原文: Major Depressive Disorder: What are the Facts?

In this age of technology, there are staggering numbers of people suffering from depressive disorders.  Many do not seek help because their symptoms are not recognized as depression, depressed people are often seen as weak, the social stigma attached to mental illness causes them to avoid needed treatment, some of the symptoms are so disabling that the people affected unable to reach out for help, symptoms are misdiagnosed as physical problems and treated, instead of treating the underlying cause.   

Research has been conducted for decades to determine why someone suffers from Major Depressive Disorder and to determine what treatment(s) work best.  There are basic questions regarding this frequently debilitating disorder such as: 

What is Major Depressive Disorder?

Depression can be caused by chemical imbalances in the brain, brought about by stress, experiencing a personal loss, or a traumatic experience.  Research has been conducted to determine if depression could be caused by a genetic defect.

According to Psychology Information Online (2003), depression is one of the most common psychological problems, it affects people whether through personal experience or through depression in a family member.  Impacts of depression are:

The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), always referred to as DSM-IV, is used for the diagnosis of depression.  It is produced by the American Psychiatric Association and is the product of a number of groups whose aim is to draw on the widest pool of information relating to mental health (p. 17).  The American Psychiatric Association Diagnostic Criteria for Major Depressive Episode is:  

At least five of the following symptoms have been present during the same two-week period and represent a change from previous functioning.  

Depression can affect anyone, and most people diagnosed with depression are successfully treated.  Major depression can occur from a single psychological trauma, or from many problems or disappointments in a person's life. Some people will have only one depressive episode, while others will experience many episodes throughout their lives. 

Who is at risk for Major Depressive Disorder?  

Depression is not a selective illness; it affects children, teenagers, adults, and senior citizens.  The percentage of the population that is depressed at any one time is about three percent in the United States and Europe, and over a period of one year, the rates are around seven percent.  Between ten and fifteen percent of the population will have a major depressive episode during their lifetime. The last study conducted in the United States found that the chance of someone having major depression in their lifetime is about one in six (Wolpert, 1999).

Depression In Children & Adolescents  

According to the Center for Mental Health Services (1996), as many as one in every 33 children may have depression.  Up to 2.5% of children and up to 8.3% of adolescents in the U.S. suffer from depression according to the National Institute for Mental Health (1999).  Statistics provided by the American Academy of Child and Adolescent Psychiatry (1999) state that once a young person has experienced an episode of major depression, he or she is at risk of experiencing another episode within the next five years.  They also state that children under stress, who experience loss, or who have attention, learning, or conduct disorders are at a higher risk for depression. The symptoms of depression in young children may vary from that in adults in severity and duration, and may be different from those experienced by adults, while the rate of depression among adolescence is similar to that of depression in adults, and may be as high as one in eight (Children's Mental Health - Children and Depression, 2003).   Signs of depression in children are much the same as those of adults, but also include:

Possible causes of depression in children and adolescents may be:

Major Depressive Disorder in Senior Citizens

Depression in the elderly frequently goes undiagnosed because the symptoms may be masked by physical complaints.  They may be at risk for depression because of life changes such a living in a nursing home or the death of a spouse or loved one, as well as by diminished physical abilities and limitations.  Many assume it that sadness and low spirits are part of the aging process.

Aging impacts the neurological function of the older adult causing deficiencies in chemicals secreted by the brain.  Other illnesses prevalent in the elderly also impact the brain's balance of chemicals that control mood; Parkinson's, stroke, head injury, thyroid dysfunction, and brain tumors are some examples.  Depression may also be caused by some medications such as antibiotics and heart and blood pressure medications (Cornwell, Brent, 1995).  Older Americans are disproportionately likely to die by suicide.  Comprising only 13% of the U. S. population, individuals 65 and older accounted for 18% of all suicide deaths in 2001.  Among the highest rates (when categorized by race and gender) were white men ages 85 and older.  Fifty-nine deaths per 100,000 persons in 2000, more than five times the national U. S. rate of 10.6 per 100,000 (NIMH, 2003).  Much like children, special care must be taken when diagnosing problems because some symptoms can be mistaken for physical ailments.

What Treatments Are Available?

There are numerous ways in which to treat depression: with medication, psychotherapy, and for more severe cases, electroconvulsive therapy (ECT).  

Antidepressant Medications

"Antidepressant drugs appear to work by altering levels of seratonin, norepinephrine, and other neurotransmitters in the brain.  Commonly used antidepressant drugs fall into three major categories: tricyclics, monoamine oxidase inhibitors (MAO inhibitors) and selective seratonin reuptake inhibitors (SSRI's).  Tricyclics, named for their three-ring chemical structure, include amitriptyline (Elavil), imipramine (Tofanil), desipramine (Norpramin), doxepin (Sinequan), and nortriptyline (Pamelor).  Side effects of tricyclics may include drowsiness, dizziness upon standing, blurred vision, nausea, insomnia, constipation, and dry mouth.

MAO inhibitors include isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate).  People who take MAO inhibitors must follow a diet that excludes tyramine-a substance found in wine, beer, some cheeses, and many fermented foods-to avoid a dangerous rise in blood pressure.  In addition, MAO inhibitors have many of the same side effects as tricyclics.

Selective serotonin reuptake inhibitors include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).  These drugs usually produce fewer and milder side effects than do other types of antidepressants, although SSRI's may cause anxiety, insomnia, drowsiness, headaches, and sexual dysfunction.  

Psychotherapy

Studies have shown that short-term psychotherapy can relieve mild to moderate depression as effectively as antidepressant drugs, without the physiological side effects.  Because people learn to change a behavior, those treated with psychotherapy appear less likely to experience a relapse than those treated with only antidepressant medication.  However, psychotherapy usually takes longer to produce benefits.

There are many types of psychotherapy.  Cognitive-behavioral therapy assumes that depression stems from negative, often irrational thinking about oneself.  In this type of therapy, a person learns to understand and eventually eliminate those habits of negative thinking.  In interpersonal therapy, the therapist helps a person resolve problems in relationships with others that may have caused the depression.  Psychodynamic therapy views depression as the result of internal, unconscious conflicts.  Psychodynamic therapists focus on a patient's past experiences and the resolution of conflicts that may have occurred in childhood.  Critics of long-term psychodynamic therapy argue that its effectiveness is scientifically unproven.  

Electroconvulsive Therapy (ECT)

Another treatment is Electroconvulsive therapy or (ECT) can often relieve severe depression in those who fail to respond to psychotherapy and antidepressant drugs.  In this type of therapy, a low-voltage electric current is passed through the brain for one to two seconds to produce a controlled seizure.  Patients usually receive six to ten ECT treatments over several weeks.  This method of treatment remains controversial because it can cause disorientation, and memory loss.  Nevertheless, research has found it highly effective in alleviating severe depression" (Encyclopedia Article - Encarta)

译文: 重度抑郁症:哪些是事实?

   
   在如今的科技时代，拥有惊人数目的人群患有抑郁症。但是，由于未将病状视为抑郁症的表现，许多人并没有寻求帮助。抑郁症患者通常看上去很虚弱，精神疾病加上社会烙印导致他们逃避亟需的治疗.部分患者甚至因某些病状致残,无法寻求帮助，而这些症状又被误诊为生理问题加以治疗，而未针对病根对症下药。

    数十年来，人们都在研究部分人会患上重度抑郁症的原因，并努力寻求最好的治疗方法。以下是有关此常见的衰弱病症的一些基本问题：

1. 什么是重度抑郁症？

2. 哪些人会患上重度抑郁症？

3. 有哪些治疗方法可供选择？

什么是重度抑郁症？
 
     抑郁可以是由于压力，个人失落感，或创伤性经历引起大脑化学不平衡所致。抑郁是否由基因缺陷所致的研究也在进行中。

     根据心理信息在线（2003），抑郁是最普遍的心理问题之一。个人的经历可引起抑郁，也可能是家人的抑郁情绪影响导致。抑郁的影响有：

致使严重的情绪痛苦

扰乱数百万人的生活

给家人和朋友的生活带来不良影响

降低工作效率，增加缺勤率
 
    在经济方面，抑郁症也带来严重的负面影响，据估计每年花费达4400万美元。路易斯.沃派特（1999）认为，“许多人不能理解抑郁症，是因为他们没有将精神疾病与癌症或心脏病一样同等对待。一部分原因在于，人们总是不记得我们的想法，不管正常或不正常，都是大脑中的神经细胞作用的结果，是有生物基础的。因此,要明白何为抑郁，理解情绪产生的心理和生理基础是很关键的。”（第12页）“在18世纪，‘抑郁’这个术语开始在所谓忧郁的研究中占据一席之地，而忧郁这个术语并非单指抑郁的情绪或抑郁症,它涵盖非常广泛的情绪状态。一直到19世纪，我们现在所称的重度抑郁症不再被诊断为忧郁，而被称作‘情绪低落’或‘臆想病’，单独划分为神经障碍中的一类。19世纪，抑郁作为以低落的情绪状态为特点的精神障碍术语出现。”（第13页）

    《精神失常的诊断与统计手册》（第四版），即俗称的DSM-IV，用于抑郁症的诊断。它是由美国精神病协会所创，也是许多团体的成果，目的在于利用与精神健康相关的大量信息资源。美国精神病协会对重度抑郁症的诊断标准是：
   
     以下至少五种症状在两周时间内持续出现，并表现出原有机能的改变:

1. 情绪低落
 
2. 活动兴趣或乐趣消减
 
3. 食欲大增或食欲极度不振，体重剧增或剧减
 
4. 失眠或嗜睡
 
5. 无价值感或极度内疚
 
6. 思考或集中精神能力降低

7. 多次想到死亡或自杀
           
     任何人都可能受抑郁的影响，而经诊断患抑郁症的大多数人都治疗成功。重度抑郁症可以是单个心理创伤引起，也可是生活中诸多问题或失落情绪导致。有的人可能一生中只会有一次抑郁发作，但也有些人可能有多次。
 
哪些人处于重度抑郁症的危险中？
  
     抑郁症并非选择性疾病，儿童、青少年、成年人和老年人都可能患抑郁症。在美国和欧洲近3%的人口患有抑郁症，而一年后上升到7%左右。10%至15%的人一生中会有一次重度抑郁发作。而美国上次的研究则发现几乎每六人中就有一人一生中会患重度抑郁症。(沃派特,1999)
 
儿童和青少年抑郁
 
    根据心理健康服务中心（1996）的统计，每33名儿童中有一名儿童可能患抑郁症。而根据国家心理健康研究所（1999）的统计，2.5%的儿童和8.3%的青少年患有抑郁症。美国儿童与青少年精神病学会提供的统计数据则表明未成年人经历过一次抑郁症发作后，未来五年里很可能再次发作。精神病学会还指出经受压力的小孩或失去过亲人、受到关注、有学识、或有品行障碍的小孩患抑郁症的几率更大。未成年人的抑郁症病状和成年人相比在程度和持续时间上都有所变化和不同，但他们患抑郁症的几率和成年人几乎相同，将近八分之一（《儿童的心理健康——儿童和抑郁症》，2003）。除与成年人相似的症状外，儿童抑郁症还包括以下：
 
课业表现糟糕或不佳
 
与权威之间的问题

自信心不足或有内疚感
 
对批评反应过激
 
频繁的身体不适，例如头痛，胃痛等
 
生气和愤怒

吸毒和（或）酗酒

儿童和青少年抑郁的可能原因：

缺乏关注，监护人的过世或长期缺席

监护人的轻视和拒绝

遗传脆弱性

住院治疗，尤其是慢性病治疗（（《儿童的心理健康——儿童和抑郁症》，2003）
 

老年人的重度抑郁症

    老年人的抑郁症往往由于身体不适症状的掩盖而未被确诊。老年人易患抑郁症多半是由于生活中的变化，比如到疗养院生活，配偶或心爱之人的逝去，或是身体能力减弱、身体受限。许多人都想当然的认为悲伤和情绪低落是衰老过程的一部分而已。

    衰老会影响老人的神经功能，导致大脑分泌化学物质不足。老年人易患的其他疾病也会影响大脑中控制情绪的化学物质的平衡，例如帕金森病、中风、脑损伤、甲状腺功能异常和脑肿瘤等。抑郁症也可能是由一些药物引起，比如抗生素、心脏及血压药物（Cornwell,Brent,1995)。美国老年人自杀的几率高得异乎寻常。尽管只占总人口的13%，但2001年65岁以上的老年人自杀却占所有自杀者的18%。从种族和性别来看，85岁以上的白人男人占的比例最大，每10万人中有59例，是美国全国自杀率每10万人10.6例的五倍多(国家健康研究院，2003)。和给小孩看病一样，为老年人诊断时需特别注意，因为某些症状可能会误诊为身体不适。

有哪些治疗方法？          

    治疗抑郁症有许多方法，如药物和心理疗法，对于病情严重者，还可才采用电痉挛治疗法（ECT）。

抗抑郁药物                   

    抗抑郁药物通过改变五羟色胺，降肾上腺素，或大脑中其他神经传递素发挥效用。常用的抗抑郁药物可分为三类：三环类抗抑郁药物，单胺氧化酶抑制剂（MAO抑制剂）和选择性五羟色胺再摄取抑制剂（SSRI's)。三环类抗抑郁药物，因其三环型化学结构得名，包括阿米替林（Elavil)，丙米嗪(Tofanil)，地昔帕明（Norpramin），多塞平（Sinequan），去甲替林（Pamelor)。三环类抗抑郁药物的副作用包括嗜睡、站立时眩晕、视物不清、反胃、失眠、便秘和口干。      

    MAO抑制剂包括异卡波肼（Marplan)、苯乙肼（Nardil)和反苯环丙胺（Parnate）。服用MAO抑制剂的病人必须调整膳食以防摄入酪胺。酪胺是红酒、啤酒、一些奶酪和许多发酵食品中含有的物质，可导致血压升高到危险的程度。另外，MAO抑制剂也有许多和三环类抗抑郁药物相同的副作用。     

    选择性五羟色胺再摄取抑制剂包括氟西汀（Prozac）、舍曲林（Zoloft）和帕罗西汀(Paxil)。这些药物比其他类型的抗抑郁药物产生的副作用更小，更温和，但SSRI's 可能引起忧虑、失眠、嗜睡、头痛和性功能障碍。

心理疗法         

    研究显示短期的心理疗法对于轻度和中度抑郁可达到抗抑郁药物相当的效果，而没有生理上的副作用。经心理疗法治疗的患者，由于学着改变了行为方式，比纯粹进行抗抑郁药物治疗的患者复发的几率似乎要小。但是，心理疗法通常要花更长的时间才能起效。       

    心理疗法分许多种类型。认知行为疗法认为抑郁的产生是由于人们对自己消极和非理性的认识。进行此类疗法，患者学习理解并最终消除消极思考的习惯。在人际关系治疗中，治疗师帮助患者解决人际关系中可能导致抑郁的问题。心理动力学疗法认为抑郁是人内心潜意识冲突的结果。心理动力学治疗师关注患者过去的经历和童年时期冲突的解决。批评家认为长期的心理动力学疗法的效用未经科学证实。

电痉挛治疗法           

    另一种疗法为电痉挛治疗法，适用于经心理疗法和抗抑郁药物治疗无效的重度抑郁症患者。此疗法采用低压电流通过大脑一到两秒的时间，制造可控的发作。患者通常在几周内接受6到10次ECT治疗。该疗法至今仍存在争议，主要是因为它会导致迷失方向和失忆。但是，研究发现此疗法对缓解重度抑郁症非常有效。