changes associated with the release of serotonin.

Its main function is to regulate mood and pain, so a decrease in the hormone leads to the fact that a decreased mood is perceived by the body as pain and discomfort in different parts of the body.

In addition, the causes of anxiety are:

• violations of work and rest schedules;
• dissatisfaction with various aspects of life: work activity, interpersonal relationships;
• prolonged physical and mental overload;
• prolonged stress.

The hereditary factor and possible complications during perinatal development are of no small importance.

Symptoms

The symptoms of masked depression are primarily associated with pain of varying degrees of intensity and localization.

Experts identify several types of depressive disorders of this nature:

1. Malfunctions in the functioning of biological rhythms: prolonged insomnia or, conversely, constant drowsiness, “inverted mode”, when a person is awake at night and sleeps during the day.
2. A pain mask associated with the appearance of heart, headaches, muscle pain and neurological problems.
3. Disturbances in the functioning of the autonomic and endocrine systems: vegetative-vascular dystonia, anorexia, bulimia, sexual dysfunction.
4. Mental disorders expressed in panic attacks, obsession, various phobias and antisocial behavior.

All of the above signs are characterized by both complex and individual manifestations.

What are the signs of mild depression? Find out from the article.

How to get rid of depression on your own after a divorce? Read on.

Diagnosis and treatment

The effectiveness of treatment for masked depression directly depends on proper diagnosis. Identifying symptoms on the part of the patient himself does not give the necessary result, but only increases the duration of diagnosis and immediate treatment.

The doctor prescribes antidepressants and sedatives, leading to an improvement in the condition at the somatic level and the elimination of painful sensations.

Drug treatment also includes the use of multivitamins, immunostimulants and restoratives. Treatment should be comprehensive with an adequate combination of medications and psychotherapy.

For effective treatment and consolidation of a positive result, it is important to take into account the opinion of specialists from related medical fields: therapeutic, gastroenterological and cardiological areas.

Forecast

Correct and timely diagnosis facilitates rapid treatment. According to statistics, every fourth woman and every tenth man experiences a similar depressive state at least once in their life. More than 90% of them make a full recovery.

The difficulty with this disease is that it can last for many years, i.e. a person is treated by a therapist, neurologist, narcologist to no avail, and ends up seeing a psychotherapist when masked depression becomes chronic.

Wearing depressive masks is a painful burden for every person. When faced with such a problem, it is important to tune in to a positive outcome and prevent the reoccurrence of masked depression - a condition that exhausts the human body both physically and emotionally.

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What is masked depression of a neurotic nature?

Masked (larved) depression is a psychiatric term meaning a depressive syndrome that has a hidden course. The disease is similar in symptoms to neurasthenia, when the patient feels a state of extreme fatigue and problems sleeping.

Clinical picture

In the masked form of the disease, the clinical symptoms of depression are mild or do not occur at all. In most cases of subsyndromal depression, apathy, hypothymia, motor and mental retardation are usually relegated to the background and are not recognized by the patient.

In the latent form of the disease, a person does not objectively comprehend the influence of the affective components of depression. The patient does not understand what it is, and is sure that he is developing a difficult to diagnose, and possibly even incurable disease. He visits various specialists in an attempt to find a somatic disease, performs complex diagnostic procedures, and as a result begins to doubt the doctor’s competence.

Most often, patients with larval depression report pain and irregular heart rhythm, lack of air, and problems with sleep. Somewhat less often, they describe a persistent headache that is not responding to medications, dyspeptic symptoms associated mainly with impaired peristalsis (diarrhea, constipation, nausea and flatulence). In some cases, patients note problems with memory and decreased concentration.

Some patients complain of sleep disturbances: intermittency, difficulty falling asleep, nightmares. Sometimes patients notice a change in their appetite: a decrease or, conversely, an increase in the need for food. Complaints of changes in libido or irregular menstruation are also common.

Objectively, patients experience slight retardation, which is often expressed in a slower speech rate. As secondary symptoms, sometimes there is increased sensitivity to bright lighting and loud sounds, but these factors are never dominant, that is, they reduce the patient’s quality of life.

The danger of the masked form of the disease is the secrecy and weakness of depressive symptoms. Failure to recognize the pathological condition in a timely manner can result in serious consequences: the disease can be complicated by the addition of panic attacks and more dangerous depressive disorders.

The progression of larval depression is accompanied by negative personality changes: uncontrollable outbursts of irritability and unmotivated aggression interfere with a person’s social life and the performance of professional duties. In psychologically immature individuals, social isolation can lead to the formation of painful addictions, such as alcoholism or drug addiction.

Causes of subdepressive state

The main causes of masked depression are hereditary predisposition and physiological and biological factors. Masked depression of a neurotic nature occurs due to a lack of substances that regulate the activity of the central nervous system. A deficiency of neurotransmitters leads to an increased reaction to impulses transmitted from organs, resulting in unpleasant and sometimes painful sensations in the patient.

External factors can trigger a subdepressive state: troubles at work and in your personal life, the death or departure of a loved one. The risk group also includes people with a family history, vascular pathologies of the brain, Parkinsonism syndrome, and multiple sclerosis.

Symptoms of larval depression

Masked depression can have two development options: agripnic, occurring with sleep disturbances, nightmares, early awakening and accompanied by heavy lifting, and anorectic, in which dyspeptic symptoms are present: loss of appetite, nausea, constipation or diarrhea, as well as weight loss.

A subdepressive state is characterized by the occurrence of many somatic and mental symptoms, such as:

• depression;
• anxiety and phobias;
• obsessions;
• symptoms of neurasthenia;
• hypersomnia, intermittent sleep, insomnia;
• decreased or increased peristalsis;
• signs of vegetative-vascular dystonia (VGS for short);
• skin itching;
• dizziness;
• lack of appetite or bulimia;
• changes in blood pressure and heart rate;
• pain in the heart area;
• neuralgia of various origins.
• increased aggressiveness, conflict;
• formation of pathological dependencies;
• sexual deviations;
• hysterical reactions aimed at attracting attention.

Often, with masked depression, the patient’s relatives note changes in his character and behavioral disturbances: conflict, impulsiveness, unmotivated aggression, irritability, excessive touchiness and tearfulness. Therefore, it is important to know what signs indicate the disease in order to start treatment on time and prevent its progression.

Treatment of the disease

Treatment of subdepression must be carried out comprehensively, using not only pharmacotherapy, but also psychocorrection methods: behavioral, art therapy, rational, psychotherapy. Psychotherapy sessions allow you to identify the psychological causes of hidden depression, teach relaxation, self-control and help in the formation of adequate self-esteem.

The main components of pharmacotherapy for masked depression are antidepressants (BP for short), tranquilizers and nootropics, as well as sedatives and vitamin-mineral complexes:

• antidepressants;
• tranquilizers and nootropics;
• sedatives;
• vitamins and minerals.

Antidepressants

The antidepressants of choice in this case should be a group of serotonin and norepinephrine reuptake inhibitors. It includes drugs such as Venlafaxine, Anafranil, Duloxetine. If the patient's leading symptom is motor and mental retardation, then it is advisable to use antidepressants that stimulate the activity of the central nervous system (Imipramine, Melipramine).

Tranquilizers and nootropics

For anxiety conditions, tranquilizers of a number of benzodiazepines (Phenazepam) are prescribed, and when sleep disorders dominate, effective drugs such as cyclopyrrolon derivatives (Zopiclone) are used.

The drug Phenibut combines the qualities of a nootropic and the anti-anxiety properties of a tranquilizer, which allows it to be used for anxiety conditions without losing the ability for productive mental activity. It is effective in conditions with components of neurosis, which are characterized by mood lability, tearfulness and excessive irritability.

The daily tranquilizer Afobazol has a mild effect, so it can be purchased at a pharmacy without a prescription. The drug is effective for phobias and anxiety, eliminates excessive irritability and tearfulness, and makes it easier to fall asleep.

Sedatives

The use of these drugs helps reduce aggressiveness, irritability, suppress excessive nervous excitement, and normalize the state of HCV. Additionally, sedatives relieve intestinal spasms, improve sleep, normalize heart rate, without having a harmful effect on the brain.

Sedatives based on peony and motherwort have a strong sedative effect, normalize the functions of the central nervous system and HCV, relieve irritability, sleep disturbances and unmotivated anxiety. Medicines containing St. John's wort have not only a sedative effect, but also antidepressant properties. Combined sedatives also have a good effect.

Vitamins and minerals

As an auxiliary treatment, it is recommended to take long-term courses of vitamin-mineral complexes that contain calcium pantothenate, magnesium, folic acid, and vitamin B6. They help the body fight the effects of stress and support the functions of the nervous system.

Treatment of masked depression using the above groups of drugs can have a positive result within a couple of weeks; quite often the symptoms of the disease disappear after 30 days of continuous treatment. But in order to avoid relapse, you should not stop drug therapy until the end of the prescribed course (usually 3-6 months).

Causes, symptoms and treatments for masked depression

Masked depression is a condition in which the classic symptoms of depression (low mood, lack of plans for the future, pessimistic mood) are not expressed or absent. What masks does depression wear?

Anxious-phobic mask

Fear of getting an incurable disease for no apparent reason, anxiety about an iron not being turned off (probably), fear of being alone, fear of death and other phobias - all these hypochondriacal phobias can exist on their own, but more often they serve as a mask for hidden depression.

If they have existed in your life for a long time and you have learned to cope with them without harming yourself and your active life, you can ignore minor fears and anxieties. If they appeared not so long ago, but have already brought great discord into your everyday life, if you feel that you cannot cope alone, seek help and begin treatment.

Obsessive behavior

Any person has the right to do strange things. The person knows that his action is absurd, but he repeats it again and again. Wiping the floor in an apartment is a necessary act, but when the dust is washed off 15 times a day, it’s already an obsession. Obsessive movements hide behind them a feeling of unsettlement and depression. Endlessly checking whether the gas or water is turned off, returning home several times to check the lock - these symptoms are characteristic of masked depression.

Hypochondria

It can act as an independent disease, but it can also be another mask for a depressed state of mind. The person becomes very suspicious; he is sure that he has a terrible incurable disease (despite the fact that there are no objective signs of the disease).

Neurasthenia

Irritability and fatigue, emotional exhaustion, general weakness are signs of neurasthenia. But neurasthenia itself can be a symptom of masked depression.

Sleep disorders

Insomnia or hypersomnia - any of these manifestations is a violation of human biorhythms. Masked depression is characterized by disturbing sleep with many awakenings. At the same time, getting up in the morning requires great volitional efforts, and the feeling of fatigue does not leave either in the morning or in the evening. A person whose depression is hidden under the guise of sleep disturbances may sleep for days on end and still not feel rested.

Autonomic and endocrine disorders

Vegetative-vascular dystonia is a disease on which all incomprehensible symptoms are usually blamed. Strictly speaking, there is no such diagnosis in the international classification of diseases. Dizziness, hot or cold flashes, changes in blood pressure, fainting - this set of symptoms can be explained by one of the masks of depression.

Heart pain, stomach pain, joint pain, headache are common masks for this mental disorder. When turning to doctors, a person sincerely feels sick, and when objective studies speak of health, the patient begins to be suspected of being a malingerer. But this is not so - the person is sick, he just needs to contact a neurologist or psychiatrist and receive adequate treatment.

Pathological changes in character

In an effort to get away from a depressed state and low mood, the patient may seek solace in pathological tendencies: alcoholism and drug addiction are a frequent companion to masked depression. Therefore, it is important for toxicologists to find out whether a killing hobby or mood problems appeared first.

Tearfulness, touchiness, and the desire to attract attention through problems with well-being are characteristics of a person susceptible to masked depression. She changes her whole life, subordinating her to her absurd laws. Pain in the cardiovascular system and rapid heartbeat do not add optimism, but taking pills that lower the heart rate and improve blood pressure is useless; the root cause needs to be treated - masked depression.

Treatment of masked depression

Patients are very often afraid to take antidepressants: many consider the pills to be dangerous to health, disrupt hormonal levels, and are highly addictive. And in general, taking antidepressants means admitting that you are mentally ill. This common misconception is especially problematic when communicating with patients suffering from masked depression. Therefore, their treatment begins with minimal doses of antidepressants in combination with herbal sedatives.

Very important!

The diseases described in the article actually exist. Making an independent diagnosis and self-medicating is very dangerous, because only qualified doctors can distinguish the masks of depression from a somatic illness. In one case, only antidepressants can solve the problem, in another - a complex of suitable medications.

If you feel unstable and strange, or observe symptoms that you cannot put into a specific picture, consult a doctor. The sooner a differentiated diagnosis is made, the sooner you can undergo treatment and return to an active normal life.

Due to misconceptions about the disease, many patients of different ages are more inclined to take a wide variety of medications than to meet with a psychotherapist or psychiatrist.

However, it has been found that many antidepressants prescribed in conventional regimens are generally ineffective. This is especially true for older people. They can delay treatment for months and years. The risk of side effects with standard therapy for masked depression is significantly greater.

Research from the International Center for Disease Control and Prevention has shown. An adequate combination of medications in small doses and psychotherapy is most effective.

Example of complaints

As an example, we will describe a fairly common option for trying to treat masked depression and contacting us with complaints. The man went through many doctors several times. At the time of treatment, he did not consider his illness to be related to a change in mental state.

I am 25 years old, female. I’ve been sick for 5 years now, I don’t know why. Before this illness I had very little pain. And only a cold. She didn’t fall, didn’t hit herself, there were no surgeries. I have always been active and healthy. It all started with the fact that I was very cold, and because of this, cramps began in my fingers, then periodic weakness in my legs, as if my legs were giving way on their own. I even fell several times and couldn’t get up. When they lifted me up, it was as if nothing had happened, she even ran calmly. Later this weakness spread to the whole body and began to intensify.
Now I have: weakness in my arms, hands, fingers, my shoulders are heavy and don’t listen to me well. I practically don’t go outside because I have terrible weakness in my legs, sometimes to the point of trembling. I need qualified help, but I still can’t figure out which doctor. Over the past 5 years, I have lost a lot of weight and lost weight; I have no appetite. I’m scared to go out alone and I can’t. My eyelids did not droop, I swallowed well, but the feces became somehow soft, unformed, and smelled strongly. There are constipation or disorders that alternate, a feeling of bloating, as if inflated from the inside. A feeling of heaviness, slight pressure in the solar plexus area, and I often feel slightly nauseous.
I have been to many different doctors, but everyone gives different diagnoses. First they diagnosed multiple sclerosis, then myopathy, later myasthenia gravis, lumbar ischialgia, and osteochondrosis. Other doctors talk about irritable bowel syndrome, the presence of worms, bulbitis, gastrodenitis, pancreatitis, reflux. I went to all the doctors, went through all the examinations 2-3 times. But they still can’t diagnose me. No treatment helps. Plasmapheresis, hormones, a bunch of injections, pills, manual therapy, acupuncture, homeopathy. Zero reaction. The latest diagnosis is myopathic-myasthenic syndrome.
Every doctor finds something, and I start another useless treatment. I even saw an oncologist, but the doctor, after listening to me, told me to go to a psychiatrist because I was depressed. But I don’t feel apathy and I don’t have tearfulness, I can laugh normally. It seemed to me that he just wanted to get rid of me.
However, my condition is getting worse every time and I am very scared that nothing helps. Can I do some more tests? No one in our family had anything like this. As a child, I was bitten by a tick, but the doctors did a test and said it wasn’t the cause. What tests can be done, where to go? I have a child, I want to live!

Therapy problems

The main problem in the treatment of masked depression is the lack of competent and complete diagnosis. Carrying out differential diagnosis at a medical consultation in the case of non-typical or not clear symptoms should be the rule. In most cases, patients do not receive adequate treatment for masked depression because the doctor cannot find the true cause of the person's complaints.

This is due to the fact that the patient does not feel or complain about psychological or mental problems. Many specialists cling to minor physiological changes, considering them the cause of complaints. Doctors often forget or do not want to admit that in every case of visiting a doctor there is a high degree of probability of the psychogenic origin of the patient’s complaints. Therefore, most people do not receive the necessary treatment for masked depression.

Many doctors do not refer patients for consultation with a psychotherapist or psychiatrist for a more detailed diagnosis. However, people themselves, when they are advised to consult a specialist in higher nervous activity, perceive the advice negatively. Very often, not understanding the problem, not feeling complaints about impaired nervous activity, they are biased towards such recommendations.

Treatment of masked depression in the clinic

Treatment of masked depression in our clinic is always tailored individually and complex therapy is recommended. We are very careful in choosing drug therapy. Unfortunately, without the use of drugs, therapy will not be sufficient or effective. However, without a specially selected psychotherapeutic program, the result in the treatment of masked depression will not be complete and will not last as long. Therefore, we recommend using both drug therapy and psychotherapy in adequate combination.

In addition, we always associate the treatment of masked depression with somatic manifestations. We take into account the opinion of doctors of related specializations, for example: a therapist, a gastroenterologist, a cardiologist, etc.. With prolonged courses of the disease and attempts at all kinds of “treatment,” completely obvious somatic changes in the body can be observed. This often requires the inclusion of correctors and additional medications to alleviate the person’s general condition.

Our methods of treating masked depression are radically different from standard and generally accepted technologies. Our experience in the treatment of disorders of higher nervous activity shows that for most people in modern conditions, different solutions and approaches are required. We have created unique techniques that have become significantly more effective in the fight against nervous system disorders.

By combining the methods of rehabilitation medicine, neurology, therapy, psychotherapy and psychiatry, we were able to achieve a significant improvement in the quality of the treatment process and the treatment of masked depression became more effective.

Complications

If you do not pay attention to the treatment of masked depression, it begins to grow, causing the manifestation of new somatic symptoms, and becomes more complicated. Scientific evidence suggests that if masked depression is left untreated or not treated correctly, it is associated with an increased risk of developing early-onset dementia.

Often masked depression can cause the development of addiction (drugs, alcohol, smoking cigarettes, strong tea and coffee, food, etc.). For example, it is not uncommon to hear: “I just need a drink to relax a little. Yes, well, today one glass does not help, because... the tension is very high. I need a little more. It's OK".

When depression is masked, it becomes difficult for others and the person themselves to understand and acknowledge what is going on behind these surface manifestations.

How does masked depression manifest itself?

• Changes in weight, sleep or appetite problems. These signs can be confusing because, depending on the individual, they can take very different, sometimes bizarre, forms. Some want to sleep all the time, while others may experience insomnia.
• Physical symptoms that do not go away. Fatigue, headaches, back pain, digestive disorders, chronic pain, menstrual problems, potency problems, sexual disorders.
• Feeling of anxiety.
• Increased excitability, irritability.
• Forgetfulness or difficulty concentrating.
• Pessimistic outlook on life.
• Feelings of guilt or helplessness.
• General apathy and lack of interest or pleasure in one's activities.
• The emergence of thoughts of suicide.
• Compulsive (uncontrollable by reason or will) purchases and actions.
• Increased alcohol consumption.
• Eating disorders.
• Hyperactivity, absorption in work.

A little history

In the 19th century, Victorian doctors identified a condition which they named "neurasthenia". This disease is characterized by a severe form of exhaustion. But they have been unable to find a medical cause, and those who suffer from it complain of everything that points to mental illness. Modern doctors now believe that neurasthenia, in most cases, should be classified as masked depression.

Some doctors say the Victorian version of the disease, called neurasthenia, is similar to chronic fatigue syndrome. As with latent depression, people with chronic fatigue experience significant stress or life changes before the illness begins to manifest itself. Additionally, like masked depression, chronic fatigue syndrome had all the physical symptoms associated with depression. However, not psychological, but somatic complaints came to the fore, but without clear biological reasons. They manifested themselves in the form of diseases of internal organs, the musculoskeletal system, skin and other diseases.

Researchers have found that masked depression, just like classical depression, occurs when there are disturbances in the metabolism of serotonin and other neurotransmitters in the nervous system. Serotonin not only helps regulate mood, but also helps regulate pain. When serotonin levels in certain brain structures decrease, depression can be experienced as pain and illness in different parts of the body.

Treatment of masked depression!

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On the contrary, people feel pain of a completely different nature, suspecting they have various diseases.

Because of this, neither the patient nor the doctors may not suspect for a long time that the person is suffering from a depressive disorder.

It is important to identify the true cause of the ailment in order to prescribe effective treatment.

The most common symptoms of masked depression are:

• Vegetovascular dystonia.
• Dizziness, migraines.
• Irritable bowel syndrome.
• Cardialagia, tachycardia, blood pressure surges.
• Cardioneurosis.
• Pain in the muscles, joints, and spine that is not justified by external factors.
• Circadian rhythm disturbances (insomnia, daytime sleepiness, increased sleep duration).
• Eating disorders (bulimia, anorexia, compulsive overeating).
• Mental disorders (obsessive-compulsive disorders, panic attacks, increased anxiety).

A striking feature of latent depression is the frequent change in somatic symptoms, which creates in a person the false feeling that he is developing several different diseases at once.

A sign that a person is developing nominal masked depression is that clinical examinations do not produce results. The person is physically absolutely healthy, but symptoms of various diseases continue to appear.

Also, the most important feature of this disease is the lack of improvement in the person’s condition when receiving treatment for the alleged diseases.

Depression is a disease of the 21st century, because modern people are haunted by many stress factors - failures at work, in the family, constant lack of time. Here you will find tips on how to avoid depression. This information is useful for everyone.

Neck muscle tension as a symptom

There are two options for the occurrence of unpleasant sensations affecting the neck muscles with masked depression:

1. Muscle tension that appears as a result of a depressed state of the body.
2. Symptoms are one of the masks that hides the disease.

In the first case, excessive tension in the neck muscles actually occurs, which leads to cramps, stooping, pain, stiffness of movement, and loss of sexual desire.

In such a situation, physiotherapy (massages, electrical procedures, mud baths) can improve the patient’s condition by achieving muscle relaxation.

When the symptoms are a manifestation of the mask of hidden depression, not only a feeling of muscle tension occurs, but also such false sensations as: heaviness in the neck and back, a feeling of “stiffness” in the joints, bursting, pulling or tightening sensations in the neck muscles. In this case, treatment attempts do not bring results or lead to a worsening of the condition.

Excessive muscle tension is directly related to a person’s psychological state, so when muscle tension appears, pay attention to the traumatic, nervous or depressing situations that have happened to you recently.

Causes

The main cause of masked depression is a decrease in the level of neurotransmitters: serotonin, dopamine and norepinephrine. The most important factor is disruption of serotonin production. This type of hormone is not only responsible for a person’s mood, but also helps the body regulate pain.

If the level of serotonin falls, then depression can manifest itself not only as a decrease in mood, but also as unpleasant or painful sensations in different areas of the body.

Factors causing disruption of neurotransmitter production have not been fully studied.

But there are several reasons why people are at risk:

• Genetic predisposition.
• Congenital pathology of metabolism of various substances (galactosemia, hyperglycemia, protein deficiency).
• Autoimmune diseases (multiple sclerosis, myxedema).
• Vascular pathologies of the brain (aneurysms, damage to the carotid artery, due to traumatic brain injury).

Differences from classic depression

In the case of classical depression, a person has the following symptoms: apathy, suicidal thoughts, guilt, depressed mood (regardless of circumstances), anxiety, anhedonia (loss of interest in activities), pessimism, decreased self-esteem, severe fatigue.

The listed mood disorders are hidden behind physical ailments with masked depression. This makes classic depression a disorder that is easier and quicker to diagnose than latent depression.

If you experience symptoms of classic depression that last more than a month, you should seek help from a doctor. Without proper treatment, depression continues to develop, significantly affecting quality of life.

Subdepressive state or masked depression?

Subdepression is a mild depressive state characterized by a decrease in mood and a feeling of melancholy, which are not as pronounced as in clinical depression.

Subdepression is not a mental illness and is caused by external factors and worries.

In contrast to masked, in which it is the internal functions of the body that are disrupted.

How could this be dangerous?

The basis of the danger is the extremely difficult diagnosis of this disease. The longer the disease remains untreated, the stronger its manifestations. In constant anxiety about the state of health, a person can greatly reduce his mental stability. This can cause the development of neuroses, psychoses, and mood disorders, which will only worsen the patient’s condition.

In addition, going through a large number of doctors and constantly receiving different diagnoses, a person will try new methods of treatment. Unnecessary use of drugs can harm a person's physical health due to various side effects, and then the disease that was just a mask can become a real disease.

Treatment of masked depression

1. Drug treatment.
2. Psychotherapy.

The use of antidepressants and sedatives is combined with psychotherapeutic work.

Medications help relieve symptoms of depression, and a psychotherapist works to identify and eliminate psychological problems caused by external factors. Therapy for masked depression shows positive results quite quickly.

Often the symptoms of the disease disappear within a month after starting treatment. However, doctors often recommend repeating the course of treatment after 3-6 months from the last course.

When treating with a psychotherapist, it will also be useful to take into account the opinion of doctors in related fields (generalist, gastroenterologist, cardiologist), because with a long period of illness and the use of the wrong treatment route, changes in the functioning of the human body are possible.