In today’s world, mental illness and distress are common and these account for a significant burden of disability within our community. At the same time, there is a growing interest in understanding and enhancing positive mental health and wellbeing; particularly from developments in the fields of positive psychology and mental health promotion. Positive Psychiatry is a new term (Jeste et al 2016) that describes a dual approach to mental health, where we build strengths, supports and healthy lifestyles as well as treating illness and distress. In this course, we will explore different aspects of good mental health as well as provide an overview of the major kinds of mental disorders, their causes, treatments and how to seek help and support. The course will feature a large number of Australian experts in psychiatry, psychology and mental health research, and we will also hear from “lived experience experts”, people who have lived with mental illness, and share their personal stories of recovery. We take an evidence-based approach to a range of strategies that anyone can use to enhance their own mental health and that of others, from exercise and relaxation techniques through to the role of love, relationships and 'good' types of work. We cover topics from creativity and yoga through to psychiatric medications and psychotherapies.
Depression
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来自 The University of Sydney 的课程
Positive Psychiatry and Mental Health
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从本节课中
Module 4 - Mental Illness
In this module, we cover the major categories of mental illness: their symptoms, causes and treatments. This includes the more common conditions such as anxiety, depression and addictions, as well as less common mental illnesses such as psychosis, schizophrenia and bipolar disorder.
与讲师见面
Sonia KumarPsychiatry Course Coordinator
Brain and Mind Centre, University of Sydney
[MUSIC]
Depression is a normal human emotion.
We can all feel sad and depressed following an unfortunate event such as
the loss of a loved one, the breakup of a relationship or
even when we experience some disappointment in our life.
Generally when this happens we will be unhappy for a time but
then our mood improves and it passes.
For some people, depression is more than that.
It is a key symptom of a disabling, but treatable clinical disorder,
clinical depression or, to use the technical name, major depression.
Clinical depression differs from normal depression in a number of ways.
The low mood will last for much of the day everyday and
will persist for more than two weeks.
It is accompanied by other symptoms such as sleep and appetite disturbances, and
it causes significant impairment.
Around one in seven or
15% of Australians will experience a clinical depression in their lifetime.
It occurs more commonly in women than men.
Over a year about 5% of women and
3% of men will have an episode of clinical depression.
It is more common in young adults, although it can affect people of any age.
While many may think of depression as a minor problem, it is in fact a major cause
of disability worldwide, as it is often a chronic and reoccurring illness.
When people are depressed, their work or
school performance deteriorates, they often take sick leave, and
if they can manage to work, they do not function as well as normally.
Clinical depression is a major contributor to what is called disease burden
worldwide.
Disease burden is a statistic that calculates the impact of a disease on
society that takes into account the disability linked to the disease,
that is, the time spent being unwell and not being able to fully function.
The important thing about clinical depression it is that it is an eminently
treatable condition, provided help is sought.
When people suffer from clinical depression they often have a low mood or
feel miserable but that is not always the case.
They may describe feeling empty or detached or
just not wanting to do anything.
A key feature is the inability to look forward to or
enjoy activities that would normally be enjoyed.
Doing something enjoyable can sometimes lift the mood and
be a distraction from the unhappiness, but it doesn't last.
As a result, people with depression often avoid doing things that would be
enjoyable, and more importantly, withdraw from friends and
company, which in turn makes things worse.
Self esteem falls.
A depressed person begins to feel worthless, having a negative view of
the self characterized by thoughts like I can't do anything right.
I'm no good.
And a negative view of the world.
Nobody likes me.
I'm hopeless.
A pessimistic view of the future.
Nothing will ever change.
Nothing will help.
If the depression is particularly severe,
they may feel that they've done something wrong.
And sometimes feel guilty as if they've done something terribly wrong.
Some people can start to feel that life is not worth living, and
think about their life ending or dying.
It would be so much easier if I weren't here.
These feelings can escalate to troubling suicidal thoughts that can take over
thinking.
And if the depression is particularly severe,
lead to making plans to kill themselves.
When suicidal thoughts are present,
it doesn't necessarily mean they'll be carried out.
But it is a clear sign that help is urgently needed.
Sleep disturbance is very common in depression with either difficulty
getting off to sleep at night or waking up frequently during the night and
taking a while to get back to sleep.
Or waking up very early in the morning feeling unrefreshed from sleep and
unable to get back to sleep.
Appetite can also change,
often with a loss of appetite with food seeming to be tasteless.
Or for some an increase in appetite with a craving for comfort foods.
Energy level falls.
And depressed individuals feel tired, lethargic, heavy, and unmotivated.
They can feel slowed down with sluggish thoughts, and difficulty with
concentration, which can be a major problem in the workplace or at school.
Some, though, can feel agitated and restless, and unable to sit still.
They may also report a number of wild physical symptoms or
experience a lot of pain.
There's no one single cause for depression.
It often arises following a stressful event, as the result of a combination of
psychological, social, genetic, and biological factors.
This is what we call a biopsychosocial and lifestyle model.
We know there's a genetic component to depression as it runs in families.
It is likely that a number of genes are involved but
no specific genes have been identified as yet.
What we can say is that some individuals have a genetic vulnerability to becoming
depressed following a stressful event.
In the more biological types of depression, there are changes to neural
transmitters or chemical messages in the brain such as serotonin.
There are also changes in the body's stress system that can cause changes in
brain functioning.
Some people have disturbances in their body clock or circadian system.
Such that when they're depressed,
their internal clock is out of sync with the outside world.
Some people are known to become depressed after a major stress because they
have a poor social network or are in a dysfunctional relationship,
especially if there's domestic violence, or don't have anyone to confide in.
Being unemployed or
experience social disadvantage also puts people at risk of becoming depressed.
Lifestyle factors, such as poor diet, lack of exercise, smoking, drinking to excess
or using illicit drugs can also contribute to an individual's becoming depressed.
Finally, we know that certain personalities such as having a low self
esteem, being overly sensitive, or
overly anxious are more at risk for becoming depressed.
Serious mental illness, the ongoing worry and stress associated with having
a long term illness can take its toll and lead to depression.
Some medical illnesses such as flu or
thyroid disease could also directly trigger depression.
The first step towards getting effective help is to see a doctor or
mental health professional.
The doctor will do a mental health assessment, and may refer you to
a psychiatrist or psychologist for a more detailed assessment.
There are a range of effective treatments available for depression,
including psychological treatment, medication,
lifestyle changes such as physical exercise.
Treatments need to be tailored to the individual depending on the type and
severity of the depression.
And understanding of the reasons behind the person becoming depressed.
Changes to lifestyle, increasing exercise, improving the diet, quitting smoking or
alcohol, are often a first line strategy to help with depression.
For people with mild to moderate depression, psychological therapy with
a psychologist or psychiatrist is generally the first line of treatment.
The most common of these therapies is cognitive behavior therapy, or CBT.
This works by modifying the characteristic negative thinking patterns of
the depressed person and making them more realistic.
And also providing behavioral strategies to overcome the lack of motivation and
encourage the person to engage in activities that will improve the mood.
Other therapy such as interpersonal therapy or
IPT focuses on personal relationships and their impact on mood.
Resolving conflicts and
increasing supportive relationships to improve depression.
Antidepressant medication is often used in the treatment of depression
where there is a strong biological component to the depression, or
when psychotherapy is not possible or doesn't lead to a full recovery.
This will be discussed further in a separate video.
It can sometimes take time to find the right medication and
people may have to try different options.
Medication may need to be continued even after recovery to reduce the possibility
of relapse.
Less common medical treatments include electroconvulsive therapy or ECT.
This once feared procedure has been found to have a valid place in the spectrum
of treatment.
ECT is now a safe and effective treatment for severe depression,
particularly in melancholic or psychotic forms of depression.
Depression is one of the commonest mental disorders and
a leading cause of disability worldwide.
However, it is treatable and most people fully recover.
Depression often occurs in people who are vulnerable following a stressful event.
But it can persist.
It is important to seek help from a health professional,
address lifestyle factors, and seek support from family and loved ones.
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