Sawasdee Krub. I’m Dr. Chakriwat. First of all Thank you all of you for your interest in medicine and health. Every month, we at CMIC post a question on Facebook about health in order to discuss it and raise awareness and understanding about various diseases. Common diseases that we see every day. Last month we asked a question about Type 2 Diabetes in order to spread information and understanding about diabetes type 2. Type 2 diabetes can happen to anyone. As we age, if we don’t look after our health don’t maintain a healthy diet don’t exercise regularly and allow ourselves to gain weight we can get type 2 diabetes. It’s important to note some diseases can be prevented. Taking preventative measures before we have health problems is very important. We hope that the questions we raise each month on Facebook will provide you with information about diseases that we see often. And that you will take that information to your primary care physician or family doctor to discuss about treatments and prevention of diseases before they happen. This month we asked a question about Dan who is an engineering student at a famous university. The important information in the question was First of all, we knew that Dan had changes in his mood and emotions and he also had problems with sleep. He feels like he doesn’t get enough sleep and wakes up very early. Even when he gets up at 5 in the morning he can’t go back to sleep. He had changes to his weight. He lost weight and he said he doesn’t have an appetite. He’s bored of food, doesn’t want to eat and doesn’t feel hungry. His energy levels.. He always feels tired. Constantly weak and tired. His level of concentration… his ability to concentrate in class.. he lost his concentration. Things he likes to do if he has time is to spend time with his family he likes to go to the temple and make merit. But lately, whatever used to make him happy no longer does. He’s no longer happy when he goes to the temple or when he spends time with his family, like before. He told his friends and family that he feels disheartened. He feels disheartened and wants to give up. Disheartened and what’s to give up. These feelings and symptoms he had for about two weeks. Just looking at the symptoms and characteristics we might think he is suffering from depression. Major Depressive Disorder. Because these symptoms are very similar to those of depression. The way to diagnose… the way to diagnose those with major depressive disorder or depression is to see if they have problems with sleep or with eating or weight. Most of the time patients would have sleeping problems. They would sleep very little and not get enough sleep and wake up very early. And with eating habits.. The patient might eat very little and not have much of an appetite. This is what we’d normally see. Another type of depression called Atypical Depression Atypical as in not normal. The patient would eat a lot. The patient would sleep a lot as well. Sleep all day, and eat a lot and gain a lot of weight. This is atypical depression. Depression that is not typical. In typical cases that we see a lot, patients lose weight, don’t eat much food, or have an appetite, have problems sleeping sleep very little and wake up very early. These are the two types of depression we see. Patients also have changes in mood and emotions. Those that are normally social and outgoing might become quiet and not want to leave the house. Their energy levels… they feel tired.. tired all the time. tired all day. They can’t concentrate. Other than that things they used to love or like to do such as golfing or running or watching movies… they’ll no longer feel like doing those things. They won’t be happy doing those things they used to love. Some patients might say they sometimes have suicidal ideation or thoughts about harming themselves. They might have feelings of worthlessness that they have no value. These symptoms if they last at least 2 weeks… If the symptoms last for over 2 weeks If these symptoms last over two weeks. We can then diagnose that the patient has major depressive disorder, or depression. Now taking a look at Dan’s symptoms we might feel confident that he has depression or major depressive disorder. But we aren’t 100% sure. We can’t be 100% sure because there are many diseases with similar symptoms. For example there are many diseases that effect weight that effect energy levels whether feeling tired or have energy or that effect sleep or effects the ability to concentrate. Therefore it’s still possible that Dan doesn’t have depression, so he should see a doctor. The doctor should perform a physical checkup and test his blood. What should they check for in the blood? The first thing is the thyroid. Test for thyroid stimulating hormone. The thyroid stimulating hormone will tell us whether the thyroid is producing too much or too little. Why do we have to check the thyroid of patients like Dan? The thyroid hormone effects metabolism therefore if we’re overweight or underweight or whether we are obese or too skinny has to do with the thyroid hormone. Feeling tired all day can also be because of low levels of the thyroid hormone. Therefore, we have to see whether Dan’s thyroid stimulating hormone are within normal levels. If the levels are too high or too low it could be the reason for the weight change. His loss of concentration, is it because of his thyroid? Or is he feeling tired all day because of low levels of the thyroid hormone. This is why we have to check the levels of thyroid stimulating hormones in patients like Dan. Next thing to check in the blood is the hemoglobin levels. The red blood cells or hemoglobin carries oxygen from the lungs we breathe air into the lungs and the hemoglobin will take the oxygen and transport it to vital organs, such as the brain, muscles, liver and kidneys. our whole body hemoglobin transports oxygen to the rest of the body. Therefore if there are problems with the structure of the hemoglobin such as anemia or other diseases, the hemoglobin won’t be able transport oxygen to the brain or the rest of the body including vital organs in enough quantities. The brain and the body would be oxygen deficient causing feelings of tiredness and weakness We also have to ask Dan whether he is on any medications. Does he consume alcohol or use any recreational drugs? Because alcohol and drugs could cause Dan to feel depressed. Therefore these lab tests are very important because the thyroid hormone the hemoglobin alcohol drugs etc. can cause symptoms that are similar to depression. Now all of Dan’s lab tests have returned. He doesn’t have thyroid abnormalities no blood disease he said he doesn’t consume alcohol or take drugs Now we are able to eliminate we can eliminate.. we can rule out these diseases the diseases like anemia and thyroid. Now the doctor can concentrate on Dan’s mental health. For example try to find a reason why he might be feeling depressed. The doctor might ask is it because Dan is at an institution that is well known and ask about how his engineering classes are going are there any problems with class? Are there any problems at home? Are there any personal problems? Does he have a significant other? Are there problems with his significant other? These are very important questions to determine if there’s anything going on in Dan’s life that could cause him to feel depressed. What’s causing him to think and dwell and feel discouraged. The most important thing this is for any medical students.. The most important question to ask someone who’s depressed… As a medical student if you see a patient who’s depressed if you only get one question to ask this patient who is depressed this question will be the most important question. This question is “Do you feel like hurting yourself?” This is because those suffering from depression might have suicidal ideation or might think about suicide or harm themselves. Because as doctors, the patient’s safety is our number one priority. We have to We have to make sure the patient is safe. Therefore the question to ask a patient that is depressed is “do you feel like hurting yourself?” That’s very important. Now we believe that we have diagnosed that Dan is suffering from depression because he has all the symptoms of the disease such as the fact that he’s had symptoms for over 2 weeks. He has problems with his appetite and is losing weight. He has problems sleeping and wakes up earlier than normal. Activities that used to bring him joy such as going to the temple or spending time with his family no longer brings him joy. He doesn’t have the ability to concentrate. He doesn’t have energy during the day. He feels discouraged. And most importantly he’s felt like this for two weeks. Two weeks is the timeline that’s very important. It has to be at least two weeks in order for us to diagnose that the patient has major depressive disorder. What’s important Dan has all these symptoms and we’ve done all these lab tests we tested his blood, given him his physical. His hormone thyroid levels are normal His hemoglobin is normal. he doesn’t have anemia or anything else. He doesn’t drink alcohol. He doesn’t do drugs. Therefore we ruled out those other diseases already. We’re confident that that he has major depressive disorder. Now on to the treatment. How do we treat Dan? For the most part, the best treatment is what’s called psychotherapy or cognitive therapy. Dan should start seeing a psychologist who will try to find the reason the reason that Dan feels depressed. Have Dan talk about what is going on in his life. And when trying to find out the cause for his depression it’s very important for Dan to be as open as possible and face the reasons he feels depressed, and accept the reasons why he is depressed. After knowing the cause confronting the cause accepting the reason why he’s depressed the next step is to find a way to cope or a coping strategy to deal with the depression. How to cope with his depression. What to do next. Now that we know the cause of the depression, accepted the reason for it, now we have to find a way to deal and move forward. When we see a psychiatrist for psychotherapy and cognitive therapy to understand our feelings the psychiatrist might prescribe a drug in the class SSRI. SSRI’s are anti-depressants. The patient taking these might feel better. When speaking to the doctor about his health why he feels depressed or find a reason feeling depressed might take drugs in the SSRI class. But the drug won’t make the depression go away. Taking it helps helps with the symptoms. Helps with feeling better. But it doesn’t cure depression. Therefore drugs are not the answer for patients in the long term. Drugs only help with the symptoms. To help treat it for good, besides the drugs the patient has to speak with a psychiatrist to find the root cause of the depression, and accept why they are depressed. And find a way to cope or find a coping strategy to handle the depression. Psychotherapy and cognitive therapy are very important. And drugs can help but they are not they’re not.. Taking drugs isn’t the cure. Other things need to be done. We have to understand the root cause. The answer for this month to the trivia is “C”. Go see a doctor. Lastly I hope all of you look after your health. In our lives we have only one body. So please take good care of your health. I’m Dr. Chakriwat. Sawadee Krub.