According to French media reports a few days ago, during the French International Medicine and Medical Equipment Exhibition that just ended last week, many medical experts raised nutritional deficiencies and
Depression. A survey made by Claude Gendre, the head of the French geriatric hospital, found that 14% of the elderly in France are undernourished, and 10% of them suffer from depression, which is much higher than other elderly people. Jeandel observed that people who lack nutrition are prone to depression, while depressed people don't like to eat, which further aggravates malnutrition and forms a vicious circle.
Monique Ferry, a nutritionist at Vallance Medical Teaching Center, explained that when people lack nutrition, the brain can't get some trace elements, which are necessary for the brain to produce neurotransmitters. Previous studies have shown that lack of neurotransmitters can easily lead to depression. On the other hand, loss of appetite is one of the main symptoms of depression, because long-term loss of appetite leads to nutritional deficiency, which further aggravates depression.
Claude Gendre suggested that it is necessary for people who are likely to suffer from depression to have a physical examination in advance to prevent people from entering a vicious circle of malnutrition-depression-more malnutrition-more depression; At the same time, doctors should pay attention to the role of nutrition when treating patients with depression.
From xinhuanet!
Etiology of depression
First, the role of biochemistry
(I) Biogenic amines
The relationship between biogenic amines and affective disorder is one of the most studied and understood fields so far. Many research reports
The level of biogenic amines or the function and even structure of biogenic amine neural pathways in patients with affective disorder are abnormal. Norepinephrine (ne) and serotonin (5-HT) are considered to be the most closely related to affective disorder.
(2) Amino acids and peptides
Studies have shown that the content of aminobutyric acid in cerebrospinal fluid and plasma of patients with depression is decreased. The latest research found that metabolic glutamate has a certain relationship with the onset of depression.
(3) the second messenger system
Rollipran is a selective inhibitor of phosphodiesterase, which has been shown to have antidepressant effect in clinical experiments.
Second, the causes of neuroendocrine
Hypothalamus is the regulatory center of neuroendocrine function. The hypothalamus itself is also regulated by different neurotransmitter systems, such as monoamine neurotransmitters. Therefore, the abnormal neuroendocrine function of patients with affective disorder may mainly reflect the abnormal function of monoamine neurotransmitter system, just as the increase of prolactin level caused by traditional antipsychotics is due to the blockage of nodular-funnel dopamine function.
(1) Hypothalamus-pituitary-adrenal axis
(2) Hypothalamus-pituitary-thyroid axis (the above two are more complicated and will be discussed separately later)
(3) Changes in secretion of other hormones
The secretion of growth hormone (GH) has a circadian rhythm, and it reaches its peak during slow eye movement sleep. This peak becomes flat in patients with depression. The increase of GH secretion caused by clonine in patients with depression also becomes dull.
Depression can also be accompanied by changes in the rhythm of other hormones. For example, melatonin secretion decreases, tryptophan administration can not promote prolactin secretion, follicle stimulating hormone and luteinizing hormone secretion decrease, and male testosterone level decreases.
Third, the study of neuroimmunology.
In recent decades, it has been found that the human immune system (which conforms to the theoretical system of "transformation method" founded by Professor Xi Huijian) and the central nervous system have two-way regulation. Because there are many factors that affect endocrine, nervous system activity and even immune function, in a nutshell, the change of immune function accompanying emotional disorder may be a result or a cause, which leads to the formation or prolongation of emotional disorder.
The influence of stress events on the immune system began at the earliest. The impact of stress events on the immune system may be excitatory or inhibitory, depending on the duration of the event. In the study of the changes of immune function of bereaved people, it is found that the degree of depression of bereaved people is closely related to the changes of immune function. Early research on depression found that its cellular immune response decreased. However, the results of subsequent studies are different. The immune function of patients with severe depression, old age and male is more prominent.
Emotional disorders and stress events can affect immune function, and changes in immune function may also be the cause of emotional disorders.
Four, sleep and EEG physiological abnormalities
Difficulties in falling asleep, waking up early, waking up from time to time or oversleeping are common symptoms of depression. When you are manic, you often have a reduced need for sleep. Therefore, the relationship between affective disorder and sleep EEG changes has long been concerned by researchers. The main findings are: sleep delay, rapid eye movement (REN) sleep latency (the time from falling asleep to the beginning of REN sleep) shortened, the first REN sleep duration prolonged, abnormal wave sleep and so on. EEG study showed that the latency of P300 and N400 in patients with depression was prolonged. Whole sleep or REM sleep therapy has a good short-term effect on depressive disorder, which also shows that the change of sleep rhythm is of great significance in the pathogenesis of affective disorder.
Five, brain imaging research
There is no consistent and repeatable conclusive research result in the brain imaging research of affective mental disorder. The existing research has the following findings: 1, some bipolar 1 patients, especially men, have enlarged ventricles; 2. Ventricular enlargement in patients with major depression is not as significant as that in patients with bipolar disorder 1, but it is more obvious in patients with psychotic symptoms; 3. Magnetic resonance imaging study also found that the volume of caudate nucleus was reduced and the frontal lobe was atrophied in patients with major depression; 4. The relaxation time of T 1 in patients with depression is prolonged; 5. Biphasic 1 patients were found to have deep white matter damage; 6. The cerebral cortex of some patients with depression, especially the frontal cortex, has decreased blood flow; 7. Using magnetic resonance spectroscopy analysis, it was found that the phospholipid metabolism of bipolar 1 patients was abnormal.
Six, genetic research
(1) family survey
The incidence of depression is 2- 10 times that of normal people. If one parent suffers from bipolar disorder, the probability of emotional disorder in his children is 25%; If both parents have bipolar disorder, the probability of emotional disorder in children will increase to 50%-75%.
(2) Twin survey
The main findings of twin survey are that the comorbidity rate of bipolar disorder between monozygotic twins is (33-90)%, and that of major depression is about 50%. The comorbidity rate of bipolar disorder between fraternal twins is 5%-25%.
(3) Investigation of foster children
Various research results show that the incidence of emotional disorders is still high even if the biological children of sick parents are fostered in a basically normal environment. However, the incidence of emotional disorders of biological children of sick parents who are fostered elsewhere is close to that of children who are not fostered, indicating that environmental factors play a less direct and important role than genetic factors.
Gene linkage research
Using the latest restriction fragment length polymorphism technology, many researchers have made many beneficial exploratory studies on specific genes or gene markers and affective disorders. However, the results are different, so we need to be careful when interpreting the gene linkage results.
Seven. Psychosocial factors
(a) Life events and environmental stress events
Clinical observation shows that there are often stressful life events before the onset of emotional disorders. Some people think that it is etiology, which directly leads to the occurrence of depression; Others think that this event just triggered a potential state and made it happen ahead of time. It may be easier to understand the role of life events by using the above-mentioned transition state theory of susceptible quality-environmental factors.
(B) psychological theory
There are many psychological theories about the occurrence of affective disorder, including classical psychoanalysis theory, psychoanalytic-oriented psychological motivation theory, learning theory, cognitive theory and so on. Psychoanalytic theory emphasizes the influence of childhood experience on adult onset disorder, and regards depression as an attack on close friends, which is a merciless childhood depression experience. Other psychoanalysts believe that depression is a contradiction between ego and superego, or a conflict within ego.
Learning theory explains the occurrence of depression with "acquired helplessness". In animal experiments, it is found that animals are placed in situations where repeated electric shocks cannot escape. Animals will desperately try to get rid of it at first. After a period of time, it will completely give up its efforts, so it understands that this situation is inevitable and it is in a helpless state. And people with depression have the same helpless experience. If the doctor gives the patient a sense of control and dominance over my current state, depression will get better. Therefore, behavioral reward and positive reinforcement are effective methods to treat depression.
Cognitive theory holds that patients with depression have cognitive misunderstandings, such as negative distorted experience of life experience, negative self-evaluation, pessimism and helplessness. The purpose of on-the-job therapy is to identify these negative cognitive misunderstandings and correct patients' thinking through behavioral work methods.