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「心理師，他只是想太多，才不是什麼憂鬱症！」

「心理師，醫生說他是憂鬱症？怎麼可能！他只是最近壓力比較大而已。」

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會談的診間，常聽到「陪同患者就醫的家屬」這樣告訴我，彷彿一個人若被判定為憂鬱症，就等於間接為他的人生宣判死刑，於是想極力地去迴避、否認家人是憂鬱症患者。臨床上，經常遇到家屬比患者本人更難接受罹患憂鬱症的事實，於此同時，也阻礙患者尋求進一步的幫助。

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假如我們將憂鬱症視為希望克服的敵人，那麼面對這場戰爭，若想要凱旋而歸，探聽敵軍軍情、擬定作戰策略、對行軍路線中的一草一木瞭若指掌，便是致勝首要的關鍵。

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我的至親好友得了憂鬱症，我能做些什麼？

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倘若面臨需要長期抗戰的憂鬱症，不僅是患者本身，他「周遭的家人、朋友」，若能對疾病有正確的認知與了解，就是康復過程中的一大利器，也是最為關鍵的一步。如果讓更多人了解憂鬱症，那麼就不會有許多人不敢說，默默承受這樣的痛苦。

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透過理解憂鬱症的症狀表現，不僅能夠協助患者「客觀」觀察自己的狀態，亦有助減緩患者不安的心情，此外，也能夠降低疾病污名化對就醫意願的影響。簡單的一步就有大大的幫助！

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藥不藥？雙向溝通來解答！

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如果開始理解憂鬱症，也許不難發現，憂鬱症就像是心靈上的感冒。我們感冒時，會去看醫生，醫生問診後，會在診間進行一系列的生理檢查，然後開立感冒藥、退燒藥、抗生素…等。

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而憂鬱症通常是求診精神科或是身心科診所，醫師同樣也會進行問診，了解你的情緒與精神狀態，並從症狀回溯患者的過去病史、生活壓力情境與情緒因應策略，最後，再視個人狀況給予藥物，或是安排心理測驗讓心理師進一步了解患者的情況。聽起來幾乎一樣對吧？

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提到精神科藥物，最常聽到的疑問是：「我該吃藥嗎？」、「精神科的藥不都有副作用？」，面對服藥問題，患者本人經常是焦慮的，此時，不妨先深呼吸讓自己保持冷靜，別讓這些擔心，妨礙自己仔細陳述身心症狀的機會。

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最後，我鼓勵患者可以將您對藥物的擔心，主動提出來與醫師討論，例如有些患者白天仍維持工作、上學，可能會擔心服用藥物是否會讓自己出現：嗜睡、沒有精神、影響記憶…等副作用；有些患者可能懷抱錯誤的迷思，會認為服用精神科的藥會讓自己成癮而一輩子難以戒掉；有些患者也可能質疑藥物的效果如何。

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只要任何會讓您對服用藥物感到擔憂的疑問，不妨在診間時立即與醫師溝通或討論，當理解藥物本身的特性與憂鬱症之間的關聯性，才比較不會對藥物治療產生排斥。

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我不想吃藥，可以只做心理治療嗎？

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藥物雖然短期內可以讓症狀得到緩解，但憂鬱症的形成，通常是一個漫長的歷程，所以也需要相當的時間，慢慢將過去所累積的負向情緒排解，進而轉化成為個人的內在力量，因此，除憂鬱症藥物外，通常也會建議患者搭配心理治療，邁向康復之路。

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心理治療可以是：個人、家族、伴侶…等，不同的治療形式，雖然心理治療的學派各異，但不論採用哪種形式或學派，我傾向在尋求問題解決前，先引導患者對「自身情緒」與「應對情緒的方式」採行以下做法：

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1. 自我覺察：邀請患者觀察自己，處在某種情困擾的情緒狀態下，生理上會出現什麼樣的變化，是：心跳加速、手汗、身體緊繃等那些反應。

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2. 辨識情緒：替所感受到的情緒命名，減少因為「模糊性」所帶來的不安。

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3. 接納情緒：不同的情緒存在都有其功能，與其用盡一切力量嘗試將負向情緒從身上趕走，不如接納該情緒是一個不斷變動的過程，狀態也許時好時壞，但這樣的起伏正是我們生命之所以豐富的一部分。

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4. 轉化情緒：透過訴說的過程，患者的情緒不但能有宣洩的出口，同時也會協助患者擴展生活中因應負向情緒的策略，像是與患者討論，下次這樣的情緒可以怎麼樣用社會可以接受的方式將情緒表達出來。

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因此，在心理治療的過程中，很常會觸及患者過去較少與人談論的情緒、經驗，而揭露這些自認為（或刻意）遺忘的負向經驗，通常是令人不愉快的。像是有患者經常認為自己不被人所需要，而在治療過程中，我引導其回溯過去家庭的互動模式時，每當患者提及自己的需求多不被家人所重視時，不時流淚、拳頭緊握、緊抓著手中物品…等，訴說這些過去，可能讓部分患者打退堂鼓，並從此認定心理治療只會使自己的狀況更差，畢竟說出這些不愉快的經驗，往往在當下（甚至幾天內）受到負面情緒影響。

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但其實不然，這樣的回溯過程是有意義的！雖然過去的負面經驗可能因為時間被沖淡，但不代表它真的「消失」在我們的生命裡，若過去那些曾經「卡住」的情緒，沒有透過足夠的時間、適當的方式咀嚼、消化，或是從中獲得面對情緒的處理方式，若未來一再碰到相似的事件，這些沒有好好被處理的情緒，反而會像滾雪球般越滾越大，越是讓人感覺心情沉重。

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如前述提及不被人所需要的例子，若不願意面對自身的脆弱，當然也不太會向周遭他人傳遞：「自己需要被理解」的訊息，而可能讓患者一再陷入妄下定論的思維迴圈，無法跳脫相同的關係和處理方式。

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因此，面對憂鬱症，藥物治療雖然有其必要性，但有時並不是您唯一的選擇，這也是心理諮商、放鬆、正念冥想等方式存在的原因。但在做出選擇前，不妨與您的醫師好好溝通什麼樣的方式較為適合自己。

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Reference

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鄭逸如、何雪綾、陳秀蓉(2017)。醫病溝通之鑰：醫療人員同理心五大心法。臺北市：五南。

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Blackledge, J. T., & Hayes, S. C. (2001). Emotion regulation in acceptance and commitment therapy. Journal of clinical psychology, 57(2), 243-255.

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Liverant, G. I., Brown, T. A., Barlow, D. H., & Roemer, L. (2008). Emotion regulation in unipolar depression: The effects of acceptance and suppression of subjective emotional experience on the intensity and duration of sadness and negative affect. Behaviour research and therapy, 46(11), 1201-1209.

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Schleim, S. (2018). Subjective experience, heterophenomenology, or neuroimaging? A perspective on the meaning and application of mental disorder terms, in particular Major Depressive Disorder. Frontiers in psychology, 9.

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Whelton, W. J. (2004). Emotional processes in psychotherapy: Evidence across therapeutic modalities. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 11(1), 58-71.

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作者：臨床心理師 董仲薇

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