Depression is a common mood disorder that can be caused by a variety of reasons, with significant and persistent depression as the main clinical feature, and the depression is not proportional to its situation, and in severe cases, suicidal thoughts and behaviors can occur. Most cases have a tendency to have recurrent episodes, with most episodes resolving and some having residual symptoms or becoming chronic.
At least 10% of patients with depression may experience manic episodes, at which point the diagnosis of bipolar disorder should be made. In addition, when we talk about depression, we are actually referring to clinical major depression, which affects 16% of the population at some point in their lives. In addition to the severe 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 4th leading disorder and is expected to become the second leading disease after coronary heart disease by 2020.
Causes.
To date, the cause and pathogenesis of depression is not clear, and there are no obvious signs and laboratory abnormalities, and it is generally said to be the result of the interaction of biological, psychological and social factors. Because the cause of depression is currently unknown, there are many hypotheses related to it, and the more commonly accepted etiological hypotheses include.
1. Genetic factors.
Large samples of population genetic epidemiological surveys show that the closer the blood relationship with the affected person, the higher the probability of the disease. The probability of first-degree relatives having the disease is much higher than that of other relatives, which is consistent with the general rule of genetic diseases.
2, biochemical factors.
Catecholamine hypothesis: mainly refers to the occurrence of depression may be related to the decrease in the concentration of neurotransmitters 5-hydroxytryptamine and norepinephrine in the synaptic gap of the brain; as many antidepressants, such as selective 5-hydroxytryptamine reuptake inhibitors or selective 5-hydroxytryptamine and norepinephrine reuptake inhibitors are used, although the concentration of these neurotransmitters in the synaptic gap of the brain increases quickly, the effect of antidepressant Generally it takes about 2 weeks for the antidepressant effect to take effect, so there is another hypothesis of increased sensitivity of 5-HT and NE receptors;
3, Psychosocial factors.
The sudden occurrence of various major life events, or their long-term persistence can cause intense or (and) persistent unpleasant emotional experiences, leading to depression.
Disease symptoms.
The typical manifestations of clinical symptoms of depression include a decrease in three dimensions of activity: depressed mood, slowed thinking, and reduced volitional activity, and some other patients will show predominantly somatic symptoms.
Specifically, this can manifest as significant and persistent depressive pessimism, which is incompatible with the reality of the environment. Patients with a milder degree of depression feel sullen and unhappy, lacking interest in everything, feeling “depressed” and “unhappy”; those with a heavier degree of depression and despair, feeling that life is like years and life is worse than death, often complaining that Patients often say, “There is no point in living”, “I feel uncomfortable”, etc. Menopausal and elderly depressed patients can be accompanied by irritability, restlessness, dullness, flushing and sweating, while children and adolescents can show irritability (e.g., impatience, anger over the slightest thing). The typical depressed state of mind is also characterized by a morning-heavy and night-light rhythm, i.e., depressed mood is more severe in the morning and can be reduced in the evening.
The patient himself may feedback that the brain is slow to respond, or memory, attention loss, learning or work ability or hesitation, lack of motivation, do not want to do anything, can be competent in the past work life now feel unable to cope; patients not only began to reduce self-evaluation, and sometimes will blame all the fault on themselves, often produce a sense of uselessness, hopelessness, helplessness and worthlessness, and even In severe cases, delusions of guilt (repeatedly dwelling on some minor faults of their own, believing that they have made a big mistake and are about to be punished), recurrent negative thoughts or behaviors may appear.
Many patients who are not on a diet experience decreased or increased appetite, weight loss or gain (e.g., more than 5% change in weight in a month), almost daily insomnia or excessive sleep, and some patients experience decreased libido and women experience menstrual disorders.
It is worth noting that due to the characteristics of Chinese culture, some patients’ emotional symptoms may not be obvious, and the prominent ones will be various physical discomforts, with gastrointestinal symptoms more common, such as loss of appetite, bloating, constipation, etc., as well as headache and chest tightness, etc. Patients often dwell on a certain physical complaint, and are prone to develop suspicion of illness, and then develop into suspicion of illness, nothingness and delusion of guilt, but the internal examination However, internal examinations reveal no major problems, and the corresponding treatment is not effective.
Disease risk.
Patients in a depressed state suffer great mental and even physical pain, which affects life treatment, family or occupational functions of patients, and the risk of suicide in depression is high. Once a patient is suspected of having depression, it is necessary to draw the attention of the patient and his family and go to a mental health institution for professional diagnosis and treatment in a timely manner. It is best to receive timely, adequate and thorough treatment (i.e., acute treatment to obtain clinical recovery, with adequate consolidation and maintenance treatment) once depression is identified, otherwise it will lead to chronicity and intractability of the disease.
Diagnostic differentiation.
Unlike many medical and surgical diseases, because the etiology of depression is currently unknown, there is as yet no clinical test or series of tests that can be used to make a diagnosis. Some symptom assessment scales can help physicians to have a quantitative reference of the severity of depressive symptoms, but they cannot be used as a basis for diagnosis.
The diagnosis of depression is still based on clinical diagnosis, so the diagnosis needs to be made in a regular hospital, and the diagnosis of depression needs to be confirmed by two psychiatrists with the title of associate chief physician or above.
Depressive episodes are dominated by depressed mood, which is not proportional to its situation and can range from sullenness to grief, and even malaise. In severe cases, psychotic symptoms such as hallucinations and delusions may occur. Anxiety and motor agitation are significant in some cases.
The symptom criteria are predominantly depressed mood and at least four of the following.
1, loss of interest, no sense of pleasure ;
2. loss of energy or fatigue;
3, psychomotor retardation or agitation;
4, low self-esteem, self-blame, or feelings of guilt;
5.Difficulty in association or reduced ability to think consciously;
6.Recurring thoughts of death or suicidal or self-injurious behavior;
7.Sleep disorders, such as insomnia, early awakening, or excessive sleep;
8.Decreased appetite or significant weight loss;
9.Decrease in sexual desire.
Severe standard social function is impaired, causing pain or adverse consequences to the person.
Criteria of disease course.
1.Meet the symptom criteria and severity criteria has lasted at least 2 weeks.
2.Some schizophrenic symptoms may exist, but do not meet the diagnosis of schizophrenia. If both symptom criteria for schizophrenia are met, the depressive episode criteria are met for at least 2 weeks after the schizophrenic symptoms have resolved.
Exclusion criteria: depression other than organic mental disorder, or depression due to psychoactive and non-addictive substances.
Disease treatment.
Once the diagnosis is established, a reasonable overall treatment plan should be developed: during the acute phase, the first priority is to take vigorous measures to relieve the patient’s suffering, relieve symptoms and control the episode as early as possible; after controlling symptoms during the acute episode to achieve recovery, a long course of treatment should be given, including prevention of relapse, relapse prevention and improvement of prognosis.
Treatment modalities for depression include medication, psychotherapy, and physical therapy.
Medication.
Medication is characterized by relatively rapid onset of action and more certain efficacy, and is suitable for patients with moderate and severe depression. Antidepressants are currently the main drugs for the treatment of various depressive disorders and can effectively relieve depressed state of mind and accompanying anxiety, tension and somatic symptoms, with an efficiency of about 60% to 80%.
Psychotherapy.
It is suitable for mild to moderate depression without negative perceptions in the acute phase, as well as consolidation and maintenance treatment after symptom control in the acute phase of all types of depression, and can be carried out simultaneously with medication. Psychotherapy requires patients to have a certain understanding and comprehension, to be able to persevere, and to a certain extent to tolerate the pain caused by the symptoms during treatment, which is not suitable for anyone, but if adhered to will increase mental health and social adaptability and effectively prevent the recurrence of depression.
Physical therapy.
This includes modified electroconvulsive therapy as well as repetitive transcranial magnetic stimulation.