Prodrome or Concomitant?

Depression and anxiety: Prodrome or concomitant?

A number of questions arise for patients who experience acute or persistent depressed mood. Instant access to the Internet or to pocket measures of pulse, blood pressure, respiration etc. often enough add to accompanying anxiety or even worse, create it. Depressed mood detracts from one's energy and often muddles thinking. It is a good time to consult your LMD or internist. A multitude of associational studies now show linkage between liver and pancreatic dysfunction, coronary disease, stroke, Alzheimer's, Parkinson's,various cancers etc., and depression.

These studies are associational and usually do not indicate directionality. But as more studies are done (and the reduction of research funding hurts), it begins to emerge that depressive symptomatology may precede diseases like Parkinson's, particularly in women, by months and years. Mechanisms will be found and the old concept of Prodrome will give way to stage of disease. This is important because active treatment may follow and postponement of disability.

Without doubt, such shifts in recognition of active disease will cause major change in treatment and insurance support. The use of benzodiazepines like aprazolam or antidepressants like elavil or sertraline or antianxiety agents like miltown can relieve the heralding anxiety or depression while the underlying disease progresses. This is one reason why most doctors oppose giving prescribing privileges to psychologists and others capable of working with mental problems. Another major function of physician groups like APA and AMA is to keep abreast and negotiate with international drug and disease classification in part to keep diagnosis and treatment from following the pathway of least monetary resistance and subordination of U.S. patient characteristics to potential non representative world standards.

It seems as though women may be more susceptible to prodrome/concomitant conundrum (empaths of the species) but knowledge and testing capability are increasing. Physician testing and judgment must keep pace with new self diagnostic measures, and with the problems that have been created by the loss or politicization of former areas of relative comfort with expressed hostility like football, baseball, soccer, boxing etc. have been politicized (probably deliberately) so that those areas are now anxiety-producing or at least much less enjoyable and diverting. The result is that we now live in a new age of anxiety, where crime and addiction are the returning( think of Bonnie and Clyde) dyssocial outlets for aggressive feelings that were formerly channeled by sports.

I have encountered a lot of fear of nuclear war and distrust of leadership on all levels of government. This is also a significant part of the ethos of our Age of Anxiety. The expression of fear and hostility may be in patient terms as symptoms or signs of discomfort but may also accompany these with frank expressions that we can term political. The orthodox wisdom is for doctors and medical staff not to engage in political conversation with patients or other staff, but in an age where repression of feelings and concerns is part of the penumbra, following the dictum may be increasingly difficult if not impossible. Physicians can confirm the general principles of citizen responsibility to choose and support representative, responsible leadership by first knowing what the citizen issues and concerns are and what sources of information are needed.

It seems to me that this level of dissemination of information is legitimate. Note that physicians may disagree with one another but the aim is not to find truth in the setting but to invoke an atmosphere of openness rather than one of fear and repression. In such a setting symptomatology may have a different expression. Stay tuned.