Depression and anxiety are among the most common health conditions in India and among the least treated. Stigma keeps people from seeking help, and when they do, symptoms often present physically rather than emotionally.
Both are treatable, and treatment works well for the large majority of people.
Distinguishing Sadness From Depression
Feeling low after a loss or a setback is normal and does not require treatment. Depression differs in duration, pervasiveness and impact.
Depression involves most of these, most of the day, nearly every day, for at least two weeks:
- Persistent low mood, or emptiness
- Loss of interest or pleasure in things previously enjoyed, which is a core feature
- Significant change in appetite or weight
- Sleep disturbance, either insomnia or sleeping excessively
- Fatigue and loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or making decisions
- Slowed movement and speech, or agitation
- Thoughts of death or suicide
Loss of interest is often more useful than sadness in identifying depression, particularly in men and older adults who may not describe themselves as sad.
How It Presents Physically in India
Many patients present with bodily symptoms rather than emotional ones, and are investigated extensively before the underlying condition is recognised.
- Persistent headaches
- Body aches and back pain
- Burning sensations in the hands and feet
- Chest tightness and palpitations
- Digestive complaints including gas and acidity
- Persistent fatigue and weakness
- Dizziness
- A sensation of heat in the head
Patients often describe weakness and tiredness rather than low mood, and undergo repeated blood tests and scans that come back normal.
Physical causes should certainly be excluded, particularly anaemia, thyroid disease and vitamin B12 deficiency, all common here. But once they are excluded and symptoms persist, depression deserves consideration rather than more tests.
Anxiety Disorders
Anxiety becomes a disorder when it is excessive, persistent and interferes with functioning.
Generalised anxiety: excessive worry about multiple things most days for months, with restlessness, muscle tension, irritability, difficulty concentrating and sleep disturbance.
Panic disorder: sudden episodes of intense fear peaking within minutes, with palpitations, sweating, trembling, breathlessness, chest pain, nausea, dizziness and a fear of dying or losing control. These are frequently mistaken for heart attacks and lead to repeated emergency visits.
Social anxiety: intense fear of judgement in social situations, leading to avoidance.
Panic attacks are genuinely frightening and physically real. The symptoms are produced by the body's alarm response, not imagined, though the danger is not.
When to Seek Help Urgently
Some situations require immediate attention rather than a routine appointment.
- Thoughts of suicide or self harm
- Making plans, or obtaining means to act on such thoughts
- Feeling that others would be better off without you
- Inability to care for yourself or dependants
- Hearing or seeing things others do not
- Beliefs that others do not share
- Severe agitation or confusion
- Postnatal depression with thoughts of harming the baby
If someone tells you they are thinking of ending their life, take it seriously, stay with them, remove access to means where possible, and get help the same day. Asking directly about suicidal thoughts does not plant the idea, and it is one of the most useful things you can do.
What Treatment Involves
Treatment is chosen according to severity, and both talking treatment and medication have good evidence.
For mild depression and anxiety: psychological therapy, structured exercise, sleep improvement and reducing alcohol are often sufficient.
For moderate to severe: a combination of medication and therapy works better than either alone.
Psychological therapies including cognitive behavioural therapy are effective and their benefits persist after treatment ends, which is an advantage over medication alone.
Medication takes two to four weeks to begin working and six to eight weeks for full effect. Side effects often appear before benefit, which is why many people stop in the first fortnight. Knowing this in advance helps considerably.
Treatment is usually continued for at least six to twelve months after recovery to prevent relapse, and stopping should be gradual and supervised.
Addressing Common Concerns
These beliefs prevent many people from starting treatment.
Are antidepressants addictive? They are not addictive in the sense of craving or dose escalation. Stopping abruptly can cause discontinuation symptoms, which is why they are tapered.
Will they change my personality? No. Effective treatment restores you to yourself. Feeling emotionally blunted suggests the dose or drug needs adjusting.
Will I need them forever? Most people take them for a defined period. Some with recurrent depression benefit from longer treatment.
Is this a weakness? Depression involves measurable changes in brain function. It is no more a character failing than diabetes is.
Will people find out? Medical confidentiality applies as it does to any other condition.
What Helps Alongside Treatment
These have genuine evidence and work alongside rather than instead of treatment.
- Exercise: effects on mild to moderate depression comparable to some medications
- Regular sleep schedule, since sleep and mood are strongly bidirectional
- Reducing alcohol, which is a depressant and worsens both conditions
- Maintaining social contact, even when the instinct is to withdraw
- Structure and routine, including getting dressed and leaving the house daily
- Behavioural activation: doing things before feeling like it, since motivation follows action rather than preceding it
- Correcting vitamin B12, vitamin D and iron deficiency
- Reducing social media use
Behavioural activation is worth emphasising. Waiting to feel motivated before doing anything is the trap depression sets, and acting first is how it is broken.
Supporting Someone Else
Families often want to help and are unsure how.
- Listen without trying to fix or minimise
- Avoid saying they should just be positive, or that others have it worse
- Do not tell them it is a phase or a lack of faith
- Offer specific practical help rather than asking what they need
- Encourage professional help and offer to accompany them
- Stay in contact even when they withdraw
- Take any mention of suicide seriously
- Look after yourself, since supporting someone is demanding
Consistency matters more than saying the right thing. Continuing to check in, without pressure, is genuinely valuable.
Persistent low mood, loss of interest, or unexplained physical symptoms lasting more than two weeks deserve assessment rather than endurance. Both depression and anxiety respond well to treatment, and seeking help is a practical decision rather than an admission of weakness.
Our psychiatry department at T. Nagar provides assessment and treatment, with confidentiality as for any other condition.
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