depression book (nepali language)

Disease with stress, headache and negative thinking: Depression

Laxmi is a 20 year female. She is studying on class 12. She failed on exam twice. Because of repeated failed on exam, her family member scold her that she is  not reading well. For last two weeks she appeared talking less, fearfulness, weeping negative thinking, guilty feeling,  headache and problem for sleep. Most of time she appear not fresh and she likes   to live alone, refuse to listen radio, TV and developed forgetfulness. Nothing happen but she immediately became tearful. She didn’t sleep  well for few weeks. She frequently expresses  “I am a worst person in the world”. She became helpless, hopeless and worthless. Sometimes she starts to say “better to die”.

She also has problem with tingle sensation all over the body, feel something on throat, problem for digestion. Sometimes she feels she has cancer, it may be difficult to cure. She was consulted to cardiologist, physician and ENT surgeon found that nothing wrong. Finally she was diagnosed as Depression (Major depressive disorder) and under the treatment by neuropsychiatries and getting better. Now this types of patient come frequently of initially difficulty to diagnosed and patients go to difficult place for the treatment however that get poor treatment because of lack of diagnosis early. In Nepal depression is commonest psychiatrist disorder more prevalent as residue of political conflict and family with foreign country job holder.

Major depressive disorder (MDD) is a condition characterized by a long-lasting depressed mood or marked loss of interest or pleasure  in all or nearly all activities. Children and adolescents with MDD may be irritable instead of sad. These symptoms, along with others described below, must be sufficiently severe to interfere significantly with the patient's daily functioning in order for a person to be diagnosed with MDD. It is commonest psychiatric disorder life time prevalence about 25%.. It  causes a lengthy period of gloom and hopelessness, and may rob the sufferer of the ability to take pleasure in activities or relationships that were previously enjoyable. In some cases, depressive episodes seem to be triggered by an obviously painful event, but MDD may also develop without a specific stressor. Sexual interest dwindles; many people with MDD become withdrawn and avoid any type of social activity. Even the ability to enjoy a good meal or a sound night's sleep is frequently lost; many depressed people report a chronic sense of malaise (general discomfort or unease).

Symptoms

Depression symptoms should be at least 2 weeks which  includes :

·         Feelings of sadness or unhappiness

·         Irritability or frustration, even over small matters

·         Loss of interest or pleasure in normal activities

·         Reduced sex drive

·         Insomnia or excessive sleeping

·         Changes in appetite — depression often causes decreased appetite and weight loss, but in some people it causes increased cravings for food and weight gain

·         Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still

·         Slowed thinking, speaking or body movements

·         Indecisiveness, distractibility and decreased concentration

·         Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort

·         Feelings of worthlessness or guilt, fixating on past failures or blaming yourself when things aren't going right

·         Trouble thinking, concentrating, making decisions and remembering things

·         Frequent thoughts of death, dying or suicide

·         Crying spells for no apparent reason

·         Unexplained physical problems, such as back pain or headaches

Depression affects each person in different ways, so depression symptoms vary from person to person. Inherited traits, age, gender and cultural background all play a role in how depression may affect anyone.

Depression symptoms in children and teens
Common symptoms of depression can be a little different in children and teens than they are in adults.

·         In younger children, symptoms of depression may include sadness, irritability, hopelessness and worry.

·         Symptoms in adolescents and teens may include anxiety, anger and avoidance of social interaction.

·         Changes in thinking and sleep are common signs of depression in adolescents and adults, but are not as common in younger children.

Depression symptoms in older adults
Depression is not a normal part of growing older, and most seniors feel satisfied with their lives. However, depression can and does occur in older adults. Unfortunately it often goes undiagnosed and untreated. Many adults with depression feel reluctant to seek help when they're feeling down.

·         In older adults, depression may go undiagnosed because symptoms — for example, fatigue, loss of appetite, sleep problems or loss of interest in sex — may seem to be caused by other illnesses

·         Older adults with depression may say they feel dissatisfied with life in general, bored, helpless or worthless. They may always want to stay at home, rather than going out to socialize or doing new things.

·         Suicidal thinking or feelings in older adults is a sign of serious depression that should never be taken lightly, especially in men. Of all people with depression, older adult men are at the highest risk of suicide.

causes

Types of Depressive Disorder

·      Neurotic depression ( vague complaints)

·      Psychotic depression ( suspiciousness)

·      Agitated depression ( restless)

·      Retarded depression ( less activity)

·      Depressive stupor ( mute emotionless)

·      Childhood depression ( children)

·      Adult depression (adult)

·      Senile depression ( old age)

·      Mask, depression ( smiling depression)

Patients with depression can be presented with following;

·      Most depressed patients presented with headache for many weeks.

·      Some patients with depression tell that they are suffering from cancer.

·      Many patients complain that they feel something on throat.

·      Some patients complain that they have sexual difficulties.

·      Many patients complain that they have vague abdominal pain.

·      Some move here and there in different clinics thinking that they have problem at heart.

·      Some patients have presented with fainting affect (pseudo seizure).

·      Some patients presented with recurrent backache & tingling sensation.

Many patients feel that they are worst person in the world.

Causes

It's not known exactly what causes depression. As with many mental illnesses, it appears a variety of factors may be involved. This includes:

·         Life events. Events such as the death or loss of a loved one, financial problems and high stress can trigger depression in some people.

·         Biological differences. People with depression appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.

·         Neurotransmitters. These naturally occurring brain chemicals linked to mood are thought to play a direct role in depression.

·         Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression. Hormone changes can result from thyroid problems, menopause and a number of other conditions.

·         Inherited traits. Depression is more common in people whose biological family members also have the condition. Researchers are trying to find genes that may be involved in causing depression.

·         Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause permanent changes in the brain that make you more susceptible to depression.

risk-factors

complications

Complications

Depression is a mental illness that can take a terrible toll on individuals and families. Untreated depression can result in emotional, behavioral and health problems that affect every area of your life. Complications associated with depression can include:

·         Alcohol abuse

·         Substance abuse

·         Anxiety

·         Heart disease and other medical conditions

·         Work or school problems

·         Family conflicts

·         Relationship difficulties

·         Social isolation

·         Suicide

preparing-for-your-appointment

tests-and-diagnosisTreatment

Numerous depression treatments are available. Medications and psychological counseling (psychotherapy) are very effective for most people.

.Medications
A number of antidepressant medications are available to treat depression. There are several different types of antidepressants. Antidepressants are generally categorized by how they affect the naturally occurring chemicals in your brain to change your mood.

Psychotherapy
Psychological counseling is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy.

There are several types of psychotherapy that are effective for depression. Cognitive behavioral therapy is one of the most commonly used therapies. This type of therapy helps you identify negative beliefs and behaviors and replace them with healthy, positive ones.

Electroconvulsive therapy (ECT)
ECT is usually used for people who don't get better with medications and for those at high risk of suicide. ECT may be an option if you have severe depression when you're pregnant and can't take your regular medications. It can also be an effective treatment for older adults who have severe depression and can't take antidepressants for health reasons.

Lifestyle and home remedies

·        
Learn about depression. Education about your condition can empower you and motivate you to stick to your treatment plan.

·         Pay attention to warning signs. Ask family members or friends to help watch for warning signs.

·         Get exercise. Physical activity reduces depression symptoms. Consider walking, jogging, swimming, gardening or taking up another activity you enjoy.

·         Avoid alcohol and illicit drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat.

·         Get plenty of sleep. Sleeping well is especially important when you're depressed. If you're having trouble sleeping, talk to your doctor about what you can do.

lifestyle-and-home-remedies coping-and-supportCoping and support

Coping with depression can be challenging. Talk to your doctor or therapist about improving your coping skills, and try these tips:

·         Simplify your life. Cut back on obligations when possible, and set reasonable goals for yourself. Give yourself permission to do less when you feel down.

·         Read reputable self-help books. Your doctor or therapist may be able to recommend books to read.

·         Join a support group. Connecting with others facing similar challenges can help you cope. Local support groups for depression are available in many communities, and support groups for depression are also offered online.

·         Don't become isolated. Try to participate in social activities, and get together with family or friends regularly.

·         Take care of yourself. Eat a healthy diet, exercise regularly and get plenty of sleep.

·         Learn ways to relax and manage your stress. Examples include meditation, yoga and tai chi.

·         Structure your time. Plan your day and activities. You may find it helpful to make a list of daily tasks, use sticky notes as reminders or use a planner to stay organized.

·         Don't make important decisions when you're down. Avoid decision making when you're feeling very depressed, since you may not be thinking clearly.

prevention  How Can We Be Mentally Healthy?

·      Don’t do deep thinking.

·      Don’t believe traditional false things like witch, ghost, etc

·      Try to be happy whatever you got but don’t forget to do hard working

·      Take as  a good way for your friends success.

·      Don’t abuse Alcohols & Drugs.

·      Do healthy competition on daily life.

·      Don’t be too moral and don’t expect it from other also.

·      Express your problem to other (ventilations).  

·      Make the environment peace and healthy.

·      Break difficult work into different fraction and try to finish one by one.

Dr C P Sedain ,Neuropsychiatrist

Chitwan med college, Bharatpur,Nepal,

Childhood Mental Disorder

Mental health disorders in children and adolescents are caused by biological, environmental, psychological factors or a combination of these. Examples of biological factors are genetic abnormalities, chemical imbalances in the body, and damage to the brain due to many causes such as a head injury. Many environmental factors also can affect mental health, including exposure to violence, extreme stress, and the loss of an important person. Families and communities working together can help children and adolescents with mental disorders. A board range of services is often necessary to meet the needs of these young people and their families.

Mental problems (Emotional and behavioral problems) are common among of all ages. Children and adolescents can have mental, emotional, and behavioral problems. These problems, or "mental disorder," are sources of stress for children and their families, schools, and communities. The number of young people and their families who are affected by mental, emotional, and behavioral disorders is significant. It is estimated that as many as one in children an adolescents may have a mental health disorder that can be identified and require treatment. Children can suffer from mental illnesses similar to those seen in the adults including depression, schizophrenia or anxiety. In addition, children can have other types of mental illnesses specifically seen in this age group. Some of these conditions include:-

a)    Mental Retardation

b)   Attention deficit hyperactive disorder (ADHD)

c)    Conduct Disorder

d)   School Refusal

e)    Enuresis

f)Temper tantrum and breath holding spells

g)    Child hood depression

             Besides these, there are many other mental disorder which can afflict a child.

A)        Specific developmental disorders: These include either the non-development or abnormal development of a specific development skills leading to various difficulties that makes it harder for children and adolescents to receive or express any information. These disorders can show up as problems with spoken and written language or motor coordination. Examples include reading disorder, disorder of written expression, mathematics disorder or stuttering.

B)        Attention-deficit/Hyperactivity Disorder: Children with attention-deficit/hyperactivity disorder are unable to focus their attention and are often impulsive and easily distracted. Most children with this disorder have great difficulty remaining till, taking turns, and keeping quite. Symptoms must be evident in sat least two settings, such as home and school, in order for attention-deficit/hyperactivity disorder to be diagnosed.

             These children are restless, fidgety and cannot sit still for long. They have difficulty in attending to one thing for long and in following instructions. Their schoolwork is disorganized and contains many careless mistakes. They are reckless and accident-prone. Their behavior is tiresome to their parents and it leads to poor academic performance and poor adjustments with peers.

C.         Conduct Disorder: Children with conduct disorder usually have little concern for other and repeatedly violate the basic right of other the rules of society. They are aggressive towards other children. Conduct disorder causes children and adolescents to act out their feelings or impulses in destructive ways. The offenses these children and adolescents commit often grow more serious over time. Such offenses may include lying, stealing, aggression, truancy, disobedience, setting of fires, and vandalism. Alcohol and drugs use may start at very early age.

D.        School refusal: The reluctance or fear to go school is seen among many fear to go school is among many children. This is knows school refusal or school phobia. School refusal may be associated with separation anxiety, shyness and carious fears. The child's mother may be over protective and anxious The child my refuse school because of problems at school, problems at home or at times, the child him/herself maybe having some problem.

E.         Enuresis: Enuresis is the repetitive voiding of urine, either during the day or night, at inappropriate places beyond the age of 5 years.

F.         Temper tantrum and breathe holding spells: Most toddlers have occasional mild temper tantrums, and only frequent or server temper are abnormal. Tantrums are often provoked by inconsistent discipline. This may include behaviors like biting, head banging, rolling on floor, incessant crying, throwing objects or hitting. These are reinforced unintentionally by attention to the child when they take place.

             Periods of breath- holding are not uncommon in per - school children. Like temper tantrums, they are often caused by frustration leading to rage. The behavior can be alarming for parents, especially if the becomes cyanosed before breathing resumes.

G.        Childhood depression: It is common psychiatric disorder on children. Many children are presented with vague symptoms like pain abdomen, headache and irritability repeatedly. We may get history of fearfulness, irritability, poor school performance, nausea, vomiting, and sleep disturbances etc.

H.        Child Abuse: This is defined as physical or psychological damage to under the age of 18 that is sustained as a result of neglect or maltreatment. The abuse my be physical, sexual and/ or emotional. Usually the abuse is done by the child's parent/s, a parent surrogate (e.g. a step mother), a relative or an employer. Child abuse of any nature has long lasting effects on the overall personality development and has negative psychological effects as well.

A child can be suspected of having some kind  of Mental health problem if:

·      The child's behavior is not appropriate for his / her age

·      The child's behavior leads to academic or social dysfunctional.

·      The child's behavior is against social norms and expectations

If there is suspicion of any mental health problem in a child, the concerned health worker should:

·      Find out details about the problems

·      Explore any difficulties / problems at home / school

·      Reassure the parents

·      Try to inform / explain the parents about the nature of the problems

·      Refer the psychotic treatment center.

Dr C P Sedain

Neuropsychiatrist,Chitwan Medical College