The Struggle Within

Depression is one of the most common yet misunderstood mental health disorders affecting millions worldwide. Double Helical delves into the strategies— early recognition, timely intervention, medication, psychotherapy, better sleep, exercise, stress management, lifestyle changes, and strong social support—that can help patients fight the blues.
By Abhigyan

Indian television actress, reality-show personality, and winner of Bigg Boss 14, Rubina Dilaik’s recent disclosure about experiencing postpartum depression after the birth of her twin daughters has opened up an important conversation around maternal mental health. But beyond the celebrity revelation lies a deeper clinical reality that mental health experts believe deserves far greater public attention.

What makes her account particularly significant is that many of the symptoms she described—emotional eating, persistent exhaustion, loss of motivation, emotional withdrawal, and feelings of isolation—are frequently dismissed in Indian households as a normal part of adjusting to motherhood. In reality, these can sometimes be important indicators of postpartum depression that often go unrecognised for months.

Beyond the Baby Blues
According to Neha Cadabam, Senior Psychologist and Executive Director at Cadabams Hospitals, one of the biggest challenges in identifying postpartum depression is that it often hides behind what clinicians refer to as a “somatic mask”. Changes in appetite, disrupted sleep, unexplained fatigue, emotional numbness, or withdrawal are frequently attributed to the physical demands of motherhood, delaying timely psychological intervention.

Moving the conversation beyond awareness and into the clinical realities of postpartum mental health in Indian households, she provides expert insights on:
• How families can distinguish between transient “baby blues” and clinically significant postpartum depression.
• Why emotional eating, withdrawal, irritability, and persistent exhaustion can sometimes signal deeper psychological distress after childbirth.
• The role of family systems, partners, and caregivers in identifying and responding to early signs of postpartum depression.

Her views become even more relevant in the context of twin pregnancies and multifoetal caregiving, where hormonal fluctuations, physical recovery demands, sleep deprivation, and caregiving responsibilities can significantly heighten psychological vulnerability.

Mental health experts also point to a powerful cultural dimension. Many women continue to struggle silently because motherhood is still associated with expectations of gratitude, joy, resilience, and self-sacrifice. Admitting emotional distress during what is widely considered a happy life stage often carries feelings of guilt, shame, or fear of judgment.

Grief and Depression: Understanding the Difference
Sometimes, it can be difficult to distinguish grief from major depression. Grief following the loss of a loved one is a normal reaction and generally does not require professional mental health treatment. However, grief that is prolonged, complicated, and significantly impairs daily functioning may require treatment. Researchers continue to study the relationship between complicated grief and major depression.

According to Meena Chandra, HOD, Ram Manohar Lohia Hospital, New Delhi, most people experience one or more symptoms associated with depression from time to time. However, the occurrence of a single symptom in isolation does not constitute depression.

When healthcare professionals suspect depression, they generally look for clusters of symptoms that occur consistently for two weeks or longer and significantly affect various aspects of a person’s functioning and quality of life.

In medical terms, depression is a genuine illness that affects the brain. Anyone who has experienced depression will tell you that it is not imaginary or merely “all in your head”. Depression is far more than simply feeling sad or low. It is a serious medical condition associated with changes in brain chemistry.

Research suggests that several factors contribute to the onset of depression, including genetics, hormonal changes, certain medical conditions, stress, grief, and difficult life circumstances. Any of these factors, either individually or in combination, may trigger biological changes that contribute to depressive symptoms.

Understanding the Symptoms and Causes of Depression
Most people who experience depression need treatment to get better. Sadness, hopelessness, guilt, moodiness, angry outbursts, and loss of interest in friends, family, and favourite activities (including sex) may indicate depression. It can affect your thoughts, behaviour, and overall physical health.

The most common behavioural manifestations include withdrawing from people, substance abuse, missing work, school, or other commitments, and attempts to harm oneself. People experiencing depression may also have physical symptoms such as tiredness or lack of energy, unexplained aches and pains, changes in appetite, weight loss or gain, changes in sleep patterns (sleeping too little or too much), and sexual problems.

Alcohol and other forms of substance abuse or dependence may also co-exist with depression. Research shows that mood disorders and substance abuse commonly occur together. Depression may also occur alongside other serious medical illnesses such as heart disease, stroke, cancer, HIV/AIDS, diabetes, and Parkinson’s disease. People who have depression along with another medical illness tend to have more severe symptoms of both conditions, greater difficulty adapting to their medical condition, and higher medical costs than those who do not have co-existing depression. Treating depression can also help improve the outcome of the co-occurring illness.

Depression is most likely caused by a combination of genetic, biological, environmental, and psychological factors. Depressive illnesses are disorders of the brain. Long-standing theories about depression suggest that important neurotransmitters—chemicals that brain cells use to communicate—may be out of balance in people with depression. However, proving this conclusively has been challenging.

Brain Chemistry and Depression
Brain-imaging technologies, such as magnetic resonance imaging (MRI), have shown that the brains of people with depression may appear different from those of people without depression. The parts of the brain involved in mood, thinking, sleep, appetite, and behaviour may function differently. However, these images do not reveal why depression has occurred, nor can they be used to diagnose depression.

Some types of depression tend to run in families. However, depression can also occur in people with no family history of the disorder. Scientists are studying certain genes that may make some individuals more prone to depression. Research indicates that the risk of depression results from the influence of several genes acting together with environmental and other factors.

In addition, trauma, the loss of a loved one, a difficult relationship, or any stressful situation may trigger a depressive episode. Other depressive episodes may occur with or without an obvious trigger.

Elaborates Dr Arvind Garg, Senior Child Specialist, Apollo Hospital, Noida: “Although scientists agree that depression is a brain disorder, debate continues regarding its exact causes. Many factors may contribute to the onset of depression, including genetic predisposition, hormonal changes, certain medical illnesses, stress, grief, and substance abuse. Any of these factors, either alone or in combination, may bring about changes in brain chemistry that contribute to the symptoms of depression, bipolar disorder, and related conditions.”

Depression and Women’s Mental Health
Depression is more commonly diagnosed among women than men. Biological, life-cycle, hormonal, and psychosocial factors experienced by women may contribute to this higher prevalence.

Researchers have shown that hormones directly affect brain chemistry, which in turn influences emotions and mood. For example, women are especially vulnerable to developing postpartum depression after giving birth, when hormonal and physical changes, combined with the responsibility of caring for a new-born, can become overwhelming.

Some women may also experience a severe form of premenstrual syndrome (PMS) known as premenstrual dysphoric disorder (PMDD). PMDD is associated with hormonal changes that typically occur around ovulation and before menstruation begins.

During the transition into menopause, some women experience an increased risk of depression. In addition, osteoporosis—bone thinning or bone loss—has been associated with depression. Scientists continue to explore these potential connections and how cyclical fluctuations in oestrogen and other hormones may affect a woman’s brain chemistry.

Finally, many women face additional stresses arising from work and home responsibilities, caring for children and ageing parents, abuse, poverty, and relationship strains. It is still unclear, however, why some women who face enormous challenges develop depression, while others facing similar challenges do not.

How Depression Differs in Men
Men often experience depression differently from women. While women with depression are more likely to experience feelings of sadness, worthlessness, and excessive guilt, men are more likely to experience fatigue, irritability, loss of interest in previously enjoyable activities, and difficulty sleeping.

Men may also be more likely than women to turn to alcohol or drugs when they are depressed. They may become frustrated, discouraged, irritable, angry, and sometimes abusive. Some men immerse themselves in work to avoid discussing their depression with family or friends, while others may behave recklessly.

Depression in Older Adults
Depression is not a normal part of ageing. Studies show that most older adults feel satisfied with their lives despite having more illnesses or physical limitations. However, when older adults do experience depression, it may be overlooked because they often display different, less obvious symptoms. They may be less likely to experience or admit to feelings of sadness or grief.

Older adults with depression often improve when they receive treatment through antidepressant medication, psychotherapy, or a combination of both. Research has shown that medication alone and combination treatment can both be effective in reducing depression in older adults. Psychotherapy alone can also be effective in helping older adults remain free of depression, particularly those with milder forms of the condition. It is especially useful for individuals who are unable or unwilling to take antidepressant medication.

The Mental Health Challenge Facing Young Adults
Constant uncertainty is no longer an occasional experience for young adults. It has become part of everyday life. Career paths feel less predictable, financial stability is harder to achieve, and even personal decisions are being made against a backdrop of shifting timelines. As they struggle to navigate this uncertainty, many young people find themselves oscillating between overthinking and impulsive decision-making.

Mental health experts believe this pattern is becoming increasingly prevalent among younger populations. In some situations, individuals remain trapped in repetitive thought cycles, revisiting the same possibilities without arriving at a decision. In others, decisions are made quickly, often without being fully thought through.

Dr Neha Cadabam says: “When uncertainty becomes a constant, the mind looks for ways to manage the discomfort it creates. One response is to keep engaging with a thought in an attempt to find clarity. The other is to make decisions quickly to avoid remaining in that uncertain space. Both responses are ways of coping, but neither consistently leads to resolution. Thoughts that are repeatedly revisited continue to occupy mental space, while decisions that are rushed often return for reconsideration. Over time, this can affect confidence in one’s own judgment and contribute to a persistent sense of mental strain.”

Depression in Children and Adolescents
Children who develop depression often continue to experience depressive episodes into adulthood. They are also more likely to develop other serious illnesses later in life.

According to Dr Anup Mohta, Director Professor, Department of Paediatric Surgery, Lady Hardinge Medical College, New Delhi, childhood depression often persists, recurs, and continues into adulthood, particularly if left untreated.

A child with depression may pretend to be ill, refuse to attend school, cling excessively to a parent, or worry that a parent may die. Older children may sulk, get into trouble at school, become negative and irritable, and feel misunderstood.

Because these signs can easily be mistaken for normal mood swings associated with developmental stages, accurately diagnosing depression in children and adolescents can be challenging.

The Adolescent Years
Before puberty, boys and girls are equally likely to develop depression. By the age of 15, however, girls are approximately twice as likely as boys to have experienced a major depressive episode.

According to Dr A K Agarwal, Professor of Excellence and Medical Advisor, Apollo Group of Hospitals, New Delhi, depression during the teenage years occurs at a time of significant personal change, when young people are forming identities independent of their parents, grappling with gender-related issues and emerging sexuality, and making independent decisions for the first time.

Depression in adolescence frequently co-occurs with other disorders such as anxiety, eating disorders, and substance abuse. It may also increase the risk of suicide.

The Wider Impact of Depression
Men and women of every age, educational level, and socioeconomic background can experience depression. There is no area of life that remains unaffected when depression is present. Marriage, parenting, friendships, careers, finances, and day-to-day functioning can all be significantly affected by the illness.

Once a depressive episode occurs, there is an increased likelihood of recurrence. The impact of depression can become even more severe when it occurs alongside other medical illnesses such as diabetes, stroke, or cardiovascular disease, or alongside related conditions such as anxiety disorders and substance abuse.

Seeking Professional Help
Once diagnosed, depression can be treated in several ways. The most common approaches include medication and psychotherapy. The earlier treatment begins, the more effective it is likely to be. Says Dr A K Aggarwal: “The first step towards obtaining appropriate treatment is to visit a doctor or mental health specialist. Certain medications and some medical conditions, such as viral infections or thyroid disorders, can produce symptoms similar to those of depression. A doctor can rule out these possibilities through a physical examination, clinical interview, and laboratory tests. If no underlying medical condition is identified, the next step is a psychological evaluation.”

Diagnosis is the key. Explains Manisha Yadav, Medical Practitioner, New Delhi, “The doctor may refer you to a mental health professional, who will discuss any family history of depression or other mental disorders and obtain a complete history of your symptoms. You should discuss when your symptoms began, how long they have lasted, how severe they are, and whether they have occurred before and, if so, how they were treated. The mental health professional may also ask whether you use alcohol or drugs and whether you have thoughts about death or suicide.”

Early Detection Makes a Difference
The burden created by depression is compounded by the fact that many people remain undiagnosed and untreated. The encouraging news is that when depression is identified and treated promptly, its symptoms can be effectively managed. A wide range of evidence-based treatments and coping strategies can help individuals lead productive and fulfilling lives.

Depression and bipolar disorder are generally most responsive to treatment when recognised and managed in their early stages, before symptoms become severe.

Depression and Bipolar Disorder: Understanding the Difference
Together with a healthcare provider, individuals can determine whether they are experiencing depression or bipolar disorder and develop a plan for improved functioning and well-being.

That conversation can begin with a primary care physician, nurse practitioner, psychiatrist, psychologist, or another qualified mental health professional. Prior to consulting a doctor or healthcare provider, many individuals find it helpful to learn more about how depression and bipolar disorder are diagnosed. Mental health professionals commonly use structured screening tools and clinical assessments to identify symptoms of depression and distinguish them from other psychiatric conditions.

Treatment Approaches
Depression, even in its most severe forms, can be effectively treated. There are several effective strategies for treating depression. Depending on an individual’s symptoms, severity of illness, and personal circumstances, healthcare professionals may recommend one or more forms of psychotherapy involving structured sessions with a trained mental health professional.

In addition, clinicians may prescribe antidepressant medications where appropriate. Lifestyle modifications—including improved sleep hygiene, healthy dietary habits, regular physical activity, and stress-management techniques—have also been shown to play an important role in symptom management and recovery.

Conclusion
Depression is far more than a temporary feeling of sadness. It is a complex medical condition influenced by biological, psychological, social, and environmental factors. Left untreated, it can significantly impair quality of life, relationships, productivity, and physical health.

The World Health Organization identifies depression as one of the leading causes of disability worldwide. Depression affects millions of people across all age groups, cultures, and socioeconomic backgrounds.

The encouraging reality, however, is that depression is highly treatable. Early recognition, timely intervention, professional support, and a compassionate social environment can substantially improve outcomes.

As conversations around mental health become more open—from postpartum depression to adolescent stress, workplace pressures, and the challenges of ageing—it is essential that awareness is accompanied by access to evidence-based care. Greater understanding, reduced stigma, and timely treatment can help millions of people lead healthier and more fulfilling lives.