What is hidden depression and how to detect it?

The difficulty in treating masked depression lies in its diagnosis. Unfortunately, this form of depression is very difficult to recognize and only a very competent doctor is able to correctly assess a person’s condition.

To diagnose masked depression, you need to look for signs other than signs of sadness and depression.

In this regard, therapy for masked depression is unable to achieve its main goal. Our specialists have extensive experience in clinical and differential diagnosis. It is also worth noting that in our clinic the patient is examined by several specialists and for each a medical consultation is held free of charge. This eliminates the possibility of an erroneous diagnosis.

If a person undergoes a full course of treatment, strictly following all the doctor’s instructions, then he gets rid of masked depression.

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 condition of your body?

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

Brain Clinic specialists treat masked depression using individually adapted methods. The concept of these techniques is an organic synthesis of the principles of restorative medicine, therapy, psychotherapy, neurology and psychiatry. Therefore, we will be able to establish an accurate and complete diagnosis and treat masked depression with maximum effect.

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What is masked depression?

Masked depression revolves around the concept of mind and body.

This type of depression may not present as classic depression. Adults may complain of constant fatigue and pain (other unpleasant sensations in the body). Many doctors cannot find any reason in the form of diseases of internal organs or other somatic diseases. In children and adolescents, masked depression may manifest itself in the form of aggression or behavioral disturbances. And the children are referred to a psychologist, but the main problem remains unnoticed. Therefore unsolved.

Similarities and differences

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 appears as something completely different and can cause insomnia, forgetfulness, and an inability to enjoy normal activities, pain or discomfort anywhere, memory loss, decreased or absent sexual satisfaction or desire, fatigue, and much more. much more.

Difficulties in diagnosis

Masked depression - “in the mask” of somatic diseases.

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

Such manifestations of depression are called masked depression, otherwise they can be called larved or hidden depression.

As a rule, in most cases, general practitioners often incorrectly diagnose the somatic complaints of patients, because patients always complain only about somatic symptoms, not to mention their internal experiences, and most practitioners do not know that such symptoms belong to depression. Typically, masked depression is mild, but tends to develop into chronic forms. Without proper treatment, over time, patients often become worse and this can trigger the manifestation of more serious disorders, such as a suicide attempt, which can end successfully. The exact cause of the development of masked depression still remains not entirely clear, but according to the results of many functional studies (these data are very important in the diagnosis of hidden forms of depression), practicing medical specialists are well aware of the mechanisms of development of such conditions. And carrying out differential diagnosis from somatic pathology is also important and should be inseparable from a full diagnostic procedure.

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

Frequent complaints with masked depression

• 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.

Diagnostics

In a conversation with a patient, the doctor first of all pays attention to long periods of depression, a decrease in the range of interests, and motor retardation. Patient complaints of apathy, loss of strength, increased anxiety, and suicidal thoughts play an important diagnostic role. There are two groups of signs of the depressive process that the doctor takes into account when diagnosing. These are positive and negative affectivity (emotionality). Additional diagnostic signs of depression are:

• family history - if among the patient’s relatives there were people suffering from depressive disorder (especially bipolar), or if there were suicides among the immediate family;
• patient's personality type – anxious personality disorder is a risk factor for depression; previous history of depression or mania;

concomitant somatic chronic pathologies; alcoholism – if the patient is partial to alcohol, then this is also a risk factor for depression.

Most people with underlying depression experience migraines, neck pain, and headaches.

Treatment of 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 using very small doses of drugs in combination with herbal drugs and special psychotherapy.

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.

Signs, manifestations, symptoms of depression

Signs of the disease can be divided into four groups.

• emotional disturbances: decreased mood, lack of ability to worry,
• disturbances of mental functions: slowing down of the pace of thinking, impaired attention,
• a feeling of insignificance, uselessness, ideas of self-blame, gloomy and negative thoughts about the meaninglessness of life, a pessimistic interpretation of the past, present and future, which can lead to suicidal attempts;
• decreased motor activity and behavioral disturbances: decreased performance, passivity, refusal to communicate, reclusiveness;
• physiological manifestations: eating disorders (usually loss of appetite), intestinal dysfunction, constipation, loss of libido;

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.

Causes

In most cases, the disease develops after sudden changes that were unfavorable. These include:

1. Marriage breakdown.
2. Dismissal from work.
3. Parting with a loved one.
4. Moving.
5. Completion of studies.

Family problems and conflicts also play an important role. With an unstable emotional background in a family where there is no understanding and difficult living conditions, there is a high risk of developing hidden depression. At the same time, a person himself cannot do anything. He will lead his usual lifestyle, try to resist the environment, but depression will affect his physiology.