Saturday, February 11, 2006

Depression - it could happen to you

I did not know Perwez Shahabuddin but two of my very dear friends did. An IIT Delhi graduate, MS and PhD from Stanford, Professor at Columbia University, Perwez committed suicide in a Days Inn motel room in November 2005.

A copy of the book 'Final Exit' was found by his body. This is a 'how to' manual for terminally ill people who want to end their life. Of course, people use it to learn about painless ways to commit suicide as well.

His wife says Perwez had called that evening asking if he should bring home some groceries. The family cannot believe he would have taken his own life. But the police say that the professor's computer indicated he may have been planning this 'final exit' for a long time.

Last night television actress Kuljeet Randhawa was found hanging from the ceiling of her Juhu home. Again, there is disbelief among family and friends. They had no idea she was contemplating such an extreme step. But then neither did those who knew IITian Vijay Nakula.

Kuljeet was a close friend of model Nafisa Joseph, who committed suicide in 2004. Before that there was Natasha Singh. And of course there are many, many less high profile cases of suicide in the newspapers everyday.

All these individuals suffered from clinical depression. In some cases, they successfully 'hid' it from the world. In Nafisa's case, she was actually under treatment. But none of them ever imagined aisa mere saath ho sakta hai.

But, it can
A few years ago I read about how depression would overtake heart disease as the world's number one killer disease. I laughed back then but here's the deal:

Approximately 20-25% of women and 12% of men will experience a serious depression at least once in their lifetimes. Of those who have experienced a major depression once before, approximately half may experience it once again.

I have. And I know many of you will as well. Which is why I am sharing with you today something that I wrote shortly after Nafisa Joseph's death - a year and a half ago.

I publish it now because I think it's time we shake off the stigma attached to any form of mental illness. The fact that I waited so long to share my experience shows that even in my mind, the doubt of 'log kya kahenge' exists.

Yes, I was once depressed. I kicked it. It wasn't easy but I emerged a better and stronger person for it.

Know that it could happen to you. Know that you too can kick it.Don't hesitate to seek help. Or to reach out and help others. This, is my way.

Inside the Black Hole and Beyond
- Rashmi Bansal
originally written, August 2004 (but never before published)

Every act of life, from the morning toothbrush to the friend at dinner, became an effort. I hated the night when I couldn't sleep and I hated the day because it went toward night.
- F. Scott Fitzgerald, author of The Great Gatsby

Astronomers define the Black Hole as a region where matter collapses into an object so massive and dense that nothing, not even light, can escape its gravitational pull. Depression is something like that.

A hole in your soul which sucks in and obliterates all that you are, all that you lived for - love, learning, laughter. It’s the human mind, collapsing into something so massively negative and dense that nothing, not even hope, an escape its gravitational pull.

And sometimes it seems like there’s just one possible escape from the pain. Suicide.

Those of us who have not been in this state of mind cannot begin to imagine what it feels like. Those of us who have, say a silent prayer for Nafisa and keep our secret. In another time and that faraway, forlorn place, the thoughts that crossed our mind… We lived to tell the tale, but never actually tell it.

Folks with B.P. and cholestorol problems swap stories. Slipped disc slips into conversation easily. Diabetics don’t shy from describing their condition. Bet you know more folks suffering from all of the above than you can count on the fingers of your two hands.

But do you know anyone who has been or currently is clinically depressed? You probably do, except you don’t know it.

Astronomical black holes cannot be seen directly (they emit no light, remember!). But they can be detected by their effect on surrounding clouds and stars. The walking and talking human black hole is similar. Rarely will you get a direct confirmation or admission of what’s going inside such a person’s head. ("He/ she seemed so normal…" is the common refrain of near and dear ones).

But there always are a number of indirect signs and signals. Except, with each of us luxuriating in our own little worlds and feeding off our own little problems, who was really listening? And even if someone did listen what would their response be beyond trying to ‘cheer you up’.

It doesn’t work and after a while, the world will conclude you are happy to be unhappy and command you to "Snap out of it". As if the clinically depressed person doesn’t want to.

Remember the black hole? Logic doesn’t work in that zone. Willpower is not enough. Depression is a medical condition.

It’s a permanent fog in the head caused by a chemical imbalance. The neuro transmitters that regulate emotions, reactions to stress, and basic drives like sleep, appetite, and sexuality aren’t doing their job. If it were that simple, you could simply pop a pill and get over it, like a stomach upset. But, the physical symptoms are rooted in psychological ones.

Clinical depression is literally seeing the world through a pair of dark glasses that distort and colour with gloom your view of everything – including yourself. It’s this distortion that causes the chemical balance in the first place.

The cycle feeds on itself and soon enough the negative 'spin' you give to everyday events and interactions develops a force of its own. You are, effectively, trapped in that metaphysical black hole.

Why we actually don these blinkers is the subject of intense research. Genetics plays a role, as do personality traits. Introverts, perfectionists, and over-achievers are all more prone to depression. So are creative people – like artists and writers. By these yardsticks, I was a sitting duck.

And if that weren’t enough, women are twice as likely to develop a major depressive episode as men. However, they’re also more likely to recognize the problem and seek help for it, which is what I did.

To cut a long story short, a dapper doc diagnosed the disorder as ‘dysthmia’. Never heard the term, have you? Well, get this. It’s a low grade, chronic form of depression. Not as severe as ‘major depression’ but something that stays with you so long you just assume you’re 'like that only'. Dysthmics even appear to function normally, they just don’t feel excited or happy about anything. Actually, they mostly don’t feel at all.

The medication doc prescribed was great. No it didn’t give a 'high' but it was like taking a mood elevator upto the very tippy top of the Petronas Towers. Emotionally Teflon coated, I felt like a whole new person. But that was part of the problem. I didn’t want to be another person. I wanted to be ‘me’.

That’s where the 'talking it out' bit kicks in. Cognitive behaviour therapy makes you realize the negative patterns of thinking you’ve entangled yourself in. And bit, by bit, a skilled professional can help you unravel the mess.

An important lesson I learnt: finding the right psychotherapist is like finding the perfect pair of jeans. If the first pair you try doesn’t fit, you don’t give up, right?

Well, the second shot hit bulls eye, and thanks to a very empathetic and perceptive counselor I became aware of the importance of 'self talk' . The constant chatter in our heads that most of us are barely aware of, but which shapes how we think about ourselves. And therefore feel, and act. A depressive state arises when our internal 'critic' becomes vicious and literally attacks us.

The result of this constant negative feedback in our own heads is low self esteem - feeling worthless and hopeless.

It doesn’t matter how beautiful, rich or successful you might appear to the outside world. Or how ‘strong’ you have always seemed to be. In your own thoroughly warped view of the world, your life sucks completely.

The other trap you’ll find a clinically depressed person in: 'learned helplessness'. For example, after several failed relationships, you might be convinced that 'no matter what I do I'll never be in the right relationship'. And lo, it becomes a self fulfilling prophecy. When, with the help of therapy, a depressed person is able to generate alternative possibilities and explanations for why things happen, he or she begins to at last see the light.

Until then, words like 'always', 'never', 'perfect' and 'impossible' dominate your thinking. When you screw up on something it’s 'I’m a complete idiot' or 'I’m never able to get things right' and not 'Oops, I goofed up this time'. Recognise and clamp down on the use of this 'all or nothing' vocabulary and the entire perspective changes. This is but obvious to 'normal' people but a huge revelation when you are in the twilight zone.

Of course, nothing is as simple as it sounds. You can accept these arguments at an intellectual level and still be unable to actually 'change' or adopt new patterns of behaviour.

It’s a slow, sometimes frustrating process but one that gradually builds the emotional velocity to escape from that black hole.

And one fine day you realize – “I did it!”

Like diabetics who need to watch their insulin levels, a person who has once been depressed always needs to be vigilant. Because there are times when you can sight that black hole in the distance. It’s only human to feel sad and low at times, but relapsing into the old and negative patterns of thinking is what you constantly have to guard against.

Rediscovering the people, places and passions you really enjoy is one habit you have to carry on. With me, that meant reconnecting with the one thing that had always made me happy but which somewhere along the way I’d lost faith in – writing. It also meant making the time and effort to meet with friends I had lost touch with, and to keep the ‘crazy’ side of me alive.

As for the Black hole. As in metaphysics, so in astrophysics. There are no absolutes. After nearly 30 years of arguing that a black hole destroys everything that falls into it, Stephen Hawking recently admitted he was wrong. It seems that black holes may after all allow information within them to escape.

It is in fact now believed that the black hole eventually shrinks to a tiny kernel, at which point a growing torrent of radiation begins to leak out. So, if an object falls into a black hole it is not completely obliterated. Instead, the black hole is altered as it absorbs the object.

Something similar holds true for the human soul. You emerge from the ‘black hole’ not as a diminished but a different, often much richer and more empathetic person. The old Rashmi would never have shared this experience. The new one has.

Because there are too many people out there I can recognize now, spinning in their private black holes. Unable to open the door when opportunity, and happiness comes knocking. "It’s not the end of the world", I want to say to them all.

Why me, is a question many of you must be asking. Well, as a wise man once put it: "One ceases to recognize the significance of mountain peaks if they are not viewed occasionally from the deepest valleys."

The view from up here – it’s truly beautiful.

Useful: Identifying clinical depression

Facts about depression:
- According to the WHO unipolar depressive disorder is the leading cause of disease burden or DALY (disease adjusted life years) for females globally.

- Nearly twice as many women as men are affected each year. Some of this is accounted for by frequent changes in hormone levels of women (eg depression is common at the time of menopause or after childbirth).

- Men may be less willing to acknowledge their emotional symptoms and more apt to suppress their depression through the use of alcohol or other substances. In such cases depression can be "masked," or viewed only as alcohol or drug dependency/abuse rather than as clinical depression.

Research indicates that depression onset is occurring earlier in life today than in past decades.

- Upto 2.5 percent of children and 8.3 percent of adolescents in the U.S. are believed to suffer from depression.

Depression helpline numbers
Sumaitri (Delhi): 2371 0763
Sanjeevani Society for Mental Health (Delhi): 4311918/ 4317285
The Samaritans (Mumbai): 23092068
Prerna (Mumbai): 25905959
Maithri (Kochi): 0484 2396 272 (/3)
Sneha (Chennai): 28273456

Alternatively, ask your family doctor to refer you to a mental health professional

44 comments:

  1. Nice info that...

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  2. Thank you so much for this post Rashmi. *tight hug*

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  3. Rashmi, this is very well-written; compassionate, personal, and informative. Tough combination to pull off. It takes guts to write something like this. keep up the great writing - enjoy reading it.

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  4. A few weeks back I wrote about the japanese hikikomori who lock themselves in their rooms for 5-15 years --- and how at one point committing suicide was the cool thing to do in Japan. thankfully, we aren't at that stage here but Indians, in my experience, don't have a healthy attitude towards the word, "depression." the think of it was some kind of loony-ness or just don't believe you!

    I went through depression twice. And was too afraid to admit it. But it is high time Indian governments/schools think of installing support systems or atleast spread awareness that depression is not akin to madness.

    In USA, every school/work place has a pscyh on board. yeah, therapy is a little glamorized- but atleast people have a healthy attitude towards those who suffer from depression. Or so I've observed.

    thank you for posting this. hopefully someone will do something about it...

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  5. Rashmi
    Do you think depression is the only cause for suicide? In 'The Tipping Point',Malcolm Gladwell talks about the islands of Micronesia, where suicide rates were seven times higher than the rest of the US. It almost seemed as if suicide had creeped into the local culture and had become 'cool'. Suicides led to suicides. Chilling but true. I knew a very headstrong business partner of mine who committed suicide last year. No one, including her family, could come up with a reason except that it was done on impulse after her wedding got postponed. Bless her soul.

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  6. Rashmi...this is indeed an excellent artice...compassionate, informative and does not sensationlize the issue. I was just watching with disgust the Aaj taks and star news' of the world sensationlizing this tragic issues with headlines like "ek model ki maut!!!" (yes, with the exclamation marks).
    Instead of understanding the root cause of the issue....which yr post does very well. Mental health problems still have a big stigma in india society... if only there was more awareness...then tragic incidents related to depression wouldn't happen.

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  7. Very useful post...

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  8. A Very big hug and a huge thank you!!!!
    thanks for being real!

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  9. Thanks Rashmi, This is very helpful article..

    My Blog - The Way I See It !

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  10. Really a very good post.
    And the thing that u started writing(which u enjoyed the most) to prevent the recurrence of depression is also very useful tip.
    Thanks

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  11. The trick lies, I think, in putting the name "depression" firmly down on the condition of which you become a part, if only temporarily.
    Once you've got that out of the way, handling depression becomes so much more easy to do medically.
    Often caring for the depressed can be a challenge in itself, and it is the next of kin who happen to need therapy in some way or form; this need should not be made light of.

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  12. Hi Rashmi,

    I had a couple of incidents including my neighbour (who was a doctor herself and a mother of a 4 year old child) committing Suicide. I saw some connection and decided to lookup on what relation do Anti-Depressants have on suicidal tendencies and I came upon this article through a google search.

    Somehow it made sense to me that anti-depressants may have some role to play in generating suicidal tendencies in people (even children). I am of the belief that the external interference with the fine chemical balance that exists in our body must be done under very careful supervision. Else it probably hits back like a withdrawal symptom when you haven't taken your medication. It may be worthwhile to find out if each one of the people who committed suicide were on anti-depressants at all.

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  13. very touching Ms bansal indeed .. i have small request plz dont be offened very personal thing where can i get the hard copy of ur article ...plz tell me

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  14. That was really personal and yes, it made a lot of sense...to me. I went through something very recently which scared the shit out of me, never realised I could reach such a nadir, any case eventually crawled my way back up but I couldn't have done it alone...EVER. Support makes all the difference.

    Where did you publish this article and I am sure it wasn't in JAM. I read about suicide pacts in Japan - totally on the Internet of all the ruddy things.

    How did the val issue go? do mail me sometime

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  15. yaa , you are more strong with your words , Good to read as well as to forward

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  16. Rashmi, your writeups are “Ek se bad kar Ek”. I am becoming a hardcore fan of yours.
    Keep it up.

    Depression and stress have been identified as the killer diseases of the 21st century. It is ironical that such a state of affairs should prevail but in my view, but that is partly due to lifestyle problems and partly due to the fact that much less is known about the inner world than external world.

    The worst thing in mental problems is that they are invisible and there is no x-ray or thermometer to gauge how bad it is. I have myself read so many cases where after the suicide the family states,” We didn’t know it was that bad”. There is a psychiatrist in Delhi, Dr Avdesh Sharma who has very good pamphlets on how to detect symptoms of various mental sicknesses including depression among your relatives.

    Being more social and group dynamics is deemed more important as that can keep you cheerful.

    I am surprised that you have not mentioned yoga at all. If you do yoga regularly, you can stay fresh throughout the day. Yoga with the ideal diet is the icing on the cake. The catch is that it is a little boring and you don’t like doing it when you are depressed.

    Last year there was an issue in March2000 from India today on student suicides called “Killer exams” in which it was stated how people all over India were taking their lives because of the fear of the board exams. The govt. then introduced policies like making the board exams optional and introducing measures like giving a 15 minute time to read the paper first and things like that. These are good measure but is not the real cause of the problem, One has to get to the root of the problem.

    The medical professionals do not always get to the root of the problem. They treat some problems at the effect level and not always at the cause level. I suffer from depression because of being in the wrong occupation. They just shrug their shoulders and say that we are not career consultants. Even the career consultants in Uniited states, far better than in India take a very long time to make the correct placements. In my view, faster ways have to be invented as work occupies too many waking hours and the depression can get spiraling out of control. The medical profession has a wrong attitude in my view though this need not be so in all such cases.

    The patient should try and figure out what works best for him. In my case, spontaneous enthusiasm works best. I try to fuel my enthusiasm by things I am interested in like buying books even though I don’t really need them. That keeps the wrong thoughts in check.

    Unfortunately, the biggest problem is that allopathic medicine does not work on everybody and is prone to side effects. One should also know the kind of depression one suffers from apart from the one on writers and poets; there is a seasonal affective disorder (SAD) which strikes in winters. It is indeed a sad state of affairs and ironical that modern man has to face all this.

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  17. Hey Rashmi, I have one basic doubt...Is being overly sad about something, also a version of depression? Or is depression something much much beyond just being sad? Because, I have been emotionally very down and sad in the past owing to certain incidents...but, I dunno if that was a sign of depression or sumthing else? But, i do want to know
    Great post!!

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  18. Being such a well read BLOG. You should've got more facts.
    In Psychiatry like in most other specialities there is a spectrum of disease.
    So there's really no line to be drawn between Normal, Depressed and Clinically depressed. You've written about clinical depression, not about the middle of the spectrum.
    And people there are people who commit suicide as a knee jerk reaction without actually going through any depression.

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  19. i think its bcoz of growing materialism tat all such cases arise! its like money fame fortune promise to provide you with happiness! but when you have them and are still unhappy you feel cheated and think that you entire life is a waste! so is the case with love! falling in love is not all rosy! every relationship has its tough times .

    as a kid i used to think this depression is just some fancy thing rich ppl pretend they have . but i think the problem is more widespread and not acknowledged the way it should have!

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  20. I heard you at nit rourkela.your initiative towards taking up this topic is appreciative because nowadays even the youngsters tend to get due to competition and immense pressure from their parents.the article on JAL was really applaudable.

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  21. Thanks Rashmi.

    Somehow, people either tend to dismiss depression in this country, or to attribute it to 'materialism' or some other such flippant answer.

    I'm not sure if I suffer from any form of depression (I think I do, but it's been controllable so far and I haven't had it diagnosed) but i'm in a relationship with someone who has a much more serious problem. If it wasn't for counselling and medication my life (and his) would be a lot harder.

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  22. hey rashmi...nice post.
    Your comparision of depression with a black hole was ver apt....ive been there too...so i know.
    I just think you should also have mentioned manic depressive psychosis wich is a bipolar disorder and is also very common...

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  23. Hi Rashmi,

    I am very pleased to read this article. Being through the journey of helplessness once I can feel it so much that I have also chronicled my experiences in http://learningcurvelife.blogspot.com. The feeling of worthlessness inside sometimes generates rudeness is behaviour which mostly people do not understand. Mind and its intricacies are fortunately being studied all over the world and I am hopeful of better understanding of mind in future.

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  24. great post! i am glad that something like this is out there of all to read. i hope that people who suffer from depression become more open and apt to tell someone by reading this.

    one thing that i am surprised isn't mentioned is religion. i don't define myself as a very religious person but a semi-cure to my depression was acknowledging that there is a god.

    ...of course everyone has their different means of curing depression from suicide to pills.

    keep up the good writing!

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  25. Hi Rashmi.Allow me to recommend the Sudarshana Kriya (a breathing exercise) taught at Art of Living workshops as a surefire cure and prevention of depression. I was a skeptic before I attended this course, but soon found that it works like magic. The effect is tangible within days of practicing the Kriya. And I also know people who have suffered from chronic clinical depresion who have greatly benefitted from it.

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  26. The truth about depression or any other emotion is that we end up holding up on to it - consciously or sub consciously. The key is to let go. It is one of the simplest and easiest methods but ironically the simplicity in all of it makes it look like crap to us. I've been using the Sedona method for over a year which is a 3 step process to letting go of anything and everything. It was amazing to see what years of therapy couldn't cure my depression which 2 weeks of using the method did.

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  27. Great post ms. Rashmi,

    Under similar circumstances and with professional help i could bounce back.
    Confession from people in different fourums would surely ease the stigma attached to depression. I hope we will be able to see some intersting case studies posted on this topic.
    bye

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  28. Beating depression is next to impossible without support. But when depressed, we also tend to avoid others, and wallow in the pit we dig for ourselves. Its a downward spiral that we slide down, and its not easy to realize that we are the only ones who can pull on the brakes.
    Even if we beat it once, its oh-so-easy to fall right back in again. Do it often enough, and soon its familiar territory...An old blanket we wrap around us.

    As you said, writing definitely helps. Sometimes when I can't bear to live with my thoughts anymore, I rant and rave on paper, and if I don't always feel released, at least I feel calmer.

    Its heartening to see that more people are waking up to the dangers of depression in India. Its often just shrugged off as temporary, or as a result of stress. Hopefully more people will come out and admit depression. Unless they do, they can't be helped.
    Coming out of depression does make us stronger, and more attuned to others. I used to avoid sharing my thoughts on it too...I just hope more young people can be helped before its too late.

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  29. I just felt that what I went through this month is the bad part of an actually much longer dysthmia. You got any phone numbers for Bangalore, Rashmi?

    Nice post. Really opened my eyes that this could (and did) happen to me.

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  30. Very good article Rashmi.

    I've read a lot online about depression and suicide, and I could send you all the information I have, if you like.

    I just failed my class 12 exams, so I have personal experience.

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  31. Rashmi,

    I got to know abt this blog only today..5 months after uve written it. im not a regular to ur blog, and came to know abt this particular blog of yours while i was surfing the net. At the outset, let me congratulate you for trying to describe a state which is not easily comprehendable and narratable. I am suffering from Depression too. But mine has taken a different turn. I have this problem of obsessive thoughts (negative ones) about everyone around me, practically. It is pathetic to stay in such a world, and while medicines do help, and it seems that u have left it behind you for a while. But soon, the black hole ( as u describe it) reappears. I am a management student, and u know abt the pressure we have w.r.t. project deadlines and stuff. At times, it is very difficult for me. But i sometimes, only sometimes, manage to lauch it off, saying to myself that almost all great men (sorry!) suffered from this ailment. So, may b ur destined for greatness! Winston Churchill Described his depression as the black dog. Rashmi, after reading ur blog, frankly, i got a lot of strength, seeing that anyone can suffer from this wretched thing, and still live happily. Lots of love..Rajesh.

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  32. Thank you. One of the most straightforward things I have come across on depression.

    Please continue posting stuff. Inter-personal relationships and psychotic problems are crucial issues for the present youth.

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  33. A nice article. My father, a scientist, is currently recovering from depression and I'm still trying to understand the reasons and solutions to this malady. The conditions were similar-no particular reason, a loss of self-esteem, a loss of hope and looking at death for salvation. It was painful to see a person whom one reveres right from childhood go through all this pain and we felt so helpless about it. After a lot of indecision and possibly 3-4 months of suffering, we had to admit him to a hospital. Things have improved and the recovery is happening. It is a slow process and requires patience. I cannot remember when I last cried but when I saw my father(a strong extrovert figure) reduced to a state of extreme paranoia where he was even afraid of us and at times unable to even recognize us, I could not hold back my tears .I could not believe what I was seeing. There are positives, I see now. The family's closer now and I and my brother realize that we have probably overcome our first real crisis in life as adults.

    I had great difficulty in explaining to others what my father's condition was and no one ever understood. Everyone had an easy solution, encourage him, do not make him sad etc.(all that filmy stuff).We did try and there were those moments when we screamed at our Father for not understanding us but hope I am sorry for all that now; depressed situations do take a toll. Things are improving and I hope to see the old happy man back.

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  34. Great Post, Rashmi!
    You have weaved together a compelling view point on this important issue.

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  35. Thank you. I and my sister are suffering from depression since four years. First my sister was diagnosed for clinical depression in the year 2003 and I was taking care of her treatment. I had panic attack in my office in March 2004 and I was taken to Sagar Apollo Hospital, Bangalore. I was referred to Psychiatrist. I was given antidepressant Prothiaden 75 mg and after some time increased to 225 Mg. After taking the medicine, I am feeling better but always reminding me that something is wrong with me. My thinking pattern has changed i.e., most of the time thinking negative, affected social life, often panic attack with fast breathing, Suicidal thoughts, feeling low, low self esteem, no confidence, and wondering mind. I am working as a Manager in a private ltd company. As of day, with god grace either in personal or official most of the positive things has happened but still I feel something is wrong with me which am difficult to express.
    With regard to my sister treatment, doctor has changed medicine to prodep for my sister. Now it looks like she is ok and not 100%. Hoping for a better future.

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  36. Antidepressants are 9 out of 10 times misused or abused due to their tranquilizing property. This very tranquilizing trait of the antidepressants makes them vulnerable to misuse. The fact of the matter is that antidepressants are to be used as tranquilizers but only on prescription. On having them otherwise one not only runs the risk of suffering the side effects but also the prospect of dependence on the drug. Antidepressants like xanax are sold online nowadays for the convenience of the people; one should not try to meddle with them or try to get them by foul means.

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  41. This, I'm sure this took quite some guts to share. Knowing you from your blog and your appearances on TV, the thought that depression could affect very normal people is only further strengthened.

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  42. Thanks a lot Rashmi!! This was really one of the killer posts - you deserve a lot of plaudits for it!! A very tight hug... am personally going through this phase - and your article really hit the bulls eye!! Cannot thank you enough - A fellow sufferer

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