Ashburn Sterling Internal Medicine and Pediatrics
Lansdowne Medical Pavilion
19415 Deerfield Ave, Suite 213
Lansdowne, Virginia 20176
(703) 729-9220
Do
you need help with depression or anxiety?
Depression
and anxiety are among the most common complaints made to primary care doctors.
Despite a wide range of treatment options too many people are never evaluated
or treated as they never seek medical advice.
The
Basics.
Sleep.
It is very important to sleep at least 8 hours a day. For those whose schedules
do not allow for an early bedtime, I often suggest getting to sleep early at least
two nights a week. If you are waking up tired, your body is asking for more sleep.
If you are waking up exhausted and you snore, an evaluation for sleep apnea may
be helpful. In some cases it may be necessary to prescribe a sleeping aid temporarily
to get you back into a normal sleeping pattern.
Exercise. Regular exercise is key to well being. People who exercise regularly feel awful
when they miss a workout. In fact regular aerobic exercise is the only intervention
proven to work for chronic fatigue syndrome. In fact, I find on nights that I
feel particularly exhausted from the days events, even though I least want to
exercise, those are exactly the nights I need exercise the most. If I do not exercise,
I go into the next day exhausted. If I force a workout, I usually feel well the
next day. For those who can not fit large workouts into their routine, I ask for
five minutes of exercise before hitting the shower. Aim for as many sit ups, push
ups or jumping jacks as you can do.The results will speak for themselves. Regular
excercise releases brain endorphins which lead to a feeling of well being.
Nutrition. Eating properly to avoid sugar or caffeine highs or lows is important to alleviate
fatigue. Eating processed, carbohydrate heavy meals and snacks, usually will make
you more tired in a few hours contributing to fatigue. Caffeine has a similar
effect on people who consume it more than once a day. Eating multiple small unprocessed
natural snacks and meals will help to keep you alert and alleviate fatigue. By
eating properly good weight loss is often achieved, which also helps to boost
self esteem.
The
Medical Evaluation
A physical examination is the next step. This will give your doctor a chance
to talk to you and examine you to look for other possible causes of your symptoms.
Included in most physical examinations is a detailed laboratory evaluation that
will look for medical causes of fatigue such as anemia and thyroid disorders.
Anemic patients are often tired, pale, and fatigue easily. Patients with an underactive
thyroid can complain of dry skin, an intolerance to being cold, weight gain, hair
loss, irregular periods, dizziness and fatigue. For patients who are perimenopausal,
mood swings are common. Fortunately good treatment options exist for all of these
conditions.
Depression is one of the most common causes of fatigue in primary care offices. Many of the
symptoms of depression are mild and nonspecific, so a conversation with your doctor
is very helpful. Symptoms of depression include unexplained crying spells, mood
swings, restlessness, sleep disturbances, lack of interest in ordinary activities,
feelings of worthlessness, feeling overwhelmed, lack of energy, difficulty maintaining
relationships, and even suicidal thoughts. Patient with depression are usually
either in a bad situation (horrible boss) or have a chemical imbalance in their
brain. They break down serotonin too quickly, so their brain serotonin levels
are low. Medication which will interfere with the breakdown of serotonin, allows
the brain serotonin levels to rise, and consequently the depression will lift.
Interestingly the majority of my patients in whom the depression is not strictly
situational, have a family history of depression. Although medication is one treatment
for depression, sleeping well, eating well and exercising frequently are sometimes
successful treatment strategies.
Anxiety is similar to feeling of depression, as anxiety is overwhelming. Although many
people experience anxiety in normal day to day stress, one important question
to ask is whether or not the anxiety interferes with your ability to function
normally. Does it prevent you from getting to the grocery store, does it actually
make it impossible for you to meet new people or talk in front of a crowd of people.
Does it make it impossible for your teenager to focus on work, or you to complete
a project that is due. Does it turn into a panic attack with chest pain, breathlessness,
heart racing, sweating, light headedness? If you are unable to accomplish these
tasks then the degree of anxiety that you are experiencing is well out of the
norm, and should really be evaluated and treated.
Treatment. There are a number of treatment options available for the treatment of axiety
and depression. There are several key elements for the best possible treatment
of depression. First a strong focus on the basics. You have to make sure that
you are sleeping, exercising and eating properly.You should not treat your depression
with overeating, drinking alcohol,or smoking. The second important element is
to take control. It is important to realize that you have the most important role
in improving your life. You may need to get a job or change a job, reevaluate
your commitments if you are overscheduled. Sometimes an attitude adjustment or
a different way of looking at things is key. Great books to read include Who
Moved my Cheese, and 7 Habits of Highly Effective People. The medications
that are prescribed will help, but it is very important that you reailize that
you have to help as well. With a strong emphasis on the basics, and a strong sense
of self motivation you have the best chance of a good response to medications,
if they are needed.
Alternative
Approaches
Vitamin
testing and replacement. Vitamin defeciency is an increasingly common diagnosis.
As most of our food supplies are heavily processed, some of that processing compromises
nutrition. For anyone who has ever grown a tomato in their backyard, the taste
and texture is quite a bit different than what you purchase at the local grocery
store. Specialized testing is now available that measures the levels of vitamins
in the body's cells. There are excellent reference labs that perform this detailed
analysis to give a great composite picture of what is necessary to replace. Once
this information is obtained, the patient can be sent to a quality vitamin supplement
facility or special order custom vitamins can be made. Good results are often
noted with this approach.
Conclusion
Fatigue
is usually the result of an array of variables. But a good evaluation with attention
to the basics often can bring good relief to a chronic problem.
Copright
Tareq Abedin, MD 2007
