Gastrointestinal flatulence, dyspepsia, is it [old gastropathy] or [gastrointestinal mood is bad]?

In recent years, Chen Laobo has had a very bad time.

I don’t have an appetite all day long. I still feel indigestion after eating something. Often belly flatulence, still feel qi wandering in it. Constipation and diarrhea alternate, all day long with a sad face, people also lost a lot of weight.

Chen Laobo has not gone to the hospital less over the years for this bad [old stomach trouble].

After all kinds of examinations, no obvious problems were found, and the conditioning was not very effective. I had to ask people to inquire about all kinds of folk remedies everywhere. I ate a lot of them at sixes and sevens, but I still didn’t get better.

After being reminded, Chen Laobo turned to the psychiatrist with the mentality of treating dead horses as living horse doctors. The psychiatrist looked through Chen Laobo’s diagnosis and treatment records in recent years. After in-depth and careful inquiries, he found that the person behind all this was not digestive tract diseases, but [hidden depression].

It turns out that Chen Laobo’s digestive tract symptoms are too obvious. When seeing a doctor, the digestive doctor only paid attention to his physical health, did not notice Chen Laobo’s psychological problems, and did not dig out the hidden deep depressive symptoms.

Under the careful inquiry of the psychiatrist, Chen Laobo began to pour out the bitter water buried in his heart.

After retirement, he had nothing to do all day long, his wife died early, and his son was busy with his work. He had been lonely and depressed all the time, and he was weak all day long. He was not interested in his favorite square dance and did not like to go out. I can’t sleep well every night. I wake up at 3 o’clock in the morning and can’t sleep. Life felt particularly boring, meaningless, and once had the idea of suicide.

After taking antidepressants from psychiatrists, Chen Laobo not only felt good, but also improved his sleep. The [old stomach trouble] that he had been worried about miraculously improved! If you eat it, you don’t have to worry about indigestion. You also have a good spirit. You look like a different person.

Occult depression is characterized by obvious physical symptoms, but there are no obvious problems in examination, and it is difficult to find snow-covered depressive symptoms.

There are two main reasons:

    The patient’s view of the disease does not think that being in a bad mood is a disease, so emotional problems will not be mentioned when stating the disease condition. Other physicians lack knowledge of psychiatry and are easy to be misdiagnosed as other diseases after excluding physical diseases. For example, they are easy to be misdiagnosed as [functional dyspepsia] in gastroenterology and [neurasthenia] or [neurosis] in neurology.

The somatic symptoms of latent depression are mainly concentrated in the following three systems:

    Cardiovascular system: chest tightness, palpitation, chest pain nervous system: dizziness, dizziness, hair swelling, reaction ability is not as good as before digestive system: anorexia, dyspepsia, nausea, stomachache, constipation or diarrhea, abdominal gas swimming

The main depressive symptoms of hidden depression include:

  1. Long-term depression and anxiety
  2. Have no interest in anything, lose energy, have less activity, and are unwilling to go out.
  3. Self-accusation, guilt, pessimism and even the idea of suicide.
  4. Can’t sleep for a long time, sleep instability, especially easy to wake up early, such as 7 o’clock in the past, now wake up at 3 o’clock in the morning, after waking up can’t continue to sleep
  5. The ability to remember and think is reduced, attention is not concentrated, and it is difficult to continue working.
  6. Loss of weight and sexual desire
  7. Symptoms are heavy in the morning and light in the evening.

If there are physical symptoms for a long time, but there is no big problem in the examination, you may as well inform the doctor of your inner experience so that the doctor can diagnose you more comprehensively so as not to delay the illness.

  1. Put down the psychological burden: Don’t feel inferior because you have [mental illness], and then close yourself to worsen your illness. You know, depression is very common in foreign countries. They compare it to [cold of the heart] to vividly illustrate the universality of depression, so you should put down the burden of the heart, cooperate with doctors, actively treat and strive for an early recovery.
  2. Listen to the doctor and add the medicine slowly: As the patients with hidden depression are mainly the elderly, as they get older, there are inevitably other problems. When using antidepressant drugs for treatment, they have to be cautious. They have to start from a small dose and add the medicine slowly. Don’t be impatient and add the medicine to the target dose in a few days.
  3. Listen to the doctor, the dose should be low: in addition, the kidney of the elderly is the same as the legs and feet. As they get older, they are not as quick as before. As the excretion of drugs slows down, the dosage cannot be the same as that of young men. Otherwise, drug poisoning is easy to occur. The recommended dose is 1/3 ~ 1/2 of the adult dose. With the improvement of depression, the physical symptoms will also disperse like Chen Laobo’s.
  4. Family members need to care for patients: of course, the care of their children, the care of their relatives and the encouragement of their old friends are also essential. Just like the Chen Laobo family, the son also realized that he had not fully fulfilled his filial piety. Although he took care of his father’s food, clothing, housing and transportation, he never paid attention to his psychological needs.

From then on, Chen Laobo’s son will take time every week to make friends with his father, talk about daily life and things he encounters at work.

Chen Laobo also followed the doctor’s advice and talked with his old friends in the community when he was all right, spitting out all the unpleasant things at ordinary times and sharing the interesting things he encountered in his life.

In the process, he was surprised to find that the elder brother who suggested him to see the psychiatric department had also suffered from hidden depression. Chen Laobo couldn’t help but sigh with emotion: “I have never been alone.”

It was the warmth of the family and the care and understanding of old friends that made Chen Laobo more confident to overcome the disease and finally won the victory.

Finally, it should be noted that drugs are not effective for everyone. At this time, if the patient does not have serious cardiovascular diseases, modified electroconvulsive therapy (MECT) can be considered, which is also suitable for the elderly with obvious suicidal tendency and antifeedant behavior.

Responsible Editor: Ding Ruoshui