Menopause and Depression
Introduction
Introduction to menopause and depression Depression is a mood disorder, and many women have had mild emotional disorders several years before menopause. Mostly, it occurs periodically several days before menstruation, and naturally relieves after menstruation, that is, "premenstrual syndrome." These patients may have an increased risk of perimenopausal depression. In addition, sleep disruption caused by hot flashes and night sweats can significantly affect the mood of the next day, leading to irritability, depression, and inattention. During the transition period of menopause, women face great changes in their physical, psychological and social roles. They physiologically transition from childbearing to old age, ovarian function from strong to declining, sexual hormones are gradually lacking, menopausal symptoms and osteoporosis may occur, and hyperlipemia a series of health problems such as illness, cardiovascular disease, and dementia; psychologically facing children's family, family structure changes, or loss of self-confidence due to loss of fertility and body shape; in the workplace, due to the retirement age, it will be decades Familiar and busy positions return to leisurely family life, social roles change, and lack of courage to adapt to new situations and open up new environments, there may be obvious anxiety and depression; with age. basic knowledge Probability ratio: 3% of specific population Susceptible people: women Mode of infection: non-infectious Complications: anxiety disorder depression
Cause
Menopause and the cause of depression
Age factor (85%):
Avis (1994) conducted a 5-year follow-up of 2,565 women aged 45-55 years and found that women with a peri-menopausal period longer than 27 weeks had an increased risk of depression. Gartrell (2000) had 253 perimenopausal and postmenopausal Women conducted a survey of the relationship between mood and maternity, oral contraceptives, and menstrual status, and found that 40% of women experienced depression during menopause, of which only 8% received antidepressant treatment and 46% received HRT Treatment suggests that most women attribute menopausal emotional problems to menopause. Borissova (1998) surveyed 322 postmenopausal women and compared them with 295 non-menopausal women. The results suggest depression and sexual life disorders in postmenopausal women. The problem is outstanding, 20% depressed, 50% anxious, and 13% self-evaluation is very low.
Other factors (15%):
Symptoms and economic income, whether marriage is stable, whether menopause and whether to adopt HRT are closely related, Bosworth (1999) surveyed 581 women aged 45-54, 28.9% of women had depressive symptoms, the symptoms and lack of exercise, income Low, taking oral contraceptives, menopausal symptoms (sleep disorders, mood swings, memory loss, etc.), regardless of menstrual status, Fry (1999) surveyed 29 women with preventive oophorectomy before menopause, the results suggest normal Compared with women, their physical symptoms and emotional problems are prominent, and their anxiety about cancer has not decreased.
Pathogenesis
Biological cause
It has been confirmed that depression has a certain neurobiological basis, mainly the reduction of neurotransmitters such as serotonin (5-HT) and norepinephrine (NE) in the synaptic cleft of the brain; and the hypothalamic-pituitary - Apoptosis of the adrenal/thyroid axis endocrine regulatory function.
2. Social psychology hypothesis
Clinical studies have confirmed that adverse life events, such as divorce, widowhood, laid-off, illness can lead to depression, exacerbation and recurrence, long-term life stress, such as chronic diseases, family disharmony, life-stricken, passive passive personality Lack of social support can also induce depression.
Prevention
Menopause and depression prevention
The elderly should pay attention to the following points in mental health care:
1 to prevent the occurrence of heart disease in old age: to improve the welfare of retired elderly people, improve their material living standards, coordinate their family life, enrich the content of cultural life, and reduce mental stress, for patients with heart disease Pay full attention to environmental adjustment and psychotherapy.
2 to prevent senile sputum: in the case of congenital diseases, elderly patients are prone to senile convulsions, it is necessary to actively prevent early physical disease, pay attention to the patient's tolerance to any drugs used, when the physical illness or nutrition is relieved After the metabolic disorder, senile convulsions are expected to return to normal.
3 pay attention to improve brain function, prevent mental disorders caused by some ischemic brain diseases, prevent the development of cerebral arteriosclerosis, strengthen cerebral blood circulation, and if necessary, preventive treatment measures, such as taking blood lipids, reducing blood vessel fragility, and promoting Small arterial expansion drugs, etc.
4 Carry out publicity and consultation on mental health for the elderly, popularize common sense of medical and health, enhance the adaptability of the elderly, and find out early, timely diagnosis and treatment, and reduce mental disorders and mental illness of the elderly.
In women, the body changes in menopause are more significant. When women are 45 to 50 years old, the ovaries stop ovulation, menstruation stops, and the decline of gonadal activity is more prominent. The resulting endocrine system and related metabolism have changed. The autonomic nervous system also has obvious disorders, and therefore also affects the high-level neural activity of the cerebral cortex. Women in menopause often have weak and weak dysfunction, lack of energy and anxiety, anxiety, plus the appearance of aging and autonomic function. Unstable, many people show menopausal symptoms to varying degrees. A few people, under the trigger of certain trauma, have a menopausal state of depression or paranoia. In the youth, they have emotional psychosis and are in menopause. It is also easy to be ill, clinically mostly with anxiety and depression as the main disease. Women in the menopause stage should strengthen physical exercise, ensure adequate sleep and pay attention to physical and mental health, pay attention to prevent trauma and physical illness, and have symptoms of menopause. Groups should use endocrine and other treatments in a timely manner. Often, doubtful people should be diagnosed and treated early.
Complication
Menopause and complications of depression Complications, anxiety, depression
The changes in the body of menopause in women are more significant. When women are 45 to 50 years old, the ovaries stop ovulation, menstruation stops, and the decline of gonadal activity is more prominent. What followed was a change in the entire endocrine system and related metabolism. The autonomic nervous system also has significant dysregulation and therefore also affects the high level of neural activity in the cerebral cortex. Women in menopause often have weakness, weakness, anxiety and anxiety. Coupled with the aging of the appearance and the instability of autonomic function, many people show menopausal symptoms to varying degrees. A few people, under the trigger of certain traumas, have a menopausal state of depression or paranoia. In the youth, people with affective psychosis are also prone to morbidity during menopause. Most of the clinical symptoms are anxiety and depression.
Symptom
Menopause and Depression Symptoms Common Symptoms Constipation Menopause Hallucination Loss of Appetite Skin Itching Depression Bradycardia Chest Depression Insomnia Fatigue
Depression is a state of mind. Depressed mood often persists for 2 weeks, and is characterized by the most severe morning. The daytime is gradually reduced, and the night is the lightest. Depression is sustained, significant mood is low, lack of pleasure and motivation. Characteristics of the disease.
Typical performance
Depression is manifested in three aspects: emotion, behavior and body. Emotional symptoms are significant depression; loss of interest and happiness; loss of self-confidence or inferiority; feeling of no sense of worthy or guilt; feeling bleak future; concept of self-injury or suicide Or behavior, behavioral symptoms are eating disorders, difficulty to concentrate, physical symptoms are sleep disorders; fatigue; decreased energy; decreased libido.
2. Somatic symptoms
Studies have found that people with depression show more physical symptoms (Table 1), which can involve various systems of the body, such as gastrointestinal symptoms (upper abdominal fullness, nausea, constipation), cardiovascular symptoms (heartache, chest tightness, premature beats, tachycardia) Slow, pre-cardiac discomfort), skin symptoms (hair loss, itchy skin) and bradykinesia, symptoms vary, severity varies, often leading to repeated patient visits, multiple tests, and negative results drive patients to see again And further examinations, so repeated, have greatly increased the family, social and medical burden.
3. Mental symptoms
Patients with depression may have hallucinations or delusions.
4. Atypical symptoms
(1) Increased appetite or significant weight gain.
(2) Increased sleep (at least 2 hours).
(3) Heavy or lead-like sensations in the limbs, sometimes lasting for hours.
(4) Personality is particularly sensitive to rejection in interpersonal communication, resulting in impaired social function. In general, atypical symptoms are common in those with a younger age of depression and more common in women.
5. Bad mood
It refers to mild symptoms but lasts for several years. Patients have depression, lack of interest, decreased energy, social withdrawal, loss of attention and memory, feeling incompetence, inferiority, guilt, irritability, anger, despair and no The incidence rate of people with bad mood is 3% to 5%. In any age group under 64 years old, the incidence of female heart disease is higher than that of men.
Examine
Menopause and depression check
Hormone level monitoring.
Diagnosis
Diagnostic diagnosis of menopause and depression
Diagnostic criteria
1. Diagnostic criteria ICD-10 and DSM-IV treat depression as a single-column syndrome. The diagnostic criteria for diagnostic criteria ICD-10 are:
(1) Depression:
1 basic symptoms: A. almost all day mood depression, almost every day; B. lack of interest or pleasure in daily activities; C. energy loss, fatigue.
2 additional symptoms: A. lack of self-confidence or self-esteem; B. unreasonable self-blame; C. repeated suicidal or want to die; D. decreased thinking ability, lack of concentration; E. psychomotor changes, agitation Or delayed; F. sleep disorder; G. appetite changes; H. sexual desire is significantly reduced.
And depressive episodes last for at least 2 weeks, without manic symptoms, and excluding psychoactive substances. Depression is a continuum with varying degrees of severity. The standard of diagnosis for mild depression is at least 2 basic symptoms. Symptoms of at least 3; the standard of diagnosis of moderate depression is at least 2 basic symptoms, at least 4 additional symptoms; the standard of diagnosis of major depression is 3 basic symptoms, 5 additional symptoms or more.
If organic factors lead to depression, such as infectious diseases, medication or hypothyroidism, you can't diagnose depression. Therefore, patients with depressive episodes need to perform necessary laboratory tests to rule out organic factors. .
(2) Endogenous depression: ICD-10 collectively refers to the somatic symptoms associated with depression as somatic syndrome, while DSM-IV defines it as endogenous depression or biological depression. Etc., the diagnostic criteria are in line with the standard of depression and have physical symptoms. The core manifestation is obvious physical activity or slow or irritating. There is no lasting feeling of happiness, and it is difficult for others to make the patient happy.
(3) Bad mood: the performance is:
1 loss of appetite or hyperactivity;
2 insomnia or excessive sleep;
3 low energy or fatigue;
4 low self-evaluation;
5 decreased attention or hesitation;
6 Despair, depression for most of the day, and lasts at least 2 years (adolescents last at least 1 year), DSM-IV also requires:
1 Depressive symptoms last at least 2 years. In these 2 years, if there is a normal mood interval, the interval is no longer than a few weeks;
2 no frivolous episodes;
3 The severity or duration of depression within two years, can not reach or rarely meet the diagnostic criteria of "recurrent mild depression" before they can be diagnosed as a bad mood.
2. Identification of depression
In clinical work, non-psychiatric doctors can only identify a small percentage of patients with mental illness. A survey of 526 medical outpatients in Washington State found that the rate of missed diagnosis of depression by physicians was 57%. WHO Multicenter According to the cooperative research data, the average recognition rate of depression among 15 different countries or regions is 55.6%. The survey in Shanghai, China found that the recognition rate of psychological and mental disorders by physicians is only 21%, far lower than that of foreign countries. Level.
(1) Reasons for unrecognized: In general hospitals or primary health care clinics, the vast majority of people with depression complain of discomfort in a certain part of the body or a systemic symptom. It is easy for the doctor to speculate that the patient has some kind of disease. Physical illness, given appropriate examination or treatment, and because of the heavy workload of daily outpatient services, the time for inquiries and examinations for each patient is very limited, so that there is very little time to actively ask patients about emotional and psychological problems, in addition, because Depression and physical illness often cause each other as a cause and effect. The clinicians often pay attention to physical discomfort in diagnosing diseases. They should explain the patient's performance and treat them according to a single disease. It is very easy to ignore the existence and treatment of depression. Psychiatrists also rarely use mental disorder examinations and evaluation methods to understand the patient's emotional problems in clinical work, and lack of experience to identify depression.
(2) Recognition method of depression: The key to the clinical diagnosis of depression is to ask the medical history in detail, to understand the patient's psychological activities and life experiences, work and family life, to carefully observe the patient's emotional response and behavioral performance, and then to conduct a comprehensive analysis.
1 In the clinical work, the symptoms can be asked from the following aspects; at the same time, pay attention to observe the patient's speech and facial expressions, and carefully observe the emotional activities of the patient's heart.
A. Are you waking up 2 hours earlier than usual, or even longer?
B. What is your mood (mental state) in 2 weeks?
C. Do you feel that you are different from what you used to be?
D. Have you ever thought of not wanting to live?
2 Objective rating scale for depression:
The A.Zung Depression Self-Assessment Scale (SDS) is a 20-question assessment (Table 2) that provides quantitative quantification of the main clinical symptoms of depression through 20 questions, indirectly reflecting the patient's emotional state. To preliminarily determine whether the patient has depressive symptoms, pay attention to depressive symptoms should be at least 2 weeks of depression, not to normalize 3 to 5 days of mood fluctuations to depressive symptoms, the rating is 1 to 4 points, refers to In the past 2 weeks, there is no or very little time (1 point), a small part of the time (3 to 5 days, 2 points), quite a lot of time (6 to 10 days, 3 points), most or all of the time (11 ~ 14 days, 4 points) The symptoms involved in the problem occurred, considering the subjectivity of the questionnaire and the patients will answer them freely without thinking, some questions are in the form of reverse questions, that is, directly asking for interest, feelings and thoughts, not depression. Symptoms, in general, the total score of more than 40 points should consider the presence of depressive symptoms; the higher the score, the more serious the depressive symptoms, however, the SDS score is only used as a reference for clinical diagnosis, and the final diagnosis still depends on the physician's clinical an examination.
B. Hamilton Depression Scale (HAMD): compiled in 1960 by Hamilton, is a classic and recognized depression rating scale. This scale currently has 17 items, 21 items and 24 items. Version, most of the HAMD projects use a 5-point scale of 0 to 4 points, 0 means asymptomatic, 1 is mild, 2 is moderate, 3 is severe, 4 is extremely severe, and a few items use 0 to 2 points. Grade scoring method, 0 means no, 1 means light to moderate, 2 means severe, and Table 3 is 24 items.
The total score is very important information, can better reflect the severity of the disease, and can be used to assess the evolution of the disease, the higher the total score, the more serious the disease, if more than 35 is divided into severe depression, 20 to 35 is divided into light or medium Depression, if less than 8 points, there is no depressive symptoms, HAMDL7 demarcation is divided into 24 points, 17, 7 points.
Differential diagnosis
Excessive sadness
ICD-10 recommends a subtype that is diagnosed as adaptive disorder for those who have a strong, abnormally excessive sorrow for 6 months or more after losing their loved ones. DSM-IV suggests that they will lose their loved ones. Those who continue to have typical depressive symptoms for a month are diagnosed with "severe depression."
Anxiety
A considerable number of patients with depression also show symptoms of anxiety, sometimes difficult to distinguish from anxiety disorders. Usually, patients with depression and anxiety disorders can have various autonomic neurological symptoms such as palpitations, insomnia, worry, etc., but patients with anxiety disorders There may be more sympathetic nervous system hyperactivity, and depression patients may have more self-evaluation or negative perceptions.
Sometimes, it is really difficult to identify depression or anxiety in the clinic. It is helpful to know the patient's primary symptoms and core symptoms by detailed medical history. If it is really difficult to distinguish, the diagnosis is preferentially considered as depression.
3. Schizophrenia, schizoaffective disorder
Depressed patients do not have psychotic symptoms without depression.
4. Bipolar disorder
Includes depression and manic episodes.
5. Dementia
If the patient is older than 65 years old, clinical symptoms of depression, need to be differentiated from dementia.
