Depression 抑郁症




Case History: Depression

C a 43-year-old professional had been feeling frustrated with his life over the past six months. After his father’s death he found himself questioning his own life. Then he was passed over for a promotion and he was dissatisfied; his job no longer interested him, he found it boring and repetitive. Soon he would awake with a low mood and would dread having to leave the house and within a month became increasingly miserable and sad. The future appeared bleak. He wanted to leave his job but was unable to make any plans. He could not concentrate and assignments piled on his desk as he just sat there trying to decide where to start. At home he would awaken in the early hours of the morning and pace about aimlessly. He lost his appetite and his wife became irritated and kept telling him to “snap out of it”. But it only made him feel worse and useless. Things came to a head early one morning when his wife found him standing by the window crying uncontrollably and saying he just wanted to end everything. 


from MOOD DISORDERS Rathi Mahendran 


Depression


What is Depression?
 
Depression, or feeling sad, is a normal emotion. Usually it is due to a disappointment or frustration, such as a difficult life situation or losing someone. With time, we learn to overcome our problems and accept changes in our lives. But in some people, depression can be so severe that it affects their entire lives, preventing them from coping as they used to. Depression of this degree is an illness and needs treatment.

What causes Depression?
  • There may be a genetic basis to the illness, as it seems to run in families in some cases. However, it can also occur in people with no such family history
  • In women, hormonal changes associated with the menstrual cycle, childbirth, miscarriage or menopause may play a role in causing depression.
  • Certain personality types – those with low self-esteem, poor coping abilities, and those who always view things negatively – are prone to depression
  • Patients with certain physical illnesses such as stroke, Parkinson’s disease, cancer and heart disease may also be more prone to depression
  • External factors such as financial problems, relationship difficulties, or any stressful life event, can trigger or contribute to depression
Whatever the cause, changes in brain chemicals and structure have been shown in patients with depression.

What happens when you have Depression?
It affects the body, mood and thoughts. It affects the way the person eats and sleeps, how he feels about himself, and how he think of things. It is not a passing blue mood that can be simply “willed away”.

How do you know if you have Depression?
The following are the most common symptoms of depression. A person with depressive illness often experiences 5 or more of such symptoms for 2 weeks or longer:
  • Feeling down, gloomy or feelings of sadness that do not go away.
  • Loss of interest in activities that were enjoyed in the past, such as socialising with friends and family.
  • Weight loss or weight gain, decrease or increase in appetite.
  • Difficulty falling asleep or staying asleep; or sleeping excessively.
  • Feeling agitated or restless.
  • Feeling tired and lacking in energy.
  • Feelings of worthlessness or excessive guilt.
  • Difficulty concentrating or have trouble thinking.
  • Frequent thoughts of death or suicide.
 Are you at risk for Depression?
Depression can affect anyone from any social, cultural or economic background. Research has shown that up to 10% of men and 20% of women will suffer from depressive illness during their lifetime. It commonly begins in people between 20 to 40 years old, although it can occur in children or older people. Research has shown that it is more common in people with a family history of depression.

How is Depression treated?
Depression is treated using medications, psychotherapy, or a combination of both.

Medications
Antidepressants are the most widely prescribed type of medication for depression. They take at least one to two weeks to begin working, although many people start feeling better once treatment begins. Side effects, if any, unfortunately often appear before people start feeling better but these side effects usually do not last.

Psychotherapy
Psychotherapy involves finding out what makes the person depressed, what he is thinking of, the way he thinks, discovering ways to deal with the problem more effectively, and helping the person learn to solve problems. Cognitive-behavioural therapy, interpersonal therapy, supportive therapy and psychodynamic psychotherapy are examples of therapies used to treat depression.

Electroconvulsive Therapy
Electroconvulsive Therapy (ECT) is a specialised form of treatment used in certain cases of depression. It involves passing a brief electrical current to the brain to cause a fit in a controlled manner. This is carried out by a team of specially trained doctors and nurses. It is safe, painless and effective, and has no long-term harmful effects to the patient.

Patients may experience some short-term memory loss, but usually recover by 4 to 6 weeks. ECT is used when the symptoms of depression are severe and cannot be controlled by other therapies, or when it needs to be controlled quickly, such as when the patient is thinking of committing suicide.

Patient Education Guide
(Downloadable in pdf format)
Living with Depression
English | Chinese 
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Depression

Introduction

This brochure is based on the Ministry of Health Clinical Practice Guidelines for Depression, and has been written for people with depression, their families and people who care for persons with depression.

We hope that patients and their families will use this brochure to discuss available treatment options with their physicians.

What is depression?

Depression, or feeling sad, is a normal emotion which we are all familiar with. Setbacks such as money, work or relationship problems often cause us to feel unhappy. With time, however, we learn to overcome our problems or accept things for the way they are. We realize that life has its ups and downs, and we are able to carry on despite these occasional difficulties. But in some cases, depression does not go away so easily., or lasts longer and deeper than it should. It is when the symptoms of depression are severe enough to disturb our daily living that depression becomes a medical problem. People with depression often have trouble coping with work, or are unable to fulfill their responsibilities at home. They no longer find their life experience enjoyable or meaningful, and may even have thoughts of death.

However, it is important to remember that depression can be treated.

What are the symptoms of depression?

Aside from feelings of sadness, symptoms of depression may include other emotional changes such as anxiety, irritability or tiredness. Different patients have different symptoms, which may be mental, behavourial or physical. When these symptoms are severe enough to interfere with social, work or family life, depression becomes an illness.

The following symptoms are seen in depression:

Sleep increase/decrease
Interest in formerly pleasurable activities diminished
Guilt, low self-esteem
Energy poor
Concentration poor
Appetite increase/decrease
Psychomotor agitation or retardation
Suicidal thoughts

A person with depression often experiences depressed mood or loss of interest with 4 or more of the above symptoms for 2 weeks or longer.

How common is depression?

Depression can affect anyone from any social, cultural or economic background.

Studies have shown that 9-20% of the population may be affected during their lifetime. In Singapore, depression affects 8.6% of adults and 5.7 % in elderly people above the age of 65.

Depression tends to recur if left untreated. It also occurs together with many medical conditions such as cancers, diabetes or heart disease, and other psychiatric disorders.

How is depression assessed and treated?

Assessment involves a detailed interview, physical examination, and possibly laboratory tests. The doctor will ask questions about the severity and duration of symptoms, and gather important information about recent life events, family history of illness, coping resources available, and assess if there is any risk of self harm.

Treatment involves the use of psychoeducation, medications and psychotherapy, or combinations of these. Each of these treatment methods has its own advantages, and appropriate treatment will be tailored to an individual’s needs. Successful treatment aims to remove all symptoms of depression, so that the patient can return to his or her previous level of good health.

Psychoeducation

The doctor will explain to the patient and his family what depression means, the types of treatments available, any possible side effects, and the length of treatment. Information on lifestyle changes, such as diet and exercise, will be discussed.

Medications

Antidepressants are the main type of medication used to treat depression. There are many types available, and they differ only in the way they act on the brain, their cost, and side effect profile. They are all broadly equally effective. As a first line treatment, most patients are either prescribed a Tricyclic Antidepressant (TCA) or a Selective Serotonin Reuptake Inhibitor (SSRI). Medications take 4 to 6 weeks to show maximum effect, although some people may start feeling better by the end of the first week. If there is no significant improvement, your doctor may switch to a different medication, add on another medication, or use combinations of antidepressants.

Once depression is in remission, medication may be continued for 6 months or more. This is to ensure that the patient remains well and does not suffer a recurrence of the illness.

Psychotherapy

Psychotherapy is a specialized form of counseling or “talk therapy” delivered by a person trained in such therapy. In milder forms of depression, patients sometimes can improve with psychotherapy alone. It may involve exploring what makes one depressed, what one’s thought processes are, discovering what ways there might be to deal with the problem more effectively, and enhancing problem-solving skills. Cognitive-behavioural therapy, interpersonal therapy, supportive therapy and psychodynamic psychotherapy are some of the therapies used to treat depression. 

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is a specialized form of treatment used in certain very severe cases of depression. It involves the passage of a brief electrical current to the brain to induce a controlled seizure. It is delivered by a team of specially trained doctors and nurses. ECT is safe, painless and effective, and does not result in any long-term harmful effects to the patient. Patients may experience some short-term memory loss, but usually recover by 4 to 6 weeks. ECT is used when the symptoms of depression are severe and there is poor response to other therapies, or when a rapid response is needed, such as when the patient is actively suicidal.

What about children and teenagers? Can they also suffer from depression?

Symptoms of depression in children and teenagers may be different from those seen in adults. Children with depression may not say they feel sad; instead they express their emotions as temper tantrums and behavioral problems, or may talk of suicide. Children and teenagers are usually treated using psychotherapy, although medications may also be used.

What about the elderly? Can they also suffer from depression?

In the elderly, physical complaints, feelings of anxiety, concentration and memory problems may overshadow feelings of sadness. Careful assessment and laboratory tests are often needed to rule out a physical illness. Treatment of depression in the elderly is the same as in adults, but medication doses may be lower. Caregivers often need support too.






One in 16 in S'pore has suffered from depression
By Olivia Siong | Posted: 18 November 2011 1220 hrs


Photos 1 of 1

Depression (photo illustration)


SINGAPORE: One in 16 people in Singapore suffered from Major Depressive Disorder in their lifetime, making it the most common mental illness here.

http://news.xin.msn.com/en/singapore/article.aspx?cp-documentid=5551098

- CNA/ck


The following are some resources on Depression complied by National Library Board, Singapore.

This is the html version of the file http://infopedia.nlb.gov.sg/Research/articles/PF-Depression-Dec05.pdf.

PathFinder

National Library Board, Information Services

According to the Singapore Ministry of Health’s public education brochure on depression, close to 9% of the adult population on our island suffer from depression and about 6% of the elderly who are above 65 years are affected. In 2001, more than 20,000 children also received psychiatric treatment in Singapore as a result of school and exam stress, exacerbated by high expectations from their parents to obtain top grades. Depression is a mental health disorder that can affect anyone regardless of age, social status, cultural or economic background. These are some of the symptoms exhibited when a person is depressed and telephone helplines that are available in Singapore for people who need a listening ear to voice out their problems and worries:

Depression

• Persistent feelings of sadness

• Loss of interest in social activities

• Weight loss or gain

• Sleeping excessively

• Insomnia

• Agitated or Restless

• Lacking in energy

• Lack of concentration

• Frequent thoughts of death or suicide

Helplines in Singapore



Samaritans of Singapore (SOS):

Tel: 1800-221-4444 or

e-mail: pat@samaritans.org.sg


Family Service Centre:

Tel: 1800-838-0100


Care Corner Mandarin Counseling Centre:

Tel: 1800-353-5800


Sage helpline:

Tel: 1800-353-8633


Touchline (Touch Youth Service):

Tel: 1800-377-2252

Source: http://www.channelnewsasia.com/yourhealth/depression.htm

Long-term anti-depressant medication and therapy are usually needed to treat depression. When left untreated, over-time, the persistent feeling of sadness can escalate into morbid illness and adversely affect a person’s social, work and family life. With early treatment and with the support and care of friends and loved ones, depression can be controlled and the sufferer can eventually lead a fairly normal lifestyle.

This pathfinder provides resources that will help you to gain an insight into the mental disorder known as depression.

Symptoms of Depression

• Persistent feelings of sadness

• Loss of interest in social activities

• Weight loss or gain

• Sleeping excessively

• Insomnia

• Agitated or Restless

• Lacking in energy

• Lack of concentration

• Frequent thoughts of death or suicide

Helplines in Singapore



Samaritans of Singapore (SOS):

Tel: 1800-221-4444 or

e-mail: pat@samaritans.org.sg


Family Service Centre:

Tel: 1800-838-0100


Care Corner Mandarin Counseling Centre:

Tel: 1800-353-5800


Sage helpline:

Tel: 1800-353-8633


Touchline (Touch Youth Service):

Tel: 1800-377-2252

Source: http://www.channelnewsasia.com/yourhealth/depression.htmPage 2

PathFinder

National Library Board, Information Services

Search Terms and Call Numbers

For library materials, a corresponding Call Number is given for every search-term. These Call Numbers are assigned based on the Dewey Decimal Classification, which the library uses to categorize its books, and to place the books on the appropriate shelves. Below is a selective list of subject headings that can be found in our computer catalogue that may help you locate materials on biographical information.

Search-Terms

Call-Numbers

Depression, mental; depression, mental treatment;

mental disorders, therapy

616.8527; 616.852706

Postpartum depression

306.8743

Manic-depressive illness; depression, bipolar

616.895

Antidepressants

615.78; 616.8527061

Psychotherapy; counseling

616.8914; 616.8915; 616.89165

Books

You can use the search-terms listed above to search for library materials at our Web-Catalogue, which is accessible at http://vistaweb.nlb.gov.sg. Please contact the library before you visit to ensure that the title you want is on the shelf. Contact details of our libraries are available at our website http://www.nlb.gov.sg/CPMS.portal

Title:

Depression: the Mood Disease

Author:

Mondimore, Francis Mark

Publisher:

Baltimore: Johns Hopkins University Press, 1990

Call number:

R 616.8527 MON

Description:

Written for patients and their families, this book provides information on the causes,

symptoms, diagnosis and treatments of depression and also discusses depression

in the elderly and mood disorders in children, adolescents and women.

Title:

Understanding Depression: Feminist Social Constructionist Approaches

Author:

Stoppard, Janet M.

Publisher:

New York: Routledge, 2000

Call number:

R 616.85270082 STO

Description:

This book approaches the understanding of depression in women from a feminist

social constructionist view. Examines the relations between women’s psychology

and biology and their susceptibility to depression, the impact of stress, marriage,

motherhood and aging on women as well as various treatments for depression.

Title:

Prozac as a Way of Life

Editors:

Elliott, Carl and Chambers, Tod

Publisher:

Chapel Hill: University of North Carolina Press, 2004.

Call number:

R 616.8527061 PRO

Description:

The eleven chapters discuss the popularity of Prozac and other mood-enhancing

drugs in treating depression and other disorders such as eating disorders and the

resulting controversial side effects such as suicidal tendencies.

Title:

Caring for DepressionPage 3

PathFinder

National Library Board, Information Services

Authors:

Wells, Kenneth B. et al

Publisher:

Cambridge, Mass.: Harvard University Press, 1996

Call number:

R 616.852706 CAR

Description:

Discusses how depression can be managed and treated in the context of changing

health care policies and models of cost-effective measures that can be adopted.

Title:

Helping Your Depressed Teenager: a Guide for Parents and Caregivers

Author:

Oster, Gerald D.

Publisher:

New York: Wiley, 1995

Call number:

R 616.85270083 OST

Description:

Offers parents and guardians a practical guide to understanding clinical depression

and accompanying suicidal tendencies in their teenage children and treatment

methods available such as counseling and medication.

Databases

Factiva

The Factiva database is available from the multimedia stations in our libraries. It is a full-text database offering

news as well as current business and industry information. It contains news articles from major newspapers

around the globe as well as The Straits Times and The Business Times. Below are two newspaper articles

retrieved from the database using the keywords listed.

Keyword(s) Used: “depression and Singapore” or “depression and children”

Title:

Swing High, Swing Low

Author:

Teo, Cheng Wee

Source:

Straits Times, Singapore (9 Jan 2005)

Description:

Article discusses a brain disorder known as manic depression or bipolar disorder

(BPD), its pre-disposing factors, symptoms and treatments available. Institute of

Mental Health’s chief of general psychiatry also reveals that BPD affects about 1 per

cent of Singaporeans.

Title:

Sad Truth - Mums Often Kill Children in Bid to Protect Them

Source:

The Straits Times Singapore (28 Mar 2004)

Description:

Article reveals that post-partum depression affects 13 per cent of mothers and could

be a possible cause for 23 out of 30 murder-suicide cases reported in Singapore

since 1973, where the women were responsible for killing not only themselves but

also their children.

ProQuest

ProQuest is a database of journal, magazine and newspaper articles. This database is available from multimedia stations in our libraries. It enables you to locate both general information and research articles.

Proquest accepts natural language searching. Below is an article retrieved from the database using the keywords listed.

Keyword(s) Used: “mental depression and treatment” or “ mental depression and antidepressants”Page 4

PathFinder

National Library Board, Information Services

Title:

Treatment of Depression in Children and Adolescents

Author:

Neal D. Ryan

Source:

The Lancet. London: Sep 10-Sep 16, 2005. Vol. 366, Iss. 9489; pg. 933, 8 pgs

Description:

This article provides an overview of the manifestation of depression in youths and

the adverse effects on their schoolwork, family and social life. Also discusses the

effectiveness of various treatments such as psychotherapeutic treatment and

pharmacological treatment.

Websites

We have reviewed websites and selected those which are most authoritative and useful to you.The list includes

websites published by well-known organisations or the government. Again, this will assist you in further in-depth

research on your own. The list was last accessed on 6 December 2005.

Title:

National Institute of Mental Health: Depression

URL:

http://www.nimh.nih.gov/publicat/depression.cfm

Description:

Online booklet describes the three common types of depression, their symptoms,

causes, and treatments, as well as information on how to cope and where to get help.

Title:

Depression.com

URL:

http://www.depression.com/

Description:

Presents a primer to understanding depression, knowing the range of treatments

available and includes coping and support strategies for the patient and caregivers.

Title:

Dr. Ivan's Depression Central

URL:

http://www.psycom.net/depression.central.html

Description:

Contains a wealth of links on the different types of depression and treatment options

such as drug medication, electroconvulsive therapy and psychotherapy.

Title:

Depression-screening.org

URL:

http://www.depression-screening.org/

Description:

Sponsored by the US Mental National Health Association, this website contains

useful information on the symptoms, causes and treatments of depression. Includes

personal stories from four people who have battled with and triumphed over clinical

depression.

Title:

Depression Information and Treatment

URL:

http://www.psychologyinfo.com/depression/

Description

Comprehensive information is provided on the causes, diagnosis and treatment of

different types of depression such as bipolar depression, dysthymic disorder and

seasonal affective disorder. Also discusses depression among the elderly, teenagers

and women.

© National Library Board 2005

Disclaimer: The contents of this document include links to other sites. As a user, you acknowledge that NLB has no control over and makes no representations of any kind, either express or implied with respect to the contents on these sites and that you waive any claim against us with respect to such sites.


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