Depression-What Is It

This is for anyone who is troubled by feelings of depression. We hope it will also be useful for the friends and relatives of anyone who is feeling like this.
It describes what it feels like to be depressed, how you can help yourself, how to help someone else who is depressed, and what help you can get from professionals. It mentions some of the things we don't know about depression..
Introduction
We all feel fed up, miserable or sad at times. These feelings don't usually last longer than a week or two, and they don't interfere too much with our lives. Sometimes there's a reason, sometimes they just come out of the blue. We usually cope with them ourselves. We may have a chat with a friend but don't otherwise need any help. Someone is said to be significantly depressed, or suffering from depression, when:

§ their feelings of depression don't go away quickly.
§ they are so bad that they interfere with their everyday life.
What does it feel like to be depressed?
The feeling of depression is much more powerful and unpleasant than the short episodes of unhappiness that we all experience from time to time. It goes on for much longer. It can last for months rather than days or weeks. Most people with depression will not have all the symptoms listed here, but most will have at least five or six.
You:

§ feel unhappy most of the time (but may feel a little better in the evenings)
§ lose interest in life and can't enjoy anything
§ find it harder to make decisions
§ can't cope with things that you used to
§ feel utterly tired
§ feel restless and agitated
§ lose appetite and weight (some people find they do the reverse and put on weight)
§ take 1-2 hours to get off to sleep, and then wake up earlier than usual
§ lose interest in sex
§ lose your self-confidence
§ feel useless, inadequate and hopeless
§ avoid other people
§ feel irritable
§ feel worse at a particular time each day, usually in the morning
§ think of suicide.

We may not realise how depressed we are, because it has come on so gradually. We may be determined to struggle on and can blame ourselves for being lazy or feeble. Other people may need to persuade us that it is not a sign of weakness to seek help.

We may try to cope with our feelings of depression by being very busy. This can make us even more stressed and exhausted. We will often notice physical pains, constant headaches or sleeplessness.

Sometimes these physical symptoms can be the first sign of a depression.

Why does it happen?
As in the everyday depression that we all experience from time to time, there will sometimes be an obvious reason for becoming depressed, sometimes not. There is usually more than one reason, and these are different for different people.

The reason may seem obvious. It can be a disappointment, frustration, losing something or someone important. Sometimes it isn't clear why we feel depressed. We're just 'in a mood', 'have got the hump', 'feel blue,' 'got out of bed the wrong side'. We really don't know why. Either way, these feelings can become so bad that we need help.

Things that happen in our livesIt is normal to feel depressed after a distressing event, such as a divorce or losing a job. We may spend time over the next few weeks or months thinking and talking about it. After a while we seem to come to terms with what's happened. But some of us get stuck in a depressed mood, which doesn't seem to lift.

CircumstancesIf we are alone, have no friends around, are stressed, have other worries or are physically run down, we are more likely to become depressed.

Physical IllnessDepression often strikes when we are physically ill. This is true for life-threatening illnesses such as cancer and heart disease, but also for illnesses that are long and uncomfortable or painful, like arthritis or bronchitis. Younger people may become depressed after viral infections, like ‘flu' or glandular fever.

PersonalityAnyone can become depressed, but some of us seem to be more likely to than others. This may be because of the particular make-up of our body, because of experiences early in our life, or both.

AlcoholMany people who drink too much alcohol become depressed. It often isn't clear as to which came first – the drinking or the depression. We know that people who drink too much are more likely to kill themselves than other people.

GenderWomen seem to get depressed more than men do. This is possibly because men are less likely to admit their feelings, bottle them up or express them in aggression or through drinking heavily. Women may be more likely to have the double stress of having to work and, at the same time, look after children.

GenesDepression can run in families. If you have one parent who has become severely depressed, then you are about eight times more likely to become depressed yourself.

What about manic depression?

About 1 in 10 people who suffer from serious depression will also have periods when they are elated and overactive. This used to be called Manic Depression, but is now often called Bipolar Affective Disorder. It affects the same number of men and women and tends to run in families.
Isn't depression just a form of weakness?
It can seem to other people that a person with depression has just 'given in', as if they have a choice in the matter. The fact is, there comes a point at which depression is much more like an illness than anything else. It can happen to the most determined of people, and calls for help, not criticism. It is not a sign of weakness – even powerful personalities can experience deep depression. Winston Churchill called it his ‘black dog'.

When should I seek help

§ When your feelings of depression are worse than usual, and don't seem to get any better.
§ When your feelings of depression affect your work, interests and feelings towards your family and friends.
§ If you find yourself feeling that life is not worth living, or that other people would be better off without you.
It may be enough to talk things over with a relative or friend, who may be able to help you through a bad patch in your life. If this doesn't seem to help, you probably need to talk it over with your family doctor. You may find that your friends and family notice a difference in you and are worried about you.

Helping yourself
1. Don't keep it to yourselfIf you've had some bad news, or a major upset, try to tell someone close to you, and tell them how you feel. It often helps to go over the painful experience several times, to cry about it, and to talk things over with someone. This is part of the mind's natural way of healing. .
2. Do somethingGet out of doors for some exercise, even if only for a walk. This will help you to keep physically fit, and you may sleep better. You may not feel able to work, but it is always good to try to keep active. This could be housework, do-it-yourself (even as little as changing a light bulb) or any part of your normal routine. It can help take your mind off painful thoughts which make you more depressed.
3. Eat wellTry to eat a good, balanced diet, even though you may not feel like eating. Fresh fruit and vegetables are particularly good. Depression can make you lose weight and run short of vitamins, which only makes matters worse.
4. Beware alcohol!Resist the temptation to drown your sorrows with a drink. Alcohol actually makes depression worse. It may make you feel better for a few hours, but will then make you feel worse again. Too much alcohol stops you from seeking the right help and from solving problems; it is also bad for your physical health.
5. SleepTry not to worry about finding it difficult to sleep. It can be helpful to listen to the radio or watch TV while you're lying down and resting your body, even if you can't sleep. If you can occupy your mind in this way, you may feel less anxious and find it easier to get off to sleep.
6. Tackle the causeIf you think you know what is behind your depression, it can help to write down the problem and then think of the things you could do to tackle it. Pick the best things to do and try them.
7. Keep hopefulRemind yourself that:
§ you are suffering from an experience which many other people have gone through.
§ you will eventually come out of it, although you may find it hard to believe at the time.
§ depression can be a useful experience – you may come out of it stronger and better able to cope. It can help you to see situations and relationships more clearly.
§ you may be able to make important decisions and changes in your life, which you were avoiding before.
What kind of help is available
Most people with depression are treated by their family psychiatrist. Depending on your symptoms, the severity of the depression and the circumstances, the doctor may suggest some form of talking treatment, antidepressant tablets, or both.

Psychotherapy/counselingSimply talking about your feelings can be helpful, however depressed you are. Your GP may have a counselor at the surgery who you can talk to.

If you have become depressed while suffering from a disability or caring for a relative, then sharing experiences with others in a self-help group may give you the support you need.

If you are not able to get over the death of someone close to you, it is particularly helpful to talk about it with someone.

Sometimes it is hard to express your real feelings even to close friends. Talking things through with a trained counsellor or therapist can be easier. It can be a relief to get things off your chest. If you can have another person's undivided attention for a while, you are likely to feel better about yourself. There are many different sorts of psychotherapy available, some of which are very effective for people with mild to moderate depression.

Cognitive Behavioural Therapy helps people overcome the negative thoughts that can sometimes be the cause of depression. Interpersonal and dynamic therapies can be helpful if you find it difficult to get on with other people.

Talking treatments do take time to work. Sessions usually last about an hour and you might need anywhere from 5 to 30 sessions. Some therapists will see you weekly, others every 2 to 3 weeks.

How do talking treatments work?It depends on what form of therapy you have. Just sharing your worries with someone else can help – you feel less alone with your troubles and feel supported.

§ Cognitive Behavioural Therapy helps you to look at and change the ideas you have that make you depressed.
§ Counselling can help you to be clearer about how you feel about your life and other people.
§ Dynamic therapies help you to see how your past experiences may be affecting your life here and now.
§ Talking in groups can be helpful in changing how you behave with other people. You get the chance, in a safe and supportive environment, to hear how people see you, and the opportunity to try out different ways of behaving and talking.

Problems with talking treatmentsThese treatments are usually very safe but they can have side-effects. Talking about things may bring up bad memories from the past, and this can make you low or distressed. Others have reported that therapy can change their outlook and the way they relate to friends and family. This can put strains on relationships. It is important to make sure that you can trust your therapist, and that they have the necessary training. If you are concerned about having therapy, talk it over with your doctor or therapist. Unfortunately, talking treatments are in short supply. In some areas, you may find yourself waiting for several months if you are referred for psychotherapy.

AntidepressantsIf your depression is severe or goes on for a long time, your doctor may suggest that you take a course of antidepressants. These are not tranquillisers, although they may help you to feel less anxious and agitated. They can help people with depression to feel and cope better, so that they can start to enjoy life and deal with their problems effectively again.

It is important to remember that, unlike many medicines, you won't feel the effect of antidepressants straight away. People often don't notice any improvement in their mood for 2 or 3 weeks, although some of the other problems may improve more quickly. For instance, people often notice that they are sleeping better and feeling less anxious in the first few days.

How do antidepressants work?The brain is made up of millions of cells which transmit messages from one to another using tiny amounts of chemical substances called neurotransmitters. Upwards of 100 different chemicals are active in different areas of the brain. It is thought that in depression, two of these neurotransmitters are particularly affected – Serotonin, sometimes referred to as 5HT, and Noradrenaline. Antidepressants increase concentrations of these two chemicals at nerve endings, and so seem to boost the function of those parts of the brain that use Serotonin and Noradrenaline.

Problems with antidepressantsLike all medicines, antidepressants do have some side-effects, though these are usually mild and tend to wear off as the treatment goes on. The newer antidepressants (called SSRIs) may make you feel a bit sick at first and you may feel a little more anxious for a short while. The older antidepressants can cause a dry mouth and constipation. Unless the side-effects are very bad, your doctor is likely to advise you to carry on with the tablets.

As with any group of medicines, different antidepressants have different effects. Your doctor can advise you on what to expect, and will want to know about anything that worries you. Make sure your pharmacist gives you an information leaflet with the tablets. Many people wonder if these tablets will make them drowsy. Generally, tablets which make you sleepy are taken at night, so any drowsiness can then help you to sleep. However, if you feel sleepy during the day, you should not drive or work with machinery till the effect wears off.

You can eat a normal diet while taking most of these tablets (if not, your doctor will tell you) and they don't cause problems with pain-killers, antibiotics or the Pill. You should avoid alcohol, though. It can make you very sleepy if you drink while you are taking the tablets.

People often worry that antidepressants are addictive. You may get withdrawal symptoms if you stop an antidepressant suddenly – these can include anxiety, diarrhoea, vivid dreams or even nightmares. This can nearly always be avoided by slowly reducing the dose before stopping. Unlike drugs such as Valium (or nicotine or alcohol), you don't have to keep taking an increasing amount to get the same effect and you will not find yourself craving an antidepressant.
Which is right for me - talking or tablets?
It depends on how your depression has developed and how severe it is. On the whole, talking treatments have been found to be effective in mild and moderate depression. Medication is not thought to be helpful in mild depression. If your depression is severe, you are more likely to need antidepressant medication, usually for a period of 7-9 months.

People often find that it is useful to have some form of psychotherapy after their mood has improved with antidepressants. It can help you to work on some of the things in your life that might otherwise make you become depressed again.

So, it may not be a case of one treatment or the other, but what is most helpful for you at a particular time. Both talking treatments and antidepressants are about equally effective in helping people get better from moderate depression. Many psychiatrists believe that antidepressants are more effective in treating severe depression.

Some people just don't like the idea of medication, some don't like the idea of psychotherapy. So, there is obviously a degree of personal choice.

When you are low it can be difficult to work out what you should do. Talk it over with friends or family or people you trust. They might be able to help you decide.
Will I need to see a psychiatrist?
Most people with depression find the help they need at their GP. A small number of people don't improve and need more specialist help. They are likely to be referred to a psychiatrist or a member of the Community Mental Health Team for more specialised help. A psychiatrist is a medical doctor who specialises in the treatment of emotional and mental disorders. Community team members may be a, psychologist, social worker or occupational therapist. Whichever profession they belong to, they will have specialist training and experience in mental health problems.

The first interview with a psychiatrist will probably last about an hour. You may be invited to bring a relative or friend with you if you wish. There is no need to feel nervous. The sort of questions asked are likely to be practical rather than deeply probing. The psychiatrist will want to find out about your general background and about any serious illnesses or emotional problems you may have had in the past. He or she will ask about what has been happening in your life recently, how the depression has developed and whether you have had any treatment for it already. It can sometimes be difficult to answer all these questions, but they help the doctor to get to know you as a person and decide on what would be the best treatment for you.

This might be practical advice, or suggesting different treatments, perhaps involving members of your family. If your depression is severe or needs a specialised type of treatment, it might be necessary to come into hospital. This is only needed for about one in every 100 people with depression.
What will happen if I dont get any treatment?
Although 4 out of 5 people get better in time, this still leaves 1 in 5 who are still depressed two years later. As yet, we can't accurately predict who will get better and who will not. Even if you get better eventually, the experience can be so unpleasant that it is worth trying to shorten the time you are depressed. Moreover, if you have a first episode of depression, you have a roughly 50:50 chance of having another one. A small number of people with depression will eventually commit suicide.

Taking up some of the suggestions in this leaflet may shorten a period of depression. If you can overcome it by yourself, then that will give you a feeling of achievement and confidence to tackle such feelings again if you feel low in the future. However, if the depression is severe or goes on for a long time, it may stop you from being able to work and enjoy life.
How can I help someone who is depressed?
Be a good listener. This can be harder than it sounds. You may have to hear the same thing over and over again. It's usually best not to offer advice unless it's asked for, even if the answer seems perfectly clear to you.

Sometimes, the depression may be brought on by an identifiable problem. If so, you may be able to help the person find a solution or at least a way of tackling the difficulty.

It's helpful just to spend time with someone who is depressed. You can encourage them, help them to talk, and help them to keep going with some of the things they normally do.

Someone who is depressed will find it hard to believe that they can ever get better. You can reassure them that they will get better, but you may have to repeat this over and over again.

Make sure that they are buying enough food and eating enough.

Help them to stay away from alcohol.

If they are getting worse, and start to talk of not wanting to live, or even hinting at harming themselves, take them seriously. Make sure that they tell their doctor.

Try to help them to accept the treatment. Don't discourage them from taking medication, or seeing a counsellor or psychotherapist. If you have worries about the treatment, then you may be able to discuss them first with the doctor.
Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com

First Aid KIt

Dear friends,

We all suffer from major or minor injuries and illness in our daily life. We adjust and take care of them very well in our routines life .Whenever we are out on journey or trek, smaller problems can create big obstacles .When small children at house develop minor injuries, a small first aid box can help to cure 90% of problems.

Prevention is better than cure

Is an old and fruitful saying. Though we can not eliminate problems, we can prevent most of them with the help of simple tips.

Take water with you or drink only purified water.
Try to eat hot or fried food as frying kills germs.
Eat at known or quality hotels.
Eat at regular intervals instead of only having food only at lunch and dinner.
Prefer vegetarian food.
Always carry a first aid kit.
Use sports shoes for travel.
Sit on the left side of vehicle as right side is usually damaged in accidents.

First aid Kit

Band aid –For minor injuries eg. Scratch.
Dettol/savlon -- To clean wounds and apply band aid or other bandages.
Injection TT (Tetanus Toxid) -- Usually all of us take injection TT in our childhood .The usual course is one injection stat and than next one in six month and than one every ten years.
Betadine Ointment – To cover the wound before bandage.
Cotton Roll – To clean the wound secretions
Gauge piece – To apply on wound with Betadine Ointment.
Cotton Bandage – To tie the gauge piece at place.
Crape Bandage – To support swelled joint or fracture in maximum comfortable position with hard support (e.g. stick)
Chlorine water disinfectant solution -- To neutralize the drinking water
Tablet Lomofen – To stop watery loose motions, 1 tablet should be taken maximum 2 tablets can be taken in gap of 2 hours
Tablet Avil – For itching and allergic reactions
Tablet Crocin – For headache and minor fatigue
Tablet Norflox TZ – For pain in abdomen and diarrhea
Tablet Voveran (25) – For severe pain
ORS packet – For loose motions, vomiting and fatigue after long workout
Glucose powder – For fatigue after long workout
Tourniquete (Nylon rope) – Usually any rope can be used for stopping of bleeding or after snake bite

Simple problems & treatments

1. Small scratch – Clean with dettol and apply band-aid.
2. Cut or medium size wound – Clean with dettol, apply betadine ointment on gauge piece and tie with cotton bandage. See a doctor.
3. Large wound – Stop bleeding with gauge piece, apply Tourniquete if necessary and see a doctor immediately.
4. Loose motions – Take lot of ORS and Tablet Lomofen, repeat Tablet Lomofen only once and see a doctor.
5. Fever & headache – Take Tablet crocin, if no improvement in half hour, see a doctor.
6. Vomiting – Take lot of ORS, if no response, take Tablet Dompan and see a doctor
7. Fracture or joint swelling – Support the area in maximum natural and comfortable position with hard structures like stick and crape or cotton bandage. Do not massage or apply any ointment. See a doctor immediately.
8. Snake bite – Apply Tourniquete above the snake bite, minimize the movements of the patient. See a doctor immediately.
9. Animal bite (e.g. Dog bite) – Clean the area with dettol. Stop the bleeding, see a doctor.
10. Sting bite or Allergy or Itching – Clean the area with dettol and take Tablet Avil. See a doctor.



Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com

Coping With Trauma-dealing with stress

How to cope after a traumatic event

Sudden illness, an accident or an assault - these are all traumatic experiences which can upset and distress us. They arouse powerful and disturbing feelings in us,which usually settle in time without any professional help.

you have been through a traumatic experience and want to understand more about how you are feeling.
you know someone who has been through a traumatic experience, and want to get a better idea of how they might be feeling.

It describes the kind of feelings that people have after a trauma, what to expect as time goes on, and mentions some ways of coping and coming to terms with what has happened.

What happens immediately after a trauma?
Shock - you feel:

stunned or dazed or numb
cut off from your feelings, or from what is going on around you.

Denial - you can't accept that it has happened - so you behave as though it hasn't. Other people may think that you are being strong, or that you don't care about what has happened.

Over several hours or days, the feelings of shock gradually fade and other thoughts and feelings take their place.

What happens next?
People react differently and take different amounts of time to come to terms with what has happened. Even so, you may be surprised by the strength of your feelings - you may feel:

Frightened …. that the same thing will happen again, or that you might lose control of your feelings and break down.

Helpless …. that something really bad happened and you could do nothing about it. You feel helpless, vulnerable and overwhelmed.

Angry …. about what has happened and with whoever was responsible.

Guilty ….. that you have survived when others have suffered or died. You may feel that you could have done something to prevent it.

Sad …. particularly if people were injured or killed, especially someone you knew.

Ashamed or embarrassed …. that you have these strong feelings you can't control, especially if you need others to support you.

Relieved …. that the danger is over and that the danger has gone.

Hopeful …. that your life will return to normal. People can start to feel more positive about things quite soon after a trauma.

What else might I notice?
Strong feelings affect your physical health. In the weeks after a trauma, you may notice:

sleeplessness
tiredness
dreams and nightmares
poor concentration
memory problems
difficulty thinking clearly
headaches
changes in appetite
changes in sex-drive or libido
aches and pains
heart beating faster

What should I do?
Give yourself timeIt takes time - weeks or months - to accept what has happened and to learn to live with it. You may need to grieve for what (or who) you have lost.

Find out what happenedIt is better to face the reality of what happened rather than wondering about what might have happened.

Be involved with other survivorsIf you go to funerals or memorial services, this may help you to come to terms with what has happened. It can help to spend time with others who have been through the same experience as you.

Ask for supportIt can be a relief to talk about what happened. You may need to ask your friends and family for the time to do this - at first they will probably not know what to say or do.

Take some time for yourselfAt times you may want to be alone or just with those close to you.

Talk it overBit by bit, let yourself think about the trauma and talk about it with others. Don't worry if you cry when you talk, it's natural and usually helpful. Take things at a pace that you feel comfortable with.

Get into a routineEven if you don't feel much like eating, try to have regular meals and to eat a balanced diet. Taking some exercise can help - but start gently.

Do some "normal" things with other peopleSometimes you will want to be with other people, but not to talk about what has happened. This can also be part of the healing process.

Take careAfter a trauma, people are more likely to have accidents. Be careful around the home and when you are driving.

What should I NOT do?
Don't bottle up your feelingsStrong feelings are natural. Don't feel embarrassed about them. Bottling them up can make you feel worse and can damage your health. Let yourself talk about what has happened and how you feel, and don't worry if you cry.

Don't take on too muchBeing active can take your mind off what has happened, but you need time to think to go over what happened so you can come to terms with it. Take some time to get back to your old routine.

Don't drink or use drugsAlcohol or drugs can blot out painful memories for a while, but they will stop you from coming to terms with what has happened. They can also cause depression and other health problems.

Don't make any major life changesTry to put off any big decisions. Your judgement may not be at its best and you may make choices you later regret. Take advice from people you trust.

When should I get professional help?
Family and friends will probably be able to see you through this difficult time. However, you may need to see a professional if your feelings are too much for you, or go on for too long. You should probably ask your GP for help if:

you have no one to share your feelings with
you can't handle your feelings and feel overwhelmed by sadness, anxiety, or
nervousness
you feel that you are not returning to normal after six weeks
you have nightmares and cannot sleep
you are getting on badly with those close to you
you stay away from other people more and more
your work is suffering
those around you suggest you seek help
you have accidents
you are drinking or smoking too much, or using drugs to cope with your feelings.

What professional help is available?
Your doctor might suggest that you talk with someone who specialises in helping people cope with traumas. They will usually use a talking treatment, such as counselling or psychotherapy. For example, a talking treatment called cognitive-behavioural therapy has been shown to be helpful.

You may find that there is a support group for people who have been through a similar trauma to yourself. It can be helpful to hear that others have had similar feelings and experiences.

Can my doctor prescribe any medication to help me cope?
Medication can sometimes be helpful following a trauma, but it is still important to see your doctor regularly to check how you are doing.

TranquillisersThere are drugs that can help to reduce the anxiety that can follow a trauma. They can also help you to get off to sleep.
In the short term tranquillisers can help you to feel less anxious and to sleep. However, if they are used for longer than a couple of weeks:

Your body gets used to their effect and they stop working
You have to take more and more to get the same effect
You may get addicted to them

AntidepressantsYou can become ill with depression following a trauma. Depression is different form normal sadness - it is worse, it affects your physical health and it goes on for longer. Depression can be treated with either antidepressant medication, or with talking treatments such as counselling or psychotherapy.


Dr. Dhananjay Gambhire.
MD. DPM.
Consultant Psychiatrist.
Mob no. 9323187784.
E.Mail-dhananjayg@gmail.com