What is depression that is now ubiquitous everywhere?  As the anxiety levels rise all over the world due to the pandemic, depression has begun to move in like a cloud and settled in our homes and in our minds. Mind the gap has now given way to Mind your mind. Depression has been defined as a mental health issue – a disorder that is characterised by melancholy, angst and a lack of interest in the everyday activities of life. So, what do we know? That ‘ depression is a common, debilitating, and potentially lethal disorder.’ That the statistics say that over 300 million people in the world are affected by it, and WHO has identified it as one of the largest contributors to global disability. The underlying statistical threat is that adolescents with major depressive disorder are 30 times more likely to commit suicide.

According to a recent book by medical authors Navneet Bains and Sara Abdijadid , “Major depressive disorder (MDD) has been ranked as the third cause of the burden of disease worldwide in 2008 by WHO, which has projected that this disease will rank first by 2030.” But the mental health experts are baffled by the sheer range of symptoms and shades of anxieties and its accompanying symptoms. The nosology or classification of depression presents a great challenge – it defies a neat description that can be labelled and addressed with specific remedies and treatments. Have we erred it by giving it a common name? It is like calling depression a mental illness and expecting it to shed some light on the layers of suffering that plagues the patients. Should we give it a wide berth and treat each and every case as a unique disorder or syndrome? That would be a challenge as the etiology of depression still eludes experts and the treatment protocols are still at a nascent stage.

The point to note is that there are no objective tests for depression.  The subjective evaluation in some hospital settings is undertaken by the Hamilton Rating Scale for Depression (HAM-D), which is a clinician-administered depression rating scale  commonly used for the assessment of depression.

Some of us are familiar with the drill. It begins with the family physician, who may perhaps zero in on the psychosomatic symptoms, and may advise the family to consult a mental health professional. Sometimes, the cases are identified early on, but in most cases, especially with the stigma associated with mental health, a lot of time is lost before the elephant in the room is acknowledged, that yes, we have a mental health problem here that needs to be addressed. And the important indicator to note and evaluate the patient for suicidal or homicidal ideations at each visit. Major depressive disorders are currently treated with a combination of a wide variety of treatment protocols such as pharmacological, psychotherapeutic, interventional, and lifestyle modification.  This issue of depression, and the medical depressive disorder, in particular, has leapt to the centre stage of medicine all over the world. The pandemic has manifested the coronavirus, which is not the case with depression which is so difficult to discern and detect. What is now emerging is the sweeping darkness of mental health that is lurking in the shadows, and is spreading its sinister tentacles around the minds of human beings.  For those who are struggling with it, or have a family member going through the stress, here is an insightful encouragement from Prince Harry: “It is okay to have depression, it is okay to have anxiety, and it is okay to have an adjustment disorder. We need to improve the conversation. We all have mental health in the same way we all have physical health.”