Sun | May 26, 2019

Michael Abrahams | Are you depressed?

Published:Monday | August 27, 2018 | 12:05 AM

Depression is a word we hear often, but many of us do not understand what it is. Even more disturbing is the fact that many who are afflicted are undiagnosed and unaware that they have the disorder. Hence, they remain untreated and suffer in silence.

The scope of depression is enormous. According to the World Health Organization (WHO), it is the leading cause of disability worldwide, affecting over 300 million people. Depression is not just feeling sad or down. It is a genuine medical condition, a mood disorder characterized by the following symptoms:

Feeling sad or having a depressed mood

Loss of interest or pleasure in activities once enjoyed

Changes in appetite - weight loss or gain unrelated to dieting

Trouble sleeping or sleeping too much

Loss of energy or increased fatigue

Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)

Feeling worthless or guilty

Difficulty thinking, concentrating or making decisions

Thoughts of death or suicide.

All the above symptoms do not have to be present but must last at least two weeks for a diagnosis to be made.

The causes of depression are varied, and include genetics, chronic pain or disability, loneliness and reactions to negative life events and situations. And the situations do not have to still exist. For example, adverse childhood experiences such as abuse, neglect and exposure to dysfunction sow the seeds for depression in adulthood. Whatever the initial cause, eventually certain brain chemicals become imbalanced, and depression of the mood is the result.

The presentation of people with depression varies as well. For example, some may become quiet and withdrawn, lose their appetite and experience weight loss and have insomnia. Others may become cranky and aggressive, overeat and gain weight and sleep for very long periods of time.

To complicate the situation even further, some people’s symptoms are masked by somatisation, which means that they complain primarily of physical, rather than emotional symptoms. These patients may visit doctor’s offices repeatedly for a variety of symptoms affecting different and unrelated areas. So, such a person may visit the doctor today for headaches, next week for back pain, then the following week for heartburn, then the following month for shortness of breath, and so on.

Some may repeatedly complain of the same symptom, such as pelvic pain, a presentation that is not uncommon in women who are survivors of sexual abuse. When people present this way, the situation can be very frustrating not only for them, but also for the physicians they consult, because if depression really is the cause of their symptoms, and is not initially considered, it is likely that the results of their investigations will be normal, and their discomfort will not be alleviated.

Persons with depression often describe feeling like they are in a deep, dark hole that they are unable to climb out of. This is because depression is really your mind playing games with you. It is your mind tricking you into thinking that things are worse than they really are. Depression diminishes positive thoughts in your brain and replaces them with negative ones. It attenuates your successes and pushes them to the background while magnifying your failures and bringing them to the fore. It replaces the lens through which you view the world, changing it from a crystal clear one to a darkly tinted, distorted, dirty and cracked one. In depression life appears dark, gloomy and hopeless when, in reality, it may not be that bad.

If any of these descriptions seem familiar and resonate with you, you may be depressed, and if you are, seeking help for your condition would be in your best interest. This means consulting a physician, who can either treat you or refer you to a mental health professional, such as a psychiatrist or a psychologist, who is skilled in managing the condition. Treatment includes psychotherapy and/or medication. Exercise, eating healthily, and surrounding yourself with positive people and energy are also extremely beneficial. If your depression is so severe that suicidal thoughts occur, visit an emergency room as soon as you can, as this may be a life-threatening emergency.

Please do not allow stigma to prevent you from seeking assistance. Depression is a threat to your health and well-being. By affecting your mood, it can interfere with your performance at home, work and school and can damage interpersonal relationships. It diminishes your self-esteem and motivation and places you in a state of inertia, killing your initiative. In doing so, it can present as a significant barrier to your success. Because of your mental state, you underachieve, and the underachievement can further weaken your motivation and self-esteem, increase your inertia and set in motion a self-perpetuating downward spiral into a hellish abyss. At its worst, the pain and anguish can be so severe that, as mentioned earlier, death may appear to be the only reasonable avenue through which to escape the torment. 

Depression also tends to worsen the symptoms of other illnesses that you might concurrently have. If you have a painful condition such as arthritis, depression may cause you to be less tolerant of the pain. If you are diabetic or hypertensive, the depression, and the stress that comes with it, make controlling the disorders a challenge. Depression can also hasten the onset and increase the risk of developing other illnesses such as heart attacks, and therefore lowers your life expectancy.

Are you depressed?

- Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback to and, or tweet @mikeyabrahams