Backstage, there have always been many friends who have left me messages asking me to talk about this disease. Well, today we are reporting the disease in the form of several cases, hoping to arouse everyone's vigilance.
Case 1: The patient is female, 36 years old, because of "intermittent limb weakness, palpitations, dizziness for more than 2 years" to visit the hospital, and it is repeated visits, limb weakness, palpitations, dizziness, which are more common symptoms, especially palpitations, dizziness, generally involving neurology, cardiovascular diseases, limb weakness is often thought to be nervous system, endocrine diseases, such as whether there is a stroke, whether there is hyperthyroid myopathy, etc.
This patient went to the doctor more and took a lot of drugs, and the effect was not good. Later, it was thought that it was hypoglycemia, and hypoglycemia would also cause limb weakness, fatigue, palpitations, and dizziness, but the treatment effect of elevating blood sugar was not good. Various examinations were carried out several times without finding abnormalities. Later, a doctor carefully found that the patient was accompanied by emotional tension, insomnia, poor appetite, etc., and suggested referral to the psychology department, and was eventually diagnosed with "depression". After giving drug treatment, the patient's symptoms improved significantly, and symptoms such as palpitations and dizziness gradually disappeared.
Case 2: The patient, a 49-year-old male, was treated for "1 year of repeated episodes of epigastric pain, nausea, and lack of appetite", and the patient had a gastroscopy and was diagnosed with superficial gastritis, but the treatment effect was not good. Or repeated epigastric pain, nausea, bad appetite and other situations, and sleep is not good, weight loss, when visiting the doctor, the patient is depressed, thinking that their disease is not cured, is an incurable disease, negative emotions. The doctor was more vigilant, found that the patient's voice was low, doubted this and that, and said terminally ill, living pain, life is better than death, the total score measured by the depression scale is 35 points, consider depression.
Finally, fluoxetine and lithium carbonate were given treatment, the condition gradually improved, and after 1 month, he recovered, resumed work, and re-measured the depression scale with a score of 12.
To mention to you, the superficial gastritis said by the gastroscope is actually nothing, and the average person who does gastroscopy may have this diagnosis, don't scare yourself.
Case three: the patient male, 29 years old, because of the feeling of systemic itching repeatedly for more than 1 year to see the doctor, 1 year ago he began to feel back itching, to the hospital, diagnosed as allergic dermatitis, the treatment effect is not good, and later developed to the limbs, chest and abdomen itching, sometimes the itch is unbearable, have to seek medical treatment everywhere, consider scabies, diabetic contact dermatitis, eczema, etc., Western medicine and Traditional Chinese medicine have seen, is not to see the improvement.
Later, some doctors were careful, and found that in addition to the itchy skin, the patient's will was relatively depressed, and most of the year had resigned at home, closed doors, depressed, and the total score measured by the depression scale was 32 points, diagnosing depression. After 2 months of treatment, it healed without skin itching. Since then, it has been thought that skin itching is caused by depression itself.
Through the above three cases, you should know that our topic today is depression.
Depression is not far away from us, and there are many people around us who have depression. According to the 2009 survey data, the monthly prevalence of depressive disorder in mainland China (see clearly, it is the monthly prevalence) is 2.0%. The 2010 WHO survey showed an annual prevalence of depressive disorders in developed countries at 5.5% and in developing countries at 5.9%. In addition, about 70% of depression will recur, about 20% will become chronic refractory, and 10% of patients will eventually die by suicide.
I have several platforms have a lot of readers to contact me, hope that I will post some articles about depression, which also proves that depressive disorder is really not a rare problem, everyone should be vigilant, when there is doubt, must remember to see a doctor.
Dr. Li solemnly said to the readers: depression is a disease, coronary heart disease is a disease, COPD is a disease, hepatitis B is a disease, asthma is a disease, are all diseases, but depression is a mental disease, other is a physical disease, all have to be treated, do not feel that mental diseases are humiliating, inferior, secretive diseases and avoid medical treatment, do not, many mental diseases are also related to the nervous system, which needs to be treated. Ordinary people should not feel that depression is terrible, coronary heart disease is not terrible, this understanding is also wrong.
It must be frank that Dr. Li has less contact with depression, rarely encounters such patients in his work, and my impression of depression is still the communication with patients with schizophrenia and depression in the psychiatric hospital during the university textbook and internship stage, which only lasted for 2 weeks, and there was not much cognition. The following sources are textbooks and literature
1. Why do I suffer from depression?
Studies have shown a clear correlation between trauma and adverse life events and the risk and severity of onset of depression in adulthood. Stressful life events are also important risk factors.
However, the cause of depressive disorder is still unknown, so there is no complete cure. There are many hypotheses about the cause, including genetic factors, neurobiological factors, and psychosocial factors.
Depression has a family cluster phenomenon, the number of patients with depression in their parents, siblings, and children is significantly higher than that of the general population, so some people think that depression is related to genes. But it is generally believed that genes only determine susceptibility to depression, and that the environment is the trigger for depression to occur. In other words, depression occurs as a result of a combination of genes and the environment.
What about neurobiology? This is more complicated, mainly due to the abnormal secretion of some neurotransmitters caused by the onset of the disease, to the study is not thorough enough, can not be fully explained, can only be said to be a hypothesis.
Psychosocial factors are critical, the vast majority of depressed patients have certain psychosocial factors at the time of the first onset, such as unpleasant events, especially serious life events (such as parental divorce, abuse, etc.), ensuing events or long-term stressful events (such as marital disharmony, cold violence, etc.).
Overall, the cause of depression is not entirely clear, and when it comes, we can't predict it, but be vigilant and detect it early.
2. What are the symptoms of depression?
Depression, loss of interest, and lack of pleasure are core symptoms of depression.
The so-called low mood is very easy to understand, that is, the mood is not good, the mood is depressed, and even pessimistic and desperate, thinking that this life is like this, this disease is not cured, the hope for life has been lost, and even self-seeking short-sightedness.
Activities, programs, etc. that I used to like suddenly dislike, such as Singing and playing the flute in the past, and suddenly I don't want to open my throat, and the flute is also shelved. Sighing all day, eyebrows locked, sad faces, silent and silent.
Most patients are also accompanied by anxiety, easy to be provoked, etc.
Slow thinking, self-conscious brain rotation, memory loss, inability to concentrate, pessimism about everything, this pessimism can not be pretended, it is real. Recalling the past, I will exaggerate some small things and think that it is an unforgivable sin, such as stealing the eraser of the same table, failing the college entrance examination at the same table, and linking these two things, then blame yourself. Thinking about the future, feeling that the future is slim, I am a burden, pessimistic, and it is better to live than to die. In severe cases, suicidal behavior is committed.
Decreased speech and movement, which is an outward manifestation of low mood. Patients are reticent, slow movements, and decreased activity. Severe cases may be bedridden, do not eat or drink, lazy to freshen up, and people who usually love cleanliness suddenly become sloppy and do not like to do housework.
The above is a typical manifestation of depression, and it is also a well-known manifestation of depression.
But depression also has physical symptoms, and these physical symptoms often cause misunderstandings, so that patients themselves, others, and even doctors have illusions, so as to make a wrong diagnosis of the disease. For example, the three cases at the beginning of the article are mistaken for depression as other diseases.
Common physical symptoms include: difficulty sleeping, loss of appetite, weight loss, constipation, decreased libido, amenorrhea, back pain, muscle pain, headache, etc.
I found a study that included 112 people with depression and analyzed their physical symptoms, as follows:
3. How to judge that you have depression?
The diagnosis of depression is not too difficult, and it is necessary to be vigilant when there are the above manifestations. It can be viewed against the following table, and the diagnosis can be considered if it meets the ABC. A may be easier to handle, the difficulty is C. Because the diagnosis of depression must first exclude some physical diseases, such as some patients with hypothyroidism will have similar depression performance, but after treatment of hypothyroidism can be recovered, depression can not be diagnosed, so the psychology outpatient teacher usually checks the thyroid function of the patient, the purpose is to exclude the impact of hyperthyroidism or hypothyroidism.
Also, Wilson's disease or other hepatitis may present with a depressive-like manifestation.
Once you suspect that you have the possibility of depression, or when the people around you have this possibility, it is recommended that they go to a professional institution as soon as possible, make a depression diagnosis as soon as possible, and intervene as soon as possible. Again, depression is also a disease, do not demonize depression, the reason why patients have strange cognitions is because they are sick. Just like schizophrenia, patients are miserable, drugs can solve the problem, even if not all of it, but it can be mostly solved, for the patient and his family is life-saving.
4. How to treat depression?
The goals of treatment for depression are: relief of depressive symptoms (clinical cure), return of functional levels to the pre-morbid state. At present, the whole process of treatment is advocated, that is, acute treatment, consolidation treatment, maintenance treatment, in other words, do not stop the drug casually.
Why don't you just stop taking the drug? Because depression has a high recurrence rate and a high disability rate, long-term treatment is required. Let patients and their families know that they should be prepared to fight a protracted war and take medication for a long time to control it. There are too many diseases that cannot be cured, depression is not alone, coronary heart disease, asthma, COPD, hypertension, hepatitis B, diabetes, most cancers, etc., which one can be cured? Basically, long-term drug control treatment is required.
Drug therapy is the most important means, and there are many drugs, but the overall efficacy is similar, 50%-70% of the effective rate, the current preferred effective antidepressant drugs are as follows:
(Chart from: Practical Internal Medicine, 15th Edition)
In addition to pharmacotherapy, there are physical therapies, including modified electroconvulsive therapy and transcranial magnetic stimulation. Electroconvulsive therapy is 70% to 90% effective, higher than the effective rate of antidepressants, and can be used as first-line treatment for patients with severe depression with psychotic symptoms, stress symptoms, suicide risk, and food refusal, and the effect is rapid.
Let's briefly talk about modified electroconvulsive therapy. The earliest is ordinary electroconvulsive therapy, at the beginning some doctors found that inducing patients with epilepsy can treat mental disorders, depression, and later developed to electroconvulsive therapy, that is, in a short period of time, let the patient's brain go through an electrical stimulation, induce epilepsy, thereby controlling mental disorders. Presumably, you have also heard that the patient had an electric shock, a violent convulsion, and then a brief control of the mental disorder. But electroconvulsive therapy looks too cruel, as if it is punishing the patient, and it is also prone to many complications, and even strong muscle contractions can lead to fractures.
Now our electroconvulsive therapy is improved, first inject the patient with sedatives (lose consciousness, do not feel pain), then inject muscle relaxants (so that the patient's muscles do not spasm), and then give electrical stimulation, at this time the patient's brain will have epileptic waveforms, but the limbs will not twitch, feel more comfortable, the family will look more humane, and not as scary as before, which requires several people to hold the patient.
However, this modified version of electroconvulsive therapy is also risky, because to inject sedatives and muscle relaxants, the patient will lose spontaneous breathing during treatment, which requires the operator (usually an anesthesiologist) to pay close attention to the patient's condition, give auxiliary breathing to maintain oxygenation, and allow the patient to successfully resume spontaneous breathing. Now there is an improved version and then upgraded, using a longer-acting muscle relaxant, and then using anesthesia machine, the patient is safer, the treatment effect is better, but the action is also very large, each time it must be similar to surgical general anesthesia.
In general, modified electroconvulsive therapy is a method, but it is generally used for patients with more serious and poor drug therapy effects, and it is not successful once or twice, it takes several times a course of treatment, and it may still recur later, or it must be combined with drug therapy.
5. When can I stop the drug?
As we just said, depression is best treated with long-term medication control. After the acute phase improves, it is necessary to consolidate the period and prevent recurrence. The consolidation phase is 4-9 months, and the therapeutic dose is the same as in the acute phase. After passing the consolidation phase, it enters the maintenance phase of treatment.
In principle, long-term medication is the safest. However, some patients are better controlled, and they are really unwilling to take drugs for a long time, so can they stop the drug? It can be tried, but there are risks. If the condition is stable, the dose may be tapered gradually after a period of maintenance. Avoid abrupt discontinuation of the drug and gradually reduce the dose. The first 2 months after discontinuation are high-risk periods for recurrence, and once relapsed, the drug should be used promptly. And to tell patients and families that there is a risk of recurrence after stopping the drug, as well as discontinuation syndrome.
I hope that all depressed patients can get appropriate treatment, when they have the above situation, do not hide the disease and avoid medical treatment, all symptoms are caused by disease, not the real situation. You think that the future is uncertain, life is better than death, in fact, it is not better to live than to die, but caused by disease, and the use of drugs can improve this situation.
blessing.