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Involutional melancholy


- protracted anxious or anxious-delusional depression, which first occurred at an involutionary age. It is noted more often in women aged 50-65 years.
Symptoms and course:
The clinical picture of the disease consists of a depressed mood, with anxiety, fear, and confusion. Patients are in a state of motor anxiety, fussiness, which at times turns into anxious and dreary excitement. They rush about, find no place for themselves, lament, repeat the same words. In this state, suicidal attempts are possible. The condition can be complicated by the addition of auditory illusions: in the conversation of others, condemnation, reproaches, and accusation are heard. The crazy ideas of self-accusation, condemnation, ruin, impoverishment, or hypochondriacal content are joined. Hypochondriacal ideas consist in the conviction of patients in the presence of severe somatic disease (cancer, heart disease, gastrointestinal tract), which is not confirmed by an objective study. In some cases, painful fears take extreme forms of denial of the functioning of individual organs and entire systems - "blood stops," "the stomach rots," "the intestines decompose," "there is no stool and no urine is secreted." A sense of hopelessness and anxious expectation can also manifest itself in a fantastically grandiose form - "everything is dying, there is a general catastrophe ... everything from my sinfulness ... the only way out is in fair retribution."
Involutional melancholy is characterized by a long course. It lasts from several months to several years. Outcomes of the disease are different. A complete recovery is possible, especially with timely and proper treatment. Cases of malignant course with increasing symptoms of general exhaustion are currently extremely rare. Sometimes for many years there has been monotonous anxiety, fixation on one’s state of health, decreased activity in terms of maintaining one’s appearance, way of life, and communication with others.
Recognition of the disease is quite complicated. Supporting signs for the diagnosis of involutional melancholy are: the age of the patients, the absence of mental disorders and bouts of depression in the past, the prevalence of depressed mood in patients with anxiety, fear, fussiness, the expectation of punishment for themselves and their loved ones, fixing attention to the somatic state. However, if somatic complaints are persistent and it is impossible to exclude the presence of a disease, it is necessary to conduct a thorough physical examination using all modern diagnostic methods.
Treatment:
Antidepressants with a calming effect are used (see Treatment methods) in combination with small doses of antipsychotics (sonapax, frenolone, etaperazine) in order to relieve fear, anxiety, delusional disorders. Drugs are prescribed carefully, in the absence of contraindications, taking into account the possible age-related reaction to the drug. In the case of ineffective drug treatment, electroconvulsive therapy is sometimes used. Treatment is usually carried out in a psychiatric hospital, as constant monitoring of the physical and mental condition of the patient is necessary, especially since the likelihood of attempts to commit suicide is not ruled out.
The forecast is generally favorable. Either full recovery occurs, or unstable sleep, headache, slight anxiety and some "internal excitement" persist for a certain time after leaving the psychosis. However, in any case, disability remains, although many by this time are in retirement age. Usually they serve themselves and their loved ones, do housework, raise grandchildren, communicate with neighbors and relatives, i.e. lead a full-fledged lifestyle.