By Ekaterina Janashia | 2026-04-10

"We are living in a permanent state where things have become worse again. And worse. And worse still," a Moscow-based psychologist told Kontur, while asking to withhold her real name.

That psychologist is Inga. And what she is describing is a mental health crisis that is becoming a biological one.

As the war in Ukraine enters its fifth year with no end date in sight, acute stress on the Russian home front is hardening into systemic physiological breakdown.

"This is how we cope with stress: we react first at the psychological level, and then, if the psyche cannot manage, it transitions to the physiological level," Inga said.

The downstream consequences, she warns, will show up in hospital wards.

"It won't be a psychologist but a doctor telling you that we will see an increase in early heart attacks and strokes, and that other diseases will 'grow younger,'" she said.

"This will lead to a rise in mortality and an even more distressing ratio between death and birth rates."

The antidepressant surge

In the absence of systemic mental health support, Russians are turning to the pharmacy. Antidepressant sales reached 22.3 million packages in 2025 -- nearly triple the volume sold in 2020, the first year of the COVID-19 pandemic. The highest-selling drug in the country is now the serotonin inhibitor Zoloft, according to Russian consultancy DSM.

Clinical experts warn the pharmaceutical boom may be masking deeper problems.

Irene de la Vega Rodríguez, a clinical psychologist at San Carlos Clinical Hospital in Madrid, told El Pais in February that antidepressants are frequently used as a first option even when unnecessary, particularly in cases of mild to moderate depression where psychotherapy would be more effective.

She cautioned against a growing tendency to medicalize the problems of everyday life, arguing that pharmaceuticals are poorly suited to address underlying social conditions.

The social fabric frays

The mental health crisis is spilling beyond the individual. Reports from the RAND Corporation and independent outlet Novaya Gazeta indicate the war is arriving home in the form of rising crime and social instability.

Since 2022, more than 8,000 participants in Russia's military operation in Ukraine have been convicted of civilian crimes. Domestic violence is rising alongside that figure, as returning veterans with untreated post-traumatic stress disorder (PTSD) are increasingly involved in violent incidents within their own families.

The gap between the Kremlin's narrative of national consolidation and the reality of a depressed, anxious, and financially strained population continues to widen.

Exhaustion without bottom

What makes this crisis particularly corrosive, Inga said, is that it offers no stable floor -- not even a painful one people can adapt to. New stressors arrive continuously: rising prices, blocked messaging apps, drone strikes on civilian areas.

"People simply cannot reach stability -- not even a 'negative' stability. One must adapt all over again, but resources are already exhausted," she said.

"Chronic stress is developing. It may not be intense, but it is wave-like, and because it has been so prolonged -- in our case, four years now -- it utterly depletes a person's mental and physical resources."

The conflict itself adds a layer that Inga describes as the most destructive of all.

"Drones are flying toward us, too; there are reports of damage, fires, and casualties," she said.

"We cannot influence this situation, which adds a traumatic tint to the stress. Many have the feeling that we are hostages. And traumatic stress is perhaps the most destructive form of stress for a human being."

For the millions of Russians already in the death zone, that feeling is no longer a metaphor.