Understanding depression
In our daily lives, we may experience some events or demands which may cause us to feel sad or tired every now and then.
Some of us might experience a long period of moodiness that seems out of proportion to the type of situations we find ourselves in, or we may gradually lack interest in the things we used to enjoy.
Don’t be quick to dismiss these feelings. If left unchecked, this sense of sadness may develop into depression if prolonged and could affect our day-to-day activities.
What is depression?
Common misconceptions:
Some common depressive disorders include:
Major depression
Major depression is also known as major depressive disorder, classic depression, or unipolar depression. People with major depression experience sadness to such a degree that it affects functioning.
Persistent depressive disorder (Dysthymia)
Dysthymia or persistent depressive disorder is a milder form of major depression that lasts for two years or more.
Although persistent depressive disorder may not be as intense as major depression, it can still strain relationships and make daily tasks difficult.
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder is a severe form of premenstrual syndrome (PMS).
Sadness and other depressive symptoms arise due to hormonal fluctuations associated with the menstrual cycle.
These symptoms can get in the way of day-to-day functioning.
Causes
Depression is caused by a combination of biological, psychological, and environmental factors.
Biological
Hereditary/genetic factors
Depression can run in families, indicating hereditary or genetic factors. Hence, some may be born with a higher risk of developing depression.
But having a relative with depression does not necessarily mean someone is vulnerable to depression.
Biological
Chemical imbalance
Another possible cause of depression is a chemical imbalance in the brain, which affects one’s moods. Hormonal imbalances can also make someone vulnerable to depression.
Biological
Existing conditions
Some conditions may also increase the risk of depression, e.g. cancer, stroke, arthritis, or heart disease.
Psychological
Psychological causes may also play a part in depression because of an individual’s biological factors and early life experiences.
People who are perfectionists, easily affected by criticism, and prone to anxiety may be more likely to suffer from depression.
Environmental
Stressful or traumatic events can cause people to suffer from depression.
This includes relationship problems, worries over finances, loss of employment, or grief from the death of a loved one.
Social circumstances may also make us more vulnerable to depression, affecting those who feel lonely, have few or no friends, or suffer from a chronic illness.
Signs and symptoms
A person who experiences five or more of these common signs and symptoms for more than two weeks may have depression.
The symptoms can be described
using the acronym
In SAD CAGES
Loss of
IN
terest in activities
S
leep disturbances
A
ppetite changes
D
epressed mood or feelings of sadness over a sustained period
C
oncentration difficulties
A
ctivity level changes
G
uilt or shame
Low
E
nergy
S
uicidal thoughts due to feelings of helplessness and hopelessness
The signs and symptoms can be managed with early treatment.
The following depressive disorders also have their individual symptoms:
Symptoms of Dysthymia occur for at least two years. They include having a depressed mood and at least two of the following symptoms:
Low self-esteem
Having too much or too little sleep
Feelings of hopelessness
Low energy or fatigue
Poor appetite or overeating
Poor concentration or
difficulty making decisions
Symptoms of PMDD typically appear in the week before menstruation and end a few days after the period begins. In PMDD, the individual has at least one symptom from the following two categories:
Category A
- Sadness and despair
- Irritability and anger
- Anxiety
- Extreme mood swings
Category B
- Food cravings or binge eating
- Feeling overwhelmed
- Cramps, bloating, breast tenderness, joint and muscle pain
- Decreased interest in usual activities
- Difficulty in concentrating
- Low energy or fatigue
- Having too much or too little sleep
Diagnosis
To diagnose depression, a healthcare professional would conduct a detailed clinical interview in which he/she would ask about the individual’s past medical and psychiatric history, family history, current symptoms, and the impact on his/her functioning.
With the patient’s consent, the healthcare professional may also request to speak with a family member to gather more information. A standardised questionnaire, physical examination, and blood tests may be administered to assess for the presence and severity of depression.
Treatment
Depression is treatable. When depression is recognised and treated, a person’s quality of life can be greatly improved.
Treatment may consist of drug (antidepressant medication) and/or non-drug therapy. Often, a combination of both medication and psychotherapy is used. Patients may also be taught effective ways to deal with life stresses.
Medication
Medications like antidepressants have mood-altering properties that seek to normalise the biochemical imbalances in the brain.
Medicine is prescribed based on the individual’s needs. There is no ‘one size fits all’ antidepressant. Some people respond better to one medicine than another.
With antidepressants, improvement does not usually show immediately. It takes about one to three weeks before changes occur, with some symptoms improving earlier in treatment than others. For example, energy levels may improve before feeling a lift in mood.
To give the medication time to work, it should be continued for at least 6 months (or longer) after symptom remission.
Continuing or stopping medication must be advised by a healthcare professional. For those with several bouts of depression, long-term treatment may be necessary to prevent further depressive episodes.
It is vital to know that medication alone may not completely cure depression. However, to aid in recovery, it is effective in treating its symptoms together with psychotherapy.
Non-drug therapy
Psychotherapy
Psychotherapy involves talking things through with a healthcare professional.
Talking to someone who can listen and understand without passing judgement can be a tremendous relief, helping in the solving of problems and the coping of life’s stressors.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a form of psychotherapy found to be effective in treating depression.
It helps in recognising and changing negative thinking and behavioural patterns.
Electro-convulsive therapy (ECT)
Electro-convulsive therapy (ECT) involves the use of electric current and is only prescribed to those with severe depression who have not responded to treatment or are highly suicidal.
It involves passing a very small electric current through the brain. The procedure is carried out under general anaesthesia taking just a few minutes, while the patient is asleep.
Learn to better manage depression with these tips:
Support networks
Support groups offer fellowship where participants learn first-hand accounts of how others cope with depression. A support system can also be made up of people we trust, friends, parents, relatives or colleagues that will support us in times of need.
Reaching out to connect and share about our thoughts and feelings can help us feel understood, explore new perspectives, and find different ways to resolve our difficulties.
Exercise
Exercise not only improves our health but releases endorphins (‘feel good’ hormones) that can elevate our mood. Check out these exercise ideas to stay active.
Learn relaxation audio exercises and guided imagery
-
Deep breathing exercises
Pick up deep breathing exercises as a method of relaxation
-
Progressive muscle relaxation
Practise progressive muscle relaxation where a group of muscles is tensed as we breathe in and relaxed as we breathe out
-
Guided imagery
Use guided imagery such as imagining ourselves at the beach, feeling the warm breeze on our skin
-
Mindfulness
Consider mindfulness where we train our mind to pay
attention to the present moment without judging our
experiences
Practise good sleep hygiene
Poor sleep hygiene has been found to worsen depressive symptoms such as poor sleeping habits, making it a vicious cycle.
Learn how to adopt practical sleep tips for a good night’s rest.
Manage unhelpful thoughts
Sometimes, unhelpful thinking patterns may magnify the negativity of the situation. For example, we may overgeneralise and think, “I have failed once, I will fail again for sure”.
Identify such negative thoughts to manage them more positively by using the My Positivity Guide. Reframe them and focus on the things we love.
Set realistic goals
Setting and accomplishing goals can be an overwhelming task when one has depression.
Use the SMART goal framework: Specific, Measurable, Achievable, Realistic, Timely to set reasonable and achievable goals.
Break down tasks into smaller chunks and affirm ourselves regularly.
Refrain from drinking
Avoid drowning our sorrows in alcohol as it depresses mood. It may give immediate relief, but it is only temporary.
Depression self-assessment
tool
Depression affects the body, mood, and thoughts to a point of dysfunction, impacting an individual’s ability to function at work, at school, and at home.
The Patient Health Questionnaire (PHQ-9) is a set of 9 questions that those aged 12 and above can use to assess if they might be suffering from depression. It helps one take stock of where they are at, so they can make a plan to feel better soon.
Please note this is a self-assessment and not a medical diagnosis.
Differentiating sadness from depression
Everyone feels sad at some point or another. It is normal for us to feel sad when we encounter disappointments from difficult life situations. Most of us learn to overcome our problems or accept changes in our lives over time. However, in other instances, this change in emotions can escalate or become prolonged that it leads to depression.
Who is affected?
In Singapore, about 1 in 16 people are diagnosed with depression in their lifetime. While depression can affect our ability to function at work and at home, the good news is that it is treatable.
How does it affect us?
Depression affects the body, mood, and thoughts to a point of disruption of normal social relations. It affects the way we eat and sleep, how we feel about ourselves, and how we perceive things Individuals with depression may face difficulties in their relationships and daily tasks and may be unable to work towards their goals in life.
What people may think:
We can simply ‘snap out of’ depression.
But did you know:
Some people mistakenly believe that it happens when they allow themselves to wallow in their grief and that it can be cured with positive thoughts or a change in attitude. In fact, depression is a serious condition that affects the way we act, think and behave and can lead to changes in our daily life/activities. Read more about the causes of depression.
What people may think:
Depression is only about being sad.
But did you know:
Depression is more than feeling sad. It involves a loss of interest or pleasure in activities once enjoyed, being affected by persistent feelings of sadness and other physical symptoms such as changes in appetite, quality of sleep and social behaviour.
What people may think:
Depression is a sign of having a weak mind or character.
But did you know:
Depression is not a sign of weakness, but a medical condition triggered by a combination of genetic, psychological, and environmental factors. It is unrelated to the strength of our state of mind and character.
Depression
self-assessment tool
Depression affects the body, mood, and thoughts to a point of dysfunction, impacting an individual’s ability to function at work, at school, and at home.
The Patient Health Questionnaire (PHQ-9) is a set of questions that those aged 12 and above can use to assess if they might be suffering from depression. It helps one take stock of where they are at, so they can make a plan to feel better soon.
Please note this is a self-assessment and not a medical diagnosis. If you are under 18 years old and concerned about your results, please seek advice from a trusted adult.
Instructions
For each question, please SELECT the option that comes closest to how you have felt IN THE PAST TWO WEEKS — not just how you feel today.
Complete all questions.
Your score will be automatically calculated and shown to you after you submit this questionnaire.
Subramaniam, M., Abdin, E., Vaingankar, J. A., Shafie, S., Chua, B. Y., Sambasivam, R., Zhang, Y. J., Shahwan, S., Chang, S., Chua, H. C., Verma, S., James, L., Kwok, K. W., Heng, D., & Chong, S. A. (2019). Tracking the mental health of a nation: Prevalence and correlates of mental disorders in the second Singapore mental health study. Epidemiology and Psychiatric Sciences, 29, e29. https://doi.org/10.1017/S2045796019000179
Select the option that comes
closest to how you have felt IN THE PAST TWO WEEKS –
not just how you feel today.
Question of
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself – or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual
Thoughts that you would be better off dead or of hurting yourself in some way
Finally, please select your age group.
This will help us provide you with resources better suited to your needs.
Your answers indicate that you could be having thoughts about self-harm or suicide. It is okay to reach out for support and help is available. If you are feeling in need of a safe space and would like for someone to provide a listening ear, please contact these helplines:
Institute of Mental Health
24-hrs
6389 2222
Additionally, learn more about managing self-harm and suicidal thoughts here.
Your answers indicate that you could be having thoughts about self-harm or suicide. It is okay to reach out for support and help is available. If you are feeling in need of a safe space and would like for someone to provide a listening ear, please contact these helplines:
Institute of Mental Health
24-hrs
6389 2222
Additionally, learn more about managing self-harm and suicidal thoughts here.
Your answers indicate that you could be having thoughts about self-harm or suicide. It is okay to reach out for support and help is available. If you are feeling in need of a safe space and would like for someone to provide a listening ear, please contact these helplines:
Institute of Mental Health
24-hrs
6389 2222
Additionally, learn more about managing self-harm and suicidal thoughts here.
Your score:
Based on your responses, you are unlikely to be experiencing depression at the moment.
You are doing a great job in taking care of yourself.
Keep up the great work!
Click “Next” for more tips to continue staying motivated.
Based on your responses, you are unlikely to be experiencing depression at the moment.
You are doing great with your self-care efforts.
It’s not always easy, so keep it up!
Click “Next” for more tips to boost your self-care.
Based on your responses, you are unlikely to be experiencing depression at the moment.
You have shown consistent commitment to self-care.
Keep prioritising your mental well-being!
Click “Next” for more tips to continue caring for yourself.
Your score:
Your answers indicate that you could be experiencing mild signs of depression.
We understand that navigating this phase of life can be challenging, especially when you are feeling uncertain about the future. These can take a toll on your mental health, which can make you feel overwhelmed and drained at times.
Click “Next” for tips to manage your emotions and better care for your well-being.
Your answers indicate that you could be experiencing mild signs of depression.
Managing various responsibilities such as work, family and
financial struggles can be demanding and overwhelming. Without
realising it, these can take a toll on your mental health, making it
easy to feel drained and helpless.
But you do not have to go through it alone.
Click “Next” for tips to help you cope and overcome your challenges.
Your answers indicate that you could be experiencing mild signs of depression.
This phase in life can bring its own set of challenges, such as coping
with retirement, family, and health issues. Sometimes, these
changes can make you feel like you are alone on this journey.
But always remember that if you are feeling overwhelmed, you
are not alone.
Click “Next” for tips to help you manage difficulties and boost your well-being.
Your score:
Your answers indicate that you could be experiencing moderate signs of depression.
Sometimes, the added academic or relationship stress can make things even harder.
Click “Next” to find out how you can cope with stress and overcome your challenges.
Your answers indicate that you could be experiencing moderate signs of depression.
Life can get pretty overwhelming, especially when you are struggling. But no matter how bad the days may seem, just know that it does not make you any less worthy of kindness and compassion.
Click “Next” to find out how you can care for yourself in difficult times.
Your answers indicate that you could be experiencing moderate signs of depression.
The later years of our lives can feel like an uncertain journey. Health issues, finances, or even the loss of a loved one can trigger confusion, frustration, and depression. While it may feel tough, remember to keep looking ahead with hope.
Click “Next” to find out how you can manage your self-care during tough times.
Your score:
Your answers indicate that you could be experiencing moderately severe signs of depression.
When you are juggling with other aspects of your life like school, relationships or work, every day may feel like a struggle. Know that you do not have to carry the burden alone. There is hope in seeking support.
Click “Next” to find out how you can reach out for help and care for your well-being.
Your answers indicate that you could be experiencing moderately severe signs of depression.
When you have to juggle other aspects of life like work and family, the weight of it all may seem unbearable. Know that you do not have to carry the burden alone. There is hope in seeking support.
Click “Next” to find out how you can reach out for help and care for your well-being.
Your answers indicate that you could be experiencing moderately severe signs of depression.
Sometimes your responsibilities can make you feel lost, angry, overwhelmed, or even confused, especially at this phase in life. Know that you do not have to carry the burden alone. There is hope in seeking support.
Click “Next” to find out how you can reach out for help and care for your well-being.
Your score:
Your answers indicate that you could be experiencing signs of severe depression.
At times, the uncertainties of the future may have you feeling isolated and lost.
Click “Next” to find out how you can seek help to overcome your difficulties and care for your well-being.
Your answers indicate that you could be experiencing signs of severe depression.
Sometimes, the weight of the world may feel unbearable.
Click “Next” to find out how you can continue to stay strong and cope better by reaching out for support.
Your answers indicate that you could be experiencing signs of severe depression.
When things get overwhelming, the future may seem bleak. But remember that you are never alone on this journey.
Click “Next” to find out how you can reach out for support to care for your well-being and overcome your challenges.
