半うつ、俺が本書いたるわ！と精神科医が思った件

Good evening. This is Takahiro Haga, a psychiatrist. Today is Saturday, June 13th. I've cut my hair short, and I'm not sure if it makes me look fresher or more suspicious, but I'll continue talking today. Today's topic is "Haga's Proposed Concept of Genuine Semi-Depression." I previously gave an oral review of a book called "Semi-Depression." It describes a state where one's condition isn't quite depression, but is leaning towards it. In other words, it's a state where social functioning isn't significantly impaired, but there are clear signs of depression. The book uses the term "semi-depression" to describe this state. This book is selling very well, and I think it's very effective in spreading the concept of "semi-depression" in Japan. However, there were two major points that bothered me. First, the biological explanation is far too simplistic. To put it more strongly, some of the explanations are not medically accurate. The second issue is that the message is too heavily based on personal experience, and while it has passion, it contains many academically inaccurate points. Of course, to communicate clearly, it's necessary to cut out some of the finer details. For example, when explaining "this is what depression is," there's actually a wide range from typical to atypical cases. Explaining everything would make the message difficult to understand. The same applies to explanations of drug side effects. Package inserts list everything from serious to mild side effects, common to extremely rare. While this is important information, simply looking at it doesn't make it clear what you should really be careful about with this medication. Therefore, I don't think it's necessarily bad to omit rare cases or finer details for the sake of clarity. Rather, I believe it's important to convey the core message clearly, even if it means taking some risks. However, there's a difference between omitting certain information and lying to increase credibility. The book explained that the mechanism of semi-depression involves three neurotransmitters: dopamine, norepinephrine, and serotonin. It stated that if one of these is impaired, it leads to semi-depression, and if all three are impaired, it leads to depression. This is a very easy-to-understand explanation. However, medically, it's quite flawed. Or rather, it's inaccurate. Doctors are, to some extent, scientists. Therefore, I believe it's wrong to provide scientifically incorrect explanations for the sake of simplicity. So, what is true "semi-depression"? Medically, this can be considered subthreshold depression, or a depressive state below the diagnostic threshold. "Threshold" refers to a threshold. Depressive states range from mild to severe. Within that range, there's a line beyond which we diagnose "depression." This line is the threshold. A state that doesn't meet the diagnostic criteria for depression, but is clearly moving in the direction of depression—this is subthreshold depression. In Japanese, this is called sub-threshold depression or a sub-threshold depressive state. This is not just a hunch; it's a condition that has been studied internationally. A well-known study is a German clinical trial published in JAMA in 2016. It involved gathering people who didn't meet the diagnostic criteria for depression but exhibited depressive symptoms. They were divided into two groups: one receiving psychological intervention, and the other being monitored without intervention. The study tracked whether they developed depression afterward. The results showed that in the group that received no intervention, approximately 40% met the diagnostic criteria for depression after 12 months. In contrast, the incidence rate in the group that received psychological intervention was reduced to approximately 27%. In other words, psychological intervention significantly reduced the incidence of depression. There's an index called NNT (Number Needed to Prevent Depression), which indicates how many people need to be intervened to prevent one person from developing depression. In this study, the NNT was approximately 5.9, or about 6 people. This means that intervening in 6 people could potentially prevent one person from developing depression. This is extremely significant. Research involving administering antidepressants to individuals who haven't been diagnosed with depression presents ethical challenges. Antidepressants have side effects, and careful consideration is needed regarding the extent to which drug treatment should be administered before the diagnostic criteria are met. On the other hand, psychosocial approaches have relatively fewer side effects. These include explaining what depression is, reviewing thought patterns, modifying negative cognitions, and providing support through social skills training for interpersonal difficulties. Such interventions have the potential to reduce the incidence of depression. Therefore, I believe that raising aware...