DEPRESSION

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 WHO theme in 2017 was "Lets talk Depression" and it is important to talk about stress. As stress can be one of the factors for developing depression, but this doesn’t hold good vice versa. What that means is depression is independent of stress and one the factors for developing depression but is an important one and can be easily treated.
 
What is stress?  Stress is a word used when people find it hard at particular task or circumstances. For some particular circumstances can be difficult and for other this can be a joyful experience. What this tells us Stress affects people differently and can also be noted as individual experiences of stress.
 
 
So actually what's the definition of stress is . Google gives a definition of a state of state of mental, emotional strain or tension arising from an adverse or demanding situation or circumstances.
 
Clinicians refers stress as any situations which tends to disturb the equilibrium between a living organism and its environment.
 
Psychologically Stress is explained using:
 
1) the psychological perception of pressure on one’s mind and body and
2) its response to it.
 
Sometimes we use stress interchangeably as situation or circumstances and as well as our bodily response when we are under stress. In this article also I will be using these words interchangeably based on the sentences and meaning.
 
 
Almost all of us handle the stress very well in a day today circumstances and to a particular task which we do almost daily or routinely. For example a Bank employee who is used to handling lot of people in his counter regularly may not find his job stressful but the same person when given more responsible job with more checks and balances may find his job very stressful. Similarly when a person is given multiple targets which can be impossible to reach or the outcome is undefined may find his job very stressful.
 
So when we understand that when there can be unexpected result for a particular action then we do start worrying or this can makes us anxious subsequently may lead to stress. However certain situations sometimes when we are aware of the expected results we do not worry much and can make us happy or rewarding as well.
 
Also we need to remember when we have some nagging problems or as clinicians call it as “sustained stress”, which are difficult to overcome or the response is varied or unknown, and then we'll end up sometimes in continuous dress which can also be called as Chronic Stress.
 
There is essentially two types of stress Acute stress, and Chronic stress and as the name suggest Acute stress are short lived stressors which can be easily overcome and chronic stress which are sustained stress and are continuous.
 
Let us understand how stress affects our body:
 
When we are under perceived stress, our brain ( especially from the Hypothalamus)  after the perceived stress, send signal to all over the body and especially to Suprarenal glands which is above our kidney to secretes stress hormones. There are many stress hormones however and all of them are not secreted there and some of them are catecholamines, cortisol's, thyroid hormones, gonadotropins  vasopressin etc. Of particular interest is the catecholamine’s and in this in particular is adrenaline the most important. When adrenaline is secreted after an perceived threat or stressful situation, leads to  increase heart rate and also  increase the blood supply to all over the body in anticipation to fight or flight. This system work out well in situations like in the battlefield or in hostile situation ( like in front of a venomous snake) and here we require a quick decision like either to fight the situation or run away from this situation. This work well in past  like in olden days where life threatening situation were much common or in our ancestors like primates and animal kingdom.
 
However in current modern situation where the threats have changed and so does our body reaction to these stimuli. Also we need to understand that stress response in males and females is also varied. And also the threat perception in modern world is different, however the response from our body remains the same.
 
When we are in acute stressful situations like life threatening situation the response generated is similar like either to fight the situation or running away from the situation. But sometimes our body reacts to just perception of threat and this awareness can make the situation worse.
 
For example a person having chest pain in the wrong side of body can make him think he is having an heart attacks and his body reacts to this perceived  mortal threat by increasing his adrenaline secretion in his body which  in turn leads to increased heart rate and unpleasant body experience due to increased blood supply to whole body. Sometimes this bodily experience itself can lead to increase anxiety and as clinicians commonly refer tp it as Panic attacks. This above can be called as acute stress response.
 
However long term Stress or chronic stress can have devastating effect on our body. These are mainly due to different hormones secreted mainly in our body such as Steroids (cortisols), thyroid hormones, prolactin, etc. The interplay of these hormones can lead to multiple health and psychiatric problems. Some of them are listed below
 
·         Anxiety or Tension
·         Depression
·         Stomach upset
·         Heart Disease including Hypertension
·         Sleep Problems
·         Diabetes
·         Memory and Concentration problems
·         Obesity etc.
 
What are the reasons for the above? as you might be aware, when during chronic stressors, our cortisol ( steroid)  levels increases leading to increased sugar and in long term increases the risk of developing Diabetes. Similarly interplay of various hormone level increases high blood pressure and cardiac disease.
 
In our brain Stress leads to havoc in our brain cells leading to cognitive disturbances which can represent as memory disturbances, sleep and Headache. For some, unfortunately stress can lead to neuron cell death called apoptosis and subsequent leading to cognitive disturbances which can become permanent. In some it can lead to chronic pain etc. In majority it can lead to various anxiety disorder and Depression. And Depression in turn worsens our stress response to anxiety provoking situations and in turn worsens various health indices and Depression itself. So it is important to understand depression and treat it.
 
Also sometimes stress can worsens our immunity response due to the high cortisol levels and in turn worsen the response to infection and in turn leading to frequent or repeated infections in some.
 
So as you can see Stress can be devastating to our body and the way we react to it makes all the differences
 
 
 
It is important to know that prevention is always better than cure and talking about it with your loved ones and perhaps or with clinician is important so that help can be provided.
 
First and the foremost is the understanding of the stress response and how it affects our body can be a game changer in defeating stress.
 
These are simple methods used to reduce stress in modern world.
 
1)      Maintaining Dairy:
 
Time management
For a profession and for all of us who are not professional but value time it is important to maintain a dairy. It is also important to what to include in the dairy. Two most important things to note is the time and the activity. Here time is very important as time management including the time we spend on mobile and Television needs to be included and the quantity of time spent on particular task. As we get used to maintain dairy we try to judiciously use time and in turn reduce the anxiety attached to it and hence the stress level
 
Activity record
Second most important is the activity to do or note and this can lessen our stress due to the fact that we may lessen our procrastination. Also important is to finish the activity in time bound manner to lessen our stress. We might be amazed when this type of task are taken up we might find sometimes time for our leisure activity which can help in reducing our stress.
 
Prioritize:
Prioritize the work in your calendar and note down the deadline and atleast write your tasks for one week in advance.
 
Simplify
Simplify your goals and also write why you have come to that conclusion. Also try to find pros and cons of your goal and its implication which can help you take proper decision and in turn lesson your burden and help in achieving your goal.
 
2)      Habits to avoid;
 
There are certain maladapative behavior and habits which we can be counterproductive and increases our stress response

a)      Alcohol:      Many believe small quantity of alcohol may be beneficial,, it may be so when the quantity is around 2 units per day or equivalent to 30-40ml of whisky. But many a times it doesn’t stop there and when we suffer from stress we tend to consume more, which worsen our stress response. Alcohol is known to be depressogenic and this means it can actually worsen your stress and depression. So the advise is to stop alcohol completely. In my practice I have also come across people stating that they take alcohol to help them in sleep due to stress. This is the worst form of self medication and this need to be avoided. Better to talk with family and if you find difficulty in leaving seek professional help.

b)      Avoid caffeine and other sugary brewages; This can affect your mood adversely and can make you grumpy when in stressful situation so avoid it.

c)      Smoking and other substance use: This also needs to be avoided for the same reason as above.

d)     Avoid technology: take some time off your mobile and your social media which is now adding to our increased stressful life situation.
 
 
3)      Setting Boundaries:
 
This is a must in the current fast phase of our life. We need to set boundaries about most of the day to day things and simply stretching ourselves to other causes will not help. Setting boundaries to yourself and others like for example switching your mobile phone off after 9 PM  or delegating certain task to your loved ones or children and expecting certain boundaries and space for your own thinking and planning.
 
4)      Developing problem solving skills:
 
This is the most important and difficult to learn. Some people take years to learn and are mostly not taught in schools and colleges.
The key here understands the problem without entrusting energy in solving problems. This is a highly skilled knowledge and one who masters it can help himself in overcoming stress and perhaps leads a successful career.
There are many methods to solve and develop the skills and one of the simplest is visualizing the problem and trying to find pros and cons of each solution you find.
 
5)      Relax
 
This is not about meditation but about taking a break from the stressful situation. Sometimes there may not be any way and sometimes taking a break can help us rejuvenate and fight for another day. This may sometimes may not solve problems, but this can sometimes help us find that there may not be any solution to their problems. But taking breaks can lead to understand that life moves on in spite of we not taking stress. Or it may help us in way that understand stress better and not worry too much about it.
 
6)      Open line of communication:
 
In your stressful life do not stop talking with your friends or closed ones may be your parents. Who might have different perspective of life and stress than you and talking it out with them may help. In stressful situation people avoid talking with their near ones and which is one of the commonest mistake people do and think the stress is unique for them. But talking with them may help and get  a novel understanding of their problems or solutions. So in time of stress the mantra is don’t stop talking or talk about it.
 
7)      Physical activity:
 
The better you are physically then more the chances of you managing the stressful situation better. Keep a regular exercise regimen like simple walking for an hour or jogging regularly  which can reduce the response of our body   to stress. This has shown in research that regular exercise can help develop good coping strategies and can lessen the stress response on our body.
 
8)      Meditation:
 
Simple regular meditation can help us overcome certain difficult situations or circumstances or may help us in problem solving. Regular mindfulness meditation or progressive muscle relaxation has found to be useful in research in reducing our stress response and also as preventive measures for depression.
               
9)      Do not hesitate to contact professionals
 
When things, in spite of our best effort. seems to be worsening our stressful condition, then perhaps its time to seek help from the professionals that means Psychiatrists. They can help you understand the stressful situation and perhaps look beyond the normal understanding of stress and help overcome the predicament. They can help you by using psychological means and many a times, medications may be required to help overcome the chronic stress. Medications sometimes can help person in fighting stressful situation and can also help overcome it and can also prevent him or her developing secondary consequences of chronic stress..

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