Depression; What is it and what to do about it?


Depression; What is it and What to do About It?
As an expat psychotherapist in New Delhi, I write a monthly column for the local chapter of the American Women’s Association to help expat women live their lives more fully. Members can pose questions to me anonymously and I do my best to try to answer them. By far and away, the greatest number of these questions have to do with depression. Here is an example of a recent question and my answer:

Dear Dhyan,

What are the symptoms of depression (both in kids and adults) and when should you seek professional advice? Can it affect your physical health?
Dear Uncertain,
I thank you so much for your question because I think it is one the aspects of mental health that confuses people the most.

Sadness vs. depression:
First, I’d like to make a distinction between sadness and depression. Sadness is a basic human emotion that all emotionally healthy people (children and adults) experience from time to time. It is normal to feel sad when we experience a loss, leave the familiar, or miss a person, pet, or in the case of children, even a favorite toy. Our ability to feel sadness is part of what makes us human.

So sadness is normal, natural and is not to be confused with depression which is usually not related to a specific event, although it may be triggered by one. For example, if we are an adult and our parent dies, it is normal and appropriate to feel sadness. We may even experience profound sadness if we were very close to our parent or had unresolved issues with them. Most adults who loose a parent experience waves of sadness that get less intense with time and the waves come further apart.

However, if we are unhappy and find ourselves continualy thinking about our parent over a prolonged period of time, this can be a sign of depression. Especially if we also have some of the physical symptoms described below,

Physical symptoms:
Some examples of physical symptoms that may be tied to depression are being tired and sleeping a lot or not being able to sleep, overeating or not having an appetite, constipation or diarrhea, drinking alcohol more than usual or relying on prescription or recreational drugs. It is important to remember that these symptoms alone are not signs of depression. But if these and other physical symptoms are accompanied by prolonged feelings of sadness, a general feeling of heaviness or malaise, lack of motivation, or a lack of interest in the people and events around us, these may be the warning signs of depression, particularly if there has been no significant trigger event. It may be helpful to seek the advice of a professional if these symptoms persist.

Physical health:
You asked if depression can affect physical health and the answer is yes. Clearly if we’re not getting the food or sleep we need to thrive, our bodies are going to be negatively affected. It can work in the reverse as well. If our body isn’t functioning optimally for a long period of time, we may become depressed. We have one mind/body system, in which the parts are interconnected and interdependent. What affects one part, affects the whole. That is one of the reasons why exercise, eating healthy foods, and getting enough sleep is so important for both the body and the mind.

Children and depression:
The symptoms of depression aren’t really different in children than in adults, but children are typically unable to verbalize their feelings so we have to anticipate or guess. If our child has left behind good friends, moved to a new school and is having difficulty making friends, we can anticipate that this will be a difficult time for her. We can normalize her feelings of sadness by telling her that we also feel sad sometimes, and that it is normal to feel unhappy for a while during difficult times.

However, if a child seems to have a general malaise or lack of interest in what is going on around him, as well as some of the physical symptoms described above, over a prolonged period of time, this may indicate depression. Particularly, if there hasn’t been anything to trigger these feelings. In such cases it can be helpful to get an evaluation by a child psychiatrist or psychologist.

A word about medication:
In this era of Prozac and psychiatric drugs, there are many misconceptions. There are three main categories of drugs that people may be prescribed for depression: antidepressants, anti-anxiety drugs and mood stabilizers. It is imperative that a trained, well qualified psychiatrist (who is a medical doctor) prescribe medication for depression and anxiety. There are now so many drugs on the market, all with different side effects for some people and not others, that it can literally be suicidal to self medicate. And the drug that works for our best friend or mom will not necessarily work for us.

I find that many people who are severely depressed believe there is a stigma associated with taking antidepressants or anti-anxiety medication. They tell themselves that even though they’re depressed, they should be strong enough to “tough it out” without help. I liken this to thinking that if you have diabetes, you shouldn’t have to rely on insulin. And these same people believe that it’s okay for other people to take anti-depressants, but not themselves.

The continum of depression:
On the other hand, there are varying degrees of depression, and not all people who are depressed need antidpressants, not by a long shot. If you notice that you go and in and out of feeling depressed, yet are not feelling debilitated, there is probably no need for you to take meds. If you are able to funtion successfully at work and at home, yet find that you’re not able to experience happiness, than it is completely up to you whether you want to consult with a professional. In cases of low level to moderate depression, counseling alone can be effective.

It has been proven with well controlled scientific studies that a combination of antidepressants and cognitive behavior therapy is the best treatment for people who suffer from prolonged or severe depression. Drugs alone or therapy alone are less than half as effective as both together. In cognitive behavioral therapy, skills are learned for recognizing the thought behind the feelings we have. It is what we are telling ourselves about ourselves or the situation, rather than the situation itself, that causes negative emotions. By recognizing these thoughts as simply thoughts, instead of some kind of truth, we can choose to believe the truth instead, and thereby change our feelings. Please keep in mind that this is a process that happens over a period of time with a trained, well qualified psychotherapist, and that it doesn’t work to tell ourselves to “stop thinking those thoughts and get over it!”

Getting help:
If you find that you have feelings of unhappiness, heaviness, malaise and/or a lack of motivation for a prolonged period of time with accompanying physical symptoms, it may behelpful to seek out a qualified psychotherapist. If you have intense mood swings between highs and lows, a therapist can assess your situation, make an evaluation, and if necessary refer you to a psychiatrist for medication, if this is something you decide you want to do. I believe there are no “shoulds” regarding taking medication and that it is always the client’s call. I find that sometimes just talking with a concerned listener will help symptoms improve. Remember, you are not alone, you don’t have to do everything by yourself, and it’s okay to ask for help.

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