Assistant Director of Clinical Psychology at the Federal Neuropsychiatric Hospital, Yaba, Lagos, Dr Akin Gabriel, who was the Vice Chairman of the Nigeria Psychological Association, Lagos Chapter, speaks to VICTORIA EDEME on the causes and effects of depression
What is depression?
Depression is simply a mood disorder. A mood disorder is a condition or illness that affects the mood, feelings, or emotions. So depression is a mood disorder that causes a persistent feeling of sadness that is also associated with a loss of interest in things and activities that one is used to or enjoyed in the past. It can also cause some issues with thinking, memory, and other behaviours like eating and sleeping. It’s from some of these behaviours that one can tell if another person may be depressed. As a person, I will know I am depressed when my feeling is usually low when I’m feeling low most of the time, and when I’m not so interested in things that I used to be happy about or have an interest in. This is what depression means.
Who are those who are more at risk of depression?
Everyone, including myself, is at risk of depression. Anybody can develop depression. If we look at the causes of depression, we would understand that anyone can be depressed. Some of the causes of depression include genetic factors. If somebody has one or two people within one’s family who have a diagnosis of depression, there’s a possibility of that person developing depression. This possibility increases with how close the relative is. For example, if there are parents that have depression, chances are higher than if it is from an extended family. Life issues could also cause depression. Everybody has issues. Everybody must go through life and overcome certain issues to manoeuvre through life and daily activities. There are always challenges that we all face as human beings in our normal daily routine. To achieve our potential, there are some obstacles and stresses that we need to go through and overcome. For some people, meeting these challenges and not being able to overcome them may make them develop feelings of anxiety, worry, tension, and frustration that could eventually lead to depression. Another cause of depression could also be things like childbirth. The process of pregnancy, labour, and delivery are stressful conditions that cause physical stress. There are so many hormones increasing and decreasing, which disrupt the physiological system of the woman. The process of delivery could also lead to a particular type of depressive disorder.
Another cause of depression is substance misuse. Some people are dependent on substances and the nature of some psychoactive substances can trigger depression in people. With these causes, anyone can become depressed. Everybody has life challenges. The differences in each person include our stress-coping capacities, views about life, identification, and discovery of our psychological resources, which are available to us to overcome challenges. The way we manage these tools determines if we come down with depression or overcome it and live a more psychologically fulfilling life.
What’s the relationship between mental health and depression?
Depression is a mental health condition. It is a mental health illness that affects mood.
How can someone know that they are going through depression?
The first thing that one will observe is the mood. Mood is a subjective feeling that you know for yourself. It’s difficult for other people to know your real mood. They may think that they know it but you are the one who knows how you are feeling. If you observe that your mind is going lower than it used to be, you have to examine why such is happening. In this case, it has to be a persistent low mood, not just a brief occurrence. You may also find out that it’s difficult to get off the low mood. For example, if you’re watching a movie and you feel a sad mood during an emotional scene that is just a reaction to the movie. But if these feelings persist for hours, days, or weeks, you can now think of having an evaluation for a mood disorder like depression. So, low mood is one of the signs.
Another sign is recurrent negative thoughts, which can be about self-worth, the world, people around you, and other thoughts. This can lead to sleeplessness as you are unable to sleep because you engage in thinking. One who is depressed will not feel happy. There is a persistent feeling of sadness that just will not go away. You will not find humour when a joke is made and you’d wonder why others are laughing. You can also notice a loss of control of one’s mood and thinking. In some cases, it can also affect the appetite; one can eat too much or have no appetite at all. There can also be some changes in a person’s appearance. The grooming will not be as good as it used to be. The hair may be dishevelled and the dressing haphazard. You may dress haggardly to work and people will wonder what is going on with you.
These are some of the obvious signs people can see when you are depressed. When depressed, you may not even participate in social activities. When you are called, you don’t pick up; you don’t honour invitations; and you give excuses. You may even find it difficult to get out of bed, pick up the phone and talk to people. There is lethargy and weakness to do anything. These are the signs you should look out for to determine if you need to be evaluated for depression.
How can people assist someone going through depression?
Looking out for a person can help them during depression. By the time a colleague, a friend, or a neighbour begins to be scarce in places where they used to be regular, you need to ask questions and check on them. It is good for you to confirm the psychological state of that individual first before accusing the person of not picking up calls or distancing themselves. Such a person may need help.
At what point does a depressed person get suicidal?
The thoughts can be so negative that you become suicidal. These are self-demeaning thoughts. Sometimes, the distress may be so severe that you think suicide is the best way to get out of it. During depression, you can also hear strange voices of people who are not there. The voices may be abusive or tormenting. At this point, you may begin to contemplate suicide as a form of escape.
In a recent report, you mentioned that four in 10 Nigerian women were depressed. How did you arrive at such statistics?
Yes, four in 10 women have one form of depression or the other, especially when you consider the various forms of depression with different levels of severity. The levels of severity of depression can be mild, moderate, and severe. Specifically, about four years ago, Adeyemi et al in the Eti-Osa Local Government Area of Lagos State found out that there was a prevalence rate of 35.6 per cent, which is about three and a half women out of 10 nursing mothers with postpartum depression. In India, about six years ago, they gave an estimate of 40 to 50 per cent of women who had postpartum depression. So there is quite a lot of depression, including postpartum depression, which is commonly known as major depressive disorder. There are several others. These figures are specific and are the current rate for postpartum depression. For other types of depression, the rate may be slightly lower, ranging between 1.5 to 2.5 women out of every 10 with depression. The highest so far is women who have depression as a result of childbirth.
Can societal pressures be a contributing factor to high rates of depression in women?
Societal pressures can lead to depression. Every human being is charged to get the best out of life and to flourish, but to achieve this you have to go through a lot of challenges. Societal pressures can be beyond one’s control, which constitute distractions and obstacles that we need to know how to manage, flourish, and achieve our goals. Societal pressures can include laws, regulations, dollar rates, increases in prices of goods and services, fuel, food, kidnapping, robbery, etc. Such societal issues can create worry, anxiety, tension, and frustration. If these feelings persist for too long, it can lead to depression. Despite the pressure, every individual is equipped with psychological resources to manage these pressures. You should focus on and discover your psychological resources irrespective of the societal pressure, and learn how to apply them to manage these societal pressures.
What are your thoughts on mental health-related issues experienced by teens?
There is no adult who wasn’t a teen at a particular time. However, the dynamics of time are changing. There are so many things we are observing with teens now. It’s the age of the Internet, social media, and other innovations. The society also reflects on the mental health of things. Everyone has a way they manage their stresses and challenges, including a newborn baby. If a newborn baby is hungry, he or she will cry out for attention to be fed. That is the way the newborn baby is attending to the stress of hunger. By the time the baby is one or two years old, he or she will have learned to request food from his/her parents. There are appropriate ways within society that will teach the individual to adapt to the environment and solve their problems. Unfortunately, it may not run smoothly.
These days, there are single parents, parents in absentia, or those who see their kids at intervals. These have an impact on the general mental health of the child or teen. The great influences that teens get from the environment, especially on the Internet and social media that they easily have access to can influence their behaviour. The teenage years are years of major influence. When a child is between the ages of 10 and 12, that child is already looking at how to identify himself and wants to pull out from the family. This process begins in childhood. From age one to two, the child depends on his parents for survival. From age three to four, the child begins to explore and the parents begin to create barriers to ensure the child is still under their care. The quest to pull out and self-discover gets to its height at ages 10 to 12 when the child can have access to social media, books, and schools where they learn about so many things.
How can individuals facing depression find professional help?
Individuals with depression can get help despite the dearth of professionals. The current population of licensed clinical psychologists in Nigeria is just about 500 as of a few months ago. The number of professional consultant psychiatrists in the country is not up to 300. The japa syndrome has taken away many of the mental health nurses from the country. The number of professional therapists and social workers is grossly inadequate. Despite that, help is available for individuals who feel that they have some of these symptoms. They can go to the Internet to search for mental health facilities around them. You can go to the nearest one you know and speak to a professional, and not a charlatan. The charlatan will complicate issues, and we also have that as a problem right now. A lot of people come up and call themselves mental health experts when they may not have the required professional licences and experiences.
Can depression/mental health-related issues lead to addiction? If yes, what kind of addiction?
Addiction occurs when you rely on substances to overcome depression.
Many years back, the issue of mental health was not quite as popular as it is now. What could have led to the rising popularity of the subject?
Thanks to the era of information, mental health topics are becoming more popular in the media. The reason for its popularity is the information that is available in the media and other non-formal groups like religious houses, schools, and markets. We also have mental health workers who go out for community outreaches and advocacy programmes to discuss more about these topics and how to identify them. More advocacy and awareness are being created by professionals through various bodies in the country.
Does the current hardship in the country contribute to the rising cases of depression?
The current hardship we are experiencing in the country is having a psychological impact on everybody. Nigerians may feel unhappy, worried, anxious, and frustrated about the future. These are normal responses to adverse situations. As they are normal, it is only normal to overcome them. It is when you don’t overcome them that they become a problem.
