How to detect depression in TB patients? Here are a few things to note

Anu Solomon

Part 1

Representation image | Getty image

Kerala is one state in the country that is progressing significantly in tuberculosis detection and treatment. Compared to other states, the number of tuberculosis patients and those who die because of tuberculosis is less in Kerala. However, many false notions exist in our society with regard to tuberculosis. Even though the diagnosis and treatment methods have been modernized, our society continues to alienate those who are affected by tuberculosis. This has been causing certain crises.
Like, those who are affected by tuberculosis may hide it from their dear ones and seek treatment secretly. Some may hide their disease and refuse to seek treatment. Some others may get worried about the disease and suffer from mental stress, not being able to open up to anybody.

Mental stress in tuberculosis patients
Mental stress among the tuberculosis patients is a factor that creates a serious challenge. Even today, the mental tensions and alienation of tuberculosis patients remain to be a serious issue in our society. The most important reason for this is the false notions that exist in our society about tuberculosis, says Dr. Arun B. Nair, Associate Professor at the Psychiatry Department of Thiruvananthapuram Government Medical College.

These include the beliefs that tuberculosis is a fatal epidemic, that everyone who comes into contact with tuberculosis patients will be affected by the disease and that they all will die. Obviously, because of these beliefs, people are afraid to interact with tuberculosis patients.

Be it neighbours or colleagues, in many ways, they show hesitancy to interact with TB patients. There were even incidents where employees of private firms were dismissed because they were affected by tuberculosis. If a member in the family is affected by tuberculosis, other members will be hesitant to live with them.

In some cases, spouses separate from their partners because of their disease. Kozhikode district TB officer Dr. P. P. Pramod Kumar remembers a husband who deserted his wife and wanted divorce because she had TB. There was also a wife who wanted to end her marriage when she came to know that her husband had TB.

It is a fact that all these are happening in Kerala. Lack of proper awareness about tuberculosis and its treatment is the major reason for this kind of approach.
Today, tuberculosis is a disease which can be completely cured.

Government hospitals have been offering free treatment for tuberculosis for years under the National Tuberculosis Eradication Program. Medicine is available from government health centres through DOTS(Directly Observed Treatment Short-course ) treatment program.

This treatment program is designed in such a way that the patient will take medicine under the direct supervision of health workers and ensure that the patient is taking proper treatment. Most of the patients who systematically take treatment in this manner are cured of the disease.

Depression in TB patients
In some TB patients, depression is found as a related condition. The chances for depression are high among those who suffer from any health problems that persist for a long period. These chances increase even further if the TB patient has diabetes or other serious lifestyle diseases.

How to detect depression in TB patients?

If at least five of nine symptoms described below persist for two weeks in TB patients, we may assume that they have depression

  • Sad mood that persists from morning till evening
  • Not interested in the activities which they used to do with much interest early.
  • Always in a pensive mood. Ruing about their state.
  • Not being optimistic about treatment and getting cured of the disease.
  • A tendency to be alone, without interacting with people.
  • Always a fearful expression on face. Crying frequently.
  • Not being able to enjoy anything. If they are elders, they won't feel happy even to meet their grandchildren.
  • Slowness in thinking and actions. If we ask them a question, it will take long to get the answer.
  • Expressing disappointment and hopelessness. They will start thinking like they will never escape, that everyone has alienated them, that they are a burden to their family and unnecessarily feel guilty.
  • A desire to die and suicide tendencies.
Reasons of depression
Most often, those who have to face alienation from the society have a higher chance to be affected by depression. The inability to live as they lived earlier owing to the disease, cracks in family relations and loneliness can lead a person to depression.

How to treat depression in TB patients?

Dr Arun B Nair

If tuberculosis patients have depression, it should be diagnosed fast and treatment should be provided for that too. There are medicines for depression which can be given along with those for tuberculosis. These medicines are those which do not react to the ones that are used for treating TB and they are safe too. These medicines too should be taken from six to nine months. Because, chemicals like Serotonin and Nor-Epinephrine will be less in the brains of those who have depression. The depression-treating drugs are for balancing the measure of these chemicals. By using these medicines for treatment, depression will be cured and the health condition will be improved, which will increase the recovery rate of the patient.
But if depression is not treated, it will lead to decreasing immunity and lead to complications.

Do tuberculosis medicines create mental problems?

Some medicines used for treating tuberculosis are likely to create mental problems as side effect. For example, symptoms of psychosis appear as a side effect of the drug named INH, which is used for treating tuberculosis. This condition is called drug-induced psychosis. It causes depression and anxiety. However, these can be effectively controlled with medicines for treating psychosis. Along with that, tuberculosis treatment can be completed using INH medicine itself.

Cerebral Tuberculomas or the type of tuberculosis that affects the brain is a disease which is rare. In those who have this condition, mental illnesses may appear as behavioural problems. In such situations, it is necessary to provide treatment for controlling behavioural problems, along with the treatment for tuberculosis.

Counselling and mental support needed
There are many persons among us who were cured of tuberculosis with proper treatment. They are called TB champions. These TB champions often get together under the aegis of TB Centres. These gatherings aim to be a platform to share experiences related to treatment and matters like that.

Such programs help to eliminate despair and other problems among the champions as well as to provide them mental support. In order to provide relief to the patients who are suffering from mental tensions, it is necessary to provide counselling to the patients and their family members, if needed.

Matters that colleagues and family members of TB patients should care about

  • Don't stop the treatment: Tuberculosis is a totally curable disease. So it is necessary to complete the treatment by taking medicines in the same measure and in the same manner as prescribed by the doctor. Never stop taking medicines. If there are any side effects for these medicines, you may inform the same as early as possible to the doctor and it can be solved with small changes in treatment. So never stop treatment.
  • Never alienate the TB patient: If there is a TB patient in your family, it is not necessary to alienate them. The life partner of the patient should talk to the doctor and understand the situation properly. The possibility for the disease spreading is determined on the basis of which organ is affected by TB. If the lungs are affected, chances are high that the disease would spread through fluids from the lungs. If that is the case, it would be ideal to wear a mask when the interacting with the patient at home, as per the instruction of the doctor.
  • Understand the disease clearly: If TB has affected other organs and not the lungs, chances for the disease spreading through lung fluids is quite less. In such situations, the family members of the patient should talk to the doctor and understand in detail matters including precautions. Actions should be taken based on this information. The individual should never be alienated or ignored.
  • Support them, do not frighten them: Any patient who suffers from a complex disease needs the support and comforting presence of family members and dear ones. They should not be blamed or alienated in such a way to break their mental balance. The complications of the disease should not be explained to them in such a way to frighten them. Do not talk to the patients about other patients or those who suffered because of this disease. Even if these are done unknowingly, they will affect the mental health of the patients. So, such things should be totally avoided.
  • Don't fall for phoney medicine: Normally, when we go ahead with treatment, people would give us many opinions. There is a tendency to mislead persons saying an alternative method of treatment is better compared to modern medicine. Such opinions are given by those who do not know anything about any medicine systems. Misleading information about treatment and related matters should never be perpetuated. Rely only on specialty treatment. Don't talk about treatment in a misleading manner.
  • Also, the patient should not be allowed to fall for these false propaganda.
  • Do those things that give happiness to the mind
  • Do those things that lighten mental stress
  • Sleep well
  • Do minor exercises, as instructed by the doctor, in such a way to help the healing process.
  • Engage in pastimes that give joy to the mind
  • Engage in healthy communication with friends and relatives through social media or through the phone. Such things will help to improve mental health.
Tomorrow: Tuberculosis in jails is controllable; but there are certain challenges

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