With this year’s World Health Day targeting the increased incidence of depression globally, Martins Ifijeh writes that it is an ailment that has remain misunderstood, the factors fueling it, and how it can be managed 
Often times when mental disorder is mentioned in Nigeria, what comes to mind is the picture of insane men and women with particular spectrum of behaviour not in conformity with ordinary living. They believed the typical naked and dirty person on the street who picks un-useful things in sight and talks periodically to himself is the ideal person with mental disorder.
But such category is just a small part of mental disorder even though it could be referred to as the extreme case of the health condition. Other forms are depression, anxiety, schizophrenia, drug addiction, bipolar disorder, eating disorder, among others.
Several indications show that over 60 million Nigerians have one form of mental disorder or the other with only about 20 per cent of persons in such category are seen to have the obvious forms of it, which includes what the ordinary Nigerian refers to madness, schizophrenia, and perhaps extreme case of drug or alcohol addiction; a reason that has largely made mental disorder in the remaining 80 per cent or 48 million Nigerians ignored or poorly understood.
On specifics, the World Health Organisation (WHO) in its 2017 World Health Day message says 7,079,815 Nigerians suffer from one of the most ignored and misunderstood form of mental disorder in the country – depression. This represents 3.9 per cent of the entire population; making Nigeria, according to the current prevalence rate, the most depressed country in Africa. Globally, Seychelles has the lowest number of depressed persons with just 3,722.
It also says 4,894,557 Nigerians, that is 2.7 per cent of the population, suffer anxiety disorders. The country is closely followed by Ethiopia with 4,480,113 sufferers, Democratic Republic of Congo with 2,871,309 sufferers, South Africa with 2,402,230 sufferers, and Tanzania with 2,138,939 sufferers.
While all forms of mental disorders are being advocated against by the health body as priority by all member nations, including Nigeria, it is believed that the poorly misunderstood types, especially depression, should be tackled head on before they silently destroy mankind.
Depression is the leading cause of disability globally, as well as the leading cause of the about 800,000 suicide deaths in the world. It is also the second leading cause of death in 15 – 29-year- olds globally
For Nigeria, with the over seven million depressed persons in the country, and the increasing suicide rates and attempts by Nigerians, experts believed the rising suicide trend can be drastically reduced by understanding depression, which they said was a preventable and treatable ailment. They said when understood by the society and spotted on time, every  Nigerian developing the condition can timely seek help before it reaches the extreme consequence, suicide.
WHO says depression is not just a feeling of sadness but a real illness which affects the brain, adding that feeling of sadness could easily go away, but depression is a serious health condition that requires proper treatment and counselling.
Depression, a highly misunderstood condition
But why is depression and the depressed highly misunderstood in Nigeria? A doctor of Psychiatry, and the Founder, Mental Balance Initiative, Dr. Reuben Oyaregbulem provides a guide. He believes the failure of clinicians to identify and diagnose depression in the country has somewhat gave seal among the society and even healthcare providers that it does not exist.
“Unfortunately, this is the worst part of it because the depressed often suffer the ailment alone without a clear signal of help from either the society or even health providers. And when the depression has reached a certain level where they have concluded no one will ever understand them, the next thing is to commit suicide or harm themselves.
“It’s sad people who face depression must be prepared for at least two long journeys. One is to face depression itself, including its symptoms – despondency, lethargy, lack of sleep, an inability to concentrate, weak productive lifestyle – are painful and difficult to manage. The second journey, is in many ways, harder, and often longer, which is to face other people’s misunderstandings of their depression, misunderstandings that are sometimes insulting, confusing, and often unhelpful in getting the symptoms under control,” he said.
According to him, Nigerians often believe when one is in a sad state or does not feel optimistic about almost anything, it means the person is just having a mood swing or stressed, and with time will get over it. Adding that the society, including doctors also believe there are people who are constantly like that, hence there is nothing anyone can do about it.
“Unfortunately, this is the major problem. Depression is not just a feeling of sadness which goes away easily. It is a tough feeling with an established imprint in the brain. It is also not stress that will go away. Agreed that stress could trigger it but the best way out of it is to treat it head on.”
Referring to the medical doctor who committed suicide by jumping through the Third Mainland Bridge into the lagoon recently, he said it was laughable for him when people started saying how can a doctor commit suicide when he is not hungry.
‘’Depression knows no status. It can affect the man on the street, who is unable to fend for his family. It can also affect the richest of men. It can affect anyone who is seen to have everything going well. Even little children suffer depression. So it is not a discriminatory illness. It can happen to anyone.
“When depression starts, almost all areas of the person’s life suffer the disorder. That is why it is one of the worst illnesses ever. Softly and slowly it affects social lives, relationships, career, finance, and also importantly the health of the individual. Once an episode of depression occurs, there is a high tendency it will reoccur again. So it is advisable not to take it with kid gloves, as presently is the case in Nigeria,” he explained.
He said although cause of depression was not absolutely known, it was believed that a lot of factors contribute to it, including genetic characteristics, changes in hormone levels, certain medical illnesses, stress, grief, substance abuse, among others.
He said any of these factors alone or in combination can bring about the specific changes in brain chemistry that lead to the many symptoms of depression, bipolar disorder and related conditions.
WHO says the health condition affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living. It added that at worst, depression can lead to suicide, now the second leading cause of death among 15-29-year-olds.
In an earlier interview with THISDAY, the Medical Director, Federal Neuropsychiatric Hospital (FNH),Yaba, Lagos, Rahman Lawal, said one of the challenges in tackling mental health generally, including depression was that there were myths and misconceptions surrounding psychiatric illness in Africa, especially in Nigeria.
“There are people who refuse to visit the hospital or bring their sick ones for treatment, because they believe psychiatric illness is a spiritual issue. Hence, they would prefer to take such patients to spiritual healing homes or faith organisations so as to get cure through spiritual means.
“Majority only take neuropsychiatric hospitals as their last resort. And you know when cases are not presented on time, they are often more difficult to treat. This is one of the reasons people don’t present their cases to the hospital, thereby preventing such sufferers from getting proper medical attention. So, what I do is that when I come across such persons, I tell them to bring their sick loved ones to the hospital whilst educating them that there are drugs for the treatment of the illnesses,” he explained.
He added that, “people should understand that psychiatric illness is also like other illnesses which require medical attention. And now we have good drugs just like the ones in developed countries.”
The grim picture
Statistics show that Nigeria has only about 150 Psychiatrists to care for over 180 million Nigerians. That is one psychiatrist to 1.2 million Nigerians. It also shows that there are five mental health nurses to 100,000 Nigerians.
Lawal says the country has only eight neuropsychiatric hospitals, but believes state governments should complement the efforts of the federal government by establishing state psychiatric hospitals in their various states.
These statistics however showed that Nigeria is not yet ready to tackle issues of mental health head on.
To make matters worse, Nigeria has no clearly defined mental health policy. Perhaps the federal, states and local governments also are of the opinion, just like most Nigerians that the insane man on the street who talks to himself and sleep on dirts, is the only one with mental disorder, hence no need to give it a priority.