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所有人一但生病，包括憂鬱症患者，最終目標都是「康復」！然而，憂鬱症治療從來不是一個「單向」的溝通，就像我們平常生病去看醫師，雖然醫師問診後會開藥，但也會提醒我們在生病期間要多休息、少吃冰、吃辣等；相同的情況，若是因為情緒心理健康等問題求診身心科、精神科，醫師同樣會建議患者：多做些讓自己開心的事情、斟酌減少工作量等。

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憂鬱時更要自助

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說到這裡，有些人可能會說：「哪有那麼容易？」、「做得到的話我早就做了！何必來看醫生？」。但這貌似司空見慣的憂鬱症復原小撇步，其實是希望患者負擔部分「讓自己康復的責任」，也就是你能「自助」的部分，怎麼說呢？

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因為，患者在不住院治療的情境下，醫師即使開藥，也不能保證患者一日三餐(甚至睡前)都按時服用藥物，吃藥的選擇權完全取決於患者；即使安排心理治療，心理師也不能肯定患者每次的療程都能到場，接受心理治療服務的選擇權亦取決於患者。由此可知，無論我們生病與否，個人對於生活的「掌控程度」可是遠比我們想像中來得多。且讓我再來說一個我所遇到的求診個案的故事給你們聽。

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家穎升大學之後，好不容易離開衝突不斷的家庭，相對地，他也需要開始獨自承擔自己在外地求學的生活開銷。因此，她平日除了上課外，還需承接數份打工，緊湊的生活安排，讓他幾乎沒有時間在下課後與班上朋友閒聊幾句，課堂即使分組報告，家穎通常也是獨自一人；職場上，不化妝的家穎經常被同事嘲諷，但礙於需要維持工作，家穎對同事的耳語也只能忍氣吞聲。

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結果，一學期不到的時間，不堪長期負荷的家穎，不僅情緒上越來越顯得低沉，還經常哭泣，並開始出現缺課、手抖、難以專注在工作上的情形，作息也變得紊亂，晚上睡覺時常被惡夢驚醒，「我怎麼還在這裡？」是每天早上睜開眼她腦海中的第一個想法，平常休閒時一直玩的手遊，也不再讓家穎感覺到有意思，獨處時冒出來的念頭：「活著也只是拖累家人」、「自己一無是處」…讓她心情越來越糟，出現的症狀也越來越多，開始懷疑自己得了憂鬱症。因此，家穎在情況變得更嚴重前，求助社區的精神科門診，他意識到了這個問題，同時希望讓自己恢復原本的狀態。

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想讓生活離開憂鬱，現階段的我可以怎麼做？

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面對想積極解決問題的患者，他們通常不會問「我是怎麼了？」，他們的目標相對明確，都希望自己能夠離開現在的狀態，因此「我該怎麼辦？」反而是現階段他們想知道的。因此，我將以臨床經驗，介紹一些簡單的方法，當你出現憂鬱症前兆或是情緒問題時，「任何人」都能在生活中可以透過這些方向，至少幫助自己暫時離開憂鬱低谷：

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現在就做些什麼吧!

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一個人陷入憂鬱的迴圈中，絕非只因為單一原因，除了慢慢解開這些結，上述這些都是你能夠做到的幾個方向，不妨從上述自己就能做到的幾個方法開始思考、練習，從現在就選擇一步踏出去吧！雖然就醫、心理諮商，某部分來說可以幫助患者緩解低落、憂鬱的症狀、協助患者正視情緒，但康復過程中，最大的主宰者仍是患者本身，那麼，就從自己開始一步步找回快樂吧！

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Reference

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Drake, R. E., & Whitley, R. (2014). Recovery and severe mental illness: description and analysis. The Canadian Journal of Psychiatry, 59(5), 236-242.

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Idusohan‐Moizer, H., Sawicka, A., Dendle, J., & Albany, M. (2015). Mindfulness‐based cognitive therapy for adults with intellectual disabilities: an evaluation of the effectiveness of mindfulness in reducing symptoms of depression and anxiety. Journal of Intellectual Disability Research, 59(2), 93-104.

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Iwasaki, Y., Coyle, C., Shank, J., Messina, E., Porter, H., Salzer, M., … & Ryan, A. (2014). Role of leisure in recovery from mental illness. American Journal of Psychiatric Rehabilitation, 17(2), 147-165.

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Ly, K. H., Janni, E., Wrede, R., Sedem, M., Donker, T., Carlbring, P., & Andersson, G. (2015). Experiences of a guided smartphone-based behavioral activation therapy for depression: a qualitative study. Internet Interventions, 2(1), 60-68.

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Pirbaglou, M., Cribbie, R., Irvine, J., Radhu, N., Vora, K., & Ritvo, P. (2013). Perfectionism, anxiety, and depressive distress: evidence for the mediating role of negative automatic thoughts and anxiety sensitivity. Journal of American College Health, 61(8), 477-483.

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Stanton, R., & Happell, B. (2014). Exercise for mental illness: A systematic review of inpatient studies. International Journal of Mental Health Nursing, 23(3), 232-242.

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作者：臨床心理師 董仲薇

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