Salud

¿Te has preguntado qué siente un depresivo?

Probablemente no, ocupado en otros afanes de la vida.

¿Será la insondable sensación de sentirse siempre solo?  ¿La sangre correr como un mar impetuoso por tus venas? ¿Un estado en que la nada adquiere sentido, pero se ignora cuál? ¿El consejo que huele a reproche? ¿Asumir la empatía como burla?  ¿La vida sin color y una letra sin música? ¿O igual que aquel que le cantó a la soledad: Hola depresión, casi siempre estás conmigo? ¿El choque con un iceberg capaz de resistir el embate de miles de Titanics? ¿Tus sentidos como las piezas de un dominó colocadas en fila y a la espera de un ligero toque para verlas caer en efecto cadena? ¿Tu fe hecha añicos para que pienses que hasta Dios te ha abandonado? ¿Un monstruo que engulle tus sueños y esperanzas? ¿Un maratón donde ya no hay meta? ¿La aparición del amigo fiel del suicidio?

Hoyo profundo y oscuro
Y si piensas que con estas interrogantes ya comprendes por lo menos un poco el estado de ánimo de una persona bajo sus efectos, Luz Bethania Antigua, quien sufrió por el suicidio de su hijo de 17 años, Alam Cabrera, debido a una profunda depresión, además de que ella también padeció ese trastorno mental agobiada por la decisión de su vástago, afirma que “es como estar en un hoyo profundo y oscuro”.

“Es el estado más deplorable en que un ser humano puede verse imbuido porque simplemente entiende que no hay salida, su mente se bloquea de una forma tan inexplicable que su estado físico llega a una condición deplorable”, indicó Antigua.

Recuerda que en su caso perdió el apetito, descuidó su apariencia física, estaba permanentemente intranquila, se encerraba en un closet por horas porque no soportaba ver la luz y llegó a una condición en que estaba físicamente viva pero mental y emocionalmente muerta.

Una depresión mayor llevó a su hijo Alam al suicidio y a ella la sumió también en una condición en que solo quería dormir y no despertar jamás. “Me sumí en un estado de abandono, y dejé de vivir”, añadió la dama, quien creó una fundación a la que puso el nombre de su hijo para prevenir el suicidio.

Antigua llamó a asumir la depresión como una enfermedad catastrófica al igual que el cáncer, las cardiopatías, derrame cerebral, diabetes, afecciones renales y otras condiciones físicas, ya que cuando la mente no funciona, el siguiente paso son las ideas suicidas.

Consideró que en el país y el mundo hay dos pandemias, una coyuntural provocada por el nuevo coronavirus Covid-19, y una permanente a la que no se le presta atención, pero que provoca más muertes cada año, llamada suicido, consumado en la mayoría de los casos por depresión.

¿Quién la conoce?
El director de Salud Mental del Ministerio de Salud Pública, Alejandro Uribe, resume esta condición tan incapacitante de la siguiente manera: “La depresión solo la entiende quien la ha sentido”.

El psiquiatra precisa que es un trastorno mental que provoca la pérdida de la esperanza, disminuye la capacidad adaptativa, ataca el funcionamiento global de la persona, baja el rendimiento y es una de las principales causas de discapacidad laboral en el mundo.

Consume cuantiosos recursos, mucho más entre los afectados por la falta de cobertura de la Seguridad Social, ya que un cuarto de la población la padece y en esa misma proporción se da entre las personas que acuden a servicios de salud por otras patologías. “La depresión a veces se presenta por sí sola y otras veces acompañando otros diagnósticos, deteriorando la condición de salud general del paciente”, añadió Uribe.

Exhorta a no minimizar la depresión con frases como “eso no es nada”, “sé fuerte”, “pon de tu parte” porque crean en quien la padece un sentimiento de frustración y culpa.

El peor vacío existencial

Para José Miguel Gómez, psiquiatra con un dilatado ejercicio en esa especialidad, la depresión “es el peor vacío existencial” que un ser humano puede padecer.

Lo que genera, a su modo de ver, no puede ser más intimidante: abatimiento, tristeza, apatía, desesperanza, pesadumbre, falta de motivación y la incapacidad de quienes la sufren de asumir un proyecto de vida.

“Hace que surjan pensamientos rumiantes y negativos porque deteriora el área cognitiva, pero también el paciente puede padecer trastornos del sueño, perder el apetito o comer mucho por ansiedad”, explicó el expresidente de la Sociedad Dominicana de Psiquiatría.

La mayoría de los psiquiatras suelen definir la depresión con una frase que sabe a cliché: “Un antes y un después”, y mucho más ahora en la era Covid.

Pandemia

Algunas de las medidas implementadas por el Covid-19 para garantizar la salud mental de la población demostraron su utilidad y podrían mantenerse porque posibilitaron hallazgos interesantes. La línea de apoyo abierta para asistir a la población permitió detectar una mayor proporción de personas con depresión, ansiedad, trastornos del sueño y estrés postraumático.

Al hacer esta reflexión, el director de Salud Mental precisa que todas las crisis dejan una enseñanza y con la pandemia del nuevo coronavirus se comprobó que hay un incremento en la demanda de servicios de salud mental y se espera que en la era postcovid también se registre un aumento significativo por los efectos económicos y psicosociales que dejará la enfermedad.

Aunque aclaró que no hay un plan elaborado para mantener esa asistencia luego de superada la pandemia, si harán todo lo que sea necesario para prestar ese tipo de servicios a la comunidad.

Recordó que en una ocasión junto al psiquiatra Nelson Moreno Ceballos pusieron en servicio una “Línea de Apoyo Emocional” con muy buenos resultados, debido a la cantidad de personas con trastornos mentales que llamaba para procurar asistencia.

“Sería una herejía decir que los peores efectos del Covid-19 vendrán después que pase la pandemia, pero para mí después que pase la pandemia van a venir problemas importantes, definitivamente”, agregó.

Como la pandemia ha venido acompañada de mucha incertidumbre, secuelas económicas graves y de cambios traumáticos en los estilos de vida, estima que “muchas personas no contarán con los mecanismos adaptativos necesarios para enfrentar esa realidad”.

Los retos
El director de Salud Mental afirmó que tiene el reto de vencer la estigmatización que padecen los pacientes con diversos trastornos mentales y dejar atrás la etapa de “cenicienta” de ese sector como parte de la atención en salud.

El psiquiatra está convencido de que se requiere incrementar la inversión en ese sector y propiciar una mejor distribución de los recursos humanos para mantener los avances logrados en los últimos cuatro años en materia de salud mental.

El expresidente de la Sociedad Dominicana de Psiquiatría critica que la mayoría de los  profesionales de esa área estén concentrados en las grandes ciudades, especialmente en la capital, dejando sin el servicio de salud mental a regiones como el noroeste, el suroeste y el este del territorio nacional.

En entrevista para LISTÍN DIARIO con ocasión de celebrarse el pasado 10 de octubre el Día Mundial de la Salud Mental, cita la incongruencia de que la única psiquiatra residente en Jarabacoa esté nombrada en La Vega y uno oriundo de San Juan de la Maguana preste servicios en Barahona.

Garantizó que dará continuidad a los programas ejecutados en la anterior gestión del psiquiatra Ángel Almánzar, a quien elogió por los cambios introducidos en la atención psiquiátrica en el país, especialmente con la eliminación del hospital psiquiátrico, llamado por la población El 28, para dar paso al Centro de Rehabilitación Psicosocial (CRPS).

Uribe destacó que República Dominicana ha impulsado una gran revolución en la atención en salud mental, dejando atrás el concepto de manicomio y estableciendo un modelo que otros países están imitando, con el reforzamiento legal a través de la Ley 12-06 sobre Salud Mental, la cual llama a brindar un trato humano y con respeto a las personas que padecen diversos trastornos mentales.

Suicidios
Con respecto al suicidio, Uribe dijo que luchan para que las administradoras de riegos de salud (ARS) incluyan la cobertura de la salud mental en la seguridad social.

Consideró que tanto a nivel privado como público el suicidio debe asumirse como una emergencia. “Una persona con ideas suicidas hay que tratarlo como un enfermo en cuanto al procedimiento, pero en lo que se averigua hay que internarlo”, indicó el maestro de la medicina.

Principal causa de suicidios
En los primeros ocho meses de este año el país registra 366 suicidios, en su mayoría ejecutados por hombres mayores de 18 años, siendo la depresión la principal causa detectada en más del 47% de los casos.

En los últimos doce años un promedio de 565 personas se han quitado la vida por año, alcanzando incluso cifras topes de 637 y 638 en los años 2011 y 2012, respectivamente.

Y la panacea para enfrentar los efectos tan devastadores de la depresión parecen ir en una misma dirección: No ignorarla.

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