One in six South Africans suffer from anxiety, depression or substance-use problems according to statistics released by the South African Depression and Anxiety Group (SADAG). Another study in 2018 by SADAG reported that taking into account the more serious mental health disorders one in every three South African can be diagnosed with a mental health condition. These numbers are so serious that its scary. Even at a global level according to the World Health Organization (WHO) depression is the second highest cause of disability in the world. Yet most people do not seek help of fear of stigma and maybe even ignorance.
More women than men are affected by depression, with some statistics showing that as many as one in every four women will experience a depressive episode during any given year. But there’s a possibility that depression is under-diagnosed in men because men present differently in terms of symptom and are low on health seeking behaviour. What we do know is that at least five times as many men as women commit suicide, although women think about it more and probably have more attempts.
Depression is common in people of all ages, but nearly 50% of affected individuals first experience depression between the ages of 20 and 50. The average age when a first depressive episode occurs is 26 years. Although depression can begin in childhood or later in life, this is less common.
So how do we treat depression?
The first step is to ensure the person is not at risk for self-harm. If they are speaking morbidly, show intent to hurt themselves or have a plan on how to do it, please rush them straight to the hospital for a suicide risk assessment and 72-hour observation to ensure their safety while they are put on medication.
However, if they are not at risk then a full medical check up is advised to rule out any general medical condition or physiological reasons for their depressive symptoms like hypothyroidism. Hypothyroidism has symptoms that can cause or be mistaken for depression to the likes of low energy, inability to concentrate, changes in sleep patterns and anxiety that can cause low mood.
Once all medical conditions are ruled out then the person should go to a mental health practitioner for example a psychologist or psychiatrist. individualised treatment plan must then be formulated. This could include medication, psychotherapy, lifestyle changes, and assistance in managing your stressors.
If the depression is not debilitating, the person is not high risk and symptoms range from mild to moderate then it’s not always necessary to be put on medication. Psychotherapy, life style changes that is encouraged through a process called behavioural activation by the psychologist is initiated. Even if the mood is low the person is still encouraged to complete activities that may bring them joy. Identifying and challenging negative thoughts that keep them in that state of mind is also dealt with in therapy. This form of therapy is called Cognitive Behaviour Therapy (CBT).
Exercise is one of the most important aspects that is encouraged for 30 minutes of exercise three to five times a week has been found to reduce the symptoms of depression profoundly. Seeking social support is also critical in improving the mood for a depressed person prefers isolation and feels extremely alone in that state.
Self-care is another aspect we focus on example eating healthy. A diet rich in Omeaga-3 fatty acids that are usually found in fresh water fish is encouraged and folic acid is also excellent that is found in spinach and avocados. These nutrient rich foods can help with symptoms of depression. Vitamin D has also been linked to depression, but this is not sourced so much from food but from sunlight. Getting enough sunlight and being active during the waking hours would help with this.
Lifestyle change is hard but the most efficient way to keep a person happy and healthy. In the rare case where these don’t work or if a person has a persistent, severe depression then a full screen by a psychiatrist is advised and possibly medical intervention in the form of an antidepressant. The most common antidepressant is the Selective serotonin reuptake inhibitors (SSRIs), e.g. Prozac.
Antidepressants don’t act rapidly for a certain dosage and concentration must be reached before they become effective. They usually take 1-2 weeks to start to have an effect, and about a month before they have a full effect. It’s important to persevere and to use the prescribed drug at the correct dosage for long enough.
Many people feel significantly better after 2-3 months on antidepressants, but it’s important to continue taking your medication for as long as your doctor advises. For a first episode of depression, this usually means taking medication 6-9 months on optimal dosage after symptom relief has been achieved, 2-5 years for a subsequent episode, and possibly lifelong if episodes recur frequently and are severe. Stopping your medication too soon increases the likelihood of a relapse and the development of a chronic, recurring illness. Any change in medication should be discussed with the treating medical practitioner first and slowly decreased if symptoms have improved.
Since I am a psychologist I feel the need to end with showing the benefits of psychotherapy in the treatment of depression. Research has shown that some forms of psychotherapy are as effective as medication in treating mild to moderate depression. Medication tends to bring about results more rapidly, but the benefits of psychotherapy may be more enduring. However, it’s generally agreed that the best form of treatment is a combination of pharmacotherapy and psychotherapy. This is especially true for more severe forms of depression, such as major depressive disorder (MDD).
These are the choices one has to make when faced with depression.