Saturday 19 / April / 2025
Dr Fabian Saarloos, clinical and health psychologist at Al Harub Medical Centre, talks about depression, the stigmas attached to it, and why it is important to treat the early symptoms as we get ready to celebrate World Health Day on April 7 that aims to mobilise action on depression.
What are the common cases of depression in Oman?
Depressive symptoms, most notably the feelings of sadness, passivity and negative conceptions about self, others, and the world are very common and recognised all over the world. According to World Health Organisation, 10 per cent of the population is suffering from a depressive disorder, and the numbers are expected to rise considering the disorders’ relation with chronic diseases like diabetes, heart problems, or cancer.
When these experiences over time increase in intensity and come to affect daily functioning in various contexts, i.e. personal, interpersonal, social, and occupational, then we can diagnose it as a depressive disorder. Depressive disorder is diagnosed in degrees of intensity (mild, moderate, and severe) and frequency (single episode vs chronic). In rare cases, people experience manic episodes in addition to their depression, which we then diagnose as bipolar disorder.
Unfortunately, there are not many statistics available on the state of depression in Oman. From my experience, I would say the most common type of depression is the single episode, ranging in intensity from moderate to severe. The problem is the stigma associated not necessarily with psychological complaints, but more with seeking help and consulting a psychologist or psychiatrist, which means that many cases are kept at home (until the disorder becomes too debilitating or people become suicidal). In addition, as depression often comes together with a chronic medical disorder (for example diabetes, cardiovascular diseases, and cancer), or as a side effect of other treatments, a lot of depressive people are not properly diagnosed as such and therefore do not seek treatment.
Is it still a taboo to talk about it?
As mentioned depression is very recognisable to all of us, so the diagnosable disorder just denotes an extreme in intensity, frequency, and chronicity of the depressive feelings which have become a way of living (i.e. interpreting everything negatively, avoiding situations, passivity, devaluating, and inhibiting the self).
When I see depressed clients, they do not find it difficult to talk about their experiences, rather they find it relieving finally having found someone who understands and knows how to deal with their pessimistic thinking and unpleasant emotions. The taboo is not so much on talking about negative feelings, but it's more on seeking help and going to a psychologist or psychiatrist, as they are seen as treating ‘crazy’ people.
On the other hand, people find it less difficult to talk to their close relatives or friends about their problems, but those aren’t specialised in treating depression and may thus just act as a buffer for as long as they are willing to listen, plus they may feel helpless and desperate after some time as well thus affecting their relationship. Also, a lot of clients have frequented traditional healers before coming to a psychologist, but those traditional healers were mostly experienced as frightening or authoritarian, thus making clients even feel more depressed, helpless, and worthless about themselves.
How often people take help?
Eventually, as depression progresses and people become more passive, don't leave the house anymore and don't take care of themselves and their bodies (for example eating and hygiene), family members are alerted and do bring them in for therapy. Also, suicidal threats or neglect of role-related responsibilities are reasons for people bringing in depressed clients (like mothers who cannot take care of their children or households anymore). From my experience in Oman, the most common reasons for seeking psychological treatment is depression and anxiety, but people tend to seek help only at later and more severe stages of the disorder.
What are the common reasons for depression being so common nowadays?
Depression is related to significant life events which involve some kind of loss, such as loss of a loved one, health, job, status or just the perception of loss. Common reasons for depression nowadays are the fast and highly-demanding lifestyle we have nowadays, which people find it difficult to flexibly adapt to.
Our society is very focused on success and achievement and expectations keep increasing. So it is very easy to always feel inferior or ‘not good enough’. Generally speaking, everyone can get depressed but not everyone will develop a full-blown depressive disorder when experiencing significant life events.
Relationships between depression and early childhood experiences, in particular regarding parents and school, have firmly been established. With a lot of children now growing up with maids and nannies instead of their parents, and going to demanding schools, it becomes difficult to develop a healthy sense of self-esteem and confidence as one does not learn to love oneself but only to receive criticism and no love at all.
Are there more women than men afflicted by this?
Statistically, more women seem to be afflicted. However, one must consider that women find it easier to talk about their emotions, as well as disclosing weaknesses and seeking help. Men tend to try to suppress feelings and uphold the image of being strong and unemotional, which eventually lead them to be the more severe and difficult cases once they seek treatment.
What are the treatments available?
Depression, to some extent is based on neurochemical imbalances, can be treated with antidepressant medications. However, these medications only restore balance for as long as they are consumed, and they come with a lot of side-effects (for example weight gain, loss of concentration, sleepiness, addiction, and suicidality).
Traditionally, depression is treated with psychotherapy, in which the client within the safe and empathic relationship with his therapist learns to discuss and accept his dysfunctional emotions and irrational thoughts. Together they develop new ways of processing with the painful feelings and develop new, more accurate and functional thoughts about the self, others, the world, and the future.
Several types of therapies have demonstrated significant effects: cognitive-behaviour therapy which is more focused on changing the thinking process, as well as psychodynamic therapy which is more concerned with processing unconscious conflicts and traumatic experiences. Studies have proven that the best way to treat depression is a combination of medication and therapy: While the brain is neurochemically controlled by antidepressants the client and therapist can work on developing more functional perspectives on dealing with one's thoughts and behaviours. The therapist can monitor the medication intake and effect, interfere when needed, and as symptoms decline he can assist with quitting the medication while keeping the client psychologically and behaviourally stable.
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