“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.
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.