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Depression, Anger Problem, Tiredness. Want To Treat Mental Illness.

Posted on Sun, 24 Jun 2012

Question: Hi, I have been on many times regarding my depression. My GP has put me on Fluoxetine 20mg daily. After 10 days I feel fine in myself but still have traits of my depression. No interest in my Sport, over tired, sleep problems etc. In delving into Depression tests I find that all my life I have had ADD without knowing it. I got bored and rather than do something essential I would engage in more exiting persuits, even though they were crazy, like tranvestism, gambling etc. It was better than enduring the boredom. I have a short fuse and a very quick temper developing into Anger. If my depression returns and coincides with an anger event I would not be able to guarantee my responses. Please see into that just what I mean, though I am not usually suicidal. What can I tell my GP to make him decide to send me for Psychiatric examination and possible hospitalisation to cure my ills. It is just like my GP does not want to hurt me. I see him next Tuesday and I would like to get the ball rolling, so as to speak. I am determined to get my Mental Illnesses cured and get on with my life. Thank You My latest BP 134 over 59 HR 60

Answered by Dr. Ashish Mittal (12 hours later)

Hello,
Thanks for your query.

Important aspects of your query are:
•     74 year old male
•     Known case of Depressive disorder
•     Past history of minor heart attack and TURP.
•     Complain of no interest in sport, tiredness and sleep problems
•     Currently on fluoxetine 20mg with partial improvement

Fluoxetine usually take around 3-4 weeks to show its effects. Even in many cases there is progressive improvement over a period of 3 months. If patient does not show improvement in existing doses then physician has option to increase dose.

In your case fluoxetine was started 10 days back and you are already perceiving improvement. I would also like you to wait for some time before getting referred to psychiatrist. Apart from that depressed patient improved fast at home rather than hospital.

Some of your problem like tiredness and sleep problem may be age related. Apart from that you can also request your physician medicine for sleep difficulty for short duration.

Regarding ADD you should get evaluated after improvement in depression as some of the attention deficit symptoms may be due to depression.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

Above answer was peer-reviewed by : Dr. Jyoti Patil

Follow up: Dr. Ashish Mittal (2 hours later)

Thank you for yur response. All my life I have had ADHD and not realised it. Being fed up with something that may have been very important I would seek some excitement like gambling and transvestism etc. It has caused me serious problems as you can guess. My ADHD started I believe when I crashed a glider at the age of 14, it was quite a traumatic experience. Having pushed these things to the back of my mind and due to looking at my depression they are coming to light. Even at the age of 5 a school mental health visitor wanted to send me to a special school which my mother would not allow. I ended up the brightest kid in the school. I have a very short fuse and a viscous temper. If my depression returns at a time when I 'blow' my top, what is the likely result. It is this that peturbs me most. I hate heights and have to press myself against the building because I feel I might jump, though I am scared of doing so. Does the above change your advise. XXXXXXX

Answered by Dr. Ashish Mittal (1 hour later)

Hello,
Thanks for reverting.
If you have chronic symptoms of attention deficit hyperactivity disorder (ADHD) from childhood, then we can go with a diagnosis of adult ADHD. In ADHD, as the age advances, hyperactivity reduces but inattention persists. ADHD patients are also at a high risk of developing depression.

As far as the management is concerned, fluoxetine has a role in managing ADHD and depression. Considering your age and history of depression, I would suggest that you continue the existing treatment. If ADHD symptoms still persist, they can be addressed after an improvement in the symptoms of depression is seen.
I hope I have answered your query. Please accept my answer if you have no further queries.
Regards,

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Ashish Mittal (23 minutes later)

Dr Mittal Ji, Thank you for your helpful response. Foreknowledge is a very good thing. I took awhile to recognise that I am Mentally Ill and a Mental Patient. I can accept that now and feel much better for it. I really only have one more need from you, and I can only ask for a gut feeling. From what you know, taking a measurement from 0-10 where 0 is normal , 5 is could benefit from Hospitalisation and 10 is should be in Hospital, where do I fit in. I am noticing increasing small suggestions of Mental Illness as I get older. Am I looking at probable Hospitalisation in the future. Thanking you in anticipation of your response. XXXXXXX

Answered by Dr. Ashish Mittal (1 hour later)

Hi,
Thanks for reverting and I am grateful for the positive feedback.

I would give you a rating of 2 on your scale. I would strongly suggest that you do not let negative feelings, thoughts or opinion dampen your enthusiasm for life. Instead, replace them with a desire to live life to the fullest and completely and totally believe that you are improving and that you'd be fine.

Wish you good health ahead,

Regards

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Aparna Kohli