Can depression really be treated? Despair as a family member of patients with depression?
There are people with depression at home, especially those with severe depression. After a long period of treatment, they seek medical treatment everywhere, such as taking medicine, psychological counseling, even massage, acupuncture, superstition and so on. As a family member, anxiety and despair are understandable.
The core problem of depression is that patients can't see their own advantages and strengths, their own future and hopes, and they think they are useless and their future is in a mess, so they are anxious and desperate. However, many patients with depression have many successful experiences. They are excellent people and promising people in the eyes of others, so adjusting depression is also to reshape their original state with their former Excellence.
As long as you have the determination to recover quickly, cooperate actively and be considerate of your family, you can recover.
The first thing is to make a diagnosis-because many physiological diseases may have symptoms of depression, so the first step of treatment is to do a comprehensive physical examination. In addition to excluding physiological factors (such as cancer, malnutrition, mild stroke and some metabolic disorders), it is also important to comprehensively review the recent treatment of patients, because some drugs may produce side effects similar to depression (such as fatigue or excessive excitement affecting sleep). Once these possibilities are ruled out, the next step is to choose the appropriate treatment strategy. In China, many patients with major depression can't get professional treatment. A large part of the reasons are that they can't recognize symptoms, are ashamed to seek medical treatment or lack evidence-based treatment knowledge. In fact, depression should be treated and can be treated. With the help of professional medical institutions and doctors, even patients with severe depression can be effectively relieved. Under the existing treatment conditions, the treatment of depression can be divided into two types: one is psychotherapy and the other is biotherapy.
1. Psychotherapy
Psychotherapy focuses on understanding how thoughts, perceptions, behaviors and depression interact. They are generally conducted by trained doctors (clinical psychologists or qualified clinical social workers in most cases) in a one-on-one or group way, which is an important part of the comprehensive treatment plan for depression. (1) Cognitive behavioral therapy. The premise of cognitive behavioral therapy is that individuals can learn to think and act differently from before, thus improving their mood. A key component of cognitive behavioral therapy is to let patients record their thoughts, emotions and behaviors. Through this monitoring, patients can identify depression or triggers and situations related to improving mood. Once the trigger is determined, the patient learns to recognize and adjust the automatically distorted thoughts and make behavioral changes to improve mood and function. For example, after a patient insisted on recording her feelings and thoughts, she found that whenever the weekend approached, her mood was always very low. A few days before each week, she would concentrate on completing work-related tasks, but she found that by Wednesday or so, she began to think, "Everyone else is planning the weekend, so I will be alone as usual." On Friday morning, she is always negative, and her thoughts will get worse: "I am a complete loser." "No one will want to be with me." Through the efforts of her and clinical therapists, she began to overcome these negative thoughts with a more balanced thinking, and there were fewer ideas of "all or nothing". For example, she no longer thinks that "no one will want to be with me", but that "I didn't give others a chance to know who I am, so I must take the initiative". Once she realizes this weekly pattern, she will take these negative thoughts as a call to action, rather than a signal that will inevitably lead to pain and loneliness on weekends.
(2) Interpersonal psychotherapy. This treatment emphasizes the importance of existing interpersonal relationships to mental health. Its core principle is that interpersonal problems can lead to depression, and depression itself affects interpersonal function. Interpersonal psychotherapy focuses on the discussion of interpersonal problems (sadness, role change, disputes, interpersonal defects) to guide treatment. Therapeutic techniques include emotional expression, emotional clarification, communication analysis and behavior change. Interpersonal psychotherapy is effective for mild to moderate depression, and can also be used to treat mood disorders, depression, anxiety and eating disorders in adolescents and the elderly.
(3) Behavior activation. Based on the theoretical basis that depression is caused by the lack of positive reinforcement, the focus of early behavioral intervention is to enhance pleasure, so it is strengthened through the timetable of pleasure activities, social skills training and time management strategies. Behavioral activation therapy for depression has made some improvements on this method, emphasizing the need to increase positive emotions by increasing the positive reinforcement of healthy behaviors. For example, for some patients trapped in a dead-end job, the treatment will include arranging them to go to the library to read books about career development every week. In behavioral activation therapy, therapists and patients will make a comprehensive list of goals in important areas of life. Every week, therapists and patients * * * formulate more specific goals and activities, which are completed by patients. When patients achieve these goals, increased positive reinforcement helps to reduce depressive symptoms.
2. Biotherapy
The most common biological therapy is drug therapy, which changes the chemicals in the brain and body that regulate mood. These treatments are very effective in relieving depressive symptoms, especially when they are combined with psychotherapy.
(1) The first generation of antidepressants-tricyclic antidepressants and monoamine oxidase inhibitors. Monoamine oxidase inhibitors (Maois) and tricyclic antidepressants (antidepressants; Tricyclic antidepressants (TCA), sometimes called traditional or first-generation antidepressants. Monoamine oxidase inhibitors can inhibit (prevent) the action of monoamine oxidase in the treatment of depression. Usually, this enzyme breaks down the neurotransmitters norepinephrine, serotonin and dopamine in the brain. By blocking the operation of this enzyme and improving the utilization rate of these neurotransmitters in synapses, it is considered to have antidepressant effect. These drugs are effective, especially for patients with depressive symptoms such as drowsiness and weight gain. People who take MAOIs should avoid eating foods containing tyramine, because the interaction between these foods and drugs can lead to high blood pressure (very high blood pressure) and may lead to death. Foods containing tyramine include smoked/pickled/cooked meat or fish, pickles, old cheese, yeast extract, broad beans, beef or chicken liver, cooked sausage, game, red/white wine, beer, white wine, gravy, caffeinated drinks, chocolate, sauce, white cheese, cream cheese, yogurt and yogurt. Because of these potentially dangerous side effects, MAOIs is usually only suitable for patients who do not respond to other drugs. The working principle of tricyclic antidepressants is to prevent the reuptake of neurotransmitters in the brain, mainly norepinephrine and serotonin. By preventing their reabsorption in neurons, their availability in synapses is prolonged. The names of these drugs are based on the fact that they all have tricyclic molecular structures. A large number of randomized clinical trials recorded the efficacy of these drugs compared with placebo. Usually patients need to take medicine for 6-8 weeks. If the response is positive, drug treatment may need to last for many months to prevent recurrence. It is very important that these drugs should not be stopped suddenly. The first generation of antidepressants are usually accompanied by a variety of side effects, including dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, daytime sleepiness and increased heart rate. Therefore, they are no longer the first choice for the treatment of depression.
(2) Second-generation antidepressants. The second generation antidepressants include selective serotonin reuptake inhibitors (SSRLS) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Fluoxetine is probably the most famous antidepressant. Approved by the US Food and Drug Administration (FDA) on 1987. At present, the working principle of the second generation antidepressants is not completely clear. In a word, their curative effect is to restore the normal chemical balance by selectively inhibiting the reuptake of 5- hydroxytryptamine by presynaptic membrane. SNRIs inhibits the reuptake of serotonin and norepinephrine, and to a lesser extent inhibits the reuptake of dopamine. SSRIs and other second-generation antidepressants seem to be as effective as TCAs and MAOIs. Their advantages are fewer and milder side effects than TCAs (side effects may include sexual problems, headache, nausea, nervousness, difficulty sleeping or waking up at night and nervousness), and these side effects are usually well tolerated by patients. At the beginning of 2 1 century, concern about the potentially fatal side effects of SSRIs increased. Several widely publicized cases led the FDA to issue a "black box" warning label, indicating that antidepressants increase the risk of suicidal thoughts in children and adolescents with severe depressive disorder. This is the most serious warning issued by the FDA on prescription drugs. It is necessary to closely monitor the treatment of young people using SSRIs drugs, especially in the first four weeks of depression. It is necessary to monitor the increase of depressive symptoms, suicidal thoughts or behaviors, or behavioral changes such as insomnia, irritability or social withdrawal. Despite the potentially dangerous side effects, these drugs have not been banned because they provide tangible benefits to adolescents with moderate and severe depression, including those who have suicidal thoughts. The drug mechanism of increasing suicidal thoughts and behaviors is still unclear. Some people suspect that SSRIs improves physical symptoms before the mood rises. Therefore, in the early stage of treatment, teenagers may feel more energetic, and this increased energy and minor changes in depression increase the possibility of putting suicidal thoughts into action. However, although careful and careful monitoring is necessary, many retrospective studies have finally concluded that the benefits of SSRI treatment far outweigh its risks.
(3) Electroshock therapy. Drug therapy is not the only biological therapy for severe depression. Electroconvulsive therapy (ECT) is one of the most effective treatments for severe depression, especially for people who are extremely depressed, unresponsive to drugs or psychotherapy, unable to take antidepressants or at serious risk of suicide. ECT is also effective in treating mania. As in the past, ECT is controversial, and some doctors and patients are still worried about the problems reported in the past few years. Initially, ECT was used to treat mental disorders. At that time, the patient did not use muscle relaxants, which often caused injuries due to strong spasms. In addition, the placement of bilateral electrodes usually leads to obvious permanent memory loss. Modern ECT methods are safer and more humane than earlier methods, and usually relieve symptoms faster than any medicine or psychotherapy. Current treatment procedures include the use of muscle relaxants and short-term general anesthesia. Electrodes are placed at precise positions on the scalp and send electrical pulses to cause temporary cerebral spasm. Its mechanism of action is still a mystery. The induced seizures do not specifically point to specific brain regions, but affect the secretion of certain neurotransmitters. Modern unilateral (unilateral) methods are equally effective and cause less amnesia. At present, the most common side effects of ECT are confusion and temporary amnesia after treatment. The application of ECT is usually several times a week for several weeks.
(4) Phototherapy for seasonal emotional disorders. Seasonal affective disorder (SAD) was first proposed by Norman Rosenthal, a psychiatrist at the National Center for Mental Health Research in the United States, in 1984. This is a subtype of major depression that plagues millions of people all over the world. SAD has the characteristics that depressive episodes are affected by seasonal changes. Although some patients will experience summer depression, most of them will attack in 65438+February, 65438+ 10 and February. Symptoms of SAD in winter include increased appetite, increased sleep, increased weight, difficulty in interpersonal communication, and a feeling of heavy limbs. The origin of SAD is not completely clear, and people think that the main reason is biology, if not all. It is particularly interesting that the farther away from the equator, the higher the prevalence and severity (although beyond a certain latitude, it began to show a stable state). In addition, relatively sensitive people may show more obvious symptoms on cloudy days. This shows that the decrease of exposure time to sunlight is related to the etiology of SAD, which may be caused by the increase of melatonin secretion. Melatonin is a hormone released by the pineal gland, and the secretion of melatonin will increase after a long period of darkness. Exposure to the sun will inhibit the secretion of melatonin. For patients who have no serious suicidal tendency or can't take antidepressants, phototherapy can be used. Include exposing the patient to strong light, which is usually formed by an artificial light source such as a light box, a visor or a dawn simulator. The brightness produced by these devices is about 10 times higher than that of ordinary household light bulbs. At the same time every day (usually in the morning), patients are treated with phototherapy, usually ensuring that the light lasts for 30 ~ 90 minutes. The patient sits under the light source with his eyes open, allowing the light to reach the retina. Treatment usually begins every winter when symptoms appear and lasts until spring. Because there is no need to use full spectrum light in phototherapy, ultraviolet rays will be filtered out to avoid hurting eyes and skin. However, phototherapy occasionally produces side effects, including photophobia (eyes are sensitive to light), headache, fatigue, restlessness, hypomania and insomnia. In addition, light boxes are expensive and are usually not covered by insurance. Despite these potential shortcomings, in all cases, a large number of cases show that phototherapy is effective in treating SAD.
(5) Transcranial magnetic stimulation. Transcranial magnetic stimulation (TMS) uses an electromagnetic coil placed on the patient's head to deliver painless local electromagnetic pulses to some brain regions. It is not clear how this therapy works. However, some clinical trials have compared it with the placebo program and concluded that transcranial magnetic stimulation can be an effective alternative to ECT or drug therapy. Lightbox therapy is sometimes used to treat seasonal mood disorder (SAD).
(6) Deep brain stimulation. Deep brain stimulation (DBS) is a kind of therapy targeting at the cingulate gyrus below the knee, which is very important for regulating the changes of negative emotions. Electrodes are implanted into specific abnormal brain regions by surgery. These electrodes are connected to a pulse generator (or "brain pacemaker") implanted in the chest wall by connecting wires. The electrode will continuously release tiny electric pulses to immediately inactivate (rather than kill) the surrounding brain cells. In this way, DBS can treat diseases characterized by overexcitation by inhibiting abnormal activities in specific brain target areas. DBS has been approved by FDA to treat Parkinson's disease and some tremor-like diseases. DBS is also used to treat mental illness. 200 1 treatment of obsessive-compulsive disorder with DBS. The results show that DBS can significantly improve the symptoms of anxiety, compulsion and depression in * * * disease. In March 2005, DBS was used to treat 6 cases of long-term refractory depression. Some patients reported that their mood improved immediately: they suddenly felt intense calm and relaxation, their mental dullness was swept away, the dark clouds cleared away, their sense of emptiness disappeared, and the fears hidden in their chests subsided. In addition, the researchers found that patients' spontaneous speech speed increased with the increase of movement speed. Although these results are interesting, they are still preliminary. The efficacy of DBS needs to be confirmed by a larger clinical controlled trial.
Depression can be cured. I can't let go of this disease in my heart, and I can't control my own thoughts, which leads to insomnia and weakness. The main reasons are sadness and fear. Sorrow is related to the lungs, and fear is related to the kidneys. Find Chinese medicine to regulate the five internal organs and keep the balance of the five internal organs. Multi-stage exercise. Adjust yourself in your heart and tell yourself every day, for parents and children. Let go of everything in your heart. Do as I say. The disease will be eradicated in three months. The patient is too young to see a psychiatrist, and his family members should be considerate and understanding.
Mainly depends on patients themselves, whether they have the determination to get out of the quagmire of depression. When he realized that he had a problem and took the initiative to ask for help, he could come out.
The best help from his family is not to comfort him, criticize him or encourage him with empty words. The best way is to accept his state. He can have a good rest if he wants to, and spend time with him if he wants to go out. Don't ask him self-righteous. For example, forcing him to play in the park and asking him to run for exercise are useful to others and may be useful to him, but we should do what we can on the premise of our own will.
Let go of all expectations and spend every day with him. This seems to be slow, but it is actually the fastest way to recover.
There is no incurable disease, only people who give up on themselves. Now that medicine is so developed, many people suffering from depression can recover. As a family member, we must face it positively, seek medical treatment in time, and cooperate with doctors for treatment. If you don't believe that you can get better, the child has no hope. Many diseases are actually related to mood. The more negative you are, the worse your health will be. There are not a few people who scare themselves and make their illness worse. So you must be open-minded and optimistic, and wish your child a speedy recovery.
Due to various factors such as life pressure, many people suffer from depression. Many people's depressive symptoms are anxiety, insomnia or obsessive-compulsive disorder. But depression can be controlled. Taking medicine under the guidance of doctors will affect health and reduce the quality of life, but many patients are unwilling to face active treatment. This is wrong. The influence of mental illness on their lives cannot be underestimated.
First of all, it should be clear that depression is a physical disease, not a mental illness. Therefore, we must treat according to the treatment attitude of physical diseases, take medicine according to the doctor's advice on time, and review regularly. The treatment and rehabilitation of depression is very long and arduous, but there are really many examples of cure around!
Clinical data prove that there is a great correlation between depression and endocrine disorders. Regular aerobic exercise can greatly improve endocrine regulation, which is why many depressed patients completely fight depression by running marathon! I hope it helps you.
You are a family member. I'm sure it will get better. If the patient sees that his family has no hope for his illness, he certainly has no desire to survive. I wish him a speedy recovery.
Personally, I feel depressed because I am full. Keep doing things every day and fall asleep when you are busy, as long as you don't give yourself a chance to entertain foolish ideas. It's just that I'm full. I've never heard of depression caused by moving bricks on the construction site.