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[YouTube搬运]斯坦福教授帮你深入了解抑郁症.

2022-05-01 20:11 作者:STRONG-Qi  | 我要投稿

抑郁症 Depression


用自己的话概括复述,大胆, 不怕犯错.

介绍抑郁

普遍 广泛 破坏性极大 越来越流行

要理解关于抑郁症的两个领域的话题才能理解抑郁症(生物学和心理学)

症状 sense of symptoms

不同于日常语言的难过沮丧,

几周,中长期的, 但是走出来的. 反应性抑郁 reactive depression

走不出来的 major depression 不在需要外界因素让他抑郁

definition: biochemical disorder with a genetic component, and early experience influences where somebody can't appreciate sunset.

定义: 有基因影响的生物化学疾病, 早期生活经验的影响, 失去审美.

毁灭性 没有比让人失去快乐的疾病更差的病

anhedonia -- hedonism, the pursuit of pleasure

anhedonia, the inability to feel pleasure.

major depression 的症状 妄想, 内疚

self-injury

psycho moto retardation

real biological disorder just as juvenile diabetes

you don't sit down a diabetic and say oh come on pull

yourself together. what's with the insulin stuff, stop babying yourself.

你不会对糖尿病病人说的话也不要对抑郁症患者说

vegetation symptoms:

wake up early exhausted but not sleep

sleeping disorder 睡眠的不同阶段

eat more 碳水的大脑反应减少压力荷尔蒙的释放

activation of stress response

压力荷尔蒙升高

肾上腺素升高

比喻无脊椎动物,废掉了 并不是major的症状

而是一个身体在爆炸(因为荷尔蒙的分泌)

stress 24/7

新陈代谢律升高,

increased muscle tone 肌肉紧绷

rhythmic patterns 每年的冬天,一年后




what's going on in the brain in major depression?

生物学,到大脑发生了什么?

化学

神经元,神经递质,信息交流需要 chemical messenger (called neurotransmitter)

传递过程...

too little norepinephrine.

1960s First anti depression MAO inhibitor

logic : it inhibit the activity of enzyme, then brain don't break down norepinephrine, just floating around there. The key is too little norepinephrine.

late 1960s, tricyclic antidepressants. logic is too little norepinephrine.

a class of drugs called reserpine : major side effect in lowering somebody's blood pressure that way is they fall into a depression.

老鼠实验 刺激神经元 Rats get stimulated in this area better than food, sex, drug. pure pleasure.

scratch itch

too little norepinephrine == loss of pleasure

但是有问题出现:1. 神秘的没有用.

2.另一种更有用 多巴胺 dopamine

3.Prozac(SSRI) 百忧解和血清素相关


证据表明:

absence of dopamine == anhedonia

absence of norepinephrine == psychomotor retardation

absence of serotonin == obsessive sense of grief


_a neurotransmitter called substance P == pain

实验发现 decrease substance P signaling, sometimes depressives get better.

what does this suggest?

it is not just a metaphor of depression as psychic pain.

your body is using the same brain chemistry to feel the psychic pain of depression.


__neuroanatomy__ 神经解剖学, the structure in the brain.

1940s triune brain concept , very explanatory.

limbic system , it's about emotion. fear lust anger rage poignance.


cortex sensory stuff.


_suppose

gored by elephant

activate stress response. feel a sense of grief. hunker down psycho moto retardation, appetite,


depression

you sit there ,and you think about kids in refugee, loss of your parents. suddenly your body feel the same


cortex gives you abstract of pain and pleasure

you have pain in order to have pleasure.


_Hormones final biology here. 荷尔蒙 激素

thyroid hormones == maintain metabolism

severe shortage of thyroid hormone == major depression

Lessons:1.20% major depressions are undiagnosed hypothyroid syndromes

2.think other than psychiatric state, better have nutrition, hormone levels


women have their highest vulnerability to depression at certain points in their reproductive life histories.

women depression more than men


社会学 sociologic framework

lack of control can cause depression

science women ruminate more on upsetting emotions than men do.

unsolid science : speculation on that you ruminate on bad feelings , you're more prone to a depression.

产后2周,更年期,更容易得抑郁症, 都是关于荷尔蒙, 激素.

雌激素, 黄体酮 estrogen and progesterone


stress hormone (battle inside)

you get exposed to a lot of glucocorticoids == risk for major depression

disease evidence : people with Cushing's

a lot of glucocorticoids, and your brain gets depleted of dopamine.





















介绍抑郁

普遍 广泛 破坏性极大 越来越流行

crippling pervasive divesting widely common


15% of people will have a major depression at some point or other in our lives.

2025 number two cause of disability, after obesity, diabetes-related disorders


two different topics and tie them together at the end.

  1. what does biology have to do with depression
  2. ... psychology ...


sense of symptoms

a semantic problem -- we all use the word depression in an everyday sense.

1.不是not 小事, feel dumped 烦躁

2. large legitimate loss setback , losing a job, unemployment, death of a loved one

extremely impaired by a sense of malaise for weeks afterward. And then come out

3.and weeks and months later, they still have not come out the other end.


reactive depression vs. major depression.

major ... no need of external trigger

definition: it's a lot biochemical disorder with a genetic component, and early experience influences. where somebody can't appreciate sunsets. 失去审美,对审美的感动.



观点worst disease you can get

why?

证明

compare cancer, heart disease.

有人会向死而生.

somebody saying "well, obviously, I am not glad I'm dying of cancer. But without this disease , I will never would realized the importance of friends.

I never would have reconciled with my family members. I never would have found my God."

On a completely weird level, I'm glad this has happened on me (got cancer.)"

Human have this astonishing capacity to derive pleasure out of the most unlikely domains.

人的适应性, 合理解释一切的动机. 苦中作乐.


生物疾病

What could possibly be worse than a disease whose defining symptom is the inability to fell pleasure?


anhedonia , the inability to feel pleasure

hedonism, the pursuit of pleasure.


grief guilt. we got the semantic problem again.

major depression. the grief and the guild can be so severe that it actually takes on a delusional quality. not delusional in the sense of a schizophrenic

感同身受.


self-injury. suicide.


psycho moto retardation 精神运动迟缓.

Everything is exhausting.

It's exhausting to do stuff, think stuff.

You cant do the laundry. because where is the basket and you got to find change for the machine. And you've got to go detergent. it's too much.

Everything is too much

fall into the paralyzed state.


not worry about suicide.

dangerous part is when somebody begins to get better from a sever depression.

something catastrophic.


something people with depression constantly battle with.


和 juvenile diabetes 一样.biological disorder.

(加梗方式). you don't sit down a diabetic and say oh, come on, stop babying yourself. insulin stuff.


为什么是Biological disorder?

因为 vegetative symptoms


sleep pattern disorder.

this screams biology! 比喻


eat more general belief that when you feel unloved carbohydrates make you feel better.

事实 bizarrely there's actually a brain chemistry of it of carbohydrates decrease stress hormone release.


12:32


stress hormones

over-activation of something , that is called the sympathetic nervous system, adrenaline.


通常的比喻 sea sponge, invertebrate thing 无脊椎动物

但这不是 major depression

somebody whose body is blasting through there, over-activated stress response, enormous battle internally -- increased metabolic rate, increased muscle tone, all of these again screaming biology.


rhythmic patterns 比如 2个月恢复,但是1年半以后再来一遍

比如 some people only get depression during winter. (something)known as seasonal affective

biological clock


总结, 症状都是有生物学原因

the notion amid all these debilitating symptoms, these are ones that are about biology, these are bodies working differently.



问题: what's going on in the brain in major depression?

1.chmestry. 2brains 2 neurons

Neuro transmitter.

证据 2 种药, 针对神经递质 肾上腺素太少

convincing, irrefutable

实验 rat 会控制一个 拉杆lever 电极刺激神经元, 爽到死。 better than food, sex


人也是

norepinephrine 去甲肾上腺素。


BUT here's the reasons you shouldn't be convinced:

1.weird time

2.more important dopamine a neurotransmitter (cocaine works on dopamine system系统?)

3.百忧解 serotonin 血清素


absence of dopamine -- anhedonia 快感缺失

... norepinephrine -- psychomotor retardation

... serotonin -- sense of grief


强迫症 Obsessive compulsive disorder 百忧解也可以


substance P -- pain

事实 get a drug that decreases substance P signaling. sometimes depressives get better

这个事实说明什么?

It is not just a metaphor of depression as psychic pain. Your body is using the same brain to feel this psychic pain of depression as just telling you, oh, I just stubbed my toe.

Interesting similarity here.


neuroanatomy, the structure in the brain.

1940s triune brain concept 大脑三部分 (三合一, 三位一体)

reptilian part of brain -- 爬行动物部分, 和爬行动物一样。what does this part of brain do?

measure blood pressure


You don't see a big limbic system until you get to mammals.

Lizards are not famous for their emotional lives. (三段论)

Limbic system is much about emotive stuff -- fear and lust anger ,rage , poignance, God knows what


Cortex

hugely expanded area in primates (灵长类动物)

what does it do?

numbers, processing visual information, sensory stuff


一个有趣的小例子

Unexpectedly, you are gored by an elephant.

what are you going to do?

You are going to activate your stress response.

You may feel a sense of grief at that point

You may kind of hunker down at that point, a little psychomotor retardation.

appetite, sex may not be the most appealing thing.

总结

You are having a stress response in response to the sort of insult that this part of the brain is thinking about.

So, what's depression.

You sit there, and you think about kids in refugee camps.

You think about the inevitable mortality of your loved ones.

You think about whatever

and suddenly your body does the exact same thing as if you were gored by an elephant.


What depression is about is the cortex whispering in your ear of the rest of the brain, saying this is as real as you were just physically assaulted by some sort of predator, whatever.


29:04


讽刺了哲学那种 cortex 的存在 是说明 痛苦是为了快乐。这是空想的,你看着那些医院里的那些割腕的病人。和他说痛苦也是为了快乐。we have pain in order to have pleasure.

脱口秀加梗。

人本主义


hormones

thyroid hormones. -- maintain your metabolism, keep your body warm enough.

shortage of it --- major depression. Hypothyroidism is associated with major depression.


女人更容易得major depression

产后, 更年期

other sociological framework

lack of control cause depression.


讨论男女差异,还有individual difference

调查问卷:调查刚刚和亲密的朋友吵架的人会选择什么样的问题。

女人选择 他们如何认识的, 关系的本质是什么,他的朋友有没有幸福的婚姻

男人选择 战争题材, 抗日。 男人cant express their emotions 男人不会表达情绪。


that is solid science

what is unsolid science?

it is that you ruminate on bad feelings you're more prone to a depression.

别想那些难过的事情,这个不是科学验证的。是人的朴素的相关性分析。是错误


34:32





心理学


38:56


Freud

what's difference /bw mourning and melancholia

the other end 不同文化都有彼岸的说法. 语言背后的形而上存在

举例 矛盾的心理, 亲人去世,Oh, thank God I'm finally done with this person.

They are never control my life. --- how can I think suck a thing like that.

Sudden crippling guile all sorts of other symptoms.

depression is aggression turned inward. // feels right , no evidence

internalize


You cant do modern science on it, which is the problem with the best parts of Freud.

you cant turn it into neurochemistry.

what do estrogen progesterone rations have to do with love hate ratios? 无法量化


所以转向 experimental psychology

define psychological stress. ...


Depression is Learned helpless (from cognitive psychology)

父母不理解, 不负责任的父母. 不知道自己想做什么, 没有安全感. 地狱一般的家庭环境.

it is learning to be helpless.

what is it?

is taking a circumstance where by any logic, you should be saying , this is awful, but it is not the whole world.And do this cognitive distortion and decide , this is , indeed, the entire world and I have no control always helpless, always hopeless.



two extremely different viewpoints 视角(心理和生物)



举例 事实

lose a parent to death when you are under 10 years of old

is one of the most reliable findings in the whole epidemiology of depression

and for the rest of your life you are more at risk for a major depression.


How to link 生物和心理

The key is Stress

depression is a genetic disorder : it has some degree of heritability.

50% chance if your twin brother has depression


genes and depression are not about inevitability.

They are about vulnerabilities.

事实 one gene having something to do with serotonin.

it doesn't increase your risk

unless you have a history of exposure to stress 养家...

parental divorce, physical abuse, death of a family member.

the gene is about how readily we recover from stressors.

Glucocorticoids regulate the function of this gene.


finally , a wonderful integrated model


This is not pull yourself together. we all get depressed.

这和糖尿病一样,都是生物疾病.


university

A community of high achieving , type A individuals is rife with major depression.

weird corrosive inhibition, embarrassment, discomfort

讽刺 ,senator with a depressed loved one will set up a funding.


基因, 和承认你有糖尿病

承认自己抑郁就像 admit that your pancreas isn't secreting insulin.

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