Problem description:
As the title!
Analysis:
Depression is one of the most common mental diseases at present. In recent years, the incidence rate in various countries in the world has been on the rise.
Depression is mainly manifested as depression, mental retardation and decreased will activity, and most cases still have various physical symptoms.
(1) Depression: The basic characteristics are depression, distress and sadness, and lack of interest. I feel pessimistic and desperate, I feel very painful, and I feel that I am dying. Often used to describe one's inner experience, such as boredom and unhappiness. Typical people are depressed, heavy during the day and light at night. Often associated with anxiety.
(2) Slow thinking: the process of thinking association is inhibited, the reaction is slow, and the brain consciously stops activities, which is manifested by the reduction of active speech, the obvious slowdown of speech speed, and the difficulty of thinking. Slow response, need to wait for a long time, under the influence of depression, low self-evaluation, inferiority, uselessness, worthlessness, feeling that living is meaningless, pessimistic suicide, self-blame, thinking that living is a burden, committing a big crime, having the concept of hypochondriac disease on the basis of physical discomfort, and thinking that they have an incurable disease.
(3) Decreased will activity: the initiative activity is obviously reduced, and people are passive. People are unwilling to participate in activities that are of interest to the outside world and often stay alone. Life is lazy and develops into silence, which can reach the level of stupor. The most dangerous thing is repeated suicide attempts and behaviors.
(4) Physical symptoms: Most patients with depression have physical and other biological symptoms, such as palpitation, chest tightness, gastrointestinal discomfort, constipation, loss of appetite and weight loss. Sleep disorders are prominent, mostly difficulty falling asleep.
(5) Others: hallucinations, depersonalization, reality depersonalization, compulsion and terror symptoms may also occur during depressive episodes. Because the thinking association is obviously slowed down and the memory declines, it is easy to affect the cognitive function of elderly patients and appear depressive pseudodementia.
Mild depression often complains of dizziness, headache, fatigue and insomnia, which is easily misdiagnosed as neurasthenia. The latter has certain psychological and social factors before the onset, such as long-term tension and excessive brain use. Emotions are mainly anxiety and fragility. The main clinical manifestations are emotional symptoms such as mental fatigue, nervousness, annoyance and irritability related to mental excitement, as well as physiological dysfunction symptoms such as muscle tension pain and sleep disorder. Good insight, passive symptoms, eager to seek treatment. Depression is mainly depression, accompanied by mental retardation, inferiority, self-guilt, wanting to die, biological symptoms (such as day and night mood, loss of appetite, * *) and so on. ). Self-knowledge is often lost, and it can be recognized without actively seeking treatment.
Recessive depression is an atypical depression, which is mainly manifested by repeated or persistent physical discomfort and autonomic symptoms, such as headache, dizziness, palpitation, chest tightness, shortness of breath, numbness of limbs, nausea and vomiting. Depression is often masked by physical symptoms, so it is also called depression allele. Most patients go to other departments instead of psychiatry. Physical examination and auxiliary examination often have no positive manifestations and are easily misdiagnosed as neurosis or other physical diseases. Symptomatic treatment is generally ineffective, and antidepressant treatment is effective.
Treatment of depression
The severity and symptoms of depression are different, and the commonly used treatment methods are:
(1) drug therapy: different drugs should be selected according to different symptoms.
1. Patients with anxiety and agitation should use amitriptyline, daily dose 150 ~ 300 mg, divided into 2 ~ 3 times;
2. Mipamine should be used in patients with depression who are slow and disobedient, and the dose is the same as amitriptyline;
3. Doxepin is used for depression patients with anxiety and obvious sleep disorder, and the dose is the same as amitriptyline;
4. Clomipramine is used for depressive patients with obsessive-compulsive disorder and panic disorder. The dose is 100 ~ 200mg per day, and it is taken 2 ~ 3 times.
5. Trim Impramine is used for patients with depression accompanied by anxiety and numerous complaints, with the same dose as amitriptyline;
6. Maprotiline is used in elderly patients with depression accompanied by anxiety and sleep disorder, and the dose is the same as amitriptyline;
7. Patients with depression accompanied by retardation and withdrawal symptoms use paroxetine at a dose of 20 ~ 60mg； every morning;
8. The elderly patients with depression accompanied by compulsion and fear were treated with fluoxetine at a dose of 20 ~ 60mg； every morning;
9. For patients with endogenous or drug-induced depression, monoamine oxidase inhibitors can be selected, with a dose of 50 ~ 100 mg per day, taken twice or three times;
10, for patients with depression accompanied by hallucinations, delusions and other symptoms of schizophrenia, antipsychotics, such as sulpiride or perphenazine, should be used in combination, and the general dose is moderate;
1 1. Depressive patients with obvious retardation and withdrawal symptoms can choose central nervous system stimulants, such as ritalin and pimoline;
12. Patients with refractory depression can be treated with soothing agents;
13, menopausal depression patients can be combined with hormone therapy.
(2) electroconvulsive therapy: For depressed patients with stiff limbs and strong suicidal words and deeds, electroconvulsive therapy can receive immediate results. In addition, it is also an effective treatment for patients with refractory depression.
(3) Sleep deprivation therapy: mainly used for endogenous depression and refractory depression. The method is to keep the patient awake on the day of treatment (take a lunch break for 30 ~ 60 minutes when necessary) and stay up all night; Stay awake during the day and don't take a lunch break before going to bed at night. As a treatment, it is treated twice a week, with 8 ~ 10 as a course of treatment. This treatment is forbidden for the elderly and patients with serious physical diseases.
With the increase in the number of patients with depression and the rapid development of psychopharmacology, more and more new varieties of antidepressants are being developed. Clinical commonly used antidepressants are divided into the following three categories.
(1) Tricyclic antidepressants: At present, the commonly used antidepressants mainly include imipramine, amitriptyline, doxepin, clomipramine and norimipramine. Its pharmacological action is related to blocking the reuptake of norepinephrine and serotonin in the brain, which can inhibit the reuptake of norepinephrine and serotonin by the presynaptic membrane of nerve endings, thus increasing the transmitter concentration in the receptor site and playing an antidepressant role.
(2) Bicyclic and tetracyclic antidepressants: Maprotiline, as the representative, has similar pharmacological effects to tricyclic antidepressants.
(3) Monoamine oxidase inhibitors: reversible and irreversible, with moclobemide as the representative of reversibility and phenelzine as the representative of irreversibility. Because of their high toxicity, these drugs are rarely used now. Its pharmacological function is to inhibit monoamine oxidase, reduce the degradation of norepinephrine, 5- hydroxytryptamine and dopamine, increase the content of catecholamine in the brain, and play an antidepressant role.
At present, some new antidepressants introduced clinically are mainly selective serotonin reuptake blockers, including fluoxetine, sertraline and paroxetine. Its pharmacological action is to selectively block the reuptake of 5- hydroxytryptamine by presynaptic membrane of nerve endings, thus increasing the level of 5- hydroxytryptamine in synaptic cleft and exerting its strong antidepressant effect. It is precisely because of the high selectivity, relatively few side effects and high compliance of patients with this drug that it is a new drug with broad development prospects.
Studies have shown that taking medicine is not the only way to fight depression. According to USA-Today, about 500,000 children and teenagers in the United States take antidepressants. There are also data showing that the proportion of children suffering from depression is much higher than before. Relatively speaking, the current drugs have less side effects and are considered safer for children. Although many young people have made remarkable progress after taking these antidepressants, doctors have not prescribed them. This problem has attracted the attention of some parents and doctors. These concerns have an indisputable basis: the US Food and Drug Administration has not approved any drugs for children. This shows that the Committee has not realized that these antidepressants are safe and effective for children. Parents and teachers are also thinking about whether drugs are the only weapon to fight depression. What should families and schools do? American society should further reflect on the social reasons behind this phenomenon.
depress
Depression is a kind of mental illness with abnormal mental state as its main clinical manifestation, and its prevalence rate is still 3-5%. This kind of cheek is more frequent or aggravated in spring and autumn, and it tends to recur, similar to the familiar sadness, but more lasting. The patient was depressed and worried all day, sighing. Serious people are depressed, pessimistic and desperate, and feel that "life is like a year" and "life is worse than death". The more they blame themselves, the more negative thoughts they have, and the better world turns gray in their eyes.
Many people are afraid to admit their pain and depression, afraid of being mistaken for "mental illness", and try their best to deny and cover up their illness, which will only delay the treatment opportunity and turn depression into a chronic and intractable disease.
People with depression don't go to see a psychiatrist because they are depressed. They often go to the internal medicine or neurology department of a general hospital to treat a series of physical symptoms related to depression, such as headache, dizziness, fatigue and memory loss, which leads to some patients being misdiagnosed as neurosis, menopausal syndrome, migraine, insomnia, or being diagnosed as yin deficiency and blood deficiency in traditional Chinese medicine.
A simple way to identify typical depression, that is, a person's depression lasts for more than two weeks, accompanied by any of the following nine symptoms:
1. Lost interest or unhappy * * *, feeling that nothing can cheer them up.
2. Loss of energy or continuous fatigue, difficulty in recovering physical strength, and bed fatigue.
3. Decreased activity or slow action, and I just want to spend most of the day in bed.
4. Excessive remorse or guilt, blaming yourself for some small mistakes in the past.
5. Lenovo is difficult or unable to concentrate, feeling that the brain is stagnant.
6. Repeated suicidal thoughts or behaviors.
7. Insomnia or early awakening, with prominent depression in the morning.
8. Lose weight or appetite, or even refuse to eat.
9.*** decline, or even nothing.
The common types of depression are as follows:
1. Endogenous depression.
2. Psychological depression.
3. Secondary depression.
Treatment:
In addition to the use principle of antidepressants, the treatment methods of the above different types of depression also have their own emphasis. The treatment of endogenous depression mainly depends on drugs, and electroconvulsive therapy can be used if necessary; To treat the symptoms of psychological depression and depressive neurosis, we should give priority to psychotherapy, encourage patients to talk about their inner depression with goodwill and sympathy, and give guidance and help so that patients can enjoy the environment and get social support; The treatment of secondary depression tries to eliminate the pathogenic factors and try to treat the body and disease; Hormone therapy can be used for menopausal depression patients with endocrine dysfunction.
Why can selective deprivation of rapid eye movement sleep treat depression?
The treatment of depression by selectively depriving REM sleep was initiated by vogel (1968) and other researchers in the late 1960s. The reason why they thought of using this treatment method was inspired by the following three aspects:
(1) The effective methods to treat depression are electric shock and antidepressants. Both electroshock and antidepressants can significantly inhibit REM sleep. Therefore, rem sleep deprivation may have the effect of treating depression.
(2) People who take reserpine sometimes suffer from drug-induced depression, and reserpine can increase REM sleep. This is strong evidence.
(3) In animal experiments, rem sleep deprivation can often enhance behaviors related to instinct, increase the activity of experimental animals, and increase their appetite and * * *. The clinical manifestations of depression are decreased activity, decreased appetite and * * *. Therefore, it is considered that rem sleep deprivation may have therapeutic effect on behavior.
Practice has proved that selective deprivation of rapid eye movement sleep can alleviate depressive episodes. However, this treatment method needs examination equipment and personnel in the sleep laboratory, which is quite troublesome, and because its curative effect is not better than taking antidepressants, it has no clinical promotion value.
What kind of disease is depression and whether it can be cured is the first concern of patients. Some patients heard the doctor say that they were suffering from depression. I was shocked, thinking that I was mentally ill and my future was all over. In fact, this is a complete misunderstanding, because mental health knowledge is not universal.
Depression is a common mental illness abroad. According to reports, its highest prevalence rate accounts for about 10% of the population, and the higher the socio-economic situation, the higher the prevalence rate. In our clinic, depression is also common in people with high social level, good economic conditions and fierce competition, so the occurrence of depression is closely related to social development. However, according to the survey, the prevalence of depression in China is not as high as that abroad. There are several possible reasons:
1. Foreigners tend to be extroverted and their emotions are easy to show, so they are also prone to emotional changes; But China people are very patient. When things happen, they can restrain themselves.
2. The knowledge of mental health abroad is very popular, and there is less discrimination when there are psychological obstacles, so if there are any emotional changes, please consult a psychologist at any time; In our country, there is still a serious prejudice against the mentally handicapped, which makes them afraid to consult a psychologist in time for fear that others will gossip and damage their future.
3. The pace of work abroad is fast, the competition is fierce, and people are easily nervous and tired. Failure in competition will undoubtedly cause an emotional blow; Although China has entered a competitive society, the traditional habit of "iron rice bowl" still exists, with a relatively secure life and a much slower working pace than that of foreign countries, so it does not constitute a strong emotional blow.
4. Differences in diagnostic criteria. The classification of mental illness abroad is somewhat different from that in China. For example, some countries have abolished the diagnostic name of neurasthenia, and in addition, they no longer distinguish between affective psychosis, depressive neurosis, reactive depression and menopausal depression. They are all classified as depression, so the incidence range is relatively large and the prevalence rate is of course high. This is an academic question, so readers don't have to get to the bottom of it too much. Of course, there will be some introductions later.
At this point, readers must not understand what kind of disease depression is. At present, the diagnosis of depression in China has two meanings. Depression in a broad sense includes affective psychosis, depressive neurosis, reactive depression, menopausal depression and so on. In a narrow sense, it only refers to emotional psychosis and depression. Depression introduced in this book is mainly in a narrow sense, and other types will also be introduced. Depression, whether in a broad sense or a narrow sense, is a mental illness with a good prognosis, that is to say, it can be completely cured, and there will be no sequelae after cure, and you can work, study and live as before. However, the depression of affective psychosis may recur, and patients should closely cooperate with doctors and take effective measures. After the last attack, you should prevent future attacks, but even if you have multiple attacks, your mental state will remain normal when you don't attack. This period of time is called intermission.
Emotional psychosis is a kind of mental illness characterized by high or low mood, also known as manic depression. Some patients have repeated manic or depressive episodes, which are called unipolar affective psychosis; Some patients have recurrent symptoms of mania and depression, which is called bipolar affective psychosis. The two are slightly different in specific treatment, and the latter has more offensive opportunities.
Although depression is a good disease after recovery, patients are very painful at the onset and can't see their future clearly. If they are influenced by traditional prejudice, they will not go to the psychiatric department for early diagnosis and treatment in time, delay their illness and suffer lasting pain. What's more, it's a pity that some patients committed suicide and left this world. This kind of case is too common, and the author has heard a lot. Generally, it is not until a serious situation occurs that family members show remorse, but it is too late to regret it. For this kind of disease with good prognosis, patients should not ruin their future, their families should treat it rationally, seize the opportunity to ask a specialist for treatment, stop tossing and turning in other clinical departments, and go to a psychologist. If so, in case of serious consequences, the family members do have the responsibility.
How to conduct self-assessment for depression? Neurasthenia, the name of disease diagnosis, is still used in China and belongs to the category of neurosis. Many people suffer from this disease, and they often go to internal medicine and neurology clinics for diagnosis and treatment. They seldom think of seeing a psychiatrist first. They just want to try psychiatry because they have been cured for a long time. Some foreign countries have abolished neurasthenia in the classification of diseases. Some foreign scholars have studied the patients diagnosed as neurasthenia in a domestic hospital, and the results show that most of them belong to depression or anxiety, not neurasthenia. Scholars in China disagree with this view. At present, most scholars advocate retaining the name of neurasthenia, but they also think that the diagnosis of neurasthenia in China is too broad, and some patients without neurasthenia have also been diagnosed as neurasthenia, some of whom are essentially depression.
So, how to distinguish neurasthenia from depression? It is very difficult, and the two are very similar. For example, the author met a patient who had been feeling headache, dizziness, fatigue, abdominal distension and pain in the loose parts all day for 4N5 years. When she walks, her heart beats faster, she has shortness of breath, chest tightness, loss of appetite, constipation and dreamy sleep. She wakes up at 4-5 in the morning, so she is groggy at work during the day, but she insists on attendance every day and works hard to complete the task. EEG, B-ultrasound, CT and other special examinations were all negative. The diagnosis is all neurasthenia. I have taken brain tonic, vitamins, traditional Chinese medicine and acupuncture, and I have also bought nutrition and supplements myself. Thousands of dollars have been spent. Someone introduced her boyfriend, but she refused, thinking that she couldn't control it, so she continued to hurt others and gradually became pessimistic and negative. She thinks it is better to leave this world as soon as possible, because she is too tired to live with illness. After seeing the doctor, she took antidepressants for two weeks. The above symptoms gradually disappeared, her mood became more and more cheerful, her sleep and appetite improved, and she was full of confidence in the future. Follow-up 1 year, the situation has been good, and the drug has been stopped.
The general clinical manifestations of this patient are very similar to neurasthenia. I complain a lot, but after taking antidepressants, it takes effect quickly. Practice has proved that her illness is not neurasthenia, but depression, which is called depression. Recessive depression shows many physical symptoms on the surface, but its essence is depression, but the symptoms of depression are covered up by physical symptoms, so it is named.
If carefully analyzed, the patient has several points worthy of attention, and her overall mood is low. Lack of energy, lack of confidence, pessimism about the future, easy to fatigue. Wake up early in sleep, loss of appetite, etc. All these suggest that the diagnosis of depression should be considered, and there are several points that are helpful for the diagnosis:
1. Her symptoms have a pattern, and morning is more important than night. She complained that the mistakes in the morning were the worst, fatigue and dizziness, but at night she felt relaxed. She watches TV and talks to people who feel better, generally neurasthenia patients. In the evening, her symptoms became more serious, which was contrary to the patient's law.
It is understood that both her grandfather and her second uncle committed suicide, and the specific skin condition is unknown. It is speculated that she may suffer from depression.
If the patient has a staged neurasthenia attack in the past medical history, the possibility of depression should be considered more. After two or three weeks of antidepressant treatment, the patient's symptoms were obviously relieved, which also proved that she really suffered from depression from the perspective of treatment.
Because the knowledge of mental health in China is not universal and there is prejudice against mental patients, neurasthenia patients often go to other places; In clinical diagnosis and treatment, other clinicians often think of the diagnosis of neurasthenia as soon as they hear these symptoms and have no abnormal findings through objective examination. Due to the failure to take effective treatment measures, the patient suffered for many years and could not be relieved. This kind of case is common in clinic, and I hope there will be similar cases. Patients with symptoms may wish to go to the psychiatric department for psychological consultation, especially those with intractable neurasthenia. Considering that some (not all) of them may belong to depression, timely treatment with antidepressants may sometimes have immediate effects. This kind of patients have poor tolerance to antidepressants and are particularly sensitive to the side effects of drugs, so they should start with low-dose treatment and gradually increase the dose. Patients should also be psychologically prepared for the occurrence of side effects of drugs. Once there are side effects, be patient, keep taking them, and don't give up halfway. Many people fail in treatment because they don't insist on taking it. After eating for a few days, I felt uncomfortable, so I stopped taking the medicine without authorization, and then I switched to other doctors for treatment. Repeated tossing and turning, nothing, delayed their illness, patients naturally continue to suffer from the disease.
Self-treatment measures for patients with depression worldwide, the number of patients with depression has increased significantly. They feel very painful and even negative and world-weary. According to the actual situation of patients with depression, the National Institute of Mental Health of the United States puts forward the following self-treatment measures:
(1) Never set some unattainable goals for yourself, but have a correct understanding of your present situation, face up to your illness, and stop taking on many positions and doing everything.
(2) You can divide a big and complicated job into several small parts, do what you can according to your priorities, and don't "bravado" to avoid being disheartened if you can't finish the job.
(3) Contact and associate with people as much as possible, and don't be alone.
(4) Take part in some activities as much as possible, try to do some light physical exercise, watch movies, TV or listen to music. Can participate in different forms and contents of social activities, such as lectures, visits, visits, etc. But not too much.
(5) Don't be impatient, don't worry about your illness, it takes time to cure.
(6) Patients should not make major decisions, such as changing jobs, getting married or getting divorced, before consulting people who know their actual situation very well.
(7) Write down your feelings and then analyze and understand them. What is negative is the expression of depression.
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