Assessment of Depression :-( You can rate yourself on this scale).
Patient can evaluate themselves by Screening and Diagnostic Instrument for Major Depressive Disorder (MDD) with:-
Disease Burden Measured in Disability-Adjusted Life Years (DALYS). :-
you can score as given below. -Over the last 2 weeks, how often have you been bothered by any of the following problems?
1) Not at all 2) Several days
3) More than half the day 4) Nearly every day
( you can rate from 1-4on fallowing points on a to i.)
· a) Little interest or pleasure in doing things.
· b) Feeling down, depressed, or hopeless.
· c) Trouble falling or staying asleep, or sleeping too much.
· d) Feeling tired or having little energy.
· e) Poor appetite or overeating.
· f) Feeling bad about yourself, or that you are a failure, or have let yourself or your family down.
· g) Trouble concentrating on things, such as reading the newspaper or watching television.
· h) Moving or speaking so slowly that other people could have noticed, Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual.
· i) Thoughts that you would be better off dead, or of hurting yourself in some way.
Diagnosis of MDD to be made if answers to a or b and five or more of a - i are (“more than half the days” score 3 or 4). (count i if present at all.)
TREATMENT OF DEPRESSION, STRESS, GRIEF –Study conducted by Psychiatrist practicing in Pune on use of COGNITIVE BEHAVIOUR THERAPY (CBT) AND COUNSELLING as only method of treatment verses use of medicine (Anti depressant drugs like Paroxetine & Sertraline) on patient suffering from DEPRESSION, STRESS DISORDER, RELATIONSHIP PROBLEMS, GRIFF, FAILURE, AND LOW MOOD DUE TO OTHER COUSES.
Dr Swapnil Deshmukh – MBBS, MD Psychiatrist – with special interest in Depressive disorder did comparison study of patient suffering from similar problems. As depressive disorder lead to- low mood, weakness, low confidence, ideas of hopelessness, ideas of worthlessness / helplessness, negative thoughts / ruminations, suicidal ideas, sleep problems, decrease interest, poor performance at work, poor / low confidence, fear to face others, fear to drive or travel, fear to face boss or do presentation and many other similar kind of problems. Some patient may also presents with predominant anxiety or pain complaints as complaint of sever palpation, tremors, sweating, and feeling of death or heart attack.
Causes of Depression:- Due to internal factor or External factors. Line of management is almost same on both. Internal factors includes – Changes in Neuro-transmitters (Serotonin, Dopamine, Epi/ nor Epinephrine); brain structural changes, Hormonal changes in body; Seasonal changes; sleep pattern changes.
External factors may be – In reaction to loss / grief.
Results were as fallows-
1) Drug treatment (medication) shows results in 90% of patients.
2) Cognitive behavior therapy takes time to show improvement. Improvement takes in 40% cases.
3) Drugs are faster acting than counseling and other psychotherapies.
4) Sever cases required both treatment simultaneously.
5) Drugs have side effects but newer treatment options are safe and can be continued for long time.
6) Drugs should be taken only after counselting PSYCHIATRIST.
7) Tranquilizers can give fast benefit but may lead to dependence or withdrawal symptoms or rebound increase in symptoms after discontinuation.
8) Tranquilizer should be avoided or should not be continued more than 3 wk.
9) The role of dietary nutrients in Depression –Folic acid ( B9 ), Pyridoxine( B6 100mg/day), Vita B12. Also Zinc, Copper, Magnesium and use of Omega-3 fatty acid can help in better outcome and prevention of depression.
10) Yoga – Relaxation – regular exercise can help patient to keep doses of medication minimum.
11) Long term treatment and preventive treatment is available and helps.
ELECTRO CONVULSIVE THERAPY HELPS IN SEVER CASES AND SUICIDAL PATIENTS but can lead to memory problems on short run.
12) rTMS, Transcranial Magnetic Stimulation is newer development in treatment of depression it is approved by US FDA in 2008, now it is available in India in few centers like Pune. Cost of therapy is low and effects are seen in 10 days. rTMS is very safe and effective treatment for resistant cases, for patients not tolerating medications due to side effect. Cost per rTMS is around 3450/- Rs ( around 73 US $ ) in Joshi Hospital Pune.