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発達障害とうつの合併(1)

 学会もあと2日間になりました。今日はワークショップで英語のシャワーを浴び、私の頭の方はただいま情報過多のため、機能不全の状態です。(早い話が、あまりたくさんの事を一度に聞いたので、頭の情報処理能力がフリーズしてしまっているわけです)

 …とりあえず頭を休めるため?ホテルでTVをつけたら「となりのトトロ」をやっていたので、さっきまでずっと見ていました。

 先日「昇るより降りる生き方」を載せたところ、うつの急性期(一番症状が重いとき)にはちゃんと治療した方がいいのではないか、というご指摘をいただきました。もちろん、ご指摘のとおり、私の言語障害…でなくて、説明不足であったと思います。誤解のないように、少しこの件について、専門家と当事者の2つの視点から、付け加えておきたいことがあります。

 子供でも大人の場合でも、ADHDや自閉症スペクトラムなどの発達障害を抱えている人に、高い割合でうつの合併が見られます。大人の場合は、うつの方が全面に出て、その背後にある発達障害に気付いてもらえないことがすくなくありません。子供(学童期~思春期)では逆に、問題行動のほうが注目されやすく、うつの発見が遅れることが多いです。

 発達障害とうつが合併するときの対応の仕方は、うつが何故起こったかにより少し違ってきます。

 ごくまれですが、もともと脳内のホルモンのアンバランスがあって、うつを起こしているときがあり、その時は薬でバランスを整えるのが効果的だと言われています。

 しかし、発達障害を抱えていることで、日常生活特に人間関係で様々なストレスや問題が発生し、その中で何らかの出来事や体験が引き金となってうつになっている場合は、抗うつ薬で多少気分が落ち着いても、うつとなるきっかけになった体験の整理がつくか、問題の解決のめどがたつまでは、ゆううつな気分はなかなか改善しません。

 うつで薬の助けがどうしても必要なのは、1週間以上眠れない時と、食欲がなく急に体重が減ってしまった時です。眠ることと食べること、この2つが損なわれると、生命を維持するのが難しくなるので、うつでこの2つの症状が長く続くときには、薬を飲み、体力を必要以上に消耗しないように、休息を取ることが大切です。

 うつは、ひどくなるとやる気が全くなくなり、外出も起きて何かをやる気力もなくなります。しかし、薬を使っても、気力を取り戻すには少し時間がかかります。また、自殺のリスクはむしろ治りがけの頃に高くなります。薬を飲み始めて段々と元気になってきたころが、一番私たちにとっては要注意の時期と考えているのです。

 発達障害がありうつが合併している場合、抗うつ剤は50%程度、気分をよくしてくれ、睡眠や食欲を改善してくれます。残りは、薬以外の援助により、本人の行きにくさを減らし、ストレスをうまくコントロールする方法を身につけることで、改善することはできますが、100%よくなる、ということは非常に難しいと思います。

 大人の発達障害の場合、何年も抗うつ薬を飲み続けていても、あまり改善が見られない、ということもあります。それでも、漫然と同じ薬が使われていたり、何種類もの抗うつ薬を処方されているのが現状です。おそらく、通常の精神科医で、発達障害とうつの合併の可能性を考えながら治療のできる人はそれほど多くないのではないかと思います。

 子供の場合も、まず発達障害を専門に診ることのできる医師の絶対数自体が少ないという大きな問題があります。抗うつ薬の中でSSRIは子供には使えませんので、それ以外のお薬が使われますが、やはり薬だけではなかなか改善は難しいと思います。

 いずれにしても、ある程度気分や症状が安定するまでは薬中心の治療、安定した後でカウンセリングなどの心理療法を取り入れるのが一番妥当な方法だと言われています。

 ある程度安定した時に、生きにくさへの対応や障害とうまくつきあうための方法を模索する中で、自分の抱える障害を受けれられるようになると、段々とうつ症状が改善されることがあります。

 「昇るより降りる生き方」という考えが生きるのがこの段階だと思います。


 

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