事件记录
面试官: When depression or bipolar disorder isn't responding to st和ard treatments, they are referred to as treatment-resistant mood disorders.
心理学家博士. 亨茨曼精神健康研究所治疗难治性情绪障碍诊所的布莱恩·米奇是治疗这些疾病的专家, 今天他将告诉大发娱乐如何去看专家可以大发娱乐患有这种疾病的人过上更快乐、更有成效的生活.
Dr. 米奇, 第一个, 难治性情绪障碍何时会被归类为难治性?
Dr. 米基: 没有什么神奇的公式, 但大多数情况下, we consider if you've had at least two adequate trials, 也就是药物试验, 心理治疗试验, that are robust 和 that lasted long enough 和 you didn't respond, we would consider that treatment-resistant.
面试官: Either through medication or through psychotherapy, you would have to go through at least two of those. And if you weren't seeing an improvement of the symptoms, that would be classified as treatment-resistant.
Dr. 米基: 正确的. 完全.
面试官: 好吧. 当一个病人在被确定为潜在的治疗抗药性后来找你, what are the interventions that you offer then initially?
Dr. 米基: 所以大发娱乐讨论的一些最初的选择是改变他们目前的药物治疗方案. 这是很常见的. Sometimes people haven't had an adequate treatment trial.
大发娱乐在诊所大发娱乐提供的另一种选择是经颅磁刺激. That's a non-invasive brain stimulation treatment.
We also can offer ketamine infusion therapy. That's an intravenous ketamine infusion that can be helpful for depression.
所以如果这些侵入性较小的选择没有效果或者造成太多的副作用, then there are other surgical options that we sometimes will go to next.
面试官: Tell me more about the less invasive options. 你试了多久? How many of those do you go through before you kind of get to that point?
Dr. 米基: That depends a lot on the particular patient, the kind of depression they're having, 它有多严重？, 和, 当然, 保险责任范围. But typically for people who are functioning fairly well, they're going to work or doing their daily routines, 那么经颅磁刺激或氯胺酮输注治疗是最有意义的.
经颅磁刺激和氯胺酮输注疗法更适合维持你的日常生活，副作用也相对较低.
对于那些患有严重抑郁症的人来说，这已经使他们非常虚弱或无法工作, or let's say they're admitted to the hospital, 然后是电休克疗法, 或等, is what we would think of probably before those other treatments.
面试官: Are people intimidated by that name, the fact that you're using electrotherapy? I mean, that could sound kind of scary.
Dr. 米基: 是的, 我认为这听起来很可怕，如果你不太了解它，或者你只知道你从电影中学到的东西, 那就太可怕了.
面试官: And what happened like 100 years ago. 现在不是这样了.
Dr. 米基: 是的, it's very different 和 it's a very safe treatment. It does have side effects 和 we counsel people about that, but it can really change the game for people with severe depression.
面试官: 听起来你有很多选择和工具可以大发娱乐那些经历了一些初步治疗但还不能处理症状的人, take care of the symptoms in a way that they're able to go back to their life.
Tell me about a typical patient that walks into your office. Describe what that looks like 和 the conversation you have.
Dr. 米基: So a typical patient that we see would come feeling pretty hopeless, 我会说, 因为他们已经尝试了很多不同的治疗方法，感觉已经到了最后，他们不知道还有什么可以尝试的.
Typically they've had years of illness, if not decades. 大发娱乐看到的大多数人在很小的时候就患有这种疾病. 所以，大多数时候，他们的疾病是在青少年时期或青年时期开始的.
Typically, people are not able to enjoy life. 他们不喜欢自己的工作. They're not enjoying their social interactions. They become less interested in pursuing hobbies 和 being with other people. Most people have then become kind of socially disconnected, 这甚至会让事情变得更糟, 因为这是 . . .
面试官: 是的, 和 not finding satisfaction in work. Do these individuals realize that this is happening 和 are like, "I would love to find satisfaction in my work, 但我就是做不到。”?
Dr. 米基: 正确的. 大多数人都是这样, 他们体验它的方式通常是他们不确定为什么他们不喜欢它. 当然, 大发娱乐在生活中都有压力, 但在这些情况下，悲伤和情绪失调以及失去兴趣和快乐的程度远远超过了这一点. It doesn't make sense in the context. That's kind of what we're talking about here when talking about depression.
这些都是人们来大发娱乐诊所之前的经历和症状. And what these treatments can do is they relatively quickly, 几周之内, start to relieve people of those symptoms. 这种影响可以持续几个月，有时甚至几年，然后人们通常会复发.
And so that's something that we also educate people about. 这不是一种治疗方法. It's a treatment that we can administer for this episode. But that can be a really meaningful difference for people.
面试官: And then if a relapse occurs, what then?
Dr. 米基: 对于复发的人，大发娱乐通常可以使用同样的治疗方法. And so we don't think of them as permanent fixes obviously. And so people will always have this kind of vulnerability. That would be the most typical pattern, that people have recurrences.
But if you underst和 the patterns, sometimes you can prevent them. That's the ultimate goal, is to prevent a recurrence. But if people do have a recurrence, then we can use these treatments again. And so those are the folks that we see 和 that I think we can help.
面试官: And for those individuals that have suffered for decades, what's the barrier to seeking out more treatment?
Dr. 米基: 有很多障碍. 一个是不知道除了他们已经尝试过的东西之外还有什么选择. Another is oftentimes just insurance barriers.
Another barrier that people have I think is just fear of the unknown, 可能不太了解这些治疗方案到底是什么样的, which we can help educate people about that.
我认为另一个原因是很多时候人们不想成为一个抑郁的人. 这不是一个伟大的地方. 所以在你真正去诊所之前你必须承认你有这种情况. I think that can be a barrier as well.
面试官: 你是否发现患有难治性情绪障碍的人无法自己寻求大发娱乐，通常需要家庭成员的大发娱乐?
Dr. 米基: 这很常见. 我认为部分原因是他们可能不愿意将自己视为抑郁症患者，或者在某些情况下他们可能没有意识到事情有多严重.
And that's one thing that depression does, is it changes how you see yourself 和 how you think about the world. 在很多情况下，它会让你更专注于自己的内心，而不太能意识到事情已经走了多远. 我想有时候人们只是不记得他们不抑郁的时候是怎样的. So it has these effects on your own cognition 和 underst和ing of yourself, 是什么让它与众不同.
面试官: You mentioned insurance can be a barrier for some people. 亨茨曼心理健康研究所是否有人担心"我该如何支付这个费用?“如果没有保险，这可能会大发娱乐人们做出一些选择?
Dr. 米基: 是的,绝对. 在大发娱乐的诊所, 大发娱乐有转诊专家，他们会提前做所有这些检查，大发娱乐你了解财务状况. 你不想在不知道成本是多少的情况下进入这种情况. And there's nothing like an extra bill to accentuate your depression. 所以，是的，这是大发娱乐非常关注的护理的一个重要方面.
面试官: 好吧, 听起来你给那些长期与情绪障碍作斗争的人带来了希望, 长时间. 大发娱乐来总结一下, 你有什么话想让听众从大发娱乐今天的谈话中带走吗?
Dr. 米基: 是的, 我会说 that there is hope. 这是大发娱乐在会诊结束时从病人那里得到的一个很常见的回答. They're often saying, "I didn't even know there were all these options.“实际上，在大发娱乐实施任何积极治疗之前，人们在一次咨询后感觉好多了，这是很常见的.