Almost every week, a patient tells me the same thing: "I know I've been feeling low, but it's probably just stress. Everyone goes through this." Sometimes they are right. But sometimes — more often than people realise — what they are describing is not ordinary sadness. It is clinical depression. And the difference matters enormously.

In India, depression is significantly underdiagnosed. The stigma around mental health, the tendency to attribute emotional pain to external circumstances, and a genuine lack of awareness about what depression actually looks like — all contribute to people suffering for months or years before seeking help. This article is my attempt to change that.

Sadness vs Depression — The Core Difference

Sadness is a normal human emotion. It is triggered by something — a loss, a disappointment, a difficult event. It comes and goes. It is proportionate to what caused it. It does not prevent you from functioning. And with time, support and self-care, it lifts.

Clinical depression is different in four fundamental ways:

The 9 Clinical Signs of Depression

In psychiatry, we use specific diagnostic criteria. A person is considered to have Major Depressive Disorder if they have 5 or more of the following symptoms for at least 2 weeks, with at least one of the symptoms being either depressed mood or loss of interest.

How Depression Presents Differently in India

Western psychiatric literature describes depression primarily through emotional symptoms. But in my clinical practice at Fortis Hospital and Nirvana Clinic, Indian patients often present differently — with what we call somatic (physical) symptoms of depression:

• Unexplained body aches and pains — headache, back pain, chest tightness, abdominal discomfort that has no medical cause
• Digestive complaints — nausea, loose motions, constipation that comes and goes without explanation
• "Heavy head" or dizziness — commonly described as "sir bhaari rehta hai" or "chakkar aate hain"
• Palpitations and breathlessness — particularly in women, often initially investigated as cardiac issues

These physical symptoms are real. They are not "in the head." They are the body's expression of a psychiatric illness — and they disappear when the depression is treated appropriately.

When Is It Time to See a Psychiatrist?

I would recommend a psychiatric evaluation if:

• You have had 5 or more of the symptoms above for 2 or more weeks
• Your symptoms are affecting your work, relationships or daily functioning
• You have had any thoughts of self-harm or not wanting to be alive
• You have tried to "push through it" for more than a month without improvement
• Family members have noticed a change in your behaviour, energy or mood

How Is Depression Treated?

The good news: depression is one of the most treatable conditions in psychiatry. With the right combination of approaches, the majority of patients achieve full remission.

• Cognitive Behavioural Therapy (CBT) — changes the negative thought patterns that fuel and sustain depression. Often the first-line treatment for mild to moderate depression.
• Antidepressant medication — when indicated, antidepressants are safe, non-addictive, and highly effective. Modern antidepressants have far fewer side effects than older generations. Medication is not permanent in most cases.
• Lifestyle interventions — regular physical activity, sleep hygiene, reducing alcohol, and social engagement all have documented antidepressant effects.
• Psychoeducation — understanding your illness reduces shame, improves treatment compliance, and accelerates recovery.

Dr. Debolina Chowdhury

MD Psychiatry · Senior Consultant, Fortis Hospital, Greater Noida · Nirvana Clinic

Dr. Debolina Chowdhury is Senior Consultant Psychiatrist at Fortis Hospital, Greater Noida and Nirvana Clinic with 14+ years of experience and 17 peer-reviewed publications. She specialises in depression, anxiety, OCD, women's mental health and child psychiatry. Consultations available in-person and online.

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