It was 9 PM and Sameer was starting to have dinner. Wanting to watch something on his laptop while eating, he decided to watch just one episode of Game of Thrones.  Before he knew it, it was 7 AM and he had watched an entire season. Sounds familiar? We have all done this thing called binge-watching at least once in our lives. Is it fun? Sure. Is it healthy?..ummm..not really, right? I mean, you lose out on sleep, forget to do your homework/office work, use up all your internet data in one night, feel sleepy the next morning and underperform at school or office. This example is of course about binge watching a show. But you’ll find similar stories of people using alcohol and drugs. Binge watching usually ends with the show’s last season. However, alcohol and drugs are not only far more difficult habits to get rid of, but have way more harmful effects than binge-watching a show. 

The world today is far more complex that what it was two or three decades ago. Our lifestyles have changed drastically in all matters-from the kind of food we eat to the modes of communication available at our disposal. Advances in technology have been a game changer and have impacted life in every possible sphere.  And at the centre of all this change are our youth. Young people today are smarter than ever before in the history of mankind. They are highly intelligent, resourceful, aware individuals and have information at their fingertips. But a more complex life also has its pressures. Adolescents and young adults today are under tremendous pressure to succeed at everything. This makes them vulnerable to faulty methods of coping such as the use of alcohol and drugs. 

According to research, tobacco and alcohol are the most commonly used substances in India and a majority of users start using these as adolescents and young adults. It has also been found that other substances such as opioids, cannabis, cough syrups etc are more in use among younger people. It is already well known that using substances can cause not just physical, but also mental health problems and worsen existing health issues. In spite of knowing this, why do young people use substances? Some reasons are similar to why Sameer binge watched  an entire season of GoT despite knowing that it is not the right thing to do. It was easily accessible (internet data is inexpensive), it was fun and pleasurable, it made him forget about the work deadlines he had to meet this week, thereby relieving him of that stress for the time being. Of course, all the stress he had avoided for now would come back later to make him worried, but for now, it was fun, right? The reasons of addiction are somewhat similar, but more layered and complex. 

1. Genetic predisposition: As is the case with most health problems, substance abuse also may be genetically inherited. This DOES NOT mean that anyone with a parent or a sibling who abuses substances will definitely turn into a user himself/herself. It only means that the probability of them using or becoming dependent on substances is slightly higher than those whose parents or siblings do not use substances.
2. Easy accessibility: This is quite obvious. Anyone with easy availability of alcohol or drugs in his/her environment is likely to abuse it
3. Experimentation: Adolescence is an age in which high value is placed on experimenting with almost everything. There is curiosity regarding a particular substance and the urge to know what it feels like to use it. Many adolescents start using substances in order to experiment thinking they can quit any time, but later get hooked to them.
4. Peer pressure: Many a time, young people feel the need to “fit in” with a group. They are made fun of if they refuse to indulge in drugs or alcohol and in order to prove a point to friends, they start using substances without realizing that this can cause problems later on. This is peer pressure. 
5. Stress/depression/anxiety: Young people who suffer from depression or anxiety or those who are highly stressed, look at substances as stress relievers or as a coping mechanism. Alcohol, drugs and other substances give only temporary relief from stress while creating much bigger physical and mental health problems.
6. Neurobiology: A pertinent question is, how do substances work? Substances are essentially chemicals. When consumed, they affect one’s body and brain in certain ways. In what way they affect the brain depends upon the amount of substance taken. A certain quantity makes one feel high, while a higher quantity acts as a sedative. Either way, these artificial chemicals mess with one’s brain and the high is only temporary. Once this high wears off, the person wants more of the substance to experience the high again. 

Most people are aware of the fact that abusing drugs, alcohol or tobacco has rather serious health implications and yet for a lot of people this high is so important that they sacrifice their health in order to achieve it. Substance abuse robs from you not just your physical and mental health, but also your loved ones, money and a potentially beautiful life for just a temporary high. So, are there ways to achieve happiness and get high other than using substances? Definitely.  There have been studies that suggest that activities such as meditation, learning an art form, physical exercise, playing a sport, volunteering for a social cause etc. don’t just give people happiness, but also provide an outlet for their emotions. Performing any of these activities makes one mentally and physically healthy. Why get high on drugs when you can get high on life?! 

Addiction to substances such as alcohol, drugs, tobacco and nowadays even technology is a problem all over the world. Most addicts don’t start out knowing that they will become addicted. They believe they have full control over the use of the substance and that they shall be able to stop whenever they want to. However, over time, they lose control and start getting dependent on the substance. Following are seven questions that may help you find out if you are addicted. Answer these questions for the past one year.

1. Do you feel a strong desire or compulsion to take the substance?
2. Have you lost control over when and how much of the substance to consume?
3. If you do not use the substance for a day or more, do you experience anxiety, palpitations, inability to focus, disturbed sleep or feel excessively sad? 
4. Have you noticed an increase in the amount of substance that you need to take in order to get the same high as earlier?
5. Is your focus nowadays only on how you will get the substance? Have you started ignoring your studies and extracurricular activities because of it?
6. Do you continue to take the substance in spite of knowing that it is causing harm to you?

If your answer to three or more of the above questions was yes, then you may have a problem of dependence. 

What should you do?

1. Do not panic. Getting out of dependence or addiction needs professional help, especially if you have been dependent for a significant period of time.
2. Make an appointment with a psychiatrist and consult them about this problem as soon as possible. If you do not know a psychiatrist in your town, see your general physician or a psychologist who can then refer you to a psychiatrist.  
3. Take a friend or a family member that you trust into confidence. It always helps to have the support of a loved one. 

With appropriate help and guidance you can triumph over the problem of addiction. The sooner you seek help, the faster you shall recover. 

Aisha looks at the clock in the living room. It is 7:30 AM. In 2 hours, she has a meeting at the office. Nothing unusual, just the regular monthly meeting. This time, Aisha doesn’t even have a presentation to make. But she is very worried. Her heart is beating fast, her palms are sweaty and when her mother calls her to have breakfast an hour later, she refuses to eat saying she is feeling nauseous. Does this sound familiar? Do you find yourself worried and tense more often than not? Feeling anxious from time to time  in the context of a stressful situation is normal, however if you feel tense most of the time, such that it interferes with your day to day life and activities, you might be suffering from an anxiety disorder. Anxiety disorders form a group of disorders that are mainly characterized by some sort of worry or fear. Examples of anxiety disorders are Social Anxiety, Generalized Anxiety Disorder, Obsessive compulsive disorder, Panic Disorder and different kinds of specific phobias. 

One of the most common anxiety disorders is Generalized Anxiety Disorder (GAD).  The name itself suggests that the anxiety is not in a specific context, but affects the person in all/general contexts.

 For Aisha, the meeting at the office is causing her anxiety. Her thoughts are running wild. If one were to see what was going on in her mind, it would be something like this. “What if the meeting does not go well? What if they ask me about my project performance?  I have the numbers ready, but what if the boss is not happy with them? And if they decide to fire me, what will I do? Should I start looking for another job? But who will hire someone who has been fired like this? Should I just take sick leave from work today? That way, I don’t have to worry about the meeting …but I have already taken 2 leaves this month, I cannot afford to take one more…God, What do I do?!”  She gets so bothered by it that she snaps at her mother the second time she calls her to have breakfast. What Aisha is having are symptoms of Generalized Anxiety.

Psychological	Physical	Behavioural
Constant worrying about day to day things Difficulty in controlling the worry Imagining worst possible outcomes for day to day events and thinking up solutions for each outome Feeling impatient and on the edge Perceiving situations as threatening even when they are not	Palpitations Fatigue Sweating Trembling Nausea, diarrhea, headaches Difficulty falling asleep/Sleep disturbances	Feeling restless, pacing around Inability to concentrate and get work done Difficulty in making decisions Avoidance of tasks or situations Getting irritated at people Compulsive behavior

It is important to note that if these symptoms are present in a naturally anxiety provoking situation, then it doesn’t mean the person has GAD. Eg; Sweating, palpitations, being tense during or just before an important examination or interview is normal. GAD is when someone is tense and worried because of everyday occurrences or without any apparent reason Eg: continuously worrying about one’s own or a family member’s health, money matters, performance at school or work etc, imagining catastrophic outcomes out of usually harmless and non-dangerous situations. An example of imagining catastrophic outcomes would be to imagine that a loved one has met with a major accident because they are late from work.

It is also important to note that for it to be diagnosed as a disorder, the anxiety should be causing problems in a person’s daily life. For example, anxiety about work performance makes the person delay the task at hand, leading to waste of time, which leads to further fear of being able to finish the task.

GAD often co-exists with depression. 

Aisha’s meeting went fine, with no questions being posed to her about her performance. She did feel relief when the meeting was over, but after some time, when her boss said he would like to discuss a new idea with her, all the thoughts and worries came back. Aisha knew this happened with her all the time. If it was not her work, it was her health, or her parents’ health or her future. But she was always worried about something. She wondered why.  

Causes of GAD: What leads to people having anxiety? As it is with most mental health issues, anxiety does not have a single cause. Causes could be genetic, biological, environmental or a combination of all these.

Genetic: People with immediate family member/s with anxiety disorders are more susceptible to GAD. This doesn’t mean that everyone with an immediate family member with an anxiety disorder is sure to have GAD. Family history only indicates a slightly higher chance of it.

Biological: The human brain has a mechanism through which it warns the person in case of a dangerous situation. This is a protective mechanism. An example would be, you move out of the way of a speeding car immediately, which takes less than a few seconds. This is because of the brain’s ability to recognize danger and warn you about it. In people with anxiety disorders, this mechanism is overactive and makes them perceive danger or a threat where there may be none. This results in feeling anxious and tense. With time, these patterns get strengthened and lead to generalized anxiety. 

Environmental factors: Life events and experiences can lead to anxiety. Negative events during childhood, significant conflict in the home environment, or dealing with chronic illnesses can lead someone to have anxiety. 

Treatment: There is help available for Generalized Anxiety Disorder. In fact, all anxiety disorders are treatable. People suffering from GAD may be treated with medication, therapy or both. But this is a decision that can only be taken by a qualified psychiatrist. People on treatment report a significant reduction in their symptoms and improvement in their day to day functioning. Of course, support from loved ones and friends is always important. 

If you think you have symptoms of GAD, don’t hesitate to seek help from a psychiatrist. If you know someone who has GAD, encourage them to seek help and support them as much as you can.

Nineteen year old Deepika has just joined a good engineering college in the city. She has been a good student and got to choose her branch of specialization in engineering. She stays in the college hostel. For the past one month, Deepika has been feeling uneasy. She finds it difficult to wake up on time for her classes. Even at class, she is unable to concentrate on what is being taught. She is late in submitting assignments and this causes her a lot of panic. She feels uninterested in activities in college and outside. She has also become short tempered and gets into verbal fights with her family members for trivial reasons. Her family and friends have been noticing these changes, but they think it is just a phase and she will be fine. Soon, her mid-term exams start. Deepika appears for 2 papers with great difficulty, but knows that she has not done well. Before the third paper, she calls up her father and cries incessantly over the phone saying she cannot appear for the exam and wants to quit engineering. Her parents get concerned and immediately travel to meet her. They try consoling her to no avail. They tell her to just give the exams and not worry or bother about the results, but she absolutely refuses. Seeing her state, they consult a psychiatrist. After speaking to Deepika and her parents at length, the psychiatrist comes to the conclusion that she is suffering from depression. 

 Depression is one of the most common mental disorders and is growing at an alarming rate. It affects people of all ages, however is most common among the ages of 15-40 years. If not treated, it can lead to worsening of symptoms, major disruption in one’s day to day functioning and in severe cases may even lead to death by way of suicide. 

However, many people do not know what depression is. Is feeling low the same as being depressed? Read on to know.

Depression is a mood disorder in which a person experiences low mood, loses interest in activities, feels tired easily. There are also disturbances in sleep and appetite. This doesn’t mean that anyone feeling low for a few days is suffering from depression. For someone to be diagnosed with clinical depression, the three signs mentioned above need to be present for most of the time for 2 weeks or longer. If the low mood is a consequence of a life event and subsides in less than two weeks, it is unlikely to be clinical depression. 

Other signs may include isolating oneself from family and friends, inability to focus on work or studies, getting irritated easily, not being able to perform routine activities with ease such as getting up on time, taking a bath, getting to college/office on time, wishing for death or thinking about suicide.

When the psychiatrist told her parents that Deepika is suffering from depression, they found it difficult to believe or understand it. After all, no one in their own family had ever had depression. The how could Deepika have it? 

The psychiatrist had to explain that after a lot of research, it has been established that there is an inadequacy of a neurotransmitter (chemical) called serotonin in the brain of people with depression. Exactly what leads to this chemical imbalance is not known. However, it is an extremely important finding as correcting this imbalance gives people relief from the symptoms of depression. Genetics also have a role to play. One whose parent/s or sibling/s have depression has a slightly higher chance of getting depressed themselves, but this certainly does not mean that depression is only caused by genetic predisposition.

An important thing to note is that there may be psychological as well as social reasons responsible for causing or triggering an episode of depression. Psychological reasons include set patterns of negative thinking and inability to cope with negative life events. Social factors may include any negative life event such as  the loss of a loved one, break up in a relationship, unmanageable stress at work or at home, failure in an examination etc.  

To put it in a nutshell, the causes of depression are a mixture of biological, genetic, psychological and social factors. 

Deepika reported to the psychiatrist in the presence of her parents that she had started feeling very lonely after about a month of joining the course. She was away from her family for the first time. She had been unable to make too many close friends because everyone was very busy and classes and practicals took up most of their time. She also found it difficult to live in the hostel and hated the food there. Basically, moving out of her hometown and living away from family was a stressful situation for Deepika. She was not used to living by herself. Added to the stress of the new surroundings, the pressure of studies and exams took a toll on her mental health. She used to feel like she was the only one who was unable to adjust and felt like a failure. When asked as to why she did not confide about her feelings into anyone, she said she was worried that her parents might get very concerned about her. She also felt a certain amount of guilt at not being able to give her best to her studies. All these things finally led her to depression. 

When should one seek treatment? If you notice yourself having symptoms mentioned above, however, they do not currently interfere with your ability to carry out day to day tasks, and there are no ideas of suicide, you may wait for 1 to 2 weeks before seeing a doctor. However, if the symptoms increase in intensity or are the same after even 1-2 weeks, you must see a doctor immediately. If there has been a past episode of depression, it is advised to see a psychiatrist at the first sign of return of symptoms. In Deepika’s case, she waited long enough to tell her parents and see a psychiatrist for her symptoms to worsen.  Now her parents were worried as to what would happen to their daughter and how she would come out of this

Is Help Available? Yes, absolutely. Depression is treatable. There are different modes of treatment.  There are medicines that help restore the chemical balance in the brain and provide relief from symptoms. Among psychological forms of treatment, cognitive behavior therapy is highly used. A trained psychologist talks to the affected person, and helps them identify the negative patterns of thinking as well as helps them learn how to cope with difficult life situations. A number of times, both medication and therapy are used together to get best results, at other times, either of the two is used. Which mode of treatment is the best for one should only be decided by a qualified psychiatrist. 

The psychiatrist treated Deepika with medications and referred her to a psychologist who started therapy with her. She was taught how to cope with a stressful situation successfully and how to seek support. Her parents were also given more information about depression. Deepika started feeling better in 4-5 weeks. She continued her sessions with her psychologist and in about 2 months, was able to resume college without major difficulties. Her parents were happy with the outcome and thanked God that they sought timely help for their daughter. 

What happens if you do not treat depression? Untreated depression may lead to complications like:

 Existing symptoms becoming more severe, 

Substance abuse

Ideas/attempts of suicide

Depression is becoming more and more prevalent everyday and needs to be treated like any other disorder of the human body. Most people with adequate treatment are able to function normally. It is only a matter of reaching out to family, friends and professionals for support. Don’t let the dark cloud overpower you, fight it!