PUBLISHED BY: Zahid
CREATED / VALIDATED BY: Janardan Panday
PUBLISHED DATE: Feb 12, 2016
Introduction
Depression is a common mental disorder, characterized by sadness, loss of interest, pleasure, feeling of guilt or low self worth, disturb sleep, poor appetite, low energy and poor concentration. It is a common mood disorder in elderly and contributes to significant psychological and physical distress, physical disability and higher mortality. Depression is not a normal part of ageing. Many of our senior citizens face difficult changes such as - the death of a spouse or chronic medical problems that can lead to depression.
Depression not only prevents from enjoying life like it could be, it also takes a heavy toll on death. Untreated depression poses serious risks for older people including illness, alcohol, drug abuse and even suicide. International studies, including those in India suggest uniform prevalence of mood disorders across the world. Life time risk for major depression ranges from 2-25% with most authorities agreeing to a range of 10-15%. It is about 10% in men and 20% in women. By 2020, the World Health Organization (WHO) expects Depression to be the second frequent cause of morbidity world over.
Aetiology
1. Family history of depression/ hereditary
2. Trauma and stress caused by things like financial problems, breakup of a relationship or death of a loved one can cause depression
3. Pessimistic personality with low self-esteem and a negative outlook are at higher risk of becoming depressed
4. Medical illnesses such as stroke, heart attack, cancer, Parkinson's disease, and hormonal disorders can cause depressive illness
5. Many medications such as steroids, pain killers, anti-hypertensive drugs, tranquilizers, cancer drugs, hormones etc. can trigger or exacerbate depression
6. Psychological disorders like Anxiety disorders, eating disorders, schizophrenia, substance abuse etc.
7. Living alone can result in depression
Risk factors
1. Family history
2. Female gender
3. Death of dear ones
4. Functional disability due to chronic illness
5. Substance abuse of alcohol and drugs
6. Cognitive impairment
7. Sleep disorders
Pathogenesis
By advancing age, Acetylcholine, dopamine and norepinephrine decrease in the CNS; elevated levels of mono amine oxidase (MAO) and decrease in number of neuro-receptors with increased resistance to diffusion of drugs contribute to the vulnerability to depression in older adults.
Clinical features
1. Mood variations; often worse in the morning, improving later in the day
2. Change in sleeping, eating habits or appetite
3. Weight gain or weight loss
4. Feeling of guilt and/ or hopelessness
5. Slowed thoughts, speech and movement
6. Negative thoughts, blaming self and low self-esteem, thoughts of death / suicide.
7. Complaints that have no physical cause (somatic complaints) such as unexplained aches and pains.
8. Short temper, feeling of anxiety
9. Tearfulness for no reason, unrealistic sense of failure
10. Lack of concentration and difficulty in making decisions
11. Feeling of loneliness
12. Reduced desire for sex
Diagnosis
Before coming on the conclusion for the diagnosis of depression, patients are required to be screened for the following common health issues that can affect mood-
1. Anxiety disorders
2. Personality disorders
3. Vit B deficiency
4. Hypothyroidism
5. Systemic malignancies
6. Nutritional deficiencies
7. Metabolic disorders including diabetes and hepatic dysfunction
Investigations
1. Neurological examination
2. Mini mental status test
3. Geriatric depression scale (GDS) (Yesavage)
4. Haemogram
5. Blood sugar
6. Blood urea and nitrogen
7. Serum creatinine
8. Liver Function Test
9. Serum Vitamin B12
10. Serum T3,T4, TSH
Management approaches
a. Prevention
1. Use of fiber rich food like whole grams, whole fruits, fresh vegetables, Amla
(Phyllanthus emblica Gartn.) is beneficial.
2. keep active physically and mentally and conduct exercise regularly.
3 Avoidance of loneliness by engaging in social activities.
4. Continuance of medications as per instructions of vaidya.
5. Practice of yogasnas and meditation
6. Avoidance of non-vegetarian diet, frequent eating and very high calory food
7. Avoidance of uncalled far excessive thinking
b. Medical management
Line of treatment
1. Nidana parivarjana (avoidance of aetiological factors) - In order to treat depression,factors like trauma, use of steroids, pain killers, etc. need to be avoided.If there is any Chronic illness It should be tackled first and living alone should be avoided.
2. Shodhana chikitsa (Bio-cleansing therapies) followed by Samana chikitsa (Palliative therapy) may be done.Following shodhana processes are specially recomended
A, Snehapana (Internal oleation) - Kalyanaka ghrita 50 ml with 2 gm Saindhava
Lavana(Rock salt) for 3 - 7 days (for early oleation) is recommended.
B, Virechana (Purgation) with Eranda taila 10 - 20 ml or Trivrita churna 5-10gm in half glass of warm milk at bed time in night is recommended.
C, Nasya karma Brihana nasya with Purana ghrita (old cow ghee) or Anu taila or
Mahakalyanaka ghrita in the dose of 8 drops in both nostrils for 7 days is recomended
D,Shiro vasti with Narayana taila for 45 minutes daily up to 7 days is helpful.
E,Shirodhara with medicated oils (Narayana taila / Chandanadi taila/ Himasagara taila) (or) Ksheera dhara / Jala dhara / Takradhara daily 30-90 minutes for 1-2 weeks
F, shiro abhyanga (head Massage) with medicated oils (Brahmi taila) etc.
