Over­whelmed by our ev­ery­day life, more of us than ever are suf­fer­ing from anx­i­ety disor­der. Fri­day ex­plores why we need to treat the prob­lem.

As the World Health Or­ga­ni­za­tion launches a cam­paign to com­bat the high preva­lence of de­pres­sion, Mri­nal Shekar finds out what hap­pens when we bot­tle it all up

Friday - - Contents -

It started with a slightly cold tingly sen­sa­tion on her palms. Some­body must’ve cranked up the air­con, Me­lanie thought as she vig­or­ously rubbed her hands to­gether and walked to­wards the wash­room. As she topped up her make-up, the sen­sa­tion de­vel­oped into a pal­pi­ta­tion and she could feel cramps de­velop in her stom­ach. The pres­sure of the im­pend­ing meet­ing with the se­nior man­age­ment who were go­ing to de­cide whether she was go­ing to get a pink slip or a trans­fer to a mo­fussil branch was tight­en­ing its grip on her. Within sec­onds, Me­lanie felt her lungs were be­ing squeezed and she could barely breathe. As she crum­bled on the floor and hot tears be­gan to flow, all Me­lanie could do was scream for help.

The un­cer­tainty of the sit­u­a­tion trig­gered a panic at­tack in Me­lanie, ex­plains con­sul­tant psy­chi­a­trist Dr Rasha Bas­sim. Never mind the fact that Me­lanie was aware that her days in the com­pany were num­bered, she still was not men­tally pre­pared for what was to hap­pen. With bills to pay and fam­ily to look af­ter, Me­lanie was in des­per­ate need of a se­cure job.

Hav­ing said that, Dr Rasha points out trig­gers do not lead to anx­i­ety, they just switch the symp­toms’ but­ton on. ‘There is a dif­fer­ence be­tween trig­gers and causes,’ she ex­plains. ‘While causes of anx­i­ety con­sist of mul­ti­ple fac­tors such as up­bring­ing, ge­netic pre­dis­po­si­tion and ear­lier life ex­pe­ri­ences that make anx­i­ety a part of the per­son, trig­gers on the other hand are events and is­sues that ig­nite the symp­toms or worsen them,’ adds Dr Rasha.

As the World Health Or­ga­ni­za­tion (WHO) de­votes 2017 to de­pres­sion and the fact that it is now the lead­ing cause of ill health and dis­abil­ity world­wide, Dr Rasha, from the Pri­ory Well­be­ing Cen­tre in Dubai’s Health­care City, says it is about time health­care poli­cies across the world stop giv­ing men­tal health the ele­phantin-the-room treat­ment. As the name of WHO’s cam­paign – ‘De­pres­sion: Let’s talk’ – sug­gests, there’s a lack of sup­port for peo­ple with men­tal disor­ders. The prob­lem is ag­gra­vated by the so­cial stigma at­tached to it which pre­vent many from ac­cess­ing the treat­ment they need to live healthy, pro­duc­tive lives.

Ac­cord­ing to the lat­est es­ti­mates from WHO, more than 300 mil­lion peo­ple glob­ally are now liv­ing with de­pres­sion, an in­crease of more than 18 per cent be­tween 2005 and 2015. While anx­i­ety and de­pres­sion are sep­a­rate disor­ders, they can and do oc­cur to­gether.

The prob­lem has reached mam­moth pro­por­tions in the UAE as well. Ac­cord­ing to re­search pub­lished last year, about 20

MORE THAN 300 MIL­LION PEO­PLE GLOB­ALLY ARE NOW LIV­ING WITH DE­PRES­SION Ac­cord­ing to RE­SEARCH pub­lished last year, about 20 per cent of the UAE pop­u­la­tion SUF­FERS from some kind of anx­i­ety disor­der. The PROB­LEM is more pro­nounced among EX­PA­TRI­ATES

per cent of the pop­u­la­tion suf­fers from some kind of anx­i­ety disor­der in the UAE. Talk­ing about the de­mo­graphic na­ture of the prob­lem, Dr Rasha says the prob­lem is more pro­nounced among

ex­pa­tri­ates, who have to deal with the added pres­sure of cop­ing with sep­a­ra­tion from friends and fam­ily and dis­place­ment from their home coun­try. ‘The sense of un­cer­tainty and need to hang onto stress­ful jobs for main­tain­ing fi­nan­cial se­cu­rity, to­gether with a lack of or de­fi­cient so­cial sup­port net­works such as fam­ily, ex­tended fam­ily and friends, cul­mi­nates in a mag­ni­fied ef­fect of anx­i­ety trig­ger­ing fac­tors and hence wors­ens the symp­toms and mul­ti­plies the rates of clin­i­cal pre­sen­ta­tions,’ she ex­plains.

So what is anx­i­ety disor­der? Is it re­ally that mon­ster that lurks in the dark crevices of our mind feed­ing on our fears and in­se­cu­ri­ties? ‘There is nor­mal or healthy anx­i­ety that one feels prior to an exam or a job interview, which tends to put the per­son on high alert and makes them pre­pare bet­ter for the event and then there is Gen­er­alised Anx­i­ety Disor­der. GAD is a psy­cho­log­i­cal con­di­tion char­ac­terised by ex­treme or ex­ces­sive worry about cer­tain as­pects in life, such as work, so­cial re­la­tion­ships/events, or fi­nan­cial is­sues. This worry is usu­ally dis­pro­por­tion­ate to the ac­tual mat­ters and can in­ter­fere or neg­a­tively af­fect how you func­tion in daily life,’ ex­plains Dr Rasha.

Apart from a con­stant state of anx­i­ety, Dr David Bald­win, pro­fes­sor of psy­chi­a­try at the Univer­sity of Southamp­ton, says the symp­toms of GAD in­clude dif­fi­culty sleep­ing, ir­ri­tabil­ity and heart pal­pi­ta­tions. ‘Peo­ple with GAD are phys­i­cally and men­tally ex­hausted,’ he ex­plains. ‘They have a sense of hav­ing lost con­trol and they don’t know how to solve their own prob­lems.’

In Me­lanie’s case, she felt she had a valid rea­son to be a wor­ry­wart since there was a lot at stake. But the neg­a­tive emo­tions were very ev­i­dently cor­rod­ing her self-con­fi­dence. She felt in­ca­pable of de­vis­ing a Plan B and the stress was hav­ing a deep im­pact on her health too. From the time she came to know that the com­pany was go­ing to un­dergo struc­tural changes and that she might re­ceive the short end of the stick, she started tak­ing med­i­ca­tion to help her fall asleep. She con­stantly felt a pain in her neck and shoul­der area and the urge to visit the wash­room fre­quently. ‘These are some of symp­toms of an anx­i­ety disor­der that one needs to look out for,’ says Dr Rasha. ‘The oth­ers are per­sis­tent worry or fear that is over­whelm­ing even on triv­ial is­sues; an­tic­i­pat­ing the worst out­comes; be­ing ir­ri­ta­ble or rest­less at times, eas­ily pro­voked and ex­pe­ri­enc­ing tight­ness in the chest.’

And that’s not all – there are some phys­i­cal symp­toms as well. ‘These are sweat­ing, dry mouth, mus­cle ten­sion, neck and shoul­der pain, headache, bowel changes tin­gling and numb­ness of hands and feet,’ says Dr Rasha.

Talk­ing about how the con­di­tion man­i­fests it­self, the doc­tor says that apart from the men­tioned symp­toms, she has seen sev­eral anx­i­ety-re­lated pa­tients who suf­fer from al­co­holism and/ or eat­ing disor­ders. ‘When­ever two disor­ders co-ex­ist, the prog­no­sis and man­age­ment can be com­pli­cated,’ she points out.

So how is GAD dif­fer­ent from de­pres­sion? Don’t both fo­cus on an over­whelm­ing sense of in­com­pe­tency as far as deal­ing with life’s sit­u­a­tions are con­cerned? Dr Bald­win ex­plains. ‘De­pres­sion is char­ac­terised by a sense of pes­simism about the past. There’s a lack of in­ter­est and a sense of slow­ing down,’ he says.

‘With anx­i­ety, peo­ple don’t fo­cus on the past, they fo­cus on the fu­ture and worry about what hasn’t hap­pened yet. There’s also not the same sense of slow­ing down; if any­thing you have more ner­vous en­ergy. Anx­i­ety suf­fer­ers present more phys­i­cal symp­toms than de­pres­sion suf­fer­ers, such as breath­less­ness, sweat­ing and med­i­cally un­ex­plained pain.’

Even though Me­lanie un­der­stood that stress had taken over her emo­tional and men­tal state, she did not seek med­i­cal help, as­sum­ing that the symp­toms will au­to­mat­i­cally dis­ap­pear once she was out of the sit­u­a­tion. She in­ter­nalised the trauma, afraid that if she shared it with her fam­ily and friends they too would get wor­ried and might think less of her.

‘While women tend to be­lieve that if they ig­nore a prob­lem, es­pe­cially an emo­tional one, it would even­tu­ally dis­ap­pear, men on the other hand, ease their symp­toms through sub­stance abuse, both seek­ing pro­fes­sional help only when they reach a chronic stage,’ ob­serves Dr Rasha.

As Me­lanie was wheeled in to a hos­pi­tal and tests, in­clud­ing an elec­tro­car­dio­gram, showed that she had a healthy heart and was an oth­er­wise healthy woman, the doc­tors ad­vised her to meet a psy­chi­a­trist to un­der­stand the na­ture of her prob­lem. The doc­tor had a cou­ple of ses­sions with Me­lanie to know more about her and the var­i­ous symp­toms that she had been show­ing. ‘Clin­i­cians carry out screen­ing via fo­cused ques­tion­naires and psy­cho­me­t­ric as­sess­ment tools,’ says Dr Rasha while ex­plain­ing the pro­ce­dure in­volved in di­ag­nos­ing the prob­lem.

In Me­lanie’s case, the fact that she came from a fam­ily where peo­ple were in­ten­tion­ally or un­in­ten­tion­ally judged by their achieve­ments and she did not have a friend around her to hold her hand and help her jump over the gap­ing emo­tional chasm that she was faced with, com­pounded the

$1 TRIL­LION A YEAR: THE COST OF LOST PRO­DUC­TIV­ITY DUE TO DE­PRES­SION AND ANX­I­ETY MORE WOMEN ARE AF­FECTED BY DE­PRES­SION THAN MEN ‘While WOMEN tend to be­lieve that if they IG­NORE a prob­lem, es­pe­cially an EMO­TIONAL one, it would even­tu­ally dis­ap­pear, MEN on the other hand, ease their symp­toms through sub­stance ABUSE’

prob­lem. The prospect of los­ing her job was the fi­nal straw that lead to her un­do­ing.

Once she was seen by the psy­chi­a­trist, Me­lanie was put on anti-anx­i­ety med­i­ca­tion and she be­gan Cog­ni­tive Be­havioural Ther­apy (CBT) where her psy­chi­a­trist – over a set of ses­sions – made her aware of her neg­a­tive thoughts, helped her view chal­leng­ing sit­u­a­tions more clearly and re­spond to them in a more ef­fec­tive way. While the med­i­ca­tion helped her calm down the ther­apy em­pow­ered her to be­come more solution-ori­ented. She is now able to man­age her thoughts and has sig­nif­i­cantly man­aged to lower her lev­els of anx­i­ety.

If it is any con­so­la­tion, Me­lanie is not alone in this phe­nom­e­non. She rep­re­sents a mas­sive sec­tion of so­ci­ety that is like a duck – calm and poised on the out­side, but ped­alling hard to stay afloat in­side.

As ac­tor Robin Wil­liams, who bat­tled de­pres­sion all his life, once said, ‘all it takes is a beau­ti­ful fake smile to hide an in­jured soul and they will never no­tice how bro­ken we re­ally are.’

Strug­gling to cope with the pres­sure of ev­ery­day life, Dr Rasha says, peo­ple to­day are over­wrought with anx­i­ety as they try to ap­pear strong and ca­pa­ble in the face of ad­ver­sity. ‘What is adding to the com­plex­ity of the prob­lem is easy ac­cess to in­for­ma­tion and news and so­cial me­dia,’ she says. Elab­o­rat­ing fur­ther, she says the in­ter­net en­ables the vi­ral spread of news and graphic pictures of war, strife and hu­man­i­tar­ian cri­sis, which cre­ates fear or awak­ens a sense of in­se­cu­rity among those who al­ready suf­fer from some form of anx­i­ety disor­der.

So what is the way for­ward? How do we come out of the dark­ness? ‘Since, as ex­pats, one of our core is­sues is the fact that our sup­port sys­tem – fam­ily and friends – is not at arm’s length, we need to build a par­al­lel sup­port sys­tem,’ says Dr Rasha. ‘To start with, pur­sue a hobby or take up a new one that you’ve al­ways wanted to do. It gives you a chance to bond with like-minded peo­ple, some of whom could be­come your good friends over a pe­riod of time – your new sup­port sys­tem. It is also im­por­tant that we fol­low a reg­u­lar ex­er­cise regime. It keeps both our body and mind healthy.’

Med­i­ca­tion, she be­lieves, should only be the last re­sort and should be taken only when pre­scribed by a doc­tor.

What­ever be the form of rope that pulls us out from the depths of dark­ness, it is imperative that we ad­dress our emo­tional trou­bles just as we would our phys­i­cal ones. ‘For over­all well-be­ing, it is im­por­tant we don’t sweep our emo­tional health un­der the car­pet,’ says Dr Rasha.

Peo­ple with Gen­er­alised Anx­i­ety Disor­der are PHYS­I­CALLY and men­tally EX­HAUSTED. They have a sense of hav­ing lost CON­TROL and they don’t know how to SOLVE their own prob­lems’ THERE’S BEEN AN 18 PER CENT IN­CREASE IN CASES SINCE 2005 JUST 3 PER CENT OF WORLD­WIDE GOVERMENT SPEND­ING IS ON MEN­TAL HEALTH

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