Sunday, February 6, 2011

अवसाद एक घातक रोग -- Devastating Depression

अवसाद अथवा डिप्रेशन एक गंभीर मानसिक रोग है , जिसे "Major depressive disorder " कहते हैं , जिसमें मरीज बहुत बुझा-बुझा सा रहता हैउसे अपना आत्मसम्मान ( self esteem ) कम लगता है तथा वह किसी भी प्रकार के मनोरंजक कार्य-कलापों में रूचि नहीं लेता है

हमारा मस्तिष्क संदेशों कों भेजने और लाने का एक बहुत बड़ा सिस्टम है , जो शरीर में होने वाली हर छोटी बड़ी क्रियाओं पर नियंत्रण रखता हैहमारा दिमाग अरबों नयूरोंस का बना हुआ है जो शरीर के विभिन्न अंगों से संदेशों कों ग्रहण करते हैं तथा प्रेषित करते हैंये सभी कार्य दिमाग के रसायन द्वारा होता है जिसे 'न्यूरोट्रांसमिटर्स ' कहते हैं यही रसायन हमारी भावनाओं के लिए भी जिम्मेदार होता हैजब यह रसायन हमारी ब्रेन सेल्स कों ठीक तरह से नहीं पहुँच पाता , तब अवसाद की अवस्था होती है


अवसाद के कारण -
  • मनोवैज्ञानिक कारण ( psychological )
  • सामाजिक कारण ( social )
  • physiological
  • अनुवांशिक ( Hereditary)
  • विकास के साथ ( Evolutionary )
  • जैविक ( Biological )
  • एल्कोहल
  • कुछ लम्बे समय तक इस्तेमाल होने वाली दवाओं के कारण
अवसाद के लक्षण -

अवसाद ग्रस्त व्यक्ति का घरेलू जीवन , सामाजिक जीवन , स्कूल लाइफ , कार्य क्षेत्र आदि सभी प्रभावित होते हैंउसका सोना , खाना-पीना , हाव भाव तथा सामान्य स्वास्थ्य सभी प्रभावित हो जाते हैंकुछ लक्षण इस प्रकार हैं-
  • बहुत लो मूड रहता ज्यादातर , जिसके कारण मरीज किसी भी प्रकार की ख़ुशी अथवा मनोरंजन का आनंद नहीं उठा पाता ।
  • अतीत की कुछ अनुपयोगी घटनाओं पर निरंतर चिंतन करता रहता है , जिसके कारण अनेक गलत धारणाओं और भ्रांतियों का शिकार हो जाता है।
  • स्वयं से घृणा करता है
  • स्वयं कों असमर्थ पाता है
  • स्वयं कों असहाय समझता है ।
  • मैं बेकार हूँ , जीवन निरर्थक है , ऐसी धारणाओं से ग्रस्त रहता है
  • उसके मन में अनायास ही एक अपराध-बोध बना रहता है
  • मरीज की सोच , काफी विकृत ( distorted) हो जाती है
  • रोग की कठोरतम ( severe) अवस्था में लक्षण कुछ ज्यादा उग्र हो जाते हैं
  • मरीज में psychosis के लक्षण आ जाते हैं जिसमें schizophrenia , पराफ्रेनिया , bipolar disorder के maniac episodes नज़र आने लगते हैं । इसे psychotic Depression कहते हैं।
  • severe case में मरीज में dillusion के लक्षण आ जाते हैं , जिसे हमारे उपनिषदों में भ्रान्ति , मोह , अविद्या अथवा माया कहा है । इस अवस्था में मरीज वस्तु तथा परिस्थिति के यथार्थ स्वरुप कों नहीं ग्रहण करता , अपितु अपनी स्वयं की बनायी धारणाओं कों विद्या ( यथार्थ ) पर आरोपित कर अविद्या या भ्रान्ति ( dillusion ) का शिकार होता है।
  • मरीज की याददाश्त कमजोर हो जाती है
  • स्वयं कों समाज तथा सामाजिक कार्य कलापों से पृथक कर लेता है ।
  • सेक्स ड्राइव कम हो जाती है ।
  • अत्यंत निराशाजनक बातें करता है तथा स्वयं कों कोसता है ।
  • अनिद्रा का होना ।
  • मरीज अनायास ही जार-जार रोने लगता है।
  • मरीज कों कमजोरी , सरदर्द , पाचन सम्बन्धी समस्याएं , भूख न लगना , वजन घटना ( कभी-कभी बिलकुल विपरीत ) आदि लक्षण पाए जाते हैं।
  • मरीज के परिवार वाले तथा मित्र , उसके व्यवहार में आलस्य और चिडचिडापन महसूस करते हैं।
  • मरीज की जीवन प्रत्याशा बहुत कम होती है तथा इनके अन्दर आत्महत्या करने की प्रवृति होती है ।

बच्चों में अवसाद -

बच्चों में भी अवसाद पाया जाता हैजिसका निदान अक्सर देर से हो पाता हैक्यूंकि बच्चों में अवसाद के लक्षण चिडचिडेपन द्वारा जाहिर होता हैभिन्न उम्र में अलग अलग लक्षण पाए जाते हैंस्कूल में उनके अकेडमिक परफार्मेंस निरंतर गिरती जाती हैअवसाद की नीव ज्यादातर बाल्य -काल में ही पड़ती हैघर में कलह-क्लेश का माहौल ही बच्चे कों अवसाद का शिकार बनाता हैये अवसाद बचपन में भी दिख सकता है अथवा उम्र के दुसरे अथवा तीसरे पड़ाव में इसका अटैक होता हैबच्चों में यह प्रायः ADHP ( Attention deficit hyperactivity disorder) , के साथ coexist करता हैबच्चों पर किसी भी प्रकार की मानसिक एवं शारीरिक हिंसा , उन्हें अवसाद ग्रस्त करती है


महिलाओं में Depression -

स्त्रियों में अन्य सामान्य कारणों के अतिरिक्त , Estrogen hormone का स्तर कम होने से भी डिप्रेशन होता है प्युबर्टी के बाद , प्रसव के पूर्व , प्रसव के बाद , मीनोपॉज़ की अवस्था के पूर्व अथवा पश्चात आदि अवस्थाओं में Estrogen का स्तर कम होने की स्थिति में मानसिक अवसाद होता हैEstrogen कों withdraw करने कीअवस्था में भी अवसाद हो जाता हैलेकिन यह अवसाद अस्थायी हैEstrogen का स्तर restore होने पर इस अस्थायी अवसाद से निजात मिल जाती है

अन्य कारणों में -
  • माँ की मृत्यु हो जाना ।
  • ऐसी व्यक्ति की मृत्यु हो जाना जिससे वो अपनी हर बात कहती थी / ( confide ) करती थी ।
  • सामर्थ्य से ज्यादा , बहुत सी जिम्मेदारियों का वहन
  • बेरोजगारी का होना , तथा आर्थिक विपन्नता अथवा निर्भरता।
  • पति के साथ अथवा घर में सौहाद्र पूर्ण परिस्थिति का न होना।

बुजुर्गों में अवसाद -

उम्र के अंतिम पड़ाव में अवसाद का होना सबसे ज्यादा कॉमन हैउन्हें अकेलापन लगता है , जीवन में रूचि कम हो जाती हैजीवन में अपनी सार्थकता कम लगने लगती है , कभी कभी अपने ही बच्चों का व्यवहार उनका मन दुखित कर देता हैउनकी भूख कम हो जाती है , वज़न गिर जाता है , अनिद्रा तथा कब्ज़ आदि हो जाता हैउनका खाली समय व्यतीत नहीं होताइन्हीं सब कारणों से अक्सर वे अवसाद ग्रस्त हो जाते हैं Dimentia नामक रोग , जिसमें व्यक्ति की याददाश्त कम हो जाती है , वो ठीक से सोच नहीं पाताये अक्सर Alzheimer नामक रोग के कारण हो जाता हैइस रोग में ब्रेन सेल्स में आपस में संचार खत्म हो जाता है

बुजुर्गों में अवसाद से लड़ने के लिए निम्न उपाय अपनाए जा सकते हैं
  • supportive therapy - परिवार वालों का प्रेम पूर्ण रवैय्या ।
  • second career - बुज़ुर्ग अपनी योग्यतानुसार कुछ रोज़गार कर सकते हैं । हालांकि भारत में ऐसी oppotunities कम हैं ।
  • किसी भी प्रकार की रूचि पैदा कर लेना - ब्लोगिंग भी एक सफल उपाय है इस वय में ।
  • exercise करना आदि
  • बच्चों कों पढाना , कोई सामाजिक कार्य करना , आदि

अवसाद की चिकित्सा-
  • psychotherapy -
  • Medication
  • Electroconvulsive thrapy
psychothrapy , १८ वर्ष के नीचे वालों के लिए उपयुक्त होती है , लेकिन भारत में mental health का स्टाफ कम है इसलिए ये कम प्रक्टिस में हैदवाओं द्वारा neurotranmitters ( serotonin , dopamine ) , आदि का स्तर बढाकर दिमाग द्वारा संदेशों का सही प्रकार से संचार होता हैElectroconvulsive treatment , रोग के उग्र अवस्था में होने पर किया जाता है दवायों द्वारा तीन माह में ही सुधार दिखाई देने लगता है


कुछ आवश्यक जानकारियाँ -
  • जो मरीज अपनी सोच में परिवर्तन लाने की क्षमता रखते हैं , उनमें जल्दी सुधार दिखाई देता है ।
  • बहुत ज्यादा पूजा पाठ करने वाले भी अक्सर अवसाद का शिकार होते देखे गए हैं।
  • अवसाद की नीव बचपन की परिस्थियों पर ही पड़ जाती है । कम उम्र में माता अथवा प्रियजन की मृत्यु , अलगाव होना अथवा माता पिता से या परिवार में उपेक्षित होना , कलह क्लेश आदि माहौल भी जिम्मेदार होते हैं अवसाद के लिए।
  • अवसाद के मरीजों में life expectancy कम होती है तथा आत्महत्या की प्रवृति होती है ।
  • Antidepressant दवाओं से लाभ शीघ्र ही दीखता है , लेकिन इनका side effects भी काफी है , कभी-कभी इन्हीं के कारण अनिद्रा ( insomnia) भी हो जाती है ।
  • Depression का pain ( असह्य दर्द ) से गहरा नाता है । ७० फीसदी अवसाद के मरीजों में किसी न किसी प्रकार के दर्द का इतिहास मिलता है।
  • अवसाद का मरीज की मानसिक तथा शरीक कमजोरी के कारण , उन्हें अन्य रोग भी ज्यादा आक्रमण करते हैं , जिसमें ह्रदय रोग सबसे आम है।

चेतावनी -
अवसाद के बारे में पढ़कर यदि आपको एक दो लक्षण स्वयं में दिखाई दें तो स्वयं कों अवसाद का मरीज समझ लेंउपरोक्त वर्णित बहुत से लक्षण अन्य रोगों में भी पाए जाते हैंकभी किसी कारण विशेष से यदि आपका मूड लो है तो उसे अवसाद नहीं कहतेयह अस्थायी अवस्था होगी जो कारण दूर होने के साथ स्वतः ही दूर हो जायेगी

आभार

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