In a WHO-organised panel discussion, experts from all medical specialities came together to shed light on depression – what it is, why it’s going unnoticed, and what can be done. “Let us together stamp out the stigma and banish the shame,” said Deepika Padukone, who also attended the public event in Bengaluru.

The Mental Health Care Bill, 2016, which was passed on March 27, was one of the most progressive steps India has taken, not only decriminalising suicide attempts, but also aiming to uphold the dignity of a patient suffering from mental illness. What it also did was repeal an archaic 1897 act, and provide a more inclusive definition of depression.

According to the bill, mental illness is “a substantial disorder of thinking, mood, perception, orientation, or memory that grossly impairs judgment, behaviour, capacity to recognise reality, or ability to meet the ordinary demands of life.”

It is the persistent sadness or the loss of interest in activities that are otherwise enjoyed, with an inability to carry out daily activities for 14 days or longer, according to WHO. The latest WHO estimates also say that, globally, there are 300 million people living with depression, out of which 56 million are Indian. This means that one in twenty Indians is currently living with depression, as revealed by the National Mental Health Survey 2015-16.

It was to address this and bring greater attention to mental illness that the WHO Country Office in India organised a regional consultation with expert panellists, in collaboration with the National Institute of Mental Health and Neurosciences (NIMHANS) and the Department of Health and Family Welfare, Government of Karnataka. Held at NIMHANS, Bengaluru, the theme for this year’s World Health Day was, for the first time, Depression: let’s talk.

Depression, hiding in plain sight

Dr. Paulomi Sudhir, Professor of Clinical Psychology at NIMHANS, stressed that one must first understand the multiple factors that lead to depression before looking at intervention. Although depression can be genetic, and is caused by deficiencies in neurotransmitters and hormones, or other medical conditions, it can also be reactive. Reactive depression can be triggered within a few hours or days of a negative experience or life event.

“Signs of depression are difficult to see because there is an overlap of physical symptoms,” says Dr. Paulomi. Body ache, palpitations, and digestive problems are just few of the many manifestations which can easily be associated with other medical conditions. Moreover, a person’s already existing medical condition can be exacerbated by depression.

Panel of doctors from various specialties discussing manifestations of depression in their patients.

Dr. Jagadisha, Professor of Psychiatry at NIMHANS, says that a doctor’s efforts to manage a medical condition go in vain when depression is not recognised and addressed.

“When a diabetic patient’s glycaemic levels are well under control, but the person still shows fatigue and other symptoms, then, a doctor must begin to probe. This can be done when doctors have a high index of suspicion about somatic (physical) complaints,” he says.

Along with Dr. Jagadisha, Dr. Kamala, Consultant in Diabetes at Jnana Sanjeevini Medical Centre, insists that all doctors need to do is ask a simple question – “How are you?” When patients are asked why they’re not able to sleep, or why they’re so stressed, they willingly talk about their problems. And that is when a doctor must make the assessment that there could be the dimension of depression involved, she says.

Let’s talk

Because depression is living and breeding among us, S.K. Chaturvedi, Dean of Behavioural Sciences, NIMHANS, says that the conversation on depression should be initiated not only by individuals and the society at large, but also by policy makers.

All the experts that shed light on depression at the event agreed upon one thing: there should be more collaboration among different medical specialities in order to detect depression, and that it should not be the responsibility of mental health professionals alone.

The panellists were selected from various medical specialities such as Gynaecology, Oncology, Cardiology, Endocrinology, and Paediatrics in order to highlight the prevalence of depression in medical conditions associated with each of these specialities.

Deepika Padukone at NIMHANS spreading the word of her campaign against depression #doobarapoocho (Image credit: Deepika Padukone FC)

Dr. Shashidhar Buggi, HOD of Cardio Thoracic Surgery and Director of the Rajiv Gandhi Institute of Chest Diseases, found that over 50 percent of in-patients were suffering from depression, an issue that would have gone unnoticed if not for the collaboration between different specialities.

Dr. John Sagar from the Department of Child and Adolescent Psychiatry, NIMHANS, said that children have higher somatic (physical) complaints than adults, and as they are not mature enough to handle the concept of depression, they tend to be affected by it more.

“Depression can strike anyone, regardless of their age, background, or economic status,” said Deepika Padukone, who spoke at the public event following the expert panel discussion.

Unfortunately, people who suffer from depression and other mental health issues face prejudice and discrimination. They are made to feel more isolated, whereas what they should be receiving is more love and support. Let us together stamp out the stigma and banish the shame.