Appetite is sharply reduced or completely absent. The body weight of patients decreases, the skin is pale, the complexion is sallow, the mucous membranes are dry. Sexual and other instinctive impulses are also suppressed. Men lack libido, women develop amenorrhea. As a reflection of the severity of the condition, peripheral sympathicotonia is observed. The characteristic triad of Protopopov is described. tachycardia, pupil dilation, and constipation. The appearance of the patient is noticeable. The skin is dry, pale, flaky. A decrease in the secretory function of the glands is expressed in the absence of tears. Hair loss and brittle nails are often observed. A decrease in skin turgor is expressed in the fact that wrinkles deepen and patients look older than their years. Blood pressure increases. Senesthopathy is common. Especially in old age.

Suicidal thoughts are the most dangerous symptom of depression. It is usually preceded by a milder disorder of this kind - thoughts of not wanting to live, when the patient does not yet have specific plans to commit suicide, but would not regret if he had to give up his life due to circumstances beyond his control. This is like a passive stage of suicidal thoughts. Suicidal thoughts are common in depression, but are much less likely to be realized due to motor retardation and passivity of patients. This not always expressed, but often experienced symptom is an absolute indication for hospitalization of patients. This manifestation of depression usually clearly correlates with the degree of melancholy and depression and is closely related to other signs of suppression of instinctive activity and, in fact, is a private manifestation of the suppression of the self-protective instinct, but due to its great clinical significance it stands out as an independent symptom.

Classifications of depressive syndromes. The classification of depressive syndromes should be based on their affective structure, since it is this structure that is most determined by the pathogenetic mechanisms of the disease state and, accordingly, serves as a criterion for choosing adequate therapy. There are 4 main depressive syndromes. Anergic depression. In this state, there is no distinct melancholy and anxiety, mood is slightly reduced, somewhat more so in the mornings, and there is no pronounced psychomotor retardation.

Somatic symptoms of depression are mild; there may not even be a significant decrease in appetite or weight loss; patients do not want to eat, but they force themselves to eat. As a rule, there are no suicidal intentions, although patients often say that they do not want to live. Obsessions are possible, which are usually of the nature of obsessive doubts and hypochondriacal ideas, but these symptoms are not necessary. Depressive-depersonalization syndrome differs significantly in structure from other depressive syndromes observed within the framework of endogenous depression, the nature of which is determined by the intensity and ratio of the affects of melancholy and anxiety. It is distinguished by the presence of depersonalization (or, using other terms, mental anesthesia), which occupies a leading place in the clinical picture and blocks the affect of melancholy and anxiety.