Doctor: – ‘How have you felt over the past few weeks?’
Patient: – ‘Very stressed! Since the onset of the lockdown restriction measures due to COVID-19 pandemic there’ve been a lot of abrupt changes at work which affected many of my routines and finances. I am adjusting to the changes gradually but the main reason I am here is to complain about having a headache.’
Doctor: – ‘Have you ever had a mental health assessment before?’
Patient: – ‘No. I have never needed one, plus we have no family history of mental illness.’
Mental health is a very important part of health and human life, however it is an aspect many people neglect and it is considered to be least likely to affect health. With recent increase in awareness campaigns on mental health issues, more persons are seeking help as well as discussing challenges they experience and how it affects them mentally. Health as defined by the World Health Organisation (WHO) is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. One whose mental wellbeing is affected cannot be said to be in a perfect state of health even when the person has not been diagnosed with any disease or shows no signs of having a disease. Just as there are many causes of mental ill health, there are also many types of mental conditions/disorders. Having good mental health can lead to more productivity, improved quality of life and community development.
There are so many factors that could affect mental health and these could be a range from daily life experiences to highly specialised action that requires skilled training. Sometimes mental disorders could arise as a result of an underlying medical condition and vice versa. Anxiety and depression are common conditions experienced by many, which in many cases are ignored.
At various times, many, if not all have experienced periods of sadness, grief, disappointments, failures, uncertainties, stress, blues and while some quickly recover from those situations, others experience the negative feelings for a longer period. This may in turn affect the way they act, think, make judgements and sustain relationships among other aspects of their lives.
Depression may mean different things to different people but what is common to all is that it is a disorder that affects individuals with some people having low mood, low energy, negative outlook about life, over thinking, losing faith in one’s capacity, having no hope for the future. It is a mood disorder that is characterized by negative feelings of hopelessness, helplessness, losing control amongst others. It is common, but often ignored and not easily identified because of its vague symptoms. Depression may follow life events and can be linked to the development of many medical conditions like chronic stress, anxiety, schizophrenia, indigestion, migraine, obesity, hypertension, stroke, heart attack and in extreme cases, there may suicide.
There are several causes of depression which may be of biological, social and psychological background, but because it is a complex disorder, it is difficult to know the exact cause. Sometimes, it could result from medical conditions (e.g stroke, hypertension, cancer, diabetes mellitus), physiological conditions like pregnancy, menopause, childbirth, parenthood, marriage, failing an examination, other causes include losing a job, starting a new job, changing schools, loss of a close relative/friend, financial difficulty, divorce, alcohol or drug abuse, genetic factors may also play a role and the list goes on.
Depression can present with various symptoms and identifying those symptoms by the individual or the people around them will affect response to intervention and outcome. Because of the social rejection or stigmatization experienced by individuals treated for depression, reporting symptoms by individuals affected have become very difficult in many parts of Nigeria. Also, the huge expectation upon certain people by society makes seeking help seem like a thing for weak people because society expects everyone to be strong and be able to cope with everything. Sadly, this is not usually the case in many situations. However, it is worthy to mention that it is absolutely fine to ask for help from qualified professionals. Common symptoms of depression include persistent – feeling of anxiety, having low energy, body weakness and fatigue, loss of interest in previously pleasurable activities, loss of appetite, irritability, mood swings, difficulty in making decisions, lack of concentration, social isolation, excessive alcohol or tobacco consumption, obesity, weight loss, unspecific body aches. Depression can also occur in children, especially during puberty. This may be due to the changes that occur and such changes can be interpreted differently amongst teens. Some features of depression in childhood may include:- Defiance, separation anxiety, complaints of boredom, poor school performance, antisocial behaviour, poor sleep, excess sleep, eating problems. When such happens, causative factors should be assessed (for example bullying, child abuse, dysfunctional homes and so on).
These days, often noticed are the negative effects of depression which may be produced while trying to cope with depression without seeking help. Some of such effects are low self –esteem, domestic violence, alcohol and drug addiction, suicide, juvenile delinquency, teenage pregnancy, divorce, road rage, unemployment, poverty, cyber-bullying, terrorism, non- communicable diseases like hypertension, stroke and heart attacks amongst many others.
Diagnosis of depression is made by a medical doctor after a detailed history and thorough clinical examination. The doctors will ask questions about the symptoms experienced and the impact the symptoms have on the quality of life of the individual involved. Other relevant medical investigations may be carried out to support diagnosis. Treatment for depression will depend on the type and severity at the time of diagnosis. Generally, modification of lifestyle can be adopted to improve health. For example, one may improve sleep, eat healthier, exercise regularly, manage stress effectively.
Active participation by the individual affected is essential in the treatment of depression as it improves outcome from management of the condition. Also, family and community support is required as people with depression can benefit from support groups and people around them can identify if there is any progress with treatment. Visits to mental health professionals as well as use of medication are some modalities that would be required for the management of the condition depending on the mental disorder diagnosed.
Depression is considered to be a public health concern. As a result of the relationship between several disease conditions and depression, it is of great importance that every case of depression no matter how severe be treated as urgent. It is important that more investment be made to sustain good mental health among the populace as well as improve facilities already available.
“The key to being happy is knowing you have the power to choose what to accept and what to let go”
– Dodinsky