For the average onlooker, it often takes a giant leap of perception and intuition to begin to understand the maze of darkness for which suicide seems a welcoming beam of light for someone suffering from depression. The seeming external calm more often than not, masks a deep-seated turmoil that decapitates the will to do and to be. And so feeling like they no longer belong to anything or anyone, life, for those suffering from depression, literally becomes meaningless, if not burdensome. In effect, depression is often physically and mentally paralyzing, almost bringing day-to-day life to a standstill.
One sufferer from depression disclosed, “With no warning signs, its like the lights just suddenly go out and everything you know and love is meaningless”. Another pointed out, “How do you begin to explain the unbearable, heavy emptiness to someone who’s never experienced it?” Yet another emphasized, “Its so hard when people tell you to cheer up or get over it, there’s nothing I’d like more than for it to be that easy.” For yet another one “Everything did seem like it was falling apart.”
The website, HealthyPlace.com states, “Depression is feeling like you’ve lost something but having no clue when or where you last had it. Then one day you realize what you’ve lost is yourself.” Yet even this attempt at explaining depressions does not give quite the picture. The fact is that depression entails all of the following:
• Fatigue or loss of energy
• Feelings of worthlessness and/or excessive guilt
• Impaired concentration and indecisiveness
• Insomnia (lack of sleep) or hypersomnia (excessive sleeping)
• Significant weight loss (due to loss of appetite – you aren’t hungry or can’t be bothered or both) or gain (due to over eating because you’re bored or feeling empty or both)
• Feeling sad, empty or hopeless most of the day. In children mood can be expressed as irritable.
• Significant loss of interest or pleasure in almost all or all activities most of the day
• Restlessness, agitation or slowing down that can be noticed by others
• Prolonged, harsh self-criticism,
• Crying spells,
• General lack of motivation,
• Unexplained aches and pains,
• Recurrent thoughts of death (not just fear of dying), recurring thoughts of suicide, plan to attempt suicide or actual suicide attempt
Depression is an illness like asthma or diabetes and thus like any other illness, can affect anyone at any age. The World Health Organization refers to depression as “a common illness worldwide” that affects an estimated 350 million people. Also, Guyana’s Mental Health Action Plan notes that depression is the fifth leading contributor to disease burden. As worrying as this trend is, the chances are that it does not take into account youth depression. Recent self esteem workshops done by the New Jersey Arya Samaj Humanitarian Mission (NJASM) and the Peace Corp in Berbcie and The Caribbean Voice, GIVE Foundation and other stakeholders in Demerara, indicate that a significant amount of students and young people suffer from depression at one time or another, often brought on by physical and/or sexual abuse suffered, sometimes at the hands of loved ones and family friends. Given that at its worst, depression can “trigger” suicide, this would partially explain why the 15 to 25 age group exhibits the highest suicide rate in Guyana. In fact, over 800,000 people die due to suicide every year.
In addition, in an effort to numb the pain or hopelessness they are experiencing, persons suffering from depression may often turn to excessive use of alcohol, drugs or other substances. While alcohol or other substances may appear to provide temporary relief, over time, the misuse of these substances will worsen the symptoms and further complicate treatment, while often triggering violent abuse and catalyzing suicide.
Advances in science, specifically brain imaging indicate that the brains of persons who are clinically depressed look different than the brains of those who are not depressed, much in the same way that a diseased heart would look different when compared to a healthy heart. In fact, a combination of genetics and environment contribute to clinical depression and episodes of depression can be triggered by traumatic experiences such as:
➢ childhood or adult physical or sexual abuse,
➢ loss of a loved one,
➢ relationship problems (like a break up with a boyfriend or girlfriend),
➢ unemployment and poverty
➢ pregnancy or childbirth,
➢ a serious physical health condition such as cancer, cardiovascular disease or HIV/AIDS,
➢ an accident or a natural disaster.
➢ a family history of depression,
➢ a profound exposure to social alienation,
The Caribbean Health Research Council notes that in the primary care setting the most likely complaints are of a physical nature. Sometimes, however, depression can have no obvious cause at all, but it could be the result of chemical imbalances in the brain.
Episodes of depression can be of mild, moderate or severe intensity and can be long-lasting or periodic and recurrent. The recommended treatment for severe episodes of depression is a combination of medication and talk therapy or counseling. Mild and moderate episodes have been treated with talk therapy or counseling alone.
In countries where resources are limited, healthcare personnel and other lay persons, have been successfully trained to provide evidence-based, structured talk therapy interventions to persons experiencing mild or moderate episodes of depression. Severe episodes of depression require more specialized intervention, which may at times lead to hospitalization.
The bottom line is that depression is treatable and curable, if identified and addressed. In Guyana, such identification can be done by trained first responders, especially given that those suffering from depression often present a façade of happiness, masking their agony with smiles and ‘normalcy’. More importantly, In Guyana, appropriate interventions can be successfully incorporated into primary care settings as part of an integrated approach to health care, as advocated by the World health Organization (WHO), especially for developing nations and with specialized resources constraints. And, in this context, the Gatekeepers’ Program becomes critical as the mechanism to ensure trained first responders within communities, nation wide. It must also be noted that treating depression will not only significantly reduce suicide, and positively impact abuse and violence, but also improve the overall well-being of the nation.
Meanwhile, for those who feel depressed and can somehow summon the will to still be engaged in any sort of activity here are some suggestions that would help:
• Create a ‘done’ list instead of a ‘to do’ list – even the smallest thing such as clipping one’s nails, doing some writing or finishing a chore. This would enable you to recognize that you are, in fact, meaningfully achieving and might spur you on to filling up more of your minutes with activities, even simple things such as making up your bed or straightening out your closet.
• Build a ‘make a life easier’ toolkit, a sort of ‘happy box, if you will that can include stuff that you may have saved over time, such as funny movies, a nice smelling candle, a favorite book, favorite pictures and posters, sayings and messages that you loved…anything that made life easier and happier for you.
• Relive those moments of compliments and accolades. And if you have saved compliments via cards, messages, notes or whatever else, go back to them, perhaps even gather them all in one place and store. They will bring back a sense of self-worth
• Let yourself cry, not so much to reflect your sadness but as a catharsis, to let it all out. You might do this by watching a movie or reading a book that brings tears to your eyes.
• Make a gratitude list. Write down everything and everyone you’re thankful for such as siblings or parents, having a roof over your head, a job that gives you satisfaction, really great friends….As clinical psychologist Dr. Andrea Bonior pointed out on Buzzfeed, “Reminding yourself of what you have leads to appreciation that helps you feel measurably more content.”
• Play with children or animals or visit an elderly person or someone sick, They give so much love that they bring back happiness, even if momentary. They make you temporarily forget your sadness and give something positive to reflect on.
• Also, if you can, find a hobby that makes you feel good, maybe something you always wanted to do but kept putting off such as planting flowers, starting a piece of writing, drawing or coloring or creating/building something such as a simple toy or paper boat.
• If you have been inside for days doing nothing, get ready for the day as if you mean to get outside…shower, brush your teeth, groom your hair and so on. And maybe, just maybe you might find the will to actually go outside and do something. Perhaps then you can get together with family or a group of friends, even if you don’t participate in the conversation. Just being there will take your mind off things for a while.
• Create a happy playlist and listen to music that makes you feel positive and good about yourself.
• If you find yourself eating a lot try to look for healthy food. Comfort food makes you feel like crap whereas health food can help change your feelings even if momentarily.
• If possible start exercising and get caught up in the mood as this will work wonders for the way you feel. Also try meditation as this too can positively impact your mood.
• Most importantly please recognize that you cannot, by yourself, get better so call someone trusted and ask that person to get you help.
Trained first responders and others trained to identify the warning signs, can also help those suffering from depression to apply the strategies outlined above, after building trust.
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