Hiding behind smiles or tears, success or failure, wealth or poverty, depression is a silent, invisible, and serious mental health issue that often gets swept under the carpet and locked behind closed doors. It is also a silent killer as depression is one of the leading causes of suicide.

The World Health Organisation describes depression as “…an illness characterised by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks”. Let’s look at some facts on depression and suicide from WHO.

• India has 9,000 psychiatrists, or one doctor for every 100,000 people.
• One out of seven people in India suffered from mental illness between 1990 to 2017.
• More women are affected by depression than men.
• Every 40 seconds, someone, somewhere in the world, commits suicide.
• For each suicide, there are more than 20 suicide attempts.
• Suicide is the second leading cause of death in 15 to 29-year-olds.

What are the signs of depression?

Identifying indicators of depression is key to understanding whether a loved one is feeling depressed or has depression. While you need to visit a psychologist and undergo assessment for a confirmed diagnosis, here are a few red flags that you should watch out for…

• Sleeping too much, too little, or restless sleep.
• Eating too much, too little or binge eating.
• Feeling empty, fatigued, hopeless, helpless, anxious, discontent and guilty.
• Losing interest in favourite things — activities, hobbies, food and friends.
• Falling concentration levels, slower than usual in performing tasks.
• Withdrawing from friends and family.
• Thinking suicidal thoughts or attempting suicide.

Please note: Having only one or two symptoms consistently or all symptoms inconsistently may not necessarily indicate depression. You must visit a mental health professional for a formal diagnosis.

When does a person need professional help?

If you think you, a friend, or a family member has been showing signs of depression consistently for six to eight weeks, it is time to speak with a mental health professional.

Is depression hereditary?

Anybody from any walk of life can have depression. Whether you’re rich or poor, old or young, successful or not, an introvert or an extrovert, man, woman, or child — you can get depression. And while some mental health issues can be hereditary and genetic, many are not. A mix of situational, emotional, biological, environmental and socio-economic factors play an important role.

Is depression treatable?

Get help. Give help. Every person with the same health issue reacts to it differently and uniquely. It is the same for depression. While some may take longer than others to respond, most people do get better with regular therapy and/or medication.

I don’t want to take medicines to treat my depression as I’ve heard it is habit forming, but my psychiatrist is recommending it. What should I do?

If you can take long-term medication to control physical health issues like diabetes, blood pressure, cholesterol, why would you avoid medicine that can help your mind and improve your quality of life? Each person reacts to medicines differently, and an expert psychiatrist will be able to guide and adjust dosages for the best outcome.

Can children be depressed too?

Anyone, at any age, can get depression. Children are susceptible to it too, especially after encountering any severe physical trauma, emotional trauma or abuse. Some common signs of depression in children are:

• Withdrawing from friends and family.
• Losing interest in favourite games, foods, hobbies and classes.
• Drastic social behavioural changes.
• Drastic changes in appetite.
• Not wanting to go to school.
• Emotional outbursts including anger, constant crying, picking fights.
• Self-harm or substance abuse.
• Taking up smoking or drinking.

If you think your child, tween, or teen is exhibiting any of these behaviours, please contact a mental health professional immediately.

What are things we can do as parents to create a stress-free environment?

We have to understand and accept that many things that cause stress in our children’s lives are situations we have not experienced ourselves. We need to keep an open mind and create a friendly rapport where our children can feel free to discuss any topic under the sun with us.

From a young age, do not shame children for asking questions you may not feel comfortable answering. While many children need encouragement to reach their true potential, give them the freedom to make academic, sports, and cultural hobby choices. Just because you scored 100 per cent in mathematics, loved to play football and played the piano like a prodigy does not mean your child needs to adopt the same path. Also, do not pass judgement on their friends who you do not like or approve of. Monitor the interactions and step in only when an issue seems serious. Keep an open door and an open-heart policy when talking to you children and you will be able to help reduce some of their stress.

If I think that my child is having some problems but not sharing them with me, how should I approach them?

Approach your child in a calm and collected manner. You can tell them that you have had a feeling that they may be stressed or sad about something, and if they want to share it with you, you are there to listen. If your child immediately does not share anything, do not get hyper. Tell them you are happy to give them their space and will talk whenever they feel comfortable. Also reassure them that no matter what, you are there for them. Try this a few times and your child is likely to open up.

Do not cry, do not try emotional blackmail, and do not try to make them feel guilty. Most children are afraid of potential consequences after sharing their problems. If you can make them feel safe, loved and not judged while talking to you, you can build a life-long healthy parent-child relationship.

What is postnatal depression?

Postnatal depression is the depression experienced by new mothers after childbirth. As per WHO, it affects one in six women who have given birth. Some of the signs of this depression include an inability to bond with the baby, not wanting to take care of the baby, feeling overwhelmed all the time, fearing one’s own capability of being a good parent, crying spells for no specific reason, and thoughts of harming oneself.

I feel that if I talk about my problems, my family might feel that I am a mental patient. How do I deal with this fear?

The first step to treating a problem is accepting it, which you have done. The second step is asking for help, which you want to do, but you are scared of being rejected and labelled. Here, education and awareness is key. Your family loves you and wants the best for you, but they may still believe in stereotypes and myths that surround mental healthcare. Help break the stigma by educating them about the importance of mental wellness and talk to them about how you feel. Once they understand, they are unlikely to be judgemental.

You can also speak with an open-minded family friend or a relative with whom you share a close bond. They can help you to communicate with your family. And if you are already in counselling, you can try a couple of family counselling sessions with your therapist.

When does one contemplate suicide?

Feelings of hopelessness, loneliness and worthlessness can cause a person to consistently replay disturbing, negative thoughts and events in their mind. When someone is overwhelmed and overwrought to the point where they feel that their family, their friends and the whole world would be better off without them, they may contemplate suicide.

Are all suicidal threats real?

Suicide threats should never be taken lightly. Inform an immediate family member or call a crisis hotline. However, some manipulative abusers use this as a tactic to keep abuse victims trapped in toxic relationships and marriages. If you feel this is the case, connect with a mental health professional to get help.

Can suicide be preventable?

Getting someone the right help at the right time is crucial to preventing suicide. Most people can be helped if we become truly aware about the emotions of the people in our lives, practise empathy, and lend a patient ear or shoulder to cry on.

How can one help a person suffering from depression and/or suicidal thoughts? If a friend or family member calls and says he/she is feeling extremely low and wants to die, what should I do immediately?

Talk to them and truly listen. Don’t pass judgement, don’t give examples from your life, don’t start listing solutions — just be there for the person and show them how they are loved and valued. Let them express themselves, uninterruptedly. At low points in our lives, more than someone telling us, “It will all be okay”, we need someone to say, “It’s okay not to be okay”. Sometimes all we need is someone to talk to. Sometimes all we need is to be heard.

However, if you think they are so distraught that they may harm themselves, do not leave this person alone. Remove all sharp objects, poisonous pesticides/ cleaning solutions, any potentially harmful medication. Also, call a crisis hotline or an emergency mental health clinic or a mental health professional. If this person has been undergoing therapy, contact their psychologist or psychiatrist.

How do I know that my loved one might be suicidal?

• A failed suicide attempt.
• Someone keeps talking about death, or death as a solution to their problems.
• Patients with chronic pain or illnesses.
• Anyone who is undergoing severe emotional distress — death of a loved one, dissolution of a marriage, compounding financial debt, extended caregiving for terminal/sick loved ones.
• Survivors of emotional, physical, or sexual abuse.

Someone who is suicidal will almost always give a signal or a call for help.

Minu Budhia is a psychotherapist, counsellor, founder of Caring Minds, ICanFlyy, Cafe ICanFlyy, and a TEDx speaker. Write to askminubudhia@caringminds.co.in