Depression is the leading cause of disability in the world. In the United States, close to 10% of adults struggle with depression. But because it's a mental illness, it can be a lot harder to understand than, say, high cholesterol. One major source of confusion is the difference between having depression and just feeling depressed. Almost everyone feels down from time to time. Getting a bad grade, losing a job, having an argument, even a rainy day can bring on feelings of sadness. Sometimes there's no trigger at all. It just pops up out of the blue. Then circumstances change, and those sad feelings disappear. Clinical depression is different. It's a medical disorder, and it won't go away just because you want it to. It lingers for at least two consecutive weeks, and significantly interferes with one's ability to work, play, or love. Depression can have a lot of different symptoms: a low mood, loss of interest in things you'd normally enjoy, changes in appetite, feeling worthless or excessively guilty, sleeping either too much or too little, poor concentration, restlessness or slowness, loss of energy, or recurrent thoughts of suicide. If you have at least five of those symptoms, according to psychiatric guidelines, you qualify for a diagnosis of depression. And it's not just behavioral symptoms. Depression has physical manifestations inside the brain. First of all, there are changes that could be seen with the naked eye and X-ray vision. These include smaller frontal lobes and hippocampal volumes. On a more microscale, depression is associated with a few things: the abnormal transmission or depletion of certain neurotransmitters, especially serotonin, norepinephrine, and dopamine, blunted circadian rhythms, or specific changes in the REM and slow-wave parts of your sleep cycle, and hormone abnormalities, such as high cortisol and deregulation of thyroid hormones. But neuroscientists still don't have a complete picture of what causes depression. It seems to have to do with a complex interaction between genes and environment, but we don't have a diagnostic tool that can accurately predict where or when it will show up. And because depression symptoms are intangible, it's hard to know who might look fine but is actually struggling. According to the National Institute of Mental Health, it takes the average person suffering with a mental illness over ten years to ask for help. But there are very effective treatments. Medications and therapy complement each other to boost brain chemicals. In extreme cases, electroconvulsive therapy, which is like a controlled seizure in the patient's brain, is also very helpful. Other promising treatments, like transcranial magnetic stimulation, are being investigated, too. So, if you know someone struggling with depression, encourage them, gently, to seek out some of these options. You might even offer to help with specific tasks, like looking up therapists in the area, or making a list of questions to ask a doctor. To someone with depression, these first steps can seem insurmountable. If they feel guilty or ashamed, point out that depression is a medical condition, just like asthma or diabetes. It's not a weakness or a personality trait, and they shouldn't expect themselves to just get over it anymore than they could will themselves to get over a broken arm. If you haven't experienced depression yourself, avoid comparing it to times you've felt down. Comparing what they're experiencing to normal, temporary feelings of sadness can make them feel guilty for struggling. Even just talking about depression openly can help. For example, research shows that asking someone about suicidal thoughts actually reduces their suicide risk. Open conversations about mental illness help erode stigma and make it easier for people to ask for help. And the more patients seek treatment, the more scientists will learn about depression, and the better the treatments will get.
憂鬱症在世界上是造成失能的主要原因 在美國 近 10% 的成人為憂鬱所苦 但由於它是心理上的疾病 所以它比像高膽固醇之類的疾病 還要讓人難以理解 一個主要令人困惑的是「憂鬱症」 和「只是感覺沮喪」的差別 每個人都有失落的時候 成績考壞 被炒魷魚 發生爭執 甚至是下雨天都可能使人憂傷 有時根本沒有什麼誘因 沮喪就會憑空出現 接著情境改變 而沮喪的心情也隨之消散 臨床上的憂鬱症是不同的 它是一種疾病 正因為你要它如此,所以揮之不去 它至少會持續兩個星期 並嚴重地干擾一個人的工作能力 遊玩意願 或情感生活 憂鬱症可以有很多不同的症狀: 心情低落、 對平常喜愛的事物興趣缺缺、 胃口改變、 覺得無用或過度的罪惡感、 睡太多或太少、 難以專注、 躁動或遲鈍、 沒有活力、 或反覆興起自殺念頭 如果你有至少5項症狀 根據精神科的準則 你會被診斷為憂鬱症 它不只是行為上的症狀而已 憂鬱症在腦部還會有實質的表徵 首先 有些改變可透過肉眼 或 X 光觀察發現 包括額葉和海馬體的容量變小 從更細微的來說 憂鬱症和有些事物有所關連: 某些神經傳導物質 不正常地傳遞或耗損 特別是血清素、去甲腎上腺素,和多巴胺 使得生理節奏失調 或睡眠週期中的快速動眼期及 慢波睡眠的特定改變 以及賀爾蒙異常 例如皮質醇過高和甲狀腺賀爾蒙失常 但神經學家還尚未全面瞭解 掌握造成憂鬱症的原因 似乎與基因和環境間 複雜的交互作用有關 但目前沒有診斷的工具 可以精確地預測在何地或何時會發病 也因為憂鬱症的症狀是變化莫測的 我們很難知道看起來好端端的人 其實正處於掙扎中 根據美國國家心理健康研究院 (National Institute of Mental Health) 通常罹患心理疾病的病患 都拖了超過10年才尋求協助 但現在有非常有效的治療方法 藥物和治療相輔相成 來強化大腦化學物質 在一些極端的個案,「電痙攣療法」 它是一種在患者腦部 以可控制的電擊來誘發痙攣的療法 也非常有幫助 其他有前景的療法 像是「經顱磁刺激法」 (transcranial magnetic stimulation) 也都在研究中 所以,如果你認識為憂鬱症所苦的人 溫和地鼓勵他,去尋求其中幾項的幫助 你甚至也可提供特別的協助 像幫他找附近的治療師 或是列出一張要問醫師問題的清單 對憂鬱症患者來說 踏出尋求治療的最初幾步 都可謂舉步難難 如果他們會覺得罪惡或羞恥 點醒他們:憂鬱是一種疾病 就像氣喘或糖尿病 不是弱點或人格特質 也不應該認為自己有辦法熬過去 這正如不能光靠自己的意志力 就治好手骨折一樣 如果你沒有得過憂鬱症 要避免拿它來和自己失意時比較 將他們的憂鬱症 和自己平常短暫的沮喪相比 會讓他們對掙扎有罪惡感 就算只是公開談論憂鬱症也會有幫助 舉例來說,研究顯示問某人對自殺的看法 真的可降低他們的自殺風險 公開談論心理疾病可以削弱它的壞名聲 讓人們能更無拘束地去尋求協助 而就診的病患越多 科學家對憂鬱症的瞭解就越多 治療方式就會越來越好