I AM DEPRESSEDLETS TALK

A survey called National Mental Health Survey(NMHS) in 2016 conducted on 12 states by the centre
and implemented by National Institute of Mental Health and Neuro sciences (NIMHANS) Bangaluru
found that our West Bengal is the 4th worst state in respect to mental Health, only after Madhya
Pradesh Manipur and Punjab. This survey was commissioned by the centre after the passing of the
Mental Health Care Bill in2013 which provides protection and promotion of rights of person with
mental illness. The prevalence of mental diseases were twice as much in urban metros compared to
rural. The most common problems were depressive episodes and recurrent depression, the study
concluded.

In this scenario of things, being a psychologist in two major hospitals in the city of Kolkata and
directing a mental health clinic , for the last 20 years ,has not been an easy task. I shall share some of
my very own experiences in the field. All the mental health professionals are today multitasking, they
are overworked. They are taking care of different age groups (adults ,teen ,couples and senior
citizens, singles etc)providing treatment, rehabilitation , holding enrichment programmes for
preventing stress and depression, all the way from schools to corporate level and its still not
enough! As psychiatry psychology and social rehabilitation needs to be amalgamated for recovery. It
is a group effort needing a high group morale and dedication.

Although the stigma regarding depression is much less today , thanks to media both print and audio
visual, along with Deepika padokone ;s video on recovering from depression, we have still a long way
to go. It is still not half fashionable to say that you are under treatment for depression than to say
that you are dieting as you are under treatment for a raised Cholesterol level.

Acceptance of depression in the family setting, today, has become easier than on job and in the
corporate world. You wouldnt go to a lawyer, doctor or a psychologist, knowing that he /she is
under treatment for depression. Would you? The chances in these cases are high as according to
NIMHANS survey 1 in 15 adults in India suffers from depressive illnesses. On job very few people
admit the need for help for the fear of being stigmatized and overlooked for promotion. They often
avoid empanelled mental health professionals and rather prefer to go to private clinics for recovery.
Thus the burden increases. Employees (there are exceptions) often ask for psychological
assessments to terminate rather than to extend help. Hence we make it clear on the assessment
reports that it is a measure of the current mental state of the patient and meant for clinical use
only . More over we do not have insurance coverage for the treatment of depression which is also
one of the reasons why depression is under diagnosed and under treated today .Hence there are
plans to assess and treat depression in people on high risk jobs with the rising cases of depression.
WHO report predicts that depression will replace cardiac problems as the second most prevalent
global illness by the year 2020.

As the cities young ones are moving out for jobs and studies Kolkata is greying faster than all the
metros in India. Geriatric depression (depression in the senior citizen) is fast becoming a cause of
concern. The helpless and lonely senior citizens live a paranoid life shutting out the world every
evening only to invite depression . They are taken care of more for their physical ailments than for
their mental agony. All they need is companionship. Many of them form a unhealthy attachment
with house hold maids and paid caregivers, as there are no other people to love and care for. They
often fail to understand that there cannot be any good health without mental health. Lack of
personal autonomy , reduced mobility, nuclear family set up, misunderstandings due to generation
gap, and loneliness are factors that leads to the isolation of this extent.

Geriatric depression in Kolkata is paving way to another fast growing industry , to take care of the
elderly in their twilight years. A number of organisations like Tribacacare and Deep probeen
porisheba is coming up with in house services with assistance, counselling, medical care and
technology. Kolkata police in collaboration with non profit dignity foundation has set up dedicated
help lines and services to keep an eye on the elderly population of the locality. India will soon
become home to the second largest senior citizens population in the world and we have 25% of our
elderly population depressed. This definitely needs a wakeup call.

The other population which is fast creating a concern in depression are couples trapped in
incompatible relationships. These relations are often emotionally and or physically abusive. We have
incidents of pre nuptial to depression soon after the honeymoon period and depression complicated
by mid life crises of the spouses. Lack of communication and a healthy sex life pile on to make
symptoms worse, In a fast paced life ,the work- life balance is going for a toss and relationships are
becoming a burden soon after the bliss of togetherness. The new woman enjoying equal status,
today very often wants to take care of her own parents which does not go down well with the
husband and his family with deeply ingrained patriarchy. Demanding in laws abusive partners, lack of
adjustment with the added disaster of close friends on FB and : friends with benefits is ripping
couples apart, The greatest challenge in these cases is to get couple together for therapy after
addressing the blame game . It takes time to make them understand that their union is sick, and
they may not be abnormal as individuals.

Cases of childhood and teen depression often pour in the clinic in large number. Maximum number
of children are dragged to the clinic by parents with academic complaints rather than sad mood.
Children often suffer the burden of parental separation, physical and sexual abuse ,excessive study
pressure and sky high expectations from parents .,In case of teenagers its more about broken love
affairs ,year loss in academics, not being able to keep up the image and negative peer group
influences. Self harm (wrist slashing and suicidal threats etc) are to be taken as psychiatric
emergencies in this group. Here the challenge is to change the behaviour of the parents for positive
interaction. Most of these cases drop out of treatment if parents are directly told to change their
behaviour, They are more comfortable changing the childs behaviour! Isnt that the reason they are
seeing us? They fail to understand that the child cannot behave right unless they feel right.

There is yet another group which causes the mental health professional to worry, but needs to be
handled delicately as it involves other professionals. Depression is one of the most common
complications in chronic illnesses like arthritis, cancer, HIV/AIDS diabetes cardiac diseases Parkinsons
,infertility , Lupus etc. Many a time, some of the consultants and physicians ( not all) treat the
primary disease and overlook the co -morbid depression. Without counselling and treatment these
patients drop in to clinics in serious conditions. They become quite difficult to manage by then.
Women with depressed mood come to the clinic mostly when they are unable to perform in daily
chores, and life seems like a burden. Women are more prone to depression in certain phases of life
like after child birth (post partum depression), following operations like hysterectomy, menopause, in
pre menstrual phases, or after death of a loved family member ,divorce and mid life crises, etc. Most
men come with job stress relationship issues, after financial losses and when faced with crises post
retirement or after being affected by medical conditions like coronary heart disease, diabetes and
hypertension.

If Depression is here to stay, we need to gear up to fight it. The stigma needs to be addressed at the
outset. We need to remember , that ironically, there is not a word for depression in any Indian
language,(Mantle 2003).Maybe that is why, in the Indian context depression is often experienced in
the the form of physical complaints , vague aches and pains etc , rather than the emotional issues. It
is in the process of counselling and clinical history taking, that the full range of the symptoms of
depression is discovered. This is because physical complaints are more acceptable and often comes
with secondary gains like a day off, spending time away from daily chores, or extra attention from
the family members.

Depression is often treated with medicines like SSRI;s (Selective serotonin reuptake inhibitors) mood
stabilizers etc. Many people from all sections of our society have great reservations against
medicines. This is often made worst by trying to find out the effects and side effects of a particular
drug from Google! They do not realise that both effects and side effects vary from person to person
and the treating doctor is the best guide not the search engine ! They often harbour misconceptions
like the medicines are for nerves and will turn one into a zombie,(t hey will give instances of
distant relatives who underwent wrong treatment etc), or they often ask whether the medicines will
cause addictions etc. They have to trust the doctors treating them rather than go doctor shopping to
find out who will give the least number of medicines! What the patients need to understand is that
untreated depression can reduce the size of the hippocampusin the brain. Hippocampus is involved
in forming emotions and memory. There is a chemical imbalance of the neurotransmitters in the
brain, during depression the needs to be addressed through medication. It affects the way a person
thinks feels and behaves. Once the chemical imbalance is addressed re-wiring of the brain is
achieved.

Some of the people have a negative attitude regarding psychotherapy and counselling .They think it is
simply talk therapy and every one can do it. They do not realise that psychotherapy is not advice
giving nor it is just talking. It follows certain steps and goals which can only be achieved only by
trained and experienced psychologists and counsellors. Untrained counselling causes more harm
than good and can also lead to psychiatric emergencies like suicide ,and homicide and damaged self
esteem.

It has been proved that psychotherapy and counselling done by trained and experienced
professionals can bring about changes in the brain too, like the medicines do. . For example when we
learn a new skill or a new method in maths, the brain changes with rewiring to reflect new learning.
Similarly when we are depressed we live in a depressed way. Psychotherapy is capable of bringing
about brain changes (changes in cellular structure of neurons as well as in the level of
neurotransmitters) by helping the patient to live in a non depressed way. We behave the way we
do because our brain reacts in a certain way to our environment. All new information or changes in
our behaviour or habit are stored in the brain,. Whenever we learn a new way of thinking and
behaving our brain changes to reflect the new behaviour leading to recovery .This is because when
we change or behaviour following effective therapy and counselling the brain will change to reflect it,
in thoughts words and actions. The popular Hindi movie Dear Zindagi did show some of the
important aspects of a therapeutic relationship and the process of recovery from depression.

Family members of depressed patients need psycho education and counselling regarding the disease.
Expressed Emotion (EE) is a measure of the family environment based on how the family members
talk spontaneously about the patient. Emotional expressions, both verbal and non verbal that is
what the relatives and friends say to the patient is important in the recovery process. Family
members with high EE are hostile overly critical and not tolerant about the patient. They believe that
the helping the patient by trying to control him and telling hi what is the right thing to do. , But in
reality ,they often exacerbate the symptoms of depression or lead to relapse.! 3 dimensions of EE
are hostility, emotional over involvement and critical comments,

If any of your family members are suffering from depression your support and encouragement can
play a significant role in recovery ,Be a compassionate listener not a mere advice giver, make him/her
understand that depression is a medical condition which needs professional help. Read up on the
treatment and explain it to her/him to do away with the fears .Do encourage physical activities
( natural depression killer) take walks or exercise together, reading books can also act as therapy in
infusing new thoughts and ideas in the mind replacing the depressed thoughts. Encourage healthy
diet by cooking and eating together. Music movement and meditations are the three well known
healers of depressed mood.

If we need to stop the depression bugfrom spreading in the society, we need awareness
programmes for all so the symptoms can be identified and addressed at the earliest, We need
adequate number of trained metal health professionals, and basic training in the management of
depression for other consultants too. We do not have decent rehabilitation homes dedicated to
depression .It is mostly treated in state hospital and private hospital OPDs , in NGO and private
clinics. Self help group for depression is almost nonexistent in our state .This is the need of the hour..
Addressing the above issues will help in resilience of our people. The emotion of feeling sad unhappy
and disappointed are a part of human beings natural existence. Such emotions can be associated
with any setbacks. However depression as a disease sets in when a person fails to bounce back
(Resilience).No matter what causes depression talking about it and sharing the feelings with friends
and journal keeping helps in a very simple way .Time has come to teach our children how to deal
with depressed mood along with how to deal with common cold. As author Cheryl Richardson said
PEOPLE START TO HEAL THE MOMENT THEY FEEL HEARD
 Some of the symptoms of depression (Source of NIMH)

Persistent sad, anxious, or empty mood

Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities
Decreased energy, fatigue, being slowed down
Difficulty concentrating, remembering, making decisions
Difficulty sleeping, early-morning awakening, or oversleeping
Appetite and/or weight changes
Thoughts of death or suicide, suicide attempts
Restlessness, irritability
Persistent physical symptoms

IF YOUR ARE EXPERIENCING ANY OF THE ABOVE SIGNS AND SYMPTOMS FOR TWO WEEKS CHECK UP FOR
DEPRESSION I MAY BE NEEDED,

MS PAROMITA MITRA BHAUMIK

www,paromitamitrabhaumik.com

CONSULTANT PSYCHOLOGIST (BELLE VUE CLINIC AND .EEDF) / LEARNING AND DEVELOPMENT COACH/ DIRECTOR AT ANUBHAV
POSITIVE PSYCHOLOGY CLINIC

CONTACT-/ WRITE TO ---9051670642;/paromitaforyou@gmail.com