Depression: Silent killer at large

Worldwide, more than 320 million people suffer from depression and it is the leading cause of ill health and disability globally. According to a Nimhans study, the prevalence of depressive disorders in India is estimated to be 2.7% of the total population

So, what does a person suffering from depression do? Despairingly and silently battle with his inner demons? Seek help from family and friends by opening up to them? Pray for divine intervention? Go to a soothsayer or “baba”? Meet up with a psychiatrist or a counsellor? Stumble from one option to the other? But wait, is he even aware he is suffering from depression? Let’s look at some chilling facts. At the recently concluded Davos Economic Forum in January, an open forum on depression titled ‘ Suffering in Silence — Tackling Depression’ emphasised that depression is a “killer”, of people, or productivity and generosity in society. Worldwide, more than 320 million people suffer from depression and it is the leading cause of ill health and disability globally. The prevalence of depressive disorders in India is estimated to be 2.7 per cent of the total population, as per a study by Nimhans, Bengaluru, conducted in 2016 across 12 Indian states.

In such a grim scenario, what is the ground reality? What are some of the challenges faced by clients when seeking treatment options from mental health professionals?

Awareness about depression is abysmally low. It is often confused with sadness and the general belief is that the person is in a slump and will “snap out of it” in due course. Consequently, counselling or psychiatric support may be taken after considerable delay, exacerbating symptoms and causing increased distress to the client and his family.

Sadness is a normal, healthy human reaction usually triggered by an adverse event; it is temporary and fades with time. Depression is an abnormal emotional state that affects our thinking, emotions, perceptions and behaviours in pervasive and chronic ways. Depression is often seen as a

“sign of weakness”, of someone not being resilient enough. Families assume that it’s “all in the head”. Or that talking will only make it worse.

Helping clients who are guided by their faith can pose a challenge. It is not unusual for clients or families to abruptly terminate medication or counselling on the advice of a spiritual “guru” or a “baba”. This can be catastrophic for the mentally- ill patient. In conditions like depression, bipolar disorder, schizophrenia and the like, medication may be the first line of treatment.

Chanting a mantra or saying positive affirmations has its benefits, but the effects may be usually palliative in nature. A question comes to mind: Is feeling better the same as getting better? We could use a reflective dialogue to explore whether the actions a client is taking are positive or negative. Taking antidepressant medication may be an important step in getting better but is rarely enough on its own. Research has repeatedly shown that a combination of medication and therapy may work best.

In an age of quick fixes, families often expect instantaneous, magical “cures” through therapy or medication. Clients may also come with the attitude that “change shouldn’t be so hard!” Counselling seeks to reduce emotional disturbance arising out of faulty, unhelpful, unhealthy or irrational attitudes that have been created and nurtured by us over the years. Antidepressants can take four to six weeks to take full effect. Sometimes, the psychiatrist may need to try a few medications to see which works best.

What may complicate the treatment picture are beliefs about the negative effects of medication that include worries about long- term effects, dependence, cost of medication and the dislike of having to rely on medicines as a “crutch”.

At times, concerns are related to more general beliefs about pharmaceuticals as a class of treatment. These are often perceived as intrinsically harmful and overprescribed by doctors.

There is still a stigma attached to depression and an “us versus them” attitude towards those affected by depression. One taboo around depression is imposed by society, when we call the person “crazy”, “weak” or a “psycho”, partly because we are ignorant about the brain and the causes of depression.

The second taboo is self- imposed, clients may inflict this upon themselves when they are unaware they suffer from depression and think they're “weak” or deeply flawed. Sometimes it takes a couple of years before a person realises that s/ he has depression.

Despite a Deepika Padukone making herself vulnerable and opening up bravely about her tryst with depression, many clients will keep their depression under wraps. A therapist may tell a client “Look at your depression like you would look at diabetes, for example. It’s a chronic, lifelong illness that has to be managed”. But all that may not cut ice in an uncooperative workplace.

In unsupportive workplaces, what are the options for a depressed client? Cutting down on workload, looking at alternative, less stressful work environments, taking occasional breaks from work or quitting. Returning to work after a period of mental illness can be especially difficult as can the prospect of facing work colleagues again. If we can’t move this discourse beyond celebrities to the general population, if there can be no openness about mental health issues, it can trigger immense stress in those holding on to their jobs.

Depression is a disease of loneliness. Many youngsters in colleges and schools may be silent sufferers who feel agonizingly and despairingly alone. And ache for somebody who will reach out to them. Most schools and colleges do not have fulltime counsellors. Peer support groups like BipolarIndia. com help tremendously but are few and far between. When a conversation between peers takes place, clients share experiences, feel understood and supported, expand their knowledge pool and adhere to medication and therapy more diligently.

On a more positive note, with rising educational levels, awareness of mental health issues and treatment seeking behaviours has improved over the last several years. There is greater openness in talking about depression. There are mental health helplines too like iCall by the Tata Institute of Social Sciences or online platforms like yourDOST, manned by teams of trained mental health professionals. Here, too, some challenges include finding adequately trained professionals to run the helplines, raising funds for the sustainability of the helplines or creating awareness among people about such helplines. The Nimhas survey reported that depression rates are much higher for women as compared to men. Also, women are particularly prone to depression in their child- bearing years, commonly manifesting as postpartum depression ( PPD). Gender related attitudes can be key triggers for postpartum depression. It is immensely challenging to work through depression alone. The supportive role of families cannot be underestimated.

YOUNGSTERS IN COLLEGES AND SCHOOLS MAY BE SILENT SUFFERERS WHO FEEL AGONIZINGLY AND DESPAIRINGLY ALONE.