Anxiety & Depression

It affects children , adolescents, young adults as well as the elderly. It is universal and both males and females are affected. It causes severe symptoms that affect how you feel, think, and handle daily activities.

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Imagine our ancestors facing survival challenges from larger animals, fearful surroundings.

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The chemical changes triggered by the hormone adrenaline in the brain would lead to an increase in the heart rate, blood pressure and overall alertness to face the situation or to run away from it to save their lives. The fight or flight reaction as it has famously come to be known.

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In our present times we face anxieties related to education, health, jobs, money, housing, family life ,

responsibilities, pressures of performance in different areas of our lives as well as uncertainties of political happenings in our surroundings.

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It indeed helps us to safely cross roads as we look both sides before crossing, face examinations and interviews and overall challenges of day to day living without being aware of it.

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Anxiety Disorder:

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2017 statistics show about 45 million Indians suffering from Anxiety disorders. Imagine in the present days. The most common of all Psychiatric disorders. Most of the patients with physical symptoms visit their GP’s. A large number are underrecognised and undertreated. The feelings of being anxious if prolonged or of severe intensity and out of proportion to the causative factor or stress leads to anxiety disorder. As a result this may lead to an increase in blood pressure or other physical symptoms.

Concerns and intruding thoughts interfere with daily functioning.

Causes:

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Anxiety disorders appear to be caused by an interaction of bio-psychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma.

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The common types include:

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Generalized Anxiety Disorder:

Generalized anxiety disorder (or GAD) is marked by excessive, exaggerated anxiety and worry about everyday life events with no obvious reasons for worry.

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Fatigue, mood irritability, muscle aches and pains are frequent complaints. There is a constant expectation of disaster and they can't stop worrying about health, money, family, work, or school.

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Social anxiety disorder.

Fear of negative evaluation or judgment by others as well as embarrassment in public places.It includes stage fright, fear of intimacy, rejection as well as fear of humiliation.

Phobias:

A phobia is a type of anxiety disorder defined by a persistent and excessive fear of an object, leading to its avoidance.

It arises rapidly and causes significant distress. There are several types of specific phobias related to objects, places, insects etc.

Panic disorder:

There are periods of intense fear arising unexpectedly, spontaneously, reaching a peak within 8-10 minutes.The patient has an overwhelming fear of suffocation and impending death and an intense desire to flee from his place. There is usually no identifiable predictable cause.

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To diagnose a person with panic disorder the panic attacks must be associated with longer than one month of subsequent persistent worry about (1) having another attack or consequences of the attack or (2) significant maladaptive behavioral changes related to the attack.

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Other symptoms or signs may include headache, cold hands, diarrhea, insomnia, fatigue, intrusive thoughts, and ruminations. The causes of panic disorder are likely biologic and psychosocial, and that panic symptoms are not life-threatening or uncommon.

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Association with depression, asthma and heart disease is an increased risk factor.

Identifying trigger factors, Regular treatment of co-existing medical conditions are of great importance.

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Selective Mutism:

Selective Mutism (refusal to speak) as in specific situations or places like schools, public places etc

Some children develop selective mutism after a stressor such as illness, separation from their caregiver, or other traumatic experiences such as abuse or neglect and bullying can especially contribute risk and also occur related to the lack of a large supportive peer group.

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Other children with selective mutism have an underlying language delay or disorder (most often expressive language disorder) or severe social anxiety and shyness.

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Selective mutism significantly impairs the individual's level of functioning, as the individual is unable to complete required educational, social, and family tasks, and the emotional distress engendered in situations requiring the person to speak out loud can result in school refusal.

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Separation anxiety disorder (SAD):

Excessive worries and distress of a recurrent occurrence experienced on real separation or anticipation of it, from home or a major attachment figure. It also includes possible harm, injury, accident or death.

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A certain amount of clinging behavior and anxiety upon separation from care givers up to the age of 3 years is normal. It may become intense and distressing over time and include:

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• Refusing to be away from home because of fear of separation

• Not wanting to be home alone and without a parent or other loved one in the house

• Reluctance or refusing to sleep away from home without a parent or other loved one nearby

• Repeated nightmares about separation

• Frequent complaints of headaches, stomachaches or other symptoms when separation from a parent or other loved one is anticipated

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Separation anxiety disorder may be associated with panic disorder and panic attacks ― repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes.

Agoraphobia:

Agoraphobia is a fear of being in situations where escape might be difficult or that help wouldn't be available if things go wrong. Agoraphobia is a type of anxiety disorder that causes people to avoid places and situations that might cause them to feel - Trapped, fearful, panicked, helpless and ashamed. There must be intense fear or anxiety in two of more of the following situations to be diagnosed with agoraphobia:

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• using public transportation, such as a train or bus

• being in open spaces, such as a store or parking lot

• being in enclosed spaces, such as an elevator or car

• being in a crowd

• being away from home alone

If someone with agoraphobia finds themselves in a stressful situation, they'll usually experience the symptoms of a panic attack, such as:

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• using public transportation, such as a train or bus

• being in open spaces, such as a store or parking lot

• being in enclosed spaces, such as an elevator or car

• being in a crowd

• being away from home alone

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Avoidant behavior:

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They'll avoid situations that cause anxiety and may only leave the house with a friend or partner. They'll order groceries online rather than going to the supermarket. This change in behavior is known as avoidance.

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A list of commonly abused substances in India:

• Nicotine as cigarettes, tobacco chewing,various forms of gutkas.

• Alcohol 14.6% on national level. (Source pib.gov.in 2019)

• Cannabis ( Charas/ Ganja/ in some countries it has religious sanctity)

• Cocaine

• Heroin LSD, PCP

• Amphetamines and methylphenidate 

• Sedatives & Hypnotics.

•  OTC ( over the counter)common syrups for cold and cough containing dextromethmorphan, diphenhydraminea)

  • Acetaminophen​

  • Antacids containing aluminium( in patients with impaired kidney  function can cause aluminium toxicity)

  • Calcium containing antacids in large amounts can cause alkalosis, needing emergency medical care.

• Non -medication products with known abuse potential, including paint thinners, glues, correction fluids, and aerosol sprays.

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For many a patient an ( ED)emergency department,is usually a starting point on their journey to recovery if they realise the desirability of giving up their addiction on their own our under pressure of their families. 

Others are unwillingly literally forced to attend healthcare facilities or simply put into closed door facilities where hardly any proper evaluation or remedial care is available. 

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What is addiction?

A compulsive drug seeking behavior or difficulty in controlling ( prescription medicines for genuine medical condition)and giving it up,in spite of its harmful effects. 

Is Addiction curable?

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It depends more on the individual’s motivation.Force and    punishment do not work over the long term. 

A dedicated team approach  available at de- addiction  centers, adequate family support, continuing abstinence. 

Rural vs urban:

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There is a widespread increase in the addiction rates in smaller towns and villages.Media accessibility, poverty, joblessness, isolation are some important factors for the increase. 

What is intoxication?

It is a condition that follows the administration of a psychoactive substance and results in disturbances in the level of consciousness, cognition, perception, judgement, affect, or behavior, or other psycho physiological functions and responses. (WHO definition)

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What is withdrawal from an addiction?

If a person has been using a substance of abuse and had developed a physiological dependence on it, stopping or reducing the dosage of the substance will lead to physical and mental symptoms. The nature ,severity and course of the withdrawal symptoms will be dependent upon the particular substance abused  

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Factors leading to development of an addiction: 

• Family.

• Genetic factor.

• Pressure from peer group or very close acquaintance or friend. 

• Mental illness. 

• Using a highly addictive substance

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Management:

Early detection before the condition worsens. Screening for drugs at general hospital and primary health centres 

• Counselling 

• Behavior therapy

• Drug treatment  of underlying psychological and medical conditions

• Recovery support systems. 

• Detox in specialist centers 

• Follow up

Practical difficulties:

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• Only one in ten patients reaches a Specialty detox center 

• Lower priority in health care system. 

• Lack of resources. 

• Lack of well equipped facilities with most existing ones act more like custodial internment with bed and meals only in the name of de-addiction centers. 

• Lack of trained staff. 

• Insufficient medical staff perhaps due to lack of glamour and satisfaction as compared to other medical branches. 

Looking ahead:

Mainstream availability in general hospitals and primary health centers. The cost of therapy with inpatient care or residential or outpatient  is cost effective as compared to no treatment with possibly disastrous consequences. 

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