Depression is a spectrum, not a consequence

What Is Clinical Depression

Ali Ilyas opens the conversation by clarifying what depression actually is, beyond the casual way the term gets thrown around in Pakistan. “Depression is a disorder in which we’re very low mood, thoughts of suicide, appetite is bad, sleep is bad, there’s an overall disruption of lifestyle,” Ali explains. He emphasizes that clinical depression invades personal, professional, and social life. But beyond this clinical definition, depression exists on a spectrum. As he puts it, “depression is a throw-around as you said as well… some people experience mild depressive symptoms, some people are moderate and some people are very severe or clinical.”

Muzamil notes that in Pakistan, sadness and depression get conflated. People use the word “depression” casually when they really mean ordinary sadness. The distinction matters because clinical depression is a serious condition requiring intervention, not just a bad mood.

The Global Burden: Suicide and Statistics

Ali brings the conversation to one of depression’s most severe outcomes: suicide. “In the last three minutes, approximately four people have killed themselves,” he says, anchoring this in World Health Organization data. “800,000 people die by suicide every single year.” This means someone dies by suicide on average every 40 seconds, worldwide. It’s a public health crisis that most conversations about mental health in Pakistan ignore.

When discussing Pakistan specifically, Ali introduces a critical problem: the statistics are vastly undercounted because suicide is criminalized under the Pakistan Penal Code. People who attempt suicide and survive face potential prosecution. This legal reality means people hide suicide attempts, hospitals underreport, and the true scale of the crisis stays invisible.

Criminalization as a Barrier to Treatment

Pakistan’s criminalization of suicide creates a paradox that Ali and Muzamil examine carefully. “These are people who need treatment, not punishment,” Muzamil says flatly. Yet that’s not how the system treats them. When someone arrives at a government hospital after a suicide attempt, the case becomes a medical-legal matter, triggering potential prosecution. Families often conceal suicide attempts, claiming accidents instead. The fear of criminalization keeps people from seeking help.

Ali points out the data: men in Larkana die by suicide at a rate of 7.06 per 100,000. In Gizhar, women over 15 die by suicide at 33.22 per 100,000, one of the world’s highest rates. For men, the risk factors cluster around single status and unemployment. For women, the risk is highest among the married, driven by domestic issues, financial dependency, and lack of household rights. These are not abstract statistics. They reflect the conditions people live in.

Depression Doesn’t Care About External Success

Muzamil raises a case that haunts him: a girl with every marker of a successful life. She had a loving family, attended a good university, had close friends, received public validation for her work. Yet she still wanted to kill herself. Why.

Ali’s response cuts through a widespread misconception: “The public view is that something horrible has to have happened for you to have severe crippling depression. The truth is that’s not the case at all.” He uses the example of wealthy actors and celebrities. When they die by suicide, people say, “What reason did he have?” The question itself reveals the misunderstanding. Depression doesn’t follow a logic of just desserts. It doesn’t require external justification.

Ali explains that depression involves genetic, psychological, and social factors all interacting. But often, the struggle is internal. Someone can build an impressive public presence while internally feeling worthless. The external success can even amplify the internal pressure.

How Friends and Family Can Help

When Muzamil asks what someone should do if a friend is depressed, Ali is clear and direct: “Just listen.” The instinct to fix, to provide solutions, often makes things worse. Muzamil recounts an instance where someone messaged him at their lowest, saying they were cutting themselves and bleeding to death, asking him to save them. Muzamil, not a professional, felt the weight of that reach. The person was so alone they turned to a stranger on Instagram.

“How lonely do you have to be to literally go on Instagram and find someone and just message them, listen, this is the deepest, darkest secret or the deepest feeling you’re going to ever have,” Muzamil says. “But you don’t have any friend. You don’t have any sibling. You don’t have anyone you can trust to have that conversation with.”

Ali’s advice for friends is compassionate but clear: show empathy, listen, and push the person toward professional treatment. “You don’t have to be a therapist to be therapeutic. Sometimes your friendship is something that can provide a lot of value to someone going through a lot,” he says. But he’s equally direct about the limits: “You can’t treat your friend’s depression. You’re not a professional.” At the end of the day, clinical depression with self-harm requires professional help.

Normalizing the Conversation

Muzamil closes by calling for the normalization of therapy in Pakistan. “I feel like we still haven’t done it in Pakistan,” he says. Even progressive people carry fear and confusion about therapy. The work is to open conversations, to make it possible for people to reach out without shame, and to take the first step toward seeking help.

The episode, grounded in Ali’s expertise and research, shows that addressing depression in Pakistan means both destigmatizing the condition and changing the systems that criminalize rather than treat it.