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It is better to cry at the psychologist than to laugh at the psychiatrist themes of the day 28.11.2017 at 21:00

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Depression in 2017 was the theme of the annual campaign of the all-Russian health organization. decided to study how much it costs to recover (or even just "treated") from depression.

Abnormal statistics

April, According to who data, the world medical depression affects over 300 million people, of whom about 8 million Russians. Each year, about 800 thousand people worldwide die by suicide is quantitatively the second leading cause of death among people aged 15-29 years. In Russia, according to Rosstat, the mortality due to suicide is reduced (by about 13% over the past two years), but growing mortality on the background of mental disorders and disorders of behaviour (by 10% from 2015 to 2016), which include depression.

Over the past five years the number of Russians seeking psychiatric help for mood disorders, decreased by 7%, said the Ministry of health in response to the request There are several reasons. Including the consolidation of mental health institutions and reduce their number in the result of healthcare reform (as a result, the reduced availability of psychiatric care due to its "distancing" of the population, especially in small towns and villages); stigmatization of psychiatry and people with depression (as a result, fear of these people losing their jobs, being "outside of society"); the lack of specifically developed and implemented measures to increase literacy and General practitioners on the issues of the essence of mental disorders and the need for their treatment, and the lack of special programmes and measures to identify depressive disorders in the early stages of the disease.


one More reason — the price. As estimated by, depression treatment, involving a visit to a psychiatrist, psychotherapy and consumption of medicines can range from 17% of the average salary in Moscow in a month (according to the Department of economic policy and development of Moscow in mid-October, the average salary in the capital was 63 thousand).

Who treats

Professional assistance in dealing with depression have three categories of professionals: clinical psychologists, doctors-psychotherapists and psychiatrists. The last two categories of doctors have the higher medical education and have an in-depth knowledge of biological, organic and biochemical properties of the psyche, and also about how they arise and develop mental disorders. Only psychiatrists and medical psychotherapists have the right to appoint and monitor medication. Clinical psychologists along with therapists can provide psychotherapy ("treatment of the word"), but can't write prescriptions.

to Determine which specialist (clinical psychologist, psychotherapist or psychiatrist) to seek help, it is possible, based on the degree of depression and its origins, explains the doctor-psychiatrist, psychotherapist, candidate of medical Sciences Vitalina Burova.

According to her, we can distinguish three degrees of severity of depression: mild, moderate and severe (to determine the severity by using different psychometric scales, for example scales of the Hamilton or Beck. — Approx. Banks.PY). "For mild depression, it is desirable to have psychotherapy, but the pill is not likely to be required. With depression of moderate severity psychotherapy complemented with drugs, if that makes sense. In severe depression the use of drugs is strictly necessarily", says Burov.

At the origin (nosology) depression also can be divided into three types: psychogenic, somatogenic and endogenous. "Psychogenic depression occurs due to stress caused by one or more external negative factors. Somatogenic — caused by severe illness or disease, in the treatment process where the patient takes the drugs with depressogenic effect, for example, cytostatics. Endogenous depression occurs in the context of such serious diseases as bipolar affective disorder, schizophrenia, schizoaffective disorder or recurrent depressive disorder. When psychogenic depression often sufficient therapy. With somatogenic need to treat the underlying disease and only when it is necessary to prescribe psychotherapy and/or medications. Endogenous depression is treated primarily with medicines, and by them — secondly — added psychotherapy. But, in my opinion, in this case, they are equally necessary," says Burov.

prices of drive in depression

treatment of depression lasts for at least a year, but depending on the origin and severity of the disease, and the patient may take two, three and longer, tell Vitalina Burova and a psychiatrist, candidate of medical Sciences Anna Etingof.

As explained by Burov, the approximate scheme of treatment of depression moderate degree of severity, which typically involve the administration of drugs as follows. Once a month, the patient visits the psychiatrist on the subject of control of action of drugs and once a week (i.e. four times per month) goes to psychotherapy sessions.

the Cost of one consultation, according to the interviewees, the, depends mainly on the expert's qualifications (work experience, academic degree, membership in associations, the availability of international certificates, etc.). Welcome private practicing psychiatrist who is an individual entrepreneur or in a private clinic — is an average of from 4 thousand to 10 thousand rubles. Session of psychotherapy from a clinical psychologist is about 1.5 thousand rubles, if we are talking about the beginner technician and higher: on average, about 3-5 thousand rubles. The doctor-the therapist session is from about 4 thousand to 15 thousand rubles, depending on his qualifications. Have known professionals who deliver public lectures and conduct blogs on the Internet, a session of psychotherapy can cost tens of thousands of rubles.

the Cost of drugs depends on the manufacturer (original antidepressant is not less than 2 thousand roubles for a pack, generic versions of varying quality are cheaper than original drugs, but their cost is often also higher than 1 thousand rubles for a pack), intake of drugs (usually anti-depressant add normotimiki, tranquilizers or antipsychotics) and dosages (one pack per month and more). The course of medication is in the middle of the year, mark Burov and Etingof.

Thus, visits to a psychiatrist, therapy and medication can cost a month from 11 thousand rubles in the year — from 132 thousand roubles (if to undergo psychotherapy at the price of 1,5 thousand roubles for a session) and from 17 thousand per month and 204 thousand rubles a year, subject to the passing of psychotherapy at average cost. The price can vary upward or downward depending on the adjustment of the frequency of visits to specialists and medications.

So, said brown, if the patient feels that the drugs are effective, and feels good, or if the psychiatrist communicates with the specialist, which a patient undergoes therapy, then to go to the psychiatrist once a month optional. "Some patients are able to easily pick up pills, so missing just a couple of visits. On the first assigned therapy, the second adjusted dosage and all: next time he comes at the end of therapy and we will decide on further withdrawal of the drug," she explains.

Anna Etingof emphasizes that the frequency of visits to a psychotherapist during the course, usually negotiated in advance. "For example, for the first time — ten visits once a week, then another ten, then every two weeks, and so on, according to the agreement," says the psychiatrist. In addition, the customer usually pays for each pass. If he misses a session, you lose the money: payment for the session is also part of the therapy. In the process of therapy, she explains, people can skip sessions, and it's bad treatment. Discipline in this case is important.

Quote "you can explain to them that depression is not madness,"

In urban public hospitals the cost of visiting a psychiatrist and psychotherapist can be cheaper. For example, the primary reception of the doctor-psychiatrist in the Scientific practical psychoneurological center named Zinovy Solovyov (known as "clinic of neuroses") worth 1.2 thousand rubles and 1 thousand rubles. In a psychiatric hospital name Gannushkina primary reception of the doctor-the psychiatrist and the psychotherapist is 2.4 thousand rubles and 1 thousand rubles, and receiving physician-psychiatrist, the candidate of medical Sciences is respectively 3 million and 2.4 thousand rubles.

All outpatient consultations in the state psychiatric hospitals paid for Muscovites, and for those from other regions. Free help unable to Muscovites, if we are talking about treatment in hospital (in the direction from the psycho-neurological dispensary, PND).

Consult a psychiatrist for free at the OMS, it is possible in the IPA, but people are often afraid to have there card to get on the record (which marks the Ministry of health). The Correspondent spoke with five people who are treated or were treated for depression (young man and four girls ranging in age from 25 to 34 years with higher education and permanent jobs).

All of them are fundamentally treated in private clinics, explaining it like this: "Put on record as a psychopath, and you can explain to them that depression does not crazy."

Catherine MARKHULIA,

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