Depression Overview

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1 Depression Overview 憂鬱症簡介 John Chen, M.D.

2 Emotions 情緒 We are created in God s image- including being an emotional creature. A gift. Happiness 高興, sadness 悲傷, anger 憤怒, relaxed 輕鬆, hopefulness 有希望, fearfulness 恐懼, despair 絕望,excitement 激動, proud 得意, nervous 緊張, embarassed 尷尬 Emotions 情緒反應 vs mood 心情

3 Bible characters 聖經人物 - Aren t they full of emotions? Psalm 38: 4 My guilt has overwhelmed me like a burden too heavy to bear 6 I am bowed down and brought very low; all day long I go about mourning, 7 My back is filled with searing pain; there is no health in my body. 8 I am feeble and utterly crushed; I groan in anguish of heart 9.my sighing is not hidden from you 10 My heart pounds, my strength fails me; even the light has gone from my eyes. 13 I am like a deaf man, who cannot hear, like a mute, who cannot open his mouth 21 O LORD, do not forsake me; be not far from me, O my God

4 Bible characters 聖經人物 - Aren t they full of emotions? 詩篇 38 4 我的罪孽高過我的頭如同重擔叫我擔當不起 5 因我的愚昧我的傷發臭流膿 6 我疼痛大大拳曲終日哀痛 7 我滿腰是火. 我的肉無一完全 8 我被壓傷身體疲倦. 因心裡不安我就唉哼 9 主阿我的心願都在你面前. 我的歎息不向你隱瞞我心跳動我力衰微連我眼中的光也沒有了 11 我的良朋密友因我的災病都躲在旁邊站著. 我的親戚本家也遠遠的站立 12 那尋索我命的設下網羅. 那想要害我的口出惡言終日思想詭計 13 但我如聾子不聽像啞巴不開口 14 我如不聽見的人口中沒有回話

5 Bible characters 聖經人物 - Aren t they full of emotions? Matthew 26: 36 Jesus went with his disciples to a place called Gethsemane, 37 he began to be sorrowful and troubled 38 "My soul is overwhelmed with sorrow to the point of death 馬太 26: 36 耶穌同門徒來到一個地方名叫客西馬尼就對他們說你們坐在這裡等我到那邊去禱告 37 於是帶著彼得和西庇太的兩個兒子同去就憂愁起來極其難過. 38 便對他們說我心裡甚是憂傷幾乎要死. 你們在這裡等候和我一同儆醒

6 Depression Facts/Statistics 統計 Major depression 重度憂鬱症 affects approximately 15 million 一千五百萬人 American adults or about 8% of the U.S. population 美國人口 age 18 and older in a given year 每年 Women 女性 experience depression about twice as often as men 是男性的兩倍 ; higher rate of depression in married women 已婚女性較高 as compared to single women Approximately 80% of people experiencing depression are not currently receiving any treatment 未接受任何治療

7 Depression Facts/Statistics 統計 about 5%-10% of women 女性 and 2%-5% of men 男性 will experience at least one 一生至少有一次 major depressive episode 重度憂鬱症 during their adult life three to five times more common in the elderly 老年人 than in young people 更為普遍 Depression weakens the immune system 會削弱免疫系統 and so one becomes susceptible to physical disorders 易得疾病

8 Depression Facts/Statistics 統計

9 Depressive Symptoms( 憂鬱症症狀 ) Persistent 持久性 sad mood 情緒低落, frequent crying 哭泣 in women vs anger 憤怒 in men Loss of interest or pleasure in hobbies and activities that were once enjoyed 失去興趣 Feelings of hopelessness 絕望, pessimism 悲觀 / 負面, guilt 內疚感, worthlessness 無價值, helplessness 無助感 Fatigue 疲勞, inability to concentrate and to make decision 注意力不集中, 不能作決定, motor and cognitive slowing 行動和認知緩慢 Changes in sleep and appetite 睡眠和食慾 Suicidal thoughts 自殺的念頭

10 Normal emotions 正常的情緒 vs clinical depression 抑鬱症 Symptom severity 症狀的嚴重程度 Duration 持續時間 Funcitonal impairment 影響日常活動 ( life being affected as a result?)

11 DSM diagnostic criteria: Symptoms 症狀 + duration of at least 2 weeks 至少 2 週 + functional impairment 影響日常活動 ( work, relationship), excluding medical problems and drug/alcohol abuse 生理疾病和藥物 / 毒品酒精濫用首先需要排除

12 Types of depression Major Depression 重度憂鬱症 : severe symptoms, at least 2 week duration, episodic 斷斷續續 Subtypes: melancholic; atypical; psychotic; catatonic; anxious/ agitated; post-partum; seasonal,etc Dysthymia 慢性抑鬱症 : less severe symptoms, at least 2 year duration, chronic and continuous 持續 The 2 types are equally disabling Can be mixed: Double Depression

13 Related conditions and diagnoses Bipolar depression 躁鬱症 - 鬱期 Adjustment disorder 適應障礙 clear trigger identified Premenstrual dysphoric disorder( PMDD)- 經前煩躁情緒低落 Depression not otherwise specified

14 Depression( 憂鬱症 )- in young people Children 兒童 - poor and especially sudden drop in school performance; persistent boredom frequent complaints of physical problems, headaches, stomachaches 經常抱怨身體不適, 頭痛, 胃痛 Teenagers 青少年 - risky behavior 冒險行為, driving recklessly/ alcohol or other drugs 開始毒品酒精濫用, engaging in promiscuous or unprotected sex 危險性行為或濫交

15 Depression( 憂鬱症 )- in the elderly 老年人 diminished ability to think or concentrate, 思考的能力減弱或集中 unexplained physical complaints 原因不明的身體不適 (for example, abdominal pain, changes in bowel habits, or muscle aches), and memory impairment 記憶障礙 (in about 10% with severe depression) pseudodementia 假性癡呆

16 Depression Causes 原因 : * Biological 身體 * Psychological 心理 * Social-environmental 環境 * Spiritual 信仰

17 Depression Causes 原因 : biological Biological- -1st step is blood test, brain scan to exclude medical reasons Possible medical conditions- thyroid, anemia, hormonal, autoimmune, vitamin deficiency,any chronic medical conditions, head Injury, pain, 甲狀腺, 貧血, 內分泌, 免疫, 維生素缺乏症, 腦損傷, 疼痛, 任何慢性疾病 Medications: BP, steroids, stimulants/diet pills, pain meds and muscle relaxants 抗高血壓藥物, 類固醇, 興奮劑 / 減肥藥, 疼痛和肌肉鬆弛劑等

18 Depression Causes: biological factors Drugs( street drugs and prescription), alcohol If above cannot be excluded-> Depression not otherwise specified

19 Depression Causes: biological factors Hereditary 遺傳 : brain chemistry, abnormal neurotransmitter 神經傳導物質異常 vitamin deficiency- Vit B12, folate, Vit D -Vitamin B-12 and other B vitamins, such as folate, play a role in the production of certain brain chemicals that are important in regulating mood and other brain functions.

20 Depression Causes: psychological-social factors personality 個性 Social-environmental: loss of relationship/ love ones/ finance 重大的財務, 關係, 健康的損失, 喪親,, major life changes 重大的生活改變, or persistent stress 長期持續的壓力 can cause levels of neurotransmitters to become unbalanced 促使神經傳導物質和其他化學現象異常

21 Depression Causes: spiritual factors Consequences of individual/marriage/ family/ societal problems and moral problems 個人 / 婚姻 / 家庭 / 社會, 道德問題的後果 Spiritual- sin 罪 vs feelings of guilt 罪惡感 emptiness, hopeless, 空虛, 無望

22 Importance of treatment 治療的重要性 Even though MDD is characterised as an episodic illness, prospective studies have found that recurrence is the norm rather than the exception 復發是常態而不是例外 Each subsequent episode increasing the probability of further episodes kindling hypothesis in which depressive episodes become more easily triggered over time 每次發作更容易引下一次復發 As the duration 持續時間 of depressive episodes increases 越長, the probability of recovery 恢復概率 substantially decreases over time 越小

23 Major depression as a progressive illness As the number of depressive episodes increase, future episodes are predicted more by the number of prior episodes rather than by life stress

24 Treatment: Identify possible causes 找出可能的原因 ( usually multiple) and address accordingly. Apply bio-psycho-socio-spiritual model Treatment of underlying medical condition, address drug and alcohol use

25 Treatment: biological Medications- many choices indications takes time to work side effect efficacy

26 Treatment: biological Diet, exercise, light therapy, fun/vacation ECT, VNS, TMS

27 Treatment: psychological Psychotherapy 心理治療 - traditional therapy: build relationship, transference & and resolve conflict that develops in the relationship underlying psychology of depression- losses cognitive-behavior supportive marital, family therapy

28 Spirituality 靈性 Spiritual- do not necessarily conflict with medical treatment. 不一定與治療衝突 Higher hope and meaning. Loss is only temporary. God does not change and is stable

29 How do Family help? varies case by case encourage treatment, do not add to bias and fear of mental health treatment understand nature of illness and be supportive, pray together activity together, help continue social network and outside contact

30 How do Family help? ensure proper nutrition, sleep, help to follow through with recommended testing, follow up visits, and medication compliance safety ( must seek help immediately if hopelessness or suicidal thoughts) remember chronic stress can lead to depression, take care of yourself too

第一章　緒論

第一章　緒論 (informed consent) 6 . (Informed 23 Consent) 24 (Informed Consent) informed consent 1. 2. 7 3. 4. 5. 6.. 26 1. 8 2. 3. 4. 5. 6.. Braddock 1993 59 65 1057 (discussion of the patient s role in decision making)