When is it mental illness? Here’s how to tell when to seek medical treatment

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Depression and anxiety seem to be on the rise these days. (Photo: Gallo Images/Getty Images)
Depression and anxiety seem to be on the rise these days. (Photo: Gallo Images/Getty Images)

It seems there’s always something to be anxious or down about these days.

Whether it’s the latest coronavirus statistics or a personal matter that has you feeling low, experts agree – the Covid-19 pandemic has caused a marked increase in mental health problems, especially anxiety and depression.

So much so that genetic predisposition, the primary risk factor for developing a mental illness, may no longer apply.

“A mental illness typically presents in someone’s twenties or thirties for the first time,” says Dr Barbara Pierce, a psychiatrist at the Bona Dea Centre in Bryanston, Johannesburg.

“But in these times of unpredictability and huge stress, we’re seeing it presenting for the first time across the age range, from children to the elderly – even in those who aren’t genetically predisposed.”

Left untreated, anxiety and depression can cause a range of problems, from the loss of work and relationships to financial difficulty, substance abuse, other health problems and even suicide.

Thankfully, when caught early it’s possible to prevent a major mental disorder or at least prevent it from worsening.

Here’s how to know if know if you’re at risk of developing clinical anxiety or depression and what to do about it.

WHEN ARE ANXIETY AND DEPRESSION CLINICAL?

“Most symptoms of mental illness, and particularly in the case of anxiety and depression, overlap with what could be considered ‘normal’ thoughts, feelings and behaviour, particularly when one is under stress,” says Dr John Parker, a psychiatrist at Lentegeur Psychiatric Hospital in Mitchells Plain, Cape Town, and a senior lecturer at the University of Cape Town’s department of psychiatry and mental health.

The important difference between anxiety and depression due to current circumstances and the development of a mental illness is the duration of the symptoms and whether serious dysfunction is caused by the symptoms, Dr Pierce adds.

“It’s normal during these challenging times for all of us to have cycles of a few days where we feel sad and hopeless, anxious and overwhelmed, angry and irritable, but such cycles typically alternate with feeling okay again. At all stages you should still be reasonably functional,” she says.

“What isn’t normal, and when someone should consider seeking help, is when such features are persistent (more than a few weeks consistently) and severe (causing serious functional impairment).”

You likely have clinical depression if you have a consistently low mood every day for the majority of the day and/or a loss of enjoyment in the usual activities or loss of the ability to experience pleasure (known as anhedonia) for two weeks or longer, Dr Pierce says.

“This is often coupled with two or more of the following (and the more symptoms you have, the more severe the depression is):

  • Sleep disturbance (too little or too much)
  • Appetite disturbance (reduced appetite causing weight loss or overeating causing weight gain)
  • Fatigue: any activity makes you feel drained and exhausted
  • Loss of concentration and focus; inability to sustain attention on one task
  • Poor short-term memory
  • Feelings of guilt and worthlessness
  • Withdrawal (not engaging and wanting to be left alone)
  • Bleak and pessimistic view of the future
  • Ideas or acts of self-harm
  • Suicidal thoughts
  • Unexplained physical symptoms
  • Low libido
depression
You likely have clinical depression if you have a consistently low mood every day for the majority of the day. (Photo: Gallo Images/Getty Images)

“As for anxiety, it’s normal to feel anxious during this pandemic,” Dr Pierce adds. “But if your anxiety is present consistently each day for a period of more than one month and is causing dysfunction in your life, it needs to be treated.”

Also, how severely you experience the impact of a stressful situation and whether you develop a mental disorder or not can depend on your personal vulnerability and resilience, Dr Parker says.

Vulnerability factors include your genetic makeup, past traumas and general levels of stress, while your resilience is affected by things such as how secure and confident you felt as a child, the strength of your relationships and how much of a sense of agency and direction you have in your life.

Parker adds that warning signs that must never be ignored are repeated thoughts of harming yourself or someone else, excessive use of sedatives, painkillers or stimulants, and substance abuse.

NAVIGATING DIFFICULT TIMES

Cultivate your mental resilience by investing time in activities such as exercise, yoga, mindfulness, spirituality and a balanced lifestyle, says Dr Parker.

“It’s also important to note what we learn about ourselves every time we manage to get through a time of stress.”

He adds that connection, social support, calm and hope are the critical ingredients needed to sustain mental health in a time like the one we’re going through now.

“As human beings we’ve had to deal with many such crises through the millennia that we’ve been on this planet and we have all the skills we need to survive and move ahead, no matter how dark the situation appears now.

depression
Persistent symptoms, if not managed, can lead to unemployment, loss of important relationships and hospitalisation. (Photo: Gallo Images/Getty Images)

WHEN DO YOU NEED MEDICATION?

The decision to use medication to treat anxiety and depression should be made between you and a medical health professional such as a psychiatrist.

“Medication should be considered when a mental illness is severe and prolonged enough that it’s causing significant dysfunction in a person’s personal, social or working lives,” Dr Pierce says.

depression
Medication to treat depression and anxiety can range from once-off to lifetime use. (Photo: Gallo Images/Getty Images

But not before then, Dr Parker warns. “Medication can be harmful when used to try to change what are normal reactions to difficult circumstances and when depression and anxiety isn’t clinical,” he says. “It’s important for our mental health that we allow ourselves to respond with unpleasant or negative emotions to bad things that happen – to recognise that this is how the world is and experience a full range of reactions.”

Dr Parker adds that medication to treat depression and anxiety can range from once-off to lifetime use.

“In someone with a first episode of clinically diagnosed depression, especially when it’s clearly related to a very stressful event, an episode of PTSD or certain anxiety disorders, it’s reasonable to discontinue medication after six months to a year. This would be once symptoms have resolved and the cause of the stress has been thoroughly dealt with.”

He warns that discontinuing psychiatric medication should never be attempted without medical guidance.

‘If anxiety causes dysfunction, it needs to be treated’
Dr Parker

THE STAGES OF DEVELOPING A MENTAL DISORDER

1. Preconception

You begin to show symptoms such as low mood or anxiety. You can still function in your daily life but you might sense that something isn’t quite right.

2. Contemplation

Symptoms become stronger and last longer or new symptoms such as extreme irritability or obsessive compulsions might start appearing. This might make work, home and social obligations challenging. Family and friends might notice that you haven’t been the same and you might consider seeking professional help.

3. Crisis

This stage can be avoided if you sought help in stages 1 and 2. Symptoms increase in severity and you might feel as if you’re in constant crisis mode and losing control of your abilities at home, school or work.

Persistent symptoms, if not managed, can lead to unemployment, loss of important relationships and hospitalisation. You might also develop other physical symptoms and conditions as a result, including irritable bowel syndrome, fatigue, insomnia, unexplained pain and heart disease. Substance abuse might become a problem.

Up to 60% of people with a mental illness abuse alcohol or drugs at some point during their illness.

Visit your GP, social worker or therapist
Visit your GP, social worker or therapist for help. (Photo: Gallo Images/Getty Images)

4. Seeking help

Ideally this stage should occur before the crisis, but in most cases the crisis is what leads people to seek help. Visit your GP, social worker or therapist and understand that treatment – whether it’s therapy or a combination of therapy and medication – might be long term. Mental illness doesn’t improve on its own and will get worse with time if left untreated.

Dr Parker suggests listening to those around you who might notice you need help before you recognise it yourself. “We can be terribly bad at recognising our own need for help. It’s usually a warning sign of a developing mental illness when someone we know and trust makes the suggestion that we need some professional help. Agree to allow someone who’s unbiased and has the required expertise to make an assessment.”

WHERE TO GET HELP
  • The South African Depression and Anxiety Group

WhatsApp: 076-882-2775

SMS: 31393 or 32312

Call: 0800-21-22-23, 0800-70-80-90 or 0800-456-789

or the suicide helpline on 0800-567-567.

  • Akeso 24-hour psychiatric response unit

Call: 0861-435-787

  • Lifeline South Africa

Call: 0861-322-322

  • healthsites.org.za

Go to the website to find support groups in your area.

This article appears in YOU Wellness, in stores now. Click here to purchase a copy

This article appears in YOU Wellness, in stores no
This article appears in YOU Wellness, in stores now.

EXTRA SOURCES: WHO.INT, MAYOCLINIC.ORG, COGNITIVE-PSYCHIATRY.COM

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