Read Other Mental Health Articles DEPRESSION: SELF DIAGNOSIS IS THE KEY   DR.AMBRISH SINGAL CONSULTANT PSYCHIATRIST M.D [PSYCHIATRY], MIPS, MAPA, AIASP, MCSEPI, MWASH CONTACT   +91-9815333660  D Depression is most commonly used and misunderstood term. Every body has heard this word but nobody is aware what Depression exactly means and how one feels when he/she is depressed, or is aware how a loved one of his feels when depressed. The reason is simple- extreme lack of awareness about Psychiatric illnesses among common people and even doctors because Psychiatry covers very less portion of the medical curricula. The awareness is so less that a person who himself is suffering from depression does not knows what exactly has happened to him and where to go for treatment that has happened to him SELF DIAGNOSIS I shall say that in today's era every person should be aware of the common psychiatric disorders and should know how to self diagnose them. I shall mention here the major signs and symptoms of depression so that even a layman can diagnose himself as well as others of the world's commonest illness- Depression. To diagnose depression there should be presence of the following signs and symptoms for a period of at least 2 weeks. The intensity of depression varies from mild to severe depending on the level it affects your social and occupational life.              Depression consists of persistent sadness of mood i.e. not feeling happy [there can be or can not be some reason behind it]. He is unable to cheer up even in happy circumstances or in situations he use to feel happy before. He feels gloomy, talks less and there is no shine on his face or in eyes. He sits with a stooped posture and has a tense looking appearance.           The patient looses interest in the pleasure activities, in which he had interest before like going out with friends, watching movies, TV, sexual activities or sitting among the family members and talking leisurely. He even looses interest in the routine work /activities of life and like to remain aloof or away in his own. He starts avoiding work and take frequent leaves.  He himself also feels dull and out of life but still does not know what has happened to him.         A depressed patient has recurrent body aches and pains and feels fatigued most of the time. He has a sense of general weakness and feels that now on working he gets tired easily than before. He also can't work enthusiastically and at that fast pace as before. He for his weakness go on taking tonics / vitamin pills or anti-pain tablets but without any results. This weakness hampers even his day-to-day life                  The victim has a disturbed pattern of sleep; there is either a delay in sleep onset or repeated awakenings at night or early awakening in the morning. Patient although sleeps at night but in the morning does not feel like he has slept and is not fresh so he wants to remain lying on the bed. Some patients even show increase in sleep, they can sleep at any time in the day and has a feeling of lethargy during the whole day.          A depressed one also has less appetite, basically there is lost of interest in eating. Although he feels hungry but does not have the 'mood' to eat. He eats forcibly as the mealtime approaches. Thus patient looses considerable weight. Some of the patients feel relaxed on eating and thus eat more and gain weight.        The patient has difficulty in concentrating in his work/studies. He finds that the mind go on wandering here and there when he tries to concentrate. There are many useless thoughts in his mind and he finds it difficult to control them. The thoughts are either without any meaning i.e. are about one has done in the day passed or is going to do in the day to come or the are pessimistic, not pleasant and are disturbing.           A depressed patient also has weak memory and forgets most often like about the routine works /chores, he forgets even after placing the household articles here and there. Again search for memory enhancing drugs is there and that too without any results.           The depressed person gradually shows a progressive loss in his patience and start getting irritable very easily. He easily gets angry and abusive at minor conflicts or even in routine talks. He has no patience to discuss the matters with others and on doing so gets irritated. The person becomes very touchy and if some conflict occurs with anybody he is unable to forget about that thing and the situation go on coming to his mind repeatedly and he feels a lot of mental pain and discomfort. He some of the time gets very emotional and weeps          There is also a new development in the form of headache, which is dull [not sharp], of continuous type and the patient feels as if one tight band is tied all around his head. The head aches, mostly in the temples, behind the head, in the neck and up to lower back even. But the underlying cause of depression is not diagnosed and patient and the doctor go on treating it superficially in the form of neck ache and backache.                Some of the patients complain heaviness of head, mind going blank and say they have no thoughts in mind. So they speak very less and there is a long pause before they respond back, as they take time to think and collecting the ideas. These people also have extreme slowing of the body movements and thus walk and talk very slowly and at a very low volume.              Patient of depression always has a low self-esteem. He loses confidence in himself and shows helplessness and inability in completing the jobs, which he use to do before. He feels he is not doing it right and there might be some mistake in it. On explaining he is unable to found any reason that why he is doubtful of his abilities now.            He grades himself inferior to others. One feels less attractive in himself, less appealing to others and does not talk much in a gathering/company of others, as he feels he will say something that others will not like He believes he cant succeed in competitions and can't meet other challenges in life too. He treats himself a useless person and believes that he cannot do any thing, which can be productive for him and his family.      A depressed person has no interest in the sexual play and avoids it. Males develop either loss of erection or are unable to sustain in or premature ejaculation. Females give no response to her partner's demands. Even if sexual contact takes place, it is without any pleasure. Thus the sexual life almost ends or becomes boring           He predicts a negative outcome of the future also and feels that nothing positive or good can happen to him now and in future. If he is facing a problem currently, he is not hopeful of getting it solved in the time to come. He even feel that there is no cure to his illness and does not go to the doctor for treatment or refuses to take the medicine.                      Suicidal tendency:  The patient start believing that there is no meaning left in the life now. It's not worth living and the circumstances around him are so much worsened that its better he should end his life now and that is the only solution to everything. He would start planning how to end his life and soon the day comes when he tries to implement his ideas. If the patient is saved then there are chances that he can repeatedly do so. All such attempts are with planning and done whole-heartedly and most of times he makes it sure that he should die. In severely depressed cases even on willing the patient does have so much courage to fulfill his wish so in such cases the patient attempts suicide when he gains courage i.e. while he is under treatment. So one has to keep a close watch always.  PANIC ATTACKS /  ANXIETY There is quiet an overlapping between anxiety and depression as most of patients with depression also star t suffering from anxiety symptoms or from full fledged panic attacks. The anxiety symptoms are very disturbing and sometimes the come sonly with them and is unaware of the underlying depression. Symptoms  of panic attack which all of you can experience          People with panic disorder have feelings of terror that strike suddenly and repeatedly with no pre warning. It cant be predicted when an attack will occur. One can be totally free from worry/tension, enjoying a party or working in office in his normal routine when a panic attack can strike. Once panic attack had occurred the person develops intense feeling of fearfulness, worrying when and where the next one will strike.        If you are having a panic attack, most likely your heart will beat faster and louder. You will start having a sense of fearfulness that u will die now or  will have loss of control . You may genuinely believe you 're having heart attack or losing your mind, or are on the verge of death. You can feel sweating in hands and feet  [cold sweating], You may feel weak, faint, or dizzy. Or have light-headedness or feel you are floating in air. There is trembling in hands and legs and also there is dryness of mouth i.e. patient had repeated desire to take sips of water.  Your hands may tingle or feel numb, and you might feel a sense of face becoming hot or cold.      You may have nausea, chest pain or difficulty in breathing or tightness in chest, and a sense of unreality [u may feel the atmosphere around has changed or u ur self has changed]     Panic attacks can occur at any time, even during sleep.   An attack generally peaks within 10 minutes, but some symptoms may last upto 30-45 mins.       Panic disorder is twice as common in women as in men. It most often begins during late adolescence or early adulthood. Risk of developing panic disorder appears to be inherited.      For those who do have panic disorder, though, it 's important to seek treatment. Untreated, the disorder can become very disabling.           Many people with panic disorder visit the hospital emergency room repeatedly or see a number of doctors especially Heart Specialists before they obtain a correct diagnosis of anxiety disorder. Thus they spend lot of money energy without getting any relief.  Such people with panic disorder go for years without learning that they have a real, treatable illness.  Panic disorder is often accompanied by other serious conditions such as depression, drug abuse, or alcoholism and may lead to a pattern of avoidance of places or situations where panic attacks have occurred. For example, if a panic attack strikes while you 're riding in an elevator, you may develop a fear of elevators. If you start avoiding them, that could affect your choice of a job or apartment and greatly restrict other parts of your life.   IN SEVERE CASES OF DEPRESSION When the severity of depression increases or when patient does not take treatment for long time or when he start using some drug [alcohol etc] along with, to get rid of his tension and sometimes even due to some unexplainable reason he develops disturbance in his thought process. He interprets the situations around him in a false manner and acts on them resulting in deranged behavior like: 1. He would start believing that there is somebody who will kill him, police or C.I.D people are after him and they are going to arrest him, so he tries to run here and there, remain fearful most of the time and tries to hide himself or commits suicide. 2. He would complain that other people talk about him or make passes at him or say bad words about him. In such cases the patient earn quarrels with others go on feeling bad and cries. 3. Some patients start believing that their spouse is unfaithful to them and had relations with other people, thus one beats his spouse most often, files the divorce etc. Patient according to his sad mood develops the idea that he is the worst person and had done lot of sins, which are unpardonable, and God should punish him. 4 He even hears voices when no source of noise is there or would hear somebody calling his name when nobody is around. In some cases patient may even land into a stage when he is unable to talk, or eat or move his body or respond to any change in his surroundings. TREATMENT       The purpose of the article is to create awareness among people about the most common illness in the World. If people can self diagnose the problem themselves, then in time they can save a lot of working hours and money, as it's a very incapacitating illness. Thus they can also prevent the after effects of the illness. HURDLES IN TREATMENT There are some of the inborn beliefs in our society, which prevents most people to seek treatment, which are: 1.People feel that it is only a temporary state of mind and will get cured of itself. 2 Patient thinks that his depression is due to various stresses in life and how can the doctor /medicines will treat him till his circumstances are not changed. 3. They do not know to go to which doctor and a psychiatrist is one who treats this illness. 4   less number of psychiatrists available  5 People only know about a psychiatrist is that he is one who treats mad people and they know they are certainly not mad 6   Since the depressed patient has no hope of getting cured and always feel discouraged he has no motivation to take the treatment.  7 Some people feel that they will be called weak by others if diagnosed to have depression, 8 The family members or friends also are unable to bring the patient for treatment to a Psychiatrist as they don't know that it's a illness and should be treated urgently. 9. A person who has been prescribed antidepressants should be careful not to take more than what they should, as it could lead to prescription drug abuse and dependency.   HARMS OF DELAYING TREATMENT. Depression if left untreated for long time leads to permanent destruction of neurons and decrease in neurotransmitters and a compensatory increase in their receptors in the brain, which results into 1 Depression becomes less responsive to treatment, 2 Even if treated, only partial cure is achieved 3 More amount of drugs or multiple drugs are required, 4 Depression takes more time in getting cured, 5 Severity increases with time 6 Thought disturbances mentioned above could take place, 7 Depression goes on recurring again and again even after once cured. 8 Patient can commit suicide during the illness; 9 Patient can land into the clutches of drugs [sleeping pills, alcohol, smoking etc] in an attempt to get rid of his mental discomfort. 10 The long time, which the patient had spent in suffering and incapacitation, is in bonus. In nutshell self-diagnosis is best and earlier the diagnosis and treatment the better is the outcome. FREQUENTLY ASKED QUESTIONS WHEN SHOULD  I  CONSULT DOCTOR? You need to see a doctor if you suffer from of these above mentioned symptoms, most of the time and most of the days continuously from last at least 2 to 3 weeks. WHAT CAUSES DEPRESSION? It's caused by a chemical imbalance in the brain. The chemical imbalance is caused by the effect of some stressful events that affect u/disturb you terribly. Such life events cause destruction of brain cells and also decrease in chemical messengers (called neurotransmitters) This decrease in neurotransmitters causes malfunctioning of brain resulting in depression. The decrease in chemicals can be genetic also i.e. transferred from your  parents or grand parents.          It can occur at any time in your life i.e. from your childhood till death. These neurotransmitters carry messages (nerve impulses) from one nerve cell to another. There are not enough of these messengers in a person with depression. Two primary messengers called serotonin and nor epinephrine, are responsible for your moods (how you feel)  WILL I BE ABLE TO LIVE MY ROUTINE NORMAL LIFE AGAIN?      Yes with proper treatment you definitely are  be able to get back to your day-to-day activities as earlier. Depression is one of the illnesses in which full cure is possible and you get back fully to your previous pattern of life and sometimes even better than that. WILL I SUFFER FROM DEPRESSION AGAIN? If left untreated, about 50-60% of the patients have chances of suffering from depressive symptoms again. Also the medical treatment recommended to you by the doctor should be continued for at least 6 to 9 months since the risk of relapse is high if the therapy is stopped too early. Your cooperation in the treatment is the most important part of the therapy. WHAT WILL HAPPEN IF DEPRESSION IS LEFT UNTREATED? Prolonged depression can be very distressing to the patient and also their loved ones. Patients cannot perform to the best of their abilities in all spheres of life including career and personal relationships. To make matters worse they may even decide to end their life and attempt suicide.            Besides, if depression is not treated it may get aggravated, becomes resistant takes more time in getting cured, started occurring again and again in spite of treatment it may aggravate other medical illness like diabetes mellitus, coronary artery disease and asthma. WHAT SHOULD I DO IF I GET SUICIDAL THOUGHTS? Tell yourself it is a symptom of depression. It is a temporary state of mind, Remember every depressed person thinks in the way you r thinking. Get immediate help form a Psychiatrist rather than following your depressing thoughts. Approach a person, may be a relative, friend or a doctor himself and let him know about your thoughts. Leave yourself under the care of either of them. Is DEPRESSION CURABLE? "Yes" Depression like many other illnesses is fully curable. Now days there is drastic improvement in quality of modern psychiatric drugs, which had a very high cure rate and had brought improvement in quality of life. HOW CAN DEPRESSION BE TREATED? First step is to consult a Psychiatrist. He will diagnose your illness and will make a treatment plan for you. Treatment of depression involves medicines and talk therapy. [Counseling /Psychotherapy.] Medicines treat the chemical imbalance in your brain and talk therapy helps in resolving the conflicts in your mind. it will help in correcting the way you think, how you cope up with your day to day stresses .  The combination of Medicines with talk Therapy is ideal and given in combination and most of the people gets treated. WHAT WOULD MY FRIENDS THINK, IF I GO TO THE PSYCHIATRIST? Most people even the most learned ones are not aware about the treatment of mental illnesses. There are lots of misconceptions in minds of people about psychiatric treatments due to lack of awareness and information about mental illnesses. Even many of doctors are not well versed with psychiatric illnesses and drugs. So some of your old fashioned friends may raise their eyebrows and create panic, which is due to illiteracy about this subject. But actually the scenario is changing very fast. More and more people are realizing that most of the mental distress and illnesses can be treated successfully by accepting treatment from a Qualified Psychiatrist. So much so that now even school going children are being brought by intelligent parents when ever they notice some change or downfall in child's school performance. HOW DO MEDICINES HELP TO TREAT DEPRESSION? Medicines being used to treat depression are called antidepressants. They correct the chemical imbalance in your brain that is causing depression. These medicines work quite effectively and nowadays all the drugs are available in India which were only available in Western countries before and the newer drugs are quite effective and safer than old medicines. These medicines also have some side effects. But the side effects y decrease with time. The modern medicines have far less side effects and are not worrisome.                     Antidepressants can show their effect right away, but it may take 2 to 3 weeks before you see full benefit. Never stop taking the medicine without checking with your doctor first. There are a number of antidepressants available today. Your doctor is the best person to make the ideal choice for you. HOW CAN MEDICINES TREAT ME WHEN THE STRESSES I AM FACING ARE STILL THERE? As already mentioned Medicines correct the chemical imbalances in the brain and thus help the brain to function properly. Once the chemical imbalances get corrected you start feeling betterment in your mood. You will feel like a changed person after u gets treated. You can now make out that the circumstances/situations that use to affect u lot in the past now does not bother u after treatment. They thus increase your ability to deal with stresses'. that you are a changed person after the treatment. So it is a miracle that you can continue to feel good even if the stresses persist and you remain in the same situation. WHAT ARE THE INSTRUCTIONS FOR PATIENTS DURING THE TREATMENT?     These instructions have to be followed very strictly if you want a complete and continuous relief- 1. Do not increase or decrease the doses /number of drugs without consulting your Psychiatrist. 2. Medicines are to be taken continuously. Never stop or discontinue the drugs for even one day without consulting your doctor. As most patients stop the drugs after they get improved, they no longer feel that they are ill, so why to take the drugs any more. 3   Regularity in taking medicine is must for long lasting and full improvement. 4. Do not change the drugs by yourself. 5. While under treatment- Consult your doctor in case: You have some new problem Have a change in your signs and symptoms Were unable to take the medicine for some days due to some reason You seem to have some side effects of the medicines.  WHAT IS THE DURATION OF TREATMENT? Treatment continues from 6 months minimum from the date of improvement up till 2-5 years Some patients have to take the medicine for lifetime. Some of the factors on which the duration of treatment depends are: 1)  Type of depression 2)  The number of episodes of depression patient had 3)  Severity of illness 4)  Duration of illness 5)  Whether the illness is hereditary 6)  Whether patient is or was taking some drug of abuse 7)  Is there any identifiable organic cause of depression [i.e. any h/o head injury, cyst/tumor in the brain or any known neurological illness.] 8)  Any known long standing medical illness like of thyroid or diabetes etc. 9)  Whether patient had psychotic symptoms/suicidal attempts along with.   ALONG WITH THE MEDICAL TREATMENT, IS THERE ANYTHING THAT I CAN DO TO RELIEVE MYSELF FROM DEPRESSION? There are certain other alternative methods, which work well to prevent and cure depression, but along with antidepressant drug treatment. These therapies does not fully cure depression but only give an aid to the antidepressant drugs. Thus the main job is done by antidepressants only. These are suggested at certain stage of treatment, as a depressed patient does not have the energy and motivation to do all the things written below.   Socialize   Even though there may be occasions where one feels lonely even in a crowd being alone physically is proven to worsen depressive symptoms. So as far as possible be in the company of people you are comfortable with. It helps. Avoid smoking and alcohol  Props such as smoking, non-prescribe drugs and alcohol can be damaging . Alcohol, in particular, is a depressant, and despite giving us a temporary list it can make matters worse as we try to retain the list by drinking more and more. Relax with yoga and exercise Yoga along with meditation rotten helps relieve patients of anxiety and depression. If you can manage some form of exercise, it will help you feel better and more positive because exercise influences the neurotransmitters positively. Celebrate your holidays well-deserved holidays or short breaks bring relief by breaking up the routine, which so easily lets us get into a rut. Take Balanced Diet Balanced diet helps to regularize the nutritional supply to our body and hence helps in relieving depressive symptoms. Develop Hobbies Occupy your mind with absorbing subjects, interests or hobbies. Studying, watching a special TV program or film or listening to music is extremely useful. Keep Smiling Changing physiology changes one's psychological state as well. Smiling, laughing an upward gaze and pushing up of shoulders and chest often change the mental states as well.