Educationals
| For Patients | |||
| DEFEAT DEPRESSION - Prof.(Dr.) Manilal Gada, Dr. Krishna S Ayyar |
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| Foreword | |||
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Introduction
A 35 year old housewife, Sushma, was suffering from chest pain, palpitation, breathlessness, headache, sleeplessness, weakness and poor appetite for over six to eight months. The symptoms had increased gradually over the last one month. She had consulted many doctors and thorough investigations were conducted including cardiogram, stress test, 2D Echo etc. for cardiac disease. All the above investigations were normal and doctors used to say comment "there is nothing wrong with you, you are only imagining the symptoms, this is all psychological". On a relatives advice the patient consulted a psychiatrist. On further inquiry it was found that in addition to the above symptoms she had lost interest in practically everything including her only son, she had no desire and initiative to do any work, had become irritable and had developed intolerance to noise. There were frequent crying spells and she felt that life was not worth living … "it was better to die". This like many other is a typical case of depressive illness presenting with a combination of physical complaints and normal clinical investigations for physical illness. The patient was given antidepressant drugs and psychotherapy. Within ten days, her physical symptoms improved and she resumed working. In four weeks she had recovered very well and was almost the same as her normal self. Depressive illness is a very commonly seen phenomenon all around us. Many people who are depressed are puzzled and confused by their feeling. They cannot understand themselves, and they do not expect any one else to understand them either. The people around do not understand the situation and often suggest that the person should pull herself together, get out more and stop dwelling on how she felt. This of course does not work and the patient feels more miserable then ever before... withdrawing further from friends and family and reluctant to consult a doctor as she feels she would be wasting his time and that he would not understand her. All these peculiar feelings - the bewilderment, the sense of inadequacy, the hopelessness, the inability to describe just how one feels - are in fact typical symptoms of depression. They are not only very upsetting: they are misleading and very unfortunate as today ... depressive illness is a treatable illness…… In the course of the booklet we will examine why these occur, who are at a maximum risk, the treatments as well as the myths and realities surrounding the disease. Depressive illness Depressive illness is universal and has been prevalent since time immemorial. Its clinical features were described in ancient Indian literature by Sudarka, a renowned playwright of 2nd century B C. It figures prominently in the sacred writing of India, its mythologies, literature - the twin epics Ramayana and Mahabharata. In the Mahabharata, Arjuna was afflicted with the illness which was relived by Lord Krishna's firm handling and counselling. Abraham Lincoln the president of USA and Winston Churchill the prime minister of England suffered from depressive illness. Depressive illness is observed in people from all countries and every culture, affecting both the sexes, sparing neither the rich nor the poor, tormenting all ages, forcing the exit of some through self-destruction and steadfastly maintaining its core clinical features down the centuries. The term "depression" is so commonly used in everyday transactions that fails to convince the people around that "Depression" could be a disease in itself. The depth and intensity of depressive illness is usually not recognised and appreciated by the family members and people around. Depressive illness is in fact one of the most agonizing illness and its real intensity is experienced only by the sufferer. Incidence The prevalence of depressive illness is estimated to be around 3% per year i.e. there are about 40 crore people around the world who will develop diagnosable and treatable depressive illness. In India, surveys have shown that 4% of the population have had or are suffering from an episode of depressive illness. That would put the number of persons suffering from depressive illness to be close to around 3.5 crore. Depressive illness is:
Depressive illness is in fact the "common cold" of psychiatric illness. Though depressive illness is so widespread the number of patients who consults a family doctor are few, and still fewer consult a psychiatrist.
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CASE: A BEREAVED FATHER
A successful businessman working for 12 to 14 hours a day had suddenly stopped going to work and was not attending to his business for the last three months. He had lost sleep, his appetite was poor and had lost about 5kgs in weight. He used to lie in bed, not communicate with anyone and was constantly lost in his own thoughts. He was frequently crying and often expressed a desire to commit suicide. This sudden change in behaviour had taken place following the sudden death of his young promising son of 22 years in a car accident. Family and friends had tried to persuade him to join work at least for a few hours a day or to take a vacation, but had failed to convince him to do so. He was diagnosed to be suffering from severe depressive illness. With treatment he improved and resumed his activities within six weeks. He remarked that "I did not know what happened to me. I had no energy to go out or talk to anyone. My body was not under my control." It is important to understand that this patient was suffering from depressive illness. He was not shirking his work purposely or he had not suddenly become lazy. Although the triggering factor was obvious (untimely death of a young son), giving him good and well meant advice of doing something (action or going back to work) was not the treatment he needed. Rather than sympathising with the person ("Depression is a natural reaction after such a tragedy"), it is important to realise that is an illness and that medical treatment will help the patient get well. Depressive illness like any other illness is a disease . Just like in other physical like typhoid fever and jaundice, where there are certain chemical changes in certain parts of the body, in depressive illness there are chemical changes in the brain. These chemical changes bring about symptoms of depressive illness. Hereditary Factors Depressive illness runs in families. The parents siblings and children of a depressed person are at a higher risk for depressive illness than those who do not have a depressed person in the family. An identical twin is at an even greater risk. Psychological Factors The nature and personality make up of an individual and the attitudes he displays, predisposes or protects the person from depressive illness. Some of the attitudes which make the person vulnerable to depressive illness are:
Depressive illness is often triggered off by stressful events in life. The major precipitating social factors for depressive illness are:
Symptoms Each individual's illness and symptoms differ from that of the others or in different depressive episodes in the same person. The following are the major symptoms seen during depressive illness though, not all will be present in any one episode. Psychological/ Behavioural symptoms
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