WHILE working on the Arab News Readers Survey for the New Year, it was very apparent that many of our readers are seriously depressed. This is a trend that has become extremely noticeable over the past year. Back in Spring 2001, people began commenting on the upsurge in the number of suicides in the Kingdom. It was no longer poor expatriates who were taking their lives over economic problems. No, now it was Saudis from all social classes seeking ways to end their existence.
It has become truly frightening. In the last year the headlines have told of men who have hung themselves, shot themselves, drowned themselves and smashed themselves into oblivion. Privately, one police officer mentioned to me that he suspected some fatal car crashes were actually suicides. Thinking that perhaps I was imagining the increase in the number of these tragic deaths, I compared notes with elders in the community. Everyone agreed. Twenty years ago the incidence of suicide in the Kingdom, whether it involved an expatriate or a Saudi, was extremely rare. It was something that people heard about perhaps twice in a lifetime, not every week.
"The dramatic rise in the number of suicides is one measure of the number of people suffering from depression, not just in Saudi society, but globally," explained Dr. Abdel Hamid Hashem, professor of psychiatry, Cairo University, and consultant psychiatrist, Al-Mouwasat Hospital, Dammam.
According to Hashem, on Oct. 4, 2001, the World Health Organization declared depression to be the leading cause of disability globally. Depression disables more individuals that any other medical condition. There is now a consensus among psychiatrists that depression is becoming an epidemic.
In the past, depression used to be a short-lived disorder lasting from six weeks to six months. Now that has changed.
"We used to think of depression as a disorder that could be cured in a very limited amount of time," explained Hashem. "That is no longer the case. Now depression has become a chronic illness for many individuals. It may last anywhere from a few years to life."
Previously the age of onset for depression was typically in the late 20s and early 30s. That has changed as well.
"These days we typically see teenagers presenting with signs of depression," said Hashem. "The illness is starting earlier and lasting longer. In addition, people are living longer and advanced age was always a key predictor for depression. So now we have many, many more people in our society who are suffering from depression at any one time. It also should be pointed out that with the advances in medical society, we are able to treat illnesses, which were once swift killers. Now people live with cancer, heart disease, diabetes and other chronic conditions. The chronically ill are also likely to be chronically depressed."
Despite the number of people suffering from depression, the disease still hasn’t been given the attention it deserves. Hashem stated that the costs of the disease are crippling socially, economically and politically. Socially, depression destroys families. Twenty-five percent of women and 15 percent of men will suffer from depression at some time during their lives. If one considers that the illness could be chronic, those are staggering numbers of individuals who require treatment. Interestingly, current research has shown that the illness is infective. Children between the ages of six and 10 years living with a depressed mother show an increased tendency to suffer from depression themselves during their teenage years.
"What is even more disheartening than the levels of individuals with this illness, are the numbers of individuals who resist treatment," said Hashem. "Many people think that they are weak in some way if they admit that they are depressed and seek treatment. Let me make it very clear, depression doesn’t indicate a weakness in faith or a weakness in personality or that one is a ‘bad’ person. Depression is a disorder of the brain just as anemia is a disorder of the blood. Early, effective treatment is the only reasonable, responsible way to deal with this illness."
It used to be that previously, depression was treated mostly by psychiatrists and psychologists. These days there are not enough specialized professionals to handle the number of patients afflicted with depression. Hashem stated that hospitals are working hard to educate primary health care physicians to treat those patients who show early signs of the disease in its mild and moderate forms. Many people who go to doctors with vague symptoms like chronic backache, fatigue and headache, are actually suffering from depression instead. Primary health care professionals who recognize the signs of depression early can initiate effective treatment, which can often halt a lifetime of suffering.
"Frequently it is those patients who are in the earliest, most treatable stages of the illness who resist treatment," explained Hashem. "They cannot accept that the source of their physical aches and pains is an illness of the brain. Once patients are extremely ill and their lives have been taken over by depression, then they willingly come for treatment, but at that point it is often a struggle to return them to good health."
Hashem gave an example of the many women he has seen who come to him for treatment of depression after a divorce. In reality the women were depressed before their divorce, in fact it might have been the root cause of the divorce, but it was not recognized.
"A woman might think that she hates her life, she hates her husband and if she gets divorced it will make her feel better, but it won’t," explained Hashem. "I have seen many cases where a woman demands a divorce from a very decent man. She is about to throw her life away. If it can be recognized that the woman is depressed, then treating her illness may help save the entire family."
As for teenagers, Hashem emphasized that it is very important for parents to realize that their children are under constant stress in our educational system. Our society demands that students will excel where previously they simply had to succeed. Students are expected to bring home excellent marks, year after year. If they don’t, they will be branded failures. This causes persistent anxiety, which is one of the major reasons for depression.
"Competition is fierce in every aspect of modern society," said Hashem. "In life we no longer alternate between periods of effort and rest. We are pressured at work, pressured at home, even in so called leisure activities like sports, we are pressured to win every time. Life has become a race of endurance. We match this constant terrible mental pressure with unacceptable care for our physical selves. We eat poorly, sleep erratically and we can’t even understand what it means to rest and relax anymore. It is no wonder that we become depressed. In fact, I believe that the potential is there for entire nations to suffer from depression."
The illness is more destructive than most people imagine. Depression is a known underlying cause for smoking, drug abuse, alcoholism and suicide. Depression lowers the body’s immunity. It has now been related to heart disease, obesity and a host of other illnesses. While the overall financial cost of depression has not yet been quantified for the Kingdom, Hashem said that it has been estimated than depression costs the United States $40-$50 billion annually.
"Everyone feels depressed now and then," said Hashem. "If you are feeling blue then go for walks and find ways to truly relax. Share your feelings with friends and relatives. If after a month you feel no better, speak with your family physician. Depression is a life-threatening illness. Give it the attention it deserves."
