Clinical depression is a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living. A person suffering from depression may feel tired, sad, irritable, lazy, unmotivated, and apathetic. Clinical depression is generally acknowledged to be more serious than normal depressed feelings. It often leads to constant negative thinking and sometimes substance abuse. Extreme depression can culminate in its sufferers attempting or committing suicide.

Without careful assessment, delirium can easily be confused with depression and a number of other psychiatric disorders because many of the signs and symptoms are conditions present in depression, as well as other mental illnesses including dementia and psychosis.

 Types of depression:

Major clinical depression:

Major Depression, or, more properly, Major Depressive Disorder (MDD), is characterized by a severely depressed mood that persists for at least two weeks. Major Depressive Disorder is specified as either "a single episode" or "recurrent"; periods of depression may occur as discrete events or recur over the lifespan. Episodes of major or clinical depression may be further divided into mild, major or severe. Where the patient has already had an episode of mania or markedly elevated mood, a diagnosis of bipolar disorder (also called bipolar affective disorder) is usually made instead of MDD; depression without periods of elation or mania is therefore sometimes referred to as unipolar depression because the mood remains on one pole. The diagnosis also usually excludes cases where the symptoms are a normal result of bereavement. Diagnosticians recognize several possible subtypes of Major Depressive Disorder. ICD-10 does not specify a melancholic subtype, but does distinguish by presence or absence of psychosis.

Dysthymia is a long-term, mild depression that lasts for a minimum of two years. There must be persistent depressed mood continuously for at least two years. By definition the symptoms are not as severe as with Major Depression, although those with Dysthymia are vulnerable to co-occurring episodes of Major Depression. This disorder often begins in adolescence and crosses the lifespan. People who are diagnosed with major depressive episodes and dysthymic disorder are diagnosed with double depression. Dysthymic disorder develops first and then one or more major depressive episodes happen later.

Bipolar I Disorder is an episodic illness in which moods may cycle between mania and depression. In the United States, Bipolar Disorder was previously called Manic Depression. This term is no longer favored by the medical community, however, even though depression plays a much stronger (in terms of disability and potential for suicide) role in the disorder. "Manic Depression" is still often used in the non-medical community. Bipolar II Disorder is an episodic illness that is defined primarily by depression but evidences episodes of hypomania.

Postpartum Depression or Post-Natal Depression is clinical depression that occurs within two years of childbirth. Owing to physical, mental and emotional exhaustion combined with sleep-deprivation, motherhood can "set women up", so to speak, for clinical depression.(Kathy,2005)

Premenstrual dysphoria is a pattern of recurrent depressive symptoms tied to the menstrual cycle. The premenstrual decline in brain serotonin function is strongly correlated with the concomitant worsening of self-rated cardinal mood symptoms.(Eriksson et al , 2006) Of considerable clinical importance, the recent understanding of premenstrual dysphoria as depression points directly to effective treatment with Selective serotonin reuptake inhibitor (SSRI) antidepressants. Previously, disrupting ovarian cyclicity had been the only recognized treatment. A recent review of studies of a number of SSRIs has revealed that they can effectively ameliorate symptoms of premenstrual dysphoria and may actually work best when taken only during the part of the menstrual cycle when dysphoric symptoms are evident.

Recurrent brief depressive disorder (or recurrent brief depression) is in the ICD-10 classification. It is described as meeting the criteria for a mild, moderate or severe depressive episode; the depressive episodes have occurred about once per month over the last year; individual episodes last less than two weeks (typically less than 2-3 days), and they do not occur solely in relation to the menstrual cycle.  Some people are at risk of self-harm, as well as the disruption to everyday life, particularly work

Physiological causes

Genetic predisposition

The tendency to develop depression may be inherited: according to the National Institute of Mental Health there is some evidence that depression may run in families, though this familial trend probably includes both biological and environmental factors.

Neurological:

Many modern antidepressant drugs change levels of certain neurotransmitters, namely serotonin and norepinephrine (noradrenaline). However, the relationship between serotonin, SSRIs, and depression usually is typically greatly oversimplified when presented to the public, though this may be due to the lack of scientific knowledge regarding the mechanisms of action. Evidence has shown the involvement of neurogenesis in depression, though the role is not exactly known.(Castren,2005). Recent research has suggested that there may be a link between depression and neurogenesis of the hippocampus. This horseshoe-shaped structure is a center for both mood and memory. Loss of neurons in the hippocampus is found in depression and correlates with impaired memory and dysthemic mood. That is why treatment usually results in an increase of serotonin levels in the brain which would in turn stimulate neurogenesis and therefore increase the total mass of the Hippocampus and restores mood and memory, therefore assisting in the fight against the mood disorder.

In about one-third of individuals diagnosed with attention-deficit hyperactivity disorder (ADHD), a developmental neurological disorder, depression is recognized as comorbid Dysthymia,(Hallowell,Edward and Ratey,2005) a form of chronic, low-level depression, is particularly common in adults with undiagnosed ADHD who have encountered years of frustrating ADHD-related problems with education, employment, and interpersonal relationships

Medical conditions

Certain illnesses, including cardiovascular disease(Maney and Maney,2004) hepatitis, mononucleosis, hypothyroidism, and organic brain damage caused by degenerative conditions such as Parkinson disease, Multiple Sclerosis or by traumatic blunt force injury may contribute to depression, as may certain prescription drugs such as hormonal contraception methods and steroids.

Dietary

The increase in depression in industrialised societies has been linked to diet, particularly to reduced levels of omega-3 fatty acids in intensively farmed food and processed foods(Felicity,2004) This link has been at least partly validated by studies using dietary supplements in schools  and by a double-blind test in a prison. An excess of omega-6 fatty acids in the diet was shown to cause depression in rats.Depression can also be caused by a magnesium deficiency or lower magnesium levels.

Sleep quality

Poor sleep quality co-occurs with major depression. Major depression leads to alterations in the function of the hypothalamus and pituitary causing excessive release of cortisol which can lead to poor sleep quality. Individuals suffering from Major Depression have been found to have an abnormal sleep architecture, often entering REM sleep sooner than usual, along with highly emotionally-charged dreaming. Antidepressant drugs, which often function as REM sleep suppressants, may serve to dampen abnormal REM activity and thus allow for a more restorative sleep to occur.

Seasonal affective disorder

Seasonal affective disorder (SAD) is a type of depressive disorder that occurs in the winter when daylight hours are short. It is believed that the body's production of melatonin, which is produced at higher levels in the dark, plays a major part in the onset of SAD and that many sufferers respond well to bright light therapy, also known as phototherapy.

Psychological factors

Low self-esteem and self-defeating or distorted thinking are connected with depression. Although it is not clear which is the cause and which is the effect, it is known that depressed persons who are able to make corrections in their thinking patterns can show improved mood and self-esteem (Cognitive Behavioral Therapy). Psychological factors related to depression include the complex development of one's personality and how one has learned to cope with external environmental factors such as stress.

Early experiences

Events such as the death of a parent, issues with biological development, school related problems, abandonment or rejection, neglect, chronic illness, and physical, psychological, or sexual abuse can also increase the likelihood of depression later in life. Post-traumatic stress disorder (PTSD) includes depression as one of its major symptom.

Life experiences

Job loss, poverty, financial difficulties, gambling addiction, long periods of unemployment, the loss of a spouse or other family member, rape, divorce or the end of a committed relationship, involuntary celibacy, inability to have proper sex or premature ejaculation or other traumatic events may trigger depression. Long-term stress at home, work, or school can also be involved.

Evolution: Potential adaptive advantages of clinical depression:

Evolutionary analyses examine the ways in which depression as a response to certain environmental stimuli may act as an adaptive advantage and increase genetic fitness, either of the individual or the society as a whole.

Treatment

Treatment of depression varies broadly among individuals. The level, type, and methods of intervention vary dramatically. There are two primary modes of treatment that are typically used in conjunction; medication and psychotherapy. A significant number of recent studies have indicated that changes in lifestyle such as regular exercise and dietary supplements have beneficial effects.(Castren,2005)

In most cases, one particular medication or combination of medications can provide significant change, although, in some cases, the condition does not respond well. Treatment-resistant depression warrants a full assessment, which may lead to the introduction of psychotherapy, a focus on lifestyle change, an increase of medication, or a change in medication.

In emergencies, hospitalization is an intervention employed to keep at-risk individuals safe until they cease to be a danger to themselves or others. An alternative treatment program is partial hospitalization, in which the patient sleeps at home but spends most of the day in a psychiatric hospital setting. This intensive treatment usually involves group therapy, individual therapy, medication management, and often in the case of children and adolescents, academics.

Medication

Medication that relieves the symptoms of depression has been available for several decades. Typical first-line therapy for depression is the use of a selective serotonin reuptake inhibitor, such as citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). Under some circumstances, medication and psychotherapy may be more effective than either treatment separately(Thase,1999). Selective serotonin reuptake inhibitors (SSRIs) 

Selective serotonin reuptake inhibitors (SSRIs) are a family of antidepressants considered to be the current standard of drug treatment. It is thought that one cause of depression is an inadequate amount of serotonin, a chemical used in the brain to transmit signals between neurons. SSRIs are said to work by preventing the reuptake of serotonin by the presynaptic nerve, thus maintaining higher levels of 5-HT in the synapse. Recently, however, work by two researchers has called into question the link between serotonin deficiency and symptoms of depression, noting that the efficacy of SSRIs as treatment does not in itself prove the link.(Lacasse and Leo,2005). Recent research indicates that these drugs may interact with transcription factors known as "clock genes", which may be important for the addictive properties of drugs of abuse and possibly in obesity.(Yuferov et al., 2005)

Recent randomized controlled trials in Archives of General Psychiatry showed that up to one-third of effects of SSRI Treatment can be seen in first week. Early effects also shown to have secondary effect of reducing absolute reduction in HDRS score by 50 percent. Even more recent studies, published by the Archives of General Psychiatry note that 25% of so-called clinical depression does not meet a disease criteria and should be considered to be ordinary sadness and adjustment to the difficulties in life.

This family of drugs includes fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro), citalopram (Celexa), and sertraline (Zoloft). These antidepressants typically have fewer adverse side effects than the tricyclics or the MAOIs, although such effects as drowsiness, dry mouth, nervousness, anxiety, insomnia, decreased appetite, and decreased ability to function sexually may occur. Some side effects may decrease as a person adjusts to the drug, but other side effects may be persistent. Though safer than first generation antidepressants, SSRI's may not work as often, suggesting the role of norepinephrine. However, it should be noted that all psycho-active medications extend the reaction time, thus increasing the likelihood of falls and road crashes.  

Psychotherapy

In psychotherapy, or counseling, one receives assistance in understanding and resolving habits or problems that may be contributing to or the cause of the depression. This may be done individually or with a group and is conducted by mental health professionals such as psychiatrists, psychologists, clinical social workers, or psychiatric nurses.

Effective psychotherapy may result in different habitual thinking and action which leads to a lower relapse rate than antidepressant drugs alone. Medication, however, may yield quicker results and be strongly indicated in a crisis. Medication and psychotherapy are generally complementary, and both may be used at the same time.

Transcranial magnetic stimulation

Repetitive transcranial magnetic stimulation (rTMS) is under study as a possible treatment for depression. Initially designed as a tool for physiological studies of the brain, this technique shows promise as a means of alleviating depression. In this therapy, a powerful magnetic field is used to stimulate the left prefrontal cortex, an area of the brain that typically shows abnormal activity in depressed people.

Recent work  in Poland suggested that weak, variable magnetic fields may offer relief from depression in those who have not responded to medication. However, some of the existing work has been questioned, with claims that the effect is not as significant once environmental conditions are controlled.

Vagus nerve stimulation

Vagus nerve stimulation therapy is a treatment used since 1997 to control seizures in epileptic patients and has recently been approved for treating resistant cases of treatment-resistant depression (TRD). The VNS Therapy device is implanted in a patient's chest with wires that connect it to the vagus nerve, which it stimulates to reach a region of the brain associated with moods. The device delivers controlled electrical currents to the vagus nerve at regular intervals.

Electroconvulsive therapy

Electroconvulsive therapy (ECT), also known as electroshock or electroshock treatment, uses short bursts of a controlled current of electricity (typically fixed at 0.9 ampere) into the brain to induce a brief, artificial seizure while the patient is under general anesthesia.

In contrast to direct electroshock of years ago, most countries now allow ECT to be administered only under anaesthesia. In a typical regimen of treatment, a patient receives three treatments per week over three or four weeks. Repeat sessions may be needed. Short-term memory loss, disorientation, and headache are very common side effects. Detailed neuropsychological testing in clinical studies has not been able to prove permanent effects on memory. ECT offers the benefit of a very fast response; however, this response has been shown not to last unless maintenance electroshock or maintenance medication is used. Whereas antidepressants usually take around a month to take effect, the results of ECT have been shown to be much faster. For this reason, it is the treatment of choice in emergencies (e.g., in catatonic depression in which the patient has ceased oral intake of fluid or nutrients).

There remains much controversy over electroshock. Advocacy groups and scientific critics, such as Dr Peter Breggin, call for restrictions on its use or complete abolishment. Like all forms of psychiatric treatment, electroshock can be given without a patient's consent, but this is subject to legal conditions dependent on the jurisdiction. In Oregon patient consent is necessary by statute.

Light therapy

Bright light (both sunlight and artificial light) is shown to be effective in seasonal affective disorder, and sometimes may be effective in other types of depression, especially atypical depression or depression with "seasonal phenotype" (overeating, oversleeping, weight gain, apathy).

Exercise

It is widely believed that physical activity and exercise help depressed patients and promote quicker and better relief from depression. They are also thought to help antidepressants and psychotherapy work better and faster. It can be difficult to find the motivation to exercise if the depression is severe, but sufferers should be encouraged to take part in some form of regularly scheduled physical activity. A workout need not be strenuous; many find walking, for example, to be of great help. Exercise produces higher levels of chemicals in the brain, notably dopamine, serotonin, and norepinephrine. In general this leads to improvements in mood, which is effective in countering depression.

Meditation

Meditation is increasingly seen as a useful treatment for some cases of depression. The current professional opinion on meditation is that it represents at least a complementary method of treating depression, a view that has been endorsed by the Mayo Clinic. Since the late 1990s, much research has been carried out to determine how meditation affects the brain (see the main article on meditation). Although the effects on the mind are complex, they are often quite positive, encouraging a calm, reflective, and rational state of mind that can be of great help against depression.

Deep brain stimulation

Though still experimental, a new form of treatment called deep brain stimulation offers some hope in the relief of treatment resistant clinical depression. Published in the journal Neuron (2005), Helen Mayberg described the implanting of electrodes in a region of the brain known as Area 25 The electrodes act in an inhibitory fashion, on an otherwise overactive region of the brain. Further research is required before it becomes available as a method of treatment, but it offers hope for those suffering from treatment resistant depression.

Dr Smita Pandey Bhat, Cinical Psychologist

Communicating with someone who has delusions

A delusion is a fixed false belief that can't be swayed by reasoning. Paranoid, grandiose, and religious delusions are most common. A paranoid delusion is very frightening: The person thinks someone is out to harm him. Acknowledge what he says but don't agree. For example, if your patient tells you that the FBI is after him, hone in on his feelings: "Sensing that you're being watched all the time must be very frightening."

Keep your patient's environment as safe as you can. Try to have the same staff assigned to his care each day and prepare him for any changes without providing too many details; for example, "Mr. Jones, we're getting some new patients today so we have to move you to a different room." If he responds negatively, reassure him that he'll be safe and you'll protect him.

Grandiose and religious delusions are typically less frightening. A person having a grandiose delusion, for example, thinks he's someone very powerful or important. Someone with a religious delusion may claim to be a religious figure.

Follow these guidelines to maintain a therapeutic relationship with your patient:

• Accept him as he is. His mental illness is causing his abnormal perceptions.
• Monitor for hallucinations and delusions to assess his response to psychotropic medications.
• Assess his safety and monitor for warning signs such as withdrawal and depression.
• Give him appropriate feedback on how you interpret his communications and try to help him focus on the realities around him.
• Encourage him to learn about his medical illness and help with his care; involve him with diversions such as reading, writing, or solving puzzles. These activities can diminish irrational thinking and help him feel comfortable and safe.

Responding to disorganized speech

Classic verbal disturbances that might occur with schizophrenia include associative looseness, neologisms, clang association, word salad, and echolalia.

Associative looseness means one thought isn't connected to the next. When you tell your patient you've brought his medication, he might reply, "Blue lights and gold. I go round and round. The grass is green." These phrases seem disconnected but could shed light on his thoughts. If you suspect that the colors are significant, ask, "Are you asking what different medications you're getting here?" If you can't make a connection, tell him you don't understand but you'll keep trying.

Dr Smita Pandey Bhat, Clinical Psychologist, Gurgaon, Delhi - NCR, INDIA

dr.smitapandey@gmail.com 

http://child-psychologist.blogspot.com

According to the National Institute of Mental Health, depression is America's leading mental health problem. Depression has been classified the common cold of psychiatry.

It may vary from slight sadness to utter misery and dejection. Most of us get the blues, and it's considered quite normal. But when those feelings of dejection and misery stay on, it could be a serious case of depression; doctors may classify it as major or clinical depression. A major depression is something that is considerably more than your everyday blues. When you need professional help, it becomes clinical depression.

Depression is frequently an after-effect of material abuse or the result of a physically continuing state of ill-health. The US statistics on Stress and related disorders show that an annual expenditure of $7500 per person is incurred on compensation claims which are stress related, a cumulative amount of $300 billion.

Stress-related disorders, mainly Depression are touted to be THE occupational disease of this new century. No other solitary factor is predicted to cause loss of more man days of work. Competitiveness and corporate productivity are facing a major drain through this one disorder. Numerous health problems are related to stress; these range from heart diseases to liver cirrhosis to suicides to memory loss to obesity.

According to a survey conducted by the American Psychological Association in 2004, more than two-thirds of Americans are likely to seek help for stress. The same survey confirms that one out of four workers have availed a day off for mental health reasons to cope with the stress factors in their lives.

Similarly, the National Institute of Mental Health report that 18.8 million American adults suffer from stress-related depression. This includes twice as many women as men. Anxiety disorders are a co-occurrence with stress and depression. The WHO (World Health Organization) reports the number of depression-affected in the world as a stupendous 121 million.

What we deduct from these statistics is three facts:

• we need to consider that stress is a genuine health issue, anxiety and depression are off shoots of stress, and women are twice as likely to suffer from stress as men.
• The symptoms of stress and depression may vary.
• More often than not stress is the starting point of any state of depression.

Random incidents like deaths, job losses etc can stress you out, but they are not regulars in your life. It's those little daily incidents like missed appointments, flat tires, bounced checks and imminent deadlines that burn you out more and cause chronic stress. Stress mobilizes your body's reflexes and releases certain hormones into the blood stream.

The results of this maybe increased or decreased respiration and heart rate, elevated or very low blood pressure and sugar level etc. This state when mis-managed leads to a host of physical and psychological symptoms including extreme loss or gain of appetite, drastic change in bowl movement patterns, pain, fatigue and irritability. As it progresses, attacks of anxiety may result. The person may develop unhealthy sleep patterns, may lack concentration and decision making power.

All these external manifestations are actually the outcome of a tormented mind. Experts like Dr. H.K. Bakhru say that stress contributes to more than 80% of all major diseases. Depression if often caused by a malfunctioning of the adrenal gland. Irregular dietary habits containing a high content of white sugar, coffee, tea and chocolates while lacking in fresh fruit and vegetables can be an indirect pathway to a decreased supply of oxygen in tissues; this increases the level of carbon dioxide in the body and results in general depression.

Excessive and indiscriminate use of drugs also leads to faulty assimilation of vitamins and minerals by the body and causes depression. Even marginal deficiencies of the B vitamins- thiamin, riboflavin and folic acid- can cause or aggravate depression says Melvin R Werbach, M.D. of the School of Medicine, University of California. Many Americans don't get to eat a diet that is plush with the essential Bs. Whole grains are generally absent in the American daily food, the focus is on refined grains. Treating depression, stress and anxiety using Naturopathy does not involve suppressing your naturally produced symptoms with drugs.

Rather, Naturopathy assumes that a person's body reacts in a certain way because it has been abused it in some manner. The naturopathic approach works to bring the body back into balance. Although antidepressant or stress-reduction pills may give temporary relief, individuals who take these pills risk side effects such as liver damage, hypersensitivity, insomnia, hallucinations, and a host of other discomforts and illnesses.

According to Naturopathic medicine, diet plays a major role in an individual's state of mental health. Dr. Priscilla of the University of California prescribes nutritional therapy to build up brain chemicals like serotonin and norepinephrine, which effect mood and are often found lacking in depressed people. 5 She recommends eating whole grains, green vegetables, eggs and fish.

Some of the other good mood foods are whole wheat bread, bananas, oranges and grapefruits. Whole wheat bread is rich in the amino-acid tryptophan. Once it enters the brain, this amino acid boosts levels of serotonin, the soothing, mood-elevating brain chemical. Bananas are rich in magnesium and research shows that increased magnesium intake results in less anxiety and better sleep. Nuts, beans and leafy green vegetables, oranges and grapefruit are invaluable in treating depression on account of their high Vitamin C content. Furthermore, the body's ability to fight fatigue is considerably decreased by the lack of Vitamin C.

There are many home remedies which are used in the treatment of depression as well.

• Apples and cashews are excellent for this purpose; supplementation with vitamins B1, phosphorous and potassium aid in the synthesis of glutamic acid which ultimately controls the wear and tear of nerve cells.
• Whereas the thiamin in cashews stimulates the appetite and the nervous system, the riboflavin in the nut makes sure that the body keeps active, happy and energetic.
• Asparagus is another wonder drug in this context. The root of asparagus is highly nutritious and used as a herbal medicine for mental disorders. It is a good tonic for the brain and the nerves.
• Cardamom is used likewise.
• Other effective treatments use the herb lemon balm and roses.

There are other approaches individuals can take in the treatment of depression and stress. Exercise, for example, effects the body's production of hormones, enhances the beta-endorphins, and improves the function of the automatic nervous system. Yoga, meditation and herbal oil massages are other techniques used in treating depression. The Mayo Clinic Health Letter of January 2005 lauds the benefits of massage in stress reduction. 

Furthermore, the March 2005 issue recommends meditation to manage stress successfully. According to this report, meditation can reduce high blood pressure, anxiety, substance abuse, post-traumatic stress syndrome and visits to health care providers. The Mayo Clinic, which is currently holding a study analyzing the effects of yoga and meditation on stress reduction with results to be released in 2008, endorses several relaxation techniques that are classified under procedures of Naturopathy. 

According to Naturopathy, there is no one method that will treat depression and anxiety. Rather, a combination of all the above mentioned techniques will bring a person to his or her normal state of health. Adequate rest, relaxation and a sound sleep wraps up the treatment effectively and successfully.

Few days back a person came to me with the complaints that he is not able to concentrate on his work anymore. He had sleepless nights and that he lost pleasure in most of the things he used to like. Also, he used to feel sad, gloomy and irritable all the time. He felt that his life is not worth living and that he should die. All the time he felt tired and low in energy. What is this person suffering from?

The answer is depression.

The people in depression feel sad, tired and low in energy all the time. They are usually not able to concentrate on their work. Either they sleep very less, wake up early in the morning or they sleep too much and feel like not getting up in the morning. The time becomes hard for them to pass as they feel very gloomy and sad. They lose pleasure in their surroundings and feel that it is very difficult for them to stand the day.

Since the arrival of the day is very painful to them they feel very difficult to get up in the morning. Even if they are not feeling sleepy they lie in the bed as the arrival of another day is not welcoming anything new to them. They feel low in energy all the time and not able to enjoy their day to day usual activities. Sometimes they feel like crying and they actually cry a lot. Most of the time they feel that they are no good, they cannot do anything well and that they are worthless.

They cut themselves of from the social circle because they have lot of shame and guilt about themselves not performing well. They feel helpless because of moving away from the society. They feel hopeless as all the things appear to them as gloomy and that they feel that the life has come to an end and that there is no hope in their life. Sometimes they think of committing suicide as well because they feel hopelessness in their lives. Sometimes they plan to take suicidal actions. Mostly people do not act on these plans but sometimes they actually does act over these plans.

So you need to be very careful if someone related to you is suffering from these problems. The treatment for depression is the medications and psychotherapies. The medications involve several antidepressants which try to ward off depression. The idea behind medications is that prolonged stress can make neuro chemical changes in the brain which might cause some changes in emotions and behavior.

The response to stress is a fight or flight reaction. Either you try to maintain your behavior through fighting it off or you try to avoid these situations or run away from the situation. For example if a snake comes through your way you will be frightened and you will undergo a lot of emotional changes resulting in the fighting behavior (to kill the snake) or the flight behavior (running away from the place). You experience these emotions due to changes in the chemicals in your brain.

But these emotions become permanent if the stress is prolonged as these chemicals cause derangements in your brain. Taking medications from outside would try to maintain your equilibrium. The medications would try to release either those chemicals in your brain which release those neurotransmitters that are healthy for you or try to block those neurotransmitters that are unhealthy for you. Psychotherapies like cognitive behavior therapy focus on the thinking style (cognitions).

It believes in the concept that the thinking style affects your emotions and behavior. If you start thinking positive then your emotions and behavior will be positive and if you think negative then your behavior and emotions will be negative and you will feel sad and gloomy all the time. So it is all about your perceptions - how you perceive the world.

For example do you feel the glass is half "empty" or half "filled". The therapist try to validate your thoughts from the reality, he/she try to focus on the evidences that what evidences are there which makes your assumptions and automatic thoughts. Then therapist gives you lots of homework’s and a schedule of activities to keep yourself busy all the time so that you do not find it difficult to kill time and that you are engaged constructively which can bring back your zeal and enthusiasm towards life. Therapist acts as a support towards all the activities you do and he/she tries to encourage the person who is depressed.

One thing I would like to add here is that the antidepressants and the Cognitive Behavior therapies might be used separately but when they are used in combination, the results and benefits are more effective. Please find out if anybody related to you is suffering from these symptoms and try to help him or her. You may contact your nearest clinical psychologist and psychiatrist for the advice.

Dr. Smita Pandey Bhat
Clinical Psychologist Delhi
Email : dr.smitapandey@gmail.com
Url : http://child-psychologist.blogspot.com 

No internal art including Qigong and taichi however seriously you practice can give you instant result. Expect at least a period of three months before you notice any positive change or improvement. You need to be sincere, relaxed and regular to enjoy the benefits.

Unlike modern medicine, Qigong and taichi are intrinsically holistic in their approach. Qigong positively affects the whole body as a unit rather than segregating body into many areas. Qigong does not and will not act on any illness directly. It simply facilitates our body’s ability to heal itself.  If our mind creates a disease, it also heals. So, your mind-body has all the abilities to take care of their needs if you let them be.

Currently, in China millions of people of varied age groups practice Qigong to remain healthy. There are more than 4000 different forms of Qigong in China. The motive of each Qigong form regardless of its style is to enhance your body – mind health needs. Qigong practiced in a group is even more effective because each practitioner shares the collective chi that emanates from each one.  Qigong has been especially effective in dealing with

• Cancer (before & after)
• Heart ailments
• Stress
• Depression
• Diabetes
• Arthritis and obesity
• Insomnia
• Multiple sclerosis etc.

90% of the illnesses are caused by stress. Qigong practice considerably reduces or eliminates stress hormone levels in the body to give you the ability to cope with stress more easily. It releases feel good hormones to lift your mood and feel light. Slow, meditative and intentful movements in Qigong have the ability to calm the mind and reduce stress. You have nothing to lose but everything to gain.

h.b.muralidhara@gmail.com