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Psychiatry • Psychology • Integrative Support

Depression (Major Depressive Disorder)

Depression is a treatable medical condition, not a weakness or a failure of will. Accurate assessment, psychological therapy, medicines when indicated, practical support and follow-up form the core of care. Ayurvedic approaches may be considered only as supervised adjuncts.

Overview and common symptoms

Major depression usually involves depressed mood or loss of interest most of the day, nearly every day, for at least two weeks, together with meaningful distress or difficulty functioning. Symptoms can include low energy, sleep or appetite change, slowed or agitated movement, poor concentration, guilt, hopelessness and thoughts of death or suicide. Children, adolescents and some adults may appear mainly irritable. Grief and life stress can coexist with depression; a clinician considers duration, severity, safety and function rather than relying on one symptom count.

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Daylight, gentle movement and a steady daily routine support mood, sleep and energy — alongside, not instead of, professional care.

Clinical assessment

  • A clinician reviews symptoms, daily function, previous episodes and treatment, physical health, sleep, alcohol or drug use, medicines, recent stress, trauma, relationships and available support.
  • Assessment should ask directly about self-harm, suicidal thoughts, intent, access to means and safety. It should also check for hallucinations, delusions, severe self-neglect or risk to another person.
  • Past periods of unusually high or irritable mood, much less need for sleep, racing thoughts or risky behaviour can indicate bipolar disorder; antidepressant treatment then requires a different plan.
  • Targeted examination or tests may be used when thyroid disease, anaemia, vitamin deficiency, infection, pregnancy, medicine effects or another condition could be contributing. A questionnaire can support monitoring but does not replace a full assessment.

Evidence-based treatment and monitoring

  • Less severe depression: options include guided self-help, behavioural activation, cognitive behavioural therapy (CBT), problem-solving approaches, group exercise and active monitoring. An antidepressant can be considered when it is the person's informed preference or clinically indicated.
  • More severe or persistent depression: structured psychotherapy, an antidepressant, or their combination may be recommended. Choice depends on symptoms, prior response, other illnesses, pregnancy, interactions, side effects, access and preference.
  • Specialist treatment: coordinated psychiatric care is important for psychotic depression, catatonia, bipolar features, repeated treatment failure or high risk. Electroconvulsive therapy or other specialist treatments may be considered for selected severe or life-threatening illness.
  • Medicine safety: benefit can take time. Early agitation, worsening anxiety, suicidal thoughts, sexual effects, bleeding risk or other adverse effects need prompt review. Do not start, combine, switch or stop antidepressants abruptly without a prescriber-led plan because withdrawal and dangerous interactions can occur.
  • Monitoring: agree an early follow-up after starting or changing treatment and track mood, interest, sleep, function, suicidal thinking, adherence and adverse effects. Relapse-prevention planning may include continued therapy or medicine, warning signs and a written crisis plan.

Clinician-supervised Ayurvedic medicines and therapies

Ayurveda may describe depressive symptoms through manas, rajas, tamas and dosha patterns. A qualified Ayurvedic clinician may discuss regular routines, gentle yoga or relaxation, massage, or individualized botanicals such as ashwagandha or brahmi. Evidence is not strong enough to use these as stand-alone treatment for major depression, psychosis or suicidal risk, and this page intentionally provides no dose.

  • Show both clinicians every product and prescription. Sedating herbs can add to antidepressants, antipsychotics, sleeping medicines, alcohol or anti-seizure medicines; other products may affect serotonin, thyroid function, blood pressure, glucose, bleeding or liver enzymes.
  • Ashwagandha can cause drowsiness and stomach effects, has been linked rarely to liver injury, and may interact with thyroid, immune, blood-pressure, diabetes, sedative and anti-seizure medicines. Avoid it in pregnancy and breastfeeding.
  • Avoid unlabelled mixtures and herbo-mineral rasa/bhasma products unless a licensed clinician can verify regulated manufacture and independent contaminant testing; some Ayurvedic products have contained toxic heavy metals.
  • Do not use fasting, purgation, sleep deprivation, forceful breathwork or intensive Panchakarma during severe depression, poor intake, mania, psychosis or a crisis. These can worsen dehydration, sleep loss, confusion or medicine effects.
  • Stop a product and seek medical advice for jaundice, unusual bleeding, severe agitation, confusion, fever with tremor, facial swelling, breathing difficulty or a rapidly worsening mood.

Practical diet, activity and daily support

  • No food or dosha diet cures depression. Aim for regular meals with vegetables and fruit, whole grains, pulses/beans, nuts or seeds, adequate protein and suitable dairy, eggs, fish or other foods according to preference and medical needs.
  • If appetite is low, use small simple meals, nourishing snacks and help with shopping or cooking. Marked weight loss, dehydration or inability to eat or drink needs clinical review.
  • Keep caffeine modest and earlier in the day. Avoid alcohol and recreational drugs because they can worsen mood, sleep, impulsivity and medicine side effects.
  • Build movement gradually, beginning with a short walk or supervised activity if energy is low. Keep a regular wake time and morning light exposure; persistent insomnia should be treated rather than blamed on poor discipline.
  • Plan one manageable task and one supportive contact each day. Family support, practical help, therapy, peer groups and workplace or financial assistance may be as important as self-care.

Crisis and immediate help

Call local emergency services now (112 in India) or go to the nearest emergency department if there is an immediate risk of suicide, self-harm or violence; a suicide attempt or overdose; a specific plan with access to means; severe confusion, psychosis or mania; or inability to maintain basic safety, food or fluids.

  • Do not leave a person at immediate risk alone. If safe, reduce access to medicines, weapons, pesticides or other lethal means and involve a trusted adult while emergency help is arranged.
  • Ask directly about suicide; doing so does not create the idea. Take all statements, sudden goodbyes, preparations, reckless behaviour and abrupt deterioration seriously.
  • In India, Tele-MANAS provides 24-hour mental-health support at 14416 or 1800-89-14416. It complements, but does not replace, emergency services when danger is immediate.

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Dr. Aditya Kulkarni

Psychiatry
📍 New Delhi
Experience: 10 yrs