Tackling depression
We need to have a more holistic approach to address mental health issues. It’s not just about improving services. A great deal of advocacy needs to be done.
SUICIDE reports can affect people everywhere, and the impact of this is usually widespread. Suicide, suicide prevention and depression quickly became legitimate topics of public interest, in the wake of the deaths of celebrities Kate Spade and Anthony Bourdain last week, prompting everyone to take a good look around to see if someone they knew is indeed suffering from depression even though they appear okay.
The problem is, we don’t know who can develop depression. While there is a genetic link to depression – depression is known to run in families – the illness is also brought about by brain chemistry (low serotonin levels in the brain), deterioration in physical health as well as major life events such as changes or stress at the workplace or in personal relationships.
Most of us have been blue in the course of our lives for various reasons – a break-up, a kerfuffle at work or a death in the family. But in most instances, this depressive mood is temporary and life resumes.
“There are some people who can’t get out of this state. If someone displays a persistent low mood for a period of at least two weeks and shows an obvious loss of interest in pleasurable activities and displays associated symptoms like loss of appetite and corresponding loss of weight, irritability, has feelings of guilt or hopelessness and inability to concentrate for at least two weeks these are the signs we have to watch out for. These are symptoms of clinical depression which is a psychiatric morbidity which needs to be diagnosed early and treated,” he says.
The 2015 National Morbidity Survey revealed that one in every three Malaysians (29.9%) struggles with mental health issues – a threefold increase from 10 years ago when the figure was 10.7%.
The most common form of mental illness is depression, which Dr Mohanraj describes as a “silent killer”.
There are clear cut symptoms for depression but because they aren’t immediately visible, they often go undiagnosed.
“A patient may go and see primary care doctors because they can’t sleep or have psychosomatic symptoms like persistent headaches or backaches. Most times, they come away with sedatives to help them sleep or painkillers or analgesics for pain management. But the root of the problem isn’t often diagnosed,” says Dr Mohanraj.
The problem, he says, isn’t a lack of expertise among the medical fraternity but a lack of awareness about the pervasiveness of mental illness and the need to screen for the illness when such symptoms are presented.
The medical profession, he stresses, needs to better address mental wellness and primary care doctors, who he describes as “the gatekeepers”, must realise their roles in diagnosing mental illness and redirecting patients to get specialist treatment as they would a heart patient, for example.
“The health services of a country are very important. Primary care doctors need to ask more questions. They need to probe in order to either to rule out depression or direct patients to psychiatric care. With early detection, mental illness can be treated early and we could save lives,” says the consultant psychiatrist.
Mental illness, specifically depression, is the main cause of suicides the world over. In Malaysia there has been a 60% increase in the past 45 years, with an estimated seven people attempting suicide daily, according to the Malaysian Psychiatric Association statistics. Studies also indicate that 13 out of every 100,000 people die from suicide a year – mental health professionals believe the figure is an under-representation because many suicides go unreported.
“Severe cases of depression manifest in psychotic symptoms and suicidal thoughts, which may start from having death wishes. Of course, a lot of people have death wishes which don’t translate into active suicidal thoughts, or a plan or the actual act. There are protective factors that keep people from acting on death wishes such as cultural or religious factors that see suicide as taboo. But there are those who see suicide as the only way to end their pain,” adds Dr Mohanraj.
An illness, not a defect
One of the biggest challenges in addressing depression is the stigma surrounding the illness.
“People still see depression as a personality defect rather than a clinical illness. They view depression as a sign of weakness or a person behaving badly and expect them to ‘snap out of it’. But it is a real serious clinical entity,” says Dr Mohanraj.
Worldwide, depression is the second biggest cause of disability, after cardiovascular disease, and in Malaysia, depression is projected to be the leading cause of disability by 2030.
Society needs to view mental illness like bone breaks or diabetes or heart disease because depression is treatable.
Treatment, he points out, is a combination of psycho-social therapies as well as medication that helps restore the chemical imbalance that causes a person to be depressed.
“Malaysia has very effective medications to restore serotonin levels in the brain, which makes a person with depression feel better. But our mental health treatments extend beyond medication. In fact, for mild cases of depression, you don’t need medication. Biopsychosocial treatment combines medicines with psycho-social interventions, helping the patient overcome negative thoughts or helping them get out of environments in which they do not thrive,” says Dr Mohanraj.
He shares an example of a suicidal patient who needed a very different type of intervention.
“He was brought into hospital and treated for depression because he had attempted suicide. He tried to gas himself in his car without realising that one of the windows wasn’t shut. He was distressed and disappointed and really wanted to die. He told me that whatever treatment he is on, he would still kill himself because there was no way out of his problem – he was in debt and had no way of getting over his financial woes.
“We engaged with Bank Negaram which has a division that helps people restructure loans and they actually paid him a visit in hospital and helped him come up with a plan. That was the intervention he needed,” shared Dr Mohanraj.
Getting everyone on board
Beating depression has to be a concerted effort. Patients need to seek treatment but for this to happen, we need to change the way we look at the illness. People suffering from depression often fear that they will be perceived by others as crazy or weak. And though cultural norms are changing, albeit slowly, Dr Mohanraj believes that all stakeholders – from the government to employers and society – need to act.
“We need to have a more holistic approach to address mental health issues. It’s not just about improving services. A great deal of advocacy needs to be done and there has to be preventive measures to deal with workplace depression as well as depression among students. This needs to be done urgently,” he says.
As an example, companies need to be able to pick up on depression among their staff. Depression in the workplace manifests as absentism, irritability, inability to focus and low productivity, for example. He opines: “If an employee has repeated MCs for non-specific complaints, employers need to find out more and intervene. It will only benefit their workforce and productivity, which is their
concern, anyway.”