Depression: 90% of people who commit suicide had untreated mental illness – Dr. Aina Oyekanmi

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On Friday, March 19, 2017, there was a confirmed report of Allwell Orji, a young medical doctor, who dived into the Lagoon on his way from church in Victoria Island.

June 10 2018, a middle aged woman reportedly disembarked from a Ford Explorer SUV and dived into Lagos Lagoon.

Abigael Ogunyinka and Titilayo Momoh in separate incidents attempted to jump into the vast deep ocean from Third Mainland Bridge and the nearby Carter Bridge.

One medical condition, depression is fingered as the culprit that is the causative factor to this growing incidence of suicide and attempted suicide in the country.

In a star nterview Newsclickng.Com’s Senior Correspondent, Adeoluwa Bravo had with one of Nigeria and Africa’s leading Consultant Psychiatrist, Dr (Mrs) Aina Oyekanmi who practice Psychiatry at the WHO certified Nuero-Psychiatric Hospital, Aro Abeokuta, the highly experienced Medical Consultant explained in details what is causes depression, its management and how it could be avoided.

Below is the Excerpt: Enjoy it

How would you describe depression to a secondary school student, and what causes depression?
Depression is usually an English word that people use colloquially when they feel sad, due to whatever reasons that make people sad. But clinical depression is different from normal sadness. When they say depression clinically, it is a very serious emotional and biological disorder that affects people’s thoughts, feeling, mood, behaviour and physical self, so depression is an illness and not something one can just wish away. People usually think that only those experiencing negative events or situation are depressed; though depression can be precipitated by negative event but even positive events like getting married, having a baby, change of environment can bring depression.

So depression is a legitimate mental illness. But often when we say mental, we refer to the mind. Because when people hear mental, they equate it with madness which is very wrong. Mental is just a technical term referring to the mind just as renal refers to the kidney. We have technical terms for all body parts so when we say mental it means the mind, and where is the mind? It is in the brain and the brain is a biological organ just like every other organ in the body.

So, depression is an illness that is coming from the brain just like every other mental illness. Talking about the causes, for most psychological disorder, the precise cause is not known. If you have malaria, everybody knows it is caused by a parasite facilitated by mosquito and if you don’t have this parasite in your blood you cannot have malaria. But in psychological disorders, depression inclusive there is really no single factor that one can pinpoint so instead of saying what is the cause we talk about the risk factors. So, what are the factors that can make it likely to happen? and I must say that depression can happen to anybody as long as you are a human being and you have a brain. Anybody can experience it when exposed to the risk factors. We can categorize the risk factors into three: The Biological Factors; Psychological Factors and the Social Factors and all these factors come together to determine whether someone will come down with a mental illness.

Most times, depression can be precipitated by an event especially a negative event but then any situation of stress even if it was caused by positive event which someone was not prepared for, can precipitate depression. Now there’s something we call vulnerability stress model. For mental disorders, repression inclusive there is a genetic risk that if you come from a family where you have a relative who have experienced depression or any other mood disorder, the person from that family has a higher risk of suffering depression, though this is not sacrosanct – it does not mean everybody will surely have it. Another case is also true that even if there is no family member that has it, it doesn’t mean that you cannot have it but what we are trying to say is that there are some conditions that will make someone more vulnerable to have depression and genetic risk is one of them.

Another thing is exposure to toxins when a child was in the womb; may be the mother was stressed, exposed to toxins or trauma that could cause some damages to the child’s brain, such child is vulnerable to having depression later in life when exposed to any little stress. Another factor is obstetric complication at child birth. This is when oxygen was unable to get to the brain of a child on time; the integrity of that brain can be compromised such that later in life when the person experience any form of stress, he or she can easily come down to depression. Also if as a child, one experienced any form of child abuse – sexual, emotional, or physical that person can also have depression later in life when faced with stress. So any condition that happens to a young brain or a maturing brain can make that person vulnerable to depression later in life. That is about biological vulnerability factors – it could be genetic risks, obstetric complication, exposure to toxins. It can also be a psychological factor such as child abuse- sexual, physical, or emotional; while social factors that contribute to vulnerability include parental discord, domestic violence etc. Children from homes with so much conflict may suffer depression when they experience stress later in their life.

So by and large, we have vulnerability and what we call precipitating factors. So by this, we can say we are all vulnerable, only that we have different vulnerability degrees. So there must have been vulnerability in place, so when stress is added to it, then a person comes to depression. So depression is not caused by a single factor, there are many risk factors which could be biological, emotional, social or psychological.

In short if someone has a low self-esteem, the person can also experience depression which is categorized under psychological; or when somebody is always pessimistic- focusing only on negative angle when something happens, such person is vulnerable to depression.

In recent years, there are many cases of suicide or attempted suicide; is this a new phenomenon or just a leap?
Well, suicide has always been there, but because of this digital age when something happen the news travel fast. Events happen in Nigeria here and people can see it in the US so when someone dies by suicide, the news travel faster because there’s now social media and people can always transmit news. So, suicide is not a new thing, it might appear that it is on the increase because before now they used to say Nigerians are the happiest people and nobody ever thought that Nigerians can actually take their own lives but we are seeing it. And that is because we live in times now where there’s so much stress: people experience financial stress, emotional stress, security issues, lack of food, power outage, all these things can also put a lot of stress on people. And we must always say it that over 90% of people that die by suicide initially had a mental illness that was not attended to.

But it is so sad that suicide is seen as a crime in Nigeria. If someone attempts suicide, the police will arrest that person and charge the person for a crime, but the person actually needs psychological intervention, meanwhile the law sees that person as a criminal. So, attempted suicide is a cry for help; and usually most people who died by suicide really did not want to die they just saw suicide as a way out or last option. For someone who has ever experienced psychological distress, it is worse than physical distress and worse than physical pain, so depression is a very bad disorder and it can lead to suicide in anybody if it is not well taken care of.

Why do people attempt suicide, with reference to various lagoon suicides in 2016, 2017, 2018 and 2019?
As weird as it might seem to see people take their own life – jumping into lagoon, they take sniper, rat poison, some people jump from a height. In fact I’ve heard of a colleague who jumped from a height – a medical doctor because he had depression and she wasn’t receiving treatment. Some people shoot themselves especially in advance countries like America where people have access to firearms. So, people die by whatever means is available to them. Some people will hang themselves, so people only hear of those people that tried to jump into the lagoon, there are thousands of people who did not die by jumping into the lagoon but by taking poison and because in Nigeria we are so secretive, we cover up everything, families see the case of suicide as ad shame, so if a relative commit suicide they don’t want people to know.

So the case of suicide in Nigeria can actually even be more than we see or hear of; unlike in advanced countries where they are not as secretive as we are. So most people that died by suicide actually had one form of mental illness that was not treated. Every case of depression that was not managed can lead to suicide, just like malaria may start by headache or cold then graduate to vomiting and before you know it if there is no treatment the person may die. The same thing happens in depression, symptoms happen very meager and people dismiss it, until it gets worse and then it proceeds to severe depression and the person might actually die.

How badly could depression grip a young person, or why would a student want to drink sniper, considering that he has less or zero responsibility/ burden?

It tells you that depression is an illness. It is like saying why would young people have malaria, anybody can have any illness and as long as you have brain you can have depression. People think that depression is all about the degree of tasks or responsibility that a person bears. But you don’t need to have a problem before you have depression; people must understand that you may even be an “A” student; your parents might be rich and yet still have depression; it’s a medical illness and it might even be stress of academics that precipitated depression for a student and you may think that the student is doing well.
Depression can happen in a young person or in an elderly person so there is no age limitation – age 10, age 20, age 70 – depression is not a respecter of age or religion or ethnicity. It can happen to anyone just like if mosquito bites an old person and a young person – they will both have malaria. So, it’s not a matter of responsibility or burden you carry that causes depression. It is a medical illness.

How do I know if someone is depressed, what are the red flags, and how long can he or she remain so?
There are different signals of depression, we use examples that people can relate with, there are different types of symptoms of depression, my own symptoms of depression may not be the same as yours. For example if two people have malaria they may have different symptoms someone may have a loss of appetite the other one may have a headache.

But there is a range of symptoms that people can experience, so what are the core symptoms that people can experience? The first one is change in mood- when there is a drastic change in mood and when this drastic change in mood is prolong, lasting up to like two weeks. For example if someone is always feeling sad or someone is always feeling irritable, you get annoyed easily- any drastic change in mood – sometimes people might not even feel sad – it might just be a feeling of emptiness or a feeling of numbness – nothing affect them when this lasts for like two weeks or more then it might be due to depression. Another symptom is when a person lose interest in things they used to enjoy- losing interest in known hobbies such as football or movies; a mother may lose interest in taking care of her children – any loss of interest in previously enjoyed activities can be due to depression. Another one is when there are changes in sleep patterns – it might be that one finds it difficult to sleep or one is over-sleeping – so any type of changes in sleep patterns could be a sign. There is also a change in appetite – over-eating or loss of appetite – a depressed person may find pleasure eating more food.

Also, people might actually sleep for longer hours and when they wake up they feel un-refreshed, people can wake up in the morning and feel like they have not even slept at all, feeling un-refreshed can be a sign of depression. Another sign is lack of concentration. You may be doing something and it seems as if your mind is not there, a task that is supposed to take you one hour is taking you five hours, or you are working and you are making mistakes, or you went into a room and you forgot what you wanted to take, or when you keep making the wrong decision which is unlike you; all these can be a sign of depression.

Another symptom is when the person withdraws from social activities. When people are depressed, they don’t feel like sitting with people, they don’t feel like hanging out with friends, they prefer to stay alone, some people just lock themselves up in the room, they don’t feel like talking to people, these might just be a sign of depression. Sometimes people go to work but they are not performing at their maximum potential, this is called presenteesm; for married people, they may not have interest in sex which is called loss of libido. Some people who are depressed may start regretting their past actions unnecessarily, while others may start blaming themselves for other people’s misfortune, asking for forgiveness on crimes they did not commit. For example an old woman who is depressed may say she was the cause of all the deaths happening in the family, and people will believe such person was a witch and lynch her, it happens. When depression gets to the extreme, a person may start thinking of taking his or her own life which is called suicide.

In what other ways or habits do people respond to depression apart from suicide attempts?

When you hear people start saying things like they are hopeless, when people start saying that they don’t see any future or any hope, negative utterances indicating extreme pessimism – they feel worthless. Ehen people start uttering such words then it might be depression. Also, when people start treating malaria or typhoid very frequently, it might be depression manifesting as bodily symptoms. Sometimes too, people can start doing drugs, smoking or drinking, for those who use to drink before they may increase their consumption – just to drown that feeling of depression. Teenagers may start taking cannabis, codeine in cough syrup, shisha etc., this may be because they are depressed and are just looking for a way out.
Tell us about the clinical solutions to depression?

Depression is a very treatable medical condition and people just suffer unnecessarily. There are two forms of treatment like I said there are different degrees of depression: we have mild, moderate and severe depression. So, just like there are different treatment for malaria, the type of drug the doctor chooses will depend on the type of symptoms which a patient manifest. There are two major ways of treating depression: one is called psychotherapy the other one is called pharmacotherapy or drug therapy.

For people that have mild depression, we might not give them drug, they might just go through psychotherapy. For example if after evaluating a patient with mild depression and the doctor sees that the person just have negative views about life, talking to the person might help the person to see how his or her negative thinking has led to depression and that might actually help the person. It might just be that the person just need to change his view of life and then the depression will go.

It might be that the person is putting so much stress on himself, maybe the person does not have financial prudence, or always committing to financial expenses that he or she does not have capacity to bear; so, simple financial prudence can actually lead to depression. For people that have moderate or severe depression, psychotherapy alone might not suffice. For such person we combine psychotherapy and pharmacotherapy. There are different drugs, so the drug given to patient ‘A’ might not be the same as given to patient ‘B’. If patient ‘A’ symptoms come with lack of sleep, the type of drug that will be given to the person will be the type that will also make him or her sleep. But if the person is sleeping too much of course, we would not want to give a drug that may affect sleep. So you might see two people with depression and are given different medication depending on the symptoms.

If you want to help Nigerians who may be depressed or contemplating suicide at the moment what would you tell them?
The advice is that suicide is not the solution, yes you might think it is a solution for you, but if you kill yourself, you have relatives, you have only transfer the pain to another person. You have only taken the pain from yourself and given it to another person (your family). So, taking your life is not the solution, no matter how horrible you feel; yes depression can make you feel so horrible, but no matter how horrible you feel, do not take your life. There is hope, there are treatment and the person will bounce back to life, so you are not the only one, I mean it can happen to anyone so don’t think, “Why Me” it can happen to anybody it is not worth taking your life; your life is more precious than this.
In conclusion, going by your analysis, should we be worried about more suicide, considering the economic situation, inflation and job loss worsened by Covid 19 pandemic in the country?

Yes, definitely, and you know this is the time more than ever that people should pay attention to their mental health. There are things that you can do to improve your mental health, to make you more resistant to any form of mental illness including depression. We live in a very stressful time just like you have rightly observed. There’s so much financial pressure, some people have lost their job, some people cannot eat, some people cannot pay their bills, on top of that too we have insecurity, terrorism here and there are so many things like that. So, just as you can strengthen your physical body, you can increase your mental immunity too, so that even in the face of stress, you will come down to depression.

Number one is to take care of your brain, eat well, eat good food, don’t eat junk foods, your brain is a biological organ. Number two, sleep well, rest your brain; some maybe browsing in the night, chatting, texting why they need to rest their body. Your body is made of biological organs that you need to rest, so don’t put unnecessary stress on yourself. Number three is that people must learn to cut their coat according to the amount of material they have. Be contented with what you have, be grateful for the little things you have because a lot of stress that people experience are self-imposed. Must you celebrate that 25th birthday that grand; must you celebrate your marriage on such scale? So many unnecessary spending and expenses; if you cannot put your children into expensive schools there are cheaper ones, don’t say that I want to do whatever my mates are doing. Shun unhealthy competition. You don’t have to do what everybody is doing. Another thing is that people should embrace a lifestyle that includes exercise. Exercise is not only when you want to lose weight, exercise helps your brain, exercise helps you to relieve your body of stress, exercise will uplift your mood.

Another thing is social connection. Even in this Covid time you can do video call, if we cannot hug ourselves or shake hands, but we can still maintain social connection. Social connection is different from physical connection, we are social beings; we thrive when we can associate with one another, so physical distancing is not emotional distancing. People should also make time out for leisure. It should not be about work always, we have to be deliberate, we have to be intentional about our mental health, you don’t have to wait for things to happen before you start running helter-skelter. So make out time for leisure – you can just go to the beach, relax, rest your body and enjoy your life. You can also do things like deep breathing, meditation, mindfulness, there are different relaxation techniques that people can read up on the Internet to ease their body of stress. Stress accumulates in the body and affects us psychologically and when it reaches a threshold, one can actually come down with depression which can lead to suicide.
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