Major depressive disorder

Major depression:

Major depression is a mood disorder caused by an individual's genetic system (gene) abnormality, or drastic changes in the acquired environment, and a series of depressive symptoms dominated by long-term spontaneous depression.

It is characterized by social disorder, incompatibility, outlier, depression, physical discomfort and loss of appetite. Severe cases may be accompanied by suicide. The patient's intellectual awareness is clear and normal. Patients with severe depression may experience pessimism, despair, hallucinations, hypofunction, and serious suicide attempts or even suicidal behaviors. It poses a serious threat to human health, so it must be taken seriously. Most patients have plans to end their lives.

Background:

With the continuous development of social economy, the acceleration of the pace of life, the increasingly fierce social competition, people's psychological pressure gradually increases, and the incidence of depression is increasing year by year. According to statistics from the World Health Organization, the global prevalence of depression is about 3% to 5%, and there are about 100 to 200 million people. By 2022, depression will become the most serious disease burden in developing countries, and major depression will become the second leading cause of death and disease. Due to the limitation of education level, the influence of traditional concepts, and the diversification of the performance of patients with depression, only 10% of patients go to the psychiatric department, and the other 90% often go to general hospitals.

There are currently no specific diagnostic tools for depression. There are three commonly used clinical symptom rating scales: Hamilton Depression Scale (HAMD), Baker Self-Rating Depression Scale (BD1) and Self-Rating Depression Scale (SDS), all of which can reliably assess the degree of depression. The total score of HAMD greater than or equal to 35 points may be a major depressive disorder.

Due to the lack of specific diagnostic methods for depression, its manifestations are very diverse. The accurate and reliable diagnosis of depression mainly depends on clinical skills and clinical judgment. Comprehensive collection of accurate and reliable medical history data, and careful and meticulous psychophysiological examination are the basis for establishing the diagnosis.

The Chinese Diagnostic Standards for Mental Illness (CCMD-3 (2001)) lists the following 10 symptoms of depression, including:

①Depressed and not commensurate with the situation;

②Lost interest and no fun;

③Lack of energy or fatigue;

④ Psychomotor retardation or agitation;

⑤ Self-evaluation, fatigue, pain, loss of libido, etc.

Emotional depression is covered but not obvious or mild. This phenomenon is called somatization. Depression patients with somatization tend to seek treatment in general hospitals. Doctors in general hospitals are often misdiagnosed and mistreated due to lack of training on diagnosis and treatment of such patients, and become a high consumer of medical resources. 

Major depressive disorder

Pathological mechanism:

The patient’s genetic system (gene) is abnormal

According to data and related topics, it is found that the patient's genetic system is abnormal, which is the main reason for the patient's depression. This disease has a certain genetic predisposition.

The parents have a common blood relationship. Not necessarily close relatives.

Malnutrition during pregnancy, or use of sedative drugs, such as Valium, chlorpromazine...

Passed to offspring through reproduction.

Unexplained genetic mutations before birth.

Throughout history, major depression has always been common and relatively common.

Severe loss, broken relationships, strained relationships, financial difficulties, or drastic changes in lifestyle can all lead to depression.

People with the following tendencies:

People with low self-esteem, self-blame, and pessimism are more likely to suffer from depression. People with certain personality characteristics are prone to depression, such as pessimism, poor self-confidence, poor grasp of life events, and excessive worry. 

These personality traits will make:

The stimulation of psychological stress events will aggravate and interfere with the individual's handling of the event.

Genetic predisposition:

If there are depression patients in the family, then family members are more likely to suffer from depression.

Emotional infection:

If family members and friends have depression, they will receive emotional cues and depression will also occur.

Disease induced:

People with poor psychological quality

Clinical manifestations:

(1) Mood changes: The most prominent symptom of the patient is persistent depression, manifested as gloomy expression, listlessness, lethargy, easy tearing, and crying. Patients are often "depressed", "desolate", "dull", "empty", and "lonely". Depression means unhappiness, always sadness, even pessimism and despair. Lin Daiyu, who frowned, sighed, and shed tears in A Dream of Red Mansions, is a typical example. "It's like someone else's wall" to describe her mood. Patients often feel depressed and depressed, and often lose their temper due to trivial matters. For a long time, most of the time the mood is low, even a few days or 1 to 2 weeks, the mood will get better, but will soon fall into depression. Nevertheless, the degree of depression of the patients is generally not serious, the emotional reaction still exists, and a few humorous words can make them laugh.

(2) Cognitive changes: Patients lack interest in daily activities, are dissatisfied with various entertainment or pleasant things, and often feel inferiority, self-blame, and guilt. I often feel that my brain is sluggish and it is difficult to think about problems. When things happen, they always think about bad things, lose confidence in life, think that the future is bleak and hopeless, feel that life is meaningless, and even attempt to commit suicide.

(3) Changes in will and behavior: the patient's will activity is reduced, it is difficult to concentrate on work, the patient is passive and over-reliant everywhere, and the psychological problem lies in the unwillingness to take responsibility. Generally speaking, depressive neurosis rarely commits suicide, but some patients feel that their lives are empty and boring and profess to want to die.

(4) Physical symptoms: Insomnia, headache, body aches, dizziness, dizziness, tinnitus and other physical symptoms are the main physical symptoms in about 80% of cases, requiring medical attention. These symptoms usually bring many different complaints to the body. 

5. Early symptoms:

1. The degree of depression ranges from mild negative emotions to sadness, pessimism, and despair. Some patients may also be anxious, agitated, and nervous.

2. Self-evaluation is too low: Patients with depression often overly devalue their abilities and view their present, past, and future in a critical, negative, and negative way. dark. In severe cases, there may be guilt or hypocrisy.

3. Lack of energy, fatigue, washing, dressing and other daily chores, and physical weakness. 

4. Loss of interest is one of the common symptoms of depression patients. Lost the enthusiasm and happiness for life and work, and lost interest in everything. Unable to experience family happiness, dismissive of past hobbies, often behind closed doors, alienating relatives and friends, and avoiding social interaction. Patients often complain of "no feeling anymore", "emotional numbness" and "no longer happy".

5. Negative pessimism: Patients with depression are very painful, pessimistic, and desperate. They feel that life is a burden, not worthy of nostalgia. Solving yourself with death can lead to strong suicidal thoughts and behaviors.

6. The patient showed obvious, persistent, widespread depression, inattention, memory loss, retarded brain development, blocked thinking, and slow movement. However, some patients exhibit irritability, anxiety, nervousness, and agitation.

7. Physiological or physical symptoms: Patients with depression often have physiological symptoms such as loss of appetite, weight loss, sleep disorders, low sexual function, and mood swings. These symptoms are common, but not all conditions.

harm:

Prone to insomnia and suicide Patients with depression often have intractable sleep disorders, with an incidence rate of up to 98%, manifested as insomnia, difficulty falling asleep, early awakening, disordered sleep rhythm, and poor sleep quality. People with depression get up early, especially 3-5 in the morning. They are depressed and are at the greatest risk of suicide. This is also one of the hazards of depression. can not afford Depressed patients have poor physical function, and their labor loss is 5 times that of non-depressed patients. More than half of people suffer from depression.

Diagnosis method:

(1) Endogenous depression:

Those with one of the following symptoms should consider the possibility of endogenous depression:

1. Immediate history of mania or depression.

2. There is a history of mania or depression in the family.

3. Mania during the course of the disease.

4. There is psychomotor retardation.

5. Wake up early or the symptoms may change in the morning and evening.

6. Low visceral function, loss of appetite or weight loss without physical disease.

7. Concepts of self-guilt, any fantasies or delusions

8. Serious suicide attempts or repeated suicide attempts.

9. Cannot take care of oneself in life, severely lack of self-awareness.

(2) Reaction to depression:

Those who have one of the following conditions should consider the possibility of reactive depression:

1. Acute onset, less than half a year course.

2. It is induced by obvious environmental factors, and the symptoms are related to environmental factors.

3. Mental trauma often lingers in the brain and is difficult to get rid of.

(3) Depression caused by drugs:

The patient may find a history of drug use.

(4) Organic diseases or depression accompanied by the body:

Organic lesions can be found.

(5) Depression accompanied by other neuroses and mental illnesses:

Except for depressive symptoms, the patient has no other symptoms of neurosis and psychosis.

Treatment methods:

Commonly used are medication, physical therapy and psychotherapy. It can be reasonably selected and used according to different depression situations.

Self-treatment

1. Learning technology: also known as supportive therapy. It means that in the process of performing medical care, medical staff reasonably use persuasion, encouragement, sympathy, comfort, support, understanding and assurance to the patient’s mental state, which can effectively eliminate the patient’s bad mood and make it in the best position to receive treatment Psychological state, so that the disease will recover quickly.

2. Going out to communicate: This method of psychotherapy for depression is mainly used to treat the acute onset of depression in adults, aiming to alleviate depression symptoms and improve some social problems of depressed patients. The common interpersonal problems of depression patients include four aspects: abnormal sad response, interpersonal conflict, difficulty in changing roles, and lack of interpersonal communication.

3. Music therapy: One of the most popular psychological treatments for depression is music therapy. The limbic system and brainstem network structure play a major role in regulating human internal organs and physical functions, and music can directly or indirectly affect these neural structures medical treatment

At present, tricyclic antidepressants are still used as first-line drugs for the treatment of depression. The second-generation atypical antidepressants are second-line drugs. The curative effect of various tricyclic antidepressants is comparable, and the clinical choice can be based on the strength of depression and sedation, side effects and patient tolerance. Imipramine and nor imipramine have weak sedative effects and are suitable for depressed patients with psychomotor retardation. Amitriptyline and doxepin have strong sedative effects and can be applied to patients with anxiety, agitation and insomnia. There are many types of second-generation atypical antidepressants, such as selective 5-HT reuptake inhibitors fluoxetine, paroxetine, and sertraline, which are widely used, have low side effects, have good safety performance, and are useful for long-term maintenance treatment.

The treatment of bipolar depression is the same as unipolar depression, but the use of antidepressants in bipolar patients may turn into hypomania, so antidepressants and lithium carbonate are often used in cooperation.

For depression patients with hallucinations and delusions, antipsychotic drugs, such as perphenazine and sulpiride, are often used in combination.

Physiotherapy:

Electroconvulsive therapy (ECT) is an effective treatment for single and bipolar depression, especially after improved ETC (MECT), which avoids adverse reactions such as fractures during the treatment, and reduces the fear and resistance of patients. MECT has a good effect on patients with strong suicide attempts, ineffective drug treatment or unable to receive drug treatment. Its adverse reactions are mainly mild manifestations such as transient memory impairment, disturbance of consciousness, headache or nausea. TMS is a physical therapy method used in psychiatric clinical research in the early 1990s. The magnetic field will not be refracted or weakened by the tissue, and the effect is more concentrated than ECT. It is also called "electrodeless" electrical stimulation. Studies have shown that rapid repetitive TMS on the left frontal cortex and slow repetitive TMS on the right prefrontal cortex can improve depression symptoms.

Psychotherapy:

Depression has the characteristics of onset time and relatively long treatment period, which can easily make patients lose confidence in the treatment, produce irritability, and affect the clinical treatment effect. Studies have shown that psychotherapy can improve patients’ awareness of themselves, face recurrence, understand the necessity of drug treatment, strengthen communication between doctors and patients, improve patient compliance, and achieve good results in treatment by informing patients of the nature of the disease and treatment. .

Exercise therapy:

Exercise is an effective way to enhance physical fitness. Exercise is one of the ways to prevent depression. In order to stay away from depression, we should also strengthen exercise.

Among the various psychological disorders, depression is the most common. Patients are depressed and unwilling to communicate with others. In severe cases, they are pessimistic and hopeless. Exercise therapy has unique effects in preventing and treating depression. Because some studies have found that while exercise strengthens metabolism, it can drain negative mental energy and prevent the onset of depression; while exercise enhances physical fitness, it can also produce positive psychological feelings, and quickly improve mood and eliminate. 

Depressive symptoms:

One is running. Studies have shown that when a person is running, the brain secretes a large amount of endorphins, which are also called pleasure hormones or young hormones. It can make people feel happy, happy, and satisfied, and can help people to relieve stress and depression. The running time is appropriate in the evening, the speed should be at least 120 steps per minute, and the frequency should be at least 3 times a week for 30-50 minutes each time.

The second is skipping rope. These can produce good psychological feelings and improve self-confidence. Rope skipping speed is 30-60 times per minute, once every other day.

The third is a walk. Whether it is a person with depression tendency or a healthy person, they should do more exercise, so as to stay away from illness and depression.

The fourth is fancy tennis. Fancy tennis is a simple, easy-to-learn, healthy and sunny aerobic recreational sport. In the design of the competition system, fancy tennis is carried out in three team forms: family three-person team, friend six-person team, and community twelve-person team, aiming to create a good atmosphere of happiness, friendship, sharing, and mutual assistance. Through daily practice and participation in competitions, players can enhance mutual friendship and effectively regulate their psychological and mental states. Medical practice abroad has proven that regular participation in such activities has a good effect on relieving symptoms of depression and preventing disease recurrence.

Main hazards:

Threat to life Suicide is the most serious consequence of major depression, and the suicide mortality rate is as high as 15%. All depression suicides said before their lives that death is a kind of relief and a very happy thing. It shows that the disease has severely damaged the patients’ brain and nerves, and they are torturing them in pain all the time, forcing them to desperate. Only choose extreme ways to get rid of. 

Inducing physical illness:

Severe depression makes the patient lazy, lonely, and has no interest in everything, which makes the body's endocrine disorders or disorders. The result is the appearance of various physical diseases, such as constipation, headache, dizziness, chest tightness, shortness of breath, general weakness, and heart palpitations , Appetite disorders, weight loss and other physical problems, these physical diseases undoubtedly increase the patient's mental and psychological pain, and then make the symptoms of depression worse.

Psychological and emotional impact:

Severe depression is a mental illness. The first thing that bears the brunt is that the patient’s psychological emotions are affected. The most direct harm is the disappearance of happiness and happiness, full of pessimism and depression, and accompanied by irritability, irritability, irritability, anxiety and other emotions. Problems, and even mild symptoms of fantasy and fear, which have a huge negative impact on the mental health of patients.

Deprivation of social function:

Severe depression can cause mental and mental disorders in patients, and deprive basic social functions. Not only can the work not be completed independently, but even the minimum self-care needs others to take care of. In addition to the above-mentioned hazards, severe depression is difficult to treat and has a long treatment cycle, which brings a huge financial burden to the family. And most importantly, the long-term illness will permeate a depressive and melancholic atmosphere in the whole family, and even affect the illness to the family members. People in modern society are under great mental pressure. Depression has become a common mental illness. It is expected that in 2020, depression will become the second largest health killer of mankind. Unlike other diseases, depression is a serious mental illness. The silence erodes our psychology and affects our normal work and life.

So what are the dangers of depression?

The first danger of depression: Depression patients are often accompanied by various physical symptoms, such as palpitation, chest tightness, shortness of breath, headache, dizziness, nausea, abdominal distension and so on.

The second hazard of depression: Depressed patients have poor physical function, and their incapacity to work is 5 times that of non-depressed patients.

The third hazard of depression: suicidal behavior is a dangerous behavior that occurs in patients with depression, and 15% of recurrent major depression will eventually commit suicide.

The hazard of depression four: Depressed patients have words and deeds that damage their own reputation and the reputation of others.

The hazards of depression five: patients with depression can cause economic disputes.

The harm of depression six: the depression of patients with depression can be transmitted to family members.

Major Depression Test:

1. Depressed most of the day.

2. Lost interest in all or most of the activities that I am usually interested in most of the day.

3. The weight is significantly decreased or increased (5% of normal body weight), and appetite is significantly decreased or increased.

4. Insomnia or excessive sleep every day.

5. Excitement or malaise every day.

6. Feel tired and lack energy every day.

7. Feeling worthless every day, or guilty and demeaning.

8. Decreased concentration and thinking ability every day, and hesitated when making decisions.

9. I often think of death. When it is serious, I have a specific plan of suicide, and even have committed suicide.

Daily health care:

1. Patients with depression should have a regular life, be happy and emotionally stable.

2. Patients with depression should have balanced nutrition, and they can eat well and smoothly.

3. Patients with depression should take proper rest to reduce consumption and refresh their body. Don't set yourself some unattainable goals, have a correct understanding of your current situation, face your own illness, stop taking on a lot of positions, and don't take over many things.

4. Depression patients can exercise moderately, move their muscles and bones, and dredge the blood. Participate in as many activities as possible in your life, try to do some light physical exercises, watch movies, TV or listen to music, etc. You can participate in social activities of different forms and contents, such as lectures, visits, visits, etc., but not too many.

Mastering daily health care measures plays a vital role in the treatment of depression. When depression strikes and interferes with our normal work and life, we should take the most effective treatment weapon to actively defend our health. Yes, Baihe Qingnao Jingshen Decoction is a pure Chinese medicine preparation with remarkable therapeutic effect. I hope all patients can show confidence and courage to meet the challenge of depression.