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?

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. Constantly 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.

Pain

Pain in the heart, stomach, joints, and 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.

– one of the types of mental disorders that is subdepressive in nature. It is difficult to detect, because... it is always hidden under the symptoms of various diseases or addictions, and depression and bad mood are hardly noticeable. Knowing exactly what symptoms of masked depression may appear, as well as understanding all the main features of this disorder, helps in its timely identification.

Features and types

Latent depression is not included in a separate section of the International Classification of Diseases (ICD), but the sharp increase in the incidence of this disorder in people in recent years makes it one of the most common.

The main feature of such depression is the almost complete absence of signs of its development against the background of the appearance of mild symptoms from other body systems that could indicate any diseases. Latent depression can occur in two forms:

1. Psychopathological. A person is always tired, depressed, lonely, anxious, he has no desire to rejoice or communicate with people, while he experiences a feeling of inferiority on the physical side.
2. Psychosomatic. A person has a large number of complaints that are partly indicative of various diseases, but they are not enough to correspond to any specific disease. He may feel pain, tingling in his limbs, and have problems with sleep and sex life.

Based on the symptoms and characteristics of the disorder, it is customary to distinguish several variants of masked depression:

• Algic-senestopathic. The patient experiences unusual sensations throughout the body, accompanied by pain. They can concentrate in only one part of the body or move throughout all organs. The nature of the manifestation depends on the location.
• Agripnic. Characterized by sleep disorders. The person falls asleep poorly, his sleep is superficial and often interrupted. Often the patient wakes up very early, after which he can no longer fall asleep again. He has a sleepy state, there is no feeling of rest.
• Vegetative-visceral. It manifests itself in the form of VSD, which is accompanied by instability of blood pressure, pulse and respiration, as well as increased sweating with an increase in body temperature. Tenesmus, flatulence, and discomfort in the abdomen are common.
• Psychopathic. Characteristic of adolescence, but can sometimes appear in adolescence. The teenager is often lazy, he is not in the mood, he perceives any requests or demands with strong negativity, and does not experience any joy. Such behavior does not always mean that the child has masked depression of a neurotic nature. Often such actions of a teenager are age-related mental characteristics.
• Drug addict. It differs from others in its development against the background of alcoholism or drug addiction. Drinking alcohol or drugs is an unconscious attempt to overcome a subdepressive state.
• Asexual. Patients have no interest in the opposite sex, they do not experience positive emotions from communication. Women develop frigidity, while men experience impotence. When depression disappears, everything returns to its place without any help.

In rare cases, several types of hidden depression can be combined at once. This makes it much more difficult to find the root cause of certain symptoms.

When depression is detected, its masked form occurs in 20% of cases.

Causes

Most often, masked depression is found in women who spend a lot of time working. Moreover, the vast majority of patients are urban residents and have families. However, this is not a direct cause of the development of depressive disorders.

Sometimes depression is of a subordinate nature, i.e. appears after the manifestation of certain physical disorders. This makes its identification even more difficult, because Even many doctors are unaware of hidden depression that appears after minor violations.

The main causes of hidden depression are:

• Genetic predisposition;
• Taking certain medications;
• Hormonal imbalance;
• Pregnancy;
• Nervous tension;
• Serious stress.

As a rule, the cause of hidden depression is not of great importance, because... Treatment is aimed specifically at eliminating the disorder itself.

Symptoms

Masked depression hides under certain “masks”, collecting symptoms of a separate category that are characteristic of a number of diseases. That is why doctors suspect the development of physiological diseases, and not a mental disorder. Signs of hidden depression can include several masks at once.

Mental pathologies:

• Paroxysmal anxiety, panic, appearance of phobias;
• Obsessive-compulsive disorders;
• Neurasthenic and hypochondriacal disorders.

Autonomic or somatization disorders:

• Dizziness;
• Neurocircular dystonia;
• Cardioneurosis;
• Neurodermatitis;
• Hyperventilation;
• Anorexia;
• Bulimia;
• Intestinal problems.

Painful manifestations:

• Neuralgia;
• Headache;
• Pain in the heart, stomach, spine;
• Polyarthralgia.

Sleep disorders:

• Insomnia;
• Severe drowsiness during the day;
• Nightmares;
• Hypersomnia.

Deviations in the social sphere:

• Lack of sexual desire;
• Formation of dependencies;
• Antisocial and hysterical behavior (touchiness, despondency, nervousness, conflict, aggression, etc.).

The depressive nature of such symptoms is suspected, as a rule, in cases where neurotic manifestations are pronounced.

Relatives of people suffering from hidden depression note a change in their behavior. Patients often feel resentful, become nervous and almost always depressed, and they tend to hide their symptoms from others, because they themselves are not aware of them.

Diagnostics

Masked depression in a person can only be treated after an accurate diagnosis has been made, which should be done by a specialist in the field of psychiatry. But when its course is hidden, the patient does not attach any importance to mental abnormalities, but instead concentrates on additional symptoms. For this reason, a person very often turns to a doctor of a completely different specialty, which corresponds to the symptomatic mask of depression. He may lose a lot of time while the doctor tries to make a diagnosis. In this case, the patient will hide all mental symptoms, because will consider them secondary and insignificant, and when asked about his well-being, he will answer that everything is fine, without reporting signs of depression.

In such cases, the doctor refers the patient to a psychotherapist. He, in turn, will begin to search for the real problem. All diagnostics consist of detailed interviews with the patient. Of particular importance are questions about:

• Well-being;
• Habits, interests, views;
• Plans for the future;
• Communication with others;
• Features of the work;
• Personal problems.

Very often the result is the identification of seriously low self-esteem, which has led to the development of negative views and hidden depression. This also explains the variety of symptoms that cause concern to the patient, because he considered them a sign of a dangerous disease.

Treatment

After confirming the diagnosis, the attending physician will give recommendations on how to treat hidden depression. Successful treatment can only be achieved if the therapy is comprehensive. This approach is very important.

Treatment includes taking several types of medications and psychotherapy, which will help speed up the resolution of the problem and avoid possible difficulties during recovery. Features of therapy:

1. Antidepressants. As a rule, Duloxetine or Anafranil is prescribed. If motor or mental function is impaired, Imipramine or Melipramine may be prescribed.
2. Tranquilizers and nootropics. They help cope with severe anxiety, as well as improve the general condition of the nervous system. Most patients are prescribed Phenazepam, Phenibut or Afobazole.
3. Sedatives. Special products can help you get rid of irritability, nervousness, aggressiveness, as well as improve heart function and improve the quality of sleep.
4. Vitamins and minerals. Taking vitamin-mineral complexes helps maintain the nervous system in a normal state and reduce the negative effects of stress.
5. Psychotherapy. The psychologist will teach the patient to easily understand himself, solve difficulties and get rid of negative thoughts. Special techniques can not only cure depressive conditions, but also completely change the patient’s life for the better.

The first positive changes after starting treatment will become noticeable within a couple of weeks. You will be able to completely get rid of latent depression in about a month. However, this is not a reason to stop treatment, because... there is a high risk of relapse. It is important to complete the entire course prescribed by your doctor. As a rule, it lasts from 3 to 6 months.

If masked depression is not treated, then there is a high probability of the addition of various mental pathologies, the elimination of which will require a lot of time and effort. But treating yourself without a doctor’s prescription is also not the right choice.

Folk remedies

For people who want to quickly improve their condition, there are folk remedies that allow you to treat depression at home. They can only be used if there are no contraindications to the use of any of the components present in the recipes.

Masked (larved) depression is a psychiatric term meaning a depressive syndrome that has a hidden course. The disease is similar in symptoms to neurasthenia. The patient feels very tired and has trouble sleeping.

In the masked form of the disease, clinical symptoms are mild or do not occur at all. 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, the patient does not objectively comprehend the influence of the affective components of depression. He 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 medical condition. He undergoes 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 an annoying one that is not amenable to the effects of medications. There are also dyspeptic symptoms, mainly associated 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. Secondary symptoms sometimes include increased sensitivity to bright lights and loud sounds. However, 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. The patient experiences uncontrollable outbursts of irritability and unmotivated aggression, which interfere with 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 provoke a subdepressive state: troubles at work and in personal life, death or. 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. The first is agrypnic, which occurs with sleep disturbances, nightmares, early awakening and accompanied by heavy getting up. The second option is anorectic, in which dyspeptic symptoms are present: loss of appetite, nausea, constipation or stomach upset, 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;
• symptoms of neurasthenia;
• hypersomnia, intermittent sleep, insomnia;
• decreased or increased peristalsis;
• signs ;
• 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, etc. 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. Involve not only pharmacotherapy, but also methods of psychocorrection: 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

Of the antidepressants, in this case, there should be a group of serotonin and norepinephrine reuptake inhibitors. It includes drugs such as Venlafaxine, Anafranil, Duloxetine. If motor and mental retardation prevails, 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 (for example Phenazepam) are prescribed. When sleep disorders are dominant, effective drugs such as cyclopyrrolone derivatives (Zopiclone) are used.

The drug Phenibut combines the qualities of a nootropic and the anti-anxiety properties of a tranquilizer. This allows you to use it in cases of anxiety and not lose the ability for productive mental activity. It is effective for conditions with components that are characterized by mood lability, tearfulness and excessive irritability.

Daytime tranquilizer Afobazol It 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, and normalize heart rate. At the same time, without having a harmful effect on the brain.

Sedatives based on peony and motherwort have a strong sedative effect and normalize the functions of the central nervous system and HCV. In addition, they 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. Such complexes contain calcium pantothenate, magnesium, folic acid, 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 positive results 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).

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 shows 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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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.

Sometimes depression hides behind ostentatious joy

External factors can trigger hidden depression, such as: 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.”

In a subdepressed state, a person finds it difficult to make life choices

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 see. 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

Depression can hide behind many masks

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.

Some life events make you sad

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.

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.

A psychotherapist helps treat depression

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.

Problems that seem insoluble can be solved

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.

Masked (larved) depression is a disease from the section of borderline psychiatry and psychotherapy, characterizing hidden depression. A feature of larval depression is that classic affective manifestations (low mood, withdrawal from contacts with the usual social circle, apathy) are expressed slightly or may not appear at all. Patients often exhibit symptoms of some difficult to diagnose rare somatic pathology.

1 General information

Mental disorders have recently become increasingly common.

The incidence rates of depressive disorders are about 6% in the adult population, ranking 4th among all pathologies leading to disability and death. According to WHO, by 2020 this indicator will rise to 2nd position after coronary heart disease.

Among depressive disorders, a significant number of cases are somatized depression. At the same time, affective disorders are detected in 87% of patients, of which masked depression accounts for about 7–31% of cases.

With this pathology, the prevailing polymorphic or low-symptomatic vegetative manifestations with imitation of various somatic diseases hide the actual depressive symptoms, which are always present and can be identified. The severity of depressive affect in such cases is always insignificant. The patient is usually unaware of the depressive component. The clinical picture contains a variety of cardiac, neurotic and gastrointestinal symptoms, biological rhythm disorders, and as a result, patients come to the conclusion that they have a severe incurable disease.

It has been established that somatization of affective disorders is largely mediated by such factors as:

• heredity;
• age;
• social status;
• premorbid personality characteristics (anxious, sensitive, neurasthenic personality types);
• environmental conditions.

Masked depression occurs more often in females, people with hereditary burden, married, professionally employed; there is a predominance of urban residents over representatives of the rural population.

The close connection between somatic manifestations and the emotional component of mental processes plays a role in the pathogenesis of masked depression. The main reason for the development of a depressive state is a violation of the metabolism of central mediator systems, in particular serotonin. It is suggested that normally somatic sensations associated with emotions are ignored, while in a painful state they absorb all the patient’s attention, determining his behavior. This is provoked by an increase in the degree of activity of the body’s responses to habitual impulses from the internal organs, so the patient is faced with a feeling of discomfort and even pain.

Mental disorders in men and women: types, description of manifestations, treatment methods

2 Reasons

As a result of research, it has been proven that functional diseases can provoke depressive disorders due to physiological, pharmacological and psychosocial factors.

What is endogenous depression: its symptoms, diagnosis and treatment

2.1 Physiological

These include the following conditions:

• Functional or structural damage to the neuronal connections responsible for the emotional component, leading to fluctuations in mood, cognitive functions and motor mechanisms. This occurs in organic neurological pathologies (stroke, Huntington's disease, Parkinson's disease, multiple sclerosis, brain tumors and other organic pathologies).
• Neurotransmitter disorders in oncology. It has been proven that cancer cell proteins induce antibodies that block serotonin receptors, thereby reducing its concentration and effects; The properties of tumors include increased metabolism of the precursor of serotonin (tryptophan), which also leads to a lack of this mediator in the synaptic cleft.
• Immune deficiency. Symptoms of depression are common after infections due to immunological imbalances due to the activation of cytokine release.
• Endocrine disorders. Depression can be a consequence of hypothyroidism, Cushing's syndrome, Addisson's disease and diabetes. The connection between endocrine and mental disorders due to increased hypothalamic-pituitary-adrenal activity in depression, increased secretion of basal cortisol and fluctuations in its daily secretion has been confirmed. Based on this, the dexamethasone test was discovered as a diagnostic tool for depressive disorders, which shows the absence of suppression of dexamethasone secretion in patients with depression.

Signs and treatment of clinical depression

2.2 Pharmacological

Some medications used in the treatment of somatic diseases can lead to the development of depressive disorders.

Medications that affect neurotransmitter processes in the structure of depression include:

• antihypertensive drugs - Clonidine, Reserpine, Methyldopa, beta-blockers (Obzidan, Propranolol), calcium channel blockers (Nifedipine);
• inotropic drugs – cardiac glycosides (Procainamide, digitalis preparations);
• hormonal drugs - oral contraceptives, corticosteroids, estrogens, progesterone, anabolic steroids;
• antiparkinsonian drugs – Levodopa, Midantan;
• NSAIDs and analgesics – Indomethacin, Phenacetin, Butadione;
• antibacterial drugs - Griseofulvin, Cycloserine, nalidixic acid;
• anticonvulsants – barbiturates, Clonazepam;
• anti-tuberculosis drugs – Isoniazid, Ethionamide;
• tranquilizers.

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2.3 Psychosocial

Somatic diseases are often accompanied by pain, suffering due to the loss of previous social status, health, financial and professional losses; may cause the patient to feel helpless, increasing the risk of disability or threat to life. Having lost interest in normal daily activities, the patient is faced with an inability to function and loses control over his own life. All this serves as a predictor for the development of a reactive depressive state.

Components of depressive disorder that can cause the development of somatic pathologies:

• Suicidal thoughts, attempts and incomplete suicides can lead to physical consequences.
• Self-neglect leads to the occurrence of somatic diseases or aggravates existing ones.
• Medicines used in the treatment of depressive disorders can cause organ pathologies, affecting the heart, kidneys, liver, etc. For example, antidepressants lead to tachycardia, orthostatic hypotension, conduction disorders, arrhythmias, liver and kidney dysfunction.
• Decreased immune cell activity due to side effects of antidepressants and other functional changes, such as hypercortisolemia, can lead to immunosuppression and weakened immunity.

3 Clinical picture

Masked depression (latent, latent, vegetative, larved or “depression without depression”) is a disease in which the symptoms of low mood are hidden under the “masks” of diseases associated with the activity of internal organs. Various sensations are noted: from general physical malaise and pain attacks in various parts of the body to sharp and sudden changes in a person’s behavioral reactions.

In the International Classification of Diseases, 10th revision (ICD-10), there is no diagnosis of “masked depression”. Typically, this term refers to affective disorders of varying severity that do not completely meet the criteria for a depressive episode, somatoform manifestations and other pathologies of a neurotic nature.

Within the framework of ICD-10, all depressive disorders have common clinical criteria.

Their classification and description are presented in the table:

Scope of violations	Description
Emotions	low mood; melancholy, sadness; low response to unpleasant and pleasant events; change in vitality: decreased energy, increased fatigue, decreased biotonus; loss of previous interests and pleasure from any activity (anhedonia), lack of desire to do anything; anxiety, apathy, irritability, tension, feelings of disappointment (frustration), a feeling of emptiness, seeing the world in “gray colors”
Cognitive functions	decreased memory and concentration; indecision or doubt in making decisions; low self-esteem, decreased self-confidence; pessimism, a sense of worthlessness; feeling of hopelessness; ideas of self-blame and self-deprecation; helplessness, suicidal thoughts
Behavior	motor retardation; low facial activity, amymia; slow body movements; problems establishing social contacts, lack of communication; in difficult situations - aimless uncontrolled hyperactivity, restlessness, agitation, fussiness, in severe cases - stupor

There are daily fluctuations in mood with a tendency to improve in the evening and depressive thinking in the morning. Patients look old, emaciated, nails and hair become weakened, brittle, and prone to loss. But in the case of masked depression, it is rare to find clearly defined depressive manifestations.

With this disorder, somatic disorders come to the fore:

• unpleasant bodily manifestations: painful sensations, discomfort, undifferentiated pain in different parts of the body, a feeling of heaviness of the body;
• changes in physiological functions: sleep disturbance (difficulty falling asleep, light, shallow sleep, early awakenings that do not bring a feeling of morning vigor), increased daytime sleepiness, changes in appetite, fluctuations in body weight, loss of desire, decreased libido;
• visceral disorders: cardiovascular disorders, gastrointestinal disorders and other difficult-to-verbalize bodily dysfunctions.

3.1 Manifestation options

The manifestation of latent depression occurs or intensifies after psycho-emotional and physical stress, weather changes, respiratory illnesses or exacerbation of chronic somatic diseases, in some cases spontaneously. For the majority of patients, the listed symptoms are not a reason to seek medical help; other patients go to general somatic medical institutions, where they are most often observed with a diagnosis of “vegetative-vascular dystonia”, “irritable bowel syndrome” and receive long-term and ineffective somatotropic therapy.

There are 2 main diagnostic criteria for larval depression:

1. 1. Psychopathological – manifested by vital depression (fatigue, unreasonable depression, feeling of physical inferiority, inability to enjoy life, lack of desire to communicate with others, difficulty in making decisions, anxiety, hypochondria).
2. 2. Psychosomatic - numerous complaints that do not fully meet the criteria for any specific disease, the impossibility of conventional drug therapy, insomnia, organ pain, paresthesia, potency or menstruation disorders.

Hidden depression can manifest itself in different ways:

1. 1. The obsessive-phobic variant is characterized by a variety of concerns, fears, obsessive thoughts and actions.
2. 2. Algic-senestopathic is manifested by various unpleasant sensations, prolonged excruciating pain, difficult for patients to describe. Patients often turn to doctors for various pain sensations in the chest, cardialgia, feeling of lack of air, and suffocation. With symptoms of dizziness and headaches, patients are observed with osteochondrosis, vertebral artery syndrome. With abdominal senestopathies with flatulence, constipation, patients are observed with gastritis, peptic ulcers, cholecystitis, pancreatitis, and sometimes require surgical treatment of appendicitis or operations in the rectal area. Somatic treatment does not help cope with complaints, so patients repeatedly seek emergency care. The main diagnosis that doctors make in such cases is vegetative-vascular dystonia.
3. 3. Diencephalic variant. It is characterized by the presence of symptoms of vegetative-vascular dystonia (visceral pseudoanginal, pseudoasthmatic disorders).
4. 4. Agripnic variant. The only manifestation of this form is sleep disturbance: difficulty falling asleep, light, shallow sleep, nightmares, early awakening in the pre-dawn hours with difficulty getting up painfully, requiring volitional effort, lack of a sense of sleep, increased daytime sleepiness (hypersomnia). At the same time, patients deny they have problems with mood disorders and depression.
5. 5. Narcotic - characterized by a desire for alcohol abuse, pseudo-binges.

With active questioning, it is possible to establish the dependence of pathological affect on the circadian rhythm in the form of an unreasonable feeling of melancholy, indifference, anxiety, and isolation from the outside world prevailing in the morning with excessive fixation on one’s bodily manifestations.

4 Masks of depression

Variants of masked depression are divided depending on the predominant symptoms - the so-called “masks”.

The main masks of hidden depression and their varieties are presented in the table:

Types of masks	Characteristic
Psychopathological disorders	anxiety-phobic (agoraphobia, panic attacks, generalized anxiety disorder, etc.); obsessive-compulsive; neurasthenic; hypochondriacal
Biological clock disorders	insomnia; nightmares; hypersomnia
Somatized autonomic and endocrine disorders	functional disorders of internal organs (cardioneurosis, hyperventilation syndrome, irritable stomach and intestinal syndrome, etc.); vegetative-vascular dystonia syndrome; anorexia, bulimia; skin itching; neurodermatitis
Algia-shaped masks	headache; pain in the heart, stomach, joints or spine; neuralgia (trigeminal, facial nerves, intercostal neuralgia, lumbosacral radiculitis); pseudorheumatic arthralgias
Behavioral disorders	drive disorders (sexual deviations, promiscuity); development of addictions (alcoholism, drug addiction, substance abuse); antisocial behavior (impulsivity, conflict, confrontational attitudes, outbursts of aggression); reactions such as hysteria (tendency to dramatize a situation, taking on the role of a patient, touchiness, desire to draw attention to one’s ailments, tearfulness)

5 Diagnostics

Diagnosis of a subdepressive state is quite difficult, because the patient turns to specialists of a different profile, not knowing exactly what both the manifestations and causes of masked depression are. No serious illnesses were found in this case. At the same time, these common diseases cannot be treated with standard medications. Patients have been examined and treated for a variety of somatic diseases for a long period without significant improvement.

It is the somatovegetative symptoms that come to the fore in the structure of complaints, while depressive symptoms are little expressed or do not appear at all. Patients may complain about low mood indirectly, justifying this by the presence of a large number of somatic diseases present, the length of observation by doctors and the impossibility of establishing an accurate diagnosis. In this case, the patient is referred to see a psychotherapist. It is he who, with the help of lengthy and detailed interviews, helps determine the diagnosis.

The specialist asks the patient about lifestyle, changes in emotional state, problems in relationships with other people and difficulties in the profession. The following deviations are most often identified: a person has low self-esteem, he is characterized by rather pessimistic views on life and his own future, he does not receive joy from the food he consumes, entertainment and from life itself. In this case, depression is accompanied by severe somatovegetative disorders: malaise, weakness, attacks of palpitations, suffocation, a feeling of lack of air, nausea, vomiting, constant constipation (rarely diarrhea), urination disorders, menstrual disorders, pain in the chest, spine, abdomen, headaches.

The diversity and “variable” nature of bodily manifestations is an important differential diagnostic criterion. Somatic disorders are characterized by variability, polymorphism, and inconsistency (there is no logical clinical connection between complaints). A thorough examination of the organs reveals only functional disorders, and organic pathology is denied.

In some cases, to make a true diagnosis, it is necessary to thoroughly study the behavior and appearance of the patient (a frozen “suffering” facial expression and a dull look). In difficult situations, the necessary information can be obtained in the process of communication with the patient through indirect questions aimed at identifying pathognomonic symptoms related to changes in the general tone of mood, desires, well-being and overall lifestyle, disruption of communications and professional activity (“Do you feel melancholy?” , “Do you have thoughts of suicide?”, “Has your joy in life disappeared?”, “Are there any plans for the future?”, etc.).

6 Treatment

Treatment of concomitant depressive disorders should be carried out in conjunction with the prescription of somatic therapy, which increases the effectiveness of the fight against masked depression. A positive result is achieved by using a combination of several treatment methods.

The main place in the treatment of depressive disorders is occupied by cognitive-behavioral psychotherapy and drug treatment. Hypnosis, sleep deprivation, yoga, and various physical procedures (light, phototherapy, acupuncture, electrosleep) can also be used.

6.1 Psychotherapy

At the initial stages of the disease, when the theme of a psychotraumatic situation predominates in the experience, pathogenetic psychotherapy is used, aimed at restructuring the patient’s system of relationships and attitudes, optimizing the action of adaptive mechanisms of psychological defense. There is a decrease in the severity of experiences, a switch from a traumatic situation, and an opportunity to verbally respond to negative experiences. With a longer course of depression with persistent somatization of affect, increasing fixation on the state of health and the formation of “vicious psychosomatic circles,” the role of psychotherapy takes on a “symptomatic” orientation. In this case, it is necessary to include medications in therapy.

With a long-term course of the disease, leading to qualitative changes in the personality, an increase in egocentrism, which contributes to greater withdrawal from the disease, and the occurrence of persistent psycho-emotional disorders, expressed in various variants of pathocharacterological (psychosomatic) personality development, the effectiveness of psychotherapy decreases. In these cases, more active drug correction is required; the role of psychotherapy is to provide general support to patients, preserve the patient’s emotional connections and is aimed at correcting the internal picture of the disorder and social adaptation.

6.2 Drug treatment

The most effective treatments for masked depression are antidepressants. Treatment with these drugs has a positive effect on the course of both affective and somatoform disorders. The choice of an antidepressant mainly depends on the spectrum of side effects against the background of existing somatic pathology: drugs with less pronounced or absent sedative, alpha-blocking and anticholinergic effects have an advantage.

Therapeutic treatment latent depression is recommended to be carried out in three stages:

1. 1. Relief therapy - carried out to achieve remission, duration - about 6-12 weeks. At this stage, patients are prescribed low dosages of antidepressants mainly from the group of SSRIs and SSRIs: Paxil (paroxetine), Cipramil (citalopram), Elicea (escitalopram), Zoloft (sertraline), Ludiomil (maprotiline), Ixel (milnacipran), Velafax (venlafaxine) in combination with low dosages of tranquilizers (Atarax, Phenazepam, Stresam, Afobazol) with gradual titration of the dose and frequency of administration. For the treatment of organ depressions with severe vegetative symptoms, the use of “small” antipsychotics (Eglonil - sulpiride, Teraligen - alimemazine) is effective.
2. 2. Stabilizing therapy - supportive follow-up treatment of residual symptoms of depression, duration - from 3 to 9 months. At this stage, therapy is carried out for hidden affective manifestations, depending on the form of depressive disorder (anxious, asthenic, melancholic, apathetic, etc.). In some cases, atypical antipsychotics with a mild stimulating effect are prescribed.
3. 3. Preventive therapy is carried out to prevent new episodes of depression, the duration is at least 1 year. During this period, therapy is aimed at relieving residual manifestations of masked depression with a gradual reduction and subsequent withdrawal of drugs. If symptoms of latent depression persist, it is recommended to prescribe low dosages of carbamazepine and lithium salts in combination with low dosages of mild antidepressants.

Non-medicinal techniques are used that affect the depressive radical - yoga, sleep deprivation, meditation. Sleep deprivation is an effective method of non-drug therapy in the treatment of the most complex, severe depressive disorders. This method is also successfully used in patients with prolonged larvae depression, resistant to the main pharmacological groups of drugs.

The prognosis for complete cure of masked depression is favorable in most cases. It depends on the duration and severity of the disease, early contact with a psychotherapist and timely initiation of high-quality individual treatment.

Criteria for the effectiveness of therapy for somatized depression:

• improvement of mood background;
• relief of somatic symptoms;
• return to normal activities, restoration of past contacts and interests;
• improving quality of life.

Masked depression or hidden, larved, vegetative depression is a chronic disease in which the classic signs of a depressive state are absent or “masked” as symptoms of somatic diseases or neurological disorders.

Most patients do not realize or do not want to admit that they have a depressive state, preferring to be “treated” by doctors of other specialties, rather than seek help from a psychiatrist or psychologist.

Causes and risk factors for developing the disease

Just like other depressive conditions, this disease develops due to a decrease in the concentration of hormones that transmit signals from the sensory organs to the brain.

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A decrease in the amount of norepinephrine, serotonin, and dopamine leads to the fact that a person ceases to experience a sense of pleasure, joy and other positive emotions from everyday events. Life seems gray, empty, “faded” to them, and their surroundings cease to arouse interest and curiosity. Why some people develop depression under certain conditions and others do not, science and medicine still cannot explain.

There are certain risk factors that increase the risk of developing subdepressive conditions or depression:

1. Heredity – a decrease in the concentration of neurotransmitters in the brain may be genetically determined. So far, this hypothesis has not found scientific confirmation, but numerous studies have proven that those whose relatives suffered from neuroses, depression and other mental illnesses have a several times higher risk of depressive episodes.
2. Hormonal disorders - the synthesis of hormones in the human body can be disrupted due to diseases of the endocrine organs, taking steroid drugs, pregnancy, after childbirth and during menopausal changes in women. Since women experience hormonal changes in their bodies much more frequently, their risk of depression is several times higher.
3. Frequent stress – constant nervous tension, frequent stressful situations cause increased synthesis of “stress hormones” - adrenaline, cortisol and others, which “block” the synthesis of “pleasure” neurotransmitters. If this happens constantly, their synthesis decreases.
4. Psychotraumatic events - separation from a loved one, breakup of a relationship, loss of a job and other events that cause strong feelings in a person can cause depression.
5. General deterioration of the body's condition - vitamin deficiency, lack of nutrients in the diet, chronic lack of sleep, physical inactivity and decreased daylight hours cause a general weakening of the body, due to which the nervous system can no longer successfully cope with stress, which can cause the onset of a depressive episode.

Symptoms of depression

With this disease, the characteristic features of depression - apathy, decreased mood and slowed thinking - may not be expressed or they are mistaken for the natural consequences of chronic somatic diseases. Patients may suffer for years from headaches, digestive disorders, heart or stomach pain, high blood pressure or pain in the spine.

A special danger of masked depression is its hidden course; patients do not always receive qualified help on time, continuing for years to be “treated” by doctors of other specialties.

Against the backdrop of severe depression, they experience menstrual irregularities, skin itching or rashes, fainting, attacks of severe pain, diarrhea or constipation. With all these complaints, they turn to doctors of various specialties and, most often, leave them with great dissatisfaction, because laboratory and instrumental studies do not reveal pathology, and the prescribed treatment does not help

Here are the “masks” - diagnoses under which larval depression is most often hidden:

• vegetative-vascular dystonia;
• arterial hypertension of unknown origin;
• osteochondrosis;
• cardioneurosis;
• irritable bowel syndrome;
• hyperventilation syndrome;
• migraine;
• dysmenorrhea of ​​unknown origin;
• skin diseases.

All these diagnoses are united by the inability to accurately diagnose pathological disorders in the body, to find out the cause of the pathology and the difficulty of treatment. Of course, not all patients with similar diagnoses suffer from neurological disorders and it is very important to understand when ordinary ailments “hide” depression.

Depression can be recognized by the following signs:

1. Constant anxiety or phobias – with this disease, a person experiences constant anxiety or fear. There can be many reasons - from fear of becoming infected with something incurable, to fear of public transport. A characteristic feature of such fears is the absence of a real reason, the patient worries and worries all the time, regardless of whether he has reasons or not, so he can worry about the iron not being turned off, even if he personally returned and checked several times, or worry every day at work whether its neighbors flooded it.
2. Obsessive states - they can become a continuation or addition to anxiety disorders or arise on their own. This may be an excessive desire for cleanliness - washing hands with antiseptics 10-15 times a day, maintaining strict order when performing daily duties, and so on. It is quite difficult to determine the line when quirks and oddities turn into obsessive states. It is worth thinking about pathology if a person not only personally performs certain actions, but also requires everyone to strictly follow these rules and reacts aggressively to any violations of the established order.
3. Neurasthenia - decreased performance, weakness, frequent headaches in themselves are not a distinctive feature of depression, but almost always accompany this disease.
4. Sleep and appetite disorders – depression is characterized by restless sleep, frequent awakenings, nightmares or weak shallow sleep and decreased appetite. Less often, against the background of nervous disorders, appetite increases and patients suddenly gain excess weight.
5. Non-localized pain - severe paroxysmal or dull nagging pain in different parts of the body occurs in all patients with this form of depression. Sometimes patients believe that they know that their heart, stomach or joints “hurt”, but upon examination they do not find any pathological changes in these organs.
6. Character changes - despite the fact that the classic signs of depression in this form are not expressed, character changes occur in all patients. This may include moodiness, irritability, tearfulness, isolation, decreased contact with other people and decreased interest in previously loved activities and hobbies. Such changes arise and develop gradually, so it often seems to others that the patient’s character has “deteriorated” due to health problems, but, in fact, they arise at the very beginning of the disease.

With masked depression, the patient will necessarily experience changes in character, difficulties with sleep and appetite. There are signs of neurasthenia and one or more of the symptoms described above are present.

It is often enough for an experienced doctor to talk with the patient or observe his behavior for some time in order to make the correct diagnosis and recommend treatment. In more complex cases, especially if the patient denies the presence of psychological problems, a more complete and thorough examination is required to exclude the presence of any serious diseases or pathologies. The presence of so-called concomitant diseases, such as vegetative-vascular dystonia, osteochondrosis, arterial hypertension or gastritis, does not exclude depression.

Treatment

Treatment of masked depression should be carried out by a specialist; only a qualified psychiatrist will be able to accurately assess the severity of the patient’s condition and select medications that will help him restore mental health. In addition to drug therapy, the help of a psychotherapist is mandatory.

Without psychotherapeutic help, treatment for depression cannot be considered complete, since unresolved internal problems after some time can again provoke the development of the disease.

Drug therapy

The most commonly used treatments for depression are:

1. Antidepressants. Modern drugs have a minimum of side effects and are not addictive. For the treatment of depression, the following are used: Venlafaxine, Flesinoxan, Fluoxetine, Cymbalta and others.
2. Tranquilizers. These drugs relieve anxiety and fear, normalize sleep, but are addictive and slow down the reaction. When taking them, you should refrain from driving a vehicle or performing work that requires quick reaction and concentration. The following drugs are popular: Phenazepam, Lorazepam and so on.
3. Nootropics and vitamins – often with depression, the patient’s body lacks nutrients and vitamins. Nootropic drugs improve metabolic processes in the brain, increase blood circulation and oxygen supply to nervous tissue. Although the effectiveness of these drugs is considered unproven, they are often used in complex therapy - Nootropil, Piracetam, Aminalon, Glycine, Succinic acid and others. In addition to these drugs, vitamins such as Magnesium B6, Folic acid, Calcium pantothenate and others are considered useful for depression.

Psychotherapy

In addition to drug treatment, psychotherapy is necessarily used. Various techniques used by a psychotherapist will help the patient understand his internal problems and learn to solve them without harming his health and psyche. To treat depression, rational, cognitive, behavioral, family, existential and other types of psychotherapy are used, for example, art therapy or treatment with light - phototherapy.

Hidden depression is a serious illness that not everyone can cope with on their own; timely treatment will allow the patient not only to quickly return to normal life and will also save him from the risk of recurrence of the disease.

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It is difficult to help someone who does not admit his illness, someone who will not talk about his state of mind. It is a daunting task to throw a lifeline to those who deny possible help. And yet, we must strive to understand and help those who live with it.

Perhaps you have heard of the mind-body connection? About how the power of the mind can affect the sensitivity of your body?

If you feel depressed, you can feel it in your own body - your body may ache, bones may ache, various organs may ache and your head may be pounding from a migraine.

Brain Clinic has been treating masked depression for many years and we know everything about its treatment. We will be able to establish an accurate and complete diagnosis and treat masked depression in the shortest possible time.

Masked depression revolves around this concept of mind and body.

Usually people have a clear understanding of depression. A person tends to think that a sure sign of depression is a feeling of helplessness and hopelessness, difficulty getting out of bed, sadness, a sharp drop in mood, apathy, lack of interest in anything, a depressed state and other signs that are closely related to mood, and this happens every day. That's all there is to recognizing depression, right?

Many people believe that depression is easily identified when it manifests itself as constant sadness. In fact, symptoms of depression can take many forms.

Chances are, if you are reading this article, you have a feeling that something is not quite right with you. You may find that you are very tired all the time and all you need to do is get a good night's sleep.

However, masked depression often manifests itself as something completely different, can cause insomnia, forgetfulness, and the inability to enjoy normal activities, pain or discomfort anywhere, memory loss, decreased or absent sexual satisfaction or desire, fatigue and much, much more.

Difficulties begin with its diagnosis, it is more difficult to identify than the usual one with its classic triad: decreased background mood, slowed thinking, slowed motor activity. The symptoms of masked depression are not typical. Depression can be hidden in several directions, “in a mask.”

These types of depression are called masked depression , otherwise they can be called larved or hidden depressions.

Masked depression is not a separate, specific type of mental illness.

Treatment of mild masked depression

More often than not, patients do not like to take conventional antidepressants due to various side effects and fear of these drugs. Therefore, in the treatment of masked depression, we recommend starting to use small doses of medications in combination with some herbal remedies and psychotherapeutic treatment methods.

“Diagnosing masked depression in children and older people is very difficult because they don’t come in and say, ‘I’m depressed. They are more likely to attribute their condition to physical symptoms, to what they feel - pain in different parts of the body, memory problems, poor sleep, changes in appetite,” says Dr Anne Fabini, director of geriatrics at Cambridge Health Alliance.

Older people, particularly older men, display their depression in unusual ways. In older men, depression may manifest itself as increased irritability more often than women. Thus, the grumpy old man stereotype may be a sign of a depressed old man.
A new report from the Centers for Disease Control and Prevention shows that depression is more common among women (10.7% of adult women) than men (7.7% of adult men). And although depression tends to peak between the ages of 45 and 64, it can appear at any point in a person's life.

People with masked depression often don't want to talk about it because they carry the stigma of mental illness. People still have misconceptions about mental health that: “I'm not crazy. I don't want people to think I'm crazy."

These “unusual” symptoms can occur quite often. They can mask depression and delay an accurate diagnosis, especially in children and the elderly.
To diagnose masked depression, you need to look for signs other than signs of sadness and depression.

Among these, it is worth noting some of the most common complaints from patients about their condition:

• sleep problems
• lack of energy
• fatigue
• problems with concentration or memory
• loss of appetite
• pain or discomfort in various parts of the body
• pains that don't go away
• therapists and other doctors do not find diseases that could be the cause of the complaints expressed.

Drug treatment of masked depression

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

However, it has been found that conventionally prescribed antidepressants tend to be less effective in older people, they can delay treatment for three months or more before they begin to work, and the risk of side effects is significantly greater with this treatment for masked depression.

Research by the international Center for Disease Control and Prevention has shown that an adequate combination of medications and psychotherapy, which are selected on an individual basis, is indeed the most effective.

Examples of treatment for masked depression

For example, we present a fairly common treatment option for masked depression and contacting the doctor of a patient who has been to all possible doctors several times and still does 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. Then they lifted her up and, as if nothing had happened, she even ran calmly. Later this weakness spread to the whole body and began to intensify.
At the moment I have the following: weakness in my arms, hands, fingers, my shoulders are heavy and don’t listen to me well. Now I hardly 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 visited different doctors several times. Everyone makes different diagnoses. First they diagnosed multiple sclerosis, then myopathy, later myasthenia gravis, lumbar ischialgia and cervical osteochondrosis. Other doctors talk about irritable bowel syndrome, the presence of worms, bulbitis, gastrodeudenitis with suspected pancreatitis, reflux. I went through all the doctors, passed all the examinations 2 and 3 times. But they still can’t diagnose me. No treatment helps. Plasmapheresis, hormones, kalimin, a bunch of injections, tablets, manual therapy, acupuncture, homeopathy. Zero reaction. The latest diagnosis is myopathic-myasthenic syndrome.
Examination by a rheumatologist: No connective tissue disease is observed. No evidence of pathology of the nerve endings of the lower extremities was identified. More data for the primary muscular level of the lesion, RV negative, mild brainstem-cerebellar syndrome, CT scan - no pathology of the mediastinum was detected, MRI of the brain - no signs of demyelinating process were detected, CSF - protein 0.31, glucose 2.92, potassium 2, 88, chlorides 118.6, sodium 139.0, cytosis 5/3, lymph-4, M-1. ENMG 24.05.07 there are disturbances in neuromuscular transmission from the deltoid muscle on the right, decrement = 25%. Examination by an ophthalmologist: nystagmus. I still have a bunch of different examinations. 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 each time and it scares me very much, because nothing helps once again. 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!

Symptoms of masked depression

If masked depression is not treated, it begins to grow, causing the manifestation of new somatic symptoms, and becomes more complicated. This can cause consequences that go far beyond constant sadness. In such cases, an increase in the mortality rate in older people, an increase in aggressiveness and antisocial behavior in children and adolescents, and a significant decrease in performance and the incidence of somatic diseases among people aged 20 to 55 years were observed. These conditions have a very significant impact on a person's quality of life. People suffer and they also often lose functional ability.

Scientific evidence shows that if masked depression is left untreated or not treated correctly, it is associated with an increased risk of developing early-onset dementia.

If you have one or more of the above

symptoms of depression

You should contact a competent psychotherapist in person for a frank, confidential conversation with the doctor about the possibility of masked depression, which can be a good step towards successful treatment and prevention of complications.

How exactly can masked depression manifest itself? How and what does she disguise herself as?

You can often hear similar sayings from people:

I'm so busy with work and I don't have time to spend with my family. I'm very sociable and hate it when I'm alone.

I feel great. Just a little tired.

I am good. I just have a lot of responsibility behind me and leave me alone.

I'm not depressed, I just don't care.

Complications of masked depression

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. Okay, I need a few. It's OK.

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

The most common symptom of masked depression

Changes in weight, sleep, or appetite: These signs of depression can be confusing because depending on the individual, they can take very different 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.

Feeling of anxiety.

Increased excitability, irritability.

Forgetfulness or difficulty concentrating.

Decreased sexual desire.

Pessimistic outlook on life: While there are many reasons to be pessimistic, a depressed person is more likely to focus on negative events and cannot find anything to do to be happy.

Feelings of guilt or helplessness.

General apathy and lack of interest or pleasure in normal activities.

The emergence of thoughts of suicide.

Compulsive (uncontrollable by one's own mind or will) purchases.

Increased alcohol consumption.

Compulsive (not controlled by one's own mind or will) overeating or other eating disorders.

Hyperactivity, absorption in work.

History of treatment of masked depression

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, is actually masked depression.

Masked depression?

Some doctors say the Victorian version of the disease, called neurasthenia, is similar to CFS. As with neurasthenia, people with chronic fatigue experience significant stress or life changes before the illness begins to manifest itself. In addition, like neurasthenia, chronic fatigue syndrome had all the physical symptoms associated with depression, but not the psychological ones - and without clear biological and somatic causes, in the form of diseases of the internal organs, musculoskeletal system, skin and other diseases.

The main hypothesis of the cause of masked depression

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

The main problem is the correctness treatment of masked depression is the lack of competent and complete diagnosis and differential diagnosis of the human condition on the part of many general practitioners and many specialists in various fields of medicine. In most cases, patients do not receive adequate treatment of 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 true cause of the patient’s complaints and health status, completely forgetting or not wanting to recognize the high degree of probability of the psychogenic origin of all existing symptoms. Therefore, most people do not get what they need treatment of masked depression.

Unfortunately, it must be admitted that many doctors do not refer patients for consultation with a psychotherapist or psychiatrist for a more detailed differential diagnosis, and even if they make such a recommendation, many people, not understanding the possible problem, do not feel

complaints about disorders of higher nervous activity

and being biased towards doctors who treat mental disorders, they do not accept such advice.

Comprehensive treatment of masked depression

Treatment of masked depression should always have a comprehensive approach and a very careful choice of drug therapy. Unfortunately, without the use of drugs, therapy will be insufficient and very long, but even without psychotherapeutic influence specially selected for each patient, the result is will not be complete and will not last long. Therefore, in treatment it is recommended to use both drug therapy and psychotherapy in their adequate combination.

In addition, when treatment of masked depression sometimes the opinion of doctors of related specializations should be taken into account, for example: a therapist, a gastroenterologist, a cardiologist, etc., since with prolonged courses of the disease and attempts at all kinds of “treatment”, completely obvious somatic changes in the body can be observed, which also require adequate therapy and relief of the general states of manifestation of the disease in humans.

Treatment of masked depression!

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