I’m a 28- year -old woman living in Nairobi. Lately, I have been finding it difficult to wake up in the morning to go to work. I drag myself out of bed whenever the alarm goes off at 5am. Sometimes I take more than 40 minutes to get out of bed after the alarm has rung. I am also bored with my work. I find it difficult to relate with my colleagues in the office but I’m happier when I get back home. I also suffer bouts of headaches, especially in the morning. Is there a problem with me or my work?
A week ago, a local TV station invited me to discuss depression. The early morning show was an eye-opener for me. In addition to all that I knew about depression before the show, at the end of the hour, it was clear many Kenyans yearn to learn about the different faces of this condition.
The first and frequently-asked question is how one can tell the difference between the clinical condition and simple sadness and disappointment.
In other words, when does depression become “clinical”, or how can one tell they need help?
The simple answer can be found in the body of your question. It is clear that what you are suffering from is a clinically significant depressive illness that now demands the attention of a clinician?
In many ways you are not functioning at your normal level.
Let us examine some of your symptoms.
First, you tell us that you have a problem waking up. Many people with a depressive illness suffer the symptoms of insomnia, or lack of sleep. In the classical situation, the depressed person is able to fall asleep, but for some reason, they suffer early morning waking, in which sleep vanishes between 2am and 4am, keeping the depressed person awake for hours. At about 5 am or more accurately just before six, the sleep comes back and waking up becomes difficult just as you describe.
It is for this reason that we warn people not to buy sleeping pills over the counter before the cause of the insomnia has been established. You tell us of your worries and troubles in the morning, with you trying to drag yourself out of bed in a state of great misery. For most people, depression is at its worst in the early morning and the feelings of deep sadness tend to lift as the day progresses.
The reason for this is to be found in the hormonal fluctuations that take place in the body over a 2hour period. It is therefore not surprising that most suicides take place in the early morning hours, when the depressed person is at his worst.
You then tell us of the symptoms of boredom. This is another classical symptom of depression, in that in your condition, nothing seems to interest you.
Many clinically depressed people lose their jobs every year because uninformed employers do not realise that depression as an illness. The bored depressed worker is unable (not unwilling) to focus on his work. The job becomes tedious and like a punishment. It becomes impossible to generate new ideas or solve any problems. Any pressure from the boss is taken as insulting and lacking sensitivity as the depressed person becomes increasing withdrawn, irritable, unproductive and tearful.
Nothing in life seems to hold any meaning or promise with promotion, food, sex, friendship, love or even a relationship with God all seem empty and hopeless as the depressed person becomes increasingly bored and preoccupied with thoughts and feelings of hopelessness and death. Like in your case, the depressed person feels bored all the time.
You tell us of your difficulties with colleagues at work. This is one of the most difficult challenges for a depressed person. He sees colleagues going about their jobs with speed, efficiency and cheerfulness while for him the mind and body feel as though they are stuck in deep mud, with every effort to get out making the victim sink even deeper into the mud.
Solace is to be found at home, alone and in a dark room, free of any noise or interference.
This soon leads to marked self neglect. Many depressed people lose weight, while others put on too much weight as they tend to overeat.
Many depressed people spend millions of shillings every year seeing doctors for what are clearly symptoms of depression that go unrecognised such as headaches.
It is estimated that 25 to 30 per cent of all visits to primary care health facilities is for psychological reasons.
Given your symptoms, it is my view that your job is fine, but that you have a depressive illness. See a doctor urgently and get treatment. Early treatment will mean a higher likelihood of complete recovery.