Mental health conditions such as depression and anxiety are very common, particularly among people who have suffered a spinal cord injury. It is estimated that they affect up to 37 percent of this community
Depression is common and can affect anyone at any point in their lives. As many as one in six South Africans suffer from anxiety, depression or substance-use problems according to statistics released by the South African Depression and Anxiety Group (SADAG). Depression is even more common among people with an SCI – estimated rates range from 11 to 37 percent.
What is depression?
There are unfortunately still serious stigmas attached to persons who suffer from mental health conditions such as depression and anxiety. Therefore, those who suffer from depression often are reluctant to see their healthcare practitioner. Everybody has days when they “feel blue” or “down in the dumps”. This is not depression. These are normal human emotions.
Depression, on the other hand, is a serious medical disorder that requires treatment. It affects both men and women. It can cause some or all of the following physical and psychological symptoms:
• Changes in sleep (too much or too little);
• Feeling down or hopeless;
• Loss of interest or pleasure in activities;
• Changes in appetite;
• Diminished energy or activity;
• Difficulty concentrating or making decisions;
• Feelings of worthlessness or self-blame; and
• Thoughts of death or suicide.
In the acute stages after SCI, periods of sadness are common and a normal part of the adjustment period. However, there is cause for concern when feeling depressed or losing interest in usual activities occurs almost daily and lasts for more than two weeks.
Causes of depression
Chemicals produced in the brain called neurotransmitters are responsible for maintaining stable mental health. Certain internal and external stressors can upset this balance, resulting in clinical depression. The imbalance is linked to changes in mood, enjoyment, sleep, energy, appetite and ability to concentrate.
It is important to diagnose and treat symptoms of depression early. Left untreated, they can last for six months or more, and the risk of suicide is higher while someone is depressed. The mainstay of treatment is usually medication, counselling, psychotherapy or a combination of these.
Increasingly, research suggests that these treatments may normalise brain changes associated with depression. Regular exercise or physical activity can also improve mood, especially when used together with counselling or medications.
Antidepressant medications seem to work by restoring a normal balance of important brain chemicals such as norepinephrine and serotonin. Rebalancing these chemicals leads to feeling better both emotionally and physically. Treating depression helps you function better at home and at work. Antidepressants are not addictive. Some people do experience side effects, but these tend to lessen over time.
If you suspect you might be depressed, take the simple depression self-test opposite. It’s important to be 100 percent honest when taking the test. When you’re done, add up your score: if it is 10 or higher and you have felt this way for some time, it’s important to contact your healthcare provider and seek treatment as a matter of urgency.
Depression Self-Test
|
Over the past two weeks, how often have you been bothered by any of the following problems? |
Not at all |
Several days |
More than half the days |
Nearly every day |
|
1. Little interest or no pleasure in doing things. |
0 |
1 |
2 |
3 |
|
2. Feeling down, depressed or hopeless. |
0 |
1 |
2 |
3 |
|
3. Trouble falling or staying asleep, or sleeping too much. |
0 |
1 |
2 |
3 |
|
4. Feeling tired or having little energy. |
0 |
1 |
2 |
3 |
|
5. Poor appetite or overeating. |
0 |
1 |
2 |
3 |
|
6. Feeling bad about yourself or that you are a failure or have let yourself or your family down. |
0 |
1 |
2 |
3 |
|
7. Trouble concentrating on activities such as reading the newspaper or watching television. |
0 |
1 |
2 |
3 |
|
8. Moving or speaking so slowly that other people have noticed, the opposite: being so fidgety or restless that people have commented on it. |
0 |
1 |
2 |
3 |
|
9. Thoughts that you would be better off dead or of hurting yourself in some way. |
0 |
1 |
2 |
3 |
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: ed.baalbergen@lifehealthcare.co.za
