Depression Kills

Teenagers who fail matric often commit suicide, grown black men who are unable to fend for their families or are unhappy in their jobs are found hanging lifeless from ceilings; women throw themselves in front of trains and off bridges unable to cope with the stresses of life.

You may be depressed and not even realise it

Depressed people are often depicted as being bed-ridden and incapable of functioning, but this is not always the case. Experts agree that not everyone experiences depression the same way.

Some people may look like they are managing their day-to-day life, smiling, functioning, and even making jokes for a living.

Nokulunga Shabalala, a clinical psychologist at Akeso Clinic, stresses that depression in not only a "white man's" condition.

Growing up in black communities, the illness is often frowned upon because it is not understood. Shabalala says apprehension to seeking psychological services is a symptom of a lack of awareness and understanding of mental health issues in some of our communities.

Access to mental healthcare services for the majority of the population has been problematic, making it a somewhat privileged service. "This can lead to thoughts of it being understood as "a white thing".

However, it is important for all individuals to access help if suffering from depression, because the experience of it is very debilitating.

Depression is not normal sadness, and it is not self-inflicted or something to be ashamed of. Prolonged feelings of depression can lead to suicide. Mental illness does not discriminate, and can affect anyone.

Just recently the popular Motsweding FM DJ, Lara Kruger, who was born Thapelo Lehulere, died because of the condition.

She was hospitalised twice in the space of one week for depression in the days leading up to her death.

In her case, it is not clear if it was suicide.

According to health website verywell.com, depression cannot kill you the way an illness like cancer or tuberculosis might. But it can have certain effects that can indirectly lead to a person being more likely to die.

It is also not a self-inflicted illness

You don't simply get depression because you lost your job, have relationship problems, or your family won't accept your sexuality.

There is always an underlining condition.

Shabalala says that major depressive disorder is a psychiatric condition.

She explains that there are contributing factors that can lead to the onset of a depressive episode.

"Some people are biologically vulnerable to depression and other psychiatric illnesses if there is a history of psychiatric illness in their family. Any form of stressor from occupational stress to interpersonal problems can trigger depression, if an individual is vulnerable to mental illness.

"Other factors include life events or environmental stressors, and in our context psychosocial stressors are huge contributing factors that may precipitate a depressive episode," she says.

In layman's terms, psycho-social factors such as stress, hostility, depression, hopelessness and your job conditions can lead to physical illness, particularly heart disease.

So being depressed can make you physically sick.

To be diagnosed, Shabalala explains that there must be no history of a manic, mixed, or hypomanic episode.

"An individual must experience depressive symptoms for at least two weeks for the diagnosis of a major depressive episode to be made. Symptoms include changes in mood and changes in functioning like in appetite and weight, social functioning, energy levels and activity as well as in thought processes. Frequently, individuals will also report thoughts of death or suicide."

She also says more women than men are prone to the illness. "Epidemiological studies of manic depressive disorder have long indicated a higher prevalence in women than in males.

"However, in terms of the course of the disorder and treatment outcomes, no clear gender differences have been observed." Even children are victims to depression.

On many occasions, individuals survive on medication, whether for physical pain or to calm the mind and numb the senses. This can lead to drug addiction, which can be deadly.

But Shabalala says an individual's biochemistry influences how they respond to psychotropic medication.

Depression cannot be cured, but it can be managed

Shabalala says some individuals seldom go into remission (two or more months of no symptoms), while others can go for many years with few or no symptoms.

Individuals presenting with more chronic symptoms of depression usually have comorbidity (personality disorders, underlying anxiety etc). "Comorbidity decreases the likelihood of complete symptom resolution.

"Depression affects functioning and motivation levels, inactivity and brooding can exacerbate depressive symptoms. It then becomes very important to ensure that the individual increases physical activity, adopts a healthy diet and relies on social support where possible."

How smiling depression masks sadness

You appear happy to others, smiling outwardly while suffering internally with depressive symptoms.

Those suffering often discount their own feelings and brush them aside, not even aware of or wanting to acknowledge their symptoms due to a fear of being considered "weak".

The smile and external facade is a defence mechanism, an attempt to hide true feelings.

Sadness can be a result of a failed relationship, career challenges or lacking what they view as a true purpose in life.

The sadness manifests as a constant feeling that "something just isn't right".

Common symptoms are feelings of anxiety, fear, anger, fatigue, irritability, hopelessness and despair.

You may also experience problems sleeping, a lack of enjoyment of pleasurable activities, and a loss of libido.

People suffering from smiling depression may offer no hint of their problem to the outside world. With their mask on, everything looks great, even perfect at times.

Underneath the mask they are suffering from sadness, panic attacks, low self-esteem, insomnia and, in some cases, suicidal thoughts.

Suicide can be a particular threat for such individuals. People suffering with classic, severe depression might have suicidal thoughts, but not the energy to act on their feelings.

Those suffering from smiling depression have the energetic ability to plan and follow through.

But with counseling or psychotherapy, it is possible to navigate out of this state of mind and be freed from sadness.

Those suffering can start by opening up to those around them. - Rita Labeaune/ www.psychologytoday.com