A consultant psychiatrist at the Lagos University Teaching Hospital, Dr. Rotimi Coker, discusses depression with TOPE OMOGBOLAGUN
What is depression?
Depression is a type of psychological illness that manifests in sufferers as frequent low moods, loss of energy and losing pleasure in things that hitherto gave joy. It can also disturb sleep and appetite.
How does it manifest?
The person manifesting depression can become irritable, gain or lose weight. In its severe form, the person with depression can become confused, the memory, attention and judgement can be impaired.
The person can also hear strange voices saying derogatory things to him or her. There can be associated feelings of guilt, hopelessness and worthlessness. These associated signs can make the individual want to attempt or commit suicide.
Depression is a dangerous form of mental illness because it is difficult to recognise by medical officers, general or family physicians in the private hospitals, general hospitals and primary health care settings. Sometimes, depression can be masked and may manifest with physical health conditions such as chest pain, back pain, sleep disturbances, and weight loss.
How is depression diagnosed?
These signs are not quite suggestive of depression thus, making depression difficult to diagnose even by medical doctors. That is one reason why those suffering from depression will be diagnosed with having frequent malaria or typhoid fever.
Is it possible for people suffering from depression not to know?
It is quite possible for individuals to be suffering from depression without actually being aware of being ill for many years thus preventing the individual from being maximally productive at work or at home. It takes an average of four to six years for someone suffering from depression to get the adequate professional care.
The number of Nigerians suffering from depression varies due to its severity. Those suffering from depression can have mild, moderate and severe forms of depression. I mentioned that it is difficult to recognise by doctors.
Thus, the percentages of those suffering from the mild to moderate forms of depression may be very high in Nigeria. However, the percentage can be put between 20 to 40 per cent of the population.
What causes depression?
There are many issues that can cause depression. For example, any significant loss can bring about depression. Significant loses such as the loss of parents, child, spouse, job or fortune, huge money, as we witnessed recently with MMM (Mavrodi Mundial Movement).
Depression can also be caused by social problems such as poverty, living in houses that are not quite conducive with difficult neighbours; family problems between husbands and wives, those who cannot communicate adequately and appropriately; separation or divorce; those experiencing frequent environmental problems such as those living in flood prone areas, or those who live in areas with frequent noise pollution.
Others include persistent stress of life at work, on the streets or at home that one cannot cope with. Depression can be caused if one suddenly develops some forms of chronic physical illnesses such as diabetes, cancer and HIV/AIDS among others; when one sets difficult and unrealistic goals and the individual finds it difficult to achieve such goals. Goals are actually difficult to attain in this ‘change’ era that we are going through at the moment in Nigeria.
Who can be depressed?
Both the young and old can be depressed. However, it is commoner in women than men. Women experience more stress than men because of their social roles as mothers, wives and workers. They may have additional roles in society as workers in the church or mosque.
Mental illness has been found to be associated with menstruation, pregnancy and child delivery and after menopause. Stress in women was also observed to advance to chronic situations because they also do not know how to manage their stress adequately.
Women, who live alone with two or three children without a confiding partner, may be vulnerable to depression. Many people experiencing depression may refuse to see medical doctors because of the social stigma associated with people who are suffering from mental disorders.
How can sufferers be helped when they refuse to see medical doctors?
The only way out of this problem is to carry out frequent advocacy programmes, awareness campaign and reach-out programmes in the all the council areas and every state in Nigeria to enlighten Nigerians that mental illnesses are not caused by demons, evil spirit, charms or as a form of punishment from the gods as portrayed in our local home videos.
These programmes will enlighten our people that mental health conditions can be cured and also properly managed like most physical health conditions. We need to also show Nigerians that people with mental health conditions (even the chronic ones) can also be productive and integrated back to society.
Society should assist the mental health experts to carry out programmes to reduce the stigma and discrimination experienced by people with mental illness. After all, anybody can be ill mentally.
How can depression be prevented?
One must learn to be optimistic in trying periods. This is because whether we like it or not, we will continue to experience difficult situations in Nigeria. We need to learn to see light at the end of the tunnel and also know that we can always find rainbow at the end of every thunderstorm of life.
In the same vein, the God that we serve will not shut one door without opening another one for us. For every major disappointment, there is a hidden blessing. In this regard, when life gives one lemon, one should make lemonade out of it or if given bitter cola, make cola drink out of it by adding a little bit of sugar.
Nonetheless, there are many ways of preventing depression and they include listening to empowering fast tempo music, dancing, smiling and laughing at all times, watching funny comedy videos, going out to the beaches and other interesting sites and locations, reading inspirational and motivational books, dressing well at all times, setting realistic, interesting and challenging goals and the acquisition of deep breathing, relaxation and meditation techniques.
The ability to acquire all these stress prevention strategies before we encounter difficult times usually help to ameliorate the consequences of emotional trauma.
How can it be managed or treated?
Depression can be treated, cured and managed successfully with psychotherapy (counselling or talk therapy). Likewise, medications referred to as antidepressants can be prescribed for those who have severe depression.
In its mild and moderate stages, the person suffering from depression can be counselled by a mental health expert by using different types of counselling techniques. The most common form of such counselling is the cognitive behaviour therapy. However, if CBT does not provide the healing that one desires, then the individual is placed on antidepressant tablets.
There are many types of good antidepressants in Nigeria. The mental health experts include psychiatrists, clinical psychologists, psychiatric nurses, social workers in mental health. However, these mental health specialists are quite few in Nigeria.
That is why we are trying to reach out and train medical officers in primary health care centres, general hospitals, general practitioners, family physicians, spiritual and community leaders on how to recognise depression and other common mental illnesses. Depression is like any other physical illness; if recognised and diagnosed at its early stages, it can be treated without any serious complications.
In the same light, the church, non-governmental organisations, the electronic and print media and Nollywood producers have major roles to play, they all need to collaborate with mental health experts in reducing the stigma associated with mental illness.
What is the relationship between depression and suicide?
One of the major causes of suicide is depression. Studies have shown that about 80 per cent of those who committed suicide successfully had received treatment in the last six months of the act.
Other causes include persistent unbearable stress at home or work, family distress, unexpected separation or divorce, recent heavy financial loss, drug abuse such as recent ingestion of high doses of mind-bending drugs, sudden reversal of fortune but most important, when someone lacks adequate and appropriate stress and resilience coping skills to manage daily insults of disappointments, frustrations and failures.
Those who committed suicide recently in Nigeria might have experienced or suffered from many of the aforementioned risk factors at the same time.