Feel that you can't stop worrying, and are always anxious? Or can't sleep and cry a lot? Or feel worthless and guilty, and have headaches that just don't go away?

Ms Evelyn Boon, Senior Principal Psychologist from the Behavioural and Medicine Unit, and Dr Chan Herng Nieng, Senior Consultant from the Department of Psychiatry at Singapore General Hospital, give detailed answers to your questions.

Question by ctlb

For the past 20 yrs I am happily working and have 3 kids. Life is always so busy, moving up the career ladder at work and rushing home to help the kids with their studies. My career in every company is short 2-3 yrs as I reckon I was too eager to jump on the next opportunity and I have been to 3 retrenchments. The last company was bought over and we closed the company. Was very happy in the nex 3 months spending times with kids and looking for job. On the fourth month I started work in a new company, new industry, new country and new responsibilities managing a small team. Started feeling very stress and strain and insomonia sets in. I will stay up whole night, took sleeping pills and sometimes with liquor, yet I cant sleep at night. When I travel, I hope the plane will crash. I left the company after the 3rd month and only after 2 weeks, I'm able to sleep now. What worries me is : 1 I have lost interest in the kids. 2 Dislike watching TV unlike before, 3. Lost confidence in finding in the next job. I am somebody who worries and think a lot and I am afraid that if I start working again, I do not know how to manage stress and ended up the insomonia problems again. Is there a way to help me pick up my life again and manage stress better.

I'm scheduled to see the psychologist will the psychologist help me? I do not want medication or just talk it out approach. I need to solve my stress management problem so that I can stay in my next job.

Answered by Ms. Evelyn Boon, Principal Psychologist and Dr. Chan Herng Nieng, Associate Consultant, Department of Psychiatry Singapore General Hospital

It is important for you to be diagnosed accurately before any treatment can help. Please seek consultation with a mental health professional, like a psychiatrist, if the symptoms have been persistent and there are thoughts or plans of self harm

Please refrain from self-medicating with sleeping tablets for insomnia, as long-term use can lead to dependence

Please avoid consuming alcohol in excess as

• Long term excessive alcohol use can lead to depression
• Long term excessive use can lead to dependence
• Alcohol can exacerbate insomnia and other sleeping disorders

If you have Major Depressive Disorder or more commonly known as clinical depression, you may require medication depending on the severity. You may also benefit from psychotherapy.

Seeing a psychologist would help to address some issues, such as learning how to manage your stress, learning how to not over worry etc. These are skills based therapy. It is also important to speak to the psychologist regarding what your goals for therapy are.

Therapy is not just talking it out but it also involves you doing some homework or tasks. For example, no stress management skills will work if you don’t put them into practice and keep at it for a while.

It is also important to understand your pattern in your working life and what you really want. For example, what are your goals for yourself in terms of work? What are your expectations?

All these issues need to be discussed with your psychologist for him/her to work out a treatment plan with you.

Question by ginger

I've been having yo-yo emotions for some years where I can be feeling ok but suddenly feel like jumping off the roof to end it all. As a youth, I would cut myself and those depressing thoughts would ease but as an adult, the depressing thoughts are still there no matter how many times I cut myself. I thought that as I grow older, I would be better able to keep things in check. I tried talking to counsellors but each time I talk about it, the more depressed I get. I tried to monitor myself and find out what triggers those depressive thoughts but nothing comes up. How do I get over this?

Answered by Ms. Evelyn Boon, Principal Psychologist, Department of Psychiatry Singapore General Hospital

It does sound like you have depression but it is difficult to assess just by those symptoms you’ve described.

I would strongly recommend that you see a psychiatrist to be properly assessed. You may require medication and/or psychotherapy depending on the severity.

Medication can help to elevate the mood. while counseling or psychotherapy would be essential to help you learn how to cope with your emotions and urges to harm yourself. However both counseling and therapy do take time. Depending on your situation, therapy can take up to a year (at least) with regular sessions (i.e. at least fortnightly sessions for few months) before you see improvements.

Depression is treatable and you can live a life free from these yo-yo emotions and self-harm. It is most important now to get an accurate diagnosis and treatment.

Question by angela

I suspect I was diagnosed with depression and I have seen doctor taking medicine but it doesn't help at all after medications taken. Sometimes out of no where just cry and will use pen to hurt my wrist. Really just wish for everything to end and find life is not meaningful. No one concern, care and love me, why I alway have to be alone. till date I still couldn't overcome my fear and trust on anyone due to my first marriage breakdown. I have stop seeing the doctor althought the medicine has finished because after taken I inend to forget alot of things including my works.

Especially when I felt very lonely and there is not one there with me. I felt very miserable and misery, don't know what should I do. Sometimes for migraine attacks worsen my concentration. It is this is due to the illness or other. (Pls advise)

Please advise should I continue to take medicine or see doctor for further investigation to justify my condition it is minor or serious.

Thanks

Answered by Ms. Evelyn Boon, Principal Psychologist and Dr. Chan Herng Nieng, Associate Consultant, Department of Psychiatry Singapore General Hospital

Firstly, it is best to go back to your doctor and discuss with him/her your concerns.

Anti-depressants usually take times to work. Usually you would need to take at least 2 weeks continuously and it may take up to 4-6 weeks for you to feel an improvement in your mood.

I understand this can feel very frustrating but it is the way the medication works. Adherence to the course of treatment is crucial for the medication to be effective. Stopping and re-starting may cause a longer delay for the effectiveness of the medication. There are several types of antidepressants and it is highly likely there will be one that is effective and does not cause side-effects to you.

If you feel that the medication is affecting your memory and concentration, it is best to discuss this with your psychiatrist and explore other alternatives. It is difficult to say if it is the medication or possibly the depression that is causing poor memory and concentration.

If you want to stop your medication, again it is best to discuss your intention with your psychiatrist so that they can better advise you.

You may consider asking them to refer you to see a psychologist to work on possible psychological issues that may have triggered your depression.

Question by turquoise

Had MDD for coming to 2nd yr soon. Sometimes I feel like stopping my antidepressants & worried about habit forming having to take sleeping pills for such long period. Tends to forget to take medicines.

I may look alright to others right now but deep down sometimes I know am not. I couldn't concentrate at work at all plus my migraine attacks worsen my concentration. Tends to surf networking sites but doesn't really helps at times, I feel very bored, couldn't sit still.

At times, I dont know why I cry for no reason. Whenever, am provoked, I feel very agitated & can scream out real loud & broke down. Am I normal? Sometimes, I feel myself crazy being like that & made my mom worried.

Sometimes, I feel as if there's 'someone' there but then there's no one around...is this additional symtom of another psychiatric illness?

I felt very lonely & anxious whenever I try to hang out at youth corner. Recent chain of events when my trust was being betrayed, I was so angry & hurt deep down. Art therapy was being stop abruptly too. Am so sadden by it.

Insomnia - usually couldnt fall asleep or wake up at night many times but recently, so sleepy even daytime that I wish I could just 'sleep forever'. Now that I tend to wake up very late during weekends, had my breakfast is like 11am or 12.30pm. After which, I could just binge!

Fell sick easily due to my many medical history which is like, why am I still here? I wanted to exercise but being pulled down by sickness, felt so weak.

Answered by Ms. Evelyn Boon, Principal Psychologist and Dr. Chan Herng Nieng, Associate Consultant, Department of Psychiatry Singapore General Hospital

Firstly it is good to hear that you are taking your medication. It is important to take it regularly for it to be effective.

It is good to discuss with your psychiatrist about your concerns regarding the long-term use of sleeping tablets. Do talk to your psychiatrist about your concerns of another psychiatric illness. Let them know of your symptoms so they can assess you better.

It does sound like you enjoyed and benefited from art therapy. Is there a chance you could continue with that?

Are you seeing a psychologist? It might be a good idea to combine psychotherapy and medication. Talk to your doctor about your symptoms and medications as well as get a referral to a therapist to work on some of the issues.

There seems to be a lot of anger and loneliness in you. It would be good to talk to a therapist to figure out why are you so angry and lonely.

It would be good for you to work with the therapist on how to get some normalcy and routine in your life.

You can also work with him/her to get you to gradually develop better health. Exercise can start from something basic like taking a walk. It need not start with a run or gym especially if you have not exercised for a long time.

Question by gohcy

hello,

can i know what causes depression and how do u diagnose depression. There will be cases where some people feel depressed but look quite ok

Answered by Ms. Evelyn Boon, Principal Psychologist and Dr. Chan Herng Nieng, Associate Consultant, Department of Psychiatry Singapore General Hospital

Depression is actually a common mood state in response to unhappy experiences in our life e.g. losing a job, quarrel with family or friends.

It becomes an illness or a disorder when it is persistent and prolonged and affects a person’s social functioning in terms of self-care, social role and family life

In a person suffering from major depressive disorder, in addition to the persistent low mood, the person may experience loss of interest or pleasure in life, disturbances on sleep, appetite and energy levels, has diminished ability to think or concentrate, experiences excessive feelings of worthlessness and guilt and may even entertain thoughts of death and suicide. It is definitely not a sign of weakness and a person cannot just “snap out of it”.

Yes there are cases that a person looks ok but feel utterly depressed as many people are good at hiding their symptoms. That is why a proper assessment is important.

Question by anggielow

I was diagnosed with depression but I stop because I feel that it dosen't help at all.The medications, talking, etc just don't make any difference. Sometimes just want to cry. Even when I'm watching TV, on the computer, in the shower, or even out doing errands, just suddenly feel like crying. Also have alot of problem making even simple decision without having the feeling of regret. Really just wish for everything to end. The psychologist did suggest admitting to IMH before but I'm not keen on taking anti-depressants again & I also really don't know what other things to do.

What other form of treatments are there? What kind of treatment / activities are there for impatients at IMH?

Answered by Dr. Chan Herng Nieng, Associate Consultant, Department of Psychiatry Singapore General Hospital

Depression is a highly treatable illness and treatment is readily available in Singapore. Many patients have been treated successfully and they return to their normal lives. Broadly speaking, the treatment options include antidepressant medications, psychotherapy and in certain patients, electroconvulsive therapy.

Antidepressants

Antidepressants are not addictive. They work by improving the serotonin transmission in the brain. Patients are advised to take antidepressants consistently for at least 2-4 weeks to see improvement. Once they have recovered and are longer depressed, it is advisable for patients to continue the antidepressant medication for at least 6 months to a year to consolidate the recovery and prevent a relapse. If there are any side effects arising from antidepressant medications, they are usually mild and transient. Please inform the doctor so that he/she can reduce the dosage or switch to another antidepressant medication to minimize the experience of side effects

Psychotherapy

A person may have difficult issues in his/her life which is contributing to depression. Psychotherapy involves working with a therapist in a structured and guided manner to deal with such issues. It is hoped that with psychotherapy, a person gains a better understanding of his/her own problems, a better understanding of himself/herself and gain skills to cope better with the difficulties in life.

Psychological treatments include cognitive behavior therapy, interpersonal behavior therapy, psychodynamic psychotherapy etc. These are all known to work for depression. In some places there are art therapy and other forms of complementary therapies as well.

Electroconvulsive therapy

In people who are intolerant of medications or not responding to psychotherapy and remain severely depressed, electro-convulsive therapy (ECT) may be an option. It involves passing an electric current through the brain for a few seconds. The whole procedure is carried out with the patient under light anesthetic with an anesthetist in attendance. It is a very safe and effective procedure for the treatment of depression.

Ref: V10