Sadness is a common emotion. It’s a ‘customary’ reaction to loss, failure, rejection; all of which are inevitable in everyone’s everyday routine existence. All such situations involve pain and the blues they cause are warranted. But staying sad for too long, letting the sorrow engulf you, and inability to snap out of it is not justifiable. That’s the difference between sadness as a passing emotion; and depression as a disorder that needs attention.

Depression is not simply a state of ‘mood’. It becomes a part of life of the depressed person. Slowed speed of thought, inability to make decisions, not wanting to talk to people; these are the initial presenting features of pathological depression (making it different from ‘just a bad mood’). Gradually the body starts getting affected. Inexplicable loss in appetite, incomplete and unrested sleep with inability to experience pleasure soon sets in. Thoughts become irreversibly negative: life seems unworthy of living, self esteem gets depleted and at times one may believe this is a worthy self-punishment since self regard gets negated entirely.

Decrease in happiness is the first sign of depression. Individuals with depression feel sad almost throughout the day, everyday. There is lessened interest in activities that previously were pleasurable. They perceive a loss of energy, and fatigue, with unreasonable guilt and self-reproach. Their ability to think and concentrate goes down as dullness sets in and contributes to indecisiveness and irritability. Suicidal thoughts may appear in extreme and severe depressed states. People give up jobs, friendships, and marriages; in several cases their life too. The end point of depression is the lowest low.

Depression may present contrarily to what is expected of it. Sometimes one may experience ‘atypical’ symptoms like overeating, excessive sleep, anger (instead of sadness), agitation, restlessness; all of which never arouse suspicion of ‘depression’. Mood changes during menstruation, chocolate craving, unexplained outbursts, seasonal mood switches are all masks that depression garbs itself in. One must be vigilant. It may occur in bouts for short periods of time (recurrent brief depression), may be seen monthly in females prior to the menses (pre-menstrual dysphoria), may follow a seasonal pattern of coming up in the summer or winter months (seasonal depression), or may be continuous and last for years (chronic depression). The pattern must be observed in order to offer appropriate treatment.

Measurement of social behavior and subjective feelings has shown that depression is one of the most disabling and distressing of all medical illnesses, causing significant distress and disability. The continuous mental pain seriously influences the quality of life and the depressed person rightly feels that their life is really not worth living. The risk for suicide is the highest in depression compared to all other medical and psychiatric disorders. We offer medication as well as psychotherapeutic techniques to help individuals perceive the beauty of life; to ensure that it becomes socially, emotionally and economically more meaningful. Depression is an illness and it is treatable. It is prudent to make the best of one’s existence in this lifetime itself; there are no second chances.