DEAR DR. DONOHUE: I hold a responsible job and earn good money. I am married to a wonderful woman and have three great children. In the face of all this, I have been so depressed for the past three months that I can barely function. I can’t concentrate, have no interest in my work and have no sexual drive. I wake up around 3 a.m. and can’t get back to sleep. Could all this by physical, or is it just in my head? — H.H.

ANSWER: It is physical, and it is in your brain. You are depressed. It’s not a willed state. It’s due to a disturbance in brain chemistry. Something has gone wrong with the chemicals that keep communication running between brain cells. Those chemicals go by the names serotonin, dopamine and norepinephrine. You have a deficiency in one or more of them.

Depression isn’t something that a person brings on himself. It might be precipitated by the loss of a job, by the death of a loved one or by an illness, or it can happen on its own. Often a person’s genetic makeup leaves that person susceptible to changes in brain chemistry that bring on a major depression.

Depression makes a person not want to get out of bed in the morning. It robs people of their normal energy. Things that used to interest them have no appeal. Appetite disappears. Sleep disturbances are common, both waking early and not being able to fall asleep again, or not being able to fall asleep from the start. Thoughts of death and suicide intrude their way into consciousness. Along with all this goes heightened anxiety that makes a person jittery and makes concentration impossible.

Depression isn’t something you can put an end to on your own. It should not be stigmatized as a weakness. Medicines can restore the brain’s chemistry. Talk therapy can address thoughts that make life seem hopeless and helpless.

If you don’t know a mental-health professional, ask the family doctor for a referral. Delaying treatment only makes the depression become more deeply rooted.

DEAR DR. DONOHUE: Can you tell me what’s going on? I take an exercise class and have been taking it for more than a year. In the past couple of weeks during the class, I break out in red, itchy spots. They’re gone the next day. Is there some way to stop this? — N.C.

ANSWER: You might have something called cholinergic urticaria. Do those red spots look like little hives? “Urticaria” is the medical name for hives. “Cholinergic” refers to a chemical released by nerves. Heat is the agent responsible for the excessive release of acetylcholine, which, in turn, is responsible for the skin breaking out in small, itchy hives. Hot showers and exercise are two of the major precipitating instigators of this sort of breakout.

During your class, keep yourself cool by frequently drinking cold water. If you can, take a cooling shower immediately after the class. An antihistamine taken an hour before you exercise often can prevent an outbreak. Hydroxyzine is one often recommended. Let your doctor know what’s happening to you.

DEAR DR. DONOHUE: For years, my mother has had rheumatoid arthritis and is able to cope with it quite well. Now she tells me she has something called Felty’s syndrome. Does it have something to do with her arthritis, or is it a new problem? — J.F.

ANSWER: Felty’s syndrome happens to a very few people who have had rheumatoid arthritis for a long time. The spleen enlarges, and there’s a drop in the white blood cell count and sometimes a drop in the red blood cell count. The drop in white blood cells opens the door to infections.

If the white blood cell count is very low, gold shots and methotrexate often can raise the count. Both of these medicines also treat rheumatoid arthritis.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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