WHEN DEPRESSION GETS LOUD

Hello readers, pardon my absence on this blog for some time. I have been busy mainly with work. I am glad to come your way once again with one of the case files from the archives. As silent as this patient might have been, he had one of the loudest thoughts that could have landed him in a thud if he had carried out his preconceived actions of harming his colleague, just to relieve himself of the agony he was going through; a totally understandable agony. Depression is a silent killer; creeping through our individual minds and tears us apart limb to limb. It works by affecting certain neurotransmitters that affect our thought patterns and behavior.


Just a week ago, I was informed I was on schedule for a case presentation that was bound to happen today. This meant I had to sift through the countless patients who presented to the clinic on a Monday morning, for a person with an interesting story we could learn a lot from. To make this easy, I found myself seated in the consulting room; placing myself at a vantage point where a good referral form with a ground-breaking diagnosis could be placed in front of me. Then in walked a gentleman…


A quick glance at him revealed a perfectly normal man in his early fifties. But I have learnt not to rely on first hand guesses in my practice, but assume every patient had a problem until proven otherwise. He greeted me politely as he took his seat close to me. “You will have to use the chair behind you” I told him as I offered an extra seat of protection by readjusting my malpositioned mask and adhering to the safety protocol of social distancing.


Where is your referral form?” I asked, after he had acclimatized himself with the surrounding and made himself comfortable in his new chair. “I don’t have a referral form, I was advised by him to come here on the request of the secretary” He replied, as he pointed his right forefinger in the direction of the secretary’s office. There was no guarantee this patient had found himself in the wrong location so I couldn’t dispel his presence with ease. I welcomed him, introduced myself and asked of his complaints as I pulled my pen out of my pocket.


Doctor, I am very sad! How could people be so callous and wicked?” He started as he almost broke into tears. Right from the start, I knew he was at the right place. His mental health had been compromised. He was the newest victim of unforeseen circumstances. As manly and tough as he was, he continued and began to cry. “Watch the people you call your friends. Now I do not mind pointing a gun at my accuser and shooting him in the head, just to go to prison and feel better” He enunciated, as tears continued to roll down his cheeks. At this point, I had to offer him a tissue paper.


Right from the start, I could tell he had been sad for long, but how long? This was someone who didn’t know where to turn to, that he had decided to take the matter in his own hands by killing his so-called friend. His friends who visited him offered him the needed encouragement, but this was always short-lived. He always sank back into his previous state anytime they left him. This pervasive feeling is known as a low mood. His mood was so low the threshold for breaking into tears was at the ground level, that a lot of strength was not needed to overcome it.


Apparently, he had been falsely accused of spending huge sums of money, after his recent promotion and appointment into a high position in his company, by a colleague of his. I could not ascertain the validity of what he said, but a guilty person would not be this sad. Unbeknownst to him, a letter had been forwarded to the Director of Internal Affairs that requested for his immediate evacuation from his current position and a transfer to a more remote place, away from his newly built house and his wife and children. This was a form of punishment to get him to either resign from his job or choose his career over his family.


He could have easily let this go and chosen the easy way out- choosing family over work. But this was a tough decision because ironically, he was out of funds. A recent diagnosis of diabetes reduced his energy levels to work effectively and his salary was barely enough to fund for his mother’s hospital bills after being diagnosed and treated for leukemia.


As a compensatory mechanism, he spent his whole day in bed brooding over his current state and wondered how his life had suddenly changed before his eyes. Everything was crystal clear now. His normal energetic self would have previously pulled himself to the living room to watch TV, or start his engine and drive around town with his kids leisurely. But he could not do either. He could stay in bed and cry the whole day, refusing to eat even his favorite meals prepared for him. The sad part was, at night, He could lie on his bed; widely awake for hours and unable to drift into wonderland. Sleep failed to listen to his desperate attempt of coming to take away his sorrows in a whiff.


Again, if he managed to find himself in the living room, he will pant after climbing the stairs on his way back to his room. However this was something he initially did with ease. The vicious cycle that had started seemed unending and culminated in his shirts and trousers slipping loose over his body. At this rate, he realized he needed help, but the question was where? As supportive as his wife was, she couldn’t satisfy his mental health needs that he had to be referred to a higher center where he had to be taken care of by competent psychiatrists to get back on his feet.


After taking the history and conducting a mental state examination, I made the diagnosis of a Moderate Depressive Episode because the symptoms he complained of primarily met the diagnostic criteria according to a classification tool used in Psychiatry ICD-10. I initially made the attempt to admit him, because he posed a significant risk to his colleague after he had declared his intention to harm him but I quickly rescinded this decision when it was brought to my attention there was no free bed in our ward to accommodate him, thus he had to be treated on out-patient basis.


As part of his treatment, I had to investigate how controlled his diabetes was, and other complications that could arise as a result, so I requested for laboratory investigations and started him on oral antidepressants. This was with the hope his symptoms will abate, as I coupled his intervention with a consult to the attending psychologist. This would help him deal with the thoughts of seeing a bottle as half empty instead of half full.


Depression is a highly treatable condition which is characterized by a persistently depressed mood or a loss of interest in activities causing significant impairment in daily life. This resolves within months when treated by a medical professional. Do not stay in your closet and think there is no help for you. If you have ever contemplated taking your own life, you might fall under the category of depression so it is essential you seek help. Get seen by a psychiatrist and get the needed help. Pull yourself close to people who have your interest at heart. A form of therapy known as Cognitive Behavioral Therapy (CBT) has a way of identifying the negative thought patterns as well as behavioral responses to stressing and challenging situations and helping you deal effectively with them. Say No to Depression and join the fight against the stigma of mental health.


Let’s make the world better with a better you in it.




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