Depression cannot be 'willed away'

Movies and TV say you have a couch. What's seeing a psychiatrist really like?

Most consults take place in a room like most doctors' offices - across a table with some chairs.

I do have a couch for people to lie down if they want to, but most conversations are face-to-face and informal.

What are some work hazards?

The biggest hazard psychiatrists face is stalkers. I have had a few.

Some patients want a lot of your attention. They go to great lengths to contact you.

The other hazard is emotional burnout. Psychiatrists spend the entire day listening to problems and trying to fix them.

I feel physically and mentally drained at the end of the day.

My own therapy is riding my bicycle. They say four wheels moves the body, but two wheels move the soul. It's true.

What's the most common question you get asked?

That would be: "Can you read people's minds?"

I can't, but over a long conversation I might have an idea of what your personality might be.

Another would be "Are all your patients crazy?" They're not.

In fact, many of them are just like you and me. They might be going through a rough patch, which can happen to anyone.

Oh, and "Do you get depressed too?" Yes I might, but I would know exactly when and how to get help.

What counts as a mental illness?

A mental illness or psychological disorder is when you have an emotional change - such as anxiety or depression - that is severe enough to affect your daily functioning.

Many people think they feel this way because they might be emotionally weak, or not trying hard enough to solve their problems. That's completely untrue.

A psychiatric disorder is like any physical disorder. There are chemical changes in the brain, for which there are treatments available.

What's the most dramatic case you've seen?

I once had to help hold down a violent young man with his mother and aunt in a hospital carpark.

Luckily, we were able to subdue him, because the security staff who arrived much later seemed too panicky to act.

What are the common conditions you treat in your practice?

That would be depression, anxiety, grief and other stress-related conditions.

I also see a fair number of patients with schizophrenia and bipolar disorder.

In recent years, people have become more aware of attention deficit disorder, so I have been seeing more young people with this condition.

What is depression?

Depression is a feeling of sadness that won't go away. Feelings of hopelessness and an inability to enjoy one's usual activities are hallmarks of depression. Energy, motivation and drive are all impaired.

In more serious cases, there might even be thoughts of death.

Can't people snap out of it? Why do they need medication?

Depression is not a sign of emotional weakness and cannot be simply be "willed away".

Counselling helps in mild cases, but for moderate to severe cases, when there is significant impairment of functioning or suicidal thoughts, medications are needed to normalise brain chemistry.

They work by increasing the levels of a neurochemical called serotonin (which is produced by the body and is thought to contribute to a sense of well-being and happiness). Newer antidepressants do more than that.

They increase not just serotonin, but other chemicals such as norepinephrine (a stress hormone that increases blood pressure, heart rate, and glucose from energy stores) and dopamine (which affects your emotions, movements and your sensations of pleasure and pain).

Some examples of antidepressants that affect serotonin include sertraline and fluoxetine. Newer medications that affect both serotonin and norepinephrine include desvenlafaxine and venlafaxine.

By targeting these brain chemicals, the patient is able to feel better sooner, think more clearly and feel more resilient.

When should I make an appointment to come and see you?

Not everyone who feels anxious or sad needs to see a psychiatrist right away.

Talking to a counsellor may help. Having a chat with a general practitioner is also useful. A GP can advise what your treatment options could be, and may even start you on medication if necessary.

So do you actually use the Rorschach test?

No, I am afraid I don't have any Rorschach inkblots. They've gone out of fashion. I stick to the classic way of careful interviewing.

juditht@sph.com.sg

This article was first published on January 31, 2016.
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