Depression in Sri Lanka, taking pills or talking?


By Dr. Marcel de Roos


People sometimes say that they feel blue or depressed. It’s not something to be alarmed about; everybody has his moods once in a while. Such feelings can occur after losing your job, a loss of somebody dear to you, a setback or apparently without a reason. Usually these feelings dissolve after a while but with some people they persist. Their whole existence seems to be coloured by it. They don’t want to be involved in things, they have no energy or sense of joy and their outlook on life seems black. People who are in this mood for more than two weeks can be clinically depressed and should consult a doctor or a psychologist.

According to the World Health Organization (WHO), depression will be the second most important medical disease worldwide by the year 2020. Depression has a high lifetime prevalence (about 16%) and at its worst can lead to suicide.

In Sri Lanka depression is a leading disease. According to the WHO in 2006 almost 400,000 Sri Lankans experienced a serious mental disorder. In some areas depression was reported as high as a quarter of the population. Suicide rates in Sri Lanka are among the highest in the world according to a WHO report in 2008 (conservative estimate: 24 per 100,000).

Not every depression is the same. They vary from mild to severe, from a few to many symptoms. The intensity of the symptoms differs a lot too. Some well known and important forms of depression are:

Major depression. The two main symptoms are that people have a depressed mood and have no interest in activities for at least two weeks for most of the time almost every day. Futhermore they must have at least three more symptoms out of seven (for instance weight change, sleeping problems, thinking about death or suicide).

Bipolar depression. Some people have periods with depression as with manic periods which are coloured by much activity and energy (hence the name bipolar, two poles).

Post natal depression. About 10 – 20% of the women after giving birth develop a depression.

There is still a lot of uncertainty about the causes of depression. A few theories have been developed which until now haven’t been completely proven (they are partly hypothetical). Nowadays researchers agree that the origins of depression are multicausal: there are biological, genetic, psycho-social and personality aspects. Each of them can contribute in some form as a factor.

The most important question is of course to determine what the best strategy is to overcome a depression. When someone is suffering from a severe depression (with strong suicidal tendencies) it is clear that medication should play a major role, at least in the first stage of the therapy. In the case of mild or moderate depression psychotherapy should be the preferred method. With mild depression even jogging (three times a week) can help. There is an abundance of research that shows that with mild or moderate depression psychotherapy (or even taking a placebo drug!) has the same or better results than medication. This said, while many anti-depressives have an impressive list of side effects. Some of those are even worse than the ailment they are supposed to cure. In Sri Lanka psychology seems to be rather unknown. It is often confused with counselling, which is only a (limited) form of psychotherapy. A psychologist deals with the whole range of disorders and methods or therapies, not only counselling. Most people in Sri Lanka when faced with a depression almost automatically end up taking prescribed medicine. Psychologists are trained to try to discover the causes of depression and to help the patient to overcome and deal with it. Medication (while it can have its use in severe cases) only suppresses the emotions and doesn’t solve anything. This is one of the reasons why having therapy with a psychologist usually takes time, it is not a quick and superficial fix.

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