Are Indians Ready to Accept ‘Depression’

What does it mean to be diagnosed with depression?

A whopping 36% of Indians suffer from depression and WHO has put India on the list of most depressed countries in the world. In a survey report by the National Institute of Mental Health and Neuro Sciences, India, one in every 20 people have been found to suffer from depression.

Shocking, is it?

Credit: MaxPixel

Well, what is more shocking is that we still can talk about epidemics, major diseases like cancer, TB, and dengue, but we don’t discuss mental health issues. The people suffering from mental health disorders have also not spoken up about their plight.

We at Bayside Journal spoke to people who have been diagnosed with different types of depression.

Harika Bantupalli, a 22-year-old girl, who had been initially misdiagnosed with chronic depression by a psychiatrist, has had depressive episodes since the time she was 16. However, she felt that it wasn’t  depression but rage, rapid mood swings, and uncontrollable emotions that were bothering her. When these episodes changed her behavioural patterns, she sought professional help again and was told  that her depressive episodes had triggered a borderline personality disorder (BPD).

Though Harika could not identify when it exactly started, but she felt anger and pain followed by a void as young as 16. She cried uncontrollably but mostly, she says, it was an emptiness that had engulfed her. Her condition became worse when she was further diagnosed with Lichen Planus – a skin rash triggered by the immune system. She felt that the scars made her look ugly – this led her to cry for hours at night. Feelings of worthlessness gripped her making her lose her self-belief and self-love. Harika started harming herself and had suicidal tendencies. One of her friends was convinced that she exhibited symptoms of depression and made her consult a psychiatrist.

Dr. Harish Shetty, a psychiatrist who sees 25 to 30 depression patients a day, clarifies Harika’s case, “Though BPD and depression are independent issues, people of any personality disorder can have depression.”

Srinath Srinivasa, 43-year-old, currently diagnosed with dissociative identity disorder (DID) is suffering from depression, anxiety, and inability to manage close relationships as a result of DID. In his case, several traumatic circumstances have hindered the development of a consistent sense of self. He had earlier been diagnosed with intense anxiety during his college days. During that time,  he felt mentally escaping into a fantasy world and shutting himself off, reading, writing, and thinking made it easier for him to cope with issues. He feels devoid of energy or motivation, and sometimes even breathing takes him a lot of effort. Though rare, Dr. Shetty says, “DID can lead to and co-exist with depression.”

Harika too tried to distract herself to keep her mind off the endless emptiness “but it was hard, to say the least, and the void was always there”.

As clinical psychologist, Miloni Ruparelia, puts it, “Depression is an underlying issue for many other major disorders.”

So, How Do You define Depression?

Depression is a mood disorder. “It takes over one’s bodily function, thoughts, and emotions of a person,” says Sheena Siddiqui, a counselling psychologist. Scientifically, depression is a deregulation in brain biochemistry triggered by factors like stress, traumatic life events, medical illness, hormonal imbalances, drug, and alcohol abuse or genetic predisposition. Dr Shetty explains, “Depression does not cause any structural changes in the brain, though it can lead to hippocampus (an area in the brain) atrophy or shrinkage.”

Harika believes, “Depression is not the thing to be glorified, or brushed off as something silly or stupid. It is like a demon of your own, a shadow that follows you everywhere and you feel asphyxiated as if you can never get out of it.”

Srinath agrees. “Depression is not something we can ‘snap’ out of. It is a state of internal implosion, where we start feeling completely worthless and even begin rejecting the idea of our existence.”

The Usage and Perception of the Term ‘Depression’ 

Despite the severity of the disease, the term ‘depression’ is used in a colloquial sense these days. “Everyone says that they are depressed. We all have our days of blue, but that doesn’t mean we are suffering from depression. It’s entirely a different mind game. Depression kills you from within and sucks the life out of you,” Harika claims. She feels that people must be made aware about the difference between depressive episodes (major depressive episode) and actual depression (major depressive disorder).

It is not only the people, who are affected by depression, their loved ones too are not aware enough about the issue. Srinath’s parents and siblings had been and probably still are embarrassed about him seeking medical help. “They used to think that this is just a result of me being brought up in relative prosperity compared to that of theirs. They also thought that I just need to ‘toughen up’ or that I am blaming them for my problems. I was accused of laziness and using ‘depression’ as an excuse.” Though he feels his family has become more understanding now, he has had to seek help on his own without their knowledge for the last 20 years.

Harika’s father was furious with her when she approached him with her problem and said that “it is all in her head”. It was only later that they supported her and cheered her up. “The most surprising thing was that they continued to love and support me, even after I was diagnosed with BPD. While the world treats me like some kind of retard and a monster, my parents were still there.”

“Half of the time depression is not identified,” laments Dr. Shetty. “Families ward off the concerns thinking the patients are irritable, angry, or lazy. If identified, most of them do not seek help and are wrongly advised by people around them to go for a walk, do yoga, or think positive. Depression is underdiagnosed and undertreated. The onus of change is put on the patient with depression, unlike in a heart patient. Most Indian families do not believe depression needs to be treated, they think, you can come out of it.”

Ruparelia believes it is the patient who needs to take the call. “If you are not able to identify and you don’t come out with your problem, nobody can treat you or help you.” She further said that, “people go through a possible denial at some level, thinking, ‘I can’t go through something like that, I can’t go to a shrink’; it becomes almost impossible to lend a helping hand as you would think, ‘while I may be upset and facing symptoms, I don’t think I need to seek help’.”

Ruparelia also strongly feels that it is because of the social stigma attached to consulting a psychologist or a psychiatrist in India that many cases go unnoticed. She states that the symptoms of depression get manifested in different ways, so once the symptoms are clearly mentioned, only then can a psychologist/psychiatrist ask the right questions, diagnose, and probably even help treat it.

What are these symptoms?

  • Extreme Reactions – From loss in appetite, sleep and activity levels to a gloomy-looking body language, depression patients confess to ‘sleeping all day and crying all night.
  • Anhedonia – A lack of interest in seemingly enjoyable activities and a visibly poor concentration are other common symptoms. Ruminating on bad experiences or negative thoughts makes one more likely to slip into depression.

Srinath, who first sought help for depression at 18 as he could not handle ragging in engineering college, discovered his depression went back to his school time and his traumatic childhood experiences.

The good news is that we can help people like Srinath and Harika to battle depression. Dr Shetty claims there are four steps to this. He says, “Firstly, accept that depression is an illness. Then, see to it that people suffering with depression seek help. Thirdly, the help should not be intervened and lastly, believe that the person is depressed, unless proved otherwise.”

Harika looks forward to the day when she can openly talk about mental health and work her way towards a depression-free life. She says, “There are not enough people who are courageous enough to seek medical help, as we live in a country where people belittle you if you suffer from mental illness and speak about it. People should know that mental health is as important as physical health – maybe even more.”