Saturday, March 16, 2013

One question I really would like to ask doctors/medical students/nurses in Malaysia; "How often do you see a patient coming in with depression as their presenting complaint"?

"Oh doctor, I can't stand it anymore. Everything is just not going the way it should be. I don't think I can take this any longer...."

I've seen that many times her in the UK, in the GP (GP is equivalent to Klinik Kesihatan in Malaysia).
And I feel like smacking the patient every time and tell her/him right on her/his face, "Life is not a bed of roses anyway, you gotta go through it like how people used to. Stop dwelling on your problem and sort it out yourself. Come on, pull yourself together!"

OK, maybe I won't smack the patient.
Maybe I'll just slam the desk.
Or maybe I'll just hit my forehead hard.
Or maybe I'll be nice and pat her hands and say everything in a nice, sweet and loving manner.

But the point is, I don't think Malaysia will have this much of depression cases.

It may be because our society does not acknowledge Depression as a medical illness. So our depressed people came in with somatic symptoms instead. "Oh doctor, my back kept aching. I don't know why. I've been putting ointments everyday"
"Oh doctor, my knee hurts"
"Oh doctor, my ankle hurts"

Maybe we do not have the "help seeking behaviour" as much as we are supposed to have.
So our depressed patients are left alone, not getting any help, left to commit suicide on their own.

Or may be, our society truly does not get depression as much.
Or may be, depression in this society has been overdiagnosed.
And in my honest opinion, I think the last two are the most likely.

I think depression is an illness of the modern society.
When expectations get too high, demands get ridiculously overwhelming, it is easy to be disappointed and frustrated. Not being able to cope with the failure or loss, or rough life, people sought for help.
I acknowledge it. But help does not come in the form of tablets and pills. Not in this case.

The society here KNOWS about antidepressants. They know antidepressants work.
Most Malaysians do not know that when you don't have energy to do anything; be it work, eat, or even getting out bed, tired all the time and you find no interest doing anything you used to enjoy or not finding the motivation to do anything, then you are suffering from "Depression".
Well, I didn't.
In fact, I only grasped this condition when I came here. I didn't even know much about it when I was in IMU. Or maybe I was dumb.
We may see that as lazy, unmotivated, sad or depressed but whatever that is, it is never a medical condition where you can get pills that will make you feel better in 3-4weeks time. So we deal with it. We started dealing with it even before it gets that bad.

And we still have good family support and religion, Alhamdulillah.

When someone in our family dies, we do bereave.
We do get sad.
I can imagine myself crying for days if something bad happened to my parents or siblings, or uncles or aunts or friends I'm close with, or anybody I'm close with for that matter.
But I know I'll still have other people who I can talk to and turn to. And if someone find themselves not having anyone to talk to, we can still talk to Him, the Almighty.

Rasulullah was sad too during the period where he lost his wife Khadijah and uncle, Abu Talib, the two beloved people of his life.
But Islam taught us to turn to Him in times of despair and joy, times of sadness and sorrow, times of rich and poor. And to accept loss and failure, joy or sorrow as not only a consequence to our actions but also as His destiny and test upon us.

So our society does not know about depression and antidepressants.
Hence we don't get hooked or dependent on it.

I know depression can get very bad.
People commit suicide from it.
They lost their personality, job and life because of it.
And that's why we'd want to catch them before it reaches that stage.
But that doesn't justify handing out antidepressants like candies to patients coming in feeling sad and low mood.
Isn't it better to prevent depression than treating it?
Isn't it better to hold family bonds stronger?
And I think one of the first steps is to stop sending elderly parents to care homes.
Take care of them in your own house, and you'll feel better. The children will see that their own parents are taking care of their grandparents and they'll take it as an obligation to take care of their parents.

Start having religion. Start having God.

And by the way, in my recent conversation with a Psychiatrist, he agreed that most "depressed" patients in GPs are not truly depressed. Antidepressants might have only a placebo effect on them.
And from this Psychiatry placement, I learnt that we can judge a patient's mood ourselves. We can use our own sense to decide whether or not this patient is really depressed. A patient coming in with full make up, blue eyelashes and green eyeshadows with flowery boots is most likely only mildly depressed, if at all. What more if the patient coming in looking bright.

-Because life is a test-