Treatment of depression
Depression is a mood disorder that is well treated and has a good prognosis, so even if you are diagnosed with depression, there is no need to worry too much about it. Zhao Zhenhai, Psychological Clinic, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine
Treatment usually includes Chinese and Western medication, psychotherapy, and physical therapy.
Treatment goals.
① To increase the clinical cure rate and minimize the disability and suicide rates.
② Cure clinical symptoms as much as possible, but not overly pursue the complete disappearance of symptoms
③ Restore social function and improve the quality of life.
④ Prevention of relapse.
(i) Principles of drug treatment.
1. Adequate dose: If the dose of the drug taken is not sufficient, it will make the drug slow to take effect and have poor curative effect. Generally speaking, the amount of commonly used drugs introduced in the manual is the therapeutic amount. Specifically, for each patient, a psychiatrist should judge whether the dosage is sufficient according to the patient’s reaction and performance after taking the drugs.
2, the full course of treatment: that is, the amount of medication taken is enough, the time taken should also be enough, not enough time will also be ineffective. Generally speaking, the adequate amount of drugs taken 6-12 weeks before assessing the efficacy, more objective and accurate, according to the efficacy and then decide the next step of treatment, whether to continue to take or change the drug or a combination of drugs.
3, the principle of individualization: means that each patient’s efficacy and side effects of the drug are different, there will be a large difference. Maybe I take this drug efficacy, no side effects, and you take this drug effect poor side effects. I will adjust the dosage and duration of medication according to the patient’s specific situation after taking the medication, which is the principle of individualization.
Note: The common problem of taking medication is that the amount taken is not enough, not enough time to adjust the medication, not enough time to take the medication, not enough maintenance time, too worried about the side effects of the drug and stop and reduce the medication on their own.
4.Adherence to the principle of medication: Since depression is a common and easily relapsed emotional disease, most patients are likely to relapse if they are not given medication intervention and do not insist on taking antidepressants, and only about 10-20% of depressed patients only get it once in their lifetime and will not relapse in the future. Therefore, in order to make every patient relapse as little or as much as possible, long-term medication maintenance treatment is essential to prevent relapse of depression.
Generally speaking, the first time you get cured, you have to take medication for more than one year; if you get sick twice, you have to take medication for more than 2-3 years; if you get sick three times or more, you have to take medication for a long period of time; this medication time is for your reference only. The psychiatrist should determine the duration of medication according to the patient’s specific situation.
5, single medication-based, if necessary, the principle of combined medication.
Single and combined refers to the same class of drugs, generally the use of antidepressants is a single drug treatment, which is preferred, but refractory depression can be combined drug treatment, or if the depressive symptoms are very serious, can also be combined between drugs, for example: duloxetine combined with escitalopram, or escitalopram combined with mirtazapine, or duloxetine combined with bupropion, the combination is mostly different The combination is mostly between drugs with different pharmacological effects, similar drugs are generally not combined, I only have refractory OCD may choose the combination of similar drugs, rarely so.
6. Adjustment ideas for poor efficacy.
If the efficacy is not good, please check whether the diagnosis is wrong, whether there are somatic diseases and other organic factors interfering with the treatment, please do the relevant examination to exclude organic diseases, in general, the adjustment idea of drugs is to change the drug, increase the amount or combination.
7, I think why some patients do not relapse?
I observed the patients who did not relapse for a long time, besides good compliance with treatment, they also have one thing in common: they all have a good personality, self-confidence, optimism and cheerfulness, boldness, independence and autonomy, I personally think that the personality reason may be the most important factor for not relapsing.
(ii) Antidepressant side effects.
Generally speaking, the adverse reactions of antidepressants commonly used in clinical practice are few and mild. Common adverse reactions include nausea, vomiting, anorexia, constipation, diarrhea, dry mouth, tremor, insomnia, anxiety and sexual dysfunction, sedation, sleepiness, dizziness, fatigue, appetite and weight gain, headache or migraine.
Usually, adverse drug reactions are related to the dose started and often taken, the method of taking, the type of drug, and also closely related to individual factors, and most of the adverse reactions disappear in 1-2 weeks after taking the drug.
How to minimize the adverse drug reactions? Personal experience: start taking a small dose of drugs, such as Sellett start taking 5 or 10mg, that is, start taking 0.25-0.5 tablets, add drugs do not have to be too fast, timely handling of adverse reactions: such as taking Valium anti-anxiety drugs, if the disease is more serious, then you can add a little faster, the disease is not serious, you can add a little slower.
Do not be frightened by a bunch of side effects listed in the manual, many patients think that as long as the drug is used, the adverse reactions listed in the manual will definitely occur, therefore, many drugs are afraid to use, resulting in delays in the treatment of the disease, in fact, the incidence of commonly used antidepressants adverse reactions is not very high, most of the adverse reactions are not heavy, especially serious side effects are actually rare, if you once occur If you have any adverse reactions, please consult your doctor and adjust the medication under the guidance of your doctor, generally the adverse reactions will be solved. If you have already had some adverse reactions in the past, you must also tell your doctor when you visit us, so that we can deal with them in a targeted way.
Chinese medicine treatment.
Chinese medicine believes that depression belongs to the depression evidence, I have reviewed a lot of literature, we generally believe that the main disease of depression is liver depression, some scholars believe that it is kidney deficiency, lung qi deficiency, etc. Treatment mostly adopts the method of dredging liver and qi, strengthening the spleen and tonifying the kidneys, commonly used formulas such as Zhuangyao San, Chai Hu Shu Liver San, etc. Acupuncture also has therapeutic effect.
My experience is that TCM with Western medicine for depression can really improve the efficacy and compliance of treatment, and I will continue to summarize my experience and explore a better combination of Chinese and Western medicine.
For each patient, the choice of medication should be based on the number of episodes, the characteristics of symptoms, previous medication, economic conditions, age, etc., and should be used under the guidance of a psychiatrist.
Electroconvulsive therapy.
Before the first antipsychotic drug chlorpromazine and the first antidepressant drug iproniazid were used for clinical treatment in the early 1950s, patients with mental illness used to use a variety of non-pharmacological treatments, such as: electroconvulsive therapy, insulin coma therapy, fever therapy, etc. These non-pharmacological treatments were used from the 1930s, and most of them were proved to be ineffective and eliminated, until now the only one still in clinical The only non-pharmacological treatment that is still in clinical use and has proven to be highly effective is electroconvulsive therapy (ECT).
The principle of electroconvulsive therapy (ECT) has not yet been elucidated. The ECT method involves placing electrodes on the two temporal parts of the head and passing a small current of direct current for 0.1-0.3 seconds to stimulate brain tissue for therapeutic purposes. At the same time, the whole body muscles twitch for ten seconds, just like a seizure, with the disadvantage that individual patients have the side effect of fracture.
Currently, it is commonly used as a non-convulsive electroconvulsive therapy (MECT): before the brain is electrified, the patient is given intravenous anesthetic and muscle relaxant drugs, so that the patient is in sleep and no convulsions occur. Fractures are not going to happen, and the price is on the expensive side, costing about hundreds of dollars to do once.
Electroconvulsive therapy does not cause organic damage to the brain, mental illness is because the brain cells are messed up in the transmission of information between the brain, like the brain as a hard drive dead, electroconvulsive is like the brain as a hard drive to a format, so the brain cells can work properly, just a metaphor I.
What kind of patients to do electroconvulsive therapy:
1, depressed patients, especially those with severe suicidal ideation, preferred electroconvulsive therapy, extremely effective in alleviating suicidal ideation.
2.Patients who are mute, patients who refuse to eat, and patients who are severely excited and agitated, electroconvulsive shock is also a good choice.
3, refractory schizophrenia, you can try electroconvulsive shock.
Precautions for electroconvulsive therapy.
1, before doing electroconvulsive shock, the doctor should assess the patient’s condition, sign an informed consent form, laboratory tests for routine blood; blood electrolytes: K, Na, Cl; electrocardiogram; electroencephalogram, take a chest X-ray.
2, to do electroconvulsive shock the night before the start to fasting water, until the electroconvulsive treatment.
Side effects of electroconvulsive shock.
1, the most common is near memory loss, will forget what happened recently, most of this memory impairment is reversible, generally will recover within a few weeks, you do not have to worry, even if you can not recover, it does not matter, the onset of memory is not what good memories, forget it.
2. headache, nausea, vomiting, etc., do not need special treatment, serious symptomatic treatment on the line.
How to do electroconvulsive therapy?
1, generally 8-12 times electroconvulsive therapy for a course of treatment, the beginning of 3-5 times a week, then 2-3 times a week, and then reduced to 1-2 times a week.
2, electroconvulsive shock will not cause organic damage to the brain, you do not need to worry.
3. Electroconvulsive therapy can be used as a preventive treatment for refractory depression, recurrent depression, and rapid cycling depression.
By the way, I would like to mention that brain surgery for mental illness is currently immature and uncertain, and may also bring some serious side effects. It is recommended that you should not consider brain surgery for mental illness at this time, as the Ministry of Health has strictly prohibited surgery for schizophrenia and other mental illnesses, and only military hospitals seem to be able to do this kind of surgery.
Psychotherapy
Psychotherapy, as mysterious as it sounds, here’s a little bit about what psychotherapy is
1. “The psychotherapy relationship is a special kind of interpersonal relationship and interpersonal interaction”
“Psychotherapy is the use of relationships to overcome resistance”, clinicians establish a good doctor-patient relationship with patients through verbal or non-verbal conversation, applying knowledge about psychology and medicine to guide and help patients overcome and correct poor lifestyles, behavioral habits, emotional disorders, cognitive biases, and adaptation problems. While counseling tends to be aimed more at ordinary people with distress, psychotherapy targets psychological disorders with a higher degree of abnormality. Psychotherapy and counseling are processes that help you understand yourself, accept yourself, and develop yourself. In Western psychotherapy, the psychologist takes a secondary role, not directly helping you to come up with ideas and solutions; rather, he or she helps you to find the deeper causes of your distress, and you yourself are the main character of psychotherapy. Only when you realize what the problem is, have a new perspective and a new way to solve the problem, and put it into action, will counseling and therapy be effective. In other words, the psychiatrist is not the main thing, the main thing is the patient himself, you are the main “doctor”, from the psychotherapy to get the feelings, understanding, experience a new attitude to their own lives, and their own initiative to change, then the psychotherapy will play its role.
I personally think that medication and psychotherapy are the left and right arms to help depressed patients recover, medication and psychotherapy are very important to make the main force of patients’ recovery.
2.Good psychotherapy.
1) You say more, the psychotherapist says less, and your feelings can be fully expressed.
2）The psychotherapist directly reason less, more inspiration and guidance, after effective consultation, you will feel understanding broadened, able to look beyond the original thinking pattern.
3）For psychotherapy to be effective, it is crucial that you take the initiative to change yourself and take the initiative to consult and treat.
4) A good psychotherapist, he is not preaching, but discussing with you, inspiring you, guiding you.
(5) General psychotherapy can not be done a few times will have good results, generally have to do many times to have good results.
Commonly used psychotherapies include supportive psychotherapy, cognitive behavioral therapy, interpersonal therapy, marriage and family therapy, and psychodynamic therapy, among which cognitive behavioral therapy has been recognized for its efficacy on depressive episodes.
3. So, what is the best person to see for psychotherapy?
1) Psychiatrists There are some psychiatrists whose specialty is psychotherapy, and it is most appropriate to find this group of psychiatrists for psychotherapy.
(2) Clinical psychologists, such as hospital psychotherapists, who have knowledge of clinical psychology.
Psychotherapy is suitable for mild to moderate depression without negative perceptions in the acute stage, as well as for consolidation and maintenance treatment after the control of symptoms in the acute stage of all kinds of depression, and can be carried out simultaneously with medication. Psychotherapy requires a certain level of understanding and comprehension, perseverance, and a certain level of ability to tolerate the pain caused by symptoms during treatment, which is not really suitable for anyone, but if adhered to will increase mental health and social adjustment, and effectively prevent the recurrence of depression. Psychological counselors are also an option, and they can be sought for consultation.
4.TCM psychotherapy for depression.
TCM psychology is a science based on the theory and practice of Chinese medicine, combined with the knowledge of modern psychology, to study the psychological phenomena of Chinese people, the laws of mental illness and treatment, a discipline arising from the combination of Chinese and Western medicine, my mentor Professor Wang Weidong of Guang’anmen Hospital of the Chinese Academy of Traditional Chinese Medicine used Chinese psychotherapy (TIP therapy) to treat depression and achieved better results, TIP therapy is a localized It is a combination of traditional Chinese medicine qigong therapy and western hypnotherapy and cognitive therapy, and through verbal and behavioral induction, the treated person is put into a hypnotic state (some intermediate state of the process from wakefulness to sleep), and the verbal and behavioral information composed by the therapist according to certain therapeutic needs is “ideas, concepts” (including ancient Chinese medicine). The therapist’s “ideas and concepts” (including various psychotherapeutic methods and techniques from ancient and modern times) are introduced to the patient, which affects the memory and implicit cognition of the patient, so that the patient receives psychotherapy and psychological rehabilitation.
The unique advantage of TIP therapy combined with our self-developed retrospective personality questionnaire is that it can identify personality problems during the patient’s growth process, and allow the depressed patient’s defective personality to grow again during treatment, thus reshaping the personality, improving the depressed patient’s personality susceptibility, improving the depressed patient’s treatment compliance, reducing the relapse rate, and potentially improving the prognosis of depression from the root. This therapy is also in line with the characteristics of TCM that the treatment of illness must be based on the root cause.
Prognosis of depression
The prognosis of depression is often good. After treatment, most patients will recover and resume their smiles, but special attention is needed: after the symptoms are relieved, it is recommended to take medication for a long time according to medical advice, and not to stop or reduce medication at will.