Depression: What to know and how to support a friend
Anthony Bourdain, Kate Spade, Chester Bennington, Chris Cornell, Robin Williams...these personalities have all struggled with severe depression and sadly, succumbed to the illness in the end. We were all shocked by the sudden death of these stars, who seemed to have it all. Fame, money, and fortune. But that's the thing with depression, no matter what situation you're in or how significant life is or isn't, anyone can be afflicted by it.
We speak to a clinical psychologist at Sunway Medical Centre on what you should know about depression and how to support those going through this.
1) What causes depression? Why is it rising today?
Depression is a complex illness. No one knows exactly what causes it, but it can occur for a variety of reasons. Some people experience depression during a serious medical illness. Others may have depression due to continuing difficulties, such as long-term unemployment, isolation or loneliness, prolonged work stress, living in an abusive or conflicting relationship. Some have a family history of depression. Major events such as loss of a loved one, even good events such as starting a new job, getting married, or having a newborn baby can lead to depression.
Some of the reasons that depression is on the rise include an ageing population, increasing individualistic "me culture", and competitive lifestyles that rewards achievement and success where our identity and esteem become reflections of these external markers of achievement.
2) Is sadness and depression the same? What about anxiety?
Sadness is a normal human emotion, usually triggered by a difficult, hurtful, or disappointing experience. When our emotional hurt fades or when we gotten over the disappointment, our sadness diminishes. Depression on the other hand, is an abnormal emotional state that affects our thinking, emotions, and behaviours. Depression often occurs in the absence of triggers and we feel sad about everything.
It is a normal part of life to worry about major life events (like having a child, taking an exam, or buying a house), or have fears about certain things (like injections or heights). The distinction between normal worry and anxiety disorder is whether the anxiety symptoms are a proportional response to the sources of anxiety. Anxiety becomes a problem when it does not go away and get worse over time. It can interfere with daily activities like school, work and relationships.
3) Who is most affected by depression? Any stats on Malaysians?
Women are twice more likely than men to develop depression. While every age group is affected by depression, certain time of life, especially stress associated with change, can make someone more susceptible to depression. College years, raising children, divorce, retirement, major medical conditions increase the risk for depression symptoms. The prevalence of depression in Malaysia was estimated to be between 8 and 12 percent.
Women are twice more likely than men to develop depression
4) What is the treatment for depression?
There are a range of effective treatments and health professionals who can help you on the road to recovery. Psychological treatments can help identify thought and behaviour patterns, and improve coping skills, so that the person is better equipped to deal with life's stresses. It can help the person to recognise relationship patterns that make he/she more vulnerable to depression. It encourages the person to notice feelings of sadness and negative thinking patterns early on, and it supports his or her recovery.
Medical treatments, such as antidepressant medication, can be an effective intervention for treating the symptoms of depression, especially moderate to severe depression.
5) As caregivers, what should family members/friends be aware of when it comes to dealing with someone who is depressed? Can you give us some examples on what to/not to say?
✓ Listen without judgment. Give the person an opportunity to share their thoughts, feelings, and experience without judging or offering a solution. Tell them "I want to better understand what you're going through right now".
✓ Express empathy and encouragement. Let the person know you have an idea what they're feeling, it helps them feel understood and supported. Say something like "I am hearing how lost and broken you're feeling right now".
✓ Help them find resources. Connect the person with mental health professionals.
✗ Don't say "Be strong", "Be positive" or "Be grateful". Doing so will not make them feel better. It will likely make them feel weak and ashamed for feeling sad.
✗ Don't be afraid to ask if they're suicidal. It will not put the idea in their head or drive them to do it. Instead, it can encourage those who have been thinking about suicide to talk about it.
✗ Don't minimise what they're going through by telling them things like "Things aren't that bad. Some people have it worse" – this may make them feel misunderstood and frustrated.
6) Sometimes as a family member or friend, we are not aware of what's going on. Can you share with us the telltale signs of when someone is depressed/suicidal?
- Loss of interest in things that were previously pleasurable. The person may only do things that require the least amount of effort, such as watching TV, playing video games, surfing the web, and looking at smartphone.
- Withdrawing from social interaction. The person finds excuses to stay in the room all day.
- Changes in eating and sleeping routines. The person may eat a lot or no appetite at all. The person may sleep throughout the day or not being able to sleep.
- Easily irritated. The person takes things very personally and you feel like you're walking on eggshells around them.
- Suicidal ideas. The person makes statements like "I'm so tired of my life", "I wish I would never wake up again" or "I don't care if I live or die".
- Younger children who are depressed may avoid school or complain of feeling ill. Adolescents may become sulky and defiant.
Depression can arise suddenly and inexplicably, even when life seems to be going well
7) What are some common myths about depression?
That depression is not a real illness. But depression is not mere sadness, lack of willpower or weakness of character. It is extremely complex, which includes social, psychological, and biological origins.
You can't simply "snap out of depression". Depression is not a choice. It drains the energy that helps us deal with things.
You must have a reason to be depressed. Negative incidents such as losing a loved one, end of a relationship can raise your risk of depression. However, depression can arise suddenly and inexplicably, even when life seems to be going well.
8) Is there a link between social media and depression?
Psychological research shows that the use of multiple social media platforms is independently associated with symptoms of depression and anxiety. While everyone has problems, people rarely post negative events of their lives online. When we look through our friends' social media updates, we may think that our friends' lives are perfect and we are the only ones suffering. Social media often makes cyberbullying easier. Secrets and false information about someone can be shared online with little effort, reputations can be destroyed in a matter of hours, and the social fallout can push a person to commit suicide.
9) Where can a depressed person or caregiver find help?
Mental health professionals, such as psychiatrists, clinical psychologists, and counsellors, are available in many public and private hospitals, mental health clinics, private centres which provide psychological and counselling services, and NGOs. Counselling services are usually available through student services for university students. Public and private schools are often equipped with school counsellors. Crisis support helplines, such as Befrienders and LifeLine counselling service, are a phone call away. Depression support groups are available through mental health NGOs. Online platforms are also available for individuals to chat with qualified counsellors or clinical psychologists.
Read a personal account of someone who has been through depression to understand more about this complex illness.
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