Module 4: Mood Disorders模块 4：情绪障碍

3rd edition as of July 2023
截至 2023 年 7 月的第三版

Module Overview 模块概述

In Module 4, we will discuss matters related to mood disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will cover major depressive disorder, persistent depressive disorder (formerly Dysthymia), bipolar I disorder, bipolar II disorder, and cyclothymic disorder. We will also cover major depressive, manic, and hypomanic episodes. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of several therapies (Module 3). Note that this module will cover two chapters from the DSM 5-TR; namely, Bipolar and Related Disorders and Depressive Disorders.
在模块 4 中，我们将讨论与心境障碍相关的问题，包括其临床表现、流行病学、共病、病因和治疗选择。我们的讨论将涵盖重度抑郁症、持续性抑郁症（以前称为心境恶劣）、双相 I 型障碍、双相 II 型障碍和环性心境障碍。我们还将讨论重度抑郁、躁狂和轻躁狂发作。请确保您参考模块 1-3 中关键术语的解释（模块 1）、解释心理病理学的各种模型概述（模块 2）以及几种疗法的描述（模块 3）。请注意，本模块将涵盖 DSM 5-TR 中的两个章节；即双相及相关障碍和抑郁障碍。

Module Outline 模块大纲

• 4.1. Clinical Presentation – Depressive Disorders
  4.1. 临床表现 - 抑郁障碍
• 4.2. Clinical Presentation – Bipolar and Related Disorders
  4.2. 临床表现 - 双相情感障碍及相关障碍
• 4.3. Epidemiology  4.3. 流行病学
• 4.4. Comorbidity  4.4. 合并症
• 4.5. Etiology  4.5. 病因学
• 4.6. Treatment  4.6. 治疗

Module Learning Outcomes 模块学习成果

• Describe how depressive disorders present.
  描述抑郁症的表现。
• Describe how bipolar and related disorders present.
  描述双相及相关障碍的表现。
• Describe the epidemiology of mood disorders.
  描述情绪障碍的流行病学。
• Describe comorbidity in relation to mood disorders.
  描述与情绪障碍相关的共病情况。
• Describe the etiology of mood disorders.
  描述情绪障碍的病因。
• Describe treatment options for mood disorders.
  描述情绪障碍的治疗方案。

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4.1. Clinical Presentation – Depressive Disorders 4.1. 临床表现 - 抑郁障碍

Section Learning Objectives 章节学习目标

• Distinguish the two distinct groups of mood disorders.
  区分两种不同的情绪障碍群体。
• Identify and describe the two types of depressive disorders.
  识别并描述两种抑郁症的类型。
• Classify symptoms of depression.
  将抑郁症的症状进行分类。
• Describe premenstrual dysphoric disorder.
  描述经前期焦虑症。

4.1.1. Distinguishing Mood Disorders 4.1.1. 精神障碍的鉴别

Within mood disorders are two distinct groups—individuals with depressive disorders and individuals with bipolar disorders. The key difference between the two mood disorder groups is episodes of mania/hypomania. More specifically, in bipolar I disorder, the individual experiences a manic episode that “may have been preceded by and may be followed by hypomanic or major depressive episodes” (APA, 2022, pg. 139) whereas for bipolar II disorder, the individual has experienced in the past or is currently experiencing a hypomanic episode and has experienced in the past or is currently experiencing a major depressive episode. In contrast, individuals presenting with a depressive disorder have never experienced a manic or hypomanic episode. * *
在心境障碍中，有两个不同的群体——患有抑郁症的人和患有双相情感障碍的人。这两种心境障碍群体之间的关键区别是躁狂/轻躁狂的发作。更具体地说，在双相 I 型障碍中，个体经历了一次躁狂发作，这种发作“可能之前有轻躁狂或重度抑郁发作，也可能之后有轻躁狂或重度抑郁发作”（APA，2022，第 139 页），而对于双相 II 型障碍，个体在过去或目前经历过轻躁狂发作，并且在过去或目前经历过重度抑郁发作。相比之下，表现出抑郁症的人从未经历过躁狂或轻躁狂发作。

4.1.2. Types of Depressive Disorders 4.1.2. 抑郁障碍的类型

The two most common types of depressive disorders are major depressive disorder (MDD) and persistent depressive disorder (PDD). Persistent depressive disorder, which in the DSM-5 now includes the diagnostic categories of dysthymia and chronic major depression, is a continuous and chronic form of depression. While the symptoms of PDD are very similar to MDD, they are usually less acute, as symptoms tend to ebb and flow over a long period (i.e., more than two years). Major depressive disorder, on the other hand, has discrete episodes lasting at least two weeks in which there are substantial changes in affect, cognition, and neurovegetative functions (APA, 2022, pg. 177).
两种最常见的抑郁障碍类型是重度抑郁症（MDD）和持续性抑郁障碍（PDD）。持续性抑郁障碍，在 DSM-5 中现在包括心境恶劣和慢性重度抑郁的诊断类别，是一种持续和慢性形式的抑郁。虽然 PDD 的症状与 MDD 非常相似，但它们通常不那么严重，因为症状往往在长时间内波动（即超过两年）。另一方面，重度抑郁症有离散的病程，至少持续两周，期间情感、认知和神经植物功能发生显著变化（APA，2022，第 177 页）。

It should be noted that after a careful review of the literature, premenstrual dysphoric disorder, was moved from “Criteria Sets and Axes Provided for Future Study” in the DSM-IV to Section II of DSM-5 as the disorder was confirmed as a “specific and treatment-responsive form of depressive disorder that begins sometime following ovulation and remits within a few days of menses and has a marked impact on functioning” (APA, 2022, pg. 177).
应注意的是，经过对文献的仔细审查，经前期紧张性障碍从 DSM-IV 的“未来研究提供的标准集和轴”移至 DSM-5 的第二部分，因为该障碍被确认为“一种特定且对治疗有反应的抑郁障碍，开始于排卵后，在月经开始后的几天内缓解，并对功能有显著影响”（APA，2022，第 177 页）。

The DSM-5 also added a new diagnosis, disruptive mood dysregulation disorder (DMDD), for children up to 12 years of age, to deal with the potential for overdiagnosis and treatment of bipolar disorder in children, both in the United States and internationally. Children with DMDD present with persistent irritability and frequent episodes of extreme behavioral dyscontrol and so develop unipolar, not bipolar, depressive disorders or anxiety disorders as they move into adolescence and adulthood.
DSM-5 还增加了一种新的诊断，即儿童破坏性情绪调节障碍（DMDD），适用于 12 岁以下的儿童，以应对儿童双相情感障碍过度诊断和治疗的潜在风险，这一风险在美国和国际上都存在。患有 DMDD 的儿童表现出持续的易怒和频繁的极端行为失控，因此当他们进入青春期和成年期时，会发展为单极抑郁症或焦虑症，而不是双相情感障碍。

For a discussion of DMDD, please visit our sister book, Behavioral Disorders of Childhood:
关于 DMDD 的讨论，请参阅我们的姐妹书籍《儿童行为障碍》

https://opentext.wsu.edu/behavioral-disorders-childhood/

4.1.3. Symptoms Associated with Depressive Disorders 4.1.3. 与抑郁障碍相关的症状

When making a diagnosis of depression, there are a wide range of symptoms that may be present. These symptoms can generally be grouped into four categories: mood, behavioral, cognitive, and physical symptoms.
在诊断抑郁症时，可能存在广泛的症状。这些症状通常可以分为四类：情绪、行为、认知和身体症状。

**     4.1.3.1. Mood. **While clinical depression can vary in its presentation among individuals, most, if not all individuals with depression will report significant mood disturbances such as a depressed mood for most of the day and/or feelings of anhedonia, which is the loss of interest in previously interesting activities.
4.1.3.1. 情绪。虽然临床抑郁症在个体之间的表现可能有所不同，但大多数甚至所有抑郁症患者都会报告出现显著的情绪障碍，如大部分时间情绪低落和/或快感缺失，即对以前感兴趣的活动失去兴趣。

**     4.1.3.2. Behavioral. **Behavioral issues such as decreased physical activity and reduced productivity—both at home and work—are often observed in individuals with depression. This is typically where a disruption in daily functioning occurs as individuals with depressive disorders are unable to maintain their social interactions and employment responsibilities.
4.1.3.2. 行为。抑郁个体常出现行为问题，如活动减少和生产力下降——无论是在家中还是工作中。这通常是日常功能失调发生的地方，因为患有抑郁症的人无法维持他们的社交互动和就业责任。

**     4.1.3.3. Cognitive. **It should not come as a surprise that there is a serious disruption in cognitions as individuals with depressive disorders typically hold a negative view of themselves and the world around them. They are quick to blame themselves when things go wrong, and rarely take credit when they experience positive achievements. Individuals with depressive disorders often feel worthless, which creates a negative feedback loop by reinforcing their overall depressed mood. They also report difficulty concentrating on tasks, as they are easily distracted from outside stimuli. This assertion is supported by research that has found individuals with depression perform worse than those without depression on tasks of memory, attention, and reasoning (Chen et al., 2013). Finally, thoughts of suicide and self-harm do occasionally occur in those with depressive disorders (Note – this will be discussed in more detail in Section 4.3).
4.1.3.3 认知。对于抑郁症患者通常对自己和周围世界持有负面看法，认知上出现严重干扰并不令人惊讶。当事情出错时，他们很快就会责怪自己，而很少在经历积极成就时获得认可。抑郁症患者常常感到自己毫无价值，这通过强化他们整体抑郁情绪而形成一个负面反馈循环。他们还报告说，由于容易受到外界刺激的干扰，他们在完成任务时难以集中注意力。这一论断得到了研究的支持，研究发现，与没有抑郁症的人相比，抑郁症患者在记忆、注意力和推理任务上的表现更差（陈等，2013）。最后，抑郁症患者偶尔会出现自杀和自残的念头（注：这将在第 4.3 节中更详细地讨论）。

**     4.1.3.4. Physical. **Changes in sleep patterns are common in those experiencing depression with reports of both hypersomnia and insomnia. Hypersomnia, or excessive sleeping, often impacts an individual’s daily functioning as they spend the majority of their time sleeping as opposed to participating in daily activities (i.e., meeting up with friends or getting to work on time). Reports of insomnia are also frequent and can occur at various points throughout the night to include difficulty falling asleep, staying asleep, or waking too early with the inability to fall back asleep before having to wake for the day. Although it is unclear whether symptoms of fatigue or loss of energy are related to insomnia issues, the fact that those experiencing hypersomnia also report symptoms of fatigue suggests that these symptoms are a component of the disorder rather than a secondary symptom of sleep disturbance.
4.1.3.4. 身体。经历抑郁症的人睡眠模式改变很常见，报告了嗜睡和失眠的情况。嗜睡，或过度睡眠，通常会影响个人的日常生活，因为他们大部分时间都在睡觉，而不是参与日常活动（例如，与朋友见面或按时上班）。失眠的报告也很常见，可能发生在夜间各个时段，包括入睡困难、保持睡眠困难或过早醒来，在必须起床之前无法再次入睡。尽管不清楚疲劳或能量丧失的症状是否与失眠问题有关，但经历嗜睡的人也报告了疲劳症状，这表明这些症状是疾病的一部分，而不是睡眠障碍的次要症状。

Additional physical symptoms, such as a change in weight or eating behaviors, are also observed.  Some individuals who are experiencing depression report a lack of appetite, often forcing themselves to eat something during the day. On the contrary, others overeat, often seeking “comfort foods,” such as those high in carbohydrates. Due to these changes in eating behaviors, there may be associated changes in weight.
额外的身体症状，如体重或饮食习惯的改变，也被观察到。一些经历抑郁的人报告食欲不振，常常强迫自己在白天吃些东西。相反，其他人过度进食，常常寻求“安慰食品”，如高碳水化合物的食物。由于这些饮食习惯的改变，体重可能会有相关变化。

Finally, psychomotor agitation or retardation, which is the purposeless or slowed physical movement of the body (i.e., pacing around a room, tapping toes, restlessness, etc.) is also reported in individuals with depressive disorders.
最终，精神运动性激越或迟滞，即身体无目的或缓慢的运动（例如，在房间里踱步、脚趾敲击、不安等），也被报告见于患有抑郁症的个人中。

4.1.4. Diagnostic Criteria and Features for Depressive Disorders 4.1.4. 抑郁障碍的诊断标准和特征

**     4.1.4.1. Major depressive disorder (MDD). **According to the DSM-5-TR (APA, 2022), to meet the criteria for a diagnosis of major depressive disorder, an individual must experience at least *five *symptoms across the four categories discussed above, and at least one of the symptoms is either 1) a depressed mood most of the day, almost every day, or 2) loss of interest or pleasure in all, or most, activities, most of the day, almost every day. These symptoms must be present for at least two weeks and cause clinically significant distress or impairment in important areas of functioning such as social and occupational. The DSM-5 cautions that responses to a significant loss (such as the death of a loved one, financial ruin, and discovery of a serious medical illness or disability), can lead to many of the symptoms described above (i.e., intense sadness, rumination about the loss, insomnia, etc.) but this may be the normal response to such a loss. Though the individual’s response resembles a major depressive episode, clinical judgment should be utilized in making any diagnosis and be based on the clinician’s understanding of the individual’s personal history and cultural norms related to how members should express distress in the context of loss.
4.1.4.1. 重性抑郁症（MDD）。根据 DSM-5-TR（APA，2022），要符合重性抑郁症的诊断标准，个体必须在上文讨论的四个类别中至少经历五种症状，并且至少有一种症状是以下之一：1）大部分时间，几乎每天都有抑郁情绪，或 2）对所有或大多数活动失去兴趣或乐趣，大部分时间，几乎每天。这些症状必须持续至少两周，并导致在社交和职业等重要功能领域产生临床意义上的痛苦或损害。DSM-5 警告说，对重大损失（如亲人的去世、财务破产、发现严重医疗疾病或残疾）的反应可能导致上述许多症状（即极度悲伤、对损失的沉思、失眠等），但这可能是对这种损失的正常反应。 尽管个人的反应类似于重度抑郁发作，但在做出任何诊断时，应运用临床判断，并基于临床医生对个人病史以及与成员在丧失情境中表达痛苦相关的文化规范的理解。

**     4.1.4.2. Persistent depressive disorder (PDD). **For a diagnosis of persistent depressive disorder, an individual must experience a depressed mood for most of the day, for more days than not, for *at least two years. (APA, 2022). *This feeling of a depressed mood is also accompanied by *two *or more additional symptoms, to include changes in appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, feelings of hopelessness, and poor concentration or difficulty with decision making. The symptoms taken together cause clinically significant distress or impairment in important areas of functioning such as social and occupational and these impacts can be as great as or greater than MDD. The individual may experience a temporary relief of symptoms; however, the individual will not be without symptoms for more than two months during this two-year period.
4.1.4.2. 持续性抑郁症（PDD）。要诊断持续性抑郁症，个体必须经历大部分时间的抑郁情绪，在大多数日子里，至少持续两年。（APA，2022）。这种抑郁情绪的感觉还伴随着两个或更多额外的症状，包括食欲变化、失眠或过度睡眠、低能量或疲劳、低自尊、绝望感以及注意力不集中或决策困难。这些症状共同导致临床上显著的痛苦或功能障碍，如社会和职业领域，这些影响可能等同于或大于重度抑郁症（MDD）。个体可能会经历症状的暂时缓解；然而，在这两年期间，个体不会没有症状超过两个月。

Making Sense of the Disorders 理解这些疾病的含义

In relation to depressive disorders, note the following:
关于抑郁症，请注意以下几点：

• Diagnosis MDD …… if symptoms have been experienced for at least two weeks  and can be regarded as severe
  诊断 MDD……如果症状已持续至少两周且可视为严重
• Diagnosis PDD … if the symptoms have been experienced for at least two years    and are not severe
  诊断 PDD……如果症状已经持续至少两年且不严重

**     4.1.4.3. Premenstrual dysphoric disorder. **In terms of premenstrual dysphoric disorder, the DSM-5-TR states in the majority of menstrual cycles, at least *five *symptoms must be present in the final week before the onset of menses, being improving with a few days after menses begins, and disappear or become negligible in the week postmenses. Individuals diagnosed with premenstrual dysphoric disorder must have one or more of the following: increased mood swings, irritability or anger, depressed mood, or anxiety/tension. Additionally, they must have one or more of the following to reach a total of five symptoms: anhedonia, difficulty concentrating, lethargy, changes in appetite, hypersomnia or insomnia, feelings of being overwhelmed or out of control, and/or experience breast tenderness or swelling. The symptoms lead to issues at work or school (i.e., decreased productivity and efficiency), within relationships (i.e., discord in the intimate partner relationship or with children, friends, or other family members), and with usual social activities (i.e., avoidance of the activities).
4.1.4.3. 经前期烦躁障碍。在经前期烦躁障碍方面，DSM-5-TR 指出，在大多数月经周期中，至少有五种症状必须在月经开始前的最后一周出现，并在月经开始后几天内改善，并在月经后一周内消失或变得可以忽略不计。被诊断为经前期烦躁障碍的个人必须具备以下一种或多种：情绪波动增加、易怒或愤怒、抑郁情绪或焦虑/紧张。此外，他们必须具备以下一种或多种以达到五个症状的总数：快感缺失、难以集中注意力、嗜睡、食欲变化、过度睡眠或失眠、感到被压垮或失控，以及/或经历乳房疼痛或肿胀。这些症状会导致工作或学校问题（即生产力下降和效率降低）、人际关系问题（即亲密伴侣关系或与孩子、朋友或其他家庭成员的争执），以及通常的社会活动问题（即避免这些活动）。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

• Mood disorder fall into one of two groups – depressive or bipolar disorders – with the key distinction between the two being episodes of mania/hypomania.
  情绪障碍分为两组——抑郁症或双相情感障碍——两者的关键区别在于躁狂/轻躁狂的发作。
• Symptoms of depression fall into one of four categories – mood, behavioral, cognitive, and physical.
  抑郁症状可分为四大类——情绪、行为、认知和身体。
• Persistent Depressive Disorder shares symptoms with Major Depressive Disorder though they are usually not as severe and ebb and flow over a period of at least two years.
  持续抑郁障碍与重度抑郁障碍共享症状，尽管它们通常不那么严重，并且至少在两年内波动。
• Premenstrual dysphoric disorder presents as mood lability, irritability, dysphoria, and anxiety symptoms occurring often during the premenstrual phase of the cycle and remit around the beginning of menses or shortly thereafter.
  经前期烦躁障碍表现为情绪波动、易怒、抑郁和焦虑症状，通常在月经周期的经前期出现，并在月经开始或之后不久缓解。

Section 4.1 Review Questions
第 4.1 节 复习问题

1. What are the different categories of mood disorder symptoms? Identify the symptoms within each category.
   不同类型情绪障碍症状有哪些？识别每个类别中的症状。
2. What are the key differences in a major depression and a persistent depressive disorder diagnosis?
   什么是重度抑郁症和持续性抑郁障碍诊断的关键区别？
3. What is premenstrual dysphoric disorder?
   什么是经前期烦躁障碍？

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4.2. Clinical Presentation – Bipolar and Related Disorders 4.2. 临床表现 - 双相及相关障碍

Section Learning Objectives 章节学习目标

• Distinguish the forms bipolar disorder takes.
  区分双相情感障碍的表现形式。
• Contrast a manic episode with a hypomanic episode.
  对比躁狂发作和轻躁狂发作。
• Define cyclothymic disorder.  定义环性心境障碍。

4.2.1. Distinguishing Bipolar I and II Disorders 4.2.1. 区分双相情感障碍 I 型和 II 型

According to the DSM-5-TR (APA, 2022), there are two types of bipolar disorder- bipolar I and bipolar II. A diagnosis of bipolar I disorder is made when there is at least one manic episode. This manic episode can be preceded by and/or followed by a hypomanic or major depressive episode, however, diagnostic criteria for a manic episode is the *only *criteria that needs to be met for a bipolar I diagnosis. A diagnosis of bipolar II Disorder is made when there is a current or history of a hypomanic episode *and *a current or past major depressive episode. Descriptions of both manic and hypomanic episodes follow below.
根据 DSM-5-TR（APA，2022），双相情感障碍有两种类型——双相 I 型和双相 II 型。当至少有一次躁狂发作时，可诊断为双相 I 型障碍。这种躁狂发作可能由轻躁狂或重度抑郁发作先于或继之，然而，躁狂发作的诊断标准是双相 I 型诊断的唯一标准。当存在轻躁狂发作的当前或既往史以及当前或过去的重度抑郁发作时，可诊断为双相 II 型障碍。以下是对躁狂和轻躁狂发作的描述。

Making Sense of the Disorders 理解这些疾病的含义

In relation to bipolar I and II disorders, note the following:
关于双相情感障碍 I 型和 II 型，请注意以下几点：

• Diagnosis bipolar I disorder …. if an individual has ever experienced a manic episode
  诊断双相 I 型障碍……如果一个人曾经经历过躁狂发作
• Diagnosis bipolar II disorder … if the criteria has only been met for a hypomanic episode
  诊断双相情感障碍 II 型……如果仅符合轻躁狂发作的标准

4.2.2. Manic and Hypomanic Episodes 4.2.2. 躁狂和轻躁狂发作

**     4.2.2.1. Manic episode. **The key feature of a manic episode is a specific period in which an individual reports abnormal, persistent, or expansive irritable mood for nearly all day, every day, for at least one week (APA, 2022). Additionally, the individual will display increased activity or energy during this same time.  With regards to mood, an individual in a manic episode will appear excessively happy, often engaging haphazardly in sexual or interpersonal interactions. They also display rapid shifts in mood, also known as mood lability, ranging from happy, neutral, to irritable. At least three of the symptoms described below (four if the mood is only irritable) must be present and represent a noticeable change in the individual’s typical behavior.
4.2.2.1. 精神病发作。精神病发作的关键特征是在一段时间内，个体报告几乎每天、几乎整天出现异常、持续或扩张的易怒情绪，至少持续一周（APA，2022）。此外，个体在此期间将表现出活动或能量的增加。就情绪而言，处于精神病发作的个体将显得过度快乐，经常随意参与性或人际互动。他们还表现出情绪的快速转变，也称为情绪波动，从快乐、中性到易怒。以下描述的症状中至少有三种（如果情绪只是易怒则为四种）必须存在，并代表个体典型行为的明显变化。

Inflated self-esteem or grandiosity (Criterion B1) is present during a manic episode. Occasionally these inflated self-esteem levels can appear delusional. For example, individuals may believe they are friends with a celebrity, do not need to abide by laws, or even perceive themselves as God. They also engage in multiple overlapping new projects (Criteria B6 and 7), often initiated with no prior knowledge about the topic, and engaged in at unusual hours of the day.
夸大的自尊或自大（标准 B1）在躁狂发作期间存在。有时这些夸大的自尊水平可能显得有妄想。例如，个人可能认为自己是名人的朋友，不需要遵守法律，甚至把自己视为上帝。他们还参与多个重叠的新项目（标准 B6 和 B7），通常在没有先了解主题的情况下开始，并在不寻常的时间进行。

Despite the increased activity level, individuals experiencing a manic episode also require a decreased need for sleep (Criterion B2), sleeping as little as a few hours a night yet still feeling rested. Reduced need for sleep may also be a precursor to a manic episode, suggesting that a manic episode is to begin imminently. It is not uncommon for those experiencing a manic episode to be more talkative than usual. It can be difficult to follow their conversation due to the quick pace of their talking, as well as tangential storytelling.  Additionally, they can be difficult to interrupt in conversation, often disregarding the reciprocal nature of communication (Criterion B3). If the individual is more irritable than expansive, speech can become hostile and they engage in tirades, particularly if they are interrupted or not allowed to engage in an activity they are seeking out (APA, 2022).
尽管活动水平有所增加，但经历躁狂发作的个人也需要减少睡眠需求（标准 B2），每晚只需睡几小时却仍然感到精力充沛。减少睡眠需求也可能是躁狂发作的前兆，表明躁狂发作即将开始。经历躁狂发作的人比平时更健谈并不罕见。由于他们说话速度快，以及旁征博引的故事讲述，他们的对话可能难以跟上。此外，他们在对话中难以被打断，通常忽视沟通的相互性（标准 B3）。如果个人比扩张性更强，言语可能变得敌对，他们可能会进行长篇大论，尤其是如果他们被打断或不允许参与他们寻求的活动（APA，2022）。

Based on their speech pattern, it should not be a surprise that racing thoughts and flights of ideas (Criterion B4) also present during manic episodes. Because of these rapid thoughts, speech may become disorganized or incoherent. Finally, individuals experiencing a manic episode are distractable (Criterion B5).
基于他们的言语模式，在躁狂发作期间出现快速思维和思想跳跃（标准 B4）并不令人惊讶。由于这些快速思维，言语可能变得杂乱无章或语无伦次。最后，经历躁狂发作的个人容易分心（标准 B5）。

**     4.2.2.2. Hypomanic episode. **As mentioned above, for a bipolar II diagnosis, an individual must report symptoms consistent with a major depressive episode *and *at least one hypomanic episode. An individual with bipolar II disorder must not have a history of a manic episode—if there is a history of mania, the diagnosis will be diagnosed with bipolar I. A hypomanic episode is like a manic episode in that the individual will experience abnormally and persistently elevated, expansive, or irritable mood and energy levels, however, the behaviors are not as extreme as in mania. Additionally, behaviors consistent with a hypomanic episode must be present for at least four days, compared to the one week in a manic episode.
4.2.2.2. 轻躁狂发作。如上所述，对于双相 II 型诊断，个体必须报告与重度抑郁发作一致的症状，以及至少一次轻躁狂发作。患有双相 II 型障碍的个体不得有躁狂发作史——如果存在躁狂病史，则诊断为双相 I 型。轻躁狂发作与躁狂发作相似，个体将经历异常且持续的高涨、扩张或易怒的情绪和能量水平，然而，行为不如躁狂那么极端。此外，与轻躁狂发作一致的行为必须持续至少四天，而躁狂发作则是一周。

Making Sense of the Disorders 理解这些疾病的含义

Take note of the following in relation to manic and hypomanic episodes:
请注意以下与躁狂和轻躁狂发作相关的内容：

• A manic episode is severe enough to cause impairments in social or occupational functioning and can lead to hospitalization to prevent harm to self or others.
  躁狂发作严重到足以导致社交或职业功能受损，并可能导致住院以防止对自己或他人造成伤害。
• A hypomanic episode is NOT severe enough to cause such impairments or hospitalization.
  轻躁狂发作并不足以引起这种损害或住院。

4.2.3. Cyclothymic Disorder 4.2.3. 循环性情感障碍

Notably, there is a subclass of individuals who experience numerous periods with hypomanic symptoms that do not meet the criteria for a hypomanic episode and *mild *depressive symptoms (i.e., do not fully meet criteria for a major depressive episode). These individuals are diagnosed with **cyclothymic disorder **(APA, 2022). Presentation of these symptoms occur for two or more years and are typically interrupted by periods of normal mood not lasting more than two months at a time. The symptoms cause clinically significant distress or impairment in important areas of functioning, such as social and occupational. While only a small percentage of the population develops cyclothymic disorder, it can eventually progress into bipolar I or bipolar II disorder (Zeschel et al., 2015).
值得注意的是，有一类个体经历了多次轻躁狂症状（不符合轻躁狂发作标准）且伴有轻度抑郁症状的周期（即不完全符合重度抑郁发作的标准）。这些个体被诊断为环性心境障碍（APA，2022）。这些症状持续两年或更长时间，通常被不超过两月的正常情绪期打断。这些症状会导致在社交和职业等重要功能领域产生临床意义上的痛苦或损害。尽管只有一小部分人口会发展为环性心境障碍，但它最终可能进展为双相 I 型或双相 II 型障碍（Zeschel 等，2015）。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

• An individual is diagnosed with bipolar I disorder if they have ever experienced a manic episode and are diagnosed with bipolar II disorder if the criteria has only been met for a hypomanic episode.
  一个人如果曾经经历过躁狂发作并被诊断为双相情感障碍 I 型，如果仅符合轻躁狂发作的标准，则被诊断为双相情感障碍 II 型。
• A manic episode is characterized by a specific period in which an individual reports abnormal, persistent, or expansive irritable mood for nearly all day, every day, for at least one week.
  躁狂发作的特征是患者在至少一周的时间里，几乎每天都报告有异常、持续或广泛的易怒情绪。
• A hypomanic episode is characterized by abnormally and persistently elevated, expansive, or irritable mood and energy levels, though not as extreme as in mania, and must be present for at least four days. It is also not severe enough to cause impairments or hospitalization.
  轻躁狂发作的特征是异常且持续的高涨、兴奋或易怒的情绪和能量水平，虽然不如躁狂症那么极端，但至少持续四天。它也不够严重，不会导致功能障碍或住院治疗。
• Cyclothymic disorder includes periods of hypomanic and mild depressive symptoms without meeting the criteria for a depressive episode which lasts two or more years and is interrupted by periods of normal moods.
  循环性情感障碍包括周期性的轻躁狂和轻度抑郁症状，但不符合持续两年或更长时间且被正常情绪期打断的抑郁发作标准。

Section 4.2 Review Questions
第 4.2 节复习题

1. What is the difference between bipolar I and II disorder?
   什么是双相 I 型和 II 型障碍的区别？
2. What are the key diagnostic differences between a hypomanic and manic episode?
   什么是躁狂和轻躁狂发作之间的关键诊断差异？
3. What is cyclothymic disorder?
   什么是环性心境障碍？

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4.3. Epidemiology 4.3. 流行病学

Section Learning Objectives 章节学习目标

• Describe the epidemiology of depressive disorders.
  描述抑郁障碍的流行病学。
• Describe the epidemiology of bipolar disorders.
  描述双相情感障碍的流行病学。
• Describe the epidemiology of suicidality.
  描述自杀症的流行病学。

4.3.1. Depressive Disorders 4.3.1. 抑郁障碍

According to the DSM-5-TR (APA, 2022), the 12-month prevalence rate for major depressive disorder is approximately 7% within the United States. Recall that DSM-5 persistent depressive disorder is a blend of DSM-IV dysthymic disorder and chronic major depressive disorder. The prevalence rate for DSM-IV dysthymic disorder is much lower than MDD, with a 0.5% rate among adults in the United States, while DSM-IV chronic major depressive disorder is 1.5%.
根据 DSM-5-TR（APA，2022），美国主要抑郁症的 12 个月患病率约为 7%。记住，DSM-5 持续性抑郁症是 DSM-IV 抑郁症和慢性重度抑郁症的混合体。DSM-IV 抑郁症的患病率远低于 MDD，美国成年人中患病率为 0.5%，而 DSM-IV 慢性重度抑郁症为 1.5%。

As well, individuals in the 18- to 29- year-old age bracket report the highest rates of MDD than any other age group. Women experience about twofold higher rates than men of MDD, especially between menarche and menopause (APA, 2022). The estimated lifetime prevalence for major depressive disorder in women is 21.3% compared to 12.7% in men (Nolen-Hoeksema, 2001). Regrading DSM-IV dysthymic disorder and chronic major depressive disorder, the prevalence among women is 1.5 and 2 times greater than the prevalence for men for each of these diagnoses, respectively (APA, 2022).
同样，18 至 29 岁年龄段的人报告的 MDD 发病率比任何其他年龄段都要高。女性 MDD 的发病率比男性高约两倍，尤其是在月经初潮和更年期之间（APA，2022）。女性重大抑郁障碍的终生患病率估计为 21.3%，而男性为 12.7%（Nolen-Hoeksema，2001）。关于 DSM-IV 抑郁障碍和慢性重大抑郁障碍，女性的患病率分别比男性的患病率高出 1.5 倍和 2 倍（APA，2022）。

4.3.2. Bipolar Disorders 4.3.2. 双相情感障碍

The 12-month prevalence of bipolar I disorder in the United States is 1.5% and did not differ statistically between men and women. In contrast, bipolar II disorder has a prevalence rate of 0.8% in the United States and 0.3% internationally (APA, 2022) and some clinical samples suggest it is more common in women, with approximately 80-90% of individuals with rapid-cycling episodes being women (Bauer & Pfenning, 2005). Childbirth may be a specific trigger for a hypomanic episode, occurring in 10-20% of women in nonclinical settings and most often in the early postpartum period.
美国双相 I 型障碍的 12 个月患病率为 1.5%，男性和女性之间没有统计学差异。相比之下，美国双相 II 型障碍的患病率为 0.8%，国际上的患病率为 0.3%（APA，2022），一些临床样本表明，它更常见于女性，大约 80-90%的快速循环发作患者为女性（Bauer & Pfenning，2005）。分娩可能是一个特定的触发因素，导致轻度躁狂发作，在非临床环境中，10-20%的女性会发生，最常见于产后早期。

4.3.3. Suicidality 4.3.3. 自杀倾向

Individuals with a depressive disorder have a 17-fold increased risk for suicide over the age- and sex-adjusted general population rate. Features associated with an increased risk for death by suicide include anhedonia, living alone, being single, disconnecting socially, having access to a firearm, early life adversity, sleep disturbance, feelings of hopelessness, and problems with decision making. Women attempt suicide at a higher rate though men are more likely to complete suicide. Finally, the premenstrual phase is considered a risk period for suicide by some (APA, 2022).
患有抑郁症的人自杀风险比年龄和性别调整后的普通人群高 17 倍。与自杀死亡风险增加相关的特征包括快感缺失、独居、单身、社交脱节、能够接触枪支、早年生活逆境、睡眠障碍、绝望感以及决策问题。女性尝试自杀的比率更高，尽管男性更有可能完成自杀。最后，有些人认为月经前期是自杀风险期（APA，2022）。

In terms of bipolar disorders, the lifetime risk of suicide is estimated to be 20- to 30- fold greater than in the general population and 5-6% of individuals with bipolar disorder die by suicide. Like depressive disorders, women attempt suicide at a higher rate though lethal suicide is more common in men with bipolar disorder. About 1/3 of individuals with bipolar II disorder report a lifetime history of suicide attempt, which is similar in bipolar I disorder, though lethality of attempts is higher in individuals with bipolar II (APA, 2022).
在双相情感障碍方面，自杀的终身风险估计是普通人群的 20-30 倍，患有双相情感障碍的人中有 5-6%死于自杀。与抑郁症一样，女性尝试自杀的比率更高，尽管在双相情感障碍的男性中致命的自杀更为常见。大约 1/3 的双相 II 型情感障碍患者报告有终身自杀尝试史，这与双相 I 型情感障碍相似，尽管双相 II 型情感障碍患者的尝试致命性更高（APA，2022）。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

• Major depressive disorder is experienced by about 7% of the population in the United States, afflicting young adults and women the most.
  重度抑郁症在美国约有 7%的人口受到影响，主要影响年轻人和女性。
• Bipolar I disorder afflicts 1.5% and bipolar II disorder afflicts 0.8% of the U.S. population with bipolar II affecting women more than men and no gender difference being apparent for bipolar I.
  双相情感障碍 I 型影响美国人口的 1.5%，双相情感障碍 II 型影响 0.8%，双相情感障碍 II 型对女性的影响大于男性，而双相情感障碍 I 型在性别上没有明显差异。
• Individuals with a depressive disorder have a 17-fold increased risk for suicide while the lifetime risk of suicide for an individual with a bipolar disorder is estimated to be 20- to 30- fold greater than in the general population and 5-6% of individuals with bipolar disorder die by suicide.
  患有抑郁症的人自杀风险增加 17 倍，而患有双相情感障碍的人终身自杀风险估计比普通人群高 20 至 30 倍，双相情感障碍患者中有 5 至 6%的人死于自杀。

Section 4.3 Review Questions
第 4.3 节复习题

1. What are the prevalence rates of the mood disorders?
   情绪障碍的患病率是多少？
2. What gender differences exist in the rate of occurrence of mood disorders?
   存在哪些性别差异影响情绪障碍的发生率？
3. How do depressive and bipolar disorders compare in terms of suicidality (attempts and lethality)?
   抑郁症和双相情感障碍在自杀倾向（尝试和致命性）方面有何比较？

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4.4. Comorbidity 4.4. 合并症

Section Learning Objectives 章节学习目标

• Describe the comorbidity of depressive disorders.
  描述抑郁障碍的共病情况。
• Describe the comorbidity of bipolar disorders.
  描述双相情感障碍的共病情况。

4.4.1. Depressive Disorders 4.4.1. 抑郁障碍

Studies exploring depression symptoms among the general population show a substantial pattern of comorbidity between depression and other mental disorders, particularly substance use disorders (Kessler, Berglund, et al., 2003). Nearly three-fourths of participants with lifetime MDD in a large-scale research study also met the criteria for at least one other DSM disorder (Kessler, Berglund, et al., 2003). MDD has been found to co-occur with substance-related disorders, panic disorder, generalized anxiety disorder, PTSD, OCD, anorexia, bulimia, and borderline personality disorder. Gender differences do exist within comorbidities such that women report comorbid anxiety disorders, bulimia, and somatoform disorders while men report comorbid alcohol and substance abuse. In contrast, those with PDD are at higher risk for psychiatric comorbidity in general and for anxiety disorders, substance use disorders, and personality disorders in particular (APA, 2022).
研究显示，在普通人群中，抑郁症与其他精神疾病（尤其是物质使用障碍）存在显著共病模式（Kessler，Berglund 等人，2003 年）。在一项大规模研究中，近四分之三的终身重度抑郁症患者也符合至少一种其他 DSM 诊断标准（Kessler，Berglund 等人，2003 年）。重度抑郁症被发现与物质相关障碍、恐慌症、广泛性焦虑症、PTSD、OCD、厌食症、暴食症和边缘型人格障碍共存。在共病中存在性别差异，女性报告共病焦虑障碍、厌食症和躯体化障碍，而男性报告共病酒精和物质滥用。相比之下，患有 PDD 的人总体上更容易出现精神共病，特别是焦虑障碍、物质使用障碍和个人障碍（APA，2022 年）。

Given the extent of comorbidity among individuals with MDD, researchers have tried to identify which disorder precipitated the other. The majority of studies found that most depression cases occur secondary to another mental health disorder, meaning that the onset of depression is a direct result of the onset of another disorder (Gotlib & Hammen, 2009).
考虑到 MDD 患者中合并症的范围，研究人员试图确定哪种疾病引发了另一种疾病。大多数研究发现，大多数抑郁症病例是继发于另一种心理健康疾病，这意味着抑郁症的发生是另一种疾病发生的直接结果（Gotlib & Hammen，2009）。

4.4.2. Bipolar Disorders 4.4.2. 双相情感障碍

Those with bipolar I disorder typically have a history of three or more mental disorders. The most frequent comorbid disorders include anxiety disorders, alcohol use disorder, other substance use disorder, and ADHD, along with borderline, schizotypal, and antisocial personality disorder.
那些患有双相情感障碍 I 型的人通常有三种或更多精神疾病的历史。最常见的共病包括焦虑障碍、酒精使用障碍、其他物质使用障碍和 ADHD，以及边缘型、偏执型和反社会型人格障碍。

Bipolar II disorder is more often than not associated with one or more comorbid mental disorders, with anxiety disorders being the most common (38% with social anxiety, 36% with specific phobia, and 30% having generalized anxiety). As with bipolar I, substance use disorders are common with alcohol use (42%) leading the way, followed by cannabis use (20%). Premenstrual syndrome and premenstrual dysphoric disorder are common in women with bipolar II disorder especially (APA, 2022).
双相情感障碍通常与一种或多种共病精神障碍相关，焦虑障碍最为常见（38%有社交焦虑，36%有特定恐惧症，30%有广泛性焦虑）。与双相情感障碍 I 型一样，物质使用障碍也很常见，其中酒精使用（42%）最为突出，其次是大麻使用（20%）。在双相情感障碍 II 型女性中，经前期综合征和经前期抑郁障碍尤为常见（APA，2022）。

Finally, cyclothymic disorder has been found to be comorbid with substance-related disorders and sleep disorders.
最终，循环性情感障碍被发现与物质相关障碍和睡眠障碍共病。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

• Depressive disorders have a high comorbidity with substance use disorders, anxiety disorders, and some personality disorders.
  抑郁症与物质使用障碍、焦虑障碍和一些人格障碍具有较高的共病率。
• Bipolar disorders have a high comorbidity with anxiety disorders and substance abuse disorders while cyclothymic disorder is comorbid with substance-related disorders and sleep disorders.
  双相情感障碍与焦虑障碍和物质滥用障碍的共病率较高，而环性心境障碍与物质相关障碍和睡眠障碍共病。

Section 4.4 Review Questions
第 4.4 节 复习问题

1. What are common comorbidities for the depressive disorders?
   什么是抑郁症的常见共病？
2. What are common comorbidities for bipolar disorders?
   什么是双相情感障碍的常见共病？

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4.5. Etiology 4.5. 病因

Section Learning Objectives 章节学习目标

• Describe the biological causes of mood disorders.
  描述情绪障碍的生物原因。
• Describe the cognitive causes of mood disorders.
  描述情绪障碍的认知原因。
• Describe the behavioral causes of mood disorders.
  描述情绪障碍的行为原因。
• Describe the sociocultural causes of mood disorders.
  描述情绪障碍的社会文化原因。

4.5.1. Biological 4.5.1. 生物

Research throughout the years continues to provide evidence that depressive disorders have some biological cause. While it does not explain every depressive case, it is safe to say that some individuals may at least have a predisposition to developing a depressive disorder. Among the biological factors are genetic factors, biochemical factors, and brain structure.
多年来，研究持续提供证据表明抑郁症有一些生物学原因。虽然它不能解释每一个抑郁症案例，但可以肯定的是，某些个体至少可能具有发展抑郁症的倾向。其中生物因素包括遗传因素、生化因素和大脑结构。

**     4.5.1.1. Genetics. **Like with any disorder, researchers often explore the prevalence rate of depressive disorders among family members to determine if there is some genetic component, whether it be a direct link or a predisposition. If there is a genetic predisposition to developing depressive disorders, one would expect a higher rate of depression within families than that of the general population. Research supports this with regards to depressive disorders as there is nearly a 30% increase in relatives diagnosed with depression compared to 10% of the general population (Levinson & Nichols, 2014). Similarly, there is an elevated prevalence among first-degree relatives for both Bipolar I and Bipolar II disorders as well.
4.5.1.1. 遗传学。与任何疾病一样，研究人员通常会调查家庭成员中抑郁症的患病率，以确定是否存在某种遗传成分，无论是直接联系还是易感性。如果存在发展抑郁症的遗传易感性，那么家庭成员中抑郁症的发病率应该比普通人群更高。研究支持这一点，因为与普通人群的 10%相比，有近 30%的亲属被诊断为抑郁症（Levinson & Nichols，2014）。同样，一级亲属中双相情感障碍 I 型和 II 型的患病率也有所上升。

Another way to study the genetic component of a disorder is via twin studies. One would expect identical twins to have a higher rate of the disorder as opposed to fraternal twins, as identical twins share the same genetic make-up, whereas fraternal twins only share roughly 50%, similar to that of siblings. A large-scale study found that if one identical twin was diagnosed with depression, there was a 46% chance their identical twin was diagnosed with depression. In contrast, the rate of a depression diagnosis in fraternal twins was only 20%. Despite the fraternal twin rate still being higher than that of a first-degree relative, this study provided enough evidence that there is a strong genetic link in the development of depression (McGuffin et al., 1996).
另一种研究疾病遗传成分的方法是通过双胞胎研究。人们预计同卵双胞胎患病的比率会比异卵双胞胎高，因为同卵双胞胎拥有相同的遗传构成，而异卵双胞胎只共享大约 50%，与兄弟姐妹相似。一项大规模研究发现，如果一个同卵双胞胎被诊断为抑郁症，那么他们的同卵双胞胎被诊断为抑郁症的概率为 46%。相比之下，异卵双胞胎抑郁症的诊断率仅为 20%。尽管异卵双胞胎的比率仍然高于一级亲属，但这项研究提供了足够的证据，表明抑郁症的发展中存在强烈的遗传联系（McGuffin 等人，1996 年）。

More recently, scientists have been studying depression at a molecular level, exploring possibilities of gene abnormalities as a cause for developing a depressive disorder. While much of the research is speculation due to sampling issues and low power, there is some evidence that depression may be tied to the 5-HTT gene on chromosome 17, as this is responsible for the activity of serotonin (Jansen et al., 2016).
最近，科学家们开始从分子层面研究抑郁症，探讨基因异常作为抑郁症发病原因的可能性。尽管由于样本问题和低效能，许多研究都是推测性的，但有一些证据表明，抑郁症可能与第 17 号染色体上的 5-HTT 基因有关，因为这是血清素活动的原因（Jansen 等人，2016 年）。

Bipolar disorders share a similar genetic predisposition to that of major depressive disorder. Twin studies within bipolar disorder yielded concordance rates for identical twins at as high as 72%, yet the range for fraternal twins, siblings, and other close relatives ranged from 5-15%. It is important to note that both percentages are significantly higher than that of the general population, suggesting a strong genetic component within bipolar disorder (Edvardsen et al., 2008). The DSM-5-TR more recently reports heritability estimates around 90% in some twin studies and the risk of bipolar disorder being around 1% in the general population compared to 5-10% in a first-degree relative (APA, 2022).
双相情感障碍与重度抑郁症具有相似的遗传易感性。在双相情感障碍的孪生子研究中，同卵双胞胎的一致率高达 72%，而异卵双胞胎、兄弟姐妹和其他近亲的一致率在 5-15%之间。需要注意的是，这两个百分比都显著高于普通人群，表明双相情感障碍中存在强烈的遗传成分（Edvardsen 等人，2008 年）。DSM-5-TR 最近报道，在某些孪生子研究中，遗传性估计值约为 90%，而在普通人群中，双相情感障碍的风险约为 1%，而在一级亲属中约为 5-10%（APA，2022 年）。

**     4.5.1.2. Biochemical. **As you will read in the treatment section, there is strong evidence of a biochemical deficit in depression and bipolar disorders. More specifically, low activity levels of norepinephrine and serotonin, have long been documented as contributing factors to developing depressive disorders. This relationship was discovered accidentally in the 1950s when MAOIs were given to tuberculosis patients, and miraculously, their depressive moods were also improved. Soon thereafter, medical providers found that medications used to treat high blood pressure by causing a reduction in norepinephrine also caused depression in their patients (Ayd, 1956).
4.5.1.2. 生化。正如您将在治疗部分中读到的那样，抑郁症和双相情感障碍存在生化缺乏的强烈证据。更具体地说，去甲肾上腺素和血清素活性水平低长期以来一直被记录为导致抑郁障碍的发展因素。这种关系是在 20 世纪 50 年代意外发现的，当时 MAOIs 被给予肺结核患者，奇迹般地，他们的抑郁情绪也得到了改善。不久之后，医疗提供者发现，通过降低去甲肾上腺素来治疗高血压的药物也导致他们的患者出现抑郁（Ayd，1956）。

While these initial findings were premature in the identification of how neurotransmitters affected the development of depressive features, they did provide insight as to *what *neurotransmitters were involved in this system. Researchers are still trying to determine exact pathways; however, it does appear that *both *norepinephrine and serotonin are involved in the development of symptoms, whether it be between the interaction between them, or their interaction on other neurotransmitters (Ding et al., 2014).
尽管这些初步发现对于确定神经递质如何影响抑郁特征的发展还为时过早，但它们确实提供了关于哪些神经递质参与这一系统的见解。研究人员仍在努力确定确切途径；然而，似乎去甲肾上腺素和血清素都参与了症状的发展，无论是它们之间的相互作用，还是它们与其他神经递质的相互作用（Ding 等人，2014 年）。

Due to the close nature of depression and bipolar disorder, researchers initially believed that both norepinephrine and serotonin were implicated in the development of bipolar disorder; however, the idea was that there was a drastic *increase *in serotonin during mania episodes. Unfortunately, research supports the opposite. It is believed that low levels of serotonin and *high levels *of norepinephrine may explain mania episodes (Soreff & McInnes, 2014). Despite these findings, additional research within this area is needed to conclusively determine what is responsible for the manic episodes within bipolar disorder.
由于抑郁症和双相情感障碍的紧密关系，研究人员最初认为去甲肾上腺素和血清素都与双相情感障碍的发展有关；然而，观点是血清素在躁狂发作期间急剧增加。不幸的是，研究支持相反的观点。人们认为，血清素水平低和去甲肾上腺素水平高可能可以解释躁狂发作（Soreff & McInnes，2014）。尽管有这些发现，仍需要在该领域进行更多研究，以最终确定双相情感障碍中躁狂发作的责任因素。

**     4.5.1.3. Endocrine system. **As you may know, the endocrine system is a collection of glands responsible for regulating hormones, metabolism, growth and development, sleep, and mood, among other things. Some research has implicated hormones, particularly cortisol, a hormone released as a stress response, in the development of depression (Owens et al., 2014). Additionally, melatonin, a hormone released when it is dark outside to assist with the transition to sleep, may also be related to depressive symptoms, particularly during the winter months.
4.5.1.3. 内分泌系统。如您所知，内分泌系统是一组负责调节激素、新陈代谢、生长和发育、睡眠和情绪等功能的腺体集合。一些研究表明，激素，尤其是作为压力反应释放的皮质醇，与抑郁症的发展有关（Owens 等人，2014 年）。此外，当外界变暗时释放的褪黑素，有助于睡眠过渡的激素，也可能与抑郁症状有关，尤其是在冬季月份。

**     4.5.1.4. Brain anatomy. **Seeing as neurotransmitters have been implicated in the development of depressive disorders, it should not be a surprise that various brain structures have also been identified as contributors to mood disorders. While exact anatomy and pathways are yet to be determined, research studies implicate the prefrontal cortex, the hippocampus, and the amygdala. More specifically, drastic changes in blood flow throughout the prefrontal cortex have been linked with depressive symptoms. Similarly, a smaller hippocampus, and consequently, fewer neurons, has also been linked to depressive symptoms. Finally, heightened activity and blood flow in the amygdala, the brain area responsible for our fight or flight response, is also consistently found in individuals with depressive symptoms.
4.5.1.4. 大脑解剖。鉴于神经递质已被认为是抑郁症发展的原因，各种大脑结构也被确定为情绪障碍的促成因素，这并不令人惊讶。尽管确切的解剖结构和路径尚未确定，但研究研究表明，前额叶皮层、海马体和杏仁核被涉及。更具体地说，前额叶皮层血液流动的剧烈变化与抑郁症状有关。同样，海马体较小，神经元数量减少，也与抑郁症状有关。最后，杏仁核（负责我们的战斗或逃跑反应的大脑区域）的活跃度和血液流动增加，在具有抑郁症状的人中也经常被发现。

Abnormalities in several brain structures have also been identified in individuals with bipolar disorder; however, what or why these structures are abnormal has yet to be determined. Researchers continue to focus on areas of the basal ganglia and cerebellum, which appear to be much smaller in individuals with bipolar disorder compared to the general public. Additionally, there appears to be a decrease in brain activity in regions associated with regulating emotions, as well as an increase in brain activity among structures related to emotional responsiveness (Houenou et al., 2011). Additional research is still needed to determine precisely how each of these brain structures may be implicated in the development of bipolar disorder.
脑部结构异常也在双相情感障碍患者中被发现；然而，这些结构为何异常以及原因尚未确定。研究人员继续关注基底神经节和小脑区域，这些区域在双相情感障碍患者中似乎比普通人要小。此外，与调节情绪相关的脑区活动似乎减少，而与情绪反应相关的脑区活动增加（Houenou 等，2011）。仍需进一步研究以确定这些脑结构如何具体涉及双相情感障碍的发展。

4.5.2. Cognitive 4.5.2. 认知

The cognitive model, arguably the most conclusive model with regards to depressive disorders, focuses on the negative thoughts and perceptions of an individual. One theory often equated with the cognitive model of depression is **learned helplessness. **Coined by Martin Seligman (1975), learned helplessness was developed based on his laboratory experiment involving dogs. In this study, Seligman restrained dogs in an apparatus and routinely shocked them regardless of their behavior. The following day, the dogs were placed in a similar apparatus; however, this time they were not restrained and there was a small barrier placed between the “shock” floor and the “safe” floor. What Seligman observed was that despite the opportunity to escape the shock, the dogs flurried for a bit, and then ultimately laid down and whimpered while being shocked.
认知模型，可以说是关于抑郁症最具有结论性的模型，它关注个体的负面思维和感知。与抑郁症的认知模型经常相提并论的一种理论是习得性无助。习得性无助是由马丁·塞利格曼（1975 年）提出的，它基于他关于狗的实验室实验而发展起来的。在这项研究中，塞利格曼将狗关在装置中，并定期对它们进行电击，无论它们的行为如何。第二天，狗被放在一个类似的装置中；然而，这次它们没有被束缚，并且在“电击”地板和“安全”地板之间放置了一个小障碍物。塞利格曼观察到，尽管有机会逃离电击，狗们先是一阵慌乱，然后最终在被电击时躺下哀嚎。

Based on this study, Seligman concluded that the animals essentially learned that they were unable to avoid the shock the day prior, and therefore, learned that they were helpless in preventing the shocks. When they were placed in a similar environment but had the opportunity to escape the shock, their learned helplessness carried over, and they continued to believe they were unable to escape the shock.
基于这项研究，塞利格曼得出结论，动物本质上学会了他们无法避免前一天的电击，因此学会了他们无法阻止电击。当它们被置于类似的环境中但有机会逃避电击时，它们学到的无助感延续下来，它们继续相信他们无法逃避电击。

This study has been linked to humans through research on attributional style (Nolen-Hoeksema, Girgus & Seligman, 1992). There are two types of attributional styles—positive and negative. A negative attributional style focuses on the internal, stable, and *global *influence of daily lives, whereas a positive attributional style focuses on the *external, unstable, *and specific influence of the environment. Research has found that individuals with a negative attributional style are more likely to experience depression. This is likely due to their negative interpretation of daily events. For example, if something bad were to happen to them, they would conclude that it is *their *fault (internal), bad things *always *happen to them (stable), and bad things happen *all *day to them. Unfortunately, this maladaptive thinking style often takes over an individual’s daily view, thus making them more vulnerable to depression.
这项研究通过归因风格（Nolen-Hoeksema、Girgus 和 Seligman，1992 年）的研究与人类联系起来。有两种归因风格——积极和消极。消极的归因风格关注日常生活内部、稳定和全局的影响，而积极的归因风格关注外部、不稳定和具体的环境影响。研究发现，具有消极归因风格的人更容易经历抑郁。这可能是由于他们对日常事件的消极解释。例如，如果不幸的事情发生在他们身上，他们会得出这是他们自己的错（内部）、坏事情总是发生在他们身上（稳定），以及他们整天都在发生坏事。不幸的是，这种不适应的思维风格往往占据了个人日常观点的主导地位，从而使他们更容易受到抑郁的影响。

In addition to attributional style, Aaron Beck also attributed negative thinking as a precursor to depressive disorders (Beck, 2002, 1991, 1967). Often viewed as the grandfather of Cognitive-Behavioral Therapy, Beck went on to coin the terms—maladaptive attitudes, cognitive triad, errors in thinking, and automatic thoughts—all of which combine to explain the cognitive model of depressive disorders.
除了归因风格外，亚伦·贝克还将消极思维视为抑郁障碍的先兆（贝克，2002，1991，1967）。通常被视为认知行为疗法的鼻祖，贝克继续创造了“不适应的态度”、“认知三角”、“思维错误”和“自动思维”等术语，所有这些术语结合起来解释了抑郁障碍的认知模型。

Maladaptive attitudes, or negative attitudes about oneself, others, and the world around them are often present in those with depressive symptoms. These attitudes are inaccurate and often global. For example, “If I fail my exam, the world will know I’m stupid.” Will the entire world *really *know you failed your exam? Not likely. Because you fail the exam, are you stupid? No. Individuals with depressive symptoms often develop these maladaptive attitudes regarding everything in their life, indirectly isolating themselves from others. The **cognitive triad **also plays into the maladaptive attitudes in that the individual interprets these negative thoughts about their experiences, themselves, and their futures.
不适应的态度，或对自己、他人和周围世界的负面态度，常常存在于有抑郁症状的人中。这些态度是不准确的，通常是普遍的。例如，“如果我考试不及格，全世界都会知道我很笨。”全世界真的会知道你考试不及格吗？不太可能。因为你考试不及格，你就笨吗？不。有抑郁症状的人往往会在他们生活的方方面面发展出这些不适应的态度，从而间接地把自己孤立于他人之外。认知三联也影响了不适应的态度，因为个人会解释关于他们的经历、自己和未来的这些负面想法。

Cognitive distortions, also known as errors in thinking, are a key component in Beck’s cognitive theory. Beck identified 15 errors in thinking that are most common in individuals with depression (see the end of the module). Among the most common are catastrophizing, jumping to conclusions, and overgeneralization. I always like to use my dad (first author’s dad) as an example for overgeneralization. Whenever we go to the grocery store, he *always *comments about how *whatever *line he chooses, at *every *store, it is always the slowest line. Does this happen *every *time he is at the store? I’m doubtful, but his error in thinking leads to him believing this is true.
认知扭曲，也称为思维错误，是贝克认知理论的关键组成部分。贝克确定了 15 种在抑郁症患者中最常见的思维错误（见模块末尾）。其中最常见的是灾难化、急于下结论和过度概括。我总是喜欢用我的父亲（第一作者的父亲）作为过度概括的例子。每次我们去杂货店，他总是评论说无论他选择哪个队伍，在每个店里，总是最慢的队伍。这每次他在店里都会发生吗？我表示怀疑，但他的思维错误导致他相信这是真的。

Finally, automatic thoughts, or the constant stream of negative thoughts, also leads to symptoms of depression as individuals begin to feel as though they are inadequate or helpless in a given situation. While some cognitions are manipulated and interpreted negatively, Beck stated that there is another set of negative thoughts that occur automatically. Research studies have continually supported Beck’s maladaptive thoughts, attitudes, and errors in thinking as fundamental issues in those with depressive disorders (Lai et al., 2014; Possel & Black, 2014). Furthermore, as you will see in the treatment section (Section 4.5), cognitive strategies are among the most effective forms of treatment for depressive disorders.
最后，自动思维，或者说持续的消极思维，也会导致抑郁症状，因为个人开始觉得自己在特定情况下不称职或无助。虽然一些认知被操纵和负面解读，贝克指出还有另一组自动出现的消极思维。研究不断支持贝克关于适应不良思维、态度和认知错误的观点，这些是抑郁症患者的基本问题（赖等，2014；波塞尔和布莱克，2014）。此外，正如你在治疗部分（第 4.5 节）中将会看到的，认知策略是治疗抑郁症最有效的形式之一。

4.5.3. Behavioral 4.5.3. 行为

The behavioral model explains depression as a result of a change in the number of rewards and punishments one receives throughout their life. This change can come from work, intimate relationships, family, or even the environment in general. Among the most influential in the field of depression is Peter Lewinsohn. He stated depression occurred in most people due to reduced positive rewards in their life. Because they were not positively rewarded, their constructive behaviors occurred more infrequently until they stop engaging in the behavior completely (Lewinsohn et al., 1990; 1984). An example of this is a student who keeps receiving bad grades on their exam despite studying for hours. Over time, the individual will reduce the amount of time they are studying, thus continuing to earn poor grades.
行为模型将抑郁症解释为一个人在其一生中获得的奖励和惩罚数量发生变化的结果。这种变化可能来自工作、亲密关系、家庭，甚至是一般的环境。在抑郁症领域最具影响力的是彼得·勒温松。他认为，抑郁症在大多数人中发生是因为他们生活中积极的奖励减少。因为他们没有得到积极的奖励，他们的建设性行为发生的频率更低，直到他们完全停止参与这种行为（Lewinsohn 等人，1990；1984）。一个例子是一个学生在考试中尽管学习了几个小时，但仍然不断得到糟糕的成绩。随着时间的推移，个人会减少他们学习的时间，从而继续获得糟糕的成绩。

4.5.4. Sociocultural 4.5.4. 社会文化

In the sociocultural theory, the role of family and one’s social environment play a substantial role in the development of depressive disorders. There are two sociocultural views: the *family-social perspective *and the *multi-cultural perspective. *
在社会文化理论中，家庭和个人的社会环境在抑郁症的发展中起着重要作用。有两种社会文化观点：家庭-社会视角和多元文化视角。

**     4.5.4.1. Family-social perspective. **Similar to that of the behavioral theory, the family-social perspective of depression suggests that depression is related to the unavailability of social support. This is often supported by research studies that show separated and divorced individuals are three times more likely to experience depressive symptoms than those that are married or even widowed (Schultz, 2007). While many factors lead a couple to separate or end their marriage, some relationships end due to a spouse’s mental health issues, particularly depressive symptoms. Depressive symptoms have been positively related to increased interpersonal conflicts, reduced communication, and intimacy issues, all of which are often reported in causal factors leading to a divorce (Najman et al., 2014).
4.5.4.1. 家庭-社会视角。与行为理论类似，抑郁症的家庭-社会视角认为，抑郁症与社会支持的不可用性有关。这通常得到研究支持的证据，研究表明，分居和离婚的人比已婚或丧偶的人更有可能经历抑郁症状（Schultz，2007）。虽然许多因素导致夫妻分居或结束婚姻，但有些关系因配偶的心理健康问题而结束，尤其是抑郁症状。抑郁症状与人际冲突增加、沟通减少和亲密关系问题呈正相关，这些都是导致离婚的常见原因（Najman 等人，2014）。

The family-social perspective can also be viewed oppositely, with stress and marital discord leading to increased rates of depression in one or both spouses (Nezlek et al., 2000). While some research indicates that having children provides a positive influence in one’s life, it can also lead to stress both within the individual, as well as between partners due to division of work and discipline differences. Studies have shown that women who had three or more young children, and also lacked a close confidante and outside employment, were more likely than other mothers to become depressed (Brown, 2002).
家庭-社会视角也可以从相反的角度看待，压力和婚姻不和会导致夫妻一方或双方患抑郁症的几率增加（Nezlek 等人，2000 年）。虽然一些研究表明有孩子对一个人的生活有积极影响，但它也可能因为工作分配和纪律差异而在个人之间以及伴侣之间导致压力。研究表明，有 3 个或更多年幼孩子的女性，如果没有亲密的知己和外部工作，比其他母亲更容易患上抑郁症（Brown，2002 年）。

**     4.5.4.2. Multi-cultural perspective. **While depression is experienced across the entire world, one’s cultural background may influence *what *symptoms of depression are presented. Common depressive symptoms such as feeling sad, lack of energy, anhedonia, difficulty concentrating, and thoughts of suicide are a hallmark in most societies; other symptoms may be more specific to one’s nationality. More specifically, individuals from non-Western countries (China and other Asian countries) often focus on the physical symptoms of depression—tiredness, weakness, sleep issues—and less of an emphasis on the cognitive symptoms.
4.5.4.2. 多元文化视角。虽然抑郁在全球范围内都有体验，但一个人的文化背景可能会影响抑郁症状的表现。常见的抑郁症状，如感到悲伤、缺乏能量、快感缺失、难以集中注意力和自杀念头，在大多数社会中都是标志性症状；其他症状可能更具体于某个国籍。更具体地说，来自非西方国家（中国和其他亚洲国家）的个人通常更关注抑郁的生理症状——疲劳、虚弱、睡眠问题——而对认知症状的关注较少。

Within the United States, many researchers have explored potential differences across ethnic or racial groups in both rates of depression, as well as presenting symptoms of those diagnosed with depression. These studies continually fail to identify any significant differences between ethnic and racial groups; however, one major study has identified a difference in the rate of recurrence of depression in Hispanic and African Americans (Gonzalez et al., 2010). While the exact reason for this is unclear, researchers propose a lack of treatment opportunities as a possible explanation. According to Gonzalez and colleagues (2010), approximately 54% of depressed white Americans seek out treatment, compared to the 34% and 40% Hispanic and African Americans, respectively. The fact that there is a large discrepancy in the use of treatment between white Americans and minority Americans suggests that these individuals are not receiving the effective treatment necessary to resolve the disorder, thus leaving them more vulnerable for repeated depressive episodes.
在美国，许多研究人员探讨了不同种族或民族群体在抑郁症患病率和抑郁症患者的症状表现方面的潜在差异。这些研究不断未能发现种族和民族群体之间存在任何显著差异；然而，一项主要研究确定了西班牙裔和非洲裔美国人在抑郁症复发率上的差异（Gonzalez 等人，2010 年）。尽管确切原因尚不清楚，研究人员提出缺乏治疗机会可能是这一现象的可能解释。根据 Gonzalez 及其同事（2010 年）的研究，大约 54%的抑郁白人美国人寻求治疗，而西班牙裔和非洲裔美国人分别为 34%和 40%。白人美国人与少数族裔美国人之间在治疗使用上的巨大差异表明，这些人没有获得解决这种疾病所需的有效治疗，因此使他们更容易反复出现抑郁发作。

**            4.5.4.3. Gender differences***. *As previously discussed, there is a significant difference between gender and rates of depression, with women twice as likely to experience an episode of depression than men (Schuch et al., 2014). There are a few speculations as to why there is such an imbalance in the rate of depression across genders.
4.5.4.3. 性别差异。如前所述，性别与抑郁症发生率之间存在显著差异，女性患抑郁症的几率是男性的两倍（Schuch 等人，2014）。关于为什么性别间抑郁症发生率存在如此不平衡，有一些猜测。

The first theory, *artifact theory, *suggests that the difference between genders is due to clinician or diagnostic systems being more sensitive to diagnosing women with depression than men. While women are often thought to be more “emotional,” easily expressing their feelings and more willing to discuss their symptoms with clinicians and physicians, men often withhold their symptoms or will present with more traditionally “masculine” symptoms of anger or aggression. While this theory is a possible explanation for the gender differences in the rate of depression, research has failed to support this theory, suggesting that men and women are equally likely to seek out treatment and discuss their depressive symptoms (McSweeney, 2004; Rieker & Bird, 2005).
第一种理论，即遗物理论，认为性别差异是由于临床医生或诊断系统对诊断女性抑郁症比男性更敏感。虽然女性通常被认为更“情绪化”，更容易表达自己的感受，更愿意与临床医生和医生讨论他们的症状，但男性往往隐瞒他们的症状或表现出更多传统上“男性化”的症状，如愤怒或攻击性。尽管这种理论可能是解释抑郁症性别差异率的可能解释，但研究未能支持这一理论，表明男性和女性寻求治疗和讨论他们的抑郁症状的可能性相同（McSweeney，2004；Rieker & Bird，2005）。

The second theory, hormone theory, suggests that variations in hormone levels trigger depression in women more than men (Graziottin & Serafini, 2009). While there is biological evidence supporting the changes in hormone levels during various phases of the menstrual cycle and their impact on women’s ability to integrate and process emotional information, research fails to support this theory as the reason for higher rates of depression in women (Whiffen & Demidenko, 2006).
第二种理论，激素理论，认为激素水平的变化比男性更容易导致女性抑郁（Graziottin & Serafini，2009）。尽管有生物学证据支持月经周期各个阶段激素水平的变化及其对女性整合和处理情绪信息能力的影响，但研究未能支持这一理论作为女性抑郁症发病率更高的原因（Whiffen & Demidenko，2006）。

The third theory, *life stress theory, *suggests that women are more likely to experience chronic stressors than men, thus accounting for their higher rate of depression (Astbury, 2010). Women face increased risk for poverty, lower employment opportunities, discrimination, and poorer quality of housing than men, all of which are strong predictors of depressive symptoms (Garcia-Toro et al., 2013).
第三种理论，生活压力理论，认为女性比男性更容易经历慢性压力源，因此解释了她们更高的抑郁症发生率（Astbury，2010）。与男性相比，女性面临更高的贫困风险、更少的就业机会、歧视和更差的住房条件，所有这些都是抑郁症状的强预测因素（Garcia-Toro 等，2013）。

The fourth theory, *gender roles theory, *suggests that social and or psychological factors related to traditional gender roles also influence the rate of depression in women. For example, men are often encouraged to develop personal autonomy, seek out activities that interest them, and display achievement-oriented goals; women are encouraged to empathize and care for others, often fostering an interdependent functioning, which may cause women to value the opinion of others more highly than their male counterparts do.
第四种理论，性别角色理论，认为与传统性别角色相关的社会和心理因素也会影响女性抑郁症的发病率。例如，男性通常被鼓励发展个人自主性，寻找自己感兴趣的活动，并表现出以成就为导向的目标；女性则被鼓励同情和关心他人，往往培养出相互依赖的功能，这可能导致女性比男性更重视他人的意见。

The final theory, rumination theory, suggests that women are more likely than men to ruminate, or intently focus, on their depressive symptoms, thus making them more vulnerable to developing depression at a clinical level (Nolen-Hoeksema, 2012). Several studies have supported this theory and shown that rumination of negative thoughts is positively related to an increase in depression symptoms (Hankin, 2009).
最终的理论，沉思理论，表明女性比男性更容易沉思，即专注于他们的抑郁症状，这使得她们更容易在临床水平上发展出抑郁症（Nolen-Hoeksema，2012）。几项研究支持了这一理论，并显示消极思维的沉思与抑郁症状的增加呈正相关（Hankin，2009）。

While many theories try to explain the gender discrepancy in depressive episodes, no single theory has produced enough evidence to fully explain why women experience depression more than men. Due to the lack of evidence, gender differences in depression remains one of the most researched topics within the subject of depression, while simultaneously being the least understood phenomena within clinical psychology.
尽管许多理论试图解释抑郁发作中的性别差异，但没有一种理论能够提供足够的证据来完全解释为什么女性比男性更容易患抑郁症。由于缺乏证据，抑郁症中的性别差异仍然是抑郁症研究领域中最受研究的话题之一，同时也是临床心理学中最不为人理解的现象之一。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

• In terms of biological explanations for depressive disorders, there is evidence that rates of depression are higher among identical twins (the same is true for bipolar disorders), that the 5-HTT gene on chromosome 17 may be involved in depressive disorders, that norepinephrine and serotonin affect depressive (both being low) and bipolar disorders (low serotonin and high norepinephrine), the hormones cortisol and melatonin affect depression, and several brain structures are implicated in depression (prefrontal cortex, hippocampus, and amygdala) and bipolar disorder (basal ganglia and cerebellum).
  在抑郁障碍的生物解释方面，有证据表明，同卵双胞胎的抑郁发生率更高（双相障碍也是如此），17 号染色体上的 5-HTT 基因可能与抑郁障碍有关，去甲肾上腺素和血清素会影响抑郁（两者都偏低）和双相障碍（血清素低，去甲肾上腺素高），皮质醇和褪黑素会影响抑郁，以及几个大脑结构与抑郁（前额叶皮层、海马体和杏仁核）和双相障碍（基底神经节和小脑）有关。
• In terms of cognitive explanations, learned helplessness, attributional style, and maladaptive attitudes to include the cognitive triad, errors in thinking, and automatic thoughts, help to explain depressive disorders.
  从认知解释的角度来看，习得性无助、归因风格和对认知三角、思维错误以及自动思维的不适应态度有助于解释抑郁障碍。
• Behavioral explanations center on changes in the rewards and punishments received throughout life.
  行为解释集中在一生中获得的奖惩变化上。
• Sociocultural explanations include the family-social perspective and multi-cultural perspective.
  社会文化解释包括家庭-社会视角和多元文化视角。
• Women are twice as likely to experience depression and this could be due to women being more likely to be diagnosed than men (called the artifact theory), variations in hormone levels in women (hormone theory), women being more likely to experience chronic stressors (life stress theory), the fostering of an interdependent functioning in women (gender roles theory), and that women are more likely to intently focus on their symptoms (rumination theory).
  女性患抑郁症的可能性是男性的两倍，这可能是由于女性比男性更容易被诊断（称为伪象理论）、女性激素水平的变化（激素理论）、女性更容易经历慢性压力源（生活压力理论）、培养女性相互依赖的功能（性别角色理论），以及女性更有可能密切关注自己的症状（沉思理论）。

Section 4.5 Review Questions
第 4.5 节 复习问题

1. How do twin studies explain the biological causes of mood disorders?
   如何通过双生子研究解释情绪障碍的生物原因？
2. What brain structures are implicated in the development of mood disorders? Discuss their role.
   大脑中哪些结构与情绪障碍的发展有关？讨论它们的作用。
3. What is learned helplessness? How has this concept been used to study the development and maintenance of mood disorders?
   什么是习得性无助？这一概念是如何被用来研究情绪障碍的发展和维持的？
4. What is the cognitive triad?
   什么是认知三元组？
5. What are common cognitive distortions observed in individuals with mood disorders?
   常见于情绪障碍个体的认知扭曲有哪些？
6. What are the identified theories that are used to explain the gender differences in mood disorder development?
   所识别的用于解释情绪障碍发展中的性别差异的理论有哪些？

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4.6. Treatment of Mood Disorders 4.6. 情绪障碍的治疗

Section Learning Objectives 章节学习目标

• Describe treatment options for depressive disorders.
  描述抑郁症的治疗方案。
• Describe treatment options for bipolar disorders.
  描述双相情感障碍的治疗方案。
• Determine the efficacy of treatment options for depressive disorders.
  确定抑郁症治疗方案的有效性。
• Determine the efficacy of treatment options for bipolar disorders.
  确定双相情感障碍治疗方案的疗效。

4.6.1. Depressive Disorders 4.6.1. 抑郁障碍

Given that Major Depressive Disorder is among the most frequent and debilitating psychiatric disorders, it should not be surprising that the research on this disorder is quite extensive. Among its treatment options, the most efficacious ones include antidepressant medications, Cognitive-Behavioral Therapy (CBT; Beck et al., 1979), Behavioral Activation (BA; Jacobson et al., 2001), and Interpersonal Therapy (IPT; Klerman et al., 1984). Although CBT is the most widely known and used treatment for Major Depressive Disorder, there is minimal evidence to support one treatment modality over the other; treatment is generally dictated by therapist competence, availability, and patient preference (Craighhead & Dunlop, 2014).
鉴于重度抑郁症是最常见和最具破坏性的精神疾病之一，这项疾病的研究相当广泛并不令人惊讶。在其治疗方法中，最有效的方法包括抗抑郁药、认知行为疗法（CBT；Beck 等人，1979 年）、行为激活（BA；Jacobson 等人，2001 年）和人际疗法（IPT；Klerman 等人，1984 年）。尽管 CBT 是治疗重度抑郁症最广为人知和常用的方法，但几乎没有证据支持一种治疗方法优于另一种；治疗通常由治疗师的专业能力、可用性和患者偏好决定（Craighhead & Dunlop，2014 年）。

**     4.6.1.1. Psychopharmacology – Antidepressant medications. **Antidepressants are often the most common first-line attempt at treatment for MDD for a few reasons. Oftentimes an individual will present with symptoms to their primary caregiver (a medical doctor) who will prescribe them some line of antidepressant medication. Medication is often seen as an “easier” treatment for depression as the individual can take the medication at their home, rather than attending weekly therapy sessions; however, this also leaves room for adherence issues as a large percentage of individuals fail to take prescription medication as indicated by their physician. Given the biological functions of neurotransmitters and their involvement in maintaining depressive symptoms, it makes sense that this is an effective type of treatment.
4.6.1.1. 精神药理学 - 抗抑郁药。抗抑郁药通常是因为几个原因而成为治疗重度抑郁症（MDD）最常见的一线尝试。通常，一个人会向他们的主要照顾者（一位医生）展示症状，医生会给他们开一些抗抑郁药。药物通常被视为一种“更容易”的治疗抑郁症的方法，因为个人可以在家中服用药物，而不是每周参加治疗会议；然而，这也留下了依从性问题，因为很大一部分人未能按照医生的建议服用处方药。鉴于神经递质的生物学功能和它们在维持抑郁症状中的作用，这种治疗方法是有效的。

Within antidepressant medications, there are a few different classes, each categorized by their structural or functional relationships. It should be noted that no specific antidepressant medication class or medication have been proven to be more effective in treating MDD than others (APA, 2010). In fact, many patients may try several different types of antidepressant medications until they find one that is effective, with minimal side effects.
在抗抑郁药物中，有几个不同的类别，每个类别都根据其结构或功能关系进行分类。需要注意的是，没有特定的抗抑郁药物类别或药物被证明在治疗重度抑郁症（MDD）方面比其他药物更有效（APA，2010）。事实上，许多患者可能需要尝试几种不同类型的抗抑郁药物，直到找到一种有效且副作用最小的药物。

**     4.6.1.2. Psychopharmacology – Selective serotonin reuptake inhibitors** (SSRIs). SSRIs are among the most common medications used to treat depression due to their relatively benign side effects. Additionally, the required dose to reach therapeutic levels is low compared to the other medication options.  Possible side effects from SSRIs include but are not limited to nausea, insomnia, and reduced sex drive.
4.6.1.2. 精神药理学 - 选择性 5-羟色胺再摄取抑制剂（SSRIs）。SSRIs 是治疗抑郁症最常用的药物之一，因为它们的副作用相对温和。此外，与其他药物相比，达到治疗水平的所需剂量较低。SSRIs 的可能副作用包括但不限于恶心、失眠和性欲减退。

SSRIs improve depression symptoms by blocking the reuptake of norepinephrine and/or serotonin in presynaptic neurons, thus allowing more of these neurotransmitters to be available for postsynaptic neurons. While this is the general mechanism through which all SSRI’s work, there are minor biological differences among different types of medications within the SSRI family. These small differences are beneficial to patients in that there are a few treatment options to maximize medication benefits and minimize side effects.
选择性 5-羟色胺再摄取抑制剂通过阻断突触前神经元中去甲肾上腺素和/或血清素的再摄取，从而允许更多的这些神经递质可供突触后神经元使用。虽然这是所有 SSRI 工作的通用机制，但 SSRI 家族中不同类型的药物之间仍存在微小的生物差异。这些微小差异对患者有益，因为可以提供几种治疗方案，以最大化药物效益并最小化副作用。

**     4.6.1.3. Psychopharmacology – Tricyclic antidepressants. **Although originally developed to treat schizophrenia, tricyclic antidepressants were adapted to treat depression after failing to manage symptoms of schizophrenia (Kuhn, 1958). The term tricyclic came from the molecular shape of the structure: three rings.
4.6.1.3. 精神药理学 - 三环类抗抑郁药。虽然最初是为了治疗精神分裂症而开发的，但由于未能管理精神分裂症的症状，三环类抗抑郁药后来被用于治疗抑郁症（库恩，1958 年）。三环这个词来自该结构的分子形状：三个环。

Tricyclic antidepressants are like SSRIs in that they work by affecting brain chemistry, altering the number of neurotransmitters available for neurons. More specifically, they block the absorption or reuptake of serotonin and norepinephrine, thus increasing their availability for postsynaptic neurons. While effective, tricyclic antidepressants have been increasingly replaced by SSRIs due to their reduced side effects. However, tricyclic antidepressants have been shown to be more effective in treating depressive symptoms in individuals who have not been able to achieve symptom reduction via other pharmacological approaches.
三环类抗抑郁药与 SSRIs 类似，通过影响大脑化学物质，改变神经元可用的神经递质数量来发挥作用。更具体地说，它们阻断血清素和去甲肾上腺素的吸收或再摄取，从而增加它们在突触后神经元中的可用性。虽然有效，但由于副作用减少，三环类抗抑郁药越来越多地被 SSRIs 所取代。然而，研究表明，对于其他药物治疗无法实现症状减轻的个体，三环类抗抑郁药在治疗抑郁症状方面更为有效。

While the majority of the side effects are minimal – dry mouth, blurry vision, constipation, others can be serious such as sexual dysfunction, tachycardia, cognitive and/or memory impairment. Due to the potential impact on the heart, tricyclic antidepressants should not be used in cardiac patients as they may exacerbate cardiac arrhythmias (Roose & Spatz, 1999).
尽管大多数副作用都很轻微——如口干、视力模糊、便秘，但其他副作用可能很严重，如性功能障碍、心动过速、认知和/或记忆力减退。由于可能对心脏产生影响，三环类抗抑郁药不应在心脏病患者中使用，因为它们可能会加剧心脏心律失常（Roose & Spatz，1999）。

**     4.6.1.4. Psychopharmacology – Monoamine oxidase inhibitors (MAOIs).  **The use of MAOIs as a treatment for depression began serendipitously as patients in the early 1950s reported reduced depression symptoms while on the medication to treat tuberculosis. Research studies confirmed that MAOIs were effective in treating depression in adults outside the treatment of tuberculosis. Although still prescribed, they are not typically first-line medications due to their safety concerns with hypertensive crises. Because of this, individuals on MAOIs have strict diet restrictions to reduce their risk of hypertensive crises (Shulman, Herrman & Walker, 2013).
4.6.1.4. 精神药理学——单胺氧化酶抑制剂（MAOIs）。20 世纪 50 年代初，患者在使用治疗结核病的药物期间报告了抑郁症状的减轻，这使得 MAOIs 作为抑郁症的治疗方法意外地开始使用。研究证实，MAOIs 在治疗非结核病成年人的抑郁症方面是有效的。尽管仍在使用，但由于其与高血压危象的安全问题，它们通常不是一线药物。因此，使用 MAOIs 的个人有严格的饮食限制，以降低其高血压危象的风险（Shulman，Herrman & Walker，2013）。

How do MAOIs work? In basic terms, monoamine oxidase is released in the brain to remove excess neurotransmitters norepinephrine, serotonin, and dopamine. MAOIs essentially prevent the monoamine oxidase (hence the name monoamine oxidase inhibitors) from removing these neurotransmitters, thus resulting in an increase in these brain chemicals (Shulman, Herman & Walker, 2013). As previously discussed, norepinephrine, serotonin, and dopamine are all involved in the biological mechanisms of maintaining depressive symptoms.
MAOIs 是如何工作的？简单来说，单胺氧化酶在大脑中释放，以去除多余的神经递质去甲肾上腺素、血清素和多巴胺。MAOIs 本质上阻止单胺氧化酶（因此得名单胺氧化酶抑制剂）去除这些神经递质，从而导致这些脑化学物质增加（Shulman，Herman & Walker，2013）。如前所述，去甲肾上腺素、血清素和多巴胺都参与了维持抑郁症状的生物机制。

While these drugs are effective, they come with serious side effects. In addition to the hypertensive episodes, they can also cause nausea, headaches, drowsiness, involuntary muscle jerks, reduced sexual desire, weight gain, etc. (APA, 2010). Despite these side effects, studies have shown that individuals prescribed MAOIs for depression have a treatment response rate of 50-70% (Krishnan, 2007). Overall, despite their effectiveness, MAOIs are likely the best treatment for late-stage, treatment-resistant depression patients who have exhausted other treatment options (Krishnan, 2007).
尽管这些药物有效，但它们伴随着严重的副作用。除了高血压发作外，它们还可能导致恶心、头痛、嗜睡、不自主肌肉抽搐、性欲降低、体重增加等。（APA，2010）。尽管有这些副作用，但研究表明，接受 MAOIs 治疗抑郁症的患者治疗反应率为 50-70%（Krishnan，2007）。总的来说，尽管它们有效，但 MAOIs 可能是对其他治疗手段无效的晚期抑郁症患者最佳的治疗选择（Krishnan，2007）。

It should be noted that occasionally, antipsychotic medications are used for individuals with MDD; however, these are limited to individuals presenting with psychotic features.
应注意的是，偶尔，抗精神病药物被用于患有重度抑郁症（MDD）的个人；然而，这些药物仅限于出现精神病症状的个人。

**     4.6.1.5. Psychotherapy – Cognitive behavioral therapy (CBT). **CBT was founded by Aaron Beck in the 1960s and is a widely practiced therapeutic tool used to treat depression (and other disorders as well). The basics of CBT involve what Beck called the cognitive triangle— cognitions (thoughts), behaviors, and emotions. Beck believed that these three components are interconnected, and therefore, affect one another. It is believed that CBT can improve emotions in depressed patients by changing both cognitions (thoughts) and behaviors, which in return enhances mood. Common cognitive interventions with CBT include thought monitoring and recording, identifying cognitive errors, examining evidence supporting/negating cognitions, and creating rational alternatives to maladaptive thought patterns. Behavioral interventions of CBT include activity planning, pleasant event scheduling, task assignments, and coping-skills training.
4.6.1.5. 心理治疗 - 认知行为疗法（CBT）。CBT 由 Aaron Beck 在 20 世纪 60 年代创立，是一种广泛使用的治疗工具，用于治疗抑郁症（以及其他疾病）。CBT 的基础包括 Beck 所称的认知三角形——认知（思想）、行为和情绪。Beck 认为这三个组成部分相互关联，因此相互影响。人们认为，CBT 可以通过改变认知（思想）和行为来改善抑郁症患者的情绪，从而提高情绪。CBT 中常见的认知干预措施包括思想监控和记录、识别认知错误、检查支持/否定认知的证据，以及创造理性替代不良思维模式。CBT 的行为干预措施包括活动计划、愉快事件安排、任务分配和应对技能培训。

CBT generally follows four phases of treatment:
CBT 通常遵循四个治疗阶段：

• **Phase 1: Increasing pleasurable activities. **Similar to behavioral activation (see below), the clinician encourages the patient to identify and engage in activities that are pleasurable to the individual. The clinician can help the patient to select the activity, as well as help them plan when they will engage in that activity.
  第一阶段：增加愉悦活动。类似于行为激活（见下文），临床医生鼓励患者识别并参与对个人来说愉悦的活动。临床医生可以帮助患者选择活动，以及帮助他们计划何时参与该活动。
• **Phase 2: Challenging automatic thoughts. **During this stage, the clinician provides psychoeducation about the negative automatic thoughts that can maintain depressive symptoms. The patient will learn to identify these thoughts on their own during the week and maintain a thought journal of these cognitions to review with the clinician in session.
  第二阶段：挑战自动思维。在这个阶段，临床医生会提供关于可能维持抑郁症状的负面自动思维的心理教育。患者在下周内将学会自己识别这些思维，并保持一份关于这些认知的思想日记，以便在会话中与临床医生回顾。
• **Phase 3: Identifying negative thoughts. **Once the individual is consistently able to identify these negative thoughts on a daily basis, the clinician can help the patient identify *how *these thoughts are maintaining their depressive symptoms. It is at this point that the patient begins to have direct insight as to how their cognitions contribute to their disorder.
  第三阶段：识别负面想法。一旦个人能够持续每天识别这些负面想法，临床医生可以帮助患者识别这些想法是如何维持他们的抑郁症状的。这时，患者开始直接了解他们的认知是如何导致他们的疾病的。
• **Phase 4: Changing thoughts. **The final stage of treatment involves challenging the negative thoughts the patient has been identifying in the last two phases of treatment and replacing them with positive thoughts.
  第四阶段：改变思维。治疗的最后阶段涉及挑战患者在治疗前两个阶段中识别出的负面思维，并用积极的思维来替代。

**     4.6.1.6. Psychotherapy – Behavioral activation (BA). **BA is similar to the behavioral component of CBT in that the goal of treatment is to alleviate depression and prevent future relapse by changing an individual’s behavior. Founded by Ferster (1973), as well as Lewinsohn and colleagues (Lewinsohn, 1974; Lewinsohn, Biglan, & Zeiss, 1976), the goal of BA is to increase the frequency of behaviors so that individuals have opportunities to experience greater contact with sources of reward in their lives. To do this, the clinician assists the patient by developing a list of pleasurable activities that they can engage in outside of treatment (i.e., going for a walk, going shopping, having dinner with a friend). Additionally, the clinician assists the patient in identifying their negative behaviors—crying, sleeping in, avoiding friends—and monitoring them so that they do not impact the outcome of their pleasurable activities. Finally, the clinician works with the patient on effective social skills. By minimizing negative behaviors and maximizing pleasurable activities, the individual will receive more positive reward and reinforcement from others and their environment, thus improving their overall mood.
4.6.1.6. 心理治疗 - 行为激活（BA）。BA 与 CBT 的行为成分相似，治疗目标是通过改变个体的行为来缓解抑郁和预防未来的复发。由 Ferster（1973 年）以及 Lewinsohn 及其同事（Lewinsohn，1974 年；Lewinsohn，Biglan 和 Zeiss，1976 年）创立，BA 的目标是增加行为发生的频率，使个体有机会更多地接触生活中的奖励来源。为此，临床医生通过制定一份他们可以在治疗外参与的活动清单（例如散步、购物、与朋友共进晚餐）来协助患者。此外，临床医生协助患者识别他们的负面行为——哭泣、睡懒觉、避免朋友，并监控它们，以确保它们不会影响他们愉快的活动结果。最后，临床医生与患者一起工作，提高他们的社交技能。 通过减少负面行为并最大化愉悦活动，个人将获得更多来自他人和环境的积极奖励和强化，从而改善他们的整体情绪。

**     4.6.1.7. Psychotherapy – Interpersonal therapy (IPT). **IPT was developed by Klerman, Weissman, and colleagues in the 1970s as a treatment arm for a pharmacotherapy study of depression (Weissman, 1995). The treatment was created based on data from post-World War II individuals who expressed a substantial impact on their psychosocial life events. Klerman and colleagues noticed a significant relationship between the development of depression and complicated bereavement, role disputes, role transitions, and interpersonal deficits in these individuals (Weissman, 1995). The idea behind IPT is that depressive episodes compromise interpersonal functioning, which makes it difficult to manage stressful life events. The basic mechanism of IPT is to establish effective strategies to manage interpersonal issues, which in return, will ameliorate depressive symptoms.
4.6.1.7. 心理治疗 - 人际治疗（IPT）。IPT 由 Klerman、Weissman 及其同事在 20 世纪 70 年代开发，作为抑郁症药物治疗研究的一个治疗分支（Weissman，1995）。该治疗是基于二战后个体对其心理社会生活事件产生重大影响的资料创建的。Klerman 及其同事注意到，在这些个体中，抑郁症的发展与复杂的丧亲之痛、角色冲突、角色转变和人际缺陷之间存在显著关系（Weissman，1995）。IPT 背后的理念是，抑郁发作会损害人际功能，这使得管理压力性生活事件变得困难。IPT 的基本机制是建立有效的策略来管理人际问题，从而改善抑郁症状。

There are two main principles of IPT. First, depression is a common medical illness with a complex and multi-determined etiology. Since depression is a medical illness, it is also treatable and *not *the patient’s fault. Second, depression is connected to a current or recent life event. The goal of IPT is to identify the interpersonal problem that is related to the depressive symptoms and solve this crisis so the patient can improve their life situation while relieving depressive symptoms.
IPT 有两个主要原则。首先，抑郁症是一种常见的医学疾病，其病因复杂且多因素决定。由于抑郁症是一种医学疾病，它也是可以治疗的，并不是患者的错。其次，抑郁症与当前或最近的生活事件有关。IPT 的目标是识别与抑郁症状相关的人际问题，并解决这一危机，以便患者在缓解抑郁症状的同时改善他们的生活状况。

**     4.6.1.8. Multimodal treatment. **While both pharmacological and psychological treatment alone is very effective in treating depression, a combination of the two treatments may offer additional benefits, particularly in the maintenance of wellness. Additionally, multimodal treatment options may be helpful for individuals who have not achieved wellness in a single modality.
4.6.1.8. 多模式治疗。虽然单独的药物治疗和心理治疗在治疗抑郁症方面非常有效，但两种治疗的结合可能带来额外的益处，尤其是在维护健康方面。此外，对于在单一模式中未能实现健康的人来说，多模式治疗选项可能有所帮助。

Multimodal treatments can be offered in three different ways: concurrently, sequentially, or within a stepped manner (McGorry et al., 2010). With a stepped manner treatment, pharmacological therapy is often used initially to treat depressive symptoms. Once the patient reports some relief in symptoms, the psychosocial treatment is added to address the remaining symptoms. While all three methods are effective in managing depressive symptoms, matching patients to their treatment preferences may produce better outcomes than clinician-driven treatment decisions.
多模式治疗可以以三种不同的方式进行：同时、依次或分步进行（McGorry 等人，2010）。在分步进行的治疗中，通常最初使用药物治疗来治疗抑郁症状。一旦患者报告症状有所缓解，就会添加心理社会治疗来处理剩余的症状。虽然这三种方法在管理抑郁症状方面都有效，但将患者与其治疗偏好相匹配可能比临床医生驱动的治疗决策产生更好的结果。

4.6.2. Bipolar Disorder 4.6.2. 双相情感障碍

**     4.6.2.1. Psychopharmacology. **Unlike treatment for MDD, there is some controversy regarding effective treatment of bipolar disorder. One suggestion is to treat bipolar disorder  aggressively with mood stabilizers such as Lithium or Depakote as these medications do not induce pharmacological mania/hypomania. These mood stabilizers are occasionally combined with antidepressants later in treatment *only *if absolutely necessary (Ghaemi, Hsu, Soldani & Goodwin, 2003). Research has shown that mood stabilizers are less potent in treating depressive symptoms, and therefore, the combination approach is believed to help manage both the manic and depressive episodes (Nivoli et al., 2011).
4.6.2.1. 精神药理学。与 MDD 的治疗不同，关于双相情感障碍的有效治疗方法存在一些争议。一种建议是积极使用情绪稳定剂如锂或德巴酮来治疗双相情感障碍，因为这些药物不会引起药理性躁狂/轻躁狂。这些情绪稳定剂在治疗后期偶尔会与抗抑郁药联合使用，只有在绝对必要时（Ghaemi，Hsu，Soldani 和 Goodwin，2003）。研究表明，情绪稳定剂在治疗抑郁症状方面效果较弱，因此，联合治疗方法被认为有助于管理躁狂和抑郁发作（Nivoli 等人，2011）。

The other treatment option is to forgo the mood stabilizer and treat symptoms with newer antidepressants early in treatment. Unfortunately, large scale research studies have not shown great support for this method (Gijsman, Geddes, Rendell, Nolen, & Goodwin, 2004; Moller, Grunze & Broich, 2006). Antidepressants often trigger a manic or hypomanic episode in bipolar patients. Because of this, the first-line treatment option for bipolar disorder  is mood stabilizers, particularly Lithium.
其他治疗方法是放弃情绪稳定剂，在治疗早期使用新的抗抑郁药来治疗症状。不幸的是，大规模的研究并没有为这种方法提供很大的支持（Gijsman，Geddes，Rendell，Nolen，& Goodwin，2004；Moller，Grunze & Broich，2006）。抗抑郁药常常会引发双相情感障碍患者的躁狂或轻躁狂发作。因此，双相情感障碍的首选治疗方法是情绪稳定剂，尤其是锂盐。

**     4.6.2.2. Psychological treatment. **Although psychopharmacology is the first and most widely used treatment for bipolar disorders, occasionally psychological interventions are also paired with medication as psychotherapy alone is not a sufficient treatment option. Majority of psychological interventions are aimed at medication adherence, as many bipolar patients stop taking their mood stabilizers when they “feel better” (Advokat et al., 2014). Social skills training and problem-solving skills are also helpful techniques to address in the therapeutic setting as individuals with bipolar disorder often struggle in this area.
4.6.2.2. 心理治疗。尽管精神药理学是治疗双相情感障碍的首选和最广泛使用的方法，但有时心理干预也会与药物治疗相结合，因为仅靠心理治疗本身不是一个足够的治疗选择。大多数心理干预旨在提高药物依从性，因为许多双相情感障碍患者在“感觉好转”时停止服用他们的情绪稳定剂（Advokat 等人，2014 年）。社交技能训练和解决问题的技巧也是治疗环境中需要考虑的有帮助的技术，因为双相情感障碍患者在这一点上往往很挣扎。

4.6.3. Outcome of Treatment 4.6.3. 治疗结果

**     4.6.3.1. Depressive treatment. **As we have discussed, major depressive disorder has a variety of treatment options, all found to be efficacious. However, research suggests that while psychopharmacological interventions are more effective in rapidly reducing symptoms, psychotherapy, or even a combined treatment approach, are more effective in establishing long-term relief of symptoms.
4.6.3.1. 抑郁症治疗。正如我们讨论过的，重度抑郁症有多种治疗方法，所有方法都被证明是有效的。然而，研究表明，虽然心理药理学干预在快速减轻症状方面更有效，但心理治疗，甚至联合治疗方法，在建立长期症状缓解方面更有效。

Rates of relapse for major depressive disorder are often associated with individuals whose onset was at a younger age (particularly adolescents), those who have already experienced multiple major depressive episodes, and those with more severe symptomology, especially those presenting with severe suicidal ideation and psychotic features (APA, 2022).
复发性重度抑郁症的比率通常与发病年龄较轻（尤其是青少年）、已经经历过多次重度抑郁发作以及症状较重的人群（特别是表现出严重自杀意念和精神病性特征的人群）有关（APA，2022）。

**     4.6.3.2. Bipolar treatment. **Lithium and other mood stabilizers are very effective in managing symptoms of patients with bipolar disorder. Unfortunately, it is the adherence to the medication regimen that is often the issue with these patients. Bipolar patients often desire the euphoric highs that are associated with manic and hypomanic episodes, leading them to forgo their medication. A combination of psychopharmacology and psychotherapy aimed at increasing the rate of adherence to medical treatment may be the most effective treatment option for bipolar I and II disorder.
4.6.3.2. 双相治疗。锂和其他情绪稳定剂在管理双相情感障碍患者的症状方面非常有效。不幸的是，这些患者的问题通常在于对药物方案的依从性。双相情感障碍患者往往渴望与躁狂和轻躁狂发作相关的欣快高潮，这导致他们放弃服药。针对提高医疗治疗依从率的心理药理学和心理咨询相结合可能是治疗双相 I 型和 II 型障碍的最有效方法。

Key Takeaways 关键要点

You should have learned the following in this section:
你应该在本节中学到了以下内容：

• Treatment of depressive disorders include psychopharmacological options such as anti-depressant mediations, SSRIs, tricyclic antidepressants, and MAOIs and/or psychotherapy options to include CBT, behavioral activation (BA), and interpersonal therapy (IPT). A combination of the two main approaches often works best, especially in relation to maintenance of wellness.
  抑郁症的治疗包括心理药理学选择，如抗抑郁药物、SSRIs、三环类抗抑郁药和 MAOIs，以及心理治疗选择，包括认知行为疗法（CBT）、行为激活（BA）和人际疗法（IPT）。两种主要方法的结合通常效果最佳，尤其是在维护健康方面。
• Treatment of bipolar disorder involves mood stabilizers such as Lithium and psychological interventions with the goal of medication adherence, as well as social skills training and problem-solving skills.
  治疗双相情感障碍包括使用锂等情绪稳定剂以及旨在提高药物依从性的心理干预，还包括社交技能培训和解决问题的能力。
• Regarding depression, psychopharmacological interventions are more effective in rapidly reducing symptoms, while psychotherapy, or even a combined treatment approach, is more effective in establishing long-term relief of symptoms.
  关于抑郁症，心理药理学干预在快速减轻症状方面更为有效，而心理治疗，甚至联合治疗方式，在建立长期症状缓解方面更为有效。
• A combination of psychopharmacology and psychotherapy aimed at increasing the rate of adherence to medical treatment may be the most effective treatment option for bipolar I and II disorder.
  心理药理学与心理治疗的结合，旨在提高医疗治疗的依从率，可能是治疗双相情感障碍 I 型和 II 型最有效的治疗选择。

Section 4.6 Review Questions
第 4.6 节复习题

1. Discuss the effectiveness of the different pharmacological treatments for mood disorders.
   讨论不同药物治疗情绪障碍的有效性。
2. What are the four phases of CBT? How do they address symptoms of mood disorder?
   认知行为疗法的四个阶段是什么？它们如何处理情绪障碍的症状？
3. What is IPT and what are its main treatment strategies?
   什么是 IPT 及其主要治疗策略？
4. What are the effective treatment options for bipolar disorder?
   双相情感障碍的有效治疗方法有哪些？

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Module Recap 模块总结

That concludes our discussion of mood disorders. You should now have a good understanding of the two major types of mood disorders – depressive and bipolar disorders. Be sure you are clear on what makes them different from one another in terms of their clinical presentation, epidemiology, comorbidity, and etiology. This will help you with understanding treatment options and their efficacy.
这结束了我们对情绪障碍的讨论。你现在应该对两种主要情绪障碍——抑郁症和双相情感障碍有很好的理解。确保你清楚它们在临床表现、流行病学、共病和病因学方面的不同之处。这将有助于你理解治疗选择及其疗效。

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3rd edition  第三版

Source: https://opentext.wsu.edu/abnormal-psych/chapter/module-4-mood-disorders/