Anjali Verma, a 44-year-old who lives in the upmarket Greater Kailash in New Delhi, cannot say that life has been unfair to her. Ostensibly, she has everything a woman wants: a nice house in a posh area, a battery of servants at her beck and call, a well-to-do husband, and children settled in plum jobs abroad. Lifestyle diseases, the bane of the affluent, are yet to catch up with her. Yet she often feels dejected and lacks appetite and sleep.

Surat-based Niraj Patel is just 34. He was never interested in running his family’s chemical business. But one fine morning he was thrown into the deep end of that business when his father died after a massive heart attack. Patel, who was always a cheerful person, soon went into a shell, became gloomy and even started thinking of committing suicide. But thanks to psychiatric counselling and medication, he is now back on track.

Nineteen-year-old Anubhav Bhave had only one goal in life — do what it takes to make his mother unhappy. Reason: She used to slap him at the slightest pretext when he was a child. Just to spite her, he chose not to study and to score low marks in the crucial board exams. When he joined university, though, he began to regret his actions and felt that he had spoilt his future by not doing well academically. Soon he started exhibiting homicidal tendencies. Now under treatment, Bhave is calmer and seems to have regained his interest in life.

All of them — Verma, Patil, and Bhave (names have been changed to protect their identities) — suffer from a disease that is becoming more and more common in urban India — depression. A World Health Organisation study projects that while neuro-psychiatric conditions, including depression, will be the second leading cause of disease burden in the world by 2020, in developing countries, including India, it will surge to the No. 1 position in the same period.

Experts too point to the growing number of cases of people coming in to be treated for depression. According to Dr Rupali Shivalkar, a clinical psychiatrist at the Institute of Human Behaviour and Allied Sciences (IHBAS) in Delhi, the institute’s outpatients department has recorded an almost 100 per cent increase in the number of such cases in the last six years. While 300 to 400 patients suffering from depression visited the institute for treatment every day in 2001, the number jumped to 600 to 700 a day in 2007.

Depression manifests itself in different forms. Some feel sad, others become agitated and aggressive. While some lose their appetite, others binge eat. Some may have disturbed sleep and others may find it hard to stay awake. Social withdrawal, diminished sex drive, suicidal tendencies and lack of concentration are some other tell-tale symptoms of depression.

“No two patients have identical symptoms,” says Dr Vihang Wahia, a practising psychiatrist in Mumbai.

Of course, all human beings have variations in their moods. Scientists describe mood as an amalgam of emotions such as anxiety, anger, pride, love, pain or joy that a person feels over a period of time.

The emotions of feeling sad, unhappy or disappointed are part of a human being’s normal existence. Such emotions are often associated with failure in academics, break-up of a relationship, setbacks in a financial investment or the death of a loved one. However, depression as a disease sets in when a person fails to bounce back from a personal setback like this.

Take 18-year-old Amitav Sanyal. He was expected to do well in his Class XII board exams as he was always a topper in school. But as luck would have it, he failed to do well in the exam. His dreams of studying medicine were shattered. He tried to commit suicide and though he was saved he lost his mental balance. Now, after six months of medical treatment and counselling, Sanyal is once again ready to face the world.

“Diagnosing depression early is very important,” says Dr Wahia. In most mild cases of depression, patients can be brought back to normality just by good counselling. “Clearing some cobwebs of life is all that required,” he observes. But it’s different in the case of those who suffer from moderate to severe depression. Certain changes occur in their brains and, in addition to counselling, they require medication to help re-wire the brain.

It is estimated that 5-10 per cent of the Indian population suffers from depression at any given time. And women seem to be more prone to the disease than men. The risk of developing depression is 10-20 per cent in women and slightly less in men. What’s more, the male to female ratio for developing depression is between 1:2 and 1:3, says Dr Dhanesh K. Gupta, associate professor at the Institute of Human Behaviour and Allied Sciences in Delhi. This is because women undergo frequent hormonal changes in the reproductively active years of their life.

In India one of the major problems in treating the growing incidence of depression is the fact that it is often not diagnosed at all. Either the doctor fails to see its severity in a patient or patients simply don’t come out and report their condition. Of course, more patients come forward with the problem now than earlier, when it used to be viewed as a social stigma. But even so, many cases are not reported early enough. As Dr Rajesh Sagar, associate professor of psychiatry at the All India Institute of Medical Sciences, New Delhi, says, “Depression is grossly under-diagnosed and under-treated in India.”

Agrees Shivalkar, “Nearly one third to a half of the patients coming for treatment of various illnesses are also suffering from psychiatric disorders. General physicians treating them often fail to diagnose these disorders.”

Efforts are now on to educate physicians, including those in the primary health system, about depressive and anxiety disorders. In fact, a non-governmental organisation called Sangath, in collaboration with the Goa government’s directorate of health services and the London School of Hygiene and Tropical Medicine, has embarked on a programme to integrate mental health treatment at primary care facilities in Goa.

However, while there seems to be a general consensus that depression and other neuro-psychiatric ailments are on the rise in India, some experts argue that there aren’t enough studies to back the premise. “It is true that a greater number of people are coming forward for consultation. But, that doesn’t prove that there were fewer cases in the past,” says Dr Alok Sarin, a consultant psychiatrist at the Sitaram Bhartiya Hospital in New Delhi.

A section of experts also feel that there is circumstantial evidence to suggest that economic and social turbulence in a society can lead to depressive symptoms. Says Sanjeev Jain of the National Institute of Mental Health and Neurosciences, Bangalore, “Overcrowding, loss of hierarchy and loss of position in the tribe can aggravate depressive disorders, as shown in some animal studies. So when society is complex, there’s a constant struggle for hierarchy. This could actually trigger depression and stress.”

Depression Primer

• It’s a prolonged state of sadness
• Leads to considerable dysfunction in all areas of life
• A significant public health problem
• It’s seen in many medical disorders
• Suicide is a major risk
• Many patients receive no treatment