There are some illnesses that are easy to see.
A broken leg.
A rash.
High blood pressure on a machine.
Then there are illnesses where the person standing in front of you can look perfectly fine.
They may be smiling.
They may be working.
They may be looking after their family.
They may even be making everyone else laugh.
And yet, inside, they are struggling.
Mental health is one of those things.
As a pharmacist, I have learned that sometimes the most important part of a conversation isn’t the medicine being collected.
It is what the person says quietly afterwards.
“I haven’t been sleeping.”
“I don’t feel like myself anymore.”
“I can’t concentrate.”
“I’m tired all the time.”
“I’m just fed up.”
Sometimes those words are a clue that something much bigger is going on.
Depression isn’t simply being sad
Everyone has bad days.
We all have periods when life gets on top of us.
Depression is different.
It can affect mood, motivation, sleep, appetite, concentration, energy and the ability to enjoy things that previously gave pleasure.
Some people become withdrawn.
Others become irritable or angry.
Some eat more.
Others lose their appetite.
Some sleep constantly.
Others lie awake for hours.
And some people become very good at hiding it.
That last group worries me the most.
What does depression actually do?
Depression affects much more than the way somebody feels emotionally.
It can affect the whole body.
Sleep becomes disturbed.
Energy disappears.
Concentration becomes difficult.
Work suffers.
Relationships can suffer.
Sexual desire can fall.
People may stop exercising or socialising.
Some turn to alcohol or drugs.
Others simply retreat into themselves.
And then a vicious cycle begins.
You don’t sleep → you’re exhausted → you stop exercising → you feel worse → you withdraw from people → you feel lonely → you sleep even worse.
Breaking that cycle can be extremely difficult without help.
And mental health isn’t just depression
Anxiety is another common problem.
There is ordinary worry, which is part of life.
Then there is anxiety that becomes excessive, persistent and difficult to control.
Some people experience racing thoughts.
Others experience palpitations, sweating, trembling, breathlessness or a feeling that something terrible is about to happen.
Panic attacks can be frightening enough to make someone think they are having a heart attack.
And there are many other mental health conditions — bipolar disorder, schizophrenia, obsessive-compulsive disorder, eating disorders and post-traumatic stress disorder, to name just a few.
These are medical conditions.
They are not character flaws.
Why do people struggle to ask for help?
This is where culture matters.
In some families and communities, talking about mental health is still uncomfortable.
There can be a fear of being labelled “weak”, “crazy” or difficult.
In some cultures, including parts of Asian communities, there can be enormous pressure to keep family problems private.
You may be expected to carry on working, looking after everyone else and pretending everything is fine.
But mental illness doesn’t disappear because we don’t talk about it.
In fact, hiding it can make things considerably worse.
What can actually help?
There isn’t one treatment for depression.
The right treatment depends on the individual and how severe the illness is.
For some people, talking therapies can be extremely effective.
Cognitive behavioural therapy, or CBT, is one example. It helps people understand the relationship between their thoughts, feelings and behaviour and develop different ways of responding.
For others, medication may be appropriate.
Antidepressants
Medicines such as SSRIs are commonly used to treat depression and several anxiety disorders.
They don’t work like a painkiller.
You don’t take one tablet and suddenly feel better.
They usually take a few weeks to have a noticeable effect, and treatment needs to be reviewed regularly.
They can be very effective, but they can also cause side effects.
Depending on the medicine, these may include nausea, headache, sleep disturbance, diarrhoea, sexual problems and emotional blunting.
Some people find the first antidepressant they try works very well.
Others need a different medicine or a different approach.
This is not a one-size-fits-all situation.
And antidepressants shouldn’t generally be stopped suddenly without medical advice, because withdrawal symptoms can occur with some medicines.
Lifestyle isn’t a cure — but it matters
I’m always cautious when people say:
“Exercise will cure your depression.”
It won’t necessarily.
But that doesn’t mean exercise isn’t important.
Regular physical activity can improve mood, sleep, cardiovascular health and general wellbeing.
Even a daily walk is a start.
Getting outside.
Seeing people.
Maintaining a routine.
Eating reasonably well.
Reducing alcohol.
Getting enough sleep.
These things sound almost too simple, but they can become powerful when done consistently.
The difficulty is that depression can take away the motivation to do them.
That’s why telling someone who is depressed to “just get some exercise” isn’t particularly helpful.
Sometimes they need support to take that first step.
What about Malaysia?
This is an area where we need to be honest.
Malaysia has excellent healthcare professionals, but mental health can still carry stigma.
Some people are more comfortable talking about diabetes, blood pressure or cholesterol than admitting they are depressed.
That needs to change.
Mental health services need to be accessible, affordable and culturally appropriate.
People should be able to seek help without feeling ashamed.
And families have an important role.
If someone you know has stopped going out, isn’t sleeping, has lost interest in everything, is drinking more, looks constantly exhausted or repeatedly says that life isn’t worth living — don’t simply tell them to cheer up.
Ask them how they really are.
And listen.
The most important question
There is one question that people sometimes feel frightened to ask:
“Are you thinking about hurting yourself or ending your life?”
Asking the question does not put the idea into someone’s head.
If you are genuinely worried about somebody, asking directly can open the conversation that they desperately need.
If someone says yes, take it seriously and seek urgent professional help rather than leaving them alone to deal with it.
My view as a pharmacist
Over the years, I’ve become increasingly convinced that one of the most important things we can do is simply notice people.
Notice when the normally cheerful person becomes withdrawn.
Notice when someone repeatedly says they aren’t sleeping.
Notice when a colleague who was always full of energy suddenly seems exhausted.
Notice when someone stops looking after themselves.
And perhaps most importantly, don’t judge them.
Depression doesn’t always look like someone crying in a dark room.
Sometimes it looks like someone going to work every morning, answering emails, making dinner, laughing with friends and saying:
“I’m fine.”
When somebody says that, sometimes the kindest thing you can do is ask:
“Are you sure?”
And then actually listen to the answer.
Until next time take care of yourself.
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