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 Sexual interest dwindles; many people with MDD become withdrawn and avoid any type of social activity.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,