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I am Rahul Shekhraj, a 28-year-old chartered accountant. My wife Radha works for a credit card company. Since the last 8 months, she has become extremely irregular in her work. She has taken leave for more days than she has worked. She has cited trivial reasons for not going to her office. She is unable to sleep at night. She goes to bed by 4 a.m. She then sleeps till 11 a.m. Even when she wakes up, she is not fresh and groans that she has to go through another grueling day. She is sad right from the morning. She hardly eats and has lost about 20 kg of weight in the last six months. She is always feeling very tired and fatigued. She complains of headaches and pains all over the body. She cries often and wants to lie in bed the whole day. I have taken leave from the office myself and stayed with her the whole day, but her mood improves only marginally. We have tried movies, vacations, weekends on resorts, eating in restaurants, and all those activities that she liked, but to no avail. I do not know what has happened to her. There have been no major upheavals in our house or relationship. Her work also seemed to be giving her satisfaction and she was even given an increment in her salary before all these problems started. Please help me bring my wife and my life back to normal.

Rahul, your wife Radha suffers from clinical depression. Everyone has felt depressed from time to time. A death in the family, a failed romance, a lost job, a serious illness, or other life crisis will cause most people to feel sad, lonely, or down for a time. A period of grief or sadness is a normal reaction to such stressful events. It is even normal to feel down sometimes for no special reason. However, it is also normal to recover after a short time and feel like yourself again. When the blues do not go away – when sad, lonely, irritable, or weary feelings prevent getting on with life – it is depression. It is an extreme, persistent disruption of her usual emotional state. Depression can come on suddenly, seemingly for no reason, or be triggered by a stressful event. It can also grow slowly over months and years, gradually draining away happiness and hope. It is also important to understand depression as a disease. She has not caused these feelings and cannot simply decide to snap out of it and stop being depressed. It is also not right to see it as a character flaw or weakness. Many people do not seek professional help because they are embarrassed to admit that they are depressed. Trying to ignore these feelings only gives them time to grow. Her mood would be sad almost all day. She has lost the ability to obtain pleasure anymore. She would be withdrawn, have diminished ability to concentrate, feel worthless, or excessively guilt without reason. There is indecisiveness. She may harbor wishes of death too. All this is in addition to the symptoms that you described of losing interest in sleep, appetite, pleasurable activities, and physical fatigue. There would be a change in her facial expression, vocal inflection, gestures, and posture. They might become laden and lethargic. Emotions are short-lived reflecting momentary contingencies. She would become hypersensitive to unpleasant events and insensitive to pleasant events, there is reduced consummatory pleasure. There are groundless apprehensions reflecting severe inner turmoil and torment; and morbidly painful emotion. Suicide may represent an attempt to find deliverance from such unrelenting psychic torment; death can be experienced as comforting. She may feel emotionally cut off from others and the world seems strange to her. The impact of the loss of emotional resonance can be so pervasive that she may surrender values and beliefs that had previously given meaning to her life. Sometimes agitation takes over with pressured speech, restlessness, wringing of hands, and pulling of hair. Mostly inertia dominates her actions. There is a paucity of movements, slumped posture with downcast gaze, feeling that everything is an effort, increased latency of responses often giving rise to monosyllabic speech, a feeling that time is passing slowly or has stopped, and a painful rumination – thinking that dwells on a few unpleasant topics. There are negative evaluations of the self and the world and the future. She may feel deprived, have low self-esteem and low self-confidence; there may be self-reproach; pessimism, and hopelessness.