Overview:
- A typical case of depressive disorder
- The core symptoms are significant and persistent depression, loss of interest, etc.
- The most common mental disorder with a high clinical cure rate
- Suicide is one of the worst outcomes for people with depression
Depression is a typical case of depressive disorder.
Depression is a mental disorder with a high prevalence and a high clinical cure rate. However, due to the lack of awareness of the disease among ordinary people, fewer patients insist on regular treatment, so it also has the characteristics of low treatment rate and high recurrence rate.
It is characterized by significant and persistent depression. Some patients have self-injury and suicide behaviors, which may be accompanied by psychotic symptoms such as delusions and hallucinations. In severe cases, depressive stupor may occur. Lack of response to stimuli, few or no words, little or no movement, etc.
Depression generally manifests as low mood, loss of interest, and lack of energy during an attack.
Epidemiology:
Most of them are acute or subacute onset, and occur in autumn and winter.
The average age of onset is 20-30 years old, and the prevalence rate of women is higher than that of men (about 2:1).
The 2019 China Mental Health Survey Research Report shows that the lifetime prevalence of depression in my country is 6.8%, and the 12-month prevalence is 3.6%. Among them, the lifetime prevalence of depression is 3.4%, and the 12-month prevalence is 3.4%. The rate is 2.1%.
Statistics from the World Health Organization (WHO) on the global burden of disease in 2017 showed that the disability-adjusted life years of depression (the total years of healthy life lost from onset to death) rose to 11th, and the study also showed that depression has become The third leading cause of years of healthy life lost due to disability (years of life lost due to premature death), depression is projected to become the second largest source of disease burden after cardiovascular disease by 2020.
Disease type:
Clinically, depressive disorders are often divided into mild, moderate and severe according to the number, type and severity of symptoms.
In addition, because specific groups of people have their corresponding characteristics, depression can also be subdivided into geriatric depression, childhood depression, postpartum depression, and so on.
Etiology:
The etiology and pathogenesis of depression involve biochemistry, neuroendocrine, neuroimmunology, sleep and brain electrophysiological abnormalities, brain imaging, genetics, psychosocial factors, etc.
Basic cause
The etiology and pathogenesis of this disease are still unclear, and a large number of research data suggest that genetic factors, neurobiochemical factors, and psychosocial factors have a significant impact on the occurrence of this disease.
Predisposing factors:
There is no clear predisposing factor for this disease, but at present, stressful life events, pessimistic personality traits, history of other mental illnesses, severe chronic diseases, alcoholism, drug abuse, etc. have a close relationship with the onset of depression .
Symptom:
The manifestations of depressive episodes can be divided into three aspects: core symptom group, psychological symptom group and physical symptom group.
In the past, the "three lows" were used to summarize depressive episodes, that is, depressed mood, slow thinking, and decreased willpower. These three symptoms are considered to be typical symptoms of severe depression, but these typical symptoms do not necessarily appear in all patients. .
Early symptoms:
It is impossible to say exactly what the early symptoms of depression are. There are many symptoms of depression. In fact, there will be certain individual differences in the symptoms that each patient exhibits at the beginning. If you find that you have significant and persistent depression and other abnormalities in your daily life, you can use the "9-item Simple Patient Health Questionnaire (PHQ-9), Zung Depression Scale (SDS), Beck Depression Inventory (BDI), quick Depression Symptom Self-Rating Questionnaire (QIDS-SR)" and other self-rating scales have certain positive significance for early screening.
Typical symptoms
core symptoms
Depression
Self-perceived or observed by others, depression, distress and sadness, feeling that the pain is hard to get over, not happy, or even feel that life is like a year, life is better than death, often frowning and sighing.
Depressed mood is present almost daily and generally does not change with environmental changes.
Loss of interest or anhedonia:
Loss of interest or decreased interest in everything, loss of enthusiasm for previous hobbies, loss of ability to experience happiness, and inability to gain pleasure from daily activities.
Even with simple activities like reading a book or watching TV, the main purpose is to pass the time, not to derive pleasure from it.
Mental Symptoms:
Anxiety
Expressed as upset, worried, nervous, cranky, worried about losing control or having an accident, etc.
Slow thinking:
Conscious unresponsiveness, difficulty in thinking about problems, decreased decision-making ability, decreased speech, slowed speech speed, decreased volume, and in severe cases, there will also be obstacles to answering and communicating.
cognitive symptoms
The main manifestations are decreased memory ability for recent events, attention deficit, decreased information processing ability, indifference to self and surrounding environment, etc.
When it is severe, it will produce "three asymptoms", that is, feeling useless, helpless and hopeless.
Uselessness: Decreased self-esteem, feeling that one's life is worthless, full of failures, and useless.
Helplessness: Feeling powerless and alone.
Hopeless: Thinking that you have no way out, no hope, and a bleak future.
Self-blame:
Blame them for some minor mistakes or mistakes in the past, and when they are serious, they will feel deep guilt or guilt, thinking that they have sinned deeply and must be punished by society.
Suicide Attempts and Behavior
Severe depression patients are often accompanied by negative suicidal ideas and behaviors. Suicidal ideas are often stubborn and recurring, and the suicide behaviors adopted are often well-planned and difficult to prevent. Therefore, suicidal behavior is the most serious and dangerous of depressive disorders. symptoms.
Psychomotor changes
Psychomotor retardation or agitation may occur.
Hysteresis: manifested as slow movement, slow thinking, decreased activity, lazy life, alienation from relatives and friends, social avoidance, decreased work efficiency, and lack of attention to personal hygiene. Not eating, the state of "depressive stupor".
Agitation: involuntarily thinking about some purposeless things repeatedly in the mind, and the content of thinking is not organized, so the behavior shows restlessness, inability to control oneself, and even aggressive behavior.
psychotic symptoms
Psychotic symptoms such as hallucinations or delusions may occur in patients with severe depressive disorder.
Insight
Some depressive disorder patients can actively seek treatment and describe their own illness and symptoms, which means complete insight.
Patients with severe depressive disorder may lack a correct understanding of the current state, or even completely lose the desire to seek treatment. This is incomplete or lack of insight.
Somatic Symptoms
sleep disorder
It is manifested as difficulty in falling asleep, light sleep, dreaminess, early awakening, lack of sleep, etc. Among them, difficulty in falling asleep is the most common, generally delayed for more than half an hour than usual, and early awakening is the most characteristic, generally waking up 2-3 hours earlier than usual, and can no longer fall asleep after waking up.
Eating and Weight Disorders
Mainly manifested as loss of appetite and weight loss.
loss of energy
Expressed as listlessness, fatigue, and laziness.
Depression day and night
Depression is often aggravated in the morning and relieved in the afternoon and evening. This symptom is one of the typical manifestations of "endogenous depression". However, the symptoms of some patients with psychogenic depressive disorder may be aggravated in the afternoon or evening, contrary to the above.
sexual dysfunction
It can be a decrease or even a complete loss of libido, and sexual dysfunction occurs.
Other nonspecific somatic symptoms
Such as headache, back pain and other pain in any part of the body, dry mouth, sweating, blurred vision, palpitation, chest tightness, nausea, vomiting, burning sensation in the stomach, frequent urination, urgency and other manifestations.
Seek medical attention
When you feel that you have long-term depression, lack of interest in everything or loss of interest, or even accompanied by slow reaction, slow thinking, memory loss and other symptoms of suspected depression, you should seek help from the doctor in time. In addition, family members or relatives find that relatives, When friends have the above-mentioned symptoms, they should also actively encourage them to seek medical treatment.
For patients who have been diagnosed with depression, they should strictly follow the doctor's advice for treatment, and insist on regular follow-up visits. Even if the condition has been effectively controlled after treatment, if there are major changes in life or if there are signs of depression, they should seek medical treatment in time.
Diagnosis process:
Generally speaking, doctors first need to fully understand the patient's medical history, including but not limited to current medical history, existing symptoms, whether there are self-injury and suicide thoughts and behaviors, whether there has been a history of manic episodes or psychotic symptoms in the past, and current treatment and curative effect, previous treatment methods, drug/psychoactive substance use, personal history, family history, etc.
Since the etiology and pathogenesis of depression are still unclear, the diagnosis of depression mainly relies on a comprehensive assessment of the patient, and then based on the clinical manifestations, course of disease, and severity of symptoms, after excluding substances, drugs, or other physical problems. After a depressive disorder, the disorder is diagnosed.
Medical department:
You can go to psychiatric hospitals, mental health centers, psychiatry or psychology departments of general hospitals and other related departments for treatment.
Clinical Other Rating Scale
For doctors to use, there are mainly Hamilton Depression Scale (HAMD) and Montgomery Depression Scale (MADRS), which can not only comprehensively and accurately evaluate the depressive symptoms of patients, but also can be mutually verified with patient self-rating scales.
Other assessment tools
Including suicide risk assessment, mania risk assessment, quality of life and social function assessment, medication side effects scale, Arizona Sexual Experience Scale (ASEX), Medication Adherence Rating Scale (MARS), etc.
These scales can assist doctors to conduct a comprehensive assessment of the risk of depressive disorder, whether it is accompanied by mania, the impact of the disease on social function, the side effects of drugs, and compliance.
Differential diagnosis
Depression needs to be differentiated from secondary mood disorders, schizophrenia and other diseases.
Depression related to medical illness
Many physical diseases, such as cardiovascular system diseases and respiratory system diseases, may be the direct cause, inducement or accompanying depressive disorder.
During the diagnosis, relevant medical history should be inquired in detail and a comprehensive examination should be carried out to clarify the relationship between the two diseases, so as to give active intervention and treatment, and one should not lose sight of the other.
Dementia
Depressive disorders in elderly patients are often accompanied by obvious changes in cognitive function, and its performance is similar to dementia, which is called pseudodementia.
Different from the slow onset of Alzheimer's disease, the onset of senile depressive disorder is more rapid. Patients have certain requirements for seeking treatment and self-awareness.
People with depressive disorders are often reluctant to answer questions on psychological tests, and people with dementia will make up as much as possible.
After antidepressant treatment, the cognitive function of depressive disorder patients will recover to a certain extent in a short period of time, but not in dementia patients.
Schizophrenia
Depression takes low mood as the primary symptom, and psychotic symptoms are secondary, while schizophrenia is just the opposite;
Mental activities such as thinking, emotion, and volitional behavior in patients with depression are coordinated, while patients with schizophrenia are uncoordinated;
Depression is an intermittent course, and the intermittent period is basically normal, while schizophrenia is mostly a progressive course, and there are often residual mental symptoms or personality changes in the remission period.
Post Traumatic Stress Disorder (PTSD)
Patients with post-traumatic stress disorder are often accompanied by depressive symptoms, but patients often encounter severe, catastrophic, and life-threatening traumatic events, such as earthquakes, abuse, rape, etc. Agitation-based emotional changes. Patients often have trauma-related nightmares, nightmares, etc., often re-experience traumatic events, and have recurrent compulsive memories.
Bipolar depression
Bipolar depression refers to a history of manic episodes and depressive episodes, and this episode is dominated by depressive symptoms. Patients with depression have no previous history of manic episodes, and always have depressive symptoms as the main clinical manifestation.
Treat
Treatment of depression not only relieves the suffering of patients, but also reduces the burden on families and society after enabling patients to return to society.
Treatment for depression mainly includes medication, psychotherapy, and physical therapy.
Treatment goals: improve clinical cure rate, improve quality of life, restore social function, and prevent recurrence.
Treatment principles: the principles of full course treatment, the principles of individualized rational drug use, the principles of quantitative assessment, the principles of single use of antidepressants, the principles of alliance treatment, etc.
The whole course of treatment of depression can be divided into three stages, namely acute stage treatment, consolidation stage treatment and maintenance stage treatment.
Medical treatment:
Due to large individual differences, there is no absolute best, fastest, or most effective medication. Except for commonly used over-the-counter drugs, you should choose the most appropriate drug based on your personal situation under the guidance of a doctor.
Drugs are the main treatment for depression, and it is recommended to choose antidepressants with good curative effect and high safety. It should be noted that psychotropic drugs should be taken under the guidance of a doctor and strictly in accordance with the doctor's advice.
The currently recommended antidepressants include selective serotonin reuptake inhibitors (SSRIs), selective serotonin and norepinephrine reuptake inhibitors (SNRIs), norepinephrine, and specific 5- Serotonin reuptake inhibitors (NaSSAs), norepinephrine and dopamine reuptake inhibitors (NDRIs), etc.
SSRIs: Representative drugs include fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram, etc. Common adverse reactions are nausea, vomiting, diarrhea, restlessness, loss of libido, headache, etc.
SNRIs: Representative drugs include venlafaxine, duloxetine, etc. Common adverse reactions are nausea, vomiting, agitation symptoms and sexual dysfunction.
NaSSAs: The representative drug is mirtazapine. Common adverse reactions were dry mouth, sedation and weight gain.
NDRIs: The representative drug is bupropion. Common adverse reactions are headache, tremor, convulsions, agitation, insomnia, and gastrointestinal discomfort.
Acute treatment
The purpose of treatment in the acute phase is to control symptoms and try to make patients achieve clinical recovery (complete disappearance of symptoms).
Antidepressants usually start working within 2 to 4 weeks.
If the drug treatment is ineffective for 6-8 weeks, another drug of the same class or another drug with a different mechanism of action can be used instead.
Consolidation treatment
The purpose is to prevent patients from relapsing symptoms due to early drug reduction or drug withdrawal after partial relief of symptoms in the acute phase.
Patients in the consolidation stage are unstable and have a high risk of relapse, and they need to continue treatment for at least 4 to 6 months. It should be emphasized that the treatment plan, dosage, and method of use are the same as those in the acute stage.
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