CHASING THE BLUES
Mood disorders get their much-needed break from being laughed at in a state-of-the-art clinic
By Michelle B. Ciriacruz
Medical Writer
Filipinos laugh. In the face of danger and calamities, we are seen laughing or joking around.
We are proud of this propensity. We explain it as our way of coping with troubles, that laughing somehow eases the pain.
Truly, humor as a defense or coping mechanism has borne out many good results. But why is suicide, the irrevocable consummation of a depressed mind, such a daily item in the news then? Are we laughing less or are we laughing too much?
Blue jokers
Psychiatrist Ruby Manalastas says using humor as a defense is good, but if we laugh at problems "to dismiss them, to minimize and trivialize them," then it becomes a "dysfunctional defense." "We're in denial," she explains--and unable to address the problems properly, without which attention they worsen or persist.
Worldwide, depression is a major health concern, according to the World Health Organization (WHO). By 2020, it estimates that suicide would be the second leading cause of death in the world. In the "Global Burden of Disease" study the WHO commissioned, depression is the second leading cause of disability--equivalent to blindness or paraplegia--in developed countries. Statistics from the National Institutes of Mental Health in the United States validate this. The agency estimates that depression costs society billions of dollars every year in work time lost.
Though sadness is a normal reaction to certain situations, Manalastas explains, it becomes a mood problem already when it seriously interferes with work and relationship.
In depression, the neurotransmitters associated with mood--serotonin, norepinephrine, and dopamine--are dysregulated. Normally, when we start feeling depressed, we are able to bounce back to normal, but in people with depression, the sadness--or irritability--lasts too long (more than two weeks) and becomes accompanied with at least five out of these nine signs and symptoms: feelings of guilt or worthlessness, suicidal thoughts and actions, decreased interest, decreased ability to experience pleasure, social withdrawal, feeling lonely, fatigue, insomnia or hypersomnia, decreased appetite.
"They spiral down," Manalastas describes.
She cites the story of one of her patients, a young woman who has been suffering from severe depression since her elementary years--yet, who remained undiagnosed until recently. She has tried to commit suicide several times, by overdosing on pills and slashing her wrist.
The young woman claims she has no joy in life. She is listless, unable to do much anymore. She has lost interest even in eating, relates Manalastas.
"People suffer for a long time before they are diagnosed. Nobody should be depressed. Nobody should suffer from it because it is treatable," Manalastas laments.
Suicidal turn
The stigma associated with depression is primarily to blame for the limited access to mental-health care--"despite the availability of a wide range of evidence-based treatment with proven efficacy," she explains. Depression is seen as a weakness, best addressed by burying it with other activities, and unfortunately, only recognized when an attempt at suicide or a successful attempt takes place.
Besides a lack of awareness of the problem, a lack of familiarity with the forms of depression also hinders diagnosis and treatment, which harms the patient, Manalastas says.
It is estimated that 400 million people worldwide suffer from mental disorder. Yet, "for every four who seek health service, one is not diagnosed correctly and, therefore, not treated," notes Manalastas.
Among the different forms of mood disorders, suicide is highest in those with bipolar disorder, where mood swings from depression to extreme mania and back again--though it presents with the former 40 to 50 percent of the time, she relates. Mood stabilizers, like lithium carbonate, lamotrigine (Lamictal), olanzapine, risperidone, quetiapine, divalproex, and carbamazepine are the appropriate medications for it.
When the usual antidepressants are given, the balance of the disorder swings to mania, which creates another problem, she explains.
The disorder tends to develop into a malignant form--a rapid cycling of moods (as many as 10 a day), which could be resistant to treatment, notes Manalastas. Mania does not make patients more suicidal but makes them more impulsive, more ready to act out their thoughts.
Most--about 70 percent--unipolar depressed people will respond to antidepressants though. But it's important to be clear about the diagnosis, explains Manalastas. One episode of mania already qualifies for a diagnosis of bipolar disorder, she points out.
In the mood
Depression is also commonly present in a variety of medical conditions, often interfering with response to treatment and recovery, Manalastas relates.
There is overwhelming evidence, she says, that if there is depression during illness or following surgery, "rehabilitation and recovery is slow." The likelihood of a recurrence of a disease is also higher, she points out.
At St. Luke's Medical Center (SLMC), depression as a primary or comorbid condition is addressed through a structured referral system. Manalastas reveals that the mood clinic that SLMC just set up this month will take care of evaluation and treatment of all mood disorders brought to the hospital.
The goals of the clinic are to provide a comprehensive treatment approach to patients with mood disorders; create programs that will identify comorbid mood disorders in high-risk settings; serve as liaison with other mood-disorder programs; and generate research on mood disorders.
Intervention to be offered is both pharmacological and nonpharmacological--individual or group psychotherapy, use of biofeedback, and relaxation therapy.
Manalastas reveals that it is embarrassing for our country not to have incidence and prevalence data on mood disorders. We keep relying on foreign data, she says.
But to be able to adequately address the mental health of Filipinos, we need to be sure that treatment programs and policies are designed for the specific needs of Filipinos.
So besides being a state-of-the-art diagnosis and treatment center for mood disorders, the center will do research in an area that is sorely in need of awareness.
A happier turn of mind
The suicides being reported daily could just be the tip of the iceberg, as far as depression is concerned. It could be that, in this country, laughter serves to hide much.
How many times have another wretched creature scaled one of the city's billboards and tried-or succeeded--to jump from its heights, either alone or taking an innocent with him or her? And after the initial reaction of shock and disbelief to morbid fascination, how many times have we snickered away at the soap-opera-like choice of death of these suicides and media coverage of them?
"Nag-suicide
na nga, pinagtatawanan pa natin," Manalastas puts it so accurately. "Is this humor?" she questions.
Maybe, we laugh to disguise our fears, feelings of inadequacy, or our own indifference to the plight of others. Or maybe, we laugh from a vicarious sense of accomplishment, so maybe, we laugh because we are envious of someone who doesn't have to hide anymore.
The creation of a mood-disorder center is a huge step in the right direction, then, to allow Filipinos to let "laughing at problems" take a back seat for a while. Maybe, then we could get a good look at how big the mental health problems plaguing the country are.
Manalastas shares that, often, one has to go outside the country for one to recognize something that's staring us right in the face--and that we have been doing little about it while the problem gets worse.
Take the series of suicides here. "Suicidal [behavior] is a symptom of depression. It goes away when the depression goes away," she points out.
"Topak," "sira ulo," "may sayad"--these represent not the people with mental disorders but the prevailing mentality that prevents these people from being helped.
"Depression has nothing to do with the person," Manalastas stresses. "It is a condition that is treatable."
She hopes to spread this word around--so that more people can go on laughing--but in a way that's for the better.
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