Depression alert

MOST people who suffer from depression will respond to treatment, says Dr Lim Chong Hum, chairman of the Guideline Development Committee for the Clinical Practice Guideline on the Management of Major Depressive Disorder.

But recognising depression is a serious concern. This lack of recognition exists on a few levels:

1. The public may not recognise when a person is depressed. This is partly because those with psychiatric illnesses tend to be stigmatised, so both the sick person and his family may choose to ignore that he may be emotionally disturbed. Besides, those who are depressed may feel hopeless and this affects their ability to seek treatment.

2. Even medical practitioners can fail to detect depression, especially when the patient does not complain of the usual psychological symptoms but only of physical symptoms such as aches.

3. Even when depression is detected, there is substantial under-treatment, including giving inadequate doses of medication or terminating treatment prematurely. This is where the Clinical Practice Guideline on the Management of MDD has a role to play. It reviews recent evidences of treatment of MDD, summarises them and draws up recommendations.

4. Patients may not take their medication as prescribed. Telling patients about the consequences of non-compliance may help. Dr Lim says depression must be treated adequately in terms of duration.

"Patients often stop their medication once they feel better, but it's important that treatment is continued. In the few months following the improvement, the person is still at risk of recurring symptoms."

Patients who only respond partially or continue to be symptomatic may have to take their medication longer.

The Clinical Practice Guideline on MDD has a programme to train healthcare workers on how to recognise and treat depression. It guides primary care doctors on the diagnosis and first line of treatment of major depression.

At the secondary level or specialised psychiatric units in hospitals, it guides on how to manage complicated cases of major depression, including those that are relatively resistant to treatment.

This article was first published in New Straits Times.