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INTRODUCTION
简介
Humans respond to stress, loss, and adversity in a variety of ways.
人类对压力、损失和逆境的反应方式多种多样。
Many of us has experienced low mood and spirit when faced with difficulty or loss.
我们中的许多人在面对困难或失落时都经历过情绪低落或精神不振。
We may lose our sleep, appetite, and may not feel like socializing and meeting people.
我们可能会失眠、食欲不振，不想参加社交活动，不愿与人交往。
This change in behavior is a normal humane reaction to a stressful situation.
这种行为上的改变是对压力环境的正常人类反应。
As such a state of transient and goes away in a couple of days.
这是一种短暂的状态，几天后就会消失。
But if symptoms such as low mood, hopelessness, changes in appetite, sleep patterns, loss of interests in hobbies, anhedonia, feelings of guilt persist for more than 2 weeks,
但如果情绪低落、绝望、食欲变化、睡眠模式改变、对爱好失去兴趣、快感缺乏、内疚感等症状持续2周以上，
and negatively affect our social, domestic and occupational functioning, then it is no more a normal reaction, but a pathological one and may merit a concern for clinical depression.
并对我们的社会，家庭和职业功能产生负面影响，那么它就不再是一种正常反应，而是一种病理反应，可能会引起临床抑郁症的关注。
Major depression is extremely common among various societies.
重度抑郁在不同的社会中非常普遍。
And despite being a treatable illness, goes largely undiagnosed due to its insidious nature and the stigma attached to its diagnosis and seeking treatment.
尽管是一种可以治疗的疾病，但由于其隐匿性以及诊断和寻求治疗所带来的耻辱，大部分不会被诊断出来。
Case for Urgency
情况的紧迫性
According to the International Global Burden of Disease study, Major Depressive Disorder (MDD), is the 3rd leading cause of the years lived with disability, YLDs, which can be described as years lived in less than ideal health, in Pakistan and globally.
根据《国际全球疾病负担研究》，在巴基斯坦和全球范围内，重度抑郁症是导致残疾年数(YLDs)的第三大原因，YLDs指的是健康状况不理想的年数。
The social economic burden and the mental illness in Pakistan is tremendous.
巴基斯坦的社会经济负担和精神疾病压力是巨大的。
Of which MDD contribute significantly and was estimated to be approximately $4,264 million in the year 2006 according to recent estimates carried out in Pakistan.
其中，重度抑郁负担巨大，根据巴基斯坦最近进行的估计，2006年估计约为42.64亿美元。
Severe form of clinical depression often translate into suicides.
严重的临床抑郁症往往会导致自杀。
According to a report published in 2014, every 40 second, a person commit suicide.
根据2014年发布的一份报告，每40秒就有一人自杀。
For every person who commit suicide, there are 20 people who attempt ending their lives.
每有一个人自杀背后就有20个人企图结束自己的生命。
Mental illness at large and major depression is particular pose for public health challenge which cause public health policy institutes and government to take appropriate steps.
一般精神疾病和重性抑郁症是公共卫生面临的特别挑战，这需要公共卫生政策机构和政府采取适当的措施。
Diagnosis
诊断
Signs and Symptoms
体征和症状
Major Depressive Disorder is diagnosed on the basis of a set of 9 symptoms formulated in the diagnostics and statistical manual, DSM-V and their context.
重度抑郁症的诊断基于诊断和统计手册、DSM-V及其背景中制定的一套9个症状。
Five or more of the 9 symptoms including at least 1 of depressed mood and loss of interest or pleasure, in the same 2-week period; and each of the symptoms represent a change from previous functioning.
在相同的两周时间里，9种症状中有5种或更多，包括至少1种情绪低落和失去兴趣或愉悦；每种症状都代表着与以前功能的变化。
These symptoms include:
这些症状包括：
- Depressed mood (subjective or observed)
抑郁情绪(主观或观察到的)
- Irritability is more common in teenagers
易怒在青少年中更为常见
- Loss of interest of pleasure
丧失享乐的兴趣
- Change in weight or appetite
体重或食欲的变化
- Insomnia or hypersomnia
失眠或嗜睡
- Psychomotor agitation (observed)
：精神运动风潮（观察）
- Loss of energy or fatigue
没精神或感到疲惫
- Feelings of worthlessness or guilt
无价值或内疚感
- Impaired concentration or indecisiveness
注意力不集中或犹豫不决
- Thoughts of death or suicidal ideation and attempt
有死亡或自杀的想法和企图
If there is depression resulting in significant clinical impairment but not meeting the above criteria for major depression, then it is termed as Adjustment Disorder with Depressed Mood.
如果出现抑郁症，导致临床功能严重受损，但不符合上述重度抑郁症的标准，则称为抑郁情绪适应障碍。
This occurs within 3 months following a stressful life event and does not persist for 6 months after the termination of the stressor.
这发生在压力生活事件后的3个月内，在压力终止后的6个月内不会持续。
If there are depressive symptoms occuring within 2 months of the death of a loved one, then it is considered as normal grief.
如果亲人去世后2个月内出现抑郁症状，则被视为正常的悲伤。
If symptoms persist beyond 2 months, then a diagnosis of major depression needs to be explored.
如果症状持续超过2个月，则需要诊断为重度抑郁症。
Severity Major Depression can be mild, moderate or severe.
抑郁症严重程度可分为轻度、中度和重度。
In mild depression despite the symptoms, functioning would still be preserved.
在轻度抑郁症中，尽管有这些症状，功能仍然正常。
In moderate depressive illness, the different facets of functioning would be markedly impaired.
在中度抑郁症中，不同方面的功能会明显受损。
Whereas in severe major depression disorder, one may experience and act on suicidal thoughts.
而在重度抑郁症患者中，一个人可能会有自杀的想法并采取行动。
In very severe forms, one may even experience hallucinations and delusions accompanying the mood symptoms which is termed as Major Depression with Psychotic features.
在非常严重的情况下，一个人甚至可能经历幻觉和妄想伴随着情绪症状，这被称为具有精神病特征的重度抑郁症。
