Depressed? So, what’s the worry?

Depression and anxiety have come out of the closet to become lifestyle problems, with Indians popping more antidepressants than ever before
This is a representative photograph(Photo: Shutterstock)
This is a representative photograph(Photo: Shutterstock)
Updated on Mar 18, 2017 05:01 PM IST
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Hindustan Times | BySanchita Sharma

Bollywood’s Deepika Padukone, Ranveer Singh, Karan Johar and Ileana D’Cruz put the spotlight on depression, Anushka Sharma took the stigma out of getting treated for anxiety and panic attacks. But much before these stars made it all right to talk about their personal battles with their unaccountable emotional vacillation, people across India were quietly seeking prescription medication to control their mental demons.

Antidepressants sales in value has shot up by more than 30% over the past four years, up from Rs 760 crore in 2013 to Rs 1,093 crore in 2016, shows data from the AIOCD Pharmasofttech AWACS, a pharmaceutical market research company.

Ten pharmaceutical companies accounted for close 80% of new anti-depression prescriptions, with psychiatrists writing more than 9.4 million new prescriptions for antidepressants in 2016 alone, up 12% from 8.4 million in 2015. Drugs from three pharmaceutical companies - Sun Pharma (23%), Wockhardt (17%) and Intas Pharma (12%) -- accounted for more than half of the 34 million new anti-depressant prescriptions in 2016.

The number is phenomenal because there are just 5,615 psychiatrists registered with the Indian Psychiatric Society and because people with chronic illnesses like depression often continue to use old prescriptions for repeated depressive episodes.

In India, 57 million persons have depression and 38 million have anxiety disorders. Suicide is the seventh most common cause of deaths in India, reports The Global Burden of Diseases Study. “Almost 90% of people who commit suicide have a psychiatric disorder and 75% are clinically depressed,” says Dr Samir Parikh, director, department of psychiatry and behavioural sciences, Fortis Hospitals.

Dr Samir Parikh counselling a patient at Fortis Shalimar Bagh in New Delhi. (Arun Sharma/HT PHOTO)
Dr Samir Parikh counselling a patient at Fortis Shalimar Bagh in New Delhi. (Arun Sharma/HT PHOTO)

Global grip

Depression is marked by feelings of low self-worth, sleeplessness, listlessness, appetite loss (or gain), irritability and sudden mood swings. “Unlike what you see in popular media, people with clinical depression are not moping and weeping all day. Highly functional people with depression can be normal professionally and socially, yet be plagued with feelings of emptiness and inadequacy when alone, which makes depression so much more hard to identify,” says Dr Parikh.

Everyone has emotional ups and downs, if symptoms of low self-worth, sleeplessness, appetite loss (or gain), irritability and sudden mood swings last for more than two weeks, you must seek professional help. And increasingly, young India is doing so that it doesn’t affect their ability to work and live life.

Untreated depression disorders are the leading cause of the more than 788,000 suicides each year worldwide, which roughly corresponds to one death every 45 seconds. It’s among the top 10 causes of deaths across the world, accounting for 1.5% of all deaths and the second leading cause of death among 15-29-year-olds.

Depression and anxiety occur more often in women and men and is less likely to be treated in women. “Women are less likely to talk about their problems and when they do, are less likely to be taken seriously. Having their symptoms dismissed as moodiness and temper can make them feel frustrated and helpless, leading to self-harm,” says Dr Rajesh Sagar, professor, department of psychiatry, All India Institute of Medical Sciences (AIIMS). In India, more young women commit suicide in India than men, unlike the rest of the world where men are three times more likely to kill themselves.

Bouncing back

Some people with depression find it difficult to admit that they are not on top of their emotions and even with the support of family and friends, take weeks to months to be diagnosed and treated.

“Depression is an equal opportunity illness that can be chronic or recurrent and affects people across ages and social strata. If the feelings of sadness, social withdrawal and listlessness do not go way in two weeks, you must get a diagnosis because like all health problems, it can be treated and fixed,” says Dr Sagar.

Drugs and treatment are a must if the condition is chronic (lasts for more than four weeks), recurrent (bouts of depression occur three four times a year) or the mood interfere with your ability to function normally for more than a two weeks.

“SRRIs (selective serotonin re-uptake inhibitors) account for one-third of depression prescriptions. These are safe drugs but may cause side effects such as gastritis, which can easily be dealt with if the medicines are had with meals, and lowered libido,” says Dr Parikh. The prescription medication has to be taken for a minimum of six months, but a relapse in less than two years needing medication for two years or more.

These medicines are free at government hospitals and it costs less than R 500 a month to treat mild to moderate depression in the private sector, so what is keeping most people away from treatment is not the cost but an inability to accept they have a problem.

“The big change over the past few years is that general practitioners and doctors from other specialities such as oncology, neurology, endocrinology, among others, are prescribing anti-depressants and anti-anxiety drugs to help people cope with other health problems -- 40% people with depression have other, often chronic, diseases,” says Dr Parikh.

“Taking psychiatry out of the psychiatry ward has turned depression into a lifestyle problem, which has helped destigmatise it more than everything else,” says Dr Parikh.

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