Dr. Gayathri K. Kumarasuriar
Let’s Talk, Macha
“Mamoos…howzit like?”
“Baaad scene, Macha! That patient jumped from the window of the 7th floor from the hospital, lah! We all going to collectlah later.”
“Depressed or what?”
“Don’t know, lah! Morning he was quiet and looked cool only. He has been in the ward more than 1 month. His liver, gone case, Macha. How we know lah, he going to take off like that?”
“Don’t be a ‘thengah’. He must have been depressed lah.”
“What’s happening, lah, dei? So many people are depressed now?”
“Yup, that’s right! That is why the World Health Day’s theme by the World Health Organisation (WHO) on 7 April 2017 is “Depression, Let’s Talk”. The incidence of depression is increasing globally and along with that, so is the rate of suicide. How well do we doctors understand the complexities that involve this disorder? It goes beyond a mere reaction to having a problem. It is that and more. You want to know, some more?”
“Can oso can , cannot oso can, lah”
“Hmmmm… listen, macha. As doctors many of us fail to recognise the subtle signs of depression. Many among us also find it a challenge to differentiate when our patients feel upset from feeling depressed.”
“Sometimes in the ward, some patients start crying. That means they are depressed, ah, Macha? Easy, we refer to the Psychiatrist to come , assess and treat lah. The fellow looks sad, we just refer.”
“Don’t be a tube light, lah, dei! Assess first lah. Not every patient who cries is depressed and not everyone who is depressed cries in front of you”
“Mamoos… !!!!! Can’t take it like!!!!!! How lah, to know?”
“We can use the Malaysian Clinical Practice Guideline on Depression (2007) which is available online. A low mood over a period of two weeks, with anhedonia, low energy, loss of appetite and weight, poor sleep, not motivated are general signs. They feel hopeless and worthless. There are many other signs of depression. Go and read lah, Macha! It won’t take you long. Some of them have suicidal thoughts as well.”
“Can ask them, ah? What if they decide to commit suicide because we ask them? Better to make don’t no, right?”
“No, lah, nothing like that. You, ah! The heights, lah. They actually feel relieved when asked because it makes them realise that it is a common thought among people who are depressed. This makes them feel less guilty having these thoughts.”
“We tell them to pray lah then, be strong. These people don’t believe in prayers, I think.”
“Dei, thengah,! You doctor or priest, dei? Please don’t tell them that. Also it is not right for us to judge them. We are not in their shoes. It has nothing to do with a person’s inner strength. Nor is it a measure of their religious or spiritual faith. There are so many factors associated with depression. The family and social background, their coping skills, their experiences in life, hereditary factors are just examples of a few factors that can contribute to a person getting depressed. We must never be judgmental.
“Ok, ok Macha, cool… cool”
“No probs, Macha. Suicide risk assessment is also important . Doctors think only Psychiatrists must know how to assess the risk. Every doctor should know. Many chronic medical illnesses have Depression as their co-morbidity. Many medications can cause depression. When there is depression, the risk of suicide is always there. There is a Guideline on Suicide Risk Management in Hospitals (2014), available online. It is not just for the Psychiatrists. It is for all the doctors to read. If you are dealing with chronic illnesses, you must know this lah Macha.
“Ok, I will look it up. Many children are also depressed now, Macha. Sad, lah. How lah to detect?.”
“You are right. Childhood depression is on the rise. Children’s lives are now confined to the four walls, their books, school, tuition and of course their hand phones and laptops. Even when they go for games, they have to excel or they may be told off by the teachers or parents. Everything is a competition now days. Such high expectations are placed upon these tiny shoulders. Macha, you hardly see children running and playing outside freely, climbing trees or fishing in the big drains, now. Apart from the same general signs as adults, depression in children may also present with headache and stomachache which on investigation would be normal and not respond to medications. Their normal activities will be affected, school performance will deteriorate. There will be a loss of interest in their activities. They may be prone for anger out bursts and temper tantrums as well. Adolescents are also vulnerable to becoming depressed. The period of adolescence is a challenging and unsettling time for an individual. Expectations from parents, social pressures and unrealistic academic demands can create a strong sense of rejection and eventually lead to depression. It is quite normal to have an adolescent being grumpy. It is after all a period of change from childhood to adulthood involving physical, emotional, psychological and social changes. One must be careful to differentiate depression from the normal teenage ‘down in the dumps ‘ .
“A few months ago, we had an elderly gentleman with Chronic Renal Failure who tried to hang himself. His son saved him.”
“Yes, we tend to over look this age group. Being alone and having chronic physical illness further increase the incidence of depression and the risk of suicide. Many assume that a declining cognitive function is a normal process of aging. It is important to remember that elderly concerned could be suffering from either Depression or Dementia. “
“When do we use antidepressants and when do we use Psychotherapy?”
“Mild Depression can be managed with Psychotherapy like Cognitive Behaviour Therapy (CBT). Antidepressants should be started for Moderate and Severe Depression. When the patient starts feeling better Psychotherapy can be introduced.”
“What about ECT?”
“Electroconvulsive Therapy (ECT)is advocated when a patient is severely depressed to the point of endangering his or her life and is suicidal. ECT can be administered safely in pregnant mothers and the elderly.”
“Preventive measures are important, here, Macha. The economic burden of Depression is also going to escalate.”
“You are right on both accounts. Prevention is better than cure. The Ministry of Health (MOH) has implemented primary prevention programs which educate the public to live healthily, advice on coping skills, to exercise and indulge in healthy hobbies. In the Health clinics, measures are taken to reduce the incidence of post partum depression. Screening for depression is an integral part of the management for pregnant mothers who go for their antenatal check up. It is important to incorporate the teaching of coping skills in the education system as it’s an essential life skill. The disease burden takes a toll on the individual, the family and eventually the country. The healthcare cost for depression and loss of productivity as a result of depression is going to further increase. This is avoidable because Depression is treatable.”
“Why are so many depressed now?
“Simple dah Macha. In general, as human beings we have forgotten how to live. We have forgotten how to enjoy life. We have no time to stop and just take a breath. We are always in a rush. We go about chasing temporary happiness and we pass that culture onto our children, unconsciously. We have forgotten how to really laugh. I’ll give you a couple of examples, Macha. Many people feel that they need that big house or big car to make them happy. How long does that happiness last before they start wanting something else to make them happy? Some parents make their children feel that they need to get straight ‘As’ to be happy. These children feel that unless they get straight ‘As’ they won’t be loved. They get ‘As’, they are bought what they want. They don’t get ‘As’ they get scolding. Our values in life have changed and we are paying the price for it.”
“Wow, Macha! You are right lah. Something to think about”
“We going to have an exhibition in the Mall for the community to educate them in conjunction with the World Health Day.”
“You who dah! Give it like, Macha”
“So come lah and check the scene!”
“Aiyoh, dei, enoughlah about depression. I am going to take off on a holiday with my family and lepak. Hearing all this I feel stressed. ”
“Goodlah Macha. Spend time with your family and trusted friends. They are our support system. Let’s go kena one teh tarik. Need advice lah. I saw this laka cherry…”
“Mamoos!!!!! Now we are talking! Set it up,like. Let’s go!”
