BN Doctors’ Lounge: Clinical Depression

Nigerians are supposedly the happiest people on the planet and perhaps the most religious as well, and so not surprisingly quite a lot of us dismiss depression as a figment of the imagination or a ‘white man’s illness’ , leaving people who are depressed alienated and alone. According to the typical Nigerian, anyone who claims to be depressed should go for deliverance or just shake it off and shake body, E go betta! Abi?

What is depression?

Depression is characterized by prolonged episodes of low mood, intense sadness, low self esteem and loss of pleasure in normally enjoyable activities without a correspondingly appropriate cause. Let us make a quick distinction here between sadness and depression. If a member of a person’s family dies or if a romantic relationship ends, it is quite normal to feel sad and unhappy. The normal reaction to grief and unpleasant situations includes a varying degree of withdrawal into self and low mood. However as time goes on, (usually within a few days or maximum a couple of weeks), a person can be expected to undergo what is referred to as adjustment and should soon enough return to a normal and balanced mood. Contrast this with a person who, despite a long time passing, remains deeply sad and unhappy or a person who is despondent and sad for no reason at all or whose sadness is not proportional to the event that triggered it.

Why do some people get depressed and some others do not?

Personality and Temperament
Let me introduce you to the personality/temperament theory by painting a picture of two extremes.
We all have that friend whose voice you hear long before they climb up the stairs, whose presence is felt long before they are seen. They talk a hundred words a second, are flashy, loud and rambunctious. They are the huggers, air kissers, back slappers, and the ones who punctuate every sentence with ‘shei you understand me now?’ or ‘you getting what I’m saying?’ They tend to say the first thing that pops into their heads and are fantastic story tellers. They don’t take life too seriously and are fun to be with. They are usually good at competitive team sports like football or rugby. Let’s call them the Expressive personality or Sanguine temperament.

Then there’s the friend who hardly says much and when they do speak you’d be like, ‘Oh! Charles, have you been in this room all along? I didn’t even notice you there’. They don’t say much but whatever they do say is witty and you can tell that it was well thought through. They are the poem writing, picture painting, music composing, hopeless romantics that believe in high and often utopian ideals. They tend to be better at one on one conversation than group interactions and they don’t usually like sports but if they do, they will prefer one man sports like athletics to team sports and prefer intellectual games like chess over contact sports. They are the Analytic personality or the Melancholic temperament.

Analytics are more prone to depression than any of the four personality types and this is in part because analytics have a propensity to be meticulous and detailed in their thinking and are known to have a deep need to follow everything through.

Take for example the Dana and Bellview plane crashes. The entire country was thrown into mourning and all Nigerians regardless of temperament or personality were sad after it happened and remained so for a varying length of time afterwards. The first people to recover were the Expressives. A few days after, they seemed to be back to their normal selves again and were the ones who made up ‘akpos jokes’ or ‘memes’ to help lighten the situation. It’s not that they are irreverent, they just don’t hold on to things. If they can’t explain it, they shrug it off and look forward to tomorrow in hope that things will get better. As you can expect, the last to move on is the Analytic. Months after he can still be found brooding and teary. It’s not that he has refused to let go, he just can’t do so until he has sufficiently explained to himself why this happened and as is often the case, these questions have no answers.

One can expect to see the same reaction in personal tragedy or unpleasant circumstances. The expressive soldiers on and lets go while the analytic hunkers down and tries to make meaning of it all. Life has many ‘big questions’ that have baffled philosophers for millennia. Why are we here? What is the purpose of life? What is the reason for our existence? While the expressive would shrug his shoulders and say ‘wetin consain me?’ or ‘na only God know!’ the analytic by reason of the way his mind works is unable to let go of these questions without resolving them and will often personalize them and make it his life’s quest to find answers for himself. The need to analyse and explain situations logically and the reality that some situations cannot be logically explained can create a raging internal conflict in the minds of analytics. These inner conflicts are what make the analytic mind more prone to depression.

Biochemistry
Our bodies are complex biochemical machines and are controlled by signals transmitted throughout the body. One type of signalling chemicals we might already be familiar with are hormones. Oestrogen and progesterone are responsible for transforming a little girl into a woman as well as initiating her menstrual cycle. Testosterone is responsible for turning skinny boys into buff men complete with biceps and a husky baritone. Another type of signal chemical is called a Neurotransmitter. Neurotransmitters are responsible for functions affecting the brain and the nervous system and these chemicals control amongst other things; our appetite, our sleep pattern, and our perception of pain. The neurotransmitter responsible for mood is Serotonin. The more serotonin available in the brain, the more balanced our mood is. If levels of serotonin drop, our mood drops also.

Ever wondered why some women are curvier than others? One theory suggests that a girl who had higher oestrogen levels circulating in her body at puberty is more likely to be curvier than another who didn’t. She has no control over this and the amount of hormones her body releases at puberty is genetically determined and inherited from the women in her family.

In the same way, as individuals, the amount of serotonin produced and the rate at which it is used up by our bodies are different and this is determined by our genes. People who have a predisposition to depression are known to have lower circulating levels of serotonin in their bodies than others who do not. Also they may have receptors that don’t respond as well as they should, or have an overactive clearance system that mops up most of the serotonin before it can properly exert its function.

As a result of this relative ‘serotonin deficiency’ persons who have this biochemical milieu are prone to depression

How can I be certain I have depression?

There are two general kinds of depressive symptoms and they are:
• Mind symptoms
• Body symptoms.
Mind symptoms include those that affect our feelings: sadness, feeling of low self esteem, loss of pleasure in fun things, feelings of hopelessness, etc.
Body symptoms include those that affect our physical functions: loss of sleep, early morning wakefulness, loss of appetite and loss of Libido

To diagnose depression your doctor will want to find out what symptoms you have and will put you in either of three broad categories.
• Mild depression is diagnosed when a patient has only mind symptoms.
• Moderate depression is diagnosed when the imbalance is enough to cause body symptoms as well as two or more mind symptoms.
• Severe depression is either mind or body symptoms accompanied by an overwhelming desire to harm one’s self or end one’s own life to escape the sadness.

If you think you are depressed please see a doctor.

Can it be treated?

There are three modalities of treatment and can correspond to the three diagnostic classes of depression

Support
Depression is higher in developed countries than it is in developing countries and studies have shown that this is directly related to availability of a functioning support system. Life in developed societies is notoriously lonely and people often have no one to turn to. Nigerians however have loads of friends and family and our support system is thought by researchers to be one of the best in the world. Take advantage of this and share your feelings with someone. Talking about how you feel is often enough to make you feel better, especially for mild depression. A friend or a partner or a member of your family can do just fine.

Natural
Low Serotonin? There must be something that can boost the levels of this naughty wachamacallit in the body abi? Yes there is! Serotonin is manufactured in the body from an amino acid called Tryptophan. Eating foods high in tryptophan will increase serotonin production in the body and are also great for relieving symptoms of moderate depression. They include mangoes, plantains, pineapples, banana, kiwifruit, plums, chicken, turkey, milk, cheese yoghurt, soybeans, sesame seeds and chocolate.

Exercise also boosts serotonin levels by triggering the release of stored neurotransmitter and is an excellent way to brighten your mood. By far the best form of exercise to boost serotonin levels is running or jogging. The combination of fresh air and the burst of muscle contraction is a winning combination. Add to that a few upbeat songs on your music player while you jog and you should be chirpy and happy in no time.

Drug treatment and Talking treatment
In some instances, even after doing all of the above, symptoms may still persist. Your doctor might decide to put you on medication. Monoamine oxidise inhibitors and Serotonin reuptake inhibitors are the class of drugs commonly used to treat depression. Not all patients get the same medication and your doctor will determine your suitability for commencing any drug treatment.
Also, your doctor after discussing with you can, decide if you would benefit from a type of talking treatment called Cognitive Behavioural Therapy. Here a specialist will help you go through the internal conflicts that may have arisen within your heart and help you resolve them. You would also learn coping mechanisms as well as how to ‘let go’ of some of the ‘big questions’ that are known to trigger depressive symptoms in patients with an analytic personality type.

In a nutshell

Depression is more than simply feeling unhappy or fed up for a few days.
We all go through spells of feeling down, but when you’re depressed you feel persistently sad for weeks or months, rather than just a few days. Depression is a real illness with real symptoms, and it’s not a sign of weakness or something you can “snap out of” by “pulling yourself together”.
The good news is that with the right treatment and support, most people can make a full recovery.

Did you know?

Some of the greatest minds of all time had the Analytic personality type? Albert Einstein, Isaac Newton, Leonardo DaVinchi, Paul of Tarsus, and King Solomon of Israel were all analytics. Can you think of any others?

(A recognised variant of depression is atypical depression where instead of a loss of appetite, loss of libido or loss of sleep a patient may find that they are eating more than usual, experiencing higher libido or sleeping more than usual. Seasonal affective disorder is depression that occurs only during the winter months and is thought to be as a result of reduced serotonin production in response to shorter hours of sunlight.
Postpartum depression is a strong feeling of sadness that can affect a new mother after she has had a baby and is thought to be as a result of sudden changes in her hormonal levels after delivery.

Other associated classifications like psychotic depression, post partum psychosis, cyclothymia, bipolar affective disorder and mania are outside the scope of this article.)

Disclaimer: This article is written for patient education. It is not intended to diagnose or prescribe treatment and does not replace the advice of your physician. It in no means attempts to cover the full medical scope of this condition.

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David Olamide Craig is a Physician, Pastor, Photographer, Poet and Playwright. He graduated Bachelor of Medicine and Bachelor of Surgery from the University of Ibadan and holds a Masters in Occupational Health from the Institute of Occupational and Environmental Medicine, University of Birmingham. He is passionate about healthy living and sustainable energy. When he is not seeing patients, Dr. Craig spends his time stretched out on his favourite couch, reading books, magazines, and blogs. Catch him on www.ijgb.com.ng and follow him on Twitter @RevDrCraig