{"id":2466,"date":"2023-12-14T09:58:10","date_gmt":"2023-12-14T01:58:10","guid":{"rendered":"https:\/\/cathayvista.top\/?p=2466"},"modified":"2026-05-26T18:05:22","modified_gmt":"2026-05-26T10:05:22","slug":"major-depressive-disorder-zhen","status":"publish","type":"post","link":"https:\/\/cathayvista.top\/index.php\/2023\/12\/14\/major-depressive-disorder-zhen\/","title":{"rendered":"\u91cd\u6027\u6291\u90c1\u969c\u788d\uff08\u6291\u90c1\u75c7\uff09 \/ Major depressive disorder – \uff08\u5168\u6587\uff09\u4e2d\u82f1\u6587\u8bcd\u6761"},"content":{"rendered":"\n
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\u7ef4\u57fa\u767e\u79d1\uff08Wikipedia\uff09\u662f\u7f8e\u56fd\u7ef4\u57fa\u5a92\u4f53\u57fa\u91d1\u4f1a\u7684\u4e92\u8054\u7f51\u767e\u79d1\u9879\u76ee\uff08\u70b9\u51fb\u8fd9\u91cc\u4e86\u89e3\u66f4\u591a\uff09<\/a>\uff0c\u5176\u5185\u5bb9\u53ef\u80fd\u53d7\u5230\u7acb\u573a\u3001\u4fe1\u606f\u6765\u6e90\u7b49\u56e0\u7d20\u5f71\u54cd\uff0c\u8bf7\u5ba2\u89c2\u770b\u5f85\u3002\u6b63\u6587\u5185\u5bb9\u4e0d\u4ee3\u8868\u8bd1\u8005\u89c2\u70b9\u3002<\/p>\n\n\n\n

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\n\n\n\n
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<\/a>\u7ef4\u57fa\u767e\u79d1\u7684\u5b98\u65b9\u63d0\u793a\uff1a\u7ef4\u57fa\u767e\u79d1<\/a>\u4e2d\u7684\u533b\u5b66\u5185\u5bb9\u4ec5\u4f9b\u53c2\u8003<\/strong>\uff0c\u5e76\u4e0d\u80fd<\/strong>\u89c6\u4f5c\u4e13\u4e1a\u610f\u89c1\u3002\u5982\u9700\u83b7\u53d6\u533b\u7597\u5e2e\u52a9\u6216\u610f\u89c1\uff0c\u8bf7\u54a8\u8be2\u4e13\u4e1a\u4eba\u58eb\u3002\u8be6\u89c1\u533b\u5b66\u58f0\u660e<\/a><\/strong>\u3002<\/p>\n<\/blockquote>\n\n\n\n

0. \u6982\u8ff0<\/h2>\n\n\n\n
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0.1 \u6587\u5b57\u8bf4\u660e<\/h3>\n\n\n\n
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\u91cd\u6027\u6291\u90c1\u969c\u788d[7]<\/a>[8]<\/a><\/sup><\/strong>\uff08major depressive disorder, MDD\uff0c\u53f0\u6e7e\u8bd1\u4e25\u91cd\u5fe7\u90c1\u75be\u60a3[9]<\/a><\/sup><\/strong>\uff09\uff0c\u53c8\u8bd1\u91cd\u5ea6\u6291\u90c1\u75c7<\/strong>[10]<\/a><\/sup>\uff08\u7b80\u79f0\u91cd\u90c1\u75c7<\/strong>[9]<\/a><\/sup>\uff09\uff0c\u4e5f\u8bd1\u6291\u90c1\u75c7<\/strong>[11]<\/a>[\u6ce8 1]<\/a><\/sup>\uff0c\u662f\u4e00\u79cd\u7cbe\u795e\u75be\u60a3<\/a>\uff0c\u7279\u5f81\u4e3a\u8d85\u8fc7\u4e24\u5468\u7684\u5927\u591a\u6570\u65f6\u95f4\u90fd\u6291\u90c1<\/a>\u4e0d\u5df2\u3002\u5e38\u5e38\u4f34\u968f\u7740\u6ca1\u6709\u7cbe\u795e\u3001\u5bf9\u4e00\u822c\u4f11\u95f2\u6d3b\u52a8\u6ca1\u6709\u5174\u8da3<\/a>\u3001\u6ca1\u6765\u7531\u7684\u75bc\u75db<\/a>\u53ca\u81ea\u5c0a\u5fc3<\/a>\u4f4e\u843d\u3002\u60a3\u8005\u53ef\u80fd\u4f1a\u6709\u5984\u60f3<\/a>\u6216\u8005\u51fa\u73b0\u5e7b\u89c9<\/a>[1]<\/a><\/sup>\u3002\u6709\u4e9b\u60a3\u8005\u7684\u6291\u90c1\u75c7\u53d1\u4f5c<\/a>\u65f6\u671f\u5206\u4e3a\u597d\u51e0\u5e74\uff0c\u53ef\u80fd\u6709\u6bb5\u671f\u95f4\u4e0e\u5e38\u4eba\u65e0\u5f02\uff0c\u4f46\u5176\u4ed6\u65f6\u95f4\u4e00\u76f4\u51fa\u73b0\u6291\u90c1\u75c7\u75c7\u72b6[3]<\/a><\/sup>\u3002\u91cd\u5ea6\u6291\u90c1\u75c7\u4f1a\u5bf9\u65e5\u5e38\u751f\u6d3b\u3001\u5de5\u4f5c\u3001\u6559\u80b2\u3001\u7761\u7720\u3001\u996e\u98df\u4e60\u60ef\u4e0e\u6574\u4f53\u5065\u5eb7\u9020\u6210\u8d1f\u9762\u5f71\u54cd[1]<\/a>[3]<\/a><\/sup>\u3002\u5728\u6210\u5e74\u7684\u6291\u90c1\u75c7\u60a3\u8005\u4e2d\uff0c\u67092\u81f38%\u6b7b\u4e8e\u81ea\u6740<\/a>[2]<\/a><\/sup>\uff1b\u800c\u5927\u7ea6\u534a\u6570\u7684\u81ea\u6740\u8eab\u4ea1\u8005\u60a3\u6709\u6291\u90c1\u75c7\u6216\u5176\u4ed6\u60c5\u611f\u969c\u788d<\/a>[13]<\/a><\/sup>\u3002<\/p>\n\n\n\n

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\u91cd\u5ea6\u6291\u90c1\u75c7\u597d\u53d1\u4e8e 20 \u591a\u5c81\u81f3 30 \u591a\u5c81\u8005\u4e4b\u95f4\uff0c\u5973\u6027\u60a3\u8005\u7684\u6bd4\u7387\u662f\u7537\u6027\u7684\u4e24\u500d[3]<\/a><\/sup>[4]<\/a><\/sup>\u30021980\u5e74\uff0c\u7f8e\u56fd\u7cbe\u795e\u533b\u5b66\u5b66\u4f1a<\/a>\u5c06\u6b64\u75c7\u7eb3\u5165\u7cbe\u795e\u75be\u75c5\u8bca\u65ad\u4e0e\u7edf\u8ba1\u624b\u518c<\/a>\u7b2c\u4e09\u7248\uff08DSM-III\uff09\uff0c\u5728\u7b2c\u4e8c\u7248\uff08DSM-II\uff09\u4e2d\uff0c\u539f\u672c\u5c06\u6b64\u75c7\u89c6\u4e3a\u795e\u7ecf\u75c7<\/a>\u7684\u5206\u652f\uff0c\u5728\u5f53\u65f6\u90a3\u4e00\u7248\uff0c\u795e\u7ecf\u75c7\u4e5f\u5305\u542b\u4e86\u6301\u7eed\u6027\u6291\u90c1\u75c7<\/a>\u548c\u9002\u5e94\u969c\u788d\u75c7<\/a>[18]<\/a><\/sup>\u3002\u521a\u60a3\u75c5\u6216\u6709\u75c5\u53f2\u7684\u60a3\u8005\u53ef\u80fd\u4f1a\u906d\u5230\u6c61\u540d\u5316<\/a>[19]<\/a><\/sup>\u3002<\/p>\n\n\n\n

Major depressive disorder is believed to be caused by a combination of genetic<\/a>, environmental, and psychological factors,[1]<\/a><\/sup> with about 40% of the risk being genetic.[5]<\/a><\/sup> Risk factors include a family history<\/a> of the condition, major life changes, certain medications, chronic health problems<\/a>, and substance use disorders<\/a>.[1]<\/a>[5]<\/a><\/sup> It can negatively affect a person’s personal life, work life, or education, and cause issues with a person’s sleeping habits, eating habits, and general health.[1]<\/a>[5]<\/a><\/sup> Major depressive disorder affected approximately 163 million people (2% of the world’s population) in 2017.[8]<\/a><\/sup> The percentage of people who are affected at one point in their life varies from 7% in Japan to 21% in France.[4]<\/a><\/sup> Lifetime rates are higher in the developed world<\/a> (15%) compared to the developing world<\/a> (11%).[4]<\/a><\/sup> The disorder causes the second-most years lived with disability<\/a>, after lower back pain<\/a>.[14]<\/a><\/sup>
\u53c2\u8003\u8bd1\u6587\uff1a\u6291\u90c1\u75c7\u88ab\u8ba4\u4e3a\u662f\u7531\u9057\u4f20\u3001\u73af\u5883\u548c\u5fc3\u7406\u56e0\u7d20\u7684\u7ec4\u5408\u5f15\u8d77\u7684\uff0c\u7ea640%\u7684\u53d1\u75c5\u98ce\u9669\u662f\u9057\u4f20\u6027\u7684\u3002 \u98ce\u9669\u56e0\u7d20\u5305\u62ec\u5bb6\u65cf\u75c5\u53f2\u3001\u91cd\u5927\u751f\u6d3b\u53d8\u5316\u3001\u67d0\u4e9b\u836f\u7269\u3001\u6162\u6027\u5065\u5eb7\u95ee\u9898\u548c\u7269\u8d28\u6ee5\u7528\u7b49\u3002 \u5b83\u53ef\u4ee5\u5bf9\u4e00\u4e2a\u4eba\u7684\u4e2a\u4eba\u751f\u6d3b\u3001\u5de5\u4f5c\u751f\u6d3b\u6216\u6559\u80b2\u4ea7\u751f\u8d1f\u9762\u5f71\u54cd\uff0c\u5e76\u5bfc\u81f4\u4e00\u4e2a\u4eba\u7684\u7761\u7720\u4e60\u60ef\u3001\u996e\u98df\u4e60\u60ef\u548c\u6574\u4f53\u5065\u5eb7\u95ee\u9898\u3002 \u6291\u90c1\u75c7\u5f71\u54cd\u4e86\u5927\u7ea61.63\u4ebf\u4eba(\u5360\u4e16\u754c\u4eba\u53e3\u76842%)\uff0c2017\u5e74\u3002 \u60a3\u75c5\u7387\u5728\u4e0d\u540c\u56fd\u5bb6\u4e4b\u95f4\u6709\u6240\u4e0d\u540c\uff0c\u4ece\u65e5\u672c\u76847%\u5230\u6cd5\u56fd\u768421%\u4e0d\u7b49\u3002 \u5728\u53d1\u8fbe\u56fd\u5bb6\uff0c\u7ec8\u8eab\u60a3\u75c5\u7387\u66f4\u9ad8(15%)\uff0c\u800c\u5728\u53d1\u5c55\u4e2d\u56fd\u5bb6\u5219\u8f83\u4f4e(11%)\u3002 \u6291\u90c1\u75c7\u5bfc\u81f4\u4e86\u7b2c\u4e8c\u591a\u7684\u6b8b\u75be\u5e74\u6570\uff0c\u4ec5\u6b21\u4e8e\u8170\u75db\u3002<\/p>\n\n\n\n

\u540c\u4e49\u8bcd<\/a> | Other names<\/td>\u4e34\u5e8a\u6291\u90c1\u75c7\uff08Clinical depression\uff09\u3001
\u91cd\u5ea6\u6291\u90c1\u75c7\uff08Major depression\uff09\u3001
\u5355\u6781\u6027\u6291\u90c1\u75c7\uff08unipolar depression\uff09\u3001
\u590d\u53d1\u578b\u6291\u90c1\uff08recurrent depression\uff09<\/td><\/tr>
\u75c7\u72b6 | Symptoms<\/a><\/td>\u6291\u90c1<\/a>\u3001\u81ea\u5c0a\u5fc3<\/a>\u4f4e\u843d\u3001\u4e27\u5931\u539f\u6709\u7684\u5174\u8da3<\/a>\u3001\u7f3a\u4e4f\u6d3b\u529b\u3001\u75bc\u75db<\/a>\u4f46\u627e\u4e0d\u5230\u660e\u786e\u7684\u539f\u56e0[1]<\/a><\/sup><\/td><\/tr>
\u533b\u5b66\u4e13\u79d1 | Specialty<\/a><\/td>Psychiatry<\/a>\uff08\u7cbe\u795e\u75c5\u5b66\uff09, clinical psychology<\/a>\uff08\u4e34\u5e8a\u5fc3\u7406\u5b66\uff09<\/td><\/tr>
\u5e76\u53d1\u75c7<\/a> | Complications<\/a><\/td>\u81ea\u6211\u4f24\u5bb3<\/a>\u3001\u81ea\u6740<\/a>[2]<\/a><\/sup><\/td><\/tr>
\u5e38\u89c1\u59cb\u53d1\u4e8e | Usual onset<\/td>20\u201330\u5c81[3]<\/a>[4]<\/a><\/sup><\/td><\/tr>
\u75c5\u7a0b | Duration<\/td>> 2 \u5468[1]<\/a><\/sup><\/td><\/tr>
\u7c7b\u578b<\/td>\u6291\u90c1\u6027\u969c\u788d<\/a>\u3001\u60c5\u7eea\u6291\u90c1<\/a>\u3001\u75be\u75c5<\/a><\/td><\/tr>
\u8087\u56e0 | Causes<\/td>Environmental (adverse life experiences<\/a>, stressful life events), genetic<\/a> and psychological factors[5]<\/a><\/sup>
\u73af\u5883\u56e0\u7d20(\u4e0d\u826f\u751f\u6d3b\u7ecf\u5386\u3001\u538b\u529b\u751f\u6d3b\u4e8b\u4ef6)\u3001\u9057\u4f20\u548c\u5fc3\u7406\u56e0\u7d20<\/td><\/tr>
\u98ce\u9669\u56e0\u5b50<\/a> | Risk factors<\/a><\/td>\u5bb6\u65cf\u75c5\u53f2<\/a>\u3001\u751f\u6d3b\u906d\u9047\u5de8\u53d8\u3001\u67d0\u4e9b\u836f\u7269\u7684\u526f\u4f5c\u7528\u3001\u6162\u6027\u75c5<\/a>\u3001\u7269\u8d28\u6ee5\u7528<\/a>[1]<\/a>[3]<\/a><\/sup><\/td><\/tr>
\u76f8\u4f3c\u75be\u75c5\u6216\u5171\u75c5<\/a> | Differential diagnosis<\/a><\/td>\u8e81\u90c1\u75c7<\/a>\u3001\u6ce8\u610f\u529b\u4e0d\u8db3\u8fc7\u52a8\u75c7<\/a>\uff08ADHD\uff09\u3001\u60b2\u4f24<\/a>[3]<\/a><\/sup><\/td><\/tr>
\u6cbb\u7597 | Treatment<\/td>\u5fc3\u7406\u6cbb\u7597<\/a>\u3001\u6297\u6291\u90c1\u836f<\/a>\u3001\u7535\u4f11\u514b\u7597\u6cd5<\/a>\u3001\u8fd0\u52a8<\/a>[1]<\/a>[5]<\/a><\/sup> transcranial magnetic stimulation<\/a>\uff08\u7ecf\u9885\u78c1\u523a\u6fc0\uff09<\/td><\/tr>
\u76db\u884c\u7387 | Frequency<\/td>163 million (2017)[8]<\/a><\/sup>
1.63\u4ebf(2017)[8]<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

\u88682\uff1a\u5206\u7c7b\u548c\u5916\u90e8\u8d44\u6e90<\/strong><\/p>\n\n\n\n

ICD<\/a>–11<\/a><\/td>6A70<\/td><\/tr>
ICD<\/a>–9-CM<\/a><\/td>296.30\u3001\u200b296.20\u3001\u200b296.2\u3001\u200b296.3<\/td><\/tr>
OMIM<\/a><\/td>608520\u3001\u200b608691<\/a><\/td><\/tr>
DiseasesDB<\/a><\/td>3589<\/a><\/td><\/tr>
MedlinePlus<\/a><\/td>003213<\/a><\/td><\/tr>
eMedicine<\/a><\/td>286759<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

1. \u75c7\u72b6\u548c\u4f53\u5f81 | Symptoms and signs<\/h2>\n\n\n\n
\n
\"\"<\/a>
\u6b64\u56fe\u7247\u9075\u5faaCC BY-SA 4.0\u534f\u8bae
\u56fe\u7247\u8bf4\u660e\uff1aAn 1892 lithograph of a woman diagnosed with melancholia<\/a>\uff08\u4e00\u5e451892\u5e74\u7684\u5e73\u7248\u753b\uff0c\u753b\u7684\u662f\u4e00\u4e2a\u88ab\u8bca\u65ad\u60a3\u6709\u5fe7\u90c1\u75c7\u7684\u5973\u4eba\uff09
\u56fe\u7247\u6765\u6e90\uff1ahttps:\/\/wellcomeimages.org\/indexplus\/obf_images\/e4\/7b\/13622efb4fa8a60a617248709dae.jpg<\/a><\/figcaption><\/figure>\n\n\n\n
\"\"<\/a>
\u6b64\u56fe\u7247\u5c5e\u4e8e\u516c\u5171\u9886\u57df
\u56fe\u7247\u8bf4\u660e\uff1aVan Gogh – Trauernder alter Mann\uff08\u68b5\u9ad8 – \u300a\u54c0\u60bc\u7684\u8001\u5934\u300b\uff09
\u56fe\u7247\u4f5c\u8005\uff1aVincent van Gogh<\/a><\/figcaption><\/figure>\n<\/figure>\n\n\n\n

\u91cd\u5ea6\u6291\u90c1\u75c7\u662f\u4e00\u79cd\u5bf9\u60a3\u8005\u5bb6\u5ead\u3001\u4eba\u9645\u5173\u7cfb\u3001\u5de5\u4f5c\u3001\u5b66\u4e60\u3001\u65e5\u5e38\u996e\u98df\u4e0e\u7761\u7720\uff0c\u4ee5\u53ca\u5176\u4ed6\u8eab\u4f53\u529f\u80fd\u4ea7\u751f\u8d1f\u9762\u5f71\u54cd\u7684\u4e25\u91cd\u75be\u75c5\u3002\u5b83\u5bf9\u4eba\u4f53\u529f\u80fd\u4e0e\u751f\u6d3b\u8d28\u91cf\u7684\u5f71\u54cd\u53ef\u4ee5\u4e0e\u7cd6\u5c3f\u75c5<\/a>\u7b49\u6162\u6027\u751f\u7406\u75be\u75c5\u76f8\u63d0\u5e76\u8bba\u3002<\/p>\n\n\n\n

\u91cd\u5ea6\u6291\u90c1\u75c7\u53d1\u4f5c\u7684\u6700\u5178\u578b\u7684\u75c7\u72b6\u5305\u62ec\uff1a\u60a3\u8005\u957f\u671f\u5904\u4e8e\u6781\u5ea6\u6291\u90c1<\/a>\u7684\u60c5\u7eea\u72b6\u6001\u4e2d\uff0c\u5bf9\u4ee5\u524d\u611f\u5230\u6709\u8da3\u7684\u6d3b\u52a8\u5931\u53bb\u5174\u8da3\u751a\u81f3\u5931\u53bb\u81ea\u8eab\u7684\u8eab\u4f53\u6d3b\u52a8\u529b(\u4f8b\u5982\uff1a\u96be\u4ee5\u81ea\u5df1\u7a7f\u8131\u8863\u670d\u3001\u8fdb\u98df\u7b49\u7b49)\uff0c\u65e0\u6cd5\u6b63\u9762\u601d\u8003\u4e3a\u60a3\u8005\u6700\u660e\u663e\u7684\u7279\u5f81\uff0c\u8ba4\u4e3a\u751f\u6d3b\u662f\u79cd\u75db\u82e6\uff0c\u8ba4\u4e3a\u81ea\u5df1\u7684\u4eba\u751f\u6beb\u65e0\u4ef7\u503c\u3001\u6781\u5ea6\u7684\u7f6a\u6076\u611f\u3001\u5bf9\u4eba\u4e8b\u7269\u7684\u61ca\u6094\u611f\u3001\u65e0\u52a9\u611f\u3001\u5bf9\u672a\u6765\u611f\u5230\u7edd\u671b\u548c\u81ea\u66b4\u81ea\u5f03[20]<\/a><\/sup>\u3002\u6709\u65f6\u60a3\u8005\u4f1a\u611f\u5230\u96be\u4ee5\u96c6\u4e2d\u6ce8\u610f\u529b\u548c\u8bb0\u5fc6\u529b\u51cf\u9000\u3001\u65f6\u95f4\u611f\u53d8\u6162\uff08\u5c24\u5176\u662f\u5fe7\u90c1\u578b\u548c\u7cbe\u795e\u75c5\u6027\u6291\u90c1\u75c7\uff09[21]<\/a><\/sup>\u3002\u60a3\u8005\u8fd8\u8868\u73b0\u51fa\u56de\u907f\u793e\u4ea4\u573a\u5408\u548c\u793e\u4ea4\u6d3b\u52a8\u3001\u6027\u51b2\u52a8<\/a>\u51cf\u9000\u3001\u6709\u81ea\u6740\u5ff5\u5934\u6216\u53cd\u590d\u60f3\u5230\u6b7b\u4ea1\u7b49\u75c7\u72b6\u3002\u5931\u7720<\/a>\u4e5f\u662f\u4e00\u79cd\u5e38\u89c1\u75c7\u72b6\uff0c\u800c\u7761\u7720\u5468\u671f\u4e5f\u4f1a\u6709\u6240\u6df7\u4e71\uff0c\u65e9\u9192\u6700\u4e3a\u5e38\u89c1\uff0c\u6709\u65f6\u4e5f\u4f1a\u6709\u55dc\u7761<\/a>\u7684\u60c5\u51b5\uff0c\u4f46\u8fd9\u79cd\u60c5\u51b5\u76f8\u5bf9\u5c11\u89c1[22]<\/a><\/sup>\u3002\u6ca1\u6709\u98df\u6b32\u3001\u4f53\u91cd\u964d\u4f4e\u4e5f\u662f\u5e38\u89c1\u75c7\u72b6\uff0c\u4f46\u662f\u5076\u5c14\u4e5f\u6709\u98df\u6b32\u589e\u52a0\u3001\u4f53\u91cd\u589e\u52a0\u7684\u60c5\u51b5[20]<\/a><\/sup>\u3002\u60a3\u8005\u8fd8\u53ef\u80fd\u4f1a\u611f\u5230\u4e00\u4e9b\u751f\u7406\u65b9\u9762\u7684\u75c7\u72b6\uff0c\u5c24\u5176\u662f\u53d1\u5c55\u4e2d\u56fd\u5bb6\u7684\u60a3\u8005\u53ef\u80fd\u4f1a\u6709\u75b2\u52b3\u3001\u5934\u75db\u548c\u80a0\u80c3\u95ee\u9898\u53d1\u751f[23]<\/a><\/sup>\u3002\u60a3\u8005\u7684\u4eb2\u53cb\u8fd8\u53ef\u80fd\u4f1a\u6ce8\u610f\u5230\u60a3\u8005\u8e81\u52a8\u4e0d\u5b89\u6216\u65e0\u7cbe\u6253\u91c7[22]<\/a><\/sup>\u3002<\/p>\n\n\n\n

A depressed person may report multiple physical symptoms such as fatigue<\/a>, headaches, or digestive problems; physical complaints are the most common presenting problem in developing countries, according to the World Health Organization<\/a>‘s criteria for depression.[24]<\/a><\/sup> Appetite<\/a> often decreases, resulting in weight loss, although increased appetite and weight gain occasionally occur.[25]<\/a><\/sup> Family and friends may notice agitation<\/a> or lethargy<\/a>.[19]<\/a><\/sup> Older depressed people may have cognitive<\/a> symptoms of recent onset, such as forgetfulness,[26]<\/a><\/sup> and a more noticeable slowing of movements.[27]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u4e00\u4e2a\u6291\u90c1\u75c7\u60a3\u8005\u53ef\u80fd\u4f1a\u62a5\u544a\u591a\u79cd\u8eab\u4f53\u75c7\u72b6\uff0c\u6bd4\u5982\u75b2\u52b3\u3001\u5934\u75db\u6216\u6d88\u5316\u95ee\u9898\uff1b\u6839\u636e\u4e16\u754c\u536b\u751f\u7ec4\u7ec7\u5bf9\u6291\u90c1\u75c7\u7684\u8bca\u65ad\u6807\u51c6\uff0c\u5728\u53d1\u5c55\u4e2d\u56fd\u5bb6\uff0c\u8eab\u4f53\u75c7\u72b6\u662f\u6700\u5e38\u89c1\u7684\u6291\u90c1\u75c7\u75c7\u72b6\u3002\u98df\u6b32\u901a\u5e38\u4f1a\u51cf\u9000\uff0c\u5bfc\u81f4\u4f53\u91cd\u51cf\u8f7b\uff0c\u5c3d\u7ba1\u6709\u65f6\u4e5f\u4f1a\u51fa\u73b0\u98df\u6b32\u589e\u52a0\u548c\u4f53\u91cd\u589e\u52a0\u7684\u60c5\u51b5\u3002\u5bb6\u4eba\u548c\u670b\u53cb\u53ef\u80fd\u4f1a\u6ce8\u610f\u5230\u60a3\u8005\u7684\u7126\u8e81\u4e0d\u5b89\u6216\u8005\u5026\u6020\u65e0\u529b\u3002\u5e74\u957f\u7684\u6291\u90c1\u75c7\u60a3\u8005\u53ef\u80fd\u4f1a\u51fa\u73b0\u8ba4\u77e5\u75c7\u72b6\uff0c\u5982\u8bb0\u5fc6\u529b\u51cf\u9000\uff0c\u5e76\u4e14\u52a8\u4f5c\u660e\u663e\u51cf\u7f13\u3002<\/p>\n\n\n\n

Major depression significantly affects a person’s family and\u00a0personal relationships<\/a>, work or school life, sleeping and eating habits, and general health.[36]<\/a><\/sup>\u00a0Family and friends may notice\u00a0agitation<\/a>\u00a0or\u00a0lethargy<\/a>.[29]<\/a><\/sup>\u00a0Older depressed people may have cognitive symptoms of recent onset, such as forgetfulness,[37]<\/a><\/sup>\u00a0and a more noticeable slowing of movements.[38]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u91cd\u5ea6\u6291\u90c1\u75c7\u4f1a\u663e\u8457\u5f71\u54cd\u4e00\u4e2a\u4eba\u7684\u5bb6\u5ead\u4e0e\u79c1\u4eba\u5173\u7cfb\u3001\u5de5\u4f5c\u6216\u5b66\u4e1a\u3001\u7761\u7720\u4e0e\u996e\u98df\u4e60\u60ef\uff0c\u4ee5\u53ca\u6574\u4f53\u5065\u5eb7\u72b6\u51b5[36]\u3002\u5bb6\u4eba\u548c\u670b\u53cb\u53ef\u80fd\u4f1a\u5bdf\u89c9\u5230\u60a3\u8005\u8868\u73b0\u51fa\u7126\u8e81\u4e0d\u5b89\u6216\u7cbe\u795e\u840e\u9761[29]\u3002\u60a3\u6709\u6291\u90c1\u75c7\u7684\u8001\u5e74\u4eba\u53ef\u80fd\u4f1a\u51fa\u73b0\u8fd1\u671f\u53d1\u4f5c\u7684\u8ba4\u77e5\u75c7\u72b6\uff0c\u6bd4\u5982\u5065\u5fd8[37]\uff0c\u4ee5\u53ca\u66f4\u660e\u663e\u7684\u52a8\u4f5c\u8fdf\u7f13[38]\u3002<\/p>\n\n\n\n

\u8001\u5e74\u65b0\u53d1\u75c5\u7684\u60a3\u8005\u53ef\u80fd\u4f1a\u4f34\u6709\u8ba4\u77e5<\/a>\u65b9\u9762\u7684\u95ee\u9898\uff0c\u6bd4\u5982\u5065\u5fd8[21]<\/a><\/sup>\u6216\u8005\u660e\u663e\u7684\u79fb\u52a8\u7f13\u6162[24]<\/a><\/sup>\u3002\u6291\u90c1\u75c7\u7ecf\u5e38\u4e0e\u8001\u5e74\u60a3\u8005\u4e2d\u5e38\u89c1\u7684\u751f\u7406\u75be\u75c5\u540c\u65f6\u5b58\u5728\uff0c\u6bd4\u5982\u4e2d\u98ce<\/a>\uff0c\u5176\u4ed6\u5fc3\u8840\u7ba1\u75be\u75c5<\/a>\u3001\u5e15\u91d1\u68ee\u75c5<\/a>\u6216\u6162\u6027\u963b\u585e\u6027\u80ba\u75c5<\/a>[25]<\/a><\/sup>\u3002<\/p>\n\n\n\n

\u5728\u4e25\u91cd\u7684\u75c5\u4f8b\u4e2d\uff0c\u60a3\u8005\u4ece\u81ea\u89c9\u601d\u89c9\u5931\u8c03<\/a>\u8f6c\u800c\u5230\u5931\u63a7\u5984\u60f3<\/a>\uff0c\u6bd4\u5982\u8ba4\u4e3a\u81ea\u5df1\u7684\u4e00\u4e2a\u5c0f\u5c0f\u884c\u4e3a\u5bf9\u4e0d\u8d77\u522b\u4eba\uff0c\u4e43\u81f3\u5bf9\u4e0d\u8d77\u5168\u4e16\u754c\u3002\u6216\u52a0\u5165\u62df\u771f\uff08\u901a\u5e38\u4ee4\u4eba\u4e0d\u5feb\u7684\uff09\u5e7b\u89c9<\/a>[26]<\/a><\/sup>\uff0c\u6bd4\u5982\u8ba4\u4e3a\u81ea\u5df1\u7684\u80a0\u5b50\u4e0d\u6d3b\u52a8\uff0c\u4e43\u81f3\u8179\u5185\u7a7a\u65e0\u4e00\u7269\u3002<\/p>\n\n\n\n

\u513f\u7ae5\u60a3\u8005\u5219\u4e00\u822c\u8868\u73b0\u51fa\u6025\u8e81\u6613\u6012\uff08\u6613\u6fc0\u60f9\uff09\u800c\u4e0d\u662f\u6291\u90c1\u5fc3\u5883[20]<\/a><\/sup>\u3002\u4e0d\u540c\u5e74\u9f84\u548c\u4e0d\u540c\u60c5\u51b5\u7684\u513f\u7ae5\u60a3\u8005\u4f1a\u8868\u73b0\u51fa\u4e0d\u540c\u75c7\u72b6[27]<\/a><\/sup>\uff0c\u6700\u5e38\u89c1\u7684\u662f\u5bf9\u5b66\u6821\u5931\u53bb\u5174\u8da3\u548c\u5b66\u4e60\u6210\u7ee9\u4e0b\u964d\u3001\u8fc7\u5206\u4f9d\u8d56\u3001\u5145\u6ee1\u4e0d\u5b89\u5168\u611f[22]<\/a><\/sup>\u3002\u7531\u4e8e\u8fd9\u4e9b\u75c7\u72b6\u5e38\u5e38\u88ab\u8ba4\u4e3a\u662f\u666e\u901a\u7684\u60c5\u7eea\u4f4e\u843d\uff0c\u6240\u4ee5\u53ef\u80fd\u9020\u6210\u5ef6\u8bef\u8bca\u65ad\u751a\u81f3\u6f0f\u8bca[20]<\/a><\/sup>\u3002\u6291\u90c1\u75c7\u53ef\u80fd\u4e0e\u6ce8\u610f\u529b\u4e0d\u8db3\u8fc7\u52a8\u75c7<\/a>\u540c\u65f6\u53d1\u751f\uff0c\u8fd9\u4f7f\u5f97\u4e24\u79cd\u75be\u75c5\u7684\u8bca\u65ad\u548c\u6cbb\u7597\u90fd\u53d8\u5f97\u66f4\u590d\u6742[28]<\/a><\/sup>\u3002<\/p>\n\n\n\n

2. \u75c5\u56e0 | Cause<\/h2>\n\n\n\n

Further information:\u00a0Biology of depression<\/a>\u00a0and\u00a0Epigenetics of depression<\/a><\/em>
\u3010\u53e6\u89c1\uff1a\u6291\u90c1\u75c7\u7684\u751f\u7269\u5b66\u4e0e\u6291\u90c1\u75c7\u7684\u8868\u89c2\u9057\u4f20\u5b66\u3011<\/em><\/p>\n\n\n\n

\"\"<\/a>
\u6b64\u56fe\u7247\u9075\u5faaCC BY-SA 4.0\u534f\u8bae
\u56fe\u7247\u9898\u6ce8\uff1aA cup analogy demonstrating the\u00a0diathesis\u2013stress model<\/a>\u00a0that under the same amount of stressors, person 2 is more vulnerable than person 1, because of their predisposition[42]<\/a><\/sup>
\u53c2\u8003\u8bd1\u6587\uff1a\u4e00\u5f20\u7528\u4ee5\u9610\u91ca\u2018\u7d20\u8d28-\u538b\u529b\u6a21\u578b\u2019\u7684\u676f\u5b50\u7c7b\u6bd4\u56fe\uff1a\u5728\u627f\u53d7\u540c\u7b49\u7a0b\u5ea6\u7684\u538b\u529b\u6e90\u65f6\uff0c\u7531\u4e8e\u4e2a\u4f532\u672c\u8eab\u5177\u6709\u6613\u611f\u6027\uff08\u5373\u5148\u5929\u7d20\u8d28\/ predisposition\uff09\uff0c\u56e0\u6b64\u6bd4\u4e2a\u4f531\u66f4\u8106\u5f31\uff08\u66f4\u5bb9\u6613\u2018\u6ea2\u51fa\u2019\u6216\u5d29\u6e83\uff09[42]\u3002
\u56fe\u7247\u6765\u6e90\uff1aBlacktc<\/a><\/figcaption><\/figure>\n\n\n\n

\u5f15\u8d77\u4e25\u91cd\u6291\u90c1\u75c7\u7684\u539f\u56e0\u5c1a\u4e0d\u6e05\u695a\u3002\u4f46\u5df2\u7ecf\u63d0\u51fa\u751f\u7269\u5fc3\u7406\u793e\u4f1a\u6a21\u5f0f<\/a>\uff0c\u8fd9\u6307\u51fa\u751f\u7269\u5b66\uff0c\u5fc3\u7406\u5b66\u548c\u793e\u4f1a\u5b66\u56e0\u7d20\u5728\u5f15\u8d77\u6291\u90c1\u75c7\u4e2d\u90fd\u8d77\u7740\u91cd\u8981\u4f5c\u7528\u3002\u7d20\u8d28\uff0d\u5e94\u6fc0\u6a21\u5f0f<\/a>\u5219\u6307\u51fa\u4e86\u5f53\u4e00\u4e2a\u9884\u5148\u5b58\u5728\u4e14\u6613\u53d7\u4f24\u5bb3\u7684\u8106\u5f31\u4f53\u8d28\u6216\u8eab\u4f53\u7d20\u8d28\uff0c\u88ab\u6781\u5176\u7d27\u5f20\u7684\u751f\u6d3b\u4e8b\u4ef6\u6240\u6fc0\u6d3b\uff0c\u6291\u90c1\u75c7\u5c31\u4f1a\u53d1\u751f\u3002\u9884\u5148\u5b58\u5728\u6613\u53d7\u4f24\u7684\u8eab\u4f53\u7d20\u8d28\u53ef\u4ee5\u662f\u9057\u4f20\u7684\uff0c\u610f\u5473\u7740\u5728\u81ea\u7136\u4e0e\u517b\u80b2\u4e4b\u95f4\u76f8\u4e92\u4f5c\u7528\uff0c\u6216\u9020\u56e0\u4e8e\u7ae5\u5e74\u65f6\u671f\u5bf9\u4e16\u95f4\u7684\u89c2\u5ff5\u3002\u7ae5\u5e74\u65f6\u671f\u88ab\u8650\u5f85\uff0c\u4e0d\u8bba\u662f\u8eab\u4f53\u8650\u5f85\uff0c\u6027\u8650\u5f85\u6216\u5fc3\u7406\u4e0a\u7684\u8650\u5f85\u90fd\u662f\u5f15\u8d77\u6291\u90c1\u75c7\u7684\u5371\u9669\u56e0\u7d20\u3002\u5176\u4ed6\u5982\u7126\u8651\u548c\u836f\u7269\u6ee5\u7528\u662f\u53ef\u4ee5\u5171\u540c\u53d1\u751f\u7684\u5176\u4ed6\u7cbe\u795e\u95ee\u9898\u3002\u513f\u7ae5\u65f6\u671f\u7684\u521b\u4f24\u4e5f\u4e0e\u6291\u90c1\u75c7\u7684\u4e25\u91cd\u7a0b\u5ea6\uff0c\u5bf9\u6cbb\u7597\u7f3a\u4e4f\u53cd\u5e94\u548c\u60a3\u75c5\u65f6\u95f4\u957f\u6709\u5173\u3002\u7ae5\u5e74\u53d7\u521b\u4f24\u540e\u66f4\u5bb9\u6613\u5f15\u53d1\u7cbe\u795e\u75be\u75c5\u5982\u6291\u90c1\u75c7\u3002\u4e5f\u63d0\u51fa\u4e86\u5404\u79cd\u57fa\u56e0\u63a7\u5236\u6613\u60a3\u75c5\u6027\u3002[35]<\/a><\/sup><\/p>\n\n\n\n

\u7d20\u8d28\uff0d\u5e94\u6fc0\u6a21\u5f0f<\/a>\u5219\u8ba4\u4e3a\u6291\u90c1\u75c7\u662f\u60a3\u8005\u7684\u65e2\u6709\u6613\u611f\u6027\uff08\u7d20\u8d28\uff09\u88ab\u751f\u6d3b\u4e2d\u7684\u5e94\u6fc0\u4e8b\u4ef6\u6fc0\u6d3b\u3002\u60a3\u8005\u7684\u8fd9\u79cd\u6613\u611f\u6027\u53ef\u4ee5\u662f\u7531\u4e8e\u9057\u4f20<\/a>\u6240\u9020\u6210\u7684[36]<\/a><\/sup>[37]<\/a><\/sup>\uff0c\u4ece\u800c\u6d89\u53ca\u5230\u5148\u5929\u4e0e\u540e\u5929<\/a>\u7684\u76f8\u4e92\u4f5c\u7528\uff0c\u6216\u8005\u662f\u4e00\u79cd\u56fe\u5f0f<\/a>\uff0c\u60a3\u8005\u5728\u513f\u65f6\u901a\u8fc7\u5b66\u4e60\u6240\u5f97\u5230\u7684\u7279\u5b9a\u8ba4\u77e5\u6a21\u5f0f[38]<\/a><\/sup>\u3002\u4ee5\u4e0a\u8fd9\u4e24\u79cd\u4e92\u52a8\u6a21\u5f0f\u90fd\u5f97\u5230\u4e86\u5b9e\u9a8c\u7684\u652f\u6301\u3002\u4f8b\u5982\uff0c\u65b0\u897f\u5170<\/a>\u7684\u7814\u7a76\u4eba\u5458\u91c7\u7528\u9884\u6d4b\u6cd5<\/a>\u7814\u7a76\u6291\u90c1\u75c7\u3002\u5b9e\u9a8c\u4e2d\u7814\u7a76\u4eba\u5458\u957f\u65f6\u95f4\u8ddf\u8e2a\u4e00\u7fa4\u539f\u672c\u5065\u5eb7\u7684\u4eba\uff0c\u5e76\u8bb0\u5f55\u4e0e\u6291\u90c1\u75c7\u6709\u5173\u7684\u60c5\u51b5\u3002\u6700\u7ec8\u7814\u7a76\u4eba\u5458\u5f97\u51fa\u7ed3\u8bba\uff0c\u4eba\u4f53\u51855-\u7f9f\u8272\u80fa\u8f6c\u8fd0\u4f53<\/a>\uff085-HTT\uff09\u57fa\u56e0\u5f71\u54cd\u5230\u4eba\u4eec\u662f\u5426\u5728\u5e94\u5bf9\u5e94\u6fc0\u4e8b\u4ef6\u65f6\u6301\u7eed\u4f53\u9a8c\u5230\u6291\u90c1\u3002\u4ed6\u4eec\u7279\u522b\u6307\u51fa\uff1a\u6291\u90c1\u75c7\u66f4\u5bb9\u6613\u53d1\u751f\u5728\u6709\u4e00\u4e2a\u6216\u4e8c\u4e2a5-\u7f9f\u8272\u80fa\u8f6c\u8fd0\u4f53\u7684\u77ed\u7b49\u4f4d\u57fa\u56e0<\/a>\u7684\u4eba\u8eab\u4e0a[36]<\/a><\/sup>\u3002<\/p>\n\n\n\n

\u4e00\u9879\u745e\u5178<\/a>\u7684\u7814\u7a76\u4f30\u8ba1\u4e86\u6291\u90c1\u75c7\u7684\u9057\u4f20<\/a>\u51e0\u7387\uff0c\u5bf9\u5973\u6027\u6765\u8bf4\u5927\u7ea6\u4e3a40%\uff0c\u5bf9\u7537\u6027\u7ea6\u4e3a30%[39]<\/a><\/sup>\u3002\u6f14\u5316\u5fc3\u7406\u5b66\u5bb6<\/a>\u8ba4\u4e3a\u4f7f\u4eba\u4eec\u60a3\u6291\u90c1\u75c7\u7684\u57fa\u56e0\u65e9\u5df2\u5b58\u5728\u4e8e\u81ea\u7136\u9009\u62e9<\/a>\u7684\u5386\u53f2\u4e2d\u3002\u5982\u679c\u60a3\u8005\u957f\u671f\u670d\u7528\u7cbe\u795e\u7c7b\u836f\u7269\uff0c\u4f8b\u5982\u957f\u671f\u4f7f\u7528\u9547\u9759\u5242\u548c\u5b89\u7720\u836f<\/a>\uff0c\u4e5f\u4f1a\u4ea7\u751f\u7c7b\u4f3c\u4e8e\u91cd\u5ea6\u6291\u90c1\u75c7\u7684\u75c7\u72b6\u3002\u8fd9\u4e9b\u75c7\u72b6\u662f\u7531\u836f\u7269\u7684\u526f\u4f5c\u7528\u6216\u8005\u836f\u7269\u7684\u6212\u65ad\u53cd\u5e94<\/a>\u5f15\u8d77\u7684\uff0c\u88ab\u79f0\u4e3a\u7cbe\u795e\u6d3b\u6027\u7269\u8d28\u6240\u81f4\u7cbe\u795e\u969c\u788d<\/a>\uff0c\u800c\u4e0d\u5c5e\u4e8e\u91cd\u5ea6\u6291\u90c1\u75c7[40]<\/a><\/sup>[41]<\/a><\/sup>\u3002<\/p>\n\n\n\n

\"\"<\/a>
\u6b64\u56fe\u7247\u9075\u5faaCC BY-SA 4.0\u534f\u8bae
\u56fe\u7247\u9898\u6ce8\uff1a\u7d20\u8d28\uff0d\u5e94\u6fc0\u6a21\u5f0f<\/a>\u9884\u6d4b\u5f53\u4eba\u4eec\u672c\u8eab\u7684\u503e\u5411\u4e0e\u5e94\u6fc0\u52a0\u5728\u4e00\u8d77\uff0c\u8d85\u8fc7\u4e00\u5b9a\u6c34\u5e73\u5c31\u4f1a\u53d1\u75c5\u3002
\u56fe\u7247\u6765\u6e90\uff1aBlacktc<\/a><\/figcaption><\/figure>\n\n\n\n

2.1 \u57fa\u56e0 | Genetics<\/h3>\n\n\n\n

Further information:\u00a0Behavioural genetics<\/a>\u00a0and\u00a0Genetic epidemiology<\/a>\u3010\u53e6\u89c1\uff1a\u884c\u4e3a\u9057\u4f20\u5b66 \u4e0e \u9057\u4f20\u6d41\u884c\u75c5\u5b66\u3011<\/em><\/p>\n\n\n\n

Genes play a major role in the development of depression.[52]<\/a><\/sup>\u00a0Family and twin studies suggest that genetic factors account for nearly 40% of the variation in risk for major depressive disorder. Like most psychiatric disorders, major depression is likely shaped by a combination of many individual genetic influences.[53]<\/a><\/sup>\u00a0In 2018, a\u00a0genome-wide association study<\/a>\u00a0discovered 44 genetic variants linked to risk for major depression;[54]<\/a><\/sup>\u00a0a 2019 study found 102 variants in the genome linked to depression.[55]<\/a><\/sup>\u00a0However, it appears that major depression is less\u00a0heritable<\/a>\u00a0compared to\u00a0bipolar disorder<\/a>\u00a0and\u00a0schizophrenia<\/a>.[56]<\/a>[57]<\/a><\/sup>\u00a0Research focusing on specific candidate genes has been criticized for its tendency to generate false positive findings.[58]<\/a><\/sup>\u00a0There are also other efforts to examine interactions between life stress and polygenic risk for depression.[59]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u57fa\u56e0\u5728\u6291\u90c1\u75c7\u7684\u53d1\u751f\u53d1\u5c55\u4e2d\u8d77\u7740\u91cd\u8981\u4f5c\u7528[52]\u3002\u5bb6\u65cf\u548c\u53cc\u80de\u80ce\u7814\u7a76\u8868\u660e\uff0c\u9057\u4f20\u56e0\u7d20\u89e3\u91ca\u4e86\u91cd\u5ea6\u6291\u90c1\u75c7\u60a3\u75c5\u98ce\u9669\u4e2d\u8fd140%\u7684\u5dee\u5f02\u3002\u50cf\u5927\u591a\u6570\u7cbe\u795e\u75be\u75c5\u4e00\u6837\uff0c\u91cd\u5ea6\u6291\u90c1\u75c7\u5f88\u53ef\u80fd\u662f\u7531\u8bb8\u591a\u72ec\u7acb\u7684\u9057\u4f20\u5f71\u54cd\u5171\u540c\u5851\u9020\u7684[53]\u30022018\u5e74\uff0c\u4e00\u9879\u5168\u57fa\u56e0\u7ec4\u5173\u8054\u7814\u7a76\uff08GWAS\uff09\u53d1\u73b0\u4e8644\u4e2a\u4e0e\u91cd\u5ea6\u6291\u90c1\u75c7\u98ce\u9669\u76f8\u5173\u7684\u9057\u4f20\u53d8\u5f02\uff1b2019\u5e74\u7684\u4e00\u9879\u7814\u7a76\u5219\u53d1\u73b0\u4e86\u57fa\u56e0\u7ec4\u4e2d102\u4e2a\u4e0e\u6291\u90c1\u75c7\u76f8\u5173\u7684\u53d8\u5f02[54][55]\u3002\u4e0d\u8fc7\uff0c\u4e0e\u53cc\u76f8\u60c5\u611f\u969c\u788d\u548c\u7cbe\u795e\u5206\u88c2\u75c7\u76f8\u6bd4\uff0c\u91cd\u5ea6\u6291\u90c1\u75c7\u7684\u9057\u4f20\u6027\u4f3c\u4e4e\u76f8\u5bf9\u8f83\u4f4e[56][57]\u3002\u4ee5\u5f80\u9488\u5bf9\u7279\u5b9a\u5019\u9009\u57fa\u56e0\u7684\u7814\u7a76\u56e0\u5bb9\u6613\u4ea7\u751f\u5047\u9633\u6027\u7ed3\u679c\u800c\u53d7\u5230\u6279\u8bc4[58]\u3002\u76ee\u524d\uff0c\u4e5f\u6709\u5176\u4ed6\u7814\u7a76\u81f4\u529b\u4e8e\u63a2\u8ba8\u751f\u6d3b\u538b\u529b\u4e0e\u6291\u90c1\u75c7\u591a\u57fa\u56e0\u98ce\u9669\u4e4b\u95f4\u7684\u76f8\u4e92\u4f5c\u7528[59]\u3002<\/p>\n\n\n\n

2.2 \u5176\u4ed6\u5065\u5eb7\u95ee\u9898<\/strong> | Other health problems<\/h3>\n\n\n\n

Depression can also arise after a chronic or terminal medical condition, such as\u00a0HIV\/AIDS<\/a>\u00a0or\u00a0asthma<\/a>, and may be labeled “secondary depression”.[60]<\/a>[61]<\/a><\/sup>\u00a0It is unknown whether the underlying diseases induce depression through effect on quality of life, or through shared etiologies (such as degeneration of the\u00a0basal ganglia<\/a>\u00a0in\u00a0Parkinson’s disease<\/a>\u00a0or immune dysregulation in asthma).[62]<\/a><\/sup>\u00a0Depression may also be\u00a0iatrogenic<\/a>\u00a0(the result of healthcare), such as drug-induced depression. Therapies associated with depression include\u00a0interferons<\/a>,\u00a0beta blockers<\/a>,[63]<\/a><\/sup>\u00a0isotretinoin<\/a>,[64]<\/a><\/sup>\u00a0contraceptives<\/a>,[63]<\/a><\/sup>\u00a0cardiac agents,[65]<\/a><\/sup>\u00a0anticonvulsants<\/a>,[66]<\/a><\/sup>\u00a0and\u00a0hormonal agents<\/a>.[67]<\/a><\/sup>\u00a0Celiac disease<\/a>\u00a0is another possible contributing factor.[68]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u6291\u90c1\u75c7\u4e5f\u53ef\u80fd\u7ee7\u53d1\u4e8e\u67d0\u4e9b\u6162\u6027\u6216\u7edd\u75c7\u6027\u7684\u8eaf\u4f53\u75be\u75c5\u4e4b\u540e\uff0c\u4f8b\u5982 HIV\/AIDS\uff08\u827e\u6ecb\u75c5\uff09\u6216\u54ee\u5598\uff0c\u8fd9\u79cd\u60c5\u51b5\u901a\u5e38\u88ab\u79f0\u4e3a\u201c\u7ee7\u53d1\u6027\u6291\u90c1\u75c7\u201d[60][61]\u3002\u76ee\u524d\u5c1a\u4e0d\u6e05\u695a\u8fd9\u4e9b\u57fa\u7840\u75be\u75c5\u7a76\u7adf\u662f\u56e0\u4e3a\u964d\u4f4e\u4e86\u60a3\u8005\u7684\u751f\u6d3b\u8d28\u91cf\u800c\u5f15\u53d1\u6291\u90c1\uff0c\u8fd8\u662f\u56e0\u4e3a\u5b83\u4eec\u4e0e\u6291\u90c1\u75c7\u6709\u7740\u5171\u540c\u7684\u75c5\u56e0\uff08\u4f8b\u5982\u5e15\u91d1\u68ee\u75c5\u4e2d\u7684\u57fa\u5e95\u795e\u7ecf\u8282\u9000\u5316\uff0c\u6216\u54ee\u5598\u4e2d\u7684\u514d\u75ab\u5931\u8c03\uff09[62]\u3002\u6291\u90c1\u75c7\u4e5f\u53ef\u80fd\u662f\u533b\u6e90\u6027\u7684\uff08\u5373\u7531\u533b\u7597\u884c\u4e3a\u5bfc\u81f4\u7684\uff09\uff0c\u6bd4\u5982\u836f\u7269\u8bf1\u53d1\u7684\u6291\u90c1\u75c7\u3002\u4e0e\u6291\u90c1\u75c7\u76f8\u5173\u7684\u836f\u7269\u7597\u6cd5\u5305\u62ec\u5e72\u6270\u7d20\u3001\u03b2\u53d7\u4f53\u963b\u6ede\u5242[63]\u3001\u5f02\u7ef4A\u9178[64]\u3001\u907f\u5b55\u836f[63]\u3001\u5fc3\u810f\u836f\u7269[65]\u3001\u6297\u60ca\u53a5\u836f[66]\u4ee5\u53ca\u6fc0\u7d20\u7c7b\u836f\u7269[67]\u3002\u4e73\u7cdc\u6cfb\uff08Celiac disease\uff09\u4e5f\u53ef\u80fd\u662f\u53e6\u4e00\u4e2a\u6f5c\u5728\u7684\u8bf1\u56e0[68]\u3002<\/p>\n\n\n\n

Substance use in early age is associated with increased risk of developing depression later in life.[69]<\/a><\/sup>\u00a0Depression occurring after giving birth is called\u00a0postpartum depression<\/a>\u00a0and is thought to be the result of hormonal changes associated with pregnancy.[70]<\/a><\/sup>\u00a0Seasonal affective disorder<\/a>, a type of depression associated with seasonal changes in sunlight, is thought to be triggered by decreased sunlight.[71]<\/a><\/sup>\u00a0Vitamin B2<\/sub>, B6<\/sub>\u00a0and B12<\/sub>\u00a0deficiency may cause depression in females.[72]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u65e9\u5e74\u6ee5\u7528\u7269\u8d28\uff08\u5982\u9152\u7cbe\u6216\u6bd2\u54c1\uff09\u4e0e\u65e5\u540e\u60a3\u4e0a\u6291\u90c1\u75c7\u7684\u98ce\u9669\u589e\u52a0\u6709\u5173[69]\u3002\u5206\u5a29\u540e\u51fa\u73b0\u7684\u6291\u90c1\u75c7\u88ab\u79f0\u4e3a\u4ea7\u540e\u6291\u90c1\u75c7\uff0c\u4eba\u4eec\u8ba4\u4e3a\u8fd9\u4e0e\u6000\u5b55\u76f8\u5173\u7684\u6fc0\u7d20\u53d8\u5316\u6709\u5173[70]\u3002\u5b63\u8282\u6027\u60c5\u611f\u969c\u788d\uff08SAD\uff09\u662f\u4e00\u79cd\u4e0e\u65e5\u7167\u968f\u5b63\u8282\u53d8\u5316\u76f8\u5173\u7684\u6291\u90c1\u75c7\uff0c\u5176\u89e6\u53d1\u56e0\u7d20\u88ab\u8ba4\u4e3a\u662f\u9633\u5149\u7167\u5c04\u51cf\u5c11[71]\u3002\u7ef4\u751f\u7d20B2\u3001B6\u548cB12\u7684\u7f3a\u4e4f\u53ef\u80fd\u4f1a\u5bfc\u81f4\u5973\u6027\u60a3\u4e0a\u6291\u90c1\u75c7[72]\u3002<\/p>\n\n\n\n

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A 2025 study found that, among more than 172,500 adults in the\u00a0UK<\/a>\u00a0aged 39 and older, those with a history of depression experienced the onset of\u00a0chronic illnesses<\/a>\u00a0approximately 30% earlier than those without depression.[73]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u4e00\u98792025\u5e74\u7684\u7814\u7a76\u53d1\u73b0\uff0c\u5728\u5bf9\u82f1\u56fd\u8d85\u8fc717.25\u4e07\u540d39\u5c81\u53ca\u4ee5\u4e0a\u7684\u6210\u5e74\u4eba\u8fdb\u884c\u8c03\u67e5\u540e\uff0c\u6709\u6291\u90c1\u75c7\u75c5\u53f2\u7684\u4eba\u60a3\u4e0a\u6162\u6027\u75be\u75c5\u7684\u65f6\u95f4\uff0c\u6bd4\u6ca1\u6709\u6291\u90c1\u75c7\u7684\u4eba\u5e73\u5747\u63d0\u524d\u4e86\u7ea630%[73]\u3002<\/p>\n\n\n\n

A\u00a0meta-analysis<\/a>\u00a0linking depression to elevated levels of\u00a0C-reactive protein<\/a>\u00a0(CRP) cites research indicating that\u00a0inflammation<\/a>\u00a0might contribute to depression.[74]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u4e00\u9879\u5c06\u6291\u90c1\u75c7\u4e0eC\u53cd\u5e94\u86cb\u767d\uff08CRP\uff09\u6c34\u5e73\u5347\u9ad8\u8054\u7cfb\u8d77\u6765\u7684\u835f\u8403\u5206\u6790\u6307\u51fa\uff0c\u6709\u7814\u7a76\u8868\u660e\u708e\u75c7\u53ef\u80fd\u662f\u5bfc\u81f4\u6291\u90c1\u75c7\u7684\u4e00\u4e2a\u56e0\u7d20[74]\u3002<\/p>\n\n\n\n

2.3 \u4eba\u683c\u6216\u8ba4\u77e5\u5fc3\u7406\u5b66\u65b9\u9762\u7684\u56e0\u7d20<\/h3>\n\n\n\n

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\"\"<\/a>
\u6b64\u56fe\u7247\u9075\u5faaCC BY-SA 4.0\u534f\u8bae
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\u56fe\u7247\u6765\u6e90\uff1aBlacktc<\/a><\/figcaption><\/figure>\n\n\n\n

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\u7cbe\u795e\u5206\u6790\u5b66<\/a>\u3001\u5b58\u5728\u4e3b\u4e49\u5fc3\u7406\u5b66<\/a>\u3001\u4eba\u672c\u4e3b\u4e49\u5fc3\u7406\u5b66<\/a>\u4e5f\u6709\u5173\u4e8e\u6291\u90c1\u75c7\u672c\u8d28\u7684\u7406\u8bba\u3002\u6839\u636e\u5965\u5730\u5229<\/a>\u7cbe\u795e\u75c5\u4e13\u5bb6\u897f\u683c\u8499\u5fb7\u00b7\u5f17\u6d1b\u4f0a\u5fb7<\/a>\u7684\u7ecf\u5178\u7cbe\u795e\u5206\u6790\u7406\u8bba\uff0c\u6291\u90c1\u75c7\u6216\u7cbe\u795e\u5fe7\u90c1\u75c7<\/a>\u53ef\u80fd\u4e0e\u4eba\u9645\u5173\u7cfb\u4e27\u5931[81]<\/a><\/sup>[82]<\/a><\/sup>\u548c\u65e9\u5e74\u7ecf\u5386\u6709\u5173[83]<\/a><\/sup>\u3002\u5b58\u5728\u4e3b\u4e49\u5fc3\u7406\u5b66\u5bb6\u5219\u628a\u6291\u90c1\u75c7\u4e0e\u73b0\u65f6\u5b58\u5728\u610f\u4e49[84]<\/a><\/sup>\u548c\u672a\u6765\u613f\u666f\u7684\u7f3a\u5931\u76f8\u8054\u7cfb[85]<\/a><\/sup>[86]<\/a><\/sup>\u3002\u5b58\u5728\u4e3b\u4e49\u5fc3\u7406\u5b66\u7684\u5960\u57fa\u4eba\u2014\u2014\u7f8e\u56fd\u5fc3\u7406\u5b66\u5bb6\u4e9a\u4f2f\u62c9\u7f55\u00b7\u9a6c\u65af\u6d1b<\/a>\u5219\u8ba4\u4e3a\u5f53\u4eba\u4eec\u65e0\u6cd5\u6ee1\u8db3\u9700\u6c42<\/a>\u6216\u8005\u81ea\u6211\u5b9e\u73b0<\/a>\u4ee5\u8ba4\u8bc6\u5230\u81ea\u5df1\u7684\u6f5c\u529b\u65f6\uff0c\u6291\u90c1\u75c7\u53ef\u80fd\u53d1\u4f5c[87]<\/a><\/sup>[88]<\/a><\/sup>\u3002<\/p>\n\n\n\n

2.4 \u73af\u5883\u56e0\u7d20<\/strong> | Environmental<\/h3>\n\n\n\n

Adverse childhood experiences<\/a>\u00a0(incorporating\u00a0childhood abuse<\/a>, neglect and\u00a0family dysfunction<\/a>) markedly increase the risk of major depression, especially if more than one type.[75]<\/a><\/sup>\u00a0Childhood trauma also correlates with severity of depression, poor responsiveness to treatment and length of illness.[76]<\/a><\/sup>\u00a0Some are more susceptible than others to developing mental illness such as depression after trauma, and various genes have been suggested to control susceptibility.[77]<\/a><\/sup>\u00a0Couples in unhappy marriages have a higher risk of developing clinical depression.[78]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u4e0d\u826f\u7684\u7ae5\u5e74\u7ecf\u5386\uff08\u5305\u62ec\u7ae5\u5e74\u65f6\u671f\u7684\u8650\u5f85\u3001\u5ffd\u89c6\u548c\u5bb6\u5ead\u529f\u80fd\u5931\u8c03\uff09\u4f1a\u663e\u8457\u589e\u52a0\u60a3\u91cd\u5ea6\u6291\u90c1\u75c7\u7684\u98ce\u9669\uff0c\u5c24\u5176\u662f\u5f53\u8fd9\u4e9b\u7ecf\u5386\u4e0d\u6b62\u4e00\u79cd\u65f6[75]\u3002\u7ae5\u5e74\u521b\u4f24\u8fd8\u4e0e\u6291\u90c1\u75c7\u7684\u4e25\u91cd\u7a0b\u5ea6\u3001\u5bf9\u6cbb\u7597\u7684\u53cd\u5e94\u4e0d\u4f73\u4ee5\u53ca\u75c5\u7a0b\u957f\u77ed\u6709\u5173[76]\u3002\u6709\u4e9b\u4eba\u5728\u7ecf\u5386\u521b\u4f24\u540e\u6bd4\u5176\u4ed6\u4eba\u66f4\u5bb9\u6613\u60a3\u4e0a\u6291\u90c1\u75c7\u7b49\u7cbe\u795e\u75be\u75c5\uff0c\u76ee\u524d\u5df2\u6709\u591a\u79cd\u57fa\u56e0\u88ab\u8ba4\u4e3a\u4e0e\u8fd9\u79cd\u6613\u611f\u6027\u6709\u5173[77]\u3002\u6b64\u5916\uff0c\u5904\u4e8e\u4e0d\u5e78\u5a5a\u59fb\u4e2d\u7684\u592b\u59bb\u60a3\u4e0a\u4e34\u5e8a\u6291\u90c1\u75c7\u7684\u98ce\u9669\u4e5f\u66f4\u9ad8[78]\u3002<\/p>\n\n\n\n

There appears to be a link between\u00a0air pollution<\/a>\u00a0and depression and suicide. There may be an association between long-term\u00a0PM2.5<\/a>\u00a0exposure and depression, and a possible association between short-term PM10 exposure and suicide.[79]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u7a7a\u6c14\u6c61\u67d3\u4e0e\u6291\u90c1\u75c7\u53ca\u81ea\u6740\u4e4b\u95f4\u4f3c\u4e4e\u5b58\u5728\u5173\u8054\u3002\u957f\u671f\u66b4\u9732\u4e8ePM2.5\u53ef\u80fd\u4e0e\u6291\u90c1\u75c7\u6709\u5173\uff0c\u800c\u77ed\u671f\u66b4\u9732\u4e8ePM10\u5219\u53ef\u80fd\u4e0e\u81ea\u6740\u5b58\u5728\u6f5c\u5728\u5173\u8054[79]\u3002<\/p>\n\n\n\n

In a review, people who lived alone were found to have a 42% greater risk of depression.[6]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u5728\u4e00\u9879\u7efc\u8ff0\u7814\u7a76\u4e2d\uff0c\u72ec\u5c45\u4eba\u7fa4\u88ab\u53d1\u73b0\u60a3\u6291\u90c1\u75c7\u7684\u98ce\u9669\u8981\u9ad8\u51fa42%[6]\u3002<\/p>\n\n\n\n

2.5 \u8fdb\u5316\u8bba\u89c6\u89d2<\/strong> | Evolutionary<\/h3>\n\n\n\n

Main article:\u00a0Evolutionary approaches to depression<\/a>\u3010\u4e3b\u6761\u76ee\uff1a\u6291\u90c1\u75c7\u7684\u8fdb\u5316\u8bba\u7814\u7a76\u3011<\/em><\/p>\n\n\n\n

Further information:\u00a0Evolutionary medicine<\/a>,\u00a0Evolutionary psychiatry<\/a>, and\u00a0Evolutionary psychology<\/a>
\u3010\u53e6\u89c1\uff1a\u8fdb\u5316\u533b\u5b66\u3001\u8fdb\u5316\u7cbe\u795e\u75c5\u5b66 \u4e0e \u8fdb\u5316\u5fc3\u7406\u5b66\u3011<\/em><\/p>\n\n\n\n

Evolutionary<\/a>\u00a0explanations propose that low mood may sometimes represent an\u00a0adaptive response<\/a>, such as conserving energy during adverse circumstances or promoting rumination on complex problems.[80]<\/a>[81]<\/a><\/sup>\u00a0Other models emphasize the potential social functions of depressive symptoms, including signaling a need for support. Recent reviews highlight both the\u00a0heuristic<\/a>\u00a0value and limitations of these perspectives, noting that\u00a0empirical<\/a>\u00a0support remains mixed.[82]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u8fdb\u5316\u8bba\u7684\u89e3\u91ca\u63d0\u51fa\uff0c\u4f4e\u843d\u7684\u60c5\u7eea\u6709\u65f6\u53ef\u80fd\u662f\u4e00\u79cd\u9002\u5e94\u6027\u7684\u53cd\u5e94\uff0c\u4f8b\u5982\u5728\u9006\u5883\u4e2d\u4fdd\u5b58\u80fd\u91cf\uff0c\u6216\u4fc3\u4f7f\u4eba\u4eec\u53cd\u590d\u601d\u8003\uff08\u53cd\u520d\uff09\u590d\u6742\u7684\u95ee\u9898[80][81]\u3002\u53e6\u4e00\u4e9b\u6a21\u578b\u5219\u5f3a\u8c03\u4e86\u6291\u90c1\u75c7\u72b6\u6f5c\u5728\u7684\u793e\u4f1a\u529f\u80fd\uff0c\u5305\u62ec\u5411\u5916\u754c\u53d1\u51fa\u201c\u9700\u8981\u652f\u6301\u201d\u7684\u4fe1\u53f7\u3002\u8fd1\u671f\u7684\u7efc\u8ff0\u6307\u51fa\uff0c\u8fd9\u4e9b\u89c2\u70b9\u65e2\u5177\u6709\u542f\u53d1\u6027\u7684\u4ef7\u503c\uff0c\u4e5f\u5b58\u5728\u4e00\u5b9a\u7684\u5c40\u9650\u6027\uff0c\u4e14\u76ee\u524d\u7684\u5b9e\u8bc1\u652f\u6301\u4ecd\u7136\u662f\u597d\u574f\u53c2\u534a\u7684[82]\u3002<\/p>\n\n\n\n

\u4ece\u6f14\u5316\u5fc3\u7406\u5b66<\/a>\u7684\u89c2\u70b9\u6765\u770b\uff0c\u6709\u4e9b\u91cd\u5ea6\u6291\u90c1\u75c7\u7684\u4ea7\u751f\u53ef\u80fd\u662f\u4e3a\u4e86\u4fc3\u8fdb\u4e2a\u4f53\u7684\u7e41\u6b96\u7684\u80fd\u529b<\/a>\u3002\u6291\u90c1\u75c7\u7684\u8fdb\u5316\u8bba\u89c2\u70b9\u548c\u6f14\u5316\u5fc3\u7406\u5b66\u8ba4\u4e3a\u57fa\u4e8e\u6291\u90c1\u75c7\u7684\u9ad8\u9057\u4f20\u6027\u548c\u9ad8\u6d41\u884c\u6027\uff0c\u6291\u90c1\u75c7\u7684\u67d0\u4e9b\u90e8\u5206\u53ef\u80fd\u6709\u4e00\u5b9a\u7684\u73af\u5883\u9002\u5e94\u6027[96]<\/a><\/sup>\uff0c\u4f8b\u5982\u4e0e\u4f9d\u9644<\/a>\u548c\u793e\u4f1a\u9636\u7ea7<\/a>\u6709\u5173\u7684\u90e8\u5206[97]<\/a><\/sup>\u3002\u7531\u6b64\uff0c\u8be5\u7406\u8bba\u8ba4\u4e3a\u6291\u90c1\u75c7\u7684\u57fa\u56e0\u53ef\u80fd\u5df2\u7ecf\u88ab\u6574\u5408\u8fdb\u4eba\u7c7b\u57fa\u56e0\u5e93\u3002\u60a3\u8005\u7684\u884c\u4e3a\u53ef\u4ee5\u88ab\u89e3\u91ca\u4e3a\u5bf9\u4eba\u9645\u5173\u7cfb\u548c\u8d44\u6e90\u7ba1\u7406\u7684\u9002\u5e94\uff0c\u5c3d\u7ba1\u7ed3\u679c\u5f80\u5f80\u662f\u4e0e\u5f53\u4eca\u73af\u5883\u4e0d\u9002\u5e94[98]<\/a><\/sup>\u3002<\/p>\n\n\n\n

\u4ece\u54a8\u8be2\u5fc3\u7406\u5b66<\/a>\u7684\u89d2\u5ea6\u770b\uff0c\u6cbb\u7597\u5e08\u53ef\u4ee5\u4e0d\u628a\u6291\u90c1\u75c7\u770b\u6210\u662f\u751f\u7269\u5316\u5b66\u65b9\u9762\u7684\u75be\u75c5\u6216\u969c\u788d\uff0c\u800c\u662f\u628a\u5b83\u770b\u4f5c\u662f\u201c\u4e00\u5957\u7531\u4e00\u4e2a\u79cd\u7fa4\u8fdb\u5316\u7684\u3001\u51e0\u4e4e\u603b\u662f\u7531\u4e00\u79cd\u89c2\u5ff5\u6fc0\u6d3b\u7684\u3001\u9020\u6210\u4e2a\u4f53\u603b\u662f\u8fc7\u5ea6\u6d88\u6781\u548c\u80fd\u529b\u4e25\u91cd\u964d\u4f4e\u7684\u60c5\u611f\u7a0b\u5e8f\uff0c\u6709\u65f6\u5b83\u4e0e\u7f6a\u6076\u611f\u3001\u7f9e\u6127\u611f\u548c\u5b64\u7acb\u611f\u76f8\u5173\u201d[99]<\/a><\/sup>\u3002\u8fd9\u5957\u7a0b\u5e8f\u53ef\u80fd\u663e\u793a\u4e86\u5728\u4eba\u7c7b\u8fc7\u53bb\u7684\u72e9\u730e\u65f6\u671f\uff0c\u56e0\u4e3a\u72e9\u730e\u80fd\u529b\u8870\u9000\u800c\u88ab\u8fb9\u7f18\u5316\u7684\u8001\u9f84\u730e\u624b\uff0c\u53ef\u80fd\u4ee5\u88ab\u758f\u8fdc\u7684\u6210\u5458\u7684\u8eab\u4efd\u7ee7\u7eed\u5728\u5f53\u4eca\u793e\u4f1a\u5b58\u5728\uff0c\u8fd9\u79cd\u88ab\u8fb9\u7f18\u5316\u800c\u4ea7\u751f\u7684\u65e0\u7528\u611f\u53ef\u80fd\u63d0\u793a\u60a3\u8005\u9700\u8981\u6765\u81ea\u670b\u53cb\u548c\u5bb6\u4eba\u7684\u652f\u6301\u3002\u53e6\u5916\uff0c\u8003\u8651\u5230\u8eaf\u4f53\u75bc\u75db\u88ab\u8fdb\u5316\u6765\u963b\u6b62\u9020\u6210\u8fdb\u4e00\u6b65\u4f24\u5bb3\u7684\u884c\u4e3a\uff0c\u4e00\u79cd\u76f8\u4f3c\u7684\u884c\u4e3a\u2014\u2014\u201c\u5fc3\u7406\u75bc\u75db\u201d\u53ef\u80fd\u88ab\u8fdb\u5316\u6765\u963b\u6b62\u60a3\u8005\u5bf9\u6076\u52a3\u73af\u5883\u7684\u8349\u7387\u548c\u4e0d\u9002\u5e94\u7684\u53cd\u5e94[100]<\/a><\/sup>\u3002<\/p>\n\n\n\n

2.6 \u793e\u4f1a\u56e0\u7d20<\/h3>\n\n\n\n

\u8d2b\u7a77\u548c\u4e0e\u793e\u4f1a\u5b64\u7acb\u901a\u5e38\u4f1a\u63d0\u9ad8\u60a3\u7cbe\u795e\u95ee\u9898\u7684\u98ce\u9669[68]<\/a><\/sup>\u3002\u513f\u65f6\u906d\u53d7\u8650\u5f85<\/a>\uff08\u8eab\u4f53\u3001\u60c5\u611f\u3001\u6027\u6216\u8005\u88ab\u5ffd\u89c6\uff09\u4f1a\u63d0\u9ad8\u5f80\u540e\u60a3\u4e0a\u6291\u90c1\u969c\u788d\u7684\u98ce\u9669[89]<\/a><\/sup>\uff1b\u5bb6\u5ead\u529f\u80fd\u53d7\u635f\uff0c\u4f8b\u5982\u7236\u6bcd\uff08\u5c24\u5176\u662f\u6bcd\u4eb2\uff09\u60a3\u6291\u90c1\u75c7\u3001\u4e25\u91cd\u7684\u592b\u59bb\u51b2\u7a81\u6216\u79bb\u5a5a<\/a>\u3001\u5931\u53bb\u53cc\u4eb2\u6216\u8005\u5176\u4ed6\u4f7f\u5bb6\u5ead\u529f\u80fd\u53d7\u635f\u7684\u60c5\u51b5\u90fd\u662f\u60a3\u75c5\u7684\u98ce\u9669\u56e0\u7d20[68]<\/a><\/sup>\u3002\u5728\u6210\u5e74\u4ee5\u540e\uff0c\u751f\u6d3b\u5e94\u6fc0\u4e8b\u4ef6\u4e0e\u91cd\u6027\u6291\u90c1\u53d1\u4f5c\u6709\u5f88\u5f3a\u7684\u8054\u7cfb[90]<\/a><\/sup>[91]<\/a><\/sup>\u3002\u5c24\u5176\u7b2c\u4e00\u6b21\u53d1\u4f5c\u6bd4\u590d\u53d1\u66f4\u5bb9\u6613\u7531\u751f\u6d3b\u5e94\u6fc0\u4e8b\u4ef6\u5f15\u53d1[92]<\/a><\/sup>\u3002<\/p>\n\n\n\n

\u662f\u7f3a\u4e4f\u793e\u4f1a\u652f\u6301<\/a>\u9020\u6210\u4e86\u5e94\u6fc0\u4e8b\u4ef6\u589e\u52a0\u8fdb\u800c\u5f15\u53d1\u6291\u90c1\u75c7\uff0c\u6216\u8005\u662f\u793e\u4f1a\u652f\u6301\u7684\u7f3a\u4e4f\u76f4\u63a5\u5f15\u53d1\u6291\u90c1\u75c7\uff0c\u751f\u6d3b\u5e94\u6fc0\u4e8b\u4ef6\u4e0e\u793e\u4f1a\u652f\u6301\u4e4b\u95f4\u7684\u5173\u7cfb\u5c1a\u6709\u4e89\u8bae[93]<\/a><\/sup>\u3002\u72af\u7f6a\u6216\u8fdd\u7981\u836f\u7269\u9020\u6210\u7684\u4e0d\u548c\u8c10\u7684\u90bb\u91cc\u5173\u7cfb\u662f\u53d1\u75c5\u7684\u5371\u9669\u56e0\u7d20\uff0c\u800c\u878d\u6d3d\u5b9c\u4eba\u7684\u90bb\u91cc\u5173\u7cfb\u5219\u662f\u9632\u6b62\u6291\u90c1\u75c7\u7684\u4fdd\u62a4\u56e0\u7d20[94]<\/a><\/sup>\u3002\u5c3d\u7ba1\u5404\u79cd\u5404\u6837\u7684\u56e0\u7d20\u4ea4\u9519\u6df7\u6742\uff0c\u4f46\u662f\u6076\u52a3\u7684\u5de5\u4f5c\u6761\u4ef6\uff0c\u7279\u522b\u662f\u8d39\u529b\u4e14\u53ea\u6709\u5f88\u5c11\u7684\u81ea\u4e3b\u51b3\u5b9a\u6743\u7684\u5de5\u4f5c\uff0c\u53ef\u80fd\u4e0e\u6291\u90c1\u75c7\u6709\u5173[95]<\/a><\/sup>\u3002<\/p>\n\n\n\n

3. \u75c5\u7406\u751f\u7406\u5b66 | Pathophysiology<\/h2>\n\n\n\n

Further information:\u00a0Biology of depression<\/a>\u00a0and\u00a0Epigenetics of depression<\/a>
\u3010\u53e6\u89c1\uff1a\u6291\u90c1\u75c7\u7684\u751f\u7269\u5b66 \u4e0e \u6291\u90c1\u75c7\u7684\u8868\u89c2\u9057\u4f20\u5b66\u3011<\/em><\/p>\n\n\n\n

The pathophysiology of depression is not completely understood, but current theories center around\u00a0monoaminergic<\/a>\u00a0systems, the\u00a0circadian rhythm<\/a>, immunological dysfunction,\u00a0HPA-axis<\/a>\u00a0dysfunction, and structural or functional abnormalities of emotional circuits.
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u6291\u90c1\u75c7\u7684\u75c5\u7406\u751f\u7406\u5b66\u5c1a\u672a\u88ab\u5b8c\u5168\u9610\u660e\uff0c\u4f46\u76ee\u524d\u7684\u7406\u8bba\u4e3b\u8981\u56f4\u7ed5\u4ee5\u4e0b\u51e0\u4e2a\u6838\u5fc3\u5c55\u5f00\uff1a\u5355\u80fa\u80fd\u7cfb\u7edf\u3001\u663c\u591c\u8282\u5f8b\u3001\u514d\u75ab\u529f\u80fd\u5931\u8c03\u3001HPA\u8f74\uff08\u4e0b\u4e18\u8111-\u5782\u4f53-\u80be\u4e0a\u817a\u8f74\uff09\u529f\u80fd\u5f02\u5e38\uff0c\u4ee5\u53ca\u60c5\u7eea\u795e\u7ecf\u56de\u8def\u5728\u7ed3\u6784\u6216\u529f\u80fd\u4e0a\u7684\u5f02\u5e38\u3002<\/p>\n\n\n\n

3.1 \u5355\u80fa<\/h3>\n\n\n\n

Derived from the effectiveness of monoaminergic drugs in treating depression, the monoamine theory posits that insufficient activity of monoamine\u00a0neurotransmitters<\/a>\u00a0is the primary cause of depression. Evidence for the monoamine theory comes from multiple areas. First, acute depletion of\u00a0tryptophan<\/a>\u2014an\u00a0amino acid<\/a>\u00a0and a necessary precursor of the monoamine\u00a0serotonin<\/a>\u2014can cause depression in those in remission or relatives of people who are depressed, suggesting that decreased serotonergic neurotransmission is important in depression.[83]<\/a><\/sup>\u00a0Second, the correlation between depression risk and polymorphisms in the\u00a05-HTTLPR<\/a>\u00a0gene, which codes for serotonin receptors, suggests a link.[84]<\/a><\/sup>\u00a0
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u57fa\u4e8e\u5355\u80fa\u7c7b\u836f\u7269\u5728\u6cbb\u7597\u6291\u90c1\u75c7\u4e2d\u7684\u6709\u6548\u6027\uff0c\u5355\u80fa\u5047\u8bf4\uff08monoamine theory\uff09\u63d0\u51fa\uff0c\u5355\u80fa\u7c7b\u795e\u7ecf\u9012\u8d28\u7684\u6d3b\u6027\u4e0d\u8db3\u662f\u5bfc\u81f4\u6291\u90c1\u75c7\u7684\u4e3b\u8981\u539f\u56e0\u3002\u652f\u6301\u5355\u80fa\u5047\u8bf4\u7684\u8bc1\u636e\u6765\u81ea\u591a\u4e2a\u9886\u57df\u3002\u9996\u5148\uff0c\u6025\u6027\u8017\u7aed\u8272\u6c28\u9178\uff08\u4e00\u79cd\u6c28\u57fa\u9178\uff0c\u4e5f\u662f\u5355\u80fa\u7c7b\u795e\u7ecf\u9012\u8d285-\u7f9f\u8272\u80fa\u7684\u5fc5\u9700\u524d\u4f53\uff09\u4f1a\u5bfc\u81f4\u6b63\u5904\u4e8e\u7f13\u89e3\u671f\u7684\u60a3\u8005\u6216\u6291\u90c1\u75c7\u60a3\u8005\u7684\u4eb2\u5c5e\u51fa\u73b0\u6291\u90c1\u75c7\u72b6\uff0c\u8fd9\u8868\u660e5-\u7f9f\u8272\u80fa\u80fd\u795e\u7ecf\u4f20\u9012\u7684\u51cf\u5f31\u5728\u6291\u90c1\u75c7\u4e2d\u8d77\u7740\u91cd\u8981\u4f5c\u7528[83]\u3002\u5176\u6b21\uff0c\u6291\u90c1\u75c7\u98ce\u9669\u4e0e5-HTTLPR\u57fa\u56e0\uff08\u8d1f\u8d23\u7f16\u78015-\u7f9f\u8272\u80fa\u53d7\u4f53\uff09\u7684\u591a\u6001\u6027\u4e4b\u95f4\u5b58\u5728\u76f8\u5173\u6027\uff0c\u8fd9\u4e5f\u6697\u793a\u4e86\u4e24\u8005\u4e4b\u95f4\u7684\u5173\u8054[84]\u3002<\/p>\n\n\n\n

Third, decreased size of the\u00a0locus coeruleus<\/a>, reduced activity of\u00a0tyrosine hydroxylase<\/a>, increased density of\u00a0alpha-2 adrenergic receptors<\/a>, and evidence from rat models suggest decreased\u00a0adrenergic<\/a>\u00a0neurotransmission in depression.[85]<\/a><\/sup>\u00a0Furthermore, decreased levels of\u00a0homovanillic acid<\/a>, altered response to\u00a0dextroamphetamine<\/a>, responses of depressive symptoms to\u00a0dopamine receptor<\/a>\u00a0agonists, decreased\u00a0dopamine receptor D1<\/sub><\/a>\u00a0binding in the\u00a0striatum<\/a>,[86]<\/a><\/sup>\u00a0and\u00a0polymorphism<\/a>\u00a0of\u00a0dopamine receptor<\/a>\u00a0genes implicate\u00a0dopamine<\/a>, another monoamine, in depression.[87]<\/a>[88]<\/a><\/sup>\u00a0
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u7b2c\u4e09\uff0c\u84dd\u6591\u6838\uff08locus coeruleus\uff09\u4f53\u79ef\u7f29\u5c0f\u3001\u916a\u6c28\u9178\u7f9f\u5316\u9176\u6d3b\u6027\u964d\u4f4e\u3001\u03b12-\u80be\u4e0a\u817a\u7d20\u53d7\u4f53\u5bc6\u5ea6\u589e\u52a0\uff0c\u4ee5\u53ca\u6765\u81ea\u5927\u9f20\u6a21\u578b\u7684\u8bc1\u636e\uff0c\u90fd\u8868\u660e\u6291\u90c1\u75c7\u4e2d\u5b58\u5728\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u80fd\u795e\u7ecf\u4f20\u9012\u7684\u51cf\u5f31[85]\u3002\u6b64\u5916\uff0c\u9ad8\u9999\u8349\u9178\uff08homovanillic acid\uff09\u6c34\u5e73\u964d\u4f4e\u3001\u5bf9\u53f3\u65cb\u82ef\u4e19\u80fa\uff08dextroamphetamine\uff09\u7684\u53cd\u5e94\u5f02\u5e38\u3001\u6291\u90c1\u75c7\u72b6\u5bf9\u591a\u5df4\u80fa\u53d7\u4f53\u6fc0\u52a8\u5242\u7684\u53cd\u5e94\u3001\u7eb9\u72b6\u4f53\u4e2d\u591a\u5df4\u80faD1\u53d7\u4f53\u7ed3\u5408\u7684\u51cf\u5c11[86]\uff0c\u4ee5\u53ca\u591a\u5df4\u80fa\u53d7\u4f53\u57fa\u56e0\u7684\u591a\u6001\u6027\uff0c\u8fd9\u4e9b\u4e5f\u90fd\u8868\u660e\u53e6\u4e00\u79cd\u5355\u80fa\u7c7b\u7269\u8d28\u2014\u2014\u591a\u5df4\u80fa\uff0c\u4e0e\u6291\u90c1\u75c7\u6709\u5173[87][88]\u3002<\/p>\n\n\n\n

Lastly, increased activity of\u00a0monoamine oxidase<\/a>, an\u00a0enzyme<\/a>\u00a0that degrades monoamines, has been associated with depression.[89]<\/a><\/sup>\u00a0However, the monoamine theory is inconsistent with observations that serotonin depletion does not cause depression in healthy persons, that antidepressants instantly increase levels of monoamines but take weeks to work, and the existence of atypical antidepressants which can be effective despite not targeting this pathway.[90]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u6700\u540e\uff0c\u5355\u80fa\u6c27\u5316\u9176\uff08\u4e00\u79cd\u8d1f\u8d23\u964d\u89e3\u5355\u80fa\u7c7b\u7269\u8d28\u7684\u9176\uff09\u7684\u6d3b\u6027\u589e\u52a0\uff0c\u4e5f\u4e0e\u6291\u90c1\u75c7\u6709\u5173[89]\u3002\u7136\u800c\uff0c\u5355\u80fa\u5047\u8bf4\u4e0e\u4ee5\u4e0b\u51e0\u70b9\u89c2\u5bdf\u7ed3\u679c\u5b58\u5728\u77db\u76fe\uff1a\u9996\u5148\uff0c5-\u7f9f\u8272\u80fa\u7684\u8017\u7aed\u5e76\u4e0d\u4f1a\u5728\u5065\u5eb7\u4eba\u7fa4\u4e2d\u5f15\u53d1\u6291\u90c1\u75c7\uff1b\u5176\u6b21\uff0c\u6297\u6291\u90c1\u836f\u7269\u867d\u7136\u80fd\u8fc5\u901f\u63d0\u9ad8\u5355\u80fa\u7c7b\u7269\u8d28\u7684\u6c34\u5e73\uff0c\u4f46\u5374\u9700\u8981\u6570\u5468\u65f6\u95f4\u624d\u80fd\u53d1\u6325\u7597\u6548\uff1b\u6b64\u5916\uff0c\u8fd8\u5b58\u5728\u4e00\u4e9b\u5e76\u4e0d\u9488\u5bf9\u8be5\u901a\u8def\u5374\u4f9d\u7136\u6709\u6548\u7684\u975e\u5178\u578b\u6297\u6291\u90c1\u836f\u7269[90]\u3002<\/p>\n\n\n\n

\u7814\u7a76\u4eba\u5458\u53d1\u73b0\uff0c\u5927\u591a\u6570\u5df2\u77e5\u7684\u6297\u6291\u90c1\u836f<\/a>\u4f1a\u589e\u52a0\u4e00\u79cd\u6216\u591a\u79cd\u5355\u80fa\u7c7b\u795e\u7ecf\u9012\u8d28<\/a>\u5728\u8111\u5185\u7684\u6c34\u5e73\u3002\u5355\u80fa\u7c7b\u795e\u7ecf\u9012\u8d28\u5305\u62ec\uff1a\u8840\u6e05\u7d20<\/a>\u3001\u53bb\u7532\u80be\u4e0a\u817a\u7d20<\/a>\u548c\u591a\u5df4\u80fa<\/a>\u3002\u6297\u6291\u90c1\u836f\u4f1a\u63d0\u9ad8\u8fd9\u4e9b\u7269\u8d28\u5728\u5927\u8111\u795e\u7ecf\u5143\u4e4b\u95f4\uff08\u7a81\u89e6\uff09\u7684\u6c34\u5e73\u3002\u4e5f\u6709\u4e00\u4e9b\u836f\u7269\u76f4\u63a5\u5f71\u54cd\u795e\u7ecf\u5143\u4e4b\u95f4\u7684\u611f\u53d7\u5668\uff0c\u4ece\u800c\u8d77\u5230\u76f8\u540c\u7684\u4f5c\u7528\u3002<\/p>\n\n\n\n

\u7814\u7a76\u4eba\u5458\u8ba4\u4e3a\uff0c\u5728\u5355\u80fa\u7c7b\u795e\u7ecf\u9012\u8d28\u4e2d\uff0c\u8840\u6e05\u7d20\u88ab\u7528\u6765\u8c03\u8282\u5176\u4ed6\u795e\u7ecf\u9012\u8d28\u7cfb\u7edf\uff0c\u8840\u6e05\u7d20\u6d3b\u6027\u964d\u4f4e\u4f1a\u5bfc\u81f4\u8fd9\u4e9b\u7cfb\u7edf\u5904\u4e8e\u5931\u8c03\u72b6\u6001[42]<\/a><\/sup>\uff0c\u56e0\u6b64\u5f53\u8840\u6e05\u7d20\u6c34\u5e73\u964d\u4f4e\u65f6\uff0c\u4f1a\u9020\u6210\u6b63\u80be\u4e0a\u817a\u7d20\u6c34\u5e73\u964d\u4f4e\uff0c\u800c\u6b63\u80be\u4e0a\u817a\u7d20\u6c34\u5e73\u964d\u4f4e\u4f1a\u4f7f\u4eba\u4ea7\u751f\u6291\u90c1\u7684\u611f\u89c9\uff08\u201c\u5141\u8bb8\u6027\u5047\u8bf4\u201d\uff09[43]<\/a><\/sup>\u3002\u5df2\u7ecf\u89c2\u5bdf\u5230\u4e00\u4e9b\u5df2\u77e5\u7684\u6297\u6291\u90c1\u836f\u4f1a\u76f4\u63a5\u63d0\u9ad8\u53bb\u6b63\u80be\u4e0a\u817a\u7d20\u6c34\u5e73\uff0c\u5176\u4ed6\u4e00\u4e9b\u6297\u6291\u90c1\u836f\u7269\u4f1a\u63d0\u9ad8\u591a\u5df4\u80fa<\/a>\u7684\u6c34\u5e73\u3002\u6839\u636e\u4ee5\u4e0a\u89c2\u5bdf\u7ed3\u679c\uff0c\u7814\u7a76\u4eba\u5458\u63d0\u51fa\u4e86\u5355\u80fa\u5047\u8bf4<\/a>\uff0c\u6309\u5f53\u65f6\u521a\u63d0\u51fa\u7684\u8bf4\u6cd5\u5c31\u662f\uff1a\u201c\u4e00\u79cd\u795e\u7ecf\u9012\u8d28\u7684\u51cf\u5c11\u5bf9\u5e94\u7740\u4e00\u4e9b\u6291\u90c1\u75c7\u7684\u75c7\u72b6\uff0c\u5373\u7532\u80be\u4e0a\u817a\u7d20\u53ef\u80fd\u4e0e\u4eba\u7684\u8b66\u89c9\u548c\u80fd\u91cf\u6709\u5173\uff0c\u540c\u65f6\u4e5f\u4e0e\u7126\u8651\u3001\u6ce8\u610f\u529b\u548c\u5bf9\u751f\u6d3b\u7684\u5174\u8da3\u6709\u5173\uff1b\uff08\u7f3a\u4e4f\uff09\u8840\u6e05\u7d20\u5219\u5bf9\u5e94\u7126\u8651\u3001\u5f3a\u8feb\u89c2\u5ff5\u548c\u884c\u4e3a\uff1b\u591a\u5df4\u80fa\u5bf9\u5e94\u6ce8\u610f\u529b\u3001\u79ef\u6781\u6027\u3001\u6109\u60a6\u548c\u5956\u8d4f\u673a\u5236\uff0c\u540c\u65f6\u4e5f\u4e0e\u60a3\u8005\u5bf9\u751f\u6d3b\u7684\u5174\u8da3\u6709\u5173\u3002\u201d[44]<\/a><\/sup>\u8fd9\u79cd\u5047\u8bf4\u7684\u652f\u6301\u8005\u63d0\u51fa\uff1a\u60a3\u8005\u5e94\u5f53\u9488\u5bf9\u6700\u7a81\u51fa\u7684\u75c7\u72b6\u9009\u62e9\u6709\u7279\u6b8a\u673a\u7406\u7684\u6297\u6291\u90c1\u836f\uff0c\u5373\u7126\u8651\u4e0e\u66b4\u8e81\u7684\u75c5\u4eba\u5e94\u8be5\u9009\u62e9\u9009\u62e9\u60275-\u7f9f\u8272\u80fa\u518d\u6444\u53d6\u6291\u5236\u5242<\/a>\uff08SSRIs\uff09\u6216\u80055-\u7f9f\u8272\u80fa\u548c\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u518d\u6444\u53d6\u6291\u5236\u5242<\/a>\uff08SNRIs\uff09\uff0c\u611f\u5230\u80fd\u91cf\u4e27\u5931\u548c\u751f\u6d3b\u65e0\u8da3\u7684\u75c5\u4eba\u5e94\u9009\u62e9\u80fd\u63d0\u9ad8\u591a\u5df4\u80fa\u548c\u6b63\u80be\u4e0a\u817a\u7d20\u6c34\u5e73\u7684\u836f\u7269\u3002[44]<\/a><\/sup><\/p>\n\n\n\n

\"\"<\/a>
\u6b64\u56fe\u7247\u9075\u5faaCC BY-SA 3.0\u534f\u8bae
\u56fe\u7247\u9898\u6ce8\uff1a\u4e00\u4e2a\u795e\u7ecf\u5143<\/a>\u7684\u8f74\u7a81\u548c\u53e6\u4e00\u4e2a\u795e\u7ecf\u5143\u7684\u6811\u7a81\u4e4b\u95f4\u7684\u7a81\u89e6<\/a>\u793a\u610f\u56fe\u3002\u7a81\u89e6\u662f\u795e\u7ecf\u5143\u4e4b\u95f4\u4e00\u79cd\u7279\u6b8a\u7684\u95f4\u9699\u3002\u52a8\u4f5c\u7535\u4f4d<\/a>\u5230\u8fbe\u8f74\u7a81\u7684\u7ec8\u7aef\u89e6\u53d1\u5316\u5b66\u4fe1\u606f\u5305\u2014\u2014\u795e\u7ecf\u9012\u8d28<\/a>\u7684\u91ca\u653e\u3002\u8fd9\u4e9b\u795e\u7ecf\u9012\u8d28\u6269\u6563\u7a7f\u8fc7\u7a81\u89e6\u7684\u95f4\u9699\u5230\u8fbe\u4e34\u8fd1\u6811\u7a81\u7684\u53d7\u4f53<\/a>\uff0c\u5f15\u53d1\u7a81\u89e6\u540e\u7535\u4f4d<\/a>\u3002\u7535\u4f4d\u4e00\u65e6\u91ca\u653e\u795e\u7ecf\u9012\u8d28\u4f1a\u88ab\u8fc5\u901f\u4ee3\u8c22\u6216\u8005\u88ab\u6cf5\u56de\u6536\u3002\u6297\u6291\u90c1\u836f\u4f1a\u5f71\u54cd\u8fd9\u4e9b\u8fc7\u7a0b\u4ee5\u6539\u5584\u6291\u90c1\u75c7\u72b6\u3002
\u539f\u4f5c\u8005\uff1aNrets \u8bd1\u8005\uff1aAlsatia\u00a0–\u00a0\u6765\u6e90\uff1ahttp:\/\/en.wikipedia.org\/wiki\/File:Synapse_Illustration2_tweaked.svg<\/a>\u00a0\u7ecf\u7b80\u4f53\u4e2d\u6587\u5316<\/figcaption><\/figure>\n\n\n\n

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One proposed explanation for the therapeutic lag, and further support for the deficiency of monoamines, is that a desensitization of\u00a0self-inhibition<\/a>\u00a0in\u00a0raphe nuclei<\/a>\u00a0by the increased serotonin,\u00a0mediated<\/a>\u00a0by antidepressants, occurs before the therapeutic efficacy of the drugs can be realized.[91]<\/a><\/sup>\u00a0However, disinhibition of the\u00a0dorsal raphe<\/a>\u00a0has been proposed to occur as a result of decreased serotonergic activity in tryptophan depletion, resulting in a depressed state mediated by increased serotonin.
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u5bf9\u4e8e\u6cbb\u7597\u6ede\u540e\u73b0\u8c61\uff0c\u4e00\u79cd\u65e8\u5728\u8fdb\u4e00\u6b65\u652f\u6301\u5355\u80fa\u7f3a\u4e4f\u7684\u89e3\u91ca\u662f\uff1a\u6297\u6291\u90c1\u836f\u7269\u589e\u52a0\u4e865-\u7f9f\u8272\u80fa\uff08\u8840\u6e05\u7d20\uff09\u6c34\u5e73\uff0c\u4ece\u800c\u4ecb\u5bfc\u4e86\u4e2d\u7f1d\u6838\uff08raphe nuclei\uff09\u81ea\u6211\u6291\u5236\u673a\u5236\u7684\u8131\u654f\uff0c\u800c\u8fd9\u4e00\u8131\u654f\u8fc7\u7a0b\u7684\u53d1\u751f\u8981\u5148\u4e8e\u836f\u7269\u771f\u6b63\u53d1\u6325\u7597\u6548\u4e4b\u524d[91]\u3002\u7136\u800c\uff0c\u4e5f\u6709\u89c2\u70b9\u63d0\u51fa\uff0c\u8272\u6c28\u9178\u8017\u7aed\u4f1a\u5bfc\u81f45-\u7f9f\u8272\u80fa\u80fd\u6d3b\u6027\u964d\u4f4e\uff0c\u8fdb\u800c\u5f15\u53d1\u80cc\u4fa7\u4e2d\u7f1d\u6838\u7684\u53bb\u6291\u5236\uff0c\u6700\u7ec8\u901a\u8fc75-\u7f9f\u8272\u80fa\u7684\u589e\u52a0\u53cd\u800c\u5bfc\u81f4\u4e86\u6291\u90c1\u72b6\u6001\u3002<\/p>\n\n\n\n

Further countering the monoamine hypothesis is the fact that rats with lesions of the dorsal raphe are not more depressive than controls; the finding of increased jugular\u00a05-HIAA<\/a>\u00a0in people who are depressed that normalized with\u00a0selective serotonin reuptake inhibitor<\/a>\u00a0(SSRI) treatment, and the preference for carbohydrates in people who are depressed.[92]<\/a><\/sup>\u00a0Already limited, the monoamine hypothesis has been further oversimplified when presented to the general public.[93]<\/a><\/sup>\u00a0A 2022 review found no consistent evidence supporting the serotonin hypothesis linking serotonin levels and depression.[94]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u8fdb\u4e00\u6b65\u53cd\u9a73\u5355\u80fa\u5047\u8bf4\u7684\u4e8b\u5b9e\u8fd8\u5305\u62ec\uff1a\u4e0e\u5bf9\u7167\u7ec4\u76f8\u6bd4\uff0c\u80cc\u4fa7\u4e2d\u7f1d\u6838\u53d7\u635f\u7684\u5927\u9f20\u5e76\u6ca1\u6709\u8868\u73b0\u51fa\u66f4\u5f3a\u7684\u6291\u90c1\u503e\u5411\uff1b\u5728\u6291\u90c1\u75c7\u60a3\u8005\u4f53\u5185\u53d1\u73b0\u4e86\u9888\u9759\u81095-HIAA\uff085-\u7f9f\u5432\u54da\u4e59\u9178\uff0c5-\u7f9f\u8272\u80fa\u7684\u4ee3\u8c22\u4ea7\u7269\uff09\u6c34\u5e73\u5347\u9ad8\uff0c\u4e14\u7ecf\u8fc7\u9009\u62e9\u60275-\u7f9f\u8272\u80fa\u518d\u6444\u53d6\u6291\u5236\u5242\uff08SSRI\uff09\u6cbb\u7597\u540e\u8be5\u6c34\u5e73\u4f1a\u6062\u590d\u6b63\u5e38\uff1b\u4ee5\u53ca\u6291\u90c1\u75c7\u60a3\u8005\u5bf9\u78b3\u6c34\u5316\u5408\u7269\u7684\u504f\u597d[92]\u3002\u5355\u80fa\u5047\u8bf4\u672c\u8eab\u8bc1\u636e\u5c31\u5df2\u7ecf\u6709\u9650\uff0c\u800c\u5728\u5411\u5927\u4f17\u79d1\u666e\u65f6\uff0c\u5b83\u66f4\u662f\u88ab\u8fdb\u4e00\u6b65\u8fc7\u5ea6\u7b80\u5316\u4e86[93]\u30022022\u5e74\u7684\u4e00\u9879\u7efc\u8ff0\u7814\u7a76\u53d1\u73b0\uff0c\u6ca1\u6709\u4e00\u81f4\u7684\u8bc1\u636e\u652f\u6301\u5c065-\u7f9f\u8272\u80fa\u6c34\u5e73\u4e0e\u6291\u90c1\u75c7\u8054\u7cfb\u8d77\u6765\u7684\u201c5-\u7f9f\u8272\u80fa\u5047\u8bf4\u201d[94]\u3002<\/p>\n\n\n\n

3.2 \u5176\u4ed6\u7406\u8bba<\/h3>\n\n\n\n

\u6838\u78c1\u5171\u632f<\/a>\u626b\u63cf\u663e\u793a\u60a3\u8005\u7684\u5927\u8111\u4e0e\u5065\u5eb7\u4eba\u7684\u5927\u8111\u7ed3\u6784\u6709\u6240\u4e0d\u540c\u3002\u5c3d\u7ba1\u7ed3\u8bba\u6709\u77db\u76fe\u4e4b\u5904\uff0c\u5143\u5206\u6790<\/a>\u663e\u793a\u6709\u8db3\u591f\u7684\u8bc1\u636e\u8868\u660e\u60a3\u8005\u8111\u5185\u6d77\u9a6c\u4f53<\/a>\u4f53\u79ef\u51cf\u5c0f[47]<\/a><\/sup>\uff0c\u8111\u90e8\u9ad8\u4fe1\u53f7<\/a>\u5f02\u5e38\u589e\u52a0[48]<\/a><\/sup>\u3002\u8fd9\u4e9b\u9ad8\u4fe1\u53f7\u4e0e\u665a\u5e74\u53d1\u75c5\u6709\u5173\uff0c\u8fd9\u4e00\u89c2\u5bdf\u7ed3\u8bba\u4fc3\u8fdb\u4e86\u8840\u7ba1\u6027\u6291\u90c1<\/a>\u7684\u76f8\u5173\u7406\u8bba\u7684\u53d1\u5c55[49]<\/a><\/sup>\u3002<\/p>\n\n\n\n

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\"\"<\/a>
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\u56fe\u7247\u9898\u6ce8\uff1a\u6291\u90c1\u75c7\u53ef\u80fd\u548c\u5927\u8111\u4e2d\u63a7\u5236\u7761\u7720\u89c9\u9192\u5468\u671f\u7684\u673a\u5236\u6709\u5173\u3002
\u56fe\u7247\u6765\u6e90\uff1aYassineMrabet<\/a>\u00a0<\/a>\u00a0\u672cPNG\u00a0\u4f4d\u56fe<\/a>\u4f7f\u7528Inkscape<\/a>\u521b\u4f5c .\u00a0<\/figcaption><\/figure>\n\n\n\n

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\u5176\u4ed6\u7814\u7a76\u53d1\u73b0\u4e00\u4e9b\u4e0e\u7ec6\u80de<\/a>\u529f\u80fd\u6709\u5173\u7684\u7269\u8d28\uff1a\u7ec6\u80de\u56e0\u5b50<\/a>\u548c\u5fc5\u8981\u7684\u8425\u517b\u7d20\u53ef\u80fd\u4e0e\u6291\u90c1\u75c7\u6709\u5173\u3002\u91cd\u5ea6\u6291\u90c1\u75c7\u60a3\u8005\u7684\u75c7\u72b6\u548c\u75c5\u6001\u884c\u4e3a<\/a>\uff08\u5f53\u514d\u75ab\u7cfb\u7edf<\/a>\u5728\u6297\u51fb\u611f\u67d3<\/a>\u65f6\u7684\u8eab\u4f53\u53cd\u5e94\uff09\u5f88\u76f8\u4f3c[60]<\/a><\/sup>\u3002\u8fd9\u589e\u5927\u4e86\u6291\u90c1\u75c7\u662f\u4e00\u79cd\u5f02\u5e38\u75c5\u6001\u884c\u4e3a\u7684\u53ef\u80fd\u6027\uff0c\u8fd9\u79cd\u884c\u4e3a\u7531\u7ec6\u80de\u56e0\u5b50\u975e\u6b63\u5e38\u5faa\u73af\u6240\u9020\u6210[61]<\/a><\/sup>[62]<\/a><\/sup>[63]<\/a><\/sup>\u3002\u7f3a\u4e4f\u4e00\u4e9b\u7279\u5b9a\u7684\u8425\u517b\uff0c\u7279\u522b\u662f\u94b4\u80fa\u7d20<\/a>\u548c\u53f6\u9178<\/a>\u4e5f\u4e0e\u6291\u90c1\u75c7\u6709\u5173[64]<\/a><\/sup>\u3002\u5176\u4ed6\u8425\u517b\u7d20\uff0c\u4f8b\u5982\u94dc<\/a>\u548c\u9541<\/a>[65]<\/a><\/sup>\u4ee5\u53ca\u7ef4\u751f\u7d20A<\/a>\u4e5f\u4e0e\u6291\u90c1\u75c7\u6709\u4e00\u5b9a\u7684\u5173\u7cfb[66]<\/a><\/sup>\u3002<\/p>\n\n\n\n

HPA-axis<\/a>\u00a0abnormalities have been suggested in depression given the association of\u00a0CRHR1<\/a>\u00a0with depression and the increased frequency of\u00a0dexamethasone test<\/a>\u00a0non-suppression in people who are depressed. However, this abnormality is not adequate as a diagnosis tool because its sensitivity is only 44%.[95]<\/a><\/sup>\u00a0These stress-related abnormalities are thought to be the cause of hippocampal volume reductions seen in people who are depressed.[96]<\/a><\/sup>\u00a0Furthermore, a\u00a0meta-analysis<\/a>\u00a0yielded decreased dexamethasone suppression, and increased response to psychological stressors.[97]<\/a><\/sup>\u00a0Further abnormal results have been obscured with the\u00a0cortisol awakening response<\/a>, with increased response being associated with depression.[98]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u9274\u4e8e CRHR1\uff08\u4fc3\u80be\u4e0a\u817a\u76ae\u8d28\u6fc0\u7d20\u91ca\u653e\u6fc0\u7d20\u53d7\u4f531\uff09\u4e0e\u6291\u90c1\u75c7\u7684\u5173\u8054\uff0c\u4ee5\u53ca\u6291\u90c1\u75c7\u60a3\u8005\u5728\u5730\u585e\u7c73\u677e\u6291\u5236\u8bd5\u9a8c\u4e2d\u4e0d\u6291\u5236\u7684\u9891\u7387\u589e\u52a0\uff0c\u4eba\u4eec\u63a8\u6d4b\u6291\u90c1\u75c7\u4e2d\u5b58\u5728 HPA \u8f74\uff08\u4e0b\u4e18\u8111-\u5782\u4f53-\u80be\u4e0a\u817a\u8f74\uff09\u7684\u5f02\u5e38\u3002\u7136\u800c\uff0c\u8fd9\u79cd\u5f02\u5e38\u5e76\u4e0d\u8db3\u4ee5\u4f5c\u4e3a\u8bca\u65ad\u5de5\u5177\uff0c\u56e0\u4e3a\u5176\u654f\u611f\u6027\u4ec5\u4e3a 44%[95]\u3002\u8fd9\u4e9b\u4e0e\u538b\u529b\u76f8\u5173\u7684\u5f02\u5e38\u88ab\u8ba4\u4e3a\u662f\u5bfc\u81f4\u6291\u90c1\u75c7\u60a3\u8005\u6d77\u9a6c\u4f53\u4f53\u79ef\u7f29\u5c0f\u7684\u539f\u56e0[96]\u3002\u6b64\u5916\uff0c\u4e00\u9879\u835f\u8403\u5206\u6790\u5f97\u51fa\u4e86\u5730\u585e\u7c73\u677e\u6291\u5236\u4f5c\u7528\u51cf\u5f31\uff0c\u4ee5\u53ca\u5bf9\u5fc3\u7406\u538b\u529b\u6e90\u7684\u53cd\u5e94\u589e\u5f3a\u7684\u7ed3\u8bba[97]\u3002\u5728\u76ae\u8d28\u9187\u89c9\u9192\u53cd\u5e94\uff08CAR\uff09\u65b9\u9762\uff0c\u4e5f\u53d1\u73b0\u4e86\u8fdb\u4e00\u6b65\u7684\u5f02\u5e38\u7ed3\u679c\uff0c\u5176\u53cd\u5e94\u589e\u5f3a\u4e0e\u6291\u90c1\u75c7\u6709\u5173[98]\u3002<\/p>\n\n\n\n

There is also a connection between the gut microbiome and the central nervous system, otherwise known as the\u00a0gut\u2013brain axis<\/a>, which is a two-way communication system between the brain and the gut. Experiments have shown that\u00a0microbiota<\/a>\u00a0in the gut can play an important role in depression, as people with MDD often have gut-brain dysfunction. One analysis showed that those with MDD have different bacteria in their guts. Bacteria\u00a0Bacteroidetes<\/a><\/em>\u00a0and\u00a0Firmicutes<\/em>\u00a0were most affected in people with MDD, and they are also impacted in people with\u00a0irritable bowel syndrome<\/a>\u00a0(IBS).[99]<\/a><\/sup>\u00a0Another study showed that people with IBS have a higher chance of developing depression, which shows the two are connected.[100]<\/a><\/sup>\u00a0There is even evidence suggesting that altering the microbes in the gut can have regulatory effects on developing depression.[99]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u80a0\u9053\u5fae\u751f\u7269\u7fa4\u4e0e\u4e2d\u67a2\u795e\u7ecf\u7cfb\u7edf\u4e4b\u95f4\u4e5f\u5b58\u5728\u4e00\u79cd\u8054\u7cfb\uff0c\u8fd9\u901a\u5e38\u88ab\u79f0\u4e3a\u201c\u80a0-\u8111\u8f74\u201d\uff08gut\u2013brain axis\uff09\uff0c\u5373\u5927\u8111\u4e0e\u80a0\u9053\u4e4b\u95f4\u7684\u4e00\u4e2a\u53cc\u5411\u901a\u8baf\u7cfb\u7edf\u3002\u5b9e\u9a8c\u8868\u660e\uff0c\u80a0\u9053\u5185\u7684\u5fae\u751f\u7269\u7fa4\u5728\u6291\u90c1\u75c7\u4e2d\u53ef\u80fd\u626e\u6f14\u7740\u91cd\u8981\u89d2\u8272\uff0c\u56e0\u4e3a\u91cd\u5ea6\u6291\u90c1\u75c7\uff08MDD\uff09\u60a3\u8005\u901a\u5e38\u5b58\u5728\u80a0-\u8111\u529f\u80fd\u7d0a\u4e71\u3002\u4e00\u9879\u5206\u6790\u663e\u793a\uff0c\u91cd\u5ea6\u6291\u90c1\u75c7\u60a3\u8005\u80a0\u9053\u5185\u7684\u7ec6\u83cc\u6784\u6210\u4e0e\u5e38\u4eba\u4e0d\u540c\u3002\u539a\u58c1\u83cc\u95e8\uff08Firmicutes\uff09\u548c\u62df\u6746\u83cc\u95e8\uff08Bacteroidetes\uff09\u5728\u91cd\u5ea6\u6291\u90c1\u75c7\u60a3\u8005\u4f53\u5185\u53d7\u5230\u7684\u5f71\u54cd\u6700\u4e3a\u663e\u8457\uff0c\u800c\u8fd9\u4e24\u79cd\u83cc\u7fa4\u5728\u80a0\u6613\u6fc0\u7efc\u5408\u5f81\uff08IBS\uff09\u60a3\u8005\u4f53\u5185\u540c\u6837\u4e5f\u4f1a\u53d7\u5230\u5f71\u54cd[99]\u3002\u53e6\u4e00\u9879\u7814\u7a76\u8868\u660e\uff0c\u80a0\u6613\u6fc0\u7efc\u5408\u5f81\u60a3\u8005\u60a3\u4e0a\u6291\u90c1\u75c7\u7684\u51e0\u7387\u66f4\u9ad8\uff0c\u8fd9\u4e5f\u5370\u8bc1\u4e86\u4e24\u8005\u4e4b\u95f4\u5b58\u5728\u5173\u8054[100]\u3002\u751a\u81f3\u6709\u8bc1\u636e\u8868\u660e\uff0c\u6539\u53d8\u80a0\u9053\u5185\u7684\u5fae\u751f\u7269\u7fa4\u53ef\u80fd\u5bf9\u6291\u90c1\u75c7\u7684\u53d1\u751f\u8d77\u5230\u8c03\u8282\u4f5c\u7528[99]\u3002<\/p>\n\n\n\n

Theories unifying\u00a0neuroimaging<\/a>\u00a0findings have been proposed. The first model proposed is the limbic-cortical model, which involves hyperactivity of the ventral paralimbic regions and hypoactivity of frontal regulatory regions in emotional processing.[101]<\/a><\/sup>\u00a0Another model, the cortico-striatal model, suggests that abnormalities of the\u00a0prefrontal cortex<\/a>\u00a0in regulating striatal and subcortical structures result in depression.[102]<\/a><\/sup>\u00a0Another model proposes hyperactivity of\u00a0salience structures<\/a>\u00a0in identifying negative stimuli and hypoactivity of cortical regulatory structures resulting in a negative\u00a0emotional bias<\/a>\u00a0and depression, consistent with emotional bias studies.[103]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u76ee\u524d\uff0c\u5b66\u754c\u5df2\u7ecf\u63d0\u51fa\u4e86\u4e00\u4e9b\u65e8\u5728\u6574\u5408\u795e\u7ecf\u5f71\u50cf\u5b66\u53d1\u73b0\u7684\u7406\u8bba\u6a21\u578b\u3002\u7b2c\u4e00\u4e2a\u88ab\u63d0\u51fa\u7684\u6a21\u578b\u662f\u201c\u8fb9\u7f18-\u76ae\u8d28\u6a21\u578b\u201d\uff0c\u5b83\u8ba4\u4e3a\u5728\u60c5\u7eea\u5904\u7406\u8fc7\u7a0b\u4e2d\uff0c\u8179\u4fa7\u65c1\u8fb9\u7f18\u533a\u57df\u4f1a\u51fa\u73b0\u8fc7\u5ea6\u6d3b\u8dc3\uff0c\u800c\u8d1f\u8d23\u8c03\u63a7\u7684\u989d\u53f6\u533a\u57df\u5219\u8868\u73b0\u51fa\u6d3b\u8dc3\u4e0d\u8db3[101]\u3002\u53e6\u4e00\u4e2a\u6a21\u578b\u662f\u201c\u76ae\u8d28-\u7eb9\u72b6\u4f53\u6a21\u578b\u201d\uff0c\u8be5\u6a21\u578b\u8ba4\u4e3a\uff0c\u524d\u989d\u53f6\u76ae\u5c42\u5728\u8c03\u63a7\u7eb9\u72b6\u4f53\u548c\u76ae\u5c42\u4e0b\u7ed3\u6784\u65f6\u51fa\u73b0\u5f02\u5e38\uff0c\u4ece\u800c\u5bfc\u81f4\u4e86\u6291\u90c1\u75c7[102]\u3002\u8fd8\u6709\u4e00\u4e2a\u6a21\u578b\u63d0\u51fa\uff0c\u8d1f\u8d23\u8bc6\u522b\u8d1f\u9762\u523a\u6fc0\u7684\u201c\u663e\u8457\u6027\u7f51\u7edc\u7ed3\u6784\u201d\u8fc7\u5ea6\u6d3b\u8dc3\uff0c\u800c\u76ae\u5c42\u8c03\u63a7\u7ed3\u6784\u5219\u6d3b\u8dc3\u4e0d\u8db3\uff0c\u6700\u7ec8\u5bfc\u81f4\u4e86\u8d1f\u9762\u60c5\u7eea\u504f\u5dee\u548c\u6291\u90c1\u75c7\uff0c\u8fd9\u4e0e\u5173\u4e8e\u60c5\u7eea\u504f\u5dee\u7684\u7814\u7a76\u7ed3\u679c\u662f\u4e00\u81f4\u7684[103]\u3002<\/p>\n\n\n\n

3.3 \u6291\u90c1\u75c7\u7684\u514d\u75ab\u53d1\u75c5\u673a\u5236\u7406\u8bba<\/strong> | Immune pathogenesis theories on depression<\/h3>\n\n\n\n

Main article:\u00a0Depression and immune function<\/a>\u3010\u4e3b\u6761\u76ee\uff1a\u6291\u90c1\u75c7\u4e0e\u514d\u75ab\u529f\u80fd\u3011<\/em><\/p>\n\n\n\n

The newer field of\u00a0psychoneuroimmunology<\/a>, the study between the immune system and the nervous system and emotional state, suggests that cytokines may impact depression.
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u65b0\u5174\u7684\u201c\u5fc3\u7406\u795e\u7ecf\u514d\u75ab\u5b66\u201d\u9886\u57df\uff0c\u4e3b\u8981\u7814\u7a76\u514d\u75ab\u7cfb\u7edf\u3001\u795e\u7ecf\u7cfb\u7edf\u4e0e\u60c5\u7eea\u72b6\u6001\u4e4b\u95f4\u7684\u76f8\u4e92\u4f5c\u7528\uff0c\u8be5\u9886\u57df\u6307\u51fa\u7ec6\u80de\u56e0\u5b50\u53ef\u80fd\u4f1a\u5bf9\u6291\u90c1\u75c7\u4ea7\u751f\u5f71\u54cd\u3002<\/p>\n\n\n\n

Immune system<\/a>\u00a0abnormalities have been observed, including increased levels of\u00a0cytokines<\/a>\u2014cells produced by immune cells that affect inflammation\u2014involved in generating\u00a0sickness behavior<\/a>, creating a pro-inflammatory profile in MDD.[104]<\/a>[105]<\/a>[106]<\/a><\/sup>\u00a0Some people with depression have increased levels of pro-inflammatory cytokines and some have decreased levels of anti-inflammatory cytokines.[107]<\/a><\/sup>\u00a0Ketamine infusion may rapidly reduce depressive symptoms in treatment-resistant depression by modulating proinflammatory cytokines.[108]<\/a><\/sup>\u00a0With this, in MDD, people will more likely have a\u00a0Th<\/sub>1-dominant<\/a>\u00a0immune profile, which is a pro-inflammatory profile. This suggests that there are components of the immune system affecting the pathology of MDD.[109]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u7814\u7a76\u4e2d\u89c2\u5bdf\u5230\u4e86\u514d\u75ab\u7cfb\u7edf\u7684\u5f02\u5e38\uff0c\u5305\u62ec\u7ec6\u80de\u56e0\u5b50\uff08\u7531\u514d\u75ab\u7ec6\u80de\u4ea7\u751f\u3001\u5f71\u54cd\u708e\u75c7\u53cd\u5e94\u7684\u4fe1\u53f7\u5206\u5b50\uff09\u6c34\u5e73\u5347\u9ad8\uff0c\u8fd9\u4e9b\u7ec6\u80de\u56e0\u5b50\u4f1a\u5f15\u53d1\u201c\u75be\u75c5\u884c\u4e3a\u201d\uff0c\u5e76\u5728\u91cd\u5ea6\u6291\u90c1\u75c7\uff08MDD\uff09\u4e2d\u5f62\u6210\u4e00\u79cd\u4fc3\u708e\u72b6\u6001[104][105][106]\u3002\u90e8\u5206\u6291\u90c1\u75c7\u60a3\u8005\u4f53\u5185\u7684\u4fc3\u708e\u7ec6\u80de\u56e0\u5b50\u6c34\u5e73\u5347\u9ad8\uff0c\u800c\u53e6\u4e00\u4e9b\u60a3\u8005\u4f53\u5185\u7684\u6297\u708e\u7ec6\u80de\u56e0\u5b50\u6c34\u5e73\u5219\u6709\u6240\u964d\u4f4e[107]\u3002\u6c2f\u80fa\u916e\uff08Ketamine\uff09\u8f93\u6ce8\u53ef\u4ee5\u901a\u8fc7\u8c03\u8282\u4fc3\u708e\u7ec6\u80de\u56e0\u5b50\uff0c\u8fc5\u901f\u7f13\u89e3\u96be\u6cbb\u6027\u6291\u90c1\u75c7\u7684\u6291\u90c1\u75c7\u72b6[108]\u3002\u56e0\u6b64\uff0c\u5728\u91cd\u5ea6\u6291\u90c1\u75c7\u4e2d\uff0c\u60a3\u8005\u66f4\u6709\u53ef\u80fd\u5448\u73b0\u51fa\u4e00\u79cd\u4ee5Th1\u4e3a\u4e3b\u5bfc\u7684\u514d\u75ab\u7279\u5f81\uff0c\u4e5f\u5c31\u662f\u4e00\u79cd\u4fc3\u708e\u7279\u5f81\u3002\u8fd9\u8868\u660e\uff0c\u514d\u75ab\u7cfb\u7edf\u7684\u67d0\u4e9b\u6210\u5206\u786e\u5b9e\u4f1a\u5f71\u54cd\u91cd\u5ea6\u6291\u90c1\u75c7\u7684\u75c5\u7406\u8fc7\u7a0b[109]\u3002<\/p>\n\n\n\n

Another way cytokines can affect depression is in the\u00a0kynurenine pathway<\/a>, and when this is overactivated, it can cause depression. This can be due to too much\u00a0microglial<\/a>\u00a0activation and too little\u00a0astrocytic<\/a>\u00a0activity. When microglia get activated, they release pro-inflammatory cytokines that cause an increase in the production of\u00a0COX2<\/sub><\/a>. This, in turn, causes the production of\u00a0PGE2<\/sub><\/a>, which is a\u00a0prostaglandin<\/a>, and this catalyzes the production of\u00a0indolamine<\/a>, IDO. IDO causes\u00a0tryptophan<\/a>\u00a0to get converted into\u00a0kynurenine<\/a>, and kynurenine becomes\u00a0quinolinic acid<\/a>.[110]<\/a><\/sup>\u00a0Quinolinic acid is an agonist for\u00a0NMDA receptors<\/a>, so it activates the pathway. Studies have shown that the post-mortem brains of patients with MDD have higher levels of quinolinic acid than people who did not have MDD. With this, researchers have also seen that the concentration of quinolinic acid correlates to the severity of depressive symptoms.[111]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u7ec6\u80de\u56e0\u5b50\u5f71\u54cd\u6291\u90c1\u75c7\u7684\u53e6\u4e00\u79cd\u9014\u5f84\u662f\u201c\u72ac\u5c3f\u6c28\u9178\u901a\u8def\u201d\uff08kynurenine pathway\uff09\uff0c\u5f53\u8fd9\u6761\u901a\u8def\u88ab\u8fc7\u5ea6\u6fc0\u6d3b\u65f6\uff0c\u5c31\u53ef\u80fd\u5f15\u53d1\u6291\u90c1\u75c7\u3002\u8fd9\u79cd\u60c5\u51b5\u901a\u5e38\u662f\u7531\u4e8e\u5c0f\u80f6\u8d28\u7ec6\u80de\uff08microglia\uff09\u8fc7\u5ea6\u6d3b\u5316\uff0c\u800c\u661f\u5f62\u80f6\u8d28\u7ec6\u80de\uff08astrocytic\uff09\u7684\u6d3b\u6027\u4e0d\u8db3\u6240\u5bfc\u81f4\u7684\u3002\u5f53\u5c0f\u80f6\u8d28\u7ec6\u80de\u88ab\u6fc0\u6d3b\u65f6\uff0c\u4f1a\u91ca\u653e\u51fa\u4fc3\u708e\u7ec6\u80de\u56e0\u5b50\uff0c\u8fdb\u800c\u5bfc\u81f4COX2\uff08\u73af\u6c27\u5316\u91762\uff09\u7684\u4ea7\u751f\u589e\u52a0\u3002\u8fd9\u53cd\u8fc7\u6765\u53c8\u4f1a\u4fc3\u4f7fPGE2\uff08\u4e00\u79cd\u524d\u5217\u817a\u7d20\uff09\u7684\u751f\u6210\uff0c\u800cPGE2\u4f1a\u50ac\u5316\u5432\u54da\u80fa\uff08indolamine\uff09\u751f\u6210IDO\uff08\u5432\u54da\u80fa2,3-\u53cc\u52a0\u6c27\u9176\uff09\u3002IDO\u4f1a\u4fc3\u4f7f\u8272\u6c28\u9178\uff08tryptophan\uff09\u8f6c\u5316\u4e3a\u72ac\u5c3f\u6c28\u9178\uff08kynurenine\uff09\uff0c\u968f\u540e\u72ac\u5c3f\u6c28\u9178\u8fdb\u4e00\u6b65\u8f6c\u5316\u4e3a\u55b9\u5549\u9178\uff08quinolinic acid\uff09[110]\u3002\u55b9\u5549\u9178\u662fNMDA\u53d7\u4f53\uff08N-\u7532\u57fa-D-\u5929\u51ac\u6c28\u9178\u53d7\u4f53\uff09\u7684\u6fc0\u52a8\u5242\uff0c\u56e0\u6b64\u4f1a\u6fc0\u6d3b\u8be5\u901a\u8def\u3002\u7814\u7a76\u8868\u660e\uff0c\u91cd\u5ea6\u6291\u90c1\u75c7\uff08MDD\uff09\u60a3\u8005\u6b7b\u540e\u7684\u5927\u8111\u4e2d\uff0c\u55b9\u5549\u9178\u7684\u6c34\u5e73\u9ad8\u4e8e\u672a\u60a3\u91cd\u5ea6\u6291\u90c1\u75c7\u7684\u4eba\u3002\u57fa\u4e8e\u6b64\uff0c\u7814\u7a76\u4eba\u5458\u8fd8\u53d1\u73b0\uff0c\u55b9\u5549\u9178\u7684\u6d53\u5ea6\u4e0e\u6291\u90c1\u75c7\u72b6\u7684\u4e25\u91cd\u7a0b\u5ea6\u5448\u6b63\u76f8\u5173[111]\u3002<\/p>\n\n\n\n

4. \u8bca\u65ad | Diagnosis<\/h2>\n\n\n\n

4.1 \u4e34\u5e8a\u8bc4\u4f30 | Assessment<\/h3>\n\n\n\n

Further information:\u00a0Rating scales for depression<\/a>\u3010\u53e6\u89c1\uff1a\u6291\u90c1\u75c7\u8bc4\u5b9a\u91cf\u8868\u3011<\/em><\/p>\n\n\n\n

\"\"<\/a>
\u6b64\u56fe\u7247\u9075\u5faaCC BY 2.0\u534f\u8bae
\u56fe\u7247\u9898\u6ce8\uff1aCaricature of a man with depression
\u56fe\u7247\u6765\u6e90\uff1a[London?] : [W. Spooner], [between 1830 and 1839?]<\/a><\/figcaption><\/figure>\n\n\n\n

\u4e34\u5e8a\u8bc4\u4f30\u53ef\u4ee5\u7531\u5bb6\u5ead\u533b\u751f<\/a>\u3001\u7cbe\u795e\u79d1\u533b\u751f<\/a>\u6216\u4e34\u5e8a\u5fc3\u7406\u5b66\u5bb6<\/a>\u4f5c\u51fa\u3002\u4e34\u5e8a\u8bc4\u4f30\u9700\u8981\u8bb0\u5f55\u75c5\u4eba\u7684\u5f53\u524d\u72b6\u51b5\u3001\u75c5\u53f2\u548c\u75c7\u72b6\uff0c\u8fd8\u8981\u8bb0\u5f55\u5bb6\u5ead\u75c5\u53f2\u4ee5\u4e86\u89e3\u75c5\u4eba\u5bb6\u5ead\u6210\u5458\u662f\u5426\u6709\u8fc7\u60c5\u611f\u969c\u788d\uff0c\u5e76\u4e14\u8ba8\u8bba\u75c5\u4eba\u662f\u5426\u6709\u9152\u7cbe\u6216\u836f\u7269\u6ee5\u7528\u3002\u4e34\u5e8a\u8bc4\u4f30\u4e5f\u5305\u62ec\u4e86\u7cbe\u795e\u72b6\u6001\u8bc4\u4f30<\/a>\uff08\u7528\u6765\u8bc4\u4f30\u75c5\u4eba\u7684\u60c5\u7eea\u548c\u601d\u60f3\uff0c\u7279\u522b\u662f\u75c5\u4eba\u662f\u5426\u7edd\u671b\u6216\u60b2\u89c2\u4e3b\u4e49\uff0c\u662f\u5426\u6709\u81ea\u6b8b\u6216\u81ea\u6740\u503e\u5411\uff0c\u662f\u5426\u7f3a\u4e4f\u79ef\u6781\u7684\u60f3\u6cd5\u6216\u8ba1\u5212\uff09[109]<\/a><\/sup>\u3002\u5728\u519c\u6751\u5730\u533a\uff0c\u4e13\u4e1a\u7684\u5fc3\u7406\u5065\u5eb7\u670d\u52a1\u5341\u5206\u7f3a\u4e4f\uff0c\u8bca\u65ad\u548c\u63a7\u5236\u75c5\u60c5\u4e3b\u8981\u4f9d\u8d56\u4e8e\u57fa\u5c42\u533b\u751f[110]<\/a><\/sup>\u3002\u8fd9\u79cd\u73b0\u8c61\u5728\u53d1\u5c55\u4e2d\u56fd\u5bb6\u66f4\u52a0\u4e25\u91cd[111]<\/a><\/sup>\u3002\u5355\u4e00\u8bc4\u5b9a\u91cf\u8868\u7684\u8bc4\u5206\u4e0d\u80fd\u7528\u6765\u786e\u8bca\u6291\u90c1\u75c7\uff0c\u4f46\u662f\u5b83\u7684\u786e\u63d0\u4f9b\u4e86\u5173\u4e8e\u4e00\u6bb5\u65f6\u95f4\u5185\u75c7\u72b6\u4e25\u91cd\u7a0b\u5ea6\u7684\u6307\u6807\uff0c\u6240\u4ee5\u5bf9\u4e8e\u8bc4\u5206\u9ad8\u4e8e\u67d0\u4e00\u5b9a\u70b9\u7684\u4eba\u53ef\u4ee5\u66f4\u591a\u5730\u8003\u8651\u786e\u8bca\u4e3a\u6291\u90c1\u75c7\u3002\u6709\u51e0\u79cd\u8bc4\u5b9a\u91cf\u8868\u88ab\u7528\u4e8e\u8fd9\u4e2a\u76ee\u7684[112]<\/a><\/sup>\u3002\u5c3d\u7ba1\u6709\u4eba\u63d0\u5021\u5bf9\u6291\u90c1\u75c7\u8fdb\u884c\u5e7f\u6cdb\u7b5b\u67e5\uff0c\u4f46\u662f\u6709\u8bc1\u636e\u8868\u660e\u5e7f\u6cdb\u7b5b\u67e5\u5e76\u4e0d\u80fd\u63d0\u9ad8\u68c0\u51fa\u7387\u4e5f\u4e0d\u80fd\u6539\u5584\u6cbb\u7597\u6548\u679c\u6216\u7ed3\u679c[113]<\/a><\/sup>\u3002<\/p>\n\n\n\n

\u521d\u7ea7\u4fdd\u5065\u533b\u751f<\/a>\u548c\u5176\u4ed6\u975e\u7cbe\u795e\u79d1\u533b\u751f\u5f80\u5f80\u5bf9\u8bca\u65ad\u6291\u90c1\u75c7\u529b\u4e0d\u4ece\u5fc3\u3002\u975e\u7cbe\u795e\u79d1\u533b\u751f\u6f0f\u8bca\u4e09\u5206\u4e4b\u4e8c\u7684\u75c5\u4eba\uff0c\u5e76\u4e14\u6cbb\u7597\u5176\u4ed6\u4e0d\u9700\u8981\u6cbb\u7597\u7684\u75c5\u4eba[114]<\/a><\/sup>\u3002<\/p>\n\n\n\n

Primary-care physicians<\/a>\u00a0have more difficulty with underrecognition and undertreatment of depression compared to psychiatrists. These cases may be missed because for some people with depression, physical symptoms often accompany depression. In addition, there may also be barriers related to the person, provider, or the medical system. Non-psychiatrist physicians have been shown to miss about two-thirds of cases, although there is some evidence of improvement in the number of missed cases.[118]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u4e0e\u7cbe\u795e\u79d1\u533b\u751f\u76f8\u6bd4\uff0c\u57fa\u5c42\u533b\u751f\u5728\u6291\u90c1\u75c7\u7684\u8bc6\u522b\u4e0d\u8db3\u548c\u6cbb\u7597\u4e0d\u8db3\u65b9\u9762\u9762\u4e34\u66f4\u591a\u56f0\u96be\u3002\u8fd9\u4e9b\u75c5\u4f8b\u53ef\u80fd\u4f1a\u88ab\u6f0f\u8bca\uff0c\u56e0\u4e3a\u5bf9\u90e8\u5206\u6291\u90c1\u75c7\u60a3\u8005\u800c\u8a00\uff0c\u8eab\u4f53\u75c7\u72b6\u5f80\u5f80\u4f1a\u4f34\u968f\u7740\u6291\u90c1\u60c5\u7eea\u4e00\u540c\u51fa\u73b0\u3002\u6b64\u5916\uff0c\u8fd8\u53ef\u80fd\u5b58\u5728\u6765\u81ea\u60a3\u8005\u3001\u533b\u751f\u6216\u533b\u7597\u4f53\u7cfb\u65b9\u9762\u7684\u969c\u788d\u3002\u975e\u7cbe\u795e\u79d1\u533b\u751f\u5927\u7ea6\u4f1a\u6f0f\u8bca\u4e09\u5206\u4e4b\u4e8c\u7684\u75c5\u4f8b\uff0c\u5c3d\u7ba1\u6709\u4e00\u4e9b\u8bc1\u636e\u8868\u660e\u6f0f\u8bca\u7387\u6709\u6240\u6539\u5584[118]\u3002<\/p>\n\n\n\n

\u5728\u5f00\u59cb\u8bca\u65ad\u91cd\u5ea6\u6291\u90c1\u75c7\u4e4b\u524d\uff0c\u533b\u751f\u901a\u5e38\u4f1a\u5bf9\u60a3\u8005\u8fdb\u884c\u4e00\u6b21\u4f53\u68c0\u548c\u4e00\u4e9b\u7279\u5b9a\u7684\u68c0\u67e5\u6765\u6392\u9664\u5176\u4ed6\u9020\u6210\u76f8\u4f3c\u75c7\u72b6\u7684\u75be\u75c5\u3002\u8fd9\u4e9b\u68c0\u67e5\u5305\u62ec\u8840\u6db2\u68c0\u6d4b\uff1a\u68c0\u67e5\u4fc3\u7532\u72b6\u817a\u6fc0\u7d20<\/a>\u548c\u7532\u72b6\u817a\u7d20<\/a>\u6765\u6392\u9664\u7532\u72b6\u817a\u673a\u80fd\u51cf\u9000<\/a>\uff1b\u68c0\u67e5\u57fa\u672c\u7535\u89e3\u8d28\u548c\u8840\u9499\u6765\u6392\u9664\u4ee3\u8c22\u7d0a\u4e71<\/a>\uff0c\u505a\u4e00\u6b21\u5168\u8840\u7ec6\u80de\u8ba1\u6570<\/a>\u5305\u62ec\u7ea2\u7ec6\u80de\u6c89\u964d\u7387<\/a>\u6765\u6392\u9664\u7cfb\u7edf\u6027\u611f\u67d3\u6216\u6162\u6027\u75be\u75c5[115]<\/a><\/sup>\uff0c\u540c\u65f6\u4e5f\u8981\u6392\u9664\u836f\u7269\u6216\u8005\u5176\u4ed6\u7269\u8d28\u6ee5\u7528\u7684\u56e0\u7d20\uff0c\u53e6\u5916\u8fd8\u9700\u8981\u68c0\u67e5\u777e\u916e<\/a>\u6c34\u5e73\u4ee5\u8bca\u65ad\u6027\u817a\u529f\u80fd\u4f4e\u4e0b\u75c7<\/a>\uff0c\u8fd9\u79cd\u75be\u75c5\u4f1a\u5f15\u8d77\u7537\u6027\u6291\u90c1[116]<\/a><\/sup>\u3002<\/p>\n\n\n\n

\u8001\u5e74\u60a3\u8005\u53ef\u80fd\u4f1a\u4e3b\u89c2\u63cf\u8ff0\u8ba4\u77e5\u65b9\u9762\u7684\u95ee\u9898\uff0c\u4f46\u662f\u8fd9\u4e5f\u53ef\u80fd\u662f\u75f4\u5446<\/a>\uff08\u4f8b\u5982\u963f\u5179\u6d77\u9ed8\u75c5<\/a>\uff09\u53d1\u4f5c\u7684\u5148\u5146[117]<\/a><\/sup>\u3002\u6291\u90c1\u662f\u5e38\u89c1\u7684\u75f4\u5446\u521d\u671f\u75c7\u72b6[118]<\/a><\/sup>\u3002\u8ba4\u77e5\u6d4b\u8bd5<\/a>\u548c\u8111\u90e8\u6210\u50cf\u53ef\u4ee5\u628a\u75f4\u5446\u4ece\u6291\u90c1\u75c7\u4e2d\u9274\u522b\u5f00\u6765[119]<\/a><\/sup>\u3002\u5bf9\u4e8e\u7cbe\u795e\u75c5\u6027\u7684\uff0c\u5feb\u901f\u53d1\u75c5\u7684\u6216\u8005\u6709\u7f55\u89c1\u75c7\u72b6\u7684\uff0c\u9700\u8981CT<\/a>\u626b\u63cf\u4ee5\u6392\u9664\u5927\u8111\u75c5\u53d8[120]<\/a><\/sup>\u3002\u4f46\u6ca1\u6709\u751f\u7269\u5b66\u6d4b\u8bd5\u53ef\u4ee5\u76f4\u63a5\u786e\u8bca\u91cd\u5ea6\u6291\u90c1\u75c7[121]<\/a><\/sup>\u3002\u9664\u975e\u6709\u533b\u5b66\u4e0a\u7684\u8ff9\u8c61\uff0c\u5426\u5219\u5728\u4ee5\u540e\u7684\u590d\u53d1\u5468\u671f\u4e2d\u4e0d\u518d\u8fdb\u884c\u8be6\u7ec6\u68c0\u67e5\u3002<\/p>\n\n\n\n

4.2 DSM-IV-TR\u548cICD-10\u8bca\u65ad\u6807\u51c6<\/strong> | DSM and ICD criteria<\/h3>\n\n\n\n

The most widely used criteria for diagnosing depressive conditions are found in the\u00a0American Psychiatric Association<\/a>‘s\u00a0Diagnostic and Statistical Manual of Mental Disorders<\/a><\/em>\u00a0(DSM) and the\u00a0World Health Organization<\/a>‘s\u00a0International Statistical Classification of Diseases and Related Health Problems<\/a><\/em>\u00a0(ICD). The latter system is typically used in European countries, while the former is used in the US and many other non-European nations,[127]<\/a><\/sup>\u00a0and the authors of both have worked towards conforming one with the other.[128]<\/a><\/sup>\u00a0Both DSM and ICD mark out typical (main) depressive symptoms.[129]<\/a><\/sup>\u00a0The most recent edition of the DSM is the Fifth Edition, Text Revision (DSM-5-TR<\/a>),[130]<\/a><\/sup>\u00a0and the most recent edition of the ICD is the Eleventh Edition (ICD-11<\/a>).[131]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u76ee\u524d\uff0c\u8bca\u65ad\u6291\u90c1\u75c7\u6700\u5e7f\u6cdb\u4f7f\u7528\u7684\u6807\u51c6\uff0c\u5206\u522b\u51fa\u81ea\u7f8e\u56fd\u7cbe\u795e\u533b\u5b66\u5b66\u4f1a\u7684\u300a\u7cbe\u795e\u969c\u788d\u8bca\u65ad\u4e0e\u7edf\u8ba1\u624b\u518c\u300b\uff08DSM\uff09\u548c\u4e16\u754c\u536b\u751f\u7ec4\u7ec7\u7684\u300a\u56fd\u9645\u75be\u75c5\u4e0e\u76f8\u5173\u5065\u5eb7\u95ee\u9898\u7edf\u8ba1\u5206\u7c7b\u300b\uff08ICD\uff09\u3002\u540e\u8005\uff08ICD\uff09\u901a\u5e38\u5728\u6b27\u6d32\u56fd\u5bb6\u4f7f\u7528\uff0c\u800c\u524d\u8005\uff08DSM\uff09\u5219\u4e3b\u8981\u5728\u7f8e\u56fd\u53ca\u8bb8\u591a\u5176\u4ed6\u975e\u6b27\u6d32\u56fd\u5bb6\u4f7f\u7528[127]\u3002\u8fd9\u4e24\u5957\u6807\u51c6\u7684\u5236\u5b9a\u8005\u4e00\u76f4\u5728\u52aa\u529b\u63a8\u52a8\u4e24\u8005\u7684\u76f8\u4e92\u7edf\u4e00[128]\u3002DSM\u548cICD\u90fd\u660e\u786e\u5217\u51fa\u4e86\u5178\u578b\u7684\uff08\u4e3b\u8981\uff09\u6291\u90c1\u75c7\u72b6[129]\u3002\u76ee\u524d\u6700\u65b0\u7248\u7684DSM\u662f\u7b2c\u4e94\u7248\u4fee\u8ba2\u6587\u672c\uff08DSM-5-TR\uff09[130]\uff0c\u800c\u6700\u65b0\u7248\u7684ICD\u662f\u7b2c\u5341\u4e00\u7248\uff08ICD-11\uff09[131]\u3002<\/p>\n\n\n\n

Under mood disorders, ICD-11 classifies major depressive disorder as either\u00a0single episode depressive disorder<\/em>\u00a0(where there is no history of depressive episodes, or of\u00a0mania<\/a>) or\u00a0recurrent depressive disorder<\/em>\u00a0(where there is a history of prior episodes, with no history of mania).[132]<\/a><\/sup>\u00a0ICD-11 symptoms, present nearly every day for at least two weeks, are a depressed mood or\u00a0anhedonia<\/a>, accompanied by other symptoms such as “difficulty concentrating, feelings of worthlessness or excessive or inappropriate guilt, hopelessness, recurrent thoughts of death or suicide, changes in appetite or sleep, psychomotor agitation or retardation, and reduced energy or fatigue.”[132]<\/a><\/sup>\u00a0
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u5728\u201c\u5fc3\u5883\u969c\u788d\u201d\uff08Mood disorders\uff09\u7684\u5206\u7c7b\u4e0b\uff0cICD-11 \u5c06\u91cd\u5ea6\u6291\u90c1\u969c\u788d\u5206\u4e3a\u201c\u5355\u6b21\u53d1\u4f5c\u6027\u6291\u90c1\u969c\u788d\u201d\uff08\u5373\u6ca1\u6709\u6291\u90c1\u53d1\u4f5c\u53f2\uff0c\u4e5f\u6ca1\u6709\u8e81\u72c2\u53f2\uff09\uff0c\u6216\u8005\u662f\u201c\u590d\u53d1\u6027\u6291\u90c1\u969c\u788d\u201d\uff08\u5373\u6709\u65e2\u5f80\u53d1\u4f5c\u53f2\uff0c\u4e14\u6ca1\u6709\u8e81\u72c2\u53f2\uff09[132]\u3002ICD-11 \u7684\u75c7\u72b6\u6807\u51c6\u8981\u6c42\u8fd9\u4e9b\u75c7\u72b6\u5728\u81f3\u5c11\u4e24\u5468\u5185\u51e0\u4e4e\u6bcf\u5929\u90fd\u4f1a\u51fa\u73b0\uff0c\u4e3b\u8981\u8868\u73b0\u4e3a\u60c5\u7eea\u4f4e\u843d\u6216\u5feb\u611f\u7f3a\u5931\uff08anhedonia\uff09\uff0c\u5e76\u4f34\u968f\u5176\u4ed6\u75c7\u72b6\uff0c\u4f8b\u5982\u201c\u6ce8\u610f\u529b\u96be\u4ee5\u96c6\u4e2d\u3001\u611f\u5230\u81ea\u5df1\u6beb\u65e0\u4ef7\u503c\u6216\u4ea7\u751f\u8fc7\u5ea6\u6216\u4e0d\u6070\u5f53\u7684\u5185\u759a\u611f\u3001\u7edd\u671b\u3001\u53cd\u590d\u51fa\u73b0\u6b7b\u4ea1\u6216\u81ea\u6740\u7684\u5ff5\u5934\u3001\u98df\u6b32\u6216\u7761\u7720\u6539\u53d8\u3001\u7cbe\u795e\u8fd0\u52a8\u6027\u6fc0\u8d8a\u6216\u8fdf\u6ede\uff0c\u4ee5\u53ca\u7cbe\u529b\u51cf\u9000\u6216\u611f\u5230\u75b2\u52b3\u201d[132]\u3002<\/p>\n\n\n\n

These symptoms must affect work, social, or domestic activities. The ICD-11 system allows further specifiers for the current depressive episode: the severity (mild, moderate, severe, unspecified); the presence of psychotic symptoms (with or without psychotic symptoms); and the degree of remission if relevant (currently in partial remission, currently in full remission).[132]<\/a><\/sup>\u00a0These two disorders are classified as “Depressive disorders”, in the category of “Mood disorders”.[132]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u8fd9\u4e9b\u75c7\u72b6\u5fc5\u987b\u5bf9\u60a3\u8005\u7684\u5de5\u4f5c\u3001\u793e\u4ea4\u6216\u5bb6\u5ead\u751f\u6d3b\u9020\u6210\u5f71\u54cd\u3002ICD-11 \u7cfb\u7edf\u5141\u8bb8\u5bf9\u5f53\u524d\u7684\u6291\u90c1\u53d1\u4f5c\u8fdb\u884c\u66f4\u7ec6\u81f4\u7684\u5206\u7c7b\u8bf4\u660e\uff1a\u5305\u62ec\u4e25\u91cd\u7a0b\u5ea6\uff08\u8f7b\u5ea6\u3001\u4e2d\u5ea6\u3001\u91cd\u5ea6\u3001\u672a\u7279\u5b9a\uff09\uff1b\u662f\u5426\u5b58\u5728\u7cbe\u795e\u75c5\u6027\u75c7\u72b6\uff08\u4f34\u6216\u4e0d\u4f34\u7cbe\u795e\u75c5\u6027\u75c7\u72b6\uff09\uff1b\u4ee5\u53ca\u5982\u679c\u76f8\u5173\u7684\u8bdd\uff0c\u7f13\u89e3\u7684\u7a0b\u5ea6\uff08\u76ee\u524d\u5904\u4e8e\u90e8\u5206\u7f13\u89e3\u671f\u3001\u76ee\u524d\u5904\u4e8e\u5b8c\u5168\u7f13\u89e3\u671f\uff09[132]\u3002\u8fd9\u4e24\u79cd\u969c\u788d\u90fd\u88ab\u5f52\u7c7b\u5728\u201c\u5fc3\u5883\u969c\u788d\u201d\u8fd9\u4e00\u5927\u7c7b\u4e0b\u7684\u201c\u6291\u90c1\u969c\u788d\u201d\u4e2d[132]\u3002<\/p>\n\n\n\n

According to DSM-5, at least one of the symptoms is either depressed mood or loss of interest or pleasure. Depressed mood occurs nearly every day as subjective feelings like sadness, emptiness, and hopelessness or observations made by others (e.g. appears tearful). Loss of interest or pleasure occurs in all, or almost all activities of the day, nearly every day. These symptoms, as well as five out of the nine more specific symptoms listed, must frequently occur for more than two weeks (to the extent in which it impairs functioning) for the diagnosis.[133]<\/a><\/sup>\u00a0Major depressive disorder is classified as a mood disorder in the DSM-5.[134]<\/a><\/sup>\u00a0The diagnosis hinges on the presence of single or recurrent\u00a0major depressive episodes<\/a>.[135]<\/a><\/sup>\u00a0Further qualifiers are used to classify both the episode itself and the course of the disorder. The category\u00a0Unspecified Depressive Disorder<\/a>\u00a0is diagnosed if the depressive episode’s manifestation does not meet the criteria for a major depressive episode.[134]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u6839\u636e DSM-5 \u7684\u6807\u51c6\uff0c\uff08\u786e\u8bca\u7684\uff09\u75c7\u72b6\u4e2d\u5fc5\u987b\u81f3\u5c11\u5305\u542b\u60c5\u7eea\u4f4e\u843d\u6216\u4e27\u5931\u5174\u8da3\u6216\u4e50\u8da3\u4e2d\u7684\u5176\u4e2d\u4e00\u9879\u3002\u60c5\u7eea\u4f4e\u843d\u51e0\u4e4e\u6bcf\u5929\u90fd\u4f1a\u51fa\u73b0\uff0c\u8868\u73b0\u4e3a\u60b2\u4f24\u3001\u7a7a\u865a\u3001\u7edd\u671b\u7b49\u4e3b\u89c2\u611f\u53d7\uff0c\u6216\u8005\u7531\u4ed6\u4eba\u89c2\u5bdf\u5230\u7684\u8868\u73b0\uff08\u4f8b\u5982\u770b\u8d77\u6765\u7ecf\u5e38\u6d41\u6cea\uff09\u3002\u4e27\u5931\u5174\u8da3\u6216\u4e50\u8da3\u5219\u8868\u73b0\u4e3a\u51e0\u4e4e\u6bcf\u5929\u3001\u5728\u4e00\u5929\u4e2d\u51e0\u4e4e\u6240\u6709\u6d3b\u52a8\u91cc\u90fd\u63d0\u4e0d\u8d77\u52b2\u3002\u4e3a\u4e86\u505a\u51fa\u8bca\u65ad\uff0c\u8fd9\u4e9b\u75c7\u72b6\u4ee5\u53ca\u4e0b\u9762\u5217\u51fa\u7684\u4e5d\u9879\u66f4\u5177\u4f53\u7684\u75c7\u72b6\u4e2d\u7684\u4e94\u9879\uff0c\u5fc5\u987b\u9891\u7e41\u51fa\u73b0\u8d85\u8fc7\u4e24\u5468\uff08\u4e14\u4e25\u91cd\u7a0b\u5ea6\u8fbe\u5230\u4e86\u5f71\u54cd\u6b63\u5e38\u529f\u80fd\u7684\u7a0b\u5ea6\uff09[133]\u3002\u5728 DSM-5 \u4e2d\uff0c\u91cd\u5ea6\u6291\u90c1\u969c\u788d\u88ab\u5f52\u7c7b\u4e3a\u4e00\u79cd\u5fc3\u5883\u969c\u788d[134]\u3002\u8be5\u8bca\u65ad\u7684\u6838\u5fc3\u5728\u4e8e\u662f\u5426\u5b58\u5728\u5355\u6b21\u6216\u53cd\u590d\u7684\u201c\u91cd\u5ea6\u6291\u90c1\u53d1\u4f5c\u201d[135]\u3002\u6b64\u5916\uff0c\u8fd8\u4f1a\u4f7f\u7528\u8fdb\u4e00\u6b65\u7684\u9650\u5b9a\u8bcd\u6765\u5bf9\u53d1\u4f5c\u672c\u8eab\u4ee5\u53ca\u75c5\u7a0b\u8fdb\u884c\u5206\u7c7b\u3002\u5982\u679c\u6291\u90c1\u53d1\u4f5c\u7684\u8868\u73b0\u6ca1\u6709\u5b8c\u5168\u8fbe\u5230\u91cd\u5ea6\u6291\u90c1\u53d1\u4f5c\u7684\u6807\u51c6\uff0c\u5219\u4f1a\u88ab\u8bca\u65ad\u4e3a\u201c\u672a\u7279\u5b9a\u7684\u6291\u90c1\u969c\u788d\u201d[134]\u3002<\/p>\n\n\n\n

4.2.1 \u91cd\u5ea6\u6291\u90c1\u53d1\u4f5c<\/strong> | Major depressive episode<\/h4>\n\n\n\n

Main article:\u00a0Major depressive episode<\/a>\u3010\u4e3b\u6761\u76ee\uff1a\u91cd\u5ea6\u6291\u90c1\u53d1\u4f5c\u3011<\/em><\/p>\n\n\n\n

A major depressive episode is characterized by the presence of a severely depressed mood that persists for at least two weeks.[35]<\/a><\/sup>\u00a0Episodes may be isolated or recurrent and are categorized as mild (few symptoms in excess of minimum criteria), moderate, or severe (marked impact on social or occupational functioning). An episode with psychotic features\u2014commonly referred to as\u00a0psychotic depression<\/a><\/em>\u2014is automatically rated as severe.[134]<\/a><\/sup>\u00a0If the person has had an episode of\u00a0mania<\/a>\u00a0or\u00a0markedly elevated mood<\/a>, a diagnosis of\u00a0bipolar disorder<\/a>\u00a0is made instead. Depression without mania is sometimes referred to as\u00a0unipolar<\/em>\u00a0because the mood remains at one emotional state or “pole”.[136]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u91cd\u5ea6\u6291\u90c1\u53d1\u4f5c\u7684\u7279\u5f81\u662f\u5b58\u5728\u6301\u7eed\u81f3\u5c11\u4e24\u5468\u7684\u4e25\u91cd\u6291\u90c1\u60c5\u7eea[35]\u3002\u8fd9\u79cd\u53d1\u4f5c\u53ef\u80fd\u662f\u5b64\u7acb\u7684\uff0c\u4e5f\u53ef\u80fd\u662f\u53cd\u590d\u51fa\u73b0\u7684\uff0c\u5e76\u88ab\u5206\u4e3a\u8f7b\u5ea6\uff08\u8d85\u51fa\u6700\u4f4e\u6807\u51c6\u7684\u75c7\u72b6\u8f83\u5c11\uff09\u3001\u4e2d\u5ea6\u6216\u91cd\u5ea6\uff08\u5bf9\u793e\u4ea4\u6216\u804c\u4e1a\u529f\u80fd\u6709\u663e\u8457\u5f71\u54cd\uff09\u3002\u5982\u679c\u53d1\u4f5c\u4f34\u6709\u7cbe\u795e\u75c5\u6027\u7279\u5f81\uff08\u901a\u5e38\u88ab\u79f0\u4e3a\u201c\u7cbe\u795e\u75c5\u6027\u6291\u90c1\u75c7\u201d\uff09\uff0c\u5219\u4f1a\u81ea\u52a8\u88ab\u8bc4\u5b9a\u4e3a\u91cd\u5ea6[134]\u3002\u5982\u679c\u4e00\u4e2a\u4eba\u66fe\u7ecf\u6709\u8fc7\u8e81\u72c2\u53d1\u4f5c\u6216\u60c5\u7eea\u663e\u8457\u9ad8\u6da8\u7684\u7ecf\u5386\uff0c\u5219\u4f1a\u88ab\u8bca\u65ad\u4e3a\u53cc\u76f8\u60c5\u611f\u969c\u788d\u3002\u6ca1\u6709\u8e81\u72c2\u75c7\u72b6\u7684\u6291\u90c1\u75c7\u6709\u65f6\u88ab\u79f0\u4e3a\u201c\u5355\u76f8\u6291\u90c1\u201d\uff0c\u56e0\u4e3a\u5176\u60c5\u7eea\u59cb\u7ec8\u505c\u7559\u5728\u4e00\u79cd\u60c5\u7eea\u72b6\u6001\u6216\u201c\u5355\u6781\u201d\u4e0a[136]\u3002<\/p>\n\n\n\n

Bereavement<\/a>\u00a0is not an exclusion criterion in the DSM-5, and it is up to the clinician to distinguish between normal reactions to a loss and MDD. Excluded are a range of related diagnoses, including\u00a0dysthymia<\/a>, which involves a chronic but milder mood disturbance;[137]<\/a><\/sup>\u00a0recurrent brief depression<\/a>, consisting of briefer depressive episodes;[138]<\/a>[139]<\/a><\/sup>\u00a0minor depressive disorder<\/a>, whereby only some symptoms of major depression are present;[140]<\/a><\/sup>\u00a0and\u00a0adjustment disorder with depressed mood<\/a>, which denotes low mood resulting from a psychological response to an identifiable event or\u00a0stressor<\/a>.[141]<\/a><\/sup>
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u5728 DSM-5 \u4e2d\uff0c\u4e27\u4eb2\uff08\u5373\u4eb2\u4eba\u79bb\u4e16\u5e26\u6765\u7684\u60b2\u4f24\uff09\u4e0d\u518d\u662f\u6392\u9664\u6807\u51c6\uff0c\u56e0\u6b64\u7531\u4e34\u5e8a\u533b\u751f\u6765\u533a\u5206\u6b63\u5e38\u7684\u4e27\u4eb2\u53cd\u5e94\u4e0e\u91cd\u5ea6\u6291\u90c1\u75c7\uff08MDD\uff09\u3002\u6b64\u5916\uff0c\u8fd8\u6392\u9664\u4e86\u4e00\u7cfb\u5217\u76f8\u5173\u7684\u8bca\u65ad\uff0c\u5305\u62ec\uff1a\u6076\u52a3\u5fc3\u5883\uff08dysthymia\uff09\uff0c\u8868\u73b0\u4e3a\u4e00\u79cd\u6162\u6027\u4f46\u7a0b\u5ea6\u8f83\u8f7b\u7684\u60c5\u7eea\u969c\u788d[137]\uff1b\u590d\u53d1\u6027\u77ed\u6682\u6291\u90c1\u969c\u788d\uff08recurrent brief depression\uff09\uff0c\u7531\u66f4\u77ed\u6682\u7684\u6291\u90c1\u53d1\u4f5c\u7ec4\u6210[138][139]\uff1b\u8f7b\u5ea6\u6291\u90c1\u969c\u788d\uff08minor depressive disorder\uff09\uff0c\u5373\u4ec5\u8868\u73b0\u51fa\u90e8\u5206\u91cd\u5ea6\u6291\u90c1\u7684\u75c7\u72b6[140]\uff1b\u4ee5\u53ca\u4f34\u6709\u6291\u90c1\u5fc3\u5883\u7684\u9002\u5e94\u969c\u788d\uff08adjustment disorder with depressed mood\uff09\uff0c\u6307\u7684\u662f\u7531\u53ef\u8bc6\u522b\u7684\u4e8b\u4ef6\u6216\u538b\u529b\u6e90\u5f15\u53d1\u7684\u5fc3\u7406\u53cd\u5e94\u6240\u5bfc\u81f4\u7684\u4f4e\u843d\u60c5\u7eea[141]\u3002<\/p>\n\n\n\n

4.2.2 \u4e9a\u578b | Subtypes<\/h4>\n\n\n\n

The DSM-5 recognizes six further subtypes of MDD, called\u00a0specifiers<\/em>, in addition to noting the length, severity and presence of psychotic features:
\u3010\u53c2\u8003\u8bd1\u6587\u3011\u9664\u4e86\u6ce8\u660e\u75c5\u7a0b\u957f\u77ed\u3001\u4e25\u91cd\u7a0b\u5ea6\u4ee5\u53ca\u662f\u5426\u5b58\u5728\u7cbe\u795e\u75c5\u6027\u7279\u5f81\u5916\uff0cDSM-5 \u8fd8\u627f\u8ba4\u91cd\u5ea6\u6291\u90c1\u75c7\uff08MDD\uff09\u6709\u4ee5\u4e0b\u516d\u79cd\u8fdb\u4e00\u6b65\u7684\u4e9a\u578b\uff0c\u79f0\u4e3a\u201c\u7279\u5b9a\u6807\u6ce8\u201d\uff1a<\/p>\n\n\n\n