Senior Consultant Psychiatrist and Psychotherapist, Apollo Hospitals, Delhi, Chairperson, Saarthak, Chairperson, AADI
Depression is a very common experience. Around 10% of people live with some form of depression. Different people use the word to mean different things. To some it implies the sadness we all feel when we are disappointed.
For example, Deepak lost his mother and he was extremely sad for a few months. He felt numb and it felt like the world had come to an end. But he gradually started to return to his usual life. He did not ever forget his mother but the pain was less and he was able to focus on his work, his wife and child and his friends.
Depression also means a way of thinking that someone may develop. Some people may see negative in all that they experience. It is like the person sees the world through a set of dark glasses. They may think negatively about themselves. They think negatively about the world and the future. They end up minimizing their achievements and magnifying their limitations.
For example, Sandhya remains dissatisfied with her life for nearly the last two years. This started after a stressful period at work. She started seeking reassurance about her skills. She felt as if she would not be able to complete the tasks that she was usually able to do. She felt people would find out she was incompetent and started avoiding colleagues at work. She started criticizing herself for every small mistake and felt worthless. She became irritable at home with her children. People at her workplace found her to be a hardworking person who performed well and was at times not sure of herself and kept to herself.
At yet other times, Depression, is an illness and it presents as a cluster of everyday feelings and thoughts, which are difficult to get out of. The person loses interest in all that they used to do. Nothing makes them happy. They experience a sense of helplessness and hopelessness, which seems to be unrelated to the situations in their life. They experience a lack of confidence. Their sleep is disturbed and they either gain or lose weight. They may also have thoughts of self-harm.
For some people, the experience of Depression can be severe and it can control their lives. Some people may be depressed to the extent that they may feel that life is not worth living, they may have little faith in themselves and have no hope for the future. Depression of this degree is an illness and needs treatment.
How to recognize Depression?
Certain characteristics, features can help you, your friends and family or your doctor make a decision that you need professional help for Depression.
• Sustained Sadness or Irritability
• Loss of interest and enjoyment of life to the extent that you do not feel interested in doing things that you normally liked or you do them as if with a sense of duty, without enjoying them.
• Fatigue, you feel exhausted without doing anything.
• Loss of self-confidence
• Feeling useless, hopeless about the future, helpless in coping with everyday problems that one may face
• Sleeplessness, either difficulty in getting to sleep or getting up early in the morning.
• Loss of appetite, decrease or increase in weight
Why do people become depressed?
One of the frequently asked questions about depression is, “What are the causes of depression?”
Usually there is more than one reason. These may differ from one person to another.
It is quite normal to feel depressed after a distressing event. But normally we are able to sort out our feelings as time lapses and come to term with them. However, at times such events lead to more severe and persistent depression—from which it is harder to break free.
Ongoing circumstances can be stressful too. If we are lonely, unable to make friends, have other worries, then we may become depressed and it becomes difficult to cope.
The period after childbirth is also a time when women can become depressed. Significant 10% of women suffer from persistent low mood.
Depression may commonly accompany prolonged physical illnesses. Illnesses, which threaten life, like cancer and heart diseases. Or illness like arthritis, a stroke, which is long and painful, may lead to depression.
Personality also plays a role in depression. Some people are more prone to depression. This could be due to one individual make up (including our body chemistry) or because of certain early experiences.
Many times none of these reasons exist, these features exist in isolation and could be due to chemical changes or deficiency in the Brain.
What will help?
Depression is easily treatable. Most people respond to antidepressants or psychological treatments like Cognitive Behaviour Therapy.
The present knowledge tells us that antidepressants increase the availability of neurotransmitters like serotonin in the space between the neurons, this through processes not yet fully understood helps people have a mood which is not sad and think in a manner that does not make them helpless or hopeless.
Many people also benefit from therapies like Cognitive Behaviour Therapy. These therapies help one recognize your feelings and thoughts, which underlie these. Once you start recognizing the negative thoughts you can learn methods to counter and replace them. Gradually these skills become a part of you and your automatic thoughts become less negative and you start feeling less depressed. It takes some effort but it works.
Most people, who have not improved, may not have received proper treatment. Depending on symptoms and then severity and the way benefit from taking the treatment many people can also gradually leave medicines as well. While medicines need to be supervised and withdrawn gradually contrary to the myth these medicines are not a life long reality.
If left untreated depression can cause significant disability. Untreated depression is likely second most likely cause of disability in India in a few years. Sometimes people who are depressed are also likely to have thoughts of self-harm and sometimes may attempt to end their life. But these unfortunate outcomes are preventable. Depression when treated cannot undo lives.
What to do if you know someone who needs help?
It is important to look for Depression as a treatable condition in people whom one loves and cares for. If someone has felt sad or irritable for more than two weeks and has had lack of interest or lack of ability to enjoy oneself then they would need to seek help.
The best thing that you can do for such a person is offering to help. The help should be non-directive, that is do not order people what they should do with their life. Second, be around and listen rather than judging them or criticizing them for their experiences. Be around, not intrusive. Be around and not judgmental. Help them seek support from a mental health professional. Help them recognize that it is alright to seek help.
There is a treatment gap of about ninety percent for mental health problems in India, that means ninety percent of people who need treatment are not able to access treatment. This is largely because of stigma. It is a common refrain., “I am not mad, why should I seek help for mental health?” In India, one person completes suicide every three minutes. It is so sad and unnecessary that people die because of lack of information and myths about mental health. Many of the people who attempt to harm themselves would recover if they had access to treatment. You could be the vehicle through whom they seek help. If you are living with Depression yourself, remember, it is not your fault, it is alright and brave to seek help. You could feel and think differently in a few weeks. Come let us talk!