Dear Dr Nina: My son is going through a hard time. How can I help?
Ask the GP...
I'm really worried about my son. He lost his job two years ago. Since then his marriage has split up and he ended up moving back in with his dad and me. He's in his forties, and while he used to be quite active - playing football and so on - he now just sits around the house watching TV. He rarely sees his friends, takes no exercise and smokes a lot. He never used to be overweight, but he's piled on the pounds in the past few years and I'm worried he's going to have a heart attack. I'm always out walking with the family dog, but I can't get him to join me. He has a very bad cough, which hasn't shifted for months and he just says I'm worrying about nothing when I say anything. What can I do to help him?
Dr Nina replies: You are right to be concerned about your son. You describe many symptoms of depression. This is very common affecting up to one-in-nine people during their lifetime. Unfortunately, all too often those affected simply withdraw into themselves and don't seek the help and support they need. It's heartbreaking watching someone you love hurt so much. For you gaining an understanding of depression is important and it'll give you the strength to help him.
Low mood becomes depression when the symptoms are persistent - being present daily for at least two weeks. There are eight main symptoms. These are: feeling sad; low energy; poor concentration; disturbed sleep (excess fatigue or broken sleep); lack of interest or social withdrawal; feelings of guilt or low self worth; physical aches or upset; feeling life isn't worth living. If five or more of these symptoms are present a diagnosis of depression is likely. Depression can occur after a major life event such as job loss or bereavement or can occur with no obvious cause. Whatever the reason for depression it's important to realise that it is a treatable condition and does not need to be endured in silence.
Despite huge media campaigns as regards mental health there still remains a stigma attached to depression. People who are depressed often end up socially isolated and this makes improved mood less likely. Many people are also afraid of what the treatment might involve and so don't approach a health professional about their feelings.
The fact is that treatment for depression has improved greatly over recent years and it can be tailored to each individual's personality and needs. In mild depression lifestyle change and psychological therapies have been shown to be as effective as medication. Exercise releases endorphins which are natural feel-good hormones and simply taking a daily walk can help improve mood. Eating a healthy, varied diet also helps. Caffeine and alcohol should be kept to a minimum as both have an adverse effect on mood. When feeling low it can be hard to motivate oneself to change, but I usually recommend setting small goals and this can lead to a sense of achievement which helps improve mood. Writing down thoughts and then discarding them can help relieve tension.
Counselling and psychotherapy are invaluable in low mood. In more severe depression, medication is usually required, but should not be feared. In most cases an initial course of six months treatment is given.
The most important factor in recovery from depression is social contact. Those who talk to family, friends and health professionals fare much better than those who suffer in silence.
As a parent your instinct is to fix things, but this can make those affected feel all the more worthless and useless. You son has to be ready to seek out help. You can help most by offering to listen, letting him know you support him and providing him with contacts and info he can reach out to himself. Websites such as yourmentalhealth.ie and aware.ie can be a great source of information.
Q. I have two angry-looking red patches on both of my legs and nowhere else — I’m wondering if it could be psoriasis or eczema? I have psoriasis in my hair sometimes but never on my body. What would the best cream be to use for it?
Dr Nina replies: It is essential for a doctor to have a good look at any skin condition in order to make a diagnosis. Patches of inflammation can be anything from a local bite or eczema, to more diffuse conditions such as psoriasis or even skin cancer. I always advise patients to take a picture of any unusual skin change or rash so if it has eased by the time they see a doctor there is still a visual clue.
Psoriasis can also cause irritated patches of skin anywhere on the body. This is a chronic skin condition thought to affect approximately 2pc of people. It causes itchy or sore patches of thick red skin with silvery scales.
We are all constantly shedding skin and in most people it takes about a month for a layer of skin to renew itself from the deeper to the outer layers. However, in psoriasis it occurs a matter of days. This rapid shedding of skin layers can result in thickening and redness leading to what is referred to as plaques of thickened scaly skin. Psoriasis usually appears between 10 and 45 years of age.
Psoriasis can occur in anyone. It often runs in families and one in three people affected have a family member who also has the condition. It can occur with other medical conditions, such as HIV or streptococcus (bacteria that commonly causes throat infection). Stress, smoking, and excess alcohol can all make it worse or cause flares. Other triggers include certain medications such as certain blood pressure or heart tablets, anti-inflammatory painkillers, anti-malaria tablets, injury to the skin, or cold weather.
Psoriasis is a chronic condition and may never go away completely but there are many treatments available and they can reduce flares and improve skin condition. The goal of treatment is to slow down the skin turnover and remove scales.
I would suggest a visit to your GP is in order so a proper diagnosis can be made and then the appropriate treatment advised.
Health & Living