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Home Doctor

HOME DOCTOR

 

  101

ways to improve your health, live longer,

diagnose diseases, cope with emergencies

and look after yourself.

 

    Modern society is moving at an ever increasing pace, and many people find that they just don’t have time to look after themselves properly. This includes preventing mishaps and disease, as well as coping with injuries and illness whenever, and wherever, they happen.

 

    As a result, many suffer unnecessary ills and mishaps, when a little bit of prevention, taking early action, or noting symptoms early rather than late, could have prevented much more serious consequences.

 

    It is far better to see a doctor and have a problem detected early, or be reassured that there no cause for concern, rather than suffer serious consequences unnecessarily or worry for no good reason.

 

    This book is designed to be a simple guide to the 101 most important ways in which you can look after your health, abnormal symptoms, and the health of those you care about.

 

  Published in 2005, its circulation already exceeds 100,000.

 

This book and the data it contains, are available for republishing or electronic use.

DEPRESSION

It is essential to look after your mental health as well as your medical health. Everyone should realise that it is really an artificial divide between the two types of health, as many mental conditions, including depression, can have a biochemical cause and its management is no different to that of high blood pressure, gout or diabetes. Look after yourself, and if your family or friends comment that you may be suffering from a low mood or personality change, seek professional help.

DEFINITION

Depression is also known as an affective disorder, melancholia, hypothymia or a nervous breakdown. It is a medical condition, not just a state of mind, that affects 30% of people at some time in their life. Patients are not able to pull themselves together and overcome the depression without medical aid, although a determination to improve the situation certainly helps the outcome.

Depression may be a symptom (having a bad day and feeling sad), personality type (inherited with the genes), reaction (depressed because of loss of job, death in family etc.) or a disease (depression due to chemical imbalances in the brain). It is usually a mixture of several of these.

TYPES

There are two main types of depression, endogenous and reactive, with very different causes.

Depression is a disease like diabetes. Diabetes is due to low levels of insulin in the blood, depression to low levels of serotonin in the brain.

ENDOGENOUS DEPRESSION

Endogenous depression has no obvious reason for the constant unhappiness, and patients slowly become sadder and sadder, more irritable, unable to sleep, lose appetite and weight, and feel there is no purpose in living. They may feel unnecessarily guilty, have a very poor opinion of themselves, feel life is hopeless and find it difficult to think or concentrate. After several months they usually improve, but sometimes it can take years.  It is due to an imbalance of the chemicals (neurotransmitters) that normally occur in the brain to control mood. The neurotransmitters include serotonin, noradrenaline and dopamine. If too little of any one is produced, the patient becomes depressed - if too much, the patient may become manic.

Endogenous depression can be further subdivided, depending on the combination of neurotransmitters that are too low. The subtypes are:-

TypeNeurotransmitter level too lowCharacteristics

Non-melancholic depressionSerotoninObsession, panic,

compulsions, anxiety

Non-psychotic melancholiaSerotonin, noradrenaline+ lack of energy, tired

Psychotic melancholiaSerotonin, noradrenaline, + unmotivated, no pleasures,

dopaminelack of concentration, no

insight.

Patients with endogenous depression are not able to pull themselves together and overcome the depression without medical aid, but doctors can alter the abnormal chemical balance by giving antidepressant medications.  When they do start to improve, some patients with depression go too far the other way and become over-happy or manic. These patients are said to be manic depressive, have bipolar personality (generally severe swings of mood) or cyclothymic disorder (milder mood changes).

There are no diagnostic blood tests or brain scans to prove the presence of endogenous depression, and the final diagnosis depends on the clinical acumen of the doctor.

REACTIVE DEPRESSION

Reactive depression is the sadness that occurs after a death in the family, loss of a job, a marriage break-up or other disaster. Patients are depressed for a definite reason, and with time, will be often be able to cope with the situation, although some patients do require medical help.

OTHER TYPES

There are many other causes of depression that overlap between the two types above or have totally independent causes.

The elderly often become depressed because they are confused, ill, unable to sleep as well as they would like, in discomfort, have no pleasure in life and can see no future. A change in attitude, environment and a bit of medication may often change their outlook dramatically.

The hormonal changes associated with menopause often triggers significant clinical depression. The varying hormone levels may cause wide variations in mood that can be corrected by hormone replacement therapy.

Many women find that the normal sex hormone variations during the month will also cause mood changes, with depression and irritability being particularly common just before a menstrual period (premenstrual tension - PMT).

Many other diseases may have depression as a component, but doctors must be careful to differentiate between depression caused by the disease process itself, and depression in the patient because they are upset at having the disease.

There is no identifiable cause for most cases of depression.

Possible medical causes for depression may include :-

- tumour, cyst, abscess, cancer or infection of the brain

- stroke (cerebrovascular accident)

- hypothyroidism (a lack of thyroxine)

- Parkinson disease (degeneration of part of brain that co-ordinates muscle movement)

- serious viral infections (eg. AIDS, hepatitis, influenza, glandular fever)

- pernicious anaemia

- systemic lupus erythematosus (an autoimmune disease)

- multiple sclerosis (a nerve disease that affects nerves in a randomly and intermittently)

- abnormalities in the levels of potassium, sodium, bicarbonate and chloride (electrolytes) in the blood due to kidney or other diseases.

A number of medications, including cortisone, methyldopa (used for high blood pressure), beta blockers (used for heart disease) and various hormones (including the contraceptive pill) may have depression as a side effect.

There are many rarer medical causes of depression.

POSTNATAL DEPRESSION

Postnatal (or postpartum) depression is a spontaneous form of depression that occurs in some women just before, or soon after childbirth, and is a response to the effect on the brain of sudden changes in hormone levels.

The woman experiences constant unhappiness for which there is no reason. They are unable to sleep, lose appetite and weight, and feel there is no purpose in living. They may feel unnecessarily guilty, have a very poor opinion of themselves, feel life is hopeless, find it difficult to think or concentrate, worry excessively about their infant or neglect the child. Rarely it may lead to attempted or actual suicide. It is diagnosed after careful psychiatric assessment.

Medications are prescribed to control the production of depressing chemicals in the brain (eg. fluvoxamine, moclobemide, nefazodone, paroxetine, venlafaxine) while hospitalised or given intensive home support. Shock therapy (electroconvulsive therapy - ECT) may be used as a last resort. Virtually all cases settle with support and medication in a few weeks.

SEASONAL AFFECTIVE DISORDER

Seasonal affective disorder is a special form of depression that is a common condition in far northern climates where there may be daylight for only two or three hours a day during winter. The cause is an inappropriate regulation of time by the body’s internal clock, which is controlled by the hormone melatonin produced in the pineal gland at the front of the brain.

Patients become irritable and depressed, and suicide may occur in severe cases.

It is difficult to manage, but living in very bright light for part of the day, antidepressant medications, or taking melatonin may help.

Patients with depression need to be constantly reassured

that the problem is not in any way their fault,

and that with time, medication and patience, it can be successfully treated.

TREATMENTS

PSYCHOLOGISTS

Psychologists are not medical doctors but have undertaken a course of training to obtain a Master of Arts degree in psychology from a university. Many further their studies to earn postgraduate degrees and doctorates (PhD). Psychologists deal with behavioural, social and emotional problems (eg. marriage counselling, dealing with badly behaved children, coping with stress). They can also help many patients cope with depression, particularly reactive and postpartum depression, and are often involved in a team approach to the problem.

MEDICATIONS

Numerous medications (antidepressants) that control the production or activity of the depressing chemicals in the brain are available to treat depression, but most antidepressant drugs work slowly over several weeks. Hospitalisation in order to use high doses of drugs or other treatments, and to protect the patient from the possibility of suicide, is sometimes necessary when the disease is first diagnosed. The other form of treatment used is shock therapy (electroconvulsive therapy - ECT), which is a safe and often very effective method of giving relief to patients with severe chronic depression.

Untreated depression may lead to attempted or actual suicide, which can be seen as a desperate plea for help.

Antidepressants are used to control depression. Depression caused by a biochemical imbalance in the brain requires appropriate medication to correct it before a tragedy occurs. There are many sub-classes of antidepressants including SSRI, RIMA,SNRI, tricyclics and MAOI.

SSRI

Selective serotonin reuptake inhibitors (SSRI) is a class of antidepressants that has received a great deal of publicity because of the extraordinary efficacy of one of its members - fluoxetine (Prozac). Introduced in 1992, this group has revolutionised the management of depression and anxiety because of its speed of action, safety and minimal side effects, and they are now the most widely used antidepressants. Other drugs in this class include paroxetine (Aropax), sertraline (Zoloft), escitalopram (Lexapro) and citalopram (Cipramil). Side effects may include nausea, drowsiness, sweating, tremor, a dry mouth and impotence.

RIMA

Reversible inhibitors of mono amine oxidase (RIMA) antidepressants are a class of very safe antidepressants introduced in the early 1990s. The only one generally available is moclobemide (Aurorix). Side effects may include disturbed sleep and dizziness.

SNRI

Serotonin and noradrenaline reuptake inhibitors (SNRI) is a class of antidepressants that was introduced in 1996 and is normally used in resistant cases of depression. Venlafaxine (Efexor) is the most common drug in this class. Side effects may include dizziness, drowsiness and a dry mouth.

Antidepressants are very effective, but they are slow to work, and as a result they are not addictive. No addict wants to take a pill that gives them a high several weeks later.

TRICYCLICS

Tricyclic antidepressants were the most widely used drugs in this class until the introduction of SSRI, and are still very effective in treating most cases, but they are slow to act, taking two to four weeks to reach full effectiveness. They also cause some sedation, and so are normally taken at night. Other side effects may include a dry mouth, tremor, dizziness, constipation, rapid heart rate, blurred vision and excess sweating. Examples include amitriptyline (Tryptanol), clomipramine (Anafranil), dothiepin (Prothiaden), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Allegron) and trimipramine (Surmontil). Mianserin (Tolvon) is a variant on the tricyclic theme that tends to be safer in patients with heart problems.

MAOI

Monoamine oxidase inhibitors (MAOI) are potent antidepressants that are only used in severe and chronic cases of depression. They are slow to become effective, and their effects may persist for a couple of weeks after they are stopped. They do not cause drowsiness, but they interact violently with many other drugs and some foods, including soy sauce, cheese, red wine and pickled foods. Any patient on MAOI should be given by their doctor a list of foods and drugs they must avoid. This list must be observed carefully, or serious side effects may occur. Other side effects may include dizziness, constipation, dry mouth, drowsiness and nausea. MAOI should not be taken at the same time as tricyclic antidepressants, and only with extreme care by epileptic patients. If taken correctly, they can dramatically improve a depressed patient's life. Examples include phenelzine (Nardil) and tranylcypromine (Parnate).

MIRTAZAPINE

Another newer antidepressants is mirtazapine (Avanza, Remeron). Its use at present tends to be restricted to more severe depression that cannot be controlled by other classes of medication. It interacts with alcohol and benzodiazepines (eg. Valium) and may cause increased appetite, weight gain, dizziness and headaches.

ELECTROCONVULSIVE THERAPY

Electroconvulsive therapy (ECT, shock treatment) has been used successfully by psychiatrists since the 1930s to treat severe depression and other mental disease, but it has been subjected to much media criticism and vilification by consumer groups in the past few decades. The adverse reactions to shock treatment come mainly from a misunderstanding of the procedure and what it can and cannot achieve.

A patient about to undergo ECT is thoroughly examined, and an electroencephalogram (EEG), and X-rays of the back and neck may be performed. The patient will be stopped from eating or drinking for eight hours before the treatment.

Despite its bad press, shock treatment can be very effective

and life saving in severely depressed patients.

For the procedure, the patient is usually taken to a specially equipped room or operating theatre. They will be asked to empty their bladder. Electrodes are attached to the temples, and then a brief general anaesthetic is administered. During this anaesthetic, which lasts only a couple of minutes, an electric current is passed through the brain. This electric current causes the patient to have an epileptic-like seizure that lasts 5 to 15 seconds, but because the patient is anaesthetised, the actual body and muscle movement is only slight or non-existent, and the patient has no pain or discomfort. The patient recovers rapidly from the anaesthetic, is confused for about an hour, may have lost any memory of events in the few hours before the shock treatment was given, and may suffer a dull headache for a day or two. There are no other side effects, and normal activity can be resumed an hour or so after the procedure.

The ECT is repeated up to three or four times a week for 8 to 12 or more treatments. Occasionally, more intensive programs of shock treatment are carried out under strictly monitored conditions. Up to 70% of patients with severe depression are significantly improved by ECT, and overall it is more effective than medication in these patients.

Depression is not a diagnosis that patients should fear, as medication and counselling by a general practitioner, psychologist or psychiatrist will cure or control the vast majority of cases.

CURIOSITY

Depression is not a new disease. In the 19th. century, women with a “delicate constitution” were often depressed and they secluded themselves from society for months on end. In the first half of the 20th. century the expression a “nervous breakdown” was the favoured term.