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克服抑郁症,从治愈失眠开始-给力心理
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克服抑郁症,从治愈失眠开始

克服抑郁症,从治愈失眠开始
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发表时间:2015-06-24 10:51:47 379 0 1

科学家们表示,抑郁症患者的失眠问题如果能够治愈,他们全面康复的机会可能会提高一倍。这项发现是基于一项通过谈话,而不是依赖药物来治疗失眠的疗法得出的。它也是睡眠和抑郁症领域里,一系列受到密切关注的研究中得出的第一项发现,这些研究结果将于明年发表。

这份新报告肯定了之前一项较小规模的前导性研究的结果,给科学家带来了信心:治疗失眠确能产生效果。如果相关数字不被推翻,这将是1987年百忧解(Prozac)问世以来,在治疗抑郁症方面取得的最大进展。

抑郁症是最常见的精神障碍,政府的统计数字显示,美国每年都有约1800万患者,其中一半以上伴有失眠症状。

了解这份新报告的专家说,其研究结果是可信的,如果得到了其他研究的支持,抑郁症治疗方式将会出现重大转变。

芝加哥拉什医学院(Rush Medical College)的精神病学教授,纳达·L·斯特兰博士(Nada L. Stotland)说,“对于这个领域来说,这绝对是一个好消息。”他没有参与这一系列最新的研究。

“从临床上说,这很合情理,”她接着说。“如果你有抑郁症,你常常会彻夜难眠,非常孤独,身处黑暗之中。每时每刻你都知道周围的世界正在沉睡,于是你所有的担心都会被放大。”

该研究是四项即将完成的睡眠和抑郁症研究之一。这些研究都是由美国国家心理健康研究院(National Institute of Mental Health)资助的,旨在评估一种治疗失眠的谈话疗法。该疗法价格低廉,相对简便,通常行之有效,但目前不是标准治疗程序的一部分。

这份新的报告来自多伦多怀雅逊大学(Ryerson University)的一个研究小组。他们发现,无论是服用抗抑郁药物,还是安慰剂药片患者,在每两周一个谈话疗程,八周四个疗程之后,87%不再失眠的患者抑郁症症状也消除了——与没有解决失眠问题的患者相比,比例高出了近一倍。这些数字与斯坦福大学(Stanford)先前进行对失眠治疗所做一项前导性研究的结果一致。

在接受采访时,该报告的第一作者科琳·E·卡尼(Colleen E. Carney)说:“我认为,从研究的进展来看,我们应该开始增加针对失眠的治疗措施,从而增强常规的抑郁症治疗的效果。”

卡尼承认,这项研究规模很小,仅有66名患者。但她表示,随着其他科学家团队发布研究结果,就能显现出更清晰的图片。这些研究正在斯坦福大学、杜克大学(Duke)和匹兹堡大学(University of Pittsburgh)进行,每项研究都有70名研究对象。本周六,行为和认知疗法协会(Association for Behavioral and Cognitive Therapies)将在纳什维尔召开一次会议,卡尼将在会上介绍自己的数据。

医生们长期以来都认为睡眠不好是抑郁症的一个症状,可以通过治疗解决,斯坦福大学精神病学和行为科学系教授雷切尔·曼伯(Rachel Manber)说,她在2008年对失眠治疗的初步尝试,为更大规模的研究提供了依据。“但我们现在知道,情况并非如此,”她说。“这种关系是双向的,失眠可能先于抑郁症。”

真正的失眠症,比大多数人偶尔出现的睡眠问题更加严重。患者必须要至少持续一个月长期出现睡眠问题,而且在工作、家庭或重要关系中造成了问题,才能诊断为失眠症。当前的几项研究显示,患上失眠之后,人们罹患抑郁症的风险会提高一倍——睡眠问题先于情绪障碍,而不是相反。

曼伯、卡尼和其他研究人员正在使用的疗法名为“针对失眠的认知行为疗法”,简称CBT-I。治疗师会指导人们建立规律的起床时间,并坚持下去;在醒着的时候不要待在床上;避免在床上进食、看书、看电视,诸如此类;取消白天的小睡。

这样做的目的是,你在床上的时间只用来睡觉,至少同样重要的是,“要抑制‘睡觉需要努力’的想法,不要认为它是一件需要你解决的事情,”卡尼说。“当人们觉得必须做些什么事好让自己入睡的时候,往往就会出问题的时候。”

这种疗法有别于一般所说的“睡眠卫生”:有规律地锻炼,但不要太靠近就寝时间,晚上避免喝咖啡,避免喝太多酒。对失眠症来说,这些健康生活习惯称不上有效的治疗手段。

斯坦福大学的曼伯在2008年对抑郁症患者进行CBT-I前导性研究时,也对对照组进行了睡眠卫生治疗。她发现,有60%的患者在接受了七个谈话疗程,并服用一种抗抑郁药后,抑郁症完全康复,而服用相同药物但接受睡眠卫生治疗的患者中,这个比例只有33%。

杜克大学负责CBT-I研究的安德鲁·克里斯托(Andrew Krystal)说,睡眠是“精神病学中尚未开发的广阔前沿”。

“人体有复杂的昼夜节律周期,在精神病学领域,我们大多无视了这些周期,”他说。“之前我们的治疗是怎么方便怎么做。我们治疗白天出现的问题,极少去了解晚上发生的事情。”

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