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How are symptoms of long term mild depression or dysthymia treated ?

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Practicing since : 2004
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Sir, I am 34 years old, male, single, working as a professional engineer. Since my childhood, I am very shy and introvert in nature. From age 8 to 14, i was being along with my grand mother, since my parents were overseas at their work. During high schools years , I felt anxiety and stress since age 12 years due to pressure of studies and expectations of my parents. Since age 13, i had developed indigestion and loose motion complaint and become very lean and weak. My physique is weak and not developed since then. At age 17, i have failed the higher secondary school, and lost my self confidence, shied away from social activities and contacts and have suicidal thoughts. I have no close friend since then. I have undergone treatment for depression and stomach problem at age 17-18 and 22-23, but without result. The depression stage is since then, occasionally increasing and decreasing depends on daily life. After i become a professional engineer at age 23, and working away from my native, and hence more isolated from my family and my relatives. presently I am living alone for past 6 years at my work place with occasional meeting with parents.The problem of indigestion, loose motion and gas trouble is continuing since age 17. After taking lunch, breakfast etc, i had a feeling of stomach upset and wanted to go to toilet and little stool along with fluid is discharged. Taken medicine several times, but without cure. please advice.
Posted Mon, 16 Apr 2012 in Depression
Answered by Dr. Ashish Mittal 15 hours later

Thanks for your query.

It is nice to see such a nice and precise description of problem in spite of having so many problems in life.

Important aspects of your query are:
•     34 years old unmarried male
•     Long duration of problem: more than 20 years
•     Symptoms of depression varying in severity over the time
•     Other symptoms: indigestion, loose motion and gas trouble leading to poor physical health
•     Last treatment received for depression, around 11 year back (at 23 year of age)

From your information it is clear that you have long term symptoms of mild depression or dysthymia. In between severity of depression increases and for that you might have received treatment (twice) although it was not effective in your case.

Depression usually accompany with anxiety and excessive worry related to health, finance and well being of family members and may also lead to excessive acid secretion causing gastritis, indigestion, loose motion and gas trouble.

So you need long term treatment of depression may be for years considering long duration of symptoms and it will decrease your gastrointestinal problem too.

In your case combined treatment with medicines like one of SSRI group of medicine or mirtazapine depending on your case suitability along with cognitive behaviour therapy by trained therapist will be helpful.

For no response, following factor may be responsible:
•     Poor treatment compliance: you need treatment for years
•     Suboptimal doses of medicine
•     Presence of substance use (if any)
•     Short duration of treatment: medicines start showing their effect in 1-2 month after dose adjustment.
•     Wrong diagnosis or treatment
•     Continued stress in life
•     Presence of long term physical illness
•     Thyroid related hormonal disturbance

In last few years very good treatment of depression is available, so seek consultation early to reduce suffering. In some treatment resistant cases combination of medicines may be required, which may take few months to adjust doses.

Final message to you: worry less, get psychiatrist consultation for treatment and have thyroid hormonal assay (serum TSH level).

Hope this answers your query. In case of any doubt, I will be available for follow ups.

Wishing you good health.

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