Musk is also taking medication, and the inner darkness of patients with depression is like a deep-sea mechanism | global | inner world

On July 5th, renowned singer Li Wen passed away unexpectedly. Li Wen's sister claimed on social media that Li Wen was suffering from depression and committed suicide, which has attracted widespread attention to mental health in society.

As an idol of millions of people, Li Wen's stage performance is full of heat and laughter, but the heart of depression patients is as dark as the deep sea. Psychologists analyze that "successful individuals" are more likely to become a potential group of "smiling depression", especially those who are introverted or perfectionists. They are usually able to conceal their emotions well, avoid their real emotional experiences, and maintain good social functioning, making it difficult for people to understand their inner state.

"People who force themselves to smile cannot actually feel true joy and joy in their hearts," Chen Jun, chief physician of the Shanghai Mental Health Center, told a reporter from First Financial News.

Depression is a common psychological disorder that can occur in anyone, and is therefore referred to by the World Health Organization as the "fourth largest disease" in the world. It is the second largest killer of humans after cancer. Although early prevention and treatment are more effective, most patients do not receive sufficient attention in the early stages of the disease, including failure to take appropriate response measures.

An underrecognized disease

A report published by the authoritative medical journal The Lancet last year estimated that 5% of the world's adults suffer from depression every year, the highest incidence rate among young people, but this global health crisis is still ignored.

Insufficient understanding of depression is the main reason that affects its prevention, diagnosis, and treatment. The Lancet report points out that depression is not equivalent to simple sadness, and it cannot be considered a sign of weakness or only appears in certain cultural groups. The report emphasizes that depression is a special health problem characterized by its persistence, significant impact on daily life, and long-term health consequences.

Depression is also related to various chronic physical diseases, and a person's physical health can affect their mental health, and vice versa. Other multifactorial diseases, such as diabetes, heart disease, cancer and dementia, and infectious diseases such as HIV and COVID-19, are often accompanied by depression, which may lead to the complexity and prolongation of the course of these related diseases.

In the worst case scenario, depression can lead to suicide. Research has shown that 70% to 80% of people in high-income countries who die from suicide, as well as about half of those in low - and middle-income countries who die from suicide, suffer from mental illness, with depression being the most common cause.

"It can be said that no disease is as common as depression, leading to such a high disease burden. This could have been completely treatable." The Lancet report states, "The high stigmatization of depression still hinders many people from seeking necessary help, many of whom are teenagers and young people at risk of depression or currently suffering from depression."

Prevention is the most easily overlooked aspect of depression. Dr. Lakshmi Vijayakumar, from the Chennai Suicide Prevention Center and volunteer health service agency SNEHA in India, said, "Investing in depression prevention is very valuable. People with common risk factors and chronic health problems have a higher prevalence of depression, which requires global adoption of common prevention measures."

Although depression is a common disease, it also has a high degree of heterogeneity, and different patients with depression exhibit various manifestations in early signals and symptoms, severity, and disease trajectory. Therefore, interventions for depression should consider the uniqueness of each individual's experience and personalized care needs.

People who appear happy may also experience depression

Li Wen always gives people a sunny and cheerful feeling, why do cheerful people also suffer from depression? Regarding this, some experts have stated that "smiling depression" is more dangerous, especially in some professions where people always smile and appear "high" due to work needs. However, this appearance masks their inner depression.

This situation is particularly common among artists. As early as 2016, 28 year old actor Qiao Renliang committed suicide due to depression, and he had always given people a lively and sunny impression before.

In 2018, the founder of the famous fashion brand Kate Spade committed suicide due to depression, which also shocked many people. In the impression of friends, this female designer has always been fond of laughter and liveliness, and her products are full of bright colors.

With the change of society and the increase of life pressure, the incidence rate of depression and anxiety has increased globally in recent years, and there are about 50 million depression patients in China. "Smiling depression" is not only common among artists, but also among ordinary professionals, especially white-collar workers.

But experts point out that this so-called "smiling depression" is not a professional term.

"'Smiling depression 'is not a clinical diagnostic term. It is just a colloquial term used to describe the symptoms of some patients. It mainly refers to two situations: first, during the period of depression, patients with bipolar disorder and manic phase appear in the public eye when their condition is stable, and then withdraw from the public eye when they are depressed, so people always see their cheerful and sunny side." Xie Bin, chief physician of the Shanghai Mental Health Center, told First Financial News.

According to research, women make up the majority of patients with depression. In 2019, Professor Huang Yueqin's team from Peking University Sixth Hospital published a study in The Lancet Psychiatry, which reported for the first time that women account for about 65% of depression patients in China. In addition, 67% of patients with depression are over 35 years old.

Experts have also stated that there are two peak age groups for the onset of depression: around 20 years old and around 40 years old. Taking the age of around 40 as an example, physiologically, this is a change from late adolescence to early adulthood; Psychologically, it is more likely to experience symptoms of depression when faced with situations such as accelerated work pace and increased life pressure.

The Healthy China Action takes "promoting mental health" as one of the 15 special actions, proposing goals such as "by 2022 and 2030, the level of residents' mental health literacy will be increased to 20% and 30%; the upward trend of anxiety disorders, depression, and insomnia will slow down".

A patient with depression is waiting for treatment in the mental health department of Shanxi Grand Hospital. Xinhua News Agency

Do you rely on dopamine to treat depression?

On a global scale, there are many successful individuals with mental disorders. Iron Man Elon Musk has recently been reported to suffer from depression. Foreign media reported last week that Musk told people that he is taking low-dose ketamine to treat depression, and some have seen him taking this medication at entertainment gatherings. Musk also admitted on Twitter that he used ketamine to treat depression.

The development of antidepressant drugs is full of challenges. SSRI is a new type of antidepressant drug, and the world's first SSRI antidepressant on the market is Prozac. The mechanism of action of ketamine is different. It is a "dissociative drug", which means that the drug has a "hallucinogenic" effect that can affect an individual's vision and hearing, and produce a feeling of "detachment from reality". This drug is often used as an anesthetic, but some people use it as a "party medicine".

As a psychoactive substance that can induce hallucinations, hallucinogens have attracted much attention in recent years due to their potential therapeutic effects in depression, anxiety, drug addiction, and other areas. However, the clinical application of hallucinogens in the treatment of depression is still limited.

In 2019, the US FDA approved the combination of a nasal spray of Johnson&Johnson with another oral antidepressant to treat refractory depression. At that time, it became the first approved new antidepressant for more than 30 years, with an onset time of about 10 days. However, this drug was controversial due to its serious side effects. Last year, China also approved the drug.

At the beginning of last year, a Chinese research team published a heavyweight article in the journal Science, revealing the molecular mechanism of hallucinogens binding to 5-HT2A receptors and designing new non hallucinogenic antidepressant molecules. This study sparked academic discussion and will promote the progress of new antidepressant therapies, benefiting more depression patients.

The co author of the study, Cheng Jianjun from the iHuman Institute of Shanghai University of Science and Technology, told a reporter from First Financial News at the time, "Due to the significant side effects of hallucinogens, they were previously only used for severe depression and refractory depression. The new drug mechanism we have discovered has modified this hallucinogenic agent, which is expected to quickly exert antidepressant effects without causing hallucinations. This will greatly expand the application group of patients."

Cheng Jianjun stated that there are many teams worldwide working on the development of new antidepressant drugs based on hallucinogenic mechanisms. But drug development takes time. His team is still further evaluating and optimizing the compound, and he looks forward to breakthroughs in clinical trials for this new type of drug soon.

In March of this year, a Chinese research team discovered the pleasure mechanism of propofol in "anesthetized milk" and explored its intervention in depression. Propofol can resist pleasure loss by inhibiting dopamine transporters, causing an increase in dopamine levels in the brain. Dopamine can transmit information of excitement and happiness, which is expected to bring hope to patients with depression.

"Lack of pleasure is the core phenotype of life loss motivation in patients with depression, and it is also an important symptom of various other mental illnesses," Professor Hu Ji from the School of Life Sciences at Shanghai University of Science and Technology told a reporter from First Financial News.