New treatment plus treatment-resistant depression can be cured despite coexistence with the disease

According to estimates by the World Health Organization, 5% of adults suffer from depression, with as many as 280 million patients worldwide.

A large-scale study by the University of Hong Kong and the Chinese University of Hong Kong found that even if patients are willing to seek medical treatment, nearly 20% of new depressive symptoms will gradually turn into “treatment-resistant depression”, and the overall risk of death is more than 50% higher than that of general depressed patients.

(Hong Kong News) The so-called “treatment-resistant depression” (TRD) means that the patient uses two or more antidepressants successively, and the dosage of each drug is sufficient. The patient follows the doctor’s instructions and takes the medication on time, but after 6 to 8 weeks, Afterwards, his depressive symptoms could not be reduced by half or more.

Emotions affect other body functions

Scholars from the University of Hong Kong, the Chinese University of Hong Kong, and University College London in the United Kingdom began following 8,223 new patients diagnosed with depression in public hospitals in Hong Kong for a period of 6 years since 2014. Among them, 1479 people (18%) experienced two treatment failures and needed to receive a third treatment, which was classified as treatment-resistant depression; 78 of them (5.3%) died during the 6 years.

The analysis found that such patients are more likely to engage in self-harm, and their overall risk of death is 52% higher than that of general depressed patients; some people also suffer from chronic diseases such as heart disease, chronic obstructive pulmonary disease, and diabetes.

“They are the most severe among the severe cases.” Professor Chen Xiuwen of the Department of Psychiatry at CUHK who participated in the study said that treatment-resistant depression deserves attention because not only do patients have a higher suicide rate, but their depression also affects other body functions. “There are more heart diseases, and it is related to Mortality rates not related to suicide also increased.”

Simin, 38, grew up in a high-pressure family and bullied at school. She began to suffer from schizophrenia, depression and panic disorder 19 years ago. She planned to commit suicide for the first time in 2016. She wrote a suicide note and met a friend to have a meal to say goodbye. Fortunately, her friend noticed something was wrong and offered condolences: “Do you want to commit suicide?” At that moment, she cried on the spot and accepted the other person’s advice to give up the idea.

However, in 2017, she experienced the death of a friend who committed suicide. She blamed herself and regretted it, which led to a relapse of depression. In mid-2018, Simin often experienced auditory hallucinations: “I stood at the fence of the shopping mall and felt someone underground saying to me: ‘Come down, you. It’ll feel good to jump off!'” Sensing a relapse, she went to the emergency room on her own. In August and September of the same year, she had a falling out with her family and was taken to the hospital, where she hanged herself with a bed sheet in the ward.

Take the initiative to request early follow-up and medication refills

Simin stayed in the psychiatric ward for four months and was discharged. She received counseling at the Samaritan Society for Suicide Prevention, and then joined the “Fellow Travelers” support group. After meeting other family members facing bereavement, she realized that she was not alone. To this day, Simin is still receiving treatment and takes 3 psychiatric drugs every day. Recently, she experienced a co-worker committing suicide, her depression worsened, and her hallucinations and auditory hallucinations reappeared, so she proactively requested an early follow-up consultation and medication from the psychiatric department, and sought psychological counseling.

Looking back on dealing with depression over the years, she emphasized: “Counseling and medication are the most helpful to me. Medication can control the symptoms. When there are no hallucinations and auditory hallucinations, and people feel clearer and more energetic, they can receive counseling. When they can be heard, they can be sorted out.” For fallacies and problems in character and behavior, you can find ways to change some behaviors.”

Chen Xiuwen bluntly said that patients with refractory depression may not be able to have their tail docked, but there are new treatments.

“In addition to traditional electroconvulsive therapy (ECT), many public hospitals have also introduced transcranial magnetic stimulation (TMS), which uses non-invasive magnetic fields to directly stimulate the left prefrontal area of ​​the brain to activate brain cells. Get up.

A study by the Chinese University of Hong Kong showed that after using TMS on 70 patients with severe depression, 6 of them had their depressive symptoms improved by more than half. “

Another drug with significant effects is the nasal spray drug esketamine, which is one of the effective molecules commonly known as “K-boy” ketamine, but only in very small amounts. It can target the NMDA receptors in the brain and help neurons reconnect. Esketamine is commonly used in North America and has also been registered in Hong Kong. Patients should spray it twice a week in the first month, and then once every 1 to 2 weeks. The entire treatment course lasts for half a year.

Cooperate with medical care to take medication on time and in the right amount

“This treatment works very quickly. Some patients have completed the third treatment and said they have never felt so good before.” CUHK conducted a clinical test earlier and prescribed the spray to 6 patients with treatment-resistant depression. Four of them were equally effective. good. At present, medicines have been introduced to Prince of Wales Hospital for use by patients with appropriate conditions.

Chen Xiuwen reiterated that it is not a “miracle drug” and is not effective for all severe depression, nor may it be effective for patients with bipolar disorder or schizophrenia. At the same time, due to the risk of drug abuse, treatment must be received in a hospital or clinic. Patients need to be medically monitored for several hours after taking the drug. Side effects such as nausea or regurgitation may also occur.

Her message to patients with severe depression is to cooperate with doctors and nurses to take medication on time and in the right amount, and learn to coexist with the disease: “Psychotherapy, cognitive behavioral therapy, etc., learn to understand the characteristics of your illness, cope with the disease, and change some values ​​or ideas. Be more tolerant of yourself… You don’t have to have your tail docked, and patients with diabetes and high blood pressure cannot force themselves to rely on life alone to control their condition.”

Simin called on depressed patients who still have suicidal thoughts to give themselves one more chance and tell trustworthy people: “Find the right person at the right time, and someone will discover and pay attention to what you do. The person who truly loves you will always be there. When I hear your thoughts, I will come to save you as soon as possible!”

What people with depression are afraid of hearing

1. Can you be more positive?

2. If you are sick, take medicine!

3. You can actually choose to make yourself feel better!

4. Don’t think so much!

5. If you don’t think about it, nothing will happen and you won’t be depressed!

6. Be happy and stop thinking about the past!

7. Be a human being when you are happy, and be a human being when you are unhappy. Why should you be unhappy?

8. Look at me, I am not depressed even though I am under so much pressure!

Source: Simin, a patient with depression, Chen Xiuwen, professor of the Department of Psychiatry, CUHK

Do not force medical consultation to affect recovery and help patients develop a sense of illness.

Many psychiatric patients have low “sense of illness” and refuse to seek treatment or take medication. What should I do?

Simin, a patient with depression and panic disorder, and Zhou Manchang, whose wife is a survivor of depression and chairman of the Hong Kong Jialianjia Mental Health Advocacy Association, both emphasized that if the patient lacks awareness of the disease and is unwilling to receive treatment, it will affect the progress of recovery; however, If family members force patients to receive treatment, it can have counter-effects at any time.

Understand the difference between before and after taking medication

Disease awareness means that patients know that they are sick and are willing to cooperate with medical treatment and treatment; it also involves experience with the disease, such as knowing that they have symptoms, understanding why diagnosis and treatment is needed, and the importance of treatment, etc.

Simin, who now works as an activity officer at the Comprehensive Mental Health Community Center, provides education and support to family members as a fellow traveler. She bluntly said that some patients with emotional illness do not admit that they are ill, and even accuse their family members of “I am not ill, you are.”

She warned that if the patient is not in danger of committing suicide or injuring others, do not force the patient to seek medical treatment or “capture” them into the hospital. “If you force the patient to call an ambulance, even if they enter the hospital and the doctor prescribes medicine, if they do not admit that they are sick, they will not be admitted to the hospital.” I won’t continue taking medicine!”

Simin reiterated that family members need to have good communication with the patients to help “stop the wind”. The patients are willing to share their thoughts or conditions. “But if the relationship is poor, you will never know their condition. Even if the patient refuses to seek medical treatment, the family members The follow-up certificate can be used to represent the patient to see a doctor at a specialist clinic to reflect the patient’s latest condition.”

She used her own experience as an example. Patients need to have a sense of disease awareness to understand the difference between before and after taking medication and recognize the efficacy of medication. “Every time an illness occurs or is close to onset, they will seek help immediately to prevent themselves from falling into the bottom.”

When patients feel the love and care of their family members, once their condition changes, it is easier for their family members to accompany them for follow-up consultations, and it is easier for the patients to respond positively.

Family members play an important role

Zhou Wanchang admitted that patients with chronic diseases such as diabetes and heart disease tend to have a sense of illness. On the other hand, mental patients such as depression and mania may have difficulty understanding the importance of treatment because their cognition and emotions are affected, especially when the disease occurs.

“To slowly allow the patient to regain a sense of illness, family members must first work hard on communication and establish mutual trust with the patient. Then when the patient’s mood is stable, they can find the right time to understand the reason for the patient’s refusal to seek medical treatment or take medication, so that the patient can recognize the signs of the disease. And analyze the duration of his mood swings and the consequences without treatment.”

He emphasized that family members play an important role in the recovery process of patients. Family members should know more about emotional illnesses, and the authorities should also strengthen the provision of relevant training to family members.

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