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depression
·Depression is the most common mental illness nowadays. It is characterized by continuous and long-term low mood as the main clinical feature. It is the most important type of mental illness in modern people. ·Clinically, it can be seen that the patient is depressed and unhappy in reality, and has been depressed and depressed for a long time. From being unhappy at the beginning to being distraught at the end, one has low self-esteem, pain, pessimism, and world-weariness, and feels that every day of life is a torture of despair. Oneself, negative, evasive, and finally even more suicidal tendencies and behaviors. ·This map introduces depression in detail and can give you a more comprehensive understanding of relevant knowledge. ·Drawing is not easy, I hope you enjoy it, thank you.
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depression
Overview
·A typical condition of depressive disorder ·The core symptoms are significant and lasting depression, loss of interest, etc. ·The most common mental disorder with high clinical cure rate ·Suicide is one of the most serious consequences for patients with depression
What is depression?
Depression is a typical condition of depressive disorder.
Depression is a mental disorder with high prevalence and high clinical cure rate. However, due to the lack of awareness of the disease among the people, As a result, fewer patients adhere to formal treatment, so the treatment acceptance rate is low and the recurrence rate is high.
It is characterized by significant and persistent depression, and some patients engage in self-injury and suicidal behavior. It may be accompanied by psychotic symptoms such as delusions and hallucinations, and in severe cases, depressive stupor may occur. It can manifest as fixed facial expressions, lack of response to stimuli, little or no speech, little or even no movement, etc.
Depression is generally characterized by low mood, loss of interest, and lack of energy.
What is the prevalence of depression in the population?
Most of them have acute or subacute onset, and tend to occur in autumn and winter.
The average age of onset is 20 to 30 years old, and the prevalence rate in women is higher than that in men (about 2:1).
The 2019 China Mental Health Survey Research Report shows that the lifetime prevalence rate of depressive disorder in my country is 6.8%. The 12-month prevalence rate is 3.6%, of which the lifetime prevalence rate of depression is 3.4% and the 12-month prevalence rate is 2.1%.
Statistics on the global burden of disease from the World Health Organization (WHO) in 2017 show that, Disability-adjusted life years (the total healthy life years lost from onset to death) of depressive disorder rose to 11th place. Research also shows that depressive disorders have become the third leading cause of healthy life years lost due to disability (years of life lost due to premature death). It is expected that by 2020, depression will become the second largest source of disease burden after cardiovascular disease.
What are the types of depression?
Clinically, depressive disorders are often divided into mild, moderate and severe according to the number, type and severity of symptoms.
In addition, because specific groups of people have corresponding characteristics, depression can also be subdivided into geriatric depression, childhood depression, postpartum depression, etc.
Cause
The etiology and pathogenesis of depression involve biochemistry, neuroendocrinology, neuroimmunology, Sleep and brain electrophysiological abnormalities, brain imaging, genetics, psychosocial factors, etc.
What are the causes of depression?
The cause and pathogenesis of this disease are still unclear, but a large amount of research data suggests genetic factors, Neurobiochemical factors and psychosocial factors have a significant impact on the occurrence of this disease.
What are the triggers of depression?
There are no clear predisposing factors for this disease, but at present, stressful life events, pessimistic personality traits, Having a history of other mental illnesses, severe chronic diseases, alcoholism, drug abuse, etc. are closely related to the onset of depression.
symptom
The manifestations of depressive episodes can be divided into three aspects: core symptom cluster, psychological symptom cluster and physical symptom cluster.
Nowadays, depressive episodes are generally summarized as "three lows", which are low mood, slow thinking, and decreased volitional activity. These three symptoms are considered typical symptoms of major depression, but these typical symptoms may not appear in all patients.
What are the early symptoms of depression?
It's impossible to say exactly what the early symptoms of depression are. Depression has many symptoms, In fact, the initial symptoms of each patient will have certain individual differences. If you find that you have significant and persistent depression or other abnormal conditions in your daily life, You can use the "9-item Patient Health Questionnaire (PHQ-9), Zung Self-Rating Depression Scale (SDS), Beck's Depression Inventory (BDI), Quick Inventory for Depression Symptoms Self-Rating (QIDS-SR)" Self-evaluation scales such as these have certain positive significance for early screening.
What are the typical symptoms of depression?
core symptom cluster
Depression
Feeling depressed, distressed, and sad, as perceived by oneself or observable by others, and finding it difficult to get through the pain. I don't feel happy. I even feel that my days are like years and life is worse than death. I often frown and sigh.
A depressed mood exists almost every day and generally does not change with changes in circumstances.
Decreased interest or anhedonia
Losing interest in everything or losing interest, losing enthusiasm for previous hobbies, Loss of the ability to experience happiness and gain pleasure from daily activities.
Even if there are some simple activities such as reading books and watching TV, their main purpose is just to kill time and cannot derive happiness from them.
psychological symptom cluster
anxiety
It manifests as upset, worry, tension, random thoughts, worry about losing control or having an accident, etc.
slow thinking
Consciously slow response, difficulty thinking about problems, reduced decision-making ability, reduced speech, The speech speed slows down, the volume decreases, and in severe cases, there will be obstacles in responding and communicating.
cognitive symptoms
Mainly manifested by decreased memory ability of recent events, attention disorder, Reduced information processing ability, indifference to self and surrounding environment, etc.
In severe cases, there will be "three no symptoms", that is, feeling useless, helpless and hopeless.
Uselessness: Lowered self-evaluation, believing that one's life is worthless, full of failures, and useless.
Helplessness: Feeling powerless and alone.
Hopeless: Thinking that you have no way out, no hope, and a slim future.
self-blame
Blame oneself for some minor faults or mistakes in the past. In severe cases, they will produce A deep sense of guilt or guilt, believing that one has sinned heavily and must be punished by society.
Suicide attempts and behaviors
Patients with severe depression are often accompanied by negative suicidal thoughts and behaviors. Suicidal thoughts are often stubborn and recurring. Suicidal behavior is often well-planned and difficult to prevent. Therefore, suicidal behavior is the most serious and dangerous symptom of depressive disorder.
psychomotor changes
Psychomotor retardation or agitation may occur.
Hysteresis
Symptoms include slow movement, slow thinking, reduced activity, laziness, alienation from relatives and friends, Avoid social interactions, reduce work efficiency, and fail to pay attention to personal hygiene. In severe cases, they may develop into less talkative, Moving less, eating less, or not talking, moving, or eating is a state of "depressive stupor".
intense
The mind will involuntarily think about some purposeless things over and over again, and the thinking content is not organized. As a result, the behavior is irritable, unable to control oneself, and even aggressive behavior may occur.
psychotic symptoms
Patients with severe depressive disorder may experience psychotic symptoms such as hallucinations or delusions.
insight
Some patients with depressive disorder can proactively seek treatment and describe their condition and symptoms, which is a sign of complete insight.
Patients with severe depressive disorder may lack a correct understanding of their current state, or even completely lose the desire to seek treatment. This is due to incomplete or lack of insight.
somatic symptom cluster
sleep disorder
Symptoms include difficulty falling asleep, light sleep, dreaminess, early awakening, and lack of sleep sensation. Among them, difficulty falling asleep is the most common. Generally, it is delayed by more than half an hour than usual, and waking up early is the most characteristic. It usually wakes up 2-3 hours earlier than usual, and cannot fall back to sleep after waking up.
Eating and weight disorders
The main symptoms are decreased appetite and weight loss.
loss of energy
It manifests as listlessness, fatigue, and laziness.
Depression is heavier during the day and lighter at night
Depression often worsens after getting up in the morning and decreases in the afternoon and evening. This symptom is one of the typical manifestations of "endogenous depression". However, the symptoms of some patients with psychogenic depressive disorder may worsen in the afternoon or evening, which is contrary to the above.
sexual dysfunction
It can be a decrease in sexual desire or even a complete loss of sexual desire, or sexual dysfunction.
Other non-specific physical symptoms
Such as headache, back pain and other pain in any part of the body, dry mouth, sweating, blurred vision, There are various symptoms such as palpitation, chest tightness, nausea, vomiting, burning sensation in the stomach, frequent urination, and urgency of urination.
Seek medical advice
When you feel you have long-term depression, no interest in anything or a decrease in interest, or even accompanied by slow reaction, slow thinking, decreased memory, etc. When symptoms of depression are suspected, you should seek medical help promptly. In addition, family members or relatives and friends should also actively encourage them to seek medical treatment when they find that their relatives or friends have the aforementioned symptoms.
For patients who have been diagnosed with depression, they should strictly follow the doctor's instructions for treatment and insist on regular follow-up visits, even if the condition has improved after treatment. Get effective control. If there are major changes in your life, or you feel signs of depression, you should seek medical treatment in time.
Diagnosis process
Generally speaking, doctors first need to fully understand the patient's medical history, including but not limited to current history, existing symptoms, Whether you have self-injury or suicidal thoughts and behaviors, whether you have a history of manic episodes or psychotic symptoms in the past, Current treatment status and efficacy, past treatment methods, drug/psychoactive substance use, personal history, family history, etc.
Since the cause and pathogenesis of depression are still unclear, the diagnosis of depression mainly relies on a comprehensive assessment of the patient. The disease is diagnosed based on its clinical manifestations, course, and severity of symptoms, after excluding depressive disorders caused by substances, drugs, or other physical problems.
Which department should I go to for treatment for depression?
You can go to psychiatric hospitals, mental health centers, general hospital psychiatry or psychology departments and other related departments for treatment.
What are the related tests for depression?
mental examination
Doctors will mainly pay attention to the patient's mental and emotional conditions.
·Understand the patient's consciousness, orientation, attention, thinking ability, memory, feeling, perception, intelligence and insight.
·Understand the patient's emotional activities, will and daily behavioral performance, etc., and pay special attention to the patient's emotions.
·Assess patients for mania, cognitive deficits, and psychotic symptoms, Assess the patient's risk for suicide and violence, as well as comorbidities with other mental disorders.
Assessment Tools
Standardized patient self-rating scales and clinical other-rating scales are commonly used in clinical practice to assess the severity of patients' depressive symptoms. Among them, self-rating scales play an important role in screening and assessing depressive disorders in the population.
self-rating scale
9-item Brief Patient Health Questionnaire (PHQ-9);
Zung Self-Rating Depression Scale (SDS);
Beck Depression Inventory (BDI);
Quick Questionnaire for Depression Symptoms Self-Rating (QIDS-SR).
The items of PHQ-9 are consistent with the symptom items of the diagnostic criteria for depressive disorder in DSM-5.
Clinical Other Rating Scale
For use by doctors, there are mainly Hamilton Depression Rating Scale (HAMD) and Montgomery Depression Rating Scale (MADRS). It can not only comprehensively and accurately evaluate the patient's depressive symptoms, but also verify each other with the patient's self-rating scale.
Other assessment tools
Including suicide risk assessment, mania risk assessment, quality of life and social function assessment, Drug Treatment Side Effects Scale, Arizona Sexual Experience Scale (ASEX), Medication Adherence Rating Scale (MARS), etc.
These scales can help doctors assess the patient's risk of depression, whether it is accompanied by mania, A comprehensive assessment of the disease's impact on social functioning, drug side effects and compliance.
What diseases should be distinguished from depression?
Depression needs to be differentiated from secondary mood disorders, schizophrenia and other diseases.
Depression related to physical illness
Many physical diseases, such as cardiovascular system diseases, respiratory system diseases, etc., may It is the direct cause, inducement or accompanying depressive disorder.
During diagnosis, detailed inquiries about relevant medical history and a comprehensive examination should be conducted. In order to clarify the relationship between the two diseases, we can provide active intervention and treatment without focusing on one and neglecting the other.
dementia
Depressive disorders in elderly patients are often accompanied by significant changes in cognitive function, which behave like dementia and are called pseudodementia.
Unlike Alzheimer's disease, which has a slow onset, depression in the elderly has a more rapid onset. Patients have certain requirements for treatment and insight, and their characteristics of lightness in the morning and lightness in the night can also be distinguished from the lightness in the morning and weight in the night of dementia.
When taking psychological tests, patients with depressive disorders are often reluctant to answer questions, while patients with dementia will make up as much as possible.
After antidepressant treatment, the cognitive function of patients with depressive disorders will recover to a certain extent within a short period of time, but this does not occur in patients with dementia.
Schizophrenia
Depression is characterized by low mood as the primary symptom and psychotic symptoms as secondary symptoms, while schizophrenia is just the opposite;
Mental activities such as thinking, emotion, and volitional behavior of patients with depression are coordinated, while those of patients with schizophrenia are uncoordinated;
Depression is an intermittent disease, and the intermittent periods are basically normal, while schizophrenia is mostly a progressive disease, and there are often residual mental symptoms or personality changes during the remission period.
Post Traumatic Stress Disorder (PTSD)
Patients with post-traumatic stress disorder are often accompanied by depressive symptoms, but patients often encounter severe, catastrophic, Traumatic events that threaten life, such as earthquakes, abuse, rape, etc., are followed by anxiety, Emotional changes that are predominantly painful or irritable. Patients often have trauma-related nightmares, Nightmares, etc., often re-experience traumatic events, and there are also recurring compulsive memories.
bipolar depression
Bipolar depression means that there have been manic episodes and depressive episodes, and this episode is dominated by depressive symptoms. Patients with depression have no history of manic episodes and always have depressive symptoms as the main clinical manifestation.
treat
Treating depression not only relieves the patient's pain, but also reduces the burden on the family and society after the patient can return to society.
Treatment of depression mainly includes medication, psychotherapy and physical therapy.
Treatment goals: improve clinical cure rate, improve quality of life, restore social functions, and prevent recurrence.
Treatment principles: the principle of full course treatment, the principle of individualized rational medication, the principle of quantitative assessment, the principle of single use of antidepressants, the principle of alliance treatment, etc.
The full treatment of depression can be divided into three stages, namely acute stage treatment, consolidation stage treatment and maintenance stage treatment.
What medications are available for depression?
Due to large individual differences, there is no absolute best, fastest or most effective medication. In addition to commonly used over-the-counter drugs, the most appropriate drug should be selected based on the individual situation under the guidance of a doctor.
Drugs are the main treatment method for depression, and it is recommended to use antidepressants with good efficacy and high safety. It should be noted that psychotropic drugs should be taken under the guidance of a doctor and strictly in accordance with the doctor's instructions.
The antidepressant drugs currently recommended for clinical use include selective serotonin reuptake inhibitors (SSRIs), Selective serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine and Specific serotonin reuptake inhibitors (NaSSAs), norepinephrine and dopamine reuptake inhibitors (NDRIs), etc.
SSRIs: Representative drugs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram, etc. Common adverse reactions include nausea, vomiting, diarrhea, restlessness, loss of libido, headache, etc.
SNRIs: Representative drugs include venlafaxine, duloxetine, etc. Common adverse reactions are nausea, vomiting, agitation and sexual dysfunction.
NaSSAs: The representative drug is mirtazapine. Common adverse reactions are dry mouth, sedation, and weight gain.
NDRIs: The representative drug is bupropion. Common adverse reactions include headache, tremor, convulsions, agitation, insomnia, gastrointestinal discomfort, etc.
acute phase treatment
·The purpose of treatment in the acute phase is to control symptoms and try to make the patient achieve clinical recovery (complete disappearance of symptoms).
·Antidepressant drugs generally start to take effect in 2 to 4 weeks.
·If drug treatment is ineffective for 6 to 8 weeks, another drug of the same type or another type of drug with a different mechanism of action can be used.
Consolidation phase treatment
·The purpose is to prevent patients from experiencing relapse of symptoms due to early reduction of medication or discontinuation of medication after partial relief of symptoms in the acute phase.
·Patients in the consolidation phase are in unstable condition and have a greater risk of relapse. They need to continue treatment for at least 4 to 6 months. It is necessary to emphasize that the treatment plan, dosage, and usage are the same as those in the acute phase.
Maintenance treatment
In order to reduce the risk of recurrence, the completion of the consolidation phase of treatment should be followed by maintenance phase of treatment.
There is insufficient research on the duration of maintenance treatment. Generally, if there are more than two relapses, especially those with onset in adolescents, Patients with psychotic symptoms, serious illness, high suicide risk, or family genetic history, The duration of maintenance treatment should be at least 2 to 3 years; those with multiple relapses (3 or more times) are advised to undergo long-term maintenance treatment.
Generally, the acute phase treatment dose is used as the maintenance treatment dose, which can effectively prevent recurrence.
After the maintenance treatment is completed and the condition is stable, the medication can be slowly reduced (several weeks) until the treatment is terminated. At the same time, early signs of recurrence should be closely monitored, and once they occur, the original treatment dose should be quickly restored.
What other treatments are available for depression?
psychotherapy
Psychotherapy mainly refers to treatment through talking and communicating with doctors. According to different problems targeted, it can be divided into supportive psychotherapy, cognitive behavioral therapy, Psychodynamic therapy, interpersonal psychotherapy, marriage and family therapy, etc.
Psychotherapy is often combined with drug treatment.
Psychotherapy is as effective as antidepressants for mild to moderate depression.
It should be noted that with severe or endogenous depression, Psychotherapy often cannot be used alone and needs to be used in combination with medications.
Physiotherapy
In clinical practice, modified electroconvulsive therapy (MECT) and Treatment adjuvant treatments such as repetitive transcranial magnetic stimulation (rTMS), among which, MECT can quickly and effectively treat depression and significantly reduce suicide mortality in patients.
How is depression treated with traditional Chinese medicine?
There is currently no evidence-based medical evidence to support the traditional Chinese medicine treatment of depression. However, some traditional Chinese medicine treatments or medicines can relieve symptoms. It is recommended to go to a regular medical institution and receive treatment under the guidance of a physician.
prognosis
Antidepressant drug treatment affects depressive mood and accompanying anxiety, It has therapeutic effects on both stress and physical symptoms, with an effective rate of 60% to 70%. Therefore, actively cooperate with the doctor’s treatment and strictly follow the doctor’s instructions when taking medications. Most patients' symptoms can be relieved and they can return to their pre-disease condition.
However, recovery from depression is related to many factors, and some patients may experience recurring episodes of depression. The course of depression may even become chronic, causing patients to have residual depression-related symptoms. Abilities such as social and vocational skills may also be affected to varying degrees.
Suicide is one of the most serious consequences of patients with depressive disorders, and the suicide rate in patients with depression is significantly higher than that in the general population.
How to recover from depression?
Patients with depression should receive rehabilitation treatment in professional medical institutions. Including the rehabilitation of personal self-care ability, rehabilitation of family functions, Rehabilitation of social skills and rehabilitation of vocational skills, etc.
Effective rehabilitation treatment can help patients build confidence in their recovery from the disease, It can help patients return to daily life and re-adapt to society more quickly, It can also reduce the burden on patients’ families.
Will depression return?
After a patient's first depressive episode is relieved with effective treatment, about half of the patients will not relapse. However, patients who have experienced three or more depressive episodes or who have not received maintenance treatment, The risk of recurrence will increase significantly, reaching more than 90%.
Unable to obtain adequate support from relatives, friends and society in daily life, Unable to adapt to society well, encountering stressful events, combined with chronic physical diseases, Failure to take antidepressant medications strictly as prescribed by your doctor may lead to the recurrence of depression.