By Annahl Anbini Hoole –
Sadness is a normal emotion we all feel reacting to difficult events in our lives. Sadness usually passes with time. Clinical depression, however, is a mood disorder. It is harder to deal with and can interfere with your everyday life. An often taboo subject in our country, it was recently brought into the limelight at WHO Sri Lanka’s and the Ministry of Health, Nutrition, & Indigenous Medicine’s Depression: Let’s Talk – an advocacy campaign commemorating World Health Day 2017. Depression is an illness, stigmatized by fear and ignorance; our cultural stoicism encourages us to either hide these symptoms or socially exclude those who cannot. Understanding depression is important to finding its cure.
WHO says 300 million worldwide suffer from depression with over 800,000 from Sri Lanka – compared to 400,000 in 2006. Although 1 in 8 Sri Lankans suffers from a mental illness, only 40% receive treatment. In 2014 WHO reported Sri Lanka as having the 4th highest suicide rate among 172 countries.
Like many Sri Lankans, Americans, and millennials, I grew up thinking “depression” was a fancy term for ingratitude or self-pity. The stigma surrounding mental health disorders leads people to hide their symptoms and refuse treatment. Mental wellness is not only important to each individual but to the whole country. Depression is associated with lower workplace productivity, increased mortality from suicide and other illnesses, and a higher risk for other mental disorders and substance abuse.
Major Depressive Disorder (MDD) is defined as experiencing 5 or more of these symptoms continuously for at least 2 weeks:
- Feeling sad or anxious or hopeless;
- Sleep changes –sleeping too much or too little;
- Losing interest or pleasure in hobbies/daily activities ;
- Change in activity –more or less active than usual;
- Feeling guilty or worthless;
- Decreased energy or fatigue;
- Trouble concentrating or remembering, inability to complete activities;
- Appetite or weight changes;
- Thoughts of death or suicide.
If you are experiencing any of the symptoms above, please visit your doctor – diagnosis is best made by a mental health professional. Symptoms may present differently in different people. In women more typical symptoms might be sadness-anxiety with decreased energy; whereas men are more likely to be easily irritable, have difficulty concentrating, and more likely to turn to alcohol/cigarettes/drugs. Females are affected more than males. Elders are less likely to complain of being sad but more likely to feel worthless and complain of body aches/pains. Depression is common in older people, who are at higher risk for suicide. It is most common among25-44 year-olds; incidence decreases with age.
There are different types of depression: MDD, dysthymia (symptoms of depression that last 2 years with episodes of major depression and periods in-between of less severity), perinatal/post-partum-depression (depression associated with child-birth), etc..
Post-partum (meaning after-childbirth) depression affects 1-in-6 women. Along with symptoms above, you may experience feeling overwhelmed/unprepared, inability to bond with your baby, guilt, or feeling irritated/angry/resentful towards your baby or others.
Depression is caused by chemical imbalance, but also a combination of genetic, biological, psychological, and environmental factors. Physical/emotional abuse, certain medications, death of a loved one, family history of depression, major life changes/stress (e.g. divorce, moving, losing a job), social isolation, medical conditions, seasonal changes, or substance abuse. Chronic conditions like heart disease, obesity, AIDs, dementia, Alzheimer’s disease, and cancer contribute.
Although there is no way to prevent depression, there are certain ways to help. If you are undergoing a stressful time, take measures to control your stress and get rid of negative thoughts, for example by talking to someone about it or through mindfulness meditation. Get help early and take measures to prevent relapsing.
WHO reported in 2014 that “As many as half of all mental health disorders start by age 14…most go unrecognized and untreated which later leads to serious consequences to mental health through life.” Suicide is the second leading cause of death in 15-29 year olds. An underestimated problem we have in schools and universities here is bullying(hazing/ragging). A study in Finland by Dr. Sourander (published in JAMA Psychiatry) found that within the study 20% who were bullies as children needed treatment for a mental-health problem as young adults and 23% who were bullied needed psychiatric help by age 30. Thirty-one percent of the bullies and bullied had psychiatric problems, with the highest rates within the study of depression, anxiety, schizophrenia, and substance-abuse. A 2013 study at Duke University confirmed bullies and the bullied have a higher risk of depression, panic-disorders, and behavioral-education-emotional problems. Bullies are more likely to have been bullied themselves.
WHO reported that in Sri Lanka, 7% of adolescents (13-17 years of age) attempted suicide at least once, 9% considered suicide, and 39% experienced bullying (within the month preceding the research alone!).
Most Sri Lankan university students/alums I’ve talked to have experienced some form of hazing; it is too often treated as a common “rite of passage” done in good fun – eerily similar to Trump’s “boy talk” or “locker room talk”. Untrained teachers, principals, and advisors, havea detrimental effect on not only the students and institutions but on society as a whole. Teachers must be capable of spotting students needing help.
My experience shows how untrained teachers become part of the problem. At a Colombo school I had students tear up my books, throw my back-pack on the ground and step on it (in front of a teacher who laughed), lift up my uniform calling me a lesbian because I considered shorts underneath more decent, and had a principal insult my parents and family multiple times. When I complained about this to a teacher, I was told to pray about it; she asked prying questions about my home-life which she tried to convince me was unhappy, and told me that the bullying is likely my fault. I avoided school and disliked subjects I used to love. Thankfully I had a strong support system in my family and lovely American teachers and advisor in my Pennsylvania high-school whose encouragement has resulted in my MD. There are those less fortunate that the system in Sri Lanka has failed.
Listening and supporting your children and giving weight to their fears and emotions are important. If it is something you feel unequipped for, seek advice from a mental health professional.
Post-Traumatic Stress Disorder (PTSD):
PTSD, often accompanied by depression, is a disorder that develops in some after a shocking or dangerous event (e.g., war, tsunami); symptoms must last a month before being classified as PTSD. PTSD patients might re-experience the event through flashbacks or bad dreams, sometimes triggered by certain places or objects. They may avoid places or events or thoughts or feelings, feel tense and easily startled, or be prone to sudden angry outbursts, or have difficulty sleeping. They may also have trouble remembering certain things that occurred at the time of the event, feel guilty or be negative, and lose interest in hobbies they used to enjoy.
A visit to your doctor or a mental health professional is the first step towards treatment. Although reading this article and consulting WebMD might make you feel you have depression, a doctor can properly examine and interview you to rule out any other illness that might present like depression. Take heart that when we read a textbook on mental illness symptoms, it might feel as if we have all of them. It is because many of these symptoms are normal and become an illness only when they are pronounced. This is why it is important to let a specialized doctor be in charge. Seeking help is the most important step. Depression, like diabetes and hypertension, needs proper treatment – it’s not something you can “shake off” or “get over,” and without proper treatment can lead to a relapse. Your doctor might recommend anti-depressants (which can take 2-4 weeks to start to work) or therapy, where you will learn to change any negative habits or ways of thinking.
Of help are exercising, time with caring friends or relatives. Alcohol and illegal-drug usage worsen your symptoms. Most valuable is talking to a mental health professional. Most religious institutions, like churches, also offer help when needed. Help Hotlines you can call in Sri Lanka are:
SUWASARIYA: 071 0 107 107;
Sumithrayo: 011 269 2909 or 011 269 6666;
Courage Compassion Commitment Foundation: 1333.
If you know someone who is depressed, threatening suicide or self-harm, do not ignore it. Be understanding and patient, encourage them to take part in social activities, and most importantly do not disregard his or her feelings.
Because depression is also genetic, in our “arranged marriage” society, prospective spouses are reluctant to marry into families where the illness is noticed. Such families avoid treatment to contain gossip. This becomes a vicious cycle as non-treatment leads to worsening. Depression, like most diseases, is treatable and manageable and need not be hidden. Genetic is not synonymous for destined. Fearless, open conversation about mental health will promote awareness and encourage people to get help. Ignorance breeds fear.