Signs of depression in women, and when to talk to someone

Depression is more than a bad week. The World Health Organization describes a low, sad, irritable or empty mood, or a loss of pleasure or interest in activities, that lasts most of the day, nearly every day, for at least two weeks. It is different from the ordinary ups and downs of life.

Signs some women notice include:

Many women do not describe this as depression at all. They say they feel tired all the time, "not myself", or full of tension. Irritability and anger can be as much a sign as sadness: the US National Institute of Mental Health puts irritability and anxiety first on its list of signs in women.

Having some of these signs does not tell you what is behind them. A thyroid that is not working well, low iron, grief and long stress can feel similar. Only a doctor can tell what's going on.

Sadness usually has a reason and eases with time. The NHS says a low mood often gets better after a few days or weeks. If it lasts two weeks or more, it could be a sign of depression.

Two questions help. How long has it lasted? And how much is it getting in the way of work, family, eating, sleeping or looking after yourself? Feeling low after a hard day is human. Feeling low most days for weeks, and finding it hard to get through ordinary tasks, is a reason to talk to someone.

Grief after a loss is a natural response, and it can look a lot like depression. If grief comes with feeling worthless or hopeless, or with thoughts of ending your life, talk to a doctor.

If you are not sure whether this is a low patch or something more, our guide on feeling low for weeks can help you think it through.

Some kinds of depression are tied to times in a woman's life. The US National Institute of Mental Health names three, and the thyroid adds a fourth link worth knowing about.

Before your period. Premenstrual dysphoric disorder (PMDD) is a more intense form of premenstrual syndrome. In the days before a period it can bring severe low mood, anger and even thoughts of suicide.

During pregnancy and after childbirth. Depression after having a baby is more than the "baby blues". It can bring deep sadness, anxiety and exhaustion that make it hard to look after yourself or your baby.

In the years before menopause. The NHS lists mood swings, low mood and depression among the symptoms of perimenopause. NIMH notes that stronger irritability, anxiety, sadness or loss of enjoyment at this time may be signs of depression.

The thyroid. The NHS lists low mood or depression, along with extreme tiredness, among the symptoms of an underactive thyroid. About 1 in 6 Indian women has an underactive thyroid. That is one reason a doctor may ask for a simple blood test. Read more about thyroid and low mood.

Depression is not caused by anything a woman has or has not done. NIMH says this plainly, and it is worth repeating to yourself if you have been told to "just adjust".

Sometimes family or friends notice before you do. The NHS lists social signs of depression such as avoiding friends, taking part in fewer activities, dropping hobbies, and having difficulties at home or at work. People may also notice someone moving or speaking more slowly than usual.

At home, this can look like staying in bed longer, eating less with the family, snapping at the children, crying more easily, or saying "I'm fine" in a way that doesn't sound fine. Worry is common too: depression and anxiety in women often come together.

If you are reading this for someone else, ask gently and listen without judging. You don't need to have answers. If she talks about death or harming herself, take it seriously and use the numbers at the top of this page.

Talking-based help is the first step that the World Health Organization recommends for depression. For moderate or severe depression, a doctor may also suggest antidepressant medicines alongside it. Whether medicine is right for you is always a doctor's decision.

The WHO also suggests small, steady things that support recovery: keep doing some of the things you used to enjoy, stay in touch with friends and family, keep regular times for eating and sleeping, and move a little every day, even if it is only a short walk. These help, but they are not a test you have to pass on your own.

There are different people you can talk to:

• A counsellor listens, helps you put things into words and helps you find the right next step.
• A doctor can look for physical causes, such as the thyroid or low iron, and decide which tests you need.
• A clinical psychologist offers structured talking sessions, such as cognitive behavioural therapy (CBT).
• A psychiatrist is a medical doctor who specialises in mental health and can prescribe medicines.

In many Indian homes, low mood gets called "just stress", "tension" or being lazy. Women are often expected to carry on for everyone else. You do not need a label, or anyone's permission, to ask for help.

Some things that make the first conversation easier:

• Pick one person you trust, not the whole family at once.
• Say what you have noticed and for how long: "I've been sleeping badly and feeling low most days for a month."
• Ask for one practical thing, such as an hour to yourself for a call, or help with the children that day.
• If elders or in-laws brush it off, you can still go ahead. It is fine to choose who you tell, and how much.

At work, you can ask for time off for a health appointment without sharing the details. Looking after your mind is looking after your health.

India's National Mental Health Survey (2015–16), run by NIMHANS for the Ministry of Health and Family Welfare, found that many people in India who need mental health care are not getting it. Asking for help is not unusual or dramatic. It is the step most people never get to take.

• How long you have felt this way, and whether it is most days.
• Sleep: trouble falling asleep, waking early, or sleeping much more.
• Changes in appetite or weight.
• Energy and concentration at work and at home.
• Whether your mood changes with your cycle, if you are pregnant or have had a baby in the last year, or if your periods are changing in your 40s.
• Any thyroid test you have had, and any medicines you take.
• Anything big that has happened: a loss, a move, money worries, trouble at home.
• Any thoughts of death or of harming yourself. Say this out loud. It changes how quickly you get help.

Talk to someone if low mood or loss of interest has lasted two weeks or more, for most of the day on most days. The NHS advises seeing a doctor at that point. Talk to someone sooner if it is getting in the way of work, family or looking after yourself, or if the things you have tried are not helping.

A Nari health counsellor can listen, help you work out what you have noticed, and book you with a Nari doctor. The doctor can check for physical causes, such as the thyroid, and decide on any tests. Counsellors never give medical advice; medical decisions come from a Nari doctor.

Nari 1 is not an emergency service. If you are thinking of harming yourself, or you are in danger, call 112 now. For free mental health support at any hour, call Tele-MANAS on 14416 or 1-800-891-4416, a Government of India helpline.