Depression treatment in Chiang Mai

[glibb]

Hi,

My husband is Thai and is suffering from fairly severe depression which is leading him to become suicidal, he talks about wanting to die and killing himself often. I am trying to find out about treatment options for Thais in Chiang Mai or surrounding areas (we live in Pai). Does anybody know of anything? I know Thai people don't tend to deal with mental health issues and it's not generally discussed but there must be some system? He's unlikely to agree to more alternative methods of treatment but all suggestions would be appreciated. Thanks.

[mcm991]

Give these guys a call.

They will put you in touch with the resouces you need.

http://www.suanprung.go.th/eng/

[Rama]

Be very careful. Electro shock therapy is still considered a valid treatment here......

[Cpkt8]

You have to be firmly positive all the time. Be strong yourself so you can lead him out of the darkness. Try talking to him about things that he likes, try connecting to him in a positive way (so as to distract him from the negative thoughts). Accompany him all the time, don't leave him alone.

Good luck:)

[CNXBKKMAN]

Suanprung Hospital in Chiang Mai city is the mental health facility for possibly the whole of Northern Thailand. As posted by mcm991 they might be the people to help.

[hml367]

Look at the pinned topic, RECOMMENDED DOCTORS AND MEDICAL SPECIALISTS. Sombat Tapanya under PSYCHIATRY/PSYCHOLOGY.

He is Thai and speaks excellent English.

[uptheos]

There is a lady doctor at Suan Prung, who also has her own clinic.

Speaks fluent English.

Dr Kittiwan

78/2 Samlan Road (the Suan Prung Gate end)

Tel 053-814772 - 081-9500674

[NancyL]

Electroconvulsive therapy has gotten a very bad name in the west as a result of one movie -- "One Flew Over the Cockoo's Nest" I understand there are situations where it is a very suitable treatment for depression after other options have been ruled out and the doctors and staff at Suan Prung are fully qualified to administer the procedure, with appropriate safeguards, which include receiving informed consent.

I have visited patients at Suan Prung and find it to be the best government hospital in northern Thailand from a ward patient standpoint. The "upgraded" Thai menu is very nice. The "wards" are rooms of four beds, air conditioned, each with their own bath/toilet which are kept very clean.

It's possible the OP's husband doesn't require an in-patient stay. In which case, he'll find the out-patient clinic to be nice. It's arranged much like other Thai hospital outpatient clinics, but not very busy, nice aircon and better maintenance than the average Thai outpatient clinic. Somehow I just don't see the heaving masses and nurses struggling heroically with bright smiles to serve 200% of the patients the clinic was designed to serve like I see at the Suan Dok out patient clinics.

Edited April 5, 2015 by NancyL

[Schillaci]

ECT is still used widely in the west with the patients consent as a rapid last resort treatment.

[orang37]

Sawasdee Khrup, Khun Glibb,

First, I'm sorry to hear you are struggling with this; seeing a beloved person in deep depression, hearing talk of suicide, is very stressful.

Second, I'd like to echo the recommendations of other people who've commented on this thread that the Suan Prung Hospital is an excellent resource, for both of you. I would recommend Dr. Kittisak at Suan Prung (male, English fair).

Along with the recognition, in the last twenty years, that there are myriad forms of depression, with different forms responding to very different therapeutic regimens and medications, there are now myriad, clinically proven, treatments for various types of depression using a wide range of medications that may affect either, or both, the serotonin, and dopamine, systems.

A good clinician, like those you will find at Suan Prung, can help you understand his depression, and, if, hopefully, he is willing to get treated (voluntary choice to seek treatment is very important step), help him get started in therapy. A good clinician will help you check and make sure there is no direct physical cause of, or contributing factor to, the depression (endocrine problem, sleep disturbance, side-effects of medication, etc.).

I, also, see nothing to fear (these days) from ECT (electro-convulsive therapy); in certain cases of depression ("endogenous" is the clinical term) it is often, literally, a life-saver, and the treatments have nothing in common with the "bugbear" stereotype presented in media in the past. I have not had ECT myself, but have known friends who have (with great results), and, I used to be psychiatric social worker, and have seen its effects on patients.

in case it may be helpful to you, I'd like to share with you some common criteria used for assessing the risk of suicide:

0. history of previous suicide attempts, or episodes of self-harm

1. frequency of suicidal ideation; degree to which suicidal ideation is manifested across different social contexts

2. extent to which possible scenarios for suicide are mentioned

3. extent to which any one particular possible scenario for suicide is mentioned

4. mention of specific methods of suicide

5. mention of plans for, or knowledge of, obtaining means for suicide (gun, poison, rope, etc.).

6. actual possession of means for suicide

7. direct statements of intent to commit suicide

8. current patterns of drug-use and/or abuse, particularly involving psychotropic medications.

9. extent of social isolation as subjectively experienced by the person who is suicidal

These factors are by no means some kind of comprehensive "scientific" diagnostic tool; they represent general guidelines, and a skilled clinician can help you interpret the unique reality of the person.

And, it's that unique reality of the person that is all-important here: what the person experiences, what the person perceives, and what interpretation of experience and perception the person creates in thought, memory, fantasy, and self-talk.

best wishes to you and your family.

~o:37;

Edited April 5, 2015 by orang37

[Beetlejuice]

To the OP:

Are you absolutely sure that your husband is presently experiencing severe depression?

I often tell my wife, when things start getting on my nerves that I feel like doing myself in at times, but I`m never really serious. If so, has he told you what is making him depressed? Or could it just be something to do with your relationship that is making your husband feel down in the dumps? If that`s the case than marriage counselling would probably be more beneficial and appropriate. Does he not sleep well, or drink or smoke or both excessively? What other signs does he display that suggest he is severely depressed? Perhaps his behaviour is quite normal when he is around other people?

I would advise first speaking with your husband in-depth to get to the root of the problem prior to submitting him for psychiatric treatment, for a problem that maybe easily resolved with a little tea and sympathy, care and understanding.

[OccamsRazor]

I would advise first speaking with your husband in-depth to get to the root of the problem prior to submitting him for psychiatric treatment, for a problem that maybe easily resolved with a little tea and sympathy, care and understanding.

Seriously? From the OP - "My husband is Thai and is suffering from fairly severe depression which is leading him to become suicidal, he talks about wanting to die and killing himself often"

That is nothing to sit around a cup of tea for and have a 'chat' and needs a proper evaluation from a professional.

[puukao]

I didn't read all posts, but will chime in...

I have seen this before, and SOMETIMES (never a 100% guarantee) they are crying out for help....suicide talk is common. And, with depression, they can forget they said those things hours later or the next day. I've heard seniors say these things a few times.....BUT I DO SOMETHING:

1. each time i tell their nurse and they tell me they will get a therapist

2. each time i talk about more exercise

3. each time i get them to try to think of stuff they can look forward to.......this one is hard.

4. they will try to pull you back in the black hole, but just smile and bring up good memories...

there is also a chance it's during the same time of the day, or if they missed a meal, forgot a nap, or exhausted....

you DON"T DON"T DON"T just "get over" being depressed, you need medical help. You never tell someone to "just get over cancer", and severe depression is pretty serious.

[Beetlejuice]

I would advise first speaking with your husband in-depth to get to the root of the problem prior to submitting him for psychiatric treatment, for a problem that maybe easily resolved with a little tea and sympathy, care and understanding.

Seriously? From the OP - "My husband is Thai and is suffering from fairly severe depression which is leading him to become suicidal, he talks about wanting to die and killing himself often"

That is nothing to sit around a cup of tea for and have a 'chat' and needs a proper evaluation from a professional.

Firstly you only quoted part of my post, which does not fairly give an accurate description of what I have commented and seriously, I know almost nothing about depression, I`m not a psychiatrist. All I know that there is two types of depression, either caused by illness of the mind that does require profession attention and depression caused by problems relating to situations, such as relationship or financial or grief.

I have asked the OP to try and specify what has actually caused her husband`s depression. I would first want to know the facts of the case in order to make any suggestions before advising someone that this requires profession help, that in my opinion should be a last resort if other methods have been tried and failed.

[amexpat]

"I didn't read all posts, but will chime in..."

I read all posts - took under four minutes. I'll chime out.

[CMHomeboy78]

There is a lady doctor at Suan Prung, who also has her own clinic.

Speaks fluent English.

Dr Kittiwan

78/2 Samlan Road (the Suan Prung Gate end)

Tel 053-814772 - 081-9500674

Yes, Dr. Kittiwan is very well-liked and is at the top of her profession.

She treats the daughter of some close friends of my wife's family.

This girl - now in her thirties - has had severe mental problems since childhood; including suicide attempts.

Dr. Kittiwan has for the past several years supervised her treatment as a patient at Suan Prung and during periods when she is living at home.

In that time there have been no further suicide attempts, and this doctors professionalism and compassion have stabilized the girl's condition.

I'm sure that anyone who knows Dr. Kittiwan would second your recommendation.

[CMBob]

I hope the OP takes the good advice about contacting the named doctor or Suan Proong Hospital as only professionals should be involved when anyone is talking about self-harm. Best wishes for the OP and her family.

And I also am hopeful that the OP will not lay out the background facts per the incredible request of the poster who also said he knows almost nothing about depression (which was rather obvious from his other comments).

[clokwise]

I would highly recommend Dr. Ngamwong at Bangkok Hospital (here in Chiang Mai). My wife had been ill and seeking treatment elsewhere for quite some time, including Dr. Kittiwan, but she was not stabilizing, getting worse in fact, and every doctor she saw had a different idea what the problem was and prescribed her totally different meds, several of which ended up being worse than the ailment. Dr. Ngamwong is very patient and he spends enough time with her (and us together) in order to understand the underlying issues. Simply having a doctor that had time just to talk with her turned out to be so important to her. He immediately started to get her off the meds she had been prescribed elsewhere and prescribed alternate, lower impact, meds. Within just a few weeks my wife was out of the fog, and now a few months later and she's gradually going off all her meds and back to normal.

[Mousehound]

I sympathise. yes you need professional help. Look after your own wellbeing as well. I find getting out in the open - take up bird watching or photography or anything that works - exercise etc, Also, a pet can be very helpful eg cat or dog. Good luck.

[Papayabokbok]

Hmmm...

Ive been there...Ate 64 tylenol once (teen) and put a blade to my wrist..(talk about painful!)

Been strapped down to hospital beds...etc....still battling the demons..anyhoo...

IF he SAYS hes gonna do it..id be suspicious...i told NO ONE...i slept 14 hrs a day,

isolated, drank booze, pulled out of society....the ONLY person i told was my mom

as she had been pretty open and even spoke of it and lent me the book "Final Exit"

and offered me meds if i chose to follow thru.....We later agreed that neither of us

would do anything "stupid" without rational thinking and full understanding of family.

I simply felt empty, no empathy, just black inside..soulless, a walking zombie--dead.

Needless to say she passed from diabetes, so i got to witness a slow, sickened, and

sad decay...it became the waiting game and it was easier to let her go than watch her

get sicker...hence i got to FEEL what it was to lose someone close to me and the pain

of that, as some say suicide is "selfish"..there is always help..just need to seek it...

I recovered from that stage and have moved on...i realize that wasnt the answer,

BUT i did NOT go around saying i was going to kill myself, i kept it well hidden

because it seems someone would intervene and ruin my plans....so when i read

that HE SAYS hes going to do it, that seems like he wants something or help and

MAY not be serious....i can only speak from MY experiences and my own battles..

Im NOT a doctor, nor claim to be one..just wanted to add in my exps with this..

hope he feels better...i felt i had no support or anyone i could really talk to then..

I still isolate, esp here, which can be crowded and yet feel very alone, but i no

longer have a wish to end it...i have learned the gift and value of my life....

Eat well..get outside--get connected--no booze or bad stuff--have support..

[dickyknee]

To the OP:

Are you absolutely sure that your husband is presently experiencing severe depression?

I often tell my wife, when things start getting on my nerves that I feel like doing myself in at times, but I`m never really serious. If so, has he told you what is making him depressed? Or could it just be something to do with your relationship that is making your husband feel down in the dumps? If that`s the case than marriage counselling would probably be more beneficial and appropriate. Does he not sleep well, or drink or smoke or both excessively? What other signs does he display that suggest he is severely depressed? Perhaps his behaviour is quite normal when he is around other people?

I would advise first speaking with your husband in-depth to get to the root of the problem prior to submitting him for psychiatric treatment, for a problem that maybe easily resolved with a little tea and sympathy, care and understanding.

one of the common misconceptions about depression is that there is no external cause. Nothing to do with circumstances, relationships etc.

That's why it's an illness.

That's one of the most difficult things to deal with when suffering, as its known there is no rational reason to feel depressed, it kinda compounds also.

[beau thai]

You have my sympathy. Living with a depressed/depressive person is just the hardest thing. Nothing you seem to do to help them brings them joy.

Just that empty, hopeless look. So hard for you.

It seems to me that many of the monks here are actually pretty good amateur psychologists, and they have a better understanding of thai people than we can ever have. We are currently dealing with a situation ( not as bad as yours ) right now, and feel it may be easier to get our thai man in front of a monk to talking openly than with a clinician. We would like it to become a regular twice a week kind of 'monk therapy' for want of a better term.

If your man already goes to the Wat that will be easier, but just an idea and you will know if it is worth a try. Also if you havent read books on Cognitive Behaviour Therapy yet, they can help you to 'manage' this situation.

Best of luck

[Sheryl]

This needs immediate professional atention. I fully conciur with ecommendations for Suanprung Hosp and Dr. Kittiwan; I would probably start with seeing Dr. Kittiwan privately as it will be quicker, he'll get more quality time with the doctor, and it will be easier for you to have some input. Specifically, it is very important that you tell the doctor what he has saidabout suicide, as patients may withhold this from doctors -- especially Thai patients, who feel "kriengjai" of the doctor.

She will likely start him on medication. Important to understand that, depending on the drug, it takes 2-4 weeks for the depression to lift, and also sometimes the first drug doesn't work and another must be tried. he needs to understand that as it is not unusual for patients to despair completely when they have finally seen a doctor, taken meds and still don't feel better. In fact, the first 1-3 weeks on antidepressent medication is a time of increased risk of suicide, I think mainly for that reason. Depressed people have lost their sense of perspective, each day seems like a year to them, so you may need to remind him of how long he has been taking the meds vs. the expected time in which improvement would occur.

Good luck

[Scott]

A post with questionable medical advice has been removed from view.

[northernjohn]

Sawasdee Khrup, Khun Glibb,

First, I'm sorry to hear you are struggling with this; seeing a beloved person in deep depression, hearing talk of suicide, is very stressful.

Second, I'd like to echo the recommendations of other people who've commented on this thread that the Suan Prung Hospital is an excellent resource, for both of you. I would recommend Dr. Kittisak at Suan Prung (male, English fair).

Along with the recognition, in the last twenty years, that there are myriad forms of depression, with different forms responding to very different therapeutic regimens and medications, there are now myriad, clinically proven, treatments for various types of depression using a wide range of medications that may affect either, or both, the serotonin, and dopamine, systems.

A good clinician, like those you will find at Suan Prung, can help you understand his depression, and, if, hopefully, he is willing to get treated (voluntary choice to seek treatment is very important step), help him get started in therapy. A good clinician will help you check and make sure there is no direct physical cause of, or contributing factor to, the depression (endocrine problem, sleep disturbance, side-effects of medication, etc.).

I, also, see nothing to fear (these days) from ECT (electro-convulsive therapy); in certain cases of depression ("endogenous" is the clinical term) it is often, literally, a life-saver, and the treatments have nothing in common with the "bugbear" stereotype presented in media in the past. I have not had ECT myself, but have known friends who have (with great results), and, I used to be psychiatric social worker, and have seen its effects on patients.

in case it may be helpful to you, I'd like to share with you some common criteria used for assessing the risk of suicide:

0. history of previous suicide attempts, or episodes of self-harm

1. frequency of suicidal ideation; degree to which suicidal ideation is manifested across different social contexts

2. extent to which possible scenarios for suicide are mentioned

3. extent to which any one particular possible scenario for suicide is mentioned

4. mention of specific methods of suicide

5. mention of plans for, or knowledge of, obtaining means for suicide (gun, poison, rope, etc.).

6. actual possession of means for suicide

7. direct statements of intent to commit suicide

8. current patterns of drug-use and/or abuse, particularly involving psychotropic medications.

9. extent of social isolation as subjectively experienced by the person who is suicidal

These factors are by no means some kind of comprehensive "scientific" diagnostic tool; they represent general guidelines, and a skilled clinician can help you interpret the unique reality of the person.

And, it's that unique reality of the person that is all-important here: what the person experiences, what the person perceives, and what interpretation of experience and perception the person creates in thought, memory, fantasy, and self-talk.

best wishes to you and your family.

~o:37;

I have to agree with you

I, also, see nothing to fear (these days) from ECT (electro-convulsive therapy); in certain cases of depression ("endogenous" is the clinical term) it is often, literally, a life-saver, and the treatments have nothing in common with the "bugbear" stereotype presented in media in the past.

Back home about ten years ago I had a friend who would go in for it about once a year. He said it was an immense help to him. He has since died but I am sure they have continued to improve on it. To many people think of it as some thing out of Frankenstein. Those days are long gone.

[Papayabokbok]

I emailed Dr Kittiwan

800 baht for one hour.......

But the monk idea sounds just as good

Sometimes just need a lending ear--understanding...

[Sheryl]

As described, this is a serious clinical depression with real risk of suicide. Monks and an understanding listener are nto sufficient. he urgently needs professional treatment.

If OP finds 800 baht consultation fee too high, as a Thai he can likely receive free treatment at Suanprong.

Moved to the health forum.

[northernjohn]

To the OP:

Are you absolutely sure that your husband is presently experiencing severe depression?

I often tell my wife, when things start getting on my nerves that I feel like doing myself in at times, but I`m never really serious. If so, has he told you what is making him depressed? Or could it just be something to do with your relationship that is making your husband feel down in the dumps? If that`s the case than marriage counselling would probably be more beneficial and appropriate. Does he not sleep well, or drink or smoke or both excessively? What other signs does he display that suggest he is severely depressed? Perhaps his behaviour is quite normal when he is around other people?

I would advise first speaking with your husband in-depth to get to the root of the problem prior to submitting him for psychiatric treatment, for a problem that maybe easily resolved with a little tea and sympathy, care and understanding.

one of the common misconceptions about depression is that there is no external cause. Nothing to do with circumstances, relationships etc.

That's why it's an illness.

That's one of the most difficult things to deal with when suffering, as its known there is no rational reason to feel depressed, it kinda compounds also.

Not always. I got mine as a result of Pretazone. I can manage with out medication it is not really a driving force. It is just a lot less fire to get out and do some thing. I want to do more but just can't get up the energy Not even close to what I was before Pretazone. Not sure on the spelling. It is for Poly Myology. This has been going on for about 18 years.

Edited April 7, 2015 by northernjohn

[Sheryl]

one of the common misconceptions about depression is that there is no external cause. Nothing to do with circumstances, relationships etc.

That's why it's an illness.

That's one of the most difficult things to deal with when suffering, as its known there is no rational reason to feel depressed, it kinda compounds also.

Not always. I got mine as a result of Pretazone. I can manage with out medication it is not really a driving force. It is just a lot less fire to get out and do some thing. I want to do more but just can't get up the energy Not even close to what I was before Pretazone. Not sure on the spelling. It is for Poly Myology. This has been going on for about 18 years.

I think you mean prednisone? Which can indeed cause not only depression but sometimes outright psychosis. Nothing to suggest the OP's husbdand is on this, though.

[Powder]

dear,

i am an qualified therapist in Holland. Stresscounselling, EMDR therapy and other mental diseases are my expertise.

I dont have the all the information, but it seems to me, and it can give great results, that he needs an expert, therapist in EMDR. You can find enough info on internet. And i think there will be 1 in your area who can do this simple but very effective therapy.

i wish you strength and hope he will feel better soon.