THE SOUTH AFRICAN
DEPRESSION AND ANXIETY
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IN THE WORKPLACE

New Research on Depression in the Workplace.

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JOURNAL

Mental Health Matters Journal for Psychiatrists & GP's

MHM September 207x300

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SPEAKING BOOKS

suicide book

Literacy is a luxury that many of us take for granted.  We depend on written communication for information, guidance, and access to heath care information That is why SADAG created SPEAKING BOOKS and revolutionized the way information is delivered to low literacy communities. It's exactly what it sounds like.a book that talks to the reader in his or her local  language, delivering critical information in an interactive, and educational way.

The customizable 16-page book, accompanied by local celebrity audio recordings, ensures that vital health and social messages can be seen, heard, read and understood..

We started with books on Teen Suicide prevention , HIV, AIDS and Depression, Understanding Mental Health and have developed over 30 titles, such as TB, Malaria, Polio, Vaccines for over 30 countries.

depression book

I'm sitting on a fifth-storey window ledge and wondering how I got here. I look down at the pavement below and know that just the tiniest shift of weight will tip me over and down onto cold concrete - the fulfilment of a fantasy that has been with me every day for the past six months. I stay on the ledge for an hour, two hours, wanting to feel the rush of air, the thud of bones on pavement, but eventually an image of my mother's face flashes into my mind and sticks there, unrelenting in its love for me, until cold and exhausted I crawl back through the window into the bedroom and cry. I never thought that I was the kind of person who would get depressed. As a child I was always the lively one, and that's how I continued to see myself during school and university. I loved my life and I loved the people in it. But depression develops gradually, creeping up on you like old age. There's a seemingly infinite number of psychological shades of grey to pass through before the dark surrounds you, but once you get there it feels impossible to get back. It started, as so many bad days do, with a hangover.

It was spring, I was 28, and I woke up feeling like I'd left my kidneys on the night bus. I looked up at the bare bulb hanging from the ceiling and thought, "I'm worthless." That day, I didn't go to gym and I cancelled going out for drinks that evening. The next day, I woke up, looked at the light bulb and thought, "I hate myself," and didn't get out of bed at all. As a freelancer I work at home in my flat, where I live alone, so, unfortunately, staying in bed was a o o luxury in which I was able to indulge. I ignored the phone and let life carry on without me, listening to the thoughts swimming around in my head, forming themselves into a hideous running commentary. In the months that followed, my friends occasionally enticed me out, but I would look at others as they laughed and wonder how they did it. I'd fake laughter to fit in, or attempt to drum up some energy by gulping down the Sauvignon. But drinking meant I'd become unnaturally lively for a few hours, before becoming aggressive or maudlin, or both. I'd get home and sob, then wake-up in the early hours - the negative commentary in my head more rampant than ever before. I'd spend weeks on my "day bed" a pink futon in the front room. Detritus piled up around it, which I had neither the energy nor inclination to clear until I was physically hemmed in.

Bizarrely, I started to fantasise about digging a hole in the ground and lying there covered with leaves, or crawling under a hedge to hide. I had a cheery on/off boyfriend called Eddie who I saw two or three times a week. I had always seen him as my mischievous partner in crime, but as I became increasingly withdrawn I'd be unable to break out of my silence, or I'd attempt to push him away by snapping at him. But even though our relationship changed dramatically, instead of walking away - like so many friends did at this time - Eddie stubbornly stayed with me. Initially bewildered, he knew my odd behaviour was a symptom that something was deeply wrong and wanted to help put it right - even if he didn't quite know how. As summer reached its peak, my depression intensified. In the sultry summer evenings it seemed to me that everyone else was out strolling in the sun or chatting with friends on the beach. Only I was indoors and alone.

When you are not creating anything, engaging with others or enjoying the fun things in life, it feels like there's little point in living - especially when your mind refuses to entertain the possibility of change. So when the first suicidal thought sneaked into my head, my mind seized upon it with the only enthusiasm it had shown for months. Every morning my waking thought was, "I want to kill myself." I would see myself lying in a bath of blood after having taken tranquillisers and vodka, cutting my wrists. I've since learned that this type of thinking is known as "suicidal ideation" and is a key symptom of depression. It is really no fun at all. I lost weight dramatically. Cooking was out of the question — there weren't any clean surfaces or clean crockery, I was hungry and I couldn't be bothered with such an involved process. But I smoked. Cigarettes and depression complement each other beautifully - I'd welcomed the health risks involved and saw each cigarette as a miniature suicide. I was thinner than I'd ever been, but I rarely went out to show off my new svelte appearance. When I did make the effort to get dressed I'd wear tracksuits. I'd go for days without having a wash and, on the rare occasions that I did have a bath, I'd often sit in it till the water got cold because I couldn't summon the energy to get out and get dressed. Twice Eddie and I went away together on misguided trips. The first was a holiday in Tenerife, when I discovered a surprising side-effect of my physical situation - my fear of flying had disappeared. In fact I actively welcomed the thought of the plane crashing. I spent the entire week weeping, snapping at Eddie or glowering (fully clothed) by the pool. The next trip was a disastrous visit to the Edinburgh Film Festival. I fought with his best friend in an Italian restaurant, stayed in the hotel room for two days and eventually climbed up on the window ledge. Looking back it was hardly surprising that I ended up on that windowsill - suicidal thoughts are a common occurrence after bouts of depression. According to a recent health report by samhsa. gov, around 10 percent of people who experience a major depressive episode make a suicide attempt, 40 percent think about committing suicide, and 56 percent believe that the world would be a better place if they were dead.

During the next five years my depression came and went. At times I'd have lots of energy and would be able to accomplish things, but a few negative thoughts would easily plunge me back into stasis and suicidal ideation, and my friends got used to me lying low. Work projects would languish unfinished as I trotted back and forth to my GP and dutifully went on and off various antidepressants with varying degrees of improvement. The most successful treatment was a course of cognitive behaviour therapy (CBT). Each week my therapist and I would revise the negative thoughts that tormented me. If I thought, "I'm a failure" we wrote down a logical revision to that thought - for example "I'm actually not a failure, I have an education and managed to earn money for myself in the past and will certainly do so again."

It sounds simple, but refuting that awful negative voice in writing really works. I bought the brilliant book Feeling Good: The New Mood Therapy by David D Burns, and learned that being tyrannised by negative thoughts forms the backbone of depression and is incredibly common. Gradually, I knew how to identify these thoughts and to be vigilant - shooting them down as they arose. "I am a parasite," was now simply "labelling". "Everyone hates me" became "mind reading." These thoughts were no longer incontrovertible facts. Three years on, I'm now married to Eddie and we're happy. I religiously eat a tin of sardines a day for mood-boosting fish oils, and do my CBT exercises from time to time. I still experience low periods every so often. But I've also found that certain beliefs can shake me out of those bad, old familiar thoughts. They are: depression will always pass; and the bars holding me in my psychological prison are imaginary and, if I take a deep breath, I can easily stride through them and take my place in the sunshine, with everyone else.

• The period following New Year has one of the highest incidents of suicide. If you are feeling chronically depressed there are ways to seek help. Contact one of the following groups: THE DEPRESSION AND ANXIETY SUPPORT GROUP OF SA 011 883 8502 or 011 884 1 797 SOUTH AFRICAN DEPRESSION & ANXIETY GROUP Oil 262 6396 (Sam - 8pm) / Emergency number 0800 567 567 or www.sadag.co.za BIPOLAR & RELATED DISORDERS ASSOCIATION 01 2 348 6057 or www.bipolar.co.za MENTAL HEALTH INFORMATION CENTRE 021 938 9229 POST NATAL DEPRESSION ASSOCIATION OF SOUTH AFRICA 021 797 4498 FURTHER READING: The Feeling Good Handbook, by David D Burns (R209, Plume; available through www.loot.co.za) Shoot the Damn Dog, by Sally Brampton (R31 0, Bloomsbury Publishing; available through www.jump.co.za)

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