Beyond the Blues: How to Recognise Depression and Find Real Help

Imagine you wake up each morning thinking about your body. You think your body is made out of wet cement. It's not just being tired, it's much worse than that. You've got all these things you need to do today (answer e-mails, make some tea, etc.) and even though everything appears normal, you're looking at yourself from the outside. You are here, but you are not really here.

If this is exactly how you feel, then you are not making this up. Also, you are definitely not alone. 

Worldwide over 280 million people have depression according to the World Health Organization. Depression is also one of the leading causes of disability in the world. In India, estimates suggest that almost one in seven people may develop a mental health disorder during their lifetime. Depression is certainly the most frequent type of mental health problem. However, because depression affects so many people it is often misunderstood. People suffering with depression can be viewed as weak. They can be called lazy. Or they can be told that they are going through a temporary phase. 

The purpose of this article is to provide information to anyone who has questioned if what they are experiencing is more than average sadness. The purpose of this article is also for any person who wants to support a loved one by understanding depression and finding ways to support. 
Depression is a physical disease. So are its cures.

What is Depression, Really?

Depression, medically referred to as major Depressive Disorder (MDD), is not a mood. It is not a personality defect. It is a brain-based illness. It disrupts how one thinks about themselves, their moods, and ultimately, their ability to perform everyday functions for days, weeks, months or even years.

The fundamental aspect of depression is disrupted brain chemistry. Specifically, there are issues related to several types of neurotransmitters such as serotonin, dopamine & norepinephrine that regulate one’s mood, motivation, and overall emotional processing. Depression is a physical problem of the brain and cannot be “willed” away any more than you could will your broken bones healed.

Depression can occur to anyone. Whether they are a high-powered executive, devoted parents, or teenagers who appear to have everything going for them - depression knows no bounds. It has no age limitations. It has no gender bias. It has no income limitation. It has no social or educational limitation.

What Does Depression Feel Like?

Describing depression in words is often inadequate because it makes it difficult to understand what someone with depression actually experiences - which is one reason why it takes such a long time for many people to identify that they may have depression.

Many people with depression say that instead of feeling sad all the time, they experience a sense of emotional emptiness. This is similar to being emotionally numb - when almost anything one usually enjoys doing doesn’t bring any enjoyment. When things previously caused happiness like, listening to music, eating food, enjoying quality time with friends/family - now seem pointless or annoying.

Additionally, there are very specific ways in which depression impairs one’s thinking. One way this happens is by creating a mental “fog”. This creates significant problems for concentration, memory, and decision-making. For many people with depression, an inner voice criticizes their thoughts constantly - telling them they are a burden, that things will never improve, and that they do not deserve support.

Physical aspects of depression are just as prevalent. Fatigue, sleeping too little and, or,  waking up multiple times during the night, changes in appetite, chronic pain (headaches), and general malaise are all examples of how physically debilitating depression can be.

Common Myths About Depression - And the Truth

Most people know there are negative beliefs surrounding depression. Below we briefly discuss several and provide an honest and straightforward way to express those same ideas. 

“Depression is simply sadness.”
While sadness is a natural, temporary reaction to a series of life events (depression is a persistent mental health disorder that typically doesn't appear as the result of any specific event). 

“If I would only think positively or get out and exercise or put my mind to it, then I wouldn't be depressed.”
Clinical depression is not a motivational issue or an incorrect way of thinking. While, both physical activity and attitude certainly influence one's overall outlook; neither positive thinking nor better lifestyle choices constitute a treatment for clinical depression, which is similar to saying that better diet and/or exercise treat type-2 diabetes. 

“If I were strong enough or had enough self-control or was smart enough...I'd never develop depression.”
Developing depression does not requires less strength, motivation, intelligence, etc., than most people believe. In fact, many highly successful, creative individuals throughout history have been diagnosed with depression. 

“Taking antidepressant medication changes who you are.”
Medications used today to treat depression are meant to create balance within your brain chemistry and do not intentionally change your personality. In fact, taking these medications may make it possible to "be yourself" once again.

When It Goes Beyond Sadness: Warning Signs to Be Aware Of 

Recognising depression - either in oneself or in someone else - is generally the biggest hurdle to getting help. This section will discuss some of the common warning signs to look for when determining if your sadness has gone beyond normal sadness: 

• Persistent low moods most of the day, almost every day, for at least two weeks 

•  Loss of interest or pleasure in things you used to enjoy (anhedonia) 

• Significant changes in sleep- insomnia, oversleeping 

• Changes in appetite & weight - eating much more or less than you normally would 

• Fatigue & lack of energy even after resting 

• Difficulty concentrating, memory loss, making decisions 

• Feeling worthless, excessive guilt or hopeless 

• Withdrawn from family & friends & other social interactions 

• Unexplained physical symptoms - headaches, stomach issues, constant back/neck pain 

• Thoughts of death or suicide; feeling like a burden on others 

As long as 5+ of those signs have been there for 2+ weeks, it is now time to get professional assistance. Do Not Wait. 

If you or anyone you know has thoughts of self-harm or suicide, contact a mental health provider or call a crisis hotline NOW. 

Treatment Options

The good news here is depression is treatable. Most people who suffer from depression find great relief through treatment. But finding the right treatment can be challenging since each person may respond differently to different treatments.

Below is a general breakdown of the currently recognised treatment options that are backed by science.

Psychotherapy

Depression is usually treated using some modality of psychotherapy (psychological treatment) in combination with drugs. 
There are many different types of psychological treatments for depression. One of the best known is Cognitive Behavioural Therapy (CBT). 
CBT helps individuals understand what they think and feel and then challenges those thoughts to find new ways of thinking. This process is helpful because it allows individuals to see their lives in a more balanced way rather than being overwhelmed by negative thoughts.
Additionally, other types of therapy have been shown to be successful. Interpersonal Psychotherapy (IPT) looks at the relationships we create and how changes in our lives affect us. Mindfulness Based Cognitive Therapy (MBCT) is a type of therapy that teaches mindfulness skills combined with cognitive behavioural therapy techniques. Psychodynamic Therapy examines how our emotions are influenced by experiences from our past and unconscious feelings. 
While you may view therapy as simply "talking about your problems," it involves a highly trained professional working with you through a structured plan to provide you with tools to develop long-lasting emotional strength.

Medications for treating depression: 

Antidepressant medications 

When your symptoms of depression are mild to severe, there are times when doctors recommend that you take an antidepressant while going to therapy. These medications function to make adjustments to the chemicals in the brain so that you will begin to experience a more stable mood. 
The common categories of antidepressant medications currently prescribed today are SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors).

A New Solution for Treatment Resistant Depression: rTMS 

In addition to various pharmacotherapies, a growing number of individuals diagnosed with treatment resistant depression are turning to neuromodulation treatments like Repetitive Transcranial Magnetic Stimulation (rTMS) and Transcranial Direct Current Stimulation (tDCS),

When Inpatient Care Is the Right Step

There are times when outpatient services and psychiatric medicine can effectively treat your symptoms, however, there are also instances where your condition could benefit from a higher level of care. Recognising when you need a more intense level of care is a sign of strength, not weakness. 
Inpatient services at one of our hospitals may be necessary if:
The depressive symptoms cause significant dysfunction to perform tasks associated with your life. 

• There are thoughts of suicide or causing harm to oneself.

• Prior treatments through outpatient programs were ineffective.

• Changes to medications are required in a medical/psychiatric hospital setting.

• Safe, structured settings are required to stabilise and begin the process of healing. 

What does Inpatient Care Entail? 

Our inpatient depression program, while offering a secure place to stay, provides so much more than a safe place to sleep. Our patients receive round-the-clock psychiatric support, a structured schedule for each day, which includes access to all forms of therapy (e.g., individual therapy, cognitive training, and mindfulness), and they can start taking advantage of advanced forms of treatment such as rTMS and tDCS under constant supervision. 

Just as importantly, we remove our patients from the stresses that are likely contributing to their depression (work pressure, relationship conflicts, home disorganisation) and allow them time and a safe environment in order to truly heal. 

At Adayu, we believe that true healing takes more than managing symptoms. We take a holistic approach and address the biologic, psychologic and social aspects of your depression equally. 

Healing takes more than managing symptoms – you deserve better.

Depression often makes you feel like nothing will improve again. This lie is a common experience shared by millions of people worldwide. People do recover from depression every day, even after years of suffering, trying different medications, feeling hopeless. today’s treatment options have never been greater than they are today. With numerous forms of proven psychotherapies (i.e. CBT, DBT) and new neuro-stimulation based therapies (i.e. rTMS and tDCS), there has never been a more promising time to seek help for your depression and find your way back to being you.

Your journey will not always follow a straight line. Sometimes you will encounter challenges and setbacks. However, working with a skilled professional staff – individuals who will actively engage with you individually, develop personalised approaches for you to manage your depression, and won’t give up on you when something initially fails – is key to successfully recovering from depression.

Start your journey now - adayu will be here to support you.

Adayu Mental Health Hospital, situated in Sector 38, Gurugram is an inpatient psychiatry hospital dedicated to treating people experiencing depression, anxiety and other mental health disorders using compassionate, research-supported methods. Each member of our multi-disciplinary team of psychiatrists, psychologists and therapists collaborate to develop treatment plans tailored specifically to the needs of each patient. 

You don't have to figure this out alone.