Understanding depression

Dr Meesha Haorongbam *

For the next few minutes sit down, close your eyes and imagine this- you are alone; you feel completely worthless and hopeless. There’s no one to lend you a hand. You doubt yourself and you feel you deserve to be punished for every awful thing you have ever done.

Everything tires you out quickly and at times you don’t even have the strength to get out from your bed. Nothing brings you joy anymore and yet, when anyone asks you what’s wrong, you smile and reply “I’m fine”. Because you don’t have the words to describe how you feel.

Now imagine having to live with those thoughts and feelings constantly. Imagine being completely engulfed by dark clouds. This is what 300 million people around the world battle with day in and day out. This is depression.

Depression is a mental illness. A mood disorder, to be more precise. It can strike anyone at any point of time regardless of any demographic variables you can name. One out of 10 people suffer from depression and one out of five has suffered from this disorder in his/her life.

Depression is a global health crisis. It is projected to be the second leading cause of disease in the world by 2020 and by 2030 it will be the largest contributor to disease burden. Nearly 5 crore Indians suffer from depression out of which Manipur contributes about 11.7 lakhs.

The National Mental Health Survey of India 2015-2016 showed Manipur with the highest lifetime prevalence of depression (19.9%) among the 12 surveyed states. We often tend to look at these statistics and think “So what? I don’t have depression and neither do any of my loved ones.” But how can you be so sure of that? In fact, what do you know about depression apart from the fact that depressed people are “sad”?

We’ve all been momentarily sad at various points of time in our lives. But the key difference between that and clinical depression is the presence of sustained sadness for most time of the day for more than two weeks.

Depression colours all aspects of your life. You feel easily fatigued and you lose interest in things you used to enjoy. You lose appetite and you have sleep disturbances. You become forgetful, you struggle to concentrate and you lose your self esteem.

You are constantly plagued by inappropriate guilt and you might even have thoughts of ending your life. Negative thoughts hijack your mind and you wonder if there is hope for getting better.

Children and adolescents exhibit some slightly different symptoms. They become irritable, throw frequent tantrums; they complain of various bodily aches and pain and there might be decline in their academic performance.

On the other end, while depression is fairly common in the elderly, it is not a normal part of aging. Depression, in the elderly, presents mostly with somatic complaints. Hence it is often overlooked.

While popular lore claims that emotions stem from the heart, scientific evidence prove that the brain is the seat of emotions. Every activity we undertake, every emotion we feel is mediated through chemicals in our brain. Any imbalance in those chemicals, which we call neurotransmitters, leads to profound changes in our feelings and behaviour.

But this is a far too simplified explanation. Depression doesn’t spring just from having too much or too little neurotransmitter(s). Rather it is the result of an interaction between genetic vulnerability, neurochemical changes, faulty mood regulation and stressful life events.

While depression can affect anyone, it does have certain risk factors:

1. Gender: It affects twice as many women as men
2. Age: Though there are some inconsistencies, depression is more diagnosed in people from 30-35 years.
3. Marital status: People who are divorced or widowed are at a higher risk than those who are in stable relationships.
4. Socioeconomic: Depression is more prevalent among those in the lower socioeconomic status. This could be because depression causes socio-occupational impairment which leads to loss of productivity and further leads to economic decline.
5. Residence: The higher stress and strain of an urban life causes higher chances of depression.
6. Social support: The better the social support, the lower the risk of depression.
7. Hereditary: Your likelihood of being diagnosed with depression increases around 10-25% if one of your parents has a history of depression. This risk increases to 50% if both of your parents has/had depression.

Depression is a treatable illness. The first, and most important, step is to acknowledge that it is an illness like any other. It is no less important and no less debilitating than other illnesses. It also requires treatment for it isn’t going to fix itself. There is no single magic pill that’s going to make depression disappear but there are effective treatments for it.

It’s often just a matter of finding the right one, or the right combination. The next step is to open up about it. This is often the hardest because of society’s stigma against mental illness. We refuse to believe that depression isn’t under one’s control.

Despite all the evidence before us we continue to believe that it’s just plain laziness. Depression isn’t a weakness or a defect in the character. So open up. You’re not alone. Millions of people have treaded the dark path before you. Your speaking out can reduce the number in the future. Lots of people deal with and recover from depression and the more people talk about it, the easier is the road to recovery.

There has been a recent surge in celebrities disclosing their battles with depression. These have helped illuminate this often neglected disorder. But we still need the general population to discuss more about this condition and rally around those who are fighting a silent battle daily.

We need to keep the conversation going to remove the cloaks of depression. Though depression is every person’s unique problem, it is best dealt with as a team. Friends, colleagues, family members, teachers, psychologists, psychiatrists, and psychiatric social workers need to work collectively. We need to work together towards enabling every individual to recognize the symptoms of depression, and to encourage each individual to speak out and share their experiences without fear of being judged.

An oft repeated query is whether one really needs antidepressants. The answer is yes- depending on the severity of depression. Some can be managed only with psychotherapy while others require a combination of psychotherapy and medications.

While the medications don’t solve the environmental problems in reactive depression, it does help alleviate the bodily and cognitive symptoms. There is no quick fix and it takes months to see and feel the effects. The aim of treatment is not to reach elation or happiness but rather to bring about a sense of normalcy and the ability to cope with whatever issues life throws at you.

Depression makes it hard for the person to see a way out but here’s the thing- as clichéd as it may sound, there is light at the end of the proverbial tunnel.

Depression has often been metaphorically referred to as the dark cloud or the black dog. So if it is the dark cloud passing across the sky- then you are the sky.

The sky has existed before the cloud but the dark cloud cannot exist without the sky. If depression is indeed a black dog, then remember- a dog can always be brought to heel.