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Depression is most commonly used and misunderstood term. Every body has heard this word but nobody is aware what Depression exactly means and how one feels when he/she is depressed, or is aware how a loved one of his feels when depressed. The reason is simple- extreme lack of awareness about Psychiatric illnesses among common people and even doctors because Psychiatry covers very less portion of the medical curricula. The awareness is so less that a person who himself is suffering from depression does not knows what exactly has happened to him and where to go for treatment that has happened to him.

SELF DIAGNOSIS
I shall say that in today?s era every person should be aware of the common psychiatric disorders and should know how to self diagnose them. I shall mention here the major signs and symptoms of depression so that even a layman can diagnose himself as well as others of the world s commonest illness- Depression. To diagnose depression there should be presence of the following signs and symptoms for a period of at least 2 weeks. The intensity of depression varies from mild to severe depending on the level it affects your social and occupational life.

             Depression consists of persistent sadness of mood i.e. not feeling happy [there can be or can not be some reason behind it]. He is unable to cheer up even in happy circumstances or in situations he use to feel happy before. He feels gloomy, talks less and there is no shine on his face or in eyes. He sits with a stooped posture and has a tense looking appearance.

The patient looses interest in the pleasure activities, in which he had interest before like going out with friends, watching movies, TV, sexual activities or sitting among the family members and talking leisurely. He even looses interest in the routine work /activities of life and like to remain aloof or away in his own. He starts avoiding work and take frequent leaves.  He himself also feels dull and out of life but still does not know what has happened to him.

A depressed patient has recurrent body aches and pains and feels fatigued most of the time. He has a sense of general weakness and feels that now on working he gets tired easily than before. He also can?t work enthusiastically and at that fast pace as before. He for his weakness go on taking tonics / vitamin pills or anti-pain tablets but without any results. This weakness hampers even his day-to-day life        

The victim has a disturbed pattern of sleep; there is either a delay in sleep onset or repeated awakenings at night or early awakening in the morning. Patient although sleeps at night but in the morning does not feel like he has slept and is not fresh so he wants to remain lying on the bed. Some patients even show increase in sleep, they can sleep at any time in the day and has a feeling of lethargy during the whole day.

A depressed one also has less appetite, basically there is lost of interest in eating. Although he feels hungry but does not have the ?mood? to eat. He eats forcibly as the mealtime approaches. Thus patient looses considerable weight. Some of the patients feel relaxed on eating and thus eat more and gain weight.

The patient has difficulty in concentrating in his work/studies. He finds that the mind go on wandering here and there when he tries to concentrate. There are many useless thoughts in his mind and he finds it difficult to control them. The thoughts are either without any meaning i.e. are about one has done in the day passed or is going to do in the day to come or the are pessimistic, not pleasant and are disturbing.

A depressed patient also has weak memory and forgets most often like about the routine works /chores, he forgets even after placing the household articles here and there. Again search for memory enhancing drugs is there and that too without any results.

The depressed person gradually shows a progressive loss in his patience and start getting irritable very easily. He easily gets angry and abusive at minor conflicts or even in routine talks. He has no patience to discuss the matters with others and on doing so gets irritated. The person becomes very touchy and if some conflict occurs with anybody he is unable to forget about that thing and the situation go on coming to his mind repeatedly and he feels a lot of mental pain and discomfort. He some of the time gets very emotional and weeps

There is also a new development in the form of headache, which is dull [not sharp], of continuous type and the patient feels as if one tight band is tied all around his head. The head aches, mostly in the temples, behind the head, in the neck and up to lower back even. But the underlying cause of depression is not diagnosed and patient and the doctor go on treating it superficially in the form of neck ache and backache.

Some of the patients complain heaviness of head, mind going blank and say they have no thoughts in mind. So they speak very less and there is a long pause before they respond back, as they take time to think and collecting the ideas. These people also have extreme slowing of the body movements and thus walk and talk very slowly and at a very low volume. 

Patient of depression always has a low self-esteem. He loses confidence in himself and shows helplessness and inability in completing the jobs, which he use to do before. He feels he is not doing it right and there might be some mistake in it. On explaining he is unable to found any reason that why he is doubtful of his abilities now.

He grades himself inferior to others. One feels less attractive in himself, less appealing to others and does not talk much in a gathering/company of others, as he feels he will say something that others will not like He believes he cant succeed in competitions and can?t meet other challenges in life too. He treats himself a useless person and believes that he cannot do any thing, which can be productive for him and his family.

A depressed person has no interest in the sexual play and avoids it. Males develop either loss of erection or are unable to sustain in or premature ejaculation. Females give no response to her partner?s demands. Even if sexual contact takes place, it is without any pleasure. Thus the sexual life almost ends or becomes boring

He predicts a negative outcome of the future also and feels that nothing positive or good can happen to him now and in future. If he is facing a problem currently, he is not hopeful of getting it solved in the time to come. He even feel that there is no cure to his illness and does not go to the doctor for treatment or refuses to take the medicine.          

Suicidal tendency:  The patient start believing that there is no meaning left in the life now. It?s not worth living and the circumstances around him are so much worsened that its better he should end his life now and that is the only solution to everything. He would start planning how to end his life and soon the day comes when he tries to implement his ideas. If the patient is saved then there are chances that he can repeatedly do so. All such attempts are with planning and done whole-heartedly and most of times he makes it sure that he should die. In severely depressed cases even on willing the patient does have so much courage to fulfill his wish so in such cases the patient attempts suicide when he gains courage i.e. while he is under treatment. So one has to keep a close watch always.

PANIC ATTACKS /  ANXIETY

There is quiet an overlapping between anxiety and depression as most of patients with depression also star t suffering from anxiety symptoms or from full fledged panic attacks. The anxiety symptoms are very disturbing and sometimes the come sonly with them and is unaware of the underlying depression.

Symptoms  of panic attack which all of you can experience

• People with panic disorder have feelings of terror that strike suddenly and repeatedly with no pre warning. It cant be predicted when an attack will occur. One can be totally free from worry/tension, enjoying a party or working in office in his normal routine when a panic attack can strike. Once panic attack had occurred the person develops intense feeling of fearfulness, worrying when and where the next one will strike. 
• If you are having a panic attack, most likely your heart will beat faster and louder. You will start having a sense of fearfulness that u will die now or  will have loss of control . You may genuinely believe you ?re having heart attack or losing your mind, or are on the verge of death.
• You can feel sweating in hands and feet  [cold sweating],
• You may feel weak, faint, or dizzy. Or have light-headedness or feel u r floating in air.
• There is trembling in hands and legs and also there is dryness of mouth i.e. patient had repeated desire to take sips of water.
•  Your hands may tingle or feel numb, and you might feel a sense of face becoming hot or cold.
• You may have nausea, chest pain or difficulty in breathing or tightness in chest, and a sense of unreality [u may feel the atmosphere around has changed or u ur self has changed]
• Panic attacks can occur at any time, even during sleep.   An attack generally peaks within 10 minutes, but some symptoms may last upto 30-45 mins.
• Panic disorder is twice as common in women as in men. It most often begins during late adolescence or early adulthood. Risk of developing panic disorder appears to be inherited.
• For those who do have panic disorder, though, it ?s important to seek treatment. Untreated, the disorder can become very disabling.
• Many people with panic disorder visit the hospital emergency room repeatedly or see a number of doctors especially Heart Specialists before they obtain a correct diagnosis of anxiety disorder. Thus they spend lot of money energy without getting any relief. 
• Such people with panic disorder go for years without learning that they have a real, treatable illness.
• Panic disorder is often accompanied by other serious conditions such as depression, drug abuse, or alcoholism and may lead to a pattern of avoidance of places or situations where panic attacks have occurred. For example, if a panic attack strikes while you ?re riding in an elevator, you may develop a fear of elevators. If you start avoiding them, that could affect your choice of a job or apartment and greatly restrict other parts of your life.

IN SEVERE CASES OF DEPRESSION
When the severity of depression increases or when patient does not take treatment for long time or when he start using some drug [alcohol etc] along with, to get rid of his tension and sometimes even due to some unexplainable reason he develops disturbance in his thought process. He interprets the situations around him in a false manner and acts on them resulting in deranged behavior like=

1. He would start believing that there is somebody who will kill him, police or C.I.D people are after him and they are going to arrest him, so he tries to run here and there, remain fearful most of the time and tries to hide himself or commits suicide.
2. He would complain that other people talk about him or make passes at him or say bad words about him. In such cases the patient earn quarrels with others go on feeling bad and cries.
3. Some patients start believing that their spouse is unfaithful to them and had relations with other people, thus one beats his spouse most often, files the divorce etc. Patient according to his sad mood develops the idea that he is the worst person and had done lot of sins, which are unpardonable, and God should punish him.
4. He even hears voices when no source of noise is there or would hear somebody calling his name when nobody is around. In some cases patient may even land into a stage when he is unable to talk, or eat or move his body or respond to any change in his surroundings.

TREATMENT
      The purpose of the article is to create awareness among people about the most common illness in the World. If people can self diagnose the problem themselves, then in time they can save a lot of working hours and money, as it?s a very incapacitating illness. Thus they can also prevent the after effects of the illness.

HURDLES IN TREATMENT

There are some of the inborn beliefs in our society, which prevents most people to seek treatment, which are

1.People feel that it is only a temporary state of mind and will get cured of itself.

2 Patient thinks that his depression is due to various stresses in life and how can the doctor /medicines will treat him till his circumstances are not changed.

3. They do not know to go to which doctor and a psychiatrist is one who treats this illness.

4   less number of psychiatrists available 

5 People only know about a psychiatrist is that he is one who treats mad people and they know they are certainly not mad

6   Since the depressed patient has no hope of getting cured and always feel discouraged he has no motivation to take the treatment. 

7 Some people feel that they will be called weak by others if diagnosed to have depression,

8 The family members or friends also are unable to bring the patient for treatment to a Psychiatrist as they don?t know that it?s a illness and should be treated urgently.

HARMS OF DELAYING TREATMENT.

Depression if left untreated for long time leads to permanent destruction of neurons and decrease in neurotransmitters and a compensatory increase in their receptors in the brain, which results into

1. Depression becomes less responsive to treatment,
2. Even if treated, only partial cure is achieved
3. More amount of drugs or multiple drugs are required,
4. Depression takes more time in getting cured,
5. Severity increases with time
6. Thought disturbances mentioned above could take place,
7. Depression goes on recurring again and again even after once cured.
8. Patient can commit suicide during the illness;
9. Patient can land into the clutches of drugs [sleeping pills, alcohol, smoking etc] in an attempt to get rid of his mental discomfort.
10. The long time, which the patient had spent in suffering and incapacitation, is in bonus.

In nutshell self-diagnosis is best and earlier the diagnosis and treatment the better is the outcome.

WHEN SHOULD  I  CONSULT DOCTOR?

You need to see a doctor if you suffer from of these above mentioned symptoms, most of the time and most of the days continuously from last at least 2 to 3 weeks.

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