Category Archives: Depression

Every Brilliant Thing

“If you live a long life and get to the end of it without ever once having felt crushingly depressed, then you probably haven’t been paying attention.”

“Every brilliant thing” is a one-man show about …depression. It was actually introduced by a friend who subscribed to Befrienders’ page on facebook and noticed the play. And it’s a comedy (the big guy sitting next to me had been laughing real hard) (yes the comedy is about depression), also interactive. It will run till this Sunday, tickets and details are available here. (Spoiler alert: I’m sharing my thought about it, I guess it’s better not read it till you have seen it, that’s if you intend to go for it.)

Firstly it’s the quote above. I noticed I asked myself inside, “have I not been paying attention?” Have I? Have you? Perhaps I haven’t lived long enough (haha). Although I doubt the validity of this quote, I love it still. It reminds me of living mindfully, which is what most people including me lack nowadays.

This spontaneously brings me to my second thought. When the actor, as a teenager, realised how much easily he felt happy as a child. How most if not all of us, when we were little, notice joyful things, act out our joy, feel happy and contented easily and casually. It’s like being happy ‘naturally’ is exclusive for children. When you get into adulthood, you lose that and have to deal with a lot of disappointment, depression, fear, sorrow etc. But why so? Perhaps as an adult we can also appreciate little brilliant thing better? Like having a friend close enough to ask him/her to check if your teeth have got broccoli on them?

Oh yes I forgot to mention that “Every Brilliant Thing” is about this boy who wrote a long list of everything worth living for after discovered that the mother attempted ending her life. So yea, every little, brilliant thing. In no order of preference, the first item was “ice cream”, the 7th item was “people falling over”, the 201th “hammocks”, the 1092th “conversation”, 1655th “Christopher Walken’s hair”. Does such list help? I personally do not think it helps if you wrote it for someone who’s suicidal, but it would be helpful if the person is motivated enough to create such list for him or herself. One of the problems is probably “will she be able to notice?” The mother ended her life still, despite all the efforts of the boy.

Then this Samaritans’ Best Practice Suicide Reporting Tips was mentioned, it’s about what the Samaritans advises journalists on how to report suicide news. If you briefly go through the list, you will probably immediately find out that our reporters do not follow the tips at all, sadly. Yes and each time shortly after a celebrity or a famous person killed him or herself (a widely publicised suicide) the suicide rates peak. (So hey one of the reasons I have stopped reading news, is that they can be really depressing nowadays). Perhaps including some sources of support at the end can be really helpful. In Malaysia, you may call the Befrienders any time 03-79568144/5 or email sam@befrienders.com.my (visit their website here). 

One final thing that made me “nodded” during the show (friend said she noticed I had been nodding a lot – it’s really just a habit, like when I’m giving talks I tend to look for this kind of audience… those who nod a lot!), is when someone says to you “you should find someone to talk to, a professional one”, you think you know yourself best, you know mental illness best, you know it all, why would you need to seek professional help, that person can’t know you better than you do etc. But really, there must be reasons for someone to say that to you, and there really can’t be any harm done for you to speak to someone. Just bear this in mind, don’t get defensive.

I wasn’t happy at all with the show starting really late (written in the email to be there 45 minutes early and the show didn’t start till 30 minutes after its scheduled time, that was really a long wait!). But I do quite enjoy it, consider it my first experience on one-man show (is Derren Brown’s considered as one?).

Anxiety VS Depression

A brief update:

Hui Bee is away for replenishment from 29th Aug to 3rd Oct. When she is back, she will again be very busy preparing for the Stage II of CBH diploma course in BeiJing. After 3 years of regular updates, huibee.com is likely to be quiet for a couple of months. But she promises that she will definitely be back here. 

焦虑 (Anxiety) 和抑郁 (Depression) 的特点

焦虑和抑郁的不同

焦虑和抑郁的相似处

又是我早年制作的表,分辨焦虑和抑郁的相同和不同之处。这只是简略概括来说,每个人的情况症状都不同,绝对不能作为诊断用途。

Introducing “Listening to Prozac”

By Peter D. Kramer

By Peter D. Kramer MD

Last year I bought this book for RM5 from the Popular RM5 book fiesta (by now you probably have realized that I bought a lot of books there, and yes you’re right, I do spend time to go through those non-fictions and try to pick some treasure!). It is written by an American psychiatrist.

This is really a book that I’d strongly recommend, to … certain people, like me – who know quite a bit about psychopharmacology, but not enough, not much about their history – who have seen how all those drugs are used practically and in day to day life, but not read much about the facts and dark stories behind them. It is an old book I have to say, but I learnt so much about the older generation anti-depressants (tricyclic like Imipramine, Monoamine Oxidase Inhibitors which is not so common these days) and those that I’m so familiar with, i.e. the SSRIs (e.g. Prozac (Fluoxetine)!).

It made me think a lot about how those so-called legal drugs are prescribed, used and misused, how it can change a person from the inside (personality! how they see themselves all their lives simply changed after they started the medicine!), how vague the definitions of psychiatric diagnosis are, how tiny the difference between well and unwell could be etc etc. It may not be a book for everyone, I’m sure some might fall asleep reading it, but it’s probably the first time I’m reading such old book (published in 1993 -before I attended elementary school :P , some updates in early 21st centuries at the back) but still get so astonished and learnt so much!

Drug Use & Drug Abuse

More specifically, it is Psychiatric drug use VS Illicit drug abuse

If I have depression, or dysthymia, or an inability to experience pleasure (anhedonia), why do I need to take psychiatric drugs? I can take cocaine, amphetamine, heroin or opium too, they make me happy and feel high too. It reminded me of the patient who took his own life by jumping off from a building. He said gathering with his bunch of friends and taking those pills are his kind of pleasurable activities (case study here), just like women go shopping or people go gym. Yea, right, how about that? Take a few “pills” and I’m better?

Antidepressants like Prozac and Lexapro (the SSRIs) do not provide pleasure, it restores the capacity for pleasure. It is neither excitatory like cocaine nor satiating like heroin. The drug taker doesn’t crave Prozac and does not feel relief when it enters the system. The desired effect, a change in responsiveness to ordinary pleasures, occur gradually and is unrelated to the daily act of consuming the drug. So unlike cocaine which produces quick, strong but short-lasting “high”, people don’t “usually” get addicted to the SSRIs.

Drug addicts use stimulant drugs hoping to cope with intolerable feelings. Without medication, they may experience little enjoyment. Prescribed medication makes drug addicts who kick the street-drug habit feel less empty and better able to enjoy ordinary pleasures. For the addict, the hope is to enhance the ability to “postpone gratification”, something antidepressants may do by increasing the ability to imagine future pleasure. If and when ordinary pleasure becomes appealing (after a drug addict is treated with psychiatric medicine and begins to experience “ordinary pleasure”), it’s hoped that self-understanding and self-control will follow (no longer rely on illicit drugs to achieve “instant pleasure”).

So can we use anti-depressants (and some other medication) to treat stimulant drug addictions? I believe with a combination of behavioural therapies, and supports from the immediate family members, anti-depressants would work. But taking only anti-depressants without strong mental and motivation to quit and sufficient social supports is definitely not enough, not in long-term for sure.

Psychiatric Drug Abuse?

But anti-depressant drugs (focusing on SSRIs here) can also be abused. There are patients whose depression were treated with the SSRIs, once successfully weaned from the tablets, want to restart it, not because they are depressed, but because life seemed brighter when they were medicated. In psychiatry it’s a bit difficult to decide where treatment ends and depression starts again.. but doesn’t this seem a bit like taking illicit drugs? Same applies to people who take excessive anxiolytics (anti-anxiety drugs / tranquilisers) to make them calm and functional, how do we define when it’s legal psychiatric drug abuse?

There are people who feel more mentally sharp and agile, talk more fluently, and more socially confident when they are on anti-depressants, they continue to take it even when they don’t show any signs of depression at all. Unlike amphetamines which also make people more alert and productive but at the same time is addictive and causing paranoia, most of these SSRIs don’t lead to any significant side effects (and (if) any discomfort tend to go away after first few days). So does this make it morally and ethically fine to take anti-depressants to increase alertness, quickness of thought, and verbal and mechanical fluency, in the absence of illness?

 

P.S. SSRIs stands for Selective Serotonin Reuptake Inhibitors, which are newer drugs used to treat depression, but also work for OCD and anxiety disorders. Some commonly used in Malaysia include Lexapro (Escitalopram), Prozac (Fluoxetine), Zoloft (Sertraline), Luvox (Fluvoxamine).

N.B. This post focuses more on major and minor depression, dysthymia and anhedonia.

給年邁父母的愛

其實很多時候我還蠻擔心接到他老人家的電話的,雖然我心裡很敬重他,但更多的,是心疼。

他是個七十多歲的老先生,是診所多年的抑鬱病患者,情況時好時壞,目前吃著的抗抑鬱藥物更已經是最大劑量。老先生已經退休,平時都在照顧中風臥病在床的妻子,給自己還有老婆打點生活的大小事務,有個兒子但不同住,關係也不大好,見面總是吵架,兒子去年剛離婚,也沒爭取到孩子的扶養權。老先生自己的身體不怎麼好,有骨刺,嚴重起來自己也是痛得徹夜難眠。

害怕接到老先生的電話,是因為老先生住得遠,平時要是病情惡化了,心情鬱悶不已,就會給我打個電話請我幫忙舒緩。而因為藥物已經是最大劑量,又真的不想因為增加沒什麼作用的藥物導致老先生得承擔更大的經濟負擔,所以平時只能儘量和老先生聊聊天減少他不必要的操心。而事實上,老先生尚算樂觀開朗,就算心情很煩躁鬱悶,也很少掛個苦瓜臉哀聲嘆氣,而且老先生的抑鬱很大程度是環境和一些他個人無法控制的因素造成的,所以藥物最多只能稍微輔助,起不了太大的作用(雖然對一件事的詮釋完全歸於個人)。

我知道我不該這麼想,但因為在這行久了,看多了,我常不自禁擔心老先生會不會覺得自己身體不好,又要照顧老夫人,和兒子關係又差(而且兒子還有許多要他擔心的事),抑鬱一發作,生活沒意義沒樂趣,一時想不開就走了。每次想到這,都會慶幸自己偶爾可以幫上一點小忙,更會明白老先生能撐到今天,很多能量來自於對老夫人的愛與責任。少一點愛,少一點責任心都不行。說得難聽些,換作是時下的年輕人(如我,雖然我也不太年輕了…),肯定早就撐不下去逃避問題去了。是的,我總認為上一代的人比較堅強,有韌性,有毅力,較能在逆境中生存甚至向上;這一代在太多保護與遷就裏長大,比較任性,欠缺責任心和堅持。

我心疼他,同時也生氣他的兒子,脾氣不好,行為不好,也不盡孝心,見面就是和老先生吵架。其實我也和這獨子有過一次接觸,感覺他生活很多狀況也自顧不暇,所以責怪他的心理很矛盾,因為其實兩父子顯然都很關心對方,有問題都不敢告訴對方怕對方操心,大概又是同樣的火爆脾氣,兩人說不上兩句就吵架了。

其實說穿了,很多老人家都一樣,寧可對外人聊心事講問題,也不要不敢對自己的家人自己的孩子說,因為孩子總是忙,因為孩子已經很累了,因為不要孩子擔心操心,因為和孩子說太多最後都變吵架,因為怕孩子嫌自己煩自己嘮叨(甚至怕孩子把自己送進老人院)… 每次和老先生的接觸,都會提醒我要對爸媽更好一些,更體貼他們一些(然後回家就忘得七七八八!)

P.S. 這是我第一用中文紀錄臨床個案(Clinical Case Studies),主要是因為我心裡有很多感受想用中文抒發;所以可能要請讀者體諒這文章可能寫得不太順暢(還要磨練磨練)