​#destigmatisedepression

It was another busy OPD day during my final year residency in Psychiatry. Warden of MBBS undergraduate Boys hostel rushed into OPD with a student and a suicide note. On enquiry, the student had written the suicide note 3 months ago during exam and unfortunately his roommate found it later and reported it to the warden. Although the student was over the episode, the warden requested for evaluation. The student also agreed and the reason for the suicide note was a break up in love relationship. Break up, financial stressors, academic failures, illness of family members, entrance exams are some of the very stressful life events in any medicos’ life. During this marathon run to achieve academic feats, the physical and mental health is often neglected.

As a medical professional, knowledge and awareness about mental wellbeing and psychological problem is desirable as early identification of condition thereby saving morbidity and mortality. This year World Health Organisation celebrated theme of Depression Let’s Talk on 7th April 2017 emphasising importance of mental health in today’s era. The example quoted at the introduction is the best example of an alert warden, teacher, medical professional and friend who took consultation with mental health professional without keeping any stigma in mind. The stressor happened 3 months before but still he preferred to take professional help to prevent further mishaps. Let’s understand some myths and facts associated with depression…

  1. Myth: Depression occurs due to weakness in character can be managed with positive attitude and thoughts

Fact: Depression is a complex multifactorial brain disorder influenced by biopsychosocial factors. It is treatable with medical and psychological interventions depending on the severity of illness after detail evaluation by a psychiatrist.

  1. Myth: Talking about depression and suicide can make a person vulnerable to it.

Fact: A talk with supportive, empathetic, patient, non-judgemental listener friend, colleague, relative or therapist can be a primary first aid in to this brain disorder of depression. Ventilate your feelings if you are distressed and let others ventilate and listen when they are distressed!

  1. Myth 3: Antidepressants can damage your brain and make u addicted to it…

Fact: Any psychotropic medication when used judiciously in a right dose, duration and right indication is useful in treatment. Moderate to severe psychiatric conditions warrants use of biological treatments like medications, electroconvulsive therapy and transcranial direct stimulation. Biological treatments are lifesaving in severe conditions. Psychotropic medication take longer duration to act and a usual maintenance dose is given for 6- 9 months. Even celebrities have taken medical management for a duration up to 1 year.

  1. Myth 4: Psychiatrist use medicines and ‘shock treatment’ for every case of depression…

Fact: Psychiatrist and other mental health professionals use comprehensive biopsychosocial approach in diagnosis and treatment of psychiatric disorders.

Use of both biological and psychosocial intervention are equally important in management. Severity of the illness is going to determine the use of appropriate intervention. A change in the perspective is required e.g. same DC current is used in ICU and psychiatric department for treatment of cardiac and psychiatric conditions respectively. One used in psychiatry department is associated with stigma and the other is not!

  1. Myth 5: Talk therapy or counselling is not helpful in depression…

Fact: Counselling techniques like cognitive behaviour therapy and rational emotive behaviour therapy are as important as any biological treatment available today. Counselling techniques are scientific and evidence based and they help in modulating thoughts, behaviours and emotions.

    On a concluding note, friends we often neglect the topics related to psychiatry and mental health during MBBS e.g. limbic system in physiology, psychotropic in pharmacology or psychiatry in medicine. But the psychological problems are rising in epidemic proportions and this conditions are influencing every other existing chronic medical disorder e.g. Diabetes. So do not hesitate to talk about it or seek help wen in distress. Be alert and listen to patient in distress. Psychiatric disorders are treatable just like any other medical condition!

Depression And Suicide Facts In Medical Professionals

(Reference : Physician Suicide – Medscape)

  • Depression is at least as common in the medical profession as in the general population, affecting an estimated 12% of males and up to 19.5% of females.

  • Depression is even more common in medical students and residents, with 15-30% of them screening positive for depressive symptoms.

  • Physicians have a far higher suicide completion rate than the general public because of their greater knowledge of and better access to lethal means.

  • The most common psychiatric diagnoses among physicians who complete suicide are affective disorders (eg, depression and bipolar disease), alcoholism, and substance abuse.

  • The most common means of suicide by physicians are lethal medication overdoses and firearms.

  • Among physicians, risk for suicide increases when mental health conditions go unaddressed, and self-medication occurs as a way to address anxiety, insomnia or other distressing symptoms

  • (Published in Govt Medical College Miraj Magazine ‘Sushrut’ 2017)

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