Depression is a serious, but common, illness. It is a state of low mood and aversion to activity that can affect a person’s thoughts, behaviour, feelings, and sense of well-being. It could be caused, according to medical experts, by a combination of genetic, biological, psychological, social and environmental factors. ISIOMA MADIKE and KUNLE OLAYENI, examines why depression is more than just sadness, in this report
It was a sad Sunday. The news jolted everyone, everywhere. No one saw it coming on a day so adored by many. Allwell Chiawolamoke Oji, a young medical doctor, went the way of all mortals on that day. But his was heartrending and disappointing. He ended his sojourn on earth in the belly of a hungry and angry lagoon.
Reports have it that Oji jumped into the lagoon out of frustration. Since the tragic incident, medical experts have been preoccupied with a common mental disorder known as depression.
Many, reports said, are coming down with this medical condition, especially those in the medical profession. Fortunately, depression is treatable. A combination of therapy and antidepressant medication can help ensure recovery, experts said.
A consultant psychiatrist at the Federal Neuro-Psychiatric Hospital, Yaba, Lagos, Dr. Bello-Mojeed Mashudat, explained to Saturday Telegraph, that depression is a mental health problem that is heralded by some specific symptoms. It is, according to her, a recurring mental health issue characterised by persistence sadness.
“There will be loss of interest in previously favourable activities in normal things victims do. In addition, there are some other associated features present in depression that when we see or notice them it will be important that we ask such a person to see a specialist,” she said. Bello-Mojeed did not stop there. She said that individuals have mental health issues, just as they have physical health problems.
“People living with a mental disorder can experience positive mental health, while others may experience poor mental health without a mental disorder.”
The doctor pointed to other health determinants to include government, health, economic and educational policies as well as control of psycho-active substance use. “Poor mental health may manifest as a feeling of distress, dissatisfaction, persistent irritability, aggression and reduced productivity, without specific psychological disor-ders.
“On the other hand, it may manifest as diagnosable disorders such as anxiety and mood maladies or psychosis, and other substance-related disorders. If these are not promptly and adequately treated, they may lead to poor productivity, disability and mortality,” Bello-Mojeed said.
The psychiatrist said that while some people have described depression as “living in a black hole” or having a feeling of impending doom, others felt lifeless, empty, and apathetic. “Men in particular might feel angry and restless.
No matter how a person experiences it, depression is different from normal sadness in that it engulfs the person’s day-to-day life, interfering with his ability to work, study, eat, sleep, and have fun.”
Aside that, Bello-Mojeed’s counterpart at the Forensic Unit, Aro in Abeokuta, Ogun State, Dr. Adegboyega Ogunwale, said it is only an anecdotal view to say that suicide is on the increase.
“We really don’t have reliable data to be able to judge whether it’s on the increase or not. Nevertheless, whatever the level we are presently, it would suggest that suicide is getting more dramatic and more frequently reported, particularly in the news media and with the advent of social media, it tends to catch public attention more quickly.
“So, when you put all of these things together, that might indicate why we are beginning to see more cases of suicide. It would be too premature to say we are having an increase in the rate of suicide in our country.
Be that as it may, the World Health Organisation (WHO) data that was made available sometimes in 2012 would suggest that the rate of suicide in Nigeria is about 4.3 cases per 100,000 of the population.
That would be roughly about 43 persons per million, which amounts to a little over 7,000 people in that given year. “One can conclude from the WHO data that we have about 7,000 suicides tending to occur in any given year. Earlier data suggested about 6,000.
So, when you put that in the context of global statistics on suicide, you are looking at roughly one million suicides occurring every year and for every suicide, 20 attempts that did not succeed would have arisen. And you have almost 20 million attempts and about one million real or completed suicides in any year.
If you put all of that together, whether it’s on the increase or not, the rate of suicide appears to be rather high for any human population right now.” Ogunwale went further to say that the causation of suicide is multi-factorial.
“There are many factors that can lead to suicide but what are the principal factors that one ought to highlight? The first one would be mental disorder. More often than not, some inherent vulnerability in that individual himself pushes them to the act. “And one cardinal vulnerability is mental disorder.
Research has shown that 90 per cent of those who attempt suicide suffer from one mental health problem or the other. Of that 90 per cent, about 60 per cent would actually suffer from depression. So, if you look at depression as a factor, 15 per cent of those who are depressed and are not treated in the community will commit suicide.
While 40 per cent of disorders of mental illnesses like schizophrenia, will attempt suicide and out of that, it is known that about 10 per cent of that number eventually commit suicides.
“When a person has depression,such person manifests helplessness; he or she feels helpless, worthless and hopeless. A gloomy picture of the future might set the stage for the person to take his or her own life.
This is common among males actually. A person who has schizophrenia may be hearing voices commanding him to kill himself. He may actually be hearing voices that are telling him he may eventually come to disgrace and dishonour and thereby, he kills himself before he goes ahead to enter disgrace.
Sometimes it’s not schizophrenia per se, but a psychological reaction to a chronic mental illness,” Ogunwale said. He recommends to government to reduce access to the means of committing suicide. According to him, people frequently commit suicide using pesticide, they can hang themselves, as well as shoot themselves.
“Very rarely do people stab themselves. There must be laws regulating sale and acquisition of such chemicals. They should not be things to be sold and bought by every Tom, Dick and Harry. There must be government regulation.
“For example, this young man, who died by jumping into lagoon, he was able to climb the railings of that long bridge. There may be need to ensure that our long bridges over large water bodies should have high railings.
This should reduce the means of committing suicide. The next thing that government must do is to ensure proper drug control policies so that that could reduce harmful use of drugs that are legitimate like alcohol.”
A psychologist, Modupeola Omoniyi, looks at depression as a mood disorder which is not merely a state of unhappiness but related to reduction in certain brain chemicals. She said that it is characterised by the presence of major symptoms like low moods, reduced energy and loss of interest in pleasurable activities.
“In addition to these symptoms, there may be the presence of associated symptoms like poor appetite, poor sleep, poor concentration, guilt feelings, and feelings of hopelessness, worthlessness, suicidal ideations and others.
“The severity is graded based on the combination of symptoms present in each individual. Contrary to the belief that people should be stimulated to snap out of this state, it is a treatable condition. Individuals with any of the symptoms are advised to seek help from mental health practitioners as early as possible to avoid biological and psychosocial complications.”
However, “depression is not enough to make a doctor commit suicide,” said Consultant General Surgeon, Dr. Emmanuel Enabulele. He argued that the circumstances of Oji’s death raised a lot of questions: “He was coming from church, with no family members, then a phone call, he pulled up, came out of car, then plunged into the lagoon to end his life.
A classical case of depression does not present that way. In suicide tendencies, people will see it coming before it occurs, but this one is so sudden, acute.
“These days, doctors are involved in other businesses other than medicine because of the recession. Maybe, he went to church to pray, got a call that things did not work out, he cracked and committed suicide.
If you talk of manic depressive psychosis, usually, it is a build-up, with mood swings, lack of interest in the environment and lack of appetite. It is not something that happens suddenly, then a plunge into a river. In fact, if it is the classical type, a person like that should not be allowed to go to church alone.”
For Dr. Charles Umeh, a clinical psychologist, “One cannot rule out mental illness such as hallucination, in which case he was hearing voices that might be telling him, ‘you are useless, just die.’ People can act on those voices.” However, medical experts are not the only ones analyzing depression conditions, the clerics too.
For instance, Bishop Stephen Ogedengbe, Founder and Head of Evangelical Ministries (Wisdom Chapel), Shasha, Lagos, told Saturday Telegraph that a Christian struggling with depression would be counseled and fed with the proper word of God. “A good priest should be observant to know the state of being of his members.
If such a situation is noticed and he could not handle it, the best thing to do in that circumstance is to refer the fellow to medical experts instead of dabbling into an area one has no expertise. Faith is such a huge part of recovery from depression and addiction,” Ogedengbe said. Islam is not different in this regard.
Sheikh AbdulRahman Olanrewaju Ahmad, National Missioner, Ansar- Ud-Deen Society of Nigeria, said with the significant growth of the Muslim population all over the world, there exists a corresponding increase in the need for mental health services that suit this group of patients.
Research, he said, demonstrates the effectiveness of the integration of spirituality and religiosity into psychotherapy and how religious beliefs could affect the management plans.
“An Iman would need to preach beliefs in the Islamic faith on the biopsychosocial model for the management of different psychiatric disorders including focusing on the modification of psychotherapeutic techniques as cognitive restructuring.
“Though, not every Iman is gifted with this knowledge. That is why it is also necessary to refer to experts who have the capacity to prescribe therapies such as music, meditation, and aromatherapies.
The main emphasis remains to ensure that Muslim psychiatric patients get ethical, acceptable, and effective treatment,” Ahmad added. However, a friend of Oji, who plead ed to remain anonymous, said that the 35-year-old medical doctor was an introvert because he was a sickler who suffered from seizure attacks. This, according to him, made Oji to keep to himself.
“The social stigma from the recurrent seizure attacks was too high for him to bear. He used a river because the seizure can come at any time,” the anonymous friend said. A few days after Oji’s tragic death, another unidentified woman also jumped into the lagoon from Maza- Maza Bridge in the Mile 2 area of Lagos.
The woman was however, lucky, as rescuers fished her out before she could drown. According to a witness, the woman, dressed in a blouse and trousers, was trekking and got to the middle of the bridge, climbed the rail and jumped.
“The thing happened so fast that we could not stop her. However, when she jumped, we called for help, prompting people under the bridge to dive in and rescue her,” said one of the witnesses, who gave his name as Emeka. Depression, experts said, is caused by a combination of genetic, biological, psychological, social and environmental factors.
People who have a family history of depression, and people with serious chronic diseases such as heart disease or cancer, are at an increased risk of depression.
Major life changes, trauma and stress can also bring about an episode of depression, although some incidents of depression begin without any obvious external cause.