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11,WARNING BELLS,YOU NEED TO WATCH,WHILE ON TREATMENT FOR DEPRESSION
Dr Harish Shetty
1] Keep a watch for missed dosages. As the patient improves s/he tends to skip medicines. This may not cause a relapse immediately but a breakdown will be around the corner. So preferably supervise the medications or following recovery keep a discrete watch of the number of pills in the box and visits to the psychiatrist.
2] Across recovery watch for ‘suicidal thoughts ‘or increase in symptoms. When the patient is very depressed s/he may have serious suicidal thoughts but may not be able to implement it due to slowness in movements and ‘psycho-motor retardation’. As s/he recovers the movements may improve and s/he may be in a position to execute the thought that may not be so intense but yet present. So keep a close watch and see a psychiatrist regularly.
3] Watch for people interacting with the patient. S/he may actually seek multiple opinions from others around. Keep a watch on those who dissuade him/her to take medicines and seek pseudo-religious or alternate therapies that do not benefit. Back seat drivers are many who might interfere with the process. See if s/he has visited an astrologer or so called gurus. Weed such people away from your patient.
4] Watch for side effects such as dryness of mouth, constipation, weight gain that may happen in a few. Get these issues discussed and resolved as that may lead to discontinuation of treatment. Tolerance to some adverse effects may be necessary and the balance sheet of the good points vs. the not so good effects of medicines needs to be weighed and understood.
5] Watch for odd behaviors while on treatment. One of them is a sudden decision to make a will or take a drastic decision in work or business. Wanting to suddenly quit a job, sell one’s business are warning signals for urgent review of the mental condition. All desires to take drastic decisions should be examined and deterred as most of the times it may be against the interests of the patient.
6] If the patient has a physical illness along with depression see that the physician and the psychiatrist talk to each other. This helps fine tuning the treatment process. If the physical illness deteriorates and needs hospitalization keep the Psychiatrist in the loop for advise during the crisis.
7] If the patient has to go through important events around the treatment such as ‘getting married’, appearing for an exam, moving to a new city/a new country or change of a job see that a Psychologist or the psychiatrist examines the stress that may be caused during recovery. A fresh detailed review will help tackling the impact of such events on the recovery . Telling the spouse of the illness is a must to build trust,faith and confidence.
8]If you loose faith in the treatment process due to partial recovery or a relapse or for any other reason please seek all the answers from your treating doctor. If you are not satisfied request him/her for a shared opinion from a colleague younger or older to your present Psychiatrist. Seeking opinions secretly and clandestinely will harm your patient. Taking a sudden decision by yourself to stop the medications of your loved one is a dangerous act.
9] Recurrent doubts of the ‘WHY’ of the ‘DEPRESSION’ may emerge intermittently in your minds. This may cause you to explode on the patient after reasonable recovery. You may believe that it may be due to a ‘broken love affair’ or ‘failure in an exam ‘e.t.c. All the resentments that are stored and accumulated across the treatment may inadvertently be showered on the patient during recovery causing a relapse. Hence you and others in the family should seek counseling during the recovery phase. The reasons that you believe that has caused the depression may not be true or not relevant during recovery. Yet if there is an ongoing stress that has caused the episode parallel counseling along with medications is a must.
10] During the course of the treatment protect the interests of the patient. If financial losses have caused or coincided with the illness expert advice by finance managers should be sought. If the spouse decides to quit the patient or during any other unanticipated crisis see that the human rights of the patient are protected. Properties held by the patient and other assets should not be allowed to be exploited by anyone. Also see to it that jobs are protected and depression is not seen as a reason to sack the patient. Seek legal advice then.
11] Sudden switch in the mood to excessive happiness, joy and ecstasy should alert you immediately. This may be due to ‘drugs’ such as ‘cannabis’ or others. Report to your doctor immediately. This may also be due to a ‘manic’ switch i.e. your patient may have a Bipolar Disorder where an episode of depression may be followed by an episode of mania where excessive spending, excessive talking, making irrational business decisions, getting violent or abusive and other similar symptoms are seen. In this phase your patient may not come to the Doctor. Rush to your psychiatrist for a review and change in medications. This could be the first ‘manic’ episode and so your patient is not suffering from Depression but Bipolar Disorder.