I am sure you have heard about mental health and mental illness, and you may wonder what the difference is.
But do you know the different kinds of mental health illnesses? Walk with us as we take you on a journey of understanding different mental health illnesses.
Mental health refers to our overall emotional, psychological, and social well-being. It affects how we think, feel, and act and helps determine how we handle stress, relate to others, and make choices. Good mental health is more than the absence of mental illness; it’s the presence of positive characteristics like resilience, balanced emotions, and a sense of purpose.
Mental illnesses, on the other hand, are health conditions involving changes in emotion, thinking, or behaviour (or a combination of these). Mental illness is a medical condition, just like heart disease or diabetes, and it is nothing to be ashamed of. Mental health conditions are far more common than you might think, mainly because people don’t like to—or are afraid to—talk about them.
As of November 2023, Nigeria is among the countries most affected by mental illness-related challenges, with about 40 to 60 million Nigerians suffering from various forms of mental illness.
Mental illnesses can result from a combination of genetic, environmental, experiential, and lifestyle factors. It is important to remember that mental illnesses are no one’s fault, and recovery is possible, especially with early treatment. Below are some common mental illnesses affecting Nigerians.
Anxiety is a normal human emotion that everyone experiences from time to time. People may feel anxious when facing problems, challenges, changes, or difficult decisions. Anxiety also drives us to do things, like preparing for an exam. Anxiety disorders, however, are dysfunctional responses to anxiety-inducing situations. The difference between normal anxiety and anxiety disorder is that anxiety disorders cause such severe distress as to interfere with someone’s ability to lead a normal life. Anxiety disorders are one of the most common mental health concerns in Nigeria. As of 2017, Over 4.9 million Nigerians (2.7%) had anxiety disorders.
Symptoms of anxiety disorder vary depending on the type, but general symptoms include:
• feelings of panic, fear, or uneasiness
• uncontrollable and obsessive thoughts
• flashbacks to traumatic events
• problems sleeping
• nightmares
• shortness of breath
• nausea
• muscle tension
• dizziness
• heart palpitations
• dry mouth
• Panic, fear, and uneasiness
• Sleep problems
• Not being able to stay calm and still
• Cold, sweaty, numb or tingling hands or feet
Everyone occasionally feels sad and may even characterise their mood as depressed occasionally; however, these feelings are usually short-lived and pass within a couple of days. When you have clinical depression, it interferes with daily life and causes significant pain for both you and those who care about you.
Depressive disorder (also called major depression and clinical depression) is a mood disorder characterised by a pervasive and persistent low mood accompanied by low self-esteem and a loss of interest or pleasure in normally enjoyable activities. The symptoms interfere with a person’s ability to work, sleep, study, eat, and enjoy pleasurable activities.
Depressive disorders are also one of the most common mental health illnesses in Nigeria. As at 2017, about 7 million Nigerians (3.9% of the population) had depressive disorders.
Persistent depressive disorders, including chronic major depressive disorder and dysthymic disorder, are characterised by chronic sadness and other symptoms of major depression but do not meet all the criteria for MDD. Two additional forms of depression include disruptive mood dysregulation disorder and premenstrual dysphoric disorder.
Symptoms of depression symptoms can vary from mild to severe and can appear differently in each person. These symptoms can include:
• Feeling sad, irritable, empty and/or hopeless.
• Losing interest or pleasure in activities you once enjoyed.
• A significant change in appetite (eating much less or more than usual) and/or weight (notable loss or gain unrelated to dieting).
• Sleeping too little or too much.
• Decreased energy or increased tiredness or fatigue
• Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech that are severe enough to be observable by others.
• Feeling worthless or excessively guilty.
• Difficulty thinking or concentrating, forgetfulness, and/or difficulty making minor decisions.
• Thoughts of death, suicidal ideation, or suicide attempts.
Researchers don’t know the exact cause of depression. They think that several factors contribute to its development, including:
Brain chemistry: An imbalance of neurotransmitters including serotonin and dopamine, contributes to the development of depression.
Genetics: If you have a first-degree relative (biological parent or sibling) with depression, you’re about three times as likely to develop the condition as the general population. However, you can have depression without a family history of it.
Stressful life events: Difficult experiences, such as the death of a loved one, trauma, divorce, isolation and lack of support, can trigger depression.
Medical conditions: Chronic pain and chronic conditions like diabetes can lead to depression.
Medication: Some medications can cause depression as a side effect. Substance use, including alcohol, can also cause depression or make it worse.
Healthcare providers diagnose depression based on a thorough understanding of your symptoms, medical history and mental health history. They may diagnose you with a specific type of depression, such as seasonal affective disorder or postpartum depression, based on the context of your symptoms. To receive a diagnosis of depression, you must have five depression symptoms every day, nearly all day, for at least two weeks. Your provider may order medical tests, such as blood tests, to see if any underlying medical conditions are causing your depressive symptoms.
The three most common treatments for depression are psychotherapy, medication, and electroconvulsive therapy.
• Psychotherapy: Currently, the most effective form of psychotherapy for depression is cognitive-behavioural therapy (CBT), which teaches clients to challenge self-defeating but enduring ways of thinking (cognitions) and change counter-productive behaviour
• Medication: Antidepressants (usually SSRIs) have been shown to cause significant improvement in the mood of those with very severe depression
• Electroconvulsive Therapy: Electroconvulsive therapy (ECT) is a procedure whereby pulses of electricity are sent through the brain via two electrodes; studies have found it to be very effective in treating severe forms of depression that have not responded to medication or therapy
Many people fail to see that such substances as alcohol, tobacco, and caffeine are drugs, too. When a person ingests a substance whether it be alcohol, cocaine, marijuana, or some form of medication trillions of powerful molecules surge through the bloodstream and into the brain. Once there, the molecules set off a series of biochemical events that disturb the normal operation of the brain and body. Not surprisingly, then, substance misuse may lead to various kinds of abnormal functioning.
Substance use disorders are also one of the mot common mental health illnesses in Nigeria. As at 2018, about 14.3 million Nigerians (14.4% of the population) had depressive disorders.
Drugs may cause temporary changes in behaviour, emotion, or thought, for example, an excessive amount of alcohol may lead to intoxication (literally, “poisoning”), a temporary state of poor judgment, mood changes, irritability, slurred speech, and poor coordination.
Substance abusers, rely on drug excessively and chronically and in so doing damage their family and social relationships, function poorly at work, or put themselves and others in danger.
A more advanced pattern, substance dependence, is also known as addiction. In this pattern, people not only abuse the drug but also centre their lives on it and perhaps acquire a physical dependence on it, marked by a tolerance for it, withdrawal symptoms, or both.
When people develop tolerance, they need increasing doses of a drug to keep getting the desired effect.
The substances people misuse fall into several categories:
The following are the most common behaviours that mean a person is using or misusing drugs or alcohol. But each person may have slightly different symptoms. Symptoms may include:
• Using or drinking larger amounts or over longer periods of time than planned.
• Continually wanting or unsuccessfully trying to cut down or control use of drugs or alcohol.
• Spending a lot of time getting, using, or recovering from use of drugs or alcohol.
• Craving, or a strong desire to use drugs or alcohol.
• Ongoing drug or alcohol use that interferes with work, school, or home duties.
• Using drugs or alcohol even with continued relationship problems caused by use.
• Giving up or reducing activities because of drug or alcohol use
• Taking risks, such as sexual risks or driving under the influence.
• Continually using drugs or alcohol even though it is causing or adding to physical or psychological problems.
• Developing tolerance or the need to use more drugs or alcohol to get the same effect. Or using the same amount of drugs or alcohol, but without the same effect.
• Having withdrawal symptoms if not using drugs or alcohol. Or using alcohol or another drug to avoid such symptoms.
The symptoms of substance use disorder may resemble other medical problems or psychiatric conditions. Always consult your doctor for a diagnosis.
There are many different types of substance use disorders, including:1
• Alcohol
• Stimulants (such as cocaine and methamphetamine)
• Cannabis (marijuana)
• Inhalants (such as solvents, aerosol sprays, nitrites, and gases)
• Hallucinogens (such as LSD, mescaline, PCP, and DMT)
• Club drugs (such as ketamine, ecstasy, GHB, and flunitrazepam)
• Opioids (such as heroin, oxycodone, codeine, morphine, and other types of prescription painkillers)
• Prescription drugs and cold medicines (such as cough syrups with dextromethorphan)
• Sedatives, anti-anxiety drugs, and hypnotics
• Anabolic steroids
• Synthetic cathinone (bath salts)
• Nicotine (from tobacco or e-cigarette/vaping sources)
Cultural and societal factors determine what are acceptable or allowable forms of drug or alcohol use. Public laws determine what kind of drug use is legal or illegal. The question of what type of substance use can be considered normal or acceptable remains controversial. Substance use disorder is caused by multiple factors, including genetic vulnerability, environmental stressors, social pressures, individual personality characteristics, and psychiatric problems. But which of these factors has the biggest influence in any one person cannot be determined in all cases.
A family doctor, psychiatrist, or qualified mental health professional usually diagnoses substance use disorder. Clinical findings often depend on the substance, the frequency of use, and the length of time since last used, and may include:
• Weight loss
• Constant fatigue
• Red eyes
• Little concern for hygiene
• Lab abnormalities
• Unexpected abnormalities in heart rate or blood pressure
• Depression, anxiety, or sleep problems
Specific treatment for substance uses disorder will be determined by your doctor based on:
• Your age, overall health, and health history
• Extent of the symptoms
• Extent of the dependence
• Type of substance you are using
• Your tolerance for specific medicines, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference
A variety of treatment (or recovery) programs for substance use disorder are available on an inpatient or outpatient basis. Programs considered are usually based on the type of substance. Detoxification (if needed, based on the substance) and long-term follow-up management or recovery-oriented systems of care are important features of successful treatment. Long-term follow-up management usually includes formalized group meetings and psychosocial support systems, as well as continued medical supervision. Individual and family psychotherapy are often recommended to address the issues that may have contributed to and resulted from the development of a substance use disorder.
Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration. These shifts can make it difficult to carry out day-to-day tasks. Bipolar disorder is not as common as other disorders in Nigeria, but many people are suffering from it.
If left untreated, bipolar disorder usually worsens. However, with a good treatment plan including psychotherapy, medications, a healthy lifestyle, a regular schedule and early identification of symptoms, many people live well with the condition.
There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behaviour (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.
• Bipolar I disorder is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Experiencing four or more episodes of mania or depression within 1 year is called “rapid cycling.”
• Bipolar II disorder is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.
• Cyclothymic disorder (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.
Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, and this is referred to as “other specified and unspecified bipolar and related disorders.”
Bipolar disorder is often diagnosed during late adolescence (teen years) or early adulthood. Sometimes, bipolar symptoms can appear in children. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.
Causes
While it’s not known what causes bipolar disorder, these factors may be involved:
Biological differences. People with bipolar disorder appear to have physical changes in their brains. The importance of these changes is still uncertain, but more research may help identify why these changes happen.
Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may cause bipolar disorder.
To diagnose bipolar disorder, your healthcare provider may use many tools, including:
A physical exam.
A thorough medical history, which will include asking about your symptoms, lifetime history, experiences and family history.
Medical tests, such as blood tests, to rule out other conditions that could be causing your symptoms, such as hyperthyroidism
A mental health evaluation. Your healthcare provider may perform the evaluation, or they may refer you to a mental health specialist, such as a psychologist or psychiatrist.
To be diagnosed with bipolar disorder, you must have experienced at least one episode of mania or hypomania. Mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM) to diagnose the type of bipolar disorder a person may be experiencing.
To determine what type of bipolar disorder you may have, your mental health provider assesses the pattern of symptoms and how much they affect your life during the most severe episodes.
People with bipolar disorder are more likely to also have the following mental health conditions:
Anxiety.
Attention Deficit Hyperactive Disorder (ADHD).
Post Traumatic Stress Disorder (PTSD).
Substance use disorders/dual diagnosis.
Because of this, as well as the fact that memory is often impaired during mania so people can’t remember experiencing it, it can be difficult for healthcare providers to properly diagnose people with bipolar disorder.
People with bipolar disorder who are experiencing a severe manic episode with hallucinations may be incorrectly diagnosed with schizophrenia. Bipolar disorder can also be misdiagnosed as borderline personality disorder (BPD).
Because of this, it’s important to be honest and thorough when explaining all your symptoms and experiences when talking with your healthcare provider. It can also be helpful to include a loved one who may be able to provide additional details about your mental health history in your discussions with your provider.
An effective treatment plan usually includes a combination of the following therapies:
Psychotherapy (talk therapy).
Medications.
Self-management strategies, like education and identifying the early symptoms of an episode or possible triggers of episodes.
Helpful lifestyle habits such as exercise, yoga and meditation. These can support, but not replace, treatment.
Other therapies, such as electroconvulsive therapy (ECT) in cases that are poorly responsive to medication or where rapid control of symptoms is necessary to prevent harm.
Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can sometimes take several months to years before you and your healthcare provider find a comprehensive treatment plan that works best for you. Although this can be discouraging, it’s important to continue treatment.
Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder don’t have mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help manage these symptoms.
If you have other mental health conditions in addition to bipolar disorder, such as anxiety or ADHD, it can be more difficult to treat the conditions. For example, the antidepressants healthcare providers prescribe to treat obsessive-compulsive disorder (OCD) and the stimulants they prescribe to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode.
Again, even though it may be difficult to treat these conditions, it’s not impossible. Be sure to stay committed to finding a treatment plan that works for you.
