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Understanding Depression: Bystanders

Here's the thing about depression:

Unless you've felt some version of this 'black dog' beastie that makes you feel listless, worthless, unable to get out of bed, unless you've felt the 'mean greys', until you've struggled with the at-times crushing load of trying to get through your day, or fake your way through conversations, to somehow prove your normalcy...

Until you or someone you've loved has gone through something similar, it's hard to relate, to empathise. Many of us judge -- some secretly, some openly -- or presume that this is a minor issue that people are not trying hard enough to deal with. Trust me, they're trying -- ever so hard -- to keep it together. 

What do they/we need from you? The friend, partner, parent, teacher, colleague?

  • Patience 
  • A safe space to talk
  • Someone to listen, even if you can't fully understand.

What do *you* need to be aware of?

  • That help is available.
  • That you can encourage your friend/ partner/ child/ student/ colleague to get professional help, where possible.
  • That it is possible to treat depression and live a life that's not just bearable, or painfully functional, but that is lively, and even light.

Please be aware of signs that your loved one is in distress -- if at any point you are worried about their physical well-being or hear them talk about ending it all, or committing suicide, please escalate to a trusted mental health expert.

It is a common misconception that people who talk about committing suicide are just looking for attention, and don't follow through. That is a myth. Please be alert to this. 

This is the list of suicide helplines for India's metros; sadly they are not all 24 hours. 
 


 

 

What Causes Depression?

The perceived wisdom is that it is some sort of brain chemical imbalance, combined at times with an environmental trigger, possibly family history, a traumatic/ major life event. There is no one-size-fits all cure or treatment, just as there doesn't seem to be a one-size-fits-all cause.

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Here is more from The Harvard Medical School's Harvard Health Publications:

"It's often said that depression results from a chemical imbalance, but that figure of speech doesn't capture how complex the disease is. Research suggests that depression doesn't spring from simply having too much or too little of certain brain chemicals. Rather, depression has many possible causes, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It's believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life."

 

What it's like to Live WIth Anxiety Disorders / Depression

Just in case you missed this on our blog roll:

Do check out this incredible comic (created by Nick Seluk of The Awkward Yeti). I first saw it on Upworthy and was blown away by it -- like so many others have been. It is reproduced here with the kind permission of The Awkward Yeti.

 

 

This incredible comic was created by Nick Seluk, creator of The Awkward Yeti, based on a story told by Sarah Flanigan, and published on taptastic.com 

It is reproduced here with kind permission from The Awkward Yeti

 

 

Hold the Judgement Please: On Feeling Suicidal and/ or Depression

Like many of you, I came across this tweet by writer Matt Haig. It says so much, that it's worth quoting in full. You will find Haig on Twitter as @matthaig1 and more on his recent book Reasons to Stay Alive here

 

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Understanding Depression: Myths Vs Facts

UNDERSTANDING PANIC ATTACKS AND PANIC DISORDERS

This information is reproduced here with kind permission from This Way Up, Australia.
This Way Up is the online not-for-profit initiative of the Clinical Research Unit for Anxiety and Depression (CRUfAD), University of New South Wales at St Vincent’s Hospital, Sydney. 

What Are Panic Attacks?

Panic attacks are sudden periods of intense anxiety or fear, where four (or more) of the following symptoms develop abruptly and peak within 10 minutes:

  • Pounding heart
  • Panic
  • Sweating
  • Trembling or shaking
  • Shortness of breath
  • Feeling of choking
  • Chest pain or discomfort
  • Nausea, abdominal pain
  • Feeling dizzy, unsteady, faint or lightheaded
  • Numb or tingling feelings
  • Hot flushes or chills
  • Feelings of unreality or of being detached from oneself
  • Fear of losing control or going crazy
  • Fear of dying

You will notice that the last two symptoms mentioned are different to all the others, in that they are fears rather than physical sensations. One of the most frightening things about a panic attack is that the person does not know what is happening to them, or why it’s happening. Because there doesn’t seem to be any reason for these sudden and intense physical symptoms, most people interpret them to mean that they are about to lose control, have a heart attack, die, or go crazy. In other words, they take the symptoms as a sign that something dangerous and terrible is happening. As you will see in the treatment section, this interpretation is very important because it can inadvertently contribute to the cycle of panic.

What Is Panic Disorder?

Panic disorder occurs when the person has recurrent panic attacks and either a fear of having another panic attack, of losing control, of having a heart attack, or of ‘going crazy’. If the person also avoids situations for fear of these attacks, they may have agoraphobia as well as panic disorder.

What Is Agoraphobia?

Agoraphobia occurs when the person is anxious about being in places or situations where they might have a panic attack. Hence they either:

  • Avoid these situations, or
  • Only go places with a companion, or
  • Endure these situations despite severe anxiety.

Most commonly, agoraphobics fear going into places where it might be difficult or embarrassing to escape quickly if they have a panic attack, or into places where there would be no quick access to medical help

How Common Is Panic Disorder And Agoraphobia?

Recent surveys of the general population have found that about 2% of adults have had panic disorder or agoraphobia in the last twelve months. That is approximately one out of every fifty adults. Panic Disorder occurs at the same rate in men and women, whereas agoraphobia is twice as common in women than it is in men. Studies have also shown that as many as 40% of people have had spontaneous panic attack at some stage in their life, but have not gone on to develop panic disorder or agoraphobia.

Treatments For Panic Disorder And Agoraphobia

Two kinds of treatment have been proven to help people overcome panic disorder and agoraphobia. One is Cognitive Behaviour Therapy (CBT), and the other is medication using either Tricyclic or Serotonin Reuptake Inhibitor Antidepressant drugs.

1. Cognitive Behaviour Therapy (CBT)

This type of therapy is conducted either in groups or in individual therapy sessions, usually with a clinical psychologist or a psychiatrist. It involves:

  • Education about the physical symptoms of panic, the role of avoidance, and the influence of thoughts and fears.
  • Changing thoughts and fears about the physical symptoms of panic.
  • Exposure to places where panic might occur.
  • Exposure to the physical sensations of panic.
  • Techniques to reduce over-breathing and anxiety symptoms.

2. Medication

Antidepressants and Benzodiazepines are the medications most commonly prescribed for the treatment of panic and agoraphobia. These medications should only be taken under supervision of your doctor, who can tell you about the correct doses and common side effects.

What Are My Chances Of Getting Better?

For every three people treated with CBT, one will be completely free of panic attacks following treatment (the other two may still be improved, but not completely panic-free). For every six people treated with medication, one will be panic free for as long as they remain on medication (the other 5 may be improved, but not completely panic free). Hence, you have a greater chance of mastering your panic attacks with CBT than with medication. With CBT, the improvement continues after treatment is over, simply because you have learnt new ways of coping.

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You will find more information on Panic Attacks and Disorders on This Way Up

Please do reach out to a trained mental health expert if you or a loved one need help.  

 

Pause...SlowING IT Down

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Understanding Anxiety Disorders

Anxiety Disorders cover a spectrum of conditions — that include panic disorder, generalised anxiety disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder and social anxiety.

Anxiety disorders are considered to be very common. They can be treated effectively -- through therapy, learning coping strategies, meditation, and at times medication is prescribed. While having some amount of anxiety every so often is completely normal and par for the course for many of us, an anxiety disorder interferes with your functioning in every day life.

Do check with a doctor, if you feel that you have frequent symptoms, excessive worrying, an inability to control that worry, or if any of the symptoms listed below persist, feel debilitating, or interfere with daily life.

 

Information on Anxiety Disorders courtesy: The US National Institute of Mental Health
 


Anxiety Disorders: Signs and Symptoms

Generalized Anxiety Disorder

People with generalized anxiety disorder display excessive anxiety or worry for months and face several anxiety-related symptoms.

Generalized anxiety disorder symptoms include:

  • Restlessness or feeling wound-up or on edge
  • Being easily fatigued
  • Difficulty concentrating or having their minds go blank
  • Irritability
  • Muscle tension
  • Difficulty controlling the worry
  • Sleep problems (difficulty falling or staying asleep or restless, unsatisfying sleep)

Panic Disorder

People with panic disorder have recurrent unexpected panic attacks, which are sudden periods of intense fear that may include palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath, smothering, or choking; and feeling of impending doom.

Panic disorder symptoms include:

  • Sudden and repeated attacks of intense fear
  • Feelings of being out of control during a panic attack
  • Intense worries about when the next attack will happen
  • Fear or avoidance of places where panic attacks have occurred in the past

  • Social Anxiety Disorder
  • People with social anxiety disorder (sometimes called “social phobia”) have a marked fear of social or performance situations in which they expect to feel embarrassed, judged, rejected, or fearful of offending others.

    Social anxiety disorder symptoms include:

    • Feeling highly anxious about being with other people and having a hard time talking to them
    • Feeling very self-conscious in front of other people and worried about feeling humiliated, embarrassed, or rejected, or fearful of offending others
    • Being very afraid that other people will judge them
    • Worrying for days or weeks before an event where other people will be
    • Staying away from places where there are other people
    • Having a hard time making friends and keeping friends
    • Blushing, sweating, or trembling around other people
    • Feeling nauseous or sick to your stomach when other people are around

      Evaluation for an anxiety disorder often begins with a visit to a primary care provider. Some physical health conditions, such as an overactive thyroid or low blood sugar, as well as taking certain medications, can imitate or worsen an anxiety disorder. A thorough mental health evaluation is also helpful, because anxiety disorders often co-exist with other related conditions, such as depression or obsessive-compulsive disorder.
       
      Source: U. S. Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health.
      Retrieved from: http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

      INDIA CONTEXT:
    •  

      For more information on the India context, and a look at three meta-analyses, please do read: An Overview of Indian Research in Anxiety Disorders, by JK Trivedi and Pawan Kumar Gupta, in The Indian Journal of Psychiatry (January 2010)

    • The Doctor is In: Connect with an expert in your city
       

I. Key Insights: A Study on Suicide in India

Suicides in India make the news often when there are "farmer suicides", or sensational and tragic cases involving celebrities, or students facing exam pressure -- the fact is the news

a) rarely reflects that confluence of factors that may result in a suicide and

b) rarely uses the opportunity to put out the public service message on help that is available.

The media by and large seems impervious to its massive influence, and possible role in enabling "copycat suicides", or "suicide contagion".

Highly recommended are these media guidelines put out by the Samaritans in the UK.

**

In India, where access to help is decidedly patchy, mental health experts still recommend that the media refrain from commenting on method of suicide, dramatic re-creations, any sort of sensationalising, or assigning simple motives, and encourage reporters and news anchors to use the opportunity to advise that help is available, and direct viewers and readers to such help as is available. A basic list of suicide helplines in the country is here (*pending cross-check/ verification by end-2016).

**

 

Why We All Must Care: India's Wake-up Call

 

 

** THE FACTS ABOUT SUICIDE IN INDIA: A SNAPSHOT
We can also take a closer look at some of the key findings of a paper done in 2015 by Dr Shamika Ravi on Suicide in India, as part of the Brookings India IMPACT Series. And do note that last point on the media.


 


KEY INSIGHTS:

  • Health (mental and physical) concerns are the leading causes of suicides in India, accounting for over 20% of all suicides
  • Bankruptcy and indebtedness account for less than 5% of all suicides
  • Housewives comprise the largest share of suicides (18%); while farmers comprise 11%
  • Suicides among most demographics are declining over time and farmer suicides are declining the fastest
  • Suicide ‘contagion’ can occur if suicides are overly dramatized and/or played up
  • Research shows that responsible media coverage of suicides can play an important role in curbing suicide contagions
     

Reference: 

  • Ravi, Shamika (2015). “A Reality Check on Suicides in India,” Brookings India IMPACT Series. Brookings Institution India Center. 
  •  

  • Do read more from that report on the Brookings India site; you can download the paper here


  • Coming soon: A directory database of peer-vetted mental health experts in India, starting with the metros

  •  

II. Talking about Suicide Prevention

Myth: People who talk about suicide are doing it for attention; they're not actually going to kill themselves

Fact: Many people who go on to kill themselves speak about it beforehand

If anyone you know talks about feeling worthless, alone, that they feel life isn't worth living, if you're worried about a sudden change in behaviour, a loss of appetite, sleeplessness, listlessness, please seek out professional help. There can be any/ many triggers -- a sudden break-up, loss of a job, financial losses -- there are often underlying symptoms and mental health issues that others may not be aware of.

Sometimes all we need to do is create a safe space, listen, and let our loved ones know that help is available. That they are *not* alone. That they are *not* weak. That there is hope of healing, no matter how dark things may seem.

Friends and colleagues in the media: We need to be aware of the need to report responsibly, be aware of the "contagion effect" and copycat suicides, be cautious while revealing details of a suicide, and avoid the urge to sensationalise. Consult this guide by the Samaritans on Reporting Responsibly please. Please also mention where help is available,  by directing viewers or readers to resources in your cities/ towns. 

 

 

 

Understanding Mental Health Issues: Why Should You Care?

To start with, it's very important to remember that mental health issues are not a sign of weakness. Also, someone cannot 'shake off' depression, just as they cannot 'shake off' a fever.

The World Health Organisation has estimated that 1 in 4 people will need care for mental health issues, at some point in their lives.

If you or a loved one suffer from any mental health issue, or worry that you may, it is important that you reach out to a qualified and trusted mental health expert -- a psychologist, or psychiatrist. 

You may find that you are advised to begin therapy - yes 'talk therapy', which is the butt of so many jokes in popular culture, and even personally, but it is that same 'talk therapy' that proves so life-altering, for so many people. You may be advised to go on medication; it could be that chemicals in your brain are mis-balanced. The point is, there is no need to suffer endlessly -- it is your fundamental right to lead a healthy life. Or it should be, at any rate.

Here in India, we all have stories of relatives who were mentally "off", considered "crazy", "not quite there". If we can, we must work together to remove the stigma, so that people can easily access the help they need. So that people can live to their fullest.

As a reporter I have found that it is only sharing stories, that we can hope to raise awareness and/or lift the stigma, collectively. (And note, that while we are starting to talk about depression now in Indian cities, we are still not comfortable discussing psychosis). Personally, we all have stories that we can choose to share; we can also help others, by listening, creating safe spaces and allowing for healing to begin.

That is the endeavour of this website, where will start by listing out common mental health issues, along with signs to watch out for, and trusted resources, whether it is through word-of-mouth, or through psychologists and psychiatrists, or through those who use their services, vouching for them, so that by the time we are done, we have a solid network.

So that the next time you or a loved one needs to get help; you'll know exactly who to call.

(NB: We will be aiming to translate information where possible into Hindi and regional languages; but that is still a few months away.)

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Where To Get Help: A City-Wise List

Our primary aim in creating a database is to provide information on TRUSTED mental health practitioners in India, based on peer- as well as client recommendations (and from health reporters), but The Health Collective cannot be held liable for any issues arising from your using these independent third party services.

Search for help (Click or scroll down): Bangalore, Delhi, Chennai, Mumbai, Goa, Hyderabad
Call for Help: SUICIDE AND STRESS HELPLINES

 

Bangalore/ Bengaluru

Psychiatrists

  • Dr Bhupendra Chaudhry
    Psychiatrist; Consultant Psychiatrist, Manipal Hospital
    Call: 080 4009 1000

    Manipal Hospital: 1800-3001-4000
    (Including for de-addiction therapy)
     
  • Dr Santosh  
    Psychiatrist
    Appointments can be booked online for NIMHANS/ as walk-ins

     
  • Dr.Yesheswini Kamaraju
    Psychiatrist
    REACH ClinicCounselling and therapy services can be booked through 
    9902075544 / 9663814455 /080 - 25530049


Psychologists


DELHI
 

Psychiatrists

  • Dr Achal Bhagat
    Psychiatrist
    Saarthak and Apollo
    Call for appt: +919560065735 or +919818865735

     
  • Dr Amit Sen
    Child & Adolescent Psychiatrist
    Children First
    Call for appointment: 011 4608 4844
     
  • Dr Alok Sarin
    Psychiatrist
    Sitaram Bhartia Hospital
    Call for appointment: 011 – 4211 1111 or Schedule Appt here

     
  •  Dr Pratap Sharan
    Psychiatrist
    AIIMS Psychiatry
    Call for appointment: +91 11 26593236, 09871074677
    E: pratapsharan@gmail.com

     
  • Dr Gorav Gupta
    Psychiatrist
    Tulasi Rehabilitation (For Substance Abuse/ De-addiction)
    Call for appointment: 9911989401 / 9891006875

     
  • Dr Anurag Misra
    Call for appointment: (+91) 9811712683
     
  • Dr Pulkit Sharma
    VIMHANS
    Call for appointment: 98114 83873
     
  • Dr Sonali Bali
    VIMHANS

    Call for appointment: 011 2980 2980
     
  • For Psychiatric in patients:
     VIMHANS in the private sector
     011 2980 2980
     
  • IHBAS in the government sector
    011 2211 4032

     
  • Sanjivini
    For: Crisis Intervention/ Counselling/ Rehabilitation for patients with schizophrenia 
    011 24311918, 24318883 (Mon-Fri) 
    26862222, 26864488, 40769002 (Mon-Sat)
    E: 
    sanjivini1971@gmail.com

 

Psychologists

  • Shelja Sen
    Child Psychologist
    Children First
    Call for appointment011 4608 4844

    For Phone and Email-based Counselling:
     
  • iCall
    The Tata Institute of Social Sciences (TISS)/ School of Human Ecology 
    022-25521111 (Mon-Sat: 8 am to 10 pm)
    E: icall@tiss.edu

     
  • Arpita Anand
    Psychologist
    E: arpita.psych@gmail.com

     
  • *PAN-INDIA
    iCall has also put together a list of trusted mental health resources here

 

CHENNAI + PHONE HELPLINE
 

  • SNEHA


 

  • Jeevan Suicide Prevention Hotline  044 2656 4444
  • Sneha Suicide Prevention Hotline 044 2464 0050
     
  • THE BANYAN
    Community mental health work and links to a separate resources page including to:
     
  • SCARF for Schizophrenia Care (Outpatient and inpatient)
    Call for Appointment: 044 -2615 1073 / 2615 3971 (9.30 am to 3.00 pm)
    Email: info@scarfindia.org 

 

MUMBAI

Psychiatrists

  • Dr Yusuf Matcheswalla
    Masina Hospital Clinic

    022 23747767/23753002
    In-patient facilities
     
  • Dr Dean Creado
    Kokilaben Hospital
    022 3069 6969
     
  • Dr Bharat R Shah
    Lilavati Hospital
    022 38542873 

     
  • Jaslok Hospital
    022 6657 3014
     

Psychologists

HYDERABAD

  • Dr Sadia
    Sai Krishna Hospital
    Call: 040-30883521 (840)

     
  • Dr.Raghurami Reddy 
    Anu NeuroPsychiatric Clinic
    040-66588377(311)

     
  • Institute of Mental Health
    Call: 098499 03003, 040 - 23813231

     
  • One Life (Hyderabad) 78930 78930
    E: support@1life.org.in

 

GOA

  • Sangath

    North Goa- E-mail: contactus@sangath.in
    Phone no. (91-832) 2904755

    South Goa - E-mail: youth1stop@gmail.com
    Phone: (91-832)  2777307/ (91-832)  2776716

     

Find SUICIDE HELPLINES here*

*Update as of May, 2017
A colleague tried to connect with these helplines and found…
Sneha in Chennai; Aasra in Mumbai: Repeatedly busy
Lifeline in Kolkata; Sumaitri in Delhi; Samaritans in Mumbai: Kept ringing with no one picking up
Sahai in Bangalore, Sneha in Chennai: Reachable

**We are updating our list to include:
Jeevan Suicide Prevention Hotline (Chennai) 044 2656 4444

Sneha Suicide Prevention Hotline (Chennai) 044 2464 0050
One Life (Hyderabad) 78930 78930
E: support@1life.org.in
Sahai Helpline (Bangalore) 080 25497777
E: sahaihelpline@gmail.com

Maithri (Kochi) +91 484 2540530
E: maithrikochi@gmail.com

 

STRESS HELPLINES

JEEVAN AASTHA HELPLINE 1800-233-330   sp-gnr@gujarat.govt.in
MAITRA HELPLINE 022-25385447   maitra@healthymind.org
MAPLEJAR 733-826-3303   maplejar@maplejar.in
THANAL  0495 237 1100   thanal.calicut@gmail.com
PRATHYASA 91-480 – 2820091        
PRATHEEKSHA 484 2448830   rajiravi2000@hotmail.com
CONNECTING INDIA                        9922001122        
ROSHNI 040 790 4646   help@roshnihyd.org  

 

NB: Please do share if you have an exceptional or trusted mental health practitioner and we will add to this list on a rolling basis (outside the metros as well).

Ask The Experts: Understanding Depression

Depression in India

According to a World Health Organization World Mental Health (WHO WMH) supported study, approximately 36% of Indians are likely to suffer from major depression at some point in their lives. Don’t you think then, that it’s really crucial for us to address this issue and spread some awareness?

Fortunately, in my 15 years of experience as a psychotherapist in India, I have witnessed a big shift toward greater acceptance and destigmatizing of mental health illnesses. This is also evident in my practice -- from struggling to receive referrals a decade ago, I now have a full schedule. On an average about 60% of the individuals that I work with cite depression as one of their core concerns.

So what is depression?

In diagnostic clinical terms depression is defined as a debilitating mood disorder. However, it can manifest itself in many forms. I believe we are all on a mental health continuum at different times in our lives, experiencing varying levels of sadness, existential angst, hopelessness. There are many who live fragile lives and are at the ‘deep end’-- filled with complete darkness and despair. There are the ‘undetected many’ who float in the middle - often experiencing a steady underlying sense of sadness; this is a feeling captured well by American comedienne Jessi Klein who joked about “being a little bit sad all of the time”.

 

 

Signs to watch out for

The National Health Service (NHS) of the United Kingdom has a comprehensive list of symptoms on their website

Look out for these symptoms if they persist for weeks or months and are interfering with your work, social life and family life. This list of symptoms provides a sense of how extensively depression can affect an individual’s psycho-emotional, physical and social life. It helps to identify early signs of depression so that you can seek help for it before things get worse. Getting help from family and friends is helpful but receiving professional support, namely psychotherapy, can help get to the root of the issues.

While many of our fears and anxieties may seem irrational, understanding why we may have developed them helps build insight, self-awareness and healthier coping mechanisms. Medication may be helpful in cases where the symptoms are severe and interfere with an individual’s capacity to function on a regular basis. 


There are factors that can trigger or predispose people towards depression:

  • Family history: Researchers believe as much as 40 percent of those with depression can trace it to a genetic link. Environmental and other factors make up the other 60 percent. Research has also shown that people with parents or siblings who have depression are up to three times more likely to have the condition.
  • Big life events can be triggers, leading to what is called ‘reactive depression’. For example this could be the birth of a child, a divorce, death of a loved one, losing your job, or children leaving home.
  • Somatic factors: Alcohol and other substance abuse or dependence may also co-exist with depression. Research shows that mood disorders and substance abuse commonly occur together. Depression also may occur with other serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes and Parkinson's disease.

 

 

Depression and anger

Depression is often inverted anger. Sadly, in my recent years of working with young adolescents I have noticed an increase in self-harming behaviour as a way of expressing rage. Anger is a highly misunderstood emotion as it is often seen negatively because of how it is expressed. You can learn to regulate it and use it powerfully to drive, motivate and protect yourself. When not understood, the very same anger that can help you move forward and defend you can hurt and debilitate you.

Hope

Depression is not a personal failure or weakness. It is neither your identity nor your personality. You can call it a condition, an illness, or symptoms or feelings that you experience. Acceptance of depression is the first step on the road to recovery. There is always hope. Reach out for help and do not hesitate to access mental health services.

You are not alone.

 

About the author:

 


 
Meera Haran Alva is a consultant psychologist and psychotherapist with 15 years of experience, based in Bangalore.

She works with children and families as a consultant psychologist at Stonehill International School, Bangalore and also has an independent practice for adults. She is a strong advocate for mental health issues and child protection rights. 

You can find more information here, including where to book an appointment. 


  

You will find more on signs of depression and other mental health issues here.