Blue world

Depression is more than just sadness, and often impairs daily functioning to such an extent that the individual can be a danger to himself.

FEELING “blue”, down or sad from time to time is normal and a part of life. Everyone has their good days and bad days, which elicit associated emotions and affect our mood.

Sadness is a normal emotional state in response to negative external events, such as failing an exam, breaking up, or death in the family. However, sadness is temporary, and often does not interfere nor impair with the daily functioning of individuals.

Depression, on the other hand, is more than just sadness, and often impairs daily functioning. It is a complex disorder, which involves the disabling of one’s physical and emotional well-being.

Common characteristics found among depressed individuals are persistent low mood, impairment in physical state (eg lack of energy, decreased concentration), impairment in emotional state (eg persistent sadness, sense of hopelessness, persistent helplessness), absence of positive affect (eg loss of interest and enjoyment in hobbies), and other associated symptoms (eg excessive worry, irritability).

Due to the lows of depression, it makes it challenging for individuals to function daily, and increases the possibility of suicidal thoughts.

More common than you think

Globally, depression is ranked fourth among the leading causes of disability and disease. Each year, 6% of adults experience an episode of depression, and over the course of their lifetime, more than 15% of the population will experience it.

The World Health Organization (WHO) predicts that depression will be the highest-ranked cause of disease burden in developed countries by the year 2020.

In Malaysia, depression accounts for 45% of the total burden of mental disorders among males and females. Six out of 100 adult patients seeking treatment in primary care clinics have been found to be depressed.

The severity of depression varies between individuals; however, there are common signs and symptoms. It is important to remember that these symptoms can be part of life’s normal struggles, setbacks and disappointments.

However, if the symptoms are present for at least two weeks, and the more symptoms an individual has, the more likely it is that the individual is suffering from depression.

The common signs and symptoms of depression are:

• Feelings of helplessness and hopelessness. For example, feeling that nothing will ever get better, and there’s nothing you can do to improve your situation.
• Loss of interest in daily activities. For example, no interest in former hobbies, pastimes, social activities, or sex. Inability to feel joy and pleasure.
• Appetite or weight changes. For example, significant weight loss or weight gain – a change of more than 5% of body weight in a month.
• Sleep changes. For example, either the inability to sleep (known as insomnia) or oversleeping (also known as hypersomnia), or waking up in the early hours of the morning.
• Anger or irritability. Feeling agitated, restless or even violent, due to decrease in tolerance.
• Loss of energy. Feeling fatigued, sluggish and physically drained.
• Self-loathing. Strong feelings of worthlessness, helplessness or guilt.
• Reckless/destructive behaviour. The engagement of escapist behaviour, such as substance abuse, compulsive gambling, reckless driving or dangerous sports.
• Concentration problems. Decrease in focus and remembering things. Decision-making is also poor due to poor concentration.
• Unexplained aches and pains. An increase in physical complaints, such as headaches, back pain, chest pains, aching muscles and stomach pain.

The roots of depression

The definite cause of depression still remains unknown. However, it is likely to result from a complex interaction of biological, psychological and/or social factors.

Genetic predisposition increases vulnerability to the development of depression within individuals. This means that depression can be inherited. A history of family members who have had or are currently suffering from depression and/or other mental disorder(s) can determine the vulnerability of developing depression within individuals.

Personality is a form of psychological factor that can affect adaptive skills to stressors. Individuals who are particularly poor in dealing with stressful situations have an increased risk of developing depression.

Psychosocial issues such as lack of social support, recent stressful life event (eg divorce, death in the family), unemployment, marital or relationship problems, and financial strain, can also increase the risk of individuals developing depression.

Terminal illnesses, such as diabetes, cancer and cardiovascular disease, which can cause pain and discomfort, and/or reduce the capacity to perform daily activities, makes depression more likely.

Nevertheless, the longer the depression is untreated, the longer the symptoms will persist and the stronger the symptoms become, which increases the chances of suicidal thoughts and attempts.

Suicide is among the 10 leading causes of death in most countries. The main key factors that drive most depressed individuals to commit suicide are the feelings of helplessness and hopelessness, being isolated and persistently feeling emotionally hurt.

According to the most recent report by the National Suicidal Registry Malaysia (NSRM), there were a total of 425 suicide cases between January and August 2010. This translates to an average of 60 cases per month (including undetermined deaths) or two cases each day.

NSRM found that Chinese made up 48% of total deaths, followed by Indians (21%), Malays (18%), and other races (13%). For suicide, NSRM also found that men outnumbered women by three to one.

Out of the total number of deaths, it was reported that only 7.1% of the deceased had a history of mental illness, of which 1.8% had a history of depression. These statistics, however, may be under-reported due to unrecognised and untreated depression.

Managing the problem

Although treatment outcomes are better when depressed individuals are treated earlier, depression is highly treatable even in its most severe form.

There are effective treatments available for depression, typically with the use of medications and/or psychotherapy.

Antidepressants are commonly used to treat depression by alleviating mood and improving sleep, appetite and concentration.

Psychotherapy involves a variety of treatment techniques aimed at identifying and working through the issues that may be the cause of the depression, and teaching individuals coping strategies and problem-solving skills.

An alternative form of therapy for severe depression is electroconvulsive therapy (ECT), which involves passing an electric current through the brain, deliberately triggering a brief seizure. The brief seizure is aimed at changing the brain chemistry that can most likely reverse symptoms.

Some ways to reduce the risk of developing depression and managing it include asking for help and support from family and friends, changes in lifestyle, and seeking professional help if social support and lifestyle changes are not enough.

Do not be afraid to talk to family and friends about your current feelings and issues. However, when social support is lacking or unavailable, do not hesitate to seek professional help as they are there to help individuals.

Lifestyle changes are not always easy, but they can be very effective. Getting regular exercise and eating healthily have been shown to naturally improve mood and sleep.

Depression is more than just sadness, and often impairs daily functioning. It negatively affects individuals physically and emotionally, and when left untreated, the risks of suicidal thoughts and suicide attempts increase.

As the severity of depression varies between individuals, so do the outcomes of treatments. What works for one individual may not work as effectively for another, and no one treatment is effective for all cases.

Therefore, it is important for depressed individuals to take some time to explore the many treatment options available.

Nevertheless, the best treatment approach utilises medication and psychotherapy, with the support of friends and family, changes in lifestyle, and improvements in emotional, adaptive and problem-solving skills.

Assoc Prof Ng Chong Guan is from the Department of Psychological Medicine, Faculty of Medicine, University of Malaya. This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.

The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist.

For more information, e-mail [e-mail]. The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.