Did you know that over 1.2 billion people are affected by an emotional health crisis? And these statistics are highly underestimated because for every one person who has opened up about a problem there are still three people who don’t. India leads the way with over 200 million people being identified as emotionally unhealthy in 2018. During the first two weeks of the lockdown, the number of emotionally distressed people increased by 20% and that number could be close to 300 million at this point. These statistics suggest just how pertinent this issue is and why we need to be taking the mental health pandemic very seriously. India is also notorious for being the suicide capital of the world with the highest suicide rate per 100,000 population. Symptoms of depression, anxiety, bipolar and other mood and mental health disorders show up in people who either have a biological or genetic predisposition or can be triggered by psychological or social factors as well.
Towards the end of December, President Ram Nath Kovind warned the country of a possible mental health epidemic and voiced his concern over the shortage of mental health professionals in the country saying that the gap needs to be addressed on priority.
He said, “The number of people affected in India is larger than the entire population of Japan. We need to address this gap and ensure that by 2022 at least those who are suffering from severe mental disorders have been diagnosed and have access to treatment facilities. Let us take it up as a national mission.”
President Kovind called upon the people to come together and fight the culture of stigma and said, “We need to talk about mental health issues and treat ailments such as depression and stress as diseases that can be cured- not as guilty secrets to be pushed under the carpet.”
The number of psychologists and psychiatrists in India is also abysmally low and is only 0.3 professionals per million people. Now we’re in 2020 and the mental health crisis has seen an all-time high because of added stresses that the coronavirus pandemic has brought- financial instability, feeling of uncertainty and lack of personal freedom being some of them. So now more than ever, we as a society need to band together and tackle this problem head-on.
The Union Health Secretary Preeti Sudan also wrote to the states and union territories asking them to create an enabling environment where mental health issues such as depression and anxiety can be openly discussed.
She wrote, “While we appreciate all the efforts being taken thus far by the states and UTs to combat COVID, it is also critical at this point that we open discussions around mental health issues. The common signs and symptoms of the depression and anxiety need to be discussed openly so that anybody who starts facing the problem is able to identify, accept and seek help. Mental health services including advocacy and awareness campaigns should essentially become part of the government’s response to COVID-19.”
In pop psychology, we hear the term depression dropped around a lot but how many people actually understand what depression is? It is not something you can ‘snap out of’ and is more than just bouts of blues. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called a major depressive disorder, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. The symptoms of depression and the low moods must persist for at least two weeks after which it could be medically called depression.
Fortunately, depression does have a cure. According to Dr Maitri Chand who is a marriage and family therapist and supervisor said that medication just on its own has the poorest results when it comes to depression while psychotherapy alone has fairly decent results but takes a long while. The best possible treatment is when psychotherapy and medication work in tandem with each other.
We spoke to Dr Chand and Dr Rajat who are both psychotherapists practising in New Delhi and asked them about the signs and symptoms of depression and here’s what they had to say:
Weight and appetite can fluctuate for people with depression but this experience can be different for each person. Some can have increased appetite and weight gain while others won’t be hungry and will lose weight.
Both changes in the quality of sleep and changes in sleep patterns can be a sign of depression. Again, the experience can be different from person to person while some can have hypersomnia others can have insomnia.
Major depression is a mood disorder that affects the way you feel about life in general. Having a hopeless or helpless outlook towards life is one of the most common symptoms of depression.
The person suffering from depression often has a crippling sense of guilt where he or she thinks it's all her fault and what is the point of anything.
Another key sign of depression is the lack of energy that people feel for doing daily tasks or undertaking activities that they otherwise enjoyed. It has the power of taking away the pleasure or enjoyment out of things one otherwise looked forward to- sports, hobbies, going out with friends etc.
The lack of motivation to go about doing daily activities and tasks is another key symptom of depression.
Problem-solving skills being hampered due to lack of clear thinking, lack of motivation and lack of energy. This is another depression symptom.
Depression can be sometimes connected with suicide and with increasing hopelessness and helplessness. When people start talking about suicide or thinking about ending their life, it could be a sign of depression.
People who suffer from depression usually feel a generally low and unelevated mood for a continuous period of time. This could vary from person to person because everyone’s general mood trajectory is different.
Women are nearly twice as likely as men to be diagnosed with depression. While the most common signs may remain the same in all genders, there are some symptoms of depression in women that may be different from others. This is because of biological, social and psychological differences. Hormonal changes during puberty can increase some girls’ risk of developing depression. However, temporary mood swings that are related to fluctuating hormones are normal and don’t cause depression. What we must be careful about during this time when we’re talking about depression in women is:
Women are also more susceptible to depression during childbirth because it can cause dramatic hormonal shifts in the body. During pregnancy or during attempts to get pregnant, other aspects of life could also cause depression in women. Lifestyle or work changes, relationship problems, postpartum depression, lack of social support, unwanted or unintended pregnancy, infertility etc.
Postpartum depression could include symptoms like:
Perimenopause and menopause are both stages when hormones fluctuate erratically and the risk of depression can increase in women. However, more commonly other factors like interrupted or poor sleep, anxiety, a history of depression, stressful life events, weight gain, menopause caused by surgical removal of the ovaries could be some of the causes of depression.
However, the higher rate of depression in women isn’t due to biology alone. Cultural stressors and life circumstances can play a vital role in it too. These factors may include:
Other symptoms of depression in women could include:
Men are culturally told to hide their feelings and be in control of their emotions. They often deny or cover up feelings of despair and hopelessness. Men suffering from depression are four times more likely to commit suicide than women. Here are the signs and symptoms of depression in men to look out for apart from the common ones mentioned above:
According to Dr Rajat, the symptoms of depression in children are likely to be somatic. These include an upset stomach or headache etc. They often mask their depression by acting out or displaying angry behaviour. They often don’t have the language to convey their feelings but can show signs of depression by showcasing patterns of not enjoying activities like playing games, going out or getting bad grades.
One has to be very careful when looking at symptoms of depression in teens because it is an age when their hormones are raging and they are experiencing biological changes in the body. They also experience and express things in a big way so it could be tricky to diagnose a mental health issue at that time. Some of the symptoms that you could keep an eye for is withdrawal, feeling disoriented, feelings of guilt and some somatic complaints like headaches and digestive problems. Female adolescents face more body image issues and also have hormonal changes within them. They could be caused due to bullying, peer pressure, changes in sense of self and identity etc.
Going for therapy may seem like a daunting task because of the stigma around mental health in general. Some people wait for symptoms of depression, anxiety and other concerns to crop up before going to a therapist but this doesn’t have to be the case. Even if you just want to talk to someone about the problems you’ve been facing in life, it can help. Everyone needs someone to talk to and therapists are trained to help you navigate these issues. It can be seen as a preventative measure rather than waiting for something to happen and then seeking help.
One thing to understand is that our mind, body and social life work in tandem with each other. When we see a disruption in one, we can often see a disruption in one or both other aspects. For healthy living, it is important for us to work on all these aspects as they are interconnected. Some ways you can keep your emotional health in check at home are:
According to WHO, 800,000 people die of suicide every year, that makes it one person dying of suicide every 40 seconds. This is a huge cause of concern. Unfortunately, our close-knit and close-minded society makes it difficult for people to open up about their mental health issues. Depression and anxiety and so many more ailments are treatable with therapy and medication but because of the stigma around it, people refuse to ask for help.
In India, the idea of log kya kahenge (what will people say) has made people feel trapped and suffer in silence and humiliation. This singular age-old social perception is relevant for everyone- it often cuts across gender, caste, religion and socio-economic class as well and reigns supreme in regulating people’s decisions. It suppresses much-needed psychological care and the pressure of being ‘normal’ manifests itself in unhealthy behaviour. It is often seen as the ‘cocktail of stigma and ignorance’ that prevents people from seeking help.
The stigma and shame can be dealt with people opening up conversations about mental health issues, talking about their feelings more openly, better parenting education, primary care physicians recognising somatic symptoms, educational institutions giving quality help to children and governing structures to invest in quality care to address the emotional health crisis.
Like any physical ailment, only a trained psychiatrist or psychologist can diagnose if you are suffering from depression or not. Seeking professional help is key.
Depression is biological. Parts of the brain including the amygdala, the thalamus and the hippocampus are all functioning differently when talking about depression. Neurotransmitters like dopamine, norepinephrine, serotonin, acetylcholine and gamma-aminobutyric acid are all high and low when a person is depressed. There can be social causes for depression too like trauma, sexual abuse, capitalism, inequality, the economy which target our sense of hope and sense of self. Apart from these, there could be a magnitude of reasons why one could be suffering from depression- talking to a psychotherapist would be the best possible solution.
Every person is different and everyone’s mind and body are different too and hence symptoms can vary as well. We suggest that if you’ve been feeling low consistently for a while and have tried to make small changes in your lifestyle or are feeling any symptoms like the ones above, seeking professional help should be your priority. Only a diagnostician can give you the correct diagnosis.
Remember, depression is curable and treatable, reach out for help.