Depression in India is rising, but we can't even talk about it
There is an urgent need to scale up services for treatment of mental illness.
Mrs B is a 54-year-old woman living in a middle class colony in city D. Her son is settled in a developed country U and her daughter is married and lives in city F. She is a homemaker and lives with her husband. Their financial condition is very stable and her husband is looking forward to his post-retirement life. Since the last two-three months she has been feeling very tired throughout the day. She has not been able to sleep at night and has been waking up early in the morning feeling very tense.
Earlier she used to eat two-to-three rotis at a time, but now she doesn't feel like eating even half. She doesn't speak to anyone in the house or to her neighbours and starts crying sometimes without any reason. She constantly complains of headache and body ache and feels sad and empty. Her husband complains that she has become very lazy and is not interested in any work. She also once told her daughter that she feels that she should end her life by hanging herself.
Mrs B could be anyone of us, a man or a woman, an 18-year-old or 60, from a metro, a tier II city or even a village! It doesn't matter, depression doesn't discriminate amongst its subjects.
Depression is one of the most important as well as one of the most disabling mental health conditions. In India it is already one of the top five causes of "years lived with disability" (a metric used to quantify and compare morbidity across populations). Depression alone accounts for around three per cent of the total disease burden in India. Most importantly, there has been a 50 per cent increase in the burden contributed by depression in the last two decades and is projected to increase further during the next 25 years as a consequence of the epidemiological and demographic transitions in India.
Just down in the dumps?
So how do you differentiate bad mood from a chronic condition? Depressed mood during most of the day (in some cases even irritable mood), nearly every day and markedly diminished interest or pleasure in all, or almost all activities for more than two weeks are prominent symptoms of depression. Watch out for accompanying physical signs such as loss of appetite and sudden weight loss (in some cases increased appetite and weight gain), sleep disturbances (mostly lack of sleep but in some cases increased sleep), being slowed down, and fatigue or loss of energy. A depressed person might experience a diminished ability to think or concentrate - there is a feeling of worthlessness and lack of self-esteem and he or she might have recurrent thoughts of death and may even plan, attempt or commit suicide as the severity of the problem increases.
It is not necessary for a person to experience all the above symptoms for the disease to qualify as depression. If you or someone you know is experiencing at least half of these for a period which extends for two weeks then it is advisable to seek professional help.
Contrary to popular belief, there are a wide range of drugs, and psychological and social interventions which have been shown to be effective and they can transform the lives of people with depression. Professionals such as psychiatrists have an array of anti-depressants (as well as other psychotropic medications) which can effectively treat moderate to severe depression, while trained psychologists can deliver psycho-social interventions such as cognitive behaviour therapy which also have similar effects.
Activities such as regular exercise, meditation/yoga/relaxation techniques, practising sleep hygiene, maintaining healthy dietary habits and proactively engaging oneself in the existing social network of family members, neighbours, relatives and friends are of great help. As part of the society, we can also look out for people who have problems similar to Mrs B. If we find someone, then the least we can do is to listen to the problems of that person without judgment, reassure him/her and strongly encourage the person to seek professional care.
A national issue
The theme for this year's World Mental Health Day is: "Dignity in mental health". People with mental health conditions are often discriminated against, stigmatised, marginalised and in several instances their human rights are violated. As serious consequences of this, very few people with depression (around five per cent) seek services for the same and amongst them very few actually receive evidence-based interventions. There is an urgent need to scale up services for treatment of depression by translating the current knowledge base into practice.
The government needs to work closely with academic institutions and civil society organisations to strengthen mental health service delivery across the country by training general physicians and lay health workers to identify and provide basic treatment for depression as well as focus on public information campaigns to ensure that the stigma towards depression and other mental health conditions is reduced. Healthy society is a pre-requisite for a developed nation and there can be no health without mental health.