QUOTIENT OF SATISFACTION (QOS): DR. SHRINIWAS KASHALIKAR

Quotient of satisfaction (QOS) is a ratio of; the extent of satisfaction to the amount of efforts put in.

It is true that both; the amount of our satisfaction and the amount of efforts put in by us; can be (though not exactly or precisely) ‘measured’ by physiological symptoms and signs (such as those due to autonomic nervous system stimulation) or by time, energy and money spent by us; respectively.

This is because the evaluation of the satisfaction and the efforts; is more a matter of subjective perception; than laboratory investigation or assessment.

Nevertheless; both our satisfaction and our efforts; are a concrete reality and not ambiguous or illusory phenomena. Hence; they can certainly be ‘quantified’ by us!

Thus besides the symptoms and signs of satisfaction; the subjective perception of intensity and duration of satisfaction; and the people involved in it can be considered; and besides the time, energy and money; the perception subjective labor, difficulty or actual pain; can be considered; to assess the amount of satisfaction and the amount of efforts respectively.

This understanding although in different semantics; is a universal legacy passed on from generation to generation; with very high QOS!

Thus generations after generations; world over; have observed and experienced that NAMASMARAN, JAP, JAAP, SIMARAN, SUMIRAN i.e. remembering one’s self (for atheists) and God (for the theists) is an activity that is like a precious stone that multiplies the QOS; in every moment and in every activity of life. Whether this holds true for us or not; can be and has to be verified; and not merely believed or disbelieved!

Introduction
Depression is more than simply feeling unhappy or fed up for a few days.
We all go through spells of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days.
Some people still think that depression is trivial and not a genuine health condition. They're wrong. Depression is a real illness with real symptoms, and it's not a sign of weakness or something you can "snap out of" by "pulling yourself together".
The good news is that with the right treatment and support, most people can make a full recovery.
How to tell if you have depression
Depression affects people in different ways and can cause a wide variety of symptoms.
They range from lasting feelings of sadness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety.
There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and complaining of various aches and pains.
The severity of the symptoms can vary. At its mildest, you may simply feel persistently low in spirit, while at its most severe depression can make you feel suicidal and that life is no longer worth living.
Most people experience feelings of stress, sadness or anxiety during difficult times. A low mood may improve after a short time, rather than being a sign of depression.
When to see Dr. B C Shah
It's important to seek help from Dr. B C Shah if you think you may be depressed.
Many people wait a long time before seeking help for depression, but it's best not to delay. The sooner you see a doctor, the sooner you can be on the way to recovery.
Sometimes there is a trigger for depression. Life-changing events, such as bereavement, losing your job or even having a baby, can bring it on.
People with a family history of depression are also more likely to experience it themselves.
But you can also become depressed for no obvious reason.
Depression is quite common and affects about one in 10 of us at some point. It affects men and women, young and old.
Depression can also strike children.
Treatment
Treatment for depression involves either medication or talking treatments, or usually a combination of the two. The kind of treatment that Dr. B C Shah recommends will be based on the type of depression you have.
Living with depression
Many people with depression benefit by making lifestyle changes such as getting more exercise, cutting down on alcohol and eating more healthily.
Self-help measures such as reading a self-help book or joining a support group are also worthwhile.
Symptoms of clinical depression
The symptoms of depression can be complex and vary widely between people. But as a general rule, if you are depressed, you feel sad, hopeless and lose interest in things you used to enjoy.
The symptoms persist for weeks or months and are bad enough to interfere with your work, social life and family life.
There are many other symptoms of depression and you're unlikely to have every one listed below.
If you experience some of these symptoms for most of the day, every day for more than two weeks, you should seek help from Dr. B C Shah.
Psychological symptoms include:
Continuous low mood or sadness
Feeling hopeless and helpless
Having low self-esteem
Feeling tearful
Feeling guilt-ridden
Feeling irritable and intolerant of others
Having no motivation or interest in things
Finding it difficult to make decisions
Not getting any enjoyment out of life
Feeling anxious or worried
Having suicidal thoughts or thoughts of harming yourself
Physical symptoms include:
Moving or speaking more slowly than usual
Change in appetite or weight (usually decreased, but sometimes increased)
Constipation
Unexplained aches and pains
Lack of energy or lack of interest in sex (loss of libido)
Changes to your menstrual cycle
Disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)
Social symptoms include:
Not doing well at work
Taking part in fewer social activities and avoiding contact with friends
Neglecting your hobbies and interests
Having difficulties in your home and family life
Depression can come on gradually, so it can be difficult to notice something is wrong. Many people continue to try to cope with their symptoms without realising they are ill. It can take a friend or family member to suggest something is wrong.
Doctors describe depression by how serious it is:
Mild depression has some impact on your daily life
Moderate depression has a significant impact on your daily life
Severe depression makes it almost impossible to get through daily life – a few people with severe depression may have psychotic symptoms
Grief and depression
It can be hard to distinguish between grief and depression. They share many of the same characteristics, but there are important differences between them.
Grief is an entirely natural response to a loss, while depression is an illness.
People who are grieving find their feelings of loss and sadness come and go, but they're still able to enjoy things and look forward to the future.
In contrast, people who are depressed have a constant feeling of sadness. They don't enjoy anything and find it hard to be positive about the future.
Other types of depression
There are different types of depression, and some conditions where depression may be one of the symptoms. These include:
Postnatal depression. Some women develop depression after having a baby. Postnatal depression is treated in similar ways to other forms of depression, with talking therapies and antidepressant medicines.
Bipolar disorder is also known as "manic depression". It's where there are spells of depression and excessively high mood (mania). The depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour such as gambling, going on spending sprees and having unsafe sex.
Seasonal affective disorder (SAD). Also known as "winter depression", SAD is a type of depression that has a seasonal pattern usually related to winter.
Causes
There is no single cause of depression. You can develop it for different reasons and it has many different triggers.
For some, an upsetting or stressful life event – such as bereavement, divorce, illness, redundancy and job or money worries – can be the cause.
Often, different causes combine to trigger depression. For example, you may feel low after an illness and then experience a traumatic event, such as bereavement, which brings on depression.
People often talk about a "downward spiral" of events that leads to depression. For example, if your relationship with your partner breaks down, you're likely to feel low, so you stop seeing friends and family and you may start drinking more. All of this can make you feel even worse and trigger depression.
Some studies have also suggested you're more likely to get depression as you get older, and that it's more common if you live in difficult social and economic circumstances.
Stressful events
Most people take time to come to terms with stressful events, such as bereavement or a relationship breakdown. When these stressful events happen, you have a higher risk of becoming depressed if you stop seeing your friends and family and you try to deal with your problems on your own.
Illness
You may have a higher risk of depression if you have a longstanding or life-threatening illness, such as coronary heart disease or cancer.
Head injuries are also an often under-recognised cause of depression. A severe head injury can trigger mood swings and emotional problems.
Some people may have an (underactive thyroid (hypothyroidism) due to problems with their immune system. In rarer cases a minor head injury can damage the pituitary gland, a pea-sized gland at the base of your brain that produces thyroid-stimulating hormones.
This can cause a number of symptoms, such as extreme tiredness and a loss of interest in sex (loss of libido), which can in turn lead to depression.
Personality
You may be more vulnerable to depression if you have certain personality traits, such as low self-esteem or being overly self-critical. This may be due to the genes you've inherited from your parents, or because of your personality or early life experiences.
Family history
If someone else in your family has suffered from depression in the past, such as a parent or sister or brother, then it's more likely you will too.
Giving birth
Some women are particularly vulnerable to depression after pregnancy. The hormonal and physical changes, as well as added responsibility of a new life, can lead to postnatal depression.
Loneliness
Becoming cut off from your family and friends can increase your risk of depression.
Alcohol and drugs
Some people try to cope when life is getting them down by drinking too much alcohol or taking drugs. This can result in a spiral of depression.
Cannabis helps you relax, but there is evidence that it can bring on depression, especially in teenagers.
And don't be tempted to drown your sorrows with a drink. Alcohol is categorised as a "strong depressant" and actually makes depression worse.
Diagnosing clinical depression
If you experience symptoms of depression for most of the day, every day for more than two weeks, you should seek help from Dr. B C Shah.
It is especially important to speak to Dr. B C Shah if you experience:
symptoms of depression that are not improving
your mood affects your work, other interests, and relationships with your family and friends
thoughts of suicide or self-harm
Sometimes, when people are depressed they find it hard to imagine that treatment can actually help. But the sooner you seek treatment, the sooner your depression will lift.
There are no physical tests for depression, though Dr. B C Shah may examine you and do some urine or blood tests to rule out other conditions that have similar symptoms, such as an underactive thyroid.
The main way in which Dr. B C Shah will tell if you have depression is by asking you lots of questions about your general health and how the way you are feeling is affecting you mentally and physically.
Try to be as open as you can be with the doctor. Describing your symptoms and how they are affecting you will really help Dr. B C Shah understand if you have depression and how severe it is.
Any discussion you have with Dr. B C Shah will be confidential. He will only ever break this rule if there's a significant risk of harm to either yourself or others, and if informing a family member or carer would reduce that risk.
Treating clinical depression
Treatment for depression usually involves a combination of medicines, talking therapies and self help.
Treatment options
The kind of treatment that your doctor recommends will be based on the type of depression you have. Below is a short description of the types of treatment your doctor may recommend.
Mild depression
Wait and see - If you're diagnosed with mild depression, your depression may improve by itself. In this case, you'll simply be seen again by Dr. B C Shah after two weeks to monitor your progress. This is known as watchful waiting.
Exercise - Exercise has been proven to help depression, and is one of the main treatments if you have mild depression. Dr. B C Shah may refer you to a qualified fitness trainer for an exercise scheme or you can find out more about starting exercisehere.
Self help groups - Talking through your feelings can be helpful. It can be either to a friend or relative, or you can ask Dr. B C Shah to suggest a local self-help group. He may also recommend self-help books and online cognitive behavioural therapy (CBT).
Mild to moderate depression
Talking therapy - If you have mild depression that isn't improving, or you have moderate depression, Dr. B C Shah may recommend a talking treatment (a type of psychotherapy). There are different types of talking therapy for depression including cognitive behavioural therapy (CBT) and counselling. Dr. B C Shah can refer you for talking treatment or, in some parts of the country, you might be able to refer yourself.
Moderate to severe depression
Antidepressants - Antidepressants are tablets that treat the symptoms of depression. There are almost 30 different kinds of antidepressant. They have to be prescribed by a doctor, usually for depression that is moderate or severe.
Combination therapy - Dr. B C Shah may recommend that you take a course of antidepressants plus talking therapy, particularly if your depression is quite severe. A combination of an antidepressant and CBT usually works better than having just one of these treatments.
Mental health teams - If you have severe depression, you may be referred to a mental health team made up of psychologists, psychiatrists, specialist nurses and occupational therapists. These teams often provide intensive specialist talking treatments as well as prescribed medication.
Living with clinical depression
There are some key steps you can take to lift your mood and help your recovery from depression.
Take your medication
It is important to take your medication as prescribed, even if you start to feel better.
If you stop your medication too soon, you could have a relapse of your depression. If you have any questions or concerns about the medication you're taking, talk to your doctor or pharmacist.
It may help to read the information leaflet that comes with your medication to find out about possible interactions with other drugs or supplements. Check with your doctor first if you plan to take any over-the-counter remedies such as painkillers, or any nutritional supplements. These can sometimes interfere with antidepressants.
Exercise and diet
Exercise and a healthy diet can make a tremendous difference to how quickly you recover from depression. And they will both improve your general health, too.
Research suggests that exercise can be as effective as antidepressants at reducing depression symptoms.
Being physically active lifts your mood, reduces stress and anxiety, boosts the release of endorphins (your body's feel-good chemicals) and improves your self-esteem.
It also helps your mood to have a healthy diet. In fact, eating healthily seems to be just as important for maintaining your mental health as it is for preventing physical health problems.

JAP, JAAP, JIKRA, SIMARAN, SUMIRAN, REMEMBRANCE AND SMARAN: DR. SHRINIWAS KASHALIKAR

The great seers see the undercurrents of unity. They live in the plane and the spirit of unity!

However; some of us often knowingly or unknowingly stick to some rigid discipline, which often assumes the form of rituals.

This is useful to preserve the heritage of the seer, by virtue of preempting complacency, lethargy and irresponsibility. It is also useful to some extent; to prevent casual approach and/or vulgarization; and maintain sanctity and due seriousness.

But when this discipline sticks to the semantics and external paraphernalia; and loses the spirit of the visionary; it becomes a hindrance to the revitalizing and rejuvenating globalization of the very spirit, with which the visionary lived.

This is exactly why; even as there are billions of us; practicing NAMASMARAN; as a result of the illuminating lives of the seers, sages, saints and prophets; there are literally; so many disunited or un-united sects and cults; even amongst the practitioners! This is also one of the reasons; why; most of us; the advocates of NAMASMARAN; do not understand and appreciate the same spirit of unity and harmony underlying the JAP, JAAP, JIKRA, SIMARAN, SUMIRAN, REMEMBRANCE and SMARAN!

We do not seem to understand that all such synonyms from different languages and different traditions; most importantly connote the conceptualization of holistic perspective, policy, plans, programs and their implementation; and actual realization of the universal unity, harmony and blossoming; foreseen by the seers!

Due to this; we are dedicated to the external forms of religions, sects, cults, traditions etc! We criticize, backbite, humiliate, abuse, run down, despise, hate and harm; the other religions, sects, cults, traditions etc! This may be a case of giving vent to basal and carnal instincts, ulterior motives, prejudices, hatred, vengeance etc; under the garb of devotion; as it is an easier way to feel righteous, secure, convinced, contented and proud! It is also; a tangible way; to boast ourselves as the true devotees (and the others as blasphemous and/or cowards)!!!

If we appreciate the plane and the spirit of unity or our respective gurus, seers, sages, saints, prophets; then; not only we (the practitioners and advocates of NAMASMARAN of different sects, cults, traditions and religions); but rest all; including even the atheists; would actually practice and propagate NAMASMARAN; and unite and blossom!

Introduction
Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.
Everyone has feelings of anxiety at some point in their life. For example, you may feel worried and anxious about sitting an exam or having a medical test or job interview.
Feeling anxious is sometimes perfectly normal. However, people with generalised anxiety disorder (GAD) find it hard to control their worries. Their feelings of anxiety are more constant and often affect their daily life.
Anxiety is the main symptom of several conditions, including:
Panic disorder
Phobias
Post-traumatic stress disorder
The information in this section is about generalised anxiety disorder (GAD).
Generalised anxiety disorder (GAD)
GAD is a long-term condition which causes you to feel anxious about a wide range of situations and issues, rather than one specific event.
People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include feeling irritable or worried and having trouble concentrating or sleeping.
How common is anxiety?
GAD affects about 1 in 20 adults in Britain. Slightly more women are affected than men, and the condition is most common in people in their 20s.
How is anxiety treated?
GAD can significantly affect your daily life, making it difficult to carry out everyday tasks. However, several different treatments are available to ease your psychological and physical symptoms. These include psychological therapy and medication.
There are also many things you can do to ease the symptoms of anxiety yourself.
Symptoms of generalised anxiety disorder
The symptoms of general anxiety disorder (GAD) often develop slowly. How severe they are varies from person to person.
Some people have only one or two symptoms, while others have many more.
Anxiety can affect you physically and mentally.
Psychological symptoms of anxiety
GAD can cause a change in your behaviour and the way you think and feel about things. Psychological symptoms of GAD include:
Restlessness
A sense of dread
Feeling constantly "on edge"
Difficulty concentrating
Irritability
Impatience
Being easily distracted
Your symptoms may cause you to withdraw from social contact (seeing your family and friends) to avoid feelings of worry and dread. You may also find going to work difficult and stressful and may take time off sick. These actions can make you worry even more about yourself and increase your lack of self-esteem.
Physical symptoms of anxiety
The physical symptoms of GAD can include:
Dizziness
Drowsiness and tiredness
Pins and needles
Irregular heartbeat (palpitations)
Muscle aches and tension
Dry mouth
Excessive sweating
Shortness of breath
Stomach ache
Nausea
Darrhoea
Headache
Excessive thirst
Frequent urinating
Painful or missed periods
Difficulty falling or staying asleep (insomnia)
How anxiety can intensify
If you are anxious as a result of a phobia or because of panic disorder, you will usually know what the cause is. For example, if you have claustrophobia (a fear of enclosed spaces), you know that being confined in a small space will trigger your anxiety.
However, if you have GAD, what you are feeling anxious about may not always be clear. Not knowing what triggers your anxiety can intensify your anxiety and you may start to worry that there will be no solution.
Causes of generalised anxiety disorder
As with most conditions that affect mental health, the exact cause of generalised anxiety disorder (GAD) is not fully understood.
Some people develop the condition for no apparent reason. Others may develop GAD after a major stressful incident.
Neurotransmitters and anxiety
Research has suggested that GAD may be caused by an imbalance of certain chemicals that occur naturally in the brain. These chemicals are known as neurotransmitters.
Two neurotransmitters thought to affect anxiety are serotonin and noradrenaline. If the level of these chemicals in your brain becomes unbalanced, it can significantly affect your mood and increase your likelihood of developing anxiety-related conditions such as GAD.
However, GAD is most likely to have a complex combination of causes, rather than being triggered by just an imbalance of brain chemicals.
Combination of causes of anxiety
Researchers believe that GAD is caused by a combination of factors, including:
Your body's biological processes
Genetics (the genes you inherit from your parents)
Your environment
Your life experience
Diagnosing generalised anxiety disorder
See Dr. B C Shah if anxiety is affecting your daily life or is causing you distress.
Generalised anxiety disorder (GAD) can be difficult to diagnose. In some cases, it can also be difficult to distinguish from other mental health conditions, such as depression.
Talking to Dr. B C Shah about anxiety
Dr. B C Shah may ask you questions about your worries, fears and emotions. They may also ask about your personal life. Tell him about all your symptoms – physical and psychological – and explain how long you have had them.
You may find it difficult to talk about your feelings, emotions and personal life. However, it is important that Dr. B C Shah understands your symptoms and circumstances so that the correct diagnosis can be made.
You are most likely to be diagnosed with GAD if you have had the symptoms for six months or more. Finding it difficult to manage your feelings of anxiety is also an indication that you may have developed the condition.
To help with the diagnosis,Dr. B C Shah may carry out a physical examination to rule out any other conditions that may be causing your symptoms.
Treating generalised anxiety disorder
There are two main forms of treatment for generalised anxiety disorder (GAD):
Psychological therapy
Medication
Depending on your circumstances, you may benefit from one of these types of treatment or a combination of the two.
Studies of different treatments for GAD have found that the benefits of psychological treatment last the longest, but no single treatment is best for everyone.
Before you begin any form of treatment, Dr. B C Shah should discuss all your treatment options with you. They should outline the pros and cons of each and make you aware of any possible risks or side effects. With Dr. B C Shah, you can make a decision on the treatment most suited to you, taking into account your personal preferences and circumstances.
Psychological treatment for anxiety
If you have been diagnosed with GAD, you will usually be advised to try psychological treatment before you are prescribed medication. The main type of psychological treatment for GAD is cognitive behavioural therapy (CBT).
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is one of the most effective types of treatment for GAD. Research suggests that around half of people who have CBT recover from GAD and many others get some benefit.
CBT works by helping you identify unhelpful and unrealistic beliefs and behavioural patterns. You and your therapist work together to change your behaviour and replace unhelpful beliefs with more realistic and balanced ones.
CBT mainly focuses on the problems you have at the moment, rather than events from the past. It teaches you new skills and helps you understand how to react more positively to situations that would usually cause you anxiety.
Applied relaxation
Applied relaxation is an alternative type of psychological treatment. It was initially used to treat phobias, but it is now also being used to treat conditions such as GAD.
Applied relaxation focuses on relaxing your muscles in a particular way during situations that usually cause anxiety. The technique will need to be taught by a trained therapist, but it involves:
Learning how to relax your muscles
Learning how to relax your muscles quickly and in response to a trigger, such as the word "relax"
Practising relaxing your muscles in situations that make you anxious
You will need 12 to 15 hour-long sessions to learn how to use applied relaxation correctly. It has been found to be as effective as CBT.
Medication for anxiety
Dr. B C Shah can prescribe a variety of different types of medication to treat GAD. Some medication is designed to be taken on a short-term basis, while other medicines are prescribed for longer periods. Depending on your symptoms, you may require medicine to treat your physical symptoms as well as your psychological ones.
If you are considering taking medication for GAD, Dr. B C Shah should discuss the different options with you in detail, including the different types of medication, length of treatment, side effects and possible interactions with other medicines before you start a course of treatment.
Long-term medication includes:
Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, citalopram or paroxetine
Venlafaxine
Pregabalin
Short-term medication includes:
Antihistamines
Benzodiazepines
Buspirone
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that increase the level of a chemical called serotonin in your brain. They can be taken on a long-term basis.
As with all antidepressants, SSRIs can take several weeks to start working. You will usually be started on a low dose which will gradually be increased as your body adjusts to the medicine.
You may be offered an SSRI called sertraline. Sertraline is not specifically licensed to treat GAD, which means that the manufacturers of the medicine have not applied for a license for it to be used to treat the condition. However, it is used to treat similar conditions, such as panic disorderand obsessive compulsive disorder (OCD).
Citalopram, fluoxetine and paroxetine are SSRIs that are often prescribed to treat GAD.
Common side effects of SSRIs include:
Nausea (feeling sick)
Low sex drive
Blurred vision
Diarrhoea or constipation
Dizziness
Dry mouth
loss of appetite
Sweating
Feeling agitated
Insomnia (problems sleeping)
When you start taking an SSRI, you should see Dr. B C Shah after two, four, six and 12 weeks to check your progress and to see if you are responding to the medicine. Not everyone responds well to antidepressant medicines, so it is important that your progress is carefully monitored.
If Dr. B C Shah feels it is necessary, you may require regular blood tests or blood pressure checks when taking antidepressant medication. If, after 12 weeks of taking the medication, you do not show any signs of improvement, Dr. B C Shah may prescribe an alternative SSRI to see if that has any effect.
When you and Dr. B C Shah decide that it is appropriate for you to stop taking your SSRI medication, you will gradually be weaned off the medication by slowly reducing your dose. Never stop taking your medication unless he specifically advises you to.
Venlafaxine
If SSRIs do not help ease your anxiety, you may be prescribed a different type of antidepressant known as venlafaxine.
Venlafaxine belongs to a group of medicines known as selective serotonin and noradrenaline reuptake inhibitors (SNRIs). This type of medicine increases the amount of the chemicals serotonin and noradrenaline in your brain, helping restore the chemical imbalance that sometimes causes GAD.
You cannot be prescribed venlafaxine if you:
Have high blood pressure that is not being treated
Have recently had a heart attack
Are at risk of having irregular heartbeats (cardiac arrhythmias)
If you have any of the above conditions, you may be at risk of developing complications if you take venlafaxine.
Common side effects of venlafaxine may include:
Nausea
Headache
Drowsiness
Dizziness
Dry mouth
Constipation
Indigestion
Insomnia
Sweating
If you are prescribed this medicine, your blood pressure will be monitored regularly.
Pregabalin
If SSRIs and SNRIs are not suitable for you, you may be offered pregabalin. This is a medication known as an anticonvulsant, which is used to treat conditions such as epilepsy (a condition that causes repeated seizures). However, it has also been found to be beneficial in treating anxiety.
The most commonly reported side effects of pregabalin include:
Drowsiness
Dizziness
Headaches
Pregabalin is less likely to cause nausea or a low sex drive than SSRIs or SNRIs.
Antihistamines
Antihistamines are usually prescribed to treat allergic reactions. However, some are also used to treat anxiety on a short-term basis.
Antihistamines have a calming effect on the brain, helping you feel less anxious.
Antihistamines are only effective when used for a short period of time and will only be prescribed for a few weeks.
Hydroxyzine is the most commonly prescribed antihistamine for treating anxiety. This antihistamine can make you feel drowsy, so it is best not to drive or operate machinery when taking the medication. Other side effects of hydroxyzine include:
Dizziness
Blurred vision
Headache
Dry mouth
Benzodiazepines
Benzodiazepines are a type of sedative that help ease the symptoms of anxiety within 30 to 90 minutes of taking the medication.
Although benzodiazepines are very effective in treating the symptoms of anxiety, they cannot be used for long periods of time. This is because they can become addictive if used for longer than four weeks. Benzodiazepines also start to lose their effectiveness after this time.
For these reasons, you will usually only be prescribed benzodiazepines to help you cope during a particularly severe period of anxiety. Benzodiazepines can cause side effects, including:
Confusion
Loss of balance
Memory loss
Drowsiness and light-headedness
Due to the above side effects, benzodiazepines can affect your ability to drive or operate machinery. Therefore, avoid these activities when taking the medication.
Speak to Dr. B C Shah if you experience any of the side effects listed above. They may be able to adjust your dose of medication or prescribe an alternative.
Buspirone
Buspirone is a medicine that can help ease the psychological symptoms of anxiety. It belongs to a group of medicines known as anxiolytics.
You will usually have to take buspirone for two weeks before you notice an improvement. It will be up to Dr. B C Shah how long you continue to take the medicine after this.
Buspirone works in a similar way to benzodiazepines, but does not become addictive. However, it is only recommended as a short-term form of medication.
Referral for anxiety
If you have tried any two treatments (out of medication, CBT and self-help with guidance from Dr. B C Shah) and you still have significant symptoms of GAD, you may want to discuss with Dr. B C Shah whether you should be referred to a mental health specialist.
An appropriate mental health specialist from your local team will carry out an overall reassessment of your condition. They will ask you about your previous treatment and how effective you found it. They may also ask about things in your life that may be affecting your condition, or how much support you get from family and friends. Your specialist will then be able to devise a treatment plan for you, which will aim to effectively treat your symptoms. This may include any of the following:
psychological therapies such as CBT
appropriate treatment of other diseases and conditions that may have an effect on your anxiety
other medication
further referral to specialists
Self-help treatments for generalised anxiety disorder
If you have generalised anxiety disorder (GAD), there are many ways that you can ease the symptoms of anxiety yourself.
Exercise for anxiety
Regular exercise, particularly aerobic exercise, will help you combat stress and release tension. It also encourages your brain to release the chemical serotonin, which can improve your mood.
Aim to do a minimum of 150 minutes of moderate exercise a week. Moderate exercise should make you feel slightly out of breath and tired. Going for a brisk walk is a good example.
Relaxation
As well as getting regular exercise, learning how to relax is important. You may find relaxation and breathing exercises helpful, or you may prefer activities such as yoga or pilates to help you unwind.
Diet
Changing your diet may help ease your symptoms. Too much caffeine can make you more anxious than normal. This is because caffeine can disrupt your sleep and also speed up your heartbeat. If you are tired, you are less likely to be able to control your anxious feelings.
Smoking and drinking
Smoking and alcohol have been shown to make feelings of anxiety worse. Drink alcohol in moderation and, if you smoke, try to give up.
The Department of Health recommends that men should not drink more than three to four units of alcohol a day and women no more than two to three units.
Support groups for anxiety
Support groups can give you useful advice about how to effectively manage your anxiety. They are also a good way to meet other people with similar experiences.
Support groups often involve face-to-face meetings where you can talk about your difficulties and problems with other people. Many support groups also provide support and guidance over the phone or in writing.
Understanding your anxiety
Some people find that reading about anxiety can help them deal with their condition. There are many books based on the principles of cognitive behavioural therapy (CBT). These may help you understand your psychological problems better and learn ways to overcome them by changing your behaviour.

Introduction
Constipation is a common condition that affects people of all ages. It can mean that you are not passing stools (poo) regularly, or you are unable to completely empty your bowels.
Constipation can also cause your stools to be hard, lumpy, large or small.
The severity of constipation varies from person to person. Many people only experience constipation for a short time, but for others, constipation can be a chronic (long-term) condition that causes significant pain and discomfort and affects quality of life.
Read more information about the symptoms of constipation.
What causes constipation?
It's often difficult to identify the cause. However, there are a number of things that increase the risk of constipation, including:
Not eating enough fibre, such as fruit, vegetables and cereals
A change in your routine or lifestyle, such as a change in your eating habits
Ignoring the urge to pass stools
Side effects of certain medication
Not drinking enough fluids
Anxiety or Depression
In children, poor diet, fear about using the toilet and poor toilet training can all be responsible.
Should I see Dr. B C Shah?
You may be able to help treat constipation yourself by making simple changes to your diet and lifestyle. If these changes do not help, see Dr. B C Shah.
You should also speak to Dr. B C Shah is you suspect your child might be constipated.
Treating constipation
An oral laxative (medication to help you empty your bowels) is usually prescribed to treat constipation.
Treatment for constipation is effective, although in some cases it can take several months before a regular bowel pattern is re-established.
Preventing constipation
Making diet and lifestyle changes, such as eating high-fibre foods, drinking plenty of fluids and regularly exercising will help to prevent or ease your constipation.
It may also help to give yourself enough time and privacy to pass stools comfortably and never ignore the urge to go to the toilet.
Complications
For most people constipation rarely causes any complications, but people with long-term constipation can develop:
Haemorrhoids (piles)
Faecal impaction (where dry, hard stools collect in the rectum)
Faecal incontinence (the leakage of liquid stools)
Who is affected?
Constipation can occur in babies, children and adults, and affects twice as many women as men.
Older people are five times more likely than younger adults to have constipation, usually because of diet, lack of exercise, use of medication and poor bowel habits.
Approximately 40% of pregnant women experience constipation during their pregnancy.
Symptoms of constipation
When you are constipated, passing stools becomes more difficult than it used to be.
Normal bowel habits vary from person to person. For example, some adults normally go to the toilet more than once a day, whereas it's normal for others to go only every three or four days. Some infants pass stools several times a day, while others pass stools only a few times a week.
Difficulty passing stools
Passing stools may feel more difficult for several reasons. For example, you may be going significantly less frequently or much less effectively (you feel you are unable to completely empty your bowel).
Passing stools may also seem more difficult because your stools are:
Dry, hard and lumpy
Abnormally large
Abnormally small
As well as causing a change in your normal bowel habits, constipation can also cause the following symptoms:
Stomach ache and cramps
Feeling bloated
Feeling nauseous
Loss of appetite
Constipation in children
As well as infrequent or irregular bowel movements, a child with constipation may also have the following signs and symptoms:
Loss of appetite
Lack of energy
Being irritable, angry or unhappy
Foul-smelling wind and stools
Abdominal pain and discomfort
Soiling their clothes
Generally feeling unwell
If your child has these symptoms or has spoken to you about having difficulty passing stools, speak to Dr. B C Shah.
Causes of constipation
Most cases of constipation are not caused by a specific condition and it may be difficult to identify the exact cause.
However, several factors can increase your chances of having constipation, including:
Not eating enough fibre, such as fruit, vegetables and cereals
A change in your routine or lifestyle, such as a change in your eating habits
Having limited privacy when using the toilet
Ignoring the urge to pass stools
Immobility or lack of exercise
Not drinking enough fluids
Being underweight or overweight
Anxiety or depression
Psychiatric problems, such as those brought on by sexual abuse, violence or trauma
Medication
Sometimes, constipation may be a side effect of a medicine that you are taking. Common types of medication that can cause constipation include:
Aluminium antacids (medicine to treat indigestion)
Antidepressants
Antiepileptics (medicine to treat epilepsy)
Antipsychotics (medicine to treat schizophrenia and other mental health conditions)
Calcium supplements
Codeine, found in some types of painkiller
Diuretics (water tablets)
Iron supplements
If your constipation is caused by medication, the condition usually eases once you stop taking the medicine. However, under no circumstances should you stop taking your medication unless Dr. B C Shah advises you to.
Speak to Dr. B C Shah if you experience constipation due to a medicine. He may be able to prescribe an alternative.
Pregnancy
About 40% of women experience some form of constipation during their pregnancy, mostly during the early stages of their pregnancy.
Constipation occurs during pregnancy because your body produces more of the female hormone progesterone which acts as a muscle relaxant.
Your bowel normally moves stools and waste products along to the anus by a process known as peristalsis. This is when the muscles that line the bowel contract and relax in a rippling, wave-like motion. An increase in progesterone makes it more difficult for the bowel muscles to contract, making it harder to move waste products along.
If you are pregnant, there are ways that you can safely treat constipation without harming you or your baby.
Other conditions
In rare cases, constipation can be a sign of an underlying condition, such as:
Colon or rectal cancer
Diabetes
Hypercalcaemia, when there is too much calcium in the bloodstream
Underactive thyroid
Muscular dystrophy, a genetic condition that causes muscle wasting
Multiple sclerosis, a condition that affects the nervous system
Parkinson's disease, a brain condition that affects the co-ordination of body movements
Spinal cord injury
Anal fissure, a small tear of the skin just inside the anus
Inflammatory bowel disease, a condition that causes the intestines to become inflamed (irritated and swollen)
Irritable bowel syndrome (IBS)
Babies and children
Constipation in babies and children is quite common. A Poor diet, fear about using the toilet and poor toilet training can all be responsible.
Poor diet
Children who are over-fed are more likely to have constipation, as are those who do not get enough fluids. Babies who have too much milk are also more likely to get constipation. As with adults, it is very important that your child has enough fibre in their diet.
Toilet training
Make sure that you do not make your child feel stressed or pressured about using the toilet. It is also important to let your children try things by themselves (when appropriate). Constantly intervening when they are using the toilet may make them feel anxious.
Toilet habits
Some children can feel stressed or anxious about using the toilet. They may have a phobia about using the toilet, or feel that they are unable to use the toilets at school.
This fear or phobia may be the result of your child experiencing pain when passing stools. This can lead to poor bowel habits, where children ignore the urge to pass stools and instead withhold them for fear of experiencing pain and discomfort. However, this will mean that their condition only worsens.
Other conditions
In rare cases, constipation in babies and children can be a sign of an underlying condition such as:
Hirschsprung's disease, which affects the bowel, making it difficult to pass stools
Anorectal malformation, where the baby's anus and rectum do not form properly
Spinal cord abnormalities, including rare conditions such as spina bifida and cerebral palsy
Cystic fibrosis, a genetic condition that causes the body to produce thick and sticky mucus, which can lead to constipation
Diagnosing constipation
Constipation is a very common condition. Dr. B C Shah will not usually need to carry out any tests or procedures, but will confirm a diagnosis of constipation based on your medical history and your symptoms.
Dr. B C Shah will ask you some questions about your bowel habits. Do not feel embarrassed about describing your bowel pattern and stools to him. It is important that Dr. B C Shah is aware of all of your symptoms so he can make the correct diagnosis.
Dr. B C Shah may also ask questions about your diet, level of exercise and whether there have been any recent changes in your routines.
Doctors define constipation in a number of ways:
Opening the bowels less than three times a week
Needing to strain to open your bowels on more than a quarter of occasions
Passing a hard or pellet-like stool on more than a quarter of occasions
Physical examination
If Dr. B C Shah suspects that you may have faecal impaction (when dry, hard stools collect in your rectum), he may carry out a physical examination.
A typical examination will begin with you lying on your back while Dr. B C Shah feels your abdomen. You will then lie on your side while Dr. B C Shah performs a rectal examination using a lubricated, gloved finger. He can feel for any stools that may have collected.
Dr. B C Shah will rarely have to conduct an internal physical examination on a child. Instead, the diagnosis can normally be made by feeling their abdomen (tummy).
Further tests
If you are experiencing severe symptoms, your doctor may request further tests, such as blood tests or thyroid tests, to diagnose or rule out other conditions.
As there is an increased risk of colorectal cancer in older adults, Dr. B C Shah may also request tests to rule out a diagnosis of cancer, including a barium enema or colonoscopy.
Treating constipation
Treatment for constipation depends on the cause, how long you have had the condition and how severe your symptoms are. In many cases it is possible to relieve symptoms through dietary and lifestyle changes.
This section covers the following:
Lifestyle advice
Laxatives
Treating faecal impaction
Pregnancy or breastfeeding
Babies who have not yet been weaned
Babies who are eating solids
Children
Lifestyle advice
Dr. B C Shah will first advise you about how you can change your diet and lifestyle, which may mean that your constipation passes without the use of medication.
Some ways you can help treat your constipation are listed below.
Increase your daily intake of fibre. You should eat at least 18-30g of fibre a day. High-fibre foods include fruit, vegetables and cereals.
Add some bulking agents, such as wheat bran, to your diet. These will help make your stools softer and easier to pass.
Avoid dehydration by drinking plenty of water.
Get more exercise by going for a daily walk or run.
If your constipation is causing pain or discomfort, you may want to take a painkiller such as paracetamol. Make sure you always follow the dosage instructions carefully. Children under 16 years of age should not take aspirin.
Identify a routine of a place and a time of day when you are comfortably able to spend time in the toilet. Respond to your bowel's natural pattern: when you feel the urge, do not delay.
If these diet and lifestyle changes do not help, Dr. B C Shah may prescribe an oral laxative.
Laxatives
Laxatives are a type of medicine that help you pass stools. There are several different types and each one has a different effect on your digestive system.
Bulk-forming laxatives
Dr. B C Shah will normally start you on a bulk-forming laxative. These laxatives work by helping your stools to retain fluid. This means they are less likely to dry out, which can lead to faecal impaction. Bulk-forming laxatives also make your stools denser and softer, which means they should be easier to pass.
Commonly prescribed bulk-forming laxatives include ispaghula husk, methylcellulose and sterculia. When taking this type of laxative, you must drink plenty of fluids. Also, do not take them before going to bed. It will usually be two to three days before you feel the effects of a bulk-forming laxative.
Osmotic laxatives
If your stools remain hard after you have taken a bulk-forming laxative, Dr. B C Shah may prescribe an osmotic laxative instead. Osmotic laxatives increase the amount of fluid in your bowels. This helps to stimulate your body to pass stools and also softens stools.
Commonly prescribed osmotic laxatives include lactulose and macrogols. As with bulk-forming laxatives, make sure you drink enough fluids. It will usually be two to three days before you feel the effect of the laxative.
Stimulant laxatives
If your stools are soft but you still have difficulty passing them,Dr. B C Shah may prescribe a stimulant laxative. This laxative stimulates the muscles that line your digestive tract, helping them to move stools and waste products along your large intestine to your anus.
The most commonly prescribed stimulant laxatives are senna, bisacodyl and sodium picosulphate. These laxatives are usually only used on a short-term basis, and they will usually start to work within 6 to 12 hours.
According to your individual preference and the speed with which you require relief, Dr. B C Shah may decide to combine different laxatives.
How long will I take laxatives for?
If you have only experienced constipation for a short time, Dr. B C Shah will normally advise you to stop taking the laxative once your stools are soft and easily passed.
However, if you have constipation due to a medicine or an underlying medical condition, you may have to take laxatives for much longer, possibly many months or even years.
If you have been taking laxatives for some time, you may have to gradually reduce your dose rather than coming off them straight away. If you have been prescribed a combination of laxatives, you will normally have to reduce the dosage of each laxative, one at a time, before you can stop taking them. This can take several months.
Dr. B C Shah will advise you when it is best to stop taking them.
Treating faecal impaction
Faecal impaction occurs when stools become hard and dry and collect in your rectum. This obstructs the rectum, making it more difficult for stools to pass along.
If you have faecal impaction, you will initially be treated with a high dose of the osmotic laxative macrogol. After a few days of using this laxative, you may also have to start taking a stimulant laxative.
If you do not respond to these laxatives, you may need one of the medications described below.
Suppository: this type of medicine is inserted into your anus. The suppository gradually dissolves at body temperature and is then absorbed into your bloodstream. Bisacodyl and glycerol are two medicines that can be given in suppository form.
Mini enema: this is when a medicine in fluid form is injected through your anus and into your large bowel. Docusate and sodium citrate can be given in this way.
Pregnancy or breastfeeding
If you are pregnant, there are ways for you to safely treat constipation without harming you or your baby. Dr. B C Shah will first advise you to change your diet by increasing fibre and fluid intake. You will also be advised to do gentle exercise.
If dietary and lifestyle changes do not work, you may be prescribed a laxative to help you pass stools more regularly.
Lots of laxatives are safe for pregnant women to use because most are not absorbed by the digestive system. This means that your baby will not feel the effects of the laxative.
Laxatives that are safe to use during pregnancy include the osmotic laxatives lactulose and macrogols. If these do not work, Dr. B C Shah may advise a small dose of bisacodyl or senna (stimulant laxatives).
However, senna may not be suitable if you are in your third trimester of pregnancy (27 weeks to birth) because this medicine is partially absorbed by your digestive system.
Babies who have not yet been weaned
If your baby is constipated but has not yet started to eat solid foods, the first way to treat them is to give them extra water between their normal feeds. If you are using formula milk, make the formula as directed by the manufacturer and do not dilute the mixture.
You may want to try gently moving your baby's legs in a bicycling motion or carefully massaging their abdomen (tummy) to help stimulate their bowels.
Babies who are eating solids
If your baby is eating solid foods, give them plenty of water or diluted fruit juice. Try to encourage them to eat fruit, which can be pureed or chopped, depending on their ability to chew. The best fruits for babies to eat to treat constipation are:
Apples
Apricots
Grapes
Peaches
Pears
Plums
Prunes
Raspberries
Strawberries
Never force your baby to eat food if they do not want to. If you do, it can turn mealtimes into a battle and your child may start to think of eating as a negative and stressful experience.
If your baby is still constipated after a change in diet, they may have to be prescribed a laxative. Bulk-forming laxatives are not suitable for babies, so they will usually be given an osmotic laxative. However, if this does not work, they can be prescribed a stimulant laxative.
Children
As with babies and adults, children with constipation will first be advised to change their diet. If this does not work, laxatives can be prescribed, usually an osmotic laxative followed, if necessary, by a stimulant laxative.
As well as eating fruit, older children should have a well-balanced diet, which also contains vegetables and wholegrain foods such as wholemeal bread and pasta.
Try to minimise stress or conflict associated with using the toilet or meal times. It is important to be positive and encouraging when it comes to establishing a toilet routine. Your child should be allowed at least 10 minutes on the toilet to make sure they have passed as many stools as possible.
To encourage a positive toilet routine, try making a diary of your child's bowel movements linked to a reward system. This can help them focus on using the toilet successfully.
Top tips for parents



A diet rich in fibre and with plenty of fluids will help, even if your child is being treated with laxatives.
Children with chronic (long-term) constipation do not normally have anything physically wrong with them. However, it can take time to correct the problem, so be patient.
Encourage your child to have a regular toilet habit and allow them plenty of time.
A reward chart for passing a stool can be useful if your child tends to ‘hold on’.
Complications with constipation
Constipation rarely causes any complications or long-term health problems. Treatment is usually effective, particularly if it is started promptly.
However, if you have chronic (long-term) constipation, you may be more at risk of experiencing complications.
Haemorrhoids
If you continually strain to pass stools, it can cause pain, discomfort and bleeding. Excessive straining can also lead to haemorrhoids (piles). Haemorrhoids are swollen blood vessels that form in the lower rectum and anus.
Haemorrhoids can cause:
itching around the anus
swelling of the anus
pain
bleeding from the anus
Faecal impaction
Chronic constipation can increase the risk of faecal impaction (where dried, hard stools collect in your rectum and anus). Once you have faecal impaction, it is very unlikely that you will be able to get rid of the stools naturally.
Faecal impaction worsens constipation because it makes it harder for stools and waste products to pass out of your anus as the path is obstructed.
If you experience faecal impaction, it can lead to a number of other complications. These include:
Swelling of the rectum
Losing sensation in and around your anus
Faecal incontinence, when you uncontrollably leak soft or liquid stools
Bleeding from your anus
Rectal prolapse, when part of your lower intestine falls out of place and protrudes from your anus
Psychological effects
If your child experiences faecal incontinence, it may affect them psychologically.
Faecal incontinence can be very upsetting and embarrassing for children. If they are at school, they may find themselves teased or socially excluded. This can make a child feel withdrawn, alone and unable to talk about what they are experiencing.
If you notice a change in your child's behaviour, talk openly and honestly with them and encourage them to tell you how they are feeling.
Also try to speak to your child's teacher to make sure they understand the situation. The teacher can help ensure your child is not upset or left feeling excluded by other children.
Preventing constipation
Although constipation is common, you can take several steps to prevent it, including making diet and lifestyle changes.
Fibre
Make sure you have enough fibre in your diet. Most adults do not eat enough fibre. You should have approximately 18g of fibre a day. You can increase your fibre intake by eating more:
Fruit
Vegetables
Wholegrain rice
Wholewheat pasta
Wholemeal bread
Seeds
Nuts
Oats
Eating more fibre will keep your bowel movements regular because it helps food pass through your digestive system more easily. Foods high in fibre also make you feel fuller for longer.
If you are increasing your fibre intake, it is important to increase it gradually. A sudden increase may make you feel bloated. You may also produce more flatulence (wind) and have stomach cramps.
Fluids
Make sure that you drink plenty of fluids to avoid dehydration and steadily increase your intake when you are exercising or when it is hot. Try to cut back on the amount of caffeine, alcohol and fizzy drinks that you consume.
Toilet habits
Never ignore the urge to go to the toilet. Ignoring the urge can significantly increase your chances of having constipation. The best time for you to pass stools is first thing in the morning, or about 30 minutes after a meal.
When you use the toilet, make sure you have enough time and privacy to pass stools comfortably.
Exercise
Keeping mobile and active will greatly reduce your risk of getting constipation. Ideally, do at least 150 minutes of physical activity every week.
Not only will regular exercise reduce your risk of becoming constipated, but it will also leave you feeling healthier and improve your mood, energy levels and general fitness.