Cry me a river

  • Health
  • Sunday, 27 Apr 2003

HOOI YOU CHING sings the blues as she parts the dark clouds that represent clinical depression, a bona fide disease just like heart disease or diabetes, only a bit more insidious.  

IS being sad the same as being depressed? Not true. Sadness is a natural human reaction against life’s adversities, a kind of coping mechanism one temporarily adopts before coming to terms with a particularly distressing situation.  

In contrast, clinical depression is that brooding sense of melancholy one can’t shake off, often lasting for prolonged periods of time like weeks, months and even years.  

According to consultant psychiatrist Dr Chee Ng, depression is not a state of mind or a character flaw but a medical condition that is as real as any other physical ailment. “Depression does not mean that you are weak or lazy or have some defect in your character. In fact, it is a medical condition just like hypertension, diabetes or arthritis that requires medical treatment,” says Dr Ng, a senior lecturer at the Centre of International Mental Health and Department of Psychiatry, University of Melbourne.  

When depression is severe, taking antidepressants prescribed by your doctor may be necessary.

Not to be confused with a case of “feeling the blues” or “in low spirits”, depression can create an overwhelming sense of hopelessness, negative perceptions and the inability to function normally whether at home, in school or in the workplace.  

Says Dr Ng, depression can be a persistent medical condition that is often accompanied by a variety of symptoms as well. “It can cause persistent physical problems like sleep problems, loss of appetite, weight loss, tiredness, lack of energy and poor physical health. 

“A person suffering from depression would feel unhappy, miserable, sad, frustrated, irritable, forgetful and even lacking in concentration. Often, there are negative thoughts of being worthless and that life is not worth living. These problems frequently lead to difficulties in maintaining routine activities, work performance or relationships with family and friends. 

“When such a person begins to think and express suicidal thoughts, medical help is urgently required because depression is a leading cause of suicide,” he warns. 

By engaging in such destructive behaviour that is both self-punishing and anti-social, depression is typically described as anger turned inwards, a term used by psychoanalyst Sigmund Freud in his theory of suicide. While it remains a mystery why some people get depressed and others don’t, it has been shown that a person who presents five or more of those symptoms for at least two weeks is said to suffer from depression. 

The cause of depression is not entirely understood but research has shown that some symptoms of depression and anxiety disorders may be related to a chemical imbalance in the brain. 

According to Dr Chee Ng, depresssion can create an overwhelming sense of hopelessness, negative perceptions and the inability to function normally.

Although there is a combination of factors that trigger depression, there have been cases of people exhibiting signs of depression for no apparent reason at all. The most common triggers for depression are painful and stressful life events like a recent loss of a loved one, relationship problems, unemployment, work stress and financial problems. Lately the outbreak and uncertainty of the SARS crisis hanging over affected areas has pushed some parts of the world into states of despair, if not panic.  

Persons who are diagnosed with a medical illness like cancer, heart disease, infectious disease, strokes and other chronic medical condition are also vulnerable to bouts of depression. Just as certain medications like steroid and hormonal treatments can wreak havoc to one’s physiological condition, so too can substance abuse like alcohol and drug abuse.  

Interestingly, depression runs in families. This genetic predisposition means that if a person suffers from depression, his/her family members are at a higher risk of getting depressed compared to the general population. Then again, most people who have a family member with depression may never develop it.  

For those who have been suffering in silence, it might be comforting to know that depression is a lot more common than most people think. Considered one of the most common problems by psychiatrists today, it is estimated that the prevalence rate in the country is between 10% and 30%.  

It is believed that one in four females and one in six males suffer from depression at some points in their life. Said to be more common than diabetes, depression is the fourth major cause of disability, making it a national health priority in most countries. A Global Burden Study projection for the year 2020 by the World Health Organisation revealed that depression would be a disease burden second only to cardiovascular diseases. 

Although researchers have discovered that women experience depression about twice as often as men, it could be due to biological reasons such as menopause and childbirth in women. Or it may be that women are taught social roles that encourage submissive behaviour such as feelings of helplessness. Perhaps it’s due to the fact that women are more forthcoming about their emotional problems and are thus more likely to seek treatment that statistics show a higher incidence rate of depression among the female population.  

However, these statistics have little meaning as long as society continues to put a label on mental illness. Says Dr Ng, persons with depression often hide their problems because they feel society lack awareness and are prejudiced against them.  

He says that the stigma attached to people with mental health problems is unfortunate because it causes unnecessary suffering and delay in treatment.  

“In mental health particularly, sometimes the facts don’t speak for themselves. Statistics on road accidents, heart disease are well known to the public. But when it comes to mental health, facts like these do not get publicised.  

“Therefore, we need to highlight the severity as well as the normality of the problem. In Australia, efforts are taken to increase scrutiny of how well medical care can meet the mental health needs of the community. In 2001, approximately AS$900mil (RM1.98bil) was spent in direct health costs for depression, which included medications, specialist psychiatric consultations, hospital admissions and additional medical investigations,” says Dr Ng, who presented a talk entitled Depression and its Medical Consequences recently.  

Other factors leading to under-diagnosis and under-treatment of depression are patient’s negative attitudes to treatment approaches, language and cultural barriers between doctors and patients, lack of diagnostic and treatment skills. 

It is the indirect costs of depression that paints a gloomier picture in a country’s socio-economic situation, where it is estimated to be two or three times higher than direct costs. Indirect costs are the result of mental illness such as depression that leads to unemployment, absence from work, loss of earnings, caregiver costs, emotional distress on family, effects of suicide and other violent acts.  

Dr Ng stresses the importance of early intervention in arresting depression. Depending on the degree of depression, treatment can be in the form of medication or therapy or both.  

“When depression is severe, taking antidepressants prescribed by your doctor may be necessary. Especially when there is a family history, a relapse or when psychological strategies don’t work. The anti-depressants available today are safe and effective. These medications are not addictive but may interact with alcohol, which is best avoided. The most common being selective serotonin reuptake inhibitors or also known as SSRIs,” he says. 

He adds that healing takes time, especially for patients who must learn to pick up the pieces after a lifetime of self-imposed exile. Generally, improvement takes about two to four weeks. He cautions that medication should not be discontinued without the doctor’s knowledge to prevent a relapse, adding that medication is usually maintained for at least six months to a year after the initial improvement.  

All said, the good news about depression is that it is common and treatable. More importantly, to defeat depression one must first recognise and treat it early. 

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