A consultant psychiatrist at the Lagos University Teaching
Hospital, Dr. Rotimi Coker, discusses depression with our correspondent.
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 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.
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