抑郁癥 Depression

用自己的話概括復(fù)述,大膽, 不怕犯錯(cuò).

介紹抑郁

普遍 廣泛 破壞性極大 越來越流行

要理解關(guān)于抑郁癥的兩個(gè)領(lǐng)域的話題才能理解抑郁癥(生物學(xué)和心理學(xué))

癥狀 sense of symptoms

不同于日常語言的難過沮喪,

幾周,中長期的, 但是走出來的. 反應(yīng)性抑郁 reactive depression

走不出來的 major depression 不在需要外界因素讓他抑郁

definition: biochemical disorder with a genetic component, and early experience influences where somebody can't appreciate sunset.

定義: 有基因影響的生物化學(xué)疾病, 早期生活經(jīng)驗(yàn)的影響, 失去審美.

毀滅性 沒有比讓人失去快樂的疾病更差的病

anhedonia -- hedonism, the pursuit of pleasure

anhedonia, the inability to feel pleasure.

major depression 的癥狀 妄想, 內(nèi)疚

self-injury

psycho moto retardation

real biological disorder just as juvenile diabetes

you don't sit down a diabetic and say oh come on pull

yourself together. what's with the insulin stuff, stop babying yourself.

你不會對糖尿病病人說的話也不要對抑郁癥患者說

vegetation symptoms:

wake up early exhausted but not sleep

sleeping disorder 睡眠的不同階段

eat more 碳水的大腦反應(yīng)減少壓力荷爾蒙的釋放

activation of stress response

壓力荷爾蒙升高

腎上腺素升高

比喻無脊椎動物，廢掉了 并不是major的癥狀

而是一個(gè)身體在爆炸（因?yàn)楹蔂柮傻姆置冢?/span>

stress 24/7

新陳代謝律升高，

increased muscle tone 肌肉緊繃

rhythmic patterns 每年的冬天，一年后

what's going on in the brain in major depression?

生物學(xué)，到大腦發(fā)生了什么？

化學(xué)

神經(jīng)元，神經(jīng)遞質(zhì),信息交流需要 chemical messenger (called neurotransmitter)

傳遞過程...

too little norepinephrine.

1960s First anti depression MAO inhibitor

logic : it inhibit the activity of enzyme, then brain don't break down norepinephrine, just floating around there. The key is too little norepinephrine.

late 1960s, tricyclic antidepressants. logic is too little norepinephrine.

a class of drugs called reserpine : major side effect in lowering somebody's blood pressure that way is they fall into a depression.

老鼠實(shí)驗(yàn) 刺激神經(jīng)元 Rats get stimulated in this area better than food, sex, drug. pure pleasure.

scratch itch

too little norepinephrine == loss of pleasure

但是有問題出現(xiàn):1. 神秘的沒有用.

2.另一種更有用 多巴胺 dopamine

3.Prozac(SSRI) 百憂解和血清素相關(guān)

證據(jù)表明:

absence of dopamine == anhedonia

absence of norepinephrine == psychomotor retardation

absence of serotonin == obsessive sense of grief

_a neurotransmitter called substance P == pain

實(shí)驗(yàn)發(fā)現(xiàn) decrease substance P signaling, sometimes depressives get better.

what does this suggest?

it is not just a metaphor of depression as psychic pain.

your body is using the same brain chemistry to feel the psychic pain of depression.

__neuroanatomy__ 神經(jīng)解剖學(xué), the structure in the brain.

1940s triune brain concept , very explanatory.

limbic system , it's about emotion. fear lust anger rage poignance.

cortex sensory stuff.

_suppose

gored by elephant

activate stress response. feel a sense of grief. hunker down psycho moto retardation, appetite,

depression

you sit there ,and you think about kids in refugee, loss of your parents. suddenly your body feel the same

cortex gives you abstract of pain and pleasure

you have pain in order to have pleasure.

_Hormones final biology here. 荷爾蒙 激素

thyroid hormones == maintain metabolism

severe shortage of thyroid hormone == major depression

Lessons:1.20% major depressions are undiagnosed hypothyroid syndromes

2.think other than psychiatric state, better have nutrition, hormone levels

women have their highest vulnerability to depression at certain points in their reproductive life histories.

women depression more than men

社會學(xué) sociologic framework

lack of control can cause depression

science women ruminate more on upsetting emotions than men do.

unsolid science : speculation on that you ruminate on bad feelings , you're more prone to a depression.

產(chǎn)后2周,更年期,更容易得抑郁癥, 都是關(guān)于荷爾蒙, 激素.

雌激素, 黃體酮 estrogen and progesterone

stress hormone (battle inside)

you get exposed to a lot of glucocorticoids == risk for major depression

disease evidence : people with Cushing's

a lot of glucocorticoids, and your brain gets depleted of dopamine.

介紹抑郁

普遍 廣泛 破壞性極大 越來越流行

crippling pervasive divesting widely common

15% of people will have a major depression at some point or other in our lives.

2025 number two cause of disability, after obesity, diabetes-related disorders

two different topics and tie them together at the end.

1. what does biology have to do with depression
2. ... psychology ...

sense of symptoms

a semantic problem -- we all use the word depression in an everyday sense.

1.不是not 小事, feel dumped 煩躁

2. large legitimate loss setback , losing a job, unemployment, death of a loved one

extremely impaired by a sense of malaise for weeks afterward. And then come out

3.and weeks and months later, they still have not come out the other end.

reactive depression vs. major depression.

major ... no need of external trigger

definition: it's a lot biochemical disorder with a genetic component, and early experience influences. where somebody can't appreciate sunsets. 失去審美,對審美的感動.

觀點(diǎn)worst disease you can get

why?

證明

compare cancer, heart disease.

有人會向死而生.

somebody saying "well, obviously, I am not glad I'm dying of cancer. But without this disease , I will never would realized the importance of friends.

I never would have reconciled with my family members. I never would have found my God."

On a completely weird level, I'm glad this has happened on me (got cancer.)"

Human have this astonishing capacity to derive pleasure out of the most unlikely domains.

人的適應(yīng)性, 合理解釋一切的動機(jī). 苦中作樂.

生物疾病

What could possibly be worse than a disease whose defining symptom is the inability to fell pleasure?

anhedonia , the inability to feel pleasure

hedonism, the pursuit of pleasure.

grief guilt. we got the semantic problem again.

major depression. the grief and the guild can be so severe that it actually takes on a delusional quality. not delusional in the sense of a schizophrenic

感同身受.

self-injury. suicide.

psycho moto retardation 精神運(yùn)動遲緩.

Everything is exhausting.

It's exhausting to do stuff, think stuff.

You cant do the laundry. because where is the basket and you got to find change for the machine. And you've got to go detergent. it's too much.

Everything is too much

fall into the paralyzed state.

not worry about suicide.

dangerous part is when somebody begins to get better from a sever depression.

something catastrophic.

something people with depression constantly battle with.

和 juvenile diabetes 一樣.biological disorder.

(加梗方式). you don't sit down a diabetic and say oh, come on, stop babying yourself. insulin stuff.

為什么是Biological disorder?

因?yàn)?vegetative symptoms

sleep pattern disorder.

this screams biology! 比喻

eat more general belief that when you feel unloved carbohydrates make you feel better.

事實(shí)　bizarrely there's actually a brain chemistry of it of carbohydrates decrease stress hormone release.

stress hormones

over-activation of something , that is called the sympathetic nervous system, adrenaline.

通常的比喻 sea sponge, invertebrate thing 無脊椎動物

但這不是 major depression

somebody whose body is blasting through there, over-activated stress response, enormous battle internally -- increased metabolic rate, increased muscle tone, all of these again screaming biology.

rhythmic patterns 比如 2個(gè)月恢復(fù)，但是1年半以后再來一遍

比如 some people only get depression during winter. (something)known as seasonal affective

biological clock

總結(jié)， 癥狀都是有生物學(xué)原因

the notion amid all these debilitating symptoms, these are ones that are about biology, these are bodies working differently.

問題： what's going on in the brain in major depression?

1.chmestry. 2brains 2 neurons

Neuro transmitter.

證據(jù) 2 種藥， 針對神經(jīng)遞質(zhì) 腎上腺素太少

convincing, irrefutable

實(shí)驗(yàn) rat 會控制一個(gè) 拉桿lever 電極刺激神經(jīng)元， 爽到死。 better than food, sex

人也是

norepinephrine 去甲腎上腺素。

BUT here's the reasons you shouldn't be convinced:

1.weird time

2.more important dopamine a neurotransmitter (cocaine works on dopamine system系統(tǒng)?)

3.百憂解 serotonin 血清素

absence of dopamine -- anhedonia 快感缺失

... norepinephrine -- psychomotor retardation

... serotonin -- sense of grief

強(qiáng)迫癥 Obsessive compulsive disorder 百憂解也可以

substance P -- pain

事實(shí) get a drug that decreases substance P signaling. sometimes depressives get better

這個(gè)事實(shí)說明什么？

It is not just a metaphor of depression as psychic pain. Your body is using the same brain to feel this psychic pain of depression as just telling you, oh, I just stubbed my toe.

Interesting similarity here.

neuroanatomy, the structure in the brain.

1940s triune brain concept 大腦三部分 （三合一， 三位一體）

reptilian part of brain -- 爬行動物部分， 和爬行動物一樣。what does this part of brain do?

measure blood pressure

You don't see a big limbic system until you get to mammals.

Lizards are not famous for their emotional lives. (三段論)

Limbic system is much about emotive stuff -- fear and lust anger ,rage , poignance, God knows what

Cortex

hugely expanded area in primates (靈長類動物）

what does it do?

numbers, processing visual information, sensory stuff

一個(gè)有趣的小例子

Unexpectedly, you are gored by an elephant.

what are you going to do?

You are going to activate your stress response.

You may feel a sense of grief at that point

You may kind of hunker down at that point, a little psychomotor retardation.

appetite, sex may not be the most appealing thing.

總結(jié)

You are having a stress response in response to the sort of insult that this part of the brain is thinking about.

So, what's depression.

You sit there, and you think about kids in refugee camps.

You think about the inevitable mortality of your loved ones.

You think about whatever

and suddenly your body does the exact same thing as if you were gored by an elephant.

What depression is about is the cortex whispering in your ear of the rest of the brain, saying this is as real as you were just physically assaulted by some sort of predator, whatever.

諷刺了哲學(xué)那種 cortex 的存在 是說明 痛苦是為了快樂。這是空想的，你看著那些醫(yī)院里的那些割腕的病人。和他說痛苦也是為了快樂。we have pain in order to have pleasure.

脫口秀加梗。

人本主義

hormones

thyroid hormones. -- maintain your metabolism, keep your body warm enough.

shortage of it --- major depression. Hypothyroidism is associated with major depression.

女人更容易得major depression

產(chǎn)后， 更年期

other sociological framework

lack of control cause depression.

討論男女差異，還有individual difference

調(diào)查問卷：調(diào)查剛剛和親密的朋友吵架的人會選擇什么樣的問題。

女人選擇 他們?nèi)绾握J(rèn)識的， 關(guān)系的本質(zhì)是什么，他的朋友有沒有幸福的婚姻

男人選擇 戰(zhàn)爭題材， 抗日。 男人cant express their emotions 男人不會表達(dá)情緒。

that is solid science

what is unsolid science?

it is that you ruminate on bad feelings you're more prone to a depression.

別想那些難過的事情，這個(gè)不是科學(xué)驗(yàn)證的。是人的樸素的相關(guān)性分析。是錯(cuò)誤

心理學(xué)

Freud

what's difference /bw mourning and melancholia

the other end 不同文化都有彼岸的說法. 語言背后的形而上存在

舉例 矛盾的心理, 親人去世,Oh, thank God I'm finally done with this person.

They are never control my life. --- how can I think suck a thing like that.

Sudden crippling guile all sorts of other symptoms.

depression is aggression turned inward. // feels right , no evidence

internalize

You cant do modern science on it, which is the problem with the best parts of Freud.

you cant turn it into neurochemistry.

what do estrogen progesterone rations have to do with love hate ratios? 無法量化

所以轉(zhuǎn)向 experimental psychology

define psychological stress. ...

Depression is Learned helpless (from cognitive psychology)

父母不理解, 不負(fù)責(zé)任的父母. 不知道自己想做什么, 沒有安全感. 地獄一般的家庭環(huán)境.

it is learning to be helpless.

what is it?

is taking a circumstance where by any logic, you should be saying , this is awful, but it is not the whole world.And do this cognitive distortion and decide , this is , indeed, the entire world and I have no control always helpless, always hopeless.

two extremely different viewpoints 視角(心理和生物)

舉例 事實(shí)

lose a parent to death when you are under 10 years of old

is one of the most reliable findings in the whole epidemiology of depression

and for the rest of your life you are more at risk for a major depression.

How to link 生物和心理

The key is Stress

depression is a genetic disorder : it has some degree of heritability.

50% chance if your twin brother has depression

genes and depression are not about inevitability.

They are about vulnerabilities.

事實(shí) one gene having something to do with serotonin.

it doesn't increase your risk

unless you have a history of exposure to stress 養(yǎng)家...

parental divorce, physical abuse, death of a family member.

the gene is about how readily we recover from stressors.

Glucocorticoids regulate the function of this gene.

finally , a wonderful integrated model

This is not pull yourself together. we all get depressed.

這和糖尿病一樣,都是生物疾病.

university

A community of high achieving , type A individuals is rife with major depression.

weird corrosive inhibition, embarrassment, discomfort

諷刺 ,senator with a depressed loved one will set up a funding.

基因, 和承認(rèn)你有糖尿病

承認(rèn)自己抑郁就像 admit that your pancreas isn't secreting insulin.