Depression: what it is, and how to ask for help

Depression is a common medical illness. About 1 in 10 Ethiopians will experience it at some point. It is not a weakness, not a lack of faith, not something you can “just get over.” It is treatable — talking to a health worker is the first step.

This page is for anyone who wonders if they might be depressed, or who is worried about someone they love.

On this page

• What depression is
• Common signs
• Depression is not sadness
• When to seek help
• What treatment looks like
• How to help someone else
• Postnatal, adolescent, and older-adult depression

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What depression is

Depression is a change in how the brain regulates mood, energy, and thinking. It shows up as low mood plus other symptoms, lasting most of the day, nearly every day, for at least two weeks.

It can happen to anyone. Common triggers include: bereavement, chronic illness (diabetes, HIV, TB), childbirth (postnatal depression), unemployment, ongoing stress, family conflict, or displacement. Sometimes it happens with no clear trigger.

Common signs

• Feeling sad, empty, or hopeless most of the day
• Loss of interest or pleasure in activities you used to enjoy
• Sleeping too much or too little
• Eating too much or too little; noticeable weight change
• Feeling very tired even after rest
• Trouble concentrating or making decisions
• Feeling worthless or excessively guilty
• Slowed movement and speech (or the opposite — restless, agitated)
• Aches, pains, or stomach problems with no clear physical cause
• Thoughts of death, self-harm, or suicide

If you have five or more of these on most days for at least two weeks — that’s depression. Talk to someone.

Depression is not sadness

Sadness is a normal reaction to a specific event. It comes and goes. You can still enjoy other things. It fades over days or weeks.

Depression is different. It is present most of the time, whether or not there’s a reason. It steals enjoyment. It doesn’t just lift on its own.

Ethiopian culture sometimes treats depression as a spiritual problem or a personal failing. It is not. It is a medical condition, and it responds to treatment the same way malaria responds to Coartem — with the right intervention, most people recover fully.

When to seek help

::: urgentAdvice severity=“emergency”

Emergency — get help now if you have:

• Thoughts of ending your life
• A plan for how you would do it
• Made any preparations
• Access to means (rope, medication, weapons)

Go to the nearest hospital emergency department. Or call a family member or friend to sit with you until you can get help. In Addis: St. Paul’s Emergency: 011 275 5555. Regional emergency numbers vary — ask a health worker for the local number.

Also call/visit a hospital emergency if you are harming yourself or someone else, or hearing voices telling you to. :::

::: urgentAdvice severity=“urgent”

Urgent advice: see a health worker this week if:

• You have most of the signs above for more than 2 weeks
• Depression is making it hard to eat, sleep, work, or care for children
• You are pregnant or in the first year after birth and feeling this way
• You have a serious physical illness AND you feel hopeless about it
• You have started using more alcohol or khat to cope :::

What treatment looks like

Depression is treated at any government health centre — no need for a specialist referral. Two options, often combined:

Talking therapy — counselling, problem-solving therapy, or group support. Some Ethiopian health centres now offer this through trained health workers under the mhGAP programme. Free.

Medication — antidepressants. The most common first-line option in Ethiopia is fluoxetine (Prozac), 20 mg once a day. Available at government pharmacies. Some people need higher doses; some do better on other medicines (sertraline, amitriptyline). Your health worker will decide.

Rules for antidepressants:

• They take 2-4 weeks to work. Don’t stop just because you don’t feel better in the first week.
• Take them every day, not just on bad days.
• Do NOT stop suddenly — talk to a health worker about tapering
• If side effects are bad (nausea, dry mouth, sleep changes) — most fade in 1-2 weeks
• Continue for at least 6-9 months after you feel well, to prevent relapse

Combining talking therapy and medication works better than either alone. Ask about both.

::: doList

Do — while you are getting better

• Keep a rough daily routine — wake, eat, sleep at similar times
• Get sunlight for at least 20 minutes a day
• Move your body — a slow walk counts
• Eat regularly, even if you don’t feel hungry
• Tell one trusted person what you are going through
• Attend your follow-up visits at the health centre
• Attend a place of worship or community group if it helps you — social connection matters :::

::: dontList

Don’t

• Do not drink alcohol or use khat to cope — both make depression worse
• Do not isolate yourself, even when you want to
• Do not skip antidepressant doses to “test” if you still need them
• Do not stop treatment when you feel better — that’s when to keep going
• Do not accept “just have more faith” as medical advice
• Do not delay talking to a health worker because of stigma :::

How to help someone else

If a family member or friend seems depressed:

• Ask directly. “Are you thinking about ending your life?” Asking does NOT put the idea in someone’s head — it opens the door.
• Listen without fixing. Sometimes people need to feel heard before they can think about solutions.
• Help them get to a health worker. Offer to go with them.
• Reduce access to means if suicide risk is present — lock up medicines, remove weapons/rope, take them to a family member’s home
• Check in regularly. Even a short call, “How are you today?”, matters.
• Do not tell them to snap out of it, or that others have worse problems. Both make people withdraw further.

You cannot cure someone else’s depression, but your steady presence helps them ask for help.

Postnatal, adolescent, and older-adult depression

Postnatal depression affects about 1 in 7 mothers. See the postpartum care article for how to recognise it and when to seek help. Treatment during breastfeeding is safe — most antidepressants pass into breastmilk in tiny amounts and pose no risk to the baby.

Adolescents (13-19) show depression differently — often as anger, irritability, sleep changes, or dropping grades rather than sad mood. Take teenage moodiness seriously if it lasts more than a few weeks.

Older adults may hide depression as physical complaints (headaches, joint pain, poor appetite). If an older relative pulls away from usual activities or loses interest in family, ask directly how they’re feeling.

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa

Sources: WHO Depression fact sheet 2023; WHO mhGAP Intervention Guide v2.0; Ethiopian MoH National Mental Health Strategy 2020/21-2029/30.

Emergency reference: St. Paul’s Hospital Emergency (Addis Ababa) 011 275 5555. Regional numbers vary — ask a health worker.

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Draft notes: ~1150 words · grade 7 · isTimeCritical false but both urgentAdvice severities used · Ethiopian context: mhGAP programme, fluoxetine first-line, direct address of stigma (“spiritual problem”), reference to khat as coping mechanism, real Addis emergency number · Sensitive topic — needs careful review by mental-health clinician per B2B-22 before publish.