eMedicineLive

Dr. Hemant Mittal is a well known psychiatrist based in Mumbai. He was brought up in North and South Americas and passed his childhood and adolescent years there until a strong urge to serve the society brought him back to India. He is one of the most popular doctors in social media networks and offers medical advice through them. He is also a motivational speaker and avid social activist. Our interview is focused on depression, a highly prevalent problem in our changing society. If you have any personal questions you may contact Dr. Hemant through his website www.mindmantra.in  or blog http://themindpath.blogspot.com/ or visit his clinic for a 45 minute high quality one-on-one professional consultancy.

All of us experience depression at some point in our life, though the severity may vary.  We sometimes see our friends or relatives having symptoms of depression. But most of us get out of depression without any medical intervention. At what point should we consult a psychiatrist if someone known to us is having depression?
Mental health or Emotional and Behavioral health is a taboo topic in society. 99% people feel that “counseling” from friends or family is the ultimate cure for the same.  If that doesn’t work faith healers are seeked upon. The moment the need or name of a psychiatrist is mentioned it instantly triggers images of mad people, sleeping pills and electric shock. Such is the impact of this erroneous thought process, that 99% people never seek treatment within the treatable period, leading to permanent structural changes within the brain. A research has proved that it might take anywhere between 6months to 15years from onset of the problem, for the patient to seek professional help. Those on the later half of that spectrum, normally experience long lasting symptoms beyond treatable modalities. Professional help should be sought in cases, where depression is not just an emotional phenomenon, but is clouding the entire social and personal self of the individual. By this I mean, that the individual has had a minimum of 2 weeks of day long sadness, with sleep and appetite disturbance, problems with concentration, crying episodes, mood swings, or any feeling/thoughts of self-harm.

Significant proportions of people suffering from depression go undiagnosed and untreated. Even doctors from other specialties do not bother much about emotional health unless it is very severe enough. What is your opinion regarding this issue?
Depression is the most misunderstood of all modern time illness. Most people just focus on its emotional side and not onto its physical aspects. It not only goes un-noticed or untreated by vast majority of doctors but also the notion of one time “positive talk” being the cure prevails among many. Most general practioners and physicians I know, have a 20% of their OPD clients suffering from this problem. Unfortunately the lack of knowledge in some cases, the fear of losing buisness, the limitation of not being able to prescribe the medications for long, and the hesitancy to sit patiently and listen, forces them to push the matter under the carpet. Also most doctors have never taken psychiatry too seriously during their MBBS. Because of this they stand at par with the common man on perceptions about psychiatry and its treatments. Psychiatry and Neurology are two dreaded subjects during MBBS. Most medical students, just study the basics regarding it or prefer to either boycott them. This leads to a limited knowledge about the brain structure, the long term neuronal damage that  depression/stress/anxiety can cause and the spectrum of psycho-somatic symptoms. This eventually creates a huge pool of financial resource for most doctors, as the patient willing goes through “n” number of tests, “n” number of medications just to find the right cause. Eventually when everything has been ruled out, he is suggested to visit a psychiatrist. 

Individuals with depression very rarely seek professional help themselves. It is their family or friends who bring them to mental health professionals. What are the significant symptoms that can help a non-medical person to suspect a possibility of clinical depression?
It’s very true what you have mentioned here. Most people are forced to seek help by pressure from family or friends. If four or more of the following are present, than a professional should be consulted:
A person having sadness for a period more than 2 weeks.
Change in personality as in Increased irritability or anger. The anger can be directed to people he/she was earlier very friendly with.
Increased intake of addictive substances like alcohol or tobacco.
Marked Changes in sleep and appetite structure.
Prevalent negative thinking
Lack of motivation. Finding excuses not to do his/her chores.
Memory or Concentration problems
Complaints of non-specific body pains, headaches, etc.

Several modalities of treatment are available for depression of which drug therapy is one. Some studies claim that some classes of antidepressants are ineffective and they are only as good as the placebo in improving the mental symptoms. There are also concerns about the side effects including suicidal ideation after initiating on antidepressants.  How successful are the treatments available for depression? Which modality has been found to be most effective?
Psychiatry is a very new branch of science. The first commercially available drugs are not even 50yrs old. Other branches of medicine have been present for more than 200yrs. The initial anti-depressants were quite an experimental break through and provided the path for modern day medicines. Over the last 20years, the invent of highly sophisticated imaging systems like PET scan and fMRI scan, new nanotechnological developments, and exponential increase within the field of brain-body research has helped to create medications which are extremely effective in helping the patient, and very minimal in side effects. The reasons why a patient ought to consult a psychiatrist first is because of the management of side-effects.  The FDA (food and drug dept.) as per law, prints all the side effects along with the medications name. This information is widely available through the net for the patient to read. Unfortunately this overload of information creates panic in his mind. A psychiatrist, who has duely attended, participated and being attentive during his post-graduation has the experience, trait and art of knowing which medicine will suit which person. The dosage are modulated according to the need of the presenting complaints. A good psychiatrist should mould the treatment according to the needs of the patient. The best treatment modality is dependent on the presenting complaints .Medications are good as an initial step as they help a person recover his emotional balance, post which counseling (CBT, REBT,etc) are very useful.

Most of us assume that children are devoid of adult life related stress. With competition in schools and parental pressure to perform better than peers increasing, children may be susceptible to stress and consequent depression. How common is depression in less than 15 year old children? How can parents figure out their kid may be having depression? What are the options available for childhood depression?
Childhood depression is on an alarming rise. The day is not far where at least 1 in every 5 students will be suffering from the same. Extreme demands from parents, society, and self are pushing children to develop faster than they need too. Today children at 10-12yrs have more knowledge and aspirations than what teens of 15-17yrs had 15years ago.  Unfortunately the society is not open to such evolutionary change and results in extreme stress. Most children are still governed by parenting rules set in the early 60’s or 70’s. The need of “stable” life is still seen narrowly based on education, marks and degrees. Appreciation and acceptance of new ways of life is still very far.
Classical signs of childhood depression are:
Child is extremely irritable at home. This leads to fights with parents.
Behavior outside home is extremely docile or “normal”
Likes to remain out of home for most of time
Disinterest in activities
Difficulties in sleep, with sleep talking behavior present in some.
Acting out behavior might be seen
Avoiding responsibilities
Extreme nervousness in performing scholastic tests as compared to before.

Because of negative social perception, there is a hesitation to visit a psychiatrist. On the other hand there are concerns that for a country like India with huge population which is transitioning from traditional support systems, there aren’t sufficient psychiatrists around.  The impact of non-availability of psychiatrist in rural areas is significant. Should medical colleges increase the number of psychiatric residency positions to meet the needs of the society?
It’s been researched that 15% of OPD patients in India suffer from various stages of curable mental health problems. This number though it translates into millions, is largely left aside. Over the next few years, it’s proposed that this percentage might grow upto 25% of total adult OPD patients. Currently India has some 5000 actively practicing psychiatrists. Most of whom are situated in metro cities or towns. The rural population is largely neglected. The govt. needs to formulate an active plan, but before that they need to recognize that mental health is an active part of the health needs. Psychiatry has been given a step-motherly treatment, and the social taboo has not helped in spreading knowledge about the same. Developed countries like USA actively send their govt. employees, army personael and law enforcers for regular psychiatric checkups. This helps them to actively have a pool of well experience, and mentally productive individuals rationalizing over the problems at hand.

The communication revolution has opened up new avenues to deliver health care. How effective are the phone and internet based mental healthcare delivery and what is the impact of these new modes of communication in mental health care?
The communication revolution has tremendously helped mental health. It has had a multi-fold impact:
It has increased the awareness of these being treatable disorders and not taboos.
It has increased reach, as people can now approach mental health providers from other cities and countries. Through my website and social media endeavors, I everyday get a good number of online/telephonic queries from people who have not been able to get quality mental health care or need guidance regarding a specific set of symptoms.
It’s really heartening to see that increased communication is helping people be more informed.
It has also increased the accountability of the psychiatrist. As now patients are better informed about a medicine, and don’t have to rely on the blind advice of their psychiatrist. This gives rise to a more informed and better quality of mental health care.

Some studies postulate a role for nutrition in depression. Some suggest that the intake of folic acid, vitamin B12, omega fatty acids and antioxidants may be helpful in depression while other studies differ. What is your opinion regarding this?
From my professional experience I do agree that nutrition plays an extremely important role in treatment of depression. Nutritional deficiencies like vitamin b12, are known to cause depressive symptoms in adults. Omega fatty acids have shown some wonderful results. Though I would like to mention, that these nutritional deficiencies are helpful only in sub-clinical or mild depression / stress levels. Moderate to Severe cases, which have a prominent stressor other than nutrition mostly require medications. This area is slowly being explored, with new research being available. The results are still very vague and need some more time to give us a clarity on the situation. I professionally have seen nutrition helping specially in case of special population like children and elderly.

You were brought up in America (South America and USA)  and could have lived a comfortable life there. What made you to decide to come back and serve in India?
The only reason was a need to give something back to the society. The one thing I learnt during my upbringing was that every person is an integral part of the society. And it’s the actions of an individual that define a society, not the society which should define an individual. During my childhood when I used to come back to India, it used to be very amusing experience. I won’t deny, but I certainly would feel that I am coming into some sort of village. The simple technological advances like a cable t.v.,  cordless phone or canned soda was a luxury for many. As I grew older, I understood that what India lacked in technology had it in integrated society. People over here cared for each other, something people in American countries didn’t have time for. When I came to defining my career, I understood that India would be a better place, as people need quality health care.  Over the years, I have focused on providing quality healthcare to all those who have come to meet me. Medical field in India has lost its shine, because it’s become a business. And that’s a mould I am not part of. Though the journey has been tough, I have made some good friends and have made some enemies. In a country that is driven by survival, people who provide quality care are seen as a threat. My experience has thought me that if you are true to the patient, and care for him/her as a fellow human in need, not as a number or just few hundred rupees in consultancy, the patient rewards you back in both emotional and economical ways.

Contact Information

Dr.Hemant Mittal
E-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Phone: 09833877966
(Monday to Friday between 7-10pm)
http://mindmantra.in/

Address: Shop no.15, shreeji plaza,
plot 24, sector-25, NERUL (east)
Navi Mumbai- 400706
Between:- Monday to Friday evenings: 7pm-10pm.
Saturday:- morning 10am-1pm and evening- 7pm to 10pm