The New Nation - Internet Edition

Depression : Some tips to face it

Easir Abedin

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850 000 thousand lives every year.

Depression is the leading cause of disability as measured by YLDs (Years Lived with Disability) and the 4th leading contributor to the global burden of disease (DALYs) in 2000. By the year 2020, depression is projected to reach 2nd place of the ranking of DALYs (Disability Adjusted Life Years) calculated for all ages, both sexes. Today, depression is already the 2nd cause of DALYs in the age category 15-44 years for both sexes combined. Depression occurs in persons of all genders, ages, and backgrounds.

Facts

Depression is common, affecting about 121 million people worldwide.

Depression is among the leading causes of disability worldwide.

Depression can be reliably diagnosed and treated in primary care.

Fewer than 25 % of those affected have access to effective treatments.

Depression can be reliably diagnosed in primary care. Antidepressant medications and brief, structured forms of psychotherapy are effective for 60-80 % of those affected and can be delivered in primary care. However, fewer than 25 % of those affected (in some countries fewer than 10 %) receive such treatments. Barriers to effective care include the lack of resources, lack of trained providers, and the social stigma associated with mental disorders including depression.

Primary care based quality improvement programs for depression have been shown to improve the

quality of care,

satisfaction with care

health outcomes,

functioning,

economic productivity,

and household wealth at a reasonable cost

WHO has recently launched an initiative on Depression in Public Health. The objectives and planned activities of this project are explained below.

Overall objective: To reduce the impact of depression by closing the substantial 'treatment gap' between available cost-effective treatments and the large number of people not receiving it, worldwide.

Specific objectives:

To educate patients, family members, providers, and policy makers about depression.

To reduce the stigma associated with depression.

To train primary care personnel in the diagnosis and management of depression.

To improve the capacity of countries to create policies supportive of improving care for depression and to provide effective management of depression in primary care.

Activities:

Global, regional, and national events to increase awareness of depression.

Production and dissemination of resources for improving depression care.

Regional and national workshops to strengthen the capacity to care for depression.

Multi-site intervention studies to improve the primary care for depression.

Well, if you want to be happy and want to bid your depression goodbye, now is the time to straighten up and hold your head high so that you can start feeling better!

Here are the best remedies on the block that'll make you feel as good as new.

THE TOP 10 TIPS TO OVERCOME OF DEPRESSION:

1. First and foremost, 'talk'.

Talking to someone close to you can go a long way in keeping away the blues. Your spouse/partner, your parents, your siblings or your close friends can be your pillar of strength during this depressive phase. Always remember… those who love you, will not judge you based on your weaknesses and will definitely give you the support you need.

2. Exercise.

Take a walk or jog a while. If you're into sports like basketball or baseball, go sweat it out in the court or on the field. Exercising helps the release of endorphins, which in turn stimulate happiness.

3. Cry.

Experts believe that crying relieves a lot of stress. You'll feel better once you've wet those eyes a bit.

4. Get some sunlight.

One of the simplest ways to get rid of depression is to step outdoors. Sunlight will surely make you feel better, especially if you tend to stay holed up in your house or in poorly lit environment.

5. Music to the rescue.

Listening to peppy numbers does surely elevate the spirits. Put on your dancing shoes and shake a leg to some groovy numbers. Join some salsa classes or take ballroom lessons. The Fred Astaire feel will make you float on air!

6. Don't stay idle.

An idle mind is the devil's workshop… an oft used phrase. Well, it's true. The more occupied you are doing chores, the lesser the time, that you'll spend thinking about depressing things.

7. Write.

Making your journal your best buddy would help you pour out your feelings and frustrations. You could chart out how you want to go about planning your strategy to combat depression.

8. Diet.

A well balanced nutritious diet would help you stay focused and keep your mind and body in perfect order, helping you cope better with anxiety during depressive phases.

9. Get a hug.

So get one of your loved ones to give you a nice, tight hug and you'll be feeling much brighter and cheerful.

10. Seek professional help.

If the depression persists for more than two weeks, with periods of lack of sleep or change in appetite or a feeling of despair or worthlessness, consult a specialist. Remember, that the doctor is your best friend and the more you let him/her know how you're feeling, the better and quicker will your recovery be. Anti- depressants can help you shorten your recovery period.

Follow these tips and you'll be fast tracking your way to recovery, holding your head really high!

"This is my depressed stance. When you're depressed, it makes a lot of difference how you stand. The worst thing you can do is straighten up and hold your head high because then you'll start to feel better. If you're going to get any joy out of being depressed, you've got to stand like this." - Charlie Brown

Amra is useful in bilious dyspepsia

Jamayet Ali

Hog plum (Amra) is a small, aromatic deciduous tree, found wild or cultivated almost throughout Bangladesh. It is said to be wild mango because of its mango-like smell. The fruit, which ripens in October-November when largest, is of the size of a gooze's egg, of a rich olive green colour, mottled with yellow and black. It has but little scent. The part nearest the rind is extremely acid, but, that being removed, the part near the stone is sweet and eatable. It is sometimes eaten raw when ripe, but more commonly it is put, while green, in fish or vegetable curries, or in lentils, to give these dishes the acid taste so much appreciated by natives. The stone easily germinates during the rainy season. This fruit is not only popular to the people but also favourite to animals. Cattle, deer, monkeys, squirrels greedily and eagerly feed on the fruit. It grows in regions where the maximum temperature in shade ranges from 38 to 48° and the rainfall between 75 and 375 cm. or more. The tree is a light- demander but sensitive to frost. The plant is artificially propagated either through seed or from cuttings. Sowing the seeds directly in the field gives better results than transplanting, provided the stones are covered with earth. However, basket-raised seedlings transplant better.

Botanical name of Amra is Spondias pinnata Linn.' It grows widely in Bangladesh, India, Srilanka, Myanmar, Hong Kong and other tropical countries. It is used as a condiment and can be made into chutneys, stews and jams. It is also made into a pickle with mustard oil, salt and chillies. The edible portion of the fruit gave, on analysis, the following values: moisture, 83.2; mineral matter, 0.6; fibre, 1.0; calorie, 66 k, protein, 1.1; fat, 0.1; carbohydrate, 15.0 gms. calcium, 55; iron, 3.9; carotene, 800m; phosphorus, 11.0; vitamin B-1, 0.28; vitamin B-2, 0.04; and vitamin C, 92mg/l00g.

The sapwood is white or grayish white; the heartwood is roseate-grey. The wood is dull, straight-grained, very coarse-textured, and not strong. The timber seasons without cracking, splitting or warping. It can be kiln-seasoned readily and stain can be avoided provided it is directly dealt with after conversion. If air-seasoned, the logs should be converted when green and the sawn stock open-piled under cover. The timber rapidly perishes in the open and is not of much value but it is moderately durable under cover. It is quickly attacked by white ants, but is not subject to borer attack, unless left in the logs. It can probably be treated without difficulty. It can be polished, but absorbs much polish. The wood is employed for packing-cases and tea-chests and for floats, canoes or boats. It is suitable for match splints, but not for match boxes and for non-ornamental plywood. The wood is fairly good for un bleached woodpulp, but is slightly inferior to the best woods in bleaching power. It is used as a, though of poor quality. A mild insipid gum, somewhat resembling gum Arabic, but darker in colour, exudes from the bark. It occurs in stalactiform pieces of a yellowish or reddish brown colour, and with a smooth shining surface. With a large volume of water it forms a gelatinous mucilage, which is precipitated by acetate of lead, gelatinized by the basic acetate and by ferric chloride, but not by borax.

Medicinal Properties: The fruit is astringent and antiscorbutic. It is stated to be useful in bilious dyspepsia. It is eaten either green or dry as an antidote for wounds caused by poisonous arrows. The juice is applied in earache. The plant is reported to have anti-tubercular properties. The bark is aromatic, astringent and refrigerant. It is useful in dysentery and diarrhoea, and is also given to prevent vomiting. A paste of it is used as an embrocation for both articular and muscular rheumatism. A decoction of the bark is stated to given in gonorrhhoea. The bark is used for tanning. The root is considered useful in regulating menstruation. The tree exudes a mild, insipid, yellowish or reddishbrown, stalactiform gum with smooth, shining surface, resembling gum Arabic, except being darker. It forms a gelatinous mucilage with water but is not wholly soluble. It is used as a demulcent and for the purpose of fumigation. The gum is sometimes employed as an adhesive. The leaves are aromatic, acidic and astringent. They are used for flavouring. Their juice is in earache. The flowers are sour and eaten as such, made into a curry, or used as a flavouring (Wealth of India, Raw Materials, Hog plum)

Medicinal Values: The leaves are tasty, appetizing, astringent. The unripe fruit is sour, indigestible, hot; destroys "vata"; enriches the blood; cures rheumatism; good for sore throat. The ripe is acrid, sweet, oily, pleasant to the taste; indigestible||refrigerant, tonic, aphrodisiac, astringent to the bowels; cures "vata", biliousness, ulcers, burning sensation, phthisis, blood complaints (Ayurveda).

The bark enters into the composition of a large number of prescriptions recommended for the treatment of snake-bite (Bapat). The bark is refrigerant medicine. It has been found useful in dysentery. Among the Mundas the bark, ground and mixed with water, is rubbed on in both articular and muscular rheumatism. A handful of the bark is pounded and infused in a pint of water; after straining, this is drunk against diarrhoea or dysentery, either all in one draught, or half of it, the remainder being taken later (Encyclopaedia Mundarica). The juice of the leaves is used for earache. The fruit is useful antiscorbutic. The pulp is acid and astringent, and is used in bilious dyspepsia. The bark is not an antidote to snake-venom (Mhaskar and Caius). (Indian Medicinal Plants, Kirtikar B.D. Basu, Vol. II, 674).

Medicine: The pulp of the fruit is described by Sanskrit writers as acid and astringent, and useful in bilious dyspepsia, for which reason the name of Pittavriksha or "bile tree" is sometimes applied to it. The fruit is much used as an acid vegetable, and is made into a preparation resembling gooseberry which is called rayete. The leaves and bark are astringent and aromatic, and are administered in dysentery. The gum is used as a demulcent (Dymock). The juice of the leaves applied locally in earache (Atkinson). By some of the Shan tribes in Burma the fruit is considered an antidote for wounds from poisoned arrows, and for this purpose is eaten either green or dry. When that cannot be obtained, alum is considered the next best remedy, a fact which would seem to indicate that astringents counteract the effects of these wounds on the system.

Special Opinions: " 'Amra' " is a useful antiscorbutic. I use it both in its green and ripe state in curries for the prisoners" (Surgeon R.L. Dutt, M.D., Pabna) (Dictionary of the Economic Products of India, hog plum, 339).

Beware of aspirin resistance

Internet

Some cardiovascular medications function as antiplatelet drugs, which prevent tiny blood cells known as platelets from clumping together - the first step in the formation of a blood clot. Others dilate blood vessels or provide two medicines in one pill.

Aspirin is an old standby, yet it continues to surprise. This common, inexpensive drug helps protect survivors of heart attack and stroke from subsequent heart attacks and death, and even helps reduce the number of deaths that occur within the first hours following a heart attack. Although aspirin is best known as an antiplatelet drug, it may also subdue the inflammation that is central to coronary artery disease.

Randomized trials have provided clear evidence of aspirin's value in both preventing heart attacks in men and treating coronary artery disease in both sexes. Over all, dozens of studies, involving tens of thousands of people, have shown that low-dose aspirin reduces the risk for heart disease and stroke by about 25%. A standard dose of aspirin to prevent heart attack is 81 mg per day, about what you'd find in a baby aspirin.

Guidelines from nearly every major medical group urge people with heart disease or at high risk for it to take aspirin. Although a major study reported in 2005 concluded that the advice is not as clear-cut for how to prevent first heart attacks in women, the prevailing consensus remains that in general, unless you are allergic to aspirin or it causes you problems, you should take it if you

*have had a heart attack

*have had an ischemic (clot-caused) stroke or a mini-stroke (transient ischemic attack)

*have angina (chest pain)

*have had a coronary artery bypass or angioplasty

*have diabetes

*are at high risk for heart disease.

Despite aspirin's benefits, it also has some drawbacks. The evidence that its benefits exceed its risks is much stronger in men than in women, at least in terms of primary prevention (avoiding a first cardiovascular event). It can increase the risk for stroke and significant gastrointestinal bleeding. Even people who take aspirin occasionally with no problems could experience bleeding complications with regular use over prolonged periods. In particular, it may not be a good choice for people with uncontrolled hypertension (a major cause of hemorrhage into the brain). In such people, aspirin could more likely cause dangerous bleeding than prevent a heart attack. In addition, aspirin occasionally irritates the stomach lining without causing bleeding. However, these side effects can be reduced with the use of coated aspirin, which minimizes stomach irritation.

Advice for Women About Aspirin

The first large-scale randomized study to specifically examine aspirin's effectiveness in preventing first heart attacks in healthy women, reported in the New England Journal of Medicine in 2005, showed that the risk/benefit analysis for aspirin is not as straightforward in women as it is in men. The study involved almost 40,000 healthy women ages 45 and older, who took 100 mg of aspirin or a placebo every other day. To their surprise, the researchers found that aspirin did not affect the risk for a first heart attack one way or the other in the group as a whole, although it did reduce the risk for stroke by 17%. Yet when the researchers did subgroup analyses, they discovered that aspirin significantly reduced the risk for first heart attack, stroke, and other cardiovascular events in women who were 65 and older. This benefit has to be weighed, however, against an increased risk for gastrointestinal bleeding.

So what do you do? If you're a woman who has already had a heart attack, stroke, or some other cardiovascular event, the advice remains the same: Take aspirin to reduce the risk for a second event. (A large study that looked at such secondary prevention concluded that aspirin benefits both men and women.) But if you're considering taking aspirin to prevent a first event, the advice is less clear-cut. Talk with your physician to determine whether - in your case - the benefits outweigh the risks.

Some people are resistant to aspirin's anticlotting effects. So far the research indicates that aspirin fails to affect platelets' tendency to clump, or does so only partially, in 5%-40% of people who take it. These people therefore don't have the same reduction in heart attack and stroke risk that other people gain from aspirin use.

There are probably several reasons why aspirin resistance occurs. The body's response to aspirin may change over time. Some people have trouble absorbing aspirin from the digestive tract. Smoking blunts the effect of aspirin on platelets, as do being overweight and having high cholesterol or high blood pressure. A variety of genes influence how the body responds to aspirin. Finally, a few studies have indicated that a common nonsteroidal anti-inflammatory drug (NSAID), ibuprofen, may block aspirin's protective effects. The occasional dose of ibuprofen isn't likely to do this, but daily use could.

Although two laboratory tests are available to measure how well aspirin may be working for you, the idea of aspirin resistance is so new that many doctors either aren't aware of it or are waiting for more evidence that it's real before ordering these tests. So what do you do in the meantime? First, talk with your doctor about being tested for aspirin responsiveness. Second, if you need to take an NSAID for arthritis or some other condition, pick one that doesn't interfere with aspirin, such as naproxen (Aleve, Naprosyn) or diclofenac (Cataflam, Voltaren). Third, don't stop taking aspirin - regardless of whether you can get tested or what the results are. Aspirin probably works in several ways to prevent heart attacks. If do you find you are aspirin resistant, talk with your doctor about other antiplatelet medications.