Facts and Figures

Conquering Depression

What can be done ?

With the advancement in pharmacological sciences and a better understanding of the biochemical basis of depression, a number of drugs have been introduced for the treatment of depression and prevention of relapses on a long-term basis. However, it is ironic that even in the affluent west, only one-third of persons with such disorders are under appropriate treatment. The situation is worse in the countries of South-East Asia, where such cases remain underdiagnosed and undertreated, despite the fact that these drugs are now quite affordable and easily available everywhere. The reasons usually cited for this state of affairs are:

     Patient’s disbelief in medications;

     Sense of hopelessness;

     Viewing illness as untreatable;

     Physician’s failure to recognize illness;

     Illness factors like marked lethargy, disinterest and death wishes;

     Poor recognition of consequences, and

     Society’s negative attitude towards illness and medication.

What the family can do

The role of the family in looking after a depressed person cannot be overemphasized. The family can provide help and support in the following ways:

     By early appreciation / recognition of onset of depression;

     By helping the patients to start treatment at an appropriate facility, and helping them to continue with the treatment;

     By providing adequate supervision and support to minimize the risk of suicide;

     By helping the patients to resume their activities and role in life on recovery, and

     By getting all the necessary guidance and information to prevent further recurrence.

The most important thing family members can do for depressed persons is to help them get an appropriate diagnosis and treatment. Patients may not recognize the illness themselves; may blame a physical illness for their bodily symptoms; may consider the entire situation arising out of a sad mood as totally hopeless, and may refuse any treatment; may hide their illness fearing rejection because of social stigma, or may contemplate suicide. All these reasons may interfere with early recognition of illness and its proper treatment. The families can help the patients to reach the appropriate treatment facility and accompany them to the doctor. Family members may be helpful in providing necessary details to the doctor for making a proper diagnosis and planning an effective treatment strategy. The family has to monitor whether the patient is taking the prescribed medication. The patient’s progress on the treatment should be modified by the family, since this will decide when to revise the treatment strategy, or when to hospitalize the patient.

                                       
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The risk of suicide has to be appreciated from the patient’s behaviour and body language. Remarks about death or suicide should not be ignored. If there is such a risk, the patient will require constant supervision; all objects capable of causing physical harm must be removed from the patient’s reach.

The family also has an important task in providing emotional support to the patient. This involves understanding the patient’s own emotional state and helplessness, exercising patience when the recovery is slow, showing affection when the patient is having very low self-esteem, and encouraging him/her to take on responsibilities gradually as they improve. When the patient begins to recover from a serious episode of illness, he/she should be allowed to approach life at his/her own pace and regain him/her self-confidence. Participation in activities that once gave him/her pleasure, such as hobbies, sports, religious or cultural activities should be encouraged, but the depressed person should not be pushed to undertake too much too soon. He/she has to regain his/her self-esteem and become comfortable again at home, at school, among friends and on the job.

Depressed persons should never be accused of laziness or of faking illness, or be expected to just shrug off the symptoms. Eventually, with treatment most people get better. The depressed persons should be reassured that, with time and help, they will get better. The depressed family member must be reassured that he/she is cared for.

Living with a person who has depression can be a great strain on the caregiver or family member. The illness may give the impression that the patient is being uncooperative or hostile. If possible, family members should take turns to look after the patient’s needs so that one family member does not feel overburdened. Family members should alleviate their own stress by remaining focused on events and activities requiring their attention.

What the patients can do for themselves

The treatment of depression and the prevention of further recurrences requires careful planning and strategy, and demands a strong commitment, both from the patient as well as the doctor. There are issues which may be unique for each patient and these need to be appreciated, understood and resolved before patients commit themselves to treatment, especially long-term treatment. It is essential to evaluate these issues to sufficiently motivate the patients to adhere to a plan, since the course of illness or treatment may be characterized by high dropout rates, non-compliance, and premature exit from the treatment programme.

Unfortunately, many people do not recognize that a sad mood can be a manifestation of depression, or that depression is a treatable illness. So, if they suspect the onset of mental illness, they should think in terms of obtaining appropriate help rather than denying its existence and consequently delaying the treatment. Many kinds of myths, misconceptions, and stigmas associated with the illness may prevent them from seeking help. Hence it is essential that they be better informed to look after themselves.

If it is suspected that the symptoms may be the manifestation of depression, the patient should consult the family physician or a nearby medical facility for confirmation of this suspicion. Sometimes the patient’s own physician may detect signs of depression when consulted for some vague bodily symptoms. Besides the patient’s own family physician or general practitioner, other people who have received training in mental health, such as a psychiatrist, psychologist, social worker, or a psychiatric nurse, can provide help. At the primary health care level, community health workers can also assist in obtaining the requisite help.
         

It is important that the patients share information with their doctors, to help them gauge the severity of illness. The general medical history, physical examination, and basic laboratory tests can help the doctor learn if a physical disorder is the cause of the depression, as is the case in 10-15% of depressed patients.   

         
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Thoughts of suicide or death are often a part of depression and such thoughts should be communicated to the doctor immediately. Close family members or friends should also be taken into confidence, and they should provide the necessary support.

People with depression may often try to ward off symptoms by consuming alcohol or other drugs which only make matters worse. Medical advice regarding medication should be scrupulously followed. Not following the advice or prematurely stopping the drugs may lead to recurrence of symptoms.

It is very important that antidepressant medications are continued long after the depressive symptoms have disappeared and taken according to the doctor’s prescription. Generally, taking medication for three to six months is considered essential for relief from symptoms. Depending on the nature and severity of their illness, patients may be advised to continue the medication even for a longer period. It must be remembered that antidepressant medicines are not habit-forming or addictive.

The patients should not blame themselves or feel ashamed of their symptoms. They should get adequate treatment, learn new skills to cope better with stresses, and should not lose hope.

What the medical community can do

It is very essential for the health professional to understand the burden caused by depression on the community.

In spite of its common occurrence in the community, depression remains unrecognized and poorly treated even by doctors. It is thus imperative that the medical community is better informed about the manifestations of illness, process of diagnosis and proper management of depression. Many myths and misconceptions associated with depression are also shared by medical personnel. Their role is significant in fighting the stigma caused by these disorders.

Many people with depression can be successfully treated by general practitioners. However, some people need specialized treatment, because either the first line of treatment does not work and they need an alternative or combination of treatments, or because the depression is very severe or lasts a long time. Most of the time, the

treatment is provided on an outpatient basis; however, some patients may require hospitalization.
     

Whenever a depressed person approaches a doctor, the latter has to take into consideration the following:

     Making a diagnosis, and understanding its possible cause;

     Appreciating the risk of suicide;

     Deciding whether to provide outpatient treatment or to hospitalize the patient;

     Advising whether the patient should continue to work or take temporary leave;

     Taking the family into confidence to ensure regularity of treatment of the patient, and providing the family members with all the necessary knowledge about the illness;

     Explaining that alcohol or other such drugs are not helpful in treating or avoiding depression;

     What mode of treatment is to be used: pharmacological, electroconvulsive, or psychotherapeutic; or a combination of these;

     Explaining to the patient what to expect from the treatment and that side-effects may appear earlier than therapeutic response;

     Telling the patient how frequently he/she should visit the clinic;

     Ensuring drug compliance;

     Advising the patients when and how to resume their family, social and occupational activities, and

     Assessing the scope and implementing the strategy for prevention of relapse of depression.

There are well-established treatments available to alleviate symptoms effectively. Such treatments are drugs (antidepressant medication), non-pharmacological interventions like psychotherapy, or a combination of drugs and psychotherapy. In some cases, other treatments, such as electroconvulsive therapy, are also useful. At many places, locally available indigenous treatments like herbal medications are also used with varying degrees of success. Yoga, meditation, and naturopathy may also advised as supportive measures.

St. John’s wort is the most prescribed anti-depressant in Germany. Hypericum is extracted from its flowers and leaves. Some consider it effective in treating depression, but its efficacy has not been scientifically tested.

The medical community has a significant role in educating the public at large about depression, its consequences, and the therapeutic and preventive measures that can be undertaken. They must actively liaise with the health planners and administrators so that they give adequate attention to these disorders in health planning. Since it has now been shown that the burden of depression is much more than what was believed earlier, resources must be appropriately allocated.

Ma Thiri Nanda Shwe War Phone

What the government can do

Mental health is an important aspect of public health that has long been segregated and neglected. That mental disorders are a significant cause of disability and account for more than 10% of the global burden of diseases has come as a surprise to many. Despite the current availability of efficacious treatments, surprisingly little has been put into practice for the management and prevention of such disorders.

Governments all over the globe, and especially in SEAR Member Countries, should attempt to change the current scenario. Governmental efforts in this direction should be guided by a set of goals. Such goals must aim to change the negative perception of mental disorders by the public, reduce the risk of occurrence of mental disorders, including depression, and provide adequate care and rehabilitation of the sufferers. The government policy must aim at maximizing scarce public resources, formulating clear strategies to reduce the disability associated with mental disorders and promoting research on preventive and promotional aspects of mental health.

Traditional beliefs in supernatural causes and remedies strongly influence people’s attitudes towards mental illnesses leading to negative responses and stigmatization of mentally ill persons. Governments should give priority to public education since many aspects of mental health care require active collaboration of the community.

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Governments should make adequate provisions for the delivery of health care and social services. In developing countries, where a majority of the population is rural-based, primary health care facilities are the main source of medical care; hence adequate manpower and supply of effective and affordable drugs must be ensured. Training programmes for primary health care--setting doctors and general practinioners should be conducted on a regular and ongoing basis.

Families are the main support system for the care of mentally sick individuals. However, severe mental disorders may deplete the resources of even the most willing and able families. Policies must be framed to bring families together and encourage them to create consumer groups.

Legal provisions for the protection of the mentally ill from unjust discrimination are becoming common in the developed countries. Such provisions must also be adopted in the Member Countries of the South-East Asia Region. The human rights of the mentally ill must be upheld with relevant legal provisions.

Governments must allocate sufficient funds for training and research in mental disorders. Only adequate research can form the basis for a sound mental health policy. Wherever manpower is scarce, enough training opportunities must be created for increasing the number of mental health professionals.

Sufferers of mental illnesses are at a severe disadvantage to express their need for care. They are easily marginalized with regard to social services and health care. The economically disadvantaged have the least access to health services and care. Health policies should recognize such inequities and seek to prevent them.

Policies must be framed to nurture positive mental health. Wars, internecine strife, crime and natural disasters disrupt social and community life, leading to psychological disorders in large numbers of people. Governments and health policies must take into account the impact of such social upheavals and make whatever provisions possible to reduce their negative effects on the psychological health of the victims.