Permanent Injuries affecting the Autonomic Nervous System and Mind

And the effects on mind can be reversible, with the help of modern medicine.

How is it that when a person gets depressed, or anxious, or psychotic for a period of time, that we do not do the most basic of investigations- checking the working of the autonomic system by checking the resting vital signs of respiratory rate, blood pressure, heart rate and body temperature?

How do we neglect to do this?

Organ failure often takes a long time to become fatal and can, instead result in disability- often affecting the brain and the mind secondarily.

It is basic first aid to check vital signs. Checking vital signs makes sure we will not miss physical and mechanical problems affecting metabolism and homeostasis.

I think that depression , bipolar or otherwise, is a serious syndrome. I think that depression is often part of ill physical health and should be carefully worked up until the physical cause underlying the depression is found and is treated; psychotherapy can be useful, but only as a ways to give psychological support; it is not a medical treatment. A psychiatric history is not the history that is needed; a paediatric and medical history is key. If the depressed person has dullness of thinking and memory, then family will need to provide the medical history.

It may take time to unravel what is medically wrong with the depressed patient; it is important to keep looking no matter how long it takes because depression has been found to shorten one’s life.

Depression and mortality in a longitudinal study: 1952–2011 Stephen E. Gilman ScD, Ewa Sucha MSc, Mila Kingsbury PhD, Nicholas J. Horton ScD, Jane M. Murphy PhD, Ian Colman PhD  Cite as: CMAJ 2017 October 23;189:E1304-10. doi: 10.1503/cmaj.170125

“Studies have shown depression to be associated with short- ened life expectancy.1  In Cuijpers and colleagues’ meta- analysis of 293 studies, depression was associated with a 50% increased risk of mortality. “2 

I think that depression iirself s not the stressor but the consequence of early illness which results in sickness behaviours from feeling bad [physically and emotionally] from injury, blood loss, or infection that is not investigated over time. I think that the reason depressed people have difficulty breathing, heart problems, digestive problems, etc…is that these problems make them tired, distressed and depressed- not the other way around. The depressed patient may not even be aware of what physical problem is ailing them.

The inflammation that is now being found in depressed patients is most likely due to something being wrong with the body, a hidden infection, a mild respiratory failure, undiagnosed intermittent heart problems, thiamine deficiency, iron deficiency, thyroid problem, etc….it may take months or years for the physical problem to become clear and medical treatment will be much more effective in fixing the depression.

The Role of Inflammation in Depression and Fatigue Chieh-Hsin Lee1 and  Fabrizio Giuliani1,2,* Front Immunol. 2019; 10: 1696. Published online 2019 Jul 19. doi: 10.3389/fimmu.2019.01696

 “Both depression and fatigue have been associated with increased inflammatory activation of the immune system affecting both the periphery and the central nervous system (CNS). This is further supported by the well-described association between diseases that involve immune activation and these symptoms in autoimmune disorders, such as multiple sclerosis and immune system activation in response to infections, like sepsis. Treatments for depression also support this immunopsychiatric link. Antidepressants have been shown to decrease inflammation, while higher levels of baseline inflammation predict lower treatment efficacy for most treatments. Those patients with higher initial immune activation may on the other hand be more responsive to treatments targeting immune pathways, which have been found to be effective in treating depression and fatigue in some cases. These results show strong support for the hypothesis that depression and fatigue are associated with an increased activation of the immune system which may serve as a valid target for treatment. Further studies should focus on the pathways involved in these symptoms and the development of treatments that target those pathways will help us to better understand these conditions and devise more targeted treatments.

Why not start to investigate depression [especially with altered mental status or mental impairment ] by measuring respiratory rate, heart rate [and signs], blood pressure and body temperature, as well as getting a paediatric and medical history as well as a history of injury.

Why not as direct questions such as ” are you having difficulty thinking?” “Are you having difficulty breathing?” ” Are you having palpitations?” ” “are you having nausea?”

To be continued……….

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