DEPRESSION: UNDERSTANDING THE SIGNS, BREAKING THE STIGMA, AND SEEKING HELP

By Dr Tariq Jagnarine

Fam Med

October is an opportunity to raise awareness about mental health and encourage conversations about depression, a condition that affects millions of people worldwide.
We often ask someone how they are doing, and the usual response is, “I’m fine.” However, behind those words, many individuals silently struggle with sadness, exhaustion, hopelessness, and emotional pain.
In Guyana, financial difficulties, family responsibilities, relationship problems, chronic illnesses, and everyday pressures can affect emotional well-being. Unfortunately, mental health concerns are sometimes dismissed as weakness, laziness, or a lack of faith.
Depression is not a sign of weakness. It is a medical condition that can affect anyone, and with appropriate support and treatment, recovery is possible.

What is depression?
Depression is a mental health condition characterised by persistent sadness, loss of interest in activities, and changes in emotional and physical well-being.
Everyone experiences sadness or disappointment occasionally. However, depression is different because symptoms usually persist for at least two weeks and interfere with everyday life, including work, school, relationships, and personal care.
According to the World Health Organisation (WHO, 2026), approximately 322 million people worldwide experience depression, including an estimated 5.2 per cent of adults.
Depression affects women more frequently than men, although men may be less likely to discuss their emotional difficulties or seek help.
It can affect children, adolescents, adults, pregnant women, new mothers, and older persons.

What causes depression?
Depression usually develops through a combination of biological, psychological, and social factors.
Common contributing factors include:
• Family history: Having relatives with depression may increase the risk.
• Stressful experiences: Financial difficulties, unemployment, relationship problems, and workplace stress.
• Trauma and loss: Abuse, violence, bereavement, or other distressing experiences.
• Chronic illnesses: Diabetes, cardiovascular disease, cancer, and chronic pain.
• Hormonal changes: Particularly during pregnancy, after childbirth, and around menopause.
• Social isolation: Loneliness, limited support, and discrimination.
• Alcohol and substance use: These may contribute to or worsen symptoms.
Depression is not caused by one factor alone, and experiencing these challenges does not necessarily mean someone will develop the condition.

Recognising the signs and symptoms
Depression does not always appear as crying or obvious sadness. Some individuals continue working, caring for their families, and socialising while privately struggling.
Common warning signs include:
• Persistent sadness, emptiness, or hopelessness
• Loss of interest in previously enjoyable activities
• Constant tiredness or lack of energy
• Difficulty sleeping or sleeping excessively
• Changes in appetite or body weigh
• Difficulty concentrating or making decisions
• Feeling worthless, guilty, or helpless
• Irritability, frustration, or unexplained anger
• Withdrawal from family and friends
• Unexplained headaches or body pains
• Reduced motivation and personal care
• Thoughts of death, self-harm, or suicide
Important: Persistent symptoms should not be ignored. Any thoughts of suicide or self-harm require prompt attention and professional assessment.

Depression may look different in different people
In primary health care, depression is not always the main reason someone visits the clinic.
Some patients repeatedly complain of headaches, fatigue, poor sleep, unexplained pain, or difficulty managing chronic illnesses. Further assessment may reveal emotional distress.
Men may experience increased irritability, withdrawal, or alcohol use rather than openly discussing sadness.
Adolescents may show declining academic performance, behavioural changes, irritability, or social isolation.
Older adults may experience memory complaints, loneliness, poor appetite, or loss of interest in daily activities.
Women may experience depression during pregnancy or after childbirth, requiring additional assessment and support.
For persons living with diabetes or other chronic conditions, depression can reduce motivation, affect medication adherence, and make disease management more difficult.

How is depression diagnosed?
Depression is diagnosed through a clinical assessment by a trained healthcare professional.
A major depressive episode generally involves symptoms occurring most of the day, nearly every day, for at least two weeks.
Assessment focuses on persistent low mood or loss of interest, associated symptoms, and how these affect daily functioning.
Healthcare providers may use a screening questionnaire called the Patient Health Questionnaire-9 (PHQ-9) to identify symptoms and monitor progress.
However, screening alone does not confirm a diagnosis. Other conditions, including thyroid disorders, medication effects, substance use, and bipolar disorder, may need consideration.
Early assessment is important because treatment can prevent worsening symptoms and improve quality of life.

Can depression be treated?
Yes. Depression is treatable, and many people improve significantly with appropriate care.
Treatment depends on the severity of symptoms, individual circumstances, patient preferences, and available services.

1.Psychological therapy
Counselling and structured psychological therapies help individuals understand their emotions, manage stress, and develop healthier coping strategies.
Common approaches include:
• Cognitive Behavioural Therapy (CBT)
• Interpersonal Psychotherapy
• Behavioural Activation
• Problem-Solving Therapy
These treatments are especially important for less severe depression and may be combined with medication when needed.

2.Medication
For moderate or severe depression, antidepressant medication may be recommended.
Common examples include fluoxetine, sertraline, and escitalopram.
These medications help regulate brain systems involved in mood and emotional functioning.
Improvement may begin within a few weeks, although achieving the full benefit can take longer.
Medication must be prescribed and monitored by a healthcare professional. Patients should attend follow-up appointments, discuss side effects, and avoid stopping treatment suddenly without medical advice.

3.Lifestyle and social support
Regular physical activity, adequate sleep, balanced meals, meaningful social connections, and reducing alcohol consumption can support recovery.
However, lifestyle changes alone may not be sufficient, particularly for individuals experiencing severe depression.

How can we protect our mental health?
Although depression cannot always be prevented, several everyday practices can support emotional well-being.
1. Stay connected: Maintain relationships with trusted friends and relatives.
2. Exercise regularly: Walking, gardening, cycling, or dancing can improve well-being.
3. Prioritise sleep: Maintain consistent sleeping habits.
4. Manage stress: Establish boundaries and seek support when overwhelmed.
5. Avoid harmful substance use: Alcohol and drugs may worsen depression.
6. Manage chronic illnesses: Attend medical appointments and follow treatment plans.
7. Seek help early: Do not wait until emotional difficulties become overwhelming.
Communities must also address violence, poverty, discrimination, and social isolation, which can negatively affect mental health.

How can you support someone with depression?
Supporting someone experiencing depression begins with compassion, patience, and understanding.
Listen without judgment. Avoid statements such as “Just be strong,” “Stop worrying,” or “Other people have bigger problems.”
Instead, ask how they are feeling, encourage them to speak openly, and offer assistance in accessing professional care.
Maintain regular contact, especially when someone begins withdrawing from family and social activities.
If someone mentions suicide, take the concern seriously. Ask directly about their safety and assist them in seeking immediate professional help.
Sometimes a simple conversation can make an important difference.

When should someone seek urgent help?
Immediate medical attention is necessary when a person expresses suicidal intentions, has attempted self-harm, experiences severe behavioural changes, or cannot maintain their personal safety.
If someone is in immediate danger, do not leave them alone when it is safe to remain with them. Seek emergency medical assistance.

Mental health support in Guyana
The Ministry of Health offers free counselling and crisis support.
National Suicide Prevention Helpline: 915
Mental Health Online Support: www.mentalhealth.gov.gy
Persons experiencing emotional difficulties can also visit their nearest health centre, polyclinic, or hospital for assessment and referral.

Final thoughts: Breaking the silence
Depression can affect anyone: the student struggling at school, the mother overwhelmed by responsibilities, the healthcare worker experiencing emotional exhaustion, or the professional who appears successful but feels hopeless inside.
In Guyana, we must continue integrating mental health into routine primary health care while creating supportive families, schools, workplaces, and communities.
Mental health deserves the same attention as physical health. Seeking professional help should be encouraged, not judged.
This October, take a moment to check on someone, listen without judgment, and remind others that they do not have to struggle alone.
Remember: Depression is real. Treatment works. Seeking help is a sign of strength, not weakness.