Let's look at depression first:
Depression is an emotional disease. Investigation in China shows that the incidence of affective psychosis is 0.76%. Women are higher than men, which may be related to women's heavier burden of life and more stress events (such as pregnancy and childbirth). It is worth noting that in recent years, the incidence of middle-aged and young people has gradually increased, which should be paid attention to.
The incidence of depression is high, but its causes are still unclear, which may be related to social and psychological factors, heredity, biochemical changes of human body and neuroendocrine. Among them, genetic factors are very important, and research shows that:
The incidence of patients in the family is 10-30 times that of the general population. The closer the blood relationship, the higher the chance of getting sick.
Depression is a disease that people recognized earlier. But people are often ashamed to admit that they have mental illness and ignore it. In fact, in regular psychiatric hospitals, doctors can quickly diagnose depression through examination and consultation. There are many effective drugs to treat depression at present. The vast majority of patients can be improved after treatment.
Depression mainly changes people's mood and does not affect people's intellectual and physical development. Therefore, patients who have suffered from depression can live and work with peace of mind as long as they are actively treated.
symptom
1. Three main symptoms of depression-criteria for judging depression
Many people are no strangers to depression, but it is essentially different from the general "unhappy". There are obvious characteristics, and there are three main symptoms, namely depression, mental retardation and exercise inhibition.
Depression means unhappiness, always sadness and even pessimism and despair.
Lin Daiyu, who frowns and sighs all day and tears easily in A Dream of Red Mansions, is a typical example.
Slow thinking means that you feel that your brain is not working, you can't remember things, and you have difficulty thinking. The patient felt empty and stupid.
Exercise inhibition means not being active and being lazy all over. Walk slowly, talk less and so on. Seriously, you may not be able to eat, move or take care of yourself.
2. Other symptoms of depression-depression has various manifestations.
Patients with the above typical symptoms are rare. Many patients have only one or two of them, and the severity varies from person to person. Depression, anxiety, loss of interest, lack of energy, pessimism and low self-evaluation are all common symptoms of depression, and sometimes it is difficult to distinguish them from general short-term bad emotions. Here is a simple way to introduce you: if the above discomfort is more serious in the morning and partially relieved in the afternoon or evening, then you are more likely to suffer from depression. This is called the rhythm change of depression.
3. Physical symptoms of depression-the most easily misdiagnosed symptoms.
Physical symptoms are relative to mental symptoms, that is, physical discomfort. Although depression is a mental illness, many patients have physical discomfort, such as dry mouth, constipation, loss of appetite, indigestion, palpitation, shortness of breath, chest tightness and so on. Generally, elderly patients are more common. These patients often go to the general outpatient department of the general hospital, and all the laboratory tests show normal. If you or your parents or family members feel unwell and can't find other organic diseases, I suggest you go to a specialized hospital. Maybe a psychologist will help you recover as soon as possible.
4. Suicide caused by depression-the most dangerous symptom
Depressed patients are depressed and pessimistic. In severe cases, it is easy to have suicidal thoughts. Moreover, because the patient's thinking logic is basically normal, the success rate of suicide is also high. Suicide is one of the most dangerous symptoms of depression. According to research, the suicide rate of patients with depression is 20 times higher than that of the general population. More than half of the social suicide population may be depressed patients. Some unexplained suicides may have suffered from severe depression before their death, but they were not found in time. Because suicide only happens when the disease develops to a certain extent. Therefore, for patients with depression, early detection and early treatment are very important. Don't wait for the patient to commit suicide before thinking that he may have depression.
deal with
You can judge whether you have this problem through the self-test of depression.
If the score shows that you may have such a problem, please seek the help of a doctor as soon as possible. Don't wait until you are very ill to see a doctor. Depression is a serious mental illness, which will bring serious consequences if it is not treated in time. Now all districts and counties have specialized psychiatric departments, and doctors can give you quick diagnosis and treatment (guidelines for entering psychological clinics).
The treatment is mainly drug therapy, supplemented by psychological support therapy.
At present, there are many drugs to treat depression, including monoamine oxidase inhibitors, tricyclic antidepressants, tetracyclic antidepressants and the latest SSRI selective serotonin reuptake inhibitors.
Among them, monoamine oxidase used earlier includes isopropylhydrazine and phenelzine, and the adverse reactions include headache, dizziness, drowsiness and fatigue. Due to many adverse reactions and the restriction of food types, it is rarely used at present.
Tricyclic antidepressants include imipramine, doxepin and amitriptyline. They are the most commonly used antidepressants with good antidepressant effect and low price. However, there are many adverse reactions of these drugs, such as drowsiness, dry mouth, constipation and palpitation.
Tetracyclic antidepressants, such as misoprostol. These drugs have good antidepressant effect and few adverse reactions, and are suitable for the elderly and cardiovascular patients.
SSRI is called selective serotonin reuptake inhibitor. Studies have shown that serotonin is a neurotransmitter between human cells and a "liaison" of intercellular information. Years of research have shown that people's emotional changes are related to the balanced distribution of serotonin. SSRI can regulate the unbalanced distribution of serotonin and improve people's bad mood.
Seroxat is an SSRI drug, which is suitable for all types of depression. Just take it once a day, 20mg each time, and the dose can be gradually increased to 50mg according to the condition. The clinical effect is good and the adverse reaction is slight. At present, it is widely used and recognized by more and more doctors and patients.
-
Brief introduction of drug therapy for obsessive-compulsive disorder
Does obsessive-compulsive disorder need medication?
Many research results show that the 5-HT nervous system in the brain of patients with obsessive-compulsive disorder is abnormal. Clinically, the drugs used to treat obsessive-compulsive disorder are mainly aimed at the functional regulation of the 5-HT nervous system in the brain, so these drugs can be used to alleviate the symptoms of obsessive-compulsive disorder. However, the inconsistency of research results and the different effects of various drugs on 5-HT system in patients with obsessive-compulsive disorder suggest that obsessive-compulsive disorder is a pathophysiological complex mental disorder. Dopamine and cholinergic nervous system in the brain may also be involved in the pathogenesis of some obsessive-compulsive disorder patients. Clinically, we are also trying to develop new drugs in this area.
Can obsessive-compulsive disorder be treated with traditional Chinese medicine?
Many patients and their families hope to treat obsessive-compulsive disorder with traditional Chinese medicine. They think that taking western medicine in psychiatric department will lead to dementia, unconsciousness and decreased ability. So I hope that traditional Chinese medicine with less side effects can solve the problem. China's medicine has profound cultural background and good clinical effect. But up to now, there is no universally recognized effective method for the treatment of obsessive-compulsive disorder. Traditional Chinese medicine is usually recommended as an auxiliary treatment, but not as the main treatment.
What drugs are there to treat obsessive-compulsive disorder?
Some antidepressants are mainly used to treat obsessive-compulsive disorder, but the usage and dosage are slightly different from those of depression. Clomipramine is a classic drug for treating obsessive-compulsive disorder. The usual dosage is 150 ~ 300mg/d, which is taken twice, and usually takes effect in 2 ~ 3 weeks. We must start with a small dose. If it is ineffective in about 4 ~ 6 weeks, consider switching to or combining with other drugs. The treatment time should not be less than 6 months, and some patients need long-term medication. Clomipramine is generally not the first choice because of its side effects, and there are safer drugs to choose from in clinic. The first choice for the treatment of obsessive-compulsive disorder is fluoxetine, paroxetine, fluvoxamine or sertraline, and the effect is basically the same as that of clomipramine with fewer side effects. In addition, benzodiazepines can be used with patients with severe anxiety; For refractory obsessive-compulsive disorder, it can be combined with mood stabilizers such as carbamazepine or sodium valproate or low-dose antipsychotic drugs, which may achieve certain curative effect.
What are the common side effects of drugs for treating obsessive-compulsive disorder?
Drugs for obsessive-compulsive disorder are not as antipsychotic as people think. After eating, people can sleep more, think slowly, and look stupid. On the contrary, these drugs have a mild sedative effect and can be taken during the day and at night when you are tired and sleepy. The common adverse reactions are gastrointestinal irritation, manifested as nausea, vomiting, anorexia, diarrhea and constipation. Usually taking medicine after breakfast can avoid this uncomfortable feeling. The elderly and infirm should start with half dose or 1/4 dose, and gradually increase the dose as appropriate.
In addition, it should be noted that some patients or their families saw many side effects in the drug instructions after taking back the drugs, so they refused to take such drugs because they were worried that they would be harmful to their health. From the specialist's point of view, there is absolutely no need to worry. The side effects recorded in the drug instructions are the adverse reactions observed when the drug is tested in different groups of people, and it is impossible for all of them to happen to one person. In addition, adverse drug reactions are also common in the elderly and children. Once there is an adverse drug reaction, as long as you contact a specialist in time, you can handle it completely. Patients and their families sometimes worry that drugs will cause permanent brain or other organ damage, which is totally unnecessary.
How long does this drug usually take?
Obsessive-compulsive disorder (OCD) is a chronic fluctuating mental illness, which is easy to recur. Therefore, medication takes a long time and patients need patience. Usually, a complete course of treatment includes the following three stages:
1, acute treatment stage:
General patients come to see a doctor, and the symptoms are often more serious. This is the acute phase of the disease. Because it usually takes 1 ~ 3 weeks from the beginning of taking the medicine to the initial curative effect, patients must not worry, and take the medicine strictly according to the doctor's advice during this period. If the drug treatment is still ineffective after 6 ~ 8 weeks, it can be treated with another drug of the same kind or another drug with different mechanism of action.
2, consolidation period treatment
When the symptoms are relieved or disappeared after 4 to 8 weeks of treatment, the doctor will still ask the patient to continue taking the medicine. The purpose of taking medicine at this time is to prevent the recurrence of symptoms, which is called consolidation period treatment. Generally, this period lasts at least 4 ~ 6 months, during which the patient's condition is not completely stable, and the risk of relapse caused by easy withdrawal of drugs is greater.
3. Maintenance treatment
After finishing the consolidation treatment, enter the maintenance treatment stage. Its purpose is to prevent the recurrence of symptoms. After the maintenance treatment, the condition is stable, and the treatment can be terminated gradually, but the early recurrence signs should be closely monitored, and once the early recurrence signs are found, the original treatment should be restored quickly. There are different opinions about the time of maintenance treatment. Please refer to the opinions of experts.
What are the consequences of stopping drug easily?
Please take medication under the guidance of a professional doctor, and don't change the treatment plan at will. In order to get rid of the shadow of mental illness as soon as possible, some patients or their families stop taking drugs as soon as the symptoms are relieved. This practice is very dangerous, which often leads to the recurrence of the disease, or the withdrawal reaction caused by sudden withdrawal. If this happens many times, it may lead to persistent obsessive-compulsive disorder and turn into chronic refractory obsessive-compulsive disorder. It will be too late to regret it.
-
Treatment of anxiety: Comprehensive treatment should be the best treatment scheme, and the treatment objectives should be: ① to properly handle acute anxiety, ② to eliminate patients' dysfunction, and ③ to reach the clinical treatment standard of completely eliminating symptoms, generally taking Hamilton Anxiety Scale (HAMA) score ≤7 as the operating standard.
(A change in lifestyle, patients in anxiety state hinder their original hobbies, which once gave patients a lot of happiness and had an important impact on individual's sense of accomplishment, values, ability to control the environment and mental health. At this time, helping patients to change their lifestyle after illness and restore their happy and stress-free activities in the past will help improve their anxiety symptoms. Obviously, to put this into practice, we need the help of people around us, especially relatives.
(2) Disease health education: It is helpful to relieve anxiety symptoms by explaining the knowledge of anxiety diseases and related factors of the diseases and teaching patients the coping methods, which can be carried out by combining individuals and groups.
(3) Cognitive therapy, anxiety patients are more likely to make two kinds of logical mistakes. One is to pay too much attention to the possibility of negative events, which will bring adverse results, and the other is to exaggerate the consequences and results of imaginary catastrophic events; By talking with patients about their emotional experience, we can understand their explanations of maladjustment symptoms, be targeted, take advantage of the situation, rebuild a realistic and reasonable understanding of life, and thus change patients' emotional response to environmental events.
(d) Behavioral therapy and relaxation training, to help patients prevent avoidance behavior, distract patients from paying excessive attention to the disease, and suggest patients to engage in some interesting activities and games, such as watching TV, playing poker, guessing riddles, playing the piano, etc. Or do some housework as much as you can, which will help to relieve anxiety, relax training, breathing exercise training and so on.
(5) Drug therapy: Looking back at the history of anti-anxiety drug therapy, people are surprised to find that anti-anxiety drugs are related to economic use and addiction. Alcohol and opium were first used to improve anxiety, and were later replaced by Australian drugs and barbiturates, which are also addictive. Milton, methaqualone and anti-anxiety drugs, which came out after 1950' s, had satisfactory effects, but they were also stopped because of their addiction. In 1960s, the first benzodiazepine drug, biodiazepine, went on the market. For decades, many variants of BIDS family have been widely used in the clinical treatment of anxiety disorder. Because of its obvious anti-anxiety effect, quick onset and high safety, it once monopolized the treatment of anxiety disorder. Similarly, due to its drug resistance, addiction and universality, as well as adverse reactions related to psychomotor activities, the British Drug Safety Committee proposed benzodiazepines in 1988.
Buspirone is a new generation of anti-anxiety drug, which is characterized by no sedative and muscle relaxation, no adverse psychomotor reactions and no addiction. However, after years of clinical experience, it has not been seen that it can replace benzodiazepines in anti-anxiety.
As early as 1960s, it was reported that tricyclic antidepressants combined with low dose (30-g/d) imipramine could effectively treat panic disorder. Many studies have shown that imipramine 75- 1.50 mg/k is effective in the treatment of generalized anxiety disorder, and clinical experience also shows that low-dose doxepin amitriptyline is effective in the treatment of anxiety symptoms. Clomipramine has been widely used to treat obsessive-compulsive disorder, phobia and panic disorder, because the adverse reactions of tricyclic antidepressants, such as cardiovascular and anticholinergic, affect patients' tolerance and compliance, and ultimately affect the curative effect. Moreover, excessive poisoning is life-threatening and not safe. When using tricyclic antidepressants to treat anxiety, we should pay attention to the small initial dose, gradually add the therapeutic dose and pay attention to the interaction between drugs.
Selective serotonin reuptake inhibitors (SSRIS). Many double-blind controlled studies and clinical application experience of placebo or active drugs show that five kinds of SSRI, such as fluoxetine, paroxetine, obsessive-compulsive disorder, fluvoxamine and citalopram, are effective in treating panic disorder, obsessive-compulsive disorder, social phobia and generalized anxiety disorder. Because SSIS is an inhibitor of cytochrome P450 enzyme system, attention should be paid to drug interaction when it is used with other drugs.
The clinical manifestations of anxiety disorder are complex, and the etiology and pathogenesis are still under study. Comprehensive psychological and drug therapy is the best treatment.
I hope I can help you.