Depression can hide behind a smile

A mass workout session. One of the significant symptoms of depression is the loss of interest in activities that were once pleasurable. – Filepic

Those suffering from this medical condition might be hiding their sadness behind a happy facade.

The world lost a wonderful comedian in Robin Williams this year, when he committed suicide after battling with depression.

Ironically, while he brought so much joy into the lives of his fans, he suffered from agonising misery himself.

About 350 million people all over the world battle with depression every day of their lives, bringing misery to their loved ones as well, yet, many of us are in denial of this reality.

Depression remains the main cause of suicide all over the world, with one million people taking their own lives each year.

In fact, for every person who commits suicide, there are twenty more who make an unsuccessful attempt to end their lives.

Indeed, what is this tragic entity called depression, and why is it so painful that people are willing to end their lives just to escape from its pain?

Sadness or depression?

Under adverse situations, like the death of a relative, humiliation, disappointment or loss of social or financial status, a psychological reaction is expected, and is, of course, normal.

Over a period of time, one can get over this sadness. This is an “adaptive” response to an upsetting situation.

However, a dysfunctional response, where there is a prolongation of symptoms – usually for more than two weeks – can result in clinical depression.

A person suffering from depression may suffer from persistent low mood, loss of interest in pleasurable activities (anhedonia), decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration.

Of these, two significant symptoms are low mood and anhedonia.

These symptoms can become chronic, leading to substantial impairment in an individual’s ability to take care of his or her daily responsibilities.

People who experience depression often worry too much about the future, and have negative thoughts about themselves and their circumstances.

Often, they experience irritability and agitation, and may complain of exhaustion and become easily upset with those around them.

Such irritability and agitation are often made worse by poor sleep, which is a prominent feature in depression.

Depression can lead to individuals feeling trapped or hopeless about their situation, and suicidal thoughts are commonly experienced. In severe depression, these thoughts are often acted upon.

It can also result from physical illnesses like cancer, diabetes and chronic pain, as well as co-exist with other conditions like schizophrenia and illicit substance or alcohol abuse.

Depression also can form one “pole” of a disorder known as bipolar mood disorder.

This condition is characterised by mood swings, where during the “high” phase, one displays increased energy, recklessness and elation, but during the “low” phase, they can be depressed, withdrawn and suicidal.

Masked mood

In some people, as in the case of Williams, depression could be masked.

This is also known as “smiling depression”.

People with this type of depression appear to carry on with life, but on the inside, they suffer from feelings of worthlessness, shame and self-loathing.

Williams was not the only funnyman to battle with depression, many other famous comedians have suffered from this condition, yet projected a happy, bubbly public persona.

Tragically, not many, including their dear ones, knew that the smile that they wore was a sad one.

What is worrying about this kind of depression is that they may smile even more after making that decision to end their pain by suicide, in anticipation of the death that will “end” their prolonged suffering.

Biology or psychology?

It’s likely that with most instances of clinical depression, the production and transmission of certain chemicals in the brain called neurotransmitters is disrupted. These chemicals are serotonin, noradrenaline and dopamine.

For example, a decrease in the production of serotonin can cause low mood and suicidal thoughts.

Therefore, for people suffering from depression, it is not a mood that one can just “snap out of”.

Aside the from abnormal functioning of chemicals in the brain, other factors like genetics, stress and personality can contribute to the development of depression.

Having a family history of depression does not mean that a person will necessarily develop depression, but it does mean that the risk of developing depression may be higher.

There are also stressful life events, like failure in an examination, a relationship breakdown or diagnosis of a chronic illness like cancer, which may act as a trigger for the onset of a depressive episode.

People react differently to these triggers, and the onset of depression can be prevented to some extent, if there are protective factors like good family support and positive cultural values.

Some personality types are more likely to develop depression.

There is evidence that people who experience high anxiety levels, are very sensitive to criticism, or have a perfectionist personality, have a higher risk of developing depression.

Treating depression

Psychological treatment, or what is commonly known as “talking therapy”, for mild depression may provide a supportive environment for a person to work through their difficulties.

Mental health professionals like psychiatrists and clinical psychologists can help by providing skills and strategies to change negative thinking patterns and behaviours that contribute to depression.

Antidepressant medications, prescribed by psychiatrists, are drugs that help restore the brain’s chemical balance to improve mood and relieve other symptoms of depression.

In more severe depression, a combination of both antidepressant medication and psychological treatment has been shown to be most helpful.

If the depression is severe and debilitating, or if the urge to act out the suicidal thought becomes overwhelming, a brief stay in an inpatient setting might be extremely beneficial.

Depression is not something to be ashamed of, or something to feel guilty about.

It is not a character flaw or a sign of weakness.

With early detection and support from family and friends, there can certainly be a light at the end of the tunnel.

¦ Datuk Dr Andrew Mohanraj Chandrase-karan is a consultant psychiatrist and member of the Health Ministry’s Mental Health Promotion Advisory Council. For more information, e-mail [e-mail]. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.