May 15, 2020

Depression: the dark cloud

Hemas Hospitals


Most of us have those sad and gloomy days, especially in this day and age where stress seem to follow us around. Sadness or unhappiness is a normal reaction in time of adversity. These feelings are usually short lived and proportional to the loss.

Which brings us to our real question: what is depression?

Medically, depression is categorized under a group of disorders called ‘mood disorders’ where the central feature is the abnormality of the mood. Someone is said to be suffering from depression when they feel low or an intense sadness that does not go away quickly or become so bad they start to interfere with their everyday life.

The sad truth is that most of us shy away from seeking help due to the embarrassment or the social stigma that surrounds depression. But depression is just like any other serious medical condition which should not be left untreated. It could get so bad that some would actually consider ending their lives through suicide which is why depression should be taken serious.


Is it as common as we think it is?

Yes, it is very common.

  • 1 in 5 people become depressed at some point in their lives.
  • 2-5% suffer from major depression in community samples
  • Can occur in any age group from children to elderly, but the mean age of onset is 27 years.
  • Females are twice as likely as males to develop major depression
  • Depressive episodes usually lasts for 1 month to 6 months. However in about 10-20% it becomes chronic and lasts for more than 2 years.

Is bad and stressful times the only reason for depression?

It is normal to think that depression is caused by difficult times thrown in our way. But like many other illnesses, depression is also multifactorial.

The causes of depression can be put into 3 main categories

Like most diseases, depression too can run in your genes. If there is a family history of depression or suicide you are considered at risk. However it does not necessarily mean that you would get depressed when the time comes. It only means you are more prone to get depression at times of adversity compared to someone who does not have a family history.

Long term physical illness like cancer, stroke, organ failure or chronic pain is often associated with depression. These patients have to undergo a lot of stress other than the stress of the illness itself. They are psychologically distressed, facing financial difficulties and the general quality of their life is compromised. All these add up to cause depression in these patients. So counselling is an important aspect of the management of these patients.

  1. Psychological causes

An individual’s personality play an important role in the development of depression. A person who has a low self-esteem, tendency to worry and be sensitive and dependent on others opinion might be more vulnerable to depression.

Someone who lacks good interpersonal relationships are more vulnerable to depression. On the other hand it is much easier for someone with good relationships to get out of depression as he/she has the necessary social support to cope up with stressors.


  1. Social causes

Personal loss and psychosocial stressors act as the immediate precipitant of depression. These are the common reason we hear all the time like death of loved one, a break up or a divorce, financial problems, unemployment etc.

Signs and symptoms

In depression, patients mostly complain of low or depressed mood along with other features like

  • Loss of interest and enjoyment
  • Reduced energy and activity
  • Reduced concentration
  • Reduced self-esteem and self confidence
  • Feeling worthless
  • pessimistic
  • disturbed sleep
  • loss of appetite
  • ideas of self-harm

In milder forms the patient would wake up feeling fresh but the mood will be lower towards the end of the day. As the condition worsens we will see the patients starting to neglect themselves. Further in to the disease there will be appearance of psychotic features like delusions and hallucinations.

If you are having any of these feature, consult a professional immediately.


Diagnosis of clinical depression is made using either of the two criteria; ICD-10 or DSM-5 classifications

Both of which analyses the signs and symptoms of depression the patient has and classify them according to severity so that it would be helpful in the management of individual patient. Symptoms should be present at least for a duration of 2 weeks.

Another important aspect in the diagnosis of depression is to see if the current episode is due to depressive disorder where the primary abnormality is in the mood.

It is also important to differentiate depression from other possible diagnosis like a grief reaction, adjustment disorder, dementia, schizophrenia, somatoform disorder.


Before starting treatment, it is important to figure out what kind of depression you are dealing with.

It can be a mild depressive episode all that you need could be proper guidance and family support. When it’s moderate to severe depression pharmacological management will be considered which means a psychiatrist will prescribe you drugs known as anti-depressants. The 1st line anti-depressant used is a group drugs known as SSRIs which seem to be very effective.

Educating the patient and the family and providing a supportive environment is an integral part of the management of these patients. Considerations should be made to minimize the risk of harm to one’s own life and the lives of others. Further measures should be taken to ensure optimal quality of life for the patient and the family and prevent relapses.


Follow up

About 85% of the patients who develop depression would experience more than one episode.

Therefore it is important to follow up these patients to assess the symptoms, risk to self, drug compliance and side effects of the drugs.


You could work on your coping mechanisms, give more time to your hobbies and interests. Make sure you spend our leisure time wisely. It is also important to concentrate on the positives in life rather than the negatives and surround yourself with good company.

The biggest problem faced today when it comes to depression is the lack of awareness. So it is important to spread awareness at a community level so that people won’t be as reluctant as they are now to seek help. It is important to know that it’s okay to ask for someone’s help.  Further, through proper awareness it’ll make it possible for us to see the signs of depression in our loved ones, so we can be the support they need to get through this battle. It is sad to think that so many lives lost due to depression only because nobody could help them overcome it.