What is depression?

Estimated reading time: 8 minutes

Depression is a serious medical illness characterised by a constant feeling of sadness, a lack of interest, difficulty in expressing and experiencing positivity, and a sustained low mood, says Mumbai-based psychiatrist Dr. Gaurav Kulkarni. For the condition to be medically termed as depression, a person has to show symptoms for two weeks or more.

According to the World Health Organisation (WHO), depression impacts more than 264 million people globally. “Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family,” says the organisation.

According to a study published in the Lancet journal,  in 2017, 197·3 million people suffered from mental disorders in India; this includes 45·7 million with depressive disorders and 44·9 million with anxiety disorders. 

In the first part of a series of interviews on depression, Dr. Kulkarni talks to us about the symptoms of depression, it’s causes, and whether men and women experience the symptoms differently. Edited excerpts:

What is depression?

Depression has become a very loosely-used term, we hear it so often that it sometimes loses its significance which can be detrimental to people suffering from it.

In our day-to-day life, we express multiple emotions — we feel happy, sad, low or down. These are all momentary expressions of emotions. When you see a sustained state of an emotion, which is very negative, low, which has a lot of sadness, sorrow, we would call it depression. It is a mood disorder. Mood is nothing but a sustained state of an emotion. Depression is a state where you experience a constant feeling of being sad, a lack of interest, difficulty in expressing positivity and in experiencing positivity. A good term to use here is anhedonia — to not be able to feel pleasure, be pessimistic, have a negative cognitive belief system, feelings of helplessness, hopelessness, and worthlessness.

Depression is a state where you experience a constant feeling of being sad, a lack of interest, difficulty in expressing positivity and in experiencing positivity. A good term to use here is anhedonia — to not be able to feel pleasure, be pessimistic, have a negative cognitive belief system, feelings of helplessness, hopelessness, and worthlessness.

A very important part of this sad and sustained low mood is that it has to be there for a span of about two weeks. This is where most of us tend to make a mistake, if a particular event during the day makes us feel bad, we think that we are depressed. But for depression to be classified and identified as clinical depression, we need to see all these phenomena for a span of about two weeks. That is when we would call that mood a clinically depressed mood.

For depression to really be classified and identified as clinical depression, we need to see all these phenomena for a span of about two weeks. That is when we would call that mood a clinically depressed mood.

What happens to a person’s brain when they are depressed? Talk to us about the biological causes of depression?

There are many possible causes for depression. These can be genetic, chemical imbalances, hormonal imbalances, stressful life events etc. You will be surprised to hear that over so many years we are still trying to figure out the exact etiology of mental health issues. Depression used to have a very different connotation, it was more of a psychological concept —  we used to think that depression is purely a psychological issue. But as we have moved ahead, as science has progressed, we are able to go more into the microbiological level, the neurobiological level and we are beginning to understand depression as a kind of a biological illness rather than only a psychological illness. The main difference between the two is that when you identify something as a biological illness, we recognise that it has a strong connection with neurobiological changes in the body, which express or manifest in the form of certain symptoms.

Specifically in depression, the biological component of depression is a disturbance at a neurobiological level in the brain, specifically the frontal lobe of the brain, which is known to do a lot of emotional and cognitive activities. In people who are suffering from depression, there may be a significant disturbance in neurochemicals called serotonin, dopamine, and norepinephrine in the brain.

When you see a significant decrease in the serotonin and the dopamine levels in certain specific areas of the brain, you will definitely see that individual expressing negative cognition, experiencing difficulty with emoting or difficulty with experiencing certain things. We have identified that every thought that comes to our mind is also a biological process. When a particular thought comes into mind, there is a biochemical movement in the brain, which at the neurobiological level is deciding what kind of thought we should have at that moment. These are a part of the reason that people with depression have pessimistic thoughts, a negative viewpoint, difficulty with feeling positive energy, and a difficulty with feeling good. It is possible that if a person were to be treated for depression biologically, even if their social scenario would remain the same, they may still be able to think and feel positive. 

Tell us about the symptoms of depression?

There are four major classes that can be used to classify the symptoms: physical, emotional, cognitive, and behavioural symptoms. Some of the important symptoms are: low mood or sadness that lasts for at least about two weeks. Second is having a lot of negative or pessimistic thoughts about yourself, others, and the world. People may also have feelings of helplessness, hopelessness, worthlessness, a sense of failure. Biological functions are significantly affected by depression, people may feel a loss in physical energy, significant exhaustion, mental exhaustion, fatigue, and physical exertion.

There are also sleep disturbances which we call insomnia, which is very common in depression. We also see symptoms like appetite loss and significant weight loss. Sometimes we have patients who are not able to express that they have depression but they would have lost a significant amount of weight without making an effort.  

Another important aspect is general sexual health. A person’s libido and the need for sexual gratification can be greatly impacted by depression. People may also see rumination, overthinking, and irrational thoughts. There is a constant sense of low energy, they may experience the feeling that they want to end their life and they don’t see the point in living. 

Suicidality is an important, integral part of depressive symptoms. Not every depressed patient will talk about suicide. But as depression intensifies, there can be feelings of self harm, minor self harm or self harm to the level of ending one’s life. We’ve seen that anxiety, which can be a very normal phenomenon sometimes becomes an integral part of a depressive phase, wherein people constantly feel anxious, vulnerable and have physical symptoms like palpitation, tremors in the hand, dizziness, all typical symptoms of anxiety. 

There are a couple of unexplained minor symptoms like headaches, constant worry about something, and physical symptoms like itching or rashes, which aren’t a part of any major medical illness; these are more psychosomatic in nature. At a cognitive level, symptoms that we often notice with office-going people, are difficulty with logic, multitasking, attention, concentration, and focus. All of these symptoms may not happen together, we may see some in the early phase and others in the later phase, but more or less, we will find them.

Is there a difference in how men and women experienced symptoms?

There are no differences in symptoms. A man with depression and a woman with depression would probably have similar symptoms.  In women, we have identified differences at a hormonal level. The general biological makeup of a woman is different from that of a man. When women go through sudden and intense hormonal changes like during puberty, menopause, pregnancy, or postpartum, they may be prone to depression. Sometimes we see that because of lifestyle differences between men and women, they may express their depression differently compared to men. We don’t usually see men coming in expressing sadness as the first symptom, but women are more cognitive sometimes. They are able to understand the issue at a multi-level, they are able to express sad feelings or mood swings better than men. These symptoms are differently perceived in men and women, but they are not different.

We don’t usually see men coming in expressing sadness as the first symptom, but women are more cognitive sometimes, that is what we’ve identified. They are able to understand the issue at a multi-level, they are able to express sad feelings or mood swings better than men. These symptoms are differently perceived in men and women, but they are not different.

There are also studies to suggest that women are almost twice as likely to develop depression compared to men. 

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