•LAGOS Mental Health Physician Reveals
Do you know that more and more women in Nigeria now suffer from depression? We can tell you that authoritatively and in this interview, Dr Maymunah Yusuf Kadiri confirms this and mentions 4 vulnerability risk factors that women face.
But, who is Dr Maymunah Yusuf Kadiri (aka Dr May). She is an award-winning mental health physician, advocate, and coach with almost 20 years of experience.
Popularly referred to as “The Celebrity Shrink”, she is the Medical Director and Psychiatrist-In-Chief at the Lekki-based Pinnacle Medical Services, Nigeria’s leading Psychology and Mental Health Clinic, which deals with a wide range of psychological, emotional, and behavioural related disorders.
Dr Kadiri is a dynamic Consultant Neuro-Psychiatrist and a Fellow of the National Post-Graduate Medical College of Nigeria (FMCPsych) with almost 20 years of experience as a practicing Physician. She is a trained and certified Rational-Emotive and Cognitive Behavioral Therapist from Albert Ellis Institute, New York, USA. She is also a certified Trauma Counselor and Neuro-feedback Practitioner.
Dr. Kadiri has wide experience in psycho-therapeutic techniques and is the founder of Pinnacle Health Radio, Africa’s #1 online health radio and a not-for-profit organization, Pinnacle Medicals SPEAKOUT Initiative, which is geared towards creating mental health literacy in Nigeria and beyond.
The Executive producer of award-winning movies, Pepper Soup (focused on drug abuse) and Little Drops of Happy (focused on depression, postpartum depression, and suicide) and creator of the most innovative mental health app in Africa, HOW BODI, Dr. Kadiri continues to be the most sought after Psychiatrist and Psychotherapist in Nigeria and beyond.
In this interview with City People’s Contributing Editor, IYABO OYAWALE (08033564055), Dr. Kadiri talks about depression amongst women and what can be done to help the affected. Enjoy it!
Depression is becoming a very common mental disorder in Nigeria, what are the statistics?
Thank you very much for that question. It’s important that we know that depression is a global major issue. It’s the topmost indicator of disability worldwide. Depression is also a major factor here in Nigeria. And, with the WHO report released on the 2nd or 3rd of this March, the first week of March, the WHO released a study which showed that during this period of COVID, there’s an exponential increase of 25% in anxiety and depression worldwide and the people most affected are women and young adults. Depression is also on the increase in Nigeria, especially with the COVID. 2 years plus inside COVID.
Wow. In your talk at Today’s Woman’s event on Sunday, you mentioned that women are prone to depression for a variety of reasons. What are they?
Women are more prone to depression because of the following reasons but you want to talk about single women and married women. Generally, in the hormonal makeup of single women, we have oestrogen and progesterone. Those are the hormones that will signal developing breasts, that will signal menstrual flow, that will signal when a woman is pregnant, that will also signal when you’re going into menopause. These hormones that we started with from the beginning, they’re going with us all through the whole journey, so, our hormonal makeup is one of the reasons. Then, another reason is the social role we play, the pressure we’re put on in the society, in the sense that we’re expected to make sure everybody in the home is fine. As I said, we’re natural nurturers. We’re to nurture. So, that role we play in our various communities is also a pressure point. Another reason is the role we play in our career and personal development. When you talk generally about women before I go into that of married women, the home we come from plays a major role. Are you from a home where there was the divorce? Do you come from a home where there was domestic violence? Were you sexually abused as a child? Some of these things we don’t really look into them. We always look at them as normal but they’re not. Not to talk of the normal family or genetic predisposition of anybody having a mental illness. Then when we leave that aside, let’s dwell on married women. Those are the 4 vulnerability risk factors I laid emphasis on. Marriage is supposed to be a protective factor, that’s just the truth because it’s like 2 good eggs are better than one. But we know that is not the reality. You get into marriage, you may be facing another cycle of abuse; you left a home where there was abuse now you’re married and still facing abuse. This can cause depression. The first vulnerability risk factor is the death of parents at an early age and we cap it at 8 years old, meaning there’s no way an 8-year-old can bring herself up. Somebody has to nurture her to adulthood. The second one is if you’re not working at all. Or, you’re just working within the home environment. If you’re not working, we already know you’re a stay-at-home mum but sometimes, some people say they’re working but it’s just within the home. That means they’re not interacting with other people or going to the office. It’s a risk factor. You can’t just be working within your home and think you’re okay. Social interaction is important. Good mental health is not just about the money; it’s also about how you interact with other people. The third one is if you have three or more children who’re 14 years and below. Because they’re young, they need a lot of care. “Sit down here, go there, do this, do that,” it takes a lot of effort from women, especially when you travel with them alone. Imagine having three children, it’s like having to divide yourself in three places. And the last but not least, which is very important when our men are involved is if your husband or your spouse or your partner is not your friend or confidante. It then means that by the time the children leave, you’re alone. So, if a woman already has two out of these four risk factors and she’s married, studies are now showing us that woman is likely depressed as it is.
At what point does depression lead to suicide? I’m asking this question because of the former Miss USA that committed suicide recently.
Depression has what we call symptoms. We have major symptoms and minor symptoms. There are three major symptoms globally and they’re low energy level or sadness, low mood, and loss of interest in things you ordinarily love to do. So, those are the three major symptoms: sadness, energy level is down, and loss of interest. We’re not talking about this sadness for a day or two. We’re talking about the sadness that is ongoing, persistent for a minimum of two weeks. When you look at the minor symptoms, they range from anything, sometimes, you may even be having depression and you’ll think you have malaria. You’ll lose appetite; it would seem as if you’re running temperature, you’ll feel very tired, muscle pain, neck pain, body ache, are they not symptoms of malaria? So, you’ll think you have malaria! But these are also symptoms of depression and they’re minor symptoms. Other symptoms include poor concentration and attention, you hold your car keys, you’ll be looking for them. You’re going from Ikeja to Lekki, before you know what’s happening, you find yourself on Sagamu road because your attention and concentration is not there. When do you start feeling suicidal? When the individual starts feeling hopeless, worthless, and helpless! At that point, they start thinking that they’re better off dead than being on this earth. They start thinking that life is not worth living. They start telling themselves that “nobody cares about me.” And this is the reason why we’re preaching kindness because when somebody is at that stage and they come to you to say “I want to speak to you” or “I think I’m depressed” and you just wave them aside. You trivialize what they’re telling you, it further re-enacts the fact that “nobody loves me” or “nobody cares about me.” So, when they’re at that point, that is when suicidal thoughts come in. People that died by suicide did not actually want to die. They wanted the pain to go away. So, it’s just for people around them to notice that there’s a change and that they need help. And this is a red flag to get this person help. So, suicidal thoughts first, then there’s planning before the person now carries out the act. But, sometimes, these suicidal thoughts come strongly that within minutes; the person is already saying “I’m tired” or “everything is not working.” Completed suicide is more common amongst men than women because of the way men are being raised. “Be a man,” “man up”, that stuff come to their mind and they tell themselves, “I’m a man” or “men don’t cry”, “so, let me just hang myself. Let me just jump onto Third Mainland Bridge.” Unlike a woman that will come to social media and say “I’m tired of life. I want to kill myself,” or cry or go and meet family members and all that. Women express themselves more. So, it’s at that point that people who’re depressed now know they’re suicidal. Sometimes, apart from being hopeless, worthless, and helpless, they also have what we call psychotic symptoms. Psychotic is a medical term but let me break it down. When they start hearing voices; when they start hearing voices in clear consciousness and these voices can be commanding, telling them go to the kitchen, take the knife, kill yourself. And then they obey. They’re hearing voices discussing them, voices of people they know or don’t know, telling them “look at her, she wants to go and bath, she’s carrying my bucket. Look at her, she is going out, what is she wearing sef.” So, this is when you see them communicating with people they’re seeing but you’re not seeing them. They can also be seeing strange things in clear consciousness. People having three heads, people walking upside down, people carrying gadgets and those things can be scary to them and they just say “I can’t deal with it.” Or, they believe that people are after them or they believe that life is not worth living, so, when you talk about hallucination, meaning hearing voices, seeing strange things, when you talk about delusions, thinking everybody is after me, life is not worth living, so, hallucinations and delusions can also make somebody be suicidal. Aside from feeling hopeless, worthless, and helpless!
Wow. The pain is so much.
So, what should somebody who’s having suicidal thoughts do?
There are warning signs of suicide, when somebody is suicidal sometimes they are aware, sometimes, they’re not aware. And the warning signs are obvious. Who is looking for the world to end now? If you’re around the person, that’s a red flag. Or, the person is sharing things to other people. Things ordinarily they love. You know this person has a bag she loves and she gives it out. Sometimes, you don’t even ask for it. Another warning sign is when the person withdraws into himself or the person becomes violent and angry. It could be the person is planning for their burial, writing their will, these are all warning signs of suicide. But, as an individual if you’re suicidal, the best thing is to submit yourself for help because suicide is a severe symptom. Suicide is not just a mild and moderate symptom. Suicide means your depression is severe or your mental illness is severe. So, going to get help is very important and most times, that help is not right straight to the hospital. It starts with the people around that person. It’s not everybody that knows where to go so the people around have a role to play in encouraging help-seeking behaviour. Even if the person knows where to go, the best doctors that handle suicide worldwide are psychiatrists, not even general doctors because psychiatrists are trained to manage people living with mental illnesses. It’s just like when a child has a convulsion, you admit. You don’t allow them to go home because when a child is brought in for convulsion, you want to know if the child will convulse again. You put the person under observation and suicide watch and manage the person. You then do a full analysis and talk to the patient to know why they got to that stage where they’re suicidal. It could be depression, it could be a bipolar affective disorder, it could be schizophrenia, it could be substance-induced, and so anything can be the reason why the person is depressed. Once you know that and you start managing the reasons why they got suicidal, the person starts getting better. Sometimes when the person has attempted suicide and they survive, you’ll know they didn’t want to die if you ask them: “Now that you survived, are you happy?” A lot of times, they’re like “thank God I didn’t die.” The truth is that they didn’t want to die; they just wanted the pain to go away. So, suicide is a major reason for admission and medication because we don’t just admit and watch over them, we’re not babysitting them. There’s a reason they got to that stage of suicide, so, if they don’t get help themselves, people around them are supposed to notice these warning signs I talked about and get them to receive help.
I have been depressed before. That is why I have some insider information. The challenge I realized is the fact that when you’re depressed, you hardly know. I was misbehaving. The people around me saw something was wrong but I didn’t see anything wrong. Now, how would an individual know he is depressed? I talked to a mental health practitioner and he said the reason you don’t know you’re depressed is that the brain tells the body when you have malaria or other symptoms but when the brain is sick, there’s no organ to communicate that to the brain.
Yea, those are the things we also notice. You find that somebody is going through depression, they don’t really know. There’s general apathy, not motivated, not wanting to go out, not wanting to get out of their bed, life is just at a standstill for them, it’s very easy at that point to go suicidal because they just feel that this stage in my life when I ought to have achieved this and that, I feel stuck. This is why the support we’re talking about is so important. When you don’t know, the people around you will know that something has changed in you. And that is their own intervention. Not necessarily to belittle what you’re going through or make you less of who you are or generalize it and say “do you even know what my problems are? My problems are worse than your own.” No. That is where the support system should come in to help you get help. You may not have the classical symptoms of depression but you’re in that languishing state. You feel languished. Nothing is really working. You feel stuck. You’re not motivated to do anything. You may not have the classical sadness, low energy level, loss of interest in things but you know you’re not flourishing. A number of us, we languish from time to time, we may not have clinical depression in our clime in Nigeria, those things can present themselves as malaria, you feel tired, your body is aching you, so, you treat malaria. You don’t feel better. You treat Typhoid. You go back again. You do a lab test. You change hospital. You change doctor. If you start hospital-shopping and doctor-shopping, something is wrong somewhere. And if you don’t know what it is, the onus falls on the people around you to help because your productivity will start dropping, your interpersonal relationship with people will be affected, your activities of daily living, waking up, brushing, having your bath, taking care of your hygiene, will also be affected. When those three areas are affected, productivity drops, interpersonal relationships suffer, and activities of daily living are affected, where the normal chores of the day, like just brushing your teeth, you’re not feeling it anymore, there’s a problem.
Let me go back to the issue of the women, because you talked about work-at-home mums, that they’re missing social interaction and that’s a risk factor for depression. What would you advise such women to do?
So, you see, this stay-at-home thing is not a bad thing. Sometimes, it’s even a decision on the women to say “look, I want to give the first five or ten years of my life, have my children, raise them to a level. Then, I’ll go and work.” Sometimes, that decision can be a game-changer, a life-changer. Because why do you want to work? Is it not to earn money? If you’re a stay-at-home mum and your husband is taking care of you, you still feel fulfilled, that’s okay but why are we saying stay-at-home mums can be affected? Being a stay-at-home mum doesn’t mean you’re locked up, it doesn’t mean you’re in isolation, it doesn’t mean you’re in prison. It means you’re taking a decision just to do that but you have to interact. Social interaction is important for the brain, it is important for your physical and mental well-being. You are not an island, you must interact with people. Because learning is on a daily basis, that is what it is. Studies have proved that social interaction improves longevity. So, you drop your children off in school, between that time and when they come back, what would you be doing? Maybe, you have a lunch date with your friends or you volunteer in your church or your children’s school for one thing or the other. You can’t be an island and you can’t be with your children alone. The experiences and memories are built that way and they also challenge the brain. Because you also need to use your brain to a large capacity. So, stay-at-home is not bad but it’s the social interaction that is the thing. Interact with people. It’s good for mental health.
What’s the help and assistance that’s available for depressed women?
Being self-aware, exercising, asking for help when you need it, eating right, are all lifestyle changes that can help. If you need further help, contact mental health professionals. They’re trained to help these individuals. You may need counselling from them. So, it’s not all mental illnesses that involve medication. That is a myth a lot of people are holding onto. “If you have a mental illness, you take medication for life.” It’s a lie. It might just be counselling and therapy the person needs. Sometimes, the person needs medication, at other times, no. Most times when people have mental health challenges, they go straight to Yaba. Yaba is a tertiary health facility. We have primary and secondary health centres. But, most people just go to tertiary health institutions, that’s why they’re overwhelmed. When the primary health centres are trained on what to do and they know when to refer, it would help. They can do follow-ups after people have been to Yaba but we’ve not gotten there yet. We’re still at the stage of reducing the stigma and discrimination attached to mental illnesses. We need to talk about that first.