Finding Light in the Dark: Understanding and Managing Depression

Dorothy Obengo, M.A., Counselling Psychologist

Towards the end of 2023, Mukulu, 43, started losing interest in things she used to enjoy before and sleeping a lot. She complained of feeling tired all the time, and getting irritated every time her husband Wena spoke to her. She often expressed anger towards their two young adult sons, 21 and 22, who had completed university but had no jobs. She would shout at them, accusing them of being idle, unmarried, and that they should get out of her house. She added that she was discouraged of educating them through university, that they were not getting jobs and she was tired of feeding them.

When Generation Z took to the streets in Kenya, Mukulu began to feel guilty and worried that the police might kill her children as they rioted with the other young people. She continued to spend most of her day in bed; she neglected her family, hygiene, and home. When she complained of headaches and pain medication did not help her, her husband Wena took her to hospital. The doctor could not find anything wrong with her and referred Mukulu to a therapist, suggesting she may be suffering from depression. At the clinic, Mukulu began her therapy and started feeling better as her sessions progressed.

This article will define depression, discuss its diagnosis, and suggest its management. We will also discuss its causes and symptoms and explore how to manage the disorder professionally.

Definition

The World Health Organisation (WHO, 2023, p. 1) defines depression as a “common mental syndrome that involves depressed mood or loss of pleasure or interest in activities for long periods.” Depressive disorders range from primary to persistent to bipolar, with severity ranging from mild to severe. The disorder negatively affects the general population in terms of how one feels, behaves, thinks, and perceives the world, leaving the individual incapacitated. Larry and Valentine (2018) support this by arguing that it is a cycle that involves negative cognitions, which lead to negative emotions that, in turn, lead to negative behaviour towards others, leading to negative responses from them that eventually keep the negative cognitions active. Generally, depression is a mood disorder that can have a profound impact on the daily functioning of the affected individuals.

Magnitude of Depression

Everywhere in the world, people struggle to fight the darkness of depression. A national survey in the United States shows that 29% of adults have been diagnosed with depression at some point in their lives, with 18% currently experiencing it (American Psychiatric Association, APA, 2024). Other studies indicate that depression is generally the most common mental health problem in older adults (Yong et al., 2023). These authors add that depression is a common mental disorder with wide-ranging effects on clients’ moods and one’s ability to function mentally and physically. Depression is more difficult to treat in older adults than in young adults due to difficulties in differentiating between the symptoms of depression and the effects of aging (Yong et al., 2023).

In Kenya today, we recently had Generation Z, in their late teens to mid-twenties, showing much distress as they protested against the government’s Finance Bill 2024. Probably many young people may end up with depression if diagnosed, and others, including their loved ones, get traumatized due to the brutal response related to the protests. This is in agreement with Memiah et al. (2022), who found out that in Kenya, many Adolescents and Young People (AYP) were reported to be suffering from depression. They quote the Kenya National Commission of Human Rights (KNCHR), who estimate that 25% and 40% of outpatients and inpatients AYPs suffer from mental health conditions respectively. Memiah et al. add that Kenya is ranked fifth among African countries and is increasing globally. In Africa, like everywhere, generally, more women than men bear the burden of depression (WHO, 2023).

Symptoms of Depression

If depressed, young children, as well as adults, may experience hopelessness, worthlessness or inappropriate guilt, fatigue, sleeplessness or hypersomnia, loss of interest in activities they formerly enjoyed, loss of appetite, unresolved grief issues, social withdrawal, and pessimism, amongst other symptoms. Sometimes, there may be suicidal thoughts and gestures. Yong et al. (2023) add that a proper understanding of the connection between physical and social causes facilitates effective treatment of depression.

Causes of Depression

Depressive episodes are classified in the Diagnostic and Statistical Manual of Mental Disorders 5th ed text revision (DSM-5-TR) as mild, moderate, and severe based on the type, severity of symptoms, and degree of impairment in functioning. Mild depression is caused by such factors as stressful life events, for example, the death of a loved one, trauma, isolation, divorce, lack of support, or any problematic experiences that can trigger depression. Moderate depression is generated by situations like those mentioned above or by medical conditions such as chronic conditions, including diabetes and chronic pain.

According to Memiah et al. (2022), existing disorders increase the risk of substance abuse and other behaviour problems among youth as they try to establish coping mechanisms. Alcohol is a depressant that can worsen depression. Severe depression develops as a result of all the above. However, genetics, as well as brain chemistry, may also be a factor in depression. If a client has a biological relative who suffers from depression, the client is likely to develop the disorder. An imbalance of neurotransmitters like dopamine and serotonin may contribute to the cause of depression.

Managing Depression

People suffering from depression may call a qualified therapist or a counsellor or visit the hospital, where the medics may refer them to a psychiatrist for an assessment if they need medication. Mild and moderate depression is managed through psychotherapy, with severe cases referred, where necessary, for medication. For effective treatment, both therapy and medication should run concurrently.

Therapy

Psychotherapy begins with the therapist building rapport with the client, discussing terms of confidentiality, and determining when a breach of privacy may be necessitated. Early in therapy, the therapist completes a thorough intake or clinical interview to gather the individual and family's history and the symptoms' onset and severity. History of prior treatment, if any, is essential to determine what treatment the client could benefit from. Psychological testing/assessment may follow to clarify the diagnosis. The objective of administering the instruments is not only to evaluate the client’s depression severity but also to rule out any suicide risk. The tools may also be utilized through treatment to determine the client's progress.

Therapy Sessions

Sessions may range in the average of ten sessions, depending on the client's needs. Towards termination or sometime midway through therapy, assessment is repeated to determine if symptoms are reducing. Referral can be done at this point if the client is not improving. The therapist may refer a client for medical evaluation to rule out general medical or substance-induced causes of depression. This is because often, a depressive disorder exists alongside other disorders, such as anxiety, or it may be a result of substance abuse. If substance-induced depressive disorder is diagnosed, with the client’s consent, the therapist will refer him/her to a doctor. The therapist works alongside the doctor as the client is detoxified, and counselling continues when the client is referred to rehabilitation. Early detection, effective management, awareness, and client sharing of their lived experiences inform overall treatment. Critical to the client’s recovery is the building or enrichment of social support systems and, where applicable, commitment to practicing the disciplines of the client’s faith.

For example, in our case study, Mukulu, through a commitment to attending psychotherapy sessions and completing her homework, has achieved her goals, such as alleviating depressive symptoms and returning to normalcy. She has learned to recognize and cope with depressive feelings, as well as develop healthier thinking patterns for herself and her family members. These have led to the alleviation and prevention of relapse, the development of better relationships with others to help her cope, and the ability to grieve any loss, normalize her mood, and return to previous levels of effective functioning. She has also identified a group of friends with whom she can continue socializing and re-establishing her faith in God. After 12 sessions in therapy, she and the therapist can now work towards termination.

Conclusion

In conclusion, understanding depression is essential for the general population. When an individual suspects that he/she may be suffering from depression or is sad most of the time for no reason, it is advised that he/she takes the initiative to look for a professionally qualified psychotherapist, MA or doctoral level, who will provide an assessment, prepare a treatment plan, carry out psychotherapy as needed and recommend the client for other accompanying treatment as necessary.

This article gives one an idea of what to expect if diagnosed with depression and the process a therapist uses to manage the disorder. Treatment may entail ongoing assessment of risk for harm, enhance sense of hope, and improve self-concept, motivation, confidence, and coping skills.

 References

American Psychiatric Association (DSM-5-TR). (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

American Psychiatric Association (APA). (2024). What is depression?https://www.psychiatry.org/patients-families/depression/what-is-depression

Larry M. & Valentine-French. (2018). Introduction to Psychology. (5th.ed.). California: College of Lake County Foundation.

Memiah, P., Wagner, F.A., Kimathi, R., Anyango, N.I., Kiogora, S., Waruinge, S., Kiruthi, F., Mwavua, S., Kithinji, C., Agache, J.O., Mangwana, W., Merci, N.M., Ayuma, L., Muhula, S., Opanga, Y., Nyambura, M., Ikahu, A., Otiso, L.. (2022). Voices from the Young in Kenya Addressing Mental Health Gaps and Recommendations. International Journal of Environmental Research and Public Health, 19, 5366. doi: 10.3390/ijerph19095366. PMID: 35564760; PMCID: PMC9104498.

WHO, (31st March 2023). Depressive disorder (depression). https://www.who.int/news-room/fact-sheets/detail/depression/?gad_source=1&gclid=EAIaIQobChMIh-nB-J6rhwMViqaDBx2DPwYXEAAYASAAEgI1tPD_BwE

Yong, S., Hung, M., Yuan, C., Chiu, C., Huang, M., and You, C. (2023). Mind and body: The complex role of social resources in understanding and managing depression in older adults. Proc. ACM Hum.-Comput. Interact. 7, CSCW1, Article 74 (April 2023), 25 pages. https://doi.org/10.1145/3579507