Stress, low mood and poor sleep feed each other.
Everyone has stressful spells, low days and bad nights. When they last for weeks and start to affect work, family or health, they are worth treating, just like BP or sugar. Depression and anxiety are common, they are not a weakness, and they get better with the right help.
In plain words.
Stress keeps the body on alert: a racing heart, tight muscles, headaches, an upset stomach, and a mind that will not switch off at night. Poor sleep then lowers mood and patience, and low mood brings more worry. Each makes the others worse.
Depression is more than sadness: low mood, or loss of interest in things you used to enjoy, on most days for two weeks or more, often with poor sleep or too much sleep, low energy, a change in appetite, poor concentration, and feeling worthless or guilty. Anxiety brings constant worry and restlessness, and sometimes sudden panic attacks with a pounding heart and breathlessness.
Many people first notice it in the body: tiredness, aches, headaches, palpitations or a poor appetite. A doctor checks for body causes that can look similar, such as an underactive or overactive thyroid, anaemia, low vitamin B12 or D, and sugar problems, and for medicines or alcohol that can affect mood and sleep.
What helps: a regular time to sleep and wake, daily activity and daylight, fewer screens late at night, less alcohol, no tea or coffee after mid-afternoon, and talking to someone you trust. Talking therapy (counselling, or CBT) works well. When depression or anxiety is moderate or severe, or lasts, medicines help too: the usual ones are not habit-forming, and are taken for months, then reduced slowly with the doctor.
A loop that feeds itself
Some stress is normal. A good night’s sleep resets it, and mood stays steady.
When stress goes on, worry spoils sleep, poor sleep lowers mood, and low mood feeds more worry. Each turn makes the next one worse, and the nights get short and broken.
The loop can be broken at any point: a regular bedtime, daily activity, talking it through, and treatment when low mood lasts. Sleep and mood then recover together.
Go to hospital now if
- Thoughts of ending your life or harming yourself, or a plan to: call 112 or go to hospital now. You can also call Tele-MANAS, the free national mental health helpline, on 14416 or 1-800-891-4416, at any hour of the day or night.
- Someone has spoken of suicide, or has taken an overdose or harmed themselves: call 112. Stay with them, and remove medicines, pesticides, ropes and sharp objects from their reach.
- Hearing voices, seeing things others cannot, or behaving very differently and unsafely: go to hospital now.
- Chest pain, breathlessness or a racing heart that feels like panic but is new or does not settle: call 112. Do not assume it is anxiety.
- Drowsiness or confusion after sleeping pills, alcohol or other medicines: call 112.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
See a doctor within a few days if
- Low mood or loss of interest has lasted two weeks or more
- Worry or panic attacks are stopping you working, going out or sleeping
- You are using alcohol, sleeping pills or other things to cope
- Low mood after having a baby has lasted more than two weeks
- Sleep has been poor for a month or more
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Short questionnaires (PHQ-9 and GAD-7) | A few simple questions that measure depression and anxiety, and show whether treatment is working. |
| Thyroid (TSH) | An underactive thyroid can cause low mood and tiredness; an overactive one, anxiety and poor sleep. |
| Haemoglobin, vitamin B12 and vitamin D | Anaemia and low vitamins add to tiredness and low mood. |
| HbA1c (sugar) | Diabetes and low mood often go together, and each makes the other harder to manage. |
| Sleep study | When loud snoring and pauses in breathing at night suggest sleep apnoea. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Do not stop an antidepressant suddenly, even when you feel better: reduce it slowly, with your doctor. Avoid sleeping pills such as alprazolam, clonazepam or zolpidem unless a doctor prescribes them for a short time: they can become habit-forming, and cause falls and confusion, especially in older people.
A video call can
- Listen, gauge how severe it is, and look for body causes with the right blood tests
- Start and adjust treatment for common depression, anxiety and sleep problems, and follow you up
- Help with stress that shows in the body: headaches, palpitations and stomach upsets
- Refer you to a counsellor, psychologist or psychiatrist when that is the better help
Needs a visit in person
- Thoughts of suicide or self-harm now: call 112 or Tele-MANAS on 14416, or go to hospital
- Severe depression, hearing voices, or very unusual behaviour: a psychiatrist in person
- An examination, when a body cause is suspected
- A sleep study, when sleep apnoea is likely
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759