Doctor of Medicine (MD)/Master of Surgery (MS)

Aahana Sapkota, Public Health student

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Yet there is debating question with regards to mental well-being: Can we achieve the complete state of well-being for real? There is always a time when we feel sad, low, demotivated or discouraged resulting in psychological issues if we fail to cope up.

Depression is common and serious mood disorder that cause distressing symptoms that negatively affects how you feel, act or think. Suicide is simply intentional killing of one-self. You may wonder whenever you heard someone intent to take own life especially a person of apparently sound mind and attitude. Suicidal thoughts are common when people are in stress or experiencing depression.

On Sat, June 13, 2020, 38-year-old Bhagwati attempted to kill herself at her home in Dolakha. Her children yelled for help. But by the time neighbors arrived, she was already unconscious. She was rushed to the district hospital, which referred her to Kathmandu as her condition was critical. “She was brought to our hospital on Sunday morning,” Dr Basudev Karki, a consultant psychiatrist at the Nepal Mental Hospital, told the post. “Her condition remains critical.” Karki said Bhagwati had been under stress after her husband lost his job during the lockdown. The family was under pressure to repay their loan and Bhagwati was especially worried about being unable to provide for her children, according to relatives.  

Patient Statistics

Depression has become a common illness worldwide, with more than 322 million people affected. About 900,000 people in Nepal are suffering from depression.

Global Burden of Disease alongside the World Health Organization estimates that around 800,000 people die from suicide every year. Globally, 1.4% of deaths were from suicide.

The increasing cases of suicides are also attributed to depression, as a person suffering from depression for a long time has 70 percent chance of committing suicide at any time.

The data compiled by Nepal Police shows that suicide cases across the country have increased by a staggering 20%. In first month of the nationwide lockdown, a total of 487 people committed suicide. The number is 20% more in comparison to the month of Falgun (mid-February to mid-March). “The increase in the number of suicide cases is somehow linked to the lockdown and the global COVID-19 pandemic. During lockdown, people suffered from mental illness such as anxiety, depression, fear of getting illness, among different problems. All these reasons have some connections behind the increase in the number of suicide cases,” Dr Sagun Ballav Pant, an assistant professor of psychiatry at the Tribhuvan University Teaching Hospital (TUTH).  

Causes and Risk Factors of Depression

Depression is one of the most common mental disorders caused by a combination of genetic, environmental, biological, physical and psychological factors.

Risk factors include:

• Genetic features
• Change in the brain neurotransmitter levels
• Certain physical illness and medication
• Major life changes, trauma, stress
• Poor nutrition
• Light pattern

According to experts, social insecurity, gender inequality, disturbed social harmony and fear of natural disaster have contributed to increasing depression cases in Nepal.

Risk Factor for Suicide

Most people who commit suicide suffer from depression and other mental illness. Public health experts say that suicide is just a symptom, and that the real reason is poor mental health status.

Risk factors include:

• Depression
• Substance abuse
• Alcohol use
• Schizophrenia
• Economic condition
• Mood and personality disorder
• History of other disorder (anxiety, post-traumatic stress)
• Hormone changes

Types of Depression

Depending on the causes, risk factors, and symptoms, depression are of several forms. Following are some common forms of depression:

• Major depression – is the most common type of depression. A person with major depression experience recurrent episodes and constant state of sadness.
• Persistent depressive disorder (also called Dysthymia) – is a depressed mood that last for at least 2 years. A person experience both major and mild depressive episodes.
• Bipolar disorder (also called Manic Depressive Disorder) – consist of both manic and depressive episodes.
• Psychotic depression – hallucination or delusions are present; person becomes catatonic or stuck in bed.
• Postpartum depression– occurs during pregnancy or child birth. Affects mother mood so she may feel disconnected from her child.
• Premenstrual dysphoric disorder – occurs during second half of the menstrual cycle and affects individual’s ability to function normally.  
• Seasonal affective disorder – is currently called major depressive disorder with seasonal pattern. It is triggered by a disturbance in the normal circadian rhythm of the body.
• Atypical depression – refers as a depressive disorder with atypical feature.  It causes irritability, relationship problem, overreacting and oversleeping.
• Situational depression – is triggered by life changing events, trauma.

Signs and Symptoms

The signs and symptoms of depression include:

• A low or depressed mood
• Reduce interest and pleasure in activity once enjoyed
• Feelings of hopelessness, guilt, helplessness and worthlessness
• Irritability and retardation
• Change in appetite
• Sleep disturbance
• Difficulty concentrating, remembering or making decision
• Weight changes
• Fatigue and lack of energy
• Feeling restless
• Recurrent thoughts of death or suicide
• Physical symptoms like aches, pains, cramps or digestive problems

Not everyone who is depressed experience all symptoms. Some experience few of them while others may experience many or all. Symptoms experienced may vary depending on the stage of illness.

Treatment

Depression, even the most severe cases can be treated and most people see improvements in their symptoms when treated with medication, psychotherapy or combination of both.

Common treatment type:

• Medication
• Food and diet
• Psychotherapy
• Supportive counseling
• Behavioral activation
• Cognitive behavioral therapy
• Hospitalization
• Self-help strategies
• Electroconvulsive therapy (ECT)

World Health Organization launched a year-long campaign this year with a slogan ‘Depression, Let’s Talk’. Another program of World Health Organization, mental health Gap Action Program (mhGAP) aims to help countries increase services for people with mental, neurological and substance abuse disorders.

Health Foundation Nepal has been running different health projects in Dang district of Nepal and serving community since 2013. HFN provides psychosocial counseling training to the community health workers and mental health awareness programs in local schools and communities in regular basis. HFN has been implementing maternal mental health project through Smile Mothers (SIM) Campaign 2020. In collaboration with a local organization, Movement for Inspiration Nepal (MOFIN), HFN has been actively working on establishing the psychiatric care and rehabilitation center in Kuirepani, Dang.

 Life becomes more challenging when you’re dealing with depression. But there are some ways to cope with depression or symptoms of depression to improve your quality of life.

• Develop good nutrition
• Improve your sleep
• Reduce your stress level
• Develop a strong support network
• Learn how to stop negative thoughts
• Exercise

Myths and Misconceptions about Depression

Depression is all in your head: The general people only see emotional side of depression but depression is physical, biological and psychological disorder that takes time and treatment to manage.

Depression is only brought on by traumatic events: Traumatic situation doesn’t cause depression; life changing events only heightens an already existing issue in someone who deals with depression.

Medication can only manage depression: Medication is also one of the types to treat depression. Therapy, especially Cognitive Behavioral Therapy (CBT) is effective to help people in depression.

Dealing with depression is normal part of life: Even though your life goes through many changes, being depressed is not something with which you have to live. It is possible to manage your depression and seek help.

Everyone experience depression in same way: People experiencing depression may have physical differences in their brain. The change in brain, hormones, can influence the severity of moods, thoughts, and physical issues.

Depression is weakness: Believing depression as a weakness is the stigmatized condition of society. Depression is biological and psychological condition that doesn’t link with how strong you are.

Talking about depression makes it worse: Because of the stigma associated with mental health condition is society, people believe that talking about depression worse it’s condition.

Keeping busy cures depression: Spending time with family and friends, getting recommendation about exercise helps to reduce depression. But it is myth that throwing themselves in works, busy schedules and finding new hobby cures depression.

Myths about Suicide

• People, who talk about suicide, do not mean to do it.
• Someone who is suicidal is determined to die.
• Most suicide happens suddenly without warning.
• Only people with mental disorder are suicidal.
• Once someone is suicidal, she/he will always be suicidal.
• Talking about suicide will lead to and encourage suicide.
• People who die by suicide are selfish and take the easy way out.
• People who want to die always find a way.

Evidence based Intervention for Suicide Prevention

The following chart, taken from the report Preventing suicide: a global imperative, summarizes the key risk factors for suicide- as per WHO analysis of available evidence- aligned with relevant intervention.

Aahana Sapkota, Public Health student, CiST College

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