Mental Health 101: All You Need to Know About Depression
There is no health without mental health. Identify the different types of mental disorders and ways to seek treatment for yourself or a loved one.
Article contribution by Homage
More than the mere absence of mental disorders, mental health is a state of complete physical, mental, and social well-being. While most of us are able to cope with the normal stresses of life, work productively, contribute to our community, and realize our abilities, persons with mental health problems may find it difficult to do so.
This article will help you understand more about the various mental conditions and their symptoms, the treatment options available, and how you can support a person with a mental condition.
We all face bouts of sadness from time to time, but most of us take comfort in the fact that these feelings are temporary and that tough times will pass. However, for persons with depression, these feelings of sadness, hopelessness and worthlessness occur over prolonged periods and can be so crippling that it interferes with their day-to-day life.
Almost half a million people in Malaysia are found to be experiencing symptoms of depression, according to the 2019 National Health and Morbidity Survey (NHMS 2019).
We all face bouts of sadness from time to time, but most of us take comfort in the fact that these feelings are temporary and that tough times will pass. However, for persons with depression, these feelings of sadness, hopelessness, and worthlessness occur over prolonged periods and can be so crippling that it interferes with their day-to-day life.
If you experience five or more of the following symptoms for more than two weeks, it could be a possible indication of depressive disorder:
● Feeling sad, guilty or helpless
● Reduced sense of self-worth
● Insomnia or excessive sleeping
● Loss of interest in activities previously enjoyed
● Weight loss or gain; or decrease or increase in appetite
● Trouble concentrating, remembering details, and making decisions
● Digestive problems that persist even with treatment
● Physical aches, pains, headaches, or cramps that do not go away
● Suicidal thoughts or attempts
Types of Depression
Did you know that there is more than one type of depression? While some forms of depression such as Seasonal Affective Disorder (SAD) and Premenstrual Dysphoric Disorder (PMDD) are cyclic in nature, others tend to be short-termed, such as postpartum and situational depression.
Major Depressive Disorder
Major depressive disorder is a common mental health condition. It is characterised by feeling depressed and experiencing other symptoms of depression daily, for at least two weeks.
Persistent Depressive Disorder (PDD)
Also known as dysthymia, persistent depressive disorder (PDD) is a long-term form of depression. Its symptoms are similar to other forms of depression, including feelings of sadness, reduced self-esteem and loss of interest in daily activities, but they tend to last for years and can significantly impact our daily life. This form of depression can be hard to diagnose as its chronic nature may lead people to accept it as a part of their character and personality.
When depression is accompanied by some form of psychosis such as hallucination and delusion, it is considered psychotic depression. Psychotic depression often results in one being out of touch with reality, hearing voices, or having strange and illogical ideas related to depression such as feeling worthless.
Postpartum Depression (PPD)
Commonly known as baby blues, postpartum depression (PPD) is caused by the hormonal changes associated with pregnancy. PPD often occurs shortly after childbirth. While most mums experience mood changes, anxiety and irritability after giving birth, PPD symptoms are often more severe, ranging from a persistent lethargy and sadness that requires medical treatment to postpartum psychosis, a condition in which the mood episode is accompanied by confusion, hallucinations, or delusions. If left untreated, PPD can last for up to a year.
Premenstrual Dysphoric Disorder (PMDD)
Women commonly experience premenstrual syndrome (PMS) which includes irritability, fatigue, anxiety, moodiness, bloating, increased appetite, food cravings, aches, and breast tenderness. Similarly, those with Premenstrual Dysphoric Disorder (PMDD) experience the same few symptoms, but at a more severe and debilitating intensity. Oftentimes, symptoms subside a few days after the period starts.
Seasonal Affective Disorder (SAD)
As the name suggests, seasonal affective disorder (SAD) is cyclic in nature and often comes and goes with the changes in season. This form of depression is less common in Malaysia and tends to affect countries further from the equator, where the amount of sunlight varies enough to affect our normal circadian rhythm. For people with SAD, depressive symptoms tend to set in during winter and disappear by spring.
When we are stressed out, our body’s natural response is to feel fear or apprehension about what is to come. However, when these feelings of anxiety are extreme, last longer than six months, and interfere with our lives, it may be classified as an anxiety disorder.
Besides panic attacks, there are several common anxiety signs and symptoms to look out for.
● Feeling nervous, restless or tense
● A sense of impending doom, danger or panic
● An increased heart rate
● Hyperventilation or rapid breathing
● Increased or heavy sweating
● Weakness or lethargy
● Trouble concentrating or thinking about anything besides the present worry
● Having gastrointestinal problems such as gas, constipation or diarrhoea
● Having the urge to avoid anxiety triggers
Types of Anxiety
Generalised Anxiety Disorder (GAD)
A national survey in 2011 showed that 1.7% of Malaysianshad generalised anxiety disorder (GAD). This form of anxiety usually develops over time and is only noticed when it starts affecting day-to-day functioning. People with GAD tend to worry excessively about various issues, including health, money, family or work, even with no reasonable cause or trigger.
Social Anxiety Disorder
As its name suggests, people with social anxiety may feel excessively anxious and self-conscious in everyday social interactions. Some telltale signs include a fear of being watched or judged by others, or worrying excessively days or weeks before a social event.
Many of us may clam up when presenting in front of a crowd or feel dizzy when we look down from a high place, but did you know that these phobias are actually diagnosable? Individuals with phobias experience an extreme and irrational fear about a situation, living creature, place or object, sometimes to a point where we shape our lives to avoid the cause of terror. Oftentimes, we know that our phobia is irrational but are unable to control the fear it induces.
People with panic disorder experience repeated episodes of sudden feelings of intense anxiety, fear or terror that reach a peak within minutes. These episodes, called panic attacks, usually pass in 5-10 minutes but can linger for hours. With symptoms such as an increased heart rate, sweating, trembling, shortness of breath, chest pain, nausea, and feeling dizzy or faint, many people wind up in the emergency room as it may feel like a heart attack or stroke. If you have experienced panic attacks at least twice and constantly change your daily routine to prevent it from occurring, you may have panic disorder.
Obsessive-Compulsive Disorder (OCD)
People with obsessive-compulsive disorder (OCD) tend to have recurring and unwanted thoughts and impulses that drive them to do something repeatedly. While many of us perform repeated actions and have our routines, it does not disrupt but rather adds structure to our lives. However, those with OCD spend so much time performing those tasks that it gets in the way of important activities, and not doing those tasks can cause great distress. Many understand that the thoughts do not make sense but are unable to stop the compulsion.
Post-Traumatic Stress Disorder (PTSD)
Does time really heal all wounds? While many of us who experience traumatic events are eventually able to cope and adjust given time and self-care, others may have symptoms such as flashbacks, nightmares, severe anxiety and uncontrollable thoughts about the event that worsen over time instead. If those symptoms start affecting day-to-day functioning, it could be an indication of post-traumatic stress disorder (PTSD).
Taking illegal drugs and using alcohol, prescription medicine and other legal substances too much or in the wrong way constitutes substance abuse, and can be detrimental to our physical, spiritual and mental well-being.
Substance Abuse Symptoms
While the symptoms vary depending on the substances used, here are some of the common signs of substance abuse and addiction:
● Cycles of increased energy, restlessness and inability to sleep
● Abnormally slow movements, speech or reaction time, confusion and disorientation
● Suddenly weight loss or weight gain
● Cycles of excessive sleep
● Unexpected changes in clothing such as wearing long-sleeved shirts to hide scarring at injection sites
● Suspected drug paraphernalia such as unexplained pipes, roach clips or syringes
● Chronic troubles with sinusitis or nosebleeds (for snorted drugs)
● Persistent cough or bronchitis, leading to coughing up excessive mucus or blood (for smoked drugs)
● Progressive severe dental problems (especially for methamphetamine)
Types of Substance Abuse
Here is a list of commonly abused substances:
Alcohol affects everyone differently. However, drinking too much and too often can damage the liver, indicate an alcohol disorder, and cause other health problems. For males, heavy drinking means having more than four drinks a day or over fourteen a week; for females, drinking more than three a day or over seven a week constitutes heavy drinking.
Prescription and Over-The-Counter Medication
Drugs are often prescribed or obtained over-the-counter to help us tackle physical discomforts such as headaches and cough. While legal, these drugs can be dangerous when abused too. Taking medicines prescribed for someone else, taking incorrect doses of the drug or taking the drug for non-medical reasons indicates a possible addiction. Commonly abused drugs include opioid pain relievers, a medicine used to treat attention deficit hyperactivity disorder (ADHD), anxiety medication, as well as cough and cold medicine that contain dextromethorphan, which can make a person feel drunk or intoxicated when taken in high doses.
Besides being highly addictive, consuming illegal drugs can be dangerous and deadly. For example, heroin may lead to collapsed veins, increased risk of hepatitis and sexually transmitted diseases, lung diseases, miscarriages, and heart or skin infections. Meanwhile, cocaine speeds up your body and may cause a person to do illogical things. The recovery process is not easy, but with rehabilitation and a proper support structure in place, these addictions can be successfully treated.
While medicinal uses of marijuana are increasingly legalised, it is still illegal in Malaysia and many other places. Not everyone has the same experience with marijuana. While we often hear people describe their experience with marijuana as euphoric and relaxing, others may feel anxious, afraid or panicked instead. In fact, it may worsen the symptoms of existing mental disorders. In high doses, marijuana can also leave you feeling paranoid or make you lose touch with reality.
Mental health treatments often involve a multidisciplinary team of counselors, psychologists, psychiatrists, nurses, mental health aides and peer support professionals. Individuals respond to the various types of treatments differently, even if they have the same diagnosis. Here are some of the treatment options available for those battling mental conditions.
While medication does not cure the mental condition itself, it helps to manage the symptoms and may make other treatments such as psychotherapy more effective. Some examples include antidepressants, anti-anxiety, mood-stabilising and antipsychotic medications. The effectiveness of medication can vary depending on an individual’s situation and bodily response to it. Some medications may have side effects, but there are many ways to reduce it such as changing the dosage, changing the time of medication administration, or how you take the medication. However, make sure to consult your doctor before making any of these changes.
Also known as talk therapy, psychotherapy involves speaking about your condition and related issues with a mental health professional. Through dialogue, your therapist can help you better understand your condition, work through your problems, and learn new skills to cope with future challenges. Therefore, it is important to choose a therapist that you trust, feel comfortable speaking openly with and are confident that he or she is able to listen and understand what you have to say.
There are many types of psychotherapy. Most can be successfully completed in a few months, while others require long-term treatment. It can take place one-on-one, in a group or with family members.
Understandably, the stigma associated with getting help for psychological or behavioural concerns may hold you back from seeking help and going for therapy. However, psychotherapy can actually benefit everyone! Even people who are not diagnosed with mental health conditions, but are undergoing transitions in life such as a career shift can benefit from it too.
Hospital and Residential Treatment Programmes
In some cases, an individual may be voluntarily or involuntarily hospitalised as a result of their mental condition. This usually occurs when you are unable to care for yourself properly or are in immediate danger of harming yourself or others.
Psychiatric hospitalisation treatment consists of stabilisation, close monitoring, medication, administration of fluids and nutrition and other necessary emergency care. There are various options available, including 24-hour inpatient care, partial or day hospitalisation, or residential treatment, which offers a temporary supportive place to live. Outpatient treatment options are available as well.
In Malaysia, resident psychiatrists are available in all state hospitals and some large district hospitals. In these units in hospitals, outreach community psychiatric services are provided.
Brain Stimulation Therapy
If medication and psychotherapy do not help, some people may consider brain stimulation therapy. In most cases, the procedure will not require invasive surgery, but rather, uses magnetic pulses and electric currents to stimulate the brain. Individuals are usually able to leave the recovery room and resume normal activities within half an hour with minimal and temporary side effects if any at all.
Some of the procedures include electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), and deep brain stimulation (DBS). Of these, only VNS, mainly used to treat epilepsy, and DBS, commonly used to treat the physical symptoms of Parkinson’s Disease and OCD, require invasive surgery for surgical implantations.
How can I help someone with a mental condition?
One of the best ways to help a loved one battling a mental condition is to provide emotional support. Set time aside with no distractions and create an open and non-judgemental space for them to speak about the issues they face.
Let them lead the discussion and avoid putting pressure on them to share anything they may not be ready to talk about. Listen carefully to what they are sharing and repeat it back to them to assure them that you understand. While it may be good to ask questions from time to time, make sure to keep them open-ended. For example, rather than saying “I can see that you are feeling low”, ask “why don’t you tell me how you are feeling?” instead.
There are also apps out there that can help individuals with their mental conditions. One such app is Naluri, an outcome-based solution as an approach to mental resilience. Other apps that can help with mindfulness are Calm and Headspace.
Offer your help and provide them with information on where they can get help. If you believe that they are in immediate danger of harming themselves or others, you or they should contact a doctor or emergency helplines such as Malaysian Mental Health Association at 03-2780 6803 or Befrienders(KL: 03-7956 8145 (24 hours), Ipoh: 05-547 7933 (4 pm to 11 pm), Penang: 04-281 5161 (3 pm to midnight) or via email at email@example.com)
Caring for a loved one with mental conditions
Being the primary caregiver for a loved one living with a mental condition can be challenging. When the going gets tough, take a deep breath, be patient and understand that your loved one does not mean to be intentionally hurtful and that it is the condition that is causing them to act that way.
While you focus on helping your loved one, make sure to take care of your physical and mental health too. It is important to recognise and acknowledge the limits of what you can give, and reach out for help – for both you and your loved one – when necessary. After all, we cannot give what we don’t have.
Homage is a personal healthcare solution that connects caregivers, nurses and therapists with seniors that need on-demand holistic home care in their own homes, allowing them to recover and age with grace, control and dignity. You can find Homage Malaysia on Facebook at @homagecaremy and Instagram at @homagecare_my
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