Chronic Depression Specialist in Gurgaon: Understanding Persistent Depression

Have you ever thought about times where you've felt "not myself" for such a long time that you're starting to forget what being "normal" really feels like?
You might not be crying all the time.
You may still go to work each day.
You're helping to take care of your family.
You're meeting deadlines.
You're going to social events.
You may even be smiling, laughing and appearing absolutely fine to those around you.
However, within the background of all of this, you may feel an ongoing, persistent feeling of sadness, emptiness, lack of motivation or emotional exhaustion.
You may wake-up every day, feeling exhausted before you even start your day.
Things that used to excite you, don't seem as exciting to you anymore.
You may find that you avoid people, put off things until the last minute, lose focus easily, or spend most of your time thinking that things could have gone better - but you don't have a clue as to how to make them better.
As you've been experiencing these same feelings for a very long time, you may have quit identifying it as depression.
You may just say:
"this is just my way."
"I'm naturally pessimistic."
"I'm never going to be ambitious anyway."
"I tend to be pretty low."
Or maybe your family will tell you:
"You've always acted like this. What's the big deal? Now you want to get treated?"
But sometimes we accept what we think is a personality trait in a form of persistent depressive disorder.
So that is what i would like to talk about today — chronic (persistent) depression; how it looks, when we often fail to recognize it as such & when to seek professional help.

What is chronic depression?

People generally associate the word depression with images of someone who cannot leave his/her bed, cries constantly, cannot work or withdraws completely from society.
This type of depression can occur. However, depression does not always display itself in extreme ways.
Some individuals experience a continuous, low-level depressive process instead of acute periods of intense symptoms.
We call one of the forms of persistent depression — persistent depressive Disorder or dysthymia — a combination of a chronic depressed or low mood plus other depressive symptoms lasting for an extended period.
The duration of symptoms in adults needs to be at least two years. The actual clinical presentation varies among individuals.
Therefore, a reason that chronic depression may be overlooked is due to functional levels.
Function means that the individual continues to perform daily activities. They report to work. Attend meetings. Care for their children. Pay their bills. Fulfil their obligations. However, functioning and mental wellness are not synonymous terms. An individual may be very functional and still suffering greatly.

How does chronic depression actually feel?

Chronic depression can manifest differently depending upon the individual.
For many, it involves an overwhelming sense of sadness.
For others it involves a general feeling of emptiness or being emotionally numbed.
Many describe it as:
"I am neither happy nor sad."
"Some things just feel like too much effort."
Individuals may also note a decrease in interest in things that had previously brought them joy. Although they may participate in them — either because they feel obligated to or they have lost interest in pursuing them.
Reduced energy is another common symptom. Many individuals experience excessive fatigue both physically and mentally. Sleep patterns may change and appetite may fluctuate as well. Concentration and decision making may become increasingly difficult for many. Even simple tasks can prove exhausting. Finally, negative thinking develops into a habitual pattern for many individuals suffering from chronic depression:

• They anticipate that everything will go poorly.

• They are excessively critical of themselves.

• They feel as though they are not accomplishing enough or are not good enough; or that everyone else is accomplishing far more than they are.

Eventually these types of thoughts become so automatic that they are not recognized as symptoms:
"This are just how I think.”

Why do so many people struggle with depression for years before getting help?

There are a number of reasons. The first is normalization. If you've experienced those feelings of being low-energy, uninterested, and hopeless for five or ten years, you might not be able to compare those feelings to anything else. As such, you might believe this is just part of your personality. Second, people often confuse functioning with depression. People will tell others: "I'm going to work today; therefore, I am not depressed." However, people do not need to completely cease functioning to warrant treatment for depression. Depression comes in different levels. Third, there's a stigma surrounding mental health. Some individuals fear that by seeing a psychiatrist, they're admitting weakness, instability, or incompetence. However, depression is not a lack of will power. Depression is a complex, multi-factorial condition caused by the interplay of biology, psychology, and social factors. Finally, some people haven't ever really gotten a thorough assessment. They may have been managing their own symptoms for years -- through hard work, distraction from their thoughts (e.g., travelling), exercise, job changes, or even telling themselves to "stay positive." While those strategies may certainly provide temporary relief and possibly assist in reducing symptoms, they probably won't eliminate them when there is an underlying depression.

This differentiation between chronic depression and episodic sadness is very important. Everyone feels down occasionally. We all go through tough times in our lives. A relationship may end. Financial burdens may occur. Work pressures could develop. Grief may strike. Family conflicts may arise. Health issues may emerge. Feeling low during difficult periods is a natural response to adversity. Chronic depression involves a prolonged series of depression-related symptoms. Symptoms extend well beyond typical ups-and-downs in mood and begin to interfere with thought processes, emotional responses, and behaviors. When assessing chronic depression, the length of time of the depression episode(s), the severity of the symptoms, co-occurring symptoms (i.e., physical or emotional), and how much it affects your ability to function in everyday activities should be considered. This is why obtaining an accurate and complete evaluation by a psychiatrist is essential. It's not enough to simply determine if someone is feeling "sad."

While most people perceive chronic depression as mild depression that remains stable over time, this is not always true. Someone who has experienced a lower-level of depression for extended periods of time may find themselves entering into a period of higher levels of depression. Such increases in depression can stem from various sources, including stress, illnesses, or major life events; and sometimes without identifiable causes. Therefore, someone who states: "I've always felt a little bit depressed," may indeed be experiencing greater levels of depression than previously realized at this time. For this reason, ignoring symptoms that have persisted for a long time is not advisable.

How does one go about visiting a psychiatrist after enduring chronic depression?

Firstly, treatment does not necessarily mean taking medication immediately upon arrival. First and foremost, we must identify exactly what is occurring. A comprehensive psychiatric evaluation includes identifying the symptoms you are currently experiencing along with their duration and intensity and how they are affecting your functioning. We also assess the quality and quantity of your sleep and appetite, your energy levels, concentration abilities, presence of anxiety symptoms and/or irritability, and how your symptoms are impacting your relationships and work performance. Additionally, we evaluate past treatments — whether you have attempted medication in the past, whether you participated in psychotherapy in the past, for how long did you receive treatment, did treatment benefit you, and were there any known adverse reactions? Your physical health must also be evaluated. Certain medical conditions; nutrient deficiencies; hormone imbalances; medication use; and substance abuse can cause or exacerbate symptoms similar to or identical to those found in depression. In addition, sometimes depression occurs concurrently with other psychiatric disorders — specifically anxiety disorders. Thus the goal is not merely labeling you as having chronic depression. The goal is to establish the total clinical picture.

Do chronic depressions need to be treated with medication?

No! Treatment is specific to each individual! Depending on the degree and type of symptomatology that you exhibit; treatment may include psychotherapy; medication; behavioral/lifestyle modifications; or combinations thereof. Psychotherapy can be especially beneficial when examining longstanding thought patterns of negativity; low self-esteem; avoidant behaviors; interpersonal difficulty; and coping mechanisms. Medication may be indicated when your symptoms are persistently present; moderately to severely debilitating; substantially impairing your functioning; recurrent; or when other therapeutic approaches alone fail to address your symptoms effectively. And if medication is prescribed — it is important to know that antidepressants are designed to treat your symptoms and improve your functionality — they will not alter your personality or lead to dependence.

Additionally — treatment needs monitoring — the initial treatment plan may not be the last treatment plan. Over time the response to treatment may need to be reassessed — and depending on the results of the review — adjustments made to the treatment plan as necessary.

What if you have tried treatment and you continue to be depressed?

In such cases — an expert consultation can prove invaluable. A patient may state: "I have tried two or three antidepressants — none of them worked." Before drawing the conclusion that depression cannot be treated — numerous questions must be asked.

• Was the diagnosis accurate?

• Was the medication appropriate for your symptoms?

• Was the medication taken consistently?

• Was the dosage sufficient for the desired effect?

• Were there considerable side effects?

• Did you receive psychotherapy?

• Have untreated anxiety symptoms/ substance abuse/ sleep disorders /medical conditions been identified?

• Are there ongoing psychosocial factors contributing to maintenance of your depression?

Also, patients may have responded to some extent — but failed to recognize that even partial improvement can be clinically meaningful — providing direction for future treatment.
Therefore — "the treatment didn't work" does not equate to "nothing will work."
Long-standing depression requires patience; careful assessments; and sometimes a more inclusive treatment approach

What can family members do?

There are many ways that family members can support individuals struggling with persistent depression; however, probably the best way they can assist is by avoiding attributing the individual's depression symptoms to lack of effort.
Instead of saying:
"You have everything. Why are you depressed?"
Try asking:
"How have you actually been feeling lately?"

Encourage him/her to see a professional without being judgmental.
Depression can impact relationships.
An individual withdrawing from others doesn't automatically equate anger at those individuals.
A disinterested person doesn't automatically equate ingratitude.
Someone constantly procrastinating doesn't automatically equate laziness.
The depression itself often impacts an individual's motivation, energy and ability to participate in activities/interactions.
Family members also do not have to assume full responsibility for helping someone recover.
While supporting a loved one is extremely helpful, it will not require the family member to become the individual's psychotherapist or carry all the burdens associated with his/her mental health issues.
Both the individual and the family can benefit from professional assistance.

When should you definitely seek help?

Don't wait until depression becomes serious before you seek an evaluation.
Consider seeing a mental-health professional if you've had continuous feelings of sadness, loss of interest in activities, low energy levels, changes in sleep/appetite patterns, difficulty concentrating, excessive guilt, hopelessness, low self-esteem or withdrawal from work/social activities.
Prompt attention from a professional is necessary when considering suicidal/homicidal ideation, self-mutilation or beliefs that life is no longer worth living.

One last thing i want you to remember

You can receive help regardless of how functional/nonfunctional you may appear.
You don't need to be unable to leave your bed.
You don't need to cry daily.
You don't need to have some sort of dramatic meltdown.
You can be successful, reliable, productive and yet experience depression.
Perhaps the most important reminder is this:
If you have felt down for so long that you're beginning to believe this is just who you are, it might be worth exploring the possibility that you are suffering from undiagnosed and untreated depression.
Persistent depression is diagnosable.
Persistent depression can be treated.
Treatment does not necessarily involve changing who you are.
Treatment involves attempting to alleviate some of the symptoms that have prevented you from achieving a more complete version of your life.
Therefore, if you are searching for a chronic depression specialist in Gurgaon or have experienced prolonged depressive symptoms yourself or with a loved one, a comprehensive psychological examination would provide insight into what may be happening.
You don't have to let things deteriorate further before reaching out for assistance.
In fact, sometimes the initial steps towards improvement begins by acknowledging that the manner in which you have been feeling for years does not have to continue for the rest of your lifetime.