Biological non-drug treatments for depression

In addition to pharmacological and psychotherapeutic treatment of depression, other methods have been proposed for its treatment.

Such methods of treating depression, often effectively combined with pharmacotherapy and psychotherapy, include: intravenous laser irradiation of blood, magnetic stimulation (transcranial low-frequency alternating magnetic field therapy, right-sided pair-polarization therapy), extracorporeal detoxification (plasmapheresis), periodic normobaric hypoxia, craniocerebral hypothermia, light treatment, sleep deprivation, dietary therapy (including its fasting options), balneotherapy (warm baths have been used for a long time to alleviate the condition of a person who is depressed), massage and physical therapy (breathing exercises and physical activity helps to alleviate the symptoms of depression).

Among biological methods of treating depression, electroconvulsive therapy occupies a special place.

Find out more: Inpatient treatment for depression

Intravenous laser irradiation of blood

According to the recommendations of domestic scientists, intravenous laser irradiation of blood should be carried out using a low-intensity helium-neon device (FALM-1). The wavelength of laser irradiation is 0.63 microns. The radiation power at the output of the light guide is 8 mW. Session duration is 15 minutes, course of therapy is 8-12 sessions. It was noted that after laser therapy while taking psychopharmacological drugs, the severity of depressive symptoms in 60% of people suffering from depression is almost halved. Patients with manifestations of apathy and melancholy are especially sensitive to laser therapy; a less clear effect is observed in complex depressive syndromes, including symptoms of depersonalization, obsessive states and hypochondria. Laser therapy is ineffective for anxiety and depression. It should be borne in mind that the effect of laser therapy as a non-drug treatment method, as well as of treatment with antidepressants, may be delayed and appear some time after completion of the course of treatment. Currently, there are various modernizations of laser therapy. An example is a differentiated method of low-intensity magnetic laser therapy. This method of treatment includes an individual stage program of a course of combined laser exposure, which consists of venous irradiation of the tissue with continuous red light (0.63 μm) and transcutaneous irradiation with pulsed infrared light (0.89 μm) of projections of a number of biologically active zones and organs using standard magnetic attachments. Laser irradiation usually does not cause side effects or complications.

What is depression?

This is a mental disorder that occurs for various physiological, hormonal, psychological, biochemical reasons. A person suffering from depression loses his zest for life and is depressed. He ceases to be interested in what is happening around him, he closes himself off from the world. Very often, loved ones do not understand the seriousness of what is happening. “Yes, it’s all from idleness”; “In our time there was no depression”; “Get out of bed and get busy” is only a small part of what people hear with depressive disorders. The truth is that in such a state it is impossible to simply “get up and do.” Imagine that a person with a broken leg is persistently offered to play football. The situation is approximately the same here. Depression is not cured by encouragement, motivation, manipulation or threats. Moreover, a person may suffer without understanding what is happening to him. Therefore, seeking help from specialists may occur several years after the onset of the disease.

There are three types of depression: somatogenic, psychogenic and endogenous.

Somatogenic depression appears as a concomitant illness in diseases such as diabetes, bronchial asthma, brain diseases, oncology, and stroke. This type of depression resolves with treatment of the underlying disease. But in most cases, therapy and antidepressants are necessary.

Psychogenic depression is a very common companion to emotional disorders. This type of depression occurs as a result of severe stress, as a reaction to a traumatic event. Dismissal from work, financial collapse, death of a loved one, divorce - all this can cause psychogenic depression.

Endogenous depression. This type of disorder can arise without psychological factors, literally out of nowhere. The cause of endogenous depression is biochemical disturbances in the body. The lack of neurotransmitters such as serotonin, dopamine, norepinephrine affects the emotional and mental state and very often provokes the onset of the disease.

If left untreated, any type of depression leads to sad consequences: from the inability to lead a social life, work, study, to suicide. Therefore, at the first signs of a disorder, you should consult a doctor. The IMCAddictionByYuzapolsky clinic diagnoses and treats depressive conditions using the most modern techniques. Our specialists will select an effective treatment regimen and help you forget about the disease once and for all!

Electroconvulsive therapy

Currently, one of the most effective non-drug methods of treating depression is electroconvulsive therapy, which is used both as an independent method of treatment and in combination with other methods of therapy (Nelson A.I., 2002).

Electroshock therapy methods have been used since ancient Greece. In the temples of Asclepius, depression was treated with electric snakes. In the Middle Ages, it was believed that a strong shock to a patient could bring him out of a state of depression.

Treatment of depression with electric shock was recommended by Hill in 1814 (commotions electriques) (Kempinski A., 2002). Particular interest in this method of treating depression was noted in the early forties of the twentieth century. Electroconvulsive therapy is now generally recognized to be highly effective in treating depression.

It is difficult to overestimate the importance of electroconvulsive therapy for those patients for whom pharmacological treatment is contraindicated (pregnancy, certain somatic diseases, etc.), as well as if it is necessary to overcome depression resistant to other types of therapy.

Typically, to obtain a therapeutic effect from electroconvulsive therapy, about 8-10 shock discharges are required at a frequency of 3 sessions per week.

Subject to monitoring the condition of patients, it is possible that they can be treated with ECT on an outpatient basis or as a day treatment for depression in a hospital.

In general, the combination of ECT with antidepressants is not recommended; the use of small doses of tranquilizers is possible.

Complications of electroconvulsive therapy include spinal injury and circulatory disorders, states of confusion after convulsive attacks, as well as periods of anterograde and retrograde memory impairment have been reported. The latter can persist for a month after the end of ECT. ECT causes a temporary rise in blood pressure (often to quite high levels) and increases the heart rate.

Relative contraindications to ECT include coronary heart disease and arrhythmias, as well as some location of the brain tumor.

Most patients are afraid of this method of therapy, so the importance of professional psychotherapeutic work with the patient, as well as its subsequent support during the ECT therapy itself, should be emphasized.

Reviews

According to reviews of people who have been treated for depressive syndrome under hypnosis, the technique is very effective. About 30% noted improvement after the first two sessions. The full course (8-10 procedures) relieved depression and depression in more than 80% of patients. Interestingly, positive dynamics of therapy are observed even among skeptical people.

In their reviews, patients note the following effects after a course of hypnotherapy:

• a surge of strength;
• increased performance;
• restoration of motivation;
• elimination of headaches;
• normalization of sleep;
• increased self-esteem;
• improved appetite;
• increasing physical activity.

Symptoms of the disease go away as a result of replacing negative unconscious attitudes with positive ones. Moreover, during a hypnotic trance session, the doctor can additionally work out other problems - phobias, panic attacks, alcohol and drug addiction, and feelings of guilt.

After working with a hypnologist, most people can stop taking antidepressants completely. Another important feature of this line of treatment is the ability to treat depression in adolescents. During adolescence, self-doubt, problems in relationships with parents and peers, as well as complexes often lead to depression and even suicidal thoughts. Timely hypnotherapy helps save the health and life of a teenager.

• “Having completed a course of hypnotherapy, I can confidently say that this is a very unusual experience. After the first sessions, I was able to completely give up the antidepressants (carmabazepim, eglanil, etc.), which had been present in my life for several years. I managed to cope with insomnia, the nightmares that had haunted me since childhood went away. I can’t say that a new life has begun, but some of the problems definitely remained in the psychotherapist’s office. I continue to work on myself. I’m glad that I didn’t have to wait very long for the result.”
• “I encountered depression after experiencing trauma. I honestly admit that going to a hypnosis session for the first time was scary. It seemed like nothing would work out. However, in the process of working with the doctor, I myself did not notice how I lost awareness and fell inside myself. I managed to feel light and free. My mood improved after just five sessions. What else I would like to note is that the pain that tormented me after the accident is almost gone. I can’t say for sure that hypnosis had this effect, but I almost managed to give up painkillers.”

• “Since childhood, I considered hypnosis to be deception and quackery. My parents frightened me with stories about gypsies and other horrors. After the divorce, he could not control himself and began to abuse alcohol. I drank a lot until I realized it was time to stop. With treatment came depression and apathy. I didn’t want to live at all. I couldn’t get the desired effect from the pills, after which I gave up. A friend advised me to go to a clinic that treats trance. Almost 2 months have passed since the first procedure and I can say that it really works. Of course, it’s hard to immediately believe skeptics, but I felt the result myself. I returned to work, started noticing changes in the weather outside, communicating with people, and not avoiding holidays. Thanks to the one who gave useful advice in a timely manner"

Magnetic stimulation

Repeated transcranial magnetic stimulation (TMS) was proposed for the non-drug treatment of depression in 1985 (Barcer A., ​​et al., 1985). This method of treating depression, as well as vagal nerve stimulation, currently represent new methods of treating depressive spectrum disorders.

Low-frequency transcranial magnetic stimulation has been proposed as an alternative treatment for depression to electroconvulsive therapy where stimuli do not reach the seizure threshold.

Compared to electroconvulsive therapy, this treatment method has an important advantage: a more precise effect on those brain structures that are involved in the pathogenesis of depression (hippocampal region). In addition, with TMS there are no cognitive impairments that occur after ECT. However, if the effect of TMS and ECT treatment is approximately equal in the treatment of mild or moderate depression, then in the case of severe depression ECT may become a more preferable method (Grunhaus L., et al. 1998).

Studies have shown that TMS induces changes in beta-adrenergic receptors similar to those that occur after ECT and has a positive effect on astroglial tissue in the brain.

TMS has proven effective not only in the treatment of depression, but also in the treatment of schizophrenia, obsessive-compulsive disorder, and post-traumatic stress disorder (George M., et al., 1999). However, it was noted that the positive effect of TMS in the treatment of depression is observed only in 50% of cases. In addition, most patients experienced frequent relapses of depression after several months of remission following TMS. The combination of high-frequency and low-frequency magnetic stimulation appears to be more preferable for the quality of remission and its duration.

From the point of view of the pathogenesis of depression, the method of cyclic transcranial magnetic stimulation seems promising, since weak magnetic fields can reduce circadian rhythms (Mosolov S.N., 2002). Currently, this method of therapy is used to overcome treatment-resistant depression.

The first TMS studies proved the superiority of fast stimulation over slow stimulation, however, the number of such studies was quite limited and the area of ​​influence was not precisely localized. Recent studies show a higher effectiveness of low-frequency magnetic stimulation compared to high-frequency (Klein E., et al., 1999).

Typically, magnetic stimulation is carried out using a unilateral technique: on the projection of the left dorsolateral prefrontal region (high frequency or fast stimulation - < 10 Hz), less often stimulation of the right prefrontal region is performed. Low-frequency magnetic stimulation affects a selective area of ​​the anterolateral prefrontal cortex of the left hemisphere.

A course of low-frequency magnetic stimulation for non-drug treatment of depression is 10 sessions, with an average duration of 30 minutes. Sessions are held every other day; stimulation parameters - 1.6 T/1 Hz. The therapeutic effect is noticeable after the first therapy session and most often manifests itself as calming, reducing the severity of anxiety, and restoring sleep. This method is of interest due to the rapid development of effect and the absence of complications. As noted above, unlike ECT, TMS does not require the use of anesthesia.

PsyAndNeuro.ru

Trichotillomania is a condition in which people experience an obsessive urge to pull out their hair, leading to thinning hair. This disorder affects approximately 0.5-2.0% of the population. In the DSM-5 (and the future ICD-11 - editor's note), trichotillomania is classified under obsessive-compulsive and related disorders.

Behavioral therapy has been successfully used in the treatment of trichotillomania, but not all patients are willing or able to comply with this treatment strategy, so there is a need for effective pharmacological treatment options. Historically, pharmacotherapy for the treatment of this disorder has been largely ineffective, but some findings have emerged in this regard. Fluoxetine, clomipramine, olanzapine, and naltrexone have been used in the treatment of trichotillomania, but evidence of their effectiveness has been varied and side effect profiles have limited practical application. Recent advances in understanding the pathophysiology of trichotillomania, as well as evidence of the effects observed with certain glutamate modulators such as N-acetylcysteine ​​and dronabinol, have provided new potential pharmacotherapy options.

Criteria for trichotillomania in DSM-5:

1. Repeated hair pulling leading to hair lossB. Repeated attempts to reduce or stop hair pulling
2. Hair pulling causes significant distress or impairment in social, occupational, or other important areas of functioning
3. This condition is not associated with other medical diseases (for example, dermatological)
4. Hair pulling cannot be explained by the presence of another mental disorder (for example, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder)

A recent study noted that the average age of onset of trichotillomania differed significantly between men and women. The overall mean age of illness was 17.7 years, the mean age in women was 14.8 years and 19.0 years in men.

The most common places where patients pull out hair are the scalp, eyebrows, pubic area, eyelashes and beard.

Dermoscopic features of trichotillomania include decreased hair density, brittle hairs of varying lengths, coiled or short vellus hair, trichoptilosis (split ends), occasional yellow spots, and absence of hair in the area as in alopecia areata.

Two different types of trichotillomania have been described, "automatic" and "focused", but most people show signs of both types. People with the automatic type are often unaware that they are pulling their hair, while people with the focused type often describe the experience of hair pulling as an integral part of their condition. Patients describe a feeling of pleasure or a decrease in negative emotions during hair pulling.

Three main additional variants of psychodermatological trichises that lead to hair loss have been described: trichotheiromania (rubbing/combing the affected area), trichotheomania (shaving/cutting) and trichodaganomania (hair biting).

Trichotheiromania is often treated with high doses of glucocorticoid creams, with varying effectiveness. A case report showed a good response to N-acetylcysteine ​​treatment in a 47-year-old man who had partial improvement after eight weeks and full hair regrowth after 16 weeks after treatment with 1200 mg N-acetylcysteine ​​per day.

Treatment includes both psychotherapeutic and pharmacological interventions. Treatment recommendations depending on the patient’s age:

• Preschool age. In this age group, trichotillomania is seen as a habit disorder similar to thumb sucking and goes away on its own. Parental support and education about the benign course of the disorder are most effective.
• School age. At school age, behavioral approaches were found to be more effective than pharmacotherapy. Because of the possibility of comorbid psychiatric disorders, psychiatric referral is warranted in this age group.
• Teenagers and adults. The most effective combination of psychopharmacotherapy, behavioral therapy and treatment of concomitant mental disorders

Cognitive behavioral therapy

Behavioral pattern replacement training is a type of CBT that is used as a 1st line of non-pharmacological intervention for trichotillomania. This therapy involves helping the patient become more aware of their hair-pulling behavior and its context, and then replacing that behavior with another behavior—such as making a fist that can be held until the pull subsides. hair pulling.

Stimulus control training

Stimulus control training involves changing a person's environment to make it less conducive to hair pulling. This may include removing things that make hair pulling easier or adding things that discourage the behavior. Examples include removing mirrors or adding an object that occupies the patient's hands, such as a stress ball or spinning object.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy attempts to help patients achieve hair-pulling behavior in terms of interfering with personal or life goals.

Although there are no FDA-approved medications for the treatment of trichotillomania, due to the condition's comorbidity with other psychiatric disorders, first-line pharmacotherapy usually consists of selective serotonin reuptake inhibitors (SSRIs) or the tricyclic antidepressant clomipramine.

Tricyclic antidepressants

In a placebo-controlled study, Ninan et al found that CBT was more effective than clomipramine and placebo. Clomipramine was found to reduce trichotillomania symptoms more than placebo, but the difference was not significant. However, there has been a case report of successful clomipramine monotherapy at a dose of 125 mg/day and clomipramine 50 mg/day therapy in combination with CBT.

SSRIs

SSRIs are widely used to treat trichotillomania in both adults and children, but evidence of benefit is weak. In animal models, SSRIs have been shown to reduce excessive grooming in mice, the genetic characteristics of which are associated with the pathogenesis of trichotillomania. In human studies, a meta-analysis by McGuire et al found a modest effect with SSRIs in the treatment of trichotillomania. However, a previous meta-analysis showed that clomipramine was more effective than placebo, but this pattern was not observed for SSRIs. A small, open-label, 16-week study showed the effectiveness of fluoxetine at doses up to 80 mg/day in reducing hair pulling, but the study did not include a control group. Placebo-controlled, double-blind studies did not show a significant benefit of fluoxetine compared to placebo. Since people with trichotillomania often have comorbid mental disorders such as depression and anxiety, there is every reason to include SSRIs in the treatment plan for such patients.

Antipsychotics

Antipsychotics have been considered as potential drugs for the treatment of trichotillomania due to their effectiveness in treating tics and the frequent comorbidity of trichotillomania and tic disorders. The most studied drug in the treatment of these patients was olanzapine, but there is evidence of the effectiveness of risperidone and haloperidol. However, we should not forget about the serious side effects that occur during antipsychotic therapy and weigh them against the potential benefits in the treatment of trichotillomania.

Opioid antagonists

The mechanism of action of these drugs in the treatment of trichotillomania is likely to be by reducing the chemical reward of hair pulling. Unfortunately, in a double-blind randomized controlled trial by Grant et al, naltrexone did not show a significant difference in reducing hair pulling compared with placebo in the treatment of trichotillomania, although it did significantly improve cognitive flexibility.

N-acetylcysteine

The mechanism of action of N-acetylcysteine ​​in neurological and psychiatric disorders is not entirely clear, but may help protect against a number of pathological processes such as oxidative stress, neuroinflammation, glutamine and dopamine dysregulation. For impulse control disorders, including trichotillomania, N-acetylcysteine ​​is thought to act primarily by regulating synaptic glutamate levels in the brain and reducing cytotoxicity. Evidence of the effectiveness of N-acetylcysteine ​​in the treatment of trichotillomania varies from study to study. In the two main placebo-controlled studies conducted, one showed a significant benefit over placebo, while the other did not.

A 2009 double-blind, placebo-controlled study that examined N-acetylcysteine ​​in 50 adults with trichotillomania found that N-acetylcysteine ​​at a dosage of 1,200 mg twice daily showed significant benefit compared with placebo.

Because of its relative safety and tolerability compared to other treatments for trichotillomania, such as antidepressants or antipsychotics, and its low cost, N-acetylcysteine ​​may become an important treatment option for those struggling with this disorder. However, further research is needed, including larger, long-term, randomized, placebo-controlled trials with more standardized outcome measures.

Milk thistle

Milk thistle has been shown to have antioxidant properties and is invaluable in the treatment of trichotillomania. A recent double-blind, placebo-controlled crossover study found that milk thistle had no significant benefit over placebo in reducing the severity of trichotillomania as assessed by the National Institute of Mental Health. However, a benefit was found in terms of Global Clinical Impression Scale score and reduction in time spent pulling hair per week. The study involved 20 people aged 12-65 years, 19 of whom were women.

Probiotics

The gut microbiota is thought to influence behavior in several ways. These include effects on vagus nerve signaling (possibly through serotonin synthesis by enterochromaffin cells), mineral metabolism, modulation of circulating cytokine levels, and changes in neurotransmitter turnover. In addition, changes in neurotrophic factor gene expression, SCFA-mediated modulation of G protein-coupled receptors, and changes in the hypothalamic-pituitary axis may also play a role.

Animal studies have shown that gut microbiota may also influence mammalian brain development, including the development of the striatum, which (among other brain regions) is structurally abnormal in individuals with trichotillomania.

Dronabinol

Dronabinol, a cannabinoid agonist, may provide potential benefit in the treatment of trichotillomania by reducing glutamate cytotoxicity in the striatum. In a small open-label study, dronabinol showed a significant benefit in reducing hair pulling in 9 of 12 patients.

Inositol

A proposed potential mechanism of action of inositol on psychiatric disorders is by attenuating serotonin-2 receptor desensitization, as the phosphatidylinositol second messenger system is used by these receptors. In a double-blind, placebo-controlled study, Leppink et al found that inositol had no significant benefit over placebo. The study lasted 10 weeks, and of the 38 participants, the majority were women. 19 patients received inositol, the remaining 19 received placebo.

Trichotillomania is a complex psychodermatological disorder that still requires much research regarding its pathogenesis and pharmacological treatment. Research into the comorbidity and genetics of this condition has shown potential for future research and new strategies for personalized treatment. In addition, some new pharmacotherapy options, including monotherapy or adjunctive therapy, show promise. Notably, N-acetylcysteine ​​appears to be a well-tolerated and safe potential treatment for adults with trichotillomania. Another option includes complementary treatments such as probiotics and the cannabinoid agonist dronabinol, but more research is needed.

Author of the translation: Gadzhieva F.Sh.

Source: Everett GJ, Jafferany M, Skurya J. Recent advances in the treatment of trichotillomania (hair-pulling disorder). Dermatol Ther. 2020;e13818. doi:10.1111/dth.13818

Vagal stimulation

Vagal stimulation for the non-drug treatment of depression was proposed in 1994 (Harden C., et al., 1994). When conducting vagal stimulation, areas of the lateral and orbital regions of the anterior parts of the brain, as well as the parabrachial nuclei of the nerve and the locus ceruleus region are affected. The impact on the last part of the brain ensures that this method influences the functional activity of the thalamus and hypothalamus.

After the use of vagal stimulation, an increase in the content of biogenic amines in the limbic region of the brain was noted (Ben-Menachem E., et al., 1995)

Sleep deprivation

A relatively gentle non-drug treatment for depression is sleep deprivation, which was actively developed in the early 70s of the twentieth century. Three types of sleep deprivation were used: total, partial and selective. Total sleep deprivation involves being awake for 36-40 hours, partial sleep deprivation means sleeping from 5 pm to 1 am, then staying awake until the next evening or sleeping from 9 pm to 1 hour 30 minutes then staying awake until the next evening - sleep duration 4, 5 hours and selective sleep deprivation, focused on selective deprivation of only REM sleep. For the treatment of depression with symptoms of melancholy, the combination of total sleep deprivation with light therapy at night turned out to be most effective. It should be noted that with complete sleep deprivation, lethargy and drowsiness are more often observed. In most cases, sleep deprivation is carried out two days later on the third; the therapeutic course includes an average of 5 sessions.

Sleep deprivation, both partial and complete, changes the structure of sleep, lengthens the latency period and reduces the duration of rapid eye movement (REM) sleep. As a rule, an improvement in mood in patients is observed after just one sleepless night, however, this effect is usually short-lived and lasts about three days. Improvement in mood occurs gradually, expressed in the form of a feeling of general relief, a decrease in the feeling of lethargy, apathy, and the disappearance of experiences of mental pain and bitterness.

In prognostic terms, the relationship between the change in the mood of a depressed patient after the first and second sleepless night is important.

The mechanism of the therapeutic effect of sleep deprivation is difficult to reduce only to the simple elimination of one of the phases of sleep or the resynchronization of a time-shifted circadian rhythm. Probably one of the mechanisms for improving the condition of a depressed patient after sleep deprivation is the activation of adrenergic structures.

Light treatment

Non-drug treatment of depression has been tried for more than twenty years using light, hoping to normalize human biological rhythms altered by the disease. Natural ways to treat depression include taking a temporary vacation in the winter to places where there is more daylight and longer hours. In addition, prolonged exposure to the street on sunny days helps overcome depression. Light therapy or phototherapy is most indicated for seasonal mood disorder, especially if episodes of worsening depression occur in the winter or spring seasons. According to some authors, with a course of light therapy from three to fourteen days, the effectiveness of this method reaches 60-70%.

It has been experimentally proven that changes in biological rhythms occur when the patient is illuminated with a light source of increased intensity. Attempts have been made to prevent seasonal exacerbation of affective psychosis by “lengthening the daytime period” using artificial lighting and sleep deprivation.

It is assumed that bright and intense light has a multifaceted effect on the centers of circadian rhythms: suppression of the secretion of the pineal gland hormone melatonin, changes in the concentration of cortisol and adrenocorticotropic hormone, increased synthesis of catecholamines, normalization of the function of the autonomic system. Most experts associate the positive effect of light therapy with an increase in the regulatory function of the cerebral cortex, as well as with the normalization of the activity of the autonomic system.

During light treatment, the patient stays daily, preferably in the morning, for several hours (less than half an hour) in a brightly lit room or next to an intense light source specially designed for this purpose.

It was previously believed that to obtain a therapeutic effect, a room illumination of at least 2600 and no more than 8000 lux was required. Such illumination was achieved by using incandescent lamps located on the ceiling of the chamber at a height of about 2.5 meters. Typically about 30 200 W incandescent lamps were used. It was noted that the effectiveness of light treatment increases when the therapeutic room is painted white or green, as well as when the patient’s body is exposed to the maximum (more than 25%).

Before starting light therapy, the patient is carefully examined, usually paying attention to the state of the autonomic system and indicators of the cardiovascular system.

Long therapy sessions were recommended - from 1.5 to 3 hours, with a total number of sessions - 15, however, it was emphasized that these numbers, as well as the time of the therapy session, should be determined based on the characteristics of the clinical picture of depression. Currently, 30 minute phototherapy sessions are recommended.

Some researchers recommend light treatment at any time of the day, both daily and with two- to three-day breaks. Phototherapy sessions are especially effective in the morning, immediately after waking up.

During the therapy session, patients, who are asked only to keep their eyes closed, are free to move around the room. To avoid getting used to the light, once every 3 minutes. should be looked at periodically for 1 second. on the lamps.

After a therapeutic session, there may be an increase in blood pressure, less often a decrease, probably due to the thermal effect, the body temperature usually increases. Quite often, patients report slight drowsiness. Changes in the RR interval on the ECG can be a reliable predictor of the effectiveness of light therapy. In some cases, the therapeutic effect is possible both during the session and 2-3 days after its completion.

The most common complications of phototherapy are: insomnia, increased fatigue, irritability, headaches. These complications usually occur in people who try to work hard during light therapy.

It is interesting to note the sensitivity to light therapy in patients with symptoms of anxiety. Patients with symptoms of melancholy and apathy respond to this type of therapy to a lesser extent. Speaking about the mechanism of the therapeutic effect of this therapy, we should emphasize the thermal effect of light. General contraindications to light treatment are cancer and eye pathology.

Currently, special table-top and stationary devices have been developed for non-drug treatment of depression using light. Full spectrum lamps are more effective because they produce light that is close to natural light. To ensure that the patient does not suffer from light treatment, special filters are used that block ultraviolet rays and thereby protect the patient’s retina from intense radiation (prevention of cataracts).

Recent studies have shown that the effectiveness of light exposure is determined by three characteristics: intensity, spectrum and exposure time. In connection with the above, phototherapy techniques are being developed to enrich the light flux with long-wave ultraviolet radiation, which has a biologically active effect. This technique involves using a full-spectrum light source, since it is as close to natural light as possible.

Modern achievements of phototherapy include “artificial dawn” (a special electric lamp at the patient’s bedside that intensifies its illumination before dawn).

Technology for treating depression with hypnosis

Hypnosis is not magic. This is a scientifically proven phenomenon of an altered state of consciousness. While in a hypnotic trance, a person concentrates on certain thoughts without scattering his attention. In this state, he is able to find in the subconscious the smallest details of his past, which he had long forgotten.

After “turning off” awareness, our brain is subject to external influence (suggestion or programming). This allows the hypnotherapist to identify negative attitudes and replace them with positive ones. This is the work that is carried out during the treatment of depression with hypnosis.

To cope with the causes and symptoms of depressive disorder, it is necessary to undergo a whole course of procedures.

The hypnotherapy algorithm for depression includes three stages:

1. Preparation. Most patients experience strong excitement, anxiety, and fear before their first hypnotic trance session. This is due to a lack of knowledge on this topic and established frightening stereotypes about hypnosis. To cope with anxiety, relax and begin to explore the subconscious, the patient needs preparation. One introductory session is usually enough for this. During this visit, the hypnotherapist gets to know the patient, finds out his problem, and puts him into a state of hypnosis for the first time. Having experienced this experience once, most people stop worrying, and the anxiety before the next procedures goes away. This becomes an excellent foundation for future effective work.
2. Search for unconscious automatisms . This stage begins from the second visit to the hypnotherapist. A calm, comfortable environment for a person is created in the specialist’s office. The doctor’s task is to completely capture the patient’s attention. Objects (pendulum or clock) are often used for this purpose. When a state of hypnotic trance is achieved, the specialist gently “leads” the patient through the dark corridors of the subconscious. The purpose of this journey is to find traumatic situations of the past, restore vivid experiences, and identify a person’s unconscious programs. Almost all patients themselves bring the specialist to the solution, since the painful experience quickly returns when awareness is turned off. By reciting traumatic situations and events from his life, a hypnotized person experiences this experience again. However, this happens painlessly and safely.
3. Therapeutic work . When a negative unconscious program is detected and the reasons for its occurrence are obvious, the doctor begins therapy. Its task is to erase pessimistic attitudes from the subconscious, as well as to instill in a person models of positive thinking. Having experienced painful moments again, the patient usually does not even remember about it. However, internal anxiety and tension subside. At this moment, the subconscious is ready to accept new information. It depends on the experience and qualifications of the hypnotherapist which attitudes will be introduced into the patient’s thinking. Therefore, you should trust such an important procedure only to trusted specialists.

Each hypnologist has his own secrets of working with patients suffering from mental disorders. At the same time, a change in the patient’s state of consciousness remains common to all techniques.

The ability of people to be influenced by a hypnotist is called hypnotizability. There are people who are more difficult to bring to the required concentration. However, a qualified hypnologist can cope with tasks of any complexity.

How long will the treatment last?

The duration of the course depends on several factors. The deeper the patient’s problems are hidden in the subconscious, the more difficult it is to find the keys to solving them. There is never just one factor that leads to the development of depressive syndrome. This is a combination of fear, anxiety, childhood trauma, self-doubt, guilt and aggression. By working through these mechanisms, the hypnologist, like a ball of thread, unwinds the reasons for the appearance of negative attitudes.

Subconscious attitudes that cause depression in people include the following programs:

• "Nobody needs me";
• “I am untalented”;
• “I am not worthy of happiness”;
• “I won’t succeed”
• “There will be nothing good in my life anymore,” etc.

Without realizing this, a person automatically carries out a vicious program, depriving himself of the pleasure of living fully. To replace negative programs with positive ones, 4-8 sessions of hypnotherapy are required.

Biofeedback

Non-drug treatment methods include biofeedback, which by and large refers to psychotherapeutic methods of treating depression. To carry out this method of treatment, special psychophysiological equipment is used, which implies the possibility of printing various psychophysiological indicators: bioelectric activity of the brain, muscles, heart, galvanic skin response, etc. 20-25 sessions of therapy are carried out, based on the use of biofeedback and aimed at increasing power of alpha waves in the left occipital region. Most patients experienced a 50% reduction in the severity of depressive symptoms.

Therapeutic massage and breathing exercises

Auxiliary methods for treating depression include breathing exercises, therapeutic massage (especially if the onset of depression is triggered by mental trauma) and meditation.

Such breathing on the seashore, in a pine forest, is useful, since such breathing increases the amount of oxygen. The massage is usually performed for 30 minutes and its therapeutic effect is associated with a decrease in stress hormones in the blood. In addition, massage relieves internal tension and normalizes sleep.

Diet food

The effectiveness of dietary nutrition as a non-drug treatment for depression has also not been confirmed by scientific research.
However, it is generally accepted that the diet of a patient with depression must necessarily include complex carbohydrates, which naturally contribute to an increase in the production of serotonin by brain neurons, the deficiency of which during depression (especially with symptoms of anxiety) is well known. Complex carbohydrates are found in legumes and whole grains. An increase in the production of norepinephrine and dopamine - neurotransmitters, the concentration of which is reduced in depression with symptoms of apathy, is promoted by a diet high in protein (beef, poultry, fish, nuts, eggs). At the same time, there is an opposite point of view about the inadmissibility of a high protein content in food that should be consumed when suffering from depression. It is recommended to exclude sugar, alcohol, caffeine, convenience foods and canned food. Foods high in saturated fatty acids are undesirable. Return to Contents

The main symptoms of anxious depression are:

- a feeling of anxiety that has no specific cause and almost does not leave the patient during the day;

- increased anxiety, tearfulness, irritability, inadequate alarm reaction to any unplanned events,

- low mood, feeling of hopelessness, constant expectation of something bad, internal tension, inability to relax;

- difficulty concentrating and maintaining attention (difficulty concentrating), memory deterioration, decreased performance;

- insomnia, fatigue, weakness, feeling of being on the verge of a breakdown.

In addition to mental symptoms, anxious depression has a lot of physical manifestations: trembling, palpitations, dizziness, pain in various parts of the body, sensations of heart failure, lack of air, difficulty breathing, tightness in the chest, “coma” in the throat, frequent urge to urinate, diarrhea , sexual dysfunction.

Often, patients begin to treat anxious depression on their own, resorting to taking over-the-counter medications available to them (phenibut, afobazole, glycine, Sonmil, Corvalol). At first, taking these medications brings some relief from anxiety symptoms, but the improvement is short-term and requires an increase in the doses of medications taken.

The next common step in self-medication for anxiety depression is daily intake of sleeping pills in increasing dosages (zopiclone, Somnol, Sonnex, Sonnat) or daily drinking of alcohol to relieve tension and alleviate anxiety symptoms. This kind of “treatment” leads to further disturbances in the metabolism of GABA and dopamine, aggravates the course of the disease, and leads to the formation of dependence on alcohol or sleeping pills. An attempt to stop taking alcohol or sleeping pills causes severe anxiety, which the sick person is unable to resist.

Important! Anxious depression requires long-term specialized treatment and does not go away on its own!