We’re getting better at talking about mental health. Public figures have, in recent years, come forward to open up about their own experiences which, to some degree, has encouraged the rest of us to speak more freely about mental health issues. We’re still not quite there, though. Many find discussing mental health taboo, too complex, too difficult to define and so the danger that it gets swept back under the carpet is still very real.

With over a quarter of the world’s population being affected by mental health problems, it’s vital that dialogue continues and campaigns, such as World Mental Health Day on October 10, keep discussions alive. In light of this year’s theme – depression – we asked Dr. Méli Noël at IMC, Jelita, to explain its complexities and talk about the types of mental health issues she sees in the clinic.

Dr. Méli, what do we mean by ‘mental health’? What does the term cover?
Mental health is a broad term that includes someone’s emotional, psychological and social well-being. The state of our mental health affects how we think, feel and act. It influences how we handle daily stressors or major life events, how we relate to others, how we make decisions for ourselves or our loved ones. When we experience mental health issues our mood, way of thinking and behavior can be affected.

Mental health is influenced by many factors including lifestyle, including exercise, sleep, diet, alcohol, smoking and drug consumption; biochemical factors such as genes, brain chemistry, anemia or under functioning thyroid; and life stressors, which could be work, relationships, major trauma or bereavement.

How often do you see patients with mental health challenges in your clinic?
I find that as a general rule, people don’t like to talk to each other about mental health. Despite all the awareness efforts that have been focused on mental health in the past years, it is still very taboo. It shouldn’t be! Suffering from mental health issues is no more shameful or a sign of weakness than being diagnosed with diabetes or high blood pressure. Also, if everyone could be in the shoes of a family doctor for a day, they would see how common mental health issues are. They can affect everyone from children to the elderly and I would say that I see at least two to three patients per day who are currently struggling with or have had mental health issues in the past.

What are the most common mental health issues you see?
I would say that, in Singapore, the most common mental health issues that people come and see me for are depression and anxiety. The stress of relocating to a new country, often with being away from family and friends, changing job or having to stop working to follow our spouse, having to settle the kids in a new routine, can all take a toll on someone’s mental health. I also see a lot of teenagers with anxiety or depression triggered by intense pressure to perform in international schools, best friends leaving the country or bullying.

This year theme for World Mental Health Day is ‘depression’. What are the main symptoms of depression?
Everyone can experience days of feeling blue, whether it is because it’s been cloudy for a while, or because of missing loved ones who live halfway around the world, or without any identifiable cause. This is normal. Mood swings do happen and they can act as a useful little voice in our heads saying “it’s time to take care of myself a little better, to take some time to do things that I enjoy and be with the people that I love.” However, for some people, the mood just doesn’t swing back up. The days turn into weeks or months and this is when we start thinking about major depressive disorder, or clinical depression.

Depression is a disease. It is caused by changes in chemicals in the brain called ‘neurotransmitters’; it is not a choice and it does not mean you are weak, bad or going crazy. Depression is characterized by different symptoms that are present for at least two weeks and represent a change from how someone normally functions. Symptoms can include depressed mood for most of the day every day (feeling sad, empty or being tearful) and loss of interest in activities that you normally enjoy. There could be changes in appetite or sleep pattern (either insomnia or sleeping more than usual), or loss of energy and fatigue. There may be inappropriate feelings of guilt or worthlessness, difficulty thinking or concentrating and, in some cases, recurrent thoughts about death and suicide.

After diagnosis, what support is available for someone suffering from depression?
If you or a loved one has been diagnosed with depression, it is really important to maintain close contact and attend frequent follow ups with your family doctor. Family doctors are well equipped to support you and help you navigate the health care system while you are recovering. Sometimes just having an open chat with your family doctor can go a long way and we can give you useful lifestyle advice.

We can also carry out basic blood work to confirm or discard any physical cause behind the depression and even prescribe medication if it becomes apparent that it’s needed. In Singapore, we are very fortunate to have amazing psychologists and counselors that can help you and support you on your road to recovery. Again, your family doctor can help connect you with the right person. There are also psychiatrists that can help us navigate the more complex and severe cases or when we might not be sure of the correct diagnosis.

Is there a certain demographic that is more susceptible to depression?
First of all, we see twice as many women suffering from depression than men. However, this might be because more women actually seek help for their symptoms. People who have a close relative who suffers from depression are also more at risk of experiencing it themselves.

Other risk factors or potential triggers include having recently experienced a major life event, such as changing or losing a job, divorce, moving, death of a loved one or major medical diagnosis. Lack of social support, using drugs or alcohol in excess and having had depression in the past can also be contributing factors.

What is your advice to someone reading this article who thinks they, or a loved one, may be suffering from depression?
If you are experiencing some of the symptoms of depression and are wondering if that diagnosis could fit you, you should talk to your family doctor. We are a great first step on the road to recovery. If making an appointment with your doctor feels like a huge task, reach out to a loved one for help and ask them to bring you to the appointment.

Depression feels like it is untreatable and like it will never end, but it’s neither and there are many effective treatments. By seeking help, you are making the first step towards recovery and, eventually, happiness and contentment.

Vicky Fagan is Awareness Manager at IMC. Originally from the UK, Vicky has worked in marketing roles in London and Sydney before settling in Singapore. Dr. Méli Noël is based at IMC, Jelita. For more information about IMC, visit: www.imc-healthcare.com

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