Yes, depression is real

According to the SA Depression and anxiety Group (Sadag), there are 23 suicides and 230 serious attempts recorded in the country a day. The dictionary defines depression as feelings of severe despondency and dejection.

It is essentially an illness that involves the body, mood and thoughts 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 even 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.

SA’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 SA. 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 to 24 year olds, and over the past two decades suicidality among men in this age group has increased by 66%.

According to a recent study, 8% of teens have actually attempted suicide, while 57.7% had told someone of their intentions to end their lives.

Young depressed woman. Istock

Risk factors

Risk factorsThe exact cause of depression isnot known, but the following factors seem to increase the risk ofdeveloping or triggeringdepression:

•  Traumatic or stressful events, such as physical or sexual abuse;
•  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 kids

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, 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 and loss of interest in normal activities and avoidance of social interaction.

Signs and symptoms in adults Adults

Manifest the same signs and symptoms which include feelings of sadness, tearfulness, emptiness or hopelessness (some describe it like feeling like you are in a dark hole).

Poor sleep patterns (either too much sleeping or insomnia), loss of interest in sex, or any activities that one used to find enjoyable, irritability or frustration over small matters, unexplainable angry outbursts, lack of energy, poor appetite or increased appetite, anxiety, agitation or restlessness, feeling worthless, feeling guilt, fixating on past failures or blaming yourself for things that aren’t your responsibility, difficulty concentrating, poor memory, frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide, unexplained physical problems such as back pain, muscle aches or headaches.

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 other people.

Treatment and 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, 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 anti-depressants. It is very important that you know the side effects of what has been prescribed as some of the side effects can be as debilitating as the illness itself. It is also important to let your physician know all other medications you are on (including counter or recreational drugs).

Don’t stop taking an antidepressant without talking to your doctor first. They aren’t considered addictive, but sometimes physical dependence (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 decrease your dose.

There are cases in children and teenagers where there is reporting of increased suicidal thoughts when taking antidepressants, especially in the first weeks after starting or when the dose is changed. Anyone taking an antidepressant should be watched closely for worsening depression or unusual behaviour.