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Why can’t I be happy all day long, don’t want to do anything, can’t sleep well, can’t eat, often wake up early, people say I have “depression”, what is it?
Why do I feel weak, can’t even do my usual favorite things, have a poor appetite, feel sick in my stomach, and have significant weight loss?
Why do I feel restless, lack of patience, and often have such and such ailments, but I can’t find out why?
What should I do if I have anxiety and sadness that I can’t talk to anyone about for a long time?
I have a relative who is in good health but has recently become depressed, pessimistic and anxious, believing that he is a sinner in history and that there is only one way to die, and has repeatedly attempted suicide.
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Typical cases]
Example 1: Lin, female, 57 years old, retired cadre. 2 years ago gradually feel life is not smooth, depressed, happy, interest declined, often feel tired and weak, reduced activity, do not want to chat, watch TV, cooking can persist, feel that life is no fun, often cry, have thoughts of death. Poor relationship with loved ones, easily lose temper and quarrel, feel slow brain reaction, poor memory, do not want to communicate with others. Poor sleep, waking up early, poor appetite, eating like completing tasks, weight loss, previously healthy.
Example 2: Wang, male, 62 years old, retired worker. A year ago, because of the house renovation, he often got up early and did some odd jobs, which was very hard. After the house was renovated, he had insomnia, felt weak, poor appetite, stomach discomfort and weight loss, so he went to the local hospital and had a lot of tests done, such as ECG, ultrasound, blood biochemistry, head CT, EEG, gastroscopy, etc., except for gastroscopy for superficial gastritis, everything else was normal. The patient continued to be seen at various local hospitals, and was advised by a doctor to go to a psychiatric clinic, which the patient and his family refused. Recently, his symptoms worsened, and he was bedridden all day long, spoke little, ate very little, and often expressed that there was no point in living, that living was too unbearable, and that it was better to die. He was introduced to our psychology department by someone and came to our hospital accompanied by his family for treatment.
[Experts answer questions
In the minds of many people, depression is not a disease at all, but only considered as a bad mood, but in fact, depression is a serious health hazard as diabetes, coronary heart disease, hypertension, peptic ulcer and other diseases. According to the information, depression has become the second killer of human health among global diseases.
Depression is the most common mental disorder in the elderly. According to statistics, the proportion of depression in the elderly over 55 years of age is as high as 10-15%, and some of these patients have very serious symptoms or even commit suicide, and the mortality rate can be as high as 30%. Studies have found that 50% to 70% of suicides and suicide attempts in the elderly are secondary to depression. Loneliness and discrimination, separation from life and death, aging and physical illness are the main causes.
When a person is sad, distressed or discouraged, he or she will show bad emotions such as sadness and depression. If this emotion is only temporary, it is a normal human emotional reaction. If it lasts for more than 2 weeks or longer, it is important to pay attention and consider whether you have depression.
Depression has now become the second most important disease among global diseases causing a serious burden to human beings, and the suffering caused to patients and their families and the damage caused to society are unparalleled by other diseases. Most elderly depressed patients are introverted, lonely and unsociable before the onset of depression, and if they are not understood or misunderstood by family members, colleagues and friends after the onset of depression, it may be difficult to get rid of the shadow of depression, which is not conducive to recovery. On the other hand, a warm and harmonious family and the care, support and understanding among family members is a good medicine to help patients get through depression.
What kind of illness is depression?
Depression is one of the most common mental illnesses, a disease with high morbidity and self-harm, as well as high recurrence and mortality (15% of deaths by suicide), and has become the second most important disease causing a serious burden to human beings among global diseases. The main manifestations are depression, pessimism, disappointment, loss of energy, loss of interest, persistent fatigue, slow thinking, lack of initiative, self-blame, often accompanied by nervousness, insomnia, early awakening, weight loss, fear of various diseases, feeling generalized discomfort, a chronic disease that affects the whole body, serious cases accompanied by suicidal thoughts or suicidal behavior. In China, only 5% of depressed patients have been treated, and a large number of patients do not receive timely diagnosis and treatment, and their condition deteriorates, even with serious consequences of suicide. Studies have shown that depressive disorder is the most common and important psychiatric disorder most closely related to suicide, and the vast majority of suicidal patients have depressive symptoms before they die by suicide, and about 60% of these patients can be diagnosed with depression.
Clinical features of geriatric depressive disorder.
In addition to having the main symptoms of general depressive disorder, geriatric depressive disorder often has the following characteristics.
①Suspicious symptoms: manifested as autonomic symptoms-based somatic symptoms. It often starts with a less serious physical illness, and although the physical symptoms are getting better, the depression and anxiety are increasing day by day.
②Anxiety and agitation: fearing that misfortune will befall oneself and one’s family and that a big disaster is imminent, rubbing one’s hands and feet, restlessness and anxiety.
③Somatic symptoms: Mainly manifested by plant nerve dysfunction or related visceral dysfunction, such as anorexia, abdominal discomfort, constipation, weight loss, chest tightness, throat congestion, headache and other pain in various parts of the body, loss of libido, insomnia, and general weakness. In addition, difficulty in falling asleep, shallow sleep, especially early awakening is more common.
Psychomotor retardation: slowed thinking, difficulty in thinking about problems, paucity of thought content, reticence, and slow movement. In severe cases, the eyes are staring, the emotions are indifferent, there is no desire, and there is indifference to external movements.
(5) Delusions: especially suspicion and delusions of futility are the most common, followed by delusions of victimization, delusions of relationship, delusions of poverty, delusions of guilt, etc.
(6) Cognitive impairment: It can be manifested as various types of cognitive impairment, similar to dementia in severe cases. Patients show characteristic indifference to their reduced intelligence, but often have better orientation and no pathological reflexes.
(7) Suicidal tendencies: The risk of suicide in elderly depressive disorders is much greater than in other age groups. It has been reported that 55% of elderly patients commit suicide in a depressed state. Suicide often occurs in the context of concomitant physical illness and has a high success rate. The main risk factors for suicide are loneliness, alcoholism, hypochondriac symptoms, agitation, and delirium.
It is worth suggesting that the more prominent manifestations of depression in old age are anxiety and excessive worry, often complicating the problem. Behaviorally, they are restless, rub their hands and feet, and repeatedly pester their family members or doctors with physical discomfort. Therefore, when somatic discomfort occurs in old age and the corresponding physical disease signs are not detected, you should think of the possibility of depression in old age, especially after the emergence of depressive mood disorder, you should promptly go to a specialist hospital.
Principles of treatment of depressive disorders in old age.
1. General treatment Strengthen dietary care, improve nutrition, and give appropriate treatment to the accompanying physical disorders.
2. Psychological treatment Elderly patients often have low comprehension, and verbal communication may be limited. Non-verbal communication and support are effective in improving the sense of powerlessness and low self-esteem of elderly depression disorder patients. Group psychotherapy is helpful in eliminating patients’ feelings of isolation, helplessness and uselessness.
3 Medication The new generation of antidepressants, SSRIs and SNRIs, are now widely used in elderly patients with depressive disorders and have good therapeutic effects.