Depression: the roles of psychologist and psychiatrist in treatment
Depression does not have a completely known cause, but studies suggest that it is largely a matter of communication impairment. brain cells, which occurs mainly through chemical substances called neurotransmitters.
Alongside the biological aspects, behavioral factors such as repeated childhood abuse may also be involved in the genesis of depression. Studies of cognitive psychology have observed in people with depression some biases of thinking that may participate in the maintenance of depression. Among these, the best known are the triad identified by Beck: negative thoughts about oneself, the surrounding environment, and the future.
These thoughts can be established on the basis of negative experiences of the person, but sin for a "hypergeneralization", that is, it tends to see in a negative way everything that occurs, even if there is not enough evidence. For example, if the person is unsuccessful in a "flirting" approach, he already concludes that he is "a failure" and / or that it is not worth trying anything, since nothing works, even.
Based on these observations behavioral-cognitive therapy was born, which seeks to correct the depressed individual's thoughts, while being encouraged to have attitudes that may demonstrate the opposite of his negative ideas: for example, make new attempts to "flirt" and realize that he can In research, we found changes in neurotransmission involving a number of substances, of which serotonin, dopamine, and noradrenaline (linked to the sensation of pleasure) are well known. there is more time. More recently studies have also detected the involvement of other molecules, such as cholecystokinin (a hormone originally related to gallbladder contraction), melatonin (the "sleep hormone"), and oxytocin (originally related to uterine contraction). > It is important to remember that it is not a simple "lack" or "excess" of these substances, as many lay people believe, but of a complex series of events involving receptors also (the molecules in the cellular membrane to which the neurotransmitters ), secondary neurotransmitters (acting within the cell rather than between cells) and long-term changes in the connections between neurons. This biological component of depression is treated with remedies, indicated by the psychiatrist - who knows the mechanism of action of the drugs better and which should be used in the various manifestations.
Depressive disorders usually improve greatly with treatment and in most cases , the symptoms disappear completely. However, in most patients, the treatment should be done over several years and, largely, kept indefinitely, because the tendency to relapse is very large. It is important to emphasize that this is not only the case with psychiatric disorders, it is also common in clinical diseases such as lupus, rheumatoid arthritis, asthma, etc. There are indications that, in at least part of the patients, drug treatment and cognitive behavioral therapy have similar effects (1,2), but the studies are still inconclusive, so that medications are usually not dispensed in the treatment of depression, and the work of the psychiatrist and psychologist is complementary.Depression is a disorder characterized by deep sadness and / or discouragement and / or loss of interest or pleasure in previously pleasurable activities, associated with a number of other symptoms (it was agreed that four of them are sufficient for the diagnosis):
weight loss or gain accentuated without being on diet or increased or decreased appetite almost every day (in children, consider inability to present expected weight gains)
insomnia or excessive sleep almost every day
Psychomotor agitation or retardation almost every day (observable by others, not just subjective feelings of restlessness or being slowed down)
fatigue and loss of energy almost every day
feeling of worthlessness or excessive guilt, almost every day (not merely self-recrimination or guilt about being ill)
decreased ability to think or focus or indecision, almost every day (by subjective report or observation made by others)
recurring thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or suicide attempt or specific plan to commit suicide. > It was agreed that these symptoms should be present for a minimum of two weeks. In order to make a diagnosis of depression, they must be serious enough to cause clinically significant distress or impairment in social, occupational, or other important areas of life.
* Summary of: American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
In a recent interview with the British newspaper I News , actor and comedian Jim Carrey revealed that he continues to struggle against depression. According to him, currently, the disease does not last long enough to suffocate it, but it is still there. "I've had [depression] for years, but now when the rain comes, it rains, but it does not stay," she said.
The study, SMILE , analyzed 36 asylums and involved the recruitment and training of staff to act as smile agents. They worked with humor skills such as jokes and improvisation. This alternative therapy was used for 12 weeks with patients in the elderly clinics. At the end of the analysis, it was found that there was a 20% reduction of agitation through humor therapy - an improvement comparable to the effects of the medication.
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