Mojo, a successful CEO in his mid-forties, lost his sense of self-confidence and became anxious.
His appetite disappeared along with his sexual desire, and he lost nearly nine kilos.
Mojo believed that his symptoms were nothing more than an expected response to his financial burden.
But after his wife insisted he needed help, he consulted Richard Friedman, professor of clinical psychiatry and director of the psychopharmacology clinic at Weill Corney Medical School, after he had begun to believe he might be a drag in his family’s life and that it would be better off without him.
Indeed, Friedman diagnosed Mojo with “clinical depression,” noting in an article for “Washington Post‘, to the fact that his patient’s belief that his grief was just a ‘normal anxiety’ is very common.
Maher Dabaa, professor of psychiatry at the American University in Cairo, explained to Al-Hurra that “clinical depression” means that the patient needs the help of a specialized psychiatrist, and that he may not be able to deal with his condition to get out of it on his own.
With the advent of the Corona pandemic, the climate crisis, rapid weather fluctuations, economic conditions, political conflicts and wars that affect the entire world, depression and anxiety rates increased, according to opinion polls.
Between 2019 and 2022, rates of anxiety symptoms in adults jumped from eight to 29 percent, and rates of depression symptoms rose from seven to 23 percent, according to the “Family Pulse” survey conducted by the National Center for Health Statistics in cooperation with the Centers for Disease Control and Prevention.
In the Arab region, according to a survey conducted by The Arab BarometerOn 25,000 male and female citizens across the Middle East and North Africa, published in September 2020, 35% of them stated that they feel stressed often.
Tunisians (53 percent), Iraqis (49 percent) and Jordanians (42 percent) were among the most frequently or most frequently reported feeling stressed. Meanwhile, citizens in Egypt (27 percent), Algeria (27 percent), Sudan (22 percent), and Kuwait (12 percent) are the least likely to report their feelings of stress.
Between three out of ten people (29 percent) said they suffer from depression.
According to the poll, it was found that Iraqis (43 percent) and Tunisians (40 percent) reported the most depressive episodes, followed by Palestinians (37 percent). In comparison, citizens of Algeria (20 percent), Morocco (20 percent), and Sudan (15 percent) are the least likely to admit depression.
Dabaa told Al-Hurra that there are studies that indicate that 80 percent of Egyptians suffer from depression, which is an exaggerated number, noting that he believes that six out of ten Egyptians have experienced a period of depression in their lives.
Hyena believes that there has been a significant increase in cases of depression recently, “although we generally have a high rate mainly because of the many challenges and difficulties in our society, including social ones such as stumbling marriage, or economic pressures,” noting that there is another depressive illness that results from organic matters. Like taking certain medications that cause side effects.
He pointed out that many depressed patients do not resort to a psychiatrist for treatment, and the condition persists for a long time, “because of popular misconceptions, including religious ones, where those who suffer from depression are stigmatized as weak in faith, and it is said: ‘You are sad, because our Lord has no place in Your life’”, considering that this is a condemnation of normal feelings and a mischaracterization of depression as “sadness.”
How do you know if you are depressed or just sad?
Friedman considers depression to be a syndrome that involves much more than sadness, and that apart from sad or flat moods, depression typically causes insomnia, loss of libido and appetite, social withdrawal, low energy, feelings of hopelessness, and suicidal thoughts, feelings, and actions.
“If you’re not sure, just ask yourself two questions: How many times in the last few weeks have you lost interest and pleasure in doing things? How many times have you felt discouraged or hopeless?” says Friedman.
pointed to A questionnaire specific to the patient’s health, saying: “If your score is three or higher, there is a good chance that you are depressed, not just distressed.”
Hyena points out that there are two factors by which he can know whether the condition is considered depression or extreme sadness only.
He said: “All people go through periods of sadness, pain and frustration, but if these feelings continue to the same degree for about 14 days, depression can be diagnosed, especially if the matter affects the person so that he can no longer live his life normally.”
On the indicators and signs of depression and what it means to be unable to lead a normal life, he said: “During this period, this person may be unable to go to work, unable to deal with people normally, avoiding others and not being able to sit with his family. And he has no ability to think well if his work requires mental effort, meaning his inability to have an analytical view or a strong logical conclusion, and there are often physical aches resulting from psychological influences.
Depression is a disease
“There is abundant scientific evidence that clinical depression is associated with distinct brain changes in the circuits that regulate mood, sleep, energy, and appetite,” Friedman asserts.
He said, “Brain imaging studies have identified multiple areas where there is altered activity or structure in people with depression. For example, in people with major depression, there is a decrease in the volume of the hippocampus (or hippocampus), a brain region important for learning and memory. The longer and more severe the depression, the greater the contraction of the hippocampus.”
Hyena, for his part, indicates that depression may come from psychological conditions or an organic cause, “meaning there is a chemical disorder in the brain, which may be due to age groups or medication that results in certain side effects, which leads to disease.”
He explains that “psychological conditions have different causes, for example, a big problem for which he does not find a solution, or a wife who is insulted or abused by her husband and always underestimates her, or a person who fails in his work and is always threatened with expulsion, or receives an insult from his manager or colleagues.”
There is no specific test or blood analysis, for example, that shows whether this depression is psychological or organic, according to Hyena.
“We don’t yet understand why the biological abnormalities in depression occur in the first place, but we think they are caused by a complex interaction between genes and environmental stress,” says Friedman.
In order to find out whether depression is organic or psychological, a hyena begins with his patients to search for whether they have a deep problem in their lives, and work to solve it, “such as reforming marriage, or changing the self-dialogues of a person who does not trust himself, then we see if the depression has decreased and returned person to lead his life in a semi-normal way, or not.
He said: “If we find that all this did not bring a result, there is a possibility that this depression is due to something organic,” noting that “these organic symptoms come suddenly related to a drug, for example, or a problem occurred in the person’s body.”
Major depression affects 17 percent of Americans in their lifetime and is a major factor in suicide, with estimates suggesting that two to 15 percent of people with depression may die by suicide, according to the Washington Post.
Psychotherapy or medication?
Hyena points out that depression that arises from organic conditions is treated with medication, while what arises from psychological conditions is treated with psychological treatment by modifying the way of thinking or dealing with marriage, reforming marriage, and the like.
But he said, “We may resort to medication from the beginning, if the person is unable to respond to psychological treatment, even for a temporary period, and then stop the medication if it is proven that the disease is related to life circumstances.”
“Both psychotherapy and antidepressants are very effective in treating depression,” says Friedman.
But he stresses that “psychotherapy is the first-line treatment for people with mild to moderate depression, but when depression is severe, meaning either psychotic symptoms or suicidal thoughts and feelings, a combination of treatment and antidepressant medication is the safest and most effective approach.”
In 2019, the Centers for Disease Control and Prevention (CDC) estimated that 15.8 percent of Americans take mental health medications, but that number rose to 25 percent last July.
“Antidepressants are not a cure for everyday unhappiness or distress, and they won’t make you happier, unless you have a form of clinical depression with associated biological changes,” Friedman warns against taking medication for people who feel very sad.
“Abuse of antidepressants to treat natural distress is like using an antibiotic to treat a cold caused by a virus,” he said.
Friedman advises exercising, noting that it has significant effects by releasing endorphins that help treat depression.
On how the drugs work, Hyena said: “They often inject a substance serotoninassociated with a feeling of happiness and that a person feels reconciled with his circumstances.
He added, “When serotonin decreases, a person cannot live his life normally,” noting that there are things other than medicines that increase this substance in the human body, such as chocolate, travel or changing life conditions and sometimes music, or sports and many other means, but the strongest And the fastest is medicine.
He considered that “these drugs come with good results, but they need experiment and there is a margin for error, meaning that we try the drug and then see its result after 14 days or more, then reduce or increase the dose, and in most cases a person needs more than one drug and coordination between them helps in reduce depression.”
As for Mojo, Dr. Friedman’s patient, he was surprised and relieved when he explained that he was suffering from severe depression rather than normal sadness or anxiety.
“My patient started taking antidepressants, his sleep and appetite improved within the first week, and by the end of the three weeks, his dread and catastrophic thinking were gone,” says Friedman.