INDEX

INDEX - POSTS ON THIS BLOG

1. ADVANCED TREATMENT IN OCD.... 
2. LAST MINUTE TIPS TO SCORE WELL IN EXAM
3. HOW TO OVER COME NEGATIVE THINKING / PESSIMISM
4. MAGNETIC STIMULATION CAN CHANGE LIFE OF MENTALLY ILL…
5. DEPRESSION- ASSESSMENT AND TREATMENT…
6. ROLE OF VITAMINS & MINERALS IN MENTAL ILLNESS…
7. RECENT ADVANCES IN TREATMENT OF SCHIZOPHRENIA…
8. OBSESSIVE COMPULSIVE DISORDER (OCD) – ADVANCED CARE IN PUNE…
9. NEW GUIDELINES IN TREATMENT OF ANXIETY, PHOBIA & PANIC PROBLEMS…
10. PSYCHIATRIC AND PSYCHOLOGICAL CARE CENTER IN PUNE… @ DECCAN.
    
    
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    DR SWAPNIL DESHMUKH CREATING AWARENESS IN NEWS, HIS OPINION PUBLISHED IN RECENT NEWS ARTICLES IN LEADING NEWS PAPERES OF INDIA. 
    
    
    Times Of India.
    Mental health issues on the rise in city
    14% of the population deals with depression, anxiety and other disorders say psychiatrists
    Mayuri.Phadnis @timesgroup.com 
    
    
        Around 14 per cent of the population in Pune suffers from mental health issues at a given time, say psychiatrists in the city. And this number, they believe, is higher than the normally acceptable incidence of 10 percent. What is alarming though, is that the situation seems to be spreading like an epidemic.
        “Nowadays, cases of depression are rising significantly. Besides depression, suicidal thoughts, anxiety, schizophrenia and bi-polar mood disorders are some of the serious issues that require clinical attention. This 14 per cent does not include issues such as stress and other disorders which are not so serious, but affect the mental health of an individual,” said Dr Swapnil Deshmukh , Secretary, Pune branch of the Indian Psychiatric Society.
       Dr Deshmukh added that the numbers might be slightly higher in Pune than in other cities given that the population here is predominantly youngsters and older people, who are at a higher risk of falling prey to these illnesses. “Mental illnesses were common among aged. However over the past few years, it has risen significantly amongst youngsters. The main reasons for this are increasing competition, lack of family support, lack of financial and job security and various addictions. The World Health Organization had issued a notice in 2009-2010 stating that mental health problems are very prevalent in India. Moreover, at the rate with which it is increasing, it would make India the country with the maximum number of depression as well as suicide cases even though China has a larger population,” he said.
        On Monday, the Supreme Court (SC) issued a notice to the Central and State governments after a plea by the National Human Rights Commission (NHRC) to seek a country-wide epidemiological survey to identify the magnitude of mental health problems. The SC in 1997 had asked them to monitor three mental health institutions — Ranchi, Agra and Gwalior. The commission extended its scope to the country dividing it into five zones — Northern, Eastern, Southern, Western and Central.
        “We found that with changes in lifestyle, mental health issues are on the rise. However, not much attention is paid to them. We are not geared to meet these challenges as we have no infrastructure and not enough healthcare workers in the sector. We do not even have a proper data base though these challenges have increased substantially. From time to time we issued government guidelines as well as suggestions, but nothing much was done about it,” he said.
        
    ALARMING FIGURES
    • MENTAL HEALTH DISORDERS IN THE CITY
    7% Anxiety and depression 3% Bipolar mood disorder 1% Schizophrenia 89% Stress and other issues
    • LACKING HEALTHCARE
    1 in 5 people in India live with mental illness There are 5,000mental health professionals 3:10,000 is the ratio of professionals to patients in Pune. ( TIO)
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    Learn what your partner loves

    
    
    

    Biswadeep Ghosh Sep 23, 2011, 12.00am IST

    
    

    (Learn what your partner…)

    
    

    The wife loves cooking. What is more, she loves discussing recipes. But, living in a nuclear family has its' disadvantages.

    
    

    She aspires to talk about food with her hubby, the only presence in her flat. But her man cannot differentiate between cabbage and cauliflower as long as they are not ready for consumption. Shouldn't the husband learn the craft of making food at least to such an extent that he can have a meaningful chat with his wife?

    
    

    
    

    Logically speaking, yes. But the husband might counter the thought by saying that, if he doesn't know how to cook, his wife knows nothing about cricket. The guy, on the other hand, is so besotted with the game that he dreams of dying with a cricket bat in his hand! Whenever he tries to talk to his wife about the merits of watching the game, she reacts with a disinterested 'I don't know why you guys are so obsessed with this game with a bat and a ball.'

    Consultant psychiatrist Dr Swapnil Deshmukh says, "In a long-term relationship, partners need to adjust to their spouses' likes and dislikes. It is important to try the activity that the partner enjoys. For example, if the husband enjoys watching cricket, and the wife makes an effort to do the same, the couple can connect on a personal level. This makes a lot of difference."

    
    

    A relationship may not run into earth-shattering problems if the husband and wife pursue completely different interests. But if each of them end favors to experience the passion of the other, life can be a little more beautiful.

    
    

    
    

    
    

    Relationships in which the husband and wife have diverse interests are very common. Such relationships can work reasonably well also. But, as Sanjana, a working journalist who is a passionate cook, says, "I would have been so much happier if my husband showed some interest in cooking. He loves to eat. But that is it." Sanjana, on the other hand, has learned the game of football ever since she got married. Today, she knows the names of players from Real Madrid and Manchester United like the proverbial back of her hand. But her hubby continues to be indifferent to the goings on the within the kitchen. That, kind of, saddens her.
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    Youth more prone, also seek psychiatric help

    
    

    Monday, Oct 10, 2011, 12:30 IST | Place: Pune | Agency: DNA

    
    

    Alifiya Khan  
      

    Stigma of mental illness stops 90% of people from seeking professional help.
    Although more than two lakh people in the city suffer from some form of mental illness, a meagre 10% seek psychiatric treatment, say doctors. This means only one in every 10 patients with mental illness have sought help, a shocking figure that points to the resistance among people to seeking treatment as well as low awareness about mental illnesses.
    On the occasion of World Mental Health Day, DNA spoke to leading psychiatrists, who said that despite advances in medical science, people are afraid or have reservations to enter a psychiatrist’s clinic.
    
    Agreeing that the younger generation is more open to psychiatric treatment, Dr Swapnil Deshmukh, consultant at Joshi Hospital, said Pune has a large population of migrant students who are quite regular in seeking help. “Even today we get patients who have tried all means of treatment like going to a general practitioner, neurosurgeon and even witch doctors before they walk into or are referred by someone to our clinics. In this group too, it is the younger population that is more proactive in seeking help and a large percentage of practice involves younger patients suffering from stress, anxiety and depression,” he said.
    “These students stay out of home and that’s why their emotional support network — family and friends — might not be so strong. That’s why we see a lot of these students seeking help from psychiatrists for stress either due to work, studies or relationship issues,” he said.
    He said youngsters do research on the Internet and try to correlate their symptoms with what they read and decide on self-medication. “Unfortunately, it is not so difficult to get drugs, if you so wish, without a prescription. What happens is that in psychiatry there is no readymade formula for medication, unlike other streams where if you have malaria, one type of treatment is given. Our line of treatment depends on various socio-economic, mental and biological factors and this kind of experiment of using the Internet has backfired and I have seen such cases,” he added.

    
    
    
    
        

ADVANCED TREATMENT IN OCD...

Dealing with resistant OCD. Other modalities

1        1. St. John's Wort and OCD

Alternative medicine such as herbal remedies have been growing in popularity in both Europe and North America. Many people with anxiety disorders such as OCD have tried alternative therapies at one time or another. One of the most popular herbal remedies for anxiety is St. John's Wort. Because antidepressant medications that target the serotonin system, such as Paroxetine and Clomipramine, are effective in treating OCD, it has been suggested that St. John's Wort -- which is said to also have antidepressant qualities -- could be an alternative therapy for reducing OCD symptoms.

2.   Repetitive Transcranial Magnetic Stimulation

r-TMS has got maximum popularity in both Europe and North America as its is safest treatment modality. rTMS, is a relatively non-invasive procedure that has received considerable attention as a possible alternative treatment to reduce OCD symptoms. Repetitive TMS is a relatively non-invasive procedure that involves placing a small device directly on the skull. This sealed device contains a coil of wire that carries electricity. The flow of electricity through the device causes cells in the brain called neurons to become either more or less active. The activity level of neurons has been linked to symptoms of mental illness like OCD. Recent research has shown very good results of this treatment in Depression and OCD. Also is approved by US-FDA.

3.   D-cycloserine and Behavior Therapy

Psychotherapeutic techniques such as exposure and response prevention therapy are highly effective in treating symptoms of OCD. However, these treatments do not always work for everyone, and the challenging nature of behavior therapy and the associated cost cause many people to decline or drop out of treatment. Given this, there has been a lot of interest in identifying ways that behavior therapy can be made both more effective and accessible for more people. One possibility may be to supplement behavior therapy with medication. A medication that has generated a lot of interest with respect to this is the drug D-cycloserine.

4.   Exercise and OCD

Most of us are familiar with the many physical benefits of aerobic exercise, including reduced cholesterol levels and lowered risk of heart disease and diabetes. However, there is growing evidence that physical activity may also help to reduce symptoms of mental illness. Indeed, it is now known that aerobic exercise can be used therapeutically to improve mild to moderate symptoms of depression, as well as reduce overall stress and anxiety levels. Recently, preliminary studies have also examined whether aerobic exercise is helpful in reducing the severity of OCD symptoms. Also Yoga and Pranayam helps in reducing anxiety symptoms.

5.   Deep Brain Stimulation for OCD

Although a number of medications and psychological therapies are available to treat OCD, it has been estimated that between 25 and 40% of people will not respond adequately to these first-line strategies. In the past 20 years, the development of sophisticated brain imaging technologies, such as functional magnetic resonance imaging (FMRI) have led to an explosive growth in our knowledge of the inner workings of the brain. Results of these investigations have begun to explain the biological and anatomical basis of OCD. In particular, these studies have suggested that treatments targeting specific circuits in the brain could be helpful in reducing OCD symptoms in those people who have severe symptoms and do not respond to traditional treatment. Deep brain stimulation may offer such a treatment.

Although there are many effective treatments for OCD, some people have what is called treatment resistant OCD. Up to a third of people with OCD have treatment resistant OCD and do not respond to standard treatment protocols. Here are some options to consider when coping with treatment resistant OCD.

1. Explore Reasons Why Your Medication May Not Be Working

Although there are many FDA approved medications available for the treatment of OCD, medications do not seem to work for one-third of people’s OCD symptoms. There are many reasons why this can happen and there are things you can do about it.

2. Consider Augmentation Treatment Strategies

Augmentation therapy treats OCD symptoms with medication. This strategy improves the odds of relieving symptoms by using combinations of drugs, rather than a single drug. Augmentation antidepressant treatment may be helpful for people who do not achieve remission with mono-therapy.

3. Explore Reasons Why Psychotherapy May Not Be Working

Although psychological treatments have come to the forefront in the treatment of OCD, they are not always effective. There are many reasons why psychotherapy for OCD may not be working for you and there are things can do about it.

4. Investigate Intensive Treatment Programs

While there are many effective medical and psychological treatments available for OCD, not all treatments work for everybody. Unfortunately, for some people nothing seems to be effective. To combat this, a number of intensive residential OCD treatment programs have been developed.

5. Consider Taking Part in a Clinical Trial

There are a number of reasons why people with OCD consider taking part in a clinical research trial. For starters, clinical trials often offer cutting edge treatments that are not yet widely available to the public.

6. Explore r-TMS, Psychosurgery and Deep Brain Stimulation for Treatment-Resistant OCD

Although a number of medications and psychological therapies are available for OCD, it has been estimated that between 25 and 40% of people will not respond to treatment. A very small minority of individuals with OCD have symptoms severe enough to consider brain surgery. Surgical procedures for OCD involve inactivating certain brain regions that are responsible for the symptoms associated with OCD. In most cases, approximately 50% to 70% of people who have these procedures see a significant improvement in symptoms. One of these neurosurgical procedures is deep brain stimulation, which appears promising although it is still in the experimental stage and often considered a last resort.

In the last 20 years, the development of sophisticated brain imaging technologies such a functional magnetic resonance imaging (FMRI) have led to an explosive growth in our knowledge of the inner workings of the brain. Results of these investigations have begun to explain the biological and anatomical basis of OCD. In particular, these studies have suggested that treatments targeting specific circuits in the brain could be helpful in reducing OCD symptoms in those people who have severe symptoms and do not respond to traditional treatment.

Repetitive Transcranial Magnetic Stimulation & Deep brain stimulation may offer such a treatment.

Deep Brain Stimulation - A Primer

Deep brain stimulation is a technique that involves precise stimulation of particular parts of the brain through the implantation of removable electrodes. rTMS is non-invasive way of modulation. The way in which deep brain stimulation works is still unknown, but it has been suggested that it restores normal activity to areas of the brain that have become dysregulated.

Deep brain stimulation and rTMS has shown considerable promise in the treatment of movement disorders such as Parkinson’s disease, and there is a growing body of evidence that it may be helpful for the treatment of OCD.

Deep brain stimulation and rTMS has a number of advantages over traditional brain surgery for OCD.

·         Deep brain stimulation can be used to treat symptoms with little risk of permanent changes in the brain.

·         The level of stimulation can be adjusted up or down, and the stimulation can be used continuously or intermittently depending on the treatment plan. This allows for greater precision and tailoring of treatment.

·         The surgery is minimally invasive, meaning there is a reduced potential for side effects. It is important to keep in mind, however, that -- like any surgery -- there is risk of complications or side effects, such as bleeding, infection or unanticipated changes in symptoms or personality. For this reason, deep brain stimulation is usually reserved for those people who have not responded to other forms of treatment.

Deep Brain Stimulation and OCD

Deep brain stimulation for the treatment of OCD has been evaluated in a handful of studies. However, because different techniques have been used and diverse brain areas targeted, it has been difficult to compare the results. These preliminary trials hold promise, but it's important to note that this is still an unapproved and experimental treatment for OCD.

Among the most exciting of these studies is an investigation that appeared in the New England Journal of Medicine. Over 10 months, half of the 18 treatment-resistant patients enrolled in the study first received a period of active stimulation of an area of the brain called the subthalamic nucleus, followed by a period of placebo stimulation. The other half of the patients received the placebo stimulation, and then the real stimulation.

Following active stimulation, the majority of patients showed a reduction in OCD symptoms as well as an improvement in their overall ability to return to normal family life, engage in new relationships or go back to work. Only a very small number of patients achieved this while receiving the placebo stimulation.

Although this treatment did not work for everyone, the results of this study are a very positive development in the treatment of OCD. Future studies will have to further examine which brain areas to target as well as determine the pattern of stimulation that works best.

LAST MINUTE TIPS TO SCORE WELL IN EXAM

No matter how much we try, the word exam always leaves us feeling worried, anxious and at times nervous leading poor performance exam. And when the exams are half a month away, it’s like a hurricane about to hit you. Just remember this it’s your exam and you have to go through it, so might as well do it with full confidence. Here are a few tips we thought could be helpful:

·         What are you thinking

You have studied for half a year or full year and then appearing for this exam. So know that you know the course and just have to perfect it. So, there is no space for bad dreams here.

·         Make a timetable
Yes, we know you have heard it many times, but it’s important. When you are left with just a day or two, don’t just gaze into your books. Make an elaborate timetable and stick it on your cupboard or wall. Keep going back to it and in no time you will be able to cover most of your portion.

·         Be an early bird
While studying late in the night might save you from the day’s noise, early morning is when the brain is at its receptive best. So start off with the tough portions and make the best use of this time.

·         Write key points to remember
Put down all that you have studied in your own words. Make small notes or snippets using this. Important dates, facts or other pointers can be recollected easily from these. This will help you in last minute revisions.

·         Choose the right place to study
Try not to study in your room all the time. Changing the place can add to your enthusiasm and encourage you to study more creatively. We recommend sitting in an airy environment, like terrace or garden and see all your stress go out of the window.

·         Eat well, sleep well
A sound mind and a sound body are most important during exams. Exercise can pump in more oxygen to your brain, improving concentration. Make sure to eat a healthy meal and keep your body hydrated.

·         Don’t leave your study time to the last minute
Last minute tips are great, but plan in advance. We are no robots who can mug up a year’s course in the last 15 days. The best way to score well is to work on a daily basis. This way, there is less to study during exam and more time to revise.

·         Your winning formula
We are sure you have your won winning formula for exams, do share it here for all your friends to know.

HOW TO OVER COME NEGATIVE THINKING / PESSIMISM :-

Our thoughts are the doorway of our emotions. “I'm completely stuck in this” - if such thoughts crop up in your mind quite often, it's time to give a serious thought to the things going wrong. A possible reason can be the responsibility of playing of several roles in life.

Many times we experience insomnia, mood swings, emotional turmoil and uneasiness while carrying out various duties in our lives. This can further make you passive on many fronts in life.

We then lose all our positive energy and become the storehouse of negative energy.

 Here are a few tips of regaining the lost positive energy in life:

Take Out Time for Yourself: Try and do a division of your heavy workload. Make a list of tasks which can be split into smaller chunks. If there are some tasks which you carry out regularly but at the back of your head you realise they aren't really important, give them up. Try and learn the art of time management. Make attempts to strike a balance between your personal professional and family life.

Bad Times would Eventually Go Away: Downbeat circumstances can become a cause of sorrow. But bear this in your mind that this time would eventually be over. Try and see if any benefits can be extracted from such harsh times. This would promote optimism in you.

Good Company: Try and avoid the company of people whose favourite pastime is exploring negativities in others. This can only aggravate your problem.

Think Positive: Don't let thoughts like: “I'm trapped”, “things are never going to change” etc. cloud your head. Easier said than done but you can at least give it a try.

At your Workplace: If you're finding it difficult to handle things in your office, do not hesitate in walking up to your boss and discussing things with him. These days many companies provide counselling to their employees.

Leisure Activities: Though clichéd but activities like watching movies, listening to music, gossiping, travelling can actually help you overcome negativities in your life.

Getaways: If you're stuck in the din and bustle of your city life, it's time to go for a nonchalant break. Plan getaways to hills, jungles, beaches et al (there's no point going to just another city for that would not help you escape from the usual uproar). You would feel rejuvenated and fresh. After coming back you will feel refreshing and more optimistic.

Eat Healthy: Eating healthy food is a key to not just remain physically fit but also to attain good mental health.

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MAGNETIC STIMULATION (rTMS) CAN CHANGE LIFE OF MENTALLY ILL.

TRANSCRANIAL MAGNETIC STIMULATION – EVOLUTIONARY NEW TREATMENT OPTION IN PSYCHIATRIC TREATMENT, BRINGING HOPE IN LONG-TERM RESISTANT PSYCHOLOGICALLY ILL...

r-TMS a boon for mentally ill.

Repetitive trans-cranial magnetic stimulation (r-TMS), is upcoming method to deal with patients suffering from psychiatric problems, it has made evolution in the field of psychiatry. Limited treatment option in psychiatric treatment has presented with so many obstacles in treatment of chronically ill patients in psychiatry. Medications have always been gold standard of treatment with other psychological therapeutic measures. Conventional treatment modalities like Electro Shock therapy (ECT) though used extensively in developing countries like India is now being replaced by new modality called r-TMS world over. High Magnetic field created around brain can selectively stimulate or inhibit specific brain areas and can be used in treatment of neurological and psychiatric illness was first time reported in 1975. Extensive research in this field has come up with new hope for patient and family with psychological problems. r-TMS is being successfully used in western world for treatment of Depression, Obsessive Compulsive Disorder (OCD), Schizophrenia, BAD Mania, Parkinson’s disease, and other Neuro-psychological problems. As compared to conventional methods like ECT, there is no need to give anaesthesia to patient, no need to induce seizure, and no side effect other than mild headache. R-TMS can be done on outpatient basis in a hospital with trained personnel and patient remain awake and sited in chair. Procedure last for around 30 to 40 minute.

ABOUT rTMS - One very promising avenue for influencing the living brain has emerged in the last decade, based on the use of pulsed magnetic fields. Machines are now available which can give up to 50 stimuli per second (rapid-rate TMS, or rTMS) and their effects are more interesting. Among a wide range of possibilities, it is proved that rTMS do have a place in the treatment of mental illnesses. It is a non-invasive technique, without help of medication, apparently free of serious side-effects, capable of modifying the activity of specific brain areas and treatment of psychiatric problems like Depression, OCD, Schizophrenia.
Approved for clinical use by the United States Federal Drug Administration (FDA) in October 2008, Transcranial Magnetic Stimulation (TMS) is a noninvasive treatment that uses a magnetic field to induce a weak current in the part of the brain responsible for depression. "TMS is an exciting development in the treatment of depression symptoms," says Dr. Richard Bermudes, founder of Sacramento TMS center USA. "It's really life changing, especially for patients who haven't been helped by traditional antidepressant medications, which is typically about 50 percent of those we see." our patients already have seen dramatic improvement with just a few treatments," says Bermudes (2010). How it works
The magnetic fields used in TMS are produced by passing current through a hand-held coil, the coil is held on the scalp - no actual contact is necessary - and the magnetic field passes through the skull and into the brain. Small induced currents can then make brain areas below the coil more or less active, depending on the settings used.
In practice, TMS and rTMS are able to influence many brain functions, including movement, visual perception, memory, reaction time, speech and mood.

Safety issues

Generally, TMS appears to be free from harmful effects. Research continues, but TMS is certainly free of obvious side-effects like those of electro-convulsive therapy (ECT), which still makes quite an impact on patients despite refinements in technique.
TMS / rTMS in the treatment of mental illness

Many mental illnesses can be demonstrated to stem from the abnormal behaviour of particular brain regions, in much the same way that diabetes is the result of malfunctioning cells in the pancreas.

It is believed that some mental disorders are the result of nerve cells being over- or under-excitable (in other words, it is too easy or too difficult for them to "fire" and work properly). In this context, successful psychiatric treatment is achieved by modifying these cells' behaviour. The range of effects produced by TMS are a clear indication of its potential to work in this way. - Dr Deshmukh. Of course, TMS could only be used to treat diseases whose functional causes are understood. Recent progress in understanding the mechanisms behind depression, obsessive-compulsive disorder, psychosis (schizophrenia) and neurological diseases like Parkinson's and Huntington's, offers some hope in these areas. The prospect of replacing ECT with a near-painless treatment, which does not require anaesthesia, would change these people's lives remarkably.

rTMS is now available in INDIA. Recently (last three month) few rTMS centers have been started in cities like Delhi, Mumbai, & Pune ( Maharashtra).

Considering high cost of standard imported rTMS machines of 3 tesla (High strength) and less trained doctors working on this tequnology, Dr Deshmukh (Pune) completed successful training and study on use of rTMS in Psychiatry. Currently in Puna- rTMS is only available at -Department of Neurology, Navalmal Firodia Super-speciality Center, Joshi Hospital, Deccan, Pune, under supervision of Psychiatrist Dr Deshmukh.

DEPRESSION - ASSESSMENT AND TREATMENT

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.