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.