By Nickky Faustine P. De Guzman

Joey de Leon may have made his apology, but discussions about depression should not end with a “sorry.” Rather, there should be a series of more engaging talks about this “disorder of emotion” until fewer and fewer Robin Williams, Chester Benningtons, and Helena Belmontes claim their own lives, and more Joey de Leons understand that depression is real.

Manila Medical hospital’s Tomas Bautista MD, a psychiatrist, said at a press conference on Oct. 19 that it is not surprising for someone like Joey de Leon to make incorrect, even insensitive, statements because depression is a highly stigmatized and misunderstood disease.

“It’s a wakeup call. Persons like Joey de Leon, whom we thought is educated, turns out to be ignorant of depression. Kasalanan ba ni Joey ’yun (Is that Joey’s fault)?,” he said.

Dr. Bautista said the word “depression” means two things.

One is a bad feeling that we get from loss, defeat, and frustration. “In this sense, every person can get depression because it happens when you did not get what you want. Something happened that you did not expect. You lost somebody. May stages ang grieving. The end part of grieving is depression, and then acceptance,” he said. This type of depression eventually eases with time.

The other kind of depression is a feeling that lingers for more than two years. This persistent and recurring feeling of sadness is called pathological depression, an illness of the brain and a disorder of emotion in the deep part of our unconscious minds. Pathological depression can last for weeks, years, and sometimes, a lifetime. If untreated, it can lead to suicide.

“Pathological depression is severe, persistent, and recurring,” said Mr. Bautista.

The symptoms of pathological depression go beyond the feeling of sadness, but include the following:

• losing interest in life

• changes in diet and sleep patterns

• psychomotor agitation or retardation

• lack of focus

• pessimism

• feelings of worthlessness

• having suicidal thoughts to end the misery

The causes of pathological depression are not clear, although experts say it is a combination of internal, external, and genetic factors. Depression may be 40% genetics and 60% environment triggered.

Citing the World Health Organization (WHO) in his presentation, Dr. Bautista said depression affects 322 million people worldwide, with the greatest number coming from the Southeast Asian region (85.67 million) followed by the Western Pacific region (66.21 million), Eastern Mediterranean Region (52.98 million), Region of the Americas (48.16 million), European Region (40.27 million), and African Region (29.19 million).

Dr. Bautista said it could be that more Asians are depressed because the people from our region value their families, are very emotional, have the concept of hiya (shame or disgrace), are very competitive, and have perfectionist cultures.

Although depression knows no age, political party, gender preference, or background, the chances of developing depression increase if one is experiencing grief from a loved one’s death or from heartbreak, suffering a physical illness, having problems with alcohol and drug abuse, are poor economically, and are unemployed.

The 2015 WHO report said the 78% of global deaths due to depression occurred in low and middle income nations.

Poorer people are more likely to be stressed because of undernourishment. When one is deprived of nutrition, the brain receptors, which send signals to the brain that we need to be happy and energetic, do not function, said Dr. Baustista.

“If you grow malnourished, how could you be exposed to some stimulus that could make you happy? If you are malnourished, you do not have enough boats in your brain to make you happy,” said Mr. Baustista.

Boats are his metaphor for the neurons that send messages to our brains to be happy. The boats carry with them messages or serotonin, the “happy” chemical, toward the ports in our brains to signal that “today is a happy day, you should smile.”

“If you’re used to being criticized, the brain will stay inactive and will not be reactive in the happy events happening around you. While there are people who are born with less serotonin, if you are a neglected child, or isolated, [you are prone to depression because] you do not grow enough ports because you lack the stimuli to make you happy. ’Yung mga depressed kaunti lang ang happy chemicals nila, or ’yung ports na dinadaanan para maging happy sila (The depressed have litttle happy chemicals or ports for them to go to so they can be happy). So the tendency is you will grow up depressed without even knowing what happiness is,” he said.

Besides medication (anti-depressants, mood stabilizers, and anti-psychotics) and psychotherapy, a change in lifestyle can also help significantly. A healthier diet, regular exercise, more sleep, and work-life balance contribute to the easing of the symptoms. Exercise and meditation can produce other happy chemicals like endorphins that encourage more boats and ports in our brains to signal that we should be in good spirits.

The 2017 WHO report said depression is ranked as the single largest contributor to global disability and the major contributor to suicide deaths — close to 800,000 deaths.

Most of those who commit suicide are between the ages of 15 to 29.

“The temperament of the millennials who are self entitled and impulsive… they do not have this mindset of the Generation X. They do what they want,” said Mr. Baustista, adding that they “only want to be gratified in whatever form.”

He said the millennials’ parents, the so-called Generation X, spoil their kids too much. “They have all the things at their hands, even those they did not ask for. The kids are well attended to and the pressure to be good parents is too high [in this age], so the parents provide too much and the kids become entitled.”

He is advocating the early prevention of depression among the young.

He said depression could start as early as five years old, with symptoms like subtle cognitive and subtle motor, which happen when children cannot read social signs.

It also does not help that more and more young people are exposed to and grew up with social media, which, experts agree, can trigger depression and feeling of envy among the users.

In today’s digital age that seems to neglect face to face communication, psychotherapy helps people deal with depression, “because some people, it turns out, only need more validation and someone to talk to,” said Dr. Bautista.

At the end of the day, “the trick is to enhance your mind and believe that you can do it yourself.” In the absence of 24/7 psychotherapists, he said people should train their thoughts to be more aware and more reflective of their self and surroundings.

In psychotherapy, treatment revolves around finding your meaning and purpose in life, said Dr. Bautista. He asks and guides his patients with questions like “what is it to live for?”

But then again, when a case is so serious that psychotherapy doesn’t seem to work, people can take medicine that will adjust the hormones they are lacking. The best combination is to do both.

There is no universal treatment that applies to everyone because each person has a different genetic makeup and environmental triggers that may cause depression. It is best to consult the experts.