Depression rises as crisis drags on

Feeling blue? In a funk? Join the crowd -- many people are feeling the stress of living in uncertain times. For some, it can mean a bout of severe depression.The Jakarta Post's Rikza Abdullah looks at the causes of the condition, its treatment and what you can do to keep out of the doldrums.

JAKARTA (JP): Businesswoman "Ina" came to Cipto Mangunkusmo General Hospital (RSCM) in Central Jakarta complaining of chronic migraines.

But doctors found it was not a textbook case of prescribing a couple of aspirins and having her call them in the morning.

They were nonplussed when laboratory tests came up empty; eventually the 39 year old was referred to the hospital's psychiatric department.

It was only through a series of interviews that the cause of the woman's troubles -- depression -- surfaced.

"We found out that she always became nervous when she received a phone call from her husband or a staff member from the office," RSCM psychiatrist Irmansyah said. "After developing our interview from that point, we discovered that she felt extremely depressed by the low education of her husband and the failure of his business.

"The psychosomatic symptoms occurred because she couldn't complain to anyone else about her psychological stress."

Ina is one of the many who suffer from overwhelming feelings of sadness, dejection and listlessness which add up to depression. It's a human condition known throughout time, but now it is increasingly striking the ranks of the country's business executives during the economic crisis.

Indonesians are not alone. Depression in the workplace is now the second most disabling disease for workers after heart disease, an International Labor Organization survey of workers in Britain, the United States, Germany, Finland and Poland found.

One in 10 workers is suffering from depression, anxiety, stress or burnout, the survey, released on Tuesday in conjunction with World Mental Health Day, said.

It costs a major price tag, too, with stressed-out workers falling sick or being too depressed to drag themselves out of bed to go to work.

For Indonesians, there has been the double blow of the crisis -- with pink slips landing on desks across the country -- and the fits and starts on the road to democracy after 32 years under Soeharto.

Abu Ardi, who says repeatedly that he would like to go insane for a month, is one of the new victims of depression.

The 45 year old had reason to be feeling down after his joint venture company suffered huge foreign exchange losses in the crisis. He began to suffer from fitful sleep as his worries mounted, taking sleeping pills before getting help for his problem.

Psychiatrist Muhammad Muadz, director of the Islamic Psychiatric Hospital in Malaka Jaya, East Jakarta, said the number of patients visiting his hospital increased following the onset of the crisis.

"Most of the patients initially complain of physical illnesses, but we later find out that they have no problems with their physical organs and their pain is caused by psychological problems," he said.

Medical internist Lukman Ali Husin of the state Persahabatan Hospital in Rawamangun, East Jakarta, said more than half of patients complaining of hypertension, migraines, dyspepsia, asthma and eczema were experiencing psychological problems, such as stress or depression.

The problem is that sufferers, either through shame or ignorance, do not seek out the help they need.

"But I'm concerned that most Indonesians are still not aware about such mental illness and many sufferers of major depression don't think about the importance of looking for help for the treatment of their illness," Irmansyah said.

Severe depression often results in psychosomatic symptoms, such as migraines, hypertension, asthma and digestive problems, and sufferers often tend to first visit physicians, who then prescribe drug treatment for the physical complaints.

It is only after the drugs fail to help that physicians wake up to the possibility of a psychological cause and refer them to psychiatrists, by which time the depression is likely to have worsened.

RSCM's psychiatric department treats about 40 out-patients daily, most of them referred by physicians.

Acceptable

Of course, it's easier for many people to admit physical illness -- and gain sympathy -- than own up to emotional problems, which might be construed by others as indicating weakness.

The problem is that being unable to vent one's feelings can exacerbate depression.

Depression can hit people of all ages, social, ethnic and racial groups. Women, however, are two times more likely to develop depression than men, according to Frank Bruno in Overcoming Depression. About 15 percent of women and 8 percent of men will battle depression for a "significant" period of their lives. At certain points during their lives, about 6 percent of women and 3 percent of men will experience depression, Bruno said.

Irmansyah believed the figure was likely to be higher today because life expectancy was longer, the prevalence of chronic diseases was on the rise and there was also greater consumption of depressive drugs, like reserpin, corticosteroid, contraceptive pills and major tranquilizers.

Experts say it is often up to the individual to recognize if depression in its early stages. Depression may be indicated by feelings of intense sadness over an extended period (more than two weeks), loss of interest in hobbies, difficulties in sleeping, feelings of guilt, loss of appetite, poor concentration and reluctance to make decisions. Physical symptoms can include digestive illnesses or changes in blood pressure.

If the depression becomes more serious and is left untreated, people may become suicidal.

The chairman of the Indonesian Psychiatric Association, Sasanto Wibisono, said an individual who was at the initial stage of depression could go to the private office of a psychiatrist or a clinical psychologist for psychological consultation.

If the depression was serious, they should visit clinics or hospitals for comprehensive treatment, he said.