Depression: how is it treated or prevented? Dr Chan Herng Nieng, Senior Consultant, at the Department of Psychiatry at Singapore General Hospital explains.
If you’re going through a period of unhappiness and feeling depressed, does that necessarily mean that you’re suffering from depression? What are the key symptoms of depression, also known as major depressive disorder, and what are the treatment options?
Dr Chan Herng Nieng, Senior Consultant,
Department of Psychiatry,
Singapore General Hospital (SGH), a member of the
SingHealth group, answers these questions and discusses treatment and prevention methods.
“Most everybody have ups and downs, but the feelings of unhappiness eventually go away after a few days. Those who suffer from depression remain in a depressed state for weeks to months, or for some, even years” explains Dr Chan.
The hallmark of depression is a persistent and pervasive low mood that is not affected by external circumstances e.g. a depressed person is usually not cheered up by joyful events. In fact, people suffering from depression lose interest in their lives and in the activities they formerly enjoyed. This negatively impacts their professional and social lives.
Symptoms of depression to watch out for:
- Withdrawal from social life
- Sleep problems (oversleeping or insomnia)
- Changes in appetite (overeating or loss of appetite)
- Fatigue and low energy
- Difficulty concentrating or making decisions
- Feelings of guilt or hopelessness
Depression makes it difficult to cope with daily life. In extreme cases, it can lead to suicidal thoughts or tendencies.
“Major depressive disorder, or what is commonly termed clinical depression, is an actual medical illness. Studies have shown abnormalities in the brain structure, chemistry and function of depression sufferers. Hence, without proper treatment, they are unable to recover on their own, no more than cancer patients can will themselves out of their disease,” says Dr Chan.
Depression in Singapore
According to the 2012 Singapore Mental Health Survey, up to 5.8 per cent of people in Singapore have suffered from major depressive disorder in their lifetime.
“Depression affects people from any social, cultural or economic background,” says Dr Chan. The onset of depression is most common between the ages of 18 to 40. However, depression can also occur in children and the elderly.
Although studies have shown a gender ratio of about 2 females to 1 male, this does not prove that women are more prone to depression. Rather, it is possible that women are more willing to come forward to seek treatment, while men may prefer to stay silent or “self-medicate” with alcohol or drugs.
Treatment for depression
Depression is commonly treated with antidepressants and psychotherapy. Electroconvulsive Therapy (ECT) may be considered in certain cases.
Antidepressants can help optimise or correct the functioning of the brain’s neurotransmitters, leading to the relief of symptoms.
“Patients occasionally report nausea, headaches or over-sedation at the beginning of treatment, but these symptoms often resolve spontaneously within days,” says Dr Chan. Certain types of antidepressants may be associated with sexual dysfunction, but this side effect resolves when they are stopped. Don’t hesitate to discuss any side effect with your doctor, so that an appropriate antidepressant can be prescribed for you.
Psychotherapy is most effective for treating mild to moderate depression. Frequently used in combination with antidepressants, this form of treatment addresses the negative thoughts, beliefs and behaviours that contribute to depression.
Through the development of a therapeutic relationship with the therapist, psychotherapy helps the patient to better cope with problems and provides the emotional support he or she needs to carry on.
Common forms of psychotherapy include cognitive-behavioural therapy (CBT), psychodynamic psychotherapy, supportive psychotherapy and interpersonal therapy.
Electroconvulsive therapy (ECT)
ECT is safe and effective form of treatment. It involves the controlled induction of seizures via the passage of a low magnitude electrical current through the brain. This procedure is performed under general anaesthesia to ensure maximum comfort.
Doctors may recommend ECT in specific cases:
- When medication and/or psychotherapy has failed
- When rapid improvement is needed
- When the depression is severe and potentially life-threatening (for instance, the patient is suicidal or refuses to eat or drink)
Tips to prevent depression
Dr Chan offers the following tips on how you can help prevent depression.
What you can do for yourself:
- Avoid drugs, alcohol or cigarettes. Heavy use or abuse may lead to depression.
- Maintain a healthy diet.
- Exercise regularly. This increases the release of mood-enhancing endorphins.
- Seek treatment if you are suffering from physical pain. Don’t let it drag you down.
- Take time to relax. For example, listen to soothing music, meditate or practise yoga.
- Recognise that being negative alters how you perceive life situations, making you vulnerable to depression.
- Set realistic goals for yourself. Manage your expectations.
- Divide major tasks into smaller, more manageable parts.
- Seek help from friends and family whenever you need it.
What you can do for your loved ones:
- Provide a listening ear.
- Encourage adherence to treatment.
- Support or join them when they engage in any of the positive activities/behaviours mentioned above.