Are we finally ready to talk about depression and suicide?

Dr Pavan Madan, Psychiatrist, based in the US, shares his insights on why there is a need to learn about depression and its various aspects to save as many lives as possible

The news of Sushant Singh Rajput’s death by suicide is sad and shocking beyond words. Every time an actor or a public figure dies by suicide, it breaks our heart. We share the news and reactions on social media for a week or two, and then do not bother to talk about mental health until the same incident repeats. One needs to learn about depression, so that, perhaps, someday, people can save themselves or someone they know, from a mental health crisis.

Words matter

Before we talk more about suicide, let’s learn the right terminology. We commonly hear people say, “Mr X committed suicide” or using the words “successful” or “failed” while talking about a suicide attempt. However, these terminologies have been shown to discourage people from seeking help due to the associated moral judgment and usage in the criminal justice system, e.g. “Mr Y committed a crime.” The World Health Organization (WHO) suggests using the phrase “died by suicide” just like you would use if someone died from cancer or diabetes.

Even one is way too many

According to a 2019 WHO report, around 800,000 people die from suicide every year. Sadly, 27 per cent (216,000) of them are from India despite our country forming only 18 per cent of the world’s population. India has one of the highest per capita suicide rates, doubling from 7.9/100,000 in 1987 to 16.3/100,000 in 2016. Suicide is the leading cause of death amidst Indian youth aged 15-39 years; 71 per cent women and 58 per cent men, who die by suicide, belong to this small age group. It is clear from this data that we are disproportionately losing Indian youth to suicide at a growing rate. Let us examine what is depression, its underlying factors and treatment options.

Sadness vs depression

Sadness is a normal human emotion in reaction to certain stressful situations. Depression is different. It is much more complex than normal sadness and has other associated features. Depression usually presents with feeling unusually or deeply sad for extended periods of time, decreased interest or ability to enjoy things, sleeping too much or not being able to fall asleep easily, eating too much or not feeling as hungry, feeling hopeless or worthless, having thoughts about not living anymore or ending life. If several of these symptoms last for more than two weeks and impair your ability to do your work or function otherwise, this may be considered a sign of depression and not just sadness. Unlike sadness, depression is a medical condition caused by a combination of factors like genetics, past trauma, poor support system, inadequate coping toolsor difficult socio-economic conditions.

Lack of awareness

Many people are not aware that depression is a treatable disease. They continue to suffer in silence, thinking it is their fate. This is especially true among housewives, who are dying by suicide at an alarming rate of 63 per day, adding to over 17 per ccent of all suicides in India. Friends and family members also lack awareness and fail to offer help. I often hear comments like “my wife is just a sad person” or “my mom is always tired and just keeps sleeping.” People just assume these feelings to be part of someone’s personality and not something that can be treated or changed.

Social stigma

In addition to lack of awareness, people hesitate to seek help for depression due to social stigma. Many people think that asking for help for mental health conditions means you are “crazy” or “weak.” This could not be far from true. Depression, anxiety and other mental health conditions are more common than we think. Moreover, it is a sign of strength to seek help for what we are not able to overcome ourselves.

Some people worry about sharing about their depression with friends or family. “Log kya kahenge?” Most people with mental health conditions suffer in secrecy. This is precisely the reason why we need to talk more about our issues and help our friends and family talk about them, so that no one feels ashamed for seeking professional help.

Lack of resources

Most psychiatrists and psychologists in India are concentrated in the urban areas. Very few of them practice in rural or suburban centres. Lack of awareness and social stigma lead to a lack of demand of these practitioners, which, further exacerbates the problem. It is a vicious cycle that will only stop with consistent efforts and time. As many mental health practitioners are now offering online sessions, consider contacting one of the websites or apps that offer these services. General physicians usually receive limited training in psychiatry and may not feel comfortable in treating mental health disorders. I would urge the Medical Council of India (MCI) to improve the quality and duration of psychiatric training for all physicians and nurses so that they are better equipped to support our society, especially in the times of a health crisis like the current pandemic.

Impact of COVID-19

The SARS-CoV-2 pandemic is not yet over, but it is likely going to leave a lasting impact on many of us. From losing employment and source of income to not being able to see friends and family members, there are many facets of the lockdown that are likely to worsen mental health issues, potentially creating an upcoming mental health crisis. While I hope that the worst is over, we should be prepared and think about some steps regarding prevention and treatment of depression. We need to constantly work on improving our resilience against adverse situations, just like we are focusing on improving our physical immunity against COVID-19.

Let us talk about it

Learn to be able to share your thoughts and feelings with a close friend, family member or therapist. If you are worried about someone, talk to them. Many people worry that if they ask or talk about suicide, their loved ones will start thinking about it. That is usually not the case. On the contrary, you might make it easier for them to share their problems and seek help. Learn to listen before giving advice.

Sometimes, listening in a calm and empathic tone, while validating feelings, is all what people need. If you feel that they need more help than you can offer, suggest seeking a professional.

Treatment options

There are three types of professional treatments available: psychotherapy or ‘talk therapy’ pharmacotherapy or medications, and procedural therapy like Electroconvulsive Therapy (ECT).

Psychotherapy involves talking to a counsellor or therapist usually once a week for about an hour. This usually takes a few weeks to start working and is often recommended for several months or longer. It is not just the ‘suggestions’ you receive from a therapist, but the process of being able to trust someone and share your innermost thoughts and feelings while feeling heard is what makes the difference. Give it a try, you may be surprised how much it helps.

Pharmacotherapy involves use of one or more medications that can change the level of neurotransmitters associated with depression in the brain. One of the most common type of medication used is called ‘Selective Serotonin Reuptake Inhibitors’ or SSRIs, which tend to increase the level of a chemical called “serotonin,” the happiness chemical, in the brain and improve symptoms of depression and anxiety. If these do not work, there are several other types of medications available.

Procedures like ECT or shock therapy or Trans Magnetic Stimulation (TMS) are effective in treating depression, but generally reserved for more severe cases or those that generally have not responded to two or more medication trials.

Lifestyle changes like regular exercise, health diet and mindfulness are all known to help with depression and work well in conjunction with other treatment options. By themselves, these are best reserved for mild or occasional symptoms or as a preventive measure.

The most effective treatment is a combination of several of these options. It is important to discuss a treatment plan and a suicide safety plan with your provider before starting any treatment.

Conclusion

Please take care of yourself and those around you. Don’t be afraid to discuss depression or another mental health concern and seek help when needed. There is no health without mental health.