What your Psychiatrists want you to know: "You smile, but you wanna cry. You talk, but you wanna be quiet. You pretend like you're happy, but you aren't"

Depression is a common mental illness affecting an estimated 57 million people in India. Not only is the economic cost of this disorder high, but its cost in human suffering is immeasurable. Depression interferes with normal functioning and causes pain and suffering to even those who care for the sufferers. 

But much of this suffering is unnecessary. Most people with depression do not seek treatment, even though, a majority of them can be helped. Effective treatments in the form of anti-depressants and psychotherapy have emerged after years of research. 

What is Depression?

Depression is a biological illness just like all other mental illnesses. It is characterised by the pervasive sadness of mood, loss of pleasure/interest in almost all activities, fatigue or loss of energy, decreased the ability to think or concentrate or decision making, negative thoughts like excessive, inappropriate guilt or feelings of worthlessness, recurrent suicidal thoughts and attempts, sleep and appetite disturbances. When the above are present for more than two weeks with a deficit in a person’s functionality, a formal diagnosis can be made. 

Why is it so important to know about depression?

  • Depression is a major public health problem in India, contributing to significant morbidity, disability as well as mortality, along with significant socioeconomic losses
  • Depression and suicide are closely interlinked. At its worst, depression may lead to completed suicide. Recognising depression at an early stage is hence critical for reducing suicide-related deaths and attempts       
  • Depression is both a cause and consequence of several chronic non-communicable illnesses and adversely associated with substance use disorders, nutritional disorders and even chronic communicable diseases like TB, HIV and others
  • People with depression are often stigmatised and excluded by family and society and tend to underperform in education and work, thereby remaining increasingly deprived of with a low quality of life 

What causes depression? 

The cause of depression as a“neurotransmitter imbalance” or low levels of “chemical(s)” in the brain is quite simplistic. However, it is the one most commonly used to explain its aetiology, especially for non-reactive depression, where apparently no obvious stressor is present before the onset of illness.

In reality, however, causes of depression are more complex and several, including biological (including genetic), social, economic and cultural factors. It is really the interplay between the aforementioned factors. 

Who is likely to suffer from depression?

Literally, anyone. Women are twice as likely to suffer from depression. Persons with a family history of clinical depression are also more likely to be depressed. However, persons from all walks of life, irrespective of age, caste, creed, colour, socio-economic background, etc. may get affected.

What can I do to help?

Learn about depression, be well-informed, ask questions to your mental health professional.

Understand that:

  • Depression is a serious condition and suicide risk may be very real
  • The harsh words or lashing out of depressed patient should not be taken personally
  • Hiding the problem doesn’t work, it may keep the patient from seeking help
  • It’s not up to you to fix someone else’s depression
  • Being a compassionate listener is more helpful than giving advice
  • Be gentle and persistent, the person may be withdrawn and may not open up in a single conversation 

Avoid saying:

  • “Cheer up, why so negative, it’s all in your head” “Why can’t you be more social?” “Take some effort to be happy” (as if the patient is deliberately sad or withdrawn)
  • “People have faced worse than this, have some courage, look at ‘so and so’”, “We all go through times like these”(comparing)
  • “You should be thankful for what you have, don’t be ungrateful”, “Look on the bright side” “you are so lazy, always tired” (don’t attribute behaviour to personal flaws)
  • “Exercise, diet and sleep well, it will go away”, “Just snap out of it” (without treatment, highly unlikely)
  • “These medicines will make you sleepy/dependant/crazy” (do not discourage ongoing treatment, first be well-informed yourself)

How do I help myself?

  • Be aware, seek help
  • Ask appropriate questions to your mental health professional regarding illness and treatment
  • Avoid seeking all answers from the internet!
  • Be compliant with treatment

What are treatment options for depression? 

Depression is best treated by a combination of medications (anti-depressants) and psychotherapy.

Do I have to take medications?

Like any other biological illness, Depression is also treated mainly with medication. Medications restore the neurotransmitter imbalance as well as increase neuroplasticity and are hence, the mainstay of treatment. Every other therapy, whether counselling or psychotherapy is complimentary.

Are medications addictive?

Anti-depressant medication is not “addictive”. Oftentimes, anxiolytics may be prescribed to relieve associated anxiety; these may have addictive potential. But they are not the mainstay of therapy and are not continued for more than initial few weeks of therapy.

Are medications sleep inducing? 

Many anti-depressants may be sedative during the initial phase of therapy, it helps especially those patients who have sleep disturbances. Anti-depressants are chosen from the various options available and prescribed as per patients’ symptoms, i.e. to suit individual patient needs. For e.g., a working professional who has no sleep disturbances will not need to be prescribed an antidepressant with sedative properties.

How long do I take these medications?

For a patient diagnosed with depression for the first time, the treatment is continued for up to 6 months following remission of symptoms and then stopped gradually. The duration of treatment increases if the illness is severe, resistant, recurrent or if there is a high chance of relapse. 

Will I need medications lifelong? Will depression come back when I stop medication?

Relapse of the illness is a possibility and should be discussed with your therapist during the course of treatment. Certain factors like no apparent stressor, very severe illness, poor response to treatment, etc are usually taken into consideration when deciding on a longer course of treatment. Hence, some patients do need treatment over longer periods.

Depression like other mental illnesses is real. People’s suffering is real. Be empathetic towards those who suffer. If you are suffering, get help. There is help available.

“Realise that you are not alone, that we are in this together and most importantly that there is hope.” 
– Deepika Padukone.