Severe Depression

Dear Doctor Friends, Suggest me Dx and Rx, 60 years old, Female patient suffering from Depression for last 15-20 years, but it has increased to SEVERE DEPRESSION during Corona Lock down timings, and it's so till today. Shocked by her husband's death (4 months before) and her daughter in law's death ( 3 months before, who has 2 children ) Anxiety about her sons (one is smoker and one is drunker ) and her grandson. Anxiety about her health. Sleeplessness Weeping aggravates Consolation ameliorates Continually thoughts run in her mind and feels as she is mad. Cold patient, can't bear cold air. Chief Complaints Chest pain Fatigue Vertigo on seeing downward Frequent Urination Frequent motion Numbness over the whole scalp Backache while bending Cough Appetite decreased Belching on Eating while she is Depressed Burning in lowest back portion while much motion Profuse perspiration History 3 normal delivery Heavy Mensuration during her life Ear operated Nose operated Typhoid Pneumonia Malaria Urine Infection FAMILY HISTORY Coma Paralysis Heart Attack Asthma Smoking Tumor Vitals BP 110/70 Pulse 76/min Sp O2 92 Weight 63kg Physical Examination Pale light blackish tongue Investigations ECG, X-ray Diagnosis Depression Management Sensival 25 Mirtazapine Multivitamin Lactic Acid + Bacillus Zincovit R-6 R-27 Ignatia 30 Berberis vulg Q Arnica mont 200

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Advise-1-fasting blood sugar and post prandial 2hrs blood sugar. 2-Hb1AC 3-fasting serum insulin for insulin resistance. 4-Thyroid profile T3 T4TSH.free T3 and freeT4. 5-ecg 6-cbc 7serum lipid profile. Pt of hypothroidism and of metabolic syndrome may present as underlying psychiatric disorder. Pt may have endogenious depression may required lithium carbonate. Tt as per reports.

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In this case of on realistic events to make up so she was depressed on this situation is called adjustment disorder due to event base. So In this case to do clearly defined symptoms of psychiatry related to do justify depression grade : mild moderate several. Second opinion she was obsessions thoughts... abouts Event,so she have no concentrated about in her lifestyle. I will be suggested to start SSRI, Sleep pill,anti psychotics and psychotherapy, because of in this situation have associated multiple somatic complains with false beliefs of eventually. SSRI_fluoxetine,Escitlopram, Anti psychotics_quetiapine, olanzepine. Mood stabilization_sodium valprate, lithium. Zolpidem, otherwise lorazepam, clonazepam, diazepam. Investigation sos based on clinical approaches. Main trouble are poor sleep and appetite with obsessions thoughts.

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आयुर्वेद के अनुसार रोगी मानसिक तनाव से ग्रस्त है। चिकित्सा संबंधी योग,,,, तगर 50 ग्राम, जटामांसी 25 ग्राम,खुराशानी अजवाइन 10 ग्राम लेकर पाउडर बनाकर 5 ग्राम सुबह-शाम सेवन कराएं। निश्चित रूप से लाभ होगा। योग परिक्षित है। पिछले 45 वर्ष से प्रयोग कर रहा हूं।

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NEED'S.. BSR..HBA1C.. ANXIOLYTIC..

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Rx carc 1m stat Staphy 30 bd for 1 week follow by sl

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Ad tab zolinex at bed time Psychotherapy

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Ignatia 10m one dose

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Add ativan 1mg HS

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Aurum met 1m/3dose weekly Gelesemium 30/tds for 15 days

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Add Ativan 2mg HS Check RBS, Hb Psychiatry counseling is required

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