第25章生活方式医学防治抑郁症
Jerome Sarris and
Adrienne O’Neil
Background背景
The number of people affected by depression has increasedin recent decades. While this is partially due to diagnosticpractices, urbanization and factors associated with the modern Western environment are undoubtedly contributing tosuch a trend. For example, in Western society, individualsare becoming increasingly sedentary and consuming poorerquality diets when compared with previous generations. Inconjunction with disruptions to the sleep/wake cycle, substance misuse, and psychosocial stressors including timepressures and social isolation, this type of lifestyle maycompromise mental health. Nevertheless, the association between “Westernization” and mental health is complex andnot linear. For example, stress, fatigue, physical inactivity,and sleep deficiency can lead to obesity, and then indirectlyexacerbate sedentary behaviour, all culminating in a depressed state. Obesogenic environments and the interactionof factors modulating deleterious effects on mental healthwarrant the use of a “Lifestyle Medicine” approach for theprevention, promotion, and management of depression. Sucha model offers a potentially safe and cost-effective adjunctive treatment option for management of the condition. Todate, however, there remains a dearth of evidence around theutility of Lifestyle Medicine in psychiatry. In this chapter, wewill consider the role of lifestyle and environmental factorsas forming the basis for practical interventions for the management of depression.
在最近的几十年中受抑郁影响的人数持续增加。这种情况部分是由于诊断实践的进步、城市化的发展，同时与现代西方化环境有关的因素也无疑助长了这种趋势。例如，在西方社会，与前几代人相比，人们变得越来越久坐不动，饮食质量也越来越差，伴随着睡眠/清醒循环周期的混乱、物质滥用和包括时间压力和社会隔离的心理社会压力，这种生活方式可能会危及心理健康。然而，“西方化”和心理健康之间的联系是复杂的，而不是线性的。例如，压力、疲劳、缺乏体力活动和睡眠不足会导致肥胖，然后间接加重久坐不动的行为，最终导致抑郁状态。引起肥胖的环境和有害心理健康的相互作用因素的整合与调节，使得通过应用“生活方式医学”的途径来预防、推动、管理抑郁症越来越有必要。这种模式为针对病情管理的辅助治疗提供了一个潜在的安全而性价比高的选项。然而，迄今为止，仍然缺乏生活方式医学在精神病学方面效用的证据。在这一章中，我们将思考生活方式和环境因素的作用，以作为抑郁症治疗的实际干预措施的基础。
Lifestyle Medicine in the Context of MentalHealth
心理健康背景下的生活方式医学
“Lifestyle Medicine”, particularly in the context of mentalhealth, is a relatively new field. While the idea has been recognised by practitioners for centuries as a means by whichto improve health outcomes, little attention has been givento its application for mental health and in particular depression. This is despite its high disability burden and it beingarguably one of the prevalent noncommunicable diseases(NCDs), with similar pathways to that of the more commonly recognised “lifestyle” disorders including cardiovascular disease and type-2 diabetes (T2D). In addition to someevidence that patients with mild depression respond well tolifestyle strategies (though improvements in depression maynot directly improve adherence to healthy diet [1]), there isindeed a bio-behavioural framework that helps explain theway in which the modern lifestyle impacts mental health thatextends beyond the putative assumption that the presence ofdepression precipitates an unhealthy diet via low motivationor lack of pleasure. Obesity, poor diet, poor/decreased sleep,exposure to chemicals and pollutants, and high stress levelshave all been shown to increase low-grade systemic inflam-mation and oxidative stress—the same pathways at play inthe pathogenesis of other NCDs—as well as disruptions tothe hypothalamic–pituitary–adrenal axis and cortisol secretion that characterise depression [2]. Specifically, increasedlevels of pro-inflammatory cytokines, interferon gamma, neopterin, reactive oxygen and nitrogen species, and resultantdamage by oxidative and nitrosative stress, in combinationwith lowered levels of antioxidants, may potentially damagemitochondria and mitochondrial DNA [2]. These events culminate in neurodegeneration and reduced neurogenesis [2]and provide context to nutritional mechanisms in the prevention and management of depression.
“生活方式医学”，特别是在心理健康方面还是一个比较新的领域。虽然数百年来这个想法已经被从业者作为一个手段来改善健康状况，但在心理健康领域，尤其是对抑郁症的关注和应用非常少。尽管它有很高的致残负担，也可以说是一个普遍的非传染性疾病（慢性病），与普遍认可的“生活方式”疾病包括心血管疾病和2型糖尿病（T2DM）有着类似的途径。此外，一些证据表明，轻度抑郁的患者对生活方式策略反馈良好（虽然抑郁症的改善可能不会直接提高健康饮食的坚持），确实有一个生物行为机制有助于解释现代生活方式对心理健康的影响，这超越了一个公认的假设，即出现抑郁形成的不健康的饮食是由于动机不足或缺乏快乐。肥胖、不良的饮食习惯、睡眠差或减少、接触化学物和污染物、高应力水平都被证明能增加低度系统性炎症和氧化应激---在其它非传染性疾病的发病机制中作用于相同的途径---以及干扰下丘脑-垂体-肾上腺轴和皮质醇分泌，这是抑郁症的特征。具体而言，增加的促炎性细胞因子、干扰素γ、新蝶呤、活性氧和氮类物和因氧化和亚硝化应激造成的损害，与低水平的抗氧化剂联合，有可能会损伤线粒体和线粒体DNA。这些事件最终导致神经退行性变和神经发生减少，并为预防和治疗抑郁症提供营养机制的环境。
