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過去臨床上常將憤怒的情緒比喻為火山噴發，至於「憂鬱」這樣的情緒，你會聯想到什麼呢？我傾向將它比喻為一種情緒地震，與地震相似，憂鬱也有餘震、主震之分，因此造成了不同程度的憂鬱症狀，當然也就有不同的應變措施，在之後文章會陸續談到關於憂鬱症診斷、治療…等議題。

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地震的發生來自深層地殼與板塊的錯動，輕則面臨短暫的震盪，重則樓房倒塌。同樣的，情緒的地震造成的短期損失，可能讓你顯得鬱鬱寡歡、沒有動機；長期下來，則很可能讓人的生產力下降，若置之不理，小則造成個人生活、家庭的困擾；鉅觀來看，也可能形成社會有形、無形的負擔。

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因此，正確的認識「憂鬱」情緒是什麼；憂鬱和憂鬱「症」之間的關係，對每個人都是非常重要的。

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情緒餘震與釋放負面情緒的能量

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我們每個人都曾經有心情不好的時候，舉凡失戀、工作壓力或是待業階段、退休、人際關係失落、股市開低走低、孕期產後…等。有時甚至沒有任何理由，我們就是感覺不對勁，此時內心深處那股低潮的情緒緩緩襲來，總感覺開心不起來、短時間內也什麼事情都不想做，食慾、睡眠也受到情緒的震盪而驟變。

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這時，很多人會開始懷疑自己有憂鬱症，或者，如果真的是憂鬱症發作該怎麼辦？在大多數的情況下，如果你知道如何讓情緒有正常的能量釋放，或者有個出口得以宣洩，那麼你很幸運，餘震不會太久，造成的破壞力也不會太大。也就是說，透過這樣反覆且適時的能量釋放，那麼就不會驟然的出現一個毀滅性的強震。

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那麼，平時我們該如何處理情緒，讓它能夠正常釋放呢？常見的方法有運動、冥想、聽音樂、和朋友傾訴、寫日記、創作…等放鬆的方法。但這裡需要提醒大家，每個人都有適合自己的方式，對於他人有用的方法，並不見得會適合自己。有時，甚至需要專業的協助，才會知道較適合自己釋放情緒的方法。

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情緒強震

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倘若一個人久未歷經情緒餘震，或對於持續高頻的震盪也視而不見，不允許情緒經驗正常的能量釋放，那麼，日積月累的低潮往往會在一瞬間引發急劇的情緒強震，伴隨的負面思考海嘯：「我做什麼都沒有用了」、「我好糟糕」、「未來沒有希望」、「我造成別人的困擾了」…等這些負面想法，快速地淹沒自己。

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這樣的後果往往遍及了整個生活，連想上岸喘一口氣都有困難的情況下，前述常用的方法就不再有效，他要如何能夠外出？他要如何跟人際產生交流？更遑論要如何上班、維持生產力？非常幸運的情況下，環境允許你有機會休息、喘一口氣，能暫時離開負向思考的洪流，察覺到自己正處在負向思考匯聚的狀況。

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否則這個人最終只能向下沉沒，等待的結果也往往是我們所不樂見的——憂鬱症。

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臨床憂鬱症該如何界定呢？

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地震來臨前普遍具有幾個徵兆，特定的動物往往會有反常的行為出現、家中電器的電磁亦可能出現異常…那麼，你或是你周遭的重要他人，是否有足夠的敏感度偵測到情緒地震呢？而目前臨床醫學上，又是怎麼定義「憂鬱症」，這樣一個對生活具破壞力的情緒強震呢？

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根據精神疾病診斷與統計手冊第五版(DSM-5)，其對於憂鬱症中的鬱症(Major Depressive Disorder)定義為：患者至少持續2週的時間，每天感覺以下五項(或更多)症狀同時出現：

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A.以下五項(或更多)症狀在兩週中同時出現，造成先前功能改變，至少包含以下症狀之一：(1) 憂鬱情緒或(2)失去興趣或愉悅感。

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1.幾乎整天且每天心情憂鬱，可由主觀報告(如感到悲傷、空虛或無助)或由他人觀察(如看起來在哭)得知。

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2. 幾乎整天且每天明顯對所有活動降低興趣或愉悅感(主觀說明或他人觀察)。

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3.體重明顯減輕或增加(一個月內體重變化超過5%)，或幾乎每天食慾降低或增加。

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4. 幾乎每天都失眠或嗜睡。

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5.幾乎每天都精神動作激動或遲緩(別人觀察到，不只是主觀感受不安或緩慢)。

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6. 幾乎每天倦怠或無精打采。

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7. 幾乎每天自我感到無價值感，或者有過度或不恰當的罪惡感(可能達妄想的程度；不僅是對生病自責或內責)

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8. 幾乎每天思考能力和專注力降低，或是猶豫不決(主觀報告或他人觀察)。

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9.反覆想到死亡(不只是害怕死亡)，反覆有自殺意念而無具體計畫，或有自殺舉動，或是有具體的自計畫。

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B. 這些症狀引起臨床上顯著苦惱或社交、職業或其他重要領域功能減損。

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C.這些症狀無法歸因於某一物質或另一身體病況的生理效應。

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D.鬱症發作無法以情感性思覺失調症、思覺失調症、類思覺失調症、妄想症或其他特定或非特定思覺失調症和其他精神病症做更好的解釋。

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E. 從未有過躁症或輕躁症發作。

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憂鬱症得來不易

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但這麼多症狀，必須包含的有：「憂鬱情緒」或是「失去興趣或愉悅感」兩項，使患者造成與原先功能出現差異。且這些症狀引起臨床上顯著苦惱或社交、職業或其他重要領域功能減損。臨床上大致要符合上述（其他更細的區分則會由專業的醫生或心理師），才會判斷你「可能」患有憂鬱症。

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為什麼說「可能」呢？因為更重要的是，這些症狀是否已經對患者的生活的各項適應功能「造成干擾」，例如症狀已影響至無法正常上班、上課、維繫關係，甚至變得難以生活自理，我們才會認為該人可能具有憂鬱症。

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而若是出現這樣低落、「憂鬱」的情緒正常嗎？這就好比說台灣是個海島國家，餘震是再自然不過的事情；對應到我們每一個人身上，情緒亦然，是我們生活的一部分，高低起伏不同情緒的出現，都是每個人都有的正常反應。確實，有些人生階段的轉換過程經常會經歷特別強烈的低落情緒，臨床上常見的如：產後憂鬱症、青少年憂鬱症…等。而情緒反應也會因應不同的自身條件，有不同的反應，同樣一個事件，可能造成每個人不同的情緒強度。

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猶如地震的級數仰賴國家中央氣象局的客觀偵測與辨別，雖然我們可以主觀觀察自身情緒震盪的幅度與強度，但憂鬱症這般等級的情緒強震則還是需要經由專業的身心科醫生進行評估與診斷，切莫驟下定論，將目前遭遇的不如意，全然歸咎於疾病。

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Reference

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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

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Folkman, S., & Moskowitz, J. T. (2000). Stress, positive emotion, and coping. Current directions in psychological science, 9(4), 115-118.

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Powell, E. (2007). Catharsis in psychology and beyond: A historic overview. The Primal Psychotherapy Page, 1.

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Rikitake, T. (1978). Biosystem behaviour as an earthquake precursor. Tectonophysics, 51(1-2), 1-20.

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Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: results from a randomized trial. International journal of stress management, 12(2), 164.

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作者：臨床心理師 董仲薇

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