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Dr K K Aggarwal

Physical illness can trigger depression

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If you have depression, a thorough physical exam and careful medical history should be undertaken to pinpoint a physical source of the problem for an appropriate treatment.

In depression, not only look for what’s going on in the mind and brain but also check what’s going on in the body. Many medical problems are linked to mood disturbances.

More than 50% of heart attack survivors and those with cancer report feeling depressed. Depression is also linked to diabetes, Parkinson’s and other chronic conditions.

Depression too can affect the course of a physical disease. Depression is linked with slower recovery from a heart attack and an increased risk for future heart trouble.

Thyroid disorders also affect mood. Overactive thyroid can cause mania and under active thyroid can cause depression. Other medical conditions associated with mood disorders include certain neurological conditions (multiple sclerosis, Parkinson’s disease, Alzheimer’s), other hormonal imbalances, and lack of vitamin B12.

1. Look for coexisting medical condition, psychiatric disorder, neurologic disease, sleep disorder or drug associated with insomnia.

2. Insomnia that last less than three months: acute insomnia, circadian rhythm sleep disorders (jet lag, shift work), and high altitude insomnia.

  1. Insomnia that last longer than one month: include inadequate sleep hygiene, psycho-physiological insomnia, idiopathic insomnia, behavioral insomnia of childhood, paradoxical insomnia, and insomnia associated with a variety of medical conditions, psychiatric disorders, neurologic diseases, sleep disorders, medications, or drugs.

Acute insomnia

a.     Acute insomnia lasts for less than three months

b.    Is temporally related to an identifiable stressor

c.     Synonyms for acute insomnia include adjustment insomnia, short-term insomnia, stress-related insomnia, and transient insomnia.

d.    Resolve when the stressor resolves or when the individual adapts to it.

e.     Stressors can be physical, psychological, psychosocial, interpersonal, or environmental:

f.     Stressor as mentioned in Vidur Niti: A thief, A lustful person, A person who has lost all his wealth, A person who has failed to achieve success, A person who is weak and has been attacked by a strong person.

g.    Ayurveda describes sleep as an aggravation of Vata. The causes are mental tension; suppressed feelings & acute bitterness.

h.     Other stressors :  Changes in the type or level of background noise; changes in the bedroom, such as a different bed or different furnishings, lighting, temperature, or occupants; consumption of or withdrawal from caffeine, nicotine, alcohol, or foods or beverages that contain these substances; stressful life events, such as loss of a loved one, divorce, loss of employment, arguments, particularly happy or sad events, work demands, or school demands; acute or chronic injuries or illnesses, particularly those causing pain or discomfort; medications or illicit drugs that have stimulant properties such as  theophylline, beta blockers, steroids, thyroxine, bronchodilators, or amphetamines, withdrawal from central nervous system depressant drugs and nursing home or hospital admission.

i.       Stress-induced insomnia is related to increased activation of arousal systems rather than decreased drive for sleep.