All of us, at some point in life, get sad, have hopeless feelings, and lack interest or pleasure in daily activities. These are natural human responses to untoward situations in life. Feeling sad is not similar to having depression; these feelings persist long and show signs of troubles in sleeping, eating, and functioning. If the ‘sad’ feeling is affecting your life extensively, then the issue may be depression. 

What Is Depression?

According to the World Health Organization, it is a common mental disorder and has become a leading cause of disability worldwide today. Depression, also known as clinical depression or a depressive disorder – is a mood disorder producing long-lasting feelings of sadness,  worthlessness, hopelessness, and pessimism. It can occur out of the blue or possibly on the crusts of a defeat or personal loss. 

Clinical depression is not like some occasional blue mood that one can “pull themselves together” to get better. Instead of viewing it like some ‘chemical imbalance’ in the brain, view it as a ‘behavioral shutdown’ which takes place in response to overwhelmingly negative situations. These negative situations are mostly those in which you have little personal control, lack appropriate resources to deal with them, and have no comfort in the form of social support. 

It can become a serious health condition affecting adversely, functioning of a person at work, school, and in the family. In the worst cases, it can lead a person to commit suicide. 

Signs and Symptoms of Depression

The General Symptoms of Depression are:

• A sad, anxious, or empty mood
• Reduced or lack of interest in pleasure activities, including sexual desires
• Agitated, restless, feeling
• Slowed movement and speech
• Fatigue or loss of energy
• Feelings of worthlessness 
• Feelings of guilt, hopelessness, and pessimism
• Irritability and difficulty in thinking, concentrating, or making decisions
• Repetitive thoughts of death or suicide, or an attempt at suicide

Not every depressed person experiences all the symptoms. Some live with hidden signs of depression till, over time, the severity of the symptoms begins to affect an individual. However, these signs can also be an indication of some other medical issues other than depression. 

Hidden Signs of Depression:

1 Changes in appetite or weight:

Mood often affects eating habits. Look for signs of too much or too little eating as it suggests the presence of depression. It brings dramatic weight changes, impacting the self-esteem of a person. 

2 Changes in sleep patterns:

Mood and sleep also have a strong link. Lack of sleep or sleeping too much both are signs that a person may have depression.

3 Alcohol or drug use:

To cope with their feelings of sadness, loneliness, or hopelessness, some people give in to alcohol or drugs. It may give them a temporary high to deal with their mood disorder, but it multiplies their problem with an alcohol or substance use disorder.

4 Forced happiness:

Some people mask the symptoms of depression with their overjoyed attitude. These people suffer from ‘smiling depression’; they put on a happy face when in the company of others and struggle with their mood disorder alone. They fear speaking their mind out loud for being judged by others.  

5 Being more realistic or pessimistic than others:

People suffering from depression may display a trait called ‘depressive realism.’ It is a habit of being more accurate in their view of events and the control they have over it while lacking optimism like normal people. 

The Symptoms of Depression –  Based on Gender: 

Females:

According to a study by the Centers for Disease Control and Prevention (CDC), women are twice as likely as men to have depression. Some of these symptoms of depression are more likely to appear in women than men – 

• Irritability
• Anxiety
• Mood swings
• Fatigue
• Dwelling on negative thoughts

There are even some specific types of depression that are unique to females:

• Postpartum depression
• Premenstrual dysphoric disorder

 Males:

For a long time, many considered clinical depression a ‘women’s disease,’ and yet more than 6 million men in the U.S continue to get affected by it each year. Men with depression tend to incline more towards excessive alcoholism, displaying anger, or engaging in risk-taking behavior than women. 

Men are less likely to express the signs of depression-like sadness or worthlessness like females. According to the American Psychological Association,  9% of men in the United States have feelings of depression; yet, they tend to deny it and refrain from talking about their emotional issues. 

Other symptoms of depression in males:

• Lack of sexual interest
• Avoiding families and social situations
• Feel withdrawn, irritable, aggressive, or hostile
• Tendency to work without a break
• Face difficulty in keeping up with work and family responsibilities
• Displaying abusive or controlling behavior in relationships

The Symptoms of Depression – Based on Age Level:

Seniors:

Geriatric depression or depression in older adults can reduce the quality of life and increase the risk of suicide. Loss of partner, friends, financial woes, isolation, reduced mobility, and chronic health ailments induce depressed feelings in older people. Even other health complications often contribute to depression in them. 

Apart from general symptoms of depression, older adults can have symptoms like 

• Crying spells
• Apathy
• Restlessness
• Lack of concentration
• Withdrawal from life activities
• Sleep problems
• Changes in appetite
• Suicidal thoughts
• Physical aches and pains

College Students:

The first time the college experience can be stressful for many. They feel pressure to keep up with new lifestyles, friends, roommates, exposure to a new culture, and experiences. Depression can influence the ability of a college student to work, study, and interact with peers. It even affects their ability to take care of themselves. 

Other than feelings of sadness, hopelessness, unhappiness, the symptoms of depression may include:

• Difficulty to concentrate on schoolwork
• Insomnia or hypersomnia
• Changes in appetite
• Withdrawn behavior from activities that they used to enjoy
• Avoiding social situations 
• Suicidal thoughts

Teenagers:

The signs of depression often begin in the teens as hormones flood the body causing physical changes and impacting their psychological behaviors. It is normal to face emotional ups and downs at this age, but if the overwhelmingly sad feeling continues for a long time, like a few weeks to months, then it is better to talk to a trusted adult about depression. 

It is crucial to know that depression is not a weakness. Family and friends must understand that merely saying things like ‘snap out of it,’ ‘just be positive,’ or ‘you can be happier if you just try harder’ would not help a depressed person.  

Look out for depression symptoms in teens like 

• Alienating from friends and family 
• Difficulty in concentrating on schoolwork, remembering information, or making decisions
• Sudden dropping grades 
• Lack of interest in school activities
• A feeling of guilt, helplessness, or worthlessness
• Having aches or pains like headaches, cramps, or stomach problems without a specific cause
• Restlessness or trouble sitting still
• Drug or alcohol use
• Suicidal thought or attempt to harm yourself 

 Children:

According to the CDC, 1 in 6 U.S. children aged 2–8 years (17.4%) have been diagnosed with a mental, behavioral, or developmental disorder. The family environment, like a history of violence or alcoholism, verbal abuse, or any physical or sexual abuse, increases the risk of depression and suicide among children. 

Even though it is rare for children or youth under 12 to attempt suicide, but they may do it impulsively while they are upset or angry. Boys are more likely to kill themselves while making a suicide attempt compared to girls of similar age. 

The primary symptoms like sadness, hopelessness, mood changes remain the same as adults. Many psychologists state evidence of children masking depression with acting out and anger behavior. Parents, teachers, and guardians must look at the symptoms children may experience like 

• Irritability
• Increased sensitivity to rejection
• Low energy
• Clinginess
• Changes in appetite
• Rebellious behavior
• Vocal outbursts or crying
• Finding schoolwork and social activities challenging
• Impaired thinking or concentration
• Reduced ability to perform in activities at home or with friends, in school, 
• Lack of interest in extracurricular activities or having hobbies or interests
• A sudden downward trend in academic performance

Types of Depression:

Sad, depressed mood can also be an indication of other mental conditions other than depression. However, mental health experts recognize depression in four main types:

Major Depressive Disorder:

It is a condition in which a person feels depressed most of the time throughout the week. They live in a constant state of sadness, lacking the interest to engage in any hobbies or activities whatsoever enjoyed earlier by them. It has signs like changes in sleep patterns, weight gain, or loss, apart from other general symptoms of depression.  

Its treatment mostly includes medications and psychotherapy. But depending upon the case, a doctor may also suggest electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or Vagus Nerve Stimulation (VNS). All these procedures stimulate specific areas of the brain that helps in better mood control. 

Bipolar Disorder:

Research shows that people experiencing bipolar disorder have symptoms of depression half of the time, making it difficult to diagnose. They have mood episodes ranging from euphoric high to depressing low. As a person exhibits episodes of mania like feeling euphoric and displaying intense excitement, frenzy, and, often, delusions, it is sometimes also called manic depression.

This condition features both symptoms of depression and schizophrenic disorders. It is unclear what triggers the mood swings but changes in circadian rhythms, whether due to lack of sleep or changes in exposure to daylight, play a vital role. Medications help with these conditions to control mood swings. Doctors may also give mood stabilizers, along with other depression medications for better results. 

Postpartum Depression/Postnatal Depression:

Many women experience postpartum depression after childbirth. It is a form of depression that sets off due to hormonal changes, along with many lifestyle adjustments and demands coinciding with motherhood. 

It has severe symptoms of depression that can persist for months or years. Research also shows, in 50% of cases, the mood shifts and anxiety begins during pregnancy, and for this reason, it is sometimes also called peripartum depression. Out of 3 to 6% of women who experience postpartum depression, a small number of them may also experience psychotic symptoms like hallucinations commanding them to kill the baby. 

80% of the women who develop mild forms of mood swings after childbirth, the symptoms usually lift in weeks, but cases, where it extends further, need medical attention. Doctors treat this condition with antidepressant drugs.

Persistent Depressive Disorder or Dysthymia:

Persistent Depressive Disorder (PDD) or Dysthymia is a low-grade, chronic depression to which women are twice as more susceptible than men. The depression symptoms in dysthymia can last at least two years, or longer and people can also experience periods of major depression sometimes. It can occur alone or combined with other mood or psychotic disorders. 

There is no specific cause for this condition though genetic factors may play a role. But it is not necessary for people with a family history to have PDD always. Other factors like abnormal functioning in brain circuits, significant life stressors, chronic illness, medications, and relationship or work problems can contribute to increasing the chances of dysthymia, specifically in people who are biologically predisposed to developing depression.

It’s mostly characterized by a sad or depressed mood that persists almost the entire day and every day. Many people also can experience changes in sleep patterns, appetite, and energy levels. People often do not get the treatment for PDD they require due to the common belief – ‘their symptoms are an inevitable part of life.’ A psychologist treats this condition with medications like antidepressants and psychotherapy like supportive therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, and interpersonal therapy (IPT). 

Forms of Depression that Develop Under Certain Conditions:

• SAD – Seasonal Affective Disorder:

It is a type of recurrent major depressive disorder that occurs due to seasonal changes. Mostly it begins as days get darker and shorter in the fall and gets better in the spring. SAD is four times more common in women as compared to men and in people living in countries with long periods of winters. The shortage of sunlight causes an inability to produce vitamin D and the overproduction of melatonin (due to darkness). 

In a few cases, exposure to an extended period of daylight in summers can also lead to SAD conditions in people. Lethargy, weight gain, and hypersomnia are common winter SAD symptoms, and insomnia or inability to fall asleep is a summer SAD symptom. 

Usually, this type of depression is mild or moderate; however, people with chronic conditions can have difficulty functioning in their daily lives. In some cases, it can be misdiagnosed as hypothyroidism, hypoglycemia, or a viral infection like mononucleosis. Its treatment includes a  combination of light therapy, vitamin D supplementation, antidepressant medication, and counseling.

• PTSD – Post Traumatic Stress Disorder:

PTSD is a mental health condition or a disorder, but in some cases, people also suffer from major depressive disorder along with it.  According to experts, the co-occurrence of major depression with PTSD reflects a distinct subtype of PTSD, wherein the cognitive function of a person gets significantly impaired. It affects the daily functioning of a person and increases the risk of suicides compared to those who are suffering from PTSD alone. 

Researchers have found evidence that those at risk of suffering from both PTSD and major depressive disorder possess a history of childhood ill-treatment, especially physical abuse. The neuroimaging studies in these cases indicated they might also have fewer nerve connections in brain circuits, causing difficulty in processing emotional memories.

• Psychotic Depression:

It is a subtype of major depressive disorder wherein a person experiences some form of psychosis. The psychosis could be –

Hallucinations like hearing a voice that tells you – ‘you are not good or worthless’ or sensing things that do not exist.

Delusions like severe feelings of worthlessness, failure, detachment from reality, or false beliefs of having committed a sin

It may cause people to get angry for no apparent reason, spend a lot of time by themselves or in bed lying during daytime or at night awake. A person suffering from psychotic depression may neglect their appearance altogether by not taking a bath or not changing clothes. It can be hard to talk to people suffering from psychotic depression. They barely speak, and even if they do, they lack sense. People suffering from it, may also feel humiliated or ashamed of their thoughts; so they try to hide them, making diagnosis of such conditions difficult.

• PMDD –  Premenstrual Dysphoric Disorder:

Those women suffering from PMDD (a premenstrual syndrome) can also have depression or a feeling of hopelessness and anxiety. Fluctuations in the hormone levels lead to a deficiency in the neurotransmitter serotonin, which causes mood disorders or depression in them.

Causes of Depression

Most studies link depression with the number of stressors experienced by a person in their lives and its cumulative effect on them. The difference is in the susceptibility of a person towards it, depending upon their

• Biological Heritage
• Parenting Culture 
• Styles of Thinking
• Coping Mechanism

It also depends on the degree to which a person feels they can control their fate in a specific situation.

Factors or Stressors – Playing a Role in Causing Depression:

• Abuses – Past or ongoing physical, sexual, or emotional abuse can increase the vulnerability of a person to clinical depression in life later. 
• Conflicts – Personal conflicts or disputes with family members or friends can develop a biological vulnerability to depression.
• Death or Loss – Loss of a significant relationship by death or divorce can cause psychological or emotional impact leading to depression.
• Genetics – A family history of depression in parents or siblings can increase the risks of depression in other biologically related persons.
• Medications – Drugs like isotretinoin (used to treat acne), antiviral drug interferon-alpha, and corticosteroids can elevate the risks of depression in a person.
• Changes in the neurotransmitter levels of the brain – It occurs in conditions like PMDD or any form of prolonged stress, causing depression in a person.
• Personal problems like loneliness: Feeling left out (especially in the case of elderly or youngsters), social isolation due to other mental illnesses, or being cast out of a family/ social group can psychologically impact a person and make them vulnerable to depression.
• Major life events – Good events like a new job, graduating, and getting married, as well as bad events like losing a job or income source, getting divorced, or retiring – all have cumulative effects on a person causing a major change in their life. It increases the risks of depression in them if they have poor coping mechanisms.
• Serious illness and health conditions – It affects the quality of life of a person and can cause depression to co-exists with the ongoing health conditions.
• Financial problems – Most people with stressful financial conditions like poverty or debts can become susceptible to depression and suicidal thoughts.
• Substance abuse –  Almost 30% of people with substance abuse problems have major depressive disorder conditions. As soon as the temporary escape from reality fades from using substances like alcohol, drugs, etc., their depression aggravates.

Treatment of Depression

Treatment can benefit any bout of depression that lasts more than two weeks. Early treatment has the highest probability of full remission of symptoms, preventing relapse or recurrence. However, in most cases, mild symptoms often go neglected.

In the U.S. itself, when it comes to depression, women are more likely to seek treatment than compared to men. Depression burdens people further with missed work and poor-productivity. It also causes a devastating effect on relationships, family life, physical health, and overall quality of life.

Depression is treatable, and a holistic approach for treating it includes psychotherapy, support of loved ones, and medications. The most basic need for any treatment to succeed is the support of family and friends around the depressed person. Most psychotherapists and psychologists prefer discussing practical solutions and possible causes of depression with family members in advance. They educate them about depression treatment. 

Most Effective Way of Depression Treatment:

Psychotherapy:

It is also known as ‘Talking Therapy,’ which involves one-on-one counseling (Interpersonal Therapy) and cognitive behavioral therapy (CBT). The goal of the treatment is to rectify the errors of thought and beliefs that ignorantly underlie depression. It further facilitates developing strategies for strengthening the coping mechanism to deal with stress.

Psychotherapists use it as a first-line treatment in some types of depression, whereas, for other cases, they use a combination of psychotherapy and medications that results in a better response from depressed patients. It is best when done in individual sessions. However, one can also have it in groups, over the telephone, or online.

• Interpersonal Therapy: It helps a person to identify their emotional problems that affect their relationships and communications. It enables them to understand how these issues affect their mood and guide them in managing them further. 
• Cognitive Behavior Therapy: It is a problem-centric, goal-oriented approach that works based on the way we think and interprets the effects of life events and how we behave towards it ultimately. It is a time-limited course of sessions that focuses on the present-day challenges, thoughts, and behaviors of a person.

Medication

Antidepressant drugs are often used for treatment by doctors in depression. It provides relief to patients from the symptoms of depression, including suicidal ideation, and directly stimulates neural circuitry. It restores effective communication between key areas of brain functions by affecting the neurotransmitters, like 

• Norepinephrine, 
• Serotonin, 
• Dopamine, 
• And others belonging to a class of chemicals known as Monoamines

A person should take these medications in the doses as prescribed by their physicians. Abrupt stopping of medicines is highly ill-advised as it can lead to relapses. The caregivers must raise concerns with the doctor if patients have any intention to stop taking the medication.

Medication Side Effects:

Antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) can have side effects – 

• Nausea
• Constipation
• Diarrhea
• Low blood sugar
• Weight loss
• A rash
• Sexual dysfunction

Check for the Food and Drug Administration (FDA) warnings on the package of antidepressants carefully, as these medications may increase suicidal thoughts or actions in some children, teenagers, and young adults in the initial few months of treatment.

Brain Stimulation Therapies

Depression can become treatment-resistant when after administering multiple types of medications, either used singly or in various combinations, fail in improving the conditions. Instead of generating a response, it creates intolerable side effects. 

Brain stimulation therapies are another treatment option when patients fail to respond to medications. 

Types of Brain Stimulation Therapies:

• Electroconvulsive therapy (ECT) – It’s useful in the treatment of severe cases of depression or depression with psychosis that does not respond to any medications. For treating bipolar disorder or schizophrenia, this therapy may work.
• Vagus nerve stimulation (VNS) – It benefits patients with symptoms like epilepsy and hard-to-treat depressions.
• Repetitive transcranial magnetic stimulation (rTMS) – It’s a non-invasive neuromodulation technique using an electromagnetic coil to send magnetic pulses to the brain for treating depression, psychosis, anxiety, and other disorders.
• Magnetic seizure therapy (MST) – It is an alternative to ECT and a most effective treatment for suicidality in treatment-resistant major depressive disorder.
• Deep brain stimulation (DBS) – Originally used for Parkinson’s disease wherein, like a pacemaker, a small device placed inside your chest that sends electrical pulses to your brain, blocking the nerve causing the issue. Presently, it’s also been used for treating depression and obsessive-compulsive disorder (OCD). 

Other Natural or Lifestyle Measures

Natural remedies:

Before modern medicines, people used herbal medicines to treat mild to moderate depression. Till today, many prefer natural remedies for treatment, an alternative to medication or therapy. FDA does not regulate herbal medicines and therefore cautions people about the quality, safety, and effectiveness of the products as a treatment for depression. 

Some of the most popular herbs and plants use to treat depression:

St. John’s Wort: 

It is the yellow flowers of St. John’s wort plant (also considered as a weed in some parts of the U.S.) often taken in liquid or capsule form and in some cases a dried herb as a tea to treat mild depression. 

People must be cautious about their intake, as its side effects can cause allergic reactions, fatigue, increased blood pressure, upset stomach, and sensitivity to the sun. Pregnant women, children, the elderly, and those people with medical conditions or taking certain medications must avoid taking this herb for any health complications. 

Ginseng:

Western scientists and health professionals often question the medicinal properties of ginseng, but people who feel weak and tired used it for stimulating physical and mental activity. Many people use it to improve their mental clarity and reduce stress. However, researchers have not found a definitive answer to the desired cognitive effect in ginseng as a food product. 

Even if it is safe to consume, it has side effects like headaches, digestive problems, nervousness, blurred vision, changes in blood pressure & blood sugar, dry mouth, dizziness, delirium, decreased heart rate, etc. Psychiatrists advise not to mix ginseng with a class of antidepressants called monoamine oxidase inhibitors (MAOIs). 

Chamomile: 

Mostly it is used in the form of tea. Various studies and some research prove its medicinal effects compared to other alternative remedies. People may try it as a supplement to other treatments, but that does not make it a mainstream medical option.

Chamomile contains flavonoids that may have an antidepressant effect, but can help only in mild cases. However, people with severe allergies to pollens and infants or very young children must avoid using it due to possible botulism spore contamination.

Lavender: 

Lavender is a herb mostly used as essential oils as its scent has a calming effect. Researchers have not found any specific proof of benefit in the case of depression; however, they found it helps to reduce anxiety and insomnia in patients. Compared to the herb form of lavender, the oils can have a toxic effect if consumed. 

Overall, it is necessary to consult with a doctor before using any of the types of natural remedies or supplements to treat depression. Its interactions with various antidepressants can make symptoms of depression worse.

Food and Diet:

The global shift towards a diet high in processed foods, saturated fats, and refined sugars has become a cause of various physical health problems. Several systematic reviews and meta-analyses showed a relationship between unhealthy diet and depression that affected, particularly, the mental health of young adults.

On the contrary, researchers found healthy food could help in managing or improving depression symptoms among patients. 

List of Some of the Healthy Foods:

• Selenium:

Food rich in selenium might help improve mood and reduce anxiety, making depression more manageable. It is present in foods like whole grains, brazil nuts, some seafood, organ meat like liver.

• Vitamin D:

Most people can get Vitamin D from sun exposure. It can uplift mood and improve symptoms of depression. It’s also found in food sources like oily fish, fortified dairy products, beef liver, eggs. 

• Omega 3 Fatty Acids: 

It helps with depressive disorders, reduces the risk of mood disorders, and brain diseases by improving brain function and preserving the myelin sheath that protects nerve cells. It’s found highly in food sources like cold-water fishes – salmon, sardines, tuna, and mackerel, flaxseed, flaxseed oil, and chia seeds, walnuts.

• Antioxidants: 

When the body fails to remove free radicals, it leads to oxidative stress that results in health problems like anxiety and depression. Eating antioxidants (Vitamin A- beta carotene, B, and C) help in removing free radicals, which may reduce symptoms of anxiety in people with a generalized anxiety disorder. Fresh fruits and vegetables, berries, soy, and other plant products may help in reducing stress-related symptoms of depression.

• B Vitamins: 

Vitamins B9- folate and B12-folic acid help protect and maintain the nervous system and brain. It minimizes the risk of mood disorders like depression. Food sources with Vitamin B12 include eggs, meat, poultry, fish, oysters, milk, and fortified cereals. Food sources with folate include dark leafy vegetables, fruits, nuts, legumes, eggs, seafood, dairy products, whole grains, meat, and poultry.   

• Zinc: 

It helps in boosting the immune system and may also influence depression. It also makes antidepressants absorption in the body better. Food sources that contain zinc include whole grains, oysters, beef, chicken, pork, beans, nuts, and pumpkin seeds. 

• Protein: 

Proteins support the growth and repair mechanism of the body. It may also help people with depression as a protein called tryptophan creates serotonin, the “feel-good” hormone. Food rich in tryptophan includes items like tuna, turkey, and chickpea. 

• Probiotics: 

Researchers suggest healthy gut microbiota like  Lactobacillus and Bifidobacterium may help reduce the risk and symptoms of depression. Food sources like yogurt and kefir may boost the growth of these beneficial gut bacterias. 

List of foods to avoid aggravating symptoms of depression:

• Alcohol
• Refined foods
• Processed oils like safflower and corn oils
• Saturated fats like trans fats in processed foods, fats in red and processed meats
• Caffeine

Supplements:

Aside from dietary changes and natural remedies, a person can also use natural supplements to gain all the above elements to treat symptoms of mild-to-moderate depression. Other than natural supplements, some non-herbal supplements may also help treat mild depressions –

S-adenosylmethionine (SAMe): It is a synthetic form of a natural chemical present in our body that works effectively as an antidepressant. 

5-hydroxytryptophan: It helps in boosting the serotonin levels in the brain that affects mood disorders. 

However, remember, the FDA does not monitor supplements for their safety and effectiveness. Herbs and supplements may provide some relief from symptoms of depression but consulting a doctor is essential for having a better quality of life for depression patients.

Exercise:

Exercising is necessary for physical and mental wellbeing, but it alone cannot fight severe depression. In moderate to severe cases, along with medications, exercises improve brain functions and uplifts mood. It regulates many other physiological events that give health benefits like protecting against heart disease and diabetes, improving sleep, and lowering blood pressure. 

High-intensity exercises and aerobics raises levels of feel-good chemicals called endorphins and stimulates the neurotransmitter norepinephrine, making it a viable option to beat mild depression. It promotes nerve cell growth in the hippocampus and renews nerve cell connections giving ease to patients from depression symptoms. 

Living with Depression

The modern-day living carries growing pressures, making almost everyone susceptible to the occasional blue mood. Further, there also has been a direct culture shift, wherein the concept of ‘Free play’ – necessary for early childhood development, is replaced by social contacts through electronic connections. It adds to the issues of socialization, fear of left alone, and loneliness. Adults are more focused on gaining material wealth than having rich experiences and social contact. All these combined play a part in raising clinical depression issues. 

Telling people suffering from depression to “pull themselves together”, does not help as they cannot get better themselves; they need support from loved ones and medical assistance. Therefore, it is necessary to accept depression as a part of modern living and, without further denial, reach out to psychotherapists or psychologists before it gets too late.