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“We always talk about breaking the stigma and lending a helping hand and ear to people to help in difficult times. But we never talk about being non-judgemental when people approach us. We should listen to their grievances without judging them – and not comparing them to others”, says Dr Rashi Agarwal, a psychiatrist at Connect 2 Clinic.
She further said that even non-professionals can help a depressed person by being good listeners, educating and informing themselves to notice those subtle cues, taking a direct, open and non-judgemental approach, and normalising the aspect of struggling with suicidal thoughts. Such a person can help the sufferer seek medical help.
The first thing to be understood about depression, according to experts, is that any sadness or low mood is not clinical depression that requires treatment by doctors. Depression is defined as a state of mind wherein the mood is not lifted by any situation and you don’t find pleasure in any of the activities that were of interest to you previously. In most cases, the sleep cycle is disturbed followed by nightmares, loss of appetite and impairment in grooming and self-care.
The symptoms of depression can be broadly classified into three: physical and cognitive symptoms.
Weakness in the body, heaviness in limbs, weight loss, headache, acidity, and gastric problems are often physical symptoms. These signs can be treated by a physician but the psychosomatic factor is missed.
When the changes in a person’s thoughts start to affect their work-life, that’s part of the cognitive symptoms. These negative thoughts preoccupy the minds more at night and early morning.
“The person might wonder why they are feeling this way. It will lead to more negative thoughts and the lack of control over thoughts will lead to more guilt and shame. It is a vicious circle”, says Dr Rupika Dhurjati, consulting psychiatrist at Fortis Hospital.
There need not be any emotional cause at all, she says. Mostly, it is biological. Then doctors go by a two-head hypothesis: genetic predisposition and environmental triggers.
At times good parenting and schooling can help people to handle these situations. But if an environmental trigger strikes – like the loss of a spouse or loss of any loved one, it is a big stressor. “For some people, chronic depression can go up to 3-4 years. In certain cases, the patient becomes highly functional by developing compensatory mechanisms to keep them distracted. Nobody will find that they are going through depression. Also, there are cases with severe acute episodes which can last up to four weeks and they can be highly suicidal”, she elaborates.
Surprisingly, while talking about the stigma, Dr Dhurjati says that she has seen people from weaker sections of the society seeking help as government hospitals provide services free of cost. However, there is more hesitation among educated high-income families.
As compared to women, men don’t show many physical symptoms. According to National Crime Records Bureau, men are more prone to suicide. In 2020, 3,433 men died due to suicide compared to 682 women. The risk increases if the person is unmarried and consumes alcohol or other substances.
Post Covid-19, there has been a surge in the number of patients seeking help, as people have become more aware of mental health problems.
“Grieving is a normal process after a loss and after some time you get accustomed to the loss. Reminiscing and remembering the past is normal. In case of Covid-19 deaths, none of the family was allowed to see the individual and the usual rituals weren’t performed. So there is a lot of guilt amongst the immediate family that they could not do enough”, explains Dr Dhurjati.
“I’ve had a patient who lost her mother during the period, and she started believing that her mother is living within her. The depression became so severe that it led to psychotic episodes”, recalls Dr Dhurjati.
She further says that these people blame themselves for the deaths. The grieving process did not go the way it should have and that led to a more severe mental health crisis.
Also, the people who were suffering from clinical depression before Covid-19 stopped their medication or therapy, which led them to be severely depressed. There were relapses during this period, without physical checkups, and no teleconsultation guidelines. The situation continued for almost six months to one year until those guidelines came up.
It was during the pandemic that telemental health support started, to have a regular check on people dealing with the lockdown.
Clinical depression should not be treated without proper medical consultation and the treatment has to be personalised. Depression is comorbid with a lot of physical conditions as well like thyroid disorder, Vitamin D deficiency, diabetes and hypertension. Not everybody needs medication necessarily. If the condition is milder, then therapy is preferred.
But when sleep and appetite are difficult, and when the biological functions are compromised and functionality is getting impaired, then the best option is to start medication for a short course.
The first course would be anywhere between two months to three months. Later, depending upon the depressive episodes, the medication is varied. Normally, the patient is not expected to continue taking medicines and thankfully, when people experience side effects, they stop them.
Children who are depressed show behavioural disturbances like becoming irritable, not eating properly, and changes in their sleep cycle. Regression of milestones is also a major sign seen in children, some stop walking or talking. They may complain of headaches and refuse to go to school, doctors say.
“There was this 4-year-old child who refused to take a bath altogether; he was afraid to go near water. But he was washing his hands again and again. We used art and play therapy in this case by bathing a doll in water. Slowly, we worked it out”, recalls Dr Dhurjati.
Therapy will only work when one is in a cognitively intact state, able to engage in therapy and understand what the other person is saying. If they are not in a state to engage in therapy, medication has to be started to bring them to that state where therapy can be introduced. “We cannot delay giving medication at the cost of their life and functionality getting severely impaired”, she further says.
On 27 August 2020, the Central government launched ‘Kiran’ for the first time — a mental health rehabilitation helpline number (1800-599-0019) — that intends to provide early screening, first-aid, psychological support, distress management, mental well-being and psychological crisis management. According to Dr Agarwal, many people have been using these helplines.
Dr Dhurjati further says that schools should start educating students to help them understand certain things. Like when a sufferer should seek help, how to understand that a person is going through this and how you’re supposed to talk to that person and not dismiss them.
A lot of schools have started mental health programs, which find mention in the New Education Policy also.
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