While there has been a positive shift in mental health awareness globally, there is still a hurtful stigma associated with depression in South Africa that manifests in microsystems such as the home, school, and work environments.
It is estimated that depression affects as many as one in six people, making it the most prominent mental health concern. Would you recognise the signs of depression in yourself, a loved one or a colleague?
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Although depression manifests in various forms, a common feature across all these disorders is the presence of persistent feelings of sadness, emptiness, or irritability, which are accompanied by significant changes that severely impact an individual’s ability to function.
It may not be necessary for loved ones to understand the textbook classification for a diagnosis of clinical depression, however there are some highlighted symptoms that should be of concern if they are present for at least two weeks and are not a ‘normal’ response to life events.
Persistent depressed mood and loss of pleasure in activities are always associated with depressive disorder. Tell-tale signs of depression not included in the clinical definition but helpful in understanding depression are:
- isolation and withdrawal from social interactions
- low self-esteem with negative self-talk
- the three ‘-nesses’: hopelessness, helplessness, and loneliness.
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There is a common misperception that depression always involves suicidal thoughts or attempts. Instead, depression can sometimes be a prelude to or indicate an increased risk for future suicidal behaviour.
If we notice that a friend, colleague, or family member may be depressed, we will want to support them to prevent the irrational outlook and impulsiveness of depression that increases their risk for harm to themselves. Whenever these symptoms or warning signs of depression are detected, the person should be encouraged and supported to seek professional assistance.
Understanding that depression is rooted in feelings of hopelessness, helplessness, and loneliness can guide us to what our body and mind need. Finding hope in the world, acknowledging that tomorrow can be better or different, or looking forward to something can help a person accumulate enough strength to just get through today.
From experience, it might be difficult to convince a loved one who is showing signs of depression that they should enter the treatment process. Ideally, the family system and support structure should be emotionally safe and secure enough to discuss this without judgment, hostility, or ridicule.
Being in a depressed state makes it exceptionally challenging to see a way through the despair that one is currently feeling. Treatment for depression includes medication and psychotherapy that assists the person with self-empowerment through changes to their thoughts, emotions, and behaviours.
Apart from seeking and sticking to professional mental health treatment, there are certain basic necessities for supporting our overall mood, thought processes and behaviour in a person who has depression.
We all need proper sleeping habits and rest or vacation time, a healthy diet, frequent exercise, balanced socialising and interaction, decent self-care, and other personal priorities such as professional or educational attainments, religion, and spirituality. See these needs as the legs of a table: if they are present and balanced, the demands of everyday life can be loaded on the table without it toppling over.
This is what we need to work towards, even though depression can make it seem virtually impossible. Finding help through self-empowerment can make this sense of helplessness disappear.
Since we can’t control other people or the future, we know that the only thing we can control is our own attitude and reactions to circumstances. Changing how we think, feel, and react towards people and situations is empowering.
Loneliness’s cure is found in connection and interaction with others. Lying in your bed with the duvet over your head is the opposite of what you need during a depressive episode.
Attending to these needs will help address the depressive shortcomings, alleviating depression since those feelings – the three -nesses – are gradually replaced, and the world will eventually seem brighter.
The first aim of dealing with depression, as well as the first step in breaking the stigma attached to it, is being able to talk confidently about it.
The reality is that in a country where one in six people are experiencing depression, finding someone who understands what you are going through is possible and professional mental health assistance is available.
The relief of knowing you are not alone can be the first step to breaking free from the shackles of depression.
What is major depressive disorder (MDD)?
Hein Hofmeyr, a clinical psychologist practising at Netcare Akeso Nelspruit, explains that there are various forms of depression outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th text revision edition (DSM-5 TR), which only differ in their intensity, duration, origin or context.
“The most common diagnosis of these is major depressive disorder (MDD), the symptoms associated with MDD are listed below. These should be considered together – if one symptom occurs in isolation, for example, sadness only is observed, this would not indicate depression,” Hofmeyr points out.
- Depressed mood
- Diminished interest or pleasure in activities
- Significant weight loss or weight gain
- Insomnia (problem sleeping) or hypersomnia (excessive sleeping)
- Fidgety or slowed movements
- Fatigue or loss of energy
- Feelings of worthlessness or excessive or inappropriate guilt
- Difficulty concentrating or indecisiveness
- Recurrent thoughts of death or suicide, with or without plan or attempts to follow through with it.
“The diagnostic criteria stipulate that five or more of the above symptoms should be present together during a minimum period of two weeks, with a notable change from the person’s usual behaviour and functioning. This is significant enough that it creates distress or impairment in areas of their lives,” he says.
It is further important that family members can’t attribute these symptoms to other reasons, such as substance abuse, adjustments to changes in life circumstances, losses, other medical conditions, puberty, conflict, or other identifiable causes. In short, an easy guideline to assess MDD symptoms is that these should not be a normal response for life experiences.”
Support seeking help for depression
If you are experiencing depression, having thoughts of harming yourself or any mental health related concerns, Netcare Akeso offers a 24-hour crisis line on 0861 435 787. Trained counsellors are available to listen without judgment and can guide you on the various options for assistance, including help accessing support for a loved one.
If you are concerned about someone exhibiting symptoms of depression and who is reluctant to seek treatment, a family member or a concerned person within their support structure can consult with the family doctor or primary healthcare provider to help initiate the recovery process.
“As helplessness and hopelessness are characteristic of depression, practically this could involve making an appointment for them at a general practitioner or clinic and accompanying them to share feedback and background of their worries and observations with the doctor,” Hofmeyr suggests.
“People tend to be more open to participating in treatment when the recommendation and referral comes from a primary healthcare provider. During this initial session, ask questions about possible referral to a psychiatrist or psychologist.
“Be sure to follow through with the full course of any treatment prescribed and don’t stop taking medication without consulting your doctor or psychiatrist.”
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Notes to editor
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Alternatively, contact Netcare Appointmed on 0860 555 565, Mondays to Fridays, 08:00 to 17:00 to make an appointment with a therapist, doctor or specialist practising at a Netcare hospital, Netcare Medicross or Netcare Akeso facility near you.
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