Depression Ki Alamat: 9 Signs That Sadness Has Become Depression

“Bas mood off hai.” “Thoda thak gaya hoon.” “Dil nahi lagta, theek ho jaayega.” In most desi homes, this is how low mood gets talked about, if it gets talked about at all. Sometimes these phrases describe a bad week that passes. Sometimes they hide something that has been sitting on a person for months.

This guide explains depression ki alamat (the signs of depression) in plain language, with the Roman Urdu phrases people actually use. It covers the nine signs that health professionals look for, how ordinary sadness differs from depression, how it can look in joint families and among Gulf expats, and what you can do today.

It is written to inform, not to diagnose. If you recognise yourself in parts of it, that is a reason to look closer, not a reason to panic.

Need help right now? If you might harm yourself or someone else, or you are in danger right now, call your local emergency number or go to the nearest emergency department.

• Pakistan: Umang mental health helpline 0311 7786264; in an emergency, police 15 or Rescue 1122
• Saudi Arabia: emergency 911; counselling line 920033360 (8am–8pm, Saturday 1pm–8pm; not 24 hours)
• India: Tele-MANAS 14416 or 1-800-891-4416 (emergency 112)
• Bangladesh: Kaan Pete Roi +880 9612-119911 (3pm to 3am daily)
• United States: 988 Suicide & Crisis Lifeline, call or text 988 (24/7)
• Canada: 9-8-8 Suicide Crisis Helpline, call or text 988 (24/7)
• UK and Ireland: Samaritans 116 123 (free, 24/7)
• European Union: emergency number 112
• Anywhere else: call your local emergency number, or find a free helpline at findahelpline.com.

Sadness and depression are not the same thing

Everyone feels sad. You fail an exam, lose a job, argue with your spouse, or miss home while working abroad, and you feel low. That is a normal human response, and it usually eases as life moves on.

Depression is different. The World Health Organization describes depressive disorder as a common mental disorder that “is different from regular mood changes and feelings about everyday life”. It involves a depressed mood, or a loss of pleasure or interest in activities, for long periods of time (WHO).

Two things help separate the two:

• Time. During a depressive episode, WHO says the symptoms last most of the day, nearly every day, for at least two weeks.
• Impact. Depression can affect relationships with family and friends, and it can cause or worsen problems at school or work. WHO describes episodes as mild, moderate or severe depending on the number and severity of symptoms and how much they affect a person’s daily functioning (WHO).

So a sad evening after bad news is not depression. Feeling empty, flat and tired almost every day for weeks, to the point that work, prayer, family time or simple chores feel impossible, deserves attention.

It is also common. WHO estimates that 5.2% of adults worldwide had depression in 2023, about 322 million people, and that depression is about 1.5 times more common in women than in men (WHO). In Pakistan, a systematic review of community studies found high rates of anxiety and depressive disorders, though the authors cautioned that many of the studies had methodological problems (Mirza & Jenkins, 2004). You are not the only one.

The 9 signs of depression

WHO lists two core signs, a depressed mood and a loss of interest or pleasure, plus seven other symptoms that may be present (WHO). Here they are, with the way they often sound in everyday Urdu and Hindi.

Sign 1: A low, empty or irritable mood most of the day

“Dil bhaari bhaari rehta hai.” “Andar se khaali khaali lagta hai.”

WHO describes a depressed mood as feeling sad, irritable or empty. The word irritable matters. Many men in particular don’t describe themselves as sad. Instead they snap at their children, lose their temper in traffic, or go silent at the dinner table. If “gussa bohat aata hai aajkal” has become your normal, low mood may be underneath it.

Sign 2: Losing interest in things you used to enjoy

“Kisi cheez mein dil nahi lagta.” “Pehle cricket ka shauq tha, ab TV bhi bura lagta hai.”

This is one of the clearest signs. Food tastes the same but brings no pleasure. Friends call and you let the phone ring. Eid, weddings and family gatherings feel like a duty to survive rather than something to look forward to.

Sign 3: Poor concentration

“Dhyan nahi lagta.” “Ek hi line teen baar parhta hoon.”

You read a message and forget it. At work, small tasks take twice as long. Students sit with books open for hours without anything going in. People often blame themselves for being lazy or careless, when concentration problems are a listed symptom of depression.

Sign 4: Excessive guilt or feeling worthless

“Main kisi kaam ka nahi.” “Sab meri wajah se ho raha hai.”

Everyone feels guilty sometimes. In depression, the guilt is out of proportion and sticks. You replay old mistakes, feel you are a burden on your parents or spouse, and dismiss anything good you have done.

Sign 5: Hopelessness about the future

“Kuch nahi badlega.” “Kya faida?”

Depression narrows the view of the future. Plans that once felt possible, such as a new job, marriage or starting a small business, start to feel pointless. This hopelessness is a symptom, not a fact about your life, even though it feels completely real from the inside.

Sign 6: Thoughts about dying or suicide

“Kabhi kabhi lagta hai na hoon toh behtar hai.”

WHO lists thoughts about dying or suicide among the symptoms of depression (WHO). If you have thoughts like these, even fleeting ones, please treat this as the one sign not to wait on. You are not alone, and many people who have felt this way have found help. Tell someone you trust today, and use one of the helplines at the top of this page. If you feel you might act on these thoughts, call your local emergency number or go to the nearest emergency department now.

Sign 7: Sleep changes

“Raat ko neend nahi aati.” “Subah chaar baje aankh khul jaati hai.” Or the opposite: “Bas sota rehta hoon.”

WHO calls this disrupted sleep. For some people that means lying awake with heavy thoughts. For others it means waking far too early, or sleeping much more than usual and still waking up tired.

Sign 8: Changes in appetite or weight

“Bhook hi nahi lagti.” Or: “Bas khaata rehta hoon, pata hi nahi chalta.”

Some people lose interest in food and lose weight without trying. Others eat more, especially late at night, and gain weight. Both can be part of depression.

Sign 9: Tiredness and low energy

“Jism mein jaan hi nahi.” “Kamzori rehti hai.”

This one is often missed in desi families, because tiredness gets blamed on the body: kamzori, vitamins, the heat, overwork. A physical check-up is sensible, because WHO notes that depression is closely related to and affected by physical health (WHO). But feeling very tired or low in energy is itself a listed symptom of depression. If tests come back normal and the exhaustion continues, ask about mood too. My article on emotional exhaustion vs laziness explains why “I’m just lazy” is rarely the full story.

How many signs, and for how long?

No article can count your symptoms for you, and only a qualified professional who talks with you can diagnose depression. As a rough guide, though, it is worth getting checked if:

• you have had a low mood or a loss of interest most days for two weeks or more, and
• several of the other signs above are present, and
• they are affecting your work, studies, family life or worship.

Sign 6 is different. Thoughts about dying or suicide are a reason to talk to someone now, however many other signs you have.

It also helps to know what depression is not. WHO describes bipolar disorder as a separate pattern, where depressive episodes alternate with periods of very high energy or irritability, racing thoughts, a reduced need for sleep and impulsive behaviour (WHO). If your low periods alternate with periods like that, tell the professional you see, because different treatments are used for bipolar disorder.

How depression hides in desi homes and Gulf lives

The nine signs are the same everywhere. What changes is how families and communities read them.

“Bas mood off hai.” Low mood is often treated as a phase, a personality trait, or something a person should snap out of. That attitude keeps people from seeking help. WHO lists social stigma associated with mental disorders as one of the barriers to effective care, and reports that even in high-income countries only about one third of people with depression receive mental health treatment (WHO).

“Log kya kahenge.” Many people fear that seeing a psychologist will label them “pagal” or hurt a sibling’s rishta. So they keep going: to the office, to family events, to every obligation, while feeling hollow inside.

The joint family. Living with parents, in-laws and siblings can be a great source of support. It can also mean no privacy, constant comparison and little room to be unwell. In a review of studies from South Asia, arguments with husbands and relationship problems with in-laws were linked with anxiety and depressive disorders in 3 of 11 studies, while people with close, confiding relationships were less likely to have them (Mirza & Jenkins, 2004). The key word is confiding. Being surrounded by family is not the same as having one person you can be honest with.

Gulf expats. For people working in Saudi Arabia or elsewhere in the Gulf, depression can hide behind long hours, distance from family and the pressure to send money home. When calls home are all “sab theek hai”, nobody notices the person in the shared room who has stopped eating properly. WHO also notes that people who go through adverse life events such as unemployment, bereavement or trauma are more likely to develop depression (WHO). A lost job abroad can bring all of these at once.

Faith and shame. Some people worry that feeling depressed means their faith is weak. WHO describes depression as the result of a complex interaction of social, psychological and biological factors (WHO). It is a health condition, not a moral failing. For many people, faith and professional help work well together.

A composite of common situations (not a real client). Faisal is 38 and works as a sales manager in Dammam. His wife and two children are with him, and his parents are in Faisalabad. For about four months he has been waking at 4am with a heavy chest, then dragging himself through the day. He has stopped playing cricket with colleagues on Fridays. He snaps at his son over homework and then feels terrible about it. On calls home he says “sab theek hai”, and he puts his tiredness down to the heat and his age. When a colleague is let go, Faisal tells himself, “Agla number mera hai, aur main kisi kaam ka nahi.” His wife finally sits him down and asks him to take a depression screening questionnaire with her. His score is in the moderate range. It doesn’t diagnose him, but it gives him words for what is happening, and he books an appointment with a doctor the following week.

Faisal’s story shows how several signs can pile up quietly: early waking, lost interest, irritability, guilt and tiredness. Each one has a ready excuse. Together they form a pattern.

Check yourself: the PHQ-9

If you want a structured way to look at your symptoms, the free depression test (PHQ-9) on this site asks nine questions about the last two weeks. It is a screening tool, not a diagnosis. To see depression alongside anxiety and stress, the DASS-21 test gives three separate scores for the past week.

The PHQ-9 scores each of its nine items from 0 (“not at all”) to 3 (“nearly every day”). In the original validation study with 6,000 people in primary care and obstetrics-gynaecology clinics, scores of 5, 10, 15 and 20 represented mild, moderate, moderately severe and severe depression. Compared with interviews by mental health professionals, a score of 10 or more had a sensitivity of 88% and a specificity of 88% for major depression (Kroenke et al., 2001).

In plain terms, the PHQ-9 is good at flagging who should have a proper assessment. It can’t tell you the cause of your symptoms, and it can’t rule out a physical problem. If you answer anything other than “not at all” to the question about thoughts of being better off dead or of hurting yourself, please use the helplines at the top of this page and talk to someone today, whatever your total score.

What you can do today

These steps won’t replace professional help if you need it, but they are things you can start right away. Most of them come from WHO’s self-care advice for depression (WHO).

1. Tell one person. WHO’s first piece of advice is to talk to someone you trust about your feelings. Choose the person who listens rather than the one who lectures. A simple start: “Kuch hafton se main theek nahi hoon. Bas sun lo.”
2. Do one small thing you used to enjoy, even without the feeling. Waiting until you feel like it can keep you stuck. Planning small, meaningful activities is the core of behavioural activation, a structured therapy that a 2014 meta-analysis of 26 randomised trials found to be an effective treatment for depression (Ekers et al., 2014). Today, that might be ten minutes in the park, one phone call, or making chai for someone.
3. Walk. WHO suggests exercising regularly, “even if it’s just a short walk”. In Gulf summers, an evening walk or a mall loop counts.
4. Anchor your day. Keep regular times for sleeping, waking and eating as much as you can. Depression erodes routine, and routine pushes back.
5. Cut down on alcohol and avoid drugs. WHO notes they can make depression worse. The same applies to using sleeping pills or anything else without medical advice.
6. Take the PHQ-9 and note your score. Retaking it every few weeks helps you and any professional you see track whether things are improving.
7. Book a check-up. Start with a doctor, psychologist or psychiatrist. A doctor can check your physical health, and a mental health professional can assess your mood properly.

If anxiety is mixed in with the low mood, such as racing thoughts, a pounding heart or constant worry, my guide on how to handle anxiety has techniques for home, work and night.

Depression is treatable

This is the most important part of this article. WHO states that there is effective treatment for mild, moderate and severe depression (WHO).

• Psychological treatments come first. WHO calls them the first treatments for depression. Effective approaches include behavioural activation, cognitive behavioural therapy (CBT), interpersonal psychotherapy and problem-solving therapy. They can happen in person or online.
• They work in South Asian settings too. In a trial across 40 Union Council areas in rural Rawalpindi, mothers with perinatal depression received a CBT-based programme delivered by trained community health workers. At six months, 23% of mothers in the programme still met the criteria for major depression, compared with 53% in the comparison group (Rahman et al., 2008). WHO’s Thinking Healthy manual now covers the use of CBT for perinatal depression. If you are pregnant or have had a baby in the past year, you can take our free postpartum depression test, which uses the same PHQ-9.
• Medicine is a decision for a doctor. WHO notes that antidepressant medicines are not needed for mild depression and can be combined with psychological treatment for moderate and severe depression. This article doesn’t give medication advice. If you are wondering about medicine, talk to a doctor or psychiatrist, and don’t start, stop or change any medicine on your own.

In the UK, NICE’s guideline on depression in adults sets out treatment choices for new episodes of less severe and more severe depression, preventing relapse and managing chronic symptoms (NICE NG222). Whatever country you are in, the message is the same: there are real options, and you can be part of choosing them.

If you are worried about someone else

You may be reading this because of a brother, a mother, a husband or a friend. A few things can help:

• Describe what you see, without labels. “Tum kuch hafton se bohat chup chup ho, aur khana bhi nahi kha rahe. Main fikr mand hoon” works better than “Tumhe depression hai.”
• Listen more than you advise. Avoid “shukar karo”, “dusron ko dekho” and “namaz parho, theek ho jaoge”. Even when meant kindly, these can make a person feel more ashamed.
• Offer practical help. Offer to find a doctor, sit with them while they take the PHQ-9, or go with them to the first appointment.
• Take any talk of death seriously. If they mention not wanting to live, stay with them, help them contact a helpline or emergency service, and don’t promise to keep it secret.

When to get professional help

Please speak to a doctor, psychologist or psychiatrist if:

• your low mood or loss of interest has lasted two weeks or more
• it is affecting your work, studies, marriage or parenting
• your PHQ-9 score is 10 or above
• you are relying on alcohol, pills or other substances to get through the day
• your low periods alternate with unusually high, restless or reckless periods
• you have any thoughts of dying or harming yourself (use the helplines at the top of this page today)

If you would like to talk to me, I offer online consultations through the book a consultation page. They are educational and supportive and are not a replacement for emergency or in-person medical care. Whoever you choose, make sure they are qualified, and that you feel safe and respected with them. You can read more about emotional health in the Mind section.

Quick FAQ

Depression ki alamat kya hain? (What are the signs of depression?)
The main signs are a low, empty or irritable mood and a loss of interest or pleasure, most of the day and nearly every day for at least two weeks. Other signs include poor concentration, excessive guilt, hopelessness, thoughts about dying, sleep changes, appetite changes and tiredness.

Kya depression apne aap theek ho jata hai? (Does depression go away on its own?)
Some low periods do lift. But depression can also worsen a person’s life situation and the depression itself, as WHO notes. Waiting it out is a gamble when effective treatments exist.

Is depression a sign of weak imaan?
No. WHO describes depression as the result of social, psychological and biological factors. Many people of strong faith experience depression, and many find that faith and treatment support each other.

Can an online test show whether I have depression?
No. The PHQ-9 is a screening tool. It can show whether your symptoms are worth a proper assessment, but only a qualified professional can make a diagnosis.

Is it depression or just tiredness?
It can be either, or both. Get a physical check-up. If the results are normal and the tiredness comes with low mood or loss of interest, ask about depression too.

References

1. World Health Organization. Depressive disorder (depression) (fact sheet). https://www.who.int/news-room/fact-sheets/detail/depression
2. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9):606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x (PubMed 11556941)
3. Mirza I, Jenkins R. Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ. 2004;328(7443):794. https://doi.org/10.1136/bmj.328.7443.794 (PubMed 15070634)
4. Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, Gilbody S. Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PLoS ONE. 2014;9(6):e100100. https://doi.org/10.1371/journal.pone.0100100 (PubMed 24936656)
5. Rahman A, Malik A, Sikander S, Roberts C, Creed F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. The Lancet. 2008;372(9642):902-909. https://doi.org/10.1016/S0140-6736(08)61400-2 (PubMed 18790313)
6. National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222). 2022. https://www.nice.org.uk/guidance/ng222

This article is for education only and is not a diagnosis or a substitute for professional care.

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Dr. Malik Sherjeel Awan

Dr. Malik Sherjeel Awan is a clinical psychologist based in Makkah. PsyD (Clinical Psychology), University of Karachi.
He writes practical, evidence-based psychology for everyday life.

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