India Today's - Guide To Mental Fitness


Until we enter a 
psychiatrist's chamber to seek help-either for ourselves or for our loved ones-it's difficult to grasp mental illnesses, forget understand their pain. They stride that shadowy zone in our lives that we'd rather not acknowledge or encounter. 

However, they are real, cause disruption and sometimes death. They are also widespread and how: almost 40% of all patients who seek care from general practitioners are in need of some kind of mental help.

What's startling is how women are sucked in a vortex of mental pain. Women bear separation from their families after marriage and often start their married lives under the shadow of difficult in-laws. In more empowered settings, the multiple roles of a woman make demands on her that can take a toll. 

Biological factors such as pre-menstrual or post-partum changes, menopause or even thyroidmalfunction, also cause mental disturbances.

The good news is that with advances in neurobiology and genetics we understand mental conditions much better today and there are newer therapies and treatments for each. It is, however, important for women to consult their doctors before planning a pregnancy or if they conceive accidentally.

While it is common for most of us to go through occasional lows and phases of sadness, these feelings are usually fleeting and pass off within a couple of days. However, when such a state of mind persists beyond two weeks or more, and starts interfering with the normal functioning of the person, it gets diagnosed as clinical depression, fast emerging as urban India's number one "silent killer", according to psychiatrists. Known to result from a combination of genetic, biochemical, environmental and psychological factors that cause parts of the brain responsible for regulating mood, thinking, sleep, appetite and behaviour to function abnormally, depression is more common among women than men. A WHO study reveals that every one out of four women suffer from depression. In most cases, however, the seed of depression is sown way back in childhood or adolescence in abuse in some other form Xemotional, physical or sexual, which manifests itself as depression in later years.
Some experience persistent anxiety or empty feelings, irritability, hopelessness, a feeling of guilt, worthlessness or helplessness, over a period of time that show up in symptoms like: Loss of interest in all pleasurable activities including sex, Fatigue and decreased energy, Difficulty in concentrating, remembering details and making decisions, Insomnia or excessive sleeping, Overeating or loss of appetite, Suicidal thoughts

It's time to see a doctor when at least two or three of the above mentioned symptoms last longer than two weeks. Unlike common perception, even the most severe cases of depression are actually treatable with medication and psychotherapy, experts assure.
One National Institute of Mental Health, US, study examining depression treatment among adults found that patients who responded to initial medication and psychotherapy were less likely to have recurring depression if they continued their combination treatment for at least two years. However, what is crucial in the course of this treatment is to see your doctor as your best friend and hide nothing from him/her.
Psychotherapy/Talk therapy
This is the best option for those with moderate depression. While some regimens are short (two to five months), most require more time depending on the severity of the case (an average of six years). Experts say two types of psychotherapies-cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) that inculcate new ways of thinking and behaviour, enabling one to feel better about oneself and increasing self-esteem are most effective. However, while psychotherapy works best for those with mild or moderate depression, for those with more severe symptoms, medication may be required alongside.
Prescribed medications in the form of anti-depressants work best and need to be taken for at least three to four weeks before their effects show. This apart, it is also important to be on medication for the time specified by the doctor, in order to prevent a relapse.

While an episode of major depression may occur only once in a person's lifetime, it stands the risk of recurring throughout a person's life in various phases. Hence prevention and medication is key. Besides, a constant tendency to harm oneself, skip medicines, impulsive and irritable behaviour are common.

Anxiety & Stress
A looming deadline, an important client meeting, a wedding in the family and similar instances causes all of us to overwork our brain cells causing anxiety and stress. While a bit of both is said to boost performance, some go through the day filled with exaggerated worry and tension. Such people constantly anticipate disaster and are overly concerned about health issues, money, family problems or difficulties at work, a condition which experts call anxiety disorder, often translating into stress.
Regarded the commonest yet most ignored of mental health issues, experts describe anxiety - the pathological counterpart of normal fear, manifest by disturbances of mood, of thinking, behaviour and physiological activity, wherein a person refuses to see the positives with a natural inclination for the negative. The likelihood of developing anxiety induced stress is linked to a combination of life experiences, psychological traits and genetic factors.
Conditions of anxiety and stress are associated with physical and psychological symptoms such as:, Palpitations, Sweating, Restlesness, Dryness of mouth, Negative thoughts, Startled responses , Trembling, Shortness of breath, Choking sensations, Chest pain, Nausea, Dizziness, Hot flashesIt is also important to rule out co- existing medical conditions such as thyroid problems and diabetes which may bring about similiar symptoms. Experts list the following three as the commonest forms of anxiety and stress disorders:

The commonest cause of all anxiety disorders that easily translates into stress, social phobia or social anxiety disorder is diagnosed when people become overwhelmingly anxious and excessively self-conscious in everyday social situations. Such people have an intense and chronic fear of being judged or watched by others and of doing things that will embarrass them. This fear often becomes so severe that it starts interfering with everyday interactions.Generalised Anxiety DisordersOne is diagnosed with GAD when one worries excessively about a variety of simple everyday problems such as the fuse blowing off, the maid not turning up, weather conditions and so on for at least six months. Similarly, they also anticipate the worst in every situation and are filled with negative thoughts. Such people are usually unable to get rid of their concerns, can't relax and have difficulty concentrating.

Panic Attacks
Usually associated with chest pain and shortness of breath, such attacks are sudden and can last up to 30 minutes, wherein people report a fear of dying or a loss of control over emotions and behaviour.

Considering those who suffer from anxiety and stress disorders are often unable to understand the nature and extent of their problem, family and friends play a crucial role in persuading victims to seek medical help. Like depression, the commonest forms of treatment include:
Counselling and Psychotherapy
Psychotherapy works best for those suffering from stress and anxiety disorders where the therapist uses certain words to make the person aware of the positives enabling him/her to take in the opportunities and directly address the causes of anxiety. Although long term, this is often considered the best way to treat anxiety disorders.
In cases of panic attacks and more severe disorders, a combination of medication and psychotherapy works best, either combined or in sequence.
Those suffering from anxiety and stress have a tendency to break down frequently and tend to be pre-occupied with themselves

Bipolar Disorder
Earlier called manic-depressive illness, this brain disorder causes unusual shifts in mood, energy and ability to function. Bipolar patients experience extreme mood swings across a spectrum, from depression and sadness to elation and excitement (mania).
These are recurrent and can be mild to severe, rapid or gradual. BD can begin in adolescence or early adulthood and continue lifelong. Untreated, it can damage relationships, lead to poor job or school performance and even suicide. However, with proper, lifelong treatment patients lead full, productive and creative lives. BD tends to run in families and researchers have been trying to identify the specific genes responsible for it. However, studies of identical twins indicate that genes as well as other triggers like stress, disturbed sleep, alcohol/drug use or negative life events play a part. Diagnosis is made on the basis of symptoms and family history.
Mania includes periods of:, Increased energy, activity, restlessness, racing thoughts and rapid talking, Excessive high or euphoric feelings, Extreme irritability and distractibility, Reduced need for sleep, Unrealistic beliefs in ones abilities and powers, Uncharacteristically poor judgment, Increased sexual drive, Abuse of drugs, particularly cocine, alcohol and sleeping medications, Provocative, intrusive, or aggressive behaviour, Denial that anything is wrong
Depression include discrete periods of: Sad, anxious or empty moods, Guilt, hopelessness or pessimism, Loss of interest or pleasure in ordinary activities, including sex, Decreased energy, fatigue, Difficulty concentrating, remembering, making decisions, Restlessness or irritability, Sleep disturbance, Loss of appetite and weight, or weight gain, Chronic pain or other persistent bodily symptoms not caused by physical disease, Thoughts of death or suicide; suicide attempts

Many patients realise they have a problem during depressive states but cannot recognise or remember manic states. The family usually seeks help.

A combination of family-focussed therapy and medication can reduce symptoms and delay relapses. Therapy, along with mood elevators helps during depressed states. However, medication is the standard for manic cycles. Because BD is a recurrent illness, longterm preventive treatment is essential. Continuous treatment is best. But even with no breaks in medication, mood changes can occur and must be reported to the doctor. Patient-family-psychiatrist liaison, with honest, open communication is critical.
Mood stabilisers are the mainstay of treatment. Usually prescribed after professional psychiatric assessment, they help control, prevent and reduce the severity of episodes. Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression. Alongside, psychotherapy is helpful for both the patient and the family. Regulating sleep, avoiding alcohol/drug abuse and healthy lifestyle counselling can show great results. Major life decisions should be avoided during extreme states.

A 2007 UK study shows that bipolar patients with a family history of suicide are three times more likely to attempt suicide. Impulsiveness, provocation, irritability, drug/alcohol use, ideas of hopelessness/guilt, social isolation can be risk factors. Side effects of meds, if experienced, should be reported to the doctor, so that they can be modified to suit the patient's needs and tolerability. Medicines should not be started, stopped or modified without psychiatric consultation. Regular reviews with the doctor are important. 

It's the feeling of being wronged, offended or denied and the response to undo that injustice. While most of us feel a fairdegree of it in our day-to-day lives (which experts say is also important for our survival), anger can become a big issue beyond a point.Intense, persisting fits of anger can become a problem for our well-being.
There are two forms of anger-episodic and dispositional-the first one in reaction to specific triggers, the second which has to do with character traits of a person. An angry person may lose their objectivity, empathy, prudence or thoughtfulness and may cause harm to others. Anger when it turns into rage can break down relationships, end up in a job loss, cause physical harm and trauma.
Many people who have an anger problem recognise it, tend to justify it, but that does not help them cope better. It could even be a manifestation of an underlying psychiatric disorder that could benefit from medication under proper psychiatric supervision. Help is available in the form of psychological therapeutic techniques and exercises.
Cognitive behaviour therapy and dialectical behaviour therapies are commonly used and work on behaviour and communication, identifies the basis of anger and encourages the patient to take responsibility for actions.
Self examination and the willingness to asses oneself honestly are built into the therapies. Patients are also encouraged to practise deep breathing and meditation as means to relax.

FEEL FREE to contact me on the above or any other mood swings, sleep, memory, thoughts, stress or sexual health related issues. -

Dr.Hemant Mittal  (MBBS, PG.DPM, M.D.(Mind Mantra Wellness Concepts - Mumbai))
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WELLNESS CLINIC - Next to Seawood Station (east), Navi Mumbai, Mumbai (India)
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