It is a condition associated with poor self esteem and self abnegation.

The cause for this malaise is not clearly know.

Predisposing factor:

Heredity is an important factor.

Organic diseases may play a role. Eg: various viral diseases, cardiovascular diseases, anaemia, carcinoma etc.

SYMPTOMS: Age: 50 to 60 years

Sex: Common in females.

The disease is associated with disturbances of mood, abnormal response to intellectual stimulation and autonomic function.

Patient loses interest in the outside world.

Mental and physical activities are retarded. There is difficulty in concentration and taking rapid decisions. There may be conspicuous self-reproachful ideas.

Patient may be afraid of an impending calamity. There may be intense feelings of guilt and self-blame which may lead to delusion.

Agitation may also be present. Daily activities become difficult and questions are answered very slowly. Autonomic changes include anorexia, loss of weight, headache, backache, aches all over the body, constipation, insomnia with early waking after two to three hours of sleep, constant sense of fatigue and listlessness.

If left as such and not treated, these patients usually commit suicide.

TYPE

Reactive:
Here depression is due to some exogenous adverse life situation such as loss of person, financial loss, etc.

Primary affective disorder:

These are due to endogenous causes which may be of a recurrent type called unipolar-orbipolar where depression and manic phases are alternately present for a variable period.

Secondary:

These are due to some underlying disease like multiple selerosis, chronic heart disease, rheumatoid arthritis, hypothyroidism, organic brain disease due to drugs like steroids, contraceptives, etc.
Treatment

Supportive psychotherapy, encouragement or reassurance should be given.

Medicines:

Ignatia, sepia, Kaliphos, Natrammur and Nuxvom.

(AW: Samrat Biswas)