(Focus - India)
In recognition of Depression Awareness Month in October, we are delighted to present the first issue of October newsletter on Depression, a multifaceted and often misunderstood condition, extends far beyond the mere experience of "feeling sad." According to the World Health Organization (WHO), approximately 280 million people in the world have depression. Despite this prevalence, misconceptions persist that not only affect how society perceives individuals living with this condition but also impact our understanding of its underlying causes. Most significantly, they deter those in need from seeking the care and support they rightfully deserve.
To learn more about this critical issue, we have had the privilege of interviewing Dr. T P Jindal a renowned Psychiatrist from India who shares invaluable insights regarding the diagnosis and treatment of depression. Dr. Jindal's message to readers is clear: depression is treatable, and seeking help is not a sign of weakness. With proper care and support, individuals can overcome depression and find hope and healing.
Dr. T P Jindal is a Senior Consultant Psychiatrist, currently serving at Jain Hospital, Delhi, India.
For treatment-resistant depression cases, there are usually two types of treatments. One is by medication, and another by electroconvulsive therapy (ECT), also known as shock therapy, in which a very fine amount of current is given to the patient's brain. So, in earlier times, if a patient was not improving by medication, ECT was the treatment of choice, and most patients did respond to it.
In India, the National Mental Health Survey 2015-16 revealed that nearly 15% of Indian adults need active intervention for one or more mental health issues, and one in 20 Indians suffers from depression [1]. What do you think is the role of primary healthcare physicians in the timely diagnosis of depression?
Dr. Jindal - Nowadays, during the MBBS curriculum, you always have one or two questions in your examination related to psychiatry. And even during the internship, doctors do get trained in the psychiatry department for 15-30 days. So, a primary health care physician is trained in treating and understanding psychiatric disorders.
Doctor, do you think depression cases are underdiagnosed in India?
Dr. Jindal - No, where the health facilities are available, they can diagnose it. Sometimes general physicians are not able to make an exact diagnosis. They can diagnose psychosis or neurosis, two major parts of psychiatric disorders. But our government has now made one psychiatrist available in one district, and there are many private psychiatrists besides it. In India, we have about 21,000 psychiatrists. Also, in all medical colleges, there are psychiatric departments. And we do have two or three big institutes like the National Institute of Mental Health and Neurosciences. They are exclusively dedicated to psychiatry and neurology.
Although there are many treatment approaches for depression, treatment-resistant depression (TRD) is a challenge for mental health care providers. How are TRD patients treated in your practice?
Dr. Jindal - So, for treatment-resistant depression cases, there are usually two types of treatments. One is by medication, and another by electroconvulsive therapy (ECT), also known as shock therapy, in which a very fine amount of current is given to the patient's brain. So, in earlier times, if a patient was not improving by medication, ECT was the treatment of choice, and most patients did respond to it. And besides, there are new medications, and patients respond to them. I have been in practice for the last 40 years, and I have not used electroconvulsive therapy in the last 15 years, as effective medicines are available.
In India, about 5% of people do suffer from depression. And there are about 2,58,000 suicides in India annually, and 8 lakh people commit suicide worldwide. Earlier, we used to administer ECT, and nowadays, it is almost not in use. So, psychiatrists try one or two drugs, and there is a combination of the drugs that may also help treat these patients.
What interesting trends do you foresee in the treatment pathway to address treatment-resistant depression?
Dr. Jindal - Some new medications are coming, and they are under investigation. A study published in the American Journal of Psychiatry has identified a potential new mechanism, ‘KCNQ2/3 potassium channels’ for treating depression and are still under investigation.
The evidence says that depression returns in many people but not in all people [2]. What are the factors that contribute to the recurrence of depression?
Dr. Jindal - In India, about 5% of people do suffer from depression. And there are about 2,58,000 suicides in India annually, and 8 lakh people commit suicide worldwide. Earlier, we used to administer ECT, and nowadays, it is almost not in use. So, psychiatrists try one or two drugs, and there is a combination of the drugs that may also help treat these patients.
There are two types of depression. One is called reactive depression – depression that occurs as a reaction to some other incident. For example, if your car is stolen, it may cause you depression. Even the death of a pet dog may cause depression. I mean, certain external factors are causing the depression. You treat the depression and the cause of the depression, and then you may be normal for your whole life. But there is another type of depression because of the gene and biochemical factors. And this type of depression tends to recur, and this is usually treated with long-term treatment. Then there is another depression called bipolar depression, and just the opposite of it called mania, where the patient is excited, very happy, dominating, and could be violent. And this may run into the family. There is no biochemical test for it, and no genetic test can confirm which gene is causing depression. It is still a clinical diagnosis. So, this depression may keep on recurring. The first time we treat it, it will need higher doses. As patients improve, we start lowering the dose. They may be okay for one year, two years, or five years.
If you find somebody suffering from depression, or if you are facing such a problem, please don't take it as a stigma. The only thing is you have to continue with the treatment. Take the treatment, and I think within five weeks, you will come out of the depression in total.
The prevalence of anxiety and depression increased by 25% worldwide during the COVID-19 pandemic [3]. What was the role of technologically delivered therapies during the COVID-19 pandemic?
Dr. Jindal - During the COVID-19 pandemic, people were isolated, so many people lost their jobs, many people lost some of their friends and relatives. And then, whenever you went out, there was always a fear of COVID. And because so many people have lost their jobs, there was a 25% increase in the case of depression. But these kinds of depression are a temporary problem.
Do you have any such cases, doctor, like depression caused due to COVID isolation or loss of a job? And how did you treat them during that lockdown time?
Dr. Jindal - Yes. So many people. We were treating them on WhatsApp. First, I would ask them for their personal information and then would tell them to call at a fixed time later. And in the meantime, we would prepare the file of the patient. And after the call, we prepare a prescription and send it electronically on WhatsApp.
So, doctor, is there any stigma surrounding mental health disorder treatments in India?
Dr. Jindal - Not now, as there are excellent treatments available. I work in a Jain hospital. Only two types of patients come here, neurology patients and psychiatric patients. And it is challenging for somebody to tell them who the psychiatric and neurology patients are. Because once they recover, they mix with society.
Before we conclude, what would be your message to our readers to decrease depression-related morbidity and mortality?
Dr. Jindal - Suppose you find somebody suffering from depression, or if you are facing such a problem, please don't take it as a stigma. The only thing is you have to continue with the treatment. Take the treatment, and I think within five weeks, you will come out of the depression in total.
Thank you, doctor. Thank you so much for your time.
Reference: