Johannesburg – More than a quarter of South Africa’s population suffers from depression, yet only one in four seek the necessary help, research has shown.
During Mental Illness Awareness Month (July), the South African Society of Psychiatrists (Sasop) emphasised that the stigma associated with mental illness, as well as the misconception about the benefits and use of antidepressants, serve as major barriers to people seeking assistance.
Dr Gagu Matsebula, a member of Sasop, said depression did not discriminate and that everyone was vulnerable.
“It is a common misconception that depression is a condition that can easily be overcome by simply ‘snapping out of it’,” he said.
No one chose to be depressed, he said, and depression was not a sign of weakness, a result of wallowing in grief or sadness, a lack of positive thinking, or self-pity.
“It is a medical condition that negatively impacts brain function due to biological or environmental factors,” he said.
“Various elements contribute to depressive episodes including one’s genetics, anxiety, early adversity, traumatic experiences, various kinds of abuse, socio-economic status, loss and bereavement, and stress.”
Matsebula explained that depression manifested as a persistent feeling of sadness as well as a loss of interest in previously enjoyed activities, and it typically lasted for more than two weeks.
“It affects thinking, memory, motivation, eating, and sleeping patterns, and can lead to substance abuse as a coping mechanism.”
He said depression was treatable. The most common treatment approach combined medication with talk therapy (psychotherapy). This approach tended to have the best outcome for patients.
“Most doctors initially prescribe selective serotonin reuptake inhibitors (SSRIs), such as Sertraline and Fluoxetine, to alleviate symptoms of moderate to severe depression. Some people fear antidepressants, but it they are safe to use. There are several types of antidepressants, with different side effect profiles.”
He explained that SSRIs worked by increasing the brain’s levels of serotonin, a neurotransmitter that carries signals between the brain’s nerve cells, ultimately improving one’s mood.
“This medication prevents the reabsorption of serotonin into nerve cells, thereby increasing its availability and improving message transmission. The ultimate goal of antidepressants is to restore the balance of deficiencies of serotonin and other neurotransmitters that may be causing the depressive symptoms.”
Matsebula said that while many individuals responded well to the first prescription of antidepressants, some might need to try several different antidepressants before finding the one that works best for them.
“It is crucial to be patient when using antidepressants and to take the medication daily as prescribed by a doctor. It may take several weeks for the medication to take full effect and it is important to continue with the prescription for at least six months to prevent symptoms from recurring. Every person responds differently to antidepressants and some individuals may require long-term usage.”
He emphasised the importance of regular appointments with a doctor to discuss symptoms and make necessary medication adjustments.
“It is vital not to stop the medication or reduce the dosage independently, even if feeling better. Unlike other medications such as sleeping tablets, antidepressants do not cause physical dependence or addiction. A doctor's guidance is crucial when increasing or reducing the dosage or ending the treatment.”
While antidepressants can treat symptoms, they may not always address the underlying causes of depression, Matsebula warned.
“Talk therapy is highly beneficial in addressing depressive symptoms by exploring, and processing, past and current experiences with a trained professional such as a psychologist.”
He said that this approach was particularly useful for situational depressive episodes, such as the loss of a loved one or partner conflict or childhood trauma, as it helped the patient gain clarity and an understanding of the root causes of distress.
Matsebula said that if you are experiencing any of the following symptoms of depression for more than two weeks, it is essential to seek help:
– Feelings of hopelessness and pessimism
– Loss of interest or pleasure in hobbies and activities that were once enjoyed
– Persistent sad, or empty, mood
– Feelings of guilt, worthlessness, helplessness, and self-reproach
– Insomnia or hypersomnia (oversleeping), or early morning awakening
– Loss of appetite and/or weight loss, or overeating and weight gain
– Decreased energy, fatigue, and feeling run down
– Increased use of alcohol and drugs
– Thoughts of death or suicide, and suicide attempts
– Restlessness, irritability, and hostility
– Difficulty concentrating, remembering, and making decisions
– Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
– Deterioration of social relationships
–Once you have consulted with your doctor, and have been prescribed antidepressants, he said it was important to consider the following to achieve the best results from the medication:
Allow enough time. Give the medication enough time to work before you stop taking it. Generally, antidepressants take anything between two to six weeks before you notice the full effects.
Take the full dosage. Follow your doctor’s instructions and take the full dosage without skipping any days or tablets. This will ensure that the medication works as it should. Your doctor will advise when it is time to gradually decrease the medication.
Don’t stop. It’s advisable that you ask your doctor about when it is time to stop using antidepressants. Stopping the medication too soon, even if you are feeling better, can lead to the depression returning or worsening.
Don’t give up. Different antidepressants work in different ways. As such, your doctor may have to adjust your medication – and its dose – before finding the right one that relieves your symptoms.
To get help for your friends, family, colleagues, or yourself, please:
Speak to your GP or contact the South African Depression and Anxiety Group (Sadag) at 0800 12 13 14, or send an SMS to 32312 and a counsellor will call you back.
“Remember, seeking professional help is crucial in managing depression effectively, and there are resources available to support you throughout your journey to recovery and living a healthy, fulfilling life,” Matsebula said.