Reality: Most people who act on their depression do get better. Studies show the best treatment is combining medication and talk therapy

Myth:Depression is difficult to treat

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W e do not function in parts, but rather as a whole. Thus the chances

of one aspect affecting the other increase. While depression is pri-marily a disorder affecting the mood, sleep, physical and mental activity of the person, dementia is a disorder that impacts the memo-ry and related aspects of cognitive functioning.

Depression is becoming increas-ingly common these days, irre-

spective of whether it is reported or not. Its symptoms majorly in-volve a low mood, feelings of lone-liness and dejectedness, loss of in-terest in earlier joyful activities, negative thinking with feelings of helplessness, hopelessness, worth-lessness and sometimes even cry-ing spells.

Chronic depression, also known as dysthymia, is when the person has experienced episodes of de-pression for at least a period of two years, as stated by the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5, 2013.

Dementia is characterised by a visible decline in certain functions associated with memory, memory formation, thought processes, skill development or other such cogni-tive functions.

Initially chronic depression was linked to social isolation, poorer health and an increased risk of death, but now studies find that de-pression is associated with subse-quent vascular dementia, condi-tions poised to expand dramatically with the ageing popu-

lation (Graham, 2013).The brain areas that are common

to both these disorders are hip-pocampus and prefrontal cortex. People who are depressed produce high levels of the hormone corti-sol, which in turn has an adverse effect on the hippocampus which is a part of the brain responsible for new learning and short-term memory. Depression also contrib-utes to chronic inflammation that damages blood vessels and im-pedes blood flow in the brain, lead-ing to the deterioration of neural networks further leading to cogni-tive decline.

Body and mind passivity is anoth-er commonality between the two. Most symptoms of depression lead to a decrease in activity in terms of both physical and mental func-tions. If this decreases for a longer duration, it may lead to a drastic decline in the functioning of these areas, physically and mentally, which is what is also seen as de-mentia.

With increasing amounts of stress in the day-to-day lives of

young adults today, there seem to be extremely altered lifestyle changes. The increased pressure and competition in the society cause various depressive symp-toms in individuals and even com-monly lead to increased amounts of forgetfulness along with a de-cline in the thinking capacities of people. These symptoms of memo-

ry lapses and impaired cognitive functioning resemble dementia-like characteristics.

Correlation of depression and de-mentia is an extremely complex is-sue. We need to understand that the two coexist and sometimes one is mistaken for the other. In fact de-pression can often mimic demen-tia, also known as pseudodemen-

tia. Many times dementia starts as symptoms of depression and as it manifests and progresses, only then does it get diagnosed as de-mentia.

Also, if there is incipient demen-tia and depression too, and you don’t care about depression, then depression hampers the care of de-mentia. If we do not treat depres-sion, dementia will worsen faster. A case study will help in under-standing this.

At the age of 51, Mr Atul (name changed to protect privacy) report-ed a sudden low mood due to his in-ability to continue his job at the of-fice because of his age. He reported losing interest in doing all daily ac-tivities and wanted to stay in bed all day, not speaking too much with anybody. He also reported feeling more useless than ever. Despite these symptoms, he did not ap-proach a mental health profession-al for the first three years. A de-cline in his ability to remember started becoming evident by the end of the third year, which in turn made him even more complacent.

Currently, at the age of 55, he had been brought by his elder son with reports of inability to remember basic things, being highly forget-ful, not being able to make any de-cision and totally shutting himself up all day. Even though current therapy and medication are help-ing him keep his symptoms under control, had he come earlier to tackle the depressive symptoms, there may have been lesser trouble associated with memory and relat-ed functions.

Thus, we understand that chronic depression may lead to the begin-ning of memory loss and loss of certain cognitive abilities that are associated with dementia, but the possibility of the same can be de-creased if depression is tackled well at the earlier stages with ther-apy and medication. A healthy life-style with mental exercises, physi-cal agility, positive thinking and good social support can help pre-vent these problems.

—The writer is a Senior Clinical Psychologist at Fortis Escorts

Heart Institute, New Delhi

Dr BHAVNA BARMI

Act Early on Chronic Depression, Else it may Lead to DementiaBy Invite

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HEALTH CAPSULE

Drinking water may be better for young athletes than con-

suming sports drinks, according to scientists who warn that energy beverages can elevate blood pressure and cause cardiac prob-lems in children and teenagers. Many people associate playing sports with having sports drinks as it is what they see profession-

als do. However, most recreational athletes do not play at an intensity or for a duration that would require their hydration to come with extra sugar and salt. “Sports drinks can replenish some of what you lost during exercise, but you really need to be exercising for more than 45 minutes to an hour before you would consider that,” said Matthew Silvis, from Pennsylvania State University in the US. “Many of our kids are not doing enough to warrant it,” said Silvis. With increasing rates of childhood obesity, having kids chug sports drinks loaded with extra sugar as they exercise is not recom-mended, researchers said.

Hospitalisation for heart attacks and strokes is less

common among people living in areas that restrict trans fats

in foods compared to residents in areas without restrictions,

new research has found. "Our study highlights the power of pub-

lic policy to impact the cardiovascular health of a population," said lead author Eric Brandt from Yale School of Medicine in New Haven, Connecticut, US. Trans fatty acids, or trans fats, are commonly found in fried foods, chips, crackers and baked goods. Eating even minimal amounts is linked to a greater risk of cardiovascular disease, the leading cause of death worldwide. Some communities in the US — most notably New York City — have eliminated the use of trans fats in restaurants and eateries in recent years. To study the impact of restricting trans fats, researchers compared outcomes for people living in New York counties with and without the restrictions.

The therapeutic or remedial effects of running extend far

beyond physical benefits, say experts. "Recreational running has dual benefits — it rejuve-

nates the mind and recharges the body. Many people find running a therapy where they can push back negative emotions, get

time to reflect, destress, plan ahead and enjoy their own compa-ny," said Pradeep Moonot, an ortho-paedist and podiatrist at Sir HN Reli-

ance Foundation Hospital and Research Centre in Mumbai. But if you think you can register for the next marathon, wait. For, running a marathon without adequate training under the guidance of an expert may cause grave injuries, warned Rishabh Telang, a fitness expert with Bengaluru-based Cult fitness chain. "It is also important to have a recovery strategy which should be aligned with physical training. Marathon runners should also be very focused. Medi-tation and yoga can help provide the mental strength that they require. A balanced diet is just as important," Telang said.

Water may Be Better than Sports Drinks for the Young

Curbs on Trans Fats Indeed Cut Heart Attack Risks

Running as Good for the Mind as for the Body

Tattoos and piercings have been around for ages, but it is only now that they are being embraced as ways of self-expression in society. While the focus is usually on the message the symbols,

words and pieces of jewellery convey, many of us miss the potential health hazards associated with these forms of body modification. Both tattooing and piercing come with a host of risks. Complications can range from scarring to contracting infections such as HIV.

Dr Shireen Furtado, a consultant dermatologist in Bengaluru, said people can develop keloids (smooth, hard nodules formed when scar tissue grows excessively) after tattooing and piercing. Also, “after tattooing, you may have allergic reaction to the chemicals or metals in tattoo ink. This is especially common in coloured dyes. There is also the risk of contracting blood-borne diseases such as tetanus, hepatitis B, hepatitis C and HIV, and viral infec-tions such as molluscum and warts if unsterile hands or equipment is used,” she said.

Mukta Sachdev, consultant dermatologist at Bengaluru's Manipal Hospital, said any piercing runs the risk of bleeding, especially in areas of the body with a lot of blood vessels, such as the tongue. "Tongue or any other oral piercing can cause speech impediments and chipped teeth if the jewellery wears the tooth enamel away. There's also a slightly higher risk of bleeding here compared with other piercing areas," Sachdev said.

Furtado said tongue piercings can increase secretion of saliva, cause difficulty in food intake and can lead to acci-dental swallowing of the jewellery. Belly piercings usually take longer than others to heal and are prone to infections as some bacteria colonise in the belly button. Pierced nip-ples can cause mastitis (inflammation of breasts).

According to Sachdev, genital piercing can sometimes make sex and urination difficult and painful.

As for the more common piercing areas, "ear carti-lage piercings (at the top of the ear) are risk-

ier than earlobe piercings. They can lead to infection and an abscess develop-

ing. Nose piercings are riskier than earlobe piercings as the inner sur-face of the nose, which can't be

disinfected, holds bacteria that can cause infection", she said.

Furtado said in piercings, there is a risk of formation

of hypertrophic scars (caused when the body produces collagen exces-sively) or granulomas (reaction from the im-mune system when it cannot eliminate a sub-stance it perceives as foreign).

“Here too, you could contract blood-borne diseases, develop aller-gic contact dermatitis due to the presence of certain metals in the

jewellery, such as nickel, and contract bacterial in-

fections such as folliculitis and pseudomonas that can

cause scarring. Inflamma-tion or nerve damage can be

caused if the piercing isn’t posi-tioned properly,” she said. “There is also the possibility of

having MRI complications: occasion-ally, chemicals in tattoo ink can

cause swelling or burn the skin when exposed to radia-tion. Another complication that may arise is called koeb-nerisation. This can occur if a person has a skin condition such as psoriasis. After getting a tattoo, the skin condition may spread to the tattooed area, usually along the margins of the tattoo. There have also been reports of basal cell cancer and squamous cell cancer developing in tattooed areas,” Furtado said.

HYGIENE… AND HEALTHVeer Hegde, founder tattoo artist at Eternal Expression Tattoo and Piercing Studio, Bengaluru, said that before getting a tattoo or a piercing, it is important to learn about the tattoo artist, piercer or doctor. “Ask around or look up reviews online and check the studio and the artist’s repu-tation,” he said. “Tattooing is a blend of art and surgery. It is very important to pick a good artist. Reputation is eve-rything: it covers hygiene standards — every single thing that comes in contact with your skin must be sterilised — then the cost of the procedure and also the expertise of the artist. Imagine how you’d pick a doctor to perform a surgery — think of all the bases you’d cover to pick one… I have people coming into the studio and the first thing they ask me is how much I charge per square. That should not be your only criterion to pick an artist. Some artists tend to open the window to let air in, or answer phone calls during the procedure — all that is a strict no. Expertise usually comes with experience.”

According to Sachdev, piercings are best done by experts in clean, hygienic areas. “To avoid complications as much as possible, it is always better to have a body piercing done

by a trained, experienced medical professional in a ster-

ile medical setting — preferably a hospital setting — with all aseptic precautions and sterility," Sachdev said.

Furtado too stressed on hygiene. “The needle and ink used for tattooing should be sterile and new, as must be the instrument used for piercing. The tattoo artist or piercer must wash her/his hands and wear clean gloves, as well as follow hygienic practices like sterilising the equipment before each procedure,” she said.

SOME PRECAUTIONS“As for safe metals that can be used for piercings, I suggest surgical-grade stainless steel, 24 karat gold or silver. While I think rings are better than studs, since the former allows free movement, it is up to the individual to make the choice,” Furtado said.

To determine if a person is allergic to any metal in tattoo dyes, she said a patch test or a photo patch test must be ad-ministered by a doctor.

Hegde said the person getting the tattoo or piercing must not be under the influence of alcohol or drugs. “Also, do not try to do the procedures yourself or have a friend do it.”

Once you have decided to get a tattoo, you must remem-ber not to tattoo in areas where there are active skin infec-tions, over a major blood vessel and in bony areas like the ankle, Sachdev said. "Healing can take much longer in bony areas as there is much less fat under the skin and less blood supply," she said, adding that one should also be vary of the colours integrated into the tattoo, as sometimes, mixing two or more colours can cause problems. She said it is advisable not to change the stud or ring for at least four to six weeks until the piercing site has healed completely.

There is usually a one-year waiting period between get-ting a tattoo and donating blood.

ARE YOU A CANDIDATE?While black-coloured tattoos and piercings done by profes-sionals are usually safe for most people, people with heart problems, epilepsy, diabetes, hemophilia, or those who have had organ transplant or are on blood thinners should not get them. It is also not recommended for pregnant and nursing women, Furtado said.

BE SURE YOU WANT ITSachdev said: “Before you get a tattoo, you must think twice about whether you really want it. Several people get drunk, get a tattoo and regret it in the morning. Many oth-ers regret their tattoos five or ten years down the line. And several people tattoo the names of their partner, regret-ting the decision when they break up. A very large number of people — I'd say about 80-90% — regret their tattoos. It is far more tedious, more expensive and difficult to get a laser removal than it is to get a tattoo. This is why I insist that people be really sure before getting one," she said.

The psychological element of getting a tattoo or a pierc-ing must also be considered. “Some employers may not want candidates with a visible tattoo or piercing. Some people have a societal image to live up to. All this must be considered,’’ Sachdev said.

REMOVAL PROCEDURESIf you decide to get rid of what you have, there are safe procedures for that too. For piercings, do not try to remove the jewellery yourself. Consult your piercers and ask them to do it. For tattoos, there are several removal options, such as laser treatments and dermabrasion. “Black tattoos are the easiest to remove, and the procedure is usually done with a Q-pulsed Nd:YAG laser. Different coloured tattoos require different types of laser for removal. While the re-moval takes several sittings spread over months to fade away to a large extent (it may not be completely removed), it is usually not painful — the pain factor is similar to a rubber band twanging the skin,” Furtado said.

Dermabrasion, which involves the removal of superfi-cial layers of skin with an abrasive tool, can be done for surface tattoos. “However, after a few years, the tattoo ink starts to deposit itself into deeper layers of the skin — in such cases, dermabrasion cannot be used,” she said.

If you do not want to remove the tattoo, but also do not want to keep the current design, you could ask your tattoo artist to camouflage it. Usually, a new pattern can be drawn over the current one to change it or skin-coloured pigments can be injected to cover a tattoo.

Rashmi.Ramesh@timesgroup.com

While a growing number of people get tattooed and pierced every day, it is important to know the health risks associated with them and how to stay safe, writes Rashmi Ramesh

P ermanent tattoos have been around since centuries. According to Veer Hegde,

tattooing was mostly practised by the warrior cultures in India and across the world. Akash Srinivas, who is pursuing

a PhD in archeology in the depart-ment of humanities and social sciences at IISER, Mohali, said that there isn't a lot of concrete evidence from India, but due to recent ethnographic research, it can be established that tribal communities engaged in tattooing. “The tribes may have perceived tattoos as a status symbol, and be-lieved that the tattoos had magical

properties and healing properties. Some tribes in northeast India, who used to be headhunters, would get tattoos when they made a successful kill, commemorating it,” he said. “There may have been gender-specifi c tattoos too,” he said.Arun Prasad, an independent

researcher and historian, said that tattooing and piercing were prob-ably practised to ward off evil, mark a life event or a successful venture, mark themselves as part of a particular tribe and to identify women as married. “Women may have been tattooed because the tribe may have believed that tat-

toos made the women unattract-ive, thus preventing their abduc-tion by opposition tribe members. Ironically, this is the exact opposite of today’s world, where more of-ten than not, tattoos are associated with beauty and strength,” he said. “Some warrior tribes may have got tattoos as a good-luck charm before heading to wars, and also as a trophy after winning wars. The tattoos could also have shown the warriors' prowess, strength, courage and virility.”As for piercing, some people

believed — and still do — that piercing has healing and medicinal properties, he said.A

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LINKING THE TWO

Correlation of depression

and dementia is an extremely complex issue

Aftercare SuggestionsAvoid exposure to water on the fi rst day, but clean it with rock salt and warm water solution the next dayKeep the tattooed skin clean by gently washing it with a mild soap and plain water after two days and pat it dry. Don’t rub Use a mild moisturiser or gel suggested by the tattoo artist to keep the tattoo from dryingAvoid sun exposure and swimming for about three weeks. How long the ink lasts depends on how you take care of the tattoo, exposure to sun-light, the quality of ink used and the expertise with which the tattoo is madeAvoid exercise that stretches or causes friction in the tattooed or pierced area for at least three weeksWear clothes that won’t cause too much frictionDon’t touch the piercing or tattoo without wash-ing your hands thoroughly with an antibacterial soap or handwash

No Formal System yetIndia has no offi cial body to regulate tattoo and piercing studios or the quality of materials usedThere are no professional courses that teach tattooing — it is mostly apprenticeship-based learning where students learn from hands-on experience

SOURCE: WEBMD

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