是由两种非常有效的化合物组成的合剂。三氟噻吨是一种神经阻滞剂,根据不同剂量具有不同药理作用。大剂量的三氟噻吨主要拮抗突触后膜的多巴胺受体,降低多巴胺能活性 ;而小剂量三氟噻吨主要作用于突触前膜多巴胺自身调节受体(D2受体),促进多巴胺的合成和释放,使突触间隙中多巴胺的含量增加,而发挥抗焦虑和抗抑郁作用。四甲蒽丙胺是一种双相抗抑郁剂,可以抑制突触前膜对去甲肾上腺素及5-羟色胺的再摄取作用,提高了突触间隙的单胺类递质的含量。两种成分的合剂具有协同的调整中枢神经系统的功能,抗抑郁、抗焦虑和兴奋特性。另一方面,本药中的四甲蒽丙胺可以对抗大剂量时三氟噻吨可能产生的锥体外系症状。三氟噻吨和四甲蒽丙胺相互拮抗的结果使本药的抗胆碱能作用较四甲蒽丙胺弱。本药对上述中枢神经递质的影响,临床上也相应表现为两种成分在治疗作用方面的协同效应和副作用的拮抗效应。此外,体内及体外试验表明,本药对组胺受体有一定的拮抗作用。并且还具有镇痛、抗惊厥作用,但无抗精神病作用。

我的情敌 前任,他的第一个女人,有天告诉他,因为我们的事,她得了抑郁症,她和我说不止一次的 我的情敌 前任,他的第一个女人,有天告诉他,因为我们的事,她得了抑郁症,她和我说不止一次的想到为他而自杀,也因此他既不敢同她结婚(之前在一起很多年就是因为性格不合她敏感娇气各种吵 一哭二闹然后就是动剪子跳楼 这是病的话根本很难正常相处),他也不敢和我结婚(父母亲戚都认可我 但是她不能释怀 怕刺激她真做了傻事 我们也会自责不能安稳过日子 ),这个局面已经僵持了快两年了,弄得现在的我也很焦虑 感到无法解脱,我曾想帮助她,还没接触就被她拒绝,她跟他说,不想看到我听到我,只要我消失,她的病就好了。我想问,是不是我放弃牺牲了自己的爱情,让出来,让男朋友去照顾她,陪伴她,她就能真的康复? 我都分不清她是不是真的得了抑郁症还只是一种要挟手段。她说她去医院 经过医生诊断的 还开了好多进口药吃。 人都是有同情心的,她的身世她的经历就像韩剧里的灰姑娘一样可怜,我不想跟这样的一个姑娘争,自己也好压抑,常常夜里睡不好觉,就是那种明明很困,打着哈欠就是躺下来大脑却停不了机的那种感觉。我是没去医院,我这样也会得抑郁症么? ... Cici | 站在门口那么久
Depression is a common mood disorder, with a high incidence and prevalence, while the overall diagnosis and treatment rate are low.Even if patients attained the initial clinical cure, there is still a high risk of depression recurrence, of which a great part may turn into self-mutilation or even suicide.Taking antidepressants as the most preferred treatment of moderate and major depression is recommended by almost all clinical treatment guidelines at home and abroad currently.At the same time, the concept of depression treatment is changing gradually from the initial single-mode drug therapy for symptom control to a comprehensive, individualized, quantitative treatment model.Promising psychological treatment, physical therapy and other alternative and complementary treatments are developing quickly.

也是这时候,大概是2015年10月的时候吧,我开始觉得自己非常不
And one of the things that often gets lost in discussions of depression is that you know it's ridiculous. You know it's ridiculous while you're experiencing it. You know that most people manage to listen to their messages and eat lunch and organize themselves to take a shower and go out the front door and that it's not a big deal, and yet you are nonetheless in its grip and you are unable to figure out any way around it. And so I began to feel myself doing less and thinking less and feeling less. It was a kind of nullity.
由于不了解你女朋友的具体情况,我不好给出意见。从你的另外一个帖子里,我能够感到你对她的关心、你的焦急,但是我也想提醒你,想要关心抑郁症患者的家属,首先要学会关心自己。一个人可以轻易学会不在乎,但学会在乎,却需要付出千百倍的勇气和努力。我的女朋友在陪伴我的时候,自己也经历了不少痛苦。她后来通过咨询心理医生应该怎么照顾我,来调整好了自己的情绪。我想告诉你的是,你要对抑郁症有所准备(教育自己,学习一些这方面的知识),即使你是一个很乐观和活泼的人。陪伴抑郁症患者很消耗人的能量。我给你推荐两个专业团队的回答。https://www.zhihu.com/question/54853415 这个问题中 ID为“简单心理”的回答,这里面你可以读到一些故事(有些故事比较恐怖,你不必被吓到,结合你自己的情况考虑,你女友未必那么严重);Knowyourself这个团队写的http://www.toutiao.com/i6402008917009760769/ “因为爱你,我想陪着你不快乐|研究:抑郁会在伴侣间传染” 。你能来问这个问题,说明你充满了爱心,我为你点赞!祝你女友能走出这段阴霾。
我的情敌 前任,他的第一个女人,有天告诉他,因为我们的事,她得了抑郁症,她和我说不止一次的 我的情敌 前任,他的第一个女人,有天告诉他,因为我们的事,她得了抑郁症,她和我说不止一次的想到为他而自杀,也因此他既不敢同她结婚(之前在一起很多年就是因为性格不合她敏感娇气各种吵 一哭二闹然后就是动剪子跳楼 这是病的话根本很难正常相处),他也不敢和我结婚(父母亲戚都认可我 但是她不能释怀 怕刺激她真做了傻事 我们也会自责不能安稳过日子 ),这个局面已经僵持了快两年了,弄得现在的我也很焦虑 感到无法解脱,我曾想帮助她,还没接触就被她拒绝,她跟他说,不想看到我听到我,只要我消失,她的病就好了。我想问,是不是我放弃牺牲了自己的爱情,让出来,让男朋友去照顾她,陪伴她,她就能真的康复? 我都分不清她是不是真的得了抑郁症还只是一种要挟手段。她说她去医院 经过医生诊断的 还开了好多进口药吃。 人都是有同情心的,她的身世她的经历就像韩剧里的灰姑娘一样可怜,我不想跟这样的一个姑娘争,自己也好压抑,常常夜里睡不好觉,就是那种明明很困,打着哈欠就是躺下来大脑却停不了机的那种感觉。我是没去医院,我这样也会得抑郁症么? ... Cici | 站在门口那么久

最近忙着写论文,这个贴就被我这么晾着了。还有两个月我就完成大作啦,继续努力~@@!最为偷懒, 最近忙着写论文,这个贴就被我这么晾着了。还有两个月我就完成大作啦,继续努力~@@!最为偷懒,就转自己以前写过的吧。 我发现我的一篇日记总是有人收藏,尤其是最近,平均每几天就有一个人收藏,后台总是给我发来通知。 那就说明这篇帖子的内容是被人需要的,有人在搜索着。 沉默,是会呼吸的痛。我能想象到,在屏幕的那一边,有一个人正在经历着精神上的痛苦,他/她想尽力地帮助自己,不放弃一丝希望。他/她虽什么也没说,但每一天的生活都是真实地痛苦着。 我希望这个帖子能帮助有需要的人好起来。 我相信你能最终好起来。因为至少还有我这样的人,还有很多专业的人士,愿意帮助你。去认识他们,去寻求帮助,你并不孤独。 《长期抑郁该如何治疗?如何预防抑郁症复发?》 https://www.douban.com/note/576926663/ ... aizzibleoK
抑郁症是一种常见的心境障碍,可由多种原因引起,以显著而持久的情绪低落、愉快感缺失为核心症状。目前抑郁症的病因、发病机制尚不明确。一般认为,抑郁症的发病主要与生物化学因素如去甲肾上腺素(norepinephrine,NE)、5-羟色胺(5-hydroxytryptamine,5-HT)和多巴胺(dopamine,DA),遗传因素,社会与环境因素有关。多数病例有反复发作倾向,每次发作大部分可以缓解,部分患者可有残留症状或进展为慢性抑郁[1]。抑郁症除导致一系列生理、心理、社会功能障碍外,还存在潜在的高自杀风险,加重患者、家属及社会的负担。世界卫生组织(WHO)调查发现,全球抑郁症患者估计为3.22亿例,占世界人口的4.4%[2]。研究表明,抑郁症已经成为全世界最大的致残性疾病[3]。在全球疾病负担过重的疾病中,抑郁症疾病负担占社会总体经济成本的三分之一,预计到2030年将上升至世界疾病负担首位[4]。流行病学资料显示,中国人中有20%存在抑郁症状,其中7%为重度抑郁; 抑郁症占中国疾病负担的第2位,其中仅有不足10%抑郁症患者得到正规治疗[5]。 现就抑郁症的治疗进展综述如下。
BACKGROUND: In 2001, the Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments (CANMAT) partnered to produce evidence-based clinical guidelines for the treatment of depressive disorders. A revision of these guidelines was undertaken by CANMAT in 2008-2009 to reflect advances in the field. There is renewed interest in refined approaches to brain stimulation, particularly for treatment resistant major depressive disorder (MDD). METHODS: The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. This section on "Neurostimulation Therapies" is one of 5 guidelines articles. RESULTS: Among the four forms of neurostimulation reviewed in this section, electroconvulsive therapy (ECT) has the most extensive evidence, spanning seven decades. Repetitive transcranial magnetic (rTMS) and vagus nerve stimulation (VNS) have been approved to treat depressed adults in both Canada and the United States with a much smaller evidence base. There is also emerging evidence that deep brain stimulation (DBS) is effective for otherwise treatment resistant depression, but this is an investigational approach in 2009. LIMITATIONS: Compared to other modalities for the treatment of MDD, the data based is limited by the relatively small numbers of randomized controlled trials (RCTs) and small sample sizes. CONCLUSIONS: There is most evidence to support ECT as a first-line treatment under specific circumstances and rTMS as a second-line treatment. Evidence to support VNS is less robust and DBS remains an investigational treatment.

4.1.3 维持期 抑郁症具有高复发性,尤其是≥3次抑郁发作及慢性抑郁患者,多个指南明确提出应该继续进行维持期治疗。如合并抑郁症家族史、起病早、症状残存、持续应激等危险因素时,需考虑进行维持治疗。WHO建议对单次发作、症状轻、间歇期长(≥5年)者,一般可不维持治疗,但也有较多专家认为首次抑郁症发作也应维持6~8个月的治疗[9]。维持治疗的时间长短各指南论述不一,差异较大,应根据患者的综合情况个体化考虑。一般倾向至少持续2~3年,多次复发者主张长期维持治疗。维持治疗期间应定期进行病情及疗效评估,关注早期复发征象,监测药物不良反应。长期维持治疗,如病情稳定,各方面评估良好者,可考虑缓慢减药直至停药。减药期间应加强监测,一旦发现早期复发征象,应立即恢复原先治疗剂量。国内外多个指南推荐,维持期建议加强心理治疗,如认知行为治疗、团体自助模式等,纠正错误的观点及认知,建立积极的自助、社交心态,可有效降低抑郁症复发率,改善疾病预后。
经颅磁刺激技术(transcranial magnetic stimulation,TMS)即以磁信号刺激颅脑神经方式达到神经功能改善目的。TMS在1985应用于临床治疗,随着技术的发展与革新,出现具有连续可调功能的重复TMS(repetitive transcranial magnetic stimulation,rTMS),并在临床精神病、神经疾病及康复领域获得越来越多的认可。低频和高频rTMS均能有效治疗抑郁症,二者效果相当,但前者耐受性更好,适应人群更广泛,故目前抑郁症治疗中主要采用低频rTMS。2016年美国临床经颅刺激学会发布的TMS治疗重度抑郁症共识[22]指出,每日左前额TMS治疗急性期抑郁症患者安全有效。该共识认为,对于临床诊断符合DSM-5定义的抑郁症,单次发作或复发性抑郁症、抗抑郁症药物治疗效果不佳或不耐受的患者,应考虑单独或合并TMS治疗。TMS在急性期及急性期后治疗中均有良好效果,并且急性期后持续TMS治疗可降低抑郁症复发风险。
Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy, so they are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
抗抑郁药物在治疗患有重度抑郁症或者更严重的成人中有很明显的效果(药物反应率为48%-50%,比安慰剂30-32%高出接近20个百分点)。另外也有部分研究发现结合多种抗抑郁药物,或者在早期增大SSRIs用量的话,疗效可能更好。而对于年龄65岁或者更老的患者,药物疗效的反应率与安慰剂的对比差异就没有那么大了。对于年龄小于13岁的小孩,药物和安慰剂的差异很小,并不显著。抑郁症同样对那些患有生理疾病的抑郁患者有效,但是在患有内科疾病(比如高血压,关节炎,肝炎)的患者中疗效较差。对于安慰剂效应,病情越重的抑郁症和忧郁症中安慰剂效应较小,反之,程度较轻,时间较短并且由之前的生活事件所引发的话抑郁症则安慰剂效应较大。当然,有很多研究争论说药物只在病症严重的患者中才有效果,其实并不是这样,虽然药物在程度严重的患者中效果更好,但是在程度较轻的患者中仍然有明显的医疗效果,而且值得注意的是即使不是精神类药物而是我们日常用的药物,它们的安慰剂与药效的对比其实也是相似的数据,只是我们大众和媒体平时过于关注精神类药物才导致我们觉得精神类药物效果差副作用大(这方面我之前的回答链接里有提到)。
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