In South Africa there are 23 suicides a day recorded and 230 serious attempts
The dictionary defines depression as feelings of severe despondency and dejection. It is essentially an illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about himself or herself, and thinks about things. It is not like temporary sadness or blue mood, nor is it a sign of personal weakness or a condition that can be wished away. People with depression cannot merely ‘pull themselves together’ and get better. Without proper counselling and/or medical treatment, symptoms can last for weeks, months, or years.
In South Africa the prevalence of major depression is said to be about 9.7% but there is also a high possibility of underreporting because of limited understanding or under diagnosis. Our country’s mental healthcare resources are wholly unequipped to handle the burden placed on them, it is estimated that over 85% of the mentally ill patients are dependent on public health-sector services. The stigmas surrounding mental health pose a major stumbling block when it comes to treating the disease in South Africa. As a result, sufferers are afraid of being discriminated against, disowned by their families or even fired from work, should they admit to having a problem. There is still the perception that someone with a mental illness is crazy, bewitched, dangerous or weak. Because there is often an absence of physical symptoms with mental illness, it is considered ‘not real’, a figment of the imagination.
Suicidality in teens and young adults is emerging as an important mental health issue that needs to be addressed. More and more young people are giving up on life in their prime years. Suicide is the second largest cause of death (after accidents) among 15-24 year olds, and over the past two decades suicidality amongst men in this age group has increased by 66%. According to a recent study, 8% of teens have actually attempted suicide before, whilst 57.7% had told someone of their intentions to end their lives.
“ The stigmas surrounding mental health pose a major stumbling block when it comes to treating the disease in South Africa.”
Dulcy Rakumakoe (CEO of U-care Medical Centres)
Risk factors of depression
The exact cause of depression is not known, but the following factors seem to increase the risk of developing or triggering depression:
Traumatic or stressful events, such as physical or sexual abuse, the death or loss of a loved one, a difficult relationship, or financial problems, poor child parent relationships, positive family history of depression, bipolar disorder, alcoholism or suicide, people with low self-esteem, self-critical or pessimistic, homosexual or transgender in unsupportive situations, history of other mental health disorders, such as anxiety disorder, eating disorders or post-traumatic stress disorder, abuse of alcohol or illegal drugs, having other serious or chronic illnesses like HIV, cancer or chronic pain, depression can also be a side effect of some high blood pressure medications or sleeping pills.
Signs and symptoms in children
The signs and symptoms are a lot like those in adults, but in younger children may also include:
- sadness
- irritability
- aggression
- clinginess
- worry
- aches and pains
- refusing to go to school
- refusing to play with other kids
- always sleeping, and
- poor appetite, or failure to gain weight.
In teens the signs may be more obvious and they may include:
- sadness
- irritability
- feeling negative and worthless
- anger
- poor performance or poor attendance at school
- feeling misunderstood and extremely sensitive
- using drugs or alcohol
- eating or sleeping too much
- self-harm or self mutilation
- loss of interest in normal activities, and
- avoidance of social interaction.
Signs and symptoms in adults
Men and women manifest the same signs and symptoms which include:
- sadness
- irritability
- aggression
- clinginess
- worry
- aches and pains
- refusing to go to school
- refusing to play with other kids
- always sleeping, and
- poor appetite, or failure to gain weight.
Other people may feel generally miserable or unhappy without really knowing why. For people with depression, these symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others.
Treatment / Management
If not properly managed, depression can lead to heart disease and diabetes, alcohol or drug abuse, anxiety, panic disorder or social phobia, family conflicts, relationship difficulties, and work or school problems, suicide and self-mutilation, such as cutting.
Psychotherapy and medications are very effective for most people with depression. If symptoms are severe it might be wise to be hospitalised until symptoms are manageable. There are many available types of antidepressants. It is very important that you know the side effects of what has been prescribed to you as some of the side effects can be as debilitating as the illness itself. It is also important that you let your physician know all other medications you might be on (even over the counter, or recreational drugs) as there might be interactions. Don’t stop taking an antidepressant without talking to your doctor first. Antidepressants aren’t considered addictive, but sometimes physical dependence (which is different from addiction) can occur. Stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms, and quitting suddenly may cause a sudden worsening of depression. Work with your doctor to gradually and safely decrease your dose.
There are cases in children and teenagers where there is reporting of increased suicidal thoughts or behaviour when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. Anyone taking an antidepressant should be watched closely for worsening depression or unusual behaviour, especially when first beginning a new medication or with a change in dosage.
Psychotherapy is very important in managing depression; examples are cognitive behavioural therapy or interpersonal therapy. It can help the patient adjust to a crisis or other current stressful situation, identify negative beliefs and behaviours and replace them with healthy, positive ones, explore relationships and experiences, and develop positive interactions with others, find better ways to cope and solve problems, identify issues that contribute to your depression and develop coping behaviours. Patients can also try self-manage the illness by adhering to the prescribed treatment plan or discussing with their physician if the treatment is not working for them, educating themselves as much as they can about depression, avoid drugs/alcohol, exercise and eat healthily, and be aware of the warning signs.
By Dulcy Rakumakoe (CEO of U-care Medical Centres)