得知我得的是焦虑症之后,我开始回忆自己这差不多两年来的种种表现。我发现,过去的两年来,只有24岁的我,活得像一个七八十岁的老人。我抗拒社交,总是无精打采,全身乏力,从一楼走到4楼中途都要停下来休息一下,说话说多一些就上气不接下气,站几分钟就得找地方靠着。买一堆党参枸杞红枣,甚至当归来泡水喝,一天不喝就觉得自己会突然晕过去。晚上入睡之前,身体总会不停地震颤。半夜会突然胸闷惊醒,就像被谁捂着鼻子和嘴巴透不过气来一样。那段时间,我一直在担心自己会突然死掉。我常常回想自己二十几年的人生,到底做了些什么?常常想起自己以前做错的事情,然后心情会突然跌入低谷,每天下班,或者周末休息的时候,我都是一个人关在房间里坐在书桌前发呆,或者看书。一整天几乎都不说话。我开始失去食欲,肚子饿了也不想吃东西。吃饭吃到一半会突然胸闷。
后来,换了工作之后,症状更加严重。我开始常常拉扯自己额前的头发,是情不自禁地抓着头发往上拉,因为我几乎每天都头晕,而且持续的时间越来越长,到最后,每天只要醒着就会头晕,拉扯头发可以让我稍微清醒一些。头晕最严重的时候,走路都需要扶着墙。每天都是没睡醒的状态,刚从床上起来,刷牙的时候就可以闭着眼睛睡着。在办公室也是强忍着不打瞌睡,实在忍不住了,就跑厕所洗个脸,或者干脆在隔间里睡一会。工作总是无法好好完成,一遇到稍微有点麻烦的事情就开始烦躁不安,只能草草做完了事。还有,总是坐不稳站不安。坐着一段时间之后就开始想往地上蹲,控制不住地想往地上坐。只能用臀部上部接近尾龙骨的部分支撑在椅子上坐着,只有这样我才能坐得久一点。站着的时候必须找东西靠着,有时候靠墙上,有时候靠着桌子,否则就会开始烦躁不安,感觉自己马上就会晕过去或者突然猝死一样。另外,我还特别怕吵闹,如果身边的人说话稍微大声一些,就会觉得很烦躁,很想逃离出去。感觉所有的噪声在拼命地往我脑子里钻。那段时间我非常抵触跟别人交谈,不必要的社交也都尽可能推掉,甚至上司请吃饭我都不想去。我开始越来越少说话,因为说多了会累,气接不上(这再次让我怀疑我肾虚)。因此,一整天,如非必要,我绝不开口说话。对于刚换了新工作的我来说,这等于是将自己与所有同事都隔绝开了。因此,每天一上班,我就觉得周围的气氛异常的压抑,大家都很陌生,即使我已经在那里上班超过两个月了,可是,依然无法跟身边的同事好好交流。上班成了一件非常痛苦的事情。
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。
得知我得的是焦虑症之后,我开始回忆自己这差不多两年来的种种表现。我发现,过去的两年来,只有24岁的我,活得像一个七八十岁的老人。我抗拒社交,总是无精打采,全身乏力,从一楼走到4楼中途都要停下来休息一下,说话说多一些就上气不接下气,站几分钟就得找地方靠着。买一堆党参枸杞红枣,甚至当归来泡水喝,一天不喝就觉得自己会突然晕过去。晚上入睡之前,身体总会不停地震颤。半夜会突然胸闷惊醒,就像被谁捂着鼻子和嘴巴透不过气来一样。那段时间,我一直在担心自己会突然死掉。我常常回想自己二十几年的人生,到底做了些什么?常常想起自己以前做错的事情,然后心情会突然跌入低谷,每天下班,或者周末休息的时候,我都是一个人关在房间里坐在书桌前发呆,或者看书。一整天几乎都不说话。我开始失去食欲,肚子饿了也不想吃东西。吃饭吃到一半会突然胸闷。

不负责任的说,根据我自己和见过抑郁患者来看,抑郁的人一般都是比较较真,对自己苛刻,对别人善良,敏感。抑郁的原因有遗传,有失恋,家里出事,学业工作人际关系等等等等上面的人已经说的很清楚了。从表现上看抑郁和普通的低潮最大的区别就是不可控制自己的情绪。而精神上最大的区别在于和常人产生厌世厌人低落情绪不同,抑郁症患者在这些背后往往都有一个他终极最讨厌的人,那就是他自己。在他们诸多觉得没意思,讨厌,肮脏的事物中,他们最为憎恨自己。我知道这个世界上对自己很满意的人不多,但是正常人不会真正特别责怪自己,厌恶自己,划伤自己,自残自杀。抑郁症患者的厌世里面绝对包含着一个自己。他们可能很多认识到这样的憎恨自己不对,然后认为自己怎么会做憎恨自己这种不对的事情呢,不能好好说话像那些好人坚强的人一样好好活着嘛? 而更加憎恨自己。这也是抑郁的一个典型恶性循环。不负责任的说抑郁症患者大都试图改变自己的这种状态,有的人成功了,有的人暂时失败着,有的人就彻底失败了,举个例子张国荣。抑郁的人一方面觉得自己真的无能为力,是自己在抑郁做不到,需要别人理解,一方面又会责怪自己:开什么玩笑,别人断胳膊少腿都没有抑郁你他娘的抑郁什么什么做不到。。。绝对不是抑郁,就是个懦夫,懒惰,胆小鬼,没能力。然后久了就会觉得像我这种没事还抑郁什么xx玩意的废柴,有什么资格活在世界上,看看人家。我说过,抑郁的人一般真的很较真。
And then the anxiety set in. If you told me that I'd have to be depressed for the next month, I would say, "As long I know it'll be over in November, I can do it." But if you said to me, "You have to have acute anxiety for the next month," I would rather slit my wrist than go through it. It was the feeling all the time like that feeling you have if you're walking and you slip or trip and the ground is rushing up at you, but instead of lasting half a second, the way that does, it lasted for six months. It's a sensation of being afraid all the time but not even knowing what it is that you're afraid of. And it was at that point that I began to think that it was just too painful to be alive, and that the only reason not to kill oneself was so as not to hurt other people.

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.
But in 1994, three years later, I found myself losing interest in almost everything. I didn't want to do any of the things I had previously wanted to do, and I didn't know why. The opposite of depression is not happiness, but vitality. And it was vitality that seemed to seep away from me in that moment. Everything there was to do seemed like too much work. I would come home and I would see the red light flashing on my answering machine, and instead of being thrilled to hear from my friends, I would think, "What a lot of people that is to have to call back." Or I would decide I should have lunch, and then I would think, but I'd have to get the food out and put it on a plate and cut it up and chew it and swallow it, and it felt to me like the Stations of the Cross.
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