Getting help for depression is part of the treatment

Getting help for depression is part of the treatment

By Rikza Abdullah

JAKARTA (JP): The good news is that therapy is successful for
80 percent of people suffering from depression in the country who
seek help.

The bad is that only 30 percent of depressed individuals are
willing to seek therapy, said psychiatrist Irmansyah.

He said treatment involved psychiatrists exploring the causes
of the depression through observation and interviews before
making a decision on the best cure.

Mental depression, according to Carole Wade and Carol Tavris
in their book Psychology, consists of emotional, behavioral,
cognitive and physical changes. Depressed people generally report
despair and hopelessness. They are tearful and weepy, often for
no apparent reason. They often have morbid or suicidal thoughts
and they lose interest or pleasure in usual activities. They
exaggerate minor failings, ignore or discount positive events and
focus on negative experiences.

Depression is accompanied by physical changes as well.
Depressed people may stop eating or overeat, have difficulty
falling asleep or sleeping through the night, lose sexual desire,
have trouble concentrating and feel tired all the time. Some
sufferers have other physical reactions, such as inexplicable
pain or headache.

Irmansyah, who works at Cipto Mangunkusumo General Hospital,
said depression could be caused by biological, social-cultural or
cognitive factors.

Without any external reasons, an individual can suffer from
mental depression if there are biological or chemical changes in
the brain. Deficient production of one or both of two
neurotransmitters -- norepinephrine (noradrenaline) and serotonin
-- is believed to cause depression, while their excessive
production may cause mania, a mental state where the individual
is consumed by ambitions, plans and power.

Irmansyah said depression of a biological cause could be
diagnosed through the observation of the patient's sleep
conditions. A depressed individual usually had very short periods
of deep sleep.

When there are no apparent external factors, depression
sometimes is traced to a history of the condition in the
patient's family.

"One day, a 35-year-old woman came to our hospital for therapy
for her depression. As her living environment was so good, we
could not find any societal reason for her to feel depressed," he
said. "We concluded that her depression was caused by a
biological factor as soon as we knew that her parents were both
severe alcoholics and that some of her relatives had experienced
depressive episodes."

The depression could also be diagnosed by checking the
patient's hormonal composition, but the method was never used in
Indonesia due to its high cost.

Drastic changes in an individual's social or professional life
may also trigger depression. Losing political power, one's job,
bereavement and overwork can cause stress which over a prolonged
period may develop into depression.

Irmansyah told of a 76-year-old man, with no history of
psychological disorders, whose health suddenly declined one year
after his wife died. He frequently expressed his wish to kill
himself.

Sensitive

He said individuals who were overly sensitive emotionally, shy
and guarded were particularly vulnerable to depression,
especially when they were involved in personal conflicts,
divorce, professional disputes or financial difficulties.

Depression can also result from cognition or the way an
individual interprets a situation. Depressed individuals often
have a particular set of distorted thoughts that add fuel to
their negative feelings. They, for instance, do not observe their
own behavior or evaluate their own competence correctly. They
focus on their mistakes, not their successes. They compare
themselves unfavorably with others and they reject compliments
from other people as being irrelevant or false.

Irmansyah said depression caused by social-cultural and
cognitive factors, which were often accompanied by psychosomatic
symptoms, could usually be detected through a combination of
behavioral observation and interviews with the patients and their
families.

Besides those factors, consumption of certain drugs, such as
reservin, estrogen and progesterone, also sometimes caused mood
disorders or depression in some people. Tumors, bleeding or other
disorders of the brain could also cause depression.

Irmansyah said depressed patients, except those with previous
manic episodes, could be prescribed consume antidepressants such
as sertraline, fluoxetine, paroxetine and fluvoxamine if the
depressive symptoms were serious, particularly when the patients
showed a behavioral indication of endangering themselves or
others. Family members of seriously depressed individuals were
advised to take them to psychiatric hospitals, not to physicians
or psychologists.

Depressed patients who experienced manic episodes were not
allowed to consume antidepressants because they might trigger
mania or bipolar disorder (also called manic depression).

Antidepressants were generally effective after being consumed
for two weeks or three weeks and improvement in the patients'
mental health could be seen after six weeks. Complete therapy
usually took a minimum of six months but it might take years for
patients with chronic depression.

Besides consuming antidepressants, depressed patients also
needed psychological counseling and cognitive and behavioral
therapies. They also needed societal rehabilitation through
various social activities.

The director of the Islamic Psychiatric Hospital in East
Jakarta, Mohammad Muadz, said that besides such professional
treatments, his hospital also involved its patients in spiritual
development activities, like congregational prayers and
comprehending religious practices, to help improve their mental
health.

Some patients, after the improvement in their health, were
employed in the hospital as part of their rehabilitation.

Irmansyah said moral support of family members was important
for the improvement of patients' mental health during and after
the therapy.

"But family members should not be too deep in showing their
sympathy," he warned. "Research conducted by the National
Institute of Mental Health in the United States indicated that 40
percent of close relatives who were involved in the therapy of
depressed individuals also showed symptoms of depression."

The cases led to the erroneous conclusion that depression was
contagious, but it was the deep involvement in the patients'
emotional turmoil which was the main factor in the frustration
and depression of the family members.

Relatives may feel responsible for causing the depression, he
said. If the feelings are compounded by ones of helplessness at
not being able to assist the patient, they may end up having
suicidal thoughts of their own.