Saturday, November 21, 2020

Major Depression-A Case History

Deepak is 80 yrs old and clinically depressed.He has been unwell for more than a year now.It started with anxiety,excessive quietude,reticence and lethargy.Six months ago this transformed into major depression.Since the last 4 months it has been at its peak.

He spends the whole day lying down with his eyes shut.He barely gets up for his meals for an hour and then it is back to bed again.He will neither talk nor respond to anyone.He has become totally apathetic and docile.Personal hygiene is at its minimum.His appetite and weight have decreased drastically.But he is not bothered about this depreciation in his health or personality.Nothing at all interests him.

He underwent a physical examination and thankfully he was found physically fit.

He and his wife Bina have been our friends for eons.She is a bit of a psychologist.She noted the changes in his personality at the very beginning and tried through various means to extricate him from anxiety but it did not work.Then they consulted their family doctor who gave him a psychiatric medicine.It did not agree with him,he became disoriented and developed fecal incontinence.

He was referred to a psychiatrist whose medicines led him to sleeping round the clock.The psychiatrist eliminated the barbiturate from his medicines.Thankfully the antidepressant agreed with him and there were no adverse effects.After taking the medicine for six months there were small signs of improvement off and on but soon he would revert to his old condition.The doctor,upon being contacted,refused to change the medicine,saying increasing the dose or potency would make him more somnolent.He advised him to gear up and be more active.

This was easier said than done.Deepak was just not interested in taking up any physical or mental activity.Even talking was too much of an effort for him.When cajoled to get up and do something he would say that he did not have the strength to do so--this,when he was physically fit.He had no desire to awaken his old booming blustering self. 

The  worst part was that there was no external problem which could be amended to grant him relief.His family and life conditions were perfect.The cause seemed to be endogenous.Perhaps it was his personality which had rendered him vulnerable to anxiety and depression.He had never shared his emotions with anyone or laughed heartily.His approach to everything had always been negative.Likewise,his reactions.All this might have led to a festering of wounds inside.

After about seven months of medication he showed signs of improvement in small measures.He agreed to go out and sit in the balcony.By and by he was persuaded to take at least 10 minutes' walk every day.It took a long time to entrench this into his routine.Then he started walking in the evening too but this left so many hours of the day to be spent positively,otherwise he was sure to give in to the urge to go and lie down on his bed.But he was not interested in taking up any activity.He refused to participate in an indoor game,read something or watch TV. 

After the passage of another two months he began to watch religious channels on TV and tried to extend his waking hours which finally settled at fourteen.Good progress,but it was extremely slow and transient.Very frustrating for the family members to watch and maintain a hopeful facade.

Talking or meeting outsiders was still difficult for him.It is rather challenging for a mental patient to accost outsiders.After countless months of isolation he cannot suddenly turn outgoing and jovial.Others take it as a cue to stand off.Sad,but this is what mostly happens.The onus to cajole and help him to join the mainstream once again rests solely on the family members.Without their support nothing can be achieved.The patient has to be encouraged to believe that he can and he will get well.He should be helped to take constructive steps one at a time.It is just like a baby learning to walk.He needs all the help he can muster.The journey is long but essential.