"Since ancient times, every autumn is sorrowful and lonely", "Ten thousand miles of sad autumn is often a guest"... As the autumn is approaching, the weather is getting colder and the vegetation is withering day by day.
Many people tend to become depressed, depressed and sad in autumn. At the same time, autumn and winter are also the seasons for depression.
So, what is going on behind "Sorrowful Autumn"?
Why is it easy to be depressed in autumn?
Everyone's emotions may be more or less affected by external environmental factors. For example, some people have different moods under different weather such as sunny and cloudy.
In autumn, many people’s moods are prone to depression, mainly due to the decrease in the length of light and the weakening of the intensity after the autumn, and the colder weather, which may induce the body's circadian rhythm or changes in the biological clock, leading to an increase in the secretion of melatonin levels and biological rhythms. The abnormality may affect the body's neuroendocrine, neurotransmitter, etc., which is a very important physiological basis that leads to depression.
Clinically, it can be seen that the onset of some depression patients shows seasonal characteristics, especially autumn and winter are the seasons of high incidence of depression.
But "seasonal depression" is not a professional term. It is just a subtype of depression. It is essentially depression, but its onset has obvious seasonal characteristics.
Studies have found that there are significant seasonal differences in 5-HT transporter (SERT) protein levels in patients with "seasonal depression", which in turn leads to fluctuations in 5-HT levels.
When the autumn night time gradually extends, the SERT level rises accordingly, resulting in a decrease in the active 5-HT level.
In addition, changes in the photoperiod can promote neurotransmitter conversion between dopamine and somatostatin (SST), which is also a very important pathogenesis of the seasonal pattern of depression.
In addition, the clinical manifestations of seasonal depression and typical depression are also different. For example, common depression is mostly manifested as insomnia, poor appetite, weight loss, etc., but seasonal depression is manifested as lethargy, binge eating, and desire for wealth. Carbohydrate-containing foods, weight gain, etc.
It is worth noting that to determine whether you are suffering from seasonal depression, you need to meet the following characteristics: the onset and relief of depression have seasonal characteristics, such as beginning in autumn and winter and relieving in spring; in the last 2 years, there have been 2 depressions The onset accords with the above-mentioned seasonal characteristics, and during this period, there is no depressive episode that does not meet the above-mentioned characteristics; there are significantly more depressive episodes with seasonal characteristics than non-seasonal features during the entire course of the patient.
And it is necessary to exclude situations that can be explained by seasonally related psychosocial factors, such as seasonal unemployment or school holidays.
Depression is not simply a "bad mood"
In fact, poor mood is not the same as depression.
However, as the public pays more attention to the topic of depression, many people will even "check in."
For example, some people will self-doubt whether they are suffering from depression one day in a bad mood. In addition, there are currently many judgments or screenings on the Internet for depression, but in fact most of them "self-test" The table is only a symptom scale or a screening scale. Even if the self-test has a "positive" result, it may not necessarily be depression. Therefore, the judgment of depression requires further evaluation by doctors in specialized hospitals.
At present, the World Health Organization has a set of universal diagnostic criteria for depression (ICD-10), which includes three core symptoms of depression, loss of interest and pleasure, reduced energy or fatigue, as well as reduced ability to concentrate and notice, self There are seven additional symptoms including decreased evaluation and self-confidence, self-guilt and sense of worthlessness, pessimistic outlook on the future, self-harm or suicidal ideas or behaviors, sleep disorders, and decreased appetite.
The standard of depression is to meet at least two core symptoms and at least two additional symptoms. These manifestations exist in most of the day and last for more than two weeks, which have a lot of negative effects on daily life, study, work, and interpersonal communication. , But also to exclude secondary depression caused by other reasons.
In addition, the severity of depression can be mild, moderate or severe. For mild conditions, two core symptoms and two additional symptoms must be met, for moderate conditions, two core symptoms and at least three additional symptoms must be met, and for severe conditions, three core symptoms and at least three additional symptoms must be met. Four additional symptoms.
Therefore, depression is not a simple "bad mood". It has strict diagnostic criteria and requires follow-up by professional doctors. The diagnosis may be revised based on new information. This is a complicated diagnostic process and cannot be based on a single individual. Symptoms or simple screening scales can be considered as depression.
The sooner the treatment, the better the effect
So far, the etiology of depression is not very clear. It is usually the result of a combination of biological, psychological and social factors.
Nevertheless, it is still a treatable disease, most of which can be cured after treatment, and like other diseases, the earlier the treatment, the better.
At present, there are three main clinical treatments for depression, namely drug therapy, psychotherapy, and physical therapy. Numerous evidence-based medical evidence and clinical practice have found that comprehensive treatment is more effective than a single treatment.
At the same time, the doctor will decide the specific treatment plan based on the severity of depression. For example, non-drug treatment can be the first choice for mild to moderate depression, while the degree of depression reaches more than moderate to severe, especially when there is a serious risk of suicide or accompanied by hallucinations. Psychotic symptoms such as delusions require medication and hospitalization if necessary.
It is worth noting that despite the overwhelming information about depression on the Internet, there are still many misunderstandings about depression.
Clinically, the manifestations of depression are complex, and different patients may vary greatly. For example, the performance of seasonal depression in eating and sleeping is completely opposite to the manifestations of ordinary depression. Some patients have physical symptoms as the main symptoms. It is easy to be considered as suffering from a physical disease, and usually go to a general hospital for treatment and examination repeatedly.
Therefore, depression is particularly easy to be misdiagnosed and missed.
In addition, some patients feel that they are suffering from depression, but they are worried about being discriminated against by others, so they dare not go or take the initiative to go to specialist hospitals for treatment. As a result, they miss the best treatment period and delay their condition. In fact, this It's not uncommon.
At present, the consultation rate for depression is still low. The latest national survey in my country found that the consultation rate and treatment rate for depression are only about 10%.
For a disease of unknown etiology, although there are currently no effective preventive measures, there are indeed some effective measures to reduce its risk, such as shaping a healthy personality with the help of a professional psychotherapist, and obtaining good family and social support. Avoid stress events, eat reasonably, live a regular life, take active outdoor exercises, and learn to talk, vent and relax.
Chen Lin, Deputy Chief Physician, Department of Psychiatry, Beijing Huilongguan Hospital