Depression Treatment Options


However the client should be aware of the treatment options so that he /she can discuss with the consultant. Broadly speaking, the treatment of depression rests on two factors Medication, and Psychotherapy or Counselling.

  • Medication is required for moderate and severe depressive disorder cases.
  • Counseling and psychotherapy serves as an edge in treating depression and need to be started simultaneously along with medicines.
  • You should continue the full course of psychotherapy even if you are feeling better to prevent a relapse.
  • Suddenly stopping antidepressants can precipitate a relapse. Medication needs be tapered gradually under your doctor’s supervision.

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Varsha Bhosle’s Suicide….A psychological perspective


Warning bells for depressed clients:

Person turns recluse
Shows little or no interest in the on-going activities / personal care
Has a history of previous suicide attempts or talks about wanting to end life
Has recently met with disappointment or failure
Has lost a loved one or moved away from a loved one
Changes in food and / or sleep habits
Increased physical complains
All the above mentioned signs were present in Varsha Bhosle. With a series of disappointments and failures in her life, losing a close friend and associate might have been the last straw which led her to end her life. However how does a caretaker determine in such a long standing case history of a depressed individual and repeated suicide attempts, when is she most likely to commit suicide? Often it so happens that the people around them take their depression as a routine and do not find anything unusually wrong in their behaviour that particular day.

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Dealing with rejection



What makes Priyanka Chopra rejected by the wives of her co actors? Is there really a flaw in her character or is she a victim of the wives’ insecurities. Decide yourself in the article dealing with rejection.
Rejection is experienced as a deep blow to self esteem as it involves blaming you as a person. It is difficult to deal with it because it conveys the message of non-acceptance and that there is something wrong with you and you are not good enough or worse still there is something wrong with you, that you will never change and that you do not belong to this group and you’ve done something wrong or unacceptable. This leaves you with a deep sense of helplessness. There is nothing that you can do to change another person’s biases and perceptions and you are left to deal with all these emotions yourself. More often than not, these perceptions are often backed by societal or religious norms justifying the persons rejection.
Often people who are a victim of rejection keep going in circles feeling victimized and angry and are unable to get over it easily. Psychotherapy helps such individuals to differentiate between what is intrinsic to themselves and that which is not. This goes a long way in handling difficult emotions of rejection. By understanding ones ownself and how one uses psychological defense of projection and introjection one realizes that the emotions thrown into him by the person rejecting actually form the dark and unknown side of the rejecting individual’s personality which is unfortunately being flashed onto your character screen. Although not aware, the person has sense that he can succumb to these very biases and therefore fights it externally whenever he sees it. Unfortunately in the process does not cure himself and accumulates greater fear of the same biases. Therefore no logical argument is able to convince the person to give them up. The reason being, if they give up these biases, maybe there is a fear that he will have to face it within himself. After all isn’t it much easier to fight the devil on an external screen than to have him within yourself.
Equipped with this understanding by experiencing it within ones ownself, the individual is able to detach oneself from the influences of these negative emotions projected on him by the world and is able to restore his self esteem. Of course talking about these emotions forms the initial part of the cathartic therapy but psychotherapy does not stop at that alone. In fact if the therapist is unable to take the client beyond catharsis, the client keeps experiencing the wound in his mind but is unable to come out of it.
Understanding the mechanisms of rejection and knowing that it is never, and I repeat, never warranted or earned are the most fundamental keys to safeguarding your self esteem and sense of self worth. This is a choice. You have to make a choice about how you are going to understand the messages of rejection you receive everyday, and how you are going to, or not going to, integrate these messages into your psyche.
Remember that facing your fears, expressing and sharing your experience, no matter how shameful, is vital in overcoming the aloneness that rejection creates and which sustains its impact.
Make a choice today to focus on the dynamic you and your untapped potential and you will be unscathed by any experiences of rejection.

TO WATCH OR TO BE



With the recent incident of the Ministers, watching pornographic film has brought about much ethical debate in the media; however the psychological impact has not been discussed. Sexuality is an issue which profoundly impacts not only an individual but also the family at large. In my experience, with only several exceptions, pornography has been a major or minor contributor or facilitator in the acquisition of their deviation or sexual addiction apart from complete psychological isolation from family. Treatment (psychotherapy) of the same is necessary as it tends to recur as all other means of control used by individual and society fail without an insight into the urge.
I found four factors common to nearly all of my clients, with almost no exceptions, especially in their early involvement with pornography.
1. Addiction
A porn movie becomes an addiction as the material provides a very powerful sexual stimulant or aphrodisiac effect with powerful imagery as a base of further fantasies, followed by sexual release, most often through masturbation. Once addicted, they could not throw off their dependence on the material by themselves, despite many negative consequences such as divorce, loss of family, and problems with the law (as with sexual assault, harassment or abuse of fellow employees). Interestingly my clinical experience, education is positively correlated with sex addiction; that is to say higher the education and intelligence greater is the person’s vulnerability to sex addiction. Reason being, their finer ability to use their intelligence to fantasize.
2. Escalation
Like drug addicts, sex addicts with the passage of time require rougher, more “kinky” kinds of sexual material to get sexually aroused. If their spouses or girlfriends were involved with them, they eventually pushed their partners into doing increasingly bizarre and deviant sexual activities. They often preferred this sexual imagery, accompanied by masturbation, to sexual intercourse itself. This nearly always diminished their capacity to love and express affection to their partner in their intimate relations. In many cases, this resulted in a fall out in the relationship when the woman refused to go further-often leading to much conflict, separation or even divorce.
3. Desensitization
Material (in books, magazines or film/videos) which was originally perceived as shocking, taboo-breaking, illegal, repulsive or immoral, though still sexually arousing, in time came to be seen as acceptable and commonplace. There was increasingly a sense that “everybody does it” and this gave them permission to also do it, even though the activity was possibly illegal and contrary to their previous moral beliefs and personal standards.

4. Acting Out Sexually
There is alarmingly increased tendency to act out sexually the behaviors viewed in the pornography including compulsive promiscuity, exhibitionism, group sex, voyeurism, frequenting massage parlors, having sex with minor children, rape, and inflicting pain on themselves or a partner during sex. This behavior frequently grew into a sexual addiction which they found themselves locked into and unable to change or reverse–no matter what the negative consequences were in their life.

PORNOGRAPHY AND ITS IMPACT ON THE FAMILY
However, in my clinical experience, the major consequence of being addicted to pornography is not the probability or possibility of committing a serious sex crime (though this can and does occur), but rather it’s disturbance of the fragile bonds of intimate family and marital relationships. This is where the most grievous pain, damage and sorrow occurs. There is repeatedly an interference with or even destruction of healthy love and sexual relationships with long term bonded partners. The most important negative consequence is that it isolates one from one’s own self. The ‘real’ world no longer appears appealing and the individual prefers to be in his own world ultimately severing emotional ties that gives meaning to his own existence. No amount of ‘knowing that its bad’ helps to reverse this habit. It’s like a latent cancer, it almost never disappears on its own or reverses its course unless there is some psychotherapeutic intervention.
PARENTING ISSUES AND PORNOGRAPHY
With the explosion of internet usage parents need to keep in control on the internet usage of their young ones. Their curious mind and age is bound to take them in this direction if left unattended on the net. Pornography films are often dismissed off as ‘educative’ or seen as rebelliousness by care givers. However parents need to be aware that there is tremendous peer pressure on the young adults and they often resort to pornography to be a part of the ‘in’ group or for the purpose of self education. When parents provide scientifically correct and age appropriate sex education to the child from a young age, they squash this curiosity and the chances of their child being misinformed via porn films. In fact sex education classes are conducted in many schools for the same purpose. It is a myth that imparting sex education will increase sexual activity in young adults. Rather as parents and caregivers it is your duty to ensure that the child is well informed about the sexual boundaries and the consequences. In fact in many of the abuse cases that I have handled in my practice, children were unable to protect themselves from further abuse because they felt responsible and guilty of the abuse and were unable to convey their feelings their parents whom they thought they could not talk as it’s a taboo topic or worse still would blame them. Because the topic was never raised by their parents they have nowhere else to talk about but their peers or left on their own for further experimentation.
Watching porn movies has a far outreaching psychological impact, especially on a young adults mind. Most of the porn films are made by men and are often extremely sexist in nature often debasing or humiliating a woman. Therefore children at a very young and impressionable age learn to disrespect women in general and treat them as object of sexual pleasure, have distorted perceptions about sexuality, destroys confidence, commitment and responsibility of an intimate relationship and institution of marriage in particular and making polygamous relationship an acceptable idea. In addition, pornography portrays “unhealthy” or even antisocial kinds of sexual activity such as sadomasochism, abuse and humiliation of the female, involvement of minors, incest, group sex, voyeurism, exhibitionism, etc.
Watching pornographic films over an extended period of time raises a fundamental question of who you become as a person watching it.

HOW TO IMPROVE YOUR MEMORY



Ramesh (37 years old) had been coming for therapy for depression for a week now. One evening he came for the session really frustrated. He asked tentatively whether loss of memory could be due to his depression or the related antidepressants that he was given by his psychiatrist. He then went on to explain that he had excellent memory as far as numbers were concerned, so much so that as a child he could remember almost all 49 children’s marks in the class as the teacher called them out aloud before handing over the papers. Yet the previous evening when he had to give his new office number to his very important client he could not just get it right. It almost cost him his contract as the client got offended.

When I asked him when he started noticing this forgetfulness in him, he mentioned that a little before his divorce 3 years ago he had been noticing his forgetfulness but had been too emotionally wrapped up to pay further attention to it. He now realizes that the forgetfulness has been increasing over the years. Initially he thought that he was preoccupied and later brushed it off as a sign of early ageing and even hereditary. But yesterday’s incident was disturbing him.

First and foremost any physical disorder needs to be eradicated. Secondly causal factors as well as the mechanism of forgetting need to be understood. Usually mental decline begins by the age of 40 or 50. However people who are undergoing high emotional stress for an extended period of time also experience these symptoms as early as in their 30’s. Some of the stressors one cannot do away with given the stressful and competitive environment we live in, however we can counter them with certain changes in lifestyle. Health conscious people interested in living quality life introduce yoga/ physical exercises to their routine along with dietary changes. Similarly for mental health one needs to introduce what is called Neurobics in their life, a mental gym. Also contrary to popular belief, the mental decline most people experience is not due to the steady death of nerve cells. Instead, it usually results from the thinning out of the number and complexity of dendrites, the branches on nerve cells that directly receive and process information from other nerve cells that forms the basis of memory. Dendrites receive information across connections called synapses. If connections aren’t regularly switched on, the dendrites can atrophy.

The function of memory is primarily carried out by the cortex and the hypothalamus in the brain. Hypothalamus is the emotional seat of the brain. Anything which is emotionally laden is usually easier to recall, however if there is a flood of emotions it leads to confusion however if this flood continues for extended period of time, it can even cause atrophy in dendrites. This reduces the brains ability to put new information into memory as well as to retrieve old information. The good news is that aging brain, however, continues to have a remarkable ability to grow, adapt, and change patterns of connections. Therefore establishing associations and new pathways for connection have a healing effect on the brain.

The exercise program calls for presenting the brain with nonroutine or unexpected experiences using various combinations of your physical senses—vision, smell, touch, taste, and hearing—as well as your emotional “sense.” It stimulates patterns of neural activity that create more connections between different brain areas and causes nerve cells to produce natural brain nutrients, called neurotrophins, that can dramatically increase the size and complexity of nerve cell dendrites. Neurotrophins make surrounding cells stronger and more resistant to the effects of aging. Also, using multisensory approach, retrieving from the memory becomes easier with a web of associations supporting the matter. More often than not, adults don’t exploit the brain’s rich potential for multisensory associations. Think of a baby encountering a rattle. She’ll look at it closely, pick it up, and run her fingers around it, shake it, listen to whether it makes a sound, and then most likely stick it in her mouth to taste and feel it with her tongue and lips. The child’s rapidly growing brain uses all of her senses to develop the network of associations that will become her memory of a rattle. Adults miss out on this multisensory experience of new associations and sensory involvement because we tend to rely heavily on only one or two senses. As we grow older, we find that life is easier and less stressful when it’s predictable. So we tend to avoid new experiences and develop routines around what we already know and feel comfortable with. By doing this, we reduce opportunities for making new associations to a level that is less than idea. Simultaneous sensory input creates a neural “safety net” that traps information for future access.

Social interactions are also non routine and therefore socializing has similar effect. However we find more often than not that people who are undergoing emotional stress / depression want to be left alone and withdraw from social contacts. Is it any wonder why Psychiatrists suggest going for a walk rather that doing a fitness workout alone in your gym? Going for a walk allows one to experience all 5 senses and also provides the brain with social nutrients necessary to heal the brain.

Here are some of the ways in which you can use mental gym to improve on your memory:

1. Involve one or more of your senses in a novel context.
By blunting the sense you normally use, force yourself to rely on other senses to do an ordinary task. For instance: Get dressed for work with your eyes closed. Eat a meal with your family in silence.
Or combine two or more senses in unexpected ways: Listen to a specific piece of music while smelling a particular aroma.

2. Engage your attention. To stand out from the background of everyday events and make your brain go into alert mode, an activity has to be unusual, fun, surprising, engage your emotions, or have meaning for you. Turn the pictures on your desktop upside down. Take your child, spouse, or parent to your office for the day.

3. Break a routine activity in an unexpected, nontrivial way.
(Novelty just for its own sake is not highly Neurobic.)
Take a completely new route to work. Shop at a road side market instead of a supermarket. Normally, placing a key in a lock uses vision and “motor memory”—an unconscious “map” in the parts of our brain that control movement—which provides an ongoing feedback that allows us to sense where parts of our body are in space. (This is called the proprioceptive sense.)

Neurobics is recommended as a lifestyle choice, not a crash course or a quick fix. Simply by making small changes in your daily habits, you can turn everyday routines into “mind-building” exercises. It’s like improving your physical state by using the stairs instead of the elevator or walking to the store instead of driving.

Ramesh worked on these mental gym exercises for about 6 months and started regaining confidence in himself and also noticed his stress reducing, life feeling more meaningful, increase in interest and involvement in routine as well as novel things and social interactions and in general an elevated mood.