DOH: It's time to talk

about, address
depression

(Philstar.com) - January 17, 2019 - 1:56pm

MANILA, Philippines — Depression is a serious health

condition that needs to be talked about and addressed, the
Department of Health reminded the public Thursday.
"In the Philippines, 3.3 million Filipinos suffer from
depressive disorders, with suicide rates in 2.5 males and 1.7
males per 100,000," the DOH said in a statement issued a
day after the apparent suicide of Razorback drummer Brian
Velasco.
"We need to start talking about depression to end the stigma
surrounding mental health because, when left unattended, it
can lead to suicide," it also said.

The DOH noted that, according to the World Health

Organization, 800,000 people die each year due to suicide.
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"To those in need of help, we have a 24-hour toll-free suicide

prevention hotline. You can call (02)804-4673; 0917-
5584673 or send an SMS to 2919 for Globe and TM
subscribers," the Health department also said.
Mental health in the Philippines
The Philippines passed the Mental Health Act, which is
meant to help protect the rights and welfare of people with
mental health conditions, shift focus of care to the
community and improve access to services, in June 2018.
The Palace, commenting on the passage of the law, said
that the implementation of a mental health policy "will help
neutralize the stigma attached to mental illness."
Sen. Risa Hontiveros, one of the authors of the bill, said then
that the law will help provide mental health services to
barangays and "integrate psychiatric and psychosocial and
neurologic services in regional, provincial and tertiary
hospitals, improve our mental healthcare facilities and
promote mental health education in our schools and
workplaces."
Awareness of mental health issues is not widespread in the
Philippines, where conditions like depression is sometimes
made fodder for jokes and insults.
In September 2018, mental health advocates called out
video blogger Drew Olivar remarked that students of the
University of the Philippines should kill themselves to thin
their numbers. The comment had been addressed to UP
students critical of the government.
"It is but just to demand that we give the topics suicide and
self harm the appropriate seriousness and sobriety they
deserve," Raymond John Naguit, national chairperson of
Youth for Mental Health,said then. Youth for Mental Health
was among the advocacy groups that pushed for passage of
the Mental Health Act.
RELATED: Why suicide is not something to joke about
In 2017, comedian Joey De Leon was criticized online for
commenting that depression is just "made up" and that
depressed people only have themselves to blame. He
apologized for the comment.
Velasco's death trended on social media because of fans
and supporters extending their sympathies to the families,
but also because of a reported video related to the death.
In its statement on Thursday, the Department of Health said
that it is aware of the existence of the video. "We request for
the public to stop sharing this tragic video and respect the
family who are still grieving and in pain due to this
unfortunate event," it said. — Jonathan de Santos

Expert treatment for depression and

anxiety
 Occasional sadness and anxiety are a normal part of life.
Some people, however, experience intense sadness or anxiety, such that it starts
disturbing their schoolwork, job performance, and even relationships. They have
what is called major depression or anxiety disorder.
The symptoms of major depression include lingering sadness or irritability, loss of
motivation and zest for living, a pessimistic or worrisome attitude, changes in sleep
pattern, changes in appetite and energy level, lower self-worth, poor concentration,
forgetfulness and thoughts of death or suicide.
Anxiety disorders, on the other hand, manifest in palpitations, breathing difficulties,
cold sweat, dizziness or light-headedness, body weakness, tremors, digestive
system problems, the sense of panic or uneasiness, fears of going crazy, losing
control and being seriously ill.
The treatment package for major depression and anxiety disorder includes
medication, talk therapy, stress management techniques, nutritional supplementation
and lifestyle changes. On medication alone, significant improvement is usually seen
in two to three weeks of taking the right dose. The “right medication” is one that is
effective, nonhabit forming, and without side effects.
Randy Dellosa, a renowned Filipino expert in the treatment of major depression and
anxiety disorder, can help people suffering from such symptoms. He is the only
Filipino who is a psychiatrist, clinical psychologist, life coach and wellness specialist.
He also does acupuncture, mind spa therapy and hypnotherapy for depressed,
anxious clients.
Randy Dellosa Wellness Center is at 105 Scout Rallos St., Quezon City.
Visit randydellosa.com or call 4156529 or 4157964.

“I think the saddest people always try to make people

happy because they know what it’s like to feel
absolutely worthless and they don’t want anyone else
to feel like that.”
— Robin Williams, US actor
Mental health is one of the most important issues that
needs to be addressed. There seems to be a
prevalent epidemic of depression. Studies show that it
has been around for centuries.
There used to be stigma when someone had a form
of mental or psychological disorder. People only
whispered about or suppressed the problem. Now it is
openly discussed.
After a series of high-profile incidents of suicide,
people wonder how to recognize and deal with it.
“Depression is a serious mental health condition that
affects a person’s emotions, thinking and behavior,”
Dr. Ma. Teresa Gustilo-Villasor explained in her
recent lecture. “Major depressive disorder is also
known as clinical depression.”

The individual feels miserable, lonely, let down.

Unfortunately, it has claimed many lives — both
young and middle-aged.
“If you know someone who is depressed, please
resolve never to ask them why…Depression just is,
like the weather. Try to understand the blackness,
lethargy, hopelessness, and loneliness they are going
through…. It’s hard to be a friend to someone who is
depressed, but it is one of the kindest noblest and
best things you will ever do.” — Stephen Fry
A chart shows that the highest percentage of
depression affects teenagers and young adults aged
16 to 29. This has increased by 50% in the past 60
years.
The World Health Organization statistics show that
half of the people with mental disorders — anxiety,
depression, mood, and thought problems develop at
age 14.
Depression and anxiety are prevalent among the
population age brackets 15 to 14; 55 to 70.
In 2014, depression was the predominant cause of
illness and disability for both boys and girls.
The Philippines’ Department of Health estimates that
one in five Filipino adults has some form of mental
illness (schizophrenia, anxiety disorders, depression.)
Depression’s traits are: sadness; irritability; loss of
interest in normal activities; thoughts of suicide or
death; tiredness, disturbance in sleep or appetite.
Anxiety has the following: restlessness; excessive
worrying; agitation, trembling, feeling nervous or
powerless, panic, high heart rate, sweating.
More young women have anxiety or affective
disorders than young men.
According to several reports and findings, the risk
factors of depression are:
“Biochemistry: The difference in certain chemicals in
the brain may contribute to the symptoms. Women
are twice as likely to be depressed.
Genetics: Depression can run in families. Having a
parent or sibling with D increases the risk of
developing the disorder.
Personality: when overwhelmed by stress: pessimism
Environmental Factors: The exposure to violence,
neglect, and abuse make the person vulnerable.
The symptoms: Mood swings, irritability, neglect of
responsibility, weight gain or loss; chronic fatigue;
withdrawal from others; changes in personal
appearance.
Men: Tendency to blame others; anger; paranoia;
creates conflict; restlessness and agitation;
compulsiveness; insomnia; becomes controlling;
shame; fear of failure; overly concerned with status;
self-medication through drugs; overuse of the internet
and email.
Women: Self-blame; sadness; apathy; worthlessness;
anxious, frightened; conflict avoidance; nervousness;
procrastination; over sleeping or insomnia; difficulty
maintaining boundaries; guilt; problems with success;
assumes low status; self-medication through food.
The medical treatment would be a combination of the
following:
Antidepressants (natural or pharmaceutical)
Lifestyle (nutrition, exercise)
Psychotherapy (Cognitive behavior therapy,
mindfulness, counseling)
Social (support network, community involvement)
There is another aspect that is essential to the
treatment. It is the psychospiritual treatment: prayer,
retreat, accompanied by therapy.
Thomas Moore, in his book Care of the Soul, wrote
about “the great malady of the 20th century implicated
in all our trouble and affecting us individually and
socially is ‘loss of soul’”
“In the modern world, we separate religion, spiritual
practice with medicine and therapy…To undertake the
restoration of soul means we have to make spirituality
a more serious part of everyday life.”
John of the Cross wrote, “In the dark night of the soul.
Bright flows the river of God.”
Facts about depression:
1) It does not go away. It can be modified.
2) Thoughts of suicide occur.
3) The condition fluctuates.
4) Behavior is complex.
5) It has an impact on family dynamic and lifestyle.
The contributing variables are: Stigma, blocks to the
appropriate treatment. The family needs treatment
and support. Stressors depend on nature and the
severity of illness. The ill person could be a parent,
child, or spouse.
Hygiene, exercise, nutrition, and sleep are very
important to a person’s wellbeing. We should be
aware and mindful to the absence of these elements.
Family history may increase the risk of depression
and anxiety. Physical/emotional abuse, certain
medications, traumatic life events, and social isolation
make a person vulnerable. Symptoms are:
concentration difficulties; feeling of worthlessness;
decreased energy and feeling.
The factors that will determine whether one will have
depression are: physical activity, Omega 3 fatty acids,
Sunlight (Vitamin D), Sleep, ruminative activity, and
social connection.
The risk factors for suicide are:
History of substance abuse; previous suicide
attempts; relationship problems; access to harmful
means; recent death of a family member or close
friend; history of mental health disorder; losing a
friend or family member to suicide; physical disability
or illness; ongoing exposure to bullying behavior.
What to do when you feel depressed:
Engage in an enjoyable activity — exercise, do
sports, play bridge, dance, cook, sing, play with pets,
fix the garden.
Avoid spending long periods of time alone.
Maintain a healthy, balanced diet.
Take care of yourself. Pamper yourself.
Break up tasks into small chunks.
Spend time with family or friends.
Postpone important decisions until you are feeling
better.
Get professional help when needed from a counselor,
doctor, therapist.
What to do for others: Know the symptoms;
Encourage the depressed person to seek help; be a
friend and listen; Stay in touch or check how they are
going; Offer practical help; Don’t make light of it; Don’t
stay away because you are out of your depth; Affirm
the person’s strengths; Take any comments about
suicide seriously; Pray for the person (in his
presence.)
There is a bright side to depression.
Carl Gustav Jung wrote, “Depression is not
necessarily pathological. It often foreshadows a
renewal of the personality or a creative burst of
energy. There are moments in human life when a new
page is turned.”

WHAT ARE THEY?

Depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent
feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. Disturbance in
sleep, appetite, and mental processes are a common accompaniment.

Two Main Categories

1. Major depressive disorder is a moderate to severe episode of depression lasting two or more weeks.
Children experiencing a major depressive episode may appear or fell irritable rather than depressed. In
addition, five or more of the following symptoms will occur on an almost daily basis for a period of at least
two weeks:

 Significant change in weight.

 Insomnia or hypersomnia (excessive sleep).
 Psychomotor agitation or retardation.
 Fatigue or loss of energy.
 Feelings of worthlessness or inappropriate guilt.
 Diminished ability to think or to concentrate. or indecisiveness.
 Recurrent thoughts of death or suicide and/or suicide attempts.

2. Dysthymic Disorder is an ongoing, chronic depression that lasts two or more years (one or more years in
children) and has an average duration of 16 years. The mild to moderated depression of dysthymic disorder
may rise and fall in intensity, and those afflicted with the disorder may experience some periods of normal,
non-depressed mood of up to two months in length. Along with an underlying feeling of depression, people
with dysthymic disorder experience two or more of the following symptoms:

 Under or overeating
 Insomnia or hypersomnia
  Low energy or fatigue
 Low self-esteem
 Poor concentration or trouble making decisions
 Feeling of hopelessness

WHAT CAUSES THEM?

 Biologic- an imbalance of certain neurotransmitters- the chemicals in the brain

that transmit messages between nerves cells-is believed to be key to depression.
 Heredity - Individuals with major depression in their immediate family are up
to three times more likely to have the disorder themselves.
 External stressors and significant life changes - such as chronic medical
problems, death of a loved one, divorce or estrangement, miscarriage, or loss of
a job, also can result in a form of depression know as adjustment disorder.
WHAT CAN BE DONE?

 Antidepressants - Major depressive and dysthymic disorders are treated with

antidepressant medication to provide an immediate relief for the symptoms of the disorder.

 Psychosocial therapy - focuses on the personal and interpersonal issues behind

depression.

 Electroconvulsant therapy - usually is employed after all therapy and

pharmaceutical treatment options have been explored. However, it is sometimes used early in
treatment when severe depression is present and the patient refuses oral medication, or
when the patient is becoming dehydrated, extremely suicidal, or psychotic.

 Alternative treatment - St. John's wort (Hypericum perforatum) is used throughout

Europe to reat depressive symptoms. Unlike traditional prescription antidepressants, this
herbal antidepressant has few reported side effects.

 Homeopathic treatment also can be therapeutic in treating depression. Good

nutrition, proper sleep, exercise, and full engagement in life are very important to a healthy
mental state.

DEPRESSIVE DISORDERS

Depressive Disorder/Mental disorders characterized by either depressed mood or markedly

diminished interest or pleasure in most activities of the day.
Causes
The causes vary:
• The research data are most consistent with the hypothesis with disregulation
of the biologic amines specifically norepinephrine and serotonin,
• Family studies reported that first degree relatives of depressed disorders have 2-
10 times more likely to have the disorder,
• Twin studies show that the concordance rate for monozygotic twins is about 50%,
• Stressful life events play the primary or principal role in depression, generally,
it is the loss of significant person.
Symptoms
• Significant weight loss or weight gain
• Difficulty in sleeping or oversleeping
• Fatigue or loss of energy
• Psychomotor agitation and slowness
• Excessive guilt or feeling of worthlessness
• Diminished ability to think or concentrate or indecisiveness
- recurrent thoughts of deaths
- recurrent suicidal ideations
Prevention and Control
There are clear guidelines for the treatment of depressive disorders. This include both
antidepressant medications and psychological interventions like cognitive therapy, behavior
therapy, interpersonal therapy and family therapy.

HOW MANY SUFFER?

 Each year in the United States, depressive disorders affect an estimated 17

million people or about 14% of adult person; 10% in Germany; 7% in Brazil;
4.2% in Turkey; 5.3% in the Philippines (Perlas, 1994).
 One in four women is likely to experience an episode of severe depression in
her lifetime, with 10-20% lifetime prevalence, compared to 5-10% for men.
 The average age a first depressive episode occurs is in the mid-20s, although the
disorder strikes all age groups indiscriminately, from children to the elderly.
 Common among those without close relationship, separated and divorced.

MENTAL HEALTH PROGRAM

Description

Mental health and well-being is a concern of all. Addressing concerns related to MNS contributes to the
attainment of the SDGs. Through a comprehensive mental health program that includes a wide range of
promotive, preventive, treatment and rehabilitative services; that is for all individuals across the life course
especially those at risk of and suffering from MNS disorders; integrated in various treatment settings from
community to facility that is implemented from the national to the barangay level; and backed with
institutional support mechanisms from different government agencies and CSOs, we hope to attain the
highest possible level of health for the nation because there is no Universal Health Care without mental
health

Vision

A society that promotes the well-being of all Filipinos, supported by transformative multi-sectoral
partnerships, comprehensive mental health policies and programs, and a responsive service delivery
network

Mission

To promote over-all wellness of all Filipinos, prevent mental, psychosocial, and neurologic disorders,
substance abuse and other forms of addiction, and reduce burden of disease by improving access to quality
care and recovery in order to attain the highest possible level of health to participate fully in society.

Objectives

1. To promote participatory governance and leadership in mental health

2. To strengthen coverage of mental health services through multi-sectoral
partnership to provide high quality service aiming at best patient experience
in a responsive service delivery network
3. To harness capacities of LGUs and organized groups to implement
promotive and preventive interventions on mental health
4. To leverage quality data and research evidence for mental health
5. To set standards for compliance in different aspects of services

Program Components

1. Wellness of Daily Living

 All health/social/poverty reduction/safety and security programs and the

like are protective factors in general for the entire population
 Promotion of Healthy Lifestyle, Prevention and Control of Diseases,
Family wellness programs, etc
 School and workplace health and wellness programs

2. Extreme Life Experience

 Provision of mental health and psychosocial support (MHPSS) during

personal and community wide disasters

3. Mental Disorder
4. Neurologic Disorders
5. Substance Abuse and other Forms of Addiction

 Provision of services for mental, neurologic and substance use disorders

at the primary level from assessment, treatment and management to
referral; and provision of psychotropic drugs which are provided for free.
 Enhancement of mental health facilities under HFEP
Partner Institutions

NGAs ( DOLE, DSWD, DepEd, Tesda, CHED, DILG)

NGOs (WHO, PPA, PAP, PNA, PLAE, AWIT Foundation, WAPR, NGF)

Policies and Laws

DOH Administrative Order No. 8 series of 2001 The National Mental Health Policy
DOH Administrative Order No. 2016-0039 Revised Operational Framework for a Comprehensive National
Mental Health Program
Republic Act No. 11036 Mental Health Act

Strategies, Action Points and Timeline

 Governance
 Service coverage
 Advocacy
 Evidence
 Regulation

Program Accomplishments/Status

1. Passage of the Republic Act No. 11036 dataed June 20, 2018 "An Act
Establishing a National Mental Health Policy for the Purpose of Enhancing the
Delivery of Integrated Mental Health Services, Promoting and Protecting the
Rights of Persons Utilizing Psychiatric, Neurologic and Psychosocial Health
Services, Appropriating Funds Therefore and for Other Purposes"
2. DOH Administrative Oreder No. 2016-0039 dated October 28, 2016 " Revised
Operational Framework for a Comprehensive National Mental Health Program"
3. National Mental Health Program Strategic Plan 2018-2022
4. Harmonized MHPPS Training Manual
5. Development of the Implementing Rules and Regulation of the RA No. 11036
also known as The Mental Health Act
6. Conduct of the Advocacy Activities such as 2nd Public Health Convention on
Mental Health, Observance of the World Health Day, World Suicide Prevention
Day, National Mental Health Week and Mental Health Fairs
7. Training on Mental Health Gap Action Programme
8. Conduct of The National Prevalence Survey on Mental Health
9. Establishment of the Medicine Access Program for Mental Health

Calendar of Activities

September 10 - World Suicide Prevention Day

October 10 -World Mental Health Day
2nd Week of Ocotber - National Mental Week

Statistics

The World Health Organization (WHO) estimates that

 a. 154 million people suffer from depression
b. million from schizophrenia
c. 877,000 people die by suicide every year
d. 50 million people suffer from epilepsy
e. 24 million from Alzheimer’s disease and other dementias
f. 15.3 million persons with drug use disorders

In the Philippines

1. 2004 WHO study, up to 60% of people attending primary care clinics daily in the
country are estimated to have one or more MNS disorders.
2. 2000 Census of Population and Housing showed that mental illness and mental
retardation rank 3rd and 4th respectively among the types of disabilities in the
country (88/100,000
3. Data from the Philippine General Hospital in 2014 show that epilepsy accounts
for 33.44% of adult and 66.20% of pediatric neurologic out-patient visits per
year.
4. Drug use prevalence among Filipinos aged 10 to 69 years old is at 2.3%, or an
estimated 1.8 million users according to the DDB 2015 Nationwide Survey on the
Nature and Extent of Drug Abuse in the Philippines
5. 2011 WHO Global School-Based Health Survey has shown that in the
Philippines, 16% of students between 13-15 years old have ever seriously
considered attempting suicide while 13% have actually attempted suicide one or
more times during the past year.
6. The incidence of suicide in males increased from 0.23 to 3.59 per 100,000
between 1984 and 2005 while rates rose from 0.12 to 1.09 per 100,000 in females
(Redaniel, Dalida and Gunnell, 2011).
7. Intentional self-harm is the 9th leading cause of death among the 20-24 years old
(DOH, 2003).
8. A study conducted among government employees in Metro Manila revealed that
32% out of 327 respondents have experienced a mental health problem in their
lifetime (DOH 2006).
9. Based on Global Epidemiology on Kaplan and Sadock’s Synopsis of Psychiatry,
2015 and Kaufman’s Clinical Neurology for Psychiatrists, 7th edition, 2013
A. Schizophrenia ---1% …..1 Million
B. Bipolar ---1% …. 1 Million
C. Major Depressive Disorder ---17% …. 17 M
D. Dementia --- 5% (of older than 65) …..
E. Epilepsy ---0.06% …. 600,000

Program Manager Contact Information

Ms. Frances Prescilla L. Cuevas

Chief Health Program Officer
Disease Prevention And Control Bureau-Essential Non-Communicable Disease Division
Tel. No. 651-7800 Local 1750-1752

Just when you think you have won the battle against heart disease, think again.
Adult survivors of congenital heart disease (CHD) of the outpatient department of the
University of the Philippines – Philippine General Hospital (UP-PGH) suffer from symptoms
of anxiety and depression.

In a study led by Dr. Jaime Alfonso Aherrera from the UP-PGH, the researchers surveyed 92
outpatients (with an average age of 33 years old) through the Hospital Anxiety and
Depression Scale – Pilipino (HADS-P), a self-administered Filipino survey questionnaire
used in detecting anxiety and depression. Results reveal that 61% of the group had shown
signs of being anxious and depressed post-hospitalization, all of which were diagnosed with
CHD. This is relatively higher than data recorded in foreign studies (34%) for the same
group.

HADS-P survey results also show that the patient’s inability to secure jobs, hence,
dependency to family members, was cited as a great factor contributing to the anxiety of
what is deemed as the vulnerable population.

Mental illness is not a popular diagnosis in the Philippines, rarely acknowledged and most of
the time, dismissed. However, medical researchers in the country are gradually discovering
that medically-ill Filipinos are in high risk of emotional illness. In another study led by Dr. Sue
Kimberly Tan (2015) of the UP-PGH, anxiety and depression were also apparent in patients
with Chronic Obstructive Pulmonary Disease, among others.

There still is no written policy on mental health screening for heart disease outpatients.
Nonetheless, screening patients with CHD for possible psychiatric concerns should be given
importance in order to promote holistic care, study says.

To access more information about the study, “Depression and Anxiety in Adults with
Congenital Heart Disease Using the Validated Filipino Version of the Hospital Anxiety and
Depression Score (HADS-P)”, you may visit http://goo.gl/n6WvjE.