Dr. Andrew Mohanraj

by Dato’ Dr Andrew Mohanraj Chandrasekaran 

Last year ,the world lost a wonderful comedian  in Robin Williams who committed suicide   after battling with depression . Ironically , while he brought so much joy into the lives of his fans ,he  suffered from agonising misery .

About 350 million people all over the world battle with depression every day of their lives bringing misery to their loved ones as well, yet many of us are in denial of this reality .

Depression remains  the main cause of suicide all over the world with one million people taking their own lives each year . In fact for every person who commits suicide, there are twenty more who make an unsuccessful attempt to end their lives. Indeed , what is this tragic entity called depression and why is it so painful  that people are willing to end  their lives just to escape from its’ pain ?

 SADNESS OR DEPRESSION?

Under adverse situations, like death of a relative, humiliation ,disappointment, or loss of social or financial status, a psychological reaction is expected, and is of course, normal. Over a period of time, one can get over this sadness. This is an “adaptive” response to an upsetting situation.

However in a  dysfunctional response, which means a prolongation of symptoms, usually for more than two weeks, can result in clinical depression.

A person suffering from depression may  suffer from   persistent low mood, loss of interest in pleasurable activities ( anhedonia ) , decreased energy, feelings of guilt or low self worth, disturbed sleep or appetite, and poor concentration.

Of these,  two significant symptoms are low mood and anhedonia. These symptoms can become chronic, leading to substantial impairment in an individual’s ability to take care of his or her every day responsibilities.

People who experience depression would often worry too much about the future and have negative thoughts about themselves and their circumstances.

Often, they experience irritability and agitation, and may complain of exhaustion and  may become  easily upset with those around them. Such irritability and  agitation are often made worse by poor sleep which a prominent feature in depression.

Depression can lead to individuals feeling trapped or hopeless about their situation, and suicidal thoughts are commonly experienced. In severe depression, these thoughts are often acted upon.

It   can also result from physical illnesses like cancer, diabetes and chronic pain. It can also co exist with other conditions like schizophrenia and illicit substance or  alcohol abuse.

Depression also can form one “pole” of a disorder known as Bipolar Mood Disorder . This condition is characterised by mood swings where during the “high ” phase , one displays increased  energy ,recklessness and elated mood but during the “low ” phase , can be depressed , withdrawn and suicidal.

DEPRESSION COULD BE MASKED

In some people as in the case of Robin Williams , depression could be masked. This is also known as “smiling depression”. People with this type of depression appear to carry on with life but inside them ,   they suffer from feelings of worthlessness , shame and self loath.

Not only Williams but many famous comedians have battled with depression yet projected a happy, bubbly public persona. Tragically , not many, including their dear ones knew that the smile that they wore was a sad smile. What is  worrying  about this kind of depression is that they may smile even more after making that decision to end their pain by suicide,  in anticipation of  death to that will “end” their  prolonged suffering.

CHEMICAL IMBALANCE OR MIND OVER MATTER?

It’s likely that with most instances of clinical depression, the production and transmission of certain chemicals in the brain called neurotransmitters is disrupted. These chemicals are serotonin, noradrenaline and dopamine. For example, a  decrease in the production of serotonin can cause low mood and suicidal thoughts. Therefore, for people suffering from depression , it is not a mood that one can “snap out of”. Besides abnormal functioning of chemicals in the brain, other factors like hereditary, stress and personality contribute to the development of depression.

ARE SOME PEOPLE MORE PRONE TO DEVELOP DEPRESSION COMPARED TO OTHERS?

Having a family history of depression does not mean that a person will necessarily develop depression, but it does mean that the risk of developing depression can be higher. There are also  other stressful life events, like failure in an examination, or a relationship breakdown, or even a chronic illness like cancer that may act as a trigger for the onset of a depressive episode. People can react differently to these triggers, and the onset of  depression can also be prevented to some extent if there are protective factors like good  family support and positive cultural values.

Some personality types are more likely to develop depression. There is evidence that people who experience high anxiety levels, are very sensitive to criticism, or those who have a perfectionist personality, have a higher risk of developing depression.

TREATING DEPRESSION

Psychological treatment or what is commonly known as ‘talking therapy” for mild depression may provide a supportive environment for a person to work through difficulties.

Mental health professionals like psychiatrists and clinical psychologists can help by providing skills and strategies to change negative thinking patterns and behaviours that contribute to depression.

Antidepressant medications, prescribed by psychiatrists, are drugs that help restore the brain’s chemical balance to improve mood and relieve other symptoms of depression.

In more severe depression, a combination of both antidepressant medication and psychological treatment has been shown to be most helpful.

If the depression is severe and debilitating, or if the urge to act out the suicidal thought becomes overwhelming, a brief stay in an inpatient setting might be extremely beneficial.

Depression is not something to be ashamed of, or something to feel guilty about. It is not a character flaw or a sign of weakness. With early detection and support from family and friends, certainly there is light at the end of the tunnel.