Part I: Get rid of misunderstandings

At about 6 o'clock in the morning, there were few pedestrians on the street, and in Ankang Hutong outside Deshengmen, Beijing, China's first mental health hospital, Beijing Anding Hospital, was already lively. The benches in the outpatient hall were full of patients, and by the time registration began at 7 o'clock, the hall was already crowded.

Outside the consultation room of chief physician Jiang Tao, there was a long queue of patients. This doctor, who is well received by patients on the website "Good Doctor Online", specializes in depression. The number of the day has long been booked, and patients continue to knock on the door and ask for extra numbers. By 10 a.m., his number had increased to more than 70.

"There has been a huge increase in the number of patients compared to before." Jiang Tao told Caixin reporters that for a long time, Beijing Anding Hospital mainly treated schizophrenia, and 70% of the patients received were diagnosed with schizophrenia. In recent years, the number of people with depression has surpassed those with schizophrenia. In 2006, Anding Hospital set up a special depression treatment center. At present, the number of patients with depression accounts for half of all patients.

Jiang Tao's observations are consistent with the results of epidemiological investigations of psychiatric disorders in many places. Fei Lipeng, a doctor at the Shanghai Institute of Mental Health, published an article in the international medical journal The Lancet based on epidemiological survey data from six regions across the country, saying that the lifetime prevalence of depression in China is 6%, much higher than the 1% of schizophrenia.

Liu Jin, M.D., from Peking University's Institute of Mental Health, summed up the situation of depression in the country as follows: "Depression and anxiety have increased, and about 50% of outpatient and 40% of inpatient departments are depression. ”

Depression is ferocious

CCTV host Cui Yongyuan recalled: "Depression is very close to me, like a brother. …… For about four or five years, I was depressed and alive...... Don't talk about how bitter depressed patients are. ”

On the afternoon of August 22, 2012, half a year after suffering from depression, Xu Huaiqian, editor of the Literature and Art Department of the People's Daily, jumped from a high-rise building and ended his life.

This is the second suicide caused by depression in the public eye in six months. On March 20, a day after the Nanjing girl committed suicide by "walking to eat", her last words published by using a "time machine" (a software that can transmit messages at regular intervals) were displayed on her Weibo page: "I have depression, so I will die." ”

This message, which seemed to come from another world, was retweeted more than 80,000 times by living people, leaving 160,000 comments.

The dead are gone. It is often difficult for the living to appreciate the pain that their life is worse than death. In fact, as long as you look up a random medical professional book, you can know that "depression is a common mood disorder, which can be caused by various reasons, with significant and persistent depression as the main clinical feature, and the depression is not commensurate with its situation, and in severe cases, suicidal thoughts and behaviors may occur." Most cases tend to recur, with most episodes relieving and some may have residual symptoms or become chronic. ”

CCTV host Cui Yongyuan once suffered from depression. He later recalled: "Depression was very close to me, as close as a brother, and I had most of the symptoms described in the medical books, as well as the improvisational part." For about four or five years, I was depressed and alive...... Don't talk about how bitter depressed patients are. ”

Even if they are tenacious, the quality of life of people with depression is extremely low.

Patients with severe depression often have severe physical disorders in the context of persistent depression: headaches, dizziness, palpitations, shortness of breath, fatigue, insomnia, chest tightness, stomach pain, bloating, constipation, loss of appetite and libido, and so on. "Depressed patients who commit suicide generally go to many departments six weeks before committing suicide, such as cardiology, gastroenterology, thoracics, neurology, and endocrinology, and 10% to 20% of patients cannot find physical problems. This is actually a somatized manifestation of depression. Tang Denghua, a doctor at Peking University Sixth Hospital (Peking University Sixth Hospital), said.

Along with somatic symptoms, the patient's mental state gradually declines. The most common symptoms are depressed mood, decreased interest, impaired brain activity, decreased self-esteem, self-blame, social phobia, helplessness and hopelessness. In such a state, some patients choose to die to be freed.

At the outpatient department of Anding Hospital, a female patient in her 60s came to see a doctor, accompanied by her daughter. She has a 20-year history of depression, at least two episodes per year, and two suicide attempts. She often carried sleeping pills and suicide notes with her. "Death is a very happy thing for me." She said. For people with moderate-to-severe depression, it seems that only suicide can end the protracted suffering.

As in other developing countries, many people with depression in China do not receive professional treatment. In 1990, only 5 percent of people with depression in China received treatment, compared with 35 percent in the United States during the same period. In 2003, an epidemiological survey of depression covering Beijing showed that the temporal prevalence of depression was 3.31%, and the lifetime prevalence (asymptomatic but symptomatic at the time of the survey) was 6.87%. This means that with a population of 12.78 million in Beijing, there were nearly 878,000 people with depression in Beijing at this point in April 2003, of whom nearly 423,000 were in the symptomatic stage.

The huge prevalence has led to significant economic losses. In 2007, Hu Dewei, a professor of health economics at the University of California, Berkeley, and the Shanghai Mental Health Center calculated the costs of depression: the total annual cost of depression in China is 51.37 billion yuan, of which 5.62 billion yuan is medical expenses, and the other are "indirect costs", including the loss of patients who lose their jobs due to illness or have to change jobs.

According to the survey, the average annual medical cost for depression is estimated to be 2,957 yuan, and 18% of respondents have lost their jobs in the past year. 6% of respondents have changed jobs; Forty per cent of respondents were able to retain their jobs, but their workload was reduced. The average monthly wage loss of respondents was 1,169 yuan, close to the average social wage of 1,183 yuan that year. Nationwide, the annual wage loss caused by depression reached 15.992 billion yuan, the cost of changing jobs was 114 million yuan, and the loss of reduced workload was 18.354 billion yuan.

Premature death due to suicide due to depression also brings financial losses. According to estimates, the indirect loss in rural areas is 4.303 billion yuan, far exceeding the 811 million yuan in urban areas.

Sparks and raging fire

Mild depression can be relieved without medication through psychotherapy or even self-adjustment; Patients with moderate depression may or may not take medication; Patients with major depressive disorder must take medication.

Andrew Solomon, an American depressed patient, wrote in his book "Melancholy" that a depressed person is like a dry firewood that ignites a raging fire if the sparks in life pass by.

Andrew describes the causes of depression as the result of the interaction of internal and external factors. This judgment is in line with the results of the current research on the causes of depression in the medical field: the pathogenesis of depression is a combination of factors, including genetic causes, biochemical causes, and psychological and social causes. There is not one, but hundreds of genes that interact to cause depression.

Modern anatomy uses a scalpel to more thoroughly describe the mechanism of depression. In the first half of the 20th century, when researchers dissected the brains of depressed suicide victims, they found lower concentrations of three neurotransmitters (5-HT, norepinephrine, and dopamine) in their brains than normal. These three neurotransmitters act like postmen, sending messages from brain cell to cell. If these three neurotransmitters are reduced and the transmission of information between brain cells is blocked, depression can unexpectedly set in.

According to the clinical observation of Jiang Tao, a doctor at Anding Hospital, depression presents an industry characteristic. The proportion of civil servants, teachers, police officers, media professionals, and entertainers suffering from depression is significantly higher than that of other professions. This phenomenon can logically be explained as follows: the working pressure is equivalent to placing dry firewood in a flammable environment.

Understanding the causes of depression determines the choice of treatment: whether to give medication or psychological intervention.

There is a misconception about depression in society, that is, depression is simply attributed to personality and psychological problems. Tang Denghua, a doctor at Peking University's Sixth Hospital, believes that people often think that a specific external event causes depression. In fact, this specific event is likely to be a consequence of depression, not a cause. For example, if a daughter commits suicide after being slapped by her mother, the real reason for suicide is not this slap, but that she is sick and easily irritated, and this slap is just the last straw.

When people hear that someone has depression, they often first guess what is causing him to "think about it", rather than thinking about it. CCTV program host Cui Yongyuan once refuted this: "Those who say that depression is not a disease, but people who can't think about it and have a small heart, you take my medicine to try, the medicine is very strong, I take that medicine, two or three pills, and I can only fall asleep at 5 o'clock, 6 o'clock, 7 o'clock, and 8 o'clock in the morning." People who do not have this disease may not be able to sleep for three days after taking this medicine. ”

The phenomenon mentioned by Cui Yongyuan has long been explained by medical science. A foreign medical journal has published an analysis of cerebrospinal fluid samples from depressed patients, and researchers have used isotope labeling technology to measure the levels of epinephrine, norepinephrine and dopamine in dozens of depressed patients. It was found that all three neurotransmitters were lower than normal in the patient group during the onset of the disease. Modern antidepressants (SSRIs and SNRIs) have been developed to stimulate the production of these three substances in the patient's brain.

Of course, the emphasis on pharmacological interventions does not mean that psychotherapy is useless. From a scientific point of view, psychotherapy can be applied to mild patients and convalescent patients; However, patients in the acute phase and patients with moderate to severe disease must rely on drug therapy.

"Depression treatment requires both medication and psychotherapy. Mild depression can be relieved without medication and through psychotherapy or even self-adjustment; Patients with moderate depression may or may not take medicine; Patients with major depressive disorder must take medication. At this time, only arrange psychological adjustment for him, and if he is not given medicine, his condition will worsen. Yao Guizhong, assistant to the dean of the Sixth Hospital of Peking University, told Caixin reporters.

In the follow-up treatment of depression, there are many people who give up treatment because they are skeptical about antidepressants. Because antidepressants have a slow onset of action, the average duration of action is 2 to 4 weeks, and the side effects are significant, and they can even worsen suicidal tendencies before they take effect. This is a major factor in the patient's resistance to taking antidepressants. Especially for some patients with treatment-resistant depression, it is difficult to find the right medication at the beginning. After trying a certain type of drug in sufficient amount and for a full course of treatment, it is necessary to change to another type of drug. It can take as few months or as much as six months for them to try out a drug that works. This in turn prolongs the duration of the suffering, increasing the patient's despair and the likelihood of suicide. For such a patient, doctors and family members can only encourage him to stick to his medication and prevent him from secretly hiding medicine.

For patients who respond to treatment, antidepressants are not stopped on the wane, otherwise they will relapse. "The first episode takes medication for at least a year, and some people with depression need to take it for life." Professor Wang Gang, director of the Depression Treatment Center of Beijing Anding Hospital, said.

Among the patients he treats, medication adherence is a challenge. 30% of patients gave up taking the drug one month after the onset of action; 50% of patients gave up taking the drug for two months; 80% of patients gave up taking the drug for three months.

Treatment of misalignment

Diagnosing depression is a difficult problem, and if the diagnosis is wrong, the treatment can be counterproductive.

In front of the gate of Beijing Anding Hospital, a patient who had suffered from years of depression hesitated and did not want to walk in. Later, he told a Caixin reporter that at that time, he thought that once he stepped into the door of Anding Hospital, he would be branded as a "mentally ill" for the rest of his life, and it would be difficult to see people.

This kind of psychology is more common among depressed patients and their families, and it has caused the current situation that the medical treatment rate of depressed patients is less than 10%.

Anding Hospital has considered this psychological feeling of the patient. On January 5, 2006, the Depression Research Center of Anding Hospital was established. Professor Wang Gang, director of the treatment center, told Caixin that he was quite careful when he first named it. Originally, I wanted to call it "Mood Disorder Treatment Center", but it was useless because of the low public recognition rate of this name. Later, I wanted to call it an "Affective Disorder Treatment Center", but I was afraid that patients would think that it was a solution to emotional problems. It was eventually named the Depression Treatment Center, which has a high level of public awareness and avoids the association of so-called psychosis among patients.

After the establishment of the depression treatment center, more and more patients with depression came to visit. "The increased prevalence of depression is also associated with an increased detection rate. Awareness of depression in China's medical community has increased over the years. Wang Gang said.

Seventeen or eighteen years ago, the recognition rate of depression in China was low, and foreign depression drugs could not be sold in China. At that time, a depressant drug manufacturer in the United States came to China to investigate, and the doctor at Anding Hospital told them: "We have very few depressions here. "They came to China to give lectures so that doctors could improve their ability to identify depression.

Diagnosing depression is a difficult problem. If the diagnosis is wrong, the treatment can be counterproductive. Before the knowledge of depression was popularized, about 20% of patients with depression were misdiagnosed as schizophrenia due to hallucinations and delusions.

After the awareness of depression has been raised, another important misdiagnosis has become an obstacle in the treatment of depression. That is, bipolar disorder is easily misdiagnosed as depression.

In the eyes of non-specialists, bipolar disorder is depression; Serious academic conception treats depression and bipolar disorder as two different disorders. Bipolar disorder is a mood disorder that combines manic or hypomanic episodes with depressive episodes since onset. Although it and depression are both mood disorders, they differ significantly in terms of treatment principles. The suicide rate of bipolar disorder is higher than that of depression, and if depression is treated, it is refractory to treatment, and after depression is relieved, it will lead to a turn to mania, and the frequency of onset will be significantly accelerated; The more frequent the attacks, the more difficult it is to treat, and the higher the risk of suicide.

Wang Gang and his team did a cross-sectional investigation of bipolar disorder misdiagnosed as depression. The transverse misdiagnosis rate (in the same period) was more than 20%. Long-term follow-up studies are associated with higher rates of misdiagnosis.

A recent study in the United States followed up 200 patients who were diagnosed with depression 13 years ago and found that 46% of patients diagnosed with depression that year were eventually diagnosed with bipolar disorder. That is, nearly half of the patients currently diagnosed with depression are actually people with bipolar disorder.

Jiang Tao, a doctor at Anding Hospital with 20 years of clinical experience, said: "Some patients with bipolar disorder have depression at the time of their first episode, and hypomania has a short time. For the patient's family, hypomania is difficult to identify, and neither the family nor the patient thinks it is a disease and will not talk to the doctor as a problem, and the doctor will have difficulty collecting information. ”

For patients who are difficult to make a diagnosis in a ten-minute outpatient clinic, Wang Gang suggested that patients with difficult diagnosis should be hospitalized for observation and treatment, or patients should be revisited in time. Of the hospitalized patients, 30% are depressed and more than 60% are patients with bipolar disorder. Without considering misdiagnosis, the lifetime prevalence of bipolar disorder is 3.7%, which is already a major mental illness.

Prevention and control are out of control

Unqualified psychological counselors and unqualified small hospitals not only make patients lose money, but also kill them.

Patients and their families do not understand depression and find it difficult to access professional treatment. At the same time, some ineffective treatments are in vogue. Some psychological counselors and small and medium-sized hospitals engage in non-standard treatment of depression to make money.

A patient with severe depression told a Caixin reporter that a counselor once said to him, "What's wrong with you? What kind of medicine do you take? "A college student who had been treated in Anding Hospital but refused to take medicine and turned to psychological counseling later committed suicide by lying on the rails. Some psychologists believe that depression is only a psychological cause, delaying moderate to severe patients who should be treated with medication.

Psychological counselors have a low entry threshold and uneven quality, resulting in confusion in the treatment of depression. Zhao Guoqiu, vice president of the Chinese Mental Health Association, said: "There are very few clinical psychology departments in the country, and there is a shortage of people with dual backgrounds in medicine and psychology. At the beginning, there was no centralized unit for psychological counselors, and later they were certified by the Ministry of Human Resources and Social Security, and the threshold for certification was very low. ”

In his opinion, many psychological counseling methods have problems with their effect evaluation and charging standards, and the links are not straightened out. Taiwan has a mental health law, which has very detailed regulations on the organization and conduct of psychological counseling; Macau and Hong Kong have similar regulations. However, the mental health law to be introduced on the mainland only regulates the behavior of hospitals and doctors, and does not involve much else.

Today, less than 10 percent of people with depression in China seek medical attention in specialized hospitals. There are also some patients who go to small and medium-sized hospitals that are not qualified to treat depression. Caixin reporters met some medical trusts waiting in Anding Hospital, claiming that their hospital can cure depression. "Our patients are often dragged to them by those people, spend more than 10,000 yuan to be cured, and then come back to continue treatment, so the disease is delayed. There is no one to supervise such a hospital at all. Wang Gang said.

In the view of many specialists, the visit of patients with depression to a specialized hospital is the beginning of the road to recovery. The aforementioned female patient who has suffered from bipolar disorder for more than 20 years was diagnosed this year and was treated at Anding Hospital for only three months before her condition stabilized. However, because she has been ill for too long, she needs to take a mood stabilizer for lifelong maintenance therapy.

Even so, she still feels that it is worth it: "In times of despair, you can never imagine that it will be like this when you are cured. Deep within her, the cloud of depression had finally lifted, and it had cut her off from the world. Now, her life has returned to normal, and the endless despair of the past has been replaced by daily life such as grocery shopping, singing, walking, and talking.

"I came back from hell to earth." She said.

This sentence is also the heart of many people who have recovered from depression.

Part II: The Road Back from Hell

September 8, 2012, Multi-purpose Hall, Peking University Sixth Hospital (Peking University Sixth Hospital).

This day is the fifth anniversary of the establishment of the self-help group for depression in the Sixth Hospital of Peking University. A small conference room filled with about 20 patients and their families. Everyone has a different story and different pain, but it all stems from depression.

Wu Liguo, one of the founders of this organization and who has been ill for more than 20 years, pasted five words written by himself on the wall when he set up the venue: "the hometown of the soul."

Several patients who participated in the event said that these five words speak to their inner feelings.

The home of the soul

Don't make moral accusations against patients or hold them to social standards. Incomprehension from the family is often more harmful to the patient.

"The role of self-help groups is to help others and to receive help. In the process of helping others, you can also get happiness and help recovery. Wang Xilin, one of the organizers of the group and chief physician of Peking University's Sixth Hospital, told Caixin, "Practice has proved that this form of rehabilitation is indeed effective." ”

In 2007, some patients with depression who were hospitalized in the hospital told Wang Xilin that they hoped that the patients would still be able to keep in touch after they were discharged from the hospital. The commonality of the disease allows patients to better understand and encourage each other. So, Wang Xilin applied for a room from the hospital as an event venue. Patients and their families hold monthly events to exchange experiences in treatment and rehabilitation, and sometimes organize recreational activities such as singing songs and visiting parks.

She also educates families about the subjective feelings of the patient, who are negative, burnout, pessimistic or irritable, and can be corrected with treatment. The acceptance and understanding of the family is very important for the patient's recovery.

Yao Guizhong, assistant to the president of the Sixth Hospital of Peking University, also said that it is very necessary for family members to communicate with doctors alone. The more family members know about depression, the more thoughtful they will be to take care of the patient.

Patient Li Xiang (pseudonym) has first-hand experience of this. She is a person with bipolar depressive disorder, both depressed and manic. When I was depressed, I was negative, pessimistic, unwilling to do anything, and didn't even take a shower in the summer. "You're all spoiled." The husband complained. When you are manic, you lose your temper at every turn. Her husband said that she was uncultivated and had a problem with her personality.

"Still, I know I'm sick." Li Xiang said, "Family members who have not experienced depression cannot understand it. ”

Wang Xilin said that patients should not be morally criticized or held to the test by social standards. Incomprehension from the family is often more harmful to the patient. Patients are relatively easy to tolerate incomprehension and prejudice against outsiders, but it is difficult to face misunderstandings and disappointments from family members. One patient who attempted suicide recounted that her despair was caused by her family.

The story of patient Liang Xiangyang belongs to this category.

In 2006, she was diagnosed with depression and doctors recommended hospitalization. However, her husband believed that it was a problem with her mind and willpower, and that the medication she was hospitalized did not work. In the end, it was her father who stepped in, and she was finally hospitalized and her condition was brought under control.

Later, while recovering, her husband was still reluctant to admit that she was sick. When she is in a pessimistic and negative position, he will say, "Now that life is so good, how can you get this disease?" "Apathy makes her run away from her family. When she was most desperate, she reached out and touched the power supply in her home, wanting to die.

She recalled that at that time, she was just angry and wanted to die at home to let her husband know that this was a consequence that he did not understand.

Suicide attempt, leaving a permanent scar on the middle finger of her left hand. Her husband was reluctant to accompany her to the hospital, believing that she had brought it upon herself.

Later, when she took home a pamphlet on depression, no one bothered to open it.

In 2007, Liang Xiangyang participated in the depression self-help group of the Sixth Hospital of Peking University. There, she exchanged experiences and knowledge with other people with depression, and in some cases became friends. She gradually developed a sense of belonging to self-help groups, which was her most important recovery support. "It's like the hometown of the soul, and I can't do without it." Liang Xiangyang said.

"You're sick, not wrong"

Supportive psychotherapy is the mainstay of depression treatment and rehabilitation. Commonly used techniques are listening, explaining, guiding, venting, reassuring, encouraging, and supporting.

"How important it is to listen!" Zhou Xinping, another patient in the self-help group, said she still can't forget her ex-husband's almost distorted, angry face. He threw things and shouted: "Don't say it, don't say it, you say so much, I can't stand it!" ”

However, when she was sick, she just wanted to vent her inner depression by saying it repeatedly. She was sick because of the poor interpersonal relationship at work. When I got home, I felt that my husband was my dearest, so I habitually told him.

But the husband could not understand. Her illness recurred, and her husband later filed for divorce. Now, after six years of divorce, she still misses her ex-husband in her heart, although she can't get care from him.

"Patiently listening to the patient's automatics makes the patient feel that someone is caring and understanding him. Listening is a prerequisite for all psychotherapy. The Guidelines for the Prevention and Treatment of Depressive Disorders, edited by the Chinese Medical Association, believe that supportive psychotherapy is the main means of treatment and rehabilitation of depression. Commonly used techniques are listening, explaining, guiding, venting, reassuring, encouraging, and supporting.

As for how family members listen, Yao Guizhong, assistant to the dean of the Sixth Hospital of Peking University, told us that we should first distinguish the three levels of patients from light, medium and severe. If it is a seriously ill patient, it is mainly accompanied, less preaching, no ideological work, no guiding opinions, silently accompanied, and the patient will be helped if necessary; If you are a mild patient, you can talk more deeply about what you want. But the main thing is to let him confide, and do not ask the patient to be held by social standards.

The doctor's listening and patient explanations are very important for the patient's recovery. Wang Xilin, chief physician of Peking University Sixth Hospital, said that when receiving treatment at the beginning, doctors should listen patiently and explain to patients' questions, and sometimes a question needs to be answered and explained repeatedly to eliminate the doubts of patients and their families, otherwise it is difficult for patients to adhere to medication. Treatment for depression is long-term, and long-term medication reduces the risk of relapse.

Wang Xilin said that due to the shortage of medical resources and too many patients, many doctors have very short outpatient hours. But sometimes a few short sentences can be comforting, such as "depression can be treated, it will definitely get better, you must be patient". Family members can also encourage and support the patient in order to win the opportunity for treatment.

Wang Xilin also said that when doctors communicate with patients or their families, it is best not to give patients some negative answers. No criticism, no accusation. Some problems may not be solved temporarily, and the reasons may be multifaceted, such as symptoms that make patients lack self-confidence, have a negative attitude towards problems, and are prone to frustration. A circuitous approach can be used, and in more severe cases, comfort and support should be the mainstay. Unconditional understanding can be of great help to a patient's recovery.

Stay away from suicide

Many people are afraid to ask patients if they have suicidal thoughts, fearing that they may induce suicide. In fact, cautious questioning does not induce patients, but helps early detection and early intervention.

"Two-thirds of people with depression have suicidal thoughts and behaviors, and 15%-25% of people with depression eventually commit suicide. Suicide is more common among young adults and older adults. The "Guidelines for the Prevention and Treatment of Depressive Disorders" edited by the Chinese Medical Association uses the above data to warn the world that depression has a high suicide rate, with a lifetime suicide rate of 15%.

There are three stages of suicide: suicidal ideation, suicide attempt, and suicidal behavior. Yao Guizhong, assistant to the dean of the Sixth Hospital of Peking University, believes that in the second stage, patients must be hospitalized.

Suicide is the most serious consequence of depression. Wang Xilin, chief physician of the Sixth Hospital of Peking University, said that family members should carefully observe patients who are more seriously ill. If the patient is resistant to treatment and does not want to continue the treatment, the family should pay attention to whether the patient has suicidal thoughts.

Wang Xilin said that many people are afraid to ask patients if they have suicidal thoughts, fearing that they may induce suicide. In fact, cautious questioning does not induce patients, but helps early detection and early intervention. If family members observe that the patient is attempting suicide, they must take him to a regular hospital in time. Always stay with the patient until the risk is removed.

Zhou Xinping, a patient, told Caixin reporters that she had stopped two patients from committing suicide. Once, a patient she knew sent her a text message: "I'm going to commit suicide, I don't want to live anymore, I've found a place to jump off the building." Zhou Xinping immediately texted back, telling him to take the medical records and money immediately, go downstairs and take a taxi to the hospital, and the doctor can relieve your pain. For patients in that state, she explains, clear, actionable advice is needed.

The patient followed her advice and her text message saved a life.

"Many people with severe depression think of giving up their lives when they are in extreme pain. Sometimes life and death are just a thought. The patient, Li Xiang, told the Caixin reporter that she had committed suicide by drinking alcohol when she was an adolescent. At the time, she had been in a state of severe depression for many years, and she did not know that she was sick.

"Individuals in adolescence and old age are more likely to commit suicide. Suicide attempts are an extremely dangerous sign and should be made known to relatives. Priority should be given and interventions should be taken accordingly. It is emphasized in the Guidelines for the Prevention and Treatment of Depressive Disorders.

Secondary growth

For the patient, it should be pushed, not pulled. You are there when he needs it. Divide the goal into a small step, and with each step forward, he experiences the joy of success, and then moves on to the next step.

The Guidelines for the Prevention and Treatment of Depressive Disorders also state that psychotherapy is needed in addition to medication during the maintenance treatment phase, that is, during rehabilitation. Psychotherapy aims to keep patients depressive-free and to reduce and eliminate the persistent factors that create fluctuations in depressive disorders. However, the guidelines do not advocate psychotherapy as a single means of preventing relapse, unless the patient is unable to take the drug for a specific reason.

Yao Guizhong, assistant to the president of the Sixth Hospital of Peking University, told Caixin reporters that after the patient's severe symptoms were eliminated, he began to enter the recovery stage, and he should strive to restore various social functions. In this process, in addition to the support of the family, the society should also give understanding and respect.

He suggested that if you find obvious depression, you should first see a professional psychiatrist, take medication after diagnosis, and then seek psychological treatment to enter the recovery stage.

He said that rehabilitation is a process that focuses on the restoration of various functions with the aim of allowing patients to return to normal social life. In this process, we must adhere to a concept: "As long as we do not harm others, everyone has the right and ability to make themselves happy and have a quality of life." ”

Wang Xilin said that depression is a relatively common mental disorder, and drug treatment is a very important treatment.

There are many types of antidepressants, and psychiatrists have experience in using them. "Individualized treatment" is also important in the drug treatment of depression, that is, the doctor selects or adjusts the type and dosage of the drug according to the characteristics of the patient's condition. "Long-term medication" should also be emphasised in drug therapy, especially for patients with a relapse – this does not mean that depression cannot be cured for a long time, and that continuing medication after symptom resolution is only to reduce the risk of recurrence. Most patients respond well, and less than one-third of complex cases are refractory.

She said that there are often patients who stop taking the drug without permission during the recovery period, resulting in relapse. Therefore, it is especially important to remind patients to go to the hospital for regular check-ups, and the doctor will judge whether the drug can be stopped. When the drug is stopped, the dose of the drug should also be gradually reduced, and the drug should be stopped slowly to avoid withdrawal reactions.

In addition, "early detection and early treatment" is very important. Especially in the process of rehabilitation, if you feel bad mood, fatigue or insomnia for no obvious reason, you should seek medical attention in time, and timely adjustment and treatment in the early stage of recurrence can usually achieve more satisfactory results.

Cognitive therapy is one of the rehabilitation methods recommended by the Chinese Medical Association. The goal of this treatment is to help people rebuild their cognition and correct their systemic biases. These biases include misinterpreting and predicting an individual's past life experiences and future prospects.

"Simply put, cognition is how you look at illness and how you see yourself." Yao Guizhong said that this is different from self-examination, not criticizing oneself from a moral point of view, but emphasizing inner harmony and peace.

As a psychiatrist with 25 years of clinical experience, Yao Guizhong has a unique set of "rehabilitation prescriptions":

The first step is a rehabilitation assessment. Assess the condition and resources, and what resources are available to the patient; What are his strengths and weaknesses.

The second step is a three-way meeting between the patient, the family and the doctor. Under the premise of fully respecting the patient's wishes, the three parties reach a common goal of rehabilitation.

The third step is to prescribe rehabilitation. Prescribing is premised on respect for the patient, and all rehabilitation programs must be agreed with the patient. The plan should be specific, operable, and checkable, with a maximum of three items at a time, and no matter how many patients there are, they will not be able to implement it.

For example, Yao Guizhong said: If a patient is seriously ill, he can be asked to walk for 10 minutes every day. Repeat it every two weeks, check how well he performs it and make adjustments when the time comes. If there is a patient who is lazy, lead him to commit to something simple.

"For example, is it okay to go to the vegetable market to buy groceries? If not, is it okay to cook at home? Not yet, is it okay to wash the dishes? It's not okay to wash the dishes of the whole family, but it's okay to just wash your own dishes? If it doesn't work again, is it okay to wash your own dishes once every three days? Is it okay to wash once a week? Just negotiate a plan of action with the patient that he can accept, and don't force him. Yao Guizhong said.

As for restoring social function, Yao Guizhong believes that social activities can be divided into several steps: receiving information, expressing information, exchanging information and adapting to the environment, which is increasingly difficult.

Specifically, the patient has difficulty socializing, and the doctor helps him analyze what went wrong. If there is a problem in expressing information, you can ask him to read a passage aloud first; Once this step is complete, ask him to repeat what the other person said. Then ask him to summarize in his own words what someone else has said. The most difficult part is that the patient speaks on his own, that is, he speaks a sentence on his own. If they are able to speak on their own, they are one step closer to reintegrating into society.

Yao Guizhong said that the rehabilitation prescription should be divided into such details, and they are all written in the medical record. The most important thing is to build trust between doctors and patients. Don't hold him to the test of social standards. For the patient, it should be pushed, not pulled. You are there for him when he needs it, helping him clear his mind and divide the goal into one small step. With each step forward, he experiences the joy of success, and then moves on to the next step.

Wang Xilin, chief physician of Peking University Sixth Hospital, said that in clinical practice, it is often found that patients and even their families have too high expectations for the treatment effect, and set too high goals for patients. Depression treatment requires long-term medication, and some patients with poor or recurrent effects should adjust their original life goals accordingly.

This adjustment is not easy. It means facing reality and accepting it. However, once this adjustment is made, it is as if the patient has removed a stone that weighs on his heart.

Wu Liguo, 58, was diagnosed with major depression as early as 1984. That year, his daughter had just been born. During his recovery, he was unable to take medication for a long time, and his condition recurred, eventually turning to bipolar disorder. In 1996, he was hospitalized for more than two years before his condition stabilized.

After being discharged from the hospital, he had a strong desire to help other patients, especially family members, "who were so difficult, so anxious, so helpless". Since then, in his 40s, he quit his job at a state-owned enterprise and worked as a volunteer at the Sixth Hospital of Peking University, organizing a fraternity for the families of mentally ill patients and a self-help group for depression.

"Recovery is a process of growth. The patient is growing on his own, growing for the second time in his life. Yao Guizhong said.

(Originally published in Caixin New Century Weekly, Issue 39, 2012; Written by Zhang Jin, Wang Chen, and Luo Jieqi)