http://tw.news.yahoo.com/article/url/d/ ... 1elcy.html
更新日期:2009/02/17 11:54 中山醫學大學附設醫院精神科主任／謝明鴻醫
憂鬱症對於國民身心健康的威脅日益加重，聯合國世界衛生組織（WHO）曾預測西元2020年時，憂鬱症將成為人類引起失能與早夭的第二大疾病，也將與癌症及愛滋病並列為新世紀的三大疾病，可見憂鬱症對人類健康殺傷力之大。不過，儘管憂鬱症日益普遍，但它的誤診情形時有所聞，而且就診率也比一般疾病低得多。
根據高醫張明永教授等人於2000年進行的研究發現，台灣社區輕鬱症的盛行率達15-25 %，重鬱症則為5 %，與歐美社會不相上下。女性的盛行率為22.2 %，高於男性的14.4 %；以年齡而言，青少年及老人憂鬱症較其他族群為高。其中老人由於身體的機能逐漸下降，且常合併慢性病及腦血管疾病等，比較容易引發血管性憂鬱症；至於臥床或須坐輪輢的老人因為行動受限、出門不易，也較可能引發憂鬱症。在青少年方面，約有20-40%的青少年有程度不一的憂鬱症狀，但青少年的憂鬱症症狀與成年人大不相同，常出現學業表現差、衝動且易與家人或同輩起衝突、甚至有物質濫用、反社會、說謊及偷竊等行為，容易被誤認為是叛逆的表現。
國內的憂鬱症患者約有七成並未就醫看診，原因包含沒意識到憂鬱症是一種疾病，或是排斥看精神科門診。不過即便在這些少數就診的憂鬱症患者當中，仍有高達58%的患者是在非精神科看診，只有22.5%的患者接受精神科的治療，而有13.14%是接受民俗療法或其他治療。與其他疾病相比，憂鬱症的就診率的確相當低，台灣憂鬱症患者超過百萬人，有極多病患並未獲得適切的治療。
值得注意的是，憂鬱症患者未必都會表達自己的情緒問題。憂鬱症患者大約有三到四成會合併身體疼痛的症狀，他們常在內科、外科及家醫科求診，在檢查不出身體任何問題後，才由各科醫師照會精神科醫師看診。研究發現，高達七成的憂鬱症患者就醫時，只報告自己的身體症狀，甚至為數不少的患者會否認自己的情緒低落。
憂鬱症的治療方式相當多元，醫師會根據患者的病情及特質提供不同治療。輕度至中度的患者可採心理治療（如支持性心理療法，人際互動療法或認知治療等），或加上藥物治療；嚴重的患者則應該以藥物為優先治療方式，因為藥物效果快，並且能有效緩解患者的心理及生理不適。目前常見的用藥包含選擇性血清素再回收抑制劑（SSRI）、選擇性血清素及正腎上腺素再回收抑制劑（SNRI）、正腎上腺素及多巴胺再回收抑制劑 (NDRI)、增加正腎上腺素及血清素活性的抗鬱劑 (NaSSA)或傳統三環抗鬱劑(TCA)等藥。此外，新的物理治療方法－透顱磁刺激(TMS)、腦深層刺激(DBS)及迷走神經刺激(VNS)等療法也正被研究用在難治型憂鬱症的治療；傳統的電痙攣治療至今已70多年歷史，目前也被用於自殺意念強烈或無法忍受藥物副作用的患者。
最後要強調的是，憂鬱症絕對不是懦弱或逃避的表現 ﹗憂鬱症是一種多元症狀表現的疾病，它影響的面向包括情緒、感覺、興趣、食慾、體重、睡眠、行為、專心力、思考力、有自殺的想法...等。最重要的是，憂鬱症是一種"傷腦筋 "的疾病，長期或多次發作時會傷害腦細胞而影響認知功能，因此早期和及時的治療才能完全痊癒 ﹗當然在漫長康復的病程中，家人及親友的扶持與陪伴將會是患者最重要的支柱。
憂鬱症 說不出口的藍色新心情？
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you heard the man
"There's no need," Harry muttered, but Uncle Vernon made any further explanation unnecessary by saying loudly,
"Well, this is good-bye then boy."
He swung his right arm upward to shake Harry's hand, but at the last moment seemed unable to face it, and merely closed his fist and began swinging it backward and forward like a metronome.
"Ready, Duddy?" asked Petunia, fussily checking the clasp of her handbag so as to avoid looking at Harry altogether.
Harry led them all back into the kitchen where wow gold, laughing and chattering, they settled on chairs, buy cheap wow dold, sat themselves upon Aunt Petunia's gleaming work surfaces, or leaned up against her spotless appliances; Ron, long and lanky; Hermione wow gold, her bushy hair tied back in a long plait lord of the rings gold; Fred and George, grinning identically; Bill, badly scarred and long-haired; Mr. Weasley, kind-faced, balding, his spectacles a little awry; Mad-Eye, battle-worn, one-legged, his bright blue magical eye whizzing in its socket; Tonks, whose short hair was her favorite shade of bright pink; Lupin, grayer, more lined; Fleur, slender and beautiful, with her long silvery blonde hair; Kingsley, bald and broad-shouldered; Hagrid, with his wild hair and beard WOW Power leveling, standing hunchbacked to avoid hitting his head on the ceiling; and Mundungus Fletcher, small, dirty, and hangdog, with his droopy beady hound's eyes and matted hair. Harry's heart seemed to expand and glow at the sight: He
felt incredibly fond of all of them, even Mundungus wow gold, whom he had tried to strangle the last time they had met. Harry looking for wow gold at the world...
Dudley did not answer but stood there with his mouth slightly ajar, reminding Harry a little of the giant, Grawp.
"Come along, then," said Uncle Vernon.
He had already reached the living room door when Dudley mumbled, "I don't understand."
"What don't you understand, popkin?" asked Petunia looking up at her son.
Dudley raised a large, hamlike hand to point at Harry.
"Why isn't he coming with us?
Uncle Vernon and Aunt Petunia froze when they stood staring at Dudley as though he had just expressed a desire to become a ballerina.
"What?" said Uncle Vernon loudly.
"Why isn't he coming too?" asked Dudley.
"Well, he\a151doesn't want to," said Uncle Vernon, turning to glare at Harry and adding, "You don't want to, do you?"
"Not in the slightest," said Harry.
"There you are," Uncle Vernon told Dudley. "Now come on we're off."
He marched out of the room. They heard the front door open, but Dudley did not move and after a few faltering steps Aunt Petunia stopped too.
"What now?" barked Uncle Vernon, reappearing in the doorway.
It seemed that Dudley was struggling with concepts too difficult to put into words. After several moments of apparently painful internal struggle he said, "But where's he going to go?"
Aunt Petunia and Uncle Vernon looked at each other. It was clear that Dudley was frightening them. Hestia Jones broke the silence.
"But\a133 surely you know where your nephew is going?" she asked looking bewildered.
"Certainly we know," said Vernon Dursley. "He's off with some of your lot, isn't he? Right, Dudley, let's get in the car, you heard the man, we're in a hurry.
"Well, this is good-bye then boy."
He swung his right arm upward to shake Harry's hand, but at the last moment seemed unable to face it, and merely closed his fist and began swinging it backward and forward like a metronome.
"Ready, Duddy?" asked Petunia, fussily checking the clasp of her handbag so as to avoid looking at Harry altogether.
Harry led them all back into the kitchen where wow gold, laughing and chattering, they settled on chairs, buy cheap wow dold, sat themselves upon Aunt Petunia's gleaming work surfaces, or leaned up against her spotless appliances; Ron, long and lanky; Hermione wow gold, her bushy hair tied back in a long plait lord of the rings gold; Fred and George, grinning identically; Bill, badly scarred and long-haired; Mr. Weasley, kind-faced, balding, his spectacles a little awry; Mad-Eye, battle-worn, one-legged, his bright blue magical eye whizzing in its socket; Tonks, whose short hair was her favorite shade of bright pink; Lupin, grayer, more lined; Fleur, slender and beautiful, with her long silvery blonde hair; Kingsley, bald and broad-shouldered; Hagrid, with his wild hair and beard WOW Power leveling, standing hunchbacked to avoid hitting his head on the ceiling; and Mundungus Fletcher, small, dirty, and hangdog, with his droopy beady hound's eyes and matted hair. Harry's heart seemed to expand and glow at the sight: He
felt incredibly fond of all of them, even Mundungus wow gold, whom he had tried to strangle the last time they had met. Harry looking for wow gold at the world...
Dudley did not answer but stood there with his mouth slightly ajar, reminding Harry a little of the giant, Grawp.
"Come along, then," said Uncle Vernon.
He had already reached the living room door when Dudley mumbled, "I don't understand."
"What don't you understand, popkin?" asked Petunia looking up at her son.
Dudley raised a large, hamlike hand to point at Harry.
"Why isn't he coming with us?
Uncle Vernon and Aunt Petunia froze when they stood staring at Dudley as though he had just expressed a desire to become a ballerina.
"What?" said Uncle Vernon loudly.
"Why isn't he coming too?" asked Dudley.
"Well, he\a151doesn't want to," said Uncle Vernon, turning to glare at Harry and adding, "You don't want to, do you?"
"Not in the slightest," said Harry.
"There you are," Uncle Vernon told Dudley. "Now come on we're off."
He marched out of the room. They heard the front door open, but Dudley did not move and after a few faltering steps Aunt Petunia stopped too.
"What now?" barked Uncle Vernon, reappearing in the doorway.
It seemed that Dudley was struggling with concepts too difficult to put into words. After several moments of apparently painful internal struggle he said, "But where's he going to go?"
Aunt Petunia and Uncle Vernon looked at each other. It was clear that Dudley was frightening them. Hestia Jones broke the silence.
"But\a133 surely you know where your nephew is going?" she asked looking bewildered.
"Certainly we know," said Vernon Dursley. "He's off with some of your lot, isn't he? Right, Dudley, let's get in the car, you heard the man, we're in a hurry.