Depression, a common mental disorder that involves a depressed mood or loss of pleasure or interest in activities for long periods of time, is often difficult for an individual experiencing it, and people around him or her, to recognize. According to doctors, it goes beyond temporary sadness, lasting more than three weeks, with a range of symptoms. ALSO READ: Depression: There is no shame in seeking help Addressing depression requires breaking the stigma, awareness of its causes, and implementing solutions. Dr Arthur Rukundo, a senior consultant psychiatrist at Ndera Neuropsychiatric Teaching Hospital, in Gasabo District, explained that sadness arises when negative thoughts outweigh positive ones. ALSO READ: Depression cases up by four fold - Ndera hospital The mind struggles with uncertain questions, making negative assumptions instead. For instance, if you ask yourself, 'Will I ever get married?' your brain might instinctively answer 'no.' Instead, it’s better to use clear statements like, 'I would love to get married and have children' or 'I don't want to get married,' he said. ALSO READ: Researchers list 7 tricks to help prevent depression in everyday life Clementine, 25, whose real name has been withheld, is from Gisozi, in Gasabo District. She is currently going through a healing process. However, it took years to recognize that she was struggling, despite exhibiting many symptoms commonly associated with the condition. ALSO READ: More young people in Rwanda are opening up on mental illness – expert Struggles stemming from childhood trauma She began self-harming at the age of 12, using a razor blade, but never knew that she was dealing with depression. “I thought it was just how I coped with anger, but deep down, I sometimes wondered if I was overreacting. Then again, who cared anyway?” Clementine told The New Times. As years passed, self-harm became her way of releasing anger. “I was okay with it until the day I cut my wrist and almost lost my life. That’s when I realized I needed help. Even then, I struggled to take action. But I also knew that if I didn’t, things might not end well—I could die,” she added. Her struggles stemmed from childhood trauma, including sexual abuse. While she chose not to share the full details, she admitted that self-harm eventually became something she felt compelled to do. At 19, she decided to seek medical help after the fear of losing her life took hold. However, she later quit her medication. “I loathed how the medicine made me feel,” she said. ALSO READ: Mental Health: Why one local bank continues to redesign its way of work Despite stopping treatment, she believes she is on a journey toward healing. “The wounds never fully heal, but I have learned how to carry them,” she reflected. “I am not there yet, but I believe I can be treated. Medical treatment helps, but it’s not enough on its own. True healing requires both professional help and a safe, healthy environment. Therapy is important, but without healthy living, it feels meaningless.” Mental disorders versus mental illness Dr Rukundo stressed the importance of distinguishing between mental disorders and mental illnesses. Mental disorders affect how people regulate emotions, cognition, and behaviour, often stemming from childhood environment and life circumstances. If left unmonitored, they can escalate into mental illnesses, he said. Children who grow up feeling unwanted or neglected may develop mental disorders. However, with a change in environment, they can recover. Personality disorders, which shape behavioural tendencies, may also contribute to conditions like antisocial behaviours, borderline personality disorder, and histrionic personality disorder. Histrionic personality disorder is common in women and is characterized by excessive emotions, attention-seeking behaviour, and a constant need for approval. Meanwhile, narcissistic personality disorder, more prevalent in men, involves an exaggerated sense of self-importance and a need for validation. People with it struggle to accept differing opinions, he explained. ALSO READ: Antenatal depression: Why pregnant women need support Mental illness, on the other hand, he explained, occurs when a person’s cognitive functions are significantly impaired, affecting their emotions, thoughts, and behaviours. It can manifest in disrupted sleep patterns, persistent headaches, appetite changes, chronic fatigue, and suicidal ideation. Depression falls under this category. Causes of depression Personality disorders: People with personality disorders, often shaped by their upbringing and life experiences, are at a higher risk of developing depression. Personality is generally established by the age of 25. Chronic illness: About 30 per cent of individuals with chronic illnesses worldwide suffer from depression. Conditions like hypertension, cancer, and HIV/AIDS can significantly impact mental health due to the burden of lifelong medication and health uncertainties. Social problems: Job loss, financial struggles, and other socioeconomic challenges can trigger depression. A sudden inability to meet financial obligations can have devastating emotional consequences. Family conflicts: Children growing up in unstable households often develop depression. In cases where family conflicts are the root cause, effective treatment often involves counselling both the child and their parents. Trauma: Experiencing traumatic events such as sexual assault, loss of a loved one, or surviving atrocities like the 1994 Genocide against the Tutsi can lead to severe depression. Work burnout: Overworking in stressful environments, dealing with excessive workloads, and facing harsh treatment from employers can contribute to mental distress. Genetics: Depression can be hereditary. Bipolar disorder is a form of depression that can be inherited. Unlike regular depression, which can be treated within six months with proper care, bipolar disorder often requires long-term medical intervention, Dr Rukundo stated. ALSO READ: How young employees can be helped to deal with depression Levels of depression and treatment With mild depression, individuals feel sadness but can still function normally. It can often be treated through counselling without medication. Moderate depression’s symptoms include headaches, anxiety, appetite changes, withdrawal from social interactions, and noticeable behavioural shifts. “This level requires treatment with antidepressants like Tryptizol, Anafranil, Citalopram, and Alprazolam,” Dr Rukundo said. Severe depression can result in hospitalization, he said. “Symptoms include hallucinations, extreme weight loss, suicidal thoughts, and complete withdrawal from daily activities. Treatment involves stronger medications such as Anafranil IV, and in extreme cases, new treatments like ketamine injections for patients who do not respond to traditional antidepressants.” ALSO READ: Mental health: How social media can be a tool for or against depression People suffering from depression benefit from a combination of psychological support, medical treatment, and lifestyle changes, including regular exercise and meditation, healthy eating habits, engaging in social activities, and following therapy and professional help. Danger of stigma Dr Rukundo emphasizes that stigma remains one of the biggest barriers to seeking treatment. ALSO READ: Mental Health: How stigma is dangerous, traps people in cycle of illness Many people avoid psychiatric hospitals because they fear being labelled mentally unstable. Employers also tend to discriminate against workers who have been treated for mental health conditions, he said. He urges society to treat depression like any other illness, rather than seeing it as a sign of weakness or personal failure. Depression is not about regret or laziness. It’s a serious condition that requires medical and emotional support.” Key facts according to the World Health Organisation (WHO): Depression is a common mental disorder. Globally, an estimated 5% of adults suffer from depression. More women are affected by depression than men. Depression can lead to suicide. There is effective treatment for mild, moderate and severe depression. Self-care According to WHO, self-care can play an important role in managing symptoms of depression and promoting overall well-being. What you can do: Try to keep doing activities you used to enjoy Stay connected to friends and family Exercise regularly, even if it’s just a short walk Stick to regular eating and sleeping habits as much as possible Avoid or cut down on alcohol and don’t use illicit drugs, which can make depression worse Talk to someone you trust about your feelings Seek help from a healthcare provider. If you have thoughts of suicide: Remember you are not alone, and that many people have gone through what you’re experiencing and found help Talk to someone you trust about how you feel Talk to a health worker, such as a doctor or counsellor Join a support group. If you think you are in immediate danger of harming yourself, according to WHO, contact any available emergency services.
