Mental health expert and psychiatrist Dr. Paul Lee of Manila Doctors Hospital and Philippine Children’s Medical Center offers practical strategies to maintain a healthy emotional and mental health to prevent depression from setting in. Prompt recognition and treatment of this mental state is also essential to prevent more serious complications.
Major depression is the number four cause of disability among the diseases worldwide (cardiovascular disease is number one). But by 2020, depression is projected to be the number two cause of disability because of a fast-paced life, difficulties of living, and instability of people (migration for work and other reasons), according to a noted Filipino psychiatrist.
Dr. Lee said that while there’s already a lesser stigma when it comes to treating the said illness in Metro Manila, in general, there’s still a stigma for mental illnesses in the Philippines.
“If you go to a psychiatrist, they’ll always say you’re crazy, which is not true. The patients you see here (probably saw some maybe the crazy ones) are the schizophrenic patients, which are only 10 percent,” said Dr. Lee
Statistics show that 1 percent of the population are schizophrenic while the incidence of mood/bipolar disorder is higher with a spectrum of bipolar disorder going as high as 8 percent of the population.
Dr. Lee explained that everybody experiences stress and have a way of coping in a healthy way, but when it is already affecting how one functions, it can already be considered a disorder.
“If you’re not stressed sometimes, you’re not stimulated. But there’s a certain level of stress and if it’s too much, it can cause certain symptoms like you’re getting nervous, anxious. When you become anxious and you cannot function well, then you have a problem. If he’s a worker, he cannot function at work or in his occupation. If he’s a student, he cannot function at school so it becomes a disorder,” said Dr. Lee.
He revealed that depression, mood disorder like bipolar disorder, and schizophrenia have genetic basis or familial history. If a couple has a family history of mental illnesses or they have a relative who has one, their offsprings are 50 percent most likely to have them also (schizophrenia).
“Now even anxiety disorder or nervousness already have predisposition. But the other one is childhood development, how you were treated as a child. So if you’re an abused child, you have a higher risk of certain conditions like anxiety and depression. In fact there are studies that show that if you lose a parent before the age of 10, you have a higher risk of having depression,” said Dr. Lee.
Dr. Lee described depressed mood as the feeling of loneliness and hopelessness. There are also vegetative symptoms like difficulty in sleeping or eating. Then there’s psychomotor retardation or slowing, difficulty in concentration or thinking, indecisiveness (e.g. when picking clothes). Suicidal ideations, tendencies, or act (slashing of wrist usually caused by depression) and sexual dysfunctions are also signs of depression.
“For extreme cases of going crazy (nagwawala), first you think they’re on drugs or alcohol (there’s a predisposition that you’ll be disinhibited). But if the manifestation is impulsivity, aggressive behavior (engaging in fights), we think of bipolar disease.”
Prevention and treatment
When treating a patient with depression, doctors usually have to diagnose him first.
“Diagnosing this condition (depression), the treatment is two-fold. Medication if you don’t know there’s an abnormal level of neurochemical in the brain. One is called serotonin and norepinephrine. Usually, neurochemicals decreases in the brain so you give medication to increase the reuptake. Reuptake is another word for excretion (labas). So you block it to increase the neurochemical secretion,” explained Dr. Lee.
Dr. Lee clarified that depression is not psychosis. Psychosis is loss of contact with reality (e.g. schizophrenia). Patients with depression and anxiety disorder (e.g. panic attack) are more likely to see a doctor, even those with generalized anxiety disorder, but patients with personality disorder won’t because they think they’re not sick.
“Here in Metro Manila, people are already very intelligent. They search the internet especially young people (ages 20-30 years old and below) and they just walk-in. I ask them how they learned about me and they say through the Internet. I don’t know what’s in there about me, maybe because of the association or hospitals,” said Dr. Lee.
In some cases, it is the friends or relatives who notice when the person starts becoming distant or he’s constantly locking himself inside a room so they’ll be the one to bring him to the doctor. One wouldn’t know person with paranoid personality disorder unless he regularly engages in a fight and has already been sent to the police.
When treating depressed patients, Dr. Lee said they use psychotherapy to find out the conflict within the patients and why he/she developed depression.
“For instance, if a patient had a lonely childhood because of his parents’ separation, he becomes depressed most of the time. So I tell him, ‘You know, not because you had a lonely childhood, you should become hopeless’.”
Psychiatrists help a patient to recondition his thinking, through cognitive behavioral therapy or CBT. They also use the psychotherapy technique, a supportive counseling, where they talk to the patient or use environmental manipulation. Length of counseling sessions depends on the severity of the problem.
“Like if he says, ‘I’m useless. I’m so lousy. I’m poor. I’m not intelligent’ – which are signs of a very low self-esteem, I tell them, ‘You graduated valedictorian. Why are you saying you’re not intelligent?’ We devise a way to decondition that thinking. We change that kind of thinking,” said Dr. Lee.
Technology vs family
But over and above the professional or medical help, Dr. Lee said that having a very good emotional system – a family is still the best way to maintain healthy emotional and mental health, but it has to be a positive familial relationship.
“There are disintegrated families. So it has to be a positive familial relationship. Family therapy can also help,” he said.
Dr. Lee revealed that technology can make a patient more depressed as it can lessen the sense of belongingness and supportive environment like the family.
“There’s positive and negative points [in technology], but the way of caring is already different. You are always alone and tend to withdraw. When you have a problem, it’s very difficult to find your loved one.”
Mental illness is a serious medical condition that has to be treated like any other illnesses. As Hollywood actress Jennifer Lawrence, during her 2013 Oscar win for Silver Linings Playbook, puts it, “It’ so bizarre how, in this world, if you have asthma, you take asthma medicine; if you have diabetes, you take diabetes medicine. But, as soon as you have to take medication for your mind, there’s such a stigma behind it. I don’t think we’re going to stop until we get rid of the stigma for mental illness.”
In the said film, Lawrence played Tiffany, a troubled girl, who met former teacher, Pat (Bradley Cooper) who recently returned to his family after a stint in a mental institution. The film about finding love amidst mental illness won four Oscars, 58 other awards, and 77 nominations.
Originally published in Health and Lifestyle magazine January 2014 with minor edits