Depression Tests Suggest Near To Or Sever Depression. Answered Questions Wrong? Electing ECT Wise?

Posted on Sat, 23 Jun 2012

Question: I have taken many depression tests lately and most suggest that I am near to or on Sever Depression and need to seek Psychiatric help. I wonder whether I have answered the questions wrongly. It asks about suicide. I am 74 and if I lost my wife, being resourceful I have had to answer positively. Questions about crying, whenever I get reminded about history, mine or otherpeople I get very emotional and this happens often, so I have had to say I cry a lot. Whenever I think about what I may have done in history, yes I feel guilty and derserve to be punished. Have I misunderstood the questions or should I really seek help. If I have to seek help and they find that I am a depressive will I be able to elect my treatment. i.e. could I refuse drugs and elect for ECT. Supposing this happened and I signed my acceptence of ECT would that mean it must go ahead or can I change my mind. I feel that it could be feerful and I would prefer that I could not change my mind at the last minute so as to speak.

Answered by Dr. Susanta Padhy (16 hours later)

Hi,

Thanks for the query.

I will be able to identify your problem better if you can respond to the following:

1. When did you lose your wife?

2. How is your social support since then?

3. Do you have any past history of depression or anxiety in your life time?

4. Do you have any such (depression) family history?

5. Your current status of prostate and the further plans of its management?

6. What type of personality do you have?

7. Do you currently have sleep disturbance, loss of interest in previously pleasurable activities, low confidence, negativity about your thought process, memory problem, attention and concentration problems?

8. What tests did you undergo for depression?

I will be in a better position to answer whether are not you have depression / pseudodementia / dementia / complicated grief or if you are normal. All these are possibilities here.

And regarding depression, these days depression is very well treatable with medications. Majority, practically don’t need Electro Convulsive Therapy (ECT). If the depression is mild, it can be treated with "counselling" without medication. For moderate to severe depression, usually medications are very helpful.

Antidepressant medications however need to be chosen in the context of medical or surgical history of the individual.

Hope I answered your query.

Awaiting your reply.

Wish you good luck and thank you once again.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Susanta Padhy (2 hours later)

\in answer to your queries{-
(1) She is still alive but I would be devastated to lose her.
(2) N/A
(3) No, but I sought psychiatric advise in my youth
(4) My granfather died of Melancola. (I think its spelt wrongly)
(5) All fine now excepting that I wear diapers 24/7
(7) I sleep for very long periods, I've lost interest in golf and my property in Spain.
I do have a memory problem and I find it very difficult to read and concentrate
(8) Various test on the internet
I hope you can now resolve my queries

Answered by Dr. Susanta Padhy (1 hour later)

Thank you for the answers

I am really sorry for the misinterpretation

So, obviously complicated grief is not a possibility

Sleep disturbances (more or less ), decreased attention and concentration , loss of interest, fear, apprehension, anxiety, subtle memory problem (like day to day forgettfullness, forgetting trivial issues )all are symptoms of depression.

memory disturbances in the setting of depression is called as pseudodementia, means, actually no dementia is there, but symptoms mimic that of dementia)

Memory impairment can also occur in Dementia. But here lack of memory to even important and significant events, situations, wealth etc. Here patient does not report about his memory impairment but on memory tests he is not able perform.

whereas, in Pseudodementia, client will have normal or near-normal memory on testing, but he will complain of memory loss disproportionately.

Other features of dementia are language disturbances, impaired judgement, loss of motor skills, misrecognition etc with progressive worsening of memory. In your case it does not seem to be dementia, but because Your current age of 74, and you have heart problems one need to rule out dementia neurology / psychiatry consultation.

In addition, to inform you, not to confuse you, often depression can be an initial presentation of dementia.

If it is depression, treatment possibilities I have discussed in my previous answer.
Psychiatrists job is to inform you not to force you the tratment. Selecting the treatment option is entirely upto you and your family.

However, if it is dementia, then it need to be subtyped and treated accordingly, by a neurology consultation

Overall, it is wise to take neurology and psychiatric consultation, particularly keeping your age, heart problem, prostate problem, family history and past history of psychiatric ailments.

Hope, I answered your query

I am available for further discussion

Good luck

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Susanta Padhy (1 hour later)

Thank you for your response. I now realise that I have not told all. Both of my Grandfathers died as in patients in Mental Hospitals. When I sought advice they wanted me also to become an in patient at a Victorian Mental Institution. When they saw my fear they fortunately changed their minds. Further to the question regarding my wife, if anything did happen and I was left alone, I would not wish to continue life. I would seek some remedy. I don't know whether that modifies your views. Regards XXXXXXX Docker

Answered by Dr. Susanta Padhy (15 hours later)

Hi and Thank you XXXXXXX Docker for your seeking further clarifications,

Opinion would remain more or less same, and at the same time I must thank you and proud of you for acknowledging that you need specialty consultation.

In fact you must seek Psychiatric consultation on priority basis and try to comply their advice after clearly discussing everything. Also no harm in taking Neurology consultation.

I am sure you will be benefited with the consultation.

Wish you all the happiness and good health.

Thank you

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Susanta Padhy (5 hours later)

Thank you for your reply. You have been very gentle with me. I was going to ask you how urgent it is for me to be face to face with a Psychiatrist but you have now answered that question. All the tests that I had taken showed severe depression. I thought that you were playing that down. I now realise and thank you for handling it this way. I feel that once I have been put in front of a Psychiatrist he will be very exacting. I can handle that and I hope that I have read the seriousness of my situation. I must re ask the question of you knowing my ancestry and problems, Do you think I will have to spend some time in a Psychiatric ward during the rest of my life?. I need to prepare my mind. Thank you so much

Answered by Dr. Susanta Padhy (1 hour later)

Hi,

Thanks for writing back.

Answering your question directly, I dont think that you need hospitalization for rest of your life, but again it depends on final assessment of your psychiatrist. And I am sure their assessment would be evidence based.

To add, there are few conditions that need hospitalization for life long, moreover they are the options, after all available treatment options failed. In your case, think not to many treatment options have been tried, as of today.

Thank you very much and wish you a speedy recovery

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Raju A.T