Suffering from depression? Have patience, it’s curable
Dr Shubh Mohan Singh and Dr Aditya Hegde
Meenakshi (name changed), a 55-year-old lady, was pleased after the marriage of her eldest son. Within a few weeks of the marriage, she noticed that her son and daughter-in-law did not get along well. They would argue about petty issues on a regular basis.

Cataract and Alzheimer’s disease: Research brings new hope
Dr R. Kumar
Old age is heralded by several signs and symptoms — graying of the hair, gray reflex in the eye due to cataract, prostate enlargement along with urinary problems, memory loss and cognitive defects like Alzheimer’s disease.



Suffering from depression? Have patience, it’s curable
Dr Shubh Mohan Singh and Dr Aditya Hegde

Meenakshi (name changed), a 55-year-old lady, was pleased after the marriage of her eldest son. Within a few weeks of the marriage, she noticed that her son and daughter-in-law did not get along well. They would argue about petty issues on a regular basis. Concerned over the future of their marriage, she tried to convince them to work out their differences, but to no avail. She started to remain sad and brood about the future of her son. Her interest in household affairs was noticeably less than before. She would feel tired and anxious all the time.

Her husband noticed that she lost interest in her favourite hobby of knitting. A few days back, she had told him of her plan to start knitting a sweater for her future grandchild. But now, she had stopped knitting all-together. He noticed her to keep to herself most of the day, not willing to go even for the morning walks they had been going together for so many years.

She appeared unhappy each time he saw her. Each time he enquired, she would say that there was nothing bothering her, except for a nagging headache. He noticed her to toss and turn in bed at night, complaining of not being able to sleep because of the headache. After a few weeks of these symptoms, her husband brought her some pills from a local chemist, which gave her no relief.

Meanwhile, Meenakshi noticed that quarrels between her son and daughter-in-law had gradually subsided, each beginning to understand the other. But her condition did not improve. As the headache persisted, she was taken to a number of different medical practitioners, including a faith healer. The different medications she took and remedies she followed gave her no relief. Soon, Meenakshi began to think that she would never improve, that she was becoming a burden on her family. She also began to skip meals, saying that she was not hungry, showing no interest even in her favourite dishes.

She often found herself thinking that it would be better to die than to live such a life. As a last resort, her husband took her to a psychiatrist, six months after the start of her symptoms. Diagnosing her as suffering from depression, the psychiatrist prescribed her a course of medications, and took twice-weekly sessions of psychotherapy. Two weeks later, Meenakshi began to sleep and eat well, noticing that her headache was also improving. By four-five weeks of starting the treatment, she was as good as before.

Depression is a commonly occurring, often seriously impairing, mental disorder. The World Health Organisation ranks depression as the fourth leading cause of disability worldwide. The ‘epidemic’ of depression is commonly underestimated. The stigma of having a mental illness and the lack of awareness among the common public and even medical professionals is immense. Because of these reasons, most sufferers do not seek medical help and continue to suffer needlessly. This affects their lives and the lives of the people around them.

Affecting people across all ages, the illness can cause severe damage to a child’s initial growing-up years, a teenager’s schooling, a person’s career or married life. It is the most significant risk factor for suicide, a leading cause of death, especially in adolescents, young adults and the elderly.

‘Depression’ is an often-misused and more often misunderstood word. Though a sensitive doctor or a psychiatrist may be the best judge, predictable or expectable reactions such as feeling low after a bad day at work, a fight with a friend, or a below-par performance in a school test may not mean you are suffering from depression. The vague use of the term often leads to delay in seeking treatment or wrongful and potentially dangerous self-medication.

You may be suffering from depression when for most of the time for most of the days over a few weeks you have the following:

  • Feel sad, are frequently tearful
  • Feel fatigued easily or get drained out after a normal day
  • Have a general sense of disinterest in things you previously enjoyed doing
  • Find it difficult to concentrate
  • Feel like being alone or don’t feel like talking to friends or family
  • Feel you are unworthy, a burden on people around
  • Feel things are never going to improve
  • Find your food tasteless, or you don’t feel hungry
  • Find it difficult to fall asleep, or you get up in the middle of the night or early in the morning, not able to fall asleep again
  • Don’t enjoy sex
  • Experience heaviness in your head, your body aches all over
  • Feel more anxious than usual
  • Have thoughts of hurting yourself or of committing suicide

If you find that you or a person you know is having a number of these symptoms over a few weeks, a visit to a psychiatrist is the best thing you can do. Depression also often presents as unexplained, chronic, physical symptoms without a demonstrable physical cause. As a result, patients suffering from such symptoms sometimes undergo numerous, unnecessary and expensive investigations, are treated with drugs they do not need and keep suffering because of this lack of awareness.

Another group of people where depression is significant are those with chronic, physical illnesses. Depression is often present are those with chronic physical illnesses such as hypertension, diabetes, cardio-vascular disorders, rheumatoid arthritis, AIDS and even cancer.

Similar to other medical illnesses of the body, such as hypertension or diabetes, depression also has a physical basis. Various strands of converging evidence suggest that depression is caused due to imbalances of various chemicals present in specific areas of the brain. Also similar to these physical illnesses, risk factors such as stress in the environment or the body in the form of an illness and a genetic predisposition in the form of a positive family history such as a family member having had depression can contribute to the development of depression. Depression does not imply a weakness in personality and cannot be treated by ‘will-power’ alone.

Mental health professionals are armed with a number of methods which are effective in the treatment of depression. Contrary to popular belief, medications used in depression are not necessarily habit-forming when used as per prescription. Medications, when prescribed are used for specified periods of time. Most of the newer medications are very safe, and do not have significant side-effects in long or short-term use.

Psychotherapy, commonly known as ‘talk-therapy’, is a specialised form of treatment. Psychotherapy uses specific strategies which are proven to be effective in the treatment of selected patients with depression. Simply put, in psychotherapy, patients ‘learn’ their way out of depression. Psychotherapy can be used alone or in combination with medications.

Another useful modality of treatment is electro-convulsive therapy (ECT). In contrast to common public opinion, partly inspired by media content (you may remember some movies showing a heavily disturbed patient being held by four hefty men receiving ‘shock treatment’), ECT is actually a humane, safe and effective treatment for many psychiatric disorders, one of them being severe depression. It is also the treatment modality of choice in very severe, life-threatening cases of depression, especially when accompanied by suicidal intent or attempt.

In short, with advances in psychiatric care, depression is now easily and rapidly treatable. Awareness of the illness and helping your dear one overcoming the inhibitions in visiting a psychiatrist for help may prevent him or her from remaining a silent sufferer

Shubh Mohan Singh is an Assistant Professor and Aditya Hegde a Resident Doctor at the Department of Psychiatry, PGIMER, Chandigarh.


Cataract and Alzheimer’s disease: Research brings new hope
Dr R. Kumar

Old age is heralded by several signs and symptoms — graying of the hair, gray reflex in the eye due to cataract, prostate enlargement along with urinary problems, memory loss and cognitive defects like Alzheimer’s disease. Could there be a common underlying cause and can you modify such genes that are responsible for the phenomenon of graying?

Older adults with age-related cataracts may be at a greater risk of Alzheimer’s disease (AD), according to a recent study. In the study investigators at Boston University Schools of Medicine and Public Health identified a gene linking age-related cataracts and Alzheimer’s disease. The investigators looked at brain MRI findings after 10 years from the original eye examination and concluded that there was a significant correlation between a quantitative measure of cortical cataract and Alzheimer’s disease-related brain degeneration.

It has an important implication that a simple eye examination at an early stage can diagnose cataract and AD. There is an old saying about the brain, “Either you use it or you lose it.” Early diagnosis may help prevent AD to some extent or to manage it better.

What happens in AD?

WHO estimates that there are 18 million people suffering from this malady, out of which 3.5 millions live in India — the number is expected to double by 2025. The patient leads a vegetative existence, often lost in neighbourhood or one’s own house and unable to recognize even near and dear ones. There is no significant treatment as yet. For diagnosis, a spinal fluid test is done to detect proteins involved in AD and brain scan may reveal typical appearances. Supplements, essential fatty acids and vitamins may be tried with uncertain results — the situation is no better with the medical management of cataract!

Significant research is on

Pathological hallmarks of AD include cerebral ?-amyloid (A?) deposition, amyloid accumulation and neuritic plaque formation. Researchers aimed to investigate the hypothesis that molecular pathological findings associated with Alzheimer’s disease overlap in the lens and brain. To establish a more direct link of delta-catenin to Alzheimer’s disease, the researchers transfected into neuronal cells delta-catenin and observed a significant and specific increase in the toxic form of amyloid ?, the protein that aggregates in Alzheimer brains and is thought to be central to the development of cataract also. In addition, the researchers found increased deposits of delta-catenin in lens tissue obtained from autopsy-confirmed Alzheimer’s cases. This study gives hope that we are moving toward earlier diagnosis and new treatment targets for these debilitating diseases of old age. One day medical treatment of AD and cataract may be found.

Cataract surgery leads to improvement in Alzheimer’s disease

In elderly adults, these two diseases frequently occur in the same person. Although a cure for AD is currently unavailable, cataracts can be effectively treated with surgery in most people. The removal of cataracts has documented benefits for visual performance and for reducing accidents and falls. In a study it was found that the surgery led to an improvement in thinking, sounder sleep, better mood and other benefits. Many also showed an easing of symptoms of depression.

The writer is a senior eye specialist based in Chandigarh.


Health Notes
Newly-developed drug ‘may lower stroke risk after brain ops’

London: A new drug could reduce the risk of stroke in thousands of patients undergoing brain operations, a new study has suggested.

If its benefits are proven in further studies, the treatment could have a major impact on patients undergoing a host of procedures.

Small strokes are a common complication arising from operations on the brain, but injecting the drug after surgery was found to reduce the number of affected sites by 40 per cent.

According to experts, while strokes often cause no harm to the patient, they can be extremely serious and protecting the brain against them could prevent patients suffering severe brain damage. — ANI

Soon, cream that may help fight skin cancer

London: Scientists have taken the first step towards creating a simple cream that they hope could one day treat skin cancer.

Researchers at Melbourne’s RMIT University have designed a new chemical that acts like a known virus by killing off melanoma cells.

While the chemical is effective at destroying the cancer cells, normal skin cells remain unharmed.

According to Dr Taghrid Istivan, the preliminary research will hopefully lead to developing a cream to treat early stage melanoma.

“We found it is active against cancer cells, against melanoma, but it doesn’t harm the normal cells,” The Telegraph quoted her as saying. — ANI