psychiatrist and CBT therapist
Natālija Bērziņa - Psychiatrist, CBT psychotherapist, PhD
“When we are no longer able to change a situation – we are challenged to change ourselves.” (Viktor E. Frankl)
Work experience:
2020 – present
Private practice.. Psychiatrist, cognitive biheivioral therapy (CBT) psychotherapist, insomnia treatment specialist
2019 – 2023
Clinic "Dzintari". Day inpatient, outpatient consultative department. Psychiatrist
2019 – 2020
“Strenči” psychoneurological hospital. Day inpatient. Psychiatrist
2018 – 2022
"Medical further education centre". Adult non-formal education institution. Lecturer
2018 - 2023
Riga Stradins University. Department of Psychiatry and Narcology. Lecturer
2018 – 2021
Riga Psychiatry and Narcology Centre. Outpatient Help Service. Psychiatrist
2018. – 2021.
Riga Stradins University. Department of Psychiatry and Narcology. Assistant
2017 - 2020
Vivendi Health Centre. Psychiatrist, lecturer
2017 – 2018
Riga Psychiatry and Narcology Center. Department 17. Doctor-intern
2016 – 2022
“Strenči” Psychoneurological Hospital. Admission Department. Psychiatrist on duty
2016 – 2018
Riga Stradins University. Faculty of Continuing Education. Department of Psychiatry and Narcology Lecturer
2014 – 2018
Riga Psychiatry and Narcology Center. Resident doctor in psychiatry
Education:
2020 - 2024
Latvia Cognitive behavioral Association. CBT therapist diploma
2017 - 2021
Riga Stradins University. Faculty of Doctoral Studies. Doctor of Medical Sciences
2014 - 2018
Riga Stradins University. Faculty of Continuing Education. Psychiatrist diploma
2008 - 2014
Riga Stradins University. Faculty of Medicine. Doctor's diploma
Professional development:
20.-22.09.2024 CBT-I Advanced course Edinburgh
2024 -
Latvian Sleep medicine association board member
2020 - 2023
Latvian Cognitive Behavioral Therapy Association. Cognitive Behavioral Psychotherapy speciality
2021
CBT-I course - Cognitive behavioral therapy course for insomnia treatment. Supervisions of insomnia treatment with Prof. Dieter Rieman
2020
Participation in the Edinburgh Sleep Medicine Course 2020
2018
Participation in ECNP Workshop on Clinical Research Methods in Barcelona, Spain
Participation in the EFPT Forum for Young Psychiatrists, in Bristol, Great Britain
Participation in the AAF/OMI Program Salzburg Medical Seminars International Psychiatry 2018, in Salzburg, Austria
2017
Participation in ECNP School of Neuropsychopharmacology, Oxford, Great Britain
Participation in the "Leadership and Professional Skills Course" for young psychiatrists, Led by prof. Norman Sartorius and prof. Ida Hageman Pedersen in Vilnius, Lithuania,
Fields of specialization:
- treating insomnia using CBT
- treatment of mood disorders, treatment of anxiety spectrum disorders
- treatment of pregnancy and postpartum psychiatric disorders
- CBT therapy
- lectures and seminars for organizations
Counseling languages: English, Latvian, Russian
This program is a science-based approach to treating insomnia that is the Gold Standard worldwide! Take a look here and learn more about the treatment of insomnia and the Grandver clinic program!
Here you will also find sleep hygiene rules and a sleep diary.
Treatment of insomnia
CBT, or cognitive behavioral therapy, has been proven effective in treating
insomnia for many years.
This approach to treating insomnia includes several components: an initial
assessment, selection and application of appropriate and effective intervention
techniques individually, and application of appropriate methods to ensure that
instructions are followed and after the sessions there will be an opportunity to use
various methods on one's own if sleep disturbances will repeat.
During the therapy session, components and techniques of therapy are discussed,
education is provided on incorrect assumptions and behaviors regarding sleep.
Unlike medications that can be used for acute and short-term insomnia, CBT for
insomnia has proven long-term effectiveness.
Treatment for chronic insomnia includes the following: stimulus control, sleep
restriction or compression, sleep hygiene discussion, relaxation training and
cognitive therapy. Usually, 3 or more approaches are used.
Classically, the course of treatment takes from 4-8 weeks with 1 session per 1-2
weeks for 30-60 minutes. The first consultation is usually 45-60 minutes,
subsequent consultations 30 minutes.
A very important tool in treating insomnia is a sleep diary. A completed sleep
diary allows you to see what your sleep patterns are like and what strategies you
need to use to improve your sleep. In this insomnia section you will also find a
sleep journal! It will be useful to fill it out before visiting an insomnia specialist.
When to use CBT for insomnia:
1) Difficulty falling asleep or staying asleep.
2) Patients who:
a) Extend sleep to compensate the lack of sleep
b) Remain in bed without falling asleep
c) Engage in various other activities in the bedroom (e.g. working or
studying in bed, watching TV) instead of sleeping.
3) Observe a state of awakening (sleeps well outside the home or becomes sleepy
as soon as gets into bed).
4) The principles of sleep hygiene are insufficiently followed.
RULES OF HEALTHY SLEEP
Adherence to sleep hygiene recommendations can prevent sleep disorders, which are accompanied by a decrease in sleep quality, a decrease in sleep duration, sleep fragmentation and severe sleep deprivation in adults.
10 RULES OF HEALTHY SLEEP FOR ADULTS
1. Make a habit of going to bed and getting up at the same time (including holidays).
2. If it is important for you to sleep during the day, stick to a regime in which the duration
of sleep during the day will not exceed 45 minutes.
3. Avoid drinking alcohol and smoking before going to bed (at least 4 hours before going
to bed).
4. Avoid caffeinated drinks/products, tea, carbonated drinks, as well as chocolate at least
4 hours before going to bed.
5. Avoid eating heavy, spicy, sweet food at least 4 hours before going to bed. At the same
time, light abstinence before bedtime (for example, unsweetened yogurt, a small portion
of low-fat cottage cheese, fruit) is useful.
6. Maintain an active lifestyle and exercise regularly, however, avoid increased physical
exertion right before bedtime.
7. Use comfortable and pleasant bedding (bed linen, pillows, mattress, etc.).
8. Set an individual temperature regime that you like in the bedroom and make sure that
the room is regularly ventilated.
9. Use every opportunity to minimize sound transmission and lighting in the bedroom
during sleep.
10. Use the bed only for sleeping and intimacy, avoid any other activities in bed (reading,
working with the computer, watching TV, etc.).
(at least 2 consultations are required)
Raksts Doctus žurnālā “Dienas un nakts bruksisms. Iemesli, teorijas un risinājumi”, 2023.gada marts
Bruksisms ir stāvoklis, kad novēro zobu rīvēšanu vai saspriegošanu, pārsvarā naktī miega laikā. Taču arī dienas laikā var būt sastopams bruksisms, kad cilvēks stipri sasprindzina žokļa muskulatūru un saspriež zobus, cilvēki to paši arī pamana. To mēdz saukt par dienas bruksismu, kas visbiežāk asociēts ar psihisku spriedzi.
Raksts Doctus žurnālā, “Miega traucējumi. Ģimenes ārstam atbild speciālists.”, 2021.gada decembris
Miega traucējumu pārvaldība bieži vien sākotnēji nonāk ģimenes ārsta pienākumu lokā, turklāt nereti šie pacienti miega problēmu risināšanai jau gadiem lietojuši trankvilizatorus, nemaz neapzinoties ilgtermiņa sekas.
Raksts Doctus žurnālā, “Miega traucējumu pārvaldība senioriem”, 2023.gada jūnijs
Bezmiegs ierindojams starp biežākajām sūdzībām — medicīnisku palīdzību bezmiega dēļ meklējuši daudzi, piemēram, Amerikas Savienotajās Valstīs ap 15 % pieaugušo. Hroniska bezmiega biežums pieaug līdz ar vecumu, epidemioloģiskie dati liecina, ka bezmiega sastopamības rādītājs no 25 % pieaugušajiem pieaug līdz 50 % senioriem.
Žurnāls ārsts.lv, “Sieviete un miegs”, 2023.gada septembris
https://arsts.lv/jaunumi/iznacis-jaunais-2023-gada-septembra-zurnals-arstslv
Veselības Ministrijas Kampaņa “Viss ir Norm.a”
Kampaņā Viss ir Norm.a ik mēnesi piedāvājam viena cilvēka reālu stāstu par to, kā viņš vai viņa mācās sadzīvot ar savas psihiskās veselības vajadzībām. Piektais no kopumā divpadsmit ir Kristas stāsts par anoreksiju Katrs stāsts, protams, ir unikāls un ne vienmēr konkrētie traucējumi visiem izpaužas vienādi. Vēl svarīgāk – ne vienmēr tos var mazināt ar vienām un tām pašām metodēm. Tomēr ir dažas kopīgas lietas, kas vieno visus stāstus: ir svarīgi palīdzēt atpazīt simptomus un brīdi, kad cilvēks pats tos vairs nespēj regulēt, lai savlaicīgi lūgtu palīdzību līdzcilvēkiem un uzticamiem speciālistiem.
Vēstuli Kristai un citiem, kas saskārušies ar ēšanas traucējumiem, uzrakstījusi Natālija Bērziņa, ārste-psihiatre, Rīgas Stradiņa universitātes Psihiatrijas un narkoloģijas katedras asistente, RSU Zinātniska grāda pretendente (Kristas stāstu par anoreksiju var izlasīt vai noskatīties šeit).
https://esparveselibu.lv/neirotiska-anoreksija-natalija-berzina
Raksts “Kā nostabilizēt miega režīmu pēc pārejas uz ziemas laiku”
Nekvalitatīvs miegs, pulksteņu rādītāju griešana un no tā izrietošie miega – nomoda režīma traucējumi tiek asociēti ar dažādām saslimšanām. Naktī uz 30. oktobrī pulksten 4.00 pulksteņa rādītājus griezīsim stundu atpakaļ, pārejot uz ziemas laiku. Pulksteņa rādītāju pagriešana destabilizē mūsu bioloģisko ritmu. Dr. Natālija Bērziņa, psihiatre, miega traucējumu speciāliste dalās ar padomiem, kas palīdzēs pielāgoties jaunajam režīmam, kā arī atgādina, kāpēc jāpievērš uzmanība savai miega kvalitātei.
Raksts: “Nesabrukt, kad viss brūk. Kā ikdienas dzīvē atpazīst psihiskās veselības draudus”
Izplatītākie psihiskie traucējumi Eiropā ir trauksme, bezmiegs un depresija. Latvijā situācija ir līdzīga un, visticamāk, jāpiemin arī izdegšanas sindroms. Diemžēl daudzi palīdzību pie speciālistiem nemeklē, ļaujot problēmai samilzt līdz apmēriem, kad bez zālēm neiztikt.
Raksts: “Pārbāzts mājoklis un gūzma dažādu kolekciju. Kā atpazīt sevī mantu vācēju”
Mājokļi, kas burtiski aizkrauti ar dažādām lietām un starp kurām izmīta šaura taciņa, nebūt nav tikai amerikāņu raidījumu fenomens. Arī Latvijā ir cilvēki, kuri dažādu apstākļu dēļ kļuvuši par vācējiem, kas krāj lietas ar domu: gan jau noderēs. Taču nenoderēs vis. Eksperti portālam LSM.lv skaidro, ka bieži vien – jo sliktāka cilvēka pašsajūta, jo vairāk viņš pērk un vāc, bet, jo vairāk viņš to dara, jo sliktāk pats par to jūtas.
Raksts “Miega ekspertes padomi jaunajām māmiņām: Kā tehnoloģijas var palīdzēt sakārtot miega režīmu?”
Kad ģimenē ienāk jaundzimušais, tās ir pārmaiņas ikvienam, it sevišķi jaunajām māmiņām, kuru ēšana, aktivitātes un arī miega režīms jāpielāgo mazulim. Miega laikā organisms funkcionē citādi nekā tad, kad esam nomodā. Tas ir laiks, kad mēs atpūšamies, uzkrājam enerģiju un apstrādājam iepriekšējā dienā uzkrāto informāciju. Praktiskā eksperimentā piekritusi piedalīties Ieva Koha-Zeltiņa – viņa vienu nedēļu cītīgi sekoja līdzi miega rādītājiem savā viedpulkstenī – ko varam secināt? Savās zināšanās par miegu un, to kā viedie pulksteņi var palīdzēt konstatēt miega traucējumus, dalās Dr. med. Natālija Bērziņa, ārste psihiatre, bezmiega ārstēšanas speciāliste.
Raksts “5 soļu skaistumkopšanas rituāls labākam miegam”
Drēgna ziema, daudz darba un dienas laikā nāk miegs, līdz atvaļinājumam vēl tālu, bet vakarā moka bezmiegs – vai pazīstamas sajūtas? Par laimi šo apstākļu ķēdē vismaz vienu mēs noteikti varam kontrolēt un uzlabot patstāvīgi – tas ir miegs. Kvalitatīvi guļot un atpūšoties, varam uzlabot savu labsajūtu, tāpēc “GrandVer Klīnika” Dr.med., ārste psihiatre Natālija Bērziņa skaidro, ko tieši nozīmē “kvalitatīvs miegs”, savukārt kosmētikas zīmols “Dzintars” dalās padomos, kā mājas apstākļos realizēt relaksējošu rituālu, kas būtiski uzlabos ikviena naktsmieru.
https://dieviete.lv/skaistumkopsana/5-solu-skaistumkopsanas-rituals-labakam-miegam/
Saruna EHR “Nākotnes formulā” par veselīgu dzīvesveidu, attiecībām ar ēdienu un veselīga miega noteikumiem
“Labs ēdiens un miegs ir fundamentāls priekšnoteikums mūsu dzīves kvalitātei. Kādi ir visbiežāk izplatītie ēšanas un miega traucējumi mūsdienās? Kā veidot balansu starp darbu un privāto dzīvi? EHR studijā stāsta Dr.med. ārste psihiatre Natālija Bērziņa, ēšanas un miega traucējumu eksperte.”
https://www.youtube.com/watch?v=e4Yv0PF7kek
Intervija “Izstāsti Latvijai”
Miegs ir neatņemama un ļoti nozīmīga daļa no mūsu dzīves, tā ilgums un kvalitāte ietekmē ne vien fizisko, bet arī psihoemocionālo pašsajūtu. Miega traucējumus vismaz reizi mūžā ir izjutis ikviens cilvēks, taču, ja tie kļūst par biežu parādību, ir vērts apsvērt domu par vizīti pie speciālista.
Bērziņa Natālija - ārsta prakse psihiatrijā
https://www.youtube.com/watch?v=exUPyUpFG1A
Saruna LR1 ar Kristiānu Lapiņu “Vai tas ir normāli?” par miegu.
“Auksts, tumšs un brīžam drēgns. Pats gadalaiks vilina iegrimšanu ziemas miegā. Ko nozīmē miega kvalitātes maiņa? Vai enerģijas trūkums, nomāktības izjūta un miegainība var liecināt arī par ko citu, raidījumā Vai tas ir normāli? analizē ārste-psihiatre Natālija Bērziņa.”
Saruna LR1 ar Kristiānu Lapiņu “Vai tas ir normāli?” par miegu.
Miegs mums ir nepieciešams ne tikai tādēļ, lai atpūstos, bet arī, lai nodrošinātu līdzsvarotu psihisko funkcionēšanu. Kādi var būt miega traucējumi, kā tie rodas, kā varam tos atpazīt un ārstēt? Vai miega traucējumi var kļūt par hronisku stāvokli un kā tie ietekmē psihisko veselību ilgtermiņā, raidījumā Vai tas ir normāli? skaidro ārste - psihiatre, medicīnas doktore Natālija Bērziņa.
Raidījums “Dr.Apinis” 1.daļa. Labs un veselīgs miegs
Kopā ar citiem studijas viesiem runājām par miegu, tā traucējumiem, izmeklējumiem un palīdzības iespējām.
https://apinis.lv/raidijumi/dr-apinis/08-11-2023-dr-apinis-1-dala/
Raidījums “Dr.Apinis” 1.daļa. Labs un veselīgs miegs.
Kopā ar citiem studijas viesiem runājām par miegu, tā traucējumiem, izmeklējumiem un palīdzības iespējām.
https://apinis.lv/raidijumi/dr-apinis/08-11-2023-dr-apinis-2-dala/
Raidījums “Dr.Apinis” 2.daļa. Psihiskā veselība.
Ar kolēģēm no reģionālās psihiskās veselības aprūpes slimnīcas runājām par psihiskās veselības aktualitātēm.
https://apinis.lv/raidijumi/dr-apinis/
Raidījums “Zilonis studijā”, S3E35, 26.10.2023
Mantu vākšana un krāšana - kurā brīdī tas ir hobijs un kad mēs varam domāt par to, ka tā ir problēma?
https://play.tv3.lv/embed-video/zilonis-studija
Raidījums “Dzīvot un sadzīvot”, S1E7, 17.11.2022
Vai trauksme, stress un bezmiegs ir mūsu psihoemocionālie traucējumi? Vai depresija ir jāārstē? Tā ir slimība vai vājuma izpausme? Kādēļ līdzcilvēkiem ir svarīgi pamanīt izmaiņas tuvinieka sajūtās, kad jāsniedz palīdzība? Par to diskutēsim raidījumā "Dzīvot un sadzīvot".
Intervija MyFitness iniciatīvai par miegu un fiziskām aktivitātēm.
"Dažādu pētījumu rezultātā pierādīts, ka traucētu miegu ir iespējams samazināt vai novērst, iesaistoties regulārās fiziskajās aktivitātēs", komentē miega traucējumu speciāliste Natālija Bērziņa.
https://www.facebook.com/watch/?v=345409620029891
Insomnia is a sleep disorder associated with difficulty falling asleep, waking up several times in the middle of the night with difficulty going back to sleep, or waking up earlier in the morning. Insomnia can be acute (up to a month) or chronic (at least 3 months). To talk about insomnia, a person must have this disorder at least 3 nights a week for at least 1 to 3 months. There are other types of sleep disorders, such as parasomnias (including noctambulism), circadian rhythm disorders, also the so-called jetlag, pathological daytime somnolence, narcolepsy, etc. The incidence of insomnia in the population varies between sources and countries. Acute insomnia can affect up to 30% of people, while chronic insomnia affects up to 15% of people. Fragile sleep is indeed found among older people, but this does not exclude that younger people may also have fragile sleep. It could also be inherited in the family
We all naturally wake up for a few seconds/minutes at night, but usually we don't even remember it because we don't wake up completely and fall back asleep very quickly. However, waking up at night can be considered a problem when you cannot fall asleep after waking up, for example for more than 10-20 minutes. Natural needs like going to the restroom at night could be because a person has drunk more liquid than he should just before going to sleep. As well as age, physiological characteristics make you wake up more often at night. Or it can also be related to anxiety, stress, experienced during the day. In cases where a person eats at night and does not remember it in the morning, we are talking about sleep behavior disorders, such as somnambulism. This is due to the fact that the necessary muscle relaxation does not occur, due to which a person can move, but the brain is, so to speak, "still sleeping".
Indeed, some "white noise", such as the sound of a refrigerator or the blowing of a hair dryer, could sometimes help some people fall asleep. Listening to the radio doesn't really disturb sleep much, unless it's a very excitatory program. Watching TV is more complicated. If there is an opportunity not to watch TV and just listen to it, it should be done. However, if a person is watching TV, then the mode should be switched to "night mode", when the light spectrum used in lighting changes. Because TV usually uses light of the blue spectrum, which is similar to sunlight, so if you watch TV in the evening without night mode, melatonin is not developed enough to promote falling asleep. And one more thing, you should not watch TV in bed and in the bedroom.
First of all, it is necessary to search and find the cause of insomnia. Therefore, you should definitely consult a family doctor to exclude possible physical illnesses (for example, sleep apnea, thyroid diseases, etc.), as well as a neurologist (restless legs syndrome, some other neurological illness). Next, if no physical reason for insomnia is found, the possibility of other illnesses should also be evaluated, such as psychological ones such as depression or anxiety. Then you should consult a psychiatrist. If insomnia is caused by experiences and daily stress, then a psychologist/psychotherapist could also help.
It is a persistent anxiety that is not focused on one specific object or situation. People are excessively and constantly worried and preoccupied with mundane matters. For example, health, finance, career or everyday life. People often suffer from fatigue due to their constant worries, muscle tension is common, sleep disorders occur, which can also lead to the development of depression. Generalized anxiety is characterized by the following symptoms:
● frequent muscle tension,
● premonition of misfortune,
● constant daily anxiety with no specific cause and many physical symptoms. Often people complain about the following physical symptoms:
● palpitations,
● increased sweating,
● tremors in hands
● dry mouth.
These can be joined by others, such as feeling short of breath, discomfort in the chest, nausea, feeling dizzy or faint, feeling unreality, fear of losing control or fainting, nervousness, feeling of a lump in the throat, hot or cold waves, increased response to irrelevant events. For generalized anxiety disorder, the main treatment is psychotherapy, which includes individual and group counselling. CBT has proven its effectiveness. Medicines, on the other hand, are the second choice, which are also prescribed when psychotherapy is ineffective.
Panic is sometimes called the most intense level of anxiety. Panic is defined as an illness when panic attacks occur at least 4 times a month and are described as mentioned below.
A panic attack is a sudden, intense fear and discomfort and has at least 4 of the following symptoms:
● increased heart rate, increased pulse, palpitations,
● sweating,
● chills or trembling,
● shortness of breath, difficulty breathing,
● suffocating feeling,
● pain, pressure or discomfort in the chest,
● nausea, stomach problems or sudden diarrhoea,
● dizziness, unsteadiness, light-headedness or fainting,
● a feeling that the surroundings are strange, unreal, remote, unfamiliar, or a feeling of alienation from oneself,
● tingling, stiffness, pricking sensation or numbness of body parts,
● hot or cold waves,
● fear of going crazy or losing control of oneself,
● fear of death.
These feelings peak in about 10 minutes and are not related to any substance use (such as drugs, alcohol, or medication) or general illness (such as hyperthyroidism).
Panic disorder is characterized by the following:
1) sudden, repeated panic attacks,
2) constant worries that they may reoccur,
3) anxiety about what the consequences of attacks will be.
The aforementioned contributes to the fact that a person begins to increasingly avoid places where he experienced a panic attack, thus difficulties in socializing, isolation and disturbances in daily functioning may gradually appear.
The most important method in curing panic is a non-drug treatment, which includes various types of psychotherapy, such as cognitive-behavioral therapy. In case of severe panic, sedative medications can be used for a short time, but their long-term use is not justified, and if certain medications cause addiction, then their long-term use is prohibited. Antidepressants, on the other hand, have proven their efficiency in the treatment of panic disorders as a course, best combined with psychotherapy and psychological counselling. To receive advice on treatment options and methods, consult a psychiatrist, who will evaluate the situation and provide you with both information and recommendations.
Typical episodes of mild, moderate or severe depression where a patient suffers from gloomy mood, decreased energy and activity. The ability to be happy, interests, and concentration have also decreased. There is always severe fatigue, even after minimal exertion. Sleep disturbances and decreased appetite are common. There is almost always low self-esteem and self-confidence and often, even in mild cases, ideas of guilt or inferiority. A downtrodden mood changes little during the day, it is not affected by external circumstances, and at the same time there may be so-called somatic symptoms, such as a lack of interest and pleasant feelings, waking up several hours before the usual time in the morning. Depression is more severe in the morning, there is a pronounced psychomotor retardation, agitation, lack of appetite, loss of body weight and libido. Depending on the number of symptoms and their severity, a depressive episode can be rated as mild, moderate, or severe.
● Depression among family members (often as a learned behavior)
● Alcohol and drug use
● Unrealistic expectations of yourself, anxiety, worry, feelings of failure and anger
● Perfectionism, lack of self-indulgence
● Hormonal system imbalance among women (e.g. after childbirth)
● Important life events – death of a close person, wedding, birth of a child
● Traumatic life events – early loss of a close person, physical, sexual, emotional abuse
● Other life events – poverty, dangerous situations, insecurity, chronic illnesses
There are different types of treatment and help available for depression. Depending on the severity of depression, a treatment at a family doctor is available, psychiatrist, hospitalization would be necessary in particularly severe cases. Below are the cases when a family doctor can help and when you should consult a psychiatrist.
1. Family doctor
● bereavement reaction (support, family etc. psychotherapy);
● mild/moderate depressive episode (if within 6-8 weeks after antidepressant use a
clinical improvement is not achieved, a psychiatric consultation is required);
● repeated episodes of depression – a mild/moderately severe episode of depression (prescription of compensated medication, if clinical improvement is not achieved within 6-8 weeks after prescribing an antidepressant, psychiatric consultation is required);
● adaptation disorder with depressive reaction;
● mild organic (symptomatic) depressive disorders.
2. Outpatient service psychiatrist:
● mild/moderate depressive episode;
● severe depressive episode in the post-hospital stage, in the period of stabilization and preventive treatment;
● comorbid conditions of all types of depression;
● organic and symptomatic depressive disorders;
● a depressive episode within bipolar affective disorders;
3. Day inpatient (depression department) psychiatrist (the patient comes to classes during the day with a psychologist and other specialists, under the supervision of a psychiatrist, the patient does not stay overnight in the hospital):
● an episode of moderately severe depression in the absence of a high risk of suicide;
● moderate/severe depressive episode after hospital discharge;
● patients requiring titration and augmentation of antidepressants;
● patients for whom group psychotherapy, social psychological assistance is recommended;
● patients with therapeutically resistant depression for whom modified electroconvulsive therapy is recommended.
4. Inpatient psychiatrist (the patient is admitted to a hospital chamber for assistance):
● a moderately severe depressive episode, several antidepressants ineffective in a sufficient dose for a long time;
● chronic, hard-to-treat depression;
● severe depressive episode with/without psychotic symptoms;
● strongly/severe organic and symptomatic depressive disorders, if the somatic illness is in a compensated state;
● patients with chronic depression for whom modified electroconvulsive therapy is recommended.
It is a group of drugs used to treat depression and anxiety. Antidepressants (AD) play a central role in the psychopharmacotherapy of depression. The use of other groups of psychotropic drugs (tranquilizers, sleep aids, antipsychotics, mood stabilizers) for the treatment of depression is considered symptomatic, they can be used in combination with antidepressants if necessary.
Since 1957, when the first antidepressant imipramine was offered for the treatment of depression, more than 30 different antidepressants are now available worldwide. They differ in terms of clinical effectiveness, mechanism of action, spectrum of side effects, and price. In general, it is considered that antidepressants can provide remission in 50-75% of patients in a moderate/severe depressive episode.
Important!
● This group is not habit forming like addictive substances.
● Antidepressants can be used as a course or in a long-term, it depends on the illness and its severity.
● Antidepressants can indeed cause side effects, but it can often be within the first 2 weeks of use and are transient. If the side effects of antidepressants do not go away or are very disturbing, the medication is usually changed.
● It may be the case that the antidepressant does not reduce bothersome symptoms and does not help. It depends on various factors, including the individual response, since antidepressants work on many different receptors.
(Information source Depression treatment guidelines of the Latvian Psychiatric Association, 2015)
Psychotherapy (PT) – treatment with specific (verbal, non-verbal) communication methods
in a structured way.
According to the recommendations of the World Health Organization (WHO), in the last ten years, PT has taken an equal place to psychopharmacological treatment in the cure of depression and shows equivalent treatment results (if the treatment is performed by a doctor qualified in psychotherapy and the depression is mild or moderate) (WHO, 2001, 2011). In Latvia, the choice of directions and forms of psychotherapy mainly depends on the availability of doctors.
Recent years of research on the effects of psychotherapy (Myiazaki et al. 2005, 2006) show that as a result of long-term psychodynamic PT there are changes in both mental processes, and an improvement in neuroplasticity in the brain can also be observed - the restoration of interneuron synaptic contacts, changes in the activities of synaptic processes, the number of neuron dendrites, as well as ensuring neurophysiological regulation, cytokine levels, and other changes.
The directions and forms of psychotherapy to be used:
● Forms of psychotherapy (PT): individual, group, child and adolescent, family.
● Directions: supportive, cognitive-behavioral, interpersonal, short-form psychodynamic psychotherapy and long-form psychodynamic psychotherapy.
These lines of psychotherapy have accumulated evidence-based results of effective therapy.
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