This is the 3722nd article of Da Medical Care
Aunt Zhang's son is handsome and smart, and his job is also very good, which is often said by parents as "other people's children". However, I don't know what the reason is, he has recently frowned bitterly, often lamented and sighed, and did not like the games, sports and other hobbies that he was interested in before, did not like to talk, did not go out. Aunt Zhang's nephew suffers from depression, and the symptoms are similar, and she thinks, "My son must also have depression." Considering her son's future and privacy, Aunt Zhang begged her nephew's medicine for her son to eat. After taking the medicine for a week, it did not work, and his son had symptoms such as easy tantrums, so he went to the hospital for diagnosis and treatment, and the doctor diagnosed "bipolar disorder - depressive episode", and it is not recommended to take antidepressants.
Aunt Zhang couldn't figure out why people were depressed and didn't let them take antidepressants???
Q1: What is depression?
Depression, also known as depressive disorder or unipolar depressive disorder, refers to a type of mood disorder caused by various causes with significant and persistent mood depression as the main clinical feature. Clinically, it is mainly manifested as low mood, loss of interest and pleasure, loss of energy, difficulty concentrating attention, memory decline, slow thinking, low self-evaluation, insufficient self-confidence, sense of worthlessness, thinking that the future is bleak, negative words and deeds, and symptoms such as sleep disorders and decreased appetite.
Q2: What is bipolar disorder
Bipolar disorder refers to a type of mood disorder that has both manic or hypomanic episodes and depressive episodes in the clinic. Manic episodes are characterized by high emotions, increased interest and motivation, and increased verbal behavior. Hypomania is similar to manic symptoms, except that the severity of the symptoms and the level of impairment of social functioning do not reach the level of manic symptoms (e.g., the patient's occupational ability is slightly impaired or not impaired). On the other hand, depressive episodes present with core symptoms such as depressed mood, decreased interest, fatigue, and retardation in thinking and behavior (similar to the manifestations of depression).
Q3: Medication for depression
Patients with depression are treated with antidepressants such as paroxetine, escitalopram, venlafaxine, and mirtazapine.
Throughout the clinical phase, there should be no symptom groups that meet the diagnostic criteria for manic and hypomanic attacks, and once present, bipolar disorder should be diagnosed.
Q4: Medication for bipolar disorder
According to the guidelines for the treatment of bipolar disorder at home and abroad, patients with bipolar disorder are recommended to take mood stabilizers as the main treatment drug regardless of the type of attack. Commonly used mood stabilizers are lithium carbonate, valproate, lamotrigine and the like. Atypical antipsychotics such as quetiapine and olanzapine also have a good mood stabilizer effect and are therefore often used in the treatment of bipolar disorder.
Avoid treatment with antidepressants to avoid inducing agitation and frequencizing episodes, or switching to rapid cycles. For patients with "bipolar disorder - depressive episodes" who do not respond to mood stabilizer treatment alone, and the depressive symptoms are very severe, a combination of antidepressants on the basis of mood stabilizer drug therapy may be considered, but the risk of turning to manic episodes should be noted. Therefore, it is not necessary to treat with antidepressants if there is a depressive episode.
Q5: The recognition rate and awareness rate of bipolar disorder are low
Due to the degree of mild mania, the author has little or no impact on social functioning, and some even have a positive impact on social functioning, so many patients or insiders do not feel abnormal. And most hypomanic patients do not admit that they have a disease, try to describe their symptoms as mildly as possible and refuse treatment. In addition, most patients with bipolar disorder begin with a depressive episode. Therefore, it often causes bipolar disorder to be missed or misdiagnosed.
Each of us will have emotions, and emotions are the states in which our inner feelings are expressed through the body. A good emotional state helps to exert an individual's enthusiasm, while a negative emotional state makes people sluggish, negative, and unenterprising. Persistent emotional state of being too excited or too depressed is a pathological emotional state, and when the relevant symptoms appear, it is recommended to seek help from a professional medical institution so as not to delay the condition or cause secondary injury.
Author: Shanghai Fengxian District Mental Health Center
Psychiatry Wang Jinde Attending Physician