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Author: Michael G Rayel

Major Depression and It’s Serious Complications

When suffering from clinical depression, people have different ways of confronting it. Some acknowledge it, face it just like any problem, and seek help. Some ignore it as if it doesn’t exist. And others simply accept that it’s there but they don’t do anything about it. In fact, they don’t even ask for help. Those who ignore and don’t do anything run the risk of developing the serious complications of depression. Like any medical disorder, untreated clinical depression has its hazards. What are some of the complications of clinical depression? How serious are they? Suicidality Without treatment, some depressed...

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Major Depression and Manic-Depression – Any difference?

Countless number of patients and their family members have asked me about manic–depression and major depression. “Is there any difference?” “Are they one and the same?” “Is the treatment the same?” And so on. Each time I encounter a chorus of questions like these, I am enthused to provide answers. You know why? Because the difference between these two disorders is enormous. The difference does not lie on clinical presentation alone. The treatment of these two disorders is significantly distinct. Let me begin by describing major depression (officially called major depressive disorder). Major depression is a primary psychiatric disorder characterized by the presence of either a depressed mood or lack of interest to do usual activities occurring on a daily basis for at least two weeks. Just like other disorders, this illness has associated features such as impairment in energy, appetite, sleep, concentration, and desire to have sex. In addition, patients afflicted with this disorder also suffer from feelings of hopelessness and worthlessness. Tearfulness or crying episodes and irritability are not uncommon. If left untreated, patients get worse. They become socially withdrawn and can’t go to work. Moreover, about 15% of depressed patients become suicidal and occasionally, homicidal. Other patients develop psychosis—hearing voices (hallucinations) or having false beliefs (delusions) that people are out to get them. What about manic-depression or bipolar disorder? Manic-depression is a type of primary psychiatric...

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Depression: Why Don’t I Respond to Medications?

Maria has been feeling depressed for at least two and a half years. About three years ago, her husband of 20 years left her for another woman. Devastated, she became despondent and tearful almost daily. Eventually, her depression got worse associated with inability to function. Her appetite, energy, concentration, and sleep became impaired. She also felt hopeless and suicidal. Her psychiatrist put her on a starting dose of antidepressant. She responded initially but after a few days, she felt just like before taking the medication. For the past two years, Maria has tried four types of antidepressants. She has...

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How to Prevent Suicide

A British weapon’s inspector was found dead in the woods after he slashed his wrist. For the past few weeks, he was entangled with a controversy about the war in Iraq. On Monday, a Hyundai executive leaped to his death from the 12th floor. He was on trial for allegedly paying off North Korea $100 million to agree to a 2000 summit between North and South Korea. In both urban and rural areas, many more suicide cases do not go unnoticed. Through local papers and the town’s rumor mills, suicide becomes a sad tale and a mystery. Why would people kill themselves? Recent studies have shown the correlation between suicide and serotonin deficiency in the brain. Moreover, the presence of significant stress has far-reaching consequences especially if such stressor, such as legal entanglements, results in profound hopelessness and depression. Frequently, when there is no immediate resolution to the problem, suicide becomes an attractive escape. It then becomes obvious that suicide is not only a medical disorder but a psychosocial issue. It is more than just a manifestation of emotional distress. It is a complication of an unresolved state of affairs. There is no question that suicide is devastating to everyone. I have seen loved ones grapple with the pain of the loss and shame associated with the manner of death. Pain and grief among relatives persist for months despite...

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My Antidepressant Doesn’t Work. What Can My Psychiatrist Do?

Maria has been increasingly depressed for the past few years. She has tried at least four newer antidepressants but so far, she doesn’t seem to respond. Unable to work, she’s now feeling helpless and hopeless. Likewise, her family is discouraged. Frustrated and baffled by Maria’s lack of progress, the family doctor refers her to a psychiatrist. What can the psychiatrist do to help Maria? The psychiatrist has several options in dealing with a treatment-resistant or refractory depression. First, Maria’s psychiatrist can optimize the dose of her antidepressant. Maria has been taking low doses of antidepressants. In spite of her...

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