What is Clinical Depression?

Depression, also known as depression, is characterized by significant and lasting depression, and is the main type of mood disorder. Clinically, it can be seen that the depression is not commensurate with their situation. Depression can range from sullen to distressed, low self-esteem, depression, and even pessimism. Suicidal attempts or behaviors may occur; even stiffness may occur. Some cases have obvious anxiety and sports agitation. In severe cases, psychotic symptoms such as hallucinations and delusions may occur. Each episode lasts for at least 2 weeks, the elderly or even years. Most cases have a tendency to recur. Most episodes can be relieved, and some may have residual symptoms or become chronic.

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"Child Shirley, good night" How to prevent suicidal crisis in a long-term depression? 2019-10-20 18:10

This article discusses depression and the thoughts of rebirth brought about by it, hoping that the deceased can get the freedom, happiness and peace that he longed for during his lifetime; I also hope that you who are reading this article will never have the moment to use this knowledge. ... more

Basic Information

nickname: Depression
English name: depression
Visiting department: Psychiatry
Common causes: Heredity, HPA axis, cytokines, sex hormones, neurotrophic factors, etc.

Common symptoms: Depression, mental retardation, reduced will activity, cognitive impairment, physical symptoms, etc.
Contagious: no
Related brain regions: Prefrontal cortex, hippocampus, amygdala, etc.

Overview of depression development

The comparison of the prevalence of depression in China and the world is as follows:

	world	Our country
Number of depression patients	322 million ^[1]	(No exact data)
Prevalence	4.4% ^[1]	(4.2 ± 1.9)% ^[1-2]

Note: 1. Most reports have determined that the prevalence of depression in China is in the range of 3% to 5%, but some reports have reached 6.1%.

2. Regional differences in the incidence of depression in China are large.

3.30 years, the reported incidence of depression has increased by 10 to 20 times, and it is still on the rise; it is not excluded that some words are incorrectly (falsely) reported with the words "indicated by the World Health Organization", so this data may not be accurate .

Depression is the fourth largest disease in the world and is expected to become the second largest by 2020; however, the medical treatment of depression in China is still in a low recognition rate, and hospitals above the prefecture level have a recognition rate of less than 20%. Less than 10% of patients have received relevant medications; moreover, at the same time, the incidence of depression (and suicides) has begun to become younger (university, even elementary and middle school student groups). ^[2] In summary, the popularization, prevention, and treatment of depression need urgent attention, and the prevention and treatment of depression has been included in the national mental health work.

Causes of depression

So far, the etiology of depression is not very clear, but it is certain that many aspects of biological, psychological and social environment are involved in the pathogenesis of depression. Biological factors are mainly related to heredity, neurobiochemistry, neuroendocrinology, and neural regeneration. Psychological predispositions that are closely related to depression are pre-morbid personality traits, such as depression temperament. Stressful life events in adulthood are important triggers for clinically significant depression. However, the above factors do not work alone. It is emphasized that the interaction between genetics and environment or stress factors, and the time when such interactions occur, have an important impact on the occurrence of depression.

Clinical manifestations of depression

Depression can be manifested as single or repeated depressive episodes. The following are the main manifestations of depressive episodes.

Low mood

Mainly manifested as significant and lasting emotional depression, depression and pessimism. The lightest person is unhappy, unhappy, and diminished. The serious person is painless, pessimistic, desperate, living like a year, and not living as well. Depressive mood of typical patients has light rhythm changes in the morning and night. On the basis of a depressed mood, patients will experience a decrease in self-evaluation, a sense of uselessness, hopelessness, helplessness, and worthlessness, often accompanied by self-blame and guilt, and serious cases of delusions of guilt and suspected illness. Hallucinations.

2. Slow thinking

The patient's thinking association speed is slow, the response is slow, the thinking is blocked, and he consciously "the brain seems to be a machine with rust", "the brain is like a layer of paste". Clinically, it can be seen that active speech is reduced, the speed of speech is significantly slowed, the voice is low, the answering is difficult, and the communication in severe cases cannot be carried out smoothly.

3. Decreased will activity

The patient's volition was significantly and permanently suppressed. Clinical manifestations Slow behavior, passive, lazy life, do not want to do things, unwilling to contact with people around, often sitting alone, or staying in bed all day, living behind closed doors, alienating relatives and friends, avoiding socializing. In severe cases, even eating, drinking and other physical needs and personal hygiene are disregarded. They are unkempt, shameless, and even develop into a silent, immobile, and foodless, known as "depressive stiffening," but after careful mental examination, patients still show pain and depression. mood. Patients with anxiety may have symptoms such as restlessness, finger gripping, rubbing their hands or tossing around. Severe patients are often accompanied by negative suicidal ideas or behaviors. The survey shows that 287,000 people die of suicide each year in China, of which 63% have mental disorders and 40% suffer from depression. ^{[3] There} are many celebrities who committed suicide due to depression, including Van Gogh, Hemingway, San Mao, Leslie Cheung, ^[3] Xu Xing, Li Xiao, Robin Williams, Qiao Renliang, etc. ^[4] . Negative pessimism and self-blame and self-confidence, lack of self-confidence can germinate despairing thoughts, "Ending your life is a kind of relief", "Living in the world is an extra person", and will make suicide attempts into suicide behavior. This is the most dangerous symptom of depression and you should be alert.

4. Cognitive Impairment

Research suggests that patients with depression suffer from cognitive impairment. Mainly manifested in the decline of recent memory, attention disorder, prolonged response time, increased alertness, poor abstract thinking ability, learning difficulties, poor language fluency, spatial perception, eye-hand coordination and thinking flexibility. Cognitive impairment leads to social dysfunction and affects patients' long-term prognosis.

5. Physical symptoms

There are mainly sleep disorders, fatigue, loss of appetite, weight loss, constipation, pain in any part of the body, loss of libido, impotence, amenorrhea and so on. Physical complaints of physical discomfort can involve various organs, such as nausea, vomiting, palpitation, chest tightness, and sweating. Symptoms of autonomic dysfunction are also more common. Complaints of pre-morbid somatic disease are usually exacerbated. Sleep disturbance is mainly manifested by early awakening, which usually wakes up 2 to 3 hours earlier than usual, and cannot fall asleep after waking, which has a characteristic significance for depressive episodes. Some manifested as difficulty falling asleep and not sleeping deeply; a few patients showed excessive sleep. Weight loss is not necessarily proportional to loss of appetite. A small number of patients may experience increased appetite and weight gain.

Depression check

For patients with suspected depression, in addition to comprehensive physical and neurological examinations, attention should be paid to auxiliary examinations and laboratory examinations. To date, there are no specific tests for depressive disorders. Therefore, the current laboratory test is mainly to exclude depression caused by physical and physical diseases. There are two types of laboratory tests that have some significance, including the dexamethasone suppression test (DST) and the thyrotropin-releasing hormone suppression test (TRHST).

Depression diagnosis

The diagnosis of depression should mainly be based on medical history, clinical symptoms, course of disease, physical examination and laboratory examination. Diagnosis of typical cases is generally not difficult. The internationally used diagnostic standards generally include ICD-10 and DSM-IV. ICD-10 is mainly used in China, which refers to the first episode of depression and relapsed depression, excluding bipolar depression. Patients usually have typical symptoms such as low mood, loss of interest and pleasure, lack of energy or fatigue. Other common symptoms are: decreased ability to concentrate and pay attention; decreased self-evaluation; the concept of self-incrimination and sense of worthlessness (even in mild attacks); pessimism about the future; the idea of self-harm or suicide Or behavior; sleep disorders; decreased appetite. The course of the disease lasted at least 2 weeks.

Depression treatment

Treatment goal

The treatment of depression episodes must meet three goals: improve the clinical cure rate, minimize the disability and suicide rate, the key is to completely eliminate clinical symptoms; improve the quality of life and restore social function; prevent relapse.

2. Principles of treatment

Individualized treatment; The dose is gradually increased, and the minimum effective amount is used as much as possible to minimize adverse reactions to improve medication compliance; A sufficient amount of foot treatment is used; Use as much as possible single medication. If the effect is not good, consider switching Treatment, synergistic treatment or combined treatment, but need to pay attention to drug interactions; informed informed before treatment; close observation of disease changes and adverse reactions during treatment and timely treatment; can be combined with psychological treatment to increase the efficacy; active treatment and depression together Other physical diseases, substance dependence, anxiety disorders, etc.

3. Drug treatment

Drug therapy is the main treatment for moderate or more depressive episodes. Currently, the first-line clinical antidepressants mainly include selective serotonin reuptake inhibitors (SSRI, representative drugs fluoxetine, paroxetine, sertraline, fluvoxamine, citalopram, and escitalopram). , Serotonin and norepinephrine reuptake inhibitors (SNRI, for the drugs venlafaxine and duloxetine), norepinephrine, and specific serotonin antidepressants (NaSSA, for the drug nitrogen equality. Traditional tricyclic and tetracyclic antidepressants and monoamine oxidase inhibitors have been significantly reduced in application due to their large adverse effects.

4. Psychotherapy

For patients with depressive episodes with significant psychosocial factors, psychotherapy is often required at the same time as medication. Commonly used psychotherapy methods include supportive psychotherapy, cognitive-behavioral therapy, interpersonal therapy, marriage and family therapy, and psychodynamic therapy. Among them, the effect of cognitive-behavioral therapy on depression has been recognized.

5. Physical therapy

In recent years, a new type of physical therapy has appearedrepetitive transcranial magnetic stimulation (rTMS) therapy, which is mainly applicable to mild to moderate depressive episodes.

Depression prevention

Someone's research on patients with depression for 10 years found that 75% to 80% of patients have multiple relapses, so patients with depression need preventive treatment. More than 3 attacks should be treated for a long time, or even medication for life. Most scholars believe that the dose of maintenance therapy should be the same as the therapeutic dose, and they should be followed up regularly for outpatient observation. Psychotherapy and social support systems also play a very important role in preventing the recurrence of this disease. Patients should be relieved or relieved of excessive psychological burden and pressure as much as possible, help patients to solve practical difficulties and problems in life and work, and improve patients' ability to cope. And actively create a good environment for it to prevent recurrence. ^[5-7]