When you hit rock bottom

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By 2017-08-20

By Sanuj Hathurusinghe
Ceylon Today Features

When the grievous news of Chester Bennington's apparent suicide came to light, it shocked the whole fan base around the world including, if I may say so; myself. Bennington was known to have suffered from Depression and substance abuse for a long period before his eventual demise. Social media posts about the death of the Linkin Park lead singer were a mixed bag. Some were deeply grief-stricken, some were indifferent and had that 'so what?' vibe to it while some went to lengths to question why we should be worried about the death of some foreign celebrity who supposedly had been under 'Depression.'

We as a society would rather not talk about subjects such as suicide and depression. They are considered taboo. If a certain illness has a psychological element to it, we try our level best to conceal it. We don't talk about it and we consider it a shame. We ignore it, refuse to seek medical help and close our eyes and wish for it to be gone when we open them again. It's all the same in the case of Depression too. Well, it doesn't work that way. It needs to be addressed, examined, diagnosed and medicated in order to be overcome.

A disabling illness that needs to be addressed

While we ignorantly overlook Depression and let time cure everything, the illness has gone on to become one of the leading illnesses that eats away healthy years from one's life expectancy.

The World Health Organization (WHO) calculates a metric called Disability-Adjusted Life Year (DALY). One DALY can be thought of as one lost year of 'healthy' life. The sum of these DALYs across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.

WHO estimates that by 2020, Depression is to be the second most disabling illness worldwide after Ischemic Heart Disease. By 2030 it is predicted that Depression would become the most disabling illness worldwide.

Could happen to anybody


The DALY predictions reveal the potential dark side we never knew Depression possessed. To become such a burden of disease, Depression has to be more commonly occurring than we think it to be. "Depression is quite common worldwide. If you follow 100 persons from their life to death around 10 to 20% of them develop Depression at some point of their lives, according to research" says Senior Registrar in Psychiatry, National Institute of Mental Health (NIMH), Sri Lanka, Dr. Buddhika Abeyrathna.

As the numbers suggest, Depression is a common illness affecting people worldwide. If you feel persistently low for more than two weeks, have lost your appetite, find it difficult to sleep properly (you might be waking up earlier and find it difficult to fall asleep again or in rare cases, might be sleeping excessively), lose interest and fail to enjoy your work, feel lethargic and if pessimistic thoughts are hovering over in your mind, the chances are you too might be undergoing an episode of Depression. "In a Sri Lankan context quite a number of people complain of body aches and pains during a depressive episode as well." added Dr. Abeyrathna.

Risk factors of Depression

"Depression is caused by a combination of biological and psychosocial factors, a chemical imbalance in the brain and life stressors together contribute to a depressive episode. Life stressors might trigger the chemical imbalance but some people develop depression in the absence of any stressor at all" says Dr. Abeyrathna.

Dr. Abeyrathna went on to describe the manner of causation of Depression. Some people are genetically more vulnerable than others to develop Depression. If you have close blood relatives who have had Depression, your chances of having Depression increases.

Early childhood experiences such as parental separation, physical or sexual abuse, non-caring or over-protective parenting styles and so forth contribute to shaping adult personality traits. People with such bad experiences and subsequent personality traits are more prone to develop Depression later.

Depressive illnesses often follow stressful life events. If you are under continuous stress or having long-term social difficulties, you are more vulnerable to develop Depression.

Certain thinking patterns in people are contributory as well. Some people characteristically have recurrent and intrusive negative thoughts about self, the world and the future. Such persons have higher chances of developing Depression.

It has been observed that in the brain, certain chemicals called monoamines are in imbalance during a depressive illness. Monoamines include Serotonin, Dopamine and Noradrenaline. In some persons with Depression, certain hormones like Cortisol are observed to be higher in the blood.

The exact mechanisms of childhood experience, genes and stressors leading to brain chemical abnormalities are not yet known to science. The more risk factors you have, the higher the chances of getting depression.

Celebrities and Depression

Although it is not that much commonly heard of in Sri Lanka, celebrities committing suicide is rather frequent in the West. Some of the famous names we all must have heard of who have committed suicide are Ernest Hemingway, Marilyn Monroe, Kurt Cobain and Robin Williams. These celebrities were known to have suffered long from Depression among many other psychological issues before deciding to end their lives on their own terms. Are celebrities prone to have more risk factors than a normal layperson? Do artistic people suffer from higher levels of life stressors?

"There are two related conditions: Depressive Disorder and Bipolar Disorder. In Depressive Disorder you only get depressive episodes.

Those who have Bipolar Disorder get depressive episodes at one time and mania at other times. It is widely speculated that Bipolar Disorder is common among artistic people although there's no proven mechanism relating the two. Many great artists do well without any bipolar illness" explained Dr. Abeyrathna.
Vincent van Gogh is one of the most famous examples of a celebrity who had Bipolar Disorder. It is believed that Van Gogh used brighter and vibrant colours in his paintings during manic episodes and dull and melancholic colours during his depressive spells.

"Maybe it is more noticed among celebrities than in others as they are constantly under the spotlight or maybe they are undergoing a higher level of stress due to their life styles and celebrity status and are more vulnerable to develop Depression" added Dr. Abeyrathna.

Overcoming Depression

It is better to take medical assistance, preferably, from a psychiatrist, if the symptoms are there. Or one can simply go to the nearest OPD in a hospital where physicians are capable of directing a patient towards psychiatric help.

"When a person gets a first significant depressive episode, doctors start medicines and the patient usually gets better in a few weeks.

But doctors advise to continue medicines usually for about nine months to prevent any recurrence. Then doctors stop medicines and see if they get further episodes. If they don't get any further episodes they can forget about medicines and that's it. If one gets further episodes after stopping medication one would need to take medicines for longer times, probably for years. There's no general rule for the duration of treatment in such cases. It is decided on an individual basis, looking at the person's risk factors" explained Dr. Abeyrathna.

According to Dr. Abeyrathna, of all persons who develop a depressive episode, around 80% usually experience further episodes. It can be well controlled by medicine and psychotherapy such as Cognitive Behavioural Therapy (CBT) but there's no definite measure to prevent development of future depressive episodes in a person given its multi causal nature of origin. "A mild depression with a few symptoms for a few days might resolve itself on its own. People think of going to a doctor when the symptoms are really affecting their life and work. When people decide to go to doctors it's most probably moderate or severe Depression than a mild one" further added Dr. Abeyrathna.

Accounts of a depressed person

Ceylon Today had the opportunity of having a chat with an individual who is taking medicine for Depression. Supun* says that he wants to get the course of pills over with quickly and return to the life before. "No one bats an eyelash as long as you're not taking medicine. The moment you start taking medicine, people get concerned and some even start avoiding you after getting to know that you're taking antidepressants. Not the best of my friends though. They still talk to me normally but I have distanced myself a bit from them until the medication finishes. I was institutionalized for a while and to be honest, now I feel fine but the doctors advised me to take medicine for at least another six months. I just want to finish taking medicine and return as a certified normal person. Me and our group of friends, we hung out a lot, did good stuff and had a good thing going on. Hopefully we can start over afresh once I return" expressed Supun.

Letting it out helps

Despite taking medicine for Depression, Supun is an ordinary individual who runs a family business with his father. It is judgemental society that has forced the likes of Supun and many others to bottle up whatever the troubles they are facing. Depression is a health concern. Even Dr. Abeyrathna stressed the importance of not using the term 'mental illness' as it is deemed to be derogatory and discriminating.

Fortunately, there are places you can go to or call and pour your stressed heart out in complete anonymity, without being judged. 'Sumithrayo,' a government approved charity, is available 365 days of the year to provide Confidential Emotional Support for people who are experiencing feelings of distress or despair.

"Usually, we get about 25 to 30 calls, visits and emails a day. Our trained volunteers here have time to listen to whatever the troubles a person is having. We don't advice, criticize or judge but help the person to come to terms with the situation and feel comfortable to move forward. In some cases where we feel like the person needs medical advice, we ask their permission first and suggest three different medical contacts that are sure to help them. We maintain complete anonymity. Even the volunteers here work anonymously as Colombo is such a small place. Our hotline, 0112692909 is open for anyone and everyone" expressed a volunteer at Sumithrayo who talked to us.

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