How it's a daily struggle for Robin Williams of the world

Everyone gets low and suffers from low-self-worth, sleeplessness or guilt. But some struggle every day - like actor Robin Williams, who battled depression and alcohol and drug-abuse for years - and one day end their own lives.

Everyone feels down and out sometime or the other, and most people snap out of it within days. Some don’t, and struggle every day with feelings of listlessness, ennui, guilt, low-self-worth, sleeplessness, appetite loss (or gain), and poor concentration. Some, like actor Robin Williams who battled depression, and alcohol and drug-abuse for years, get fed up and take their own lives.

Down and out

Often, people don’t talk about feeling low and their depression gets dismissed as moodiness. So it’s up to family, friends and associates to identify symptoms and recommend treatment if the problem 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.

Symptoms usually include:
* Feeling low
* Guilt
* Social withdrawal
* Low self worth, lowered confidence
* Disturbed sleep
* Changes in appetite (eating too much or too little)
* Fatigue, listlessness
* Poor concentration
* Irritability or shortness of temper

Treatment
* Depression is treated using anti-depressants such as selective serotonin reuptake inhibitors (SSRIs)
* Fluoxetine is the only antidepressant approved to treat depression in children

More than 8 lakh (800,000) people die from suicide each year, which roughly corresponds to one death every 40 seconds. It’s the eighth highest cause of deaths globally, shows World Health Organisation data.

“Depression and substance abuse (alcohol and drug addiction) often go hand-in-hand. 90% people who commit suicide have a psychiatric disorder and 75% are clinically depressed,” says Dr Samir Parikh, head of psychiatry, Fortis Hospitals.

Adolescent and teen suicides have quadrupled globally in the past decade. 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 than women.

One reason for the gender bias is that psychological disorders like depression and anxiety occur more often in women, with the gender disparity emerging at puberty. Social factors such as subjugation of women add to the problem, making many women feel frustrated and helpless.

“People with suicidal thoughts should be helped to identify ‘counters’ what would stop them from taking their lives. These counters differ with people, and could be religion, children, family, responsibilities, fear of being called a coward, among others,” says Parikh. “You have to give them some hope to live.”

‘Psychological counters’, such as a promise to meet or do something fun on a fixed day, help, as does being around to prevent the person from slipping into an abyss of hopelessness.

“If feelings of sadness, social withdrawal and listlessness do not go way in two weeks, the person must see a doctor,” says Rajesh Sagar, associate professor, department of psychiatry, All India Institute of Medical Sciences (AIIMS).

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.