Knowing depression and how to manage it

Depression can be a normal reaction to loss, life’s struggles, or an injured self-esteem. But if in addition, there are feelings of helplessness and worthlessness, which last for many days or weeks and keep the individual from functioning normally, then the depression may be more than sadness, said Sam Obafemi, President, Sam Obafemi Behavioural Change Academy, (SOBCA).

The outfit undertakes and develops programmes that provide solutions in Anger management, Emotional Intelligence, Fear mastery and Core CBT (Cognitive Behavioral Therapy).

Obafemi explained that stress could be a main cause of depression, as stress can be mental, emotional, psychological, financial, and physical.

“Each of this stress variant is a direct cause of further medical conditions, which depression can stem from,” he said. “Managing these conditions is a responsibility for both the patients and practitioners. Usually, one thing leads to another, and findings have shown that stress leads to depression.”

So, what are the statistics of people living with depression?
Obafemi said there are no reliable local figures.

“But from my personal experience of working on the field for 13 years now, I can assert that the statistics of depression among women is as high as one in every three, while for men, it is one in every four. Literally every week, we receive SOS calls to intervene in suicidal or near-suicidal tendencies. Many people, who feel they are only ‘sad,’ undertake our assessment and we deduce they are undergoing mild depressions. The reality in our hands is heartbreaking, but we will not despair.

How can depression be managed?
“To effectively manage depression, then stress must be scrapped out of one’s daily routine. But as soothing as it sounds, stress cannot be completely removed or avoided. Indeed, stress is needed for man to be alive and productive, but the goal is to regulate stress,” he said.

“In SOBCA, we have a model called the EPSR, pronounced ‘eh-P-SA,’ which suggests that to manage stress, patients must manage their internal energy, by being selective about thoughts, feelings and actions. They must develop capacity for pace management, which is interpreted as living in the present, rather than living in the past or in the future. The other aspects of the EPSR model admonishes on Self and Relationship management. This is because we have discovered that high relationship crisis stems from deficiencies in ‘self-acceptance.’ This means that the more people accept their own realities and personalities, the better they can accept others and, by extension, live with a stress-regulated mind.

Going forward, Obafemi said people need to be flexible and open to possibilities.
“It is certain that positive mental living is the fastest means to living above stress and depression. When we develop the capacity to be flexible and not rigid, we have capacity to change our experiences. The power to influence and change our experiences lies with us and before long, we will be able to keep stress at effective threshold,” he explained.

How does the individual know that he/she is depressed and what can be done to overcome it?
Obafemi explained that depression comes with very many symptoms, but the easiest way to detect it is when the individual desists from or stop enjoying the things he/she hitherto enjoyed.

He said: “Some people withdraw from previous interests, while some indulge more in such interests. For instance, depression makes some people spend more, while some tend to spend less. Some would eat more and others less. While some would have more sex, others would have less.

“Depression is known, when a person begins to have protracted negative or disempowering thoughts and behaviour. A person would begin to feel like a victim, feel inferior, but by the time the individual starts contemplating self-destructive thoughts, such as, suicide, depression has probably peaked. Such people need to permit themselves to seek help, by talking to someone they trust or to professionals, who will be unbiased and empathetic.

“First step is to talk to a professional or who can help find a professional. One can also buy resource books and audios that enlighten on such areas. The options are numerous. Most times, the challenge is not lack of options; rather, it is lack of will. Such people know the options, but they’re always running away from exploring them, because they fear stigmatisation or they just want to ‘end their lives’.

“I encourage such individuals to give life another chance and call on any professional within their reach. People should please live for others to benefit from their lives.”

According to WHO, mental health is “a state of well-being in which the individual realises his/her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. Mental health is not just the absence of mental disorder.”

The world body said health problem could happen to anyone at some point, which can affect his/her daily life, relationships or physical health.

Dr. Maymunah Yusuf Kadiri, a consultant neuro-psychiatrist & psychotherapist medical director/psychiatrist with Pinnacle Medical Services told The Guardian that depression is a common mental disorder that affects more than 350 million people of all ages, in all communities, and is a significant contributor to the global burden of disease.

“It presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or recurrent and lead to substantial impairments in an individual’s ability to take care of his or her everyday responsibilities. At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850, 000 lives every year.”

Maymunah said: “Globally, depression is common, very disabling, and accounts for a higher societal burden than many common chronic physical conditions, it is a neuro-biological-chemical process.”

On the symptoms of depression, she said though it varies from one person to another, but the core symptoms include, low mood or sadness, loss of interest or pleasure, loss of energy/more tired than usual.

“Other symptoms include disturbed sleep or difficulty falling asleep, waking early in the morning, disturbed appetite – either eating more or less than usual, poor concentration, agitation or slowing of movement or speech, loss of interest in sex, loss of self-confidence or self-esteem, thoughts of death or suicide and feelings of guilt.

Those who are at risk include people who have a family member with depression, (genetic), people who have experienced a stressful or traumatic life event, single parents, dual career families, military deployment or reintegration, marriage or divorce, family death, especially suicide. Also, people with work-related concerns (economic crisis/windfall, job loss/promotion, lay-offs, conflict with co-worker, competitiveness.

“Also affected are people lacking social support of a spouse, friends, and family, or having poor communication in their relationships. People whose lives are out of balance: poor eating, little exercise, sleep disturbance, illness, alcoholism or other addictive behaviours are also at risk. People, who have chronic medical conditions or persistent pain, people who have rigid personalities, perfectionistic tendencies, and compulsivity.

“In developing countries such as Nigeria, the prevalence rates of depression are higher because environmental factors that contribute to the genesis of depressive disorders are more preponderant. These include high rates of poverty, a lack of social welfare and high rates of endemic infectious diseases, to mention just a few. Also, depression tends to be masked in Africans by somatic symptoms, which may explain why it is under diagnosed or under-recognised. In Nigeria, depression is much higher in the elderly, with more female than the male.”

“The causes of depression can be broken down into the following:
• Biochemistry: deficiencies in two chemicals in the brain (serotonin and norepinephrine) are thought to be responsible for certain symptoms of depression, including anxiety, irritability, and fatigue.

• Genetics: depression can run in families. For example, if one identical twin has depression, the other twin has a 70 per cent chance of also having the illness during their lifetime. Environmental and other stressors: Significant loss, a difficult relationship, financial problems or a major life change are often cited as contributors to depression.
Continuous exposure to violence, neglect, abuse, or poverty may make people more vulnerable to depression.

• Physiological: Sometimes the onset of depression is associated with, or a symptom of, an acute or chronic physical illness, such as stroke, diabetes or heart attack. It can be a side effect of medication or a symptom of drug or alcohol abuse.
Depression can be the result of dieting or a hormonal change in females.

• Personality: People with low self-esteem, who are easily overwhelmed by stress, have a tendency to worry excessively or who are generally pessimistic appear to be especially vulnerable to depression.”

Maymunah gave a few tips on how to manage depression, which include: “Maintaining a healthy diet, managing a good sleep/wake cycle, diversification of interests, letting go of emotions, staying close to nature and developing a good sense of humour.

“Treatment for depression involves, counseling/psychotherapy (supportive counseling cognitive/behavioural therapy (CBT) problem solving – behavioural or interpersonal) and medication (antidepressant, which does not cure depression, but only helps to make the patient feel better by controlling certain symptoms, biofeedback and neurofeedback.”

She advised that awareness through health promotion, seminars by media (radio and television), education in schools, government agencies, various organisations about mental illness and de-stigmatisation can help to curb the prevalence of depression in the society.

She said: “Depression can be treated successfully with antidepressant medications and psychotherapy in 65 to 80 percent of all cases— a success rate that exceeds many current common medical treatments for non-psychiatric illnesses.”