(If you feel suicidal or know someone in distress, please reach out to them with kindness and call these numbers of local emergency services, helplines, and mental health NGOs)
First things first: mental illness is a real, medical problem - JUST like diabetes or asthma.
When Bollywood actor Sushant Singh Rajput died from an apparent suicide in his Mumbai home on Sunday, 14 June, one hoped that it would finally open up an honest discussion on mental health. Instead, the media coverage and discourse on mental illness has taken an ugly turn in the ensuing months, revealing just how stigmatized mental health is and just how poor our understanding of mental illness is.
Today, Bollywood actor Kangana Ranaut stirred the pot again by claiming that “depression is a consequence of drug abuse.”
FIT spoke to Dr Pratima Murthy, Professor, Dept. of Psychiatry, & Chief, De-addiction Services National Institute Of Mental Health And Neuro Sciences (NIHMANS), who said,
“One of the comorbities of depression is substance abuse. It’s a bit of a chicken and egg situation. The way we deal with it is we allow people to detox and then evaluate for an independent depression diagnosis. Depression can be caused by multiple reasons, and low mood and other mental and physical symptoms can be worsened by substance abuse.”Dr Pratima Murthy, NIHMANS
Depression is a Real Mental Illness
At FIT, we hope to bust some mental health myths and remove the stigma associated with real health issues like anxiety and depression. Here’s how we know it’s real:
1. Listen to experts: According to the World Health Organisation (WHO), depression is a common mental illness that affects more than 264 million people worldwide. It results from “a complex mix of social, psychological and biological factors.”
Like Dr Soumitra Pathare, a consultant psychiatrist and Director of Centre for Mental Health Law and Policy at ILS tweeted in response to the misinformation on drug use and depression said,
For example, someone recently unemployed or bereaved can develop depression. Or someone who identifies as part of the LGBTQ+ community and exists in an unsupportive environment can also develop depression.
“People with chronic illnesses like diabetes also often develop depression,” adds Dr Amrish Mithal, chairman and head of Endocrinology & Diabetes at Max Hosptial, New Delhi.
People with other mental illnesses or blood relatives with a history of mental illness are also more prone to develop depression. India’s National Health Portal also references WHO to determine depression as an illness with “multifactorial causes.”
What else can cause depression? According to the Mayo Clinic, biological factors like hormones, brain chemistry, biological differences and brain chemistry all contribute to depression as well.
In short, a host of social-political-biological and economic reasons can cause a person to develop depression. The stigma around mental health and illness in India makes it extremely difficult for patients to seek help. Once understood as real health conditions and identified, they can be treated with regular therapy, medication, peer support or a combination of these.
Depression and Substance Abuse
Ranaut said that it is substance abuse that causes depression. While that claim has been categorically proven wrong by subject matter experts - there is still a connection between substance abuse and depression.
“Alcohol is classically called a depressant of the central nervous system because it actually reduces the level of consciousness with the increasing doses. So what is called ‘cormobidity’ of depression is very common in people who use substances. Substances are used to alleviate depression, but they are also associated with the recurrence of depression.”Dr Pratima Murthy, NIHMANS
She adds that "Drug withdrawal mimics depression - low mood, frustration, irritation, lack of sleep - and so it is very important we evaluate for an independent depression diagnosis,” adds Dr Murthy.
“Often when people detox, their sleep is regularised and their mood symptoms actually go away. But in a substantial number of people, especially those who have a co-occurring disorder like depression, we have to monitor and treat the cause of depression because otherwise the low mood itself becomes a trigger for depression.”Dr Pratima Murthy, NIHMANS
People with depression often self-soothe with drugs and alcohol. There are many reasons for this from the temporary ‘high’ it brings to ease the pain, to the stigma around mental health making it difficult to reach out for professional help to the lack of affordable, accessible mental health professionals.
Nyana Sabarwal, a mental health professional and suicide interventionist who lost her mother to suicide said, “Looking back, I understand that she self-medicated with substance abuse.”
In fact, Hvovi Bhagwagar, a clinical psychologist from Mumbai and Dr Kamna Chhibber, Clinical Psychologist, Head, Mental Health and Behavioral Sciences at Fortis Healthcare told FIT that self-harm including sudden, increased substance abuse is a major sign that someone is in need of support.
Dr Murthy said that self-medicating is a short-term solution, and “the depression continues, and leads to physical health and mental health issues.”
One of the issues that people with substance disorders is have is mood regulation, and substances can worsen mood disregulation. So drugs and other substance abuse can actually worsen this kind of disregulation. It’s important to find out the cause and treat the mood disorder.”Dr Pratima Murthy, NIHMANS
According to The National Mental Health Survey (NHMS) 2015-16 alcohol and substance abuse was prevalent more in rural areas of the country as opposed to the urban metros. According to the report, "the rate of alcohol and substance use disorders was 24 % in rural India as compared to 18% in urban metros."
‘People With Depression Are Prone to Substance Abuse’
According to the Addiction Center, “An estimated one-third of people with major depression also have an alcohol problem. For people suffering, substance abuse offers a tiny respite - but these can become addictive, and the more you consume, the more your body depends on them. Addiction needs to be understood as a disease that happens as a result of alteration in your neural pathways, not as a weakness of will-power or character or a moral flaw.
In fact, prolonged substance abuse can worsen symptoms of your depression and lead to other issues like brain damage.
A study in the Indian Journal of Medical Specialities looked at substance abuse and depression among auto-rickshaw drivers in Delhi found that “more depression was estimated in auto-rickshaw drivers who had substance abuse.”
“Auto-rickshaw drivers who had depression and the consumption of alcohol and tobacco use were high (63% and 83.5%, respectively) compared to drivers who had no depression (consumption of alcohol and tobacco were 37% and 16%, respectively).”Kaul S, Gupta AK, Sarkar T, Ahsan SK, Singh NP, study authors
Another NIHMANs study from 2010 analysed substance abuse in women and found that often because of socio-cultural roles, emotional problems and poor social support, “women are more vulnerable to the adverse physical consequences of substance use.” Here, they found an increased link between substance abuse and depression - with depression being one of the associated factors of increased substance abuse, along with other sociocultural, biological and genetic factors. Another NIHMANS study found that people with alcohol dependence had high rates of depression and other mental illnesses.
The relationship between substance abuse and depression is symbiotic - the more depressed a person, the more likely they are to self-soothe via substance abuse and the substance abuse in turn worsens the depression. However, as we have explained, depression is primarily caused by other factors and is a real mental health problem.
The important takeaway is that increased substance abuse is often a cry for help and one of the warning signs of suicide.
A study in the Journal of Psychiatry and Neuroscience says that once the comorbidity of alcohol and depression has been established, doctors must identify the symptoms and causes of depression and help treat the patient.
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