うつ病について精神科医が徹底的に話します。

Good evening, I'm psychiatrist Takahiro Haga. Today, for the second installment of "Dr. Haga Talks in Depth," I'll be talking about depression. Thank you for tuning in. First of all, depression is a much broader illness than you might think. In a nutshell, it's a state of low mental energy. When you have plenty of mental energy, you feel somehow brighter and naturally feel positive, thinking, "I'll do this today," or "I'll try that." On the other hand, when your mental energy is low, you feel depressed for no reason. You have no motivation at all. Your body feels heavy like lead. You feel extremely sleepy, or conversely, you can't sleep. Minor delusions such as "I'm worthless" or "I'm a sinner." Hypochondriacal anxiety that "I must have some serious illness." These are some of the symptoms you may experience. An overwhelming desire to die is also a sign of a "significant decline in mental energy." The important thing to remember here is that "everyone experiences a temporary decline in mental energy." If you've been up all night or dealing with problems for three days and nights in a row, it's only natural that you'll feel depressed and unmotivated. In some ways, this is a normal reaction. So, when does depression become a medical condition? When depression and lack of motivation continue for a certain period of time. This makes it impossible to maintain social and daily life. These two points are key. For example, someone who was previously able to go to work regularly may suddenly become unable to do so due to a decline in mental energy, and be forced to take a leave of absence. A housewife may find that she is barely able to do housework, and her room becomes a mess. When daily functioning has declined to this extent, it is considered to be a medical condition called depression. Depression does have a constitutional component, but compared to bipolar disorder and schizophrenia, environmental and stress factors are thought to play a slightly greater role. The most common age for it to occur is around 30. While schizophrenia and bipolar disorder are common in people around the age of 20, depression is more likely to develop after the brain has fully developed at around 25, during a period of great responsibility, such as a job offer, promotion, marriage, divorce, or move. Depression develops when a fully developed brain is overloaded for five to ten years and reaches a critical point. Roughly speaking, what's happening inside the brain is that the network of the hippocampus (memory), amygdala (emotions), and prefrontal cortex (rationality) isn't functioning properly. The hippocampus keeps digging up unpleasant memories. In response, the amygdala intensifies negative emotions like anxiety, fear, and depression. The prefrontal cortex (rationality) can't effectively control these. As this loop continues, negative thoughts become increasingly reinforced. Cognitive behavioral therapy is a typical psychotherapy that addresses this issue. For example, say you confessed your feelings to someone and were rejected. Will you interpret it as, "They completely disliked me, I'm worthless"? Will you interpret it as, "It just wasn't meant to be this time. Maybe I'll meet someone else in five or ten years." Even the same event can have a huge psychological impact depending on how you interpret it. Cognitive behavioral therapy works by gradually training this "habit of interpreting" in the prefrontal cortex. Many people think, "I know I should think positively without anyone telling me." However, just like learning English, "I know the method and the materials, but it's difficult to continue systematically on my own." That's why many people can actually change their way of thinking by working steadily with a counselor, about once a week. Perfectionism and negative thinking are common thought patterns among people with depression. Human society is actually designed to tolerate a lot of failure. A soccer forward has 10 chances, and if he scores once, he becomes a hero. A baseball player with a batting average of .300 is still considered a "great player" even if he fails seven times. However, people with depression tend to think, "If I have 10 tries, I have to succeed 10 times," and even if they succeed 3 out of 10 times, they'll blame themselves for "failing 7 times." This "habit of perspective" can be changed with time and training. It's actually possible for a gloomy person to become a more cheerful person. Next, let's talk about medication. Antidepressants, which are used to treat depression, are, roughly speaking, "drugs that increase serotonin." Increasing serotonin increases the amount of BDNF, a growth factor for nerve cells, which strengthens the ability to reorganize circuits that are about to break down or have incorrect connections into a more desirable form. The analogy I often use here is the "railroad tracks analogy." Counseling is the process of creating a blueprint f...