Nothing, perhaps, is sweeter than the first feeble cry of a newborn to a mother. Prabha Subramanian, after two long and gruelling hours in a labour room, heard three such intermittent cries on a hot August afternoon before she slipped into a much-needed post-delivery slumber. The mother of three healthy triplets woke up to a reality she had never imagined for herself. The lingering flowery fragrance of baby powder gave her a headache; the constant clatter in her household as everyone desperately attended to the needs of the infants made her look for solace in her bedroom, shielded by her curtains. Every time she fed her babies, she only wished that they would finish soon and she could return to her do-not-disturb zone. The 29-year-old mother of three first hated her babies, and this unwelcome feeling of ‘hatred’ was soon replaced by guilt. She knew she needed help and approached her doctor in Thiruvananthapuram, who after listening to her mildly broke the news that she was suffering from postpartum depression.
In the skies of faraway France, Andreas Lubitz carefully spiked the cockpit coffee of the flight captain with diuretic drugs. As the sick skipper went to the bathroom, the co-pilot seized the opportunity to take control of the Germanwings Airbus 320. He then plunged the aircraft—and all 150 people on board—into a mountainside on the French Alps on March 24 this year.
His were the hands that pushed the botox on pop queen Madonna’s face. He was the creator of model and actress Stephanie Seymour’s never-changing youthful looks. Worried Hollywood celebrities rushed to his address when they saw the first signs of the much-dreaded wrinkles or age spots. He gave them new faces to face the world; he made them sparkle. He was found dead in his Miami home in the US on April 5. He was Fredric Brandt, a celebrity dermatologist.
Somewhere in France, India or the US, there lurked a menace that linked these otherwise unrelated incidents. Lubitz was clinically depressed, as it was revealed after his death and the intentional accident of the jet. Brandt had suffered from severe to mild bouts of depression for decades and he chose death as the only escape from this condition. Here in India, Bollywood actress Deepika Padukone recently talked about how she struggled to overcome depression and finally emerged a winner with the help of family, friends and doctors. According to WHO, India is the most depressed country in the world. And India also has the highest suicide rate than any other country. Alarming as it may sound, experts are of the opinion that if people’s views on depression are not altered or if the rate at which it is growing is not slowed, it will only be a matter of few years for it to turn into an epidemic. “If we look at the statistics, it is easy to conclude that depression will turn into an epidemic if not treated in time. Ninety per cent of people who commit suicide have some kind of psychiatric ailment and 75 per cent of people with mental illness have depression,” says Dr Samir Parikh, director, Mental Health and Behavioural Sciences at Fortis Healthcare, Delhi. Every month, around 150-200 patients who visit Parikh are diagnosed with depression. And the number grows into hundreds of lakhs if we take into account the patients of doctors across the country. These are just the reported cases.
Due to low awareness on the illness, many fail to seek professional help and end on a sad note. What is more worrying is that it may happen to people of any age group. “I have come across patients who are as young as 10 to 12 years old. Depression is also common among elderly people who live an isolated life. I had a patient in her eighties whose children had abandoned her as they had to pursue their life abroad. With no one to talk or bond with, isolation led her to depression,” says Dr Sameer Malhotra, Head of the Department of Mental Health and Behavioural Sciences, Max Healthcare, Delhi. Depression, according to Malhotra, is on the rise among the middle-class people. While he hesitates to share the number of cases he sees every month, he agrees that it’s way beyond hundreds.
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As we listened to Padukone talking at length about the ‘pittish feeling in her stomach’ or a ‘certain emptiness’ within her, there might have occurred a moment of doubt making us believe that, maybe, depression is a disease of the rich and affluent, or maybe it is an ailment that affects a population following a certain lifestyle. But, before we write off depression as a lifestyle disease or a condition that is difficult to understand, we need to get our facts correct. The causes of depression are many, including familial, and some diseases may trigger depression as a side effect.
Dr Geetha Desai, Associate Professor in the Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, says, “If a woman has a history of vulnerability such as a biological or genetic predisposition to a mental disease, then there are more chances of her suffering from that disease, given a set of environmental factors. For instance, if she has suffered from mild depression, then chances that she may develop postpartum depression after having a baby are more.” Depression, just like any other ailment, too is a medical condition and caused by biochemical imbalance in the brain.
“Deficiencies in two chemicals in the brain, serotonin and norepinephrine, are thought to be responsible for certain symptoms of depression, including anxiety, irritability and fatigue,” says Parikh. Genetics, personality and environmental are some of the other factors related to depression. “Depression can run in the family. For example, if one identical twin has depression, the other has a 70 per cent chance of developing the illness sometime in life. People with low self-esteem, who are easily overwhelmed by stress, or who are generally pessimistic, appear to be vulnerable to depression,” adds Parikh. “Biochemical imbalance plays a huge part. But I won’t deny that even psychological and social issues are important. Because when we see a person suffering from depression, we not only give him medicines to treat biological imbalance, we also address his psychological issues,” says Dr Sangeeta Datta of Guwahati.
Forty-year-old Wasim Ahmed was happy when he was elevated to a post that he was longing for, for quite some time. He, however, had to stay back in the office after duty hours. The life he wished after the promotion did not materialise. Long hours at work made outings with his family rare. He started making mistakes and the work piled up. Some thought he had become lazy, but the management forced him to take a break. So, he consulted G Zaileshia, a Kochi-based clinical psychologist and psychotherapist. “I advised him on time management. He was able to change his life and work,” says Zaileshia.
Change in lifestyle, continuous exposure to violence, neglect, abuse or poverty may make people, who are already susceptible to depression, all the more vulnerable to the illness. Depression, however, could still occur under ideal living circumstances. “There is a feeling that only those who are weak have depression, or that people can self-impose the illness and so on. But depression, like any other medical illness, can happen to anyone,” says Parikh. It, however, can also happen without any reason. “Depression can be independent of all these causes. It is called endogenous depression,” adds Dr B N Gangadhar, Professor of Psychiatry at NIMHANS.
Experts believe that the prominence of the Internet, smartphones and social media has a tremendous influence on children and young adults. “People spend hours on their cellphones, laptops and messaging services like WhatsApp. These things cause a lot of communication gap. It also leads to a lack of sleep among young adults. Substance abuse is also a stimulating factor,” observes Dr Chandra Chud Vanapalli, Consultant Psychiatrist at Care Hospital, Hyderabad. Pointing out that marital stress is one of the most common factors leading to depression in women, he says, “The most common is relationship issues between wife and husband. Because of communication gap, they have problems. After a few months, small issues can turn into big ones.”
Explaining that a lack of communication, misunderstanding and excessive stress are some of the primary reasons that lead to stress and suicidal tendencies, doctors are of the opinion that working women are most vulnerable. “They have to face stress from office as well as home. Some of them have to take care of their in-laws and children, and deal with work pressure at the same time. The situation becomes worse when the husband does not cooperate,” Dr Vanapalli explains.
While symptoms of depression may begin from a person feeling low and emotionally empty, losing productivity to irritability, developing insomnia and lack of appetite and shunning company, Dr Alexander Gnanadurai, Associate Professor of Psychology at Madras Medical College, says the signs should not be taken lightly when they recur or persist for a long time, and the patient should be taken to a psychiatrist.
Depression has three stages—mild, moderate and severe. While the patient shows four types of symptoms in the first stage, it graduates to six in the next stage and eight in the subsequent one. “Usually, patients try to fight out the previous two stages, thinking they will recover eventually. When they do not, they come to us—when the depression has taken a severe form and become difficult to treat,” says Gnanadurai.
Social stigma associated with the disease is one of the reasons for the rise in cases of depression. “We have blood investigation to identify malaria; we have CT scan and other tests to identify disorders in the brain; whereas people don’t try to identify depression. There is a lot of stigma involved, as friends and relatives of the individual feel embarrassed. Even though a patient is depressed, he never admits it. Half of the people are not even aware that they need a psychiatrist. Those who are aware don’t seek help because they feel psychiatrist are mental doctors who prescribe sleeping pills,” says Vanapalli, adding, “Most people don’t know what depression is and just label people as depressed. There is a specific criterion to diagnose a patient with depression and if people are depressed for a day, then it is not depression. You can label an individual as a patient suffering from mild, moderate or severe depression only when he meets the criteria for diagnosis. The person has to be depressed for a minimum of two weeks to fall into the category.”
What is worse is that, if not treated in time, it may aggravate to a stage where a patient will reach a point of no return. For 16-year-old Pallavi Mishra, her world came to an end when she failed in her board exams. Her mark sheet carried more than just her scores. In that piece of paper, she held her death sentence. A week after her results were announced, she was found dead in her room. “Suicide is a big concern. It is the eighth highest killer in the world,” adds Parikh. According to Dr Ashok Pai, Chairman of the Karnataka Suicide and Mental Health Task Force, depressive people have a low threshold for emotional stress and may be suicidal. “Of a number of students who fail the SSLC exams, only a handful commit suicide. This is because their mind responds differently to stress,” he says.
Like herds of locusts feeding on crops, depression pulled the ropes around thousands of farmers in Andhra Pradesh and Telangana. Economic burden was the reason that caused mass depression in the states and later the epidemic of suicide. Similarly, Tamil Nadu has been recording a significant number of suicides year after year. According to the National Crime Records Bureau (NCRB) figures for 2013, the state recorded 16,601 suicides, only 21 less than Maharashtra that occupied the first rank in the ignominious table. In other words, one in eight suicides in the country was reported in Tamil Nadu. The suicide rate was 24.3 per lakh population, alarmingly higher than the national average of 11. State capital Chennai has a higher suicide rate of 28.2, having recorded as many as 2,450 suicides in 2013. Curiously, Tamil Nadu has a large share of the suicides reported among children below 14 years and elderly above 60. Of the 2,891 cases of children suicides across the country, 345 or 11.9 per cent were from the state—only five less than Madhya Pradesh at the top. In Assam, around 15,000 suicides were reported between 2008 and 2012. As the NCRB does not directly attribute the suicides to depression, it is difficult to link the illness to the cause of deaths. However, as many as 26.3 per cent of the suicides were due to ‘illness’, of which maximum cases were due to ‘insanity’.
The treatments for depression, however, differ from patient to patient. “While patients with mild depression respond to counseling and psychotherapy, the ones with severe depression have to be administered antidepressants. The medication usually ranges from six months to one year. The suicidal ones, on the other hand, are counselled and in many cases given electroconvulsive therapy (ECT) to change their mind,” says Gnanadurai. But more than medication, it is the support of the family that matters the most. It was Padukone’s mother who saw the first signs of depression in her otherwise cheerful daughter and made her visit a counsellor for advice. A lot depends on the patient and his or her understanding of the condition, and a willingness to cooperate.
With Chandrakanth Viswanath, S N Agragami, Samhati Mohapatra, Suhas Yellapantula, Papiya Bhattacharya and Prasanta Mazumdar