“I’m So Depressed”

I have had a hard time writing an article about depression in The Gambia.  Depression is a huge problem in the western world but I have seen less of it here.  Maybe everyone who is depressed is hiding away in their compounds; or maybe the life here somehow prevents the development of major depression in most people.  Maybe bigger problems keep depression from being so obvious. 
One of the ways we try to help people in the West combat depression is by helping them learn to live in the present and not waste a lot of time dwelling on past failures, losses and hurts.  Here, there isn’t the luxury of that; most people must struggle each day to make a living for themselves and their families.   While this is a difficult life, it does encourage a focus on the present rather than the past and an ability to move quickly on in spite of disappointments and hardships.  I’ve also noticed that many people here are able to enjoy the simple things - a beautiful morning, a bird’s song - more than dwelling on the accumulation of “things” which simply isn’t possible and in the end isn’t very satisfying anyway. 
So, what exactly is depression?  Everyone occasionally feels “blue” or sad but these feelings are fleeting and pass within a couple of days. Depressive disorder on the other hand, interferes with daily functioning and causes pain for both the person with the disorder and those who care about him or her.  Not everyone with depressive disorder experiences the same exact symptoms, but do usually have three or four of the following:
* Persistent sad, anxious or “empty” feelings

* Feelings of hopelessness and/or pessimism

* Feelings of guilt, worthlessness and helplessness
* Irritability and restlessness

* Loss of interest in activities once pleasurable, including sex

* Fatigue and decreased energy

* Difficulty concentrating, remembering details, and making decisions

* Sleeping problems, early morning wakefulness or sleeping excessively

* Overeating or appetite loss

* Persistent thoughts of death
* Constant aches and pains or digestive problems that do not diminish  even after treatment
* Bouts of panic, “anxiety attacks” and generally feeling out of control

There is no single cause of depression; it results from a variety of factors.  Researchers do know that it is a disorder of the brain: imaging technologies such as magnetic resonance imaging (MRI) of the brain show differences between the brains of people who have depression versus those who do not.  In other words, depression is real.  People who say, “Oh, it is just all in your head” are actually right because it is literally in your brain.  The parts of the brain responsible for regulating mood, thinking, sleep, appetite and behavior appear to function abnormally during depression.  Neurotransmitters, chemicals the brain cells use to communicate with each other, appear to be out of balance.  Though we can see these differences in the brains of depressed people, it does not explain why the depression has occurred.  This is still a question: why does one person going through a difficult time get depressed and another doesn’t?  Some kinds of depression tend to run in families suggesting a genetic link; but then others without a family history also suffer.  In addition, trauma, loss of a loved one, a difficult relationship or any stressful situation may trigger a depressive episode.  Though, again, further subsequent episodes may occur with or without an obvious trigger.
Women are more affected by depression than are men, probably because of dramatic biological and hormonal changes that take place in their life cycle.  Research has shown that hormones directly affect the chemistry of mood and emotions.  For example, women are particularly vulnerable to depression during teen-age years, just after giving birth and around menopause when hormonal changes are many.  Some women also experience severe mood swings just before their menstrual period each mo nth due to hormonal fluctuations.  In addition, women are often stressed because of their complex roles caring for children and aging relatives, and having to balance home and work or other duties.  Men on the other hand are more affected by employment and work issues which may cause disappointment and depression.  Men often complain of the fatigue, sleeplessness, loss of interest in pleasurable activities and irritability of depression while women are more inclined to focus on feelings of guilt, worthlessness and sadness.  Men are more likely to turn to alcohol or drugs when they are depressed and can become quite frustrated and angry, even abusive.  Some men throw themselves into work or sport to avoid talking about their feelings of depression or engage in reckless, risky behavior because they “just don’t care”.  Though women attempt suicide more often than men, men actually succeed in killing themselves more often than women do. 
Depression can occur in the elderly as well as in childhood.  A child with depression may pretend to be sick, refuse to go to school, cling to a parent or be worried that a parent may die.  Older children and adolescents may sulk, get into trouble at school, be negative and irritable and feel misunderstood and alone.  Up to the age of fifteen, boys and girls have equal numbers of depression but after that age, girls have twice as many depressive episodes as boys.
A. If you know someone who is depressed it will affect you too.  There are some things you can do to help:
* Offer emotional support, understanding, patience and encouragement;

* Engage your friend in conversation and listen very carefully to what they   say.  Don’t tell them what to do.
* Never put down your friends’ expression of feelings but point out the reality and offer hope;

* Never ignore your friends’ talk of suicide and alert the appropriate family and medical people;

* Invite your friend to go out with you and participate in activities and   don’t give up if they decline at first;
* Also don’t push too hard if your friend is reluctant as this can lead to increased feelings of failure;

* Remind your friend that they have not always felt this way and that they  will not always feel this way.  Time will help.

If you have depression, you may feel exhausted and hopeless.  It may be very difficult to take action to help yourself.  But remind yourself that even this is part of the depression and that it doesn’t reflect the real circumstances.  As you begin to recognize your depression and to take steps to help yourself, your negative thoughts will fade slowly, slowly.  Some of the things you can do to help yourself are:
* Engage in mild activity or exercise even if it is just a short walk at first. 

Exercise has been shown to cure depression as well as antidepressant  medications do.  It affects body chemistry in much the same way. 

* Participate in religious, social, family and other activities;
* Go to a ball game or a social ceremony, things y ou used to enjoy doing, even if you don’t feel like it;
* Set realistic goals for yourself.  Divide large tasks into smaller steps so  you can see your progress as you go along

* Try not to isolate yourself.  Confide in a trusted friend and spend time   with other people even if you don’t feel like it at first.
* Expect you mood to change very gradually.  You will not suddenly “snap out of it”.  Often sleep and appetite rhythms improve before your  depressed mood will begin to lift;

* Postpone major decisions - marriage, job change, moving - until you are  feeling more like yourself.  When you do make a decision, check it out with people who know you very well and may be more realistic than you  are able to be right now.

* Remember that a more positive attitude will return as you feel better  and your depression lifts.  Depression never lasts forever.  And  sometimes you have to begin acting “as if” you are not depressed before   you actually feel better.