Depression, a common and serious medical illness, is one of the most debated mental health issue around the world. In Cambodia, the lack of understanding on this critical matter has contributed to the spread of misconceptions about depression. To give light to depression, executive director of Transcultural Psychosocial Organisation (TPO) Cambodia Dr Chhim Sotheara talks with Youth Today’s Ean Monileak and Borin Sopheavuthtey.
YT: What is depression? How can we recognise the symptoms of this mental illness?
Dr Sotheara: Depression is basically about loss. For example, loss of opportunity, loss of wealth, loss of employment, loss of relationships, loss of family, loss of loved ones, etc. Losing those things – big or small – makes the person overthink about the past and what he or she has lost. The victims suffer from regret and self-hate or self-blame. For instance, they blame themselves for not doing this or that and think of themselves as weak, bad, stupid, and useless; that’s why they face failures. They basically find excuses to blame themselves for things of the past that is, sometimes, not even important. At extreme case, the patients are hopeless and depressed to the point of committing suicide.
There are other symptoms to be noticed such as the loss of happiness, lost interest in the things they loved, and lost interest in doing anything. For example, the patients used to be cheerful and friendly, but now they lost their interest in socialising. They also lost interest in taking care of themselves. They don’t dress themselves properly, don’t comb their hair or do their hair properly, don’t shower, etc. They feel exhausted and they don’t want to do anything at all.
There are also other side effects on their body. They have a dead look on their faces, their movements are slow, and they struggle to speak. Their internal organs are also affected. For example, they might face constipation, insomnia, stomachache, etc. They also face obesity because of stress eating. They feel happy from having foods in their stomach and they think their exhaustion can be helped with foods. This overeating can also lead to diabetes and high blood pressure.
To simply put, depressed people are living in the past. Depression makes the patients think of themselves as useless and that it’s the end of the world.
YT: What makes people depressed?
Dr Sotheara: There are internal and external factors. Internal factor refers to the chemical “serotonin” inside our body that is responsible for our moods and feelings. For depressed individuals, the production of serotonin is decreasing. The decrease of serotonin in the brain makes the patients feel lost and depressed. External factors are stressors or psychosocial such as what pushes them to feel depressed – loss of employment – and sometimes, it’s their own mentality: pessimism.
YT: What age group suffers the most from depression?
Dr Sotheara: Statistically, I am not sure. But generally, those in the productive age – labour age – group suffer more. This age includes adolescents and adults, but not seniors. We haven’t done statistics for this, but we have more depressed patients in this age group. Usually in this age, we face a lot of challenges in life. Youth in Cambodia does not have many opportunities like in other countries where they get to work since grade 10 or so. They are able to find their own income and independence. But, Cambodian youth do not have the same opportunity. The transition from childhood to adulthood also brings different challenges such as love, employment, independence, school, finance, etc. With all these challenges, they risk having depression. For normal people, they get stronger after every challenge. But for some, they become depressed. The lack of proper mental services or support for youth also poses difficulty. Depression is a serious problem. World Health Organisation predicts that by 2020, suicide or mental illness will become the second cause of world mortality.
YT: How can we treat people with depression?
Dr Sotheara: Depression is treatable. Even if it’s not 100 percent cured, treatment can make it better for the patients to be able to function well in the society. There are three factors for treatment.
First, it is a biological treatment by taking antidepressant medication. The medicines help produce more serotonin. After taking antidepressants, the patients’ moods can be lifted. It can take at least one year for treatment if it’s the first time for the patients. However, if it relapses, it might take longer than that. Sometimes, it’s even a lifelong treatment.
Second, it’s a psychological treatment where we try to change the way the patients think. Some patients are pessimist; they always see the world in a bad light. The treatment will make the patients see the good in the world.
Third, it’s a social factor. The environment surrounds them make them depressed. For example, a dysfunctional family where the parents always fight or parents and children always fight. They don’t understand one another; thus, they can have depression. The treatment is therapy where we make the patients understand one another. It can be individual therapy, family therapy, or couple therapy.
Depression breaks the routine. It makes the patients not sleepy, not wanting to get up, not hungry, not energised, lost interest in things. For treatment, we encourage the patients to keep up with their routine. The patients have to have a proper time to sleep, to get up, to eat, to exercise, etc. They need to push themselves to do these things even if they feel exhausted. Keeping up with these daily routine and having treatment make it even faster for the patients to recover.
YT: Does depression have different types or levels?
Dr Sotheara: There are different levels of depression: mild, moderate, severe without psychotic symptoms, and severe with psychotic symptoms. Also, there are many other types of depression. One of the types I’ve observed is “smiling” depression. It’s a kind of highly functioning depression. Usually, depressed patients are sad and gloomy.
However, this type of depressed individuals appears to be “happy”. They are hiding behind their mask. It’s hard for us to catch that they are depressed because they appear to be functioning well like normal people. Only the patients know that they are depressed.
On the outside, they seem like everyone else, but on the inside they have depression. That’s why sometimes we see the news of celebrities committing suicide and we are shocked to see that. They have this kind of “smiling” depression that they hide from others. They try to be like normal people, but at the end, they fall victims to depression. Depression is a silent killer.
YT: There are many cases of young people using sharp objects to harm themselves. Is it related to depression?
Dr Sotheara: Depressed patients usually practice self-harm. They cut themselves. Society mistakes that as a side effect of drugs. But, they are not drug addicts. They are depressed. Inflicting pain makes them focus on the physical pain rather than the mental pain. But physical pain only lasts for a short time.
YT: How can we differentiate depression and sadness?
Dr Sotheara: There is a difference between depression and sadness. Everyone feels sad at some point in their lives, but it does not mean they all have depression. Those who have depression are hopeless, exhausted, and are losing interest in things for at least two weeks. It’s a consistent feeling. Sometimes, we mistake sadness for depression. Just feeling down for a few days does not mean you have depression.
YT: What are the common misconceptions about depression or mental illnesses?
Dr Sotheara: People lack knowledge on mental health. Even some doctors discriminate against mental health specialists. They think mental illness equals “crazy”. So, psychiatrists who work with those “crazy” patients are also crazy themselves. But now, things are getting a bit better. People start to understand more about depression and mental health. Mental illnesses do not mean “crazy”. A huge chunk of mental patients aren’t crazy. Only about 10 percent of mental patients are schizophrenics. Another misconception is that both the patient and the doctors mistake the symptoms of mental illnesses as general diseases such as stomachache or lung problems. Those symptoms are of anxiety and other mental disorders, but those patients do not get relevant treatments. Only when it cannot be treated at general hospitals that they come to psychiatrists.
YT: What are your tips for people with depression?
Dr Sotheara: You need to have a balanced lifestyle. Depression can be formed from your excessive obsession in something. For example, workaholic with no time for leisure can suffer from depression and other mental illnesses. Machines or computers need rest; we as humans also need rest. Also, we need to understand that mental illness isn’t that different from other illnesses. We shouldn’t be ashamed to have depression. If you know you have depression or other mental illness, you should seek professional help. Asking for help doesn’t mean you are weak; it means you are brave enough to find solutions to your problems.