graphicwithart via Getty Images When coupled with depression, chronic loneliness can be hard to treat. Even when people accept they are lonely, depression makes them wary of connecting with people.

This article is part of Second Thoughts, a series on mental health in India.

A 29-year-old digital marketer based in Bengaluru is trying not to think too much about the fact that she doesn’t have any plans for the New Year, but she is, she admits, a “little concerned”. Holidays are never easy for her—having recently moved to Bengaluru from Delhi, she remembers being alone for Diwali last year. By the end of the day, she had had a panic attack.

“I was quite shaken,” she said. “So I am cautious when festivals come up. More than seasons, events now trigger my depression and anxiety.”

People living in countries which don’t get enough sunlight are sometimes prone to Seasonal Affective Disorder, a type of depression that emerges in particular seasons, especially winter.

India’s proximity to the Equator, says Kolkata-based psychiatrist Dr Aniruddha Deb, spares the woman from suffering this despair. But the end of one year and the beginning of a new one can be hard on many Indians too, especially with a line-up of festivals (and the attendant advertising campaigns and social media posts) reminding one that it is not ‘normal’ to be alone.

Depression, however, is not always connected to seasons and dates, and Dr Deb says that loneliness can be a primary cause. After all, it can affect a person any day in a year, across class lines.

“Lack of social interaction can give rise to a sense of despair for any individual. This then leads to depression. Loneliness can lead to psychosis, but that is rare. Depression is its most common expression,” he said.

The numbers vary on how many Indians suffer from chronic loneliness, but conversations with medical professionals and sufferers suggest that the count is significant. And while much is rightly written on how older people are often left alone once their children move out, not enough attention is being paid to the thousands of lonely young people in India.

“Lack of social interaction can give rise to a sense of despair for any individual. This then leads to depression. Loneliness can lead to psychosis, but that is rare. Depression is its most common expression.” - Dr Aniruddha Deb, psychiatrist

For at least some of the many who move away from their support systems to build lives and careers, the independence comes at the price of isolation. And their struggles to deal with this may be manifesting as depression and anxiety.

The woman mentioned above, who didn’t want her name to be used for this article, was 14 when her father passed away. “That’s when I was first diagnosed with clinical depression,” she said. She refused the medication she was prescribed, and the decade that followed was turbulent: “There were days I felt fine, but on others, I knew I had a problem.”

In 2015, when she decided to get herself a new prescription, the doctor told her she was also suffering from anxiety.

In the past three years, she has only relied on her pills intermittently. “I’m someone who is used to feeling emotions, and these medicines just left me numb. My apathetic self was just not me,” she said.

Some nights, she wakes up feeling fearful and anxious—it can take 3-4 hours to calm herself down. “When I would have a panic attack in Delhi, I’d have either my flatmate or a friend to comfort me, but I live alone in Bangalore now. There’s no one around to help.”

Not only did she change jobs and cities in 2017, she was also forced to pick up the pieces after breaking up with her boyfriend, one of the few people she had confided in about her depression.

“He would even come with me to the psychiatrist, but when we broke up, he said he was leaving me because he could not take all this nonsense any more. I felt altogether unlovable and alone,” she said.

According to Dr Deb, the burden of loneliness can be higher for women, who don’t always have as much access to public spaces and recreational facilities as men do.

“It’s always more difficult for a woman to start on a new job, to get a promotion, and to re-establish herself in a new city. There’s good reason for her to feel lonelier,” he said.

stevanovicigor via Getty Images Representative image.

The woman’s ‘impostor syndrome’, she says, leaves her insecure and under-confident at work. Her anxiety magnifies problems and she can, as a result, feel exceedingly overwhelmed. “It’s not like I can’t call my mother or a friend, but I constantly feel like I am not being able to communicate what I feel. And those are the times when I feel I am very lonely.”

She often finds her friends cannot grasp her suffering. She said, “It’s hard for them to understand because they have never felt something similar. My anxiety has physical manifestations. How is it possible for someone to comprehend that the anxiety I’m feeling is not letting me breathe properly?”

Where do they all come from?

The 29-year-old’s description of her anxiety suggests that the psychological can be physical too. In a 2014 study published in the Journal of the American Heart Association, a group of American cardiologists showed that clinical depression is as powerful a risk factor for heart disease as diabetes and smoking.

More recently, in October 2017, former U.S. Surgeon General Dr Vivek H Murthy said that loneliness reduces one’s life span more than obesity.

“The reduction in life span is similar to that caused by smoking 15 cigarettes a day,” he said.

Speaking to The Washington Post, Dr Murthy insisted he wasn’t being an alarmist when calling loneliness an ‘epidemic’.

“It’s far more widespread than people believe, and like many illnesses that are related to our mental and psychological state, it’s swept under the rug,” he said.

A study by The Economist, published in September, which surveyed representative samples of people in three rich countries, found that 9% of adults in Japan, 22% in the US and 23% in Britain always or often feel lonely, or lack companionship, or feel left out or isolated. According to figures published by the UK’s Office for National Statistics, 2.4 million adult British residents suffer from chronic loneliness. In January 2018, PM Theresa May even appointed a minister for loneliness, but long-term solutions have proved elusive.

In India, loneliness has never really been given much priority. There are many reasons for this—as a much poorer country than, say, Britain, addressing basic physical needs often take priority over isolation and mental health here. Also, accessing help for even more serious mental health issues continues to be a challenge, and hence, loneliness doesn’t get the importance it deserves.

The last official count of lonely Indians dates back 14 years. In 2004, the National Sample Survey Office found that 1.23 million men and 3.68 million women were living alone and suffered loneliness.

d3sign via Getty Images The burden of loneliness can be higher for women, who don’t always have as much access to public spaces and recreational facilities as men do.

To assess the attitudes, anxieties and aspirations of India’s youth (aged 15-34), the Centre for the Study of Developing Societies, along with German foundation Konrad Adenauer Stiftung, conducted a survey of 6,122 young people across 19 states in 2016. Their findings, released in April 2017, showed that 12% of the respondents confessed to feeling depressed often, while 8% said they frequently felt very lonely.

When coupled with depression, chronic loneliness can be hard to treat. Even when people accept they are lonely, their depression leaves them wary of connecting with people. In some cases, technology and social media creates an illusion of proximity that might seem enough, but for those who acknowledged their loneliness to this writer, Facebook and Instagram also made the lack conspicuous.

Torn between interdependence and the desire to strike out on our own, we find the loneliness puzzle hard to solve. While we wait for intervention, putting stock in empathy may seem the most viable option for now.

An existential crisis

Loneliness, psychotherapist Chetna Duggal reminds us, is in no way a new problem. In the early half of the 20th century, for instance, existentialist writers were trying to answer the question—should human beings connect with others or be by themselves? Duggal uses the metaphor of a porcupine to illustrate her point: “When porcupines huddle together, they start hurting each other. When they move away, they don’t feel warm enough. Similarly, when we’re too close to people, we feel suffocated. When we’re far away, we feel isolated. The problem was the same in the ’40s as it is now.”

“As we move away from a collectivist society, support systems break down. Because of globalisation, people are living far away from their families, and then social media is also coming in the way of actual human interaction” - Chetna Duggal, psychotherapist

Duggal, who also teaches at the Tata School of Social Sciences, adds, however, that while loneliness may be a perennial human problem, there is a big difference in its contemporary manifestation.

“What we’re seeing now is of a different magnitude,” she said. “As we move away from a collectivist society, support systems break down. Because of globalisation, people are living far away from their families, and then social media is also coming in the way of actual human interaction.”

In June 2014, a young woman moved from Hyderabad to Delhi. Ten days later, her home was burgled. Her career in publishing had barely begun.

“My laptop was stolen with everything else I owned. I was new to the city and the language. I had no friends here, and I didn’t know my colleagues or their numbers,” the woman, now aged 27, said.

The woman, who wanted to remain anonymous, remembers crying all the time as she ran from one police station to another. There were days in college when she says she’d prefer the dark of her room to the company of friends, but looking back, she finds it hard to think of a time she felt lonelier.

Four years later, the editor says things have gotten marginally better.

“I don’t feel physically lonely anymore,” she said. “I know I have friends I can reach out to. My inability to do that, however, is a different matter.”

While the woman says that the chronic loneliness came before the depression, she adds that she also suffers from anxiety now. Unable to express to others what she is feeling, the anxiety leaves her more isolated. Simple tasks like buying groceries have become difficult.

“I go and look at the vegetables, and I can’t decide what to buy. I break into tears and come home without anything. I live with my partner, and earlier this year, I realised my condition was taking a toll on him, so I thought I’d seek help,” she said.

Since January, the editor confesses to having been irregular with her therapy and her mood stabilisers. “I have changed jobs and a new environment does not help my anxiety. I think I’ll take my pills now.”

“Women and queer persons have, for ages now, seen that distancing from families is the only way to live authentic lives. In this process, if there is loneliness, of course the system and not the individual is to be blamed.” - Pooja Nair, psychotherapist

Duggal points to the fact that depression is often accompanied by anxiety, which brings with it its own set of fears.

“Anxiety and depression tend to co-exist. You want to be with people because you think that will make you feel better, but you’re also worried that people will judge you, so there can be some anxiety there.”

The publishing professional, for instance, has resolved to not ask her friends for help. “My friends are successful. They have money, I don’t. I feel like a loser,” she said.

Social media often triggers her loneliness, and she has often considered deleting her Instagram and Facebook accounts. “It reminds you of everything you are not doing.”

Turning to her parents is not an option, for a reason that many women living away from home will identify with.

“They’d only ask why I would not come back.”

Pooja Nair, a Mumbai-based psychotherapist, says that “women and queer persons have, for ages now, seen that distancing from families is the only way to live authentic lives. In this process, if there is loneliness, of course the system and not the individual is to be blamed.”

Nair stresses on the need for better support systems.

“The attitude of society towards these phases lead to a withholding or granting of support. The lack of support would then obviously make it difficult to deal with the transition period of each phase. The individual is then forced to build only internal resources,” she said.

No companions in grief

In The Lonely City: Adventures in the Art of Being Alone, Olivia Laing writes, “So much of the pain of loneliness is to do with concealment, with feeling compelled to hide vulnerability, to tuck ugliness away, to cover up scars as if they are literally repulsive. But why hide? What’s so shameful about wanting, about desire, about having failed to achieve satisfaction, about experiencing unhappiness?”

Having lost her boyfriend to a road accident last year, a Bombay-based lawyer seems to have had enough of concealing her loneliness. She told HuffPost India, “I have always grappled with the sense of never really belonging. I always felt I was talking past people or at them, never really to them. I felt like no one really understood me. This feeling only got further magnified when my boyfriend passed.”

In her book 'The Lonely City', writer Olivia Laing says that 'so much of the pain of loneliness is to do with concealment, with feeling compelled to hide vulnerability'.

Though her family never really addressed her loss, the 27-year-old was surrounded by friends during her hour of grief.

“The few people I was banking on came back and told me things like, ‘Shit happens’, ‘Worse things have happened’, and ‘You have to move on’. I think people should stop themselves from piling on the platitudes when someone is grieving. It just helped alienate me further,” she said.

In the beginning, Joan Didion’s books helped, but soon the lawyer found herself angry every time she would speak. When her sleep was constantly interrupted by nightmares, she decided to see a psychiatrist.

“I live alone. I’m the sort of person who can solve her problems on her own, so it became really important for me to fix this. The antidepressants helped more than therapy. It felt like I was walking through concrete at one point, but now I do not wake up with crippling grief.”

For the lawyer, loneliness was a mix of guilt, rage and fear.

“I was never a petty person, but I’d begun to begrudge people their happiness.”

It was “a moment of spite” that made her decide she would become well.

“The world can have their happily-ever-afters. I just told myself I’m going to be a good lawyer.”

Even the loneliest, it seems, must pull themselves up by their own bootstraps in the end.

Shreevatsa Nevatia is the author of How to Travel Light, a bipolar memoir.

This article is part of Second Thoughts, a series on mental health in India. Write to us here: secondthoughts@huffpost.in