Psychiatric aspects of neurological disorders, patients with neurological disorders often also have psychological disorders.
Depression is a very common disorder today, according to the DSM-5 (Diagnostic Manual of the American Psychiatric Association) classification of depressive disorders.
- Disruptive mood dysregulation disorder
- Major depression
- Dysthymic disorder
- Premenstrual dysphoric disorder
- Drug-induced dep. Disorder.
- Impairment due to other medical condition.
- Other unspecified dep. Disorder.
- Unspecified dep. Deterioration. It is categorized as.
In some cases, depression accompanies a neurological disorder. In this article, we will talk about how neurological diseases and depression coexist.
According to the World Health Organization, by 2020, depression will rank 2nd in the world in terms of prevalence and its negative effects on human life will increase in importance. Today, clinical depression is diagnosed in around 17% of cases. The rate of people who do not receive a diagnosis, do not consult a physician but experience depressive symptoms on an outpatient basis is around 30-50%.
1 out of every 5 people experience depression at some point in their lives. Women are twice as likely as men to suffer from depression or seek help for depression. Women are most likely to suffer from depression between the ages of 35-45, men between 55-70. (X) Having a family member with depression, (x) being a woman, (x) living alone increases the risk of depression.
To find out if you have depression, first ask yourself these two questions;
- In the previous two weeks, have you felt exhausted, depressed or hopeless?
- During the previous two weeks, have you experienced a decrease in interest in and enjoyment of things you used to do?
Depression has cognitive, behavioral, physical and emotional symptoms.
- Depression is basically a disease of unhappiness and lack of joy.
- People feel sad, pessimistic and reluctant.
- Tasks that used to be easy to do before start to seem difficult.
- A person with depression loses self-confidence, finds it difficult to concentrate, to watch a movie from beginning to end, to read an article in the newspaper.
- Forgetfulness, absent-mindedness, difficulty in making simple decisions.
- Patients say that their strength and power are not what they used to be and that they feel lifeless and lack energy.
- Sleep problems are characterized by inability to fall asleep, waking up at night, waking up early in the morning, waking up unrested in the morning or oversleeping.
- Appetite usually decreases, weight is lost and sometimes overeating may occur due to distress.
- There may be thoughts of death, more thoughts of deceased relatives, worries about the disease, fear of death.
- Physical problems also increase during depression. Regular blood pressure becomes uncontrollable, blood sugar fluctuates up and down. Often the first onset of chronic diseases occurs during periods of depression. Many studies have shown that when depression is added to the picture in people who have had a heart attack, heart-related problems and the risk of having a second attack increase.
Successful treatment of depression results in improvement in all these symptoms.
Depression is caused by thought patterns that perpetuate the depressed mood. The depressed person perceives himself/herself/life and others negatively. He/she increases negative self-criticism. Tends to read between the lines when speaking. Develops negative thoughts about the future. For example, "He implied to me that I definitely failed." "I am not a good mother, why did I give birth." "I can't accomplish anything." "What's the point of my efforts, my life will be full of illness" "I won't be able to beat this illness." And suicidal thoughts develop.
When we look at the relationship between neurological diseases and depression, we see that changes in the mental state are part of the neurological disorder. Mental state affects the course of the neurological picture and the way the person copes with the disease.
Depression occurs in 3 ways in neurological diseases;
- Depression occurs before the neurological disease. For example, dementia. This disease usually starts with depression beforehand, and the person is diagnosed with dementia in the follow-up.
- Depression occurs simultaneously with the diagnosis of neurological disease. For example, Parkinson's disease
- It can occur after a neurological disease. For example, stroke, cerebral hemorrhage, embolism.
In cases such as MS, epilepsy, head trauma, depression can occur simultaneously with the diagnosis or after the diagnosis.
For example: The causes of depression in MS can be both organic and social. From an organic point of view, lesions affecting certain areas of the CNS, MS plaque formations in the temporal lobe can cause depression, and depression can occur due to social stress and withdrawal from social life.
The reason for the addition/continuation of depression to neurological diseases,
- The person can become isolated from social life because of their illness,
- They may lack social support,
- Since they lack ego strength, they may have difficulty in accepting the disease in the fight against it,
- Since physical activities are restricted, there may be changes in brain chemistry as a result of reduced activity, which is reflected in mood,
- Depression can be ignored in the treatment of neurological disease,
- In a serious neurological disease, being sad and pessimistic can be considered 'normal' and how this affects the person's life can be overlooked,
- Sometimes, in order not to demoralize the person, sadness is ignored, talking about the illness is avoided, and feelings are covered up.
However, depression is not a natural reaction to a neurological disease and needs to be treated effectively and quickly.
SO HOW SHOULD IT BE TREATED?
If you have asked yourself the two questions we mentioned at the beginning and received at least one yes, something is not right and you should contact your neurologist doctor who is following you, although you can apply yourself.
Medical intervention is absolutely necessary for intense and prolonged depression. Studies have shown that medication is effective in 2 out of every 3 depressed people. When a person is depressed, the release of serotonin and norepinephrine, which are natural brain chemistry, decreases. The medication stabilizes the chemical by blocking the relevant receptor site. It takes 2-4 weeks to see the beneficial effects of the medication.
Cognitive restructuring, the depressed person tends to see more negative aspects of his/her experiences. The aim here is to show the person how to test negative thoughts in order to deal with all the information in his/her life in a more realistic way and to provide mental flexibility. The aim is not pollyannaism, but to evaluate things more realistically.
IMPROVING INTERPERSONAL RELATIONS It is important to improve close relationships. It is important to intervene in the deterioration of social relations that comes with neurological disease, and to support the person or his/her relatives to gain social support.
Group therapies are effective in this area. It is important for the person to meet with people who are the same as the disease group, for the feeling of not being alone, for normalization, for the supportive aspect of group integrity.
ACTIVITY PLANNING, if you are depressed you are less active. The depressed person tends to give up previously enjoyable activities. The weekly number of activities that are often enjoyable should be increased and planned in such a way as to minimize the limitation of the neurological disease. The plan should be made in such a way as to minimize the restriction of the neurological disease.
It is important not to expect the activity to give you the same pleasure as it did before you became depressed. Initially it will be less enjoyable, but over time it will improve as the depression decreases and you get better.