The Silent Suffering – Understanding Clinical Depression in Pakistan

May 1

Clinical Depression is one of the most common yet misunderstood mental illnesses, often confused with temporary feelings of sadness or mood swings. In reality, it is a serious medical condition that affects how a person feels, thinks, and functions in daily life. As of 2025, it is estimated that 20–30% of the population in Pakistan suffers from Clinical Depression — a staggering figure that underscores a growing public health concern.

Globally, it is said that 1 in 4 people will experience a mental illness at some point in their lives. In a Pakistani context, where extended families often live together and the average household size can be over 6–10 members, it is likely that every family includes at least one individual silently suffering from mental health issues. Yet, the discussion around mental health remains shrouded in silence, denial, and stigma.

The Cultural Silence Around Mental Health

In Pakistan, mental illness is often dismissed as a weakness of character, a lack of faith, or even a punishment from God. Terms like "pagal" (mad) are casually thrown around, reinforcing harmful stereotypes and deterring people from seeking help. Families may hide the issue rather than talk about it, fearing social ostracism, damaged marriage prospects, or loss of respect in the community.

Many individuals suffering from depression remain undiagnosed due to limited awareness, fear of judgment, and insufficient mental health services. Mental illness is rarely discussed in schools, religious settings, or even healthcare settings, and many individuals turn to spiritual healers or hakeems instead of mental health professionals. While faith can provide support, clinical depression is a medical condition that requires evidence-based treatment.

Recognizing the Symptoms

Depression is more than just a phase. It involves a persistently low mood or lack of interest in daily activities for at least two weeks. Common symptoms include:

Fatigue, lethargy, and reduced ability to concentrate
Frequent crying spells or irritability without clear reason
Disturbed sleep – either insomnia or excessive sleeping
Changes in appetite – eating too little or too much
Physical symptoms like unexplained aches, headaches, and digestive issues
Feelings of hopelessness, guilt, or worthlessness
Loss of interest in religious, social, or family activities
Suicidal thoughts or attempts

In Pakistan, depression often presents with physical complaints. Many patients, particularly women, visit general physicians for persistent headaches, joint pains, stomach discomfort, or disrupted menstrual cycles — which are actually manifestations of underlying depression.

Causes in the Pakistani Context

The causes of depression are multifactorial — including biological, psychological, and environmental factors. In Pakistan, these stressors are amplified by:

Economic pressures: Poverty, unemployment, inflation, and job insecurity
Social expectations: Gender roles, academic pressure, and early marriages
Family dynamics: Marital conflict, domestic violence, and intergenerational trauma
Stigma and lack of awareness: Mental illness is often misunderstood or spiritualized
Limited access to care: With less than 500 psychiatrists for over 240 million people, access to trained professionals is severely limited, especially in rural areas

Additionally, women are disproportionately affected due to societal pressures, lack of autonomy, and overburdening roles as caregivers, daughters-in-law, or mothers. Postpartum depression, though common, is rarely diagnosed or treated.

Hope and Healing

Despite the grim picture, the good news is: Depression is treatable. Recovery is possible with timely and appropriate intervention. Treatment options include:

Psychotherapy (Talk therapy): Especially effective for mild to moderate depression
Antidepressant medication: Non-addictive and safe under medical supervision
Lifestyle changes: Regular physical activity, healthy diet, sleep hygiene, and stress management techniques like deep breathing and muscle relaxation
Community and family support: Reducing isolation and encouraging open conversations

Antidepressants usually take 4–6 weeks to show effects and are typically prescribed for 6 to 9 months. They are not habit-forming, unlike sleeping pills, which should only be used under medical advice.

Breaking the Silence

To combat depression in Pakistan, it is essential to:

Educate families and communities about mental health
Incorporate mental health awareness in schools, workplaces, and mosques
Train general physicians to screen for mental health symptoms
Establish helplines and affordable counseling centers in both urban and rural areas
Encourage religious and cultural leaders to speak about mental health openly and compassionately

And REMEMBER!