DR FAITH BYISRAEL
The recent death of the mentally ill gentleman in Speyside has highlighted several facts – probably the most important being the way we treat friends and family with mental illness, particularly during this pandemic. The pandemic and the many stresses associated with it has also caused many of us to experience a wide range of mental health issues – from anxiety, to depression. In this article, we’ll talk specifically about depression, the various types and what can be done to treat with it.
Mental Health Awareness Month
According to the Mental Health America, May has been designated as Mental Health Awareness Month since 1949. The theme for 2021, Tools 2 Thrive, continues by “providing practical tools that everyone can use to improve their mental health and increase their resiliency regardless of their personal situation.” Some of those tools include information on
• Adapting after trauma and stress
• Dealing with anger and frustration
• Getting out of thinking traps
• Processing big changes
• Taking time for yourself
• Radical acceptance
Is depression a problem in TT?
Data on depression in Trinidad and Tobago is limited. A study by Maharajh and others in 2003 with Tobagonian adolescents (aged 14 -18) showed that approximately ten per cent of that population was depressed. Another study of TT’s adolescent in 2006 showed that approximately 14 per cent of the population was depressed. In that study, depression was identified more in females (17.9 per cent) than in males (8.2 per cent). In 2013, the Minister of Health estimated that about 52,000 people were living with depression in TT. If these numbers are correct, it is obvious that depression is indeed an issue. A 2019 article by Mandreker Bahall reported that “the prevalence of depression to be 12.8 per cent among adults visiting family physicians, 28.3 per cent among patients with chronic diseases, 14.0 per cent among adolescents, and 17.9 per cent among patients treated for type 2 diabetes mellitus” in TT.
What is depression?
So, what is depression? Everyone feels sad, down or “blue” sometimes, but these feelings usually go away after a short time. Depression, however, is a mental illness where you often feel sad, but it also includes you no longer being interested in activities that you normally enjoy, in addition to you being unable to carry out your daily activities for at least two weeks. According to the World Health Organization (WHO), people with depression also have several of the following issues: “a loss of energy; a change in appetite; sleeping more (or sleeping less); anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.”
The National Institute of Mental Health identifies two main forms of depression:
• Major depression, where you have symptoms of depression most of the day, nearly every day for at least two weeks. This feeling interferes with your ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in your lifetime, but more often, you may have several episodes.
• Persistent depressive disorder (dysthymia), where you have symptoms of depression that last for at least two years. If you are diagnosed with this form of depression you may have episodes of major depression along with periods of less severe symptoms.
Some forms of depression are slightly different though, and may develop under unique circumstances, such as:
• Perinatal/post-partum depression: Women with this type of depression experience full-blown major depression during pregnancy or after delivery.
• Seasonal affective disorder (SAD): A type of depression that comes and goes with the seasons, typically starting in the late fall and early winter (in countries with these seasons) and going away during the spring and summer.
• Psychotic depression: This type of depression occurs when a person has severe depression plus some form of psychosis, such as delusions (beliefs that are clearly false), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).
Depression is something that can happen to anyone. However, it looks different in different groups of people. According to the National Institute of Mental Health:
• Women have depression more often than men, which may be due to biological, life cycle, and hormonal factors unique to women. Women with depression typically have symptoms of sadness, worthlessness, and guilt.
• Men with depression are more likely to be very tired, irritable, and sometimes angry. They may lose interest in work or activities they once enjoyed, have sleep problems, and behave recklessly, including the misuse of drugs or alcohol. Many men do not recognise their depression and fail to seek help.
• Older adults with depression may have less obvious symptoms, or they may be less likely to admit to feelings of sadness or grief. They are also more likely to have medical conditions, such as heart disease, which may cause or contribute to depression.
• Younger children with depression may pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.
• Older children and teens with depression may get into trouble at school, sulk, and be irritable. Teens with depression may have symptoms of other disorders, such as anxiety, eating disorders, or substance abuse.
What to do if you think you are depressed?
According to the WHO, some things that you can do if you think that you have depression are:
1.Talk to someone you trust about your feelings. Many people report feeling better after talking to someone who cares about them and their well-being.
2.Seek professional help. Talk to your doctor, a nurse, or a social worker. The doctors and nurses are available at the health centres and hospital. In Tobago, there are mental-health clinics at the Scarborough General Hospital and at various health centres. The Scarborough General Hospital has in-patient services (660-4744 ext. 3166) and out-patient services (660-4744 ext. 3157). The health centres with mental-health clinics include Scarborough, Bethel, Roxborough, Mason Hall and Canaan. These clinics are scheduled at different times of the month, so for more information, please call 660-7000 ext. 4220. Treatment for depression may include medications called antidepressants, and psychotherapy which helps by teaching new ways of thinking and behaving, and changing habits that may be contributing to depression.
3.Remember that with the right help, you can get better.
4.Try to keep doing the activities that you used to enjoy when you were well.
5.Keep in contact with friends and family. It is very important to stay connected.
6.Exercise regularly, even if it’s just a short walk. Research has shown that exercise does make people feel better.
7.Try to maintain healthy eating and sleeping habits.
8.Accept that you might have depression and adjust your expectations. You may not be able to accomplish as much as you usually do.
9.Avoid or reduce how much alcohol you drink, and try to stay away from using illicit/illegal drugs; they can worsen depression.
10.If you feel suicidal, contact someone for help immediately. You may call 211 for emergency responses.
What can I do for someone who is depressed?
According to the WHO, here are some things that you can do to support someone who has depression:
1.Make it clear that you want to help, listen without judgement, and offer support.
2.Find out more about depression.
3.Encourage them to seek professional help when available. Offer to accompany them to appointments.
4.If medication is prescribed, help them to take it as prescribed. Be patient; it usually takes a few weeks before they feel better.
5.Help them with everyday tasks and to have regular eating and sleeping patterns.
6.Encourage regular exercise and social activities.
7.Encourage them to focus on the positive, rather than the negative.
8.If they are thinking about self-harm, or have already intentionally harmed themselves, do not leave them alone. Seek further help from the emergency services or a health-care professional and remove items such as medications, sharp objects and firearms to which they may have access.
9.Take care of yourself too. Try to find ways to relax and continue doing things you enjoy.
Depression is relatively common in TT and it’s time we start treating it like any other disease. Given the current pandemic and its increased risk for depression, it is critical that all of us identify Tools 2 Thrive and use them as needed.
Dr Faith B Yisrael is a health educator, social scientist, public health specialist and politician.