Gourion D
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Encephale. 2009 Dec;35 Suppl 7:S250-6. doi: 10.1016/S0013-7006(09)73480-3.
Major depression is a common, severe, chronic, and often life-threatening illness. There is a growing body of evidence that, far from being a disease with purely psychological manifestations, major depression is a systemic disease with deleterious effects on multiple organ systems. Stressful life events have a substantial causal association with depression, and there is now compelling evidence that even early life stress constitutes a major risk factor for the subsequent development of depression. This review will focus on the association between severity of depression and diachronic vulnerability across the life-span, in terms of events of life, stress, and hormonal modulation, with a special focus on depression in young adults, women during postpartum and in depression in ederly people. Given the high prevalence of depressive disorders, the significant burden and the severity of disease in adolescents and young adults experiencing their first episode, they represent a group at high risk of relapse, recurrence, comorbidity and suicide to whom early intervention and prevention efforts should be targeted. Females exhibit different stress sensitivities than males which might contribute to their increased vulnerability for depression and the disease exhibit a prevalence among women which is 2-3x higher than in men. The postpartum period is considered the time of greatest risk for women to develop major depression and postpartum depression affects approximately 15% of women. In old age, depression mainly affects those with chronic medical illness, severe disability or mental decline. Depression in elderly worsens the outcomes of many medical illness and increases mortality. Environmental factors, such as isolation, caregiving and bereavement, contribute to further increase susceptibility to depression or triggering depression in already vulnerable elderly people. Suitable treatment of depression in elderly reduces the symptoms, prevents suicidal ideation, improves cognitive and functional status in order to improve the recovery of a good quality of life, as well as the mortality risk.
重度抑郁症是一种常见、严重、慢性且往往危及生命的疾病。越来越多的证据表明，重度抑郁症远非一种仅有心理表现的疾病，而是一种对多个器官系统有有害影响的全身性疾病。生活中的应激事件与抑郁症有实质性的因果关联，现在有令人信服的证据表明，即使是早年的压力也是随后发生抑郁症的主要危险因素。本综述将重点关注抑郁症严重程度与一生中历时性易感性之间的关联，涉及生活事件、压力和激素调节，特别关注年轻成年人、产后女性和老年人的抑郁症。鉴于抑郁症的高患病率、青少年和年轻成年人首次发作时的重大负担和疾病严重程度，他们是复发、再发、共病和自杀的高风险群体，早期干预和预防措施应针对这一群体。女性表现出与男性不同的应激敏感性，这可能导致她们更容易患抑郁症，而且该疾病在女性中的患病率比男性高2至3倍。产后时期被认为是女性患重度抑郁症风险最高的时期，产后抑郁症影响约15%的女性。在老年，抑郁症主要影响患有慢性疾病、严重残疾或精神衰退的人。老年抑郁症会使许多疾病的预后恶化并增加死亡率。环境因素，如孤独、照料和丧亲之痛，会进一步增加易患抑郁症的老年人患抑郁症或引发抑郁症的易感性。对老年人的抑郁症进行适当治疗可减轻症状、预防自杀念头、改善认知和功能状态，以提高恢复良好生活质量的几率，并降低死亡风险。
