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Anxiety and Depression

Do you need help with depression or anxiety?

Depression and anxiety are among the most common complaints made to primary care doctors. Despite a wide range of treatment options too many people are never evaluated or treated as they never seek medical advice.

The Basics.

Sleep. It is very important to sleep at least 8 hours a day. For those whose schedules do not allow for an early bedtime, I often suggest getting to sleep early at least two nights a week. If you are waking up tired, your body is asking for more sleep. If you are waking up exhausted and you snore, an evaluation for sleep apnea may be helpful. In some cases it may be necessary to prescribe a sleeping aid temporarily to get you back into a normal sleeping pattern.

Exercise. Regular exercise is key to well being. People who exercise regularly feel awful when they miss a workout. In fact regular aerobic exercise is the only intervention proven to work for chronic fatigue syndrome. In fact, I find on nights that I feel particularly exhausted from the days events, even though I least want to exercise, those are exactly the nights I need exercise the most. If I do not exercise, I go into the next day exhausted. If I force a workout, I usually feel well the next day. For those who can not fit large workouts into their routine, I ask for five minutes of exercise before hitting the shower. Aim for as many sit ups, push ups or jumping jacks as you can do.The results will speak for themselves. Regular excercise releases brain endorphins which lead to a feeling of well being.

Nutrition. Eating properly to avoid sugar or caffeine highs or lows is important to alleviate fatigue. Eating processed, carbohydrate heavy meals and snacks, usually will make you more tired in a few hours contributing to fatigue. Caffeine has a similar effect on people who consume it more than once a day. Eating multiple small unprocessed natural snacks and meals will help to keep you alert and alleviate fatigue. By eating properly good weight loss is often achieved, which also helps to boost self esteem.

The Medical Evaluation Loudoun family practice, Loudoun family doctor

A physical examination is the next step. This will give your doctor a chance to talk to you and examine you to look for other possible causes of your symptoms. Included in most physical examinations is a detailed laboratory evaluation that will look for medical causes of fatigue such as anemia and thyroid disorders. Anemic patients are often tired, pale, and fatigue easily. Patients with an underactive thyroid can complain of dry skin, an intolerance to being cold, weight gain, hair loss, irregular periods, dizziness and fatigue. For patients who are perimenopausal, mood swings are common. Fortunately good treatment options exist for all of these conditions.

Depression is one of the most common causes of fatigue in primary care offices. Many of the symptoms of depression are mild and nonspecific, so a conversation with your doctor is very helpful. Symptoms of depression include unexplained crying spells, mood swings, restlessness, sleep disturbances, lack of interest in ordinary activities, feelings of worthlessness, feeling overwhelmed, lack of energy, difficulty maintaining relationships, and even suicidal thoughts. Patient with depression are usually either in a bad situation (horrible boss) or have a chemical imbalance in their brain. They break down serotonin too quickly, so their brain serotonin levels are low. Medication which will interfere with the breakdown of serotonin, allows the brain serotonin levels to rise, and consequently the depression will lift. Interestingly the majority of my patients in whom the depression is not strictly situational, have a family history of depression. Although medication is one treatment for depression, sleeping well, eating well and exercising frequently are sometimes successful treatment strategies.

Anxiety is similar to feeling of depression, as anxiety is overwhelming. Although many people experience anxiety in normal day to day stress, one important question to ask is whether or not the anxiety interferes with your ability to function normally. Does it prevent you from getting to the grocery store, does it actually make it impossible for you to meet new people or talk in front of a crowd of people. Does it make it impossible for your teenager to focus on work, or you to complete a project that is due. Does it turn into a panic attack with chest pain, breathlessness, heart racing, sweating, light headedness? If you are unable to accomplish these tasks then the degree of anxiety that you are experiencing is well out of the norm, and should really be evaluated and treated.

Treatment. There are a number of treatment options available for the treatment of axiety and depression. There are several key elements for the best possible treatment of depression. First a strong focus on the basics. You have to make sure that you are sleeping, exercising and eating properly.You should not treat your depression with overeating, drinking alcohol,or smoking. The second important element is to take control. It is important to realize that you have the most important role in improving your life. You may need to get a job or change a job, reevaluate your commitments if you are overscheduled. Sometimes an attitude adjustment or a different way of looking at things is key. Great books to read include Who Moved my Cheese, and 7 Habits of Highly Effective People. The medications that are prescribed will help, but it is very important that you reailize that you have to help as well. With a strong emphasis on the basics, and a strong sense of self motivation you have the best chance of a good response to medications, if they are needed.

Alternative Approaches Loudoun family physician, Best doctors

Vitamin testing and replacement. Vitamin defeciency is an increasingly common diagnosis. As most of our food supplies are heavily processed, some of that processing compromises nutrition. For anyone who has ever grown a tomato in their backyard, the taste and texture is quite a bit different than what you purchase at the local grocery store. Specialized testing is now available that measures the levels of vitamins in the body's cells. There are excellent reference labs that perform this detailed analysis to give a great composite picture of what is necessary to replace. Once this information is obtained, the patient can be sent to a quality vitamin supplement facility or special order custom vitamins can be made. Good results are often noted with this approach.

Conclusion

Fatigue is usually the result of an array of variables. But a good evaluation with attention to the basics often can bring good relief to a chronic problem.

Copright Tareq Abedin, MD 2007

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