Depression in the practice of a cosmetologist: how to recognize

The most common psychiatric diagnosis today is depression in its various modifications. According to various experts, depression affects up to a third of the population of the entire planet; today, according to world statistics, it is already the main cause of social maladjustment.

However, understanding of the problem called depression among both specialists and ordinary people is at a fairly low level. And it looks two ways. On the one hand, we tend to use the word “depression” lightly. And, despite the fact that depression and bad mood, as a reaction to difficulties in life, are very different conditions, in the mass consciousness such a difference is completely leveled out. Almost like we say, “I’m depressed.” It even became some kind of fashion statement.

On the other hand, we ignore until the last moment the truly serious manifestations of the morbidity of our condition. Like steadfast tin soldiers, real “Jane soldiers,” we resist our exhaustion with all our might, pretending that the lack of sleep can be overcome, and the reluctance to eat or the uncontrollable eating of everything in a row is just because it’s colder. This picture is observed both in the most prosperous countries and among highly successful people; neither family, nor children, nor material wealth can save you from depression. As a doctor, I once thought: “What’s the matter?” And the answer turned out like this.

Modern society teaches us to conform. The criteria of success, well-being, love, security, youth, integrity, beauty, happiness, etc. We not only must, but we ourselves want to be “on top” - at school, at home, at college, at work, everywhere and always . The ideal of modern life is hyper-productivity and hyper-efficiency, in all aspects of life, from professional activities to leisure, motherhood or fatherhood, love, friendship. We strive for other people's ideals, do modern haircuts, dye our hair in exotic colors, raise children using the most advanced technologies, attend an incredible number of self-improvement courses, and vacation far away. And all this for the sake of simple and understandable “pay attention to me”, “praise me”, “love me”, “admire me” - show me that I am, I exist.

In such an effort, we forget about ourselves - the true, real one, in some matters the best, and in others an ordinary person with weaknesses and shortcomings. This is how the question of accepting yourself as you are, self-love, and trust arises. And, if you cannot accept yourself, a conflict is born - the most difficult and unbearable, internal. This condition is not always depression, but from such postulates it is very easy to end up in a situation of severe mental disorder.

So, depression (from the Latin depressio - suppression, oppression) is a mental disorder characterized by pathologically low mood (hypotymia) with a negative, pessimistic assessment of oneself, one’s position in the surrounding reality and one’s future. The manifestations of depressive disorders can be considered in four categories.

• Mood and affect-sadness - reduced reactivity to pleasant/unpleasant events, feelings of emptiness, apathy, tension, irritability, anger.
• Intellectual-cognitive sphere - decreased concentration, self-esteem, self-identification, self-blame (for no reason), guilt, helplessness, indecisiveness, pessimism, desire to die, suicidal ideas.
• Psychomotor activity - retardation (slowing body movements, reduced facial expression, narrowing of the communication sphere) or agitation (restlessness, aimless uncontrolled hyperactivity).
• Somato-vegetative manifestations - changes in basic functions (insomnia, drowsiness, increased/decreased appetite, decreased sexual desire), changes in the vital tone of functions (feelings of constant fatigue, weakness, lack of energy), unpleasant bodily sensations (aching pain in various parts of the body, feeling tension, cold, heaviness in the body), visceral symptoms (gastrointestinal, cardiovascular complaints).

Thus, we see that depression is not only and not so much a decrease in mood, but a whole complex of body responses to stress. Answers that are beyond a person’s will, beyond the ability to “pull himself together,” “get himself together,” remember how he could have done something before for the sake of his loved ones, for his own sake.

It should be noted that depression has physical and mental components. Rare events in a person's life affect both components of depression. Such complex aspects include appearance: its perception by me, the impression of how others perceive my appearance, the difficulties and benefits that my appearance brings for me. And, if we are talking about the problem of conformity, then, first of all, we try to conform externally: hairstyle, makeup, clothes, well-groomed face, etc. That is why, when we talk about depression, we always dwell on the issue of appearance.

Very often, a depressed patient is not aware of what is really happening to him. He goes to doctors and tries to cure a wide variety of symptoms and manifestations of depression. Among doctors of various specialties there are very often cosmetologists. Patients with depression come with a variety of needs, and they do not always look depressed, overwhelmed and exhausted. But they all want to get, no more, no less, happiness in the cosmetology salon. They want to regain not just a little youth, external freshness, they want to gain strength and motivation to “get back on track” again, confirmation of their fitness - they want to become healthy. And they are disingenuous not in front of you, but in front of themselves. A person in such a state really “hopes” that he just had a moment, that nothing serious is happening, that now he will be put in order and everything will return to normal.

And the main task of a cosmetologist in such a situation is to recognize depression. Otherwise, the treatment not only cannot be successful, but, in most cases, will cause harm. The patient will try to solve the problem that led to depression through appearance, but any cosmetic procedure will not be able to do this. The patient will be (in any case!) not satisfied with the result and the work of the cosmetologist.

What to do? First of all, start with your medical history. As complete and comprehensive as possible. One should not believe that a patient who clearly formulates a task clearly understands his condition. You should be interested in all aspects of his health and life: does he sleep, does he have an appetite, what else bothers him, how are his relationships in the family, at work, what is his sexual relationship, in the end. If any of these answers alarm you, conduct any screening technique for depression. Such techniques differ in that they help to consider various areas and aspects of possible depression, but at the same time they contain a small number of questions (from 7 to 20) and are simple and economical for the patient and the doctor.

I present one of these questionnaires below: the Quick Inventory of Depressive Symptomatology (QIDS).

How to use it? Have your client circle one answer that best describes how they felt over the past 7 days.

1. Falling asleep:

0 – It doesn’t take me more than 30 minutes to fall asleep.

1 – Sometimes it takes me at least 30 minutes to fall asleep.

2 - Most often it takes me at least 30 minutes to fall asleep.

3 - Most often it takes me more than an hour to fall asleep.

2. Sleep during the night.

0 – I don’t wake up in the middle of the night.

1 – I have shallow, restless sleep, I wake up several times a night for short periods of time.

2 – I wake up at least once a night, but quickly fall back to sleep.

3 - I wake up more than once a night and can't fall asleep for 20 minutes or longer most of the time.

3. Waking up too early.

0 – Most of the time I wake up no more than 30 minutes before I need to.

1 – Most of the time I wake up more than 30 minutes before my required time.

2 - I almost always wake up an hour or more before my due time, but eventually fall back to sleep.

3 - I wake up at least an hour before my scheduled time and cannot fall back to sleep.

4. Sleeping too much.

0 – I sleep no more than 7-8 hours a night and do not nap during the day.

1 - I sleep no more than 10 hours in a 24-hour period, including naps.

2 - I sleep no more than 12 hours in a 24-hour period, including naps.

3 - I sleep more than 12 hours in a 24-hour period, including naps.

5. Feeling of melancholy.

0 – I don’t feel sad.

1 - I feel sad less than half the time.

2 - I feel sad more than half the time.

3 - I feel sad almost all the time.

6. Decreased appetite.

0 – My usual appetite has not changed.

1 - I eat slightly less or smaller amounts of food than usual.

2 - I eat significantly less than usual and make an effort.

3 - I rarely eat in a 24-hour period and only with special effort or when others force me to eat.

7. Increased appetite.

0 – No change compared to my usual appetite.

1 – I feel the need to eat more often than usual.

2 – I regularly eat more often and/or more than usual.

3 - I feel the need to overeat during main meals. So it is between them.

8. Weight loss (over the last 2 weeks).

0 – My weight has not changed.

1 - I feel a slight weight loss.

2 - I lost 2 pounds or more.

3 - I lost 5 pounds or more.

9. Weight gain (over the last 2 weeks).

0 – My weight has not changed.

1 – I feel a slight weight gain.

2 - I gained 2 pounds or more.

3 – I have gained 5 pounds or more.

10. Concentration/decision making.

0 – There is no change in my normal ability to concentrate or make decisions.

1 - From time to time I feel indecisive or feel like my attention is wandering.

2 - Most of the time I try to concentrate my attention or make a decision.

3 - I can't concentrate enough to read or can't make even the simplest decisions.

11. Look at yourself.

0 – I see myself as equally worthy and deserving of attention as other people.

1 - I feel like I'm beating myself up more than usual.

2 - I feel like I am a problem (creating problems) for others.

3 - I almost constantly think about my big and small shortcomings.

12. Thoughts about death or suicidal ideation.

0 – I don’t think about suicide or death.

1 - I feel the emptiness of life or its worthlessness.

2 - I think about suicide or death several times a week for several minutes.

3 - I think about suicide or death several times a day in different details or have tried to commit suicide.

13. General interest.

0 – There is no change in my interest in other people or activities.

1 – I notice that I am losing interest in people or activities.

2 - I found that I was only interested in one or two of my past activities.

3 - I am not interested in the types of activities that interested me before.

14. Energy level.

0 – No change in my usual energy level.

1 – I get tired more easily than usual.

2 - I have to make a significant effort to start or finish my usual daily activities (for example, going shopping, doing homework, cooking, or going to work).

3 – It’s really hard for me to bear my daily loads because I have no strength.

15. Feeling of a slower pace of life.

0 – I move and talk at my normal speed.

1 - I feel like my thinking is slow or my voice sounds muffled or unclear.

2 – It takes me a few seconds to answer most questions, and I'm sure my thinking is slow.

3 – I am often unable to answer questions without extra effort.

16. Feeling of anxiety (restlessness).

0 – I don’t feel anxious.

1 - I often feel restless, clench my hands, or feel the need to change positions while sitting.

2 - I feel the need to move here and there and I am very restless.

3 - from time to time I am unable to sit still and have to walk back and forth.

Calculate the total number of points scored by the respondent. So, the accounting criteria:

• 0-5 points - normal;

• 6-10 points - low severity of depressive symptoms;

• 11-15 points - moderate degree;

• 16-20 points - severe;

• 21 and more - very difficult.

Such a questionnaire does not make it possible to unambiguously make a diagnosis, much less prescribe treatment. But it does one thing very well: it helps you accurately determine whether you need the help of a psychiatrist in working with this patient.

One more important issue should be addressed: cosmetologists should not be afraid to take a psychiatrist into their team - not necessarily on staff, but definitely on a partner team. The patient will never leave the specialist who was able to understand his problems even better than he himself. The patient will definitely be satisfied with your work, and your work will have a very strong and lasting effect. As a psychiatrist, I have noted many times how my patients diagnosed with depression transform during the moments of recovery: they literally become younger without additional intervention. And I can only imagine how patients will blossom after a cosmetologist and a psychiatrist work together on them.