With the introduction of antidepressants into medical practice, the course and prognosis of depression has changed, and the number of erased, masked depressions has increased .
The latent course of depression, the tendency to hide under the guise of diseases of the internal organs is one of the most characteristic features of modern depression. According to the medical literature, latent variants account for 30 to 80% of all depressive disorders. At the same time, one should bear in mind the frequent combination of depression with a neurotic state of the so-called. somatized disorders. In the presence of such conditions, a mild depressive episode is noted in 40% of cases, moderate in 46%, and severe in 14%.
At the same time, the isolation of masked depression can be interpreted as an expansion of the boundaries of depression. In some cases, masked depressions include depression with sleep disturbances and depression with impaired drives (anorexia, bulimia, sexual dysfunctions).
If depression is hidden behind a mask, it is usually combined with alexithymia, i.e. with the inability of the patient to accurately describe their feelings and sensations. The level of alexithymia is more pronounced in gastrointestinal diseases and respiratory disorders . In this case, patients may not be aware of the depressive disorder and clearly identify their emotions. Sometimes they are convinced that they have some rare and difficult to diagnose disease and insist (assuming the incompetence of the doctor) on numerous examinations in non-psychiatric medical institutions. At the same time, with active questioning, it is possible to reveal a tendency to daily fluctuations in mood changes in the form of unusual sadness, despondency, indifference and detachment from the environment prevailing in the morning, with excessive fixation on their bodily sensations.
Until now, many masks of depression, personality traits, the role of various factors in their origin remain unclear . Also , the question of the so-called somatic depressive equivalents, that is , disorders of internal organs that completely replace depressive states, has not been developed . Common masks for depression are pain with vague descriptions in various parts of the body, feeling of weakness, sleep disturbances, changes in appetite, cardiovascular disorders, etc.
In most of these patients is often marked by severe fatigue, loss of interest and feelings of pleasure. In 84% of cases, in the subjective perception of patients with latent depression, complaints of increased fatigue are noted .
Patients associate their depression with unpleasant sensations from the internal organs. At the same time, the clinical picture is dominated by somatic equivalents of suppressed mood in the form of functional disorders of organs and systems, changes on the part of the autonomic system, while mood changes hidden by somatic symptoms remain in the background and can be detected only with appropriate research. The most subjectively painful masks of depression are disorders of the stomach and intestines.
As a specific personality trait of patients with latent depression, there is a tendency to attribute functional disorders on the part of internal organs to any specific reason. Such patterns are especially typical for patients with gastrointestinal disorders.
One of the most common “masks” of depression in general medical practice, which occurs in 50% of patients, is persistent pain. Chronic pain as a mask for depression can occur in almost any part of the body. Most often, the doctor has to deal with headaches, back pain, pain in the heart or abdomen, pain in the joints. In the latter case, it manifests itself in a variety of pain syndromes, and pain is usually noted in at least two points. According to Russian scientists, the frequency of depression in these cases reaches 80%. According to the views of American researchers, in the painful version of depression, patients complain of pain associated with at least 4 organs or parts of the body.