DEPRESSION: EVERYTHING YOU NEED TO KNOW
Welcome to this week’s story. I will be the first to admit that the title you see up there is a misnomer. What is a misnomer, you ask? Well, it’s “a name or title that is wrong or inappropriate for the thing it refers to”. By the end of the story, you’ll understand why.
What is depression?
Depression is an illness that affects the whole person — thoughts, feelings, behaviour, and physical health. Depression, as we all know it, is a persistent state of feeling that just sucks. It is often said to be more than just sadness.
Some say it is like a dark cloud that follows you around. Some describe it as a terrifying blanket of emptiness that descends upon you, and there’s no lifting it. It is an absence of feeling, like there is a hole where your heart should be. Some describe it as a peculiar anguish that reaches down into your soul and tries to squeeze the life out of it. Others say it’s a state of constant negativity directed at yourself. In fact, some people may not even recognise the sadness, feeling instead a general unease, preoccupied with pains and aches and bizarre heaviness on parts of their body.
Essentially, it’s that feeling plus a pervasive sense of helplessness and loss of joy in the things that make us alive.
Why is it a disease/disorder?
Depression is rightly called a mood disorder. There’s a distinction between disorders and diseases, but I won’t bore you with the technical specifics. If it makes you feel awful, creates difficulties in living, working and relating, is recognized reliably with the scientific method (diagnosed) and treatment is possible, it’s a disease.
There’s a lot we still don’t know about depression. What we do know is that:
· Millions of people all over the world are not faking these symptoms: there really is something wrong
· Multiple risk factors come together to cause depression
· It is not caused by witches or evil spirits
· Depression can lead to Inflammation, immune system changes, fatigue and digestive problems
· When people get the right treatment, these problems go away
Why is it worth talking about?
Depression can happen to anybody, from the very young to the very old, rich and poor. The WHO estimates that over 280 million people in the world have depression. The affected person might suffer greatly and function poorly at work, at school, and in the family. By extension, it can cause the community to suffer.
Worldwide, more than 10% of pregnant women — and women who have just given birth experience — depression. What happens when the hand that rocks the cradle loses its gentle steadfastness? Not treated, depression often gets worse, resulting in emotional, behavioural and health problems that affect every area of your life.
At its worst, depression can lead to suicide. More than 700,000 people die because of suicide every year. And suicide is a leading cause of death in the young men and women.
What causes people to be depressed?
My patients always ask me this. They look at me with vacant eyes as I offer a long-winded explanation. In the end, they nod their heads. I’ve realized that they come to the notion that I just don’t know.
Perhaps I’m not very good at explaining. Or maybe nobody knows.
The long and short of it is that there’s no single cause of depression. It occurs for a variety of reasons and many triggers merge to cause depression.
People often talk about a “downward spiral” of events that leads to depression. For example, if your relationship with your partner breaks down, you’re likely to feel low, you may stop seeing friends and family, and you may start drinking more. All of this can make you feel worse and triggers depression. What we do know is that your chance of becoming depressed is partly negated by the genes you inherit from your parents. Other possibilities include:
· Stressful events
· Personality
· Family history
· Pregnancy and giving birth
· Menopause
· Loneliness
· Alcohol and drugs
· Illness (including physical and other mental illnesses)
Individual lives are very different and so are our demons (and angels). Within an individual’s life, situations and context are similarly fluid. Yet not one singular trait causes depression. In depressed and normal people, usually there are many issues that might trigger depression. It’s incredibly difficult to predict who will be depressed at any given time.
How do you know if you are depressed?
A depressive episode differs from regular mood fluctuations. They last most of the day, nearly every day, for at least two weeks.
You would typically appreciate a change from the way you used to feel. It’s called a depressed mood and may come in a variety of “flavours” — sad, irritable, empty, restless, heartbroken or even unsure of the feeling. In addition, you may feel a loss of pleasure or interest in activities.
Other symptoms may include:
- feeling exhausted.
- poor concentration and a sense of being unable to think clearly
- loss of self-confidence or low self-worth
- negative self-talk
- hopelessness about the future
- thoughts about dying or suicide
- disrupted sleep
- feeling very low appetite or rarely, excess fixation on food
- excessive guilt and rumination over failures and disappointments
These symptoms are insidious. They start as good old sadness, and slowly, over time, they morph into a monster that threatens to consume you. They affect your personal effectiveness and enjoyment of life, family bonds, relationships, school, work, participation in the community, and everything that makes you a person. If left untreated, depression can lead to death.
How do you know if someone is depressed?
It’s equally important to recognise when people close to you are depressed and struggling and can’t reach out yet. Merely noticing that they are not well may go a long way in reassuring them that someone cares. They want to know they’re not invisible and that there is hope.
There are the obvious signs such as:
· Social withdrawal or isolation
· That look of gloom that does not go away
· Changes in appetite or weight
· Irritability or tendency to lash out in anger
· Loss of interest or pleasure in activities once enjoyed
· Falling performance at school, work or some other endeavour
· Talking about death or suicide.
Then, there are the less obvious signs, such as:
· Alcohol or drug abuse. Notice when they drink more than usual. They won’t tell you. Sometimes they’re ashamed of this, too.
· Pessimism. They may start to believe that every plan will meet some unseen obstacle and their whole outlook on life becomes negative. This is especially worrying if it’s someone you knew to be optimistic.
· Forced happiness. Many try to mask their depression by “smiling for the camera”. They may seem overly excited, friendly or even optimistic, but if you pay close attention, there’s a fakeness about this whole performance.
· Careless mistakes. This is sometimes a sign of poor concentration. If they’re in a delicate occupation, this could be costly and it’s important to notice and reach out.
Most of all, take it seriously if they confide in you that they’re feeling low and find it difficult to cope.
How bad can depression get?
Depression is classically graded along the continuum of mild, moderate and severe. For research (and of course, to sound very scientific), we assign cut-off points based on number and severity of symptoms. Therefore, the more symptoms you have, the more severe your depression is. These distinctions are clearly arbitrary, and don’t offer much clarity in everyday life.
People with mild depression are sad, no doubt. They have reduced interest in things they used to enjoy and may have difficulty getting out of bed in the morning. They are reasonably low in confidence, sigh a lot more and they bitch about everything. They’ll tell you they have difficulty sleeping at night and are struggling with daily life — but only if you ask them. If you’re not that close to them, you might assume they’re having a bad day — or a relentlessly shitty week.
A person with severe depression cannot get out of bed in the morning. They feel miserable about everything, including their existence. They hate themselves and believe they’re a curse on this wretched earth. They find their minds fuzzy and unfit for thinking, and wouldn’t want to think anyway, because all their thoughts are negative, disorganised, scary, or uninspired. They can’t sleep, they can’t eat, they lose weight and neglect their physical appearance.
Their sex life is dead because they can’t conjure any sex drive, let alone some form of arousal. They get delusional, believing that they are guilty of unforgivable sins, are destitute and headed for total ruin, and that other people see them the same way — and are actively trying to get rid of them. Sometimes, they hear harsh voices and see things that aren’t there. They are highly suicidal.
Somewhere in the middle are people with moderate depression. The majority of people fall into this category. They will not manifest all the symptoms of depression, but their mood change is places a noticeable dent on their quality of life, relationship with others, and productivity at work.
How to deal with depression
Keep the door open. Don’t withdraw from friends and family and shut everyone out. Socialising improves your mood. It may seem like they don’t really understand what you’re going through, and your sort of right. But they don’t have to understand to keep hope alive for you. Staying in touch means you don’t have to fight the cold feelings all by yourself.
Try to eat a healthy diet. There’s a wise saying that a journey of a thousand miles begins with a nice meal. Some people don’t feel like eating when they’re depressed and are at risk of becoming underweight. Others find comfort in food and can put on excess weight. A healthy diet provides your body with the fuel and nutrients it needs to heal itself. It also gives you something to look forward to.
Get up and show up. Evidence shows that exercise helps lift your mood. You’re not trying to run for miles or become the gym captain. Just getting more activity, like walking, can ramp up your energy levels and give you the motivation to try once more. I know you feel tired. But if you stay in bed all day, you’re only going to fall deeper into the rabbit hole of helplessness and self-loathing. Make the effort to hang out with friends. You don’t have to be the one making it happen. All you have to do is be where it’s happening.
Don’t drown your feelings. It’s a completely normal human sentiment to seek escape from a painful reality. People with mood disorders often use alcohol or drugs to help them cope with overwhelming feelings of sadness, loneliness, or hopelessness. And for a while, it seems to work. Drugs affect the same brain chemicals that go haywire during a depressive episode. However, the brain changes that cause depression start long before you notice that your sadness is not ordinary, and quick fixes just won’t cut it. Feelings are stubborn things that always find their way back up to the surface — they demand to be felt. Your silver lining is not at the bottom of a bottle.
Seek help. Depression is like falling into quicksand. Sometimes the more you kick and struggle, the farther down you go. The bravest thing to do in such a circumstance is to reach out for help. Start by talking to friends and family. Tell them how you feel and let them know that you can’t handle it all alone. A close confidante, a colleague or boss at work, a guidance counsellor, or an understanding professor at school, can help. Get an appointment with your GP if you have one. Arrange ta visit with a psychologist or psychiatrist who will carefully explore your symptoms and determine how best to assist you in your recovery journey.
Where to go from here
Depression is a vast topic. It is probably the poster child of modern mental health and has a folk legend of its own. Some of what is out there in the social media and public space may be low on fact and high on cliché. Influencers are not mental health experts. Sometimes, you just need someone to make it make sense.
This post is a good starting point, but this is not all you need to know about depression. As I said, this title is a misnomer.
In the next couple of stories, I’ll discuss details to break down depression into sizeable chunks that are easily relatable. In case you haven’t seen them, I talk about stress, PTSD, anxiety, panic and lots more elsewhere. Remember that you can always ask me about things you’ve been curious about in connection with mental health. Leave your questions in the comments or get to me directly at nnajioforpeter@gmail.com.
