What Is the Connection Between Cortisol and Depression?

Major depression, also known as clinical depression, major depression, and unipolar depression, is a mental illness. The typical manifestation of this mental illness is that the patient is in a depressed emotional state, his self-esteem is reduced, and he loses interest in the activities he loves in the past. The term "depression" usually refers to major depressive disorder, but it is also sometimes used to refer to other depressive disorders. The relatively precise term "major depressive disorder" is often used in research and diagnosis. Major depressive disorder is a disability that negatively affects a patient's physical functions such as family, work, study, daily diet, and sleep. In the United States, approximately 3.4% of patients commit suicide. Of all suicides, 60% have major depression or other psychological disorders.

Major depressive disorder

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Major depression, also known as clinical depression, major depression, unipolar depression, is a

The diagnosis of major depressive disorder is based on the following aspects: the subjective description of the patient's symptoms, the description of the patient's behavior by relatives and friends, and the detection of the patient's mental state. No laboratory test can be used to directly diagnose major depressive disorder, but doctors usually ask patients to do some physical examination to rule out other diseases that cause similar symptoms. Major depressive disorder most often occurs between the ages of 30 and 40 and reaches another peak between the ages of 50 and 60. The incidence of major depressive disorder in women is reported to be about twice that of men, but suicide rates are higher in men.

Most patients with major depressive disorder receive in the community

Major depressive disorder is a serious illness that negatively affects a patient's family, relationships, work, study, daily diet and sleep, and other physical functions. Its effect on human function and quality of life can be compared with chronic physiological diseases such as diabetes.

The most typical symptoms of major depressive episodes include: the patient has been in an extremely depressed emotional state for a long time, has lost interest in activities that were previously interesting, and considers his life worthless, extreme guilt, regret, helplessness, despair Feeling and self-abandonment. ^[1]

According to the bio-psycho-social model, biological factors, psychological factors, and social factors all affect the incidence and development of depression to varying degrees. Another theory, the quality-stress model, considers depression as a patient's predisposition (quality) to be activated by stressful events in life. This patient's susceptibility can be caused by heredity, which involves the interaction between innate and acquired, or a schema, a specific cognitive model that the patient learned through childhood. Both of these interaction modes have been experimentally supported. For example, researchers in New Zealand use predictive methods to study depression. In the experiment, researchers tracked a group of healthy people for a long time and recorded the conditions related to depression. Ultimately, the researchers concluded that the serotonin transporter (5-HTT) gene in the human body affects whether people continue to experience depression during stressful events. They specifically point out that depression is more likely to occur in people with short alleles of one or two serotonin transporters.

A Swedish study estimates the genetic chance of depression, which is about 40% for women and about 30% for men. Evolutionary psychologists believe that the genes that make people suffer from depression already exist in the history of natural selection. If patients take psychotropic drugs for a long period of time, such as long-term use of sedatives and sleeping pills, they may also develop symptoms similar to major depression. These symptoms are caused by side effects of the drug or withdrawal of the drug, and are called substance-related mood disorders and are not major depressive disorders.

The three most common treatments for depression are psychotherapy, medication, and electrical spasm.

Psychotherapy is preferred for patients under the age of 18, and electroconvulsive therapy is the last resort for all patients. Treatment is generally performed in an outpatient setting but patients with a significant tendency to self-harm or harm others should be admitted to the hospital for treatment. Many studies report that physical exercise has a positive effect on treatment.

In developing countries, treatment options are greatly restricted. When it comes to mental health, patients often have difficulty accessing medication and psychotherapy. Mental health services are scarce in many countries, and depression is seen as a phenomenon unique to developed countries, rather than an inherent, life-threatening condition, although evidence suggests the opposite.

With or without treatment, major depressive episodes usually resolve over time. Patients waiting to see their symptoms have reduced by 10-15% within a few months, and about 20% of patients no longer meet the diagnostic criteria for depression. The median duration of a single episode is approximately 23 weeks and is most likely to recover in the first three months.

A survey of the general population shows that about half of people with or without a major depressive episode (with or without treatment) recover and no longer relapse, and about 35% have at least one more episode and 15% Of people experience chronic relapse. Studies on inpatients have shown a lower recovery rate and are more likely to develop chronic, while studies mainly on outpatients have shown that almost all patients recover, with a median duration of onset of 11 months. About 90% of patients with severe or psychotic depression who often meet the diagnostic criteria for other mental disorders will experience relapse.

If treatment does not completely relieve all symptoms, then patients are more likely to experience relapses. Current treatment guidelines recommend that antidepressants be continued for 4 to 6 months after the symptoms have subsided to prevent recurrence. Many randomized controlled trials have shown that continuing to take antidepressants after recovery can reduce the chance of recurrence by 70% (41% of patients in the placebo group and 18% of patients in the antidepressant group). This preventive effect is effective for at least the first 36 months of administration.

Depression patients have a shorter life expectancy than healthy people, partly because they are at risk for suicide, but there are also other reasons that patients have increased susceptibility to physical diseases such as heart disease. Up to 60% of suicidal people have a mood disorder (such as major depressive disorder), and if the patient has significant despair or has both depression and borderline personality disorder, the risk of suicide is very high. The lifetime suicide rate associated with diagnosed major depressive disorder is about 3.4%, which is an average. Suicide rates vary widely between men and women, with men nearly 7% and women 1% (although women attempt suicide more often). This estimate is much lower than the previously widely accepted data (15%), which was derived from older studies of hospitalized patients.

There is a fundamental difference between Chinese medicine's views on depression and the Western medicine system. Traditional Chinese medicine has a long history of understanding depression. The "Su Wenliu Yuanyuan Chronicle" has the following meanings: the stagnation of the stagnation, the stagnation of the stagnation, the stagnation of the fire, the stagnation of the stagnation, and the sorrow of Jin Yu. In other words, the expression of water depression. The so-called depression in Chinese medicine mentioned here is one for the disease name and the other for emotional illness. Major depressive disorder belongs to the latter. In addition to depression, deficiency syndrome is also a major cause of depression. According to a survey of 1977 depression patients across 8 provinces of mainland China, the pathogenesis of depression is mainly related to the liver, spleen, and heart referred to by Chinese medicine, and the most common are liver stagnation, qi stagnation and liver stagnation. Spleen deficiency, liver stagnation and sputum obstruction, heart and spleen deficiency syndromes are of four types. And emotional factors, namely: joy, anger, worry, thought, sadness, terror, and shock, too much emotion is the cause of depression. In view of the above causes, the method of traditional Chinese medicine for treating depression is generally based on the principles of relieving liver and relieving depression, promoting blood circulation and removing blood stasis. Although there are small-scale studies showing that Chinese medicines are even less effective in treating depression than SSRIs such as fluoxetine, these studies often have methodological problems. A 2008 meta-analysis of Chinese, English, Japanese, Korean databases and dissertation databases indicated that the efficacy of TCM electroacupuncture treatment was not statistically different from that of the antidepressant fluoxetine, and was significantly better than that of the blank control group. The side effects of electroacupuncture in TCM are mild, which shows that TCM has great potential in treating depression.

Hippocrates, an ancient Greek physician, classified "mental depression" as an independent disease with specific psychological and physical symptoms. He believes that "fear and despair last a long time" as a sign of the disease. His concept is similar to depression today, but much broader, and it is advisable that it highlights a collection of symptoms formed by sadness, depression, disappointment, fear, irritability, delusions, and obsessions. .

The word "depression" comes from the Latin verb "deprimere" which means "press down." Since the 14th century, "to depress" has been used to refer to depression. In 1665, writer Richard Baker used the word depression for the first time in his book "Chronicles" to indicate "emotional extreme depression". In 1753, the British writer Samuel Johnson Johnson) uses the word in a similar way. Soon, the term began to be used in the fields of physiology and economics. In 1856, French psychiatrist Louis Delasiauve used it for the first time to describe a psychiatric symptom. By the 1860s, it had begun to appear in medical dictionaries, describing physiological and metaphorical diminished emotional function. Beginning with Aristotle, mental depression is considered to be associated with outstandingly talented and knowledgeable men, and it is considered a danger caused by thought and innovation. With the renewal of ideas, this view was gradually abandoned, and from the 19th century it became more relevant to women.

Sigmund Freud compared his state of mental depression to mourning in his 1917 paper, Mourning and Melancholy. He hypothesized that the loss of an object, such as the loss of an important relationship or loss of love due to death, may cause the loss of the subject (self), because the depressed individual will be closely connected with the emotional object through the subconscious narcissistic attention (the libido of the self) Connection. This loss causes more severe symptoms of depression than mourning. Patients not only have a negative view of the outside world, but also suffer damage to themselves. Patients' self-awareness decline is reflected in: self-blame, self-derogation, and consciousness worthless. Freud also emphasized that early experience was a trigger. Adolf Meyer proposes a model that integrates social and biological factors. He emphasizes the individual's response in his specific environment and believes that the word "depression" should be used instead of "mental depression". The first edition of the Diagnostic and Statistical Manual of Mental Illness (DSM-I, 1952) includes diagnostic criteria for "depressive reactions," and DSM-II (1968) calls it "depressive neurosis." Early DSMs defined depression as an overreaction to internal conflicts or exact events. Depression and bipolar disorder together fall into the category of major affective disorder.

By the middle of the 20th century, researchers proposed the theory of chemical imbalance: depression is caused by neurotransmitter disorders in the brain. The two drugs reserpine and isoniazid change the levels of monoamine neurotransmitters. In the 1950s, researchers proposed the "monoamine hypothesis" by observing the effects of these two drugs on the symptoms of depression.

The term "major depressive disorder" was coined by some American clinicians in the mid-1970s. It was originally included as part of the "diagnostic criteria for research" and was formally included in DSM-III by 1980. To maintain consistency, ICD-10 uses almost the same diagnostic criteria. It uses the lowest threshold of DSM as a diagnostic criterion for mild depressive episodes and uses a higher criterion than DSM to diagnose moderate and severe depressive episodes. Previously, the concept of "mental depression" continued to exist as a subtype of major depressive disorder.

The new definition of depression is widely accepted, but there are also some different views and findings. Debates continue over whether to return to the diagnostic criteria for mental depression, and these debates are generally based on experience. The new standard expanded the coverage of depression, which has also been criticized and considered to be related to the development and promotion of antidepressants in the late 1950s and the development of biological models of depression.