Monday March 17 2014

Depression: Why you might be having blues


By Christine W. Wanjala

“All the signs were there. I just did not know what they meant. What I knew is that the gloom would not go away. A weight was crushing my chest. It made it hard to smile, to talk to people, to just live.
“‘You have so much going on right now, you will be fine. I am praying for you. Think positive. You will overcome this,’ is what my best friend said. I wanted to believe her so much, I wanted the dark clouds to go away so much. So I waited for a little lightness in my heart, a little eagerness that would hint that this was all temporary. I tried to reach for that inner strength we are always told we have, still nothing.

“I guess because I was not in physical pain, it was harder for those around me to understand. It felt more like something inside me had sunk or like I had fallen in a pit I was too powerless to get myself out of.

Yes I had lost my mother four months before, and we were having a prolonged fight with my husband over his almost teenage stepdaughter staying with us. I had cried many tears over my mother and had several heated arguments with my husband over the living arrangements but this was different. The fight had gone out me.

“Every waking moment was ruled by a pervading sense of hopelessness. The feeling that everything in my life was pointless. It is hard to describe the exhaustion with everything that would set in the minute I woke up in the morning.

‘What is it nowadays? What is bothering you? Why are you always so sad? You have to pull yourself together at least for your daughter,’ my concerned husband said. I had no answers then, no appetite either. No urge to see anyone even Mary, my friend. I would grit my teeth when the phone rang, or my five-year-old followed me around denying me the solitude I craved so much.”

This is a narration by Julia (second name withheld), a mother of one, on her experience with depression. She is just one of the many Ugandans who have experienced the often under looked condition.

According to Dr Sheila Ndyanabangi, the Principal Medical Officer in Charge of Mental Health and Control of Substance abuse in the Ministry of Health, one in four Ugandans is projected to suffer from some form of depression at some point in their lives. Like Julia, many will not know what hit them.

This is typical of many people suffering from depression according to Dan Sentamu, the co-coordinator of the Kampala centre of Heart Sounds, a peer support organisation for people with mental conditions, including depression. “Many times the depressed person does not even understand what he is going through,” he says.

Sometimes it is not that easily evidenced on the outside, not as it would on other mental challenges. Sentamu, who has also suffered depression, says attempts to describe it leads to conclusions that one is suffering from low moods. Something that a little pep talk can fix, and firmly within a person’s control.

The truth is, there is a difference between sadness and depression, the illness. Not everyone who says, “I am so depressed”, actually is.
“You can be feeling sad because of a certain occurrence in your life. That is a normal phenomenon. It is depression if one continues feeling sad for a prolonged period of time,” says Eugene Kinyanda, a consultant psychiatrist.

The statistics
Uganda has still not had a national survey on depression due to what psychiatrist and researcher in mental health Eugene Kinyanda calls absence of a proper longitudinal study. This is a study done over a long period of time, and repeated from time to time. What we have are cross-sectional studies, those that are done once and not repeated.

It is therefore hard to conclusively tell whether depression is on the increase or decline in the country. However, Ndyanabangi says figures of patients from different centres has shown an increase in the number of Ugandans being treated for depression. “However, it could be as a result of more people seeking professional help as compared to yesteryears,” she adds.

One of the biggest studies covering 11 districts in mainly war-affected north and northeastern region revealed that depression rates ranged from 14 per cent to 40 per cent in some areas. Majority of these cases will go untreated, those that get to hospital report after months of suffering, as a last resort. And Julia’s case was not different, she too, waited and until her body could push on no more.

“I was barely eating and lost a lot of weight very fast. I am sure people whispered but I was beyond caring. It is the weakness, the constant exhaustion that made me go to see a doctor. My husband thought I had something like typhoid,” Julia narrates how she ended up getting treatment.

It was at the hospital where the doctor referred her to a psychologist and where she was eventually diagnosed with severe depression.
Symptoms of depression are feeling low, empty or sadness continuously for an extended amount of time. Dr Kinyanda says it usually goes on for over two weeks.

A depressed person is also going to lose interest in things they were previously interested in. Other symptoms will be loss of appetite, and consequently weight loss, loss of libido, feeling of worthlessness, negative thoughts, low energy and sometimes over time suicidal thoughts creep in.

For one to be diagnosed with depression, these symptoms must be interfering with normal function of a person. Depression can cause an unbearable lack of energy even for simple tasks like bathing, or brushing their teeth,” says the psychiatrist.

Sentamu shudders when he recalls the time he had depression. “It is a very hard thing, very serious. You only understand it fully if you have experienced it or interacted with people who are suffering from it. It is beyond a state of mind, a condition,” he shares.

The good news is that depression can be treated. Julia is a living testament. Over several months, she has fought her way out of despair.
The temptation to handle it at home is great, what with the belief that depression is something one can snap out of. But Kinyanda is categorical about the importance of seeking professional help.

Ideally, a psychiatrist should be able to diagnose and treat a person with depression. But psychiatrists are few and far between in Uganda.
Psychiatric nurses or officers are more accessible for most. “They are trained to diagnose and handle depression and are found in all regional hospitals all over the country and several other health centres,” says Kinyanda.

A clinical psychologist is also qualified and trained to help a person with depression. “Some counsellors who have earned the title by short courses or dispensing free advice are best for ordinary sadness.
Depression needs very highly qualified professionals,” cautions Kinyanda.
Anti-depressant drugs are just one approach of treating depression. There is also psychotherapy which is sometimes called counselling or talk therapy and involves focusing on helping a person learn to deal with issues. Kinyanda says professionals use a combination of both to tackle depression cases and that treatment should last for at least six months to make a full recovery.

The cause of depression will determine whether the depression was a one-off occurrence or a recurring problem in someone’s life. “Some people are genetically predisposed to depression and will have to keep getting treatment all their lives. If for example the depression was triggered by a major life event, a person may recover and not regress again,” explains Kinyanda.

With proper care, a person will feel as good as new in a few weeks but therein lies the danger. One may abandon treatment which will expose them to the risk of the depression recurring. “Research has shown that one fully recovers after at least six months of treatment. Keep the treatment, even if you feel fine until you complete the dosage,” adds Kinyanda.

Though she has recovered, Julia worries the darkness will creep in again. This time though she has the benefit of knowing when and where to seek help. Sentamu is more positive surrounded by other people who have gone through the same.Sharing with them has kept him going.

“I know that the first step is to accept depression as a condition. Interacting with others sharing expereinces always goes a long way in helping one cope after the treatment is done. Depressed people do not want to talk but we encourage each other since we are all familiar with the expereince. We remind each other to fight it. I stay in the circle and also keep myself busy, keep positive,” he says.

Depression in Children
Dr Sheila Ndyanabangi, the Principal Medical Officer in Charge of Mental Health and Control of Substance abuse in the ministry of health, says depression is more common in women than men world over. Uganda is no exception.

“It also very common in elderly people. But generally depression occurs in all age groups from adolescents upwards, [but] we do not say children have depression,” she says.
Not to say that children do not suffer from emotional problems because they do.

Eugene Kinyanda, a psychiatrist and researcher in mental health, says emotional problems in children will not present like in adults. “With children, they will manifest in other ways likes school problems, or violent outbursts.”

Child psychologist Betty Kyomugimba says parents should look out for telltale symptoms like a child beginning to constantly isolate themselves, lack of interest in play, and also negativity when they speak.
Kinyanda says a professional will approach depression in a child differently and treatment includes family therapy.

Types Of Depression
Reactive depression
This is when one gets depressed as a result of a major occurrence like grief from loss of a loved one and financial strain. Eugene Kinyanda, a consultant psychiatrist, says this type can be traced to a particular trigger and normally a person has had no history of depression and once they are treated, it may not recur.

Non-reactive or uni polar depression
This one is what people with a genetic predisposition are likely to get. If you look in the family of a person with non-reactive depression, you are likely to get other family members who suffer from the same,” explaines Kinyanda. The pressure that triggers it does not have to be that big either, meaning the slightest disappointment can send such a person into the depths of depression. A person with non-reactive depression has several episodes throughout their lives.

Bi polar depression
When a bi polar person has depression, one of the two poles of his or her emotional states will swing between. They experience periods of depression, and periods of mania, where they are super excited, have lots of energy and feel like they are can do just anything. Then get periods of normal mood in between.