Depression, the silent killer

Dr Prakriti Poddar

DEPRESSION is a word we often throw around without realising the depth of the disease. It is a mental health condition that affects people of all ages in the form of one or recurrent major depressive episodes (MDEs) that can be mild, moderate, or severe. There is no single cause of depression known — it is a disorder of the brain that occurs due to a combination of genetic and environmental factors working together. It is a frequent mood disorder that is severely disabling and has a significant impact on everyday life of an individual as well as society at large, including a substantial economic burden on society. According to The Lancet, mental disorders are among the leading causes of non-fatal disease burden in India; 197.3 million people had mental disorders in India in 2017, which includes 45.7 million people with depressive disorders and 44.9 million people with anxiety disorders. It goes on to state that mental disorders comprised 2.5 per cent of the total disability-adjusted life-years (DALYs) in India in 1990 that increased to 4.7 per cent in 2017. Among non-communicable diseases (NCD), mental health is the largest contributor to economic loss in India — an estimated 20 percent of economic loss from NCDs between 2012 and 2030 worth $6.2 trillion will be caused by mental health issues.

Need for big effort

And yet, it takes a suicide to make people post ‘I am there’ messages on social media. It is time we shun this ‘one at a time’ approach towards depression and other mental health conditions and take up the cudgels to support them. A mark of depression is the tendency to fatally injure oneself — that is, attempt suicide. Depression is a risk factor for suicidal thinking and good mental health care can reduce the risk; thankfully, there are several ways to help affected person access these. Suicide prevention programmes and hotlines can provide support and can withhold the tendency for some time. However, the focus on suicide and its prevention draws attention away from the fact that in ‘worst case’ situations depression and resultant suicidal thinking/suicide attempts/suicide can be compelling. According to the World Health Organisation, ‘suicide epidemics’ have been a quagmire and are known to occur sporadically, but repeatedly, in certain populations such as American Indians and in certain sites such as psychiatric inpatient units. Those who commit such acts predominantly suffer from mood disorders, and the most prevalent mood disorder is major depression.

Hear them out

The Mental Healthcare Act, 2017, is a welcome step in acknowledging this disease that is often silent. Mental health budget is less than 1 per cent of India’s total health budget and conservative estimated cost on the government to implement the Act is Rs94,073 crore per annum. However, clinical therapies can have limited impact in the absence of an effective social support group. One of the most important things that we can offer someone suffering from mental health condition is to allow them space and comfort of talking – listening to how they are feeling without forcing them to open up can relieve them partially. Also, ask what is most helpful for them when they are feeling depressed and listen to what they have to say. But unless you are a trained professional dealing with mental health, try not to give advice. It is important to understand depression, so some familiarity with its symptoms, possible course and treatments may help understand the person and how he or she is feeling. Support their treatment and carry on with regular activity – remind them of their appointments or medicines, or carry on with the habit of watching movies on a Friday night.

—The writer is a mental health expert, Poddar Foundation, Mumbai

When mental health affects your body

Depression may trigger insomnia, increased pain sensitivity, weight fluctuations, fatigue, narrow the blood vessels and lower your libido. Here are some preventive measures and the way out:

• Take good care of yourself — get enough sleep, eat nutritious food and exercise regularly.
• Reach out to family and friends if you are feeling lonely or sad.
• Fight stress with exercise, meditation and yoga.
• Know yourself better — find your strengths and pay attention to what makes your symptoms worse. This can help your doctor or therapist.
• Stick with your treatment plan. If you are on medicine, take it as prescribed.
• Do not skip sessions. Tell your doctor what is and is not working for you.

What triggers this disorder?

There is no single cause, but one or more of the following may cause depression:

Stressful events: Personal events such as divorce, loss of job, death of a friend or close relative.

Family history: Genes have a role to play, so if you have a parent or a sibling with the condition, chances are you will also develop it.

Giving birth: The hormonal and physical changes in a woman’s body during pregnancy and after birth, coupled with the added responsibility of a new life, may cause post-natal depression, also known as ‘baby blues’.

Substance abuse: A sustained high consumption of alcohol and psychedelic can affect brain.

Illness: Chronic or life-threatening illness, e.g. coronary heart disease or cancer, can cause depression. Other triggers can be poor hormonal balance (hypothyroidism) or head injury.

Gender: Women are more prone to depression than men, mainly due to socio-cultural surroundings.

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