India is the most depressed country in the world. Don't believe us? According to the World Health Organization (WHO), India's depression levels are as high as 36 per cent and shockingly this number is the highest in the world. What makes this even more alarming is the fact that WHO projects depression to be the second leading cause of disability worldwide by 2020. However, the biggest challenge lies elsewhere; it is about mental and physical illnesses being treated differently in our country.

We’re not comfortable talking about depression.

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Let's accept it. In an age and time where we all are fighting hard to prove our mental prowess, it is considered shameful being diagnosed as mentally ill. It was not until Deepika Padukone brought the term depression out of closet in India that mindsets started to change against the unspoken suggestion that any kind of mental illness should be veiled from society.

Interestingly, in a quick Twitter poll on TOI Health, people were asked if they were diagnosed with depression, would they feel comfortable revealing about it to their colleagues and neighbours. Out of the 910 people who participated in the poll, 50 per cent said they would reveal their condition and the other 50 per cent admitted that they would not be comfortable with it.

While it would be right to say that we are gradually letting the term 'depression' trickle in to our day-to-day lives, have we accepted it fully yet? It is odd how if a loved one mentions their plan to visit a psychiatrist for help, we won't feel the same sense of liberation that we sensed earlier. This sort of admission from our loved one clouds our mind with doubts and suspicion.

The two biggest challenges in treating depression are the social stigma attached to it and the lack of awareness and knowledge about the illness. Anna Chandy, Chairperson of the Board of Trustees, The Live Love Laugh Foundation explains, "Due to these two factors, individuals who are affected by depression (as well as their family members), not only fail to recognise the onset of depression but also try to suppress or refuse to acknowledge that there could be a problem." When it comes to actually treating depression, we need to empower society with greater awareness of mental health and put in place the appropriate structure, framework and infrastructure that will help in combating this. This includes raising awareness which we believe will eventually help in reducing the stigma. This is what the Live Love Laugh Foundation has set out to do, she adds.

Often, we fail to see it coming and don’t get help in time.

According to a depression campaign that spanned over three weeks called #BattleTheBlues, 83 per cent participants were found to suffer from moderate depression and 71 per cent with severe depression. Ten per cent of the participants had no depression signs.

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Dr Ajay Phadke, CEO and founder of Type A Thought, a digital counselling platform for mental and emotional wellness shares, "These were the people searching for help online, which indicates there is a lot of undiagnosed depression in the Indian population." The test is called PHQ - 9, a public domain test developed by Phyzer.

People other than the patient do not see it as a mood problem but something that a person can 'snap out of' and therefore this makes the patient feel even more lonely and hopeless. Lack of motivation is one of the symptoms of depression. By the time people reach out to a professional for help, their motivation is so low that following up with treatment is very difficult for them and thus most of them dropout without completing the treatment, points out Dr Phadke.

Our environment can contribute to the feeling of loss of control that furthers depression.

Signs and symptoms

Most of us don't understand what depression looks and feels like. What we don't know is that many people who are suffering from depression continue to function but in a different degree. So what are the tell-tale signs?

Depression can vary from person to person and some of the early signs that tend to be ignored include:

• Physical symptoms such as fatigue, low energy and body aches

• Sleep disturbances

• Irritability

• Changes in appetite

• Loss of confidence

• Lack of concentration

• Difficulty with decisions

• Social withdrawal

• Defiant behaviour

• Deep sadness/inability to experience pleasure

Things to know

India Depression

Depression is characterised by deep melancholic sadness with debilitating effects, like inability to feel motivated in directing one's attention to some productive activity, intense fatigue and lethargy, lack of interest in initiating and maintaining social interactions and an overall disinterest in any activity that employs 'mental energy' or requires 'initiative-taking', shares Delhi-based Dr Kaustubhi Shukla, Clinical Psychologist, Puspawati Singhnia Research Institute.

What’s important to diagnose the condition is reporting of all or most of the aforementioned symptoms and emotional signs like frequent crying spells, break-downs, and feelings of sadness, helplessness and hopelessness. Usually if the duration of these signs and symptoms last for 6 months to 1 year, it is indicative of a diagnosis of clinical depression.

Dr Anitha M S, Consultant Psychiatrist from Wellbeing feels one must honestly answer these questions if they suspect depression spells:

• Do I feel low in my spirits most of the day, nearly every day?

• Do I have low or no interest in all/most activities most of the day, nearly every day?

• Do I feel that I cannot be bothered with most things and cannot motivate myself to do anything?

• Do I frequently feel that everything is an effort, even things that were so easy for me to do?

• Do I feel I cannot concentrate on work and seem to postpone work and end up thinking about the same things again and again?

• Do I frequently have negative thoughts like guilt, pessimism and feelings of worthlessness/low self-esteem?

• Do I have recurrent thoughts of death and suicide?

• Is my appetite, sleep or weight varied?

Women are more prone to depression.

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Like it or not, gender plays a role here too. According to Dr Phadke, "Women are twice as likely to undergo depression. It is majorly because two kinds of depression named Postpartum Depression and Premenstrual Dysphoric Disorder occur only in women. Apart from this, certain external factors which cause hopelessness and loss of control also tend to happen to women more than men. Some of these factors are sexual harassment, acid attacks, rape and domestic violence."

This article was originally published on Times of India.