21/05/2024
Brought to by no one but one of ours Doctor. Adesoye Tosin (Dr. Tee)
DEPRESSION IN SICKLE CELL DISEASE
Anybody can feel sad, something could suddenly happen and make anybody feel hopeless or worthless at a point in time, there may be occurrences that make you lose interest in activities that you used to love. When these things happen and you get over them within hours or a few days it can not be called depression.
For a depression diagnosis to be made, most of the time there has to be a combination of symptoms that is persistent daily for at least 2wks.
Chronic illnesses especially those that involve chronic pain like sickle cell disease can easily predispose people to depression. Studies have shown that depression is commoner in people living with sickle cell disease compared to people living without it. So it's not surprising that depression is one of the major psychosocial complications of sickle cell disease.
WHAT IS DEPRESSION
Depression is a mood disorder characterized by sad mood, reduced energy, loss of interest in activities you once enjoyed, feeling of worthlessness or hopelessness occurring persistently for at least 2weeks and significant enough to affect your daily functioning like working, eating, sleeping etc.
Depression can happen in any age group but it often begins in adulthood .
Depression can affect people differently, A might be depressed and not be able to sleep while B might be depressed and be over sleeping, B might not be able to eat while A might be overeating as a result of depression so do not assume that because someone is eating or sleeping well he/she is not depressed.
Depression is usually under-diagnosed because of the stigma associated with mental illnesses and in Africa most people don't take depression seriously, many don't even see it as an illness.
Depression is actually responsible for a lot of disabilities and death, so it's high time we started taking it seriously.
CAUSES OF DEPRESSION IN SICKLE CELL DISEASE
1. Stigmatization
The stigma associated with sickle cell disease; myths like “ All sickle cell warriors die young.” "They can never marry." "They can't have kids" etc.
Hurtful words like "He has yellow fever stay away from him" ``she looks like she has HIV.” ''It's contagious.” “Stay away from him".
All these statements and actions take their toll on the mind of sickle cell warriors. This is why many warriors will go to any length to hide their status as sickle cell warriors. This is also why many warriors have low self esteem which eventually culminates into depression.
If you are a non warrior, watch what you say and how you act towards sickle cell warriors, don't be that person that pushes them into depression, don't be!
2. Delayed puberty
Delay in pubertal development is one of the complications of sickle cell disease . Not all warriors experience delay by the way, but there are some warriors who only experience pubertal development 2 or more years later than the average age of attaining puberty. The delay can be for 2yrs, 5yrs or even 10 years for some warriors, when this happens the affected warriors are predisposed to depression starting with low self esteem. A 19yr old without breasts will not easily be able to mingle with peers without being mocked, a 23yr old Male warrior who has not yet attained puberty can be affected psychologically.
These are things parents of sickle cell warriors need to pay more attention to; How a warrior's health and challenges affect their state of mind.
3. Chronic pain and frequent hospitalization
Medical conditions characterized with chronic pain like SCD, cancer etc. easily predisposes people to depression. Being in unbearable pain too frequently can cause sadness, hopelessness, it can put people in a depressed state and make them want to give up. Also, any warrior who gets frequently hospitalized as a result of sickle cell complications can easily be predisposed to depression.
4. Isolation
A lot of warriors are loners. The health status of some warriors can sometimes be bad enough to keep them from socializing. It's not even always the bad health, sometimes, being alone is their way to run away from stigmatization which easily tilts them towards depression.
5. Relationship Challenges
There are different sickle cell warriors who are married with kids, but not to forget that a good number of warriors are equally single.
Stigmatization is one of the reasons why some warriors find getting into relationships challenging. Warriors need good and brave partners who are ready to go all the way with them through thick and thin .
Finding such heroic partners who will look beyond stigmatization and the myths is usually challenging. Sometimes it's not just about good and brave partners, a lot of sickle cell warriors are very selective about their choice of a partner especially when it comes to compatible genotypes, many want genotype AA to avoid giving birth to more children with SCD, this has also proven to be a major additional challenge.
In a society like Nigeria where many expect men and women to be married and have kids at a certain age. These expectations can sometimes be heavy on the mind of warriors who are single especially in a society where they make people feel abnormal, worthless or cursed for not being married or have children at a certain age. This burden can easily affect the mind of warriors and push them towards depression
Broken relationships or marriage can also be a stressor that can predispose warriors to depression.
6. Disabilities
SCD has some devastating complications that can cause physical disabilities. SCD can cause blindness, deafness, bone deformities, inability to walk well, paralysis(from stroke) and complications like avascular necrosis, chronic leg ulcers, chronic osteomyelitis that has confined some warriors to wheelchairs or use of other walking aids. These sorts of complications can easily cause depression for sickle cell warriors who experience them.
7. Unemployment
Quite a number of sickle cell warriors especially in Africa are unemployed and it is not usually because they are not smart enough, this is why 👇
Private job owners find it difficult to grant sick leaves frequently for weeks or months unlike the government. Sickle cell warriors usually need sick leaves when they are in a crisis, so many warriors lose their jobs due to long or frequent hospital stays.
Also, some employers discriminate against hiring warriors because of their health status. This is why quite a lot of warriors are unemployed. Both unemployment and lack of money can be a major trigger of depression.
RISK FACTORS FOR DEPRESSION
1. Genetics: Positive personal or family history of depression can predispose you to depression
2. Abuse: Past physical, sexual,emotional abuse can trigger depression
3.Substance Abuse: Alcohol or drug abuse can lead to depression. They are depressants
4. Chronic illnesses and Chronic pain conditions: People suffering from chronic illnesses like sickle cell disease,diabetes, chronic obstructive pulmonary disease, multiple sclerosis e.t.c are predisposed to depression.
5.Personality: Pessimistic people and people with low self esteem are predisposed to depression.
6. Childhood trauma
7. Life events: divorce, unemployment, financial problems, bereavement, break in relationship with friends or family, pregnancy or childbirth can trigger depression
8.Medications: some beta blockers, corticosteroids, benzodiazepines hypnotics and some other medications can trigger depression
9. Gender: It's commoner in females
SYMPTOMS OF DEPRESSION
CORE SYMPTOMS
1. Sad/low mood
2. diminished or loss of interest in pleasurable activities
3. Decreased energy
OTHER SYMPTOMS
3. Feeling of hopelessness
4.feeling of worthlessness
5.feeling of guilt
6.loss of appetite or overeating with corresponding weight changes
7.moving or talking more slowly than usual
8. Difficulty in concentrating, remembering or making decisions
9. Sleeping difficulty(insomnia), early awakening or sleeping too much (hypersomnia)
10 .Recurrent thought of death or su***de, su***de plans or attempt
11. Low libido
12. Restlessness
13. Unexplained pain like headache, backache etc. With no obvious cause
For a depression diagnosis to be made, most of the time there has to be a combination of symptoms that is persistent daily for at least 2wks.
Depression could be mild ,moderate or severe and there are also many clinical variants of depression which we won't discuss here.
Anyways, depression has a good prognosis if managed appropriately but will people stop suffering in silence?
Time to speak up and get treatment before it eats you up. Speak to a professional today and get help.
SYMPTOMS THAT SUGGEST SEVERE DEPRESSION
1. Thought of death, su***de, su***de plan or attempt
2. Having False beliefs (delusions), False perceptions e.g seeing or hearing voices that are not real
3. Impaired function: Inability to fulfill family or work responsibilities and Inability to take care of oneself (poor grooming) such as bathing,brushing teeth, dressing up.
EFFECTS OF DEPRESSION ON SICKLE CELL WARRIORS
1. Unhappiness
2. Low self esteem
3. Increased crisis and hospital stays, depression is one of the emotional triggers of sickle cell crisis.
4. Predisposition to drug abuse
5. Functional impairment, it can cause underperformance at school or work and subsequently job loss or school failure.
6. Low quality of life
7. Death
Note : it is recommended that sickle cell warriors(especially teens and adults) with moderate to severe forms of the disease should routinely talk to a psychotherapist annually or biannually or even more if needed. Don't get it wrong, psychotherapy is also helpful for children's mental health just that psychosocial complications OF SCD is commoner in teens and adults. Psychotherapy helps to deal with the pain , stigma , complications of sickle cell disease which may sometimes be overwhelming for some warriors to handle.
MANAGEMENT OF DEPRESSION
If you are having many of the symptoms mentioned above constantly for over 2weeks . See a specialist to clarify if you are depressed or not and to decide if you need therapy . If you ever have suicidal thoughts, suicidal talks, suicidal plans or suicidal attempts, that symptom single handedly makes you "severely depressed'' see a psychiatrist immediately.
Depression has a good prognosis when they are diagnosed and properly managed.
Depression may be as simple as needing only TALK THERAPY by a professional in many cases.
Sometimes it may be a combination of TALK THERAPY and PHARMACOTHERAPY which includes the use of ANTIDEPRESSANTS with or without ANTIPSYCHOTICS depending on the severity and the type. The very severe form can be managed with ELECTROCONVULSIVE THERAPY if indicated.
TO NON WARRIORS, FAMILY , FRIENDS AND CAREGIVER OF WARRIORS
Parents, friends and family need to pay more attention to the mental health of their warriors especially in Africa. We tend to put all the attention on their physical health forgetting their mental health is as important.
I read a story of a Nigerian warrior who once stabbed his mum during a crisis because of the excruciating pain and devastating complications he was experiencing. He felt it was the mother's fault and attacked her during another episode of pain crisis, he must have been severely depressed, thank God the mother didn't die.
Also watch what you say and how you treat sickle cell warriors around you, do not be one of the people that push them into depression with your vile or insensitive words.
Warriors can also be insensitive and stigmatize other warriors, the fact that you are lucky to have sickle cell so mild doesn't give you the right to be insensitive towards those that have it severe with challenging complications.
I will be sharing some QUICK TIPS TO MAINTAIN ONE'S HAPPINESS IN THE FACE OF SICKLE CELL CHALLENGES in my next posts. These tips have worked for me, I hope they work for you too.
Dr. Adesoye Oluwatosin
(Dr. Tee)
