Depressão / Melancolia
Autor: René Schubert | Publicado: 2016-08-24T14:47:00-03:00















Síntese de palestras ministradas por René Schubert acerca da temática: Depressão. O tema tem muitos pontos de vista e maneiras de ser abordado. Aqui transcrevo alguns dos apontamentos feitos durante aulas e palestras proferidos abordando a depressão - claro que o tema é muito mais vasto e complexo do que coloco aqui. Utilizo principalmente o referencial da psicologia e psicanálise, assim como referências da psiquiatria e neurologia, mas compreendo que muitos outros referenciais e teorias poderiam aprofundar e complementar o material exposto aqui. As informações postadas aqui são referentes a pesquisa de dados feitas no ano de 2016.

Espero que a leitura propicie informação, reflexão e maiores questionamentos!








"Ah,
Quanta melancolia! &nbsp;


Quanta, quanta solidão!&nbsp;


Aquela alma, que vazia,


Que sinto inútil e fria&nbsp;


Dentro do meu coração!&nbsp;







Que
angústia desesperada!&nbsp;


Que mágoa que sabe a fim!&nbsp;


Se a nau foi abandonada,&nbsp;

E o cego caiu na estrada 


Deixai-os, que é tudo assim.&nbsp;







Sem
sossego, sem sossego,&nbsp;


Nenhum momento de meu&nbsp;







Onde
for que a alma emprego 


Na estrada morreu o cego&nbsp;


A nau desapareceu. "



Fernando
Pessoa








Segundo a Organização Mundial de Saúde (OMS) - 350 a 400 Milhões
de
pessoas sofrem de alguma forma de depressão. Ou seja, 5% da população Mundial.
No Brasil os números são mais substantivos - segundo IBGE, 7,6% da população
brasileira foi diagnosticada com depressão. Segundo a FIOCRUZ, 1 em cada 4
mulheres sofrem com a
depressão pós-parto,
maior número
na
média global (Julho
2016
- Folha de SP)



A
principal e mais séria complicação da depressão é o suicídio. Estima-se que 15% dos pacientes com depressão primária venham eventualmente a
cometer o Suicídio.



A depressão afeta 350 a 400 milhões de
pessoas em todo o mundo e leva, anualmente, a 800 mil casos de suicídio. Mesmo com tanto
remédio, o número de pessoas sofrendo de depressão dobrou nos últimos 50 anos - Atualmente 10% da
população mundial sofre do mal. 

&nbsp;&nbsp;
O suicídio é, atualmente, a terceira
principal causa de morte em crianças de 5 a 14.anos e a segunda em adolescentes
e adultos jovens de 14 a 24 anos. 

&nbsp;&nbsp;
As taxas de suicídio efetivo em homens
são maiores do que em mulheres, enquanto as taxas de tentativas de suicídio são maiores em mulheres.&nbsp;
O risco de ter a doença é de 3 a 12% nos
homens e de 20 a 26% nas mulheres, sendo que esse risco aumenta caso o
parentesco seja de primeiro grau com as pessoas que já tem o diagnóstico. As
proporções podem aumentar de acordos com outros fatores de risco como consumo
de álcool e outras drogas. Não existem estudos conclusivos que possam afirmar
que a depressão seja uma doença genética, mas sabe-se que na maioria dos casos
existe antecedentes familiares.&nbsp;
Já
em populações clínicas, a incidência é ainda maior, uma vez que a depressão é encontrada em 5% a 10% dos pacientes ambulatoriais e 9%
a 16% de
internados. 


Pacientes
com doenças clínicas e depressão têm maior risco de não aderirem às
recomendações médicas. Depressão e ansiedade parecem aumentar a percepção de
sintomas físicos inexplicáveis . A associação entre depressão e doenças
clínicas é muito freqüente,
levando a pior evolução tanto do quadro psiquiátrico como da doença clínica,
com menor aderência às orientações terapêuticas, além de maior morbidade e
mortalidade. 


A depressão muitas vezes é subdiagnosticada e subtratada,
principalmente pela presença de sintomas depressivos, que também podem ocorrer
em doenças crônicas, como fadiga e anorexia. 


&nbsp;A OMS classificou a depressão como uma das doenças que
mais causam incapacidade. É a 4ª numa lista de 5.&nbsp;



&nbsp;A palavra depressão é utilizada
para designar tanto um estado afetivo denominado tristeza, que se constitui
como resposta universal às situações de perda, derrota, desapontamento e outras
adversidades.&nbsp;




Alguns sinais:


Humor
depressivo ou irritabilidade, ansiedade e angústia
Desespero,
Desamparo, Sentimento de Abandono
Desânimo,
cansaço fácil, necessidade de maior esforço para faz
Falta
de vontade e indecisão 
Desinteresse,
falta de motivação e apatia
Desatenção,
falta de foco, impaciência
Dificuldade
quanto a memória e fatos e eventos
Perda
ou aumento do apetite e do peso
Insônia
– Distúrbios de sono
Dores
físicas
Insegurança,
culpa, auto acusação, auto depreciação, pessimismo
Pensamentos
de morte, ideação suicida
Dificuldades
na esfera sexual, relacional, social


Sintomas e sinais do ponto de vista psiquiátrico: 






Afetivos – irritabilidade aumentada, sentimento de
falta de sentimento, apatia, choro fácil, sentimento de melancolia, tristeza,
angústia ou ansiedade, desespero, desesperança; 
Alterações Ideativas – pessimismo em relação a tudo, ideias de
arrependimento e culpa, tédio, desejo de suicídio; 
Cognitivos – déficit de atenção, concentração,
memória, dificuldade de tomar decisões; 
Autovaloração – baixa
auto-estima,
incapacidade, vergonha e autodepreciação; 
Volição e psicomotricidade – aumento
na latência, diminuição da fala, redução da voz, negativismo, lentidão
psicomotora; 
Sintomas Fisiológicos – fadiga, cansaço, perda ou aumento de
apetite, perda de interesse sexual, insônia ou hipersomnia, anedonia; 
Sintomas Comportamentais - passividade,
evitação e
déficit social.&nbsp;





&nbsp;



&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; O
indivíduo deprimido pode excluir os acontecimentos positivos dando mais ênfase
aos acontecimentos negativos. 




&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; As
pessoas deprimidas colocam significados
distorcidos em
três domínios aos eventos da vida. O interno versus externo, onde o indivíduo
deprimido assume culpa excessiva pelos eventos negativos. Global versus
específico, onde concluem que as ocorrências negativas são de implicações de
longo alcance, globais ou totalmente abrangentes. Fixo versus mutável, na qual
situações negativas ou problemáticas são vistas como imutáveis sem melhoria no
futuro. 




&nbsp;&nbsp;&nbsp;&nbsp; Para
Aaron T. Beck (2007) as atribuições por acontecimentos negativos são sempre internas,
devido à autocrítica e
culpa excessiva,
administra autopunição excessiva, inibindo seu comportamento, enquanto que os
acontecimentos positivos são atribuídos ao externo. 




&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; As
tarefas de vida diária são prejudicadas e é evidenciado o aumento da
dependência, pois o deprimido se enxerga desamparado, devido ao emprego de
grande dificuldade às tarefas simples do cotidiano esperando sempre que essas
tarefas terminem mal, assim o indivíduo vai buscar ajuda e tranquilização em
pessoas as quais considera mais competente que ele.&nbsp;





Discurso depressivo...ou melhor, depreciativo:




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<![endif]-->



“Meu trabalho é desnecessário”



“Tudo o que faço fica ruim, é uma
porcaria”



“Tento manter meus funcionários
motivados, mas eu não estou motivado”



“Meu trabalho é chato”&nbsp; 



“Minhas filhas não precisam de mim”



“Não consigo me relacionar com minhas
filhas”



“Sou obrigado a continuar porque tenho
filho(a)s”



“Não tenho controle sobre meus filhos”



“Se eu falar o que sinto, vou estragar
tudo” 



&nbsp;"Ninguém confia em mim”&nbsp; 



"Acho que só vai piorar"



“Não tenho como mudar isso” 



“Sou infeliz e deixo todos a minha volta
infelizes”&nbsp; 



"Nunca vou fazer o que gosto” 



“Nada da certo na minha vida” 



“Vou me esforçar para que? Sei que não
vai dar certo!” 



“Não queria sair da cama...ia ser tudo
igual” 



“Como alguém vai se interessar por mim,
não sou interessante” 



“Não consigo terminar nada: ler um
livro, as tarefas domésticas, ver um filme...” 



“Não gosto deste jeito que sou...queria
ser outra coisa”&nbsp;&nbsp;


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E é com esta carga afetiva,
com estas crenças e palavras que muitas vezes a pessoa com depressão se
manifesta, se insere no dia a dia, se condiciona, replica e intensifica a dinâmica
depressiva. Estas frases foram selecionadas a partir de colocações feitas por pacientes em alguns momentos no tratamento psicoterapêutico e, traduzem de maneira clara o posicionamento pessimista, desanimado, inseguro, receoso, triste e depreciativo do paciente com depressão.









Depressão / Melancolia



Há uma distinção histórica, estrutural e
dinâmica entre melancolia e depressão. 
A psiquiatria, organizada pela nosografia - a
busca sintomática - utiliza o termo depressão e
subdivide tal em vários subtipos.&nbsp;

&nbsp;
A psicanálise, que se baseia na postura
do sujeito frente ao seu sintoma e qual uso faz disto, utiliza o termo melancolia –
como estrutura e depressão, como uma da sintomatologia – Sigmund Freud desenvolve tal
temática no trabalho “Luto e Melancolia” (1917)
A crise depressiva pode aparecer sem motivo aparente, porém é comum encontrarmos causas desencadeantes como: um choque&nbsp; emocional
ou
situações de conflito
O Início: Lento
– pessoa por semanas começa a se queixar de desanimo, cefaléias, dificuldades no trabalho (concentração), falta de disposição em geral e insônia.
Apresentação: O
melancólico geralmente permanece sentado, em geral imóvel, corpo dobrado, rosto
pálido e trás a mascara da tristeza – os traços caem, olhos são abertos e olhar
fixo, a testa franzida – a fala é rara, sendo mais comuns gemidos e choros.
O melancólico se
abandona à inércia –
a inibição psíquica é muito presente. A linguagem é restrita até chegar ao mutismo. Tristeza profunda e desconsolada acompanham a pessoa.
O sentimento de auto comiseração destroi a auto-estima da pessoa lentamente.
Sentimentos de auto-depreciação, impotência, incapacidade acompanhados de improdutividade. Anestesia afetiva, pessimismo constante,
auto acusações e sintomas hipocondríacos. Excesso ou falta de sono. O desejo e a busca da morte são evidentes na rejeição do alimento e nas idéias de morte e do morrer.
Somaticamente: Os distúrbios digestivos são constantes; observam-se
náuseas,
anorexia, constipação ou episódios de diarreia. Diminuição
dos reflexos e hipotonia
muscular. Perturbações no
pulso e pressão
arterial.
É fundamental não perder de vista a
duração da evolução espontânea – abreviada pelas terapêuticas atuais – passados
3 meses o quadro tende a agravar e se firmar.
O retorno do sono e apetite sempre
indicam sinais de retorno do equilíbrio - vitalidade.














Psicofarmacologia


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Em
diversos quadros de depressão o acompanhamento de um profissional psiquiatra é
de fundamental importância e muitas vezes serão ministrados antidepressivos e outros psicotrópicos visando auxiliar o paciente no enfrentamento e recuperação da
depressão.



Estudos
detectaram que alterações bioquímicas foram identificadas no cérebro das
pessoas deprimidas, como níveis diminuídos de serotonina e/ou aumentados da
enzima monoamino oxidase, perda de células do hipocampo e padrões anormais de
atividade neural na amígdala e em partes do cortex pré-frontal dorso-lateral.
Porém os mecanismos que provocam essas alterações bioquímicas são desconhecidos



Os
antidepressivos são drogas que aumentam o tônus psíquico melhorando o humor e, consequentemente, melhorando a psicomotricidade de maneira global.



Os
antidepressivos foram desenvolvidos para bloquear vários aspectos do processo
de transmissão sináptica nos neurônios que contêm serotonina, norepinefrina e
dopamina no cérebro e, por isso, aumentam os níveis desses neurotransmissores.
Com o aumento dos níveis dos neurotransmissores, o humor e as emoções devem se
estabilizar e, talvez, voltar ao normal ( lembrando que com cada paciente a interação com a medicação é singular, por fatores diversos).



Alguns
antidepressivos podem ter efeitos colaterais como mudança na pressão arterial e
na produção de saliva. Os antidepressivos podem interferir em outras funções,
como apetite, sono e função sexual. Por isto o acompanhamento com o psiquiatra é fundamental para verificar a presença e/ou predominância de efeitos colaterais, os efeitos e resultados obtidos e com isto fazer a administração da medicação que melhor se adapte ao cliente - em um acompanhamento de médio e longo prazo.



Os
antidepressivos são classificados de acordo com os neurotransmissores que
afetam e a forma como afetam. Antidepressivos
mais conhecidos e utilizados: Zoloft, Prozac, Sertralina, Efexor, Imipramina,
Fluoxetina, Citalopran, Paroxetina, entre outros.
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Alguns subtipos da Depressão
(Psiquiatria):



Episódio ou fase Depressiva: fadiga,
perda de concentração, sentimentos de culpa, distúrbios sono e apetite, alteração de
humor – 1 à 2 meses



Distimia: depressão crônica – intensidade
leve, porém duradoura. Mau humor crônico, irritabilidade e desesperança –
Ininterruptamente por 2 anos



Depressão atípica: aumento do apetite
(doce) com ganho de peso, hipersonia, sensação de peso no corpo, sensibilidade
exacerbada á “possibilidade de rejeição”, reatividade humorosa, fobias e
aspecto histriônico



Depressão Psicótica: considerada uma
depressão severa devido ao grave risco suicídio.

sintomas depressivos associados a
alucinação e delírios. Apatia e Impulsividade.



Esturpor Depressivo: estado no
qual o indivíduo permanece dias na cama ou

cadeira, sofá em estado de catalepsia
com negativismo e mutismo – as complicações

clinicas podem levar à morte.



Depressão Ansiosa: inquietação
psicomotora associada à angustia; Insônia, Irritação e

impulsividade que, num momento pode
levar ao suicídio.



Depressão Melancólica: sintomas clássicos das depressões
endógenas – andedonia,

tristeza vital, angustia, lentificação,
perda de apetite e peso, ideação de culpa, insônia,

ideação suicida&nbsp; - piora de manhã e melhora durante o dia.



Depressão Secundária: associada à
doenças ou quadro somático – AVC/Derrame

/Câncer/Impotencia Sexual/
Stress/Lupus/AIDS - entre outros quadros clínicos



Transtorno Bipolar - Psicose Maníaco -
depressiva - PMD:&nbsp; alternância de
períodos de depressão e&nbsp; mania. Nesta fase, a pessoa apresenta
modificações na forma de pensar, agir e sentir e vive num ritmo acelerado,
assumindo comportamentos extravagantes como sair comprando compulsivamente e/ou
envolvendo-se em experiências perigosas sem levar em conta o mal que podem
causar























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Melancolia
e Luto (Psicanálise):



Para a Psicanálise, o traço principal da
melancolia é o desinteresse gereneralizado pela vida (perda da vitalidade), a
banalização de todos os eventos e indiferença pelos acontecimentos.
“Na melancolia, a agressividade volta-se
contra si mesmo, em uma atitude propriamente de aniquilamento do “ego” . Esta
agressividade está sempre estreitamente ligada à angústia” Sigmund Freud
A Paixão pela Tristeza
Sigmund Freud e Karl Abraham foram os
psicanalistas que mais se ocuparam da melancolia e que mais acrescentaram com
suas idéias pontuais: foi Freud que desenvolveu o conceito de melancolia em seu
comparativo com o Luto
A abordagem psicanalítica admite que o melancólico
expressa por seu comportamento auto-acusador uma profunda frustração de não ser
amado e de não poder mais amar – a melancolia é uma situação de “perda do
objeto amado” - se porta como se estivesse de luto pelo objeto (imaginário,
simbólico ou real)
No luto temos um processo, elaboração
partindo da relação objetal (Real e Fantasia) e relação com o mundo (interno e
externo). Na melancolia o próprio Eu (ego) do sujeito esta em questão, sofrendo
diretamente a perda, empobrecimento, vazio, desvalorização.

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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Preformatted"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Variable"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Normal Table"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="annotation subject"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Outline List 2"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Outline List 3"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Simple 1"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Simple 2"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Simple 3"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Classic 1"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Classic 2"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Classic 3"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Classic 4"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Colorful 2"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Colorful 3"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Columns 1"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Columns 4"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Grid 2"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Grid 3"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Grid 4"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table Grid 6"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table List 3"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Table List 8"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" Priority="34" QFormat="true"
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  <w:LsdException Locked="false" Priority="30" QFormat="true"
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  <w:LsdException Locked="false" Priority="19" QFormat="true"
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  <w:LsdException Locked="false" Priority="21" QFormat="true"
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  <w:LsdException Locked="false" Priority="31" QFormat="true"
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  <w:LsdException Locked="false" Priority="32" QFormat="true"
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  <w:LsdException Locked="false" Priority="37" SemiHidden="true"
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  <w:LsdException Locked="false" Priority="39" SemiHidden="true"
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  <w:LsdException Locked="false" Priority="46"
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  <w:LsdException Locked="false" Priority="51"
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  <w:LsdException Locked="false" Priority="52"
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  <w:LsdException Locked="false" Priority="46"
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  <w:LsdException Locked="false" Priority="51"
   Name="Grid Table 6 Colorful Accent 2"/>
  <w:LsdException Locked="false" Priority="52"
   Name="Grid Table 7 Colorful Accent 2"/>
  <w:LsdException Locked="false" Priority="46"
   Name="Grid Table 1 Light Accent 3"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="Grid Table 6 Colorful Accent 3"/>
  <w:LsdException Locked="false" Priority="52"
   Name="Grid Table 7 Colorful Accent 3"/>
  <w:LsdException Locked="false" Priority="46"
   Name="Grid Table 1 Light Accent 4"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="Grid Table 6 Colorful Accent 4"/>
  <w:LsdException Locked="false" Priority="52"
   Name="Grid Table 7 Colorful Accent 4"/>
  <w:LsdException Locked="false" Priority="46"
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  <w:LsdException Locked="false" Priority="51"
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  <w:LsdException Locked="false" Priority="52"
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  <w:LsdException Locked="false" Priority="46"
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  <w:LsdException Locked="false" Priority="51"
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  <w:LsdException Locked="false" Priority="52"
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  <w:LsdException Locked="false" Priority="46"
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  <w:LsdException Locked="false" Priority="51"
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  <w:LsdException Locked="false" Priority="52"
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  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 3"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 3"/>
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   Name="List Table 1 Light Accent 4"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 4"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 4"/>
  <w:LsdException Locked="false" Priority="46"
   Name="List Table 1 Light Accent 5"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 5"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 5"/>
  <w:LsdException Locked="false" Priority="46"
   Name="List Table 1 Light Accent 6"/>
  
  
  
  
  <w:LsdException Locked="false" Priority="51"
   Name="List Table 6 Colorful Accent 6"/>
  <w:LsdException Locked="false" Priority="52"
   Name="List Table 7 Colorful Accent 6"/>
 
<![endif]--><!--[if gte mso 10]>

 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
 mso-style-noshow:yes;
 mso-style-priority:99;
 mso-style-parent:"";
 mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
 mso-para-margin-top:0cm;
 mso-para-margin-right:0cm;
 mso-para-margin-bottom:8.0pt;
 mso-para-margin-left:0cm;
 line-height:107%;
 mso-pagination:widow-orphan;
 font-size:11.0pt;
 font-family:"Calibri",sans-serif;
 mso-ascii-font-family:Calibri;
 mso-ascii-theme-font:minor-latin;
 mso-hansi-font-family:Calibri;
 mso-hansi-theme-font:minor-latin;
 mso-fareast-language:EN-US;}

<![endif]-->




&nbsp;










<!--[if gte mso 9]>
 
  
 
<![endif]-->
<!--[if gte mso 9]>
 
  Normal
  0
  
  
  21
  
  
  false
  false
  false
  
  PT-BR
  X-NONE
  X-NONE
  
   
   
   
   
   
   
   
   
   
  
  
   
   
   
   
   
   
   
   
   
   
   
  
<![endif]--><!--[if gte mso 9]>
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   UnhideWhenUsed="true" QFormat="true" Name="heading 5"/>
  <w:LsdException Locked="false" Priority="9" SemiHidden="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="line number"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="toa heading"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="List Bullet"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="List 2"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="List 3"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="List 4"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="List Bullet 5"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" Priority="1" SemiHidden="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Body Text Indent"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="List Continue 2"/>
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Message Header"/>
  
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Body Text First Indent"/>
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Body Text 2"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="E-mail Signature"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Top of Form"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Bottom of Form"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Acronym"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Address"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Cite"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Preformatted"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Typewriter"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="HTML Variable"/>
  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
   Name="Normal Table"/>
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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  <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<![endif]--><!--[if gte mso 10]>

 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
 mso-style-noshow:yes;
 mso-style-priority:99;
 mso-style-parent:"";
 mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
 mso-para-margin-top:0cm;
 mso-para-margin-right:0cm;
 mso-para-margin-bottom:8.0pt;
 mso-para-margin-left:0cm;
 line-height:107%;
 mso-pagination:widow-orphan;
 font-size:11.0pt;
 font-family:"Calibri",sans-serif;
 mso-ascii-font-family:Calibri;
 mso-ascii-theme-font:minor-latin;
 mso-hansi-font-family:Calibri;
 mso-hansi-theme-font:minor-latin;
 mso-fareast-language:EN-US;}

<![endif]-->



Luto
e Melancolia - e como a instância do EU (ego) se comporta, lida, administra.
 




<!--[if gte mso 9]>
 
  
 
<![endif]-->
<!--[if gte mso 9]>
 
  Normal
  0
  
  
  21
  
  
  false
  false
  false
  
  PT-BR
  X-NONE
  X-NONE
  
   
   
   
   
   
   
   
   
   
  
  
   
   
   
   
   
   
   
   
   
   
   
  
<![endif]--><!--[if gte mso 9]>
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<![endif]-->





No
relacionamento a dois há o espaço do Eu, o espaço do Outro e o espaço
compartilhado, o Nós. Muitas vezes se usa a expressão "Ele(a) foi embora e
deixou um buraco/vazio em mim" "Levou um pedaço de mim". Na
Melancolia há o buraco, vazio...no luto a elaboração deste com o o passar do
tempo ( tempo aqui singular para cada um)








<!--[if gte mso 9]>
 
  
 
<![endif]-->



Fases
do Luto: Negação, raiva, barganha, depressão e aceitação - teoria desenvolvida
pela médica Elisabeth Kubler-Ross


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<![endif]--><!--[if gte mso 10]>

 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
 mso-style-noshow:yes;
 mso-style-priority:99;
 mso-style-parent:"";
 mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
 mso-para-margin-top:0cm;
 mso-para-margin-right:0cm;
 mso-para-margin-bottom:8.0pt;
 mso-para-margin-left:0cm;
 line-height:107%;
 mso-pagination:widow-orphan;
 font-size:11.0pt;
 font-family:"Calibri",sans-serif;
 mso-ascii-font-family:Calibri;
 mso-ascii-theme-font:minor-latin;
 mso-hansi-font-family:Calibri;
 mso-hansi-theme-font:minor-latin;
 mso-fareast-language:EN-US;}

<![endif]-->







<!--[if gte mso 9]>
 
  
 
<![endif]-->



Alguns
exemplos do discurso presente durante as fases o Luto
<!--[if gte mso 9]>
 
  Normal
  0
  
  
  21
  
  
  false
  false
  false
  
  PT-BR
  X-NONE
  X-NONE
  
   
   
   
   
   
   
   
   
   
  
  
   
   
   
   
   
   
   
   
   
   
   
  
<![endif]--><!--[if gte mso 9]>
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<![endif]-->






&nbsp;Tratamento: 

A
depressão é uma doença reversível, ou seja, há cura completa se tratada
adequadamente 
Principalmente atividade e enfrentamento! Tirar-se
do ciclo repetitivo, passivo, queixoso auto-destrutivo, auto-piedoso e
mórbido que o estado depressivo ou melancolia institui!
Psicoterapia
Individual e/ou
Familiar se for o caso
Acompanhamento&nbsp; psiquiátrico psicofarmacologico, dependendo da gravidade do quadro&nbsp; - uso de antidepressivos ou ansiolíticos
Acompanhamento nutricional&nbsp; 
Atividade física – caminhada, natação, equitação, dança,
yoga - movimente-se!
Atividade
social – Investimento em hobbys, cursos, estudos. Encontros sociais com familiares, amigos e colegas.





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Sugestão
de Vídeos:

















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<![endif]-->



Sugestão
de leitura:



Luto
e melancolia / Transitoriedade – Sigmund Freud

O
corpo em depressão – Alexander Lowen

Terapia
Cognitiva da Depressão – Aaron Beck

Sobre
a morte e o morrer - Elisabeth Kübler-Ross

Classificação
Internacional de Doenças – CID 10 - Organização Mundial de saúde 

Manual
Diagnóstico e Estatístico de Transtornos Mentais- DSM IV

O
Demônio do meio dia – Andrew Solomon 

A
Cura de Schopenhauer - Irvin Yalom.

Neve
– Orham Pamuk

Dom
Casmurro – Machado de Assis

Dom
Quixote – Miguel de Cervantes&nbsp;



Crime
e Castigo – Fidor Dostoevsky

Cem
anos de Solidão – Gabriel García Marques








Links
aprofundando e abordando a temática:



UOL
- Cientistas descobrem 17 variações genéticas ligadas ao risco de depressão -
http://noticias.uol.com.br/ultimas-noticias/agencia-estado/2016/08/02/cientistas-descobrem-17-variacoes-geneticas-ligadas-ao-risco-de-depressao.htm

HUFFPOST
Brasil - Quando termina a tristeza e começa a depressão? -
http://www.brasilpost.com.br/2016/07/12/diferenca-tristeza-depressao_n_10888366.html

HypeScience
- Sintomas de depressão: 11 sinais de que esse mal está dominando você -
http://hypescience.com/sintomas-de-depressao/

Revista
Veja- 8 sinais de que você pode estar com depressão -
http://veja.abril.com.br/saude/8-sinais-de-que-voce-pode-estar-com-depressao/

MDSaúde
- DEPRESSÃO – Causas, Sintomas, Diagnóstico e Tratamento -
http://www.mdsaude.com/2012/04/o-que-e-depressao.html

Fãs
da Psicanálise - Depressão: homens ignoram sintomas -&nbsp;
http://www.fasdapsicanalise.com.br/depressao-homens-ignoram-sintomas-e-demoram-mais-para-buscar-tratamento/

Tanatologia
e Constelação familiar - http://aconstelacaofamiliar.blogspot.com.br/2012/10/tanatologia-e-constelacao-familiar.html
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<![endif]--><!--[if gte mso 10]>

 /* Style Definitions */
 table.MsoNormalTable
 {mso-style-name:"Tabela normal";
 mso-tstyle-rowband-size:0;
 mso-tstyle-colband-size:0;
 mso-style-noshow:yes;
 mso-style-priority:99;
 mso-style-parent:"";
 mso-padding-alt:0cm 5.4pt 0cm 5.4pt;
 mso-para-margin-top:0cm;
 mso-para-margin-right:0cm;
 mso-para-margin-bottom:8.0pt;
 mso-para-margin-left:0cm;
 line-height:107%;
 mso-pagination:widow-orphan;
 font-size:11.0pt;
 font-family:"Calibri",sans-serif;
 mso-ascii-font-family:Calibri;
 mso-ascii-theme-font:minor-latin;
 mso-hansi-font-family:Calibri;
 mso-hansi-theme-font:minor-latin;
 mso-fareast-language:EN-US;}

<![endif]-->