Depression

Depression (major depressive disorder) is a common and serious mental health condition characterised by persistent low mood, loss of interest or pleasure in activities, and a range of emotional and physical symptoms that significantly impair a person's ability to function at work, in school, and in relationships. Depression is not a sign of weakness or laziness — it is a medical condition with biological, psychological, and social causes that responds to treatment. In Nigeria, depression is widespread but severely underdiagnosed and undertreated, largely due to stigma, limited mental health services, and the tendency to attribute mental illness to spiritual causes. The World Health Organization estimates that depression is a leading cause of disability worldwide.

Depression involves more than just feeling sad. Symptoms must be present for most of the day, nearly every day, for at least 2 weeks: Emotional symptoms: • Persistent low mood, sadness, emptiness, or hopelessness • Loss of interest or pleasure in activities previously enjoyed (anhedonia) • Irritability, frustration, or restlessness — sometimes more prominent than sadness • Feeling worthless, guilty, or excessively self-critical • Difficulty making decisions, concentrating, or remembering things • Thoughts of death or suicide, or recurrent suicidal ideation Physical symptoms: • Fatigue and loss of energy — even small tasks feel exhausting • Changes in appetite and weight (increased or decreased) • Sleep disturbances — insomnia (especially early morning awakening) or sleeping too much • Psychomotor changes — moving and speaking more slowly, or feeling restless and agitated • Unexplained physical pains — headaches, stomach aches, back pain with no clear physical cause In Nigeria, depression may present predominantly as physical (somatic) complaints — fatigue, headache, pain — rather than emotional symptoms, especially when patients are unaware of or stigmatised by the mental health label.

Depression does not have a single cause. It results from a complex interaction of: Biological factors: • Imbalances in brain neurotransmitters — particularly serotonin, norepinephrine, and dopamine • Genetic predisposition — depression runs in families • Hormonal changes — postpartum depression, thyroid disease, menopause • Chronic medical illness — diabetes, heart disease, cancer, stroke, HIV, chronic pain • Certain medications — steroids, some antihypertensives, beta-blockers Psychological factors: • History of trauma, abuse, or neglect in childhood • Low self-esteem and negative thinking patterns • Anxiety disorders frequently co-occur with depression Social and environmental factors: • Stressful life events — bereavement, job loss, relationship breakdown, financial difficulty • Social isolation and loneliness • Economic hardship and poverty — particularly relevant in the Nigerian context • Domestic violence and gender-based violence

• Family history of depression or other mental health disorders • Previous episode of depression (the most powerful predictor of future episodes) • Chronic medical conditions • Chronic pain • Substance misuse — alcohol, cannabis, and other drugs can cause and worsen depression • Stressful or traumatic life events • Lack of social support • Female sex — women are approximately twice as likely as men to be diagnosed with depression (though men may be less likely to seek help) • Postnatal period — postpartum depression affects 10–15% of new mothers • Unemployment and financial insecurity

• Recurrent and increasingly severe depressive episodes • Anxiety disorders — often co-occur with depression • Substance misuse — as a form of self-medication • Social withdrawal and relationship breakdown • Poor work, academic, and social performance • Physical health deterioration — depression is associated with poorer outcomes in virtually all medical conditions • Suicide — depression is the most significant risk factor for suicide; an estimated 800,000 people die by suicide globally each year

Protective factors and prevention: • Build and maintain strong social connections — social support is one of the most powerful protective factors against depression • Exercise regularly — 30 minutes of moderate exercise most days has significant antidepressant effects • Prioritise sleep — 7–9 hours per night • Manage stress — develop healthy coping strategies (prayer, meditation, exercise, talking to trusted friends or counsellors) • Limit alcohol and avoid illicit drug use • Seek help early — early treatment prevents episodes from becoming severe and chronic • If you have had a previous episode: continue antidepressant medication for as long as your doctor recommends (usually at least 6–12 months) to prevent relapse Treatment: • Psychological therapies — Cognitive Behavioural Therapy (CBT) is highly effective; counselling and psychotherapy • Antidepressant medications — SSRIs (e.g., fluoxetine, sertraline) are the first-line class • A combination of medication and therapy is most effective for moderate-to-severe depression