Audience Questions

IISc Unheard Stories | Shades of Blue: Understanding Depression

Saturday, 9 Nov 2019, 4:00-6:00 PM | A R Auditorium, Dept of Mechanical Engineering

About Depression, Triggers, Signs and Symptoms:

1. There are days when it’s very difficult to get out of bed. Zero motivation. Feeling
low. But somehow, you get up and move on with normal chores, and as the day
progresses your mood improves, and day ends relatively positively. When this
happens repeatedly for many days, it concerns. Is it normal? Or is it depression?
Does it need medical help?

It seems the symptoms here are of significant depression. You need psychological help,
very likely medical (drug) intervention too.Yes, a psychiatrist or a clinical psychologist
would help. The decision on medication can be taken in consultation with them. While a
clinical psychologist cannot prescribe medicines, as a psychiatrist can, she can recognise
when such an intervention will be needed.

When it happens for more than two weeks it is depression. It is better to consult a
psychiatrist/clinical psychologist to ascertain the severity of depression. However, if it is
causing significant disturbance in the functioning then it is better to take medication.
Self help methods such as being active, following a routine, being with people who can
understand, involving in activities which you like and can give happiness are useful when
depression is mild-moderate in severity. However, when these are not giving significant
results, or if you are finding it difficult to tolerate, it is better to seek help.

2. Something common in IISc among students and faculties is the “existential

depression”. Any Solutions?

Sometimes when things are not going according to what we want or when we do not find
satisfaction in the kind of work that we do, we feel depressed or anxious. This is the time
to sit back and reflect/clarify our priorities in life and the reasons for our distress. We
should also look at our fears which may be preventing us to choose the paths that we
want to take. We need to work on our fears before choosing the paths that we want to
travel.
 3. I am suffering from a confused state of sadness/ depression but still I feel hopeful &
optimistic. I suddenly get saddened & teary eyes with sudden thoughts running in
my mind. I feel helpless for myself & overcoming with the thoughts that is troubling
me. Is this suggesting I need a counsellor now?

Yes. Sometimes it may be a temporary passing phase after a stressful incident, however,
if it continues for more than two weeks, better to seek counseling/therapy.

4. Does logical thinking increase depression when you are wrong at first. It is a vicious
logical conclusion that you are wrong.

When we find that we have made a mistake we may feel bad for sometime and we may
take various steps to rectify our mistakes if it is possible. When it is not possible is when
sometimes we may develop depression.

5. How the bipolar depression is different from lots of depression?

Bipolar depression different from unipolar depression.

Bipolar affective disorder has both mania and depression.
Mania is the opposite of depression. There is increased energy , elated mood,
oversocialization, decreased need for sleep and grandiosity, hyperactivity etc.
Bipolar depression should be treated with antidepressants undercover of mood stabilizers
as it can cause a switch to mania.

Treatment, therapy and their limitations

6. How do we handle depression (chronic; repetitive, not curable)?

If it is recurrent then both medicines and therapy are advised. Psychotherapy aimed at
addressing identification and management of early signs, skills training for prevention of
depression (problem solving, coping, communication, interpersonal relationships) would
be useful.

Resistant depression can be treated with stimulants and electroconvulsive therapy or

transmagnetic therapy.

7. How should one choose a psychiatrist? What if the person has consulted many
counsellors and psychiatrists but not found anyone suitable to the level that the
person loses hope in therapy?
 When you choose the therapist, the first thing that needs to be kept in mind is to approach
a trained Clinical Psychologist. In the current scenario where many people without
adequate qualification are practicing counseling, it is important to ensure that the person
has done M.Phil in Clinical Psychology so that they are trained in various therapies for
depression. In addition, please do not hurry, it takes some time for the therapies to work,
and for which your efforts are equally important.

8. Is there such a thing as “Getting out of depression/ Anxiety”? What is it or the

closest things to it? How do I identify and convince it in myself or a close one? What
next?

Definitely one can be in remission after an attack of depression or anxiety. There is

pleasure in previously pleasurable activities, there is no fatigue without exertion, there is
hopefulness, need to meet friends , family and reconnect. And improvement in personal
grooming, appetite, sleep. Since depression can be a recurrent illness, one needs to
anticipate the early signs and symptoms of depression and maintain a mood diary for
early diagnosis and intervention.

9. How much does the recovery depends on the competency of the

psychiatrist/psychologist and the willingness of the person to accept their illness
and make sincere efforts in improving?

Competence of the psychiatrist as well as psychotherapist are very crucial. Of equal

importance is the willingness of the person and the efforts to follow the suggestions of
the therapist.

11. What is the purpose of the anti-anxiety/anti-depressant medicines? First and most
important is to cure the symptoms of course. But in the long term, shouldn't the
therapy help one to get back to the normal routine? Whereas medicines are
continued for such a long time that the person ends up feeling drowsier and less
motivated everyday where he/she finds difficulty to do normal everyday stuff. Thus,
returning to the normal routine becomes more difficult every day. Shouldn't there
be a proper program and follow up by a doctor to take care of that?

Along with the medication, for improvement in functioning the efforts of the individual is
very important. Without individual’s efforts it becomes difficult to maintain adequate
 functioning. Thus it is essential that the treatment is a combination of both at least in
chronic depression.

12. Sometimes long-term usage of the medicines can lead to serious physiological
problems (may be as side effects of the medicines and the condition all together?
Because every person is different so the condition may vary from one to the other)
and at that point shouldn't there be proper diagnosis for the symptoms? Shouldn't
these problems be taken care of with equal importance as the depression/anxiety?

Yes.

13. Before starting the medicines, shouldn't the whole medical history, physical
conditions of the patient be judged critically? And even when the treatment is going
on shouldn't these conditions (body weight, pulse rate, blood pressure at the very
least) be monitored carefully by doctors?

Yes.

14. What happens if depression is untreated?

It will have a chronic course, resulting in significant reduction of functioning,

productivity, well being of the person. It can also have serious impact on family
relationships and experience of burden. The chances of suicide will increase.

Vulnerability, Risk Factors and Relapse

15. What is the risk factor/ genetic disposition to bipolar depression or depression?

Family history of depression/ bipolar affective disorders or substance abuse among first
degree relatives increases the biological risk of developing them. Modifiable factors
could be child abuse , neglect or bullying.

16. As a victim of mental abuse, I feel hopeless most of the time. As a result, I am too
polite with everyone, I generally feel out of place in social circles. What should I do?

Please seek help (Psychotherapy).

17. Do gender issues such as homosexuality, asexuality, being transgender or queer

contribute to depression?
 Yes, because of the stress caused by social stigma, inability to carry out normal life taks.

18. Are certain class of people more vulnerable to depression than others? For
example, someone from a rural background, a particular social or economic class.

Poverty is one of the vulnerability factors, in addition, ongoing family stressors,

relationship problems, also predisposes people. The recent National Mental Health
Survey shows that people in the urban settings experience more depression. This may be
because of isolation, lack of support and work pressure.

19. I have read stories on survivor diaries where some of these people have gone
through something which is a lot worse than what I have faced. I marvel at their
resilience and coping ability even in the time of such severe emotional crisis. But I
tipped off into severe depression and I am still recovering. I wonder why I do not
have the resilience that they do. How do I become more resilient to life crisis and
avoid a relapse? Why was I so severely affected by situations which are not as
severe as the one’s I read?

Each individual have their own thresholds, and each individual is vulnerable to different
things. Worrying over this may not be useful. You may look at strengthening those areas
which you feel are weaker in you.

20. Are there certain personality traits in people which makes them more susceptible to
depression than others? I have read that most people who are neurotic
perfectionists are often more at risk of having an episode of major depression. They
also seem to have a very high standard (often impossible to achieve) for everything
they do and are more anxious in starting anything, paying a lot of attention to
details, care a lot about what others think about them.

Yes, personality plays a very important role.

Support and Recovery

21. Mental health disorders are painful & hard to patients & also for the caregivers.
And, since the time taken by the therapy/ medication is long the caregivers be it
family/ friends’ lose motivation and that affects both the relationship b/w the
patient and the treatment process​.

Yes it is true, that is when the caregiver needs support.

22. There might be some triggers/constant negative thoughts or incidents which we

might not be comfortable in sharing with others. How to decide whom to share
with? How to break the inhibition and talk openly? How to decide to which extent I
can /should open up & which things to address personally/ internally myself?
Sometimes it is tough to say somethings event a professional. What to do then?

It takes time to trust a therapist and share things. You may take your own time to share
the most sensitive things till you develop trust in the person. One thing that needs to be
kept in mind is that most qualified psychotherapists maintain confidentiality and they can
handle the difficult issues.

23. When to start talking? More importantly, where to start? The depression might
have started when situations were different, but the current situation that escalated
it, might be different. So Where to start?

It always starts with the current problem/situation and if it is relevant you may want to
share the past also. A good place to start might be a psychologist.

24. How to stop feeling guilty when you lack the motivation to work on your goals say
academic (most) or health or even relationship and friendship as a result of mental
health issues and depression? And this is even when you are taking medical
professional help?

You have to be patient with yourself. You are the first priority when you are depressed.
Please do think that other things can wait and you will not lose much if you are delayed
in completing things by sometime.

25. There has been a rise in suicides in premier institutes, IIT Hyderabad seeing 3
suicides, IISc 2 this year. I always feel people in highly competitive Institutes lack
empathy. How should I react/ listen /help a depressed friend? What are the signals
 they show before they commit suicide- What reason should I give them to continue
their life?

Talking about suicide/lack of interest, hope, meaning of life, etc may help. being
withdrawn change in eating, sleeping and behavior patterns of the person, reduction in
productivity etc; indicating that they have less time, they are planning to give a surprise,
they may not see you again etc are some signals to watch out for

26. As a friend, how can I help my friend who is diagnosed with depression?

Facilitate sharing and help seeking. Provide whatever support is required, spend time
while also establishing clear boundaries on when to stop so that you don’t become
affected

27. How to deal with a depressed person who is relying on you too much?

Mobilise alternative support systems. Establish clear boundaries and it is important to

take time off for yourself.

28. When someone talks of suicide? What measures can be taken towards prevention
by friends?

Monitor, be with them, ask them to contact when the get suicidal ideas, inform close
family members. Take them for consultation. Know reliable mental health emergency
numbers (for IISc: check the Wellness Centre website).