Patient's Story 3 (Signs of Depression)

Signs of Depression

Personal background and history

I am a male, age 63 years, and am married with 3 children (2 sons and a daughter). I have served in the civil service for about 30 years and the private sector 12 years until my final retirement at the age of 62. From childhood and during the period of working life, my general health status was satisfactory and disease-free except for the common cold.

As I was a family man, I was actively working and busy bringing up a family throughout my working life until retirement, without any time to seek the simplest pleasures of life or cultivate a hobby.

Signs and symptoms of the illness

I retired for the second time from private sector in late 1998 at age 55 years. During the retirement year 1999, I began to feel very light and drifting when I walked about. I was always anxious and had palpitations. Sometimes, I experienced slight difficulty in breathing. This sensation progressed and became worse when all my children left the family either for career advancement elsewhere or for further education abroad. I began to feel the effects of the empty nest syndrome and very lonely day in and day out at home. I had no one to confide with when my wife was at work. I used to buy lunch and eat with my relatives in their homes. I can;t go to busy and brightly-lit places, such as hypermarkets, banks and restaurants, as I was not stable and feared I may fall. It was tolerable in dark and quiet places. I can't look down to sweep the floor as I feel unstable. I can't look at wavy water like flood and sea water as well as water running from tap as the sight of it made me shaky. Every night before retiring to bed was torture. I would sit before the TV until 1 - 2 a.m. and when almost asleep I would quickly jump into bed to sleep. Even so. it was not a sound sleep, sometimes tossing in bed and most of the time the brain was awake. Every evening, I would contact my children just to listen to their voices and when I don;t I would go to their bedrooms to look at their beds and clothing to get a feeling that they are at home. I always felt restless at any place, unable to sit still for 5 minutes after which I would be up and about. Other minor activities which I couldn't do as it would make me feel unstable, dizzy, afraid or anxious are swinging my head from left to right, queuing for my turn, going to certain place alone, and waiting for someone to arrive.

Visit to the doctors

From 1999 to 2004, I went to hospital to seek treatment from various doctors regarding my health complaints.

I visited the physician who was indeed very kind to me because he examined me, give me drug treatment and extensive counseling over a period of 5 years. While seeking treatment, I was re-employed from 200-2005, age 57 years - 62 years to keep myself busy.

Every now and then, he tested my blood, pressure, thyroid, heart beat, lung function, pulse rate and found them normal except my pulse rate was little fast. He could not treat me further but at each visit prescribed me with vitamins, folic acid, alprazolam and atenolol at very low dose. Over a period of time, he noticed a sad, cheerless and depressed countenance in me and found that there was fright and anxiety in my heart beat. While undergoing treatment with the physician, I was also referred to 4 ear, nose and throat (ENT) specialist doctors who gave me extensive ENT test but there was no abnormal finding. They prescribed me with ginkgo biloba, vitamins and Betasere as well as counseling on how to adjust my physical movements to keep a stable balance at each visit. I had visited ENT clinics for 2 years and was finally discharged by a Taiwanese specialist doctor who confirmed that I had no ENT problems. I was referred by the physician to see the ophthalmologist. After 2 visits to the eye clinic, I was again discharged as there was no adverse finding.


Referral to the consultant psychiatrist

Finally, the physician coaxed me to seek treatment from the consultant psychiatrist as I had developed depression, anxiety and fright. I was, therefore, discharged from medical outpatient department (MOPD) on July 4, 2004 and referred to the consultant psychiatrist on October 10, 2004. I have been under his care up to date. After history taking and assessment, the psychiatrist prescribed me and antidepressant at half dose for one week and thereafter increased a full dose to be taken orally once a day after dinner. This drug did not cause me any major side effects except loose stool on and off for about 2 weeks in the beginning. Apart from drug therapy, the psychiatrist explained my depressive illness with anxiety symptoms and the benefits of the medicine, provided me with counseling and made available occupational therapy and relaxation exercise.

Present health status

After a few months on therapy, I am able to go out alone with the least fear. I am able to go to the hypermarkets, restaurants banks, post-offices and other public laces, which I feared to go previously. I am able to do the things which I would not do at home. My dizziness and unstable feeling and floating sensations have been reduced to the minimum. Suffice to say that the treatment has brought me 85% to normality. As I have been told that no drugs can produce a 100% cure of a condition of illness, the remaining 15% depends on how I adapt myself by using various means. Therefore, I have developed a list of guidelines for my daily existence. I normally follow a combination of a few of these guidelines everyday and interchange the guidelines at each passing day. In general, I abstain myself from stress and over excitement, unhappiness, idling and go for simple enjoyment, hobby and short vocations.

Stress and excitement

I do not indulge in gambling in stocks, lottery, and alcohol consumption as these activities will trigger my heart beat and pulse rate faster and ultimately makes me physically unstable. I do not walk under the hot sun around the town area for long hours and I don't rush to complte any work.

Unhappiness

I abstain from anger, hatred, quarrels, arguments, sad memories. Normally, in such state of mind, I would think of anything that would make me happy, e.g. my grandchildren and their jokes, pranks, behaviors, speech. An unhappy state of mind will create shortness of breath in me.

Idling

Idling will depress me. Usually, I perform housekeeping duties at home - mopping, sweeping, ironing, painting, works, etc. Since I am a Buddhist, I recite Buddhist mantra; go to the temple to do some voluntary work. I go out to settle my utility bills.

Simple joys

I have tea session with friends and enjoy the happy interactions. Shopping or window shopping for garments and food and doing anything within the law that will create enjoyment.

Read the daily newspapers, novels, religious text for relaxation. Grow and groom bonsai plants. General car maintenance work. Take up a Pitman shorthand course by self-study to activate the brain.

Retreat to the rural areas to visit relatives. Pay occasional visits to my children and relatives. If financial budget permits, go for a short vacation abroad.

This short report about my illness is written as a record of appreciation and respect for all the doctors who had taken care of me.


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