G Radheshyam was diagnosed with depression 32 years ago. Then a lively 18-year-old, he had just lost his elder brother to a heart attack.
“With his death, I lost a piece of myself,” he says. “It was gruelling as I felt I could never talk, call, laugh, or tell my brother that I absolutely love his guts. At some point, guilt crept in on me whispering in my ears things I could have done to save him. I kept dwelling on those feelings,” he adds. A bigger pain for him was to see his mother and other family members grieve over his brother.
Although Radheshyam was rippled with unease, the teenager could not bring himself to sharing his situation with friends or loved ones. The bubbly kid of the house started camouflaging his behaviour, which had also led to an eating disorder. After a year of restlessness, reduced appetite, and sleep disturbances, Radheshyam was diagnosed with major depressive disorder.
Delayed by fear of judgement
“In a week, if I attend to 100 people with depression, 15 to 20 percent of them come for help after sitting on their problem for over six months,” says Dr Vishal Chhabra, Senior Consultant, Fortis Hospital. The fear of being judged when they tell their story to someone is at the root of their hesitation.
“If you tell your employer that you want to take leave due to a viral fever or headache, it will be [generally] granted immediately. However, if you tell them you need the leave as you are depressed, they will ask you to control your mind,” Dr Chhabra says. “That’s the biggest misconception. Depression cannot be controlled. It is a disorder that has genetic, hormonal, structural, and chemical change linkages.”
Medication prevents relapse
“Depression is treatable. The more we talk about mental disorders, the earlier we can treat them.” – Dr Ajit Dandekar, Honorary Psychiatrist, Nanavati Super Speciality Hospital, Mumbai.
Depression, which is a mood disorder, causes a persistent feeling of sadness and loss of interest in almost everything. Also known as major depressive disorder or clinical depression, it impacts the way an individual thinks and feels. If left unaddressed, it can lead to several physical and emotional problems. The disorder may require long-term treatment; however, most people show improvement within a year with psychotherapy, medication, or both.
“There is a dire need to spread awareness among the masses about depression and its causes. The more we talk about mental disorders, the earlier we can treat them. Depression is treatable,” says Dr Dandekar.
The treatment of chronic diseases requires long-term adherence to medication. The full benefits of prescribed medications are often not realised mostly because the prescription is not followed. This causes at least 1,00,000 preventable deaths each year.
“For depression, people do not take an early treatment and the ones who do, often do not follow the prescribed medication. They think depression is like having a cold or a cough. They take medicine for a week and as soon as recovery starts, they stop following the treatment. Over 50 percent of such cases relapse within a year,” says Dr Ashlesha Bagadia, Consultant Psychiatrist and Director of Psychotherapy Advanced Resource Centre.
There is an established link between suicide and mental disorders. In India, suicide is an emerging and serious public health issue with a mortality rate of 16.5 per 1,00,000 population in 2016 Suicide – India (who.int), compared to the then global average of 10.5 per 1,00,000.
“Risk factors of suicide include loneliness, discrimination, financial problems, relationship break-up, chronic pain and illness, abuse, and violence. Not everyone with such problems commits suicide. It is only people who have a hidden story going on, besides extra stress, who end their lives,” said Dr K.K. Mishra, Treasurer, Indian Psychiatric Society.
Elders at risk
Additionally, age plays a crucial role in mental health. Old age is a period when people not only deal with physical ageing but also challenges of mental and social well-being. Due to cerebral pathology, normal ageing of the brain, and deteriorating physical health, the elderly cohort becomes more susceptible to mental disorders. Depression in elderly: A review of Indian research Grover S, Malhotra N – J Geriatr Ment Health (jgmh.org)
Among all mental disorders, depression accounts for the greatest burden among the elderly.
“The tricky part in middle [and old] age is that at the root of physical issues there are often psychological problems which are missed. People are often screened by non-mental health professionals who do various [bodily] tests and find nothing. My suggestion to them is if they do not find any physical problem, they should tell the individual and the family to visit a psychiatrist,” says Dr Dandekar of Nanavati Hospital.
WHO warns of a growing burden
According to the World Health Organization (WHO), about 280 million people suffer from depression globally Depression (who.int). In India, roughly 56 million people are reeling under the disorder and 38 million have anxiety. Depression in India: The Latest Statistics (mindvoyage.in)
The WHO has also warned that by 2030, after HIV-AIDS, depression will be a leading cause of disease burden. Although due to advancements in healthcare innovations, we now have effective treatment options for mental disorders, more than 75 percent of people in low- and middle-income countries, including India, receive no treatment. Depression (who.int)
Causes of depression
- Biological differences – Due to the range of hormonal changes women go through in their lifetime, women are twice as likely to experience depression compared to men.
- Brain chemistry – Brain scans have revealed distinct biomarkers (like less water moving across the blood-brain barrier) in people with depression, particularly in the amygdala and hippocampus regions of the brain.
- Hormones – Research has shown that people with depression have a higher level of cortisol, the stress hormone.
- Inherited traits – Though depression is not a direct genetic disorder, the interaction of different genes plays a role in the propensity towards developing depression.
- Take steps to control stress
- Reach out to family and friends
- Get treatment at the earliest sign of depression
- Get a long-term treatment to prevent a relapse of symptoms
Risk factors depression
- Certain personality traits such as low self-esteem
- Stressful or traumatic events
- History of depression in the family
- Abuse of alcohol or drugs
- Chronic illnesses including stroke, cancer, or heart disease
- Certain medications such as sleeping pills or some high blood pressure medications