A professor of Psychiatry and honorary consultant at the University of Jos/Jos University Teaching Hospital, Taiwo Bindo, discusses symptoms, diagnosis and treatment of depression, in this interview with ALEXANDER OKERE
When is a person said to be depressed, medically speaking?
It is when an individual feels low in mood or is often irritable. In layman’s terms, it is an affective disorder; which means it affects the emotions of the individual.
To make a diagnosis of depression, one needs to establish low mood, laughing all day or most times of the day for at least two weeks.
Is depression different from or similar to grief?
It is different, though their symptoms may look alike. Grief is in response to a loss of a loved one, a job, or anything else that one holds dear. Grief is in response to something one was attached to but has lost. The response depends on how close one was to the person or object lost. It is expected that someone who loses something will grieve over it for some time and within that period, the severity of those symptoms is meant to wane. Within three or six months, it is expected that a person should be largely out of grief. If not, it is called pathological grief.
What are the causes of depression?
Some of the causes include the personality of the individual. Some people have a dependent personality, which makes their chances of having depression higher. Another is the predisposition around the time of birth; for instance, the pregnancy, delivery, and early childhood.
Does depression exist in different forms?
Depression is depression but we talk about unipolar depression in which each time an individual falls ill, they come down with depression. Depression usually has a time limit, so with or without treatment, some people get well. There is bipolar depression in which a person may occasionally be depressed and at other times, may be excited, what we call hypomania or manic illness. There is also a situation where there is a mixture of manic and depressive symptoms. When depression occurs in women after delivery, it is called postpartum depression.
What are the general symptoms of depression?
The primary symptoms include a change in mood which must be there almost all day or most of the day for at least two weeks. The individual feels tired easily, what we call easy fatigability. There is a loss of interest in things that ordinarily give the individual pleasure. For instance, someone who is depressed will not be interested in chatting, reading, exercising, doing sports, and hanging out. Those are the core symptoms of depression. Other things could be a change in sleep pattern; some have insomnia and find it difficult to sleep. The commonest is that people with depression can sleep for a while, wake up earlier than usual, two hours before the normal time, but are not able to go back to sleep. However, people may sleep more than usual.
Some people say they tend to eat more when they feel bad. Is this a sign of depression?
Another symptom is a change in appetite. More often an individual with this mood disorder may not be interested in eating, so they lose weight, or they could eat more than usual and then add weight. That means people tend to soak their depression in eating. When they find anything to eat, they eat just to keep their mouth moving. Also, depression causes some people to feel guilty, rejected, easily accept wrongdoing, and tend to apologise too often. Other symptoms are the feeling of hopelessness, worthlessness, and negative thoughts about the past, present, and future. If the condition is complicated, the individual tends to have a delusion of persecution, feeling that people are against or want to kill them. People could also hallucinate; they see things others around are not able to see, hear voices that others are not able to hear, and perceive bad odours emanating from their bodies that others are not able to perceive. When the individual sits down and someone nearby stands up and leaves, the depressed individual thinks the person left because of the bad odour.
Can a person with this mood disorder have suicidal thoughts?
Of course, suicidal thoughts may also come in, with the individual questioning their existence and thinking they are better off dead. Suicidal behavior comes in, from the ideation to the planning and possibly the full act of killing themselves.
Also, people believe and it has been documented that Africans tend to somatise, meaning that they convert their emotional issues into bodily symptoms. An average Caucasian may walk up to you weeping but an African may not weep even when they feel low in mood, based on their ethnic or religious backgrounds. So, they tend to suppress such feelings that eventually manifest in physical symptoms like body pains that cannot be attributed to any organ of the body as a peculiar way of presenting pain. So, in some people, depression may present as a peppery sensation in the body or heaviness of the head. Some feel a crawling sensation.
Can transferred aggression be attributed to depression?
It could be because people who are depressed and cannot find expression for what they are going through tend to be irritable. They get unnecessarily angry. I refer to them as a time bomb.
Do the symptoms you have mentioned apply to males, females, teens and children?
Women are more likely to have some of the symptoms. Children don’t present with the classical weepy spells or begging for forgiveness. What they may do is refuse to go to school because they are not able to concentrate, so their performance tends to fall.
What is the prevalence rate in Nigeria?
Generally, we believe that prevalence will range from five to 10 per cent but people have recorded higher figures, particularly in hospital prevalence studies. But for community studies, we talk about 10 per cent of the population.
Some people may consider 10 per cent as seemingly low, considering how hard the times are now for many Nigerians in the country. Don’t you think community prevalence could be higher?
Seemingly low? For a population of 220 million, 10 per cent is about 22 million. It is not low, looking at statistics but I can tell you that with the challenges we are facing in the country, that figure was probably obtained in 2001 or 2004. If you look at it in the present setting, it probably may be higher because of the economic situation, banditry and others. The happiness that people see is just on the surface. Every Nigerian has had symptoms of depression. We may not have been diagnosed but people have felt unhappy and unhappiness does not really translate to depression.
Recently a video surfaced showing a LAUTECH graduate demanding a refund of his school fees, saying the certificate he received from the school had not been useful to him in earning a living. What do you think is the problem here?
Quite a number of people attributed that to mental illness but I don’t think so. I don’t know what led him to ask for a refund because it has never happened before. However, with the situation we are in now, where a graduate can be unemployed for years, one could feel let down by the country or an institution based on one’s expectations not being met. That may just be what happened. So, he may have done that to seek help. If we check everybody whose behaviour suddenly derails from the norm, then virtually every Nigerian will be sent for assessment. I won’t say that he needs an assessment for what he did.
Academic activities have been grounded for over six months in many government universities due to the ongoing ASUU strike and students have been made to bear the brunt. How can this affect their mental health? Can this situation trigger depression?
Students are not the only ones affected. We, lecturers, are also affected. Our families are also affected. In response to your question, yes, it could lead to emotional turmoil in an individual. Those who are at risk of depression or mental illness will be affected and fall ill. When students spend seven months at home, some looking forward to graduation having finished their examinations, and waiting for their results, they could be predisposed to mental illness if they are at risk.
How bad can the prevalence of depression in Nigeria get if the current economic and security situations do not improve?
Everything will get worse. The incidence and prevalence of depression will increase. With what is going on now, many people are going through a lot.
Are we likely going to see an increase in violent behaviours and crime?
Depression in itself may not necessarily lead to that but the happenings around may actually lead people into the use of substances because that is one way that some people tend to cope with depression. They drink, smoke, and take unprescribed tablets to help them sleep.
Is depression hereditary?
What we say for mental illness is the fact that there is a genetic predisposition, which we call nature, and the environmental situation called nurture. The two work hand in hand to make an individual fall ill. The closer a person is to a relation who has had a mental illness, particularly depression, the higher the risk of that person developing the problem. In monozygotic twins, twins from the same cell, the chances are largely 50 per cent.
Does rape put the victim at risk of being depressed?
Rape has a significant impact on the emotional balance of an individual but it depends on the value that the individual attaches to the sexual activity.
Can transgender people be classified as persons at risk of depression?
I am very careful about this because of the way the country or the world is but if you probe closer, a number of them have some emotional or psychological problem. There is a diagnosis called personality identity disorder. A number of them will fall under that; they find it difficult to identify with a particular gender.
How can the mood disorder be diagnosed?
The person needs to be seen and then a history will need to be taken to identify if there are other symptoms. A mental state examination of the individual is done. An investigation is done to rule out physical illnesses before a psychological investigation is done. We use a biopsychosocial investigation, involving a blood test, personality examination, and an investigation of things in the social environment that could be responsible for the mood disorder. These are done to make a diagnosis and then, the diagnosis is premised on the information available.
Is depression treatable?
Yes, it is. Medication can be given to help to raise the level of serotonin in the brain. Serotonin has been linked with sleep disorders. If negative thoughts are predisposing a person to depression, then there must be reorientation or reorganisation for the person. If the individual is well attended to, they tend to do well.
What are the major complications of depression when left untreated?
One of the problems is that people present late and that means the outcome tends to be worse than it should be. Therefore, people tend to labour on it for a long time. In the social environment, marital issues are affected, relationships with friends are affected and one’s occupation could be affected because productivity reduces while absenteeism is higher. Companies that do not understand this can sack the individual and make the matter worse.
Is it possible for untreated depression to lead to complete loss of sanity?
Complete loss of sanity is a big word I run away from. People talk about madness. There are various forms of illnesses. We have mild, moderate, and severe forms. So, not taking steps to treat it could make it severe. A boy who believes people do not like him can run away from home and hide in a bush. When people see that, they believe he has run mad. However, madness is a form of mental illness that, when attended to appropriately, can lead to appropriate treatment.
How can depression be prevented?
If one knows that one is at risk, then one must live healthy by sleeping well for five to eight hours at night, eating well, exercising well, and knowing how to handle disappointment. One of the major challenges we have in the crop of people is the fact that our level of resilience has reduced over the years. People who live in a protected environment where their parents do everything are not able to develop the mental strength to face challenges in life.
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