I. The concept of depressive disorder
Depressive disorder is a common mood disorder, can be caused by various reasons, with significant and persistent depression as the main clinical features, and the depression is not proportional to its situation, the clinical manifestations can range from sullenness to grief, and even wood stiffness; some cases have obvious anxiety and motor agitation; severe cases can appear hallucinations, delusions and other psychotic symptoms. Most cases have a tendency to have recurrent episodes, and most episodes can resolve with each episode; some may have residual symptoms or turn chronic. Depressive disorders mainly include: depression, bad mood, psychogenic depression, depression in patients with brain or physical diseases, depression with psychoactive substances or non-addictive substances, post-psychotic depression, etc.
Second, the diagnostic criteria and classification of depressive disorders
1.Chinese Classification and Diagnostic Criteria for Mental Disorders (CCMD I3) diagnostic criteria for depressive disorders are as follows.
Depressive episodes.
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.
Symptom criteria: predominantly depressed mood and at least four of the following.
(1) Loss of interest and unpleasantness.
(2) A sense of diminished 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) Recurrent 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) Decreased sexual desire.
Severe criteria: impaired social functioning, causing distress or adverse consequences to the person.
Disease course criteria.
(1) Meet the symptom criteria and severity criteria has lasted at least 2 weeks.
(2) Some schizophrenic symptoms may be present but do not meet the diagnosis of schizophrenia. If both symptom criteria for schizophrenia are met, the criteria for depressive episode are met for at least 2 weeks after remission of schizophrenic symptoms.
Exclusion criteria: Exclude organic mental disorders, or depression due to psychoactive and non-addictive substances.
2. International Classification of Diseases, 10th edition (ICD-10 Classification of Mental and Behavioral Disorders, WH0. 1992), depressive disorder classification and diagnostic criteria
Three different forms of depressive episodes (mild, moderate, and severe). Typical episodes in all forms usually have depressed mood, loss of interest and pleasantness, and decreased energy leading to increased exertion and decreased activity. Also common are symptoms of significant burnout from doing things for a little while. Other common symptoms are.
(1) Reduced ability to focus and pay attention.
(2) Decreased self-esteem and self-confidence.
(3) Perceptions of self-guilt and feelings of worthlessness (even in mild episodes).
(4) Perception of a bleak and pessimistic future.
(5) Self-injurious or suicidal ideation or behavior.
(6) Sleep disturbances.
(7) Decreased appetite.
Third, the treatment of depression disorder
1. Depression is a highly recurrent disorder (>50%). It has been reported that environment, behavior and stress can alter gene expression. Depression relapse can affect the biochemical processes in the brain, increasing sensitivity to environmental stress and the risk of relapse. Medications, although not etiologic, can reduce relapse by reducing episodes and decreasing biochemical alterations in gene activation, especially for high-risk groups with a history of previous episodes, family history, women, postpartum, chronic physical illness, high life burden, mental stress, lack of social support and substance dependence.
2.Drug treatment for depressive disorders
Antidepressants are the main drugs for the treatment of various depressive disorders, which can effectively relieve depressive mood and accompanying anxiety, tension and somatic symptoms, with an efficiency of about 60% to 80%.
3.Treatment strategy of antidepressant drugs.
Depression is a highly recurrent disease, the whole treatment is currently advocated. The full treatment of depression is divided into three phases: acute treatment, recovery (consolidation) treatment and maintenance treatment. In single-episode depression, 50% to 85% will have a second episode, so maintenance treatment is often needed to prevent relapse.
(1) Acute phase treatment
Recommended 6-8 weeks. Control symptoms and try to achieve clinical recovery. When treating depression, medication usually begins to work in 2 to 4 weeks. If the patient is not effective with medication for 4 to 6 weeks, it may be effective to switch to other drugs of the same type or drugs with a different mechanism of action.
(2) Recovery period (consolidation period)
Treatment for at least 4 to 6 months, during which the patient’s condition is unstable and the risk of relapse is high, and in principle, the drugs that were effective in the acute phase of treatment should continue to be used at the same dose.
(3) Maintenance period treatment
Depression is a highly recurrent disease, so maintenance treatment is required to prevent relapse. After the maintenance treatment is completed and the disease is stable, the medication can be slowly reduced until the termination of treatment, but the early signs of relapse should be closely monitored and the original treatment should be rapidly resumed once the early signs of relapse are detected. WH0 recommends that maintenance treatment should not be used if there is only one episode (single episode) with mild symptoms and a long interval (≥5 years). Most opinions suggest that maintenance treatment for the first depressive episode should be 6-8 months; those with more than 2 relapses, especially those with 2 episodes in the last 5 years, should be maintained. Maintenance treatment should be considered for patients with adolescent onset, with psychotic symptoms, severe illness, high risk of suicide, and a genetic family history. The duration of maintenance has not been adequately studied and is generally at least 2 to 3 years, with long-term maintenance treatment advocated for multiple relapses. Some data suggest that using the acute treatment dose as the maintenance treatment dose is more effective in preventing relapse.