(25)什么是抑郁症?What is Depression??-公开课-关爱惟士
(25)什么是抑郁症?What is Depression??

课程视频:http://player.youku.com/embed/XMjY4NjQzMDQzMg




Text Overview of Video

Professor Nicola Lautenschlager

Nicola Lautenschlager教授


It is important to discriminate, when we use the term “depression,” between the term how we use it often in everyday life, “Oh I feel depressed today,” and depression as a medical condition. In the latter scenario, depression is a mental health problem, and is an illness and, obviously, is a very important illness to treat, because if not recognised and treated, it can come along with very severe health outcomes. It is one of the most common mental health conditions, and it is actually also one of the most common health conditions, full stop. Current estimations of how common depression is globally, estimate that roughly, at any given time, 350 million people suffer from depression globally. When it comes to using depression as a term in our everyday language, we often describe with that [word] just having a bad day, and sometimes it can also mean feeling stressed. We all can have symptoms of depression. Let’s say we go through a very difficult phase in our life. We have adverse life circumstances, without actually fulfilling the criteria to experience full-blown depression as a medical condition. What are the essential criteria or essential symptoms of depression as an illness? Obviously, most important is the symptom of feeling down or having a low mood. That’s usually considered central in a depressive episode, for example, but it has to be more than that. Usually it has to be around for a certain duration of weeks. It has to be severe enough that it impacts on the person’s daily life. For example, it impacts on their work or impacts on their family life. There are other important symptoms like having poor sleep, or having changed appetite, having changed energy levels, and the interesting thing about depression is that it can go either way. You have people who are more fatigued and sleep more, and have no energy, and find it very difficult to get out of bed and do things. But then you can also have people who have more an agitated depression, meaning they’re restless, they can’t sleep, they are overactive, they’re reactive, but all the activities they might do might not be very meaningful, because they can’t concentrate.

当我们使用“抑郁症”一词时,把我们日常用词“哦,我今天感到郁闷”和抑郁症作为一种医学名词区分清楚,是很重要的。在后一种情况下,抑郁症是一个精神健康问题,是一种疾病。这显然是一种非常重要的疾病,因为如果不承认和治疗这种疾病,它可以产生非常严重的结果。它绝对是最常见的精神健康问题之一。目前对全球抑郁症普遍性的估计是,在任何特定时间,全球大致估计有3.5亿抑郁症患者。当谈到我们在日常用语中使用抑郁这个词时,我们经常用这个词来描述糟糕的一天,有时它也可以指感到有压力。我们都会有抑郁症状。让我们说,在我们的生活中我们经历了一个非常困难的阶段。我们有不利的生活环境,实际上没有满足作为医疗条件全面体验抑郁症的标准。抑郁症作为疾病的基本标准或基本症状是什么?显然,大多数重要的的症状是情绪低落或情绪低潮。例如,这通常被认为是抑郁发作的中心,但它不仅仅如此。通常它必须有数周的持续,必须足够严重到影响人的日常生活。例如,它影响他们的工作或他们的家庭生活。另外它还有如睡眠不足,食欲改变,能量水平变化等其他重要的症状。关于抑郁症的有趣的事情是,它可以采取任何一种方式。有些抑郁症患者感到疲劳,并且睡眠更多,无精打采,并发现很难起床去做事。但是,有更多的激动性忧郁症患者,他们坐立不安,无法入睡,他们过度活跃,他们有反应能力,但因为他们不能集中精力导致他们可能做的所有活动没有什么意义。


The challenge with depression is that it can come with various forms of presentation, and therefore can be missed, for example, in general practice, especially if it presents in an unusual form. One interesting question is, “Does depression look different in a younger person versus an older person?” What’s important to understand is that the core symptoms of depression are the same in young and old. But research tells us that in old age there are certain symptoms which are more prominent, when it comes to depression, than in younger people. I’ll give you an example. Older people with depression tend to feel more somatic symptoms and these are usually the complaints or the concerns they communicate to their general practitioner. So they have headaches or they have problems with their stomach or their bowels. They might have pain in their chest or they feel they have weak muscles. So we have to be mindful, working in the health field, or also just as family members, that when an older person has many changing and various health complaints, somatic health complaints, that what could be behind it is a depression, especially if the general practitioner investigating can’t find any causes for these complaints. That’s different to younger people. Since younger people tend to experience more the mental health side of depression, with having a low mood and feeling irritable, for example.

抑郁症的挑战是,它可以带有各种形式的表现,因此,例如在一般实践中,特别是如果它以不寻常的形式出现,可能会被错过。一个有趣的问题是,“年轻人和老年人抑郁症看起来不同吗?”重要的是要明白,抑郁症的核心症状在年轻人和老年人中是相同的。但研究告诉我们,人年老时,有些在抑郁症方面症状比年轻人中更突出。我给你举一个例子。抑郁症老年患者往往感觉更多的躯体症状,他们往往向他们的全科医生的倾诉和抱怨他们有头痛或胃肠的问题。他们或许感觉他们的胸痛或肌肉无力。所以作为在健康领域的工作者,或者只是作为家庭成员,我们必须注意,当一个老年人有许多健康方面的投诉,身体健康的抱怨,它的背后可能是一种抑郁症,特别是如果全科医生检查后无法找到这些投诉的任何原因。这点与年轻人不同。因为年轻人倾向于经历更多的心理健康方面的抑郁症,例如情绪低落和感觉易怒。



Another important fact to be aware of, is that older generations of people tend to associate a bigger stigma with having a mental health condition such as depression, and therefore are much more reluctant to talk about it, because they often interpret that as a failure of who they are, and it might be a sign of weakness, or weakness of character. It is rarer in older people for them to talk about their mental health, even to their loved ones, than on average it is in younger people. There is also an interesting gender bias. So, not surprisingly, looking at western societies, men find it harder to talk about their mental health than women, and there is also a geographical difference, that people living in rural communities find it harder to talk about their mental health compared to people living in cities.

另一个需要注意的重要事实是,老一代人倾向于将更大的耻辱感与精神健康出问题(如抑郁症)联系起来,因此更加不愿意谈论它,因为他们经常将其解释为他们很失败,或者认为它可能是一个弱点或性格上的弱点的迹象。平均来说和年轻人相比,老年人很少谈论他们的心理健康,特别是和他们的亲人。另外还有一个有趣的性别偏见。所以,毫不奇怪,在西方社会,男人发现比女人更难以谈论他们的心理健康,还有一个地理差异,和生活在城市的人相比,生活在农村社区的人更难以谈论他们的心理健康。


One important point when it comes to depression in older people is, to try to investigate “Why is the person experiencing depression in the first place?” This is particularly important if it is an older person who never had a depressive episode before in their life. We call that having late onset depression for the first time in their life. The reason why this is important is, that there are different health or medical conditions which might be causing the symptoms of depression. It could be just a depressive episode for various reasons, and these reasons could be changing of the body, physiologically, due to ageing, additionally with chronic health issues, additionally through changes to their life circumstances, but it also could be a symptom of emerging biological changes to the brain, due to cognitive decline or emerging dementia. We do know that there is a certain percentage of people who develop, later on, dementia, such as Alzheimer's disease, where the first symptom was actually change to their mood with developing depression, and research has shown that can be several years before there is any onset of clear cognitive changes.

对于老年人的抑郁症,一个要点是试图调查“为什么这个人首先经历抑郁症?”这对于从前从未有过抑郁发作的一个老年抑郁症患者是特别重要的。在他们的老年生活中发生了第一次抑郁症发作,这种抑郁症我们称其为晚发性抑郁症。这很重要的原因是,有不同的健康或医疗条件可能会导致抑郁症的症状。它可能只是由于各种原因的一种抑郁发作,这些原因可能是由于老化导致的生理上的身体的改变,还有慢性健康问题,另外还有他们的生活环境的改变,但它也可能是一种由于认知衰退或新出现的痴呆引起脑的生物变化的症状。我们知道,有一定百分比的人后来会发展成认知症,如阿尔茨海默病,其中第一个症状是抑郁症的发展导致他们的情绪改变。并且研究表明,在出现任何明显的认知变化之前可能是几年的时间。


It is important not to scare people who have late onset depression, because that might not be the case for them. What the recommendation is for clinicians is, if a person develops late onset depression, to assess their memory, and even after they have recovered from the depression, to see them on a regular basis and to continue to assess their memory, just to have an eye on it. Because usually, if it would be due to underlying dementia processes, eventually you would be able to measure the cognitive decline. To give you an idea, most studies statistically estimate that a person with late onset depression has roughly a twofold risk of developing cognitive decline, compared to an older person who doesn’t experience late onset depression.

重要的是不要恐吓有晚发性抑郁症的人,因为他们可能不会发展成认知症。如果一个人患了迟发性抑郁症,对临床医生的建议是,去评估他们的记忆力,甚至在他们从抑郁症恢复之后,定期随访他们并继续评估他们的记忆力,只要留意他们就可以了。因为通常,如果它是由于潜在的痴呆过程,最终你将能够衡量的认知衰退。为了给你一个想法,大多数研究统计学估计,与没有经历迟发性抑郁症的老年人相比,具有迟发性抑郁症的人具有发展认知衰退的两倍风险。


How common is that, that an older person with depression also has problems with their cognition? Studies estimate between 40% to 60% of older people who experience depression have, at the same time, problems with their cognition. Very often it is around being able to concentrate and pay attention, which is typical for depression, but this is a much higher percentage than in younger people. Sometimes one comes across a term called “pseudo dementia” especially in the older literature which tries to describe these changes to cognition, while depression is present, and it’s called “pseudo” because very often when the person has recovered from their depressive symptoms, also their cognition returns to normal again.

老年人有抑郁症也有他们的认知问题,这是多么常见呢?研究估计40%至60%的老年人经历过抑郁症,同时,他们有认知问题,很多时候它是指无法集中精力和注意力,这是典型的抑郁症,但这是一个比年轻人高得多的百分比。有时候,特别是在老的文献中,一个称为“假性痴呆” 的术语,试图描述这些认知的变化,而当抑郁症存在,它被称为“伪”,因为很多时候,当人们从抑郁症状恢复后,他们的认知又恢复正常。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任


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