Depression

by Stepney Emeh
edited by Juwah C. Awele

What is depression, is there a clear cut definition? How do you know when you are depressed? What do you do when you or someone you know is feeling depressed? This short piece will try to answer these questions and more, we proceed.

First we will start with what depression is, or is not, and for the purpose of this article, I will make use of the medical term for depression, Major Depressive Disorder (MDD). Significant research has been made into MDD and different guidelines have been put out with which one can determine if a certain person is clinically depressed or not. These guidelines can be found under the following;

§  International Classification of Diseases (ICD) 10th edition; and

§  Diagnostic and Statistical Manual of Mental Disorders (DSM) V

I will be using the DSM V classification for this article due to personal preference. The DSM V says that before a person can adequately be classified as having MDD, the following diagnostic criteria must have been fully checked:

1.     Depressed mood most of the day, nearly every day as indicated by either subjective report (e.g feeling sad, empty, hopeless) or observations made by others (e.g appears tearful).

2.     Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly everyday

3.     Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly everyday

4.     Insomnia or hypersomnia nearly everyday

5.     Psychomotor retardation or agitation nearly everyday

6.     Fatigue or loss of energy nearly everyday

7.     Feeling of worthlessness or excessive or inappropriate guilt nearly everyday

8.     Diminished ability to think or concentrate or indecisiveness nearly everyday

9.     Recurrent thoughts of death, recurrent suicidal ideations with thought out plans

At least five of the aforementioned symptoms must have been present during the same two week period and represent a change from previous functioning and at least one of the first two symptoms must be present before a clinical diagnosis can be made.

I put up these criteria to underscore the fact that it takes quite a number of things to add up before a person can be considered depressed. Depression requires prompt medical attention and as such the term should not be used loosely. Although there may be situations where the criteria may not necessarily fit, that determination should be left to a health professional.

Suicide

This is a very important aspect of MDD, in fact, it is its major sequelae. From a research done in 2014 by Centre for Disease Control (CDC) in the US, the following facts about suicide in the United States, which may give insight to potential issues and trends here in Nigeria, West Africa or Africa in general, are worthy of note:

§  3.5 - 4% more males die due to suicide than females

§  Suicide is attempted 3 times as often by females

§  Suicide is the 10th leading cause of death currently in the US

§  Suicide was the 2nd leading cause of death for adults between the ages of 10 and 34 in the US

§  Doctors and Dentists have the highest suicide rate among the working class.

According to the World Health Organization (WHO) Mental Health Atlas survey in 2014, the suicide rate in Nigeria is at 6.5 per 100,000 and the Society of Family Physicians of Nigeria also came up with a report that about 7 million Nigerians are living with depression which of course is a risk factor for suicide. It begs the question, why is mental health not being spoken about, why is there such a taboo regarding issues bothering on mental health? It is unfortunate that in our environment these issues are quickly shrugged off as attention seeking but still; what can we as individuals or as a people do to help others, or even ourselves, whenever we see them, or ourselves, falling into that dark space?

As the old saying goes, “Prevention is better than cure.”

We should always check up on friends, family and loved ones as a lot of the time there are subtle cries for help. The DSM V criteria can be used as a detector for these cries and whenever signs point towards the extreme, professional help should be suggested. Again more fora should be made available for the discuss on mental health, especially depression, and persons who have fought the severest forms of this unimaginable mental battle should be given the opportunity to speak and share their stories which could very likely help other people going through similar issues.

Always remember that not everyone who smiles is happy and so it is good to pay attention to the little triggers. Never shrug off anyone who says s/he is feeling depressed or suicidal, rather help in any way you can and always suggest professional help.

Finally, the journey back from a mental breakdown can be long, tedious and very frustrating and patience is required when dealing with issues of the mind; No one should be expected to, "just feel better".

Overall, pray for your friends and family always.

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Drugs, Politics & History

by Stepney Emeh

edited by Juwah C. Awele

Welcome to the first of a series of discussions on a range of topics I feel is currently affecting and shaping our existence in what I like to call “today’s Nigeria” and I would like to discuss with the youth, yes that may include you.  

For starters, I would like to talk about the current endemic use of drugs that has swept the young people in and of this country. This particular topic is very important to me for the mere fact that I am a health professional and have seen, first hand, the effect of drug abuse and even medication consumed in very high quantities.

From my research and experiences, I will give you a very simplified classification of the type of drugs currently in circulation in Nigeria and which I believe can be put into two groups:

HARD drugs, group one (1), examples of which include heroin, cocaine, amphetamine, ecstasy, GHB, and alcohol;

SOFT drugs, group two (2), examples of which include cannabis (hash and marijuana are gotten from this) and valium.

When you talk to a generous number of youth in an attempt to find out why they use these drugs, hard or soft, you come to realise that a majority of these young people began substance abuse as a result of peer pressure. Another sizeable number say they started using drugs because a parent or older person at home was a consumer and still some others might site medical reasons such as marijuana for severe headaches, as an anticonvulsant or to help with glaucoma.

The topic of drug abuse seems to have re-emerged in current discourse because there seems to be an increase in drug related deaths in today’s Nigeria, which begs the following questions.

·      Why do we glorify the use of drugs?

·      Why is excessive smoking and drinking currently the new ‘cool’?

·      Why is there a surge in the consumption of drugs?; and

·      Why are the real medical implications of these drugs not being publicised to the youth?

I believe a single response that cuts across these questions is that perceptions are disconnected from reality. The perception that the drugs are just for recreation or that drugs help the users escape daily life struggles are disconnected from the reality that the use of these drugs is slowly, but surely, sucking life out of our youth, the reality of the medical complications.

Before attempting to solve a problem, you must have acknowledged that a problem exists, you must agree that there is one. I may not pull out all the possible facts and figures to convince you but from my experience in the field, I can tell you that there is one and if you are not in a position to see it now, then know that if nothing is done about the current trend then it may soon be clear for you to also see.

We proceed to possible solutions.

The first step is sensitization. We need to let young people know the hazards of snorting powders, smoking combinations and injecting cocktails and this starts from home. It may be a sibling, neighbour, friend, cousin or spouse, advising them, showing them or telling them the adverse effect of these substances. Whoever it is, the message may go a long way in reducing abuse.

The second step is sensitization phase-II. This time led by the community, government and/or corporate bodies., advertisements that will act as reinforcements to the home-based messages need to be put in place through various media platforms – print (newspapers to billboards), audio and visual – to engage and educate our youth. The conversation on substance abuse needs to be driven aggressively by all and considered critically.

The third step is control. How does the government reduce the availability of or at least strictly supervise the use of drugs? We clearly can see that declaring drugs 'illegal' isn't working. The main issue here has been reported on several fronts as the lack of financing for our anti-drug agencies. The NDLEA, NAFDAC and the other outfits need to be adequately funded and personnel of these agencies need to be trained and re-trained to give them the required skills to tackle this new high. The current laws need to be implemented to the letter and a nationwide crack down on drug peddlers needs to be carried out.

The fourth step is adequate rehabilitation. Ideally every teaching hospital should have a well-equipped rehabilitation centre for drug addicts undergoing treatment. Also private individuals should be encouraged to help in building rehabilitation centres. Rehabilitation is important because there is a need to reintegrate people who have fallen prey to addiction into the un-addicted world.

Let us not pretend that this issue does not exist because it is very real. It is an issue that is eating into our youth and you might well know that the Nigerian youth constitute a greater percentage of the general population and are a great potential labour force. A sub-productive younger generation means lower productivity in the nation which in turn means decreased economic viability and possible disaster for the future.

These are just my thoughts and I felt I should share them.

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