Depression comes to town, still the old story

Twenty-two years ago (how time flies), a multinational company introduced a new drug for the management of depression. It was the first of its kind and quite different from the old antidepressants which were dreaded then because of their grave side-effects. The new drug which belongs to a newly discovered group known as selective serotonin reuptake inhibitors (SSRIs) was well accepted and endorsed by psychiatrists not only because of its effectiveness but because of its safety profile and tolerable side-effects.

But the company soon discovered that the market for this drug was just not big enough to justify its huge investment. Oh, there were more than enough patients that would benefit from the novel drug quite alright but the problem is, the patients didn’t know they had a problem that could be treated with a drug. Not only that, a majority of the medical personnel that would prescribe the drug did not recognise that depression is even a medical condition which should be treated like ailments such as hypertension, diabetes or some known mental disorders which they could recognise easily or sometimes detect through laboratory investigations.

The company realised it must first raise or even create awareness first about the condition called depression both within medical circle and among the lay public worldwide.

In Nigeria, the company established an Advisory Board made up of the country’s top psychiatrists, one or two pharmacists and a journalist, yours sincerely.

To understand the topic, the company gave me a public enlightenment video tape of a documentary produced for global viewing on the subject. I found the documentary so interesting and highly educative that I began to write so authoritatively within a short time about depression. By the time the Advisory Board was inaugurated and held its first meeting at Gateway Hotel, Otta, I’d become enlightened enough about depression that I reported the Board’s deliberation with so much ease on my health pages in Vanguard.
The first thing the Board did was to determine whether depression was a problem in Nigeria in the first place. By the time the renowned psychiatrists identified the local names in different Nigerian languages – I still remembered Prof. Morakinyo from Obafemj Awolowo University identifying it as what the Yoruba refer to as “irewesi okan” –  it was clear that indeed Nigerians suffer from depression in their millions.

More revelations were to follow. Yes, Nigerians know such a condition exists but in most cases, they don’t see it as condition for which they should seek help, at least not in the hospital. Those who try to call for help are either stigmatised, not taken seriously or have their condition ascribed to the gods or evil spirits or dismissed simply as hallucinations or outright pretence.

Unfortunately, even the medical community is almost as ignorant as the lay public about depression. So you are likely to hear a doctor tell a patient after several failed treatments with laboratory tests not showing any significant problem, that his complaints are probably a figment of his imaginations or just in his head.

Unfortunately, such a patient also have to contend with societal beliefs and our peculiar health care delivery system which does seem to reckon much with mental ailments. I will not talk much about the symptoms of depression as identified by the experts. Please see my feature story on depression for details: http://nigeriahealthonline.com/2015/10/22/depression-a-condition-to-watch.nho/

The psychiatrists agreed that depression is a medical condition that requires treatment. They also discussed signs that doctors should look out for to be able to diagnose depression and the need for doctors to refer patients to specialists when they (patients) are not responding to treatment.
The world has moved on since then. In most developed countries, there are not so much myths surrounding depression. It’s is a known condition with clear approaches for modern management.

I honestly can’t tell if the situation has changed in Nigeria from the old days when depression was managed with complex group of  drugs such as the Tricyclic antidepressants (TCAs) or Monoamine oxidase inhibitors (MAOIs)  and understood only  by psychiatrists. That a medical doctor who was surrounded by colleagues was not discovered to be suffering from depression (if the social media stories about him are true) until he committed suicide, says how much our medical people know about depression, not to talk about the lay public.

But depression is quietly sneaking in on us and is fast becoming a serious problem, especially in this very difficult period of recession.  The Global Health Estimates of Depression and Other Common Mental Disorders  released by the World Health Organisation (WHO) recently shows that Nigeria recorded  the highest number of people in Africa who suffered from depressive disorders in 2015 estimated at  7, 079, 815 million and  equivalent to  3.9% of our population.

Depression is ranked by WHO as the single largest contributor to global disability and a major contributor to suicide deaths – about 800 000 per year globally. It affects people of all ages, from all walks of life, in all countries. WHO ranks it as the second leading cause of death among 15-29-year olds! And it is now such a serious problem that it has been singled out for global attention this year as the WHO marks the World Health Day on April 7. This day would probably have gone unnoticed in Nigeria if not for the unfortunate death of the young medical doctor.

Now that late Dr. Orji has jostled our memory about the deadly condition called depression, here’s hoping our health authorities will wake up, as a tribute to his young soul and kick off a campaign to enlighten Nigerians, both the general public and our doctors.

We have a big health problem in our hands.  I think the health ministry, particularly the Public Health Department, should start talking depression now.

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