Are you suffering from mental and emotional problems as a woman? Dr Helen Chen, Head and Senior Consultant at KK Women's and Children's Hospital, gives detailed answers to your questions.
Emotional and mental wellness are key to good health. However, many women experience emotional problems at different stages of their life. Some may suffer from a more severe form of premenstrual syndrome during their reproductive years, while others may go through depression during and after pregnancy. Women transitioning into menopause have also been known to have emotional anxieties.
Dr Helen Chen, Head and Senior Consultant from the Department of Psychological Medicine (Mental Wellness Service) at KK Women's and Children's Hospital, gives detailed answers to your questions.
Question by mosmos
Hi Dr Chen, Are there any simple medication to control emotional/mental stress during pregnancy? Is it advisable to take any form of medication during pregnancy? Thanks.
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
This is a complicated area, and I would recommend a full psychiatric assessment as we usually need more details about the symptoms to decide on whether medication is needed. Generally, medications are recommended if the depression and anxiety is moderate to severe in severity. It is important to treat antenatal depression adequately, as it can lead to low birthweight, preterm birth and postnatal depression.
Medications should preferably be avoided in the first trimester as this is a time of when the organs are forming, but in certain cases, especially when a woman has had a pre-existing severe depressive illness, the benefit of continued treatment to prevent a relapse and possible self-harm outweighs the harm.
At KKH, we carefully assess the history and risk for each pregnant patient, and consider the safest option. Indeed, there are some medications that can be quite safely taken at the different stages. I would strongly recommend early consult with a psychiatrist with a special interest in pregnancy-related conditions (otherwise known as perinatal psychiastrist). In fact, we are increasingly seeing women who come before conceiving, and this allows for comprehensive care planning.
Question by octane
Dear Dr Helen, During menopause, what are the ways to control mood swings and depression? Are there any supplement or medication to increase a person mood during menopause?
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
Lifestyle changes can be of help. These include getting adequate rest, regular exercise, managing stress. Soy extracts or plant oestrogen supplements can help with climacteric symptoms of hot flushes, and this in itself can alleviate mood swings as a by-effect.
Because of the concern of blood-clots and cancer, hormone replacement therapy is becoming less popular. In contrast, the serotonin reuptake inhibitors are much safer, and apart helping to modulate mood swings and treat perimenopausal depression. Some studies have shown benefit with symptoms of hot flushes too.
Question by dsim
Hi Dr Chen, How would I know that I have fallen into depression and not a temporary state of unhappiness?
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
It can indeed be difficult to tease these apart. And often, reading a list of criteria makes us tend to check on all the items and claim we must be having the condition stated. As a rule, the key symptoms of depression are either 1) low mood/feeling depressed or 2) loss of interest/pleasure.
Other symptoms of depression include: poor sleep (especially early morning awakening), loss of appetite/weight (or increased weight/overeating), loss of concentration/forgetfulness, loss of energy, feeling agitated/restless/slowed down or lethargic, negative thinking/self-blame/excessive guilt, feelings of hopelessness/suicidal thoughts.
These symptoms must be present persistently for a period of two weeks or longer, and cause significant distress or impact on the functioning level of the person.
If you are asking this question, it suggests to me that perhaps your state is a little unclear, and possibly, your symptoms maycome and go, as it does for many patients. I suggest you consult your family doctor, or a psychiatrist as a proper assessment can be beneficial. Sometimes, untreated depression can lead to lasting problems in our personal life.
Question by chai
Hi Dr, If I am always feeling down and nothing seems to excite me any longer, is this depression?
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
The key symptoms that must be present are either 1) low mood/feeling depressed or 2) loss of interest/pleasure.
Other symptoms of depression include poor sleep (especially early morning awakening), loss of appetite/weight (or increased weight/overeating), loss of concentration/forgetfulness, loss of energy, feeling agitated/restless/slowed down or lethargic, negative thinking/self-blame/excessive guilt, feelings of hopelessness/suicidal thoughts.
These symptoms must be present persistently for a period of two weeks or longer, and cause significant distress or impact on the functioning level of the person.
Question by rsim
Hi Dr, Are there any treatment for depression? What is the recovery rate for depression after treatment?
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
Treatment for depression can be in various forms, including psychological therapy, social interventions which target the sources of stress, and medication for those with moderate to severe depression.
For those with persistent depression, or what doctors term treatment-resistant depression, there are also special modalities such as electroconvulsive therapy and transcranial magnetic stimulation. Life-style changes can also help, such as getting involved in volunteer work, exercise, meditation or mindfulnessness practice.
The recovery rate is dependant on the nature of the depression – because depression is not just a single condition, but a spectrum of disorders, with different sources of stress in each patient, including personality/coping styles. Hence the rates really depend on which patient population, what measures are used, what interventions were given. Most published studies typically examine single or combined intervention effect, such as antidepressants and/or therapy, so we do not have clear information of what recovery rates are like across the broad categories/populations.
With the right treatment plan, the majority of patients can make good progress. However, in some patients who are not motivated to accepting help, or for whom life stressors are overwhelming, depression can be protracted, and sometimes end tragically in suicide. Hence the importance of early detection and treatment of depression.
Question by pocoyosky
Hi Dr, Is it normal to feel depressed before our menstruation cycle?
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
Just before your menses arrives, there is an increasing level of progesterone, the “depressogenic” hormone, over the preceding two weeks. In addition to these, some women experience uncomfortable physical symptoms of breast tenderness, bloatedness, and cramps.
There is for some women, a frustration with the onset of menses, as one may need to restrict activities like swimming, or wearing tight or light-coloured clothing, or even sex. A 2012 review paper found that premenstrual dysphoric disorder, a form of depression characterised by premenstrual episodes that affect functioning, occurs in 1.3-2.8% women in Asia, as compared to 3-8% in western countries.
Question by simly6
Hi Dr, I observed that women going through menopause seems to easily flare into temper. Is this part of menopause changes?
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
The menopausal transition is accompanied by various physical and emotional symptoms – part of this has to do with the hormonal changes(especially reduced levels of oestrogen, the “feel-good” hormone for females) and vasomotor instability.
These account for the symptoms of hot flushes, flashes, dryness and bloatedness, as well as irritability, mood disturbance and anxiety symptoms. There are often other possible factors that can contribute to emotionality at this period in a woman’s middle years – the perceived loss of femininity, or sense of sexuality, the loss of reproductive functioning, “empty nest” syndrome, possible concurrent changes in career or stress of caring for elderly parents.
Question by sch
Hi Dr, Is constant worrying a form of emotional anxiety?
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
I gather you are referring to anxiety as in a disorder or abnormal state when you say “emotional anxiety”. You are partly right, in that constant and excessive worrying without a good reason is a feature of anxiety disorder. However, that “good reason” is a relative state – for example, a mother might constantly worry if her toddler is running a high fever because she had a febrile fit the last time this happened, whilst another mother’s worry that her toddler will get been brain damaged by high fever because she remembered what her grandmother told her.
It would be difficult to make a judgement call on what constitutes a good enough reason, and indeed, we all have different capacity to cope with uncertainty, and some have a greater innate tendency to worry.
A more useful way of assessing if someone has an anxiety disorder is, if the constant worrying is accompanied by physical symptoms of anxiety such as palpitations, breathlessness, tremulousness, chest discomfort etc. Additionally, there should be significant distress and impairment of social/occupational functioning as a result of these symptoms.
Question by mrina
Hi Dr, What are the symptoms of depression?
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
The key symptoms that must be present are either 1) low mood/feeling depressed or 2) loss of interest/pleasure.
Other symptoms of depression include poor sleep (especially early morning awakening), loss of appetite/weight (or increased weight/overeating), loss of concentration/forgetfulness, loss of energy, feeling agitated/restless/slowed down or lethargic, negative thinking/self-blame/excessive guilt, feelings of hopelessness/suicidal thoughts.
These symptoms must be present persistently for a period of two weeks or longer, and cause significant distress or impact on the functioning level of the person.
Question by XXX
Dr Chen, I am married for 15 years and I am sexually inactive for 10 years. Could this be the reason for emotional disturbances and serious craving for food during pre menstrual? What is the period for pre menstrual? Thank You
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
Sexual activity, and patterns of sexuality is a complex area, and certainly, frustration about repressed sexual needs can lead to emotional disturbances, which can in turn be related to a tendency to comfort eat. However, there can also be many other reasons for emotional disturbances, and the premenstrual hormonal changes can lead to food craving, as a form of tension-relief for some women.
I would suggest you seek consultation with a psychiatrist with a special interest in women’s mental health issues for a full assessment, and this would entail a detailed enquiry into the nature of your symptoms, and background history and experiences.
Question by lifeartsg
How exactly are menppausal 'emotional anxieties' different from the usual kind of anxieties people may have?
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
It is usually during the perimenopausal period, when the menses is changing – becoming lighter, or heavier for some women, irregular or less frequent – that women experience emotional changes. This is largely postulated to be due to the hormonal changes, particularly the drop in oestrogen (the “feel-good” hormone for women) during those years. Women often report prominent physical symptoms such as hot flushes, night sweats and insomnia, along with the palpitations, or tension and anxiety they experience.
In women of other age-groups, typical presentations of anxiety include excessive and constant worrying thoughts, a state of tension, as well as accompanying physical symptoms such as palpitations, breathlessness, giddiness, tremulousness, muscle cramps, headache etc. These can be persistent, or episodic, or come in intense waves as seen in panic disorder, or situation-specific. Hormonal changes are less likely to be a main cause of anxiety but some patients have reported that their anxiety tends to worsen before their menses.
Question by lanaquek
Dear Dr Chen, My mother age 65, has been suffering from depression for the past 3 years. She has lost about 20kg since, and has lost all interest in life. She refuses to step out of the house at all. She is a totally different person whom she once used to be - cheerful and energetic. She does not wants to speak much, refuses to listen to us and spends most of the time lying in bed in the room by herself. We are very concerned and wonder if she will ever recover. We are open to any suggestions that can help, but it is her who refuses to seek help. As her daughter with a family of my own, I am very worried for her and also for my dad who is staying and taking care of her.
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
It must indeed be very difficult for you, and your family – to feel worried, concerned, and yet not being able to get her to seek help.
She does need psychiatric treatment. Although we often highlight the importance of patients’ rights and respect their autonomy, in some instances, it is reasonable to override their wishes, as it is in good faith for their own wellbeing. In this case, your mother is not her usual self, and her depression is preventing her from accepting help.
It may be helpful for you to try to approach it from the physical symptoms, as most elderly patients do not endorse mental symptoms – so perhaps try persuading her to see a doctor because of the lack of energy and weight loss.
Do not tell her that she must be depressed, because she will not admit it and for you to leave her alone.
Do not tell her what kind of doctor you are bringing her to see, and try to speak to the doctor separately to explain your families’ difficulties.
Most psychiatrists are familiar with these struggles, and will try to accommodate family requests for the patient’s interest, if appropriate. Psychiatrists with special interest and training in elderly patients may be the best suited to care for your mother. Alternatively, some geriatricians are also experienced in recognising and treating depressed patients, so this will help you overcome the challenge of her refusing psychiatric help. My sincere wishes to you and your family that your mother recovers in time.
Question by yijuntan26
Dear Dr Chen,
I would like to ask how could one maintain mental wellness when his or her personality or past experiences has conditioned him or her to have the tendency of comparing, of being inferior, having poor self-image and esteem, unable to control own emotions and be easily affected by how others portray him or her?
Thank you very much!!
Answered by Dr Helen Chen Head & Senior Consultant Department of Psychological Medicine KK Women’s and Children’s Hospital
The first step is being aware of these influences and it is heartening to know that the person has set a goal of maintaining mental wellness.
For most people, our past experiences have a lasting impact on how we feel, think and behave. For some, reading self-help books, talking to supportive friends/family, keeping a reflective journal, taking up a hobby etc, can help to nurture resilience and help one to maintain emotional wellness.
For those with more difficult past experiences, and for whom these self-help methods are not effective, psychotherapy will be beneficial. There are many approaches of psychotherapy, but on the whole, they help the individual through the process of exploring past hurts/fears/experiences or thinking patterns, and the link to current difficulties, within a secure therapeutic setting. Lastly, it is important to seek consultation to check if there are any underlying depression, as this needs to be addressed first.
Ref: S13
