How to Cope with Depression

Feeling sad is normal, but when this sadness becomes so severe that it overwhelms your life, you need to seek help. Learn about the signs and causes of depression and the types of treatment and medication available.

Everyone has felt sad at one time or another. Usually, it is due to disappointment, frustration or losing someone. Feeling sad is normal. Time heals, the mood lifts and people continue to get on with their lives.

But for some people, depression can be so severe that it dominates their lives, preventing them from coping as they are used to. Depression of this degree is an illness or medical condition and requires treatment.

Prevalence of Depression in Singapore

Depression is twice as common in women than men

Depression has been called the “common cold of mental health problem”. The World Health Organisation (WHO) recently ranked depression as the leading cause of morbidity in developing nations in the next century.

The lifetime occurrence rate is between 3% to 6% and it is twice as common in women as it is in men. People aged between 20 and 40 years commonly experience depression, although it can occur in children or older people as well. Research has shown that it is even more common in people with a family history of depression.

Symptoms of Depression

A symptom of depression is feeling worthlessness or guilt

The following are the most common symptoms of depression. If you experience five or more of these symptoms for two weeks or longer, you are probably depressed.

Persistent sadness or feeling down or gloomy
A loss of interest in activities previously enjoyed, such as socialising with friends and family, most of the day, nearly every day
Loss of appetite and loss of weight
Insomnia or sleeping more than normal
Feeling restless and agitated more easily
Feeling tired and having little energy
Unable to concentrate and think clearly and thereby becoming indecisive
A feeling of worthlessness and guilt
Recurrent thoughts of death

Causes of Depression

Stressful life events can trigger the start of depression

Some types of depression run in families. Hereditary or genetic factors are risk factors. In some families, major depression seems to occur generation after generation.

Studies have also suggested some biological components in depression. It may be associated with having too little or too much chemical in the brain. Certain medications have mood-altering properties. Anti-depressant medication acts by altering and normalising the biochemical imbalances in the brain.

Stressful life events such as loss of job, retirement, divorce, the death of a loved one or moving to a new house can be a trigger of depression. Social circumstances also play a part. If we are alone, have few or no friends or suffer from chronic health problems, then we may be more vulnerable to depression.

People with a life-threatening or long-term physical illness such as cancer, stroke, arthritis or heart disease are also more vulnerable to clinical depression.

Personality may also play a part in developing depression. Some of us are more vulnerable than others because of the individual make-up or early life experiences.

Very often, a combination of genetic, psychological and environmental factors are involved in the onset of depression.

The good news is that whatever the cause or form of depression, depression is treatable.

Related: Coping With Bereavement

Depression Treatments

Anti-depressant medication provides quick relief to people with depression with little or no energy

Depression is highly treatable. When clinical depression is recognised and treated, a person’s quality of life can be greatly improved.

Treatment consists of drug (anti-depressant medication) and non-drug therapy. Usually, combined treatment is best: medication to gain relatively quick relief and psychotherapy to learn more effective ways to deal with life stresses.

Antidepressant Medication

Insomnia is a symptom of depression and medication is prescribed based on symptoms

Medicine is prescribed according to each individual's symptoms, so there is no 'one size fits all' type of antidepressant. Some people with depression respond better to one medication than another. With most of these medicines, improvement is not immediate. It takes one to three weeks before changes occur.

Some symptoms diminish early in treatment, others diminish later. Energy levels or sleeping and eating patterns, for example, may improve before the depressed mood lifts. Medication should be taken for 6 to 12 months (or longer) as instructed to allow the medication time to work. For those who have had several bouts of depression, long-term treatment with medication is the most effective means of preventing more episodes.

While all anti-depressant medications are equally effective, they have different side effects. The most often used anti-depressants to treat depression include tricyclics, monoamine oxidase inhibitors, lithium and selective serotonin inhibitors (SSRI).

Be patient when you take the medication. Anti-depressant medications do not begin working the day you take them but your mood will improve after one to two weeks. You may notice some improvements on the first day, especially in your sleep and you feel less tense and anxious. Such anti-depressant medications are not addictive.

You can eat a normal diet (if not, your doctor will tell you). The medications are compatible with painkillers, antibiotics, and contraceptives. However, you should avoid alcohol as medication and alcohol combined can make you too drowsy.

Do not stop the medication once you start to feel better as you may relapse into depression again. You should discuss this with your doctor and let him advise you when to stop.

Like all medications, anti-depressants have some side effects, though these are usually mild and tend to wear off as treatment goes on.

Some side effects of antidepressant medication:

Dry mouth
Constipation
Dizziness
Drowsiness
Nausea and stomach discomfort

Non-Drug Therapy for Depression

Exercise elevates moods and helps prevent depression

Psychotherapy

Psychotherapy can be defined as "psychological treatment through the establishment of a relationship between the therapist and patient to relieve symptoms and correct unhealthy patterns of behaviour." The key is in managing the relationship, and this requires training and experience.

The depressed person receives therapy through talking with a therapist, as opposed to relying solely on medication to treat depression. A trained and experienced therapist can provide a safe platform for a depressed person to work through his issues through formal psychotherapy. There is a variety of psychotherapies which can be tailored to the individual's needs.

To make an appointment to see a doctor, please call 6389 2200.

Exercise

Exercise not only improves your health but also gives you a sense of accomplishment. Endorphins (‘feel good’ hormones) are released during exercise and this can elevate your mood.

Relaxation Therapy

This involves deep breathing exercises and progressive muscle relaxation.

Support Groups

Support groups offer fellowship and you get to hear first-hand accounts of how others with depression have learned to cope. Presently the Singapore Association for Mental Health (SAMH), Institute of Mental Health (IMH) and the Behavioural Medicine Clinic at IMH run support groups. The group at IMH is a psychoeducation group, i.e. you learn about the depressive illness and methods of coping.

Electro-Convulsive Therapy (ECT)

ECT is for those with severe depression who have not responded to treatment or are highly suicidal. It involves giving a light general anaesthetic and passing an electric current through the brain for a few seconds. The whole procedure takes only about 15 minutes and the patient is only aware of having gone to sleep.

Self-Help for People with Depression

Do light activities like taking the dog for a walk

Don’t bottle things up. Try to talk to someone close to you. It helps to have a good cry and talk things through.
Don’t set yourself unrealistic or difficult goals. Do what you can.
Do something — do some light activities or get out of the house for some exercise and some fresh air. It helps to take your mind off things.
Eat a balanced diet even when you may not feel like eating.
Do not drown your sorrows in alcohol. Alcohol depresses mood. It may give immediate relief but this is temporary. You will end up more depressed. It is also bad for your health.
Don’t despair, remind yourself that many other people have suffered from depression and have become better. You will eventually come out of it, just like they did.

Living with People with Depression

Get him to see a doctor so that he can be diagnosed and treated.
Offer emotional support. Spend time and encourage him to open up. Offer a listening ear.
Encourage him to continue with treatment. Reassure him that he will get better.
If the depressed person has mentioned not wanting to live or suicide, it is important to tell his therapist.