Mental Health

Depression: More Than Sadness, Less Than the End

By Shreya Giria

Digital Discourse Foundation

“I feel devastated, hollow and purposeless; I am at a loss to undertake even the most mundane of daily chores”. This was how Ms. Anita Bhatia (name changed) of Bangalore described herself to me after facing a recent ordeal. Anita felt frustrated as she couldn’t point to the genesis of this new low: she was feeling exhausted, disoriented and drained all the time. She had a great job, understanding colleagues, a supportive husband and two healthy kids - in short she was ‘successful’.

Counsellors often meet clients showing symptoms of depression for a while, who brush it aside for months, hoping it will simply pass. Psychiatric definition of depression is “a condition of general emotional dejection and withdrawal; sadness greater and more prolonged than that warranted by any objective reason (

According to the American Psychological Association, in the article titled “Overcoming Depression: How Psychologists Help With Depressive Disorders”, published on October, 2016, “Depression is caused by a combination of genetic, biological, psychological, social and environmental factors. People who have a family history of depression, and people with serious chronic diseases such as heart disease or cancer, are at an increased risk of depression. Major life changes, trauma and stress can also bring about an episode of depression, although some episodes of depression begin without any obvious external cause.”

According to a research article (World Mental Health Day: India's Mental Health Crisis In Numbers) in Huffington Post, author Jacob Koshy says India is rapidly climbing up in rates of depression. “By the most conservative estimates, at least 5% of the population lives with a mental illness, which translates to over 50 million people”. (500 lakh or 5,00,000,000).

India with a population of 1.32 billion has less than 50 hospitals dedicated to mental health in India of which few leading ones are: NIMHANS (, VIMHANS and the Yerawada Mental Hospital. These are managed by the Government and are chronically plagued by resource crunch, lack of hygiene and corruption.

Gender sensitivity is also absent in some of these institutions. In fact incidents of rape are often suppressed in mental health care institutions, even in the West, given that human rights of mental health care patients is another issue in itself. Two articles found on ( and ( make shocking reading.

The scenario for Asia is not very encouraging either. A 2002 study published in World Psychiatry “Mental health and mental health care in Asia” ( author Deva Meshvara says “Over 450 million persons are reported to suffer from mental or neurological disorders in the continent”. In another article ( “Mental Health Services in Asia: International Perspective and Challenge for the coming years”. Author Naotaka Shinfuku of the International Centre for Medical Research in Kobe University says in some places like Indonesia the ratio of beds to psychiatric care is at the alarming rate of 1: 600,000.

The WHO fact sheet ( on mental health care mentions that globally, more that 300 million / 300,000,000 or (3000 lakh) people of all ages suffer from depression.

The world awoke to a cruel manifestation of the neglect of mental health when the pilot of a GermanWings airliner (9525) Andreas Lubitz, deliberately crashed the aircraft he was co-pilot of, into the Alps in France in March 2014 apparently as he was nursing a grudge against his former girlfriend. 150 souls perished for no fault of theirs. If only he had sought help from counselors, perhaps this manslaughter could have been averted. The incident continues to weigh down on the German psyche having socio economic and geo political ramifications for future generations.

What compounds the problem further is a secretive attitude about mental health and a reluctance to bring it up in conversations. If however, they were dealing with a condition that may appear more tangible, like a cardiovascular condition, or arthritis, they would have a better chance of being understood as truly having a problem.

Speaking to Digital Discourse, Mamtha Rajesh a Senior counsellor in Bangalore says “Mental health is also a health issue … like we go to the doctor for physical ailments or illnesses … we need to regularly consult psychiatrists to address our mental health issues”.

Mental health being largely absent from the public health administration in the world today, it has seized the attention of WHO ( To make mental health a priority, the World Health Organisation of the United Nations has started investing in mental health. In a press release WHO says “Every US$ 1 invested in scaling up treatment for depression and anxiety leads to a return of US$ 4 in better health and ability to work, according to a new WHO - led study which estimates, for the first time, both the health and economic benefits of investing in treatment of the most common forms of mental illness globally”.

The new study calculated treatment costs and health outcomes in 36 low -, middle- and high - income countries for the 15 years from 2016-2030. The estimated costs of scaling up treatment, primarily psychosocial counselling and antidepressant medication, amounted to US$ 147 billion. Yet the returns far outweigh the costs. A 5% improvement in labour force participation and productivity is valued at US$ 399 billion, and improved health adds another US$ 310 billion in returns. “We know that treatment of depression and anxiety makes good sense for health and wellbeing; this new study confirms that it makes sound economic sense too,” said Dr Margaret Chan, Director-General of WHO in a press release on 13th April 2016 ( “We must now find ways to make sure that access to mental health services becomes a reality for all men, women and children, wherever they live.”

Depression is often a taboo topic and the term isn’t used accurately. Using depression as a synonym of feeling sad or gloomy can be misleading. Alternatively, not mentioning anything at all when one really is going through a low phase can be dangerous. Some symptoms of depression are prolonged sadness or feelings of emptiness, feelings of hopelessness, helplessness, and/or worthlessness. Often the primary problem reported can be angry outbursts, irritability or difficultly in concentration, restlessness, fatigue, and chronic pains and aches. A common benchmark for professionals to understand depression is changes in sleep and appetite (a change into too much or too little). Certain other vital signs to note are a loss of interest in activities, and withdrawal or isolation from friends and family. Often these may be accompanied by thoughts of self-harm, and suicide.

Anxiety is documented as having impact on physical health. A case in point is the documented increase in occurrence of hypertension in Nicobarese in the Asian Tsunami - ravaged Indian archipelago of Andaman Nicobar Islands in the Bay of Bengal.

Documentation has established binging and bulimia in people suffering from break ups in relationships which can cause deleterious health hazards like diabetes, hypertension, amputation and strokes; prompting medical practitioners to bemoan the neglect of mental health care in public health.

Latest research is probing pharmacological, therapeutic and alternative interventions for depression. It has been established that cases of acute depression, demand pharmacological intervention. Psychotherapy is useful either in combination with medicines, or without. The efficacy of psychotherapy lies in the fact that it can help in dealing with the symptoms, and triggers that may have played a role in it. Some examples of external triggers are: grief over the death of a loved one, or going through a job loss. Without societal support, depression can feel debilitating.

Fortunately today there is a greater awareness and people are willing to seek counselling to remedy or heal their sense of loss. 39 years old Ms. Natalia Whitaker (name changed) a US media professional posted in New Delhi was devastated on discovering that she had Type II diabetes; she knew that her sedentary lifestyle, consummate passion for junk food, Delhi Belly, stress from squeezing deadlines and a broken marriage were to blame. She took professional counseling in a leading hospital in New Delhi, and started addressing her emotional need for seeking self-pity by facing the situation head on.

Coming to terms with the bitter truth took a month during which she made conscious efforts at consuming fibrous food. Next she booked up for yoga and aerobics classes. Gradually she consciously cut down eating junk food and went for long walks while listening to classical music. Within six months, not only was her blood sugar under control, but she had also developed a positive attitude to nutritious, healthy food, gave herself ample time for recreational activities, gave up sedentary lifestyle, and had figured out a work life balance for herself. It was another instance of canning mental health care.

Back in the early 2000s when ER (name concealed) discovered he was HIV + ve, he decided to live life to the fullest - after counselling. He founded the Karnataka chapter of Network of Positive People, married a HIV +ve widow and went ahead to beget a child – which after sufficient medical precaution and protocols turned out to be HIV – ve. He lived to tell the tale and counsels other HIV +ve persons now.

Media percolates awareness, and triggers change in society – positively; and can be the most effective game changer.

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Tags: Mental Health, Media, awareness, counseling.