My father was diagnosed with chronic depression in February. It turned out that he'd been suffering from the condition for at least a year before that. He never felt it. And there were no visible signs either. But it lay in the subterranean, slowly yet surely eating into his life.
It was in September (2014) when his physical health started deteriorating that he visited the doctor. He'd lost ample weight without any effort; he was constantly fatigued and severely insomniac. His appetite had gone down significantly and he felt extremely lethargic. There were several aches and pains, some digestive disorders, and 'tension' in the muscles as well. As months went by, he became cranky, irritable and anxious, which was entirely uncharacteristic of him. He eventually stopped going out of the house and was struggling to even get out of bed. What bothered him most was his unchecked weight loss - he lost 15.5 kilos in six months (and he isn't diabetic) until February. That's when things started spiraling out of control. He started getting panic attacks every day -- sometimes mild, sometimes severe. Panic attacks look like heart attacks, with involuntary muscle-twitching, fast breathing, and a sense of passing out. It typically lasts 10-12 minutes. There's absolutely nothing that caregivers can do to help the sufferer, except hold them tight, may be embrace them, and keep saying: 'Nothing's wrong. You'll get through it.' My father's panic attacks were so severe that he would fall over backwards when he tried standing up even with support on either side.
We visited a neuro-psychotherapist, and after more than six months of going from pillar to post in Mumbai's top hospitals, diagnosis finally happened. He was suffering from depression and anxiety of the highest order. It had set in (without any outward expression though) post his retirement two years ago, and was apparently common among individuals making a transition from "high-profile, high-engagement jobs that require a lot of multitasking" to a more homebound life. And he was, in fact, making that transition. His depression lay in the subconscious, never quite affecting him enough for either him or people around him to gauge that something was amiss. When the doctor asked him if he felt hopeless, he said, "only now, in the last few months, but never before."
His treatment began in March. We were compelled to visit a psychiatrist because his condition was so severe that he *had* to be put on anti-depressants immediately. Depression essentially is a chemical imbalance -- a drop in serotonin levels in the brain -- that really wreaks havoc in the central nervous system. It is as much a physiological condition -- as all his symptoms demonstrated -- as psychological. It was a Herculean task to convince my father that depression could hit anyone at any point in life. It had hit him after retirement but it could hit people in the peak of their careers too. Case in point: Deepika Padukone who around that time was making headlines for coming out with her depression. Doctors suggested that we make my father watch Deepika's bare-it-all interview with Barkha Dutt. That would allow him to understand that he's not alone in this hellhole. It would also help him shed the stigma of having to visit a "mental health" institute every fortnight. That bit plagued him to no end, despite the fact that he had a supportive family that understood his condition and was more than willing (and capable) to do the handholding required in such illnesses. But what made it worse were people's 'oh-how-can-it-happen-to-him-of-all-people' reactions. (Well, it can happen to ALL people!) Such insensitive reactions pulled him down further. He not only hated to admit his condition but was constantly bothered by what others were saying about him. He would tell us every now and then, "What will I tell people when they ask me about my health? That I am under psychiatric treatment?!"
"What will I tell people when they ask me about my health? That I am under psychiatric treatment?!"
'Psychiatrist' is another very loosely used and entirely misunderstood term in our society. A psychiatrist is not someone who gives electric shocks to screaming patients in dark rooms -- an image constructed in our minds by years and years of Bollywood tripe. Instead, he's some kind of a behavioural scientist if I may call it that. But we hardly care about the nuances of mental health.
On the first day the psychiatrist asked my dad to pen his thoughts on a piece of paper. My dad promptly said, "I can't. My head is all jumbled up. I can't think clearly." The doctor replied, "That you could explain your condition so clearly shows you can... write. It means you're alert, and thinking." Eventually he wrote a long note. His handwriting hadn't suffered; his language was impeccable; his thoughts were clear though he was repeating himself. When I read the note, I turned cold. It mentioned the words "half-dead" and "death" in as many as five places. The note reeked of self-pity and guilt for his family. I asked the doctor if we had reasons to be worried... so many mentions of death in one note! He assured me that it was common for patients suffering from clinical depression to think that way and it did not imply that my father was suicidal.
"When I read the note, I turned cold. It mentioned the words "half-dead" and "death" in as many as five places."
The doctor told us that we as caregivers have to put on the bravest face and wear a nothing-is-wrong-with-you conviction. Even the slightest display of concern or grief would mean the patient feeding off it and going further down in depression. It was incredibly tough for us, especially when you spent all your waking (and sleeping) time with someone who was talking only about his fears, anxieties and feelings of worthlessness. It meant putting up a straight face in front of him and then locking yourself in the bathroom and turning on the taps before weeping your guts out.
In the initial two weeks of medication, there wasn't any significant improvement. Instead, the side effects -- dry mouth, sudden appetite, fast breath, dizziness, low blood pressure -- started showing up. That freaked him out even more. He would keep count of the number of times his breathing had gone fast. After every half an hour he would tell us that his was an "extreme case" and was "incurable". He was ridden with guilt for putting his family through this. He would go on and on about how I'd taken a break from work to attend to him. While that was the most natural thing for me to do, it made him feel like baggage. But he couldn't let us go. He would hate to be alone in a room. One afternoon he broke down. It was an unbearable sight to have him as that wary, uncontrollable mess.
Our job though was only to hear him out. And constantly be by his side, may be hold his hand (a very important gesture for patients suffering from anxiety) and tell him that depression is like any other physical ailment. Whenever he wondered 'what will I tell people' I'd ask him, "If you had typhoid or jaundice, would you think so much?" He would seem partly convinced. But next day he would repeat the same things. There was so much despair and darkness within him that it was impossible for any light to seep in. It was important though on our part to not overdo any instructions because his mind was ill-equipped to process sermons. He wasn't fit for counseling yet. We had to measure every word we spoke to him.
"He would often sit quietly in a corner with his head hung down. Was he thinking something? "No," he would say."
After about six weeks of heavy medication, he showed some signs of recovery. The positives: he started going out for evening walks with me (he still lacked the confidence to venture out on his own), his appetite improved, he was reading the newspaper again, he began watching the IPL, and checking his mails and messages. The negatives: he was still anxious, concentration-less, and unable to official work. He wasn't talking much either. Not that he was a chatterbox at any time, but he spoke very little now. And smiled even lesser. He would often sit quietly in a corner with his head hung down. Was he thinking something? "No," he would say. Then why was he sitting in that manner? "I don't know," would be the answer. If you asked him how he was, he would invariably say "not good".
His counseling began in mid-April. After the first session, the psychologist told us that there was still "sufficient depression" in him, and his was a "classic case" of depression and anxiety. What aggravated it was his introverted nature and his age that heralds some amount of worthlessness in most people, especially men. "Because women have housework and TV to get through," he said. Gender stereotyping!
He's had three sessions so far and is improving, albeit slowly. He's more active than now: he's doing yoga, he's going grocery shopping on his own, he's staying up to watch IPL, he's expressing a range of emotions from anger to humour, he's playing Sudoku -- a mental activity advised by the therapist, and most importantly, eating more and sleeping better. And now if you ask him how he is, he'll say, "A bit better. But still not fine."
There's still a long way to go, say doctors. He's still frail though the weight loss has been checked. He still gets fatigued within a few hours. He's still anxious about little things like a pending mobile / credit card bill, and is still fairly heavily medicated. Right now all the positive hormones in his body are being secreted by the anti-depressants. The biggest challenge lies ahead when he is put off them, and his body has to secrete those happy hormones on its own. That's when a patient has withdrawal symptoms and always stands a chance of falling back into that depressive hellhole.
We're told that clinical depression takes at least six months to a year to be fully weeded out of the system. It's been only three months of medication and therapy for him. There's indeed a long way to go. Sometimes you just have to keep staring at the night sky before it's finally dawn...