Depression is a common mood disorder characterized by a sullen temperament and the loss of interest or pleasure in your usual haunts or activities. It’s a bespoke sadness that alters your personality, thinking and actions. At its severe end, feelings of worthlessness accompany intentions of suicide. As serious as the illness can get, it’s still perfectly treatable. 

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If the weight of depression is affecting your daily life, remember that reaching out to mental health professionals is a valid and practical choice. Their expertise can provide valuable insights and tailored treatments, offering you the support needed to navigate through the challenges of depression. 

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  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Anxiety, agitation or restlessness
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports
  • Brain chemistry
  • Hormone levels
  • Family history
  • Prolonged emotional or Physical Pain
  • Psychotherapy
  • Medication
  • Complementary medicine
  • Brain stimulation therapy
  • Psychiatry
  • Psychology
  • Therapy

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What is Depression?

Depression is often depicted as fat clouds of despair threatening to erupt over a lethargic or insipid individual. Meanwhile, the people under the clouds describe it as feeling aimless, like being steeped in a pot of melancholy and stirred endlessly by a spoon of self-loathing. 

Where sadness is a natural human emotion bound to negative experiences, depression is a seemingly endless sorrow which affects around 5% of adults globally. Closer to home, a survey some years ago found that number to be one in every 20 Indians, or 5.3% of the population suffered from depressive disorders at some point in their lives.

This survey conducted in 2015 by the National Institute of Mental Health and Neurosciences (NIMHANS) and the National Mental Health Survey (NHMS) was the last comprehensive Mental Health Survey in India. The survey would further reveal that 15% of Indian adults required active intervention for one or more mental health issues. The same survey indicated that at the time of the survey, 2.7% were reported to be actively dealing with these disorders. 

Though several other smaller-scale surveys have been carried out since, by organisations such as UNICEF and Deloitte, these do not provide a complete image of depression rates across the country. The Union Ministry of Health & Family Welfare recently announced the launch of a new Mental Health Survey, the first in eight years, targeting metropolitan cities in India. We anticipate a more accurate representation of depression rates upon the conclusion of this survey, expected between 2024 and 2025.

Meanwhile, people still gravitate towards the idea that major depressive disorder is nothing more than a profound sadness. The truth is a little more insidious, that clinical depression makes you tired, it swallows your appetite, it corrodes your interest in pleasurable activities, it brings out a reclusive side that makes personal and professional relationships difficult, it hounds your every waking moment with feelings of worthlessness and brings you to the brink of self-harm. To put it simply, it’s not something you can just ‘snap out of’.

Distinguishing between sadness or grief and depression is important and can assist people in getting the help, support or treatment they need. A common sight that we’ve all seen is people relating their grief for a loved one or a lost love, as depression. Though it is true that grief and depression can co-exist, when it does co-occur, the grief is more severe and lasts longer than grief without depression. 

Anyone can get depression, in fact the illness is so common that approximately 280 million people in the world have it, but people that have survived abuse, recently lost someone, facing additional stress like the loss of a job or a major disaster are especially susceptible to depression. It’s a leading cause of disability around the world and contributes greatly to the global burden of disease. Which makes it crucial to note that depression is a very treatable illness. Its effects can be long-lasting or recurrent, but great progress has been made in being able to manage the symptoms through medication, psychotherapy or both.

Symptoms of Depression:

Once again, how the symptoms of depression manifest in your life might be unique to you, but knowing all the faces people typically recognise it by is both prudent and immensely helpful. So, let’s go over some of them.


  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Fellings of worthlessness or guilt, fixating on past failures or self-blame
  • Anxiety, agitation or restlessness
  • Loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports


  • Tiredness and lack of energy, so even small tasks take extra effort
  • Unexplained physical problems, such as back pain or headaches
  • Sleep disturbances, including insomnia or sleeping too much
  • Reduced appetite and weight loss or increased cravings for food and weight gain
  • Slowed thinking, speaking or body movements, and angry outbursts, irritability or frustration, even over small matters
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide

During a depressive episode these symptoms occur most of the day, nearly every day and cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others.  Some people may feel generally miserable or unhappy without really knowing why.

Age is another huge factor in not just when but how depression expresses itself. 

Depression Symptoms in Children and Teens

Children with depression may be anxious, cranky, pretend to be sick, refuse to go to school, cling to a parent, or worry that a parent may die.

Older children and teens with depression may get into trouble at school, sulk, be easily frustrated, feel restless, or have low self-esteem. They also may have other disorders, such as anxiety and eating disorders, attention-deficit hyperactivity disorder, or substance use disorder. 

Older children and teens are more likely to experience excessive sleepiness (called hypersomnia) and increased appetite (called hyperphagia). In adolescence, females begin to experience depression more often than males, likely due to the biological, life cycle, and hormonal factors unique to women.

Younger adults with depression are more likely to be irritable, complain of weight gain and hypersomnia, and have a negative view of life and the future. They often have other disorders, such as generalised anxiety disorder, social phobia, panic disorder, and substance use disorders.

Middle-aged adults with depression may have more depressive episodes, decreased libido, middle-of-the-night insomnia, or early morning awakening. They also may more frequently report having gastrointestinal symptoms such as diarrhoea or constipation.

Depression Symptoms in Older Adults

Older adults with depression commonly experience sadness or grief or may have other less obvious symptoms. They may report a lack of emotions rather than a depressed mood. Older adults also are more likely to have other medical conditions or pain that may cause or contribute to depression. In severe cases, memory and thinking problems (called pseudodementia) may be prominent.

People have reported having depressive episodes multiple times, or just once during their life.  This gives us the last, but essential, pattern of depressive episodes:

  • Single episode depressive disorder, meaning the person’s first and only episode;
  • Recurrent depressive disorder, meaning the person has a history of at least two depressive episodes; and
  • Bipolar disorder, meaning that depressive episodes alternate with periods of manic symptoms, which include euphoria or irritability, increased activity or energy, and other symptoms such as increased talkativeness, racing thoughts, increased self-esteem, decreased need for sleep, distractibility, and impulsive reckless behaviour.  

What all this research firmly establishes is that depression affects people differently. That it varies in severity, how often they happen, and how long they last

Causes of Depression: 

We’ve become so accustomed to the certainty of cause and effect, that only a coin spun into the air could land face up, sometimes it doesn't occur to us that perhaps the coin was always there to be found. 

In the section below, we go over some of the faces with which depression visits us, but what invites it into our lives are varied and many. Though researches remain confounded trying to pin it down to a particular set of risk factors, they’ve however narrowed it down to these social, psychological and biological factors:

  • Brain chemistry: There may be a chemical imbalance in parts of the brain that manage mood, thoughts, sleep, appetite, and behaviour in people who have depression. Furthermore, they’ve noticed that the structure of the brain could lead to depression. There’s a greater risk for depression if the frontal lobe of your brain is less active. However, scientists don’t know if this happens before or after the onset of depressive symptoms.

  • Hormone levels: Changes in female hormones oestrogen and progesterone during different periods of time like during the menstrual cycle, postpartum period, perimenopause, or menopause may all raise a person’s risk for depression.

The prevalence of major depression is twice as high in females  as in males.

  • Family history: You’re at a higher risk for developing depression if you have a family history of depression or another mood disorder.

  • Gender identity: According to a 2018 study, the risk of depression for transgender people is nearly 4-fold that of cisgender people,

  • Pain. People who feel emotional or chronic physical pain for long periods of time are significantly more likely to develop depression. 

Some events affect the way your body reacts to fear and stressful situations. This becomes a risk factor for those who have endured early childhood trauma.

  • Medical conditions. Certain conditions may put you at higher risk, such as chronic illness, insomnia, chronic pain, Parkinson’s disease, stroke, heart attack, and cancer.

Even some medications can cause depression as a side effect. Substance use, including alcohol, can also cause depression or make it worse.

Studies have also linked depressive symptoms to low levels of vitamin D.

Types of Depression:

The more we study depression as an illness, the more we realise how nuanced a disease it really is, how subtly it makes us believe our worst opinions of ourselves and invades every aspect of our lives. The American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies depressive disorders as the following:

  • Clinical depression (major depressive disorder): A diagnosis of major depressive disorder means you’ve felt sad, low or worthless most days for at least two weeks while also having other symptoms such as sleep problems, loss of interest in activities or change in appetite. This is the most severe form of depression and one of the most common forms.

  • Persistent depressive disorder (PDD): Persistent depressive disorder, or as it used to be called Dysthymia is a continuous, long-term form of depression. You may feel sad and empty, lose interest in daily activities and have trouble getting things done. You may also have low self-esteem, feel like a failure and feel hopeless. These feelings last for years and may interfere with your relationships, school, work and daily activities.

If you have persistent depressive disorder, you may find it hard to be upbeat even on happy occasions. You may be described as having a gloomy personality, constantly complaining or not able to have fun. Persistent depressive disorder is not as severe as major depression, but your current depressed mood may be mild, moderate or severe.

Because persistent depressive disorder is long term, coping with depression symptoms can be challenging. A combination of talk therapy and medicine can be effective in treating this condition.

  • Disruptive mood dysregulation disorder (DMDD): DMDD is a condition in which children or adolescents experience ongoing irritability, anger, and frequent, intense temper outbursts.

  • The symptoms of DMDD go beyond a “bad mood.” DMDD symptoms are severe. Youth who have DMDD experience significant problems at home, at school, and often with peers. They also tend to have high rates of health care service use, hospitalisation, and school suspension, and they are more likely to develop other mood disorders.

  • With PMDD, you have premenstrual syndrome (PMS) symptoms along with mood symptoms, such as extreme irritability, anxiety or depression. These symptoms improve within a few days after your period starts, but they can be severe enough to interfere with your life.

  • Premenstrual dysphoric disorder (PMDD): Premenstrual dysphoric disorder is a more serious form of premenstrual syndrome (PMS), and causes physical and emotional symptoms every menstrual cycle in the week or two before your period. 

Where PMS causes bloating, headaches and breast tenderness, with PMDD, you might have PMS symptoms along with extreme irritability, anxiety or depression. These symptoms improve within a few days after your period starts, but they can be severe enough to interfere with your life.

The cause of PMDD isn't clear. Underlying depression and anxiety are common in both PMS and PMDD, so it's possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders.

  • Depressive disorder due to another medical condition: Depression caused by chronic illness can aggravate the illness, causing a vicious cycle to develop. Depression is especially likely to occur when the illness causes pain, disability or social isolation. Depression in turn can intensify pain, fatigue, and the self-doubt that can lead the person to avoid other people.

    Examples include hypothyroidism, heart disease, lupus, cancer, chronic pain, diabetes, HIV, Parkinson’s disease, Multiple Sclerosis and cancer. If you’re able to treat the underlying condition the depression usually improves as well.

Left untreated, depression can get worse and make other health concerns worse too.

The rates for depression that occurs with other medical illnesses is quite high:

  • Heart attack: 40% to 65%.
  • Coronary artery disease (without heart attack): 18% to 20%.
  • Parkinson’s disease: 40%.
  • Multiple sclerosis: 40%.
  • Stroke: 10% to 27%.
  • Cancer: 25%.
  • Diabetes: 25%.

When you leave the clinical aspect behind, you might that there are also a few situational forms of major depressive disorder, including:

  • Seasonal affective disorder (seasonal depression): Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons — SAD begins and ends at about the same times every year.

If you're like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. These symptoms often resolve during the spring and summer months. Less often, SAD causes depression in the spring or early summer and resolves during the fall or winter months.

Treatment for SAD may include light therapy (phototherapy), psychotherapy and medications.

  • Prenatal depression and postpartum depression: The DSM refers to these as “major depressive disorder (MDD) with peripartum onset.”

    Prenatal depression is depression that happens during pregnancy. Depression causes ongoing or extreme sadness. It can also cause anxiety, fatigue and trouble sleeping. If you have this mood disorder, you may withdraw from family and friends. You may not have any interest in activities you once enjoyed.

    Prenatal depression can affect you at any time during pregnancy.

    Postpartum depression (PPD) is depression that develops after someone gives birth. Postpartum depression doesn't just affect the birthing person. It can affect surrogates and adoptive parents, too. People experience hormonal, physical, emotional, financial and social changes after having a baby. These changes can cause symptoms of postpartum depression.

It’s important to note that prenatal and postpartum depression are different from the “baby blues." The “baby blues” usually resolve within two to three weeks. Meanwhile, prenatal and postpartum depression don’t go away without treatment.

  • Atypical depression: Atypical depression (also called major depression with atypical features) is a specific type of depression in which the symptoms stray from the traditional criteria. 

“Atypical” doesn’t mean that the condition is odd or unusual. It’s just different from “typical” depression. One symptom specific to atypical depression is a temporary mood improvement in response to actual or potential positive events. This is known as mood reactivity. Other key symptoms include increased appetite and rejection sensitivity.

In addition, atypical depression tends to begin at an earlier age and last longer (often becoming a chronic condition) than typical depression.

Diagnosis and Treatment of Depression:

Before a healthcare provider is involved, it’s important to note that for a diagnosis of depression, symptoms must last at least two weeks and represent a noticeable change in your previous level of functioning.

Healthcare providers diagnose depression based on a thorough understanding of your symptoms, medical history and mental health history They may draw blood to rule out medical conditions (e.g. thyroid problems, a brain tumour or vitamin deficiency) which mimics symptoms of depression so it is important to rule out general medical causes, because reversing the medical cause would alleviate the depression-like symptoms.

After this procedure, they may diagnose you with a specific type of depression based on the context of your symptoms. 

Depression is one of the most treatable mental health conditions. Approximately 80% to 90% of people with depression who seek treatment eventually respond well to treatment.

Treatment for depression can involve a combination of lifestyle changes, talking therapies and medicine. Your recommended treatment will be based on whether you have mild, moderate or severe depression.

  • Psychotherapy: Psychotherapy (talk therapy) involves talking with a mental health professional. Your therapist helps you identify and change unhealthy emotions, thoughts and behaviours. There are many types of psychotherapy — cognitive behavioural therapy (CBT) is the most common. Sometimes, brief therapy is all you need. Other people continue therapy for several months or years.

  • Medication: Prescription medicine called antidepressants can help change the brain chemistry that causes depression. There are several different types of antidepressants, and it may take time to figure out the one that’s best for you. Some antidepressants have side effects, which often improve with time. If they don’t, talk to your healthcare provider because a different medication may work better for you.

  • Complementary medicine: This involves treatments you may receive along with traditional Western medicine. People with mild depression or ongoing symptoms can improve their well-being with therapies such as acupuncture, massage, hypnosis and biofeedback.

  • Brain stimulation therapy: Brain stimulation therapy can help people who have severe depression or depression with psychosis. Types of brain stimulation therapy include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS).

Coping with Depression

Depression generally isn't a disorder that you can treat on your own. But in addition to professional treatment, these self-care steps can help:

  • Simplify your life. Cut back on obligations when possible, and set reasonable goals for yourself. Give yourself permission to do less when you feel down.
  • Take care of yourself. Eat healthy, be physically active and get plenty of sleep. Consider walking, jogging, swimming, gardening or another activity that you enjoy. Sleeping well is important for both your physical and mental well-being. If you're having trouble sleeping, talk to your doctor about what you can do.
  • Write in a journal. Journaling, as part of your treatment, may improve mood by allowing you to express pain, anger, fear or other emotions.
  • Stick to your treatment plan. Don't skip psychotherapy sessions or appointments. Even if you're feeling well, don't skip your medications. If you stop, depression symptoms may come back, and you could also experience withdrawal-like symptoms. Recognize that it will take time to feel better.

  • Learn ways to relax and manage your stress. Examples include meditation, progressive muscle relaxation, yoga and tai chi.

  • Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your depression symptoms. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Ask relatives or friends to help watch for warning signs.
  • Reading a self-help book or joining a support group are also worthwhile. They can help you gain a better understanding about what causes you to feel depressed. Sharing your experiences with others in a similar situation can also be very supportive. 
  • Locate helpful groups. 
  • Avoid alcohol and recreational drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your doctor or therapist if you need help with alcohol or substance use.
  • Don't become isolated. Try to participate in social activities, and get together with family or friends regularly. Support groups for people with depression can help you connect to others facing similar challenges and share experiences.

  • Don't make important decisions when you're down. Avoid decision-making when you're feeling depressed, since you may not be thinking clearly.

If you have thoughts of suicide:

  • remember you are not alone, and that many people have gone through what you’re experiencing and found help
  • talk to someone you trust about how you feel
  • talk to a health worker, such as a doctor or counsellor
  • join a support group.

If you think you are in immediate danger of harming yourself, contact any available emergency services or a crisis line.

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