In the townships, suicide by taking rat poison is becoming more common, says a counsellor.

Over a million South Africans are on some form of antidepressant medication, and this staggering figure is for the private health sector alone.

The stats are from Pharma Dynamics, a provider of antidepressant medication, which surveyed the 8.8 million South Africans on medical aid, and found that between 880 000 and 1 056 000 of them are on antidepressants (10 percent to 12 percent).

These figures show that depression is one of our most pervasive health issues, and we are not alone. Depression is an epidemic globally According to a study published in The Lancet, medical disorders and substance abuse combined are the leading cause of non-fatal illness worldwide, contributing nearly 23 percent of the total global disease burden.

“The numbers are frightening,” says Mariska van Aswegen, spokeswoman for Pharma Dynamics. “More than 30 percent of South Africans will experience at least one episode of clinical depression in their lifetime, one in four people in the workplace have been diagnosed with depression and 31.5 percent of teenagers have attempted suicide.

“South Africans consume 56 percent more antidepressants than five years ago,” adds Van Aswegen.

“Most of us experience occasional bouts of depression, usually brought on by a specific situation or major life event. These could include divorce, sudden unemployment or death of a loved one, but decades of research on mental health conditions have revealed correlations between certain lifestyle factors and increased depression rates.”

Van Aswegen says junk food, consumerism, chronic disease, sedentary living and ignorance are some of the culprits behind the rise of depression. “Junk food has been scientifically linked to depression, with a study by the University College London finding that people who regularly eat junk food are 58 percent more likely to be clinically depressed,” she says.

“Science too has proved that consumerism – seeking happiness in things that intrinsically cannot provide lasting happiness – leads to chronic depression. Materialism is a major modern-day affliction,” Van Aswegen says.

Also, many people – especially those from broken homes – tend to make choices that keep them in the realm of “familiar misery”.

Other contributors to depression include chronic disease – cardiovascular disease, hypertension, cancer and diabetes, lack of exercise (exercise releases feel-good endorphins) and repression of emotions (sadness, hurt and grief are meant to be expressed, as this aids recovery).

In treating depression, says psychiatrist Dr Shaheen Kader, antidepressants play a vital, even life-saving role, and should ideally be coupled with counselling.

“The more severe the depression, the more effective the drugs, which are continually improving. The long-term effects of the new- generation antidepressants released in the past three years are yet to be determined, but will likely show a 50 percent reduction of symptoms – from sexual dysfunction to weight gain – in two to four weeks, as well as better effect on stress, anxiety and cognitive function,” he says.

Kader notes that before antidepressants are prescribed, a patient’s social and environmental circumstances should be thoroughly evaluated. “The depression may be caused by a social situation that can be managed without medication, and a specialist psychiatrist or psychologist rather than a GP is best placed to evaluate this,” he says.

Once antidepressants are prescribed, it normally takes some time to get the type and dosage right. “One type of medication has different effects and side-effects, depending on the individual.

“For example, for some people, a sedative effect is beneficial, while for others it is not. So the meds may be changed, the dose adjusted or perhaps another medication added on,” Kader explains.

Antidepressants are an important treatment for depression, Kader says. “It is a common illness, and it is best that it is treated pharmacologically as well as through counselling.”

Resources: Pharma Dynamics helpline on 0800 205 026 and SA Depression and Anxiety Group on 0800 708 090.

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PATIENTS ON ANTIDEPRESSANTS SPEAK OUT

Erina

I have an almost lifelong experience of depression (diagnosis is major depression), so I’ve been on antidepressants for many more years than I have been off them.

In the search for effective medication, I’ve taken most kinds – SSRIs, SNRIs (serotonin and noradrenalin reuptake inhibitors), atypical antidepressants, tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs) etc.

Scientific research into antidepressants has confirmed my personal experience that there is no magic bullet and that these drugs don’t make you “happy”, but they may take the edge off states of depression and allow you to take part in your own psychotherapy, and life, again.

It is also possible that the effects of the drugs have kept me alive at times when suicide was tempting.

But I have found psychotherapy much more effective to be able to live, work and love. The best therapy for me has been psychoanalysis, by analysts who also see the benefits of using antidepressants and prescribe them.

Only once, when I first used Prozac, did I feel very “together” and also happier, but this did not last. Mostly it merely took the edge off, allowing me to remain functional.

There are also definite downsides, apart from the usual side-effects, some of which I have experienced (like nausea), but I have not greatly suffered from these. Side-effects of SSRIs and SNRIs famously include inhibition of orgasm and the libido. This has also not affected me much, or when it did, it was brief, making me uncertain that non-orgasm is in fact caused by the drugs.

Mostly I resent the fact that I must take medication, probably for life, the efficacy of which is uncertain. From my own research it is clear that diseases of the brain are not identifiable in the way that diseases like diabetes, malaria or influenza are identified, and that antidepressants do not “correct” chemical imbalances in the brain, as it is still not fully understood how antidepressants work. Yet I dare not turn my back on my medication.

Another downer is that, at times, not even the most careful assessment by pharmaceutical and psychiatric experts to find the right drug at the right dose makes any difference.

Also, as terrible as this may sound, depression, and everything related to it, is part and parcel of the totality of my life, and it is no longer possible to imagine my world without it. The world is still funny, curious and interesting, even if sometimes I see this darkly or through a haze of medication.

Pat

I battled for years until I got a proper assessment from a psychiatrist. The first psychiatrist diagnosed depression and gave me Prozac. I had terrible side-effects – I lost my appetite and felt weak.

The second psychiatrist diagnosed Bipolar 4, and gave me Lamictin. I felt numb. My GP prescribed Cipralex and it was okay, but I was still depressed and couldn’t concentrate on my work.

Then I went to (a clinic where a doctor) did an exhaustive diagnosis – asking about 50 questions. He diagnosed dysthymia, long-term depression of a lower level. Now I take meds at night (Exsira) for serotonin and norepinephrine and Wellbutrin mornings for dopamine.

After a year my mood is much better.

* Not their real names

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WHAT TO LOOK OUT FOR

● Feelings of worthlessness

● Constant fatigue

● Insomnia

● Suicidal thoughts

● Loss of appetite

● Loss of interest in activities that one previously enjoyed