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Depressed? It's not enough to just talk to friends

Twenty-six-year-old Mar Elizer "Eli" Rodriguez is a spiritual leader. He's someone to go to for guidance when one feels lost or confused. He supposedly has the answers.
It turns out he doesn't. 
Last year, Eli felt the first symptoms of depression. He couldn't eat, couldn't sleep, couldn't concentrate at work, and didn't feel like getting out of bed. His initial reaction was denial.
"Ironic nga kasi pastor ako, tapos nagtuturo ka ng patungkol sa buhay, meaning sa buhay. Tapos ako mismo nakaramdam noon," Eli said. "Hindi ko matanggap, e."
Eli could not recall how and when it started. But he remembers not wanting to go to work the next day and feeling sick of the routine. He then decided to take a leave from office.
Fortunately for Eli, he was working at a psychiatric facility that offered free services to its employees. Through this, Eli gained the courage to tell his colleagues, and eventually his boss, that he was experiencing a certain kind of sadness—the type that could not be cured by a trip to the cinema or a chat with friends.
"Parang nakaramdam ako nung feeling na ayaw mo nang umandar 'yung buhay. Gusto mo nang tumigil. Parang gusto mo lang humiga. Tapos umabot pa sa point na paano kaya kung wakasan 'yung buhay," Eli said, also clarifying he did not attempt suicide.
Eli was diagnosed with major depression and subsequently underwent psychotherapy.
Depression: a definition
Dr. Randy Dellosa, owner and resident psychiatrist at the Quezon City facility where Eli works, said that the main problem of how depression is addressed in the Philippines is that people have a difficult time detecting it.
"People confuse depression for normal sadness," said Dellosa. 
Dellosa explained sadness as fleeting. "Temporary siya (sadness) and hindi nagiging sagabal sa pamumuhay."
Dellosa further explained that clinical depression is a neurochemical imbalance, which is treated with either psychotherapy (counseling) or by anti-depressants.
Depression is a state of mind that afflicts even the happiest of people, people like Eli. 
The Filipino tendency is to associate depression with traumatic events like death in the family, natural tragedy, heartbreak, and the like, when in fact, depression can occur even without the trigger of trauma.
Sometimes, depression can be an offshoot of medical problems such as hypothyroidism and heart problems, according to Dellosa. 
Lacking in psychiatrists, funds
According to World Health Organization (WHO), only one out of three Filipinos suffering from depression will seek the help of a specialist. The second will opt not to see a doctor and the third will go on living unaware of his/her condition.

This is important to note, as the latter two types of depressed persons number among those who have committed suicide.
The Department of Health (DOH) stated in its health statistics from the year 2000 that the incidence of intentional self-harm among Filipinos is 1.8 per 100,000 population.
Apart from the fact that not everybody can afford treatment, psychiatrists are also in want in the Philippines. According to the latest data from the Philippine Psychiatric Association, there are only 450 psychiatrists in the Philippines. WHO data shows there are 4.5 million depressed Filipinos, the highest in Southeast Asia.

That translates to an average of one psychiatrist attending to 10,000 patients.
NGO efforts
The gap is partially filled by non-profit organizations providing services for the depressed.

One of the most prominent mental health advocacy groups in the country is the Natasha Goulbourn Foundation (NGF), named after Natasha Goulbourn, who according to her mother, fashion designer Jean Goulbourn, on the foundation's website," died in 2002 at the age of 27 after a bout with depression." 

Goulbourn is currently serving as the president of the organization.
Mrs. Goulbourn told this author she didn't need to tell the story of Natasha anymore, not because she didn't want to, but because she felt that she reached a period where we should be demanding the government for action instead of dwelling on heart-wrenching stories.
"It has to start with the Department of Health. Kailangan [tumulong] sila because they are the ministry of the country. They should give us direction sa buong nation kung ano ang dapat gawin," Goulbourn said.
For her part, NGF launched "Hopeline" last year, the first ever suicide hotline in the Philippines. 
As of the moment, Hopeline has 12 trained personnel taking calls day in, day out. They were trained prior to the launch and undergo re-briefing every month.
"Para maturuan sila how to handle depression, a trained expert that can at least listen, they need someone to listen to them," Goulbourn added.
Goulbourn stressed that depressed people need to talk to someone who knows how to handle their condition. 
'It's not enough to talk to friends'
In the Philippines, when someone goes to us to say they're depressed, we usually answer back with a casual, "Ikain mo lang yan!" or "Iinom mo lang yan." Sometimes, the more understanding peer will tell the person, "Usap tayo."
But it is not enough to talk to friends. Friends do not know the science of what may be going on in your brain; despite their purest and sincerest intentions, they may not be able to help you.
"The problem with talking to a friend is they're not therapists. If you keep on telling them your problems, they'll tire out eventually," Dellosa said. "Psychotherapists are professional friends. They know how to create compassionate distance and they'll be neutral, objective, and help the depressed person."
With Hopeline, pamphlets, posters, internet campaign and more, NGF hopes to make this country more aware of depression, especially since the concept of it is still lost to many and the image of depression remains that of a crazy person locked behind grills at the back of your house.
Government action
Former DOH Secretary Manuel Dayrit ordered the Mental Health policy in 2001. In 2007, Dr. Francisco Duque, then Health Chief, issued another order. Fast forward to 2012 and Dr. Jasmin Peralta, head of the agency's Special Concerns Division, told this author they were still amending the order.
The thing they're lacking, Peralta said, is research.
"Pero para maipatupad ang mga research natin, kailangan natin ng pondo," Peralta said. 
Perhaps, Peralta suggested, there is also a lack of support from interest groups. She said that the reason the country has progressed in terms of researching about the Human Immunodeficiency Virus (HIV) and implementing programs to address it is because support from international organizations poured in.
The same thing cannot be said about depression, according to Peralta.
DOH has a proposed solution for this: pass a Mental Health Act.
According to Peralta, the country needs a definitive law so it is clear where the funding will come from and which agencies will be responsible for implementing policies.
Peralta noted that depression is currently just a clause in laws such as R.A 1965 or the Dangerous Drug Act—given that depression is either a cause or result of substance and drug addiction.
In the meantime, DOH has in place barangay-level programs wherein health officers will be trained how to handle depression cases.
"'Yung mga health providers natin sa mga barangay or sa LGU, sila mismo at their end e makita na nila na may mga sintomas. On their end, puwede na silang mag-counseling," Peralta said.
First World problem?
In a country of happy people, it seems like no one has the right to be sad.

In a country of poor people, it's even a worse crime to say "there's something wrong with the chemicals in my brain" when there are millions of people who complain of having no food in their stomach.
"Between feeding them and nourishing their stomach, that question is very challenging," Goulbourn said. "You can nourish the body, but if the brain is not nourished, even the body cannot absorb that."
In 2004, WHO announced that by 2030, depression will become the largest contributor to the world's disease burden. Psychiatrists, interest groups, and the DOH agree that, as with other diseases, prevention is the key.
And, just like with other disease, a healthy lifestyle is what's needed.
"People should have a strong knowledge of what food and nutrients to give to handle the chemical imbalance. And the lifestyle habits, exercise is the best, the oxygen for the brain is running and walking two hours a day," Goulbourn said.
The Institute of Optimum Nutrition in the United Kingdom has the following in its list of mood-enhancing foods: chocolates, strawberries, ice cream, pasta, French bread, bananas, grapes, oranges, nuts and sesame seeds.
"This is a silent killer," Goulbourn said.
And it's time we talk about it, time we move the authorities to do something about it so that we are prepared when it comes silently, in the dead of night. — VC/KG, GMA News
This story first appeared as a television report on GMA News TV's "State of the Nation" with Jessica Soho, produced and researched by Lian Buan and Marj Casal.