Depression
Depression is a psychiatric term originally translated from the English depression, unlike the English-speaking world, the Chinese do not use it to describe their mood. If we take a literal approach, depression seems to be depression and depression, but this is far from the original meaning in English. Literally, it would be more appropriate to translate it as “depressed”. Because the original meaning has the meaning of “falling down”. The famous Great Depression, the English is Great Depression.
As a morbid depression, its core experience – low mood (or extreme depression), it is difficult to express in ordinary language. The typical experience of depression is a very rare experience (only a few thousandths of the population have experienced it), not the usual boredom or depression, but a fundamental difference in the underlying experience. Some patients use the metaphor of “falling into a deep well with no bottom, and always falling down”.
When it comes to anxiety, although it is also a pathological experience, it can be understood by the general reader through a description. However, no author in Chinese and English psychiatry textbooks can outline the experience of depression in one paragraph. This unspeakable suffering is not just difficult to express in Chinese; William Styron, a Pulitzer Prize winner, once wrote about his own experience of clinical depression.
”In my mind, this feeling (of depression) is close to actual pain, but different enough to be difficult to describe. This led me to try again to touch that pain of an elusive nature ……William James, who had struggled with depression for years and finally gave up trying to find a proper description, suggests in his work Religious Experiences of All Kinds that it is almost impossible to describe that pain. ‘It is an actively active suffering, a spiritual neuralgia, which normal life is utterly incapable of comprehending.'”
The two Willems, one a master of language, the other a philosopher-cum-psychologist. The difficulty they both had in trying to adequately and accurately describe their experience of depression speaks volumes about the specificity of the experience. Conversely, it is not surprising that an experience that only a few thousandths of the population have had would be difficult to develop universally accepted language.
Another factor that makes morbid depression difficult to describe is that it is somewhat divorced from specific life events. This is similar to pathological anxiety. However, anxiety is outwardly apparent, and although onlookers may not understand why the patient is so worried, it is clear that the patient is worried; whereas depression is an internalized experience, and it is even more puzzling if one is then unable to say exactly what is making it difficult for him or her.
In order to present depression more or less clearly, it seems necessary to use cases. Here is a typical example of depression.
Old Fan, recently, he was not able to fight, and felt that nothing was meaningful. He talks less, always sits and worries, or just lies down. Do something to feel tired. The family advised him to go out and take a break, and it was hard to get up the courage to see the usual favorite chess game, but I felt that I could not keep up with people’s thoughts, and I felt bad, and the usual fun of watching chess was not there at all. Sometimes I couldn’t help but shed tears, and I felt that I was having a particularly hard time, as if I had fallen into an abyss. At night, I seemed to be in a better mood, and I was able to talk to my family. I look forward to going to sleep, but I wake up in the early morning before dawn, waiting for another day to pass like a year.
Old Fan also can not eat, constipation, chest tightness, a month lost more than 10 pounds. He went to the hospital for a checkup, but did not say what the disease was, he felt he might have a terminal illness that could not be cured, and his family and doctors did not tell the truth to himself.
The “depression” of a depressed person is so deep that it can affect physiological functions (e.g., slowed heart rate, low body temperature) to the extent of psychomotor retardation, so K. Schneider called it “vital depression “. This is the reason why the typical depressed patient has very strong suicidal intentions and a very high risk of suicide once psychomotor skills are slightly restored.
Brief history of depression and changes in diagnosis
1. Ancient Greco-Roman doctors recognized that excessive sadness was a disease and called it melancholia (from the Greek melagkholia, melas meaning “black” and khole meaning “bile”, at that time). Melancholia is rarely used in contemporary psychiatric literature, and the DSM-IV (p. 384) uses the adjective melancholic to indicate depression that is severe, with significant psychomotor retardation or typical endogenous depressive features.
2. It was probably in the early 19th century that psychiatrists began to recognize that the two opposite conditions, depression and mania, were linked and that both could occur alternately in the same person. At the end of the 19th century, E. Kraepelin identified manic-depressive psychosis and early-onset dementia (now called schizophrenia) as the two main endogenous psychoses and described in detail their clinical phases, course and outcome. course and outcome.
3. Almost simultaneously with the establishment of Kraepelin’s classical psychiatric classification system, the concepts or clinical categories of affective personality disorder (including depressive personality disorder) and depressive neurosis (neurotic depression) were also proposed and generated widespread interest and controversy.
4. Since much of the past controversy involved etiology, and pragmatic psychiatrists admitted that the etiology was not clear, coupled with the successive marketing and widespread use of effective antidepressants, the psychiatric community put the controversial theoretical issues on hold and adopted a symptomatological description approach to classify depression for the benefit of clinical practice and to facilitate the development of research such as psychopharmacology and epidemiology. In this way, the scope of depression became very broad. In ICD-9 (1978), for example, there are 10 major (3-digit coded categories; note that there are only 30 3-digit coded major categories in ICD-9, Chapter 5, Mental Disorders) or 19 minor (4-digit coded categories) categories (see ICD-9 Quick Reference List No. 1) for “those in which depression is predominant or constitutes a distinctive feature of the clinical picture” (see ICD-9 Quick Reference List No. 1). and is first transcribed as follows.
295 Schizophrenia
295.7 Schizotypal Affective
296 Affective psychoses (with depression in 7 subcategories)
298 Other non-organic psychiatric disorders (by: reactive psychiatric disorders)
298.0 Depressive type
300 Neurotic disorders
300.4 Depressive type
301 Personality disorders
301.1 Affective personality disorders (including depressive personality)
308 Stress-induced acute reactions
308.0 Predominantly affective disorder (can be depressive)
308.4 Mixed (can have depression)
309 Adaptive reactions
309.0 Transient depressive reactions
309.1 Delayed depressive reaction
309.4 Mixed disorder with mood and behavior (can be depressed)
311 Depressive disorder not elsewhere classifiable
312 Behavioral disorder that cannot be categorized elsewhere
312.3 Mixed disorder of behavior and mood (can have depression)
313 Child-adolescent with specific mood disorder
303.1 Complaining, complaining and unhappiness
313.8 Other or mixed (can have depression)
According to W. Mayer-Gross (1955, p. 187), “the average frequency of affective disorders requiring psychiatric treatment in the population is about 3 to 4 per 1,000,” which should refer only to Kraepelin’s manic-depressive psychosis.
The DSM-II (1968) describes depressive episodes as “depressive episodes characterized by severe emotional depression and psychomotor retardation.” This is consistent with Kraepelin’s (1913) concept of manic-depressive psychosis, and ICD-9 (1978) still maintains the nomenclature of affective psychosis (296 Affective Psychosis).
The translation of Major Depressive Episode in the American DSM-IV (1994) as “major depressive episode” seems to be inappropriate and may cause misunderstanding or confusion, because “major depressive episode” itself has “mild The term “Major Depressive Episode” itself is divided into “Mild”, “Moderate” and “Severe”. Notably, “Mild episodes are characterized by the presence of only 5 or 6 depressive symptoms and can have mild functional impairment or no functional impairment with significant or unusual effort on the part of the patient.” (p.376) This means that mild depression in MDE can be objectively invisible if the patient’s internal experience is not known. It is evident that MDE in DSM-IV has completely overturned the definition of DSM-II.
The change in the official US diagnostic criteria began with DSM-III (1980), for the diagnosis of depressive episodes depressed mood is not required to be severe, and psychomotor retardation can be completely absent. In other words, the absence of both features described by DSM-II can still be diagnosed as a depressive episode according to DSM-III.
It should also be noted that DSM-IV (1994, p. 345) has a category of depression titled “300.4 Dysthymic Disorder” (poor mood). According to the ICD-9 classification code it uses, 300.4 refers to “neurotic depression”, but also includes depressive personality.
Max Hamilton, in the foreword to Dysthymic Disorder (Gaskell, Royal College of Psychiatrists, 1990), co-edited by Burton, SW and Akiskal, HS, writes: “Dysthymia lies on the border between the normal and the pathological. Dysthymia lies on the border between the normal and the pathological.” (On the edge of the border between the normal and pathological). In this way, dysphoria is much broader than neurotic depression.
If the diagnosis is so broadened to include depression in all 10 of the ICD-9 categories, it is not surprising that the prevalence of depression is 10 to 20 times higher than 3 to 4 per 1,000, or even higher. It is worth mentioning that in the above 10 categories of ICD-9, where there is depression, there is also anxiety, or a mixture of both.
To summarize, it makes little clinical sense for physicians today to simply diagnose “depression” or “depressive states” without further categorization or description: it can be a very specific type of psychiatric disorder (endogenous depression), or it can be It can be an intermediate type in the transition between schizophrenia and affective disorders, a syndrome in which organic factors predominate after a stroke, a psychiatric abnormality under the direct physiological influence of a physical illness, alcohol or drugs, a personality polarization (depressive personality disorder), a category of neurotic disorders with blurred boundaries (depressive neurosis), stress or adaptation disorders, can be manifested in children, can have an entangled mix with anxiety, and may even be a variant of normal.
Thus, the broad differential diagnosis of depressive states involves almost all of the broad categories in the new ICD-10. It involves debates over biomedical versus psychosocial routes, stress response versus qualitative doctrines, continuous spectrum thinking versus “typical” modes of thinking …… and the entry qualification to engage in these debates is precisely to follow the historical trail and first grasp the various “archetypes”.
Dysthymia
”Dysphoric disorder” (dysthymic disorder) is a diagnostic category created by DSM-III (1980). Conditions that used to be diagnosed as depressive neurosis and depressive personality disorder are now renamed dysthymic disorder and placed in the broad category of dysthymic disorder, alongside depressive episodes of monophasic and bipolar disorders. This implies a dilution of psychosis in the classification and a tendency for the concept of endogenecity to disappear from the classification.
A noteworthy clinical study on pharmacotherapy by Z. Rihmer (1990) divided patients with severe mood disorders into two groups, one with subclinical affective disorders and one with personality spectrum disorders, and found that the two responded differently to pharmacotherapy. For antidepressants, 67% of the subclinical group responded. 14% partially responded and 19% did not respond, while 13% of the personality spectrum group responded, 22% partially responded and 65% did not respond. By responding, we mean that the treatment was effective; by not responding, we mean that the treatment was ineffective. This suggests that subclinical affective disorders and depressive episodes are not very different in terms of treatment response.
Harsh mood disorders include the following four conditions: 1) depressive variants in the prodromal phase of depressive illness; 2) incomplete remission after an acute episode of depressive illness; 3) reactions to long-standing social or personal problems; and 4) depressive types of personality disorders. The DSM-IV (1994, p. 347) refers to a lifetime prevalence of about 6% and a point-in-time prevalence of about 3% for dysphoric disorder, and M. Hamilton (1990) suggests that dysphoric disorder lies on the border between normal and pathological.
This highlights a paradox. As a general rule, conditions on the border between normal and pathological should be more common and have a higher prevalence than the more typical (more abnormal) Major Depression, which now turns out to be somewhat lower instead. Looking at the diagnostic criteria, it is easy to see that a diagnosis of Major Depression requires a duration of only 2 weeks, while a diagnosis of Dysthymic Disorder requires 2 years to be met. It is this difference that makes the prevalence figures appear “upside down”. That is, in order not to make the depressive disorder infinitely larger, for the more common negative emotions, strict time criteria are required. Indeed, the “belly” of depression is too large to encompass all negative human emotions. Unless there is a typical endogenous depressive episode or evidence of a recurrent episodic course, the criteria for the duration of Major Depression (2 weeks for diagnosis) are quite questionable.