In South Africa the number of people suffering from major depressive disorder has risen by 58% from 1990 to 2013 affecting 407 578 people and world-wide just over 253 million.
Dr Mvuyiso Talatala, board member of the Psychiatry Management Group (PsychMG), says the significant increase is due to a number of factors of which raised awareness of the disorder and people seeking help are amongst some of them. This is in spite of the mental health services (and psychiatric services) in South Africa being under-resourced contributing greatly to the under diagnosis of depression and preventing people seeking treatment.
He says events such as the World Health Day held on 7 April focusing this year on depression, will continue to assist efforts in creating world-wide awareness of the condition and treatment options.
“Depression continues to be amongst the leading causes of disability and can affect anybody at any time in their life. However depression remains largely underfunded despite evidence that shows that treating depression improves a country’s economy.
“Due to limited funding for mental health and a delay in implementing appropriate policies, there is still an emphasis on the treatment of more severe illnesses such as bipolar disorder and schizophrenia in South Africa. There is less funding for treatment of depression at primary health care level in the public sector and in outpatient care in the private sector. The funding is skewed towards hospital based care in both public and private sector and this is more apparent in the private sector.”
He says people with depression often find it difficult to talk about their condition with family and in the workplace due to the stigma associated with mental illness. There is often an impression that people suffering from depression are lazy and should snap out of it.
“Stigma stems from a lack of knowledge, awareness and it being perceived as a cultural taboo. The lack of access to medical help results in a community that does not have people who have been successfully treated for depression who could talk about their journey and destigmatise mental illness. Psychiatry in the townships and rural communities ends up being associated with treatment of schizophrenia. Schizophrenia itself carries a lot of stigma. Seeing a psychiatrist for ones depression then becomes associated with seeking help for schizophrenia and being ‘crazy’.”
Dr Talatala says one of the serious consequences of depression is suicide which is amongst the leading causes of death in people aged 15 to 29 years.
“Depression results from a complex interaction of social, psychological and biological factors. Those at highest risk are people who have endured distressing experiences such as trauma, unemployment and bereavement. Genetics, changes in hormone levels, certain medical conditions, stress, or difficult life circumstances are all contributing factors. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and condition”.
He says depression is an illness characterised by persistent sadness and loss of interest in activities one would normally enjoy.
“It’s different from usual mood fluctuations and emotional responses to challenges in everyday life and can be categorized as mild, moderate, or severe depressive episodes. Symptoms of hopelessness, worthlessness, indecisiveness, lack of sleep or increased sleep, reduced or increased appetite and at times anxiety, lasting longer than two weeks might be a sure sign of depression. It severely affects relationships and leads to absenteeism or reduced productivity at work which could lead to job losses.”
Dr Talatala emphasises that depression is treatable through medications or psychotherapy or a combination of both. But the first step is seeking help.
“I would suggest going to a public health clinic or a general practitioner and voice your concerns as soon as possible. It’s however important that patients adhere to and stick to treatment. Too often patients stop using medication mid-way of their treatment with long-term effects on their healing process.
“But the best way is to try and prevent depression in the first place. Monitor your stress and seek immediate help before it spirals out of control. It’s important to identify the stressors in your life and address them to avoid long-term health effects. Live a healthy lifestyle with adequate sleep, exercise, diet and avoiding substance abuse such as drugs and alcohol.”