An Overview of Indian Research in Depression

12/27/2019 An overview of Indian research in depression
Indian J Psychiatry. 2010 Jan; 52(Suppl1): S178–S188. PMCID: PMC3146226

doi: 10.4103/0019-5545.69231: 10.4103/0019-5545.69231 PMID: 21836676
An overview of Indian research in depression

Sandeep Grover, Alakananda Dutt, and Ajit Avasthi
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Address for correspondence: Dr. Sandeep Grover, Department of Psychiatry, Postgraduate Institute of Medical
Education and Research, Chandigarh - 160 012, India [email protected]
Copyright © Indian Journal of Psychiatry
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Depression as a disorder has always been a focus of attention of researchers in India. Over the last 50-60
years, large number of studies has been published from India addressing various aspects of this commonly
prevalent disorder. The various aspects studied included epidemiology, demographic and psychosocial risk
factor, neurobiology, symptomatology, comorbidity, assessment and diagnosis, impact of depression,
treatment related issues and prevention of depression in addition to the efficacy and tolerability of various
antidepressants. Here, we review data on various aspects of depression, originating from India.
Keywords: Depression, clinical features, India
INTRODUCTION
Depression is a disorder of major public health importance, in terms of its prevalence and the suffering,
dysfunction, morbidity, and economic burden. Depression is more common in women than men. The
report on Global Burden of Disease estimates the point prevalence of unipolar depressive episodes to be
1.9% for men and 3.2% for women, and the one-year prevalence has been estimated to be 5.8% for men
and 9.5% for women. It is estimated that by the year 2020 if current trends for demographic and
epidemiological transition continue, the burden of depression will increase to 5.7% of the total burden of
disease and it would be the second leading cause of disability-adjusted life years (DALYs), second only to
ischemic heart disease.[1] In view of the morbidity, depression as a disorder has always been a focus of
attention of researchers in India. Various authors have tried to study its prevalence, nosological issues,
psychosocial risk factors including life events, sympto matology in the cultural context, comorbidity,
psychoneurobiology, treatment, outcome, prevention, disability and burden. Some of the studies have also
tried to address various issues in children and elderly.
This review focuses on research done on various depressive disorders in India. For this, a thorough internet
search was done using key words like depression, life events, prevalence, classification, cultural issues,
outcome, prevention, disability and burden etc in various combinations. The various search engines like
Pubmed, Google Scholar, Sciencedirect, Search Medica, Scopus, And Medknow etc were used. In addition
thorough search of all the issues of Indian Journal of Psychiatry available online was done. Hand search of
some of the missing issues was also attempted and this yielded a few more articles. Review articles which
were felt to be not reflecting the Indian scenario to a large extent or not covering the available Indian data
were excluded. Treatment issues (antidepressants) are reviewed separately by us in this compilation of
annotations to be published. Data from animal studies and originating in the form of case reports and small
case series, until felt necessary haven’t been included. The available data has been organized under the
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146226/?report=printable 1/19
headings of epidemiology, demographic and psychosocial risk factors, neurobiology, symptomatology,

comorbidity, assessment and diagnosis, impact of depression, treatment related issues and prevention of
depression.
Epidemiology
Many studies have estimated the prevalence of depression in community samples and the prevalence rates
have varied from 1.7 to 74 per thousand population.[2,3] Reddy and Chandrasekhar[2] carried out a
metanalysis, which included 13 studies on epidemiology of psychiatric disorders which include 33572
subjects from the community and reported prevalence of depression to be 7.9 to 8.9 per thousand
population and the prevalence rates were nearly twice in the urban areas.[2] The findings with regard to
prevalence in urban population are in line with the findings of a survey done on the entire adult population
of an industrial township, which showed that the prevalence rate for depression to be 19.4 per thousand.[4]
A recent large population-based study from South India, which screened more than 24,000 subjects in
Chennai using Patient Health Questionnaire (PHQ)-12 reported overall prevalence of depression to be
15.1% after adjusting for age using the 2001 census data.[5] In another recent study, Nandi et al.[3]
compared the prevalence of depression in the same catchment area after a period of 20 years (first in 1972
and then in 1992) and reported that the prevalence of depression increased from 49.93 cases per 1000
population to 73.97 cases per 1000 population.[3] Studies done in primary care clinics/center have
estimated a prevalence rate of 21-40.45%.[6–9] Studies done in hospitals have shown that 5 to 26.7% of
cases attending the psychiatric outpatient clinics have depression.[10–13]
Studies on the elderly population, either in the community, inpatient, outpatient and old age homes have
shown that depression is the commonest mental illness in elderly subjects.[14–19] Nandi et al.[14] studied
psychiatric morbidity of the elderly population of a rural community in West Bengal. In a sample of 183
subjects (male 85, female 98) they found 60% of the population to be mentally ill with higher morbidity in
women compared to men (77.6% and 42.4% respectively). There was significantly more morbidity in
population in the age group 70-74 and 80+ as compared to normal population. The total mental morbidity
rate was as high as 612/1000 population. Depression was the commonest illness of old age in this sample,
the rate being 522/1000 population (101 cases out of 112 were diagnosed as cases of depression). Women
had a higher rate of depression-704/1000 population. Another significant finding was the high rate of
morbidity amongst the widowed persons.
An epidemiological study from rural Uttar Pradesh showed that psychiatric morbidity in the geriatric
group (43.32%) was higher than in the nongeriatric group (4.66%) and most common psychiatric
morbidity was neurotic depression, followed by manic-depressive psychosis depression, and anxiety state.
Psychiatric morbidity was more prevalent in those who were socially, economically, and educationally
disadvantaged.[15] Recent community-based studies have reported a prevalence rate of 21.7% to 45.9%.
[20,21]
Chhabra and Kar[16] studied the profile of psychiatric disorders in elderly psychiatric inpatients and
reported that mood disorders were the most common diagnosis (46.5%). Older studies from Gero-
psychiatric clinics reported a prevalence of depression ranging from 13 to 22.2%.[22,23] A recent
outpatient study, which evaluated psychiatric morbidity in 100 randomly selected elderly subjects
attending geriatric clinic, found that 29% patients suffered from psychiatric illness of which depressive
disorders were the most common.[17] Another study also reported depression to be the most common
psychiatric diagnosis among the 1586 elderly subjects (age ≥60 years), who attended the Geriatric Clinic
of the All India Institute of Medical Sciences, New Delhi.[24] In a study of old age home population, Guha
and Valdiya[18] reported that major depressive disorder (13.4%) was the most common psychiatric
diagnosis in this population.
With regard to epidemiology of depression in children and adolescents in a community sample from south
India, Srinath et al.[25] reported a prevalence of 0.1% in the 4-16 year age group and no child in the age
group 0-3 was diagnosed to have depression. Another study from north India reported an annual incidence
rate of 1.61/1000 children in a community based study on school children.[26] Clinic-based studies have
reported a prevalence rate of 1.2 to 9.2% for the affective dis orders, amongst which unipolar depression
was the commonest category in most of the studies.[27–32] However, in a recent study evaluating the
trend of various diagnoses in clinic population, Malhotra et al.[33] reported increase in prevalence of
affective disorders from 2% to 13.49% in children (0-14 years) attending the psychiatric outpatient clinics.
Studies done in women during and after pregnancy have reported incidence of post-natal depression to be
11%.[34]
Demographic and psychosocial risk factors for depression

In terms of sociodemographic variables studies have shown that depression is more common in women,
[4,5,35–37] younger subjects,[13] in subjects from poor economic background[5,36,38] and subjects with
poor nutritional status,[38] Muslims,[35] those who are divorced or widowed,[5] those residing in nuclear
families[39] and urban areas.[2] Studies which have evaluated the subjects with late onset or old age
depression (first episode of depression at or after the age of 50) have also shown that depression is more
common in low social class, widowed state,[14,37,40] unemployed condition, low educational level, in
subjects living in nuclear family or in those living alone.[15,21,37,40] With regard to gender most of the
studies have reported that it is more common in elderly females,[14,37,40] however, some clinic-based
studies suggest that it is more common in elderly males.[41] It is also seen that prevalence of depression
increases with increasing age in elderly.[20]
Studies have shown that compared to healthy controls and subjects with schizophrenia, depressed patients
have significantly greater number of life events prior (6-12 months) to the onset of their illness.[42–46] In
terms of type of life events, it is seen that depressed patients experience significantly higher proportion of
life events related to death of a family member, personal health related events, bereavement, interpersonal
and social events[34,42,44,47] and lower number of life events in the form of illness of family members
compared to patients with schizophrenia.[44]
It is also seen that compared to patients with mild depression patients with moderate and severe depression
tend to use avoidance as a coping strategies more frequently for the stressful life events, suggesting that it
may be a maladaptive way to cope with the situation, which is responsible for development of depression.
[43] Studies have also reported that parental loss before the age of 18 years, parental disharmony and
eldest birth order tend to be more common in subjects with depression.[48]
Studies in elderly also suggest that life events, especially financial problems and death in the family are as
important a precipitating event for depression as they are in young adult.[20,40,49] It is also seen that
stressful life events were specifically more in the elderly females and those with lower per capita income.
[50]
With respect to life events in children and adolescents, Patel et al. found that depressed adolescent girls
report life events in the form of death of a family member, change in residence, failure in examination, end
of a relationship and serious illness.[51] Other risk factors identified to be associated with depression in
children include stress at school and family as well as family history of mental illness.[52] However, one
of the older studies failed to find a link between childhood bereavement and depression.[53]
Women as a group have also received considerable attention with regard to risk factors for development of
depressive disorders. In an incidence study of common mental disorders, Patel et al.[54] reported that
poverty (low income and having difficulty in making ends meet), being married as compared with being
single, use of tobacco, experiencing abnormal vaginal discharge and reporting a chronic physical illness
were associated with risk of developing a common mental disorder.[54] Studies have also reported that
economic and interpersonal relationship difficulties, partner violence, sexual coercion by the partner as the
common causal factors related to development of depression in general and depression during antenatal
and postnatal period.[34,55–58] It has been shown that gender of the newborn child is an important
determinant of postnatal depression.[34,56,57]
Among the psychological factors, attribution style was proposed to predispose individuals to depression
and maintain depressive symptoms once they develop. A study using the Attribution Style
Questionnaire[59] showed that depressed patients have a specific attribution style for their failures and
successes in comparison to patients with schizophrenia and medical disorders. According to this study,
patients with depression made more internal, stable and global attributions for bad events when compared
to other disorders.[60] A study evaluating the cognitive model of depression as given by Beck failed to
find support for the causal role of cognitive errors in relapse of depressed subjects as a significant
proportion of patients were free from cognitive distortions following remission. However, it was also
observed that those who had persistent cognitive distortions during remission ran the risk of early relapse.
[61] It has also been seen that patients with neurosis, including depression, have poor social interactions
and reports of more interactions of unpleasant type and less of pleasant type of social interactions as
compared with healthy controls.[62]
With regard to personality factors, a study showed that higher scores on the hardiness, a personality trait,
correlates with lower scores on the depression scale suggesting that presence of hardiness doesn’t allow
depressive feelings to become more severe.[63]
Studies on Neurobiology
Compared to schizophrenia, there is relatively less research on the neurobiology of depression from India.
Neurochemicals Studies have evaluated the levels of catecholamine metabolites in cerebrospinal fluid,
urine and blood. Studies have showed that urinary 5-hydroxyindoleacetic acid (5HIAA), a metabolic end
product of serotonin was significantly higher in depressed patients as compared to controls and these
values decreased following successful treatment.[64,65] However, one study didn’t find any difference in
the CSF 5HIAA levels between subjects with depression and healthy controls.[66] Studies have also
shown significant positive correlation between the severity of depression and the patient’s urinary 5HIAA
values[64,65] and negative correlation between the suicidal ideations and the patient’s urinary and
cerebrospinal fluid (CSF) 5HIAA and homovanillic acid (HVA) values.[65] It has also been found that
compared to controls, platelet serotonin (5HT) uptake is significantly lower in patients with depression,
which improves temporarily with Electroconvulsive Therapy (ECT).[67] Another study by the same
authors showed that treatment with Imipramine resulted in significant decrease in platelet 5HT uptake
while ECT led to a significant increase in uptake.[68] With regard to dopamine metabolites, it has been
seen that HVA levels are low in depressed subjects compared to controls and this correlates with platelet
monoamine oxidase (MAO) activity, erythrocyte adenosine deaminase activity and 5-HIAA levels.
Further it was seen that compared to healthy controls HVA/5-HIAA ratio was also lower in subjects with
depression.[66] Studies have also shown that both ECT and imipramine cause significant reduction in
platelet MAO activity which normalizes during the post-treatment phase.[69] It has been demonstrated that
there is significantly low serum dopamine-β-hydroxylase activity in patients with psychotic major
depressive disorder compared to healthy controls. However, dopamine-β-hydroxylase activity did not
differ between healthy controls, acute schizophrenia patients, subjects with non-psychotic depression and
mania.[70] Srinivasan et al.[71] also showed that during the acute phase of depression there is low urinary
5-vinyl mandelic acid (VMA), which decrease further during treatment with imipramine. The authors also
observed similar finding with respect to effect of imipramine in normal subjects. The levels also normalize
in post treatment phase in depressed subjects and after stoppage of treatment in normal subjects.
Electrophysiology Many studies have evaluated the pretreatment P300 amplitude and latency in
depressed subjects and compared the same with healthy controls. All studies have consistently shown that
P300 amplitude is smaller in depressed subjects and this normalizes with recovery[72–74] suggesting that
it may be a state marker of depression. However, the findings with regard to pretreatment P300 latency are
inconsistent.[72–74] Studies have also shown that P300 latency has a significant positive correlation with
age of the patient and severity of depression while P300 amplitude have a significant negative correlation
with age[73] and severity of depression.[72] A study showed that P300 amplitude is lower in depressed
subjects, but there is no difference between subjects with depression and dysthymia,[74] however, the
pretreatment P300 amplitude does not predict the treatment response.[75]
Studies have also shown that there is no difference between subjects of melancholic depression and control
group in the latency of the middle components of evoked potential.[76] Studies done using Bereitschafts
potential (BP) a measure of frontal lobe functions have also shown that the amplitude and frequency are
lower in subjects with melancholic depression compared to the healthy controls.[76]
Endocrinology As a marker for melancholia, studies have shown that dexamethasone suppression test
(DST) has low sensitivity but high specificity.[77–79] Studies have also shown that, compared to DST
suppressors, DST non-suppressors are significantly more depressed, attempt suicide more frequently, have
higher rates of past and family history of depression, more frequently require electroconvulsive therapy
and show better response to treatment.[79] A similar finding with respect to response to treatment has also
been reported in another study.[80] Another study on subjects with post-stroke depression showed that
DST response parallels the clinical course and response to treatment.[81]
A study of absolute eosinophil counts as an indirect measure of adrenocortical function showed that initial
pretreatment level of eosinophils was higher than normal in depressed subjects, which showed a variable
response to treatment indicating towards a varying degree of diminished activity of adrenal cortex.[82]
Studies have also shown that plasma cortisol levels are higher in depressed subjects compared to healthy
subjects and the increase in levels do not correlate with severity of depression.[83] Studies have also
demonstrated that abnormal plasma cortisol level can differentiate patients with depression from patients
with schizophrenia and healthy controls with a confidence level of 60%-93.3%. Urinary free cortisol after
dexamethasone suppression test was considered as the best indicator of differentiating depressed patients
from healthy subjects and patients with schizophrenia.[84]
Adrenocorticotrophic Hormone (ACTH) measurements, both at baseline and post-DST in patients of major
depression, have been found to be significantly high at baseline and post DST as compared to healthy
controls.[85] A study evaluated the role of dexamethasone in treatment based on the hypothesis that
dexamethasone would hasten recovery, but did not find any advantage in favor of dexamethasone
compared to placebo.[86]
Two studies have found that significantly higher number of patients with unipolar depression have
subnormal T3 and T4 levels and a corresponding increase in thyroid stimulating hormone (TSH) levels
compared with healthy controls.[87,88] In the second study, mildly depressed patients had significantly
lower and severely depressed patients had significantly higher levels of TSH suggesting the direct
relationship of severity of depression and TSH levels.[88] Another study found that 20.5% subjects of
major depressive disorders have hypothyroidism.[89] When drug naive first episode depression patients
were evaluated, they showed significantly higher T4 levels, but there was no significant difference in the
level of T3 and TSH between depressed and healthy control subjects. However, when depressed subjects
with and without psychotic features were compared, it was seen that subjects with psychotic symptoms
had significantly higher levels of TSH.[90]
Immunology It has been shown that there is significant increase in total CSF protein levels in depressed
subjects compared to subjects with neurological and surgical illnesses. It was seen that levels of
immunoglobulin (Ig) M, IgG and IgA are higher in depressed and neurologically ill subjects compared to
subjects with surgical illnesses. Further, when the levels of immunoglobulins were compared between
depressed and normal subjects, IgG and IgA were significantly higher in depressed subjects. However, the
study did not find evidence of viral markers for rubella and cytomegalovirus in CSF of depressed subjects.
[91]
Extracellular fluid Verma and Wig[92] showed that the extracellular fluid (ECF) volume of patients with
depression tends to be lower than normal controls and normalization of the same correlates with clinical
improvement.
Melatonin Studies have shown that urinary melatonin levels can help in distinguishing subjects of
endogenous depression from those with neurotic depression. Nocturnal as well as 24 hours urinary
melatonin levels are low in subjects with endogenous depression whereas subjects with neurotic
depression have higher than normal levels. It was also seen that melatonin levels were related to suicide
attempts, diurnal variation and psychomotor retardation.[93]
Neurocognitive functioning Studies from India suggest that definite cognitive impairments are present in
the domains of intelligence and memory (Bhatia’s Battery test or the Weschler Adult Performance
Intelligence Scale and PGI memory scale) in the depressed state but these don’t persist following recovery.
[94–96] It is also reported that subjects with depression perform poorly on the Wisconsin Card Sorting
Test (WCST) as compared to controls suggesting cognitive inflexibility and prefrontal dysfunction.
Further, more severe illness is associated with greater impairment in the executive functioning on WCST.
[97] Other studies which have evaluated various cognitive domains have shown that when patients with
depression are asked to discriminate the emotional tone in terms of intensity of facial expression while
presented in pairs, it is seen that they are highly evaluative of sadness and less evaluative of happiness, in
comparison to the normal.[98]
Genetics A recent study, showed the importance of genetic factors in treatment response. Significantly
better response to escitalopram was seen in patients homozygous for long allele of the serotonin
transporter gene compared to the patients who were homozygous for short allele or heterozygous for short
and long allele.[99] Another study showed that short variants of D7S1875 marker in LEP gene may be a
risk factor for depression.[100]
Lipids A recent study evaluated the serum total cholesterol level in depressed subjects and showed that
there is significant elevation of serum total cholesterol in depressed patients compared with normal
controls and this persists even after controlling for the confounders.[101] Another study suggested that
measurement of serum cholesterol levels may actually indicate towards hypothyroidism in depressed
subjects.[89]
Symptomatology
Many studies have reported the symptom profile of subjects with depressive disorders.[5,13,36,39,52,102–
118] The findings of symptomatology in general can be understood with respect to somatic symptoms,
guilt and other depressive ideations, suicidal behavior, phenomenology of delusions and sleep architecture.
Studies have also compared the symptomatology across different regions of the country. Studies have also
attempted to distinguish the phenomenology in depression from negative symptoms of schizophrenia and
the phenomenology in dysthymia.
One common theme with regard to symptomatology of depression, which has been reported by most of the
researchers is high prevalence of somatic symptoms and some studies report that somatic symptoms are
the most common manifestation of depression in India.[5,36,104–106,110,111,119,113,114,122] Erna
Hoch[120] also reported that many Indian subjects with depression have hypochondriacal ideas
considering body and its functioning. Studies have also shown pain as a depressive equivalent symptom.
[42,1] Studies which have compared Indian subjects with depressed subjects from the West have also
reported that somatic symptoms are more common in Indian subjects.[104] On the other hand studies on
prevalence of functional somatic complaints in patients attending the psychiatric outpatient have also
reported that most of these cases are diagnosed as depression.[122,124] It has also been shown that
depressed subjects have greater difficulty in identifying bodily sensations and feelings as well as in
expressing feelings.[125]
However, some of the studies evaluating depressive symptoms using the standardized instrument have
reported that other symptoms are also present quite frequently in depressed subjects. One study which
assessed 100 subjects with depression on HDRS reported that depressed mood and difficulties in work are
present in all cases. Other symptoms reported in more than 50% of subjects included late insomnia,
somatic anxiety, initial insomnia, psychic anxiety, suicidal ideations, retardation, loss of insight, middle
insomnia, genital symptoms, hypochondriasis, gastrointestinal symptoms, agitation somatic symptoms in
general and diurnal variation. Depersonalization, paranoid and obsessional symptoms were reported very
infrequently. Guilt was present in about half of the subjects.[106] Gutpa et al.[103] also studied the
symptomatology of depression from north India and compared it with findings from south India.
Significantly higher number of subjects from north India reported joylessness, disruption in social
functioning, lack of self confidence, early morning awakening, lack of appetite, feeling of pressure, other
psychological symptoms, psychomotor restlessness, mood worsening in the morning, subjective
experience of memory loss, retardation and guilt feeling; significantly higher number of subjects from
south India reported hypochondriasis. There was no difference in other symptoms.
Another study from north India evaluated the symptomatology of depression and reported sadness, lack of
interest, disturbed sleep, hypochondriasis, poor concentration, agitation, suicidal thoughts, and appetite
change as the commonly occurring symptoms. Guilt was reported in about 40% of cases. The authors also
compared their findings with studies from other parts of the country and the West and reported that lack of
interest was more common in subjects from north India while reduced self-confidence, delusions and
suicidal thoughts were seen more often in the south Indian sample.[47] Studies from Mumbai less
frequently reported hypochondriasis, guilt, weight change, reduced interest and more frequently reported
constipation.[47]
Earlier a few dynamically oriented psychiatrists envisaged guilt as the core symptom of depression. It is
also suggested that guilt is less commonly seen in eastern population compared to the west. Studies done
in India suggest that it is present in 5.3-67.5% of subjects.[36,47,106,126–129] Bhattacharyya and
Vyas[130] also reported lesser frequency of guilt feeling in Indian subjects compared to Australian
subjects. Venkoba Rao[127] on the basis of karma theory hypothesized that guilt may not be integral part
of depression in Indian subjects and is actually a consequence of depression.[127] Sethi et al.[131] also
reported that there is no relationship of guilt with severity of depression[131] and Trivedi et al.[132]
reported higher level of guilt in depressed subjects as compared to neurotic subjects.[132]
Studies have also evaluated suicidal thinking in depressed subjects. Venkoba Rao and Nammalvar[107]
reported that about two-third of depressed subjects have suicidal behavior and on the basis of the content
they classified suicidal ideation into four broad categories, viz., ideas to kill oneself, a mere wish to die, a
wish to be killed and a fourth unclassifiable category. In a recent study on the relationship between anger
and suicidality, depressed patients with anger attacks exhibited more suicide-related phenomena in
comparison to depressed patients without anger attacks.[133] Studies which have evaluated depressed
subjects with suicidal ideation have shown that 16.6% of these subjects make suicidal attempt and a higher
risk of suicidal attempt is found in individuals less than 30 years of age, single men, married women and
students and higher education.
Attempters scored significantly higher in severity of suicidal ideation, agitation and paranoid symptoms
whereas among non-attempters, hypochondriasis and general somatic symptoms were more common.[111]
Studies have also shown that depressed subjects who attempt suicide are at higher risk of indulging in
further suicidal behavior, compared to those who do not attempt.[134] However, it has also been shown
that presence of suicidal behavior does not predict overall poor clinical outcome.[135]
Studies have reported that amongst the delusions in subjects with depression, delusions of persecution
occurs most frequently (67.5%) (with persecution involving either the patients themselves or people close
to them) followed by delusions of reference. Hypochondriacal, guilt and nihilistic delusions, which are
considered classical in depression, are relatively uncommon in Indian subjects.[109]
In terms of sleep architecture, it is reported that subjects with depression have lesser total sleep time,
longer sleep latency, frequent awakenings, greater wake-after-sleep onset and offset times, lesser sleep
efficiency and tendency to wake up earlier than controls. Subjects with severe depression differ from
patients with mild and moderate depression with regards to total sleep time, night-time sleep and sleep
efficiency.[136]
Studies which have tried to distinguish depression from negative symptoms have shown that depressed
patients score significantly higher on subjective complaints, total score, global ratings on Scale for the
Assessment of Negative Symptoms (SANS), while schizophrenia is associated with significantly higher
scores on global rating of alogia, poor eye contact, inappropriate affect, and blocking.[115] Another study
showed that anhedonia-asociality are seen commonly in both patients with depression and schizophrenia
while the global ratings on affective flattening, alogia, avolition and inattention are significantly higher in
subjects with schizophrenia.[114]
A study which tried to distinguish the symptomatology of chronic major depression and dysthymia showed
that symptomatically dysthymia and chronic major depression are indistinguishable.[137]
Studies have evaluated the symptomatology of depression in elderly depressed subjects too and have
reported that the common symptoms in order of frequency were sadness, depressed mood, somatic
symptoms and signs, suicidal ideas, lack of energy, anxiety or tension, inability to fall asleep, early
awakening, hopelessness, irritability and inability to enjoy.[41] Another study from community sample
reported that disturbed sleep pattern is the most common symptom in depressed elderly subjects.[21]
One study which evaluated the symptomatology of depression in children and adolescents reported
multiple somatic complaints as the most common presenting complaint in children with depression.[117]
Another study, which compared the symptomatology of children and adults, showed that more children
than the adults presented with the somatic symptoms and the predominant mood symptom in children was
irritability in contrast to sadness in adults.[118] Other commonly reported symptoms of depression across
studies include low mood, diminished interest in play and activities, excessive tiredness, low self-esteem,
problems with concentration, behavior symptoms like anger and aggression, decreased interest in school
and recent deterioration in school performance, death wish and suicidal behavior.[52,117]
In terms of symptomatology in postpartum depression, infanticidal ideas have been reported in depressed
mothers.[34] Studies evaluating subjects with seasonal affective disorder found that atypical vegetative
features are not prominent part of the symptomatology in India.[138,139]
Comorbidity
Many studies done in subjects with depression have shown high level of comorbidity of both psychiatric
and physical illnesses, especially in elderly individuals with depression.[140,141] On the other hand
studies on the prevalence of psychiatric morbidity in physical disorders have shown that depression is
quite prevalent in these conditions.
The commonly reported physical illnesses in subjects with depression include those involving the
musculoskeletal, cardiovascular and ophthalmological systems and the commonly reported diagnosis in
order of frequency were osteoarthritis, hypertension and cataract in one study.[141] The commonly and
consistently reported comorbid conditions in children with depression include anxiety and
conversion/dissociative disorder.[51,116,117] Other comorbid conditions include, dysthymia, adjustment
disorder, conduct disorder and attention deficit hyperactivity disorder.[52,117,118]
Studies done in subjects with intentional self harm,[142] subjects with serious suicide attempts,[143]
divorce seeking couples,[144] earth quake victims,[145] women after childbirth,[56] obsessive compulsive
disorder,[146] alcohol dependent subjects,[147] dementia,[148] Dhat syndrome,[149,150] medical in-
patients,[151–153] epilepsy,[154] neurological disorders,[155] end stage renal disease,[156,157] cancer,
[158] chronic and disfiguring skin disorders,[159] age related macular degeneration,[160] HIV-infected
heterosexuals,[161] industrial population[162] have shown that depression is the most common or one of
the most common psychiatric diagnosis in such patient groups and prevalence rate as high as 86.7% has
been reported.
Assessment and Diagnostic issues

In clinical and research work, apart from uniform diagnostic criteria, some means to objectively quantify
the presence of particular symptoms and level of their severity is required. For this purpose, a number of
rating scales have been devised worldwide, of which clinician rated Hamilton Depression Rating Scale
(HDRS),[163] self reporting Beck Depressive Inventory,[164] Montgomery-Asberg Depression rating
scale (MADRS) are the most popular ones. Indian researchers have adapted/modified these scales for the
Indian population.[165–167] Additionally scales like Amritsar Depressive Inventory (ADI) a self reporting
scale has been developed on the basis of symptoms and signs of depression as manifested by Indian
patients.[168] Avasthi et al.[169] translated the PRIME-MD questionnaire in Hindi and showed that it is
useful for screening various psychiatric disorders. Brief Patient Health Questionnaire (PHQ) has also been
translated in 11 languages and validated for Indian population.[170] Many studies have also evaluated the
psychometric properties of various scales in India.[171–173]
Impact of Depression
Studies have shown that depressive disorders lead to significant dysfunction,[174] disability[175] and poor
quality of life in sufferers[176] and pose a significant burden on the caregivers.[177] The pattern of burden
experienced by relatives of patients with affective disorders and schizophrenia have been shown to be
similar, being principally felt in the areas of family routine, leisure, interaction and finances. However, the
caregivers of subjects with depression experience lesser degree of burden compared to caregivers of
schizophrenia and bipolar disorders.[177,178] Another study showed that the burden of dysthymia is
similar to neurotic disorders like obsessive compulsive disorder and generalized anxiety disorder.[179] It
has also been seen that patients with dysthymia have significant impairment on measures of quality of life,
disability, social support and marital adjustment compared to normal/medically ill controls. The study also
showed that duration of illness and severity of depression are the most important correlates of impaired
quality of life and disability.[180] A study assessing the relationship of stigma to both depression and
somatization in psychiatric patients of south India showed that although both depressive and somatic
symptoms were distressing, perceived stigma was more for depressive symptoms. Depressive symptoms
were perceived as socially disadvantageous as compared to somatization symptoms.[167]
Course and Outcome

There are very few studies which have evaluated the course and outcome of depression. Venkoba Rao and
Nammalvar[181] followed up 109 out of 122 cases of endogenous depression 3-13 years after their index
diagnosis. No recurrence occurred in 28 cases. Forty-two cases turned out to be bipolar and 21 remained
unipolar. Manic episodes outnumbered the depressive ones. The change of polarity from depression to
mania occurred within three years after the initial depression, though in others the shift occurred between 3
to 12 years. The number of episodes of depression before the onset of mania varied from one to three.
While the onset of depression before the age of 40 years predisposed to recurrences, there was risk of
chronicity in those patients who developed the illness after 40 years. Gada[182] studied 92 out of 100
cases of major depressive disorder five to 10 years after the index diagnosis and showed that 36.6% cases
had no recurrence of episodes and 63.4% had recurrence. Of the total subjects, 37.8% were diagnosed as
bipolar disorders and 25.6% were diagnosed as recurrent depressive disorder.
The change of diagnosis from major depressive disorder to bipolar disorder occurred within three years
after the initial depression in 77% of cases. In another study Brown et al.[183] reported that in their cohort
all subjects experienced full recovery within the one-year period. At one-year follow-up, 71% of
depressive patients demonstrated no symptoms or social impairment.[183] The mean duration of
depressive episode was 14.2 weeks and the rate of relapse was 18%. The authors concluded that overall
outcome was considerably more favorable than in comparable studies of affective disorders in developed
settings. All these findings suggest that depressive disorders have high chance of recurrence and many of
the subjects initially diagnosed as cases of unipolar depression are later diagnosed as bipolar disorder. In
another prospective study of subjects with seasonal affective disorder (SAD), Avasthi et al.[184] reported
that after the initial diagnosis of SAD the subjects did not display any variation in mood, behavior, sleep
pattern and weight fluctuation over a period of five to seven years.
Study done in elderly patients with depression have reported that complete recovery occurs in 58% of
cases and 24% of cases have partial recovery with 18% registering relapses.[41] Sachdev et al.[185]
studied various factors related to prognosis of depression and found that sleep-disturbances, agitation,
depth of depression, age at the time of present onset, age at first onset, history over one year with no
symptom-free period, sudden onset of illness, adequate premorbid personality and adequate psychogenesis
are of prognostic significance.
Treatment related issues

One of the important patient characteristic which has been reported to influence treatment adherence is
their attitudes and beliefs towards medication. In a recent study, Chakraborty et al.[186] reported that most
of the patients value the doctor-patient relationship and their partners are also supportive regarding
diagnosis and treatment of depression. However, most patients have erroneous beliefs regarding
antidepressants per se which in turn influence the drug compliance.
Prevention
Sethi et al.[187] proposed a prevention model for depression focusing on improving social network and
educational programs, designed to educate the public with regard to the risks inherent to change of jobs,
residence, pattern of living as well as how to protect against them and removal of malnutrition and
infections. A recent review suggests that religiosity can be protective against depression.[188]
Conclusion and future directions

Depression is the most common psychiatric disorder reported in most of the community based studies. It is
also reported as one of the most common psychiatric disorder in outpatient clinic population and in
subjects seen in various medical and surgical setting. It is also reported to be the most common psychiatric
disorder in elderly subjects across various settings. Studies from India have also shown that life events
during the period preceding the onset of depression play a major role in depression. Studies on women
have also shown the importance of identifying risk factors like interpersonal conflicts, marital disharmony
and sexual coercion.
There is need for further study of factors like cost, attitude towards treatment, adherence, compliance and
neurobiological correlates. There is also a need to study the course of depressive disorders in India so as to
determine the need and duration of continuation treatment. Studies should also evaluate the cost-effective
models of treatment which can be easily used in the primary care setting to effectively treat depression.
Footnotes
Source of Support: Nil
Conflict of Interest: None declared.
REFERENCES
1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global Burden of Disease and Risk Factors.
Washington: The World Bank; 2006. [PubMed: 21250371]
2. Reddy MV, Chandrashekhar CR. Prevalence of mental and behavioural disorders in India: A
metaanalysis. Indian J Psychiatry. 1998;40:149–57. [PMCID: PMC2965838] [PubMed: 21494462]
3. Nandi DN, Banerjee G, Mukherjee SP, Ghosh A, Nandi PS, Nandi S. Psychiatric morbidity of a rural
Indian community changes over a 20 year interval. British J Psychiatry. 2000;176:351–6. [PubMed:
10827883]
4. Sethi BB, Prakash R. Depression in Industrial population. Indian J Psychiatry. 1979;21:359–61.
5. Poongothai S, Pradeepa R, Ganesan A, Mohan V. Prevalence of depression in a large urban South Indian
population - The Chennai Urban Rural Epidemiology Study (CURES-70) PloS One. 2009;4:E7185.
[PMCID: PMC2748692] [PubMed: 19784380]
6. Kishore J, Reddaiah VP, Kapoor V, Gill JS. Characteristics of mental morbidity in a rural primary health
center of Haryana. Indian J Psychiatry. 1996;38:137–42. [PMCID: PMC2970831] [PubMed: 21584121]
7. Amin G, Shah S, Vankar GK. The prevalence and recognition of depression in primary care. Indian J
Psychiatry. 1998;40:364–369. [PMCID: PMC2966689] [PubMed: 21494502]
8. Pothen M, Kuruvilla A, Philip K, Joseph A, Jacob KS. Common mental disorders among primary care
attenders in Vellore, South India: Nature, prevalence and risk factors. Int J Soc Psychiatry. 2003;49:119–
25. [PubMed: 12887046]
9. Nambi SK, Prasad J, Singh D, Abraham V, Kuruvilla A, Jacob KS. Explanatory models and common
mental disorders among patients with unexplained somatic symptoms attending a primary care facility in
Tamil Nadu. Natl Med J India. 2002;15:331–5. [PubMed: 12540066]
10. Teja JS, Narang RL. Pattern of incidence of Depression in India. Indian J Psychiatry. 1970;12:33–9.
11. Bagadia VN, Jeste DV, Doshi SU, Shah LP. Depression: A study of demographic factors in 233 cases.
Indian J Psychiatry. 1973;15:209–16.
12. Raju SS. Frequency of depressive disorders in psychiatric clinics in India: A comparative analysis.
13. Ponnudurai R, Somasundaram O, Balakrishnan S, Srinivasan N. Depression-a study of 80 cases. Indian

J Psychiatry. 1981;23:256–8. [PMCID: PMC3012955] [PubMed: 22064611]
14. Nandi PS, Banerjee G, Mukherjee SP, Nandi S, Nandi DN. A study of psychiatric morbidity of the
elderly population of a rural community in West Bengal. Indian J Psychiatry. 1997;39:122–9.
[PMCID: PMC2967096] [PubMed: 21584058]
15. Tiwari SC. Geriatric Psychiatric morbidity in rural Northern India: Implications for the future. Int
Psychogeriatrics. 2000;12:35–48. [PubMed: 10798452]
16. Chhabra V, Kar N. Geriatric patients in a psychiatric ward: A 10 year profile. Indian J Psychiatry.
2002;44:S47.
17. Jhirwal OP, Gupta LN, Singhal AK, Verma KK. Psychiatric problems of service utilizers in a newly
created geriatric clinic of tertiary Hospital setting. Indian J Psychiatry. 2004;46:S49.
18. Guha S, Valdiya PS. Psychiatric morbidity amongst the inmates of old age home. Indian J Psychiatry.
2000;42:S44.
19. Jain A, Jhirwal OP, Chakrabarti S. Socio-demographic and clinical profile of elderly patients attending
a psychiatric clinic in a tertiary hospital setting. Indian J Psychiatry. 2005;47:S13.
20. Barua A, Acharya D, Nagaraj K, Vinod Bhat H, Nair NS. Depression in elderly: A cross-sectional
study in rural South India. J Int Med Sci Acad. 2007;20:259–61.
21. Jain RK, Aras RY. Depression in geriatric population in urban slums of Mumbai. Indian J Pub Health.
2007;51:112–3. [PubMed: 18240472]
22. Venkoba Rao A, Madhavan T. A geropsychiatric morbidity survey in a semiurban are near Madurai.
Indian J Psychiatry. 1982;24:258. [PMCID: PMC3012815] [PubMed: 21965921]
23. Venkoba Rao A. Mental health and ageing in India. Indian J Psychiatry. 1981;23:1.
[PMCID: PMC3013178] [PubMed: 22058509]
24. Dey AB, Soneja S, Nagarkar KM, Jhingan HP. Evaluation of the health and functional status of older
Indians as a prelude to the development of a health programme. Natl Med J India. 2001;14:135–8.
[PubMed: 11467139]
25. Srinath S, Girimaji SC, Gururaj G, Seshadri S, Subbakrishna DK, Bhola P, et al. Epidemiological study
of child and adolescent psychiatric disorders in urban and rural areas of Bangalore, India. Indian J Med
Res. 2005;122:67–9. [PubMed: 16106093]
26. Malhotra S, Kohli A, Kapoor M, Pradhan B. Incidence of childhood psychiatric disorders in India.
Indian J Psychiatry. 2009;51:101–7. [PMCID: PMC2755176] [PubMed: 19823628]
27. Malhotra S, Chakrabarti S. A clinical profile of depression in children. Indian J Social Psychiatry.
1992;8:54–8.
28. Malhotra S, Gupta N, Singh G. Retrospective study of affective disorders in children attending a child
psychiatry clinic. Indian J Med Res. 1999;109:71–5.
29. Sidana A, Bhatia MS, Choudhary S. Prevalence and pattern of psychiatric morbidity in children. Indian
J Med Sci. 1998;52:556–8. [PubMed: 10327795]
30. Chadda RK, Sourabh Pattern of psychiatric morbidity in children attending a general psychiatric unit.
Indian J Pediatr. 1994;61:281–5. [PubMed: 7960002]
31. Srinath S, Bayle A. Manic depressive psychosis in children. In: Channabasavanna SM, Shah SA,
editors. Affective disorders: Recent research and related developments. 1987.
32. Choudhary P, Srinath S, Girimaji SC, Seshadri S. A study of childhood onset affective disorder.
NIMHANS J. 1995;13:97–100.
33. Malhotra S, Biswas P, Sharan P, Grover S. Characteristics of patients visiting the child and adolescent
psychiatric clinic: A 26-year study from North India. J Indian Assoc Child Adoles Mental Health.
2007;3:53–60.
34. Chandran M, Tharyan P, Muliyil J, Abraham S. Post-partum depression in a cohort of women from a
rural area of Tamil Nadu, India Incidence and risk factors. British J Psychiatry. 2002;181:499–504.
[PubMed: 12456520]
35. Nandi DN, Banerjee G, Boral GC, Ganguli H, Ajmany S, Ghosh A, Sarkar S. Socio-economic status
and prevalence of mental disorders in certain rural communities in India. Acta Psych Scand. 1979;59:276–
93. [PubMed: 433627]
36. Bagadia VN, Jeste DV, Doshi SU, Shah LP. Depression: A clinical study of 233 cases. Indian J
Psychiatry. 1973;15:224–30.
37. Ramachandran V, Menon MS, Arunagiri S. Socio-cultural factors in late onset depression. Indian J
38. Mohandas E. Roadmap to Indian Psychiatry. Indian J Psychiatry. 2009;51:173–9.

[PMCID: PMC2772227] [PubMed: 19881044]
39. Sethi BB, Sharma M. Depressive disorders and family constellation. Indian J Psychiatry. 1980;22:69–
73. [PMCID: PMC3013336] [PubMed: 22058442]
40. Sharma DK, Satija DC, Nathawat SS. Psychological determinants of depression in old age. Indian J
41. Venkoba Rao A, Madhavan T. Depression and suicide behaviour in the aged. Indian J Psychiatry.
1983;25:251–9. [PMCID: PMC3012296] [PubMed: 21847300]
42. Chatterjee RN, Mukherjee SP, Nandi DN. Life events and depression. Indian J Psychiatry.
1981;23:333–7. [PMCID: PMC3012904] [PubMed: 22058558]
43. Satija YK, Advani GB, Nathawat SS. Influence of stressful life events and coping strategies in
depression. Indian J Psychiatry. 1998;40:165–71. [PMCID: PMC2965840] [PubMed: 21494464]
44. Prakash R, Trivedi JK, Sethi BB. Life events in depression. Indian J Psychiatry. 1980;22:56–60.
[PMCID: PMC3013333] [PubMed: 22058439]
45. Venkoba Rao A, Nammalvar N. Life changes and depressive disease. Indian J Psychiatry.
1976;18:293–304.
46. Raju SS, Kumaraswamy N, Mani AJ. Socio-demographic factors of depressive disorders in India: A
comparative appraisal. Indian J Psychiatry. 1980;22:356–60. [PMCID: PMC3013597] [PubMed:
22058498]
47. Bhugra D, Gupta KR, Wright B. Depression in North India comparison of symptoms and life events
with other patient groups. Int J Psychiatry Clin Prac. 1997;1:83–7. [PubMed: 24936661]
48. Bagadia VN, Jeste DV, Dave KP, Doshi SU, Shah LP. Depression: Family and psychodynamic study of
233 cases. Indian J Psychiatry. 1973;15:217–23.
49. Chakrabarti S, Nehra R, Sharma P, Mankotia A, Jhirwal OP. Clinical and psychosocial profile elderly
depressives and its comparison with young depressives. Indian J Psychiatry. 2005;47:S13.
50. Agrawal N, Jhingan HP. Life events and depression in elderly. Indian J Psychiatry. 2002;44:34–40.
[PMCID: PMC2953652] [PubMed: 21206879]
51. Patel S, Shah R, Patel H, Tilwani M, Vankar GK. Depressive symptomatology among adolescent
schoolgirls. Indian J Psychiatry. 1998;40:S35.
52. Krishnakumar P, Geeta MG. Clinical profile of depressive disorder in children. Indian Pediatrics.
2006;43:521–6. [PubMed: 16820661]
53. Venkoba Rao A. Broken home (in particular reference to parental deaths) and its relationship to
depressive illness. Indian J Psychiatry. 1970;12:23–32.
54. Patel V, Kirkwood BR, Pednekar S, Weiss H, Mabey D. Risk factors for common mental disorders in
women Population-based longitudinal study. British J Psychiatry. 2006;189:547–55. [PubMed: 17139040]
55. Pereira B, Andrew G, Pednekar S. The explanatory models of depression in low income countries:
Listening to women in India. J Affect Disord. 2007;102:209–18. [PubMed: 17074394]
56. Patel V, Rodrigues M, DeSouza N. Gender, Poverty, and Postnatal Depression: A study of mothers in
Goa, India. Am J Psychiatry. 2002;159:43–7. [PubMed: 11772688]
57. Rodrigues M, Patel V, Jaswal S, De Souza N. Listening to mothers: Qualitative studies on motherhood
and depression from Goa, India. Soc Sci Med. 2003;57:1797–806. [PubMed: 14499506]
58. Verma D, Chandra PS, Thomas T, Carey MP. Intimate partner violence and sexual coercion among
pregnant women in India: Relationship with depression and post-traumatic stress disorder. J Affect Disord.
2007;102:227–35. [PMCID: PMC1978173] [PubMed: 17109969]
59. Seligman ME, Abramson LY, Semmel A, Von Baeyer C. Depressive attributional style. J Abnorm
Psychol. 1979;88:242–7. [PubMed: 500951]
60. Bhojak MM, Was JN, Nathawat SS, Vijayvergia D. A study of attributional style in depression
compared with schizophrenic and normal patients. Indian J Psychiatry. 1989;31:116–21.
[PMCID: PMC2991671] [PubMed: 21927368]
61. Venkoba Rao A, Reddy TK, Prabakar ER, Baskaran S, Swaminathan R, Belinda C, et al. Cognitive
disorder and Depression (An Analysis of the Causal Relationship and Susceptibility to Relapses) Indian J
62. Srivastava S. Deficiencies in social relationships of individuals with neurosis. Indian J Psychiatry.
2006;48:154–8. [PMCID: PMC2932985] [PubMed: 20844645]
63. Sinha V, Singh RN. Immunological Role of Hardiness on Depression. Indian J Psychol Med.
2009;31:39–44. [PMCID: PMC3168079] [PubMed: 21938090]
64. Bhatia SG, Varma VK, Amma MPK. A study of the relationship between urinary 5-hydroxyindoles
and depressive states. Indian J Psychiatry. 1978;20:6–14.
65. Palaniappan V, Ramachandran V, Somasundaram O. Norepinephrine and Serotonin metabolism and

clinical response to combined imipramine and amitriptyline therapy in depression. Indian J Psychiatry.
1991;33:224–31. [PMCID: PMC2988307] [PubMed: 21927500]
66. Reddy PL, Khanna S, Subhash MN, Channabasavanna SM, Sridhara Rao BS. CSF amine metabolites
in depression. Biol Psychiatry. 1992;31:112–8. [PubMed: 1371076]
67. Dalal PK, Lal N, Trivedi JK, Seth PK, Agarwal AK, Khalid A. ECT and Platelet 5HT uptake in major
68. Dalal PK, Lal N, Trivedi JK, Seth PK, Agarwal AK, Khalid A. Active platelet 5-HT uptake in
depressives treated with Imipramine and ECT. Indian J Psychiatry. 1998;40:60–6. [PMCID: PMC2964820]
[PubMed: 21494445]
69. Trivedi JK, Singh RP, Lal N, Viswanathan PN, Kumar S. Effect of imipramine and ECT on platelet
MAO activity in depressives. Indian J Psychiatry. 1989;31:139–43. [PMCID: PMC2991675] [PubMed:
21927372]
70. Sapru MK, Rao BS, Channabasavanna SM. Serum dopamine-P- hydroxylase activity in clinical
subtypes of depression. Acta Psychiatr Scand. 1989;80:474–8. [PubMed: 2596346]
71. Srinivasan V, Venkoba Rao A, Devi PS. 3 Methoxy-4 Hydroxy Mandelic Acid excretion and
Imipramine administration in depressive and normal subjects: A comparative study. Indian J Psychiatry.
1975;17:56–62.
72. Gangadhar BN, Ancy J, Janakiranaiah N, Umapathy C. P300 amplitude in non-bipolar, melancholic
depression. J Affect Disord. 1993;28:57–60. [PubMed: 8326081]
73. Singh R, Shukla R, Dalal PK, Singh PK, Trivedi JK. P 300 event related potential in depression. Indian
74. Naga Venkatesha Murthy PJ, Gangadhar BN, Janakiramaiah N, Subbakrishna DK. Normalization of
P300 amplitude following treatment of dysthymia. Biol Psychiatry. 1997;42:740–3. [PubMed: 9325569]
75. Naga Venkatesha Murthy PJ, Janakiramaiah N, Gangadhar BN, Subbakrishna DK. P300 amplitude and
antidepressant response to Sudarshan Kriya Yoga (SKY) J Affect Disord. 1998;50:45–8. [PubMed:
9716279]
76. Khanna S, Mukundan CR, Channabasavanna SM. Bereitschafts potential in melancholic depression.
Biol Psychiatry. 1989;26:526–9. [PubMed: 2790093]
77. Reddy MS, Kuruvilla K. Dexamethasone suppression test in depression. Indian J Psychiatry.
1986;28:195–200. [PMCID: PMC3172529] [PubMed: 21927174]
78. Ghulam R, Anand M, Lal N, Trivedi JK. Dexamethasone suppression test for major depression. Indian
79. Chaudhary S, Valdiya PS, Augustine M. The dexamethasone suppression test in endogenous
80. Ghulam R, Trivedi JK, Singh N, Anand M. Post dexamethasone plasma cortisol levels as indicator of
tricyclic response in major depression. Indian J Psychiatry. 1990;32:351–5. [PMCID: PMC2990852]
[PubMed: 21927490]
81. Agarwal A, Nag D, Kars AM, Agarwal AK, Choudhury SR. DST in the course of post stroke
82. Rao AV, Devi SP, Muthayya NM. A report on eosinophilic response as a measure of adrenocortical
function in depressive Illness. Indian J Psychiatry. 1967;9:153–7.
83. Verghese A, Beig A, Senseman LA, Sundar Rao PSS, Benjamin V. A social and psychiatric study of a
representative group of families in Vellore town. Indian J Med Res. 1973;61:608–20. [PubMed: 4752395]
84. Gurnani KC, Sharma SN, Chansouria JPN, Gurnani S. Adrenocortical dysfunction in depression:
Response to dexamethasone suppression test-a comparative study. Indian J Psychiatry. 1988;30:153–9.
[PMCID: PMC3010042] [PubMed: 21927301]
85. Jainer AK, Sharma M, Trivedi JK, A CG, Tiwari SC. ACTH and the dexamethasone uppression test in
86. Kumar S, Davis RB. Dexamethasone in depressive syndromes. Indian J Psychiatry. 1970;12:260–3.
87. Boral GG, Ghosh AB, Pal SK, Ghosh KK, Nandi DN. Thyroid function in depression. Indian J
88. Saxena J, Singh PN, Srivastava U, Siddiqui AQ. A study of thyroid hormones (T3, T4 and TSH) in
patients of depression. Indian J Psychiatry. 2000;42:243–6. [PMCID: PMC2958345] [PubMed: 21407950]
89. Gupta S, Saha PK, Mukhopadhyay A. Prevalence of hypothyroidism and importance of cholesterol
estimation in patients suffering from major depressive disorder. J Indian Med Assoc. 2008;106:240–2.
[PubMed: 18828343]
90. Chopra VK, Daya Ram. Basal Thyroid Functions In First Episode Depressive Illness: A Controlled
Study. Indian J Psychiatry. 2001;43:61–6. [PMCID: PMC2955935] [PubMed: 21407841]
91. Tiwari SC, Lal N, Trivedi JK, Chaturvedi UC, Varma SL, Bahuguna LM. Immunoglobulins and viral
antibodies in depressive patients. Indian J Psychiatry. 1990;32:318–23. [PMCID: PMC2990846] [PubMed:
21927484]
92. Verma H, Wig NN. A study of extra - cellular fluid volume in depression and response to therapy.
93. Venkoba Rao A, Devi SP, Srinivasan V. Urinary melatonin in depression. Indian J Psychiatry.
1983;25:167–72. [PMCID: PMC3012312] [PubMed: 21847281]
94. Chandra S, Agarwal AK. Memory in depression. Indian J Psychiatry. 1982;24:338–45.

[PMCID: PMC3012793] [PubMed: 21965935]
95. Sharma I, Singh P, Agnihotri SS. Cognitive dysfunction in depression. Indian J Psychiatry.
1984;26:51–4. [PMCID: PMC3012253] [PubMed: 21965956]
96. John S, Kuruvilla K. Cognitive dysfunction in Depression. Indian J Psychiatry. 1992;34:30–3.

[PMCID: PMC2980980] [PubMed: 21776094]
97. Tandon R, Singh AP, Sinha PK, Trivedi JK. Executive functions in depression: A clinical report. Indian
98. Nandi DN, Saha GB, Bhattacharya BB, Mandal MK. A study on perception of facial expressions of
emotions in depression. Indian J Psychiatry. 1982;24:284–90. [PMCID: PMC3012819] [PubMed:
21965925]
99. Margoob MA, Mushtaq D, Murtza I, Mushtaq H, Ali A. Serotonin transporter gene polymorphism and
treatment response to serotonin reuptake inhibitor (escitalopram) in depression: An open pilot study. Indian
100. Kapoor M, Kapur S, Mehra S, Dube U, Sharad S, Sidhu S. Genetic variation in D7S1875 repeat
polymorphism of leptin gene is associated with increased risk for depression: A case-control study from
India. Depress Anxiety. 2009;26:791–5. [PubMed: 19382181]
101. Das PP, Malhotra S, Chakrabarti S, Sharma S. Elevated total cholesterol in severely depressed
patients: Role in cardiovascular risk? World J Biol Psychiatry. 2009 URL:
http://dx.doi.org/10.1080/15622970902960889. [PubMed: 19462342]
102. Gupta R, Singh P, Verma S, Garg D. Standardized assessment of depressive disorders: A replicated
study from northern India. Acta Psychiatr Scand. 1991;84:310–2. [PubMed: 1746278]
103. Gupta R, Khandelwal S, Varma VK, Wig NN, Rao U, Tripathi BM. Depressive symptoms-an
intercentre comparison. Indian J Psychiatry. 1982;24:380–2. [PMCID: PMC3012800] [PubMed:
21965942]
104. Derasari S, Shah VD. Comparison of symptomatology of depression between India and U.S.A. Indian
105. Chaturvedi SK, Upadhyaya M. Double Depression and Somatization. Am J Psychiatry.

1989;46:1354–5. [PubMed: 2782488]
106. Teja S, Narang RL, Aggarwal AK. Depression across cultures. British J Psychiatry. 1971;119:253–60.
[PubMed: 5568193]
107. Rao AV, Nammalvar N. Death orientation in depression. Indian J Psychiatry. 1979;22:199–205.
108. Srivastava AS, Kumar R. Suicidal ideation and attempts in patients with major depression:
Sociodemographic and clinical variables. Indian J Psychiatry. 2005;47:225–8. [PMCID: PMC2921140]
[PubMed: 20711312]
109. Rao KN, Begum S. A phenomenological study of delusions in depression. Indian J Psychiatry.
1993;35:40–2. [PMCID: PMC2972567] [PubMed: 21776167]
110. Singh G, Verma HC. Depressive equivalents -pain as a symptom of depression. Indian J Psychiatry.
1971;13:49–55.
111. Saxena S, Nepal MK, Mohan D. DSM III Axis I diagnoses of Indian psychiatric patients with somatic
symptoms. Am J Psychiatry. 1988;145:1023–4. [PubMed: 3394855]
112. Gupta R, Dahiya S, Bhatia MS. Effect of depression on sleep: Qualitative or quantitative? Indian J
113. Chaturvedi SK, Sarmukaddam S. Negative symptoms in depression. Indian J Psychiatry.

1985;27:139–44. [PMCID: PMC3011145] [PubMed: 21927088]
114. Chaturvedi SK, Rao GP, Mathai JP, Sarmukaddam S, Gopinath PS. Negative symptoms in
schizophrenia and depression. Indian J Psychiatry. 1985;27:237–41. [PMCID: PMC3011124] [PubMed:
21927110]
115. Kulhara P, Chadda R. A study of negative symptoms in schizophrenia and depression. Compr
Psychiatry. 1987;28:229–35. [PubMed: 3595110]
116. Tripathi M, Vibha D. Reversible dementias. Indian J Psychiatry. 2009;51:S52–5.

[PMCID: PMC3038529] [PubMed: 21416018]
117. Tharoor H, Kar N, Shameera, Jagdisha Profile of childhood depression in a south Indian clinic
population. Indian J Psychiatry. 2002;45:S9.
118. Bhargava SC, Sethi S. Depressive disorder in children. J Indian Assoc Child Adol Mental Health.
2005;1:4.
119. Sharma H, Shah S. Psychiatric comorbidity of headache in a medical relief camp in a rural area.
120. Hoch E. Contents of depressive ideas in Indian Patients. Indian J Psychiatry. 1961;3:28–36.
121. Chaturvedi SK. Depressive psychosis presenting as chronic pain disorder. Indian J Psychiatry.
1987;29:235–8. [PMCID: PMC3172479] [PubMed: 21927244]
122. Gautam SK, Kapur RL. Psychiatric patients with somatic complaints. Indian J Psychiatry.
1977;19:75–80.
123. Srinivasan K, Srinivasa Murthy R, Janakiramaiah N. A nosological study of patients presenting with
somatic complaints. Acta Psychiatr Scand. 1986;73:1–5. [PubMed: 3962697]
124. Banerjee G, Sinha S, Mukherjee DG, Sen G. A study of psychiatric disorders other than psychosis in
the referred cases with somatic complaints. Indian J Psychiatry. 1987;29:363–6. [PMCID: PMC3172450]
[PubMed: 21927270]
125. Duddu V, Issac MK, Chaturvedi SK. Alexithymia in somatoform and depressive disorder. J
Psychosom Res. 2003;54:435–8. [PubMed: 12726899]
126. Ansari SA. Symptomatology of Indian depressives. Transactions of All India Institute of Mental
Health. Bangalore. 1969;9:1.
127. Venkoba Rao A. Affective illness in first degree relatives, Parental loss and family jointness in
depressive disorders. Br J Psychiatry. 1973;122:601. [PubMed: 4717036]
128. Venkoba Rao A. Depression: A psychiatric analysis of 30 cases. Indian J Psychiatry. 1966;8:143.
129. Sethi BB, Nathawat SS, Gupta SC. Depression in India. J Soc Psychol. 1973;91:3. [PubMed:
4749504]
130. Bhattacharya D, Vyas JN. A cross-cultural study of depression in Australian and Indian patients.
131. Sethi BB, Prakash R, Arora U. Guilt and hostility in depression. Indian J Psychiatry. 1980;22:156–60.
[PMCID: PMC3013304] [PubMed: 22058459]
132. Trivedi JK, Dube S, Raz R, Seethi BB. A comparative study of guilt and hostility in depressive
subjects. Indian J Psychiatry. 1981;23:156–9. [PMCID: PMC3013168] [PubMed: 22064807]
133. Painuly N, Sharan P, Mattoo SK. Antecedents, concomitants and consequences of anger attacks in
depression. Psychiatry Res. 2007;53:39–45. [PubMed: 17544515]
134. Chatterjee A, Chakraborty R, Chaudhary S. Indicators of suicidal attempt in depression. Indian J

Psychiatry. 2006;48:276. [PMCID: PMC2915611] [PubMed: 20703360]
135. Malhotra K, Schwartz T, Hameed U. Presence of suicidality as a prognostic indicator. J Postgrad

Med. 2004;50:185–8. [PubMed: 15377802]
136. Gupta R, Dahiya S, Bhatia MS. Effect of depression on sleep: Qualitative or quantitative? Indian J
137. Singhal S, Kumar S, Agarwal AK. A clinical study of chronic depression. Indian J Psychiatry.
1991;33:261–5. [PMCID: PMC2988310] [PubMed: 21897468]
138. Srivastava S, Sharma M. Seasonal affective disorder: A report from India (latitude 26° 45’ N) J Affect
Disord. 1998;49:145–50. [PubMed: 9609679]
139. Avasthi A, Sharma A, Gupta N, Kulhara P, Varma VK, Malhotra S, et al. Seasonality and affective
disorders: A report from North India. J Affect Disord. 2001;64:145–54. [PubMed: 11313081]
140. Sagar RS, Mohan D, Kumar V, Khandelwal SK, Nair PG. Physical illnesses among elderly
psychiatric out-patients with depression. Indian J Psychiatry. 1992;34:41–4. [PMCID: PMC2980983]
[PubMed: 21776097]
141. Satapathy R, Kar N, Das I, Kar GC, Pati T. A study of major physical disorders among the elderly
depressives. Indian J Psychiatry. 1997;39:278–81. [PMCID: PMC2967158] [PubMed: 21584092]
142. Das PP, Grover S, Avasthi A, Chakrabarti S, Malhotra S, Kumar S. Intentional self-harm seen in
psychiatric referrals in a tertiary care hospital. Indian J Psychiatry. 2008;50:187–91.
[PMCID: PMC2738363] [PubMed: 19742182]
143. Kumar CT, Mohan R, Ranjith G, Chandrasekaran R. Gender differences in medically serious suicide
attempts: A study from South India. Psychiatry Res. 2006;144:79–86. [PubMed: 16919336]
144. Batra L, Gautam S. Psychiatric morbidity and personality profile in divorce seeking couples. Indian J
145. Sharan P, Chaudhary G, Kavathekar SA, Saxena S. Preliminary report of psychiatric disorders in
survivors of a severe earthquake. Am J Psychiatry. 1996;53:556–8. [PubMed: 8599406]
146. Gupta A, Bahadur I, Gupta KR, Bhugra D. Self-awareness of depression and life events in three
groups of patients: Psychotic depression, obsessive-compulsive disorder and chronic medical illness in
North India. Indian J Psychiatry. 2006;48:251–3. [PMCID: PMC2915597] [PubMed: 20703346]
147. Singh NH, Sharma SG, Pasweth AM. Psychiatric co-morbidity among alcohol dependants. Indian J
148. Shaji S, Bose S, Kuriakose S. Behavioral and psychological symptoms of dementia: A study of
symptomatology. Indian J Psychiatry. 2009;51:38–41. [PMCID: PMC2738411] [PubMed: 19742201]
149. Chadda RK, Ahuja N. Dhat Syndrome a sex neurosis of the Indian subcontinent. Br J Psychiatry.
1990;156:577–9. [PubMed: 2386873]
150. Bhatia MS, Malik SC. Dhat Syndrome - a useful diagnostic entity in Indian culture. Br J Psychiatry.
1991;159:691–5. [PubMed: 1756347]
151. Singh G, Sachdev JS, Kaur H. Prevalence of depression among medical inpatients. Indian J
Psychiatry. 1979;21:274–8.
152. De AK, Kar P. Psychiatric disorders in medical in-patients-a study in a teaching hospital. Indian J
153. Sood A, Singh P, Gargi PD. Psychiatric morbidity in non-psychiatric geriatric inpatients. Indian J
154. Jacob R, Kumar MS, Rajkumar R, Palaniappan V. A study to assess depression, its correlates and
suicidal behaviour in epilepsy. Indian J Psychiatry. 2002;44:161–4. [PMCID: PMC2954344] [PubMed:
21206562]
155. Gupta A, Deepika S, Taly AB, Srivastava A, Surender V, Thyloth M. Quality of life and
psychological problems in patients undergoing neurological rehabilitation. Ann Indian Acad Neurol.
2008;11:225–30. [PMCID: PMC2771998] [PubMed: 19893678]
156. Pawar AA, Rathod J, Chaudhury S, Saxena SK, Saldanha D, Ryali VS, Srivastava K. Cognitive and
emotional effects of renal transplantation. Indian J Psychiatry. 2006;48:21–6. [PMCID: PMC2913638]
[PubMed: 20703410]
157. De Sousa A. Psychiatric issues in renal failure and dialysis. Indian J Nephrology. 2008;18:47–50.
[PMCID: PMC2813124] [PubMed: 20142902]
158. Mishra SK, Mohapatra PK, Bhattacharya K, Gupta T, Agarwal JP. Prevalence of psychiatric disorder
in asymptomatic or minimally symptomatic cancer patients on treatment. J Cancer Res Ther. 2006;2:136–
9. [PubMed: 17998693]
159. Sharma N, Koranne RV, Singh RK. A comparative study of psychiatric morbidity in dermatologic
patients. Indian J Dermatol. 2003;48:137–41.
160. Banerjee A, Kumar S, Kulhara P, Gupta A. Prevalence of depression and its effect on disability in
patients with age-related macular degeneration. Indian J Ophthalmol. 2008;56:469–74.
[PMCID: PMC2612975] [PubMed: 18974517]
161. Chandra PS, Ravi V, Desai A, Subbakrishna DK. Anxiety and depression among HIV-infected
heterosexuals–A report from India. J Psychosomatic Res. 1998;45:401–9. [PubMed: 9835233]
162. Dutta S, Kar N, Thirthalli J, Nair S. Prevalence and risk factors of psychiatric disorders in an
industrial population in India. Indian J Psychiatry. 2007;49:103–8. [PMCID: PMC2917073] [PubMed:
20711391]
163. Hamilton M. “A rating scale for depression.” J Neurol Neurosurg Psychiatry. 1960;23:56–62.
[PMCID: PMC495331] [PubMed: 14399272]
164. Beck AT, Ward CH, Mendelson M, Erbough J. “An Inventory for measuring depression” Arch Gen
Psychiatry. 1961;4:561–71. [PubMed: 13688369]
165. Ajmany S, Nandi DN. Adaptation of A. T. Beck et al.‘s “an inventory for measuring depression”
166. Ganguli M, Dube S, Johnston JM, Pandav R, Chandra V, Dodge HH. Depressive symptoms, cognitive
impairment and functional impairment in a rural elderly population in India: A Hindi version of the
geriatric depression scale (GDS-H) Int J Geriatr Psychiatry. 1999;14:807–20. [PubMed: 10521880]
167. Raguram R, Weiss MG, Channabasavanna SM, Devms GM. Stigma, depression, and somatization in
south India. Am J Psychiatry. 1996;153:1043–9. [PubMed: 8678173]
168. Singh G, Verma HC, Verma RS, Kaur H. A new depressive Inventory (Amritsar Depressive
Inventory) Indian J Psychiatry. 1974;16:183.
169. Avasthi A, Varma SC, Kulhara P, Nehra R, Grover S, Sharma S. Diagnosis of common mental
disorders by using PRIME-MD Patient Health Questionnaire. Indian J Med Res. 2008;127:159–64.
[PubMed: 18403794]
170. Kochhar PH, Rajadhyaksha SS, Suvarna VR. Translation and validation of brief patient health
questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients. J
Postgrad Med. 2007;53:102–7. [PubMed: 17495375]
171. Singh G, Sachdeva JS, Verma SK, Kuar H. Correlation between the ADI self rating scale, the
Hamilton rating scale and clinical assessment of depression. Indian J Psychiatry. 1981;23:142–5.
[PMCID: PMC3013165] [PubMed: 22058534]
172. Prasad MK, Udupa K, Kishore KR, Thirthalli J, Sathyaprabha TN, Gangadhar BN. Inter-rater
reliability of Hamilton depression rating scale using video- recorded interviews - Focus on rater-blinding.
173. Basker M, Moses PD, Russell S, Swamidhas P, Russell S. The psychometric properties of Beck
Depression Inventory for adolescent depression in a primary-care paediatric setting in India. J Child
Adolesc Psychiatry Ment Health. 2007;1:8. [PMCID: PMC1976414] [PubMed: 17688697]
174. Chadda RK. Social support and psychosocial dysfunction in depression. Indian J Psychiatry.
1995;37:119–23. [PMCID: PMC2971494] [PubMed: 21743731]
175. Chaudhary PK, Deka K, Chetia D. Disability associated with mental disorders. Indian J Psychiatry.
2006;48:95–101. [PMCID: PMC2913573] [PubMed: 20703393]
176. Tharoor H, Chauhan A, Sharma PS. A cross-sectional comparison of disability and quality of life in
euthymic patients with bipolar affective or recurrent depressive disorder with and without comorbid
chronic medical illness. Indian J Psychiatry. 2008;50:24–9. [PMCID: PMC2745870] [PubMed: 19771303]
177. Chakrabarti S, Kulhara P, Verma SK. Extent and determinants of burden among families of patients
with affective disorders. Acta Psychiatr Scand. 1992;86:247–52. [PubMed: 1414422]
178. Chakrabarti S, Raj L, Kulhara P, Avasthi A, Verma SK. Comparison of the extent and pattern of
family burden in affective disorders and schizophrenia. Indian J Psychiatry. 1995;37:105–12.
[PMCID: PMC2971492] [PubMed: 21743729]
179. Chakrabarti S, Kulhara P, Verma SK. Family burden of neurosis: Extent and determinants. Hong
Kong J Psychiatry. 1996;6:23–8.
180. Subodh BN, Avasthi A, Chakrabarti S. Psychosocial impact of dysthymia: A study among married
patients. J Affect Disord. 2008;109:199–204. [PubMed: 18164766]
181. Venkoba Rao A, Nammalvar N. The course and outcome in depressive illness. A follow-up study of
122 cases in Madurai, India. Br J Psychiatry. 1977;130:392–6. [PubMed: 858014]
182. Gada M. The course of depressive illness: A follow-up investigation of 92 cases. Indian J Psychiatry.
1989;31:196–200. [PMCID: PMC2992112] [PubMed: 21927383]
183. Brown AS, Varma VK, Malhotra S, Jiloha RC, Conover SA, Susser ES. Course of acute affective
disorders in a developing country setting. J Nerv Ment Dis. 1998;186:207–13. [PubMed: 9569888]
184. Avasthi A, Khehra N, Gupta N. A follow up study of seasonality in affective disorders: A preliminary
study. Indian J Psychiatry. 2007;49:49–51. [PMCID: PMC2899999] [PubMed: 20640065]
185. Sachdev S, Nandi DN, Mukherjee SP. Prognosis of depression. Indian J Psychiatry. 1983;25:115–20.
[PMCID: PMC3012334] [PubMed: 21847268]
186. Chakraborty K, Avasthi A, Kumar S, Grover S. Attitudes and beliefs of patients of first episode
depression towards antidepressants and their adherence to treatment. Soc Psychiatry Psychiatr Epidemiol.
2009;44:482–8. [PubMed: 19011717]
187. Sethi BB, Sharma M, Chaturvedi PK. A model for prevention and treatment of depression in
developing nations. Indian J Psychiatry. 1984;26:393–402. [PMCID: PMC3011206] [PubMed: 21966019]
188. Verghese A. Spirituality and mental health. Indian J Psychiatry. 2008;50:233–7.

[PMCID: PMC2755140] [PubMed: 19823605]
Articles from Indian Journal of Psychiatry are provided here courtesy of Wolters Kluwer -- Medknow
Publications

An Overview of Indian Research in Depression

Uploaded by

Copyright:

Available Formats

An Overview of Indian Research in Depression

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

An Overview of Indian Research in Depression

Uploaded by

Copyright:

Available Formats

12/27/2019 An overview of Indian research in depression

Indian J Psychiatry. 2010 Jan; 52(Suppl1): S178–S188. PMCID: PMC3146226

An overview of Indian research in depression

Copyright © Indian Journal of Psychiatry

Keywords: Depression, clinical features, India

headings of epidemiology, demographic and psychosocial risk factors, neurobiology, symptomatology,

Demographic and psychosocial risk factors for depression

Assessment and Diagnostic issues

Course and Outcome

Treatment related issues

Conclusion and future directions

Conflict of Interest: None declared.

4. Sethi BB, Prakash R. Depression in Industrial population. Indian J Psychiatry. 1979;21:359–61.

13. Ponnudurai R, Somasundaram O, Balakrishnan S, Srinivasan N. Depression-a study of 80 cases. Indian

38. Mohandas E. Roadmap to Indian Psychiatry. Indian J Psychiatry. 2009;51:173–9.

65. Palaniappan V, Ramachandran V, Somasundaram O. Norepinephrine and Serotonin metabolism and

94. Chandra S, Agarwal AK. Memory in depression. Indian J Psychiatry. 1982;24:338–45.

96. John S, Kuruvilla K. Cognitive dysfunction in Depression. Indian J Psychiatry. 1992;34:30–3.

105. Chaturvedi SK, Upadhyaya M. Double Depression and Somatization. Am J Psychiatry.

113. Chaturvedi SK, Sarmukaddam S. Negative symptoms in depression. Indian J Psychiatry.

116. Tripathi M, Vibha D. Reversible dementias. Indian J Psychiatry. 2009;51:S52–5.

134. Chatterjee A, Chakraborty R, Chaudhary S. Indicators of suicidal attempt in depression. Indian J

135. Malhotra K, Schwartz T, Hameed U. Presence of suicidality as a prognostic indicator. J Postgrad

188. Verghese A. Spirituality and mental health. Indian J Psychiatry. 2008;50:233–7.

You might also like