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Have you ever had a sharp, stabbing pain somewhere and then, when it came back at other times, it caused worry that there was something really wrong with you?

These pains may occur in the chest or back muscles, are sharp and stabbing and usually shortlived, even if severe. They are usually muscular and the underlying cause is usually nervous tension.

Attacks of severe pain in the rectum which occur at irregular intervals and are fleeting or last only a few minutes are similar.

This condition is called proctalgia fugax. The pain may occur at night or following straining at stool or after ejaculation. Examination shows things to be normal and no organic cause can be found.

The pain is thought to arise from a cramp-like spasm of one of the muscles in the pelvic floor and so is similar to the muscle pains. Some researchers believe it is a variant of the irritable bowel syndrome.

The condition may improve with psychotherapy, with tranquillisers or with drugs designed to relieve the muscle spasm.

A full explanation of the benign nature of the disorder may be sufficient to relieve the patient’s anxiety and so relieve the condition.

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Masked depression may show itself as other symptoms such as chronic fatigue, bowel disorders, indigestion or headaches.

Pessimism, despair and withdrawal are usually characteristic of all depressed states.

A reactive depression may last for six to 12 months and then spontaneously lift or the depression may persist for many years, varying a little up or down.

Not only does depression interfere with a patient’s life, taking away his enjoyment and affecting his efficiency and work output, it also has its effect on those around him, particularly his immediate family.

It is important for the doctor, for those who counsel people and for those who work and live with a depressed person to recognise that any depression may lead to suicide if the person feels hopeless.

Other treatment is ineffective unless the correct diagnosis is made.

Anxiety may be associated with depression and may mask it. Only the anxiety may be seen and a tranquilliser prescribed. Most tranquillisers do nothing for the underlying depression. The anxiety state calms down but this allows the depression to well up.

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