Depression is not all the same: meet the less common types that impact quality of life
Our mental health has been put to the test by the covid-19 pandemic
The covid-19 pandemic has endangered not only the physical but mental health of the population. The isolation imposed by measures to contain the spread of the disease, the economic crisis, unemployment and anxiety about contamination are some of the factors that put our psychological well-being to the test.
It is not for nothing that studies show an increase in the rates of depression, a disease that affects more than 320 million people worldwide, according to the World Health Organization (WHO).
- The depression that impacts most patients is unipolar, also known as major depressive disorder. The most common cause is genetic, but it can also be caused by losses, stress and even neurological problems.
But there are different classes of depression. According to the psychiatrist Ana Paula Carvalho, coordinator of the Depression League of the Institute of Psychiatry of the Hospital das Clínicas of the Medical School of USP (FMUSP), there are three less known and common types in the population: psychotic, distal and bipolar depression.
Because they are more difficult to diagnose, it is important to get to know each one better.
Bipolar depression: the most difficult to identify
Type 1 bipolar disorder is the most classic form and is characterized by euphoria (mania and hypomania). As for type 2, which is bipolar depression, the patient presents with sadness and hypomania - a milder state of euphoria, optimism and, at times, aggression.
"Generally, when only bipolarity occurs, it is easier to recognize the disease, since the patient has evident symptoms. However, when the depressive condition appears together, it can take years to arrive at an accurate diagnosis", says Luiz Dickeman, psychiatrist from the Federal University of São Paulo (Unifesp).
The specialist explains that, for the patient to be characterized with the condition, he needs to have episodes of hypomania at least once in his life, for four days or more.
"He must be exposed to risky activities such as excessive spending, an exacerbated desire to have sex, little sleep."
A study published in the Brazilian journal of Psychiatry showed that, on average, it takes eight years to diagnose a patient with bipolar depression.
The most common cause of depression is genetic
Other American publications have already shown that the diagnosis can take up to 15 years.
"The error occurs by the doctor himself, who does not investigate the symptoms thoroughly and believes that the person suffers only with unipolar, which is the most common and well-known. In addition, the patient omits if he has had episodes of hypomania in years, increasing , often, the risk of suicide ", says Dickeman, who is also director of the Brazilian Institute of Practical Pharmacology (BIPP).
Fabiano Alves Gomes, psychiatrist and professor at Queen's University, Canada, explains that, while the prevalence of unipolar depression is approximately 15%, the most classic forms of bipolar disorder (type 1 and type 2) have a prevalence of about 3% of the population.
In this type, the most indicated treatment is not with antidepressants, but with mood stabilizers. "It is possible to achieve complete recovery, especially if treated properly and at the beginning," says Gomes.
Dysthymia: less known among patients themselves
Persistent depressive disorder or dysthymia is a chronic depression, characterized by symptoms that last for up to two years or more. The cause is still little known by doctors, but experts believe it is multifactorial.
It is less common, and the patient himself may not recognize it because he thinks the signs are related to personality.
"He is the typical person who complains all the time, who has a pessimistic view of things and lives in a regret routine. What makes diagnosis difficult is that in the vast majority of cases, family and friends think it is her 'way' and that will pass with age ", says Carvalho.
However, the symptoms can progress to more severe depression. "The patient is slow to seek help because he believes that it is nothing and the depressive condition only worsens.
"Sometimes, he remains with the problem for 20 years, until he goes to the doctor. The distemic is below the normal range", reinforces the specialist.
Unlike unipolar, in which neurotransmitters are affected, dysthymia does not alter the patient's biological functions.
"He is a functional person, who eats, sleeps, can work. The big problem is that the disease has a great impact on the quality of life, since the individual complains all the time, is always in a bad mood and suffers from low self-esteem. "says Dickeman.
The most suitable treatment is the combination of medications in doses generally higher than those of unipolar depression, in addition to psychotherapy.
Psychotic depression: the most serious form of the disorder
In addition to sadness, the patient always presents psychotic symptoms such as hallucinations and delusions. "It's an alteration of the five senses. You can hear and see things, smell and even touch the skin," explains Dickeman.
Considered rare by doctors, psychotic-type depression is caused by grief, trauma, or overcharging yourself.
According to the Unifesp psychiatrist, it is easier to diagnose, since the symptoms are noticed in the first visits. However, what often happens is that the disease causes a great deal of family wear and tear, and the patient is often beside himself.
Depression can also be caused by loss, stress and even neurological problems
"It is almost not known by people and ends up surprising everyone who lives together, because the symptoms are exacerbated. Sometimes, the symptoms are confused with those of schizophrenia", he says.
In this depressive situation, the chances of suicidal reactions are greater and, therefore, family members should be aware. It is necessary to have frequent medical follow-up until the symptoms improve.
"It is essential to distinguish the various types of depression, because the treatment is different. Psychotic depression requires an association of antipsychotics. All can be done with magnetic stimulation and electroconvulsive therapy techniques that provide good results. If left untreated, patients remain depressed and in addition to psychological suffering, they present loss of functionality, cognitive difficulties, physical illness and risk of suicide ", says Fabiano Alves Gomes.
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