Zenith Medical

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Do I have Depression | Singapore

depression-hope

Common symptoms of Depression

You are likely to be depressed if have the following for more than 2 weeks. (Source: DSM 5th) The more symptoms you experience, the more likely you are depressed.

  • Lousy mood
    • Nearly every day and all the time
    • Other similar feelings: sadness, tearfulness, hopelessness and feeling empty
  • Loss of interest
    • Can’t seem to find pleasure or fun in all or almost ALL activities in the day
      • Commonly seen in our clinics: loss of interest in sex, work, hobbies and child care
      • “Nothing seems interesting or fun anymore”
  • Drastic weight change
    • Includes weight loss or weight gain
    • When not intentionally trying to do so, i.e through dieting
  • Sleep disturbance
  • Can be sleeping a lot or cannot sleep
  • Extremely common in Singapore
  • Often the first complaint seen in our clinic
  • Unusual physical problems
    • Very common in the elderly
    • Can be a mixed bag of symptoms like: aches and pains, digestive issues, ear, nose, throat and eye problems, giddiness and headache
    • Normally would have seen many doctors and tried many treatments to no avail
  • “No energy”.
    • Severe soul sucking lethargy and tiredness
    • Movements, speaking and sometimes even eating can be slow
  • Feelings of guilt or worthlessness
    • Excessively blaming yourself for many things which are beyond your control
  • Decreased ability to work
    • Poor concentration
    • Severe indecisiveness, e.g. can spend an entire day thinking about whether you should leave your room or whether you should clear the bin
  • Suicidal thoughts
    • Thinking about dying as nothing is worthwhile anymore, and nothing is “working”
    • You might have a plan or no plans yet
    • If you have this, no matter what, don’t waste time reading, please SEEK HELP NOW.
      • Call 995
      • Call SOS: 1800 221 4444
      • Walk in to ANY nearest Clinic
      • Walk in to IMH Emergency
      • Talk to someone

Am I depressed?

As you can see above, there are many symptoms and they are quite common. So, am I depressed? What if I don’t have all the symptoms?

For a start, I highly recommend this TEDed Video.

“What is the difference between sadness and depression?”

As you can see from above, depression is quite different from the usual sadness.

Depression happens ALL THE TIME even when there can be no obvious triggers. It is also much more severe than the usual sinking sadness that everybody feels from time to time. Sadness is very much a normal human emotion.

One way of differentiating sadness and depression is to use the Beck’s cognitive triad1.

The triad consists of a distorted “self view”, “world view” and “future view”.

Example 1

Let’s use an example: say you lost your job today. You start to feel sad that you are possibly incompetent. You sulk at home, but as your bank account nears zero, you start looking for a job again. Before you know it, you are back on track again and your sadness lifts as you find yourself useful again.

This is normal sadness.

Another example

OK, say you lost your job again today, and you start to feel sad that you are possibly incompetent. You start to think that perhaps you have been incompetent your whole life and right from the beginning since you were born (“distorted self view”). Then, you start thinking that everyone around you is against you, blaming you and have always been unhappy due to your incompetence (“distorted world view”). As you continue to starve at home and do “nothing”, you feel that the future is bleak as you are so useless anyway (“distorted future view”). Sometimes, you even contemplate suicide.

This is NOT normal sadness, this is depression.

But it’s OK if you still cannot differentiate between the two, you can always talk to one of us: our psychologist or our doctors to have a proper evaluation.

Most importantly, it can be treated.

What depression is not:

  • a sign of weakness
  • a character flaw
  • madness
  • contagious
  • something to be ashamed about
  • a punishment from God due to your heavy “sins”

You CANNOT talk someone into depression, or for that effect out of depression (unless you are trained in therapy).

What is depression then?

Depression is an illness, much like fever, cough and flu, except that depression is much worse, much more disabling and much more chronic: think stroke, heart attack and renal dialysis. (These diseases are scary as they don’t kill, but they make you live on miserably)

Although experts do not have a definite answer yet, most of us would agree that depression is an “end result” of many different physical, mental and biological stresses coming together.

What we do know is that it is a REAL illness with physical deterioration, hormonal changes2 and shrinkage in the brain3.

So asking someone to “snap out” of depression is certainly going to work as well as asking someone to “snap out” of his fever, for example.

Why do I get depression?

These are the known risk factors of depression4:

  • Internal Factors
    • Genetics
      • When doctors want to study genetic links, we normally look at twins who have the exact same set of genes.
        • For depression, the chance of the twin having it is 37%5  (compare that with type 2 diabetes: 90%6)
    • Neuroticism
      • Tendency for feeling sad
    • Low self-esteem
    • Early-onset anxiety disorder (younger than 18 years old)
    • Past history of major depression
    • Parenting factors7
      • Parents having a mental illness
      • Substance abuse in parents
      • Parents with criminal records or parents who are incarcerated in jail
      • Low parental warmth
  • External Factors
    • Substance misuse
    • Conduct disorder
  • Adversity in life
    • Trauma (emotional) during childhood or adulthood
    • Stressful life events in the past year
    • Loss of a parent
    • History of divorce
    • Marital problems
    • Low social support
    • Low education

Different types of depression

  • Adjustment Disorder
    • Short duration of some of the above symptoms in response to an extremely stressful event.
    • Expected to recover after the event passes, if it passes.
  • Dysthymia
    • Persistent “chronic” depression.
    • Typically takes about 2 years to diagnose.
  • Bipolar Disorder
    • The depression is part of the cycle between mania and depression.
  • Postnatal Depression
    • Depression triggered by the burdens of caring for a newborn. It affects both males and females.
    • Risk increases if you have8:
      • psychological difficulties in the past
      • marital discord
      • have little support in childcare
      • other stresses while caring for the child (ie child has a medical or developmental problem)

Symptoms | Treatment | Suicide | Community Resources

How depression affects people at different stages of life

In children

The child’s mental health is heavily influenced by the environment on top of their genes. Children are dependent on their caregivers and circumstances and cannot fend for themselves.

Severe adversity such as the loss of a loving parent or abuse from a caregiver could leave a child confused and traumatised.

However, no two child are the same. Some children are more prone to developing problems than others. Once mental illnesses set in, changes in behaviour and daily functioning can be observed by caregivers and teachers.

Common symptoms:

  • Increased irritability
  • Anger outbursts
  • Pain such as headache and stomachache that cannot be explained
  • Sudden drop in school performance and social withdrawal

In teenagers

Teenage years are punctuated with many roles to navigate — changing hormone levels, constantly growing physical body, adjustment to new schools, major exams such as PSLE and ‘O’/’N’/’A’ Levels, forming new friendships and romantic relationships… to name a few.

In the face of constant changes, unpredictable outcomes and stormy emotions, it is no wonder that many teenagers find it difficult to cope. They may withdraw socially from time to time. While some manage to bounce back and fight on, others fall into depression.

If the adolescent’s low mood, irritability, ability to connect with others and academic achievement are severely affected for more than two weeks, it could be a warning sign that depression has already crept in.

In adults

Adulthood is the time when all the responsibilities arrive at your doorstep at one go.

Suddenly, you are responsible for the physical and mental well-being of your children, your parents and your partner, all in a limited time and space (yes, houses in Singapore are just too small!). While adulthood presents us with challenges in and of themselves, having had a rough childhood (e.g. having suffered emotional or physical abuse or losses) puts one at a higher risk of depression in adulthood.

Adults with severe depression report strong and recurrent thoughts of hopelessness, self-blame and self-criticism. Thoughts take on a life of their own, and depressed people are well aware of this phenomenon. Anger is common. It is natural to feel angry with oneself when one cannot muster enough physical and mental strength to accomplish the work that needs to be done. Not having the “energy” to negotiate with and persuade others, a depressed person might find himself/herself lashing out at others while all he/she wanted to do was to problem-solve. What follows is more guilt, increased self-blame, harsher self-criticism and another downward spiral into deeper depression.

In elderly

Oftentimes, depression in elderly is a continuation of the disease since their younger years. While age-related changes and difficulties could lead to a brief period of reactive depression, a full-blown depression is often the result of the condition being untreated in their younger days.

The golden years also herald the start of many chronic and medical illnesses. A crushing diagnosis of cancer or a terminal illness can bring even the strongest person to his/her knees. It can be very normal to experience reactive depression, which is depression directly due to a medical illness, but it doesn’t mean that it cannot be treated.

“Hassles”9 , or small inconveniences in life, have been recognised to be related to depression in the elderly. Seemingly minor problems can accumulate and the more “hassles” there are, the more likely an elderly will suffer depression especially when the coping mechanism is unhealthy. Here are some of the commonly recognised “hassles”:

  • Difficulty walking and getting around
  • Caring for another sick family member
  • Physical pains
  • Financial issues
  • Eyesight and hearing problems

Other than medical illnesses, close friends and family members will also start to pass on and the “survivor” can feel intense loneliness and social isolation, which can in turn predispose him/her to the onset of depression.

Common triggers of depression in Punggol/Singapore

Punggol is a new town teeming with young working families. Not surprisingly, common triggers of depression our clients have experienced include:

  • Marital discord and extramarital affairs
  • Childbirth (for the mother as well as the father!)
  • Highly stressful work environment (think: trainee teachers on practicum, National Servicemen, bankers etc).
  • Traumatic childhood experiences that can interfere with the ability to form stable and trusting connections as a person enters adulthood

Symptoms | Treatment | Suicide | Community Resources

Treatment

When we feel completely stuck in this “cloud” of depression, we can easily lose sight of what we really NEED vs what we WANT.

It is often helpful to talk to someone kind and supportive. It can be a friend, a relative, a spiritual mentor or a therapist. Sometimes, we just need someone to see that we are suffering. We see flickers of hope when we have someone to accompany us in this dark time. Sometimes we see solutions through talking. Sometimes the solution is simply to allow ourselves to grief without guilt.

I encourage you to reach out – to yourself and to others. Sadness is a common suffering of humanity. It strikes everyone at least a few times in our lifetime.

Talk to an agony aunt

If you happen to be the person putting on this “agony aunt” or “counsellor” hat, here are some quick tips:

DO NOT:

  • Ask them to snap out of it
  • Be judgmental
  • Offer quick judgement or a quick fix
  • Rush

DO:

  • Listen attentively, lean your body forward and maintain eye contact
  • Be sensitive to his/her emotions (not the circumstance)
  • Resist the urge to do as much as possible. Try to refrain from providing “solutions” most of the time (Why? You are depriving someone of the joy of learning to overcome and improve themselves)
  • Allow your own emotions, such as crying if you feel like crying
  • Stay with the emotion
  • Refer him/her to a trained professional if you think that this is too much for you to handle

Psychotherapy

You could see a psychologist for therapy. Read this article for more details. Get to the root of the problems.

Medications

The success rate of treatment with medications for illnesses of mild to moderate severity is about 50-60% no matter which medication is taken10 with a higher success rate the earlier the illness is picked up11.

The doctor might recommend the following types of medications for you:

  • Antidepressants
    • Broad class of medications thought to increase the energy levels and lift the mood.
    • The experts think that it works on the “serotonin pathway in the brain”, but the truth is that nobody really knows how exactly it works. For that reason, we also cannot predict exactly who will not respond to them.
    • A quick Google search will show many possible side effects. Keep in mind that they are only possible, not definite. Most people do well on these medications with no side effects.
    • The doctor must have weighed the benefits and risks before giving one to you.
    • If you have been prescribed one, please remember that the most important thing is to stay on it.
    • It takes some time for the full effects to kick in.
    • If you do experience any side effects, the one person you should talk to is your doctor.
  • Antipsychotics
    • Less commonly prescribed for depression, normally reserved for the patients whose conditions are more severe.
    • Again, if this has been prescribed for you, you are highly recommended to stay on it.
    • The doctor probably thinks that you are at a significant risk of harming someone/yourself, being admitted to a hospital or having a very serious illness.
    • Again, please stay on it, and if you do experience any side effects, the only person you should talk to is your doctor.
  • Sleeping tablets
    • For short-term use only to help solve sleep problems.
    • Long-term usage might be associated with addictions.

“Do I need both medication and therapy?”

The success rate is highest when both medication and therapy are used together.

“Can I be treated?”

…. and how long does it take?

We understand that the longer the duration of untreated depression, the stronger the “imprint” and the higher the chance of “permanent” injury to your mind and body. Hence, the earlier we pick up this problem, the faster the patient can recover. The patient will also require less medications and a shorter duration of therapy.

Depression in Singapore is often picked up very late and hence, treatment is started late. It is very sad when it happens and when it happens every day, it is a tragedy on a societal scale. So please, if you know someone whom you suspect could be sick with these symptoms, please ask them to seek help early. Speak to our psychologist or our doctors. You can also bring them to this FREE clinic at *SCAPE.

Symptoms | Treatment | Suicide | Community Resources

Community Resources

Websites or readings

Thrive: Khoo Teck Puat Hospital mental health website.
Great patient information leaflet from AAFP about medications.

Find a psychiatrist

You can find one in any government hospital or private practice. Those in government hospitals will require a referral from a polyclinic.

Find a family physician who has interest in psychiatry

Sorry, IMH and AIC has taken the list offline. As of now, our doctor is the only one on this list. We are obtaining consent from the other doctors to be placed here.

Find a psychologist

You can leave us a request for therapy by leaving your details in the form below. We will contact you to book an appointment.

Alternatively, you can check out a list of psychologists who have joined the Singapore Psychological Society.

(Wondering what is the difference between a psychiatrist, psychologist, family physician and therapist? Read here)

Find a therapist

Find support

Here is a wonderfully inspiring video by them.

If you think your website or organisation belongs here, please contact me now.

Symptoms | Treatment | Suicide | Community Resources

Suicide

If you have 5 minutes in your life, please read this great article. If you don’t, please:

References:

1. Beck’s cognitive triad [Internet]. Wikipedia. 2016 [cited 2016 Dec 16];Available from: https://en.wikipedia.org/w/index.php?title=Beck%27s_cognitive_triad&oldid=749761453

2. Vreeburg SA, Hoogendijk WJG, van Pelt J, et al. Major depressive disorder and hypothalamic-pituitary-adrenal axis activity: results from a large cohort study. Arch Gen Psychiatry 2009;66(6):617–26.

3. Koolschijn PCMP, van Haren NEM, Lensvelt-Mulders GJLM, Hulshoff Pol HE, Kahn RS. Brain volume abnormalities in major depressive disorder: a meta-analysis of magnetic resonance imaging studies. Hum Brain Mapp 2009;30(11):3719–35.

4. Kendler KS, Gardner CO, Prescott CA. Toward a comprehensive developmental model for major depression in men. Am J Psychiatry 2006;163(1):115–24.5. Sullivan PF, Neale MC, Kendler KS. Genetic epidemiology of major depression: review and meta-analysis. Am J Psychiatry 2000;157(10):1552–62.

6. Barnett AH, Eff C, Leslie RD, Pyke DA. Diabetes in identical twins. A study of 200 pairs. Diabetologia 1981;20(2):87–93.

7. Green JG, McLaughlin KA, Berglund PA, et al. Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry 2010;67(2):113–23.

8. O’hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. International Review of Psychiatry 1996;8(1):37–54.

9. Catanzaro SJ, Horaney F, Creasey G. Hassles, coping, and depressive symptoms in an elderly community sample: The role of mood regulation expectancies. Journal of Counseling Psychology 1995;42(3):259–65.

10. Papakostas GI, Fava M. Does the probability of receiving placebo influence clinical trial outcome? A meta-regression of double-blind, randomized clinical trials in MDD. Eur Neuropsychopharmacol 2009;19(1):34–40.

11. Ghio L, Gotelli S, Marcenaro M, Amore M, Natta W. Duration of untreated illness and outcomes in unipolar depression: a systematic review and meta-analysis. J Affect Disord 2014;152–154:45–51.

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