Updated: Jan 12
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Depression — a word most people tend to throw around without realising the severity of. Globally, more than 264 million people suffer from depression. Depression is more than just feelings of sadness or unhappiness. It has the power to disrupt the daily routine of the sufferer. In worse cases, depression can lead to suicide. 
What is Depression?
Depression, also known as major depressive disorder or clinical depression, is a mood disorder that can happen at any point in life, and negatively affects the psychosocial function of the patient.
This means that his or her ability to perform normal daily activities such as sleeping or eating, as well as to form relationships is severely limited.
Studies have shown that the prevalence of depression is more common in women compared to men.  Also, the first episode of depression usually occurs in people in their late teens to mid-20s.
What are the symptoms of Depression?
As depression is not the same as the occasional unhappiness that we may feel, it is important to know the symptoms of depression. This way, you will be able to seek professional help if needed. 
Symptoms of depression include:
Feelings of sadness, hopelessness, emptiness or tearfulness
Anhedonia (inability to feel pleasure in normally pleasurable situations)
Feelings of guilt or worthlessness
Feelings of anxiety, agitation or restlessness
Angry outbursts, irritability or frustration
Suicidal thoughts or plans
Changes in appetite, resulting in weight loss or weight gain that is not related to dieting
Fatigue or loss of energy
Sleep disturbances such as having trouble sleeping or sleeping too much
Decreased ability to think or concentrate, or indecisiveness
Although the symptoms above are observed by most patients of depression, there may be additional symptoms to look out for in patients from certain age groups.
Aches and pains
Refusing to attend school
Poor performance or attendance at school
Feeling misunderstood or extremely sensitive
Using recreational drugs or alcohol
Avoidance of social interactions
Memory difficulties or personality changes
Aches or pain
Loss of interest in sex not due to a medical condition
Avoidance of social interactions
How does depression feel?
Many people have the misconception that depression is just the feeling of unhappiness or sadness and that people can “snap out of it”. 
While the feeling of sadness is common amongst those suffering from depression, depression is much more severe than just mere sadness. Symptoms of depression can last for months or even years. The simplest of task can seem to take up an excessive amount of energy.
Some sufferers describe being in depression as the feeling of not being able to continue living or emptiness that resembles a black hole. It is also not uncommon to hear sufferers describe depression as being self-consuming and wanting to isolate oneself from others.
How does depression affect your brain?
Research has shown that depression can affect your brain by causing structural alterations to various parts of the brain, such as the: 
Frontal lobe: responsible for a wide variety of functions such as motor functions, memory, language, judgement and social behaviour
Thalamus: controls emotions, memory and arousal
Striatum: involved in decision-making, reward perception, motivation
Parietal lobe: involved in organisation and decision-making, and is related to emotional processing and cognitive changes (how people observe, think, solve problems and remember)
Hippocampus: involved in memory recall, learning
Apart from structural alterations to various parts of the brain, depression also interferes with several circuits in the brain such as the:
Prefrontal-subcortical circuit: involved in emotional and cognitive processing
Prefrontal-hippocampal circuit: involved in attention span, information processing and memory
Fronto Thalamic circuit: involved in decision-making and problem-solving
Due to the structural alterations and impairment of circuits in the brain, depression contributes to several symptoms observed in depression such as:
Lowered attention span
Poor information processing
Reduced executive function of the brain, such as not having the mental ability to perform simple tasks
Increase in suicidal tendencies
How is depression different from sadness?
You may wonder how to differentiate between depression and sadness. Sadness is a normal emotion that everyone will feel at various points in their life, such as the death of a loved one, financial troubles or even failing an exam in school. Generally, people can feel better when they are sad by crying or venting. 
The main difference is that, unlike depression, sadness usually goes away with time and does not usually result in a person being unable to carry out normal daily activities.
Sadness is a reaction to an event, while depression is a pair of glasses that make everything in life appear negative.
How is depression diagnosed in Singapore?
To be diagnosed with depression in Singapore, an individual has to experience at least 5 depression symptoms for nearly the whole day, every day for at least 2 weeks. At least one of the depression symptoms that the individual presents should be either a depressed mood or loss of pleasure or interest. 
Assessment of depression and examination of mental state
Firstly, basic checks regarding the patient’s history, mental state and physical health are carried out.
Detailed history of presenting symptoms are obtained and the severity and duration of the episode are determined.
Any history of prior episodes, prior manic or hypomanic episode, substance abuse or other psychiatric illnesses are obtained.
Family history is checked for any mental illness, depression and suicide.
Personal history, as well as available resources and support, are established.
Life events and stressors are determined.
Functional impairment is evaluated.
Severity of symptoms is evaluated.
Psychotic symptoms are assessed.
Risk of suicide, self-harm, and risk of harm to others are assessed.
Physical examinations are done to rule out medical or surgical conditions that may be causing the symptoms.
Laboratory tests may be ordered if required.
DSM-5 and ICD-10
In Singapore, depression is most commonly determined using DSM-5 and/or ICD-10 which are the standard classification tools used in healthcare.
Depressed mood or self-report or observation by others
Loss of interest or pleasure
Loss of interest
Fatigue or loss of energy
Reduction in energy
Worthlessness or excessive or inappropriate guilt
Loss of confidence or self-esteem or Unreasonable feelings of self-reproach or inappropriate guilt
Recurrent thoughts of death, suicidal thoughts or actual suicidal attempts
Recurrent thoughts of death or suicide
Diminished ability to think or concentrate or indecisiveness
Diminished ability to think or concentrate or indecisiveness
Psychomotor agitation or retardation
Change in psychomotor activity with agitation or retardation
Insomnia or Hypersomnia
Significant appetite and or weight loss
Change in appetite with weight change
While DSM-5 is usually used to determine if a depressive episode is occurring, the severity of depression is determined using ICD-10 according to the number of symptoms that the patient reports having.
ICD-10 Depression Episode
Apart from DSM-5 and ICD-10, Singapore utilises a number of other diagnostic tools and questionnaires to help in the diagnosis.
Hamilton Depression Rating Scale (HAM-D): Used on patients already diagnosed with depression and used to evaluate severity of depression
Hospital Anxiety and Depression Scale (HADS): Developed for general medical patients (does not include physical symptoms due to medical conditions e.g. pain) and can be used to screen for anxiety and depression
Montgomery-Asberg Depression Rating Scale (MADRS): Used to evaluate severity of depression
Beck Depression Inventory
Patient Health Questionnaire 9 (PHQ9): Used for screening, monitoring and assessing the diagnosis and severity of depression
What are the causes of depression?
While scientists are unable to pinpoint a direct cause of depression yet, there are a number of factors that have been linked to depression, such as: 
Genetics: Your genetic makeup can determine the vulnerability of a person to become depressed.
Changes in neurotransmitter levels: Over- or under-sensitivity to neurotransmitters (chemicals that help to transmit messages in our body) can cause one’s mood to be affected significantly.
Environmental factors (e.g. stressful life events): Chronic stress or trauma can result in changes in your brain and body, resulting in depression.
Medical conditions: Medical conditions such as thyroid imbalance, heart diseases, neurodegenerative diseases such as Alzheimer’s disease, and nutritional deficiencies can cause depression.
Drug and alcohol use
Can depression be cured?
Depression is a lifelong condition, and there is no permanent cure for it. Studies have shown that at least 50% of people who have recovered from an episode of depression will go on to have one or more additional episodes in the future.
Having said that, depression can actually be treated and be put under control with the right treatment. Patients can take medication and make lifestyle changes that can enable them to live a long and healthy life. 
Can depression cause death?
Depression does not necessarily result in death, but there are links between depression and suicide. Depression can cause suicidal tendencies in some, especially if the extent of depression is more severe. Statistics show that 4% of people treated for depression in the hospital actually commit suicide.
Suicide is preventable and it is important to look out for signs so help can be given before a life is lost. Some tell-tale signs of possible suicide include:
Direct or indirect talk of wanting to die
Increased social isolation
Giving away valued possessions or preparing for death
Can depression be inherited?
Yes, depression can be inherited. Studies have shown that genetics have played a strong part in the contribution of depression and that the predisposition to depression is determined by both genetics and environmental factors.
Scientists estimate the heritability of depression to be about 40-50%. If someone has a family history of depression, the person is 2-3 times more likely to develop depression compared to someone who does not have a family history of depression. 
That being said, having a family history of depression does not mean that your offspring will definitely inherit it, as depression can be affected by a whole list of environmental factors. Studies are still being carried out to further determine the specific genes involved in the inheritance of depression so a more detailed understanding can be established.
Are depression and anxiety related?
Depression and anxiety are different mental conditions, but they often occur together. Feelings of anxiety are a symptom of depression. Depression can also occur due to anxiety disorders such as generalised anxiety disorder, panic disorder and separation anxiety disorder.
What are the types of depression?
There are several types of depression, such as:
Major depressive disorder (MDD) or clinical depression
Persistent depressive disorder (PDD): chronic depression lasting for more than two years but usually less severe than MDD
Bipolar depression: periods of extremely low mood due to bipolar disorder
Postpartum (or perinatal) depression: a type of depression happening after birth due to changes in hormones, fatigue and other hormones in women, or lifestyle changes in men.
Seasonal affective disorder (SAD): recurring type of depression that usually strikes in fall or winter
Premenstrual dysphoric disorder: similar to premenstrual disorder (PMS) but more severe, usually causing severe irritability, depression and anxiety 1-2 weeks before your menstrual cycle begins
Psychotic depression: severe depression symptoms accompanied by delusions and hallucinations
What are the treatment options for depression in Singapore?
After being diagnosed with depression, your doctor will offer some treatment options depending on the severity of your depression (mild/moderate/severe). There are a number of treatment options available which are helpful in managing and treating depression.
Treatment of depression in Singapore usually occurs in 3 phases:
Acute phase: aims to remove all signs and symptoms of current depression episode and to restore psychosocial and occupational functions
Continuation phase: intended to prevent relapse of depression (recovery is declared when the patient displays no signs and symptoms of depression for 6 months after acute phase)
Maintenance phase: aims to prevent a new episode of depression and may be prescribed for 1 year to a lifetime, depending on the chances of recurrence
Pharmacotherapy, in the form of antidepressant drugs, has been shown to be effective in the treatment of depression.
Antidepressants work by increasing levels of neurotransmitters in the brain such as serotonin and noradrenaline, which are linked to mood and emotions. Serotonin helps to regulate satisfaction, happiness and optimism, while noradrenaline helps to regulate attention, motivation, reward, learning and memory.
Common antidepressant drugs prescribed in Singapore include:
tricyclic antidepressant (TCAs) e.g. Amitriptyline (Tryptizol)
Serotonin Reuptake Inhibitors (SSRIs) e.g. Fluoxetine
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) e.g. Duloxetine and Venlafaxine
Noradrenaline and specific serotonergic antidepressants (NASSAs) e.g. Mirtazapine
Psychotherapy involves fostering a relationship between the patient and a therapist, who will listen to and help the patient to overcome negative feelings or behaviour. Psychotherapy can be done individually, as a family, as a couple, or in a group (3 to 15 people).
There are a few types of psychotherapy available, such as:
Cognitive therapy focuses on the idea that our thoughts affect our emotions. As such, in cognitive therapy, therapists help patients learn to identify common patterns of negative thinking and to turn the negative thoughts into positive ones, which can improve mood.
Behavioural therapy focuses on changing behaviours that affect emotions. As such, patients are encouraged to engage in activities that will improve their mood and well-being.
Cognitive-behavioural therapy (CBT):
Cognitive therapy and behavioural therapy are often combined together. CBT focuses on addressing the negative thought patterns and behaviours that contribute to depression. This way, you can learn new and healthier ways of thinking and responding.
During CBT, you may be asked to keep a journal that tracks any self-defeating or negative emotions or thoughts. Other activities that you may be requested to do during the course of your CBT include relaxation activities and completing worksheets.
Interpersonal therapy focuses on interpersonal conflict and poor social support that results in depression. During interpersonal therapy, your therapist will examine past and present relationships with your family, friends and coworkers.
You will learn new ways to resolve conflicts, as well as improve your communication to help build a stronger social support system.
Psychodynamic psychotherapy assumes that depression occurs due to unresolved conflicts (mostly arising from childhood). This type of therapy helps patients become more aware of their emotions, and help them put their feelings into perspective.
Electroconvulsive therapy (ECT) is a procedure done under general anaesthesia, whereby small currents of electricity are passed through the brain, triggering a brief seizure. It is said that ECT causes changes in brain chemistry and can reverse symptoms of depression and other mental health symptoms quickly.
ECT has been used for more than 50 years, and 80-90% of patients showed improvement after the treatment and remained well for months thereafter. In Singapore, written consent has to be given before ECT treatment can proceed.
What are the costs of treatment for depression in Singapore?
The costs of treatment for depression in Singapore are not necessarily expensive, as patients can qualify for a subsidised rate if they are referred to IMH by a doctor at a polyclinic.
Of course, the prices can increase sharply if treatment was sought at a private hospital or a private therapist instead. Different types of medications given may also cause the costs to vary.
Subsidised cost per month
Unsubsidised cost per month
Therapy and Counselling
$240 for 4 sessions
$800 for 4 sessions
If you have to be warded to receive inpatient care at IMH, the costs are as follows:
Saying Wellness Centre (private)
General Ward (may differ based on patient's subsidy level)
Daily ward fee
1 bedded: $440
2 bedded: $310
B1 4 bedded: $250
B2 4-6 bedded: $61
C 8-12 bedded: $32
Daily treatment fee
1 bedded: $94
2 bedded: $94
B1 4 bedded: $78
B2 4-6 bedded: $31
C 8-12 bedded: $15
Can I use Medisave for my depression treatments?
Yes, inpatient psychiatric treatments for depression in Singapore are claimable by Medisave (up to $150/day and capped at $5000/year). You may claim up to $100/day under Medishield Life.
Are there any alternative treatments for depression?
Some may turn to alternative treatments to help manage or treat their depression. Some alternative treatments include:
Herbal medicine: St John’s wort, ginseng, chamomile and lavender have been said to help reduce the symptoms of depression and also reduce anxiety and stress.
Acupuncture: Studies have shown that acupuncture can reduce the severity of depression.
Exercise: Exercise releases endorphins, which make people feel good. At the same time, exercise supports nerve cell growth in the hippocampus, which improves nerve cell communication and reduces symptoms of depression.
Meditation: Meditation trains the brain to achieve focus and can return to the state of focus when negative feelings or emotions occur.
Yoga: Yoga can reduce the impacts of stresses and help with anxiety and depression.
Deep breathing: Deep breathing slows down the release of cortisol (stress hormone), which increases the symptoms of anxiety and depression.
How can I prevent depression?
Here are some ways to help prevent depression or a relapse of depression:
Avoid stress: Stress is linked to depression and anxiety, and people have a higher chance of getting depression if they have chronic stress.
Exercise: Physical activity acts as an antidepressant and can reduce symptoms of depression.
Keep a healthy diet: Keeping a healthy diet can help prevent depression and boost well-being. Eat fresh fruits and vegetables, fish and whole grains while cutting down on red meat, trans fats and sugar.
Have enough sleep: There is a link between insomnia and depression. Lack of sleep may worsen the symptoms of depression.
Refrain from alcohol and drug use: Alcohol and the use of recreational drugs increase the risk of depression.
Where can I seek help for depression in Singapore?
If you suspect you are suffering from depression, do not hesitate to seek help. The earlier you seek help, the earlier professional help can be rendered to you to help bring your condition under control.
Places where you can seek help for depression include polyclinics, public and private hospitals, as well as Clinic B or the Child Guidance Clinic at the Institute of Mental Health (IMH).
If you do not wish to visit hospitals or IMH, there are also free hotlines available for you to talk to someone.
National Care Hotline (8am-12am daily): 1800-202-6868
IMH’s Mental Health Helpline: 6389-2222
Samaritans of Singapore: 1800-221-4444
Silver Ribbon Singapore: 6385-3714
Tinkle Friend: 1800-272-4788
Depression is a serious mental health condition that has the ability to throw your life off balance, and even result in the loss of your loved ones. Do try to seek help as soon as possible if you suspect that you may be depressed, so you may receive treatment and manage your condition.
For those who know someone who is depressed, remember to be patient with them and lend them a listening ear.
At frankie, we make mental healthcare and wellness easy for all with just one small task a day. Head on guided wellness journeys that understand your stressors or triggers or work with our behavioural and wellness professionals - all from the comfort and privacy of your home. Sign up for our Closed BETA here.
This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.
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