Depression

For some, its like a crawling thought inside your head that you can’t control. For some, it’s like a cold that challenges the warmth in the body. For some, it’s like aches in the stomach, back, and top shoulders. For some, it’s like urging to get up out of bed but find themselves staying longer than usual or perhaps the wakefulness during the night. For some, it’s like feeling worthless and a failure at everything. For some, it’s like hopelessness. For some, it’s like being tired all the time. For some, it’s eating endlessly despite the feeling of hunger- others quite the opposite, not eating. For some, it’s like being stuck in a loop in time. For some, it’s like barely floating on the ocean. For some, it’s like being lodging between nothingness and striving. For some, it’s like screams inside of you- hoping for someone to hear you. For some, it’s being trapped somewhere but nowhere at the same time. For some, it’s like the thrill of pleasure from pain. For some, it’s like chugging glasses of wine or any other alcoholic beverage. For some, it’s like continuously feeling the void of what is. For some, it’s like being uncomfortable with silence- since thoughts get extremely loud. For some, it’s like being invisible. For some…

Depression is a mental disorder that affects how you feel, think and act. And it can strike anyone. It is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. People suffering from depression today are over 300 million according to WHO. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when recurrent and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and affect relationships. Depression is more prevalent in females compared to males-with statistics of 5.1% to 3.6% respectively. There are different forms of depression, such as persistent depressive disorder (also called dysthymia), postpartum depression, psychotic depression, seasonal affective disorder, and major depression. [1,2]

“It is characterized by a combination of symptoms, including low mood, loss of positivity, feeling guilty or worthless, sleep disturbances, fatigue, lack of energy, changes in appetite, loss of interest in activities you once enjoyed and thoughts of death or suicide,” says Wayne Drevets, M.D, Vice President, Disease Area Leader in Mood Disorders, Janssen Pharmaceutical Companies of Johnson & Johnson. [3]

depression in developing countries.

Not so long ago, many psychiatrists believed depression was a uniquely western phenomenon. One typical branch of this belief was advocated by JC Carothers, a psychiatrist and WHO expert. He wrote an influential dissertation on the “African mind” in 1953, arguing that the continent’s inhabitants lacked the psychological development and sense of personal responsibility required to suffer despair. In 1993, Vikram Patel, a psychiatrist, moved to Zimbabwe for a research fellowship. His goal was to find evidence for the view, which was widespread among psychiatrists at the time, that what appeared to be depression in developing countries was actually a response to deprivation and injustice – conditions compounded by colonization.

He began his research by conducting focus groups and cultures with traditional healers and those who cared for patients with mental illnesses, followed by interviews with patients. He inquired as to what mental disease was, what caused it, and how it could be treated. The most common ailment had a name: kufungisisa, which means excessive anxiety about a condition in Shona, the indigenous language. What surprised Patel the most were the patients’ responses.- No matter what they called it, no matter what they believed to be the cause or the treatment. They highlighted hopelessness, tiredness, unwillingness to face their difficulties, and a loss of enthusiasm in life – classic indicators of depression.

Patel had previously assumed that depression was merely an appropriate response to misfortune. Your husband is an alcoholic who beats you. Your crop was a failure. Your family is evicted. Your children are starving. Of course, you’re depressed. You and your family require alcoholism treatment, fertilizer subsidies, and a secure job. What role does psychotherapy play in this? Well, there is a difference between sadness and depression. Sadness is a natural reaction to misfortune. Depression, on the other hand, is not the same thing. Yes, the poor are more prone to depression but that does not indicate that poverty causes depression- it is a correlation however. Depression is like a veil of negative thoughts that paralyzes the person suffering, preventing her from responding to traumatic occurrences.[4]

Depression manifests distinctively in developing countries than in more developed ones. The causes of depression are disturbing: war, torture, epidemics; stressors of daily life in poor countries, such as poverty, extreme food shortages, death of a loved one, etc. A total of 161 papers in the Journal of the American Medical Association reported on surveys of 80,000 refugee studies found a correlation between torture and depression. Syrian refugees in Lebanon were most typically diagnosed with depression and anxiety, according to Doctors Without Borders. According to one study conducted in rural Pakistan, half of the women examined suffered from depression. This was linked to their early marriage and motherhood, several pregnancies, and adjusting to a new life that they had not chosen.[5]

South Asia represents approximately 23% of the global population and one-fifth of the world’s mental health cases- countries include India, Pakistan, Bangladesh, Nepal, Sri Lanka, Afghanistan, Bhutan, and the Maldives. Characterized by significant poverty rates in this region, roughly 150–200 million people have a recognized psychiatric disease and have inadequate access to mental health services. Major Depressive Disorder (MDD) is the most prevalent in all South Asian countries. In another study, rural India had 430 persons out of every thousand at-risk individuals who were depressed — about half of the population. It was found that 39.6 percent of the population suffered from mild to serious depression according to research. The burden of depressive disorders was higher among females and older adults than among males and young people. Previous studies have found that females are more likely than males to experience adverse life events that are strongly linked to the onset of depressive episodes, such as gender discrimination, physical and sexual abuse, relationship breakdown, intimate partner violence, antenatal and postnatal stress, and critical cultural norms. [6]

Untreated depression can take a toll on physical health. It may crimple your thoughts and affect they way you eat, sleep, feel., cardiovascular diseases, physical pain, et cetera. It can also lead to suicide. Note that -The majority of people with serious depression do not attempt suicide. However, according to the National Institute of Mental Health, more than 90% of people who die by suicide suffer from depression or other mental illnesses, as well as a substance misuse problem.[7] The key to preventing depression from increasing and leading to these catastrophic problems is to get professional help as soon as possible. However, many developing countries do not have this access to professional help. Despite the fact that there are proven, effective treatments for mental disorders, a great percentage of people in developing nations have no access to care.  Mental health services and programs should be addressed in developing countries. A lack of resources, a lack of educated healthcare workers, and the societal stigma associated with mental diseases are all barriers to effective care.

References

[1]“Depression and Other Common Mental Disorders: Global Health Estimates.” World Health Organization, World Health Organization, 1 Jan. 1970, https://apps.who.int/iris/handle/10665/254610.

[2]“Depression.” World Health Organization, World Health Organization, https://www.who.int/news-room/fact-sheets/detail/depression.

[3]Reece, Tamekia. “7 Things We Now Know about Depression.” Content Lab U.S., Johnson & Johnson, 29 Sept. 2021, https://www.jnj.com/health-and-wellness/facts-about-depression.

[4]“Busting the Myth That Depression Doesn’t Affect People in Poor Countries.” The Guardian, Guardian News and Media, 30 Apr. 2019, https://www.theguardian.com/society/2019/apr/30/busting-the-myth-that-depression-doesnt-affect-people-in-poor-countries.

[5]“Addressing Depression in Developing Countries.” BORGEN, 14 Feb. 2018, https://www.borgenmagazine.com/depression-in-developing-countries/#:~:text=Depression%20in%20developing%20countries%20looks%20different%20than%20in,and%20homelessness.%20These%20are%20all%20linked%20to%20depression.

[6]Ogbo, Felix Akpojene, et al. “The Burden of Depressive Disorders in South Asia, 1990–2016: Findings from the Global Burden of Disease Study.” BMC Psychiatry, BioMed Central, 16 Oct. 2018, https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1918-1.

[7]Bruce, Debra Fulghum. “Side Effects of Untreated Depression.” WebMD, WebMD, https://www.webmd.com/depression/guide/untreated-depression-effects.

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