Mental Health - the spectrum

Disclaimer: I am not a doctor/ mental health professional and information for this post has been obtained from several sources. Feel free to do your own research for anything stated that you may not agree with.

This blog post is inspired by the most recent @plasasandpoyo podcast where hosts spoke about mental illness in Sierra Leone. The conversation highlighted the much needed work that needs to be done in my home country. The tight-nit nature of a small country means the mentality of immediate circle of friends, family and others really affects the Sierra leonean understanding of mental health and psychiatric disorders.

When talking about mental health, there are many layers. Science has evolved and the western world is starting to better understand the finer details. I feel quite confident saying that millenials/ generation Z are the most in touch with our feelings and this is reflected in the rise in mental health reportings of conditions such as anxiety and depression.

West African culture is deeply rooted in pushing this mentality of always being okay. Adults rarely express their periods of stress to children and children are scolded for being stressed. Not to put a blame on "African" culture as western societies also push out a narrative of there being a universal “normal” . Humans are supposed to fit into this checklist and everything outside is an abnormality. This approach is useful when identifying treatments and trying to cure a disease but when this is applied to mental disorders it becomes much harder.

What is the set normal?,

Where is the cut off line ?

How do we as humans who function of emotions understand what controls our own emotions?

When it comes to the brain, most people know it is relatively complex. The brains signalling mechanisms control almost everything in our body. Thank you central nervous system ;). One of the most common brain pathways taught to almost every child is the “pain reflex”. You touch a hot object, but you do not feel pain until your brain sends signals back to the area affected. In terms of emotions,this is controlled differently, there are three main neurotransmitters associated with such behaviour:

Serotonin : mood, memory, sleep, appetite, sexuality

Noradrenaline: attention, stress, wakefulness, feeding

Dopamine: motivation, reward, reinforcement, movement, coordination

The amount of these neurotransmitters found floating around synapses controls signalling within cells that go on to trigger different pathways associated with different behaviours. Serotonin is also classified as the happy hormone and is released in times when you eat and can also be associated with rewarding behaviour. Noradrenaline (you may be familiar with the term adrenaline that is often mentioned when talking about fight/flight response). The more noradrenaline the more signalling and this is therefore similar for affective disorders.

Affective disorders are a set of psychiatric conditions also called mood disorders. Affective disorders can be further divided into anxiety disorders: PTSD( post traumatic stress disorder), Panic disorder ,OCD,general anxiety and phobias . Mood disorders include depression and bipolar disorders which can also be further subdivided.

Although the exact cause of affective disorders has not yet been set in concrete they have been attributed to imbalances in those neurotransmitters previously mentioned.

So how would you get an imbalance? This is where genetics can come into play. For neurotransmitters to continue causing signalling effects they must stay in the synapse. Genetic disorders can cause an increased rate of removal of these transmitters. Genetics can also lead to inactive receptors(the thing the neurotransmitter binds to) and hence ineffective signalling. This theory of neurotransmitter imbalance and affective disorders is heavily supported due to the effectiveness of current treatments that aim to increase the amount of neurotransmitter at the synapse for affective disorders such as depression.

The exact cause of mood disorders are not conclusive, as with many things that affect our body, there is never one cause, it is a mix of genetics and environmental conditions. Our genes encode everything that goes on in our body, they contain the baseline of instructions to tell our body basically how to do everything. Environmental factors explain the things we are exposed to. The combination of all these factors can trigger different reactions within our bodies.

It is worth noting that affective disorders and level of neurotransmitters do not fit into a box like other diseases i.e if you have diabetes you know that above a certain level you are diabetic and below this you are not. Affective disorders follow more of a spectrum and cannot be diagnosed within a day, week or even month.

Diagnosis, Signs and symptoms of Affective disorders.

Anxiety:

Anxiety can present itself in different forms, some symptoms you may experience some in everyday life but when they start to affect your normal routine is a major sign of concern.

In the western world, general anxiety disorder(GAD) is the most diagnosed form of anxiety. The american psychiatric association first introduced the diagnosis of GAD in the DSM 111. The DSM -111 definition of anxiety disorder required uncontrollable and diffuse( not focused on a single major life problem) anxiety or worry that is excessive or unrealistic in relation to objective life circumstances and that persists for 1 month or longer. Over the course of time the timing was then increased to 6 months.

Depression:

To be clinically diagnosed an individual undergoes a series of clinical tests and evaluations. These include a full psychological history, lab tests ( cortisol and thyroid status). Cortisol is a hormone produced under “stressful” conditions. Depression is not to be confused with periods of feeling "sad". Mood fluctuations are a normal part of life and its okay to acknowledge these moments. When these "sad moments" become regular life is when professional help is needed.

To end this post. Science can't really explain mood fluctuations as it there isnt a one size fits all presentation of affective disorders. From a personal point of view, it is important to be aware of your feelings as that will help you identify periods that you may need more support. As mentioned in the introduction, the people around you affect your attitude towards mental health. I encourage you after this post and listening to @plasasandpoyopodcast if you are Sierra Leonean, to continue the discussion with people around you.