Tuesday, April 17, 2012

Depression? Oh, Grow Up!

Assalammualaikum :)

"Doc, I've been having a rough time lately.
It's all so bad I can't take it anymore. My kids are not performing well at school, and Wendy keeps falling sick. I have to constantly take leave to cater for her.

James not helping either. His company is retrenching so he is always working late, trying to prove his value to the company. All this is taking its toll on me. I feel low all the time"

And so, the GP will prescribe her low dose antidepressant (citalopram, yeayyy!!).

-not a true case, only adapted-

During my 8 weeks in GP placement (4 last year and 4 this year), I saw countless depression cases. There will be AT LEAST two or three cases in a day, either a follow up or a newly diagnosed depressed patient.

Every time before a patient walk in, the doctor will usually go thru the patient's medical record in the computer system, trying to recall who this patient is, and trying to figure out what might be the reason of his/her visit that day. And every time I saw "DEPRESSION" under the "Active Problems" heading, I became depressed. "Oh NOOOO!!! Another depression case! Get me out of here!!"

I am not sure if depression is not prevalent in Malaysia, or the society do not recognise it as a medical condition but I've never ever see neither hear anyone coming in to see the GP with depression or low mood as the chief complaint.

"Doktor, makcik tak sehat ni.. Makcik asyik sakit belakang, sakit lutut. Nk bangun dari katil pun susah. Makcik tau ni semua sebab makcik dah tua, makcik faham tu. Tapi ni, anak makcik tu kerja kt KL kaya raya, tapi jarangnye la hai nk dtg jenguk makcik ni. Tu ayam itik je la teman makcik. Pedih hati makcik ni doktor... Sedih memanjang, makan pun x lalu. Rindu dengan cucu2 makcik tu....
Makcik rasa makcik perlu ubat untuk gembira skit la doktor. Ada tak?"

Ahahaha.. Even imagining and typing the above dialogue out tickled me.
No, the conversation above never happened. No makcik does that.

In my country, people having a rough time with difficult lives either fall apart completely, or pull themselves back together after some time and brace through their lives, without the help of anti-depressants. They work to make ends meet without citalopram or sertraline.

Seeing the number of depression cases in the GP setting made me see the Western community as a weak, too dependent community. I am not sure how distorted is this view of mine, being an Asian myself. Are these people that dependent, or are their lives that miserable?

Then I got the chance to speak to a Russian GP. She was born, bred and trained in Russia before migrating to Britain decades ago. With thick Russian accent, she jumped at me when I asked if these depression cases she's seeing are true cases. She jumped because she felt the exact same way! She said in Russia, people pull themselves together and get through their lives independently. Life was a lot harder there, even I can imagine that. In Russia, no one comes to the GP for depression. They don't even come for coughs and colds.
Here in Britain, the people always need assurance, huggings, delicate sentences and the mushy2 motivations (quoted from her). They are soft and dependent.
And so she looked very delighted because I shared the same opinion with her, having come from a different culture. But I think I'm even more delighted to know that I am not the only person who think these depression cases I'm observing are merely weak people.

I do not deny that there are truly depressed people out there. But personally I do not believe in drugs and medicines to cure the depression. Medicines might treat Parkinson's or Huntingtons, but not depression. Depressed or happy results from your own response to the stimuli around you, not solely on the concentration of neurotransmitters in your brain.

To add to my agony, my main learning issue for this week's PBL is DEPRESSION. And I'm supposed to chair the discussion on DEPRESSION tomorrow. How on earth am I supposed to discuss DEPRESSION when I do not even see it as a true medical condition? It exists, but it doesn't exist. I can't really explain it. But uh, I can never be a psychiatrist. I'll always come to only two conclusions; either this patient in front of me is making up his stories, or he's mad.

Life is not a bed of roses.
Life's hard? Oh come on, grow up!

I wonder what does Psychiatry say about religion?
Can religion/supplication/meditation replace pharmacological anti-depressants?
The feeling of submitting oneself to a higher being, depending on Him, loving Him and be loved by Him, can that be an anti-depressant?
I wonder....

p/s: Aarrghhh!! I prefer studying cirrhosis, stomach ulcers, or even diarrhoea than depression.

-Because life is a test-

Just a random picture I found on FB. Let's laugh! Bcos laughter's the best medicine =)



  1. heyy, this is great! Intelligently spoken.. you make me wonder the same thing. could it also be a placebo? :D *wonder wonder*

    1. Hahaha...
      You mean a placebo will have the same effects as all the anti-depressants?
      Oh well, I'm sure they won't.
      Trials must have been done to see the efficacy of these drugs against placebo even after they are marketed.
      If they have the same effects then oh, those pharmaceutical companies must be making an awful lot of money!

      But still, I believe depression shd not be cured by pharmacological intervention. Despite having different mode of actions, these anti-depressants are centrally acting drugs, just like coccaine, amphetamines etc.
      Who will be depressed aft a dose of coccaine? Only the respiratory system will! Haha..

    2. Typo. "even BEFORE they were marketed" :)