Depression is a common but serious mood disorder. To be diagnosed with depression, the symptoms must be present for at least two weeks.
Depression causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating and/or working.
WHO defines depression as “a mood disorder where motivation is lower than usual for a prolonged period, with other symptoms ranging from, but not limited to, loss of appetite, insomnia, and hallucinations.”
Winston Churchill… One of the most famous Depressive Personality
Lord Beaverbrook, a close friend of the former British Prime Minister Sir Winston Churchill once remarked that Churchill always shuttled between two extremes. He was either “at the top of the wheel of confidence or at the bottom of an intense depression.” Such was the manic depression Churchill suffered from, which he referred to as his ‘black dog’.
Churchill wasn’t alone; there’s a black dog inside every one of us. Sometimes we successfully manage to keep it at bay overshadowing it with our cheerful spirit, but at times depression eats us up from inside and we feel like we are dying a slow death. Mood swings become a part of our routine.
Depression – A leading Global Disease
It is often believed, albeit falsely, that since depression is a matter of the mind it is easy for the person to come out of it. The truth, however, is more gruesome. The 2012 Report by the World Health Organisation came up with some mind-numbing numbers. According to their estimate, there are almost 350 million depression sufferers in the world and by 2020; depression will become the leading global disease burden, i.e. a disease with which one lives for years.
If you still think that depression takes a toll only on personal life and can be easily overcome, then you’re grossly mistaken. The blues of depression have spread their fangs to your workplace as well, disrupting professional lives. In fact, corporate depression has become a major cause of concern for both the employers and employees worldwide.
The PPC Worldwide survey on Indian companies reiterated this point. According to the study conducted in 2012, more than 62% of health concerns in India Inc. are due to work stress.
A research study based on the World Mental Health Survey Initiative of WHO found out that the highest rate of major depression in the world happens in India with the figure as high as 35.9%.
It is an overwhelmingly distressing disorder of the Mind
Depression has a different meaning for every individual. While some people look at it as living amidst imminent disaster, others may feel inert, void and indifferent or restless and aggressive.
Whatever be the variations in their experiences, depression takes a toll not only on your mental stability but your physical health too.
1. Depression is often confused with Sadness. It is believed that in coping with the challenges and disappointments in life, one experiences downswing or melancholy that the individual can overcome in due course of time. But depression is beyond just feeling low.
2. It disrupts life. It is different from usual sadness in the sense that it disrupts your daily life and diminishes your ability to routine things like work, eat, sleep or enjoy life.
3. It is a persisting depressive feeling. Depression is a state where the pall of gloom, low mood or the feelings of helplessness, hopelessness and worthlessness lasts longer than normal.
4. Healthy lifestyle takes a backseat. People who are depressed tend to neglect healthy lifestyle practices and get stuck in behaviour and patterns, which in turn, lead to a chronic stress burden, thereby increasing the risk of major depression.
Types of Depression
1. Major Depression: Symptoms of major depression range from moderate to severe. It lasts for only 5-6 months. Though it is a recurring disorder, but some people get only one episode in their life.
2. Dysthymia Depression: The symptoms of Dysthymia are not too strong as that of major depression but they can last for two three years. One remains in the state of low mood and difficult to live an open life.
3. Bipolar ‘manic’ Disorder: In Bipolar Disorder one attains a cyclic mood with an impulsive behavior, short attention span and insomnia. It can last for days, weeks or several weeks.
4. Seasonal Depression: Seasonal depression is also called seasonal affective disorder (SAD) affecting people due to change of seasons/weather. They become sad, tense and stressed with no interest in friends and family.
There are different types of Depression in men, women, young and older people in accordance to which the different treatment is to be recommended.
Here’s what happens when you are Depressed
Some people may experience a single bout, while for others it might be a recurring phenomenon. So the symptoms may vary too, but there are some common signs that signal you’re dealing with depression.
1. Poor memory and trouble in concentrating.
2. Persistent feeling of sadness throughout the day.
3. Reduced energy levels making you feel fatigued or physically drained.
4. You consistently experience a feeling of being trapped inside a dark room.
5. Decreased ability to control emotions like anger, anxiety, irritability and guilt.
6. Changes in sleep patterns causing insomnia, broken sleep, early morning waking or over sleeping.
7. You have NO Hope. The light at the end of the tunnel, looks to you as the sign of an oncoming freight train. Everything looks bleak.
8. Changes in appetite and weight leading to weight loss or weight gain at the rate of more than 5% of your body weight in a month.
9. Decrease in the level to tolerate pains and aches and an increase in physical ailments like headaches, back pain, muscle ache or stomach pain.
10. You cocoon yourself further inside your shell and hide your condition from everyone so as to avoid embarrassment or negative opinion.
11. Loss of interest in daily activities like pursuing your hobbies or socialising with people or even engaging in sex. You feel that you’ve lost the ability to experience pleasure or happiness.
Depression at Workplace
We open ourselves up to the people we are close to – our family, friends and loved ones. But the situation becomes worse at workplace. Conscious about the professional environment and formality in the relations, a depressed person hardly expresses his problem to his colleagues, seniors or seeks expert help.
However, there are certain symptoms that show how the actions of a person change at workplace when he is going through depression.
1. Reduced productivity
2. Decrease in dependability
3. Increase in errors in work
4. Alcohol and/or drug abuse
5. Being tired throughout the day
6. Lack of motivation and cooperation
7. Increase in physical aches and pains
8. More prone to accidents and physical injury
9. Difficulty in concentration. Decision making
10. Increased frequency of absent days or sick leaves
Causes: Genetics, illnesses, emotions
Unlike a physical ailment, which is visible to the eyes, the actual reasons that trigger depression inside the closed chambers of the human mind are yet to be ascertained.
There have been disagreements among researchers on the causes that lead to depression. Also, the fact that the nature of depression varies from one person to another makes the matter worse. However, there are a number of broadly agreed upon reasons whose combined effect results in depression.
1. Genetic causes.
The risk of depression increases manifold in people who have a family history of depression. Research has shown us that more than 4,000 diseases can be caused by the genetic depression variants. For example, children born to a parent with depressive tendencies or having siblings exhibiting the same traits will have almost 50% chance of developing depression later in their lives.
2. Circadian Rhythm.
The internal master biological clock plays a vital role in orchestrating the circadian rhythms of multiple biological processes. A disturbed circadian rhythm over a long period of time can lead to depression.
3. Illness induced causes.
It is estimated that up to 35% of people suffering from a major illness experience symptoms of depression. Depression caused by chronic illness can in turn worsen the ailment, triggering a vicious cycle to develop.
4. Biochemical causes.
Every cell communicates with each other by engaging the neurotransmitters Dopamine, which helps to control the brain’s reward and pleasure centers and Serotonin that helps in managing our well being and happiness. If the Dopamine and Serotonin levels are imbalanced, the transmission from one cell to another becomes hazy and if this continues for long, it can lead to brain fog resulting in chronic fatigue, fibromyalgia, stress and ultimately depression.
5. Chronic Stress.
If not handled well, stressful life situations sustained over a period of time can increase the risk of developing depression. In sustained stress, the body keeps producing the stress hormone cortisol, restraining the smooth working of bodily functions.
6. Emotional causes.
More than 90% of our ailments are partly stress induced psychosomatic illnesses. The human brain processes between 20000 to 70000 random thoughts – good or bad – in a day. Therefore, distorted thinking on a daily basis can turn a simple thought or emotion into an experience of depression.
7. Personality induced causes.
People with low self esteem or overly self critical personality styles are more prone to get affected by depression. Some of the personality styles that can cause depressions are the anxious-worrying-irritable personality style, self-critical personality style, self-absorbed and perfectionist personality style, socially avoidant and personally reserved personality style and rejection sensitive personality style.
8. Other causes.
Being bullied, death in the family or of a close friend, setbacks in career and finances, failing a critical exam at school and substance abuse also leads to depression. We often do not pay proper attention to or ignore these causes, but they too can culminate in chronic depression at some point in our lives.
Science behind Depression: Biology of a Dark Mind
What is happening in the brain of a depressed person… A literal ton of research has been done to show that numerous brain areas show altered activities in depressed patients. This led to the origin of biochemical origin of the disease, as opposed to its psychological or situational origin.
A number of chemicals and neuorchemicals are involved, working both inside and outside the nerve cells and it is a result of these chemical reactions happening constantly that depression creeps in.
1. Brain regions.
Science has tracked the seat of depression to the brain. Many areas in the brain regulates mood. Nerve cell connections, nerve cell growth and functioning of nerve circuits are seem to be altered in depression.
The brain areas that are affected in depression are the amygdala, the thalamus, and the hippocampus. Research shows that the hippocampus (part of limbic system responsible for processing long term memory) is smaller in some depressed people.
In one study of 24 depressed women published in The Journal of Neuroscience, investigators found that the hippocampus was 9% to 13% smaller as compared to the age matched controls. The more severe depression a woman had, the smaller the hippocampus was.
Stress, that is supposed to play a critical role in depression, may be a responsible factor here, since experts believe stress can suppress the synthesis of new neurons (nerve cells) in the hippocampus.
The possible connection between reduced production of new neurons in the hippocampus and low moods are supported by the role of antidepressants.
As these medications immediately boost the amount of neurotransmitters in the brain but still people don’t begin to feel better for several weeks or longer.
This is because the mood only improves as the nerves grow and form new connections- this process takes several weeks. This is supported by animal studies that have shown that antidepressants stimulate the branching of nerve cells (neurogenesis), strengthens nerve cell connections, and improve the exchange of information between nerve circuits in the hippocampus.
- Amygdala. The Amygdala is also a part of the limbic system (area that governs emotions).The amygdala is activated when a person recalls emotionally stimulating memories or intrusive memories. The activity of amygdala is seems to be elevated in depressed patients.
- Thalamus. The Thalamus is the area of the brain that receives maximum amount of sensory information and it relays it to the appropriate higher brain area. It is involved in behavior, movement, thinking and learning. Some research suggests that depression may result from problems in the thalamus, which helps in linking sensory input to pleasant and unpleasant feelings.
Neurotransmitters are chemical messengers responsible for communication between the nerve cells. Most antidepressants increase the concentration of these chemicals in the spaces (the synapse) between two nerve cells
Brain cells usually produce a certain levels of neurotransmitters that keep senses, learning, thinking, movements, and moods working efficiently. But in some depressed or manic people this complex system goes awry, which can significantly affect mood.
Kinds of Neurotransmitters: Description of neurotransmitters that are believed to play a role in depression…
- Acetylcholine: Enhances memory, learning, decision making and recall.
- Serotonin: Regulate circadian rhythm and mood and inhibits pain. Lack of serotonin leads to anxiety, obsessions and compulsions. Some depressed people have reduced serotonin levels.
- Norepinephrine: Raises blood pressure, determine arousal, energy and reward. It can trigger anxiety and is involved in some types of depression
- Dopamine: Influences motivation, interest in life and plays a role in how a person perceives reality. Alteration in dopamine transmission have been linked with psychosis- hallucinations or delusions
- Glutamate: An excitatory neurotransmitter, lack of which is seen in bipolar disorder and schizophrenia.
- Gamma-aminobutyric acid: GABA is an amino acid that acts as an inhibitory neurotransmitter, which helps to quell anxiety.
Genes make proteins that control every biological process. But if the genes make wrong protein at the wrong time, they can alter your biology in a way that results in altered mood processing. In a genetically vulnerable person, even a trivial form of stress can push this system off balance.
In 2003, Researchers found that people having a particular variant in a serotonin transporter gene (5-HTT) were more likely to become depressed. All of us inherits two copies of this gene — one from each parent. The gene comes in “short” i.e. less efficient and “long” i.e. more efficient variant. Combination of short or long versions cannot directly lead to depression. But people getting “short” version are more vulnerable to depression if they experience stressful life events.
In a study of about 800 young adults conducted for a five-year period, the researchers found that 33% of those with at least one “short” gene became depressed after a series of stressful life events. Whereas, only 17% of those with two “longs” genes developed depression in similar circumstances
In 2008 study published in archives of general psychiatry, researchers studied a protective version of gene CRHR1. In this study, researchers tested DNA of 621 adults who suffered childhood abuse. They found that people having protective version of this gene were having half the symptoms of depression than people without this gene.
Another interesting discovery is the identification of another DNA variant named- G1463A. People having this atypical DNA sequence are more vulnerable to depression than those who don’t.
Perhaps the easiest way to know the influence of genes is to look at families. A person who has a first degree relative suffering from depression has a higher susceptibility for developing depression.
Studies have documented the role of altered neuroplasticity in the incidence of depression. A review published in Neuropsychopharmacology (2008) found chronic stress can alter neuroplasticity by convergence of three phenomenons:
Chronic stress can substantially reduce number of dendrtitic spines ( projection of a nerve cell that is helpful in information transmission, memory storage, motivation and learning).
- Chronic stress can also reduce the length and complexity of cortical dendrites ( implicated in memory ,learning and modulation of sensory associations).
- Chronic stress has been seen to impair neurogenesis.
Studies have shown that many molecular mechanisms of neuroplasticity are induced by anti-depressants-that includes-synaptic plasticity ( changes in dendritic spines in many brain areas, most prominently in hippocampus), increase in level and complexity of dendritic lengths and neurogenesis.
5. Hormones and Endocrine System.
Hormones are the chemical messengers that are produced by endocrine system. The endocrine system is under the control of hypothalamus (switching station of the brain)- that controls circadian, seasonal rhythms, appetite, behavior, temperature, immune functions and blood pressure.
Circadian rhythm or 24-hour body cycle is mainly controlled by hypothalamus, which does so, by determining the amount of light in a day-night cycle. Both brain activity and hormone production are dependent on this rhythm. Altered circadian rhythm can lead to mood disturbances.
Similarly seasonal rhythms are determined by amount of light in a particular season and its alteration is seen in seasonal affective disorder (SAD).
The hypothalamus is also responsible for the production of Stress hormones. Numerous studies have documented a positive correlation between increase levels of stress hormones and depression.
Other than hypothalamus, endocrine organs such as the thyroid, adrenal glands, ovaries and testes have also been linked with depression.
Low levels of thyroid hormones, produced by thyroid gland in neck, can lead to depressive symptoms. The adrenal glands, located near the kidneys, produce cortisol that controls metabolism, immune function, and the stress response. Over-activity of adrenal glands is usually seen in depressed individuals.
Reduced level of Estrogen produced by ovaries can alter activity of neurotransmitters- serotonin and norepinephrine and can lead to depression. This explains why women are more prone to depression than men.
Testosterone, produced by the testes in males, is also linked to depression. Studies have suggested a decrease in its level after the age of 50. This might be one of the reasons why men after 50 become more susceptible to develop depression.
Managing Depression without Medication
Managing Depression without Medication gives an introduction of a few modalities that can help manage Depression.
In a comprehensive study on depression and anxiety conducted recently by the researchers at the University of Queensland, it has been found that 1 in every 21 persons will have major depression at some point of time. This data points to the growing peril of depression looming over the world. Depression doesn’t happen in a day, so there are no quick fixes to overcome it.
The road to wellness in depressed state isn’t an easy one, but that doesn’t mean it is unattainable. You have to start from the scratch and re-build your lost happiness brick-by-brick. The key point in recovering is to make yourself feel better.
However hard it may sound initially, you need to pursue it persistently to reach your goal. Start small with whatever resources you have and then take it forward. In the beginning, you may not have the energy to engage in long-term plans. So, keep them short-term and track your progress as and when you reach your aim.
1. Stay connected and get Social support.
One tends to withdraw or isolate even from close friends and family members, when depressed. Strong Social network reduce isolation, a major risk factor for depression.
1. Consider volunteering as it a wonderful way to get social support while helping others and yourself too.
2. Build new friendships. Having an active social life can boost your immune system and help reduce Depression.
3. Give priority to face-time. Social media, chatting and phone calls are great ways of communication but they can’t beat good in-person time.
4. Care for a pet. While pets can’t replace importance of human connection, howbeit they can bring joy and companionship in your life.
5. Talk your feelings out. Talk to one person about your feelings as talking can get you outside of yourself.
2. Exercise helps beat Stress.
Exercise often seems like the last thing you want to do with Depression. But once you get motivated, exercise may prove as one of the most important tool in your recovery arsenal.
Research shows that regular exercise can be as effective as pharmacological treatments for relieving depression symptoms. It also helps prevent relapse once you are out of it.
Exercise is recommended for three to five times a week for about 20-30 minutes. “Aerobic exercise such as brisk walking is the best, but any expanse of exercise is better than none,” says P. Murali Doraiswamy, MD, professor of psychiatry and behavioral sciences at Duke University School of Medicine.
A 2005 study found that brisk walking for about 35 minutes a day five times a week can significantly influence mild to moderate depression symptoms. (These exercise parameters were calculated for someone who weighs about 150 pounds. If you weigh more, increase the time of exercising, while the opposite is true if you weigh less than 150 pounds.)
1. Exercise is a powerful healing tool: Exercise can appease depression by altering the mood regulating neurotransmitters- norepinephrine and serotonin.
2. It also releases the endorphins responsible for the “runner’s high” which some encounter.
3. It reduces pro-inflammatory cytokines that can worsen depression.
4. It increases body temperature, which can have calming effects.
5. It has many psychological benefits too like boosting self confidence and will power.
3. Yoga therapy for Depression.
Yoga therapy is an effective and natural treatment for depression. Studies have shown Yoga asana, pranayama and mediation can help reduce cellular stress and aid in alleviation Depression.
Sequence of Yoga asana one can practice…
1. Backbending Yoga Asana. It expands the thorax and helps to imbibe confidence and grace. It improves posture, ease breathing and reduces stress by releasing tension in thoracic region.
2. Inversion Asana. Inversion asana have mood lifting and empowering effects.
3. Relaxation Posture. Important recipe for emotional wellness. Use of props and supports have added benefit for people with Depression.
A growing number of studies point towards benefits of yoga therapy and general yoga care towards the management of life stresses and depression. For more… Yoga for Depression
4. Healthy Diet is a Mood Booster.
Never skip a meal as fluctuating blood sugar can worsen the symptoms…
1. Avoid caffeine as it reduces serotonin production.
2. Boost your vitamin-B complex especially folic acid and vitamin B-12 To get more, eat more citrus fruits, green leafy veggies, beans, chicken, and eggs.
3. Minimise sugar and refined carbs: Depressed people may crave for sugary foods but these “feel-good” foods can quickly crash your mood and energy.
4. Include serotonin-enhancing foods like food rich in omega-3 fatty acids (salmon, mackerel, tuna, sardines, herring), healthy oils (coconut oil) and high protein diet (especially high in tryptophan like turkey).
5. Meditation for Depression.
Meditation deactivates the depression center (amygdala) of the brain. Most of the depressed people have hyperactive amygdala- the region known as the anxiety and fear center of the brain. Meditation, by deactivating amygdala, optimises the brain for restoring happiness.
1. Meditation produces the same brainwaves as used for depression treatment. Neuroscience has built a mountain of evidence confirming that meditation produces alpha and theta brainwaves in the brain; which are the same brainwaves produced in the brain during meditation and biofeedback therapy for treating depression.
2. Meditation boosts two highly important neurotransmitters Serotonin and Epinephrine; lower levels of which is associated with depression.
3. Meditation increases hippocampus density; the area of the brain responsible of memory and orientation and is highly underdeveloped in depressed people.
4. Meditation is the antithesis of depression. Depressed people have underdeveloped “happy” left prefrontal cortexes: the region of the brain best known to control executive function. Whereas meditation by increasing thickness of prefrontal cortex re-wires your brain for happiness.
6. Conscious Breathing techniques help.
Conscious Breathing can help cure depression by improving autonomic, hormonal function, emotional processing and social bonding.
A type of controlled breathing called Sudarshan Kriya Yoga (SKY) yoga shows promise in providing relief. SKY program involves several types of cyclical breathing patterns, ranging from slow and calming to rapid and stimulating.
A study examined the effects of SKY in 60 alcohol-dependent depressed men who were randomly assigned to two groups: A SKY program or a standard alcoholism treatment control group.
After three weeks, depression scores dropped 75% in the SKY group, as compared to 60% in the standard treatment control group. Levels of cortisol and corticotrophin (stress hormones) dropped significantly in the SKY group, but not in the control group.
All pranayama and breathing techniques helps to remove pranic blocks and improve circulation of prana in body. It includes… Anuloma Viloma (people with depression should avoid holding breath), Bhramari pranayama, Bhastrika pranayama, Kapalabhati, Ujjayi pranayama without Kumbhak.
7. Sleeping on time, every night, helps.
Depressed people generally don’t have sound sleep; as they cincture themselves in worry or involve themselves in some disorganised problems. Depression is sometimes linked to insomnia. Moreover, the combination of depression and insomnia will only worsen the situation.
Hence, good sleep hygiene including measures such as following regular sleep routines, avoiding stimulants like caffeine, reading a book or listening to favorable music and management of sleep disorders like sleep apnea is important to help break this vicious circle.
8. Expose yourself to Sunlight every day.
Lack of sunlight and particularly vitamin D can reduce the serotonin levels and make depression worse.
According to World Health Organization, aim for at least 5- 15 minutes of sun exposure a day to boost your mood. If you are reluctant to sit in the sun or live in a place with little sunshine, try using a light therapy box.
9. Psychotherapy for Depression.
Cognitive behavioral therapy (CBT) helps depressed people find new ways of dealing with negative thoughts and obtrusive behaviors. Instead of probing into the past to determine where the negativity comes from, CBT helps patients to be in the present moment and enabling them to understand how their beliefs or actions are contributing to depression.
Once the so called contributors are identified, a therapist will work with the patient to swap those negative attitudes with more positive ones and use them in the real world. Research has shown that many people undergoing CBT for depression has significant improvement.
Many other types of therapies are available, namely…
1. Problem solving therapy.
2. Dynamic psychotherapy.
3. Emotion focused therapy.
4. Interpersonal psychotherapy.
5. Behavioural activation management.
10. Vitamins and supplements can help.
If your depression symptoms are due to nutritional deficiency, you may benefit from vitamin supplements.
One of the most studied supplements for treatment of mild to moderate depression is St. John’s wort, a yellow-flowered plant that can be used in the form of tea, pills and extracts.
The National Center for Complementary and Alternative Medicine reviewed 37 studies and found it may be as beneficial as certain antidepressants for treating mild depression but, it can diminish the effectiveness of some prescription medications, including birth control pills, antidepressants, blood thinners, and some anticancer medications. So be sure your doctor is aware of what supplement you are taking.
11. Acupuncture helps reduce Depression.
Acupuncture is increasingly becoming popular as a natural treatment for depression. One area where acupuncture has been studied widely for depression is in depression associated with pregnancy. Because of potential side effects of medicinal treatment in pregnant women, acupuncture is proved to be a valuable alternative.
In a study conducted by Stanford University School of Medicine, 150 pregnant women with major depression were randomly divided into three groups: acupuncture specific for depression, control acupuncture (needles inserted into points not specific for alleviating depression) and massage group.
After eight weeks of the therapy, researchers found that women in depression specific acupuncture group experienced higher reduction in depression than women in other groups.
In acupuncture, a practitioner inserts fine needles into the skin at points thought to correspond with specific organs. While Western researchers suggests that the needles may produce natural painkillers in the brain; the traditional practitioners believe that acupuncture alleviates depression symptoms by correcting energy blocks or imbalances in the body.
12. Light therapy helps SAD.
Light therapy is a way to treat certain types of depression like seasonal affective disorder (SAD), which occurs at a certain time each year particularly in the fall or winter.
During light therapy, the patient has to sit near a device called a light therapy box. The box gives off bright light that mimics natural sunlight.
Light therapy is thought to affect brain chemicals associated with mood, easing SAD symptoms. Using a light therapy box may also help with other types of depression like bipolar disorder and sleep disorders
A review done by researchers at the University of North Carolina, published in the American journal of psychiatry reported that Light therapy or dawn simulation produce results equal to that given by common antidepressants.
13. Music therapy works.
Music therapy is one of the expressive therapies, consisting of techniques in which a music therapist uses music to improve health in several domains- cognitive function, social skill development, quality of life, emotional regulation or distraction.
A 2009 review appeared in Clinical Psychology Review, found a significant dose effect of music therapy in depressed people, with improvement after 3 to 10 sessions and major improvement after 16 to 51 sessions of music therapy.
14. Be Hopeful; look at the bigger picture.
Once you’ve successfully managed to avoid pessimistic thoughts from affecting you, you’ve won half the battle. Being hopeful and allowing only cheerful thoughts to your mind can help to get you out of depression.
1. Look at the brighter side of life.
2. Spend time with positive people who can enhance the positivity in you.
3. Whenever negative thoughts come to your mind note them down. Review them later in a good mood and try to find out positive ways of dealing with the negative situations.
The information provided on this blog is intended for general reading purpose only and is not, in any case, intended to be a substitute for professional medical advice. Please consult a related professional regarding your concerns.