I. What kind of disease is depression
Depression, also known as depressive disorder, is a common mood disorder that can be caused by a variety of reasons, with significant and persistent depression as the main clinical features, and the depression is not proportional to its situation, and in severe cases, suicidal thoughts and behavior can occur. Most cases have a tendency to have recurrent episodes, with most episodes resolving. The duration of untreated depressive episodes generally lasts 6-13 months, and some may have residual symptoms or become chronic. Approximately 5-10% of patients with first-episode depression may later be found to actually have bipolar disorder.
Typical clinical symptoms of depression include depressed mood, slowed thinking, decreased volitional activity, and in some patients, somatic complaints such as fatigue and pain may be predominant. Specifically, this can manifest as significant and persistent mood pessimism that is out of proportion to the reality of the situation. Patients with a lighter degree feel sullen, no sense of joy, lack of interest in everything, feeling “depressed” and “unhappy”; those with a heavier degree can be pessimistic and desperate, with a sense that life is like a year, life is worse than death, and patients often complain that Patients often say, “There is no point in living”, “I feel uncomfortable”, etc.
Sixteen percent of the population will be affected by depression at some point in their lives. In addition to the heavy emotional and social costs of suffering from depression, the economic costs are also enormous. According to the World Health Organization, depression has become the world’s fourth leading disease, and is expected to become the second leading disease after coronary heart disease by 2020.
Second, the damage of depression on the brain.
1, compared with healthy people, some depressed patients have a decrease in the volume of gray matter in some brain areas. The gray matter density in the hippocampus, amygdala, and dorsomedial prefrontal cortex of the brain of depressed patients decreased significantly.
2, The more severe the depression, the less brain-derived neurotrophic factor.
3, cognitive impairment: mainly manifested as a decline in proximal memory, slowed response, poor abstract thinking ability, learning difficulties, reduced spatial perception, eye-hand coordination and thinking flexibility.
Third, the key to the treatment of depression: timely and thorough
1, depression treatment is not timely, the danger of delayed treatment.
Untimely treatment is associated with hippocampal volume reduction, which predicts ineffective or poor efficacy of subsequent antidepressant treatment. Untimely treatment of depression may lead to a decrease in the volume of the gray matter of the hippocampus bilaterally in the patient’s brain; and a decrease in the volume of the hippocampus means that future antidepressant treatment is ineffective or inefficient.
2, the danger of incomplete treatment of depression, not reaching clinical cure with residual symptoms.
(1) Patients with incomplete treatment of depression have a significant decrease in gray matter density in some brain regions, which include.
Anterior cingulate cortex, dorsomedial prefrontal cortex, dorsolateral prefrontal cortex, hippocampus , and left amygdala.
Effective treatment can restore normal function of the prefrontal and limbic loops and minimize the risk of future structural brain changes.
(2) Incomplete treatment of depression increases the risk of relapse and shortens the time between relapses.
Any residual symptoms of depression may be a reflection of the active state of the disease and increase the risk of relapse.
Timely and effective treatment of depression and elimination of all residual symptoms can reduce the chances of relapse.
Fourth, depression is prone to relapse, and what are the dangers of relapse
Studies that tracked depression for 10 years showed that 75-80% of patients relapsed multiple times. The probability of having a relapse within 5 years after the first depressive episode is 50%, the probability of having a relapse after the second depressive episode is 70%, and the probability of having a relapse after the third depressive episode is 100%.
1. The more the number of relapses, the lower the brain-derived neurotrophic factor (BDNF); low BDNF, in turn, makes the chance of relapse greater, while leading to a decrease in brain neuroplasticity.
2, the greater the number of relapses, the longer the treatment course, the worse the efficacy, and increase the risk of suicide. The suicide rate of depression is 10-15%.
3, more relapses, the family economic burden is heavier, the quality of life is more affected.
4. The number of relapses directly affects the growth and mental health of the next generation.
V. Depression requires long-term drug treatment
Most cases of depression have a tendency to recur and require long-term treatment to prevent relapse. The treatment includes: medication, psychotherapy and physical therapy. Once the diagnosis is established, a reasonable overall treatment plan should be formulated: in the acute stage, the first priority is to take strong comprehensive measures, such as hospitalization, to relieve the patient’s pain, relieve symptoms and control the attack as early as possible; after the acute attack period to control symptoms to achieve recovery, a long course of treatment should be given, including prevention of relapse, relapse prevention and improvement of prognosis.
Medication is the main method of treatment, and medication is effective in 75-85% of patients. The full efficacy of antidepressants may not be fully apparent until 1-2 months after treatment. The earlier treatment is initiated, the more effective it is. After clinical recovery from acute antidepressant treatment, maintenance medication for depression will take 6 months-1 year for the first episode, 3-5 years for the second episode, and long-term treatment for more than 2 episodes. After clinical recovery from acute treatment, maintenance treatment needs to be consolidated, and adequate maintenance treatment is the most important means of preventing relapse.
Psychotherapy and social support systems also play a very important role in the prevention of recurrence. A series of psychotherapeutic techniques such as supportive psychotherapy, cognitive, behavioral, marital and family therapy, and group therapy can help patients identify cognitive distortions, correct patients’ maladaptive behaviors and personalities, improve their cognitive defense system and psychological coping ability, mobilize motivation, reduce excessive psychological burden, improve the ability to solve practical problems, increase satisfaction with family and marital life, reduce depressive symptoms, and promote recovery and prevent relapse.
Repetitive transcranial magnetic stimulation is a mild and effective physical therapy method with few side effects and few contraindications, and is generally applicable to depression. The general treatment cycle is 1-2 sessions, each session is 10-15 days, 1-2 sessions per day, each session is 20-30 minutes. Patients with severe depressive symptoms and obvious suicide attempts can be considered for non-convulsive electroconvulsive therapy, with 6-10 sessions as a course of treatment, with fast and effective results. Electroconvulsive therapy is one of the measures to treat severe depression in the acute phase, and this treatment is still followed by maintenance treatment with medication.