By Dr Aung Tun

 

DUE to the rapid changes and stresses of modern life, mental health prob­lems are on the rise in Myanmar. What was previously called “being down” or “low spirits” has now evolved into the more profound condition of Depression, a health issue that threatens everyone. This article will detail what De­pression is, its symptoms, causes, treatment, and, most importantly, prevention methods.

 

What is Depression?

Depression is a severe men­tal health disorder that affects the mind and body. It is more intense than ordinary sadness or low spirits and can hinder a person from carrying out normal daily activities. Symptoms persist for at least two weeks and impact mood, thoughts, and physical functions.

 

The key point to understand is that Depression is not a sign of mental weakness or a personal­ity flaw. It is a treatable medical illness related to an imbalance of chemical substances (Neuro­transmitters) in the brain and changes in the brain’s growth and connectivity patterns.

 

Global and Myanmar Prev­alence

• Global Situation:

* According to the World Health Organization (WHO), approx­imately 332 million people, including about 5 per cent of adults worldwide, suffer from depression, making it one of the leading causes of disability.

* More than 700,000 people com­mit suicide annually due to depression.

* Depression is about 1.5 times more common in women than in men. Globally, over 10 per cent of pregnant women and women who have recently giv­en birth suffer from depres­sion.

 

• Myanmar Situation:

Depression has become a significant health burden in My­anmar. The number of people suf­fering from depression has signifi­cantly increased due to social and economic instability, the lingering effects of the COVID-19 pandemic, conflict and quakes.

* According to Myanmar’s 2016 GSHS Survey, mental health problems exist among stu­dents aged 13–17.

* Feelings of Harm: Approx­imately 10.5 per cent of sur­veyed students reported having attempted to harm or kill themselves in the past 12 months.

* Loneliness: Approximately 11.3 per cent of students re­ported feeling lonely or seclud­ed in the past 12 months.

* Anxiety: Approximately 6.6 per cent of students reported having their normal sleep dis­rupted at night due to worry or anxiety in the past 12 months.

* These data indicate alarm­ing mental health conditions among adolescents in Myan­mar.

* However, due to limited men­tal health treatment services and the existence of stigma surrounding mental illness in the community, very few people seek treatment.

How to Recognize Depression

The symptoms of depression manifest as psychological, physi­cal, and behavioural changes.

 

Psychological Symptoms:

* Feeling sad, hopeless, or low-spirited on a daily basis.

* Loss of interest in previously enjoyable activities.

* Feelings of guilt or worthless­ness.

* Increased worry and anxiety.

* Difficulty concentrating or making decisions.

* Thoughts of self-harm or sui­cide (A very critical symptom).

 

Physical Symptoms:

* Feeling low on energy, easy fatigue.

* Changes in sleep patterns (in­somnia or excessive sleeping).

* Changes in appetite (loss of appetite, weight loss, or over­eating, weight gain).

* Physical pain such as head­aches or body aches.

* Decreased libido.

 

Behavioral Symptoms:

* Social withdrawal or isolation.

* Decline in work or academic performance.

* Neglecting self-care.

* Irritability and restlessness.

 

Why Does Depression Occur?

Depression is not caused by a sin­gle factor but often arises from a combination of biological, psychological, and socio-en­vironmental factors.

• Biological Causes:

* Brain Chemistry: Imbalances in neurotransmitters such as Serotonin, Norepinephrine, and Dopamine.

* Hormones: Thyroid hormone imbalances; hormonal chang­es during pregnancy and the postpartum period.

* Genetics: A higher risk for those with a family history of depression.

• Psychological and Socio-En­vironmental Causes:

* Childhood Experiences: Ne­glect, abuse, or parental loss in childhood.

* Adverse Life Events: Trau­matic experiences such as grief (loss), the loss of a loved one, financial difficulties, job loss, or marital problems.

* Chronic Illnesses: Increased stress due to illnesses like can­cer, heart disease, or diabetes.

* Medication and Substance Abuse: Side effects of certain medications, or the use of alcohol and illicit drugs, can contribute to depression.

Types of Depression

Based on the severity and pattern of the illness, depression is primarily classified into the fol­lowing types:

* Major Depressive Disorder (MDD): The most severe and common type. Characterized by a full set of symptoms last­ing for at least two consecutive weeks, significantly impairing daily functioning.

* Persistent Depressive Dis­order (PDD): A less severe or moderate form of depres­sion that lasts for at least two years.

* Psychotic Depression: In­cludes symptoms such as hal­lucinations or delusions.

* Depressive Episode of Bi­polar Mood Disorder: Alter­nating periods of mania and depression.

* Peripartum Depression: Oc­curs during pregnancy and up to the first year after childbirth (Requires special attention for maternal health).

* Seasonal Affective Disorder (SAD): Depression that spe­cifically occurs during the win­ter months with less daylight exposure.

* Disruptive Mood Dysreg­ulation Disorder: A type of depression in children and adolescents characterized by severe irritability and frequent angry outbursts.

 

How is Depression Diag­nosed?

Depression cannot be di­rectly identified by physical tests (eg, blood tests). The diagnosis involves the following steps:

* Medical History Interview: The doctor will ask detailed questions about your symp­toms, feelings, family history, current medications, and life experiences.

* Psychological Assessment: Standardized mental health questionnaires (eg, PHQ-9) may be used to assess the se­verity of symptoms.

* Physical Examination: Blood tests, etc., may be performed to rule out other medical con­ditions (eg, thyroid disease, vitamin deficiency) that could cause depressive symptoms.

 

The diagnosis requires at least five symptoms, present for at least two consecutive weeks, according to the DSM-5 (Diag­nostic and Statistical Manual of Mental Disorders) criteria. These symptoms must include either “sadness/depressed mood” or “loss of interest/pleasure.”

 

What are the Complications of Depression?

If left untreated, depression can severely affect all areas of life:

* Personal and Family Life: Marital problems, family con­flicts, and negative impact on children’s mental health.

* Work and Financial: Reduced work capacity, job loss, and financial difficulties.

* Health: Worsening of chron­ic diseases like heart disease and diabetes, and a weakened immune system.

* Social: Breakdown of friend­ships, social isolation.

* Self-Harm: Increased suicidal ideation and acts of self-harm (leading to loss of life).

It is crucial to be aware that depression is a life-threatening illness.

 

How Can Depression Be Treated?

Depression is a treatable illness. There are several treat­ment methods, and a combination approach is often needed depend­ing on the patient’s condition.

• Psychotherapy:

* Cognitive Behavioural Ther­apy (CBT): Focuses on chang­ing the thinking patterns that contribute to depression.

* Interpersonal Therapy (IPT): Focuses on resolving social and relationship prob­lems.

• Medication:

* Antidepressants: Types such as SSRIs (Selective Seroto­nin Reuptake Inhibitors) and SNRIs (Serotonin and Norepi­nephrine Reuptake Inhibitors) must be taken as prescribed by a doctor. The medication may take several weeks to show effect and must only be stopped after consultation with the doctor.

• Other Therapies:

* Electroconvulsive Therapy (ECT): An effective treatment for severe depression; con­ducted safely and systemati­cally in modern practice.

* Exercise: Regular physical activity promotes the release of mood-boosting chemicals in the brain.

* Nutrition: Consuming foods rich in Omega-3 fatty acids, Vitamin B, and Vitamin D.

 

How to Prevent Depression

Prevention is more effective than treatment. Depression can be prevented through the follow­ing methods:

* Improve Social Relation­ships: Maintain strong con­nections with family and friends. Avoid loneliness.

* Manage Stress: Practice yoga, meditation, and breath­ing exercises.

* Regular Physical Activity: Engage in at least 30 minutes of exercise, such as walking, daily.

* Healthy Sleep Pattern: Get 7-9 hours of sleep per night.

* Consume Nutritious Foods: Eat a balanced diet of fruits, vegetables, and protein.

* Avoid Alcohol and Illicit Drugs: These can worsen depression.

* Schedule Rest Time: Set aside time for self-care and enjoyable activities.

* Don’t Hesitate to Ask for Help: Consult a mental health professional if you have expe­rienced traumatic events.

 

Act Early to Overcome the Danger of Depression

Depression is an illness that can affect anyone; it is not a cause for shame or fear. If you or some­one close to you suspects they have symptoms of depression, follow the steps below to over­come this danger:

* Immediately see nearby healthcare professionals or a mental health doctor. Early treatment can prevent compli­cations and lead to a return to a happy and fulfilling life.

If you are personally experi­encing it:

* Share your feelings with some­one you trust. This method will benefit you.

* Continue engaging in enjoya­ble activities from your routine to distract yourself.

* Connect with friends and fam­ily members.

* Take a short walk or engage in regular physical activity.

* Try your best to maintain regular sleeping and eating patterns.

* Do not use alcohol or illicit drugs. They can worsen de­pression.

* If you feel suicidal, contact someone you trust and seek emergency help.

 

References

1. World Health Organization. (2017). Depression and Other Common Mental Disorders: Global Health Estimates.

2. American Psychiatric Asso­ciation. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edi­tion (DSM-5®).

3. Ministry of Health and Sports, Myanmar. (2019). National Mental Health Strategy 2019-2023.

4. National Institute of Mental Health (NIMH). (2022). De­pression.

5. World Health Organization. (2020). Psychological First Aid: Guide for Field Workers.

6. Myanmar Medical Council. (2021). Continuing Medical Education Materials on Psychiatry.

7. Global School-based Student Health Survey (GSHS). (2017). Myanmar 2016 GSHS Fact Sheet.

8. Journal of the American Academy of Child & Adoles­cent Psychiatry. (2019). Glob­al Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents: A Meta-analysis.