Depression in Nigeria: Signs, Causes and Treatment

Depression is more than feeling sad. It means low mood or a loss of interest in almost everything, most of the day, nearly every day, for at least two weeks, along with other symptoms such as poor sleep, tiredness and hopelessness. It's common, it isn't a weakness, and it's treatable.

If you're thinking about ending your life, get help now. In immediate danger, call 112, or 767 in Lagos. To talk to someone at any hour, Safe Place Nigeria is on 0800 800 2000, toll-free and answered 24 hours a day.

What depression is

Everyone has low days. Depression is different: the low mood or loss of interest stays, day after day, and starts to get in the way of work, study, family and the things you used to enjoy. Doctors look for these signs over at least two weeks:

• Low mood: feeling sad, empty or irritable most of the day.
• Loss of interest or pleasure: nothing feels worth doing, even things you used to love.
• Changes in sleep: trouble sleeping, waking very early, or sleeping much more than usual.
• Changes in appetite or weight.
• Tiredness: feeling drained after very little effort.
• Poor concentration: finding it hard to think, read or decide.
• Guilt or low self-worth: feeling useless or blaming yourself for everything.
• Hopelessness about the future.
• Moving or speaking more slowly, or being restless, in a way other people notice.
• Thoughts of death or suicide.

A diagnosis needs several of these together, enough to affect daily life. Some people mainly feel irritable or numb rather than sad.

You may hear a few related terms. Clinical depression and major depressive disorder mean the same thing. Unipolar depression means depression without the "highs" of bipolar disorder, which is treated differently; our glossary explains unipolar depression. Depression after having a baby is covered on our postpartum depression page.

Sadness, grief or depression?

Sadness usually has a clear cause, comes in waves and leaves room for good moments and laughter. It tends to ease within days or a couple of weeks. If your mood has been low for two weeks or more, especially with no enjoyment, hopelessness or poor concentration, it's worth talking to a professional. Two weeks of sadness on its own isn't depression, but it's a reasonable time to check.

A reason doesn't rule depression out. Losing a job, a breakup or money trouble can set it off, and it's still depression if the signs are there.

Grief after a death is not depression, even when it's intense and lasts months. Signs that depression may have developed alongside grief include constant low mood with no good moments a month or more after the loss, feeling worthless for reasons unconnected to the person who died, or thoughts of suicide. Our guides on sadness and depression and coping with grief and loss go further.

How depression can show up in Nigeria

Many people first notice depression in their body: tiredness, poor sleep, aches and pains, or a hot or heavy feeling in the head. The World Health Organization's diagnostic manual lists descriptions like "heat inside the body" and "thinking too much" among the ways people talk about low mood. These are real symptoms. If you see a doctor about them, tell them about your mood too, because depression is easy to miss when only the body is discussed.

Depression doesn't always look like sadness. In men especially, it can show up as anger, irritability, or drinking more; our piece on signs of depression in men covers this. Some people keep going to work and smiling while feeling empty inside, which we describe in high-functioning depression.

Stigma keeps many people quiet. In Nigerian studies, many people put mental illness down to spiritual causes, and few recognise depression when they see it. Depression is not weakness or laziness, and it's not something you can pray or "snap" your way out of. Faith can be a real support, and a pastor or imam can be the trusted person who helps you get care. What doesn't help is being told to pray instead of getting treatment. More on this in mental health stigma in Nigeria.

How common it is

Worldwide, about 322 million people had depression in 2023, roughly 5 in every 100 adults, according to the World Health Organization. It's more common in women than in men.

There's no recent national figure for Nigeria, and the studies that exist measured different things:

• Nigeria's national mental health survey (interviews in 21 states, 2002 to 2004) found that 3.1% of adults had had major depression at some point. Its authors and other researchers think this is an underestimate, partly because people may not tell interviewers about their mood.
• People aged 65 and over in Yoruba-speaking areas (2003 to 2004): about 1 in 4 had had major depression in their lifetime.
• Lagos State Mental Health Survey (more than 11,000 adults, 2015): 5.5% had current symptoms of depression, measured with a questionnaire.
• WHO's modelled estimate put the number of Nigerians with depressive disorders at about 7.1 million in 2015.

What every study agrees on is the treatment gap. In the national survey, fewer than 1 in 5 people who'd had depression in the past year got any treatment.

What causes it

There's rarely a single cause. Depression comes from a mix of life events, how you think and cope, your health and your genes. Common triggers include bereavement, job loss, money worries, relationship problems, childbirth, loneliness, long-term illness, and alcohol or drug use. A family history raises the risk.

Some physical problems, such as an underactive thyroid, and some medicines can cause similar symptoms, so a doctor may examine you or run tests.

The idea that depression is simply a "chemical imbalance" or low serotonin isn't supported by the research. That doesn't make it any less real, and treatments still work.

Treatment that works

Depression is treatable, and you have choices. Guidelines from the World Health Organization and the UK's National Institute for Health and Care Excellence (NICE) recommend starting with the least intensive treatment that fits how you're doing.

Talking therapy

Structured talking therapies are the first treatment for depression. The main ones are:

• Cognitive behavioural therapy (CBT): changing the thinking patterns and habits that keep low mood going.
• Behavioural activation: gradually getting back to activities that matter to you, even before you feel like it.
• Interpersonal therapy: working on relationships, conflicts and life changes.
• Problem-solving therapy: breaking overwhelming problems into steps.
• Counselling.

For milder depression, guided self-help, a structured course or workbook with short sessions of support, is a good first step. For moderate or severe depression, CBT or behavioural activation, often over 12 to 16 sessions, can be used on their own or with medicine.

These therapies work in Africa too. In Uganda, group interpersonal therapy delivered in villages cut depression sharply. In Zimbabwe, six sessions of problem-solving therapy on a "Friendship Bench", led by trained community health workers, did the same. In Ibadan, maternal-care staff trained to give psychological care helped most pregnant women with depression recover by six months after birth.

Therapy by video works about as well as therapy in person, so you don't need a clinic nearby to start. You can find a therapist who works with depression and book by video, voice or chat.

Medicines

Antidepressants are medicines a doctor prescribes for depression and several anxiety problems. The most common type is SSRIs. They aren't usually the first treatment for mild depression, but they can help with moderate or severe depression, often together with therapy.

• They usually take a few weeks to work, so don't judge them in the first week or two.
• People usually keep taking them for at least six months after they feel better.
• They aren't addictive in the way street drugs are, but stopping suddenly can cause withdrawal symptoms, so reduce them gradually with your doctor.
• If thoughts of suicide start or get worse after starting or changing an antidepressant, contact the prescriber straight away. Young people need closer follow-up.
• They aren't recommended for treating depression in children.

The therapists on Mytherapist.ng provide talking therapy and don't prescribe. If you might need medication, see a doctor or psychiatrist; your therapist can work alongside them. Our guide to therapy or medication explains how to decide.

Herbal remedies aren't a safe shortcut. Doctors don't recommend St John's wort, for example, because its strength varies and it interacts with other medicines, including contraceptive pills.

What you can do today

Self-help won't replace treatment for moderate or severe depression, but these steps are part of what therapists teach, and they help:

• Do one small thing you used to enjoy, even if you don't feel like it. With depression, motivation often follows action, not the other way round.
• Move your body. A walk counts. Regular activity eases depression for many people.
• Keep regular sleep and meal times, even at weekends.
• Stay in touch with one or two people you trust, even briefly.
• Cut down on alcohol, which deepens low mood.
• Set small, specific targets and put off big decisions until you feel better.
• Catch, check and change unhelpful thoughts. Notice a thought like "I always fail", ask what you'd say to a friend who thought it, and try a fairer version.

Helping a friend or family member

If someone you love seems depressed:

• Tell them you've noticed and you're worried. Ask open questions, such as "How have you been feeling?", and listen more than you advise.
• Keep spending normal time with them, and offer practical help: a meal, a lift to an appointment, sitting with them while they book one.
• Avoid "pull yourself together", "be strong" or "others have it worse". Those remarks come from not seeing the illness, and they make people hide it.
• Encourage professional help, without forcing it.
• Ask directly about suicide if you're worried. Asking doesn't put the idea in their head, and talking about it can bring relief. If they can't keep themselves safe, get urgent help now.
• Look after yourself too. Supporting someone is tiring.

Our guide on how to help a friend with depression has words you can use.

Depression tests

The most widely used depression check is the PHQ-9, nine questions about how often symptoms have bothered you over the last two weeks. It's free to use and a useful starting point, but it's a screening tool, not a diagnosis. In research, counting everyone who scores 10 or more overstates how many people have depression about two and a half times, and the questionnaire can't rule out bipolar disorder, grief or a physical cause.

If your answers worry you, talk to a doctor or therapist. If you answered yes to the question about being better off dead or hurting yourself, talk to someone today.

Getting help in Nigeria

You can go to any health facility, and by law, if it can't help you, it should refer you to one that can. A common route is a primary health centre, family doctor or general hospital first, then a psychiatry clinic at a teaching hospital or one of about eight federal neuropsychiatric hospitals. In Lagos, the Federal Neuro-Psychiatric Hospital in Yaba runs a 24-hour emergency unit, and some primary health centres now offer mental health services.

Talking therapy is also available from clinical psychologists, therapists and counselors, including online. You can find a therapist who works with depression on Mytherapist.ng and see their prices before you book.

Most people in Nigeria pay for mental health care themselves. Health insurance cover varies, so ask your HMO or NHIA provider exactly what's covered: psychiatrist visits, medicines and talking therapy. Our guides to the cost of therapy and free and low-cost options can help you plan.

If you're thinking about suicide

Depression can make life feel unbearable and the future look hopeless. Those thoughts are a symptom of the illness, and they can change with help. You're not alone, and people do come through this.

In immediate danger, call 112, or 767 in Lagos. To talk to someone at any hour, Safe Place Nigeria is on 0800 800 2000. It's toll-free and answered 24 hours a day. More numbers, including Lagos Lifeline, are on our helplines page.

Get help now, not at your next appointment, if you have a plan or intention to end your life, if you've harmed yourself, or if you feel you can't keep yourself safe. Go to the nearest hospital emergency unit or stay with someone you trust. Our guide to a mental health emergency explains what to do.