Depression

What is depression?

Depression, known medically as depressive disorder or clinical depression, is more than a bad day or a sad phase. It is a health condition in which low mood, or a loss of interest and pleasure, lasts most of the day, nearly every day, for at least two weeks. It affects how a person thinks, sleeps, eats, works and relates to others.

Everyone feels low at times, especially after a loss or a setback, and those feelings usually ease as life moves on. Depression is different. It tends to persist, it can arrive even when life seems to be going well, and it drains the energy a person needs to cope. It is not laziness, weakness or a lack of faith, and nobody can simply “snap out of it”.

Depression is common in India. The National Mental Health Survey 2015–16, led by NIMHANS, found that about 1 in 20 adults had experienced depression at some point in life, and about 1 in 40 had it at the time of the survey. It was more common in women, in people aged 40–49 and in those living in cities.

Depression may happen once or return several times. Some people who have depression also have periods of unusually high mood and energy. This is bipolar disorder, which needs a different treatment plan, so your psychiatrist will always ask about it.

Signs to look out for

Depression affects both the mind and the body. You or someone close to you may have depression if several of these have been present for two weeks or more.

Feelings and thoughts

• Feeling sad, empty, hopeless or tearful most of the time
• Losing interest or pleasure in things you used to enjoy
• Feeling worthless, guilty or like a burden to others
• Difficulty concentrating, remembering or making simple decisions
• Irritability, anger or restlessness
• Thoughts that life is not worth living

Body and behaviour

• Tiredness and low energy, even after rest
• Poor sleep, waking very early, or sleeping much more than usual
• Loss of appetite and weight, or eating more than usual
• Body aches, headaches, heaviness or stomach problems without a clear physical cause
• Moving or speaking more slowly, or feeling “slowed down”
• Withdrawing from family, friends, work or studies

In India, many people with depression first visit a doctor for body aches, weakness, poor sleep or “gas” rather than low mood. Tests come back normal, tonics and painkillers don’t help, and the real cause is missed. If physical complaints keep returning and tests are normal, it is worth asking whether depression could be part of the picture.

Is it “just stress” or depression?

Stress is a response to pressure, such as exams, deadlines, money worries or conflict at home. It usually eases when the pressure lifts or you get a break. You may feel tense and tired, but you can still enjoy a good evening with family or a weekend away.

Depression is more likely when:

• The low mood or loss of interest has lasted two weeks or longer
• It continues even after the stressful situation improves
• Nothing brings pleasure, even things you normally love
• Sleep, appetite and energy have clearly changed
• You are struggling to manage work, home or studies
• You feel hopeless or have thoughts of death

Long-lasting or severe stress can itself lead to depression. You don’t need to work out which it is on your own; a psychiatrist can help you tell the difference.

Why does it happen?

There is rarely a single cause. Several factors usually combine:

• Genes and family history. Depression in a parent or sibling increases the risk.
• Difficult life events. Loss of a loved one, relationship breakdown, job loss, financial pressure or trauma.
• Long-term physical illness. Conditions such as diabetes, heart disease, thyroid problems and chronic pain often go hand in hand with depression.
• Alcohol and drugs. Heavy drinking and drug use can cause or worsen depression.
• Loneliness and inactivity. Isolation and lack of physical activity raise the risk.

Sometimes no clear reason can be found. Depression can affect anyone, including people who seem to “have everything”.

Depression in different people

Men

Men are often less likely to recognise low mood or talk about it. Depression may show instead as anger, irritability, working very long hours, withdrawing from the family or drinking more. The expectation to always be “strong” can delay help for years.

Older adults

In older people, depression is often mistaken for “just old age”. It may show as aches, poor sleep, loss of interest, worry about health or memory complaints, rather than sadness. Loneliness, illness and the loss of a spouse add to the risk. Depression can look like dementia, and memory often improves once the depression is treated.

After childbirth (postpartum depression)

Many new mothers feel tearful and emotional in the first few days after delivery. These “baby blues” usually settle within about two weeks. Postpartum depression is deeper and lasts longer, with persistent low mood, anxiety, guilt, exhaustion beyond normal tiredness, or difficulty bonding with the baby. Worldwide, more than 1 in 10 women experience depression during pregnancy or after childbirth. It is not a failure as a mother, and it can be treated in ways that take pregnancy and breastfeeding into account. Rarely, a mother becomes confused or has strange beliefs soon after birth; this needs emergency care.

Teenagers

In teenagers, depression often looks like irritability, anger, falling marks, refusing to go to school, staying alone in their room or on the phone, or changes in sleep. It is easily dismissed as attitude or exam stress. Talking therapies are usually the first step; if medicines are needed, they are prescribed carefully and monitored closely. Under-18s are seen with a parent or guardian.

Depression and alcohol use

Many people drink to numb low mood or to fall asleep. Alcohol may bring brief relief, but it worsens mood, sleep and anxiety over the following days and raises the risk of self-harm. Heavy drinking can also cause depression by itself. When both are present, treating them together, known as dual diagnosis care, works better than treating either alone.

Depression and thoughts of suicide

Depression can make a person feel hopeless and trapped, and some people begin to feel that life is not worth living. These thoughts are a symptom of the illness, not the truth about the person’s situation or worth. With treatment, they fade.

If you are having such thoughts:

• Tell someone you trust today
• Speak to a psychiatrist, or call Tele-MANAS on 14416, free and available 24×7 in your language
• If you feel you might act on them, call 112 or go to the nearest emergency

If you are worried about someone:

• Ask gently and directly how they are feeling, including whether they have thought about ending their life. Asking does not put the idea in their head; it often brings relief.
• Listen without judging, arguing or lecturing
• If they are in immediate danger, stay with them and call 112
• Help them reach professional care, and keep checking in

Help is available, and people do come through this.

When to see a psychiatrist

Consider speaking to a psychiatrist if:

• Low mood or loss of interest has lasted more than two weeks
• Sleep, appetite, energy or concentration have changed
• Work, studies, home life or relationships are suffering
• Physical complaints continue despite normal tests
• You are using alcohol or sleeping pills to cope
• You have had depression before and notice the signs returning

If you have thoughts that life is not worth living, please seek help now rather than waiting. Early treatment is simpler and recovery is usually quicker.

How depression is diagnosed

A first consultation is a conversation, not a judgement. The psychiatrist will ask about your mood, sleep, appetite, energy, stressful events, physical health, current medicines, alcohol use, past episodes, any periods of unusually high mood and family history. With your permission, a family member can join part of the discussion.

Short questionnaires help measure severity. Blood tests, such as thyroid function, blood sugar, a blood count and vitamin levels, may be advised to rule out physical causes of similar symptoms. The diagnosis follows international criteria (ICD-11), and depression is described as mild, moderate or severe, which guides treatment.

Treatment

Treatment is tailored to the person, and it usually combines the following.

1. Talking therapies (psychotherapy)

Therapy helps you understand what keeps depression going and teaches practical ways to recover. Commonly used approaches include:

• Cognitive behavioural therapy (CBT): noticing and changing harsh, hopeless thinking patterns and the habits linked to them
• Behavioural activation: gradually returning to meaningful and enjoyable activities, because doing often comes before feeling better
• Interpersonal therapy: working through relationship conflicts, grief and life changes such as retirement or becoming a parent
• Problem-solving therapy: breaking overwhelming problems into manageable steps

Mild depression often improves with therapy alone. Sessions can be held in person or online.

2. Antidepressant medicines

Antidepressants help restore the brain systems involved in mood, sleep and appetite. A few things are important to know:

• They take time. Clear improvement usually takes several weeks. Sleep and energy often improve before mood does.
• They are not addictive. They do not cause craving or a need for higher doses to get the same effect.
• Don’t stop suddenly. Stopping abruptly can cause unpleasant symptoms and increases the risk of relapse. Medicines are reduced gradually, with your doctor.
• Continue after you feel well. Treatment usually continues for several months after recovery to prevent depression returning.
• Side effects are usually mild and often settle within the first couple of weeks. Tell your doctor about any that trouble you.

Antidepressants should only be started, changed or stopped with a doctor. Never take tablets prescribed for someone else. Sleeping pills alone do not treat depression, and some can become habit-forming.

3. Lifestyle foundations

These support recovery alongside treatment, not instead of it:

• Keep regular sleeping and waking times
• Move your body every day, even if it is just a short walk
• Eat regular meals
• Stay in touch with people, even briefly
• Set small, achievable goals for each day
• Avoid alcohol, cannabis and unprescribed sleeping pills

Yoga, prayer or meditation can also help if they are meaningful to you.

4. Combined care

For moderate or severe depression, therapy and medicines together usually work better than either alone. Anxiety, alcohol use, sleep problems and physical illnesses are treated at the same time, and family sessions can help everyone understand the illness.

Outpatient, online or inpatient care?

• Outpatient care suits most people, with regular consultations while living at home.
• Online consultations are convenient for therapy, follow-up and people living outside Delhi NCR.
• Hospital care may be advised for severe depression with a risk of suicide, when someone has stopped eating or caring for themselves, or when there are psychotic symptoms.

Dr. Tarwani sees patients at Sukoon Health in Gurugram and South Delhi, and online.

Recovery and staying well

Recovery is usually gradual, with good days and bad days along the way. Sleep, appetite and energy often improve first, and mood follows.

Depression can return, especially if treatment is stopped too early. Learning your personal early warning signs, such as poor sleep, withdrawing from people or losing interest, and keeping follow-up appointments help catch a return early. Many people recover fully and go on to lead rich, fulfilling lives.

For families

Supporting someone with depression can be confusing and tiring. A few things help:

• Take it seriously, and avoid phrases like “cheer up”, “think positive” or “others have it worse”
• Listen more than you advise
• Encourage treatment, and offer to come along to appointments
• Help with small daily tasks and gentle activity, without taking over
• Support the medicine routine, and don’t suggest stopping medicines once the person seems better
• Take any talk of death or hopelessness seriously and seek help
• Look after your own health and rest

You are welcome to consult Dr. Tarwani first, on your own, to plan the next steps.

Common myths

• “Depression is just sadness. Snap out of it.” Depression is a health condition affecting the brain and body. Willpower alone rarely lifts it.
• “Only weak people get depressed.” Depression affects people of every background and personality, including those who seem strong and successful.
• “Real men don’t get depression.” Men get depression too, but it often shows as anger, overwork or drinking.
• “Antidepressants are addictive and change your personality.” They are not addictive, and the aim of treatment is to help you feel like yourself again.
• “Once you start medicines, you have to take them for life.” Most people take them for a limited period; the duration depends on your history.
• “Asking about suicide puts the idea in someone’s head.” Asking gently and directly is safe and can open the door to help.