The year 2020 is expected to be the year with the worst mental health outcomes largely because of COVID-19, the quarantine, and the loneliness after the loss of loved ones.

Recently one of the prominent Bollywood actors committed suicide. Reports say that he was diagnosed with clinical depression. Many of his friends and coworkers reported that they were not aware of his situation.

Mental health is a topic that is almost a taboo in India. Nepali culture is no different when it comes to talking about mental health. When people talk about mental health in Nepal, it’s often understood as someone is “crazy.” Because of the stigma attached to mental health, we don’t want to talk about it. Even in Western cultures and countries, where seeking therapeutic counseling is common, people rarely discuss their mental health issues. 

We generally hear about mental health when famous people reveal about their mental health or end up being on news after suicidal ideation or suicide. Americans reacted to the suicide of Anthony Bourdin, the famous chef/ journalist of CNN, and Kate Spade, the world famous American fashion designer, in June of 2018, three days apart of each other, like people who watch Hindi movies are talking about mental health after Sushant Singh Rajput died of suicide. It feels like Sushant’s suicide has ignited a broader conversation on mental health in Indian and Nepali media the same way American media talked about depression and suicide a couple of years back.

Thin line

Nepali silence on the issue of mental health can be captured best in numbers. Nepal Police data shows that 1,105 people have committed suicide since March 24 lockdown. This has been published in different newspapers, including this one, citing Nepal Police as the source of data. The numbers are likely higher since not all suicide cases are reported to the police. So how is this data being communicated in everyday life? Are people learning from this data and changing their approach in talking about depression? I feel there is a huge gap in that.

We loosely use the term 'depression' to mean we are sad, the same way we use the term “crazy” to describe others. The choice of words is erroneous. “I feel so depressed ke...,” is a common lingo in conversations with friends in Nepal. If I am sad, for some reason for a day or two, I am not in depression. Sadness and depression are not interchangeable like we use culturally. Forty million people have lost their jobs in the US alone. They are sad because of the economic fall down. But that does not mean they are depressed. Yes, some of them might experience mild depression for some time, but the majority will get out of it without any signs of depression. In Nepal too, the suicide numbers of the last two and half months captures similar concerns. People are feeling the same pain. Loneliness, economic slowdown, and joblessness are real stressors for people on the edge. In difficult times, everyone feels sad. It’s Ok and normal to feel sad—whether it's underperforming in exams or losing someone— it is a part of life. But when circumstances change or the feelings of sadness disappear, we again start looking hopeful.

Signs of depression

On the other hand, people undergoing depression need help to bring their lives to normal again because depression is a mental illness which affects one's thoughts, feelings, and behavior. There are lots of symptoms associated with depression. American Psychiatric Association (APA) lists symptoms of depression as " low mood, changes in appetite, loss of interest in things you normally enjoy, changes in appetite, feeling worthless or excessively guilty, sleeping either too much or too little, poor concentration, restlessness or slowness, loss of energy or recurrence thought of suicide." The Diagnostic and Statistical Manual of Mental Disorders (DSM) has the same criteria to make the diagnosis. But five or more of these symptoms need to be present during the two weeks periods “and at least one of the symptoms must diminish pleasure” to qualify for the diagnosis of depression, according to DSM 5. 

If these symptoms are exhibited by your loved ones, at least for two weeks, you definitely need to be concerned. But please remember that the diagnosis of depression needs to be determined by the health professional after a thorough diagnosis. For that people need to be open to talk about their mental health with their doctors, close friends, and trusted family members. It is important to understand that symptoms of depression do not go away on its own. But depression is treatable. Treatment with psychotherapy (talk therapy) and medication can be effective. 

Chemicals and genetics
There may not be a clear trigger why an individual is feeling depressed. Chemicals in our brains affect our behavior. For example an excessive level of cortisol impacts our neurotransmitters negatively. When that happens one neuron can’t release a chemical messenger that is a key to communicating between neurons. Antidepressant medications reduce levels of cortisol and enhance the performance of neurotransmitters like dopamine so the neurons start communicating effectively again.

Various studies have also shown that genetics play an important role in depression. People with a family history of depression are more likely to be diagnosed with the disorder. Various environmental factors may also trigger depression. APA states that “one in six people (16.6%) will experience depression at some time in their lives. That means depression can strike at any time, but on average, it first appears during the late teens to mid-20s.”

There are several other factors for depression that sometimes become difficult to put in perspective. Newly resettled Bhutanese had a very high rate of suicide in the US, signaling that the demographic was suffering from depression that was not diagnosed and treated in time. 
We may be surrounded by people who are undergoing mental health issues who could be waiting to be diagnosed and treated. Talking openly about mental illnesses can make it easier for people to seek and ask for help as research has shown that talking openly about suicidal thoughts has actually reduced suicide in people. It does not increase the risk but decreases the chances of suicide. If you have not been diagnosed with depression, it is better to avoid comparing it to your temporary feelings of sadness. Reaching out for diagnosis of the illness is the most important task. Because treatment can start after the diagnosis, people with depression can function well in life with the help of medication and/ or with appropriate therapeutic support and can be cured just like physical illness. 

Millions of people struggle with depression every day. According to the World Health Organization (WHO) "globally more than 264 million people of all ages suffer from depression". Some commit suicide too. According to the Centers for Disease Control and Prevention, 48,344 people died by suicide in the US in 2018 alone. More than 5,317 people took their own lives in Nepal in 2018 as per the data collected by Nepal Police. The rate of suicide is increasing in both the countries, according to the WHO. Stereotypes tell us that these people are weak. But experts will tell you that these people did not die because they were weak. They died because they did not receive help in time. 

It's difficult to comprehend depression since it's not obvious like getting a fever or having a stomach bug. We can only find out whether someone is depressed or not by observing their behavior, and understanding their thoughts and feelings closely. The year 2020 is expected to be the year with the worst mental health outcomes largely because of COVID-19, the quarantine, and the loneliness after the loss of loved ones.

Nepal is already showing the symptoms of that crisis in numbers. It's our responsibility to be aware of our surroundings and keep an open mind to make sure that people around us receive compassionate mental health care in a timely manner. The real question is: Is this conversation going to make changes in people’s approach to talking about mental health? And if so, how is that going to impact the policies for a constructive program concentrated around educating people and saving lives?

The author is a Baby Lab (Cognitive Lab) Manager in University of Massachusetts, Boston

 
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