What is depression?
What would it feel like if one day the future became blurred, life lost its direction, and time was frozen in pain?
Depression is such a terrible disease. Depression is not the bad mood we usually experience. Even literary scholars and psychologists who have experienced depression can hardly use simple words to make the world understand how they felt at that time. We can only say that depression is a kind of extreme “depression”, and some people who have experienced it themselves have used the metaphor of “falling into a deep well with no bottom, and falling forever”. Liu Qi, Psychiatry Department, Peking University Sixth Hospital
Depression affects all aspects of a person’s life, and we can try to understand the feelings of depression from the following aspects.
Not being motivated or not interested in doing things: you are not interested in what you used to be interested in, and even if you do it reluctantly, it is not fun.
Feeling down, depressed or hopeless: Some people use the term “gloomy, like the gloomy weather before it rains” as a metaphor for the mood inside.
Sleep problems: These include difficulty falling asleep, restless sleep, early awakening or excessive sleep.
Feeling tired or uninspired: Depression makes people feel uninspired and unmotivated to do things.
Loss of appetite or eating too much: Eating problems are often accompanied by significant weight loss or weight gain.
Feeling bad about yourself: or feeling like a failure or letting yourself and your family down.
Inability to concentrate: Difficulty concentrating on tasks, often “wandering” from watching TV or reading the newspaper.
Significantly slower speech and work: A person with severe depression is like a machine with rust everywhere, although no part is broken, but the whole is not working.
Pessimistic thoughts: Thoughts of dying or harming oneself in some way, or in severe cases, committing suicide.
Affects physiological functions: such as dizziness, headache, palpitations, sweating, fear of cold and heat, skin tingling, frequent urination, bloating, constipation, loss of libido, etc.
How do you get depression?
The exact pathogenesis of depression is still not well understood worldwide. In general, depression is associated with biological, psychological and social factors.
Genetic and environmental interactions.
The prevalence of depression in relatives is much higher than in the general population, and the closer the blood relationship the higher the prevalence. Approximately one quarter of patients have a family history of depression. Stressful events can trigger the expression of “pathogenic” genes, and in the presence of stress, a person’s genetic background can determine whether or not he or she will experience a depressive episode.
Neurobiochemical factors.
1. depressed patients have disorders of brain transmitters (decreased levels of 5-HT, NE and DA, increased sensitivity of NE receptors). 2. abnormalities of the endocrine system (e.g. pituitary gland, thyroid) can lead to depression. 3. patients with physical and mental illness have a higher likelihood of depression.
Psychosocial factors.
Unfavorable social environment has an important impact on the occurrence of depression, which can be summarized as follows: 1. poor parenting in infancy, experiencing abuse or neglect in childhood. 2. loss events, such as bereavement, divorce, serious illness in the immediate family, or loss of employment. 3. poor life status: depression is also likely to occur in people who are poor, unemployed, living in difficulty, and lacking care from loved ones.
Personality factors: Individuals with more obvious personality traits such as anxiety, obsessive-compulsive, impulsive and other traits are prone to depression.
They can be overly suspicious or cautious, overly concerned about details, rules, entries, order or forms, striving for perfection, overly moralistic, cautious, overly focused on work effectiveness at the expense of fun and interpersonal interaction, overly attached to social conventions, stereotypical and stubborn, etc.
How many people suffer from depression?
Multiple large epidemiological studies of depressive disorders have been conducted worldwide over the past few decades and found that
In the general population, the 12-month prevalence of major depressive disorder is 3-10%; surveys of children, adolescents, and older adults have shown that depression is a common disorder in these age groups.
Among patients with somatic disorders, the rate of concurrent depressive disorders can be as high as 20-60%; among those with other psychiatric disorders, depressive disorders are also frequently concurrent.
Iceberg phenomenon: In fact, only a small percentage of depressed patients automatically seek medical help. Therefore, the number of patients with depressive disorders observed clinically is only the “tip of the iceberg”.
According to dozens of studies in China, it is estimated that
- At this moment in time, 16 out of every 1000 Chinese people suffer from major depressive disorder.
In a year, 23 out of every 1,000 Chinese will suffer from this disorder.
- Rural populations are more likely to have major depressive disorder (2.0%) than urban populations (1.7%)
Women are more likely to suffer from major depressive disorder (2.3%) than men (1.4%)
How to treat depression?
Remember, depression is not your fault, it is a brain disease with a “physical basis + psychological + social causes”. You can help yourself through it by getting outside resources and support.
Treatment for depression includes medication, formal psychotherapy, and physical therapy. These methods may be used individually or in combination.
Systemic therapy is effective for most depressive episodes and usually restores patients to their pre-morbid level of functioning within 1-3 months. Some very mild degrees of depressive disorders can be cured without treatment.
Treatment with antidepressants is effective even if there is an obvious trigger for the onset of depression, such as a serious physical illness (e.g., cancer, heart disease) or unemployment or bereavement; treatment of persistent depressive states should not be neglected just because depression is understandable. As long as there are no contraindications, antidepressants are the first-line option for the treatment of moderate and severe depression and poor mood. And meta-analyses show similar efficacy for most antidepressants.
The full benefits of successful treatment include symptom relief; improvements in interpersonal, marital, and occupational functioning; and reduced likelihood of suicide and prevention of subsequent relapse. Successful treatment of depressive disorders also facilitates the treatment of co-occurring somatic disorders, thereby improving the individual’s long-term prognosis. The benefits of depressive disorder treatment usually far outweigh the risks.
The physician will develop a treatment plan for the patient based on a combination of
Age, current general health level and past medical history
The severity of the depression and the predicted duration of the illness
The patient’s physical ability to tolerate specific medications or other treatments
Input from the patient
Medication
Antidepressants work by rebalancing the neurotransmitter balance in different brain regions to achieve mood improvement.
Antidepressants usually take 1-2 weeks to work and you will need to be patient. There may be some mild adverse effects at the beginning, such as flushing, rapid heartbeat, constipation, nausea, insomnia, anxiety, dizziness, dry mouth, etc., which usually fade away in the first 2 weeks. Antidepressants can also have more serious adverse effects (e.g. postural hypotension, cardiac conduction abnormalities) that require prompt medical attention.
Antidepressants themselves do not cause physical addiction. However, if the medication is suddenly stopped, the spillover syndrome and relapse of depression can occur.
Commonly used antidepressants and doses
Drug
Commonly used dose (mg/day)
Medication
Commonly used dose (mg/day)
Tricyclic antidepressants
Selective 5hydroxytryptamine reuptake inhibitors
Amitriptyline
150-300
Fluoxetine
20-60
Promethazine
150-300
Paroxetine
20-60
Doxepin
150-300
Sertraline
50-200
Clomipramine
100-250
Fluvoxamine
50-300
Maprotiline
100-250
Citalopram
20-60
Escitalopram
10-20
Norepinephrine and specific 5-hydroxytryptaminergic antidepressants
Selective 5hydroxytryptamine and noradrenaline reuptake inhibitors
Mianserin
60-120
Venlafaxine
75-225
Mirtazapine
15-45
Duloxetine
60-120
Milnacipran
100-200
5 Serotonin-modulated antidepressants
Dopamine and norepinephrine reuptake inhibitors
Trazodone
200-600
Bupropion
200-300
Nefazodone
300-600
Melatonergic antidepressants
Selective norepinephrine reuptake inhibitors
Agomelatine
25-50
Reboxetine
8-12
Monoamine oxidase inhibitors
St. John’s wort extract
Moclobemide
300-600
Lutea
900
Clinical use of antidepressants should be preferred for their efficacy, safety, tolerability, ease of administration, and lack of risk of overdose toxicity. When you are taking other medications at the same time, it is important to inform your doctor to avoid interactions with the medications you are taking.
Psychotherapy
Understanding the emotional impact of life stresses or events and relationships can help you improve your ability to cope and thus return to normalcy and happiness.
Psychotherapy requires the help of a professional psychiatrist and usually requires several sessions, a relatively long process, and can be painful to experience. There are many different treatment approaches, the more effective ones are
Cognitive-Behavioral Therapy: The treatment framework emphasizes changing abnormal thoughts (maladaptive values, attitudes and thought patterns) rather than attempting to directly change depressed mood. Key strategies for successful treatment include
Identifying negative thinking
Evaluating whether they are real
Replacing them with more positive and realistic thoughts
Changing abnormal attitudes
Interpersonal orientation psychotherapy: focuses on four major areas of current interpersonal relationships: abnormal grief, role reversal, role playing, and relationship deficits. Generally, treatment needs to last 12-20 weeks for 50 minutes per week.
Behavioral therapy, marital therapy, family therapy, and short course kinetic psychotherapy can be used as adjunctive treatment.
For milder patients, psychotherapy is comparable to medication, with medication taking effect more quickly. For patients with moderate to severe depression psychotherapy is less effective than medication. If psychotherapy is ineffective or if symptoms do not resolve completely within 12 weeks, medication with more definite efficacy should be considered. Combining psychotherapy with antidepressants can reduce the relapse rate.
Psychotherapy alone should not be used in patients with severe depression. The efficacy of various psychotherapies and medications will be reduced if accompanied by personality disorders.
Physical therapy
Electroconvulsive therapy: Electroconvulsive therapy (ECT) is a treatment by releasing electric currents at unilateral/bilateral points in the brain, causing many changes in brain neurotransmitters. It is an effective and safe treatment for all types of depression, and ECT is especially needed as a priority for the following conditions.
Patients who are severely depressed or in life-threatening situations that require a rapid onset of action, such as high risk of suicide or refusal to eat or drink.
Failure to respond to more than one antidepressant or inability to tolerate pharmacotherapy
The following information on ECT would be helpful.
Usually 2-3 treatments per week for a total of 6-12 sessions
This is not a simple electrical stimulation treatment, but rather a facilitated change in brain electrical activity
ECT will be administered under short general anesthesia and muscle relaxation to minimize twitching and its associated risks
ECT does not damage the brain; however, ECT (especially in elderly patients) may result in brief (lasting several hours) post-ictal confusion, headache, or memory impairment, especially with paracrine amnesia, which may resolve after 3-6 months.
ECT rarely leads to serious somatic and psychiatric comorbidities
Contraindications to ECT include recent stroke or myocardial infarction, unstable coronary artery disease, and occupying brain disease.
Repetitive Transcranial Magnetic Stimulation: Repetitive Transcranial Magnetic Stimulation (rTMS) is a biostimulation technique that uses a time-varying magnetic field to act on the brain, thereby affecting the brain’s metabolism and neural potential activity. Repetitive transcranial magnetic stimulation has shown initial efficacy in the treatment of depression and can be used as a stand-alone or combination treatment for depression.
Depressive disorders are treated in three periods
Acute phase treatment
The main treatment goals are: to reduce and eliminate depressive symptoms and to bring the patient to a premorbid level of functioning. Treatment continues from the start until the symptoms resolve. Some symptom relief occurs after 1-2 weeks of treatment with adequate doses of antidepressants. partial effectiveness (40-50% symptom reduction) should be achieved in 4-6 weeks, and complete or almost complete symptom relief usually takes 10-12 weeks.
Consolidation therapy
During the acute phase of treatment, medications suppress depressive symptoms without immediately correcting the pathophysiological basis for the symptoms. Therefore, the goal of consolidation treatment is to prevent symptoms from fluctuating again. It usually lasts from 4 to 9 months. Consolidation treatment with antidepressants is also required after the acute phase of ECT has taken effect. Psychotherapy during this period may help to restore their social functioning.
Maintenance treatment
Many patients with depressive disorders will relapse. The goal of maintenance treatment is to prevent relapses.
Long-term maintenance treatment is highly recommended for patients with three or more episodes of depressive disorder.
Maintenance treatment is strongly recommended for patients who have had two depressive episodes and have
Positive family history of bipolar disorder
Relapse within 1 year after discontinuation of effective treatment
Positive family history of depression
First depressive episode before age 20
Two episodes within the past 3 years that were severe, sudden, or life-threatening
How can I help someone who is depressed?
If someone close to you is suffering from depression, whether it is a loved one or a friend, it can affect you too. The most important thing you can do is to help him/her get diagnosed and treated. You can accompany the person to the doctor and encourage them to stay in treatment. If there is no significant improvement after 6 to 8 weeks of consistent treatment, you will need to accompany the person to explore other treatment options with the doctor.
Remember: depression is a common illness that can be treated effectively. Depression is not weakness or laziness; the patient is already struggling to cope.
How to help the person – a loved one or friend who suffers from depression.
Please give emotional support, understanding, patience and encouragement
Please talk to the person and listen carefully
Never belittle their painful feelings, but also point out that the real situation is not as bad as they think it is, and give hope
Never ignore the flow of suicidal words and behaviors and report them early to the person’s therapist or doctor, with intensive care
Invite him to walks, outings, or other activities, and if he refuses, keep trying, but do not press for it
Offer help to get him through his doctor’s appointment
Remind him that depression will leave him in time and with treatment
Develop a short-term activity plan to bring joy or help the patient build confidence.
Encourage the patient not to be pessimistic or self-critical, not to act on pessimistic thoughts (e.g., divorce, quitting), and not to focus on negative or guilt-ridden thoughts.
Identify current life problems or social stressors. Focus on the small, concrete steps the patient can take to deal with these problems. Do not make major decisions or life changes.
If somatic symptoms are present, explore the relationship between somatic symptoms and emotions.
Once the illness has improved, work with the patient to develop a plan of action if signs of relapse occur.
If I am depressed, how can I help myself?
If you suffer from depression, you may feel exhausted, helpless, and hopeless. As a result, self-help becomes extremely difficult. But when you realize that you are depressed and decide to start treatment, things will start to get better.
How to help yourself.
Please do not delay avoiding medical appointments and treatment. Some studies show that the longer you delay, the more damage you cause. Therefore, seek professional help as soon as possible, the sooner the better.
Please try to be active and exercise. Go to a movie or attend a ballgame, in short, any activity you used to enjoy.
Set realistic and achievable goals for yourself. Make short-term activity plans to bring joy and help build confidence.
Break up big tasks into smaller pieces and set priorities to accomplish the smaller things that you can do first.
Spend time with other people and build a trusting relationship with a trusted friend or loved one. Try not to isolate yourself, don’t alienate others, and be receptive to help from others.
Please be reasonable in your expectations. Depression will get better gradually, not immediately. Don’t expect to suddenly “jump out” of the depression mire. In the treatment of depression, improvements in sleep and appetite usually precede depression.
Don’t make major decisions, such as getting married, getting divorced or changing jobs, until you get better. Discuss these decisions with others who know you well and can give you an objective opinion about your situation.
Remember that when your antidepressant treatment is working, positive thinking will replace negative thoughts.
Learn about depression on an ongoing basis. Try to develop a plan of action to monitor for signs of relapse once you get better
What do you need to do during your visit?
An effective antidepressant treatment plan is based on patient compliance while the doctor continually evaluates the effectiveness of the treatment and makes adjustments to the treatment plan. It takes the efforts of both parties to build a good therapeutic alliance.
The first step is to look at common impediments to the clinical process.
Patients (and sometimes families) are unable to accept the diagnosis due to social stigma or misconceptions that depressive disorders imply weakness of character, self-submersion, bullheadedness, caution, or divine retribution.
Symptoms of depressive disorders (e.g., hopelessness, lack of energy, lack of motivation, withdrawal) can make it impossible for patients to carry out treatment plans.
Medication and psychotherapy typically take more than 2 weeks to take effect.
There are misconceptions about the effects of antidepressants (e.g., that they are addictive, or make people stupid).
What you need to do to address these obstacles is to
Express yourself openly about your illness and treatment, and speak up about your concerns and the difficulties you are having with treatment.
Seek explanations from your doctor and actively learn about depression.
When you are taking multiple other medications at the same time, be sure to inform your doctor to avoid interactions with medications you are already taking.
Ask for help and supervision from your family if you are unable to follow your treatment plan because of your symptoms.
973 Depression Program Introduction
Program Information
The “Establishment of Objective Diagnostic Indicators and Individualized Interventions for Major Depressive Disorder (MDD)” is a scientific project funded by the National Key Basic Research and Development Program (973 Program) to establish objective diagnostic indicators and individualized interventions for MDD. The Sixth Hospital of Peking University is the leader of this project. Through comparing patients and healthy people, collecting treatment-related information, and through comprehensive analysis, doctors will select indicators that can guide antidepressant treatment, and finally establish a system for evaluating the efficacy of depression treatment and guiding individualized treatment.
Project content
Clinical assessment: Before (and/or at the end of) 2, 4, 8 weeks (and/or at the end of) 6 months, 1 year and 2 years of treatment, your doctor will take a medical history, assess clinical scales and relevant questionnaires to get a comprehensive understanding of your clinical characteristics, severity of illness, cognitive and emotional improvement, and adverse effects.
Laboratory measurements: Before your medication (and/or after the acute phase of treatment), your doctor will perform a physical examination and relevant laboratory tests (including: taking 5 ml of venous blood, EEG, polysomnography, evoked event potential), respectively.
Participant benefits
If you meet the study inclusion criteria for diagnostic indicators and individual interventions, you will be assigned to the appropriate study group for assessment and treatment of your psychological and physical condition. You will be provided with a full set of free psychological assessments during the study, and appointments and follow-up visits will ensure that you receive standardized, individualized treatment. We will answer your medical questions face-to-face and follow up on your recovery process.
Your participation or withdrawal from the study is completely free and will not affect your follow-up care. Your clinical data and other information is entered into a database in the form of a code, which does not contain any personally identifiable information. Your identity and privacy will be kept strictly confidential at all times.