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Cyclical Depression

Question:

Dr. Dombeck , I have been complaining of a cyclical depressed mode since childhood , (i am 25 years old now married male), every 2 or 3 years I have a an attack of depressed mode for about a year duration. I am a GP , my symptoms start insidiously and become stationary for a hole year with intolerable depressive thoughts , sometimes suicidal thoughts, and in many events i experienced hearing incomprehensible sounds buzzing in my ears (experienced more during stress). until now I do not know any aggravating or relifing factors. I am not on any medications,have no allergies, and have never smoked drinked or used drugs. I was an abused child during the period from 6 to 12 years of age. i have no surgical or medical history. i have a family history of 4 similar conditions. (my older brother and sister and 2 of my uncles). no one seeked medical advice but me -through this message- one symptom which I doubt it is relevant is having a notable difficulty in making decisions,another is having anxiety provoked diarrhea. would you guide me out this darkness ?

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Answer:

Based on what information you’ve provided here, it is possible (although by no means certain) that you experience recurrent episodes of Major Depression . A vulnerability to this condition may run in the family based on the history you suggest. The mechanism is possibly genetic and inherited biologically, manifesting as a facet of temperament (inborn biologically given personality) known variously as Emotional Stability or Neuroticism. This would create a vulnerability which would then become activated by some combination of life stressors, or possibly just active without any particular cause. You mention that you were abused for an extended period of time, and that sort of thing could do it easily. That the earliest episodes of this depression coincide in time with the period during which you were actively abused may mean something, but there’s no way to know for sure.

Usually when people think about cycles and depression, they start thinking about Bipolar Disorder (otherwise known as Manic Depression), because that disorder is defined by depressed moods and a pronounced cycling pattern. However, that diagnosis is not likely here because there is no suggestion in your report of anything resembling a manic episode, usually characterized by a period of joyful or agitated and energetic activity, which though useful on the way up (it is easier to get things done when you don’t need to sleep for days), frequently degenerates into psychotic delusions, and impulsive hedonistic actions such as promiscuous sexuality and compulsive gambling. Major Depression can also manifest as a cyclical disorder, but the term used with this condition is "recurrent" rather than "cyclic", suggesting that the mood disorder comes and goes and then comes again.

Suicidal thoughts are common during a depressive episode, which is what the active portion of the mood disorder is known as. The buzzing sound in your ears might possibly be the beginnings of an auditory hallucination process, which can occur in the context of severe depressions. In full psychotic bloom, such hallucinations can manifest as what appear to be voices, in a process similar to what occurs in Schizophrenia and other psychotic disorders. They might possibly manifest as a buzzing noise when the psychotic process doesn’t fully occur. I’m guessing at that last part, by the way. The diarrhea might be something similar to Irritable Bowel Syndrome or IBS, which is a variety of anxiety disorder characterized by gastrointestinal distress. I suggest this not because it has to be that, but because there is a strong suggestion that you and your sibs are loaded for Neuroticism, which would make you more vulnerable than others who aren’t high in that temperamental attribute to both depression and anxiety conditions.

I hope you will see a Psychiatrist about this condition of yours, and also encourage your siblings and uncles to do the same. If this is depression, a psychiatrist will be able to provide you with a diagnosis to that effect, and more importantly, prescribe medications to help you manage your depression. Now, there are several good, sometimes better ways, to treat depression than medications alone, but since the suggestion here is that you may have a bit of a psychotic component to your depression (e.g., if that buzzing noise is truly best thought of as a proto-hallucination) and if that is the case, the psychiatrist might prescribe something more than a simple antidepressant during the most severe parts of your cycle. Psychiatrists will not uncommonly add an antipsychotic medication to the mix they prescribe to depressive patients when they think that will help.

You should know that depression is a treatable illness, and that if you go for treatment you can expect that your symptoms can be lessened substantially or possibly eliminated (although I don’t think that is always a reasonable outcome to expect). Our Major Depression Topic Center provides pretty comprehensive coverage of the whole spectrum of unipolar (e.g. non-bipolar, depression only) depressive disorders including how they occur and how they are best treated. The options include primarily antidepressant medication and specific forms of specialized psychotherapy, in particular Cognitive (or Cognitive-Behavioral) Therapy for Depression , and also some less common treatments including stimulation therapies (e.g., electro-convulsive therapy , transcranial magnetic stimulation therapy, and even deep-brain stimulation with a pacemaker type device). Good self-care can go a long way to helping prevent or remediate depressed mood. Providing yourself with a good foundation is vital. This includes eating properly, getting enough sleep, making time for pleasurable recreation and socialization and vacation, and taking active steps to manage or contain stress. Vigorous and frequent physical exercise has been shown to have a useful antidepressant effect . Light therapy can be useful when mood disorders are linked to seasonal light fluctuations (but that doesn’t seem to be the case here).

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