Depression

Depression is a medical condition that changes mood, thinking, sleep, appetite and energy, and holds them changed for weeks or months at a time. It is a disorder of how the brain regulates mood, and a person does not bring it on themselves or shake it off by deciding to.

It arises from several things acting together. A family history raises the likelihood. So do sustained life pressures such as bereavement, financial strain, isolation or an unhappy job, and so does anything that alters the body's chemistry: an underactive thyroid, low haemoglobin, chronic pain, long-term illness, alcohol, and the months after childbirth. In many people no single trigger is identifiable, and that does not make the condition less real or less treatable.

Depression is common in India and is treated successfully every day. Most people improve substantially with treatment, and the majority of them are treated entirely as outpatients while carrying on with work and family life.

Diagnosis is made in conversation, and the first consultation is long because of it. Your doctor is establishing how low the mood has been, how long it has lasted, how much of the day it occupies, and what it has taken away from your work, your sleep and your relationships. Severity and duration are what separate a difficult few weeks from a treatable illness.

They will ask directly about thoughts of harming yourself. The question is asked of everybody and asking it does not plant the idea; answering it honestly is what lets your doctor judge how urgently you need help.

They will also look for things that imitate depression or sit alongside it. Thyroid function, haemoglobin, vitamin B12 and vitamin D are checked where the picture suggests them, and your doctor will ask about alcohol, about medicines you are taking, and about any past stretch of unusually high mood, elevated energy or reduced need for sleep. That last question matters, because a history of such a period changes the treatment completely.

Bringing a family member who has watched the last few months is useful, since the change is often clearer from outside than from inside.

Improvement is gradual and measured in weeks. Where medicine is used, sleep and appetite usually settle first, often within two weeks, while mood and interest lift later; six to eight weeks at an adequate dose is the fair point to judge whether it is working. Talking treatment works to a similar timetable, over roughly eight to sixteen weekly sessions.

Most people keep working throughout. Where the illness is severe, two to four weeks away from work, with a phased return afterwards, is a reasonable plan and your doctor can certify it.

Treatment continues well past the point of feeling better. Stopping as soon as you feel well is the commonest reason depression returns, so treatment is usually carried on for six to twelve months after recovery and then reduced slowly with your doctor instead of being stopped at once. Reviews are every two to four weeks at the start and further apart once you are stable.