Depression is perhaps the most common of all mental health problems. It affects approximately 5% of the Caribbean and Latin American population. At a seminar on depression in the workplace, Dr. Fuad Khan spoke about the need to reduce stigma when dealing with challenges like depression, which can have a profound effect on multiple areas of a person's life.
What is it?
Depression is an emotional state characterised by deep sadness and feelings of worthlessness and guilt. There is also the tendency to withdraw from others, loss of appetite, difficulty sleeping, decreased sexual desire and a lack of interest and pleasure in usual activities.
There are different types of depression, all with varying causes, symptoms, intensity and durations.
Depressed mood:
This is a low mood characterised by feelings of sadness, worthlessness, hopelessness, restlessness, irritability, worry, emptiness, guilt, hurt and helplessness. Many people also experience loss or increase of appetite or weight; problems in concentration, memory or decision making; insomnia or excessive sleeping; fatigue and loss of energy; digestive problems; aches and pains; loss of interest in once pleasurable activities and thoughts of suicide.
Major Depressive Disorder (MDD):
This can be characterised by a single depressive episode or by more than one. However, there must be an interval of at least two (2) months where symptoms are not present to be considered as separate episodes.
A depressive episode occurs when there are at least two (2) weeks of depressed mood or loss of pleasure and interest in activities. There must also be at least four (4) of the following:
- sleeping too much or problems sleeping
- physical restlessness or sluggishness
- daily fatigue or loss of energy
- daily feelings of worthlessness or excessive, unnecessary guilt
- daily reduced ability to think, concentrate or make decisions
- recurring thoughts of death, recurring thoughts of suicide, attempts at suicide or a specific plan for committing suicide.
For a diagnosis of MDD the symptoms must cause significant impairment in or reduce the quality of the person's life.
If someone is diagnosed with MDD, then there are also sub-categories or specifiers that they can be grouped under, such as: Catatonic, Melancholic, Atypical, Post-Partum and Seasonal Affective Disorder.
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| Depression can feel like a black cloud hanging over you while everyone else's skies are blue. Photo by Miguel Sevilla-Callejo |
Another depressive disorder is Dysthmic Disorder which is characterised by a depressed mood that lasts most of the day, most days for at least two (2) years.
Additionally there are other depressive disorders that are not severe enough to qualify as MDD. These, such as Premenstrual Dysphoric Disorder, are grouped into a category called "Depressive Disorders Not Otherwise Specified". This category also includes situations in which the therapist finds that there is a depressive disorder present, but is unable to determine which specific diagnosis it falls under.
What happens?
People can become depressed for many different reasons. Tabanca or job loss may cause someone to experience a depressed mood. Some medications have side effects which can cause a major depressive episode. Young women who may seem irrationally upset maybe be experiencing premenstrual dysphoric disorder. There are often direct events leading to depression, but sometimes depression can occur without an external cause.
There are many different avenues of thought when it comes to theories about what causes depression. Some of these theories are complicated and confusing so to keep things short and simple, they've just been listed below instead of carefully detailed. Feel free to look up the theories that interest you, or leave us a comment if you have questions about anything!
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| Brain scans reveal big differences in the brains of people with and without depression. High activity is represented by greens, oranges and reds. Low activity is represented by blues and black. Here you can see that a brain affected by depression is not as active as a brain that is unaffected. |
Biological causes: low levels of neurotransmitter chemicals in the brain; structural differences in the brain; hormonal changes; weather or atmospheric changes.
Psychological causes: low self-esteem; self-defeating or distorted thinking.
Social causes: poverty; social isolation or rejection; abuse; parental illness or mental illness; family conflict or divorce; death of a loved one; prejudice or discrimination; job stress or dissatisfaction; unemployment.
Substance Use and Abuse can also cause depression in some people.
How can we help?
Sadness, bad days and bad moods are part of daily life. They are natural and normal reactions to difficulties and disappointments. It is important to remember, however, that depression is not just a case of being down in the dumps. While advice like "try and be positive" or "drink a beer and forget your worries" might be helpful in cases of everyday blues, depression is not so easy to beat. In fact, the use of drugs like alcohol or marijuana may worsen the symptoms of depression. While you may feel relief in the short term, once you sober up, you might feel more upset than before.
Doing exercise can help to chase away the cloud of depression. Although it may feel like an effort to get out of bed, working out for an hour in the gym, a brisk walk around the Savannah or even some sit-ups on your bedroom floor can help to boost your mood and your concentration. If you can include a friend, that's even better. Being in the company of others can lift your spirits. Make sure that you choose good company though; spend time with people who are warm, supportive and patient with you rather than those who are insensitive and push you unnecessarily.
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| A walk around the Savannah with a friend can make you feel better. Treat yourself to a snow-cone or some cold coconut water -- or encourage your friend to treat you! ;) |
If you are reaching out to someone who is depressed, be aware that sometimes friendship isn't enough. Being a source of encouragement and understanding is very important, so don't give up even though you may feel like you can't get through to your friend. Sometimes additional help is needed in the form of anti-depressant medication. These pills can only be prescribed by a family doctor or a psychiatrist and should ideally be accompanied by regular therapy sessions.
Depression can also get worse around significant dates like birthdays, anniversaries or holidays. Make the extra effort to reach out to people around these times. It's important to have a support system around, especially on days that usually involve socialising, like Christmas, New Year's and birthdays.
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| Holidays are traditionally a time of togetherness, but depression can make it hard for people to connect and feel loved. |
In a lot of cases depression isn't something that you beat once. It can re-occur, which is very disheartening for people who are trying to get their lives back on track. It's okay, don't feel defeated. Depression is like that; it goes for a while and then it can come back again, but the important thing to remember is that depression is not permanent. There are highs and lows, and although sometimes the low points are too painful and they seem inescapable, don't ever lose hope that things will change for the better.
"As much as I hate some of the places...depression has dragged me down to, in a lot of ways I'm grateful for it, because yeah it has put me in valleys but only to show me there are peaks, and yeah it has dragged me through the dark but only to remind me there is light. My pain more than anything...has given me perspective, and my hurt has forced me to have hope...and faith in myself, faith in others, faith that it can get better." - Kevin Breel in his TED Talk.
Resources:
Depression Understood: Contact Information for Trinidad & Tobago
Further Information:
I Had a Black Dog, His Name Was Depression
UWI St Augustine Counselling & Psychological Services Depression pamphlet
UWI St. Augustine CAPS Self-Help: How To Help Depression
Dealing With a Deep, Dark Caribbean Secret
Trinidad & Tobago Guardian: More People Suffer From Depression
Trinidad & Tobago Ministry of Health's Mental Health Drama Competition: Depression
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