Depression is a killer…

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It is the year end and a lot of changes have occurred in my life. The biggest perhaps is shifting homes again after 2 years being hidden in the middle of the city. I will miss my KL Tower view but to be fair, the view of this new high rise is mesmerising especially in the mornings. My heart is a lot calmer being away from the city centre although it is still near enough to get to the places I frequent often. Even the cats are enjoying this new found space and I find my fingers etching to write more things. But alas, only yesterday the cable guys sorted out my unit problem so only now we have connectivity.

Change…. when I was younger, I was always excited with change, but the drastic changes of my past life has sometimes made me think back and wonder how did I manage to survive. Some memories even seem so surreal that it may well be taken out from one of the fiction books that I use to dig myself into to escape the world, but the scars are real. As  I grow older I start to prefer stability in things and too much abrupt changes disrupts more than just my thoughts but also the liabilities around me. The biggest two are my two girls, whom I have been assuming the full time caretaker and financier for all these years. Now they are much grown and despite understanding more about life, the expenses that come are much much more. But it’s alright. God will never forsake. And I hold that closely to my heart.

Despite the economy taking a real slow turn this year end, I find myself in the midst of multiple opportunities and I have to sit back and start to process each and every one. All are good for earning, but being at where I am now, I have discovered that despite being multi talented, focusing on what you do best is still the best. Medical aesthetics is not just a field I’ve been in for a decade, but a passion and a talent. However, there is still a  lot of public reeducation that needs to be done. Yes, it is a super lucrative business, but to reach that certain level of skill and competency requires years of clinical training and experience that a lot of people including doctors try to shortcut.

Initially, I wanted to write about something else, but the recent news of the Korean pop singer committing suicide out of depression and loneliness, made me decide to talk about depression instead.

Depression is a real disease. Recently when I was addressing some pre retirement corporate on healthy ageing, I showed them the statistics on mental health where close to 50% of the numbers was depression. Imagine 1 in 3 people living in Malaysia has some form of mental illness (statistics 2015). And out of that approximate 2 million people, almost half are depressed. Based on the numbers we are worst than the US where they reported 1 in 5 people have mental illnesses.

Depression doesn’t only affect adults but also children and mostly it is related to income groups and family discord. This is why recently the Ministry of Education gave the directive to conduct the DASS (Depression, anxiety and stress score) test on school children, and my child was subjected to this test. Despite the good intention to identify children with stress, anxiety and depressive issues, the approach was totally wrong because no parental consent was taken, no proper prior counselling made and the worst part is that the student was given the scores which is completely against the whole procedure. The DASS score is a clinical tool to assess and must be done by a person who understands the procedure properly and not just some counselling teacher that perhaps only have limited experience in handling or understanding the consequences of test completely. Furthermore, there was no confidentiality and later found out that other student problems in the school was also spread by the counsellor to other people. I am still waiting for the appointment for the counsellor to meet me which at this rate, a formal complaint to MOE would issue since there was no effort from the school side to rectify the problem.

Dear Ministry of Education, you cannot simply pick a fancy test and expect it to be carried out properly by your staffs without the proper training to conduct the test. If used well, it can benefit the school and the student and the families but if it is done this way, more problems will ensue such as the student is being branded as highly stressed or depressed etc. It became a mockery among peers which adds more peer pressure on the student.

Coming back to depression, occasionally we do feel sad. Especially when there is a lost of loved ones, a separation, a major disaster, etc, which is a normal reaction. However, prolonged sadness that does not improve and leads to other symptoms such as social isolation, change in behaviour, sleep pattern and eating habits way beyond the normal grieving period may mean that you have depressive symptoms but a true diagnosis can only be made by a proper psychiatrist. General practice doctors like me can identify the symptoms, but at one point, if behaviour modifications and positive reinforcement does not work, we still need to refer the patient to the psychiatrist.

Going to a psychiatrist does not mean you are crazy, okay? The mental illness is just as severe as the bodily illness and they have ways and methods of  overcoming when the usual methods fail. They also have the authority of prescribing medication and long mcs if required that other doctors cannot touch. But most of the time, the treatment is talking. There is no harm going in for a consult, you may discover things about yourself you never knew.

So what to do if you are depressed? Depending on the level of depression, more moderate to severe depression requires professional help. However, a good insight in knowing that you have this problem and wanting to change is a good start if you want to try out lifestyle modifications.

These are a few things you can do to alleviate the feeling of depression:

  1. Identify the root cause of the depression and try to solve the problem. Understanding more about the depression helps so reading about symptoms and how to overcome is good.
  2. Exercise. Exercise has been shown to help reduce the feeling of depression because of the endorphins produced when you sweat. In fact, running has been associated with improved depression scores based on multiple studies. So if you are feeling down, hit the gym or take a run in the park.
  3. Social support. This is where friends come in play. Sometimes all you need is some crazy friends to cheer up your mood by doing all sorts of activities together. It eliminates feeling of loneliness and self unworthiness being in the company of other like minded people.
  4. Volunteer work. Some people do not have that many friends or not as sociable. Volunteer work in homes, or charities can actually help reduce the feeling of depression as it gives you a sense of being needed.
  5. Nutrition. Eating a well balanced diet is also a key to reduce depressive feelings. Although, most people would turn to high caloric sugary foods or comfort foods that may give you that sudden high, but once the sugar crashes, you will feel crappier than before. Certain foods actually help to reduce depression such as turkey, walnuts, salmon and other fatty fish, dark leafy greens such as kale, avocado, berries, mushrooms, onions, tomatoes, beans, seeds and grains and apples.
  6. Sleep. Sleep is really one of the main mood predicators for all humans. Lack of sleep will cause increase in irritability and emotional lability thus worsening depression symptoms. Try to get a good 6-9 hours sleep every day but not more than 11 hours for adults. Some people are able to sleep directly, whilst some people have broken sleep. As long as the hours are sufficient, you would be functioning just as well.
  7. Reduce stress. Make changes in your life that can help to reduce stress. For example, create a system to facilitate leaving the house for work every morning so that you leave on time and not forget anything, sleep at the same time every night or most nights, eat a more nutritious diet and avoid high sugary foods, get out of toxic relationships, pace your work and delegate where you can to reduce work overload, keep good friends who are positive around you and change unhealthy or unproductive habits such as impulse shopping or binge drinking.
  8. Talk. Sometimes the best therapy is just to talk and let it out. Find a good listener, someone who can listen and not judge. It can be a teacher, a doctor, a close friend or a relative. The good thing about talking is you feel a bit of relief sharing the burden, and that this other person also knows what you are going through and can help to pull you out when you sink in too deep.

The most important thing that you have to remember is that everyone goes through some form of depression at least once in their lives. It is not wrong to feel sad, but prolonged sadness and feeling down etches more towards the disease. Even if you have had depression before, you can always come out of it if you really put your mind to it or reach out for help when you feel that you cannot do it on your own. It is okay to ask for help. If anyone puts you down for being depressed, stay away from them. Keep yourself surrounded by people who are positive and understand what you are going through. Make an active decision to get out of depression. You will succeed, no matter how slow. But you can do it. Just need to have more faith in yourself, God and the people around you.

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