Lifting Depression

The Straits Times, Mind Your Body, 4 October 2012, By DR JOSHUA KUA

Peter, a German in his 50s, came to consult me two weeks ago.

He is based in Taipei and works for his brother.

He was in Singapore on a business trip when, one evening, he felt breathless and some tightness in the chest.

He does not have any heart problems.

But as his father died from a heart attack at a very young age, he decided to see a cardiologist at Raffles Hospital.

After some tests, his heart was found to be fine.

He felt relieved but, somehow, was still carrying a “gloomy feel”.

“I should have been happier, but I wasn’t,” he said.

In addition, he was feeling very tired, having problems sleeping and was not able to focus.

“I know I am on the fringe of depression,” he murmured.

It turned out that Peter had a bout of clinical depression in Germany five years ago for which he received inpatient treatment.

With antidepressant treatment and cognitive behavioural therapy (CBT), he recovered.

However, he felt somewhat “numbed” and “flat” after taking the medication and decided to stop doing so.

“I knew it was a risky thing but I thought the CBT had given me some coping skills to prevent a relapse,” he told me.

At that time, he had also left a well-paid but highly stressful job and changed his lifestyle dramatically.

He moved to another country and led a quiet and relatively stress-free life for a few years.

About one year ago, he decided to return to his previous lifestyle and took up a new job in Taipei.

He enjoyed the work, but soon found that being a one-man show was too stressful for him.

Sitting across from me, Peter went on to talk, in a rather sombre tone, about his pent-up feelings and struggles.

He knew he could not go on doing the same thing.

“I drink too much alcohol at times and smoke too much. I am not exercising. I am getting 300 e-mail messages every day. I am currently overweight,” he said.

I was impressed by his eloquence and insight into his illness.

When I asked him what he intended to do about it, he was able to calmly articulate some of the things he could do to alleviate stress.

These included confiding in his wife, who is supportive, taking a break every two hours from work, putting up a business case to his boss about getting an assistant, getting an office space as he currently works from his rental flat in Taipei and reducing his e-mail load by not handling e-mail messages that were meant for his boss but copied to him.

As I had just given a talk to a local bank on stress management, I shared a few slides on areas relevant to Peter.

He listened attentively and could identify with many, if not all, the points I raised.

I then helped him to organise his thoughts and advised him on a few strategies to develop an action plan to combat his stress and depression.

Although he declined medication, I gave him some information and suggestions on when he should return for medication.

At that moment, I was prompted to put on my psychotherapy cap and talked about self-esteem issues.

Peter was able to identify that one of the reasons he was driving himself so hard at work was because, since young, he had always wanted to prove his worth to his brother and to live up to his expectations.

With much insight, Peter said: “I was foolish. My self-worth should not be based on this alone.

“I guess I have been carrying these unnecessary thoughts unconsciously all these years.”

At the end of the hour-long session, Peter was visibly delighted.
He said he felt so much better after the session.

He hit the nail on the head when he said it was such a huge relief to be able to speak to someone who could understand how he felt and what he had gone through.

He said in his previous episode of depression, some well-meaning family members even asked him to “just be a man and snap out of depression”.
I would say that the session was led by Peter 80 per cent of the time.

I wish more of my patients could be like him – understand their conditions and have the courage to seek treatment early and take ownership for their own recovery.

Of course, his decision regarding medication is controversial.
But I am sure he will seek help and accept medication if his condition does not improve.

I felt a great sense of satisfaction in being able to help Peter.
I was gratified when he complimented me and said: “Doctor, you are good and I am glad I came to look for you.”

Peter then told me he would be meeting his wife the following week for some leisure time in Singapore.

“Doctor, if I don’t see you next week, it means I am fine,” he said confidently.

He did not return the following week and I could not be happier.

Dr Joshua Kua is a Consultant Psychiatrist at Raffles Counselling Centre. His areas of expertise include adult psychiatry, geriatric psychiatry, psycho-oncology, psychotherapy and counselling.