[Creative Cultivation Program] Don’t ignore it anymore! Depression will become the most burdensome disease in the world by 2030

Author: Hu Shaohua

Recently, Chinese scientist Professor Hu Hailan won the "World Outstanding Women Scientists Achievement Award", which is the only award in the world that rewards women scientists worldwide and can be called the "Female Nobel Prize in Science". The reason for the award is that she made major discoveries in social and emotional neuroscience, which provided a theoretical basis for innovative treatments and new drug development for depression.

Why is depression research receiving so much attention? In fact, it is not an exaggeration. Today we will talk about depression, which is often misunderstood but has a wide impact.

According to statistics from the World Health Organization, more than 350 million people worldwide suffer from depression, which has become the world's fourth largest disease and is still growing rapidly. In 2020, major depression increased by 28% worldwide, and the number of depression patients in my country has exceeded 95 million, with a lifetime prevalence rate of 6.8%. At present, depression has become the second largest killer of humans and the second largest disease burden in my country.

The WHO predicts that depression will become the leading cause of global disease burden by 2030. Depression is associated with an increased risk of developing conditions such as diabetes, heart disease and stroke, further increasing its disease burden. In addition, depression can lead to suicide. It is estimated that of the 800,000 suicides worldwide each year, up to 50% occur during a depressive episode, and people with depression are almost 20 times more likely to die by suicide than the general population.

Studies have shown that patients with depressive disorders have significantly impaired social functions, but the utilization rate of health services is very low, and they rarely receive adequate treatment. In my country, only 9.5% of patients diagnosed with depressive disorders in the past 12 months have received treatment from health service institutions during the same period. Since most patients with depressive disorders do not seek help from professional institutions, only 0.5% of patients receive adequate treatment.

The inadequate treatment of depression is related to the public's lack of understanding of depression. For example, many people confuse depression with depressive mood and depressive symptoms, and believe that it is not a disease but a problem of thought, so patients with depression do not need professional treatment, especially drug treatment. There are also confirmed patients who refuse to take medication because they are afraid of the side effects of antidepressants, and some people even believe that true depression cannot be cured. But this is not the case.

Depression is a mental illness. The causes of depression are very complex and are the result of the interaction of biological, psychological, and social factors.

From a biological perspective, that is, genetics, depression is not a hereditary disease. It is not the case that if a parent has depression, the child will also have depression. However, depression has a genetic susceptibility. If a first-degree relative has depression, the risk of developing depression increases three times.

In terms of social factors, temporally relevant stressful events (usually experiencing some negative events in the year before the onset of the disease), such as job loss, economic insecurity, chronic or life-threatening health problems, violence, separation and bereavement, most often occur in adulthood. On the other hand, adverse events experienced in childhood, such as physical and sexual abuse, psychological neglect, exposure to domestic violence or premature separation from parents due to death or separation, are antecedents of depression in late life.

So, how do biological, psychological, and social factors interact?

When experiencing life events with significant stress or long-term chronic stress, if the individual's ability to cope with stress is insufficient, a series of changes will occur in the body. Peripheral changes in cortisol levels and inflammatory mechanisms can induce depressive symptoms by disrupting neuroplasticity and corresponding neurogenesis at the cellular level, affecting brain structure and function, and people with genetic susceptibility are more likely to experience depressive symptoms.

In 2018, Hu Hailan's team discovered that there is a very small nucleus in the brain that plays a very important role in mediating negative emotions. They call it the "anti-reward center" in the brain. When the activity in the nucleus is abnormal or enters a high discharge state, the brain's "reward center" will be over-inhibited. The "reward center" is the source of dopamine, serotonin, and other chemicals related to nuclear pleasure, cardiac pleasure, and reward feelings. This may be the reason why people enter a state of depression.

Currently, the commonly used antidepressants in clinical practice are mainly from the "classic monoamine strategy" drugs discovered in the 1950s and 1960s, which are slow to take effect and have low efficacy. In recent years, ketamine, as a new antidepressant, has been hailed as the greatest discovery in the past half century due to its rapid antidepressant effect (it can quickly improve mood within a few hours) and significant efficacy. However, due to its potential addictiveness, ketamine is classified as a psychotropic drug, which limits its application in clinical antidepressant treatment.

Hu Hailan's team also found that ketamine can take effect quickly because it can quickly block the excessive discharge or over-activation of the "anti-reward center", thus acting as a switch. The team has found that at least one molecular target and the target of ketamine work in the same pathway. The team predicts that blocking this target will also have an anti-depressant effect. There are already drugs for this target in the clinic to treat other diseases. The team has started cooperation with the clinical team two or three years ago.

So, how can you quickly check yourself or help people around you identify depression? You may wish to refer to the following table:

If the following "three low" symptoms appear and last for more than two weeks, you should be alert: 1) low mood and lack of pleasure; 2) slow thinking, decreased memory and attention, slow reaction, etc. This is manifested in daze in study, life/work, poor memory, that is, slow thinking; 3) decreased will activity, not talking, not moving. Be aware as early as possible of whether you or someone around you has early signs of depression: anorexia or overeating; excessive sleep or insomnia; often getting angry and impulsive over trivial matters, being more impatient and impulsive than before; being unable to concentrate and having decreased memory; 5) Losing interest in many things and feeling lonely. Maybe you used to love playing with friends, but those activities that once excited you are now boring; feeling worthless or good for nothing; 7) Feeling like dying from time to time, and having suicidal thoughts/ideas; 8) Panic or anxiety, persistent and uncontrollable panic, usually accompanied by some physical discomfort, such as rapid heart rate and profuse sweating; 9) Unexplained pain and discomfort. Depression may also affect people's bodies, such as headaches, stomachaches, neck and back pain, and even nausea.

suggestion:

1) Correctly view “Can depression be cured?”

The course of depression, with periods of remission and chronicity, varies widely. After depression remits, residual symptoms and functional impairment often persist. In addition, the chance of relapse is high, as approximately 80% of patients experience at least one relapse in their lifetime.

Environmental factors are uncontrollable, and psychological coping ability cannot be improved overnight. Therefore, the purpose of treatment is not to cure the disease, but to reduce the painful experience and functional impairment caused by depressive symptoms.

2) How to prevent it?

Reducing adverse experiences in childhood and throughout the lifespan, including neglect and trauma, to reduce rates of depression;

Interventions at the individual level focus on lifestyle factors (such as smoking, alcohol consumption, and physical inactivity) as well as other risk factors such as intimate partner violence and stressful life events (such as bereavement or financial crisis).

"No two people have exactly the same life stories and circumstances, which ultimately leads to each person's unique experience with depression and different needs for help, support, and treatment," said Vikram Patel, co-chair of the report and professor at Harvard Medical School. "Similar to cancer care, depression is viewed in a staged and continuum form, and a framework is provided to recommend appropriate interventions starting from the origin of the disease."

This article is produced by Science Popularization China-Starry Sky Cultivation Program. Please indicate the source when reprinting