Let’s Talk About Depression!

World Health Day on 7 April 2017 focuses on depression.

The Heart and Stroke Foundation South Africa (HSFSA) supports the World Health Organisation (WHO) in addressing the seriousness of depression, and takes a deeper look at the links and effects of depression on heart health.

What is Depression?
Registered clinical psychologist and CEO of the Heart and Stroke Foundation South Africa, Professor Pamela Naidoo says “Depression is a common mental disorder characterized by lowered mood, negative thoughts, low energy levels and appetite disturbance. In its extreme form, it often meets the criteria for a Major Depressive Disorder (MDD) and individuals diagnosed with MDD often express suicidal thoughts.”

The common signs of depression can be understood broadly within two categories, namely biological and cognitive. Symptoms associated with the biological category include appetite disturbance, decreased sexual drive, low energy levels, and disturbed sleep patterns; whilst symptoms associated with the cognitive category include negative thoughts about oneself, others and the environment.

How many of us are depressed?
The World Health Organization estimates that 300 million people suffer from depression worldwide. Young people, including children can also get depressed so it is important for caregivers and parents to be mindful of their child’s mood and behaviours associated with feelings of sadness. “In South Africa, the prevalence of depression among adults has been reported to be 9.7% for lifetime prevalence” explains Professor Naidoo, CEO of the HSFSA.

Many studies report that more women report being depressed than men, while more men commit suicide as a result of depression compared to women. Given this scenario it is important to understand what the signs and symptoms of depression are so that you are able to recognize when you are feeling extreme sadness or whether another family member, friend or colleague is experiencing this.

Depression impacts your health
People who are diagnosed with a medical condition such as heart disease, stroke, diabetes, rheumatoid arthritis, cancer, HIV or AIDS and a host of other conditions that are debilitating and life-long, are often found to be depressed. Depression often present if the individuals affected have a poor quality of life as a result of their medical condition. The presence of depression may negatively impact an individual’s behaviour due to impaired judgement which often results in, for example, non-adherence to treatment regimens, increased alcohol use, use of illegal substances and other risk-taking behaviours.

Depression is sometimes thought to contribute, along with other factors, to the onset of chronic medical conditions, such as cardiovascular disease and cancer. On-going stress and depression may lead to your body not being able to function maximally, compromising your immune system which may lead to disease onset.

Depression impacts your heart
There are biological mechanisms that link major depressive disorder (MDD) to coronary heart disease (CHD). When an individual is under stress, this may lead to the onset of MDD and ultimately CHD. In other words, the neurochemical pathway of stress and depression may result in CHD. Stress and depression, therefore, are risk factors as much as cigarette smoking, diabetes, and hypertension, for CHD onset. Risk factors for poor health, such as having CHD, needs to be managed through the adoption of a balanced and healthy life-style.

Individuals with CHD are often found to be depressed because of poor health and the need to adapt their way of life. If the depression is not well managed through professional health interventions, those with CHD may suffer a deterioration of their condition.

Steps to manage depression

Step 1: Seek professional health services from a psychologist or psychiatrist since depression is complex and its complexity is better understood by a trained professional. “Speaking to your GP or your medical specialist will also be helpful as he/she can refer you to the correct health practitioner to manage your depression” encourages Professor Naidoo, registered clinical psychologist. A health practitioner can guide you on whether you require counselling or psychotherapy for your depression. You may also require medication combined with psychotherapy if your depression is severe.

Step 2: Maintain an active lifestyle
Here physical activity takes centre stage. “The interaction between a lack of exercise and mood levels can lead to a vicious circle. Stress and depression can reduce an individual’s level of physical activity by altering usual exercise behaviour. Similarly, a lack of physical activity can dampen mood, perpetuating a cycle of depressive symptoms” explains registered dietitian and exercise physiologist, Gabriel Eksteen of the Heart and Stroke Foundation South Africa. Exercise has anti-depressive effects and can be used as an adjunct treatment for low mood and depression.

Studies have shown that exercise improves mood and self-esteem. Exercise can desensitize individuals to symptoms of anxiety, offer distraction, and evoke a greater sense of being capable of managing ones’ life (self-efficacy). Registered dietitian and exercise physiologist for the HSFSA, Gabriel Eksteen advises “Physiologically, moderate intensity exercise can reduce stress hormone levels, increases serotonin levels, and increase natural opioids a.k.a endorphins in the brain, which leads to an increased  sense of well-being. Moderate exercise is also known to enhance mood from as early as five minutes into a walk whilst providing long-lasting benefits.”

Step 3: Maintain a balanced diet
Naturally good nutrition goes hand-in-hand with exercise and forms part of a balanced lifestyle. One of the symptoms of depression is a decreased appetite which if persistent may lead to poor nutritional status. Poor nutritional status, combined with other symptoms of depression such as low energy levels may worsen the intensity of the depression. Make an conscious effort, therefore, to eat healthy foods and engage in physical activity in order to improve your mood.

Step 4: Socialize
Depressed individuals often report social withdrawal as a symptom. Make a concerted effort to maintain the social relationships that are important to you within a circle of trust which can help you to express your feelings in a safe environment. Family, friends and other people in your closest social network can provide the support you require until you feel better.

Step 5: Reach out
If you are concerned about how depression affects your heart health, then please contact the Heart and Stroke Foundation South Africa at heart@heartfoundation.co.za or call 08601 (HEART) 43278

Depression poster

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