最重症うつ病の実際を精神科医が語ります。

Good evening. I'm Haga Takahiro, a psychiatrist. Today, I'd like to explain in detail, from a psychiatrist's perspective, what exactly is the most severe form of depression? The reason I decided to take up this topic is that there's a channel run by a nurse working at a university hospital that I often talk about, and it has a video titled "The Most Severe Depression as Seen by a Psychiatric Nurse." It's been viewed over 200,000 times, and I've watched it myself. However, from a psychiatrist's perspective, there were a few parts that made me think, "Hmm? Isn't that quite off?" Furthermore, while the video says things like, "The most severe form of depression was cured with this treatment," the crucial question of "what kind of treatment" is never clearly explained, no matter how many times I watch it. After watching it, I'm left feeling a bit unsettled. And since I'm no YouTube pro, I honestly don't really understand why it got 200,000 views. However, on the other hand, if I were to talk sincerely, seriously, and coherently about the most severe forms of depression, my video might get 200,000 views, so I decided to make one. Broadly speaking, depression has two major symptoms. One is a depressed mood. The other is a loss of motivation. A depressed mood is like a low mood in terms of tension. You feel gloomy, gloomy, and down. That's what a depressed mood is. And then there's the loss of motivation. This can get even more serious than the "lack of motivation" or "lack of guts" that you might imagine. What happens when your motivation, willpower, and desire reach their extreme limits? Ultimately, you become unable to take action based on the three basic human needs. First, the desire for sleep. When your desire for sleep drops dramatically, you may find it impossible to sleep at all. Conversely, you may just lie around aimlessly, not even knowing whether you're asleep or awake. You may reach a state known as "friends with the floor." This is another major sleep-related abnormality. Next, appetite. This is truly dangerous. When you hear about a loss of appetite, people who want to lose weight might think it's a good thing. Recently, there have been reports of GLP-1 drugs like Manjaro and Ozempic being used for weight loss. A once-weekly injection suppresses appetite and leads to weight loss. However, the loss of appetite that occurs in the most severe stages of depression isn't just about "eating less." Even if you want to eat, you can't. Even if you try to force someone to feed you, you can't. The act of eating itself becomes impossible. People often describe it as "chewing gravel," but in my clinical practice, not many people actually use that exact description. However, when appetite is dramatically reduced, even if you bring food to your mouth, your mouth won't open, you spit it out, or you can't swallow. This can be life-threatening. What happens when you can't eat? You become pathologically thin. This leads to a state of progressive malnutrition known as "cachexia." This causes the stomach and intestines to stop functioning. The stomach stops producing acid, and the intestines' peristalsis slows down, losing their ability to propel food forward. Organs that are not used lose function. As a result, digestion and absorption become impossible. This can lead to morbid weight loss and, ultimately, death. The most severe forms of depression can reach this level. And sex drive, another of the three basic needs, declines relatively early. In my experience, the progression often follows this order: mild sex drive, followed by sleep disruption, and finally appetite loss. Of course, this varies from person to person. However, the stage when appetite approaches zero is quite urgent. When you can no longer take in calories, your body and mind become immobile. This can lead to complete immobility. This is where contracture comes into play. Contracture is when joints stiffen and become immobile. Joints are the spaces that connect bones, creating a range of motion. Within each joint is a joint capsule, which contains a lubricant called synovial fluid. This allows for smooth movement. However, if a joint is left completely immobile for a long period of time, the circulation of synovial fluid slows down, causing the joint to stiffen. This can lead to conditions such as elbows and knees remaining bent and unable to straighten. This is sometimes seen in the final stages of dementia, but the same thing can happen in the most severe cases of depression. In the past, you might imagine a nurse pushing you around, but today's hospital care is characterized by a greater division of labor. Many hospitals have systems in place to provide rehabilitation specialists and 30- to 60-minute range-of-motion exercises upon admission. More and more hospitals are offering rehabilitation on weekends, and this is also part of the medical fee structure. Now, let's talk about nutrition. "If they can't eat, I can just give t...