What Is The Cause And Treatment For Depression

Posted on Sat, 22 Mar 2014

Question: I am in the pursuit of proving how extreme my PTSD is at this point in my life, I am trying to get my SSDI case won. At this point I am completely fearful of driving and large crowds at malls grocery stores as well as getting into a car. Noises and environmental things really gives me major anxiety. A little more about me, I have been a mother of 6 children, and work for approx. 18 years since my youngest was 2 yrs old. I have had 5 rapes in my lifetime, and seen many counselors, psychologists over the years. I always ended up putting on a brave face and getting done what needed to be done. In 2008 (I had no more control of it) my body and mind totally gave up and fell apart on me and I was sleeping 22 hrs a day for 2 years. I had been diagnosed by Social Security doctor as well as other doctors in my past (seems that I never really got healing though). My eating habits tend to reflect my depression (I lose weight quickly and that depresses me further). I have loss of vision at times, brain fog,confusion, and short term memory loss. I am not sure, but I was under the impression that I would have a response in minutes?? Its been nearly an hour?

Answered by Dr. Srikanth Reddy (6 hours later)

Brief Answer: Clarifications Detailed Answer: Hello, Thanks for using health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. However I would require a couple of more details to help you in answering your query in a better justified way. 1. Is there any history of substance use? 2. Are you having depressive symptoms weight loss excess sleep at present? 3. Are you currently on any treament? Hope to hear from you at your earliest convenience. Regards and wish you good health, Dr. Srikanth Reddy MD Neuro-Psychiatrist and Sexologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Srikanth Reddy (2 hours later)

1. No 2.Yes 3. No

Answered by Dr. Srikanth Reddy (12 minutes later)

Brief Answer: Treating depression is a must Detailed Answer: Hello Thanks for the follow-up details From what you have stated it is quite clear that you are having a depressive episode. Depression can occur with regular stress and it can also occur biologically without any stress as well. And in your case, you have got plenty of traumatic moments in your life and that certainly predisposes you to depression. From what you have stated, you certainly have a very severe depression. You need proper treatment for the same. There are various effective therapies for depression like fluoxetine, venlafaxine, bupropion, mirtazapine or escitalopram and they are all very effective and mostly safe. Most of them are equally effective and my favourite choice among them is fluoxetine. You may also require some benzodiazepines like clonazepam or lorazepam for a short period like 2-3 weeks to reduce the anxiety and help with your sleep. If you are averse to the drug therapies then there is also an option of cognitive behavioural therapy. This therapy is taken by either a psychologist or a psychiatrist in which the therapist identifies impaired cognitions (Thoughts) and try to correct them. They are 15-20 min weekly session and there should be around 8-10 sessions to help you with your illness. It may take a few weeks to improve and you need to see your psychiatrist who can start you on a combination of these therapies. Not taking treatment is not going to help you but infact going to make things worse. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Srikanth Reddy (2 hours later)

I m sorry, I believe there may have been some confusion. I thought you had the ability to view the listed medications and health issues as well as Allergies. So, that said, are you able better to give me a more thorough evaluation, direction, and potential diagnosis as well as prognosis (this has been going on for years, and cant seem to get anything "clearly put"). 1) Current Medications; Xanax (@bedtime 0.25mg), Cymbalta (60 mg am), Hydrocodone (every 4 hrs), Allergy meds, Vit E, Multi Vit, Calcium, Omeprozole, Phenegran, 2) Diagnosis's of; Anxiety Disorder, PTSD, Fibromyalgia (SEVERE body and joint PAIN), CFS, Migraines everyday of my life.,Hiatal Hernia, Irritable Bowel and Bladder issues. Anaphylactic, Shingles. 3) I AM under a Doctors care to "manage" Fibromyalgia "symptoms" 4) Currently NOT under a Psycologist or Psyhcologist. Been through ALOT of counselors and therapist in the past years prior to 2007. 5) HAVE had a diagnosis in the past that states I am NOT Bipolar. 6)Allergies to ; Penicillin, Ibuprofen Thank you, Sincerely, L. XXXXXXX

Answered by Dr. Srikanth Reddy (4 hours later)

Brief Answer: Severe Depressive Episode Detailed Answer: Hello Thanks for the follow-up details and follow-up question. I did have knowledge of medical history but did not have information about your current medications. The diagnosis that seems most appropriate to explain your history findings is: Severe Depressive Episode without Psychotic Symptoms with Melancholia (Specifier) as per the Diagnostic and Statistical Manual of Mental Health Disorder IV edition Text Revision. The anxiety symptoms, somatic symptoms and cognitive symptoms are probably part of the first diagnosis. Obviously then there are certain medical diagnoses of Irritable bowel syndrome, hiatus hernia, anaphylaxis, shingles are all independent medical diagnoses not related to your psychiatric disorders. Coming to the treatment part I understand that You are on cymbalta 60 mg which is a good drug for somatic symptoms and depression as well but unfortunately not the first line for depression. If such a patient would have come to my clinic I would have simply added venlafaxine (Effexor) 37.5 mg at night and then gradually increase the total dosage of venlafaxine to 75mg then to 15 mg and then to 225 mg in divided doses every week. Acting on the serotonine and nor-adrenaline, this drug has been very effective for such illnesses having depressive, anxiety and cognitive symptoms. xanax can stay as this is in a low dose and will take care of the anxiety part symptomatically. Further considering the fact that you have plenty of ongoing stress and too many significant stress in the past then psychotherapy is a must. For such conditions, cognitive behavioural therapy is always a good option for such illness as I had said before. Directions: You need to meet your psychiatrist and probably discuss with his the drug changes that I have suggested and also request him to refer you to one of the good cognitive behavioural therapist. Evaluation: Its better to get a thyroid levels done as the hypothyroid state can lead to a resistant depression. Prognosis: Considering the fact that the illness has persisted for long and there are lot many ongoing stressors, the prognosis is not very encouraging. But you certainly should go for the treatment. Even if the symptoms come down, the qulaity of life will improve a lot. Regarding the disability benefits, you need to discuss with your disability lawyer. you are suffering from significant medical illnesses and the disability is certainly effecting your daily life. You have enough evidence to support the various illnesses. Probably your lawyer may help you to get the necessary benefits. Hope this helps you, Kind regards Dr. Srikanth Reddy MD

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar