There are days when we all feel low.
Maybe something has gone wrong at work. You had an argument with someone close to you. You did not get the result you expected. Sometimes life simply feels heavy for a while.
Usually, with some time, rest, support, or a change in circumstances, we start feeling like ourselves again.
Depression can be different.
A person may continue going to work, attending college, looking after children and doing the things expected of them, while internally feeling completely exhausted or disconnected.
Sometimes the person cannot even explain why.
They may say:
“Nothing is really wrong, but I don’t feel like myself anymore.”
Or:
“I have everything I should be happy about, but I don’t feel happy.”
This is one of the reasons depression can be difficult to recognize, both for the person experiencing it and for the people around them.
What is depression?
Depression is more than feeling sad.
In depression, a person’s mood, interest, energy, thinking, sleep, appetite and ability to function can change. These changes persist and begin to interfere with everyday life.
Some people mainly feel sad or hopeless. Others feel irritated, empty or emotionally numb.
A person who normally enjoys meeting friends may start avoiding everyone. Someone who used to enjoy playing football, going out for coffee or watching movies may lose interest in these things.
Sometimes the biggest complaint is not sadness at all.
It may be:
“I am tired all the time.”
“I cannot concentrate on my studies.”
“I don’t feel like talking to anyone.”
“I just want to stay in bed.”
This is why depression can sometimes be missed, especially when the person continues to fulfil their responsibilities.
What causes depression?
There is usually no single cause.
Depression can develop after a difficult life event, such as a relationship breakdown, financial problems, loss, work-related stress or academic difficulties. But sometimes depression develops even when there is no obvious event that explains it.
Biological factors, family history, personality, long-term stress, sleep problems, physical health conditions and substance use can all be relevant.
In Nepal, family and social circumstances can also become part of the picture. Someone may be dealing with pressure from work, expectations from family, responsibilities toward parents, difficulties in marriage, caring for children, or being separated from a spouse who is working abroad.
None of these automatically means a person will develop depression.
But when several difficulties continue at the same time, emotional health can be affected.
Sometimes depression also occurs alongside anxiety. In other situations, symptoms that look like depression may be related to another mental-health or physical-health problem.
That is why an assessment matters.
What are the symptoms of depression?
Depression can look different from one person to another.
Common symptoms include a persistently low mood or feeling empty, losing interest in things you normally enjoy, feeling unusually tired, having difficulty concentrating, changes in sleep or appetite, feeling worthless or excessively guilty, and becoming socially withdrawn.
Some people become more irritable than sad.
Others may complain mainly about headaches, body aches, stomach discomfort or general weakness.
A person may also start neglecting normal responsibilities.
For example, a student who previously studied regularly may stop attending classes. Someone who was active at home may spend much of the day lying in bed. A working person may find even ordinary tasks unusually difficult.
The important thing is not whether someone has one or two of these symptoms.
It is the overall pattern, duration, severity and effect on daily life.
Is feeling sad the same as depression?
No.
Sadness is a normal human emotion.
If you lose someone you love, have a difficult breakup, fail an exam, lose a job or go through another painful experience, feeling sad is understandable.
The distinction is not always simple, especially when grief and depression overlap.
This is one reason I would be cautious about diagnosing yourself based on an online checklist.
If low mood or loss of interest is persistent, severe, or is significantly affecting your ability to work, study, care for yourself or maintain relationships, it is worth speaking with a mental-health professional.
How is depression treated?
Depression is treatable, but the treatment depends on the individual.
For some people, psychotherapy may be enough. For others, medication may be recommended. Some people benefit from both.
Lifestyle changes and social support are also useful parts of recovery, although they should not be presented as a replacement for treatment when depression is significant.
The first step is usually to understand how severe the symptoms are and what may be contributing to them.
Therapy for depression
Psychotherapy, or talking therapy, can be an important part of depression treatment.
One commonly used approach is Cognitive Behavioural Therapy (CBT).
CBT helps people understand patterns between their thoughts, feelings and behaviour.
For example, a person who is depressed may start thinking:
“I am useless.”
“I will never improve.”
“There is no point trying.”
Because these thoughts feel convincing, the person may stop doing things, avoid people and become less active. That can then make the mood even lower.
Therapy does not mean simply telling someone to “think positively.”
It involves understanding these patterns and gradually developing healthier ways of responding to difficult thoughts, emotions and situations.
Other forms of psychotherapy may also be appropriate depending on the person and the nature of the problem.
Depression medicine
Antidepressant medication may be recommended for some people with depression, particularly when symptoms are moderate to severe, persistent, significantly affecting functioning, or when psychotherapy alone has not been sufficient.
There are different types of antidepressants, and the choice depends on the person’s symptoms, medical history, other medications, previous treatment and individual circumstances.
Antidepressants are not sleeping pills or simply “happy tablets.” Their purpose is to treat depressive symptoms.
They also do not work instantly. A doctor may need to monitor symptoms, side effects and progress over time.
Medication should be taken only as prescribed. Stopping some antidepressants suddenly can cause problems, so any change should be discussed with the prescribing doctor.
Does everyone with depression need medication?
No.
Treatment should be individualized.
Someone with mild depression may benefit substantially from psychotherapy, activity, social support and addressing the circumstances contributing to the problem.
Someone with more severe depression may need medication, therapy, or both.
If depression is associated with significant functional impairment, suicidal thoughts, psychotic symptoms, or other serious concerns, more intensive professional treatment may be necessary.
The goal is not to give everyone the same treatment.
What can you do yourself?
There are some simple things that can support recovery.
Try to maintain a regular sleep and waking routine rather than allowing depression to completely reverse your day and night.
Keep some structure in your day even when motivation is low.
This can be difficult because depression often tells you to wait until you “feel better” before doing anything.
Sometimes the opposite is more useful.
Take a short walk. Have a shower. Eat something properly. Attend your class. Call someone you trust. Sit outside for a while.
These things may sound very small.
But when someone is depressed, small steps can be meaningful.
Physical activity can also help some people with mood and overall wellbeing. It does not need to mean going to a gym. Walking around the neighbourhood or getting some regular movement into your day is a reasonable starting point.
Try not to isolate yourself completely.
You do not have to explain everything to everyone. Even staying connected with one trusted person can make a difference.
And if alcohol or other substances have become a way of coping with low mood, it is worth discussing this honestly with a professional.
What about “just being strong”?
I hear this idea quite often.
People may tell someone with depression:
“Be strong.”
“Don’t think too much.”
“You have everything in life. Why are you depressed?”
“Just keep yourself busy.”
These comments are usually meant to help, but they can leave a person feeling misunderstood.
Depression is not a character weakness.
At the same time, having depression does not mean a person has no control over their life.
With appropriate support and treatment, people can learn to manage symptoms and gradually return to their normal activities.
When should you see a psychiatrist for depression?
You do not have to wait until you are unable to function.
Consider seeking professional help if low mood or loss of interest continues, you are struggling to work or study, your sleep or appetite has changed significantly, you have become increasingly withdrawn, or you feel that everyday activities have become unusually difficult.
It is especially important to seek help if you are feeling hopeless, worthless, or that life is not worth living.
If you are having thoughts of suicide or self-harm, or feel that you may act on them, seek urgent help rather than dealing with it alone. Contact a trusted person, a mental-health professional, or the nearest emergency service.
Can depression come back?
It can.
Some people experience depression only once, while others have repeated episodes.
This does not mean that treatment has failed.
It means that depression, like many other health conditions, can sometimes return.
Learning to recognize early changes in sleep, mood, motivation, social withdrawal or thinking can help a person seek support earlier.
If you have previously been treated for depression, it is also useful to discuss with your doctor how and when treatment should be reduced or stopped rather than making changes suddenly on your own.
Frequently Asked Questions About Depression
What are the early signs of depression?
Early signs can include losing interest in usual activities, persistent low mood, tiredness, changes in sleep, reduced concentration, withdrawing from people, changes in appetite, or feeling unusually negative about yourself or the future.
Not everyone experiences all of these symptoms.
How do I know if I have depression?
An online symptom checklist can give you an idea of what you are experiencing, but it cannot by itself establish a diagnosis.
A mental-health professional can look at the symptoms, their duration, severity, effect on daily life, and possible alternative explanations.
What is the best treatment for depression?
There is no single treatment that is best for everyone.
Depending on the severity and type of depression, treatment may include psychotherapy, antidepressant medication, lifestyle and behavioural changes, or a combination.
What is the best medicine for depression?
There is no single “best” antidepressant for every person.
Medication choice depends on symptoms, previous response to treatment, side effects, other medical conditions, other medicines and individual circumstances.
It should be prescribed and monitored by a qualified doctor.
Can depression be cured permanently?
Many people recover from a depressive episode and return to their usual lives.
For some people, depression can recur. The aim of treatment is to help the person recover, function better and reduce the risk or impact of future episodes where possible.
Can depression go away without medication?
Sometimes symptoms improve without medication, particularly when depression is mild and contributing circumstances are addressed.
However, persistent or significant depression should not simply be ignored. Psychotherapy and other professional support can be useful even when medication is not needed.
Can depression cause physical symptoms?
Yes.
Depression can be associated with tiredness, changes in sleep and appetite, reduced energy, difficulty concentrating, and various physical complaints.
However, new or persistent physical symptoms should not automatically be assumed to be caused by depression. Medical evaluation may sometimes be necessary.
Can anxiety and depression happen together?
Yes.
A person can experience significant anxiety and depression at the same time. When this happens, treatment needs to consider both sets of symptoms rather than focusing on only one.
Should I see a psychologist or psychiatrist for depression?
Both may be appropriate.
A psychologist or therapist can provide psychotherapy. A psychiatrist is a medical doctor who can assess mental-health conditions and prescribe medication when appropriate, in addition to providing or coordinating psychological treatment.
The right choice depends on your symptoms and needs.
Depression treatment in Nepal
If you are struggling with persistent low mood, loss of interest, anxiety, sleep problems, or other emotional difficulties, getting an assessment can help you understand what is actually happening.
At Dr. Purushottam Adhikari’s Mind Clinic in Raniban, Kathmandu, we provide psychiatric assessment and treatment for depression and related mental-health concerns.
Depending on the individual situation, treatment may involve psychotherapy, medication when appropriate, or a combination of approaches.
We also provide online mental-health consultations where clinically appropriate, which can be useful for people living outside Kathmandu or Nepali individuals living abroad.
The purpose of a consultation is not simply to give a diagnosis or prescribe a medicine.
It is to understand the person, the symptoms, the circumstances around them, and what kind of help may be appropriate.
A final thought
Depression can make a person feel disconnected from the life they once knew.
Things that used to feel ordinary—getting out of bed, going to work, studying, meeting friends, talking with family—can start feeling like major tasks.
If this is happening to you, try not to judge yourself too quickly.
You may not need to “try harder.” You may need to understand what is happening and get the right kind of support.
And if someone close to you seems different—quieter, withdrawn, constantly tired, unusually irritable, or no longer interested in things they once enjoyed—rather than simply telling them to be positive, consider asking how they are actually doing.
Sometimes a genuine conversation is where help begins.
Depression is a medical and psychological problem that deserves proper attention, but it does not have to define a person’s life.