Depression

Mood disorders are psychological conditions where one’s mood state is disturbed to an extent that social and occupational function is severely affected. We all have our own “thermostat” and barometer when it comes to our mood. Our mood may fluctuate within a certain range over the months depending on our personal circumstances, but it generally stays within a normal healthy range which allows us to function in our personal, professional and academic lives regardless of stressors. However, when this biological thermostat or “set point” is disturbed such that our mood is abnormally and persistently low or high, one could be experiencing a mood disorder.

Broadly speaking, there are two types of mood disorders. In Major Depressive Disorder and Dysthymic Disorder, one experiences sustained episodes of low mood, low energy and low motivation. Collectively these are known as unipolar depressive disorders. On the other hand, mood states can swing to the other extreme to become abnormally high and euphoric in Bipolar Disorder.

Risk factors:
  • A family history of mood disorders, especially in parents or siblings
  • A previous mood episode (depressed or manic)
  • Adverse childhood experiences such as abuse or neglect
  • Chronic and painful medical conditions
  • A history of brain disease such as epilepsy, stroke or Parkinson’s disease
  • Certain hormonal problems such as low thyroid levels, abnormal cortisol levels, or high calcium levels in the blood
  • Personality factors such as introversion, pessimism, high degree of neuroticism
  • High levels of environmental stress from work or family
  • Exposure to mind-altering substances such as alcohol or other substances

Most mood disorders are diagnosed based on episodes. A diagnosis of Major Depressive Disorder is made when there is at least one major depressive episode. Likewise, a diagnosis of Bipolar Disorder is made when there is at least one manic episode.

A major depressive episode is a sustained period of abnormally low mood, low energy and low motivation to participate in life. The episode should last for at least 2 weeks for a diagnosis to be made. The 2011 Singapore Mental Health Study found that 1 in 17 local residents have suffered from depression at some point in their lives.

Symptoms of a major depressive episode:
  • Depressed mood as reported by the person, and observed by others
  • Loss of interest or pleasure in activities
  • Disturbances in appetite (more often reduced), accompanied by changes in weight
  • Disturbances in sleep (more often insomnia although some depressed persons find themselves sleeping excessively)
  • Low energy levels, feeling constantly tired and fatigue
  • Slowing of mental processes and body movements
  • Unable to concentrate and focus on important tasks and work
  • Feeling worthless, helpless and hopeless
  • Suicidal thoughts and behaviours

A manic episode is a period of abnormally and persistently elevated or irritable mood, accompanied with abnormally high levels of energy and goal-directed behaviours, which last at least one week.

Symptoms of a manic episode:
  • Inflated self-esteem or grandiosity
  • Reduced need for sleep eg. Feeling refreshed after only 2-3 hours of sleep
  • More talkative than usual
  • Having a lot of ideas about life, work, business and wanting to execute them
  • Increased energy in personal social, school or work-related pursuits
  • Distractibility eg attention is too easily drawn to too many things
  • Engaging in risky activities which result in harm eg. Unrestrained spending sprees, sexual indiscretions, foolish business investments
  • Agitated behaviours

Early diagnosis and access to treatment is crucial. A mood episode has the potential to wreak mayhem to one’s family life, work, school and social life. The longer we allow a mood episode to drag on, the longer the chemical disturbances in the brain goes uncorrected, and more damage it can do to the person’s life.

Treatment
  • Anti-depressants have been scientifically proven in large international studies to be effective in the treatment for depression. They act on 1 or more neurotransmitters in the brain and promote re-balancing of these neurochemicals. Some medications act on serotonin, while others act on noradrenaline and dopamine. Some medications act on more than one neurotransmitter systems. To derive the full benefits of anti-depressant medications, one should persist with the medications for a month or two. 
  • Psychological therapy of various modalities have also been proven to help with treatment of mood disorders. Therapy comes in many forms. It aims to equip us with the skills needed to manage negative emotions and adversity in life. While medications focus on restoring the chemical balance in our brains, therapy teaches lifelong skills which will also help to prevent another mood episode.
  • Lifestyle modification such as exercise, diet and sleep interventions is helpful to alleviate depressive symptoms. For instance, behavioral activation via increase in exercise helps to boost levels of feel-good chemicals in our brains. Exercise also helps us to sleep better and regulates our appetite.
  • Social interventions. Helping the family / school / company understand the disorder may go a long way in enlisting their support and fostering stronger bonds. However, we will only reach out to them with your explicit permission. We understand that sometimes, letting others know about your condition may backfire in ways which are unexpected.

SEEK HELP TODAY

Depression is like a pair of sunglasses, robbing our lives of light, colour and joy. The way we look at the world, events and people around us, is fundamentally altered by the lens of depression. Recovering from depression means welcoming positive emotions, important people and joyful responsibilities back into our lives. We learn to do away with unnecessary suffering while accepting that some suffering may be part and parcel of life. We see colours again and work towards living a good life in accordance to the values which we cherish.

If you suspect that you or a family member is suffering from depression or another mood condition such as bipolar disorder, do not hesitate to seek help early. Call or whatsapp us to arrange a chat with one of our psychiatrists or psychologists. Early treatment often translates to better health outcomes.
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