DOWN IN THE DUMPS

Dr Maniam Thambu, a consultant psychiatrist of 26 years, shares with Dr Lim Poh Ann the facts and myths of depression.

What exactly is depression?

All of us feel the normal upswing and downswing of emotions every now and then when we’re under stress or experiencing a loss. These normal feelings are usually of short duration, and do not affect our ability to function in social roles, work or studies. The ‘depression’ I am referring to is an illness that is persistent, that causes physical and psychological symptoms of varying severity and affects the person’s ability to function socially or at work. The symptoms of depression include feelings of despondency, withdrawal, insomnia, loss of appetite and loss of interest in pleasurable activities. It is an illness that has potentially serious consequences such as suicide, heart disease and dementia.

How often do you see cases of depression in your practice? Who are the ones prone to this?

Depression is so common that I see it in my practice every day. Generally all groups — whatever age, sex or occupation — may develop depression but women are more vulnerable, being twice more likely to suffer from it. Depression often starts when people are young adults, though teens and older adults may also be afflicted.

What are some of the factors which cause/precipitate depression?

There is no single cause for depression. It is the result of the interaction of multiple factors. Predisposing factors include heredity, adverse childhood experiences (such as abuse) and certain personality types. Then in the presence of life stressors, such as loss, drugs or alcohol, which act as triggers, the illness starts. Biochemical imbalance in the brain and prolonged stress can aggravate the condition. 

Can faith and strong grounding in God’s Word help a person overcome depression?

In mild depression … ‘Yes’. A firm foundation in Scripture can instil healthy ways of thinking, and develop a healthy dependence and trust in God. Severe depression however, requires medical treatment. As is usually the case, as in diabetes, adherence to religious practices does not mean one can forego treatment. The problem is clinical depression often gets mistaken for normal mood swings and thus fails to get treatment early.

How do you manage patients with depression? Do church and family have a part to play?

In mild cases, cognitive behavioral therapy is useful to correct distorted and unhealthy thought patterns. In severe depression, however, medication is also needed. Obviously church and family have an important role. They need to be understanding, sensitive, supportive and quick to provide practical help. The church must not overload the person with duties that they cannot cope. Simplistic advice, such as ‘you must pray more’, ‘repent’ or ‘trust God more’ has often added to the frustration and misery of patients. Misguided advice such as ‘trust God and you won’t need to take medicine’ is harmful. It’s like telling a patient with a fractured bone, or diabetic complications, not to go for treatment but to just trust God.

When should we refer the depressed person to a psychiatrist? What are some of the danger signs to watch out for?

Whenever a person starts talking about wanting to die or finds life too much to bear, that is a warning sign. The depressed person shows suicidal intent when he suddenly writes a will, a farewell note, makes arrangements for his family or pets to be taken care of by others, or gives away his treasured possessions. For such individuals, psychiatric referral is urgently needed. I have come across a youth pastor who could not recognise severe depression in a young man. He continued giving religious counselling and the latter committed suicide.

How can we reduce the likelihood of depression occurring? How can we cultivate coping skills?

A lot of information is available on the Internet on how to cope, reduce stress, relax, how to solve problems and deal with one’s negative thoughts. Go to good websites (beware of rubbish sites). One site I often refer my patients to is this: www.moodgym.anu.edu.au Also check out “Beyond blue” or the NAMI website from the US.

Dr Maniam Thambu is a Consultant Psychiatrist and Professor at UKM Medical Centre, Kuala Lumpur.


 The above article was first published in Asian Beacon magazine, Oct 2011, issue 43.5.