Depression, diagnosis and their dealings, right from childhood up to childbirth & beyond---Part-3

Depression, diagnosis and their dealings (from childhood to many many years)---Part-3

As depression is a serious matter there are many factors which should be considered for dealing with the management of depression. It is also a fact that the cases of depression are found around all ages and in both sexes. The diagnosis and management of depression have very critical phases, and are purely case dependent.

Diagnosis of depression

Depression may be easily diagnosed by taking simple self-tests or taking part in the depression quiz in which depressive symptoms related questions are asked. In case the sadness lasts more than two weeks, it will be the time when medical advice is needed before wasting further time and allowing the matter to worsen. The other situation like the sufferer is facing problem in attending to the daily chores in the work, school or maintaining relationships with others, these are the indications of depression and the doctor’s advice becomes imminent in this situation.

The important of accurate diagnosis

The first diagnosis should be accurate so that treatment can go to the right direction. The accurate diagnosis needs complete physical as well psychological checkups and their evaluations, so that the person’s depressive disorder can be correctly diagnosed / evaluated. Once the diagnosis is correctly done, the type of illness can be known.

The doctor can either find out or rule out the reason

Since many medications for some different diseases or even the depression related diseases may be the cause for side effects or the symptoms for depressive disorders. The doctor can either find out or rule out the reason after physically examining or personally interviewing or through some other tests.

Some screening tools, symptom tests or depressive elements’ investigations are done through questionnaires, which can correctly diagnose the type of depression. In some cases, full mental health tests are also done.

How thorough diagnostic evaluations are done?

For thoroughly diagnosing a patient, complete recording of the histories of the patient’s symptoms are needed. They must be as follows:-

Ø The start of the symptoms

Ø How long the symptoms lasted?

Ø What was the severity of the symptoms?

Ø Any occurrence of the symptom before? In case the symptoms had occurred before, were they treated? If treated, what type of treatment was administered?

Ø Is there any drug effect?

Ø Is the patient alcoholic?

Ø Had the patient tried or talked about suicide at any point of time?

Ø Has / (had from the ancestors) anyone in the family similar depressive symptoms? If yes, what types of treatment were administered to the affected person?

The other branch of diagnostic evaluation

Other branch of diagnostic evaluation is examining the mental status. By this way a patient’s thought, speech pattern and extent of damage of memory are evaluated so that whether the case is maniac depressive illness or the case is depression can be ascertained.

Tests available as on today

As on today, for testing mental disorder, no laboratory test, x-ray or blood tests are required. SPECT, PET scans, CT scans and MRI tests are done for many other diseases that include brain tumor, stroke types of neurological disorders types of diseases. But they cannot detect the depressive disorders/problem that involves both complex and subtle changes in the psychiatric problem. Nevertheless, these techniques are very effective in the researches in mental health. In most probability, these tests will be of much help for the diagnosis of these illnesses.

Relation between antidepressants and sexual dysfunctions

Sexual dysfunction and antidepressants SSRI are very closely related with each other. The reason is sex drive is reported to be reduced by the SSRI for both sexes. SSRI either hampers achieving orgasm or causes delay in it among the women. The condition is known as anorgasmia. The delay in ejaculating or complete loss of ejaculating in men may also be the reason of this medical condition. What are the reasons of impaired sex drives or anorgasmia is not yet known in the medical world. The antidepressant classes discuss about the sexual side effects as the subjects of, MAOIs, dual-action antidepressants and TCAs.

 

Following options are available for the management of sexual dysfunctions, because of SSRIs.

Ø Bringing down the dose of SSRI: - If a patient is under high dosages of SSRI, it will be better to reduce the doses. By this way the antidepressant level of the patient will also be brought down. But one point should be very carefully remembered that the patient must neither change (of his / her own) the medication nor change medication doses. If necessary, consultation with the appropriate authority is a must.

Ø Viagra or sildenafil trial: - As per some studies on men, who are found to have responded to SSRI but have sexual dysfunction, have improved upon their sexual function after using Viagra. The users of Viagra are found to have improved upon their arousal, eventually erections and systematic ejaculation and also orgasm, after Viagra uses, compared to the others. The findings do not falsify the fact that Viagra is never used for increasing libido.

Ø Those women who suffer from sexual dysfunction because of SSRI and men who fail to respond to Viagra: For this type of patients, different category of antidepressants (other than SSRI) will be helpful. The different category of antidepressants is mirtazapine, duloxetine, bupropion, and duloxetine. These medicines do not have any sexual side effects or to say they have comparatively less side effects.

Ø Patients who need to switch over from SSRI to other antidepressant class: - In case of lack of therapeutic response or lack of tolerance to the other antidepressants, SSRI is the option with other additional medicines. The example is bupropion which is added with SSRI for improving sexual function. Further researches are going on for determining the success of the strategy.

Ø Buspirone is prescribed by the doctors for the improvement of sexual function: - SSRI is administered on the in patients. Further researches are going on for knowing about the success of the strategy.

 

Can antidepressants be discontinued? (Different medicines and their impacts on abrupt stoppage)

 

Thinning of antidepressant should be gradual; it should never be discontinued abruptly. If done, some patients may suffer from discontinuation syndrome. The example:- Abrupt disruption of SSRI i.e. paroxetine may lead to nausea, a flu-like symptom, anxiety, irritability, body aches, fatigue, vivid dreams and dizziness. These symptoms are typical, if medicines are abruptly discontinued. The symptoms may last up to 3 weeks. In the SSRI group of antidepressants, fluvoxamine and paroxetine become the causes for distinct discontinuation symptoms, if compared with sertraline, fluoxetine and citalopram. A few patients suffer from discontinuation symptoms, even though SSRI is gradually slowed down. If duloxetine, venlafaxine, or desvenlafaxine are abruptly stopped, the discontinuation symptom, which is similar to SSRI, will become prominent.

 

The repercussion of abrupt stoppage of MAOIs will result in agitation, irritability, and delirium. In the same manner, abrupt stoppage of TCA can lead to abnormal heart rhythms, agitation and irritability.

Complications connected with depression

 

Functions as well structures of many organs of our body can be highly impacted by depressions.

 

Complications of depression

As said earlier, human body structure and the brain functions are very much impacted by depression, making tremendous negative consequences for the patients. Because of these situations various negative depressive conditions are seen among the patients. The patients on this type are the victims of chronic depression, anxiety and have either more medical problems or other emotional issues or chronic pain. Patients, who have chronic illness such as heart disease and diabetes or even having depression, will have another worse condition of medical illness due to the several and serious problems

Depression and its prognosis

Since there are many clinical depressions, new episodes of depressions are bound to come out. People with at least one such episode, will have eventual new type of episodes.  Besides this, many more subsequent depressions can be triggered than the first one. In most of the cases, sufferers get recovery from the episodes. The fact is those who suffer from mild depressions and are medically treated, found to respond equally to placebo i.e. sugar pills. But the severely depressed patients are found to be responding less with the intake of placebo antidepressant medications. However, there is an optimism that the teenagers who are not found to have responded well in the first medicines, do better when they are treated with some other medicines in their adulthood. These same patients may also look better if new medicines are administered with psychotherapy.

Prevention of depression

One of the best preventive measures of depression is cognitive techniques, programs that involve skills of teaching of thinking and enables a person to cope with the stress which is found to be effective in the prevention of depressions. To prevent the serious “postpartum depression”, have the key aspects like helping the new mother to bring down those aspects in their lives that are causing depressions. These factors may be domestic / marriage / social support etc.

Are there any home remedies or self-help for treating depressions?

The patients of this medical condition remain worthless, helpless, exhausted, and hopeless. Because of these negative feelings & thoughts, patients feel like giving up. These negative feelings are the parts of the depressive state of mind and factually do not reveal about the real situation. It is a matter of fact that once the treatment begins, the negative thinking starts fading away. Hence, by the time the patient is under medical treatment, the following can be of much help to the patients:-

Ø Taking healthy foods is the best method. If opposite that means, if the patient does not take adequate amounts of nutrients, while on the other side excessive fats, sodium and sugars are taken from different fast foods and ice creams or many such items, the situation can further worsen the medical conditions of the sufferer(s).

Ø For some depressive patients, Vitamin D and foliate food supplements are very effective in helping the mood of the patients.

Ø Doctors advise the patients to take sufficient rest for physically promoting the improvements of moods

Ø A patient must express his / her feelings to his / her friends through some media. Social media can help a lot in these days for sharing one’s views with many. By this way many negative thoughts can be relieved of.

Ø A patient must not take any great deal of responsibility or set difficult goals to achieve.

Ø If the large task is there to achieve, they should be broken to smaller ones as per the priority and segregate them “when to be done” and “what to be done” segregations.

Ø A patient must not expect too much from self to avoid the increase in the feelings of failures

Ø It is good for a patient to be with others, instead of remaining alone.

Ø A patient needs to participate in those activities which can make him / her feel better.

Ø Activities like going to ball game, movies etc. are always good.

Ø Participation in religious or social activities is also helpful for the patients.

Ø But, never to rush for it nor to overdo it.

Ø In case your mood is not getting improved right away, not to lose heart, because feeling better is always a time taking factor.

Ø No major life decision should be made. Major decisions mean job change, marriage or getting divorced and so on. All these things should be under the careful supervision of your doctor, who knows you thoroughly. This will help your situations to be objectively supervised.

Ø It is always advisable to postpone any such important decisions, if your depression is aggravated.

Ø A patient must not “snap out” of his / her depression.

Ø It is always better to help yourself and not blame yourself if you are not achieving at par.

Ø Negative thinking of any sort must not be accepted, because it is the part of the depression. The problem is very likely to disappear once you start responding to the treatments.

Ø In case of your emergency need like harming yourself or someone, plan who can come forward for your help. You must plan like calling doctors, family, friends or local emergency services etc.

 

Ø You must keep yourself away from those things which can hurt you or others around you. Things like firearms, extraordinary medicines or any sharp material which can easily harm anyone.

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