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Dealing with depression
“There are wounds that never show on the body…” — Laurell K. Hamilton
Asim Jamil, a young man in his 30s, killed himself some days ago. A huge tragedy. May Allah bless his soul. My heartfelt condolences to the grieving family. He was the second son of the famous Maulana Tariq Jamil, a renowned religious scholar and a household name in Pakistan.
To quell rumours, the bereft older brother recorded and released a video message on social media, explaining the circumstances of his death. Tired of the chronic depression he had been suffering from since the age of 13, Asim took his security guard’s gun and shot himself in the chest.
The brother explained that for the last six months his depression had become severe and he was undergoing ‘electric shock treatment’. This was the will of God and we are satisfied with His will, he said.
What is the depression the late Asim Jamil was suffering from?
We all feel low from time to time for various reasons. Usually, it is due to some loss or sense of failure — for example, the loss of a loved one. Sometimes one feels low without any understandable reason. But most often, the sadness goes away in a few days or weeks and we are back to normal. However, if it persists beyond two weeks and increases in severity, then a point comes when it becomes a disability — a depressive illness or a depressive disorder — and requires therapeutic intervention, like any other physical health condition.
Globally, an estimated 5pc of adults suffer from depression.
It is just like having a common cold which generally stays for a few days and then goes away, but then, sometimes, turns into a respiratory tract infection requiring antimicrobial treatment. Rarely, it may even turn into life-threatening pneumonia.
In the manner of a physical health condition, depression is a mental health condition. Human health, according to the WHO definition, is a state of complete physical and mental well-being, together. So, the physical and mental dimensions are inextricably woven in the word ‘health’. They coexist within us, influence each other and require equal attention.
According to WHO, a depressive disorder involves a depressed mood or loss of pleasure or interest in activities for long periods of time. It can affect all aspects of life, including relationships with family, friends and community. Other symptoms may include poor concentration, feelings of excessive guilt or low self-esteem, hopelessness about the future, thoughts about dying or suicide, loss of or disrupted sleep, changes in appetite or weight, and feeling very tired or having low energy. A person suffering from depression prefers isolation.
A depressive episode can be categorised as mild, moderate, or severe, depending on the number and severity of symptoms, as well as the impact on an individual’s functioning. There can be a single episode of depressive disorder or there can be recurrent episodes. Depression can be a part of bipolar disorder, in which depressive episodes alternate with periods of manic symptoms, which include euphoria or irritability and increased activity or energy. Sometimes depressive illness runs in families.
Depression is on the rise. Globally, an estimated five per cent of adults suffer from depression. In Pakistan, in 1990 depressive disorders ranked 22nd among the leading 25 causes of Disability Adjusted Life Years, a metric calculated by adding years of life lost due to premature death and years of life lived with disability. By 2019, depressive disorders had jumped to the 16th position. Depression is about 50pc more common in women than men. Globally, one in four women suffers from pregnancy- or childbirth-related depression (perinatal/postnatal depression), the prevalence of which would be even higher in Pakistan.
Depressive illness or depressive disorder is a treatable condition. For mild depression, cognitive behaviour therapy, a form of talking therapy or psychotherapy by a trained person is helpful. Moderate to severe depression requires high-intensity psychological intervention or antidepressant medication or both. Antidepressant medication must be taken only under continued medical supervision.
The treatment is long-term — six months or more — and the medicines have side effects (dependence is not one of them). They are usually quite effective but must be taken under professional supervision. In a few cases of severe depressive illness, psychotherapy or medication don’t work.
In such cases, sometimes electroconvulsive therapy (ECT) is also administered but it is a very specialised treatment and has to be administered at the advice and under the supervision of a psychiatrist. In common parlance, ECT is referred to as ‘electric shocks’, as Asim Jamil’s brother mentioned in his message.
There is a general lack of awareness and understanding about mental disorders, including depression, even among educated people. Commenting on Asim Jamil’s unfortunate death by suicide due to depressive illness, a senior and popular media anchor described depression in his vlog as a special kind of madness and a contagious condition! Because of such ignorance, people suffering from mental illnesses are stigmatised, called mad, mocked and mistreated.
Our medical training also lacks the required attention to mental health. In our country, mental health issues are increasing and so common that they cannot be left to psychiatrists or psychologists alone. In any case, we have only less than 1,000 psychiatrists and less than 3,000 psychologists in the country. Globally, it is estimated that around 60pc of patients with depression lack treatment, one can well imagine the situation in an income-poor country like Pakistan.
Physical and mental illnesses often coexist. Preventive, promotive, curative and rehabilitative mental health services should be an integral component of quality primary healthcare, and all members of the PHC team and the people themselves must be trained to deal with mental health issues.
Asim Jamil’s tragic death was highlighted because of his famous father. It is, however, a stark reminder of the vast amount of silent and unaddressed mental health suffering all around us.
The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University, WHO adviser on UHC, and member of the Pakistan Mental Health Coalition.
Published in Dawn, November 3rd, 2023
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