Doctors that specialize in depression

Contents

Doctors for Depression

Psychiatrist

Psychiatrists are licensed physicians who treat mental health conditions. Once they finish medical school, they have four more years of training in psychiatry. They specialize in mental health and emotional problems. A psychiatrist’s special training and ability to prescribe medications can help to improve your symptoms. Some psychiatrists combine medications with psychotherapy. They can help you talk through any emotional issues that may be contributing to your condition. When used in combination with medication, talk therapy has proven very effective in treating clinical depression.

Psychologists

Psychologists are professionals who are prepared at the doctoral level in most states. In some states they can write prescriptions. However, their main focus is psychotherapy or talk therapy. They hold advanced degrees in the science of behavior, thoughts, and emotions. After getting their degrees, they must go through an internship to learn how to perform advanced psychological testing and therapy. Similar to physicians, they must be licensed in their state of practice in order to provide care. They help patients learn how to cope with mental health problems and day-to-day life issues in a healthy way.

Social workers

Social workers need a master’s degree in order to provide talk therapy. They are trained to help individuals with emotional situations. Although social workers have less schooling than psychologists, they can be just as helpful.

What Kind of Doctor Should I See for Depression?

Dealing with depression is hardly an easy journey, and it’s not one that you should take on alone. Trying to cure your symptoms without expert help is a recipe for relapse, but talking with your doctor is a good way to keep your symptoms under control to reduce their impact on your life.

If you’ve read this far, you’re probably thinking “well, what kind of doctor should I see for depression?’

It’s hard to know whether your general doctor will work, or whether you should seek out expert help instead. And, if you decide you need expert help, how do you find the right doctor?

Treatment Options for Depression

Optimal treatment methods for depression have changed in recent years. It’s no longer good enough to provide patients with a pill that stifles their symptoms. Depression treatment needs to focus on bringing you back to complete wellness, both physically and mentally.

Relapse rates for depression are staggeringly high (sometimes as high as 90 percent!), which is why it’s so important to develop a treatment plan that brings you back to complete health. Even lingering low-level symptoms can profoundly impact your brain, dramatically increasing your likelihood of retriggering depression.

To have the best chance of beating depression for good, many experts recommend seeking out treatment for at least nine months. If you’ve experienced chronic depression or repeated bouts, you might need therapy for two years or longer to sufficiently prevent a relapse.

Finding the Right Doctor

When looking for a doctor to help you defeat depression permanently, it’s important to find the right one. You’ll likely be interacting directly for months, even years to come, so it’s important that you find someone you feel comfortable with for the long haul.

When faced with depression, anxiety, or other mental health issues, many people seek out the services of a therapist. Therapists receive specialized training that equips them to treat a variety of problems, and they can look at your depression from multiple angles to provide you with a more comprehensive treatment plan.

Finding the right therapist can be anything but easy, especially if you need one who specializes in depression.

Real Life Counseling provides you with a directory of counselors, an expert in treating depression. You can look through our listings of licensed counselors to find the right kind one for you. Check out the counselor list and find the right one to help you get your depression under control for good.

Mental Health

Author: Canadian Mental Health Association, BC Division

Talking to your health professional about depression is a very important first step. It’s the beginning of your journey to wellness. Once you’ve received a diagnosis, you and your health professional will need to build a treatment plan that works for you. This is vital—if your treatment plan doesn’t address your own needs and concerns, you may not see the benefits in areas of your life that are most important to you. To work with your doctor, you’ll need to take an active role in your care. In our companion tip sheet on dealing with a depression diagnosis, you learned about the importance of learning about depression. Now, you’ll use the information you’ve learned to make decisions around your treatment plan, and later on, you’ll use your treatment to help you manage symptoms and other problems with greater independence.

Treatment for depression is very important. It may be easy to believe that it’s not serious and that you can just “get over it” on your own. It may also be easy to think that nothing will ever help you feel better, and to wonder why you should bother at all. But like many other health problems, it won’t just go away on its own. Left untreated, depression may get worse, lead to other health problems or last for a long time. With treatment, you may start to feel better soon. Deciding to seek help for depression is an important first step on your path to wellness.

What mental health professionals might I see?

You will likely encounter different mental health professionals on your recovery journey. They have different kinds of training and offer different services and supports. Here are the professionals you might see:

  • Family doctors or general practitioners (also called GPs) are medical doctors. They have general medical training, and may have experience in dealing with mental illnesses. They are often your first step in navigating the mental health system. Family doctors can diagnose depression, prescribe medication and refer you to specialized services, like the professionals listed below. Some family doctors even have training in talk therapies like cognitive-behavioural therapy.

  • Psychiatrists are also medical doctors. They have general medical training as well as specialized training in psychiatry. They can diagnose depression, prescribe medication and provide different talk therapies.

  • Registered psychologists can give a diagnosis and provide different therapies, but they don’t prescribe medication.

  • Counsellors (such as Registered Clinical Counsellors or Canadian Certified Counsellors) provide a clinical assessment, prevention strategies, and therapies.

  • Social Workers assess, refer or provide counselling to people living with mental illnesses or people who have difficulties with everyday living skills. They often work as a “case manager” on mental health teams or at mental health centres, which means that they help people solve problems and connect people to different resources.

  • Employee Assistance Plan (EAP) Professionals have various forms of training. They provide counselling through workplace insurance plans.

  • Registered nurses are medically trained caregivers. They work throughout the mental health system and can help with many different health concerns, like monitoring medication. Registered Psychiatric Nurses have special training and specifically care for people living with mental illnesses.

  • Occupational therapists help people improve their daily living skills. They often work within mental health teams.

  • Vocational rehabilitation therapists help people return to their job or find a new job. They may help people upgrade their skills, help people navigate accommodations at their workplace, and help people create a build career plans

How do I talk with these health professionals?

The most effective way to take charge of your health is through shared decision-making. This means that you are an equal partner in the decisions that affect your health. It means taking an active role in finding the treatment approach that works best for you. You may find you want to be very involved, or you may prefer less direct involvement. And your role may vary depending on the stage of your illness you’re at: whether you’ve been recently diagnosed or whether you have a lot of experience with your illness. Regardless of your preferred level of involvement, you do need to be involved to some degree.

Taking an active role in your treatment requires a number of different skills. First of all, it means you need to be able to communicate clearly with your doctor or other health professional. You’ll need to speak with them in an informed way about what you think the problem is, how it affects your daily life and what you expect to get out of treatment. Good communication with your doctor allows you to share in the key decisions about your treatment plan or strategy.

Once you’ve developed your initial strategy, your next role is to help monitor the results. For this, you’ll need to know when and how to measure success. For example, you’ll need to know how long it may take for the medication to start working or how long it may take to see results from psychotherapy. You also need a clear idea of what impacts you hope treatment will have on your daily life. This helps you measure success against these expectations.

When you have an idea of what you hope to achieve, you need to be able to tell your doctor or mental health care professional what has been happening between visits. If necessary, you may need to discuss adjustments to your plan—such as changing a medication dose, trying a different medication or trying a different treatment approach altogether. It may take a while to find the approach—or combination of approaches—that works best for you.

Remember that you’re doing all this work while you’re depressed. Depression can affect how you interact with your health professional. Depression can affect your memory and concentration. That’s why it’s helpful to bring lists of questions in with you, or take notes, or give yourself reminders of appointments. You can also take along any self-assessments, like online self-tests, you’ve completed. Depression can also make you feel hopeless (what’s the point of getting help?) and ashamed (I’m embarrassed to tell my doctor how bad it is…), which is why bringing a loved one or a self-test printout to appointments can help you too.

Shared decision-making can be viewed as a series of steps that lead to an effective treatment plan for you. These steps are:

  • Defining the problem. Your role is explaining the problem in your own terms.

  • Setting goals. Deciding what the goals of treatment will be, or deciding what will happen as a result of treatment.

  • Making decisions. Developing and deciding on treatment strategies. You’ll want to balance the advice of the mental health professional with your own expectations and priorities for treatment.

  • Monitoring results. Evaluating whether strategies are working, and re-assessing the treatment plan as needed.

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Step One: Defining the problem

When you go to see a mental health professional, they will talk with you to assess your problem. Your job is to give as much information as you can in your own words to give the doctor the full picture of what’s going on. Your doctor will also need to know what you’ve experienced in the past and what treatments you’ve tried in the past.

It’s also important to talk about how your mental health is affecting different areas of your life, such as your job, your home life and your relationships. For example, do you have a hard time concentrating at work? Do you spend less time with family and friends? Do you feel like you don’t have the energy for social events? Are you less certain that life is still worth living? This is valuable information for your mental health professional. It will also help you set goals in the next step, as your treatment plan should help you make changes in the way your mental health affects your daily life.

It’s useful to think of these issues ahead of time and write down key information. You can bring this to your appointment to help remind yourself of what you want to discuss. Some people find it helpful to bring trusted family members or friends to explain the changes they’ve noticed.

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Step Two: Setting goals and making decisions

Before you decide on a treatment strategy, you need to think about what you want to change. Your eventual satisfaction with your treatment plan will depend on whether it helps you deal with the way depression impacts your life.
Your sense of priorities may be different from those of your health care professional, so you will need to be able to explain what your priorities are and why they’re important.

When you’re working these issues out, you’ll need to be open to advice from your health professional or support network, and open to consider new information and perspectives that may change your ideas. The ideal situation is one where you can communicate your own concerns, list new information and perspectives, and then come together and agree on a strategy of what goals to address first.

Once you’ve decided on some of the issues you can realistically address, you then need to decide on some concrete goals that you plan to achieve. Concrete goals are specific enough that you can picture what they will look like and mean in your daily life. For example, if you’ve become more socially isolated, a goal may be to become more socially active. To achieve this, you need to be more specific. A concrete goal out of this might be to phone one friend in the next week.

How do I set concrete goals?

Ideally, your goals should be SMART. That is:

  • Specific—how exactly will you do it?

  • Measurable—how will you measure progress in your goal?

  • Achievable—does your goal seem too hard to reach?

  • Realistic—knowing yourself, are you willing and able to put in the work do it?

  • Timely—when do you want to achieve your goal by?

That means your “goal statement” should state:

  • What you want to achieve and who is responsible

  • How much you are going to change

  • When you’re going to achieve it

  • How you’ll measure whether you’ve achieved it or not.

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Step Three: Making decisions

Deciding on a treatment plan that you can live with involves different parts:

  • Considering the evidence

  • Considering your own preferences and values

  • Considering other people’s experiences

Considering the evidence

When you consider an option for treatment, you need to know some basic facts about the treatment. You need to find out how the approach works, how long it will take to work, what the potential risks and benefits may be, and whether it’s an appropriate choice for you. Here are some questions to keep in mind when you consider the evidence, whether it came from your doctor or you came across it on your own:

What are the intervention options? What could the risks or benefits look like in your life? What are the chances that the risks or benefits might occur, when might they occur, and how long might they last?
What might happen if you do nothing? What are the possible negative outcomes? How do the benefits and harm weigh up to you? What do you want to get out of treatment? What risks are you willing to take? Do I have enough information to make an informed choice? Are there any treatment options you haven’t considered?

If you’re considering information you heard from a friends or information from the media, the Internet or a book someone gave you, check out our tip sheet “Evaluating Mental Health and Substance Use Information”.

Considering your own preferences and values

Making a decision involves more than weighing information. It also involves thinking about your own attitudes—including your values and fears.

You will need to consider all the things that influence your thinking, including your personal values, emotions and attitudes about your illness and potential treatments. For example, some people have concerns about medications, like concerns about becoming too reliant on medication or fear of side effects. Before making a decision one way or the other, you should reflect carefully on which of the issues apply to you and have an open discussion with your mental health professional so that you can address your own particular concerns. This helps you make an informed choice.

Your culture and family background will also play a role in how you approach treatment, and in what you think causes your depression and what can help it. It’s important that your doctor understands your point of view. It’s also important you talk about other treatments you’re considering, as there may be risks in combining some treatments. Doctors are highly valued in most cultures. But asking questions and sharing concerns is not a sign of disrespect. It’s a sign you want to learn more from their knowledge.

Considering other people’s experiences

It may be helpful to look at other people’s experiences. It can provide a lot of valuable information, and can often provide reassurance. It’s best to talk to several people, not just one or two, to get a variety of perspectives. Everyone’s situation is unique, but there are often things in common. Support groups are a good place to learn from others. You can also find stories of other people’s experiences in books and online.

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Step Four: Monitoring results

Once you start a particular treatment approach, it’s important to monitor whether it works in relation to your goals. Remember, the success of your treatment isn’t just about symptoms and side effects. You’ll also need to evaluate the success of the treatment in terms of its success in minimizing the impact of your illness on your life, and your ability to function in settings and roles that are important to you.

To play an active role in monitoring your treatment, you’ll need a sound understanding of your illness and of potential side effects to watch for. You may need help telling the difference between a symptom of your illness and a side effect of your treatment because they may look the same. There are many tools to help you track your progress, such as diaries and charts. We’ve included one here and on the HeretoHelp website, but you can use others you like better. You can even find software, apps and online resources to help you track your progress.

In the short term, the purpose of using these monitoring tools and approaches is to get a general sense of whether your treatment strategies are working as well as you think they should. They can also help track other influences on your depression. You can then communicate with your doctor, so that if need be, you can reassess the treatment strategies and attempt to figure out a better one. In the early stages of developing a treatment strategy, you should meet fairly regularly with your mental health professional to monitor your progress and come up with different strategies, if necessary.

Remember to be patient. In some cases, it can take a number of tries to find an approach that works. This is a normal, although frustrating, part of the journey. If nothing seems to work, it’s important to make sure that your diagnosis is correct, or see if another problem is making your mental health harder to manage. For some people, the barrier to finding an approach that works is not a misdiagnosis, but low expectations on the part of the mental health professional. If you feel like you should be feeling better but your mental health professional is unwilling to try different options, you should consider asking for a second opinion or looking for someone who may be able to help you better.

It is important to maintain hope in situations where nothing seems to work. If you and your mental health professional take a systematic approach to exploring different options, the chances of finding the right approach are quite high. In the meantime, you need to keep trying different options until you find an answer that helps you live successfully with your illness.

Sticking with your treatment plan

Once you’ve arrived at a treatment plan that works, it’s important to stick with it. This isn’t always easy, and you may have to think about some of the issues in advance. For example, if you don’t feel comfortable taking medication for a long period of time, it may be tempting to quit taking medication when you start to feel better (usually after a few weeks). Unfortunately, this can lead to a relapse or other problems.
If your treatment plan isn’t working for you—for whatever reason—it’s important to have an honest discussion with your health care professional. This is especially important if you want to stop taking medication. Suddenly stopping a psychiatric medication can be uncomfortable or even dangerous. Your doctor can help you re-evaluate your treatment plan and move to a different strategy safely.

It may be more helpful to think of these issues in terms of managing your health rather than “compliance” or “adherence,” which is what health professionals call sticking with your treatment. You may want to think about how your treatment plan can help you manage depression, rather than wonder how long you’ll need to take medication or wonder how long you’ll need to see your therapist.

Now that you’ve decided what you want to change, the next step is figuring out how you’re going to change it. In some cases, this will involve helping to choose a medication that’s right for you. In other cases, it may involve counselling approaches like cognitive-behavioural therapy. Or it may be a combination of medication and counselling. You may also benefit from information or referrals to community resources like case management, supported housing, supported employment or income assistance programs. Finally, you’ll need to decide on a plan for dealing with your illness outside of your doctor’s office.

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Activity: Mood Journal

Example:

Mood influences

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

Medication (dose)

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Counselling

1 hr appt

Skills I practiced today

10 min mindfullness meditation

thinking traps worksheet

10 min mindfulness meditation

10 min mindfulness meditation

10 min mindfulness meditation

Sleep

6.5 hrs

6 hrs

7 hrs

7 hrs

7.5 hrs

8 hrs

8 hrs

Exercise

30 mins

30 mins

30 mins

1 hr

Overall stress level

Alcohol and other substance use

1 drink

2 drinks

2 drinks

Work time

5 hrs

5 hrs

6 hrs

5 hrs

5 hrs

Overall mood

Mood influences

Mon

Tues

Wed

Thurs

Fri

Sat

Sun

Medication (dose)

Counselling

Skills I practiced today

Sleep

Exercise

Overall stress level

Alcohol and other substance use

Overall mood

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Where do I go from here?

Your doctor or mental health professional can recommend resources in your community. In addition to professional resources, you may find non-professional support helpful.

BC Partners for Mental Health and Addictions Information
Visit www.heretohelp.bc.ca for more fact sheets on depression and mood disorders, self-tests and personal stories. You can also find the info sheets, ”Dealing with a Depression Diagnosis” and “Preventing Relapse from Depression.”

Support groups
Support groups are an important way to find support and information. They may help you feel less alone and more connected, even if you haven’t told many others about your diagnosis. You can find support groups in your community through the Mood Disorders Association of BC online at www.mdabc.net or by phone at 604.873.0103. You can also find support groups online. For more on choosing the right support group for you, see the fact sheet, “Picking the Support Group that’s Right for You” at www.heretohelp.bc.ca.

Understanding Psychiatric Medications
The Centre for Addiction and Mental Health in Ontario offers guides for four different kinds of psychiatric medications: antidepressants, antipsychotics, mood stabilizers and benzodiazepines. You can find these guides online at www.camh.net.

Canadian Network for Mood and Anxiety Treatments
Visit www.canmat.org for information on treatments for anxiety disorders and mood disorders. You can also find the Depression Guidelines, which lists evidence-based treatments for depression.

Reclaiming Your Power During Medication Appointments
Visit www.power2u.org/articles/selfhelp/reclaim.html for the article, “Reclaiming Your Power During Medication Appointments” from the National Empowerment Center. It describes how to think about medication and work with health professionals as you work towards your treatment goals.

Learn more

This the second module in a three-part series. The other two modules are Dealing with a Depression Diagnosis and Preventing Relapse of Depression.

This tip sheet has been adapted from an older resource from BC Partners and HeretoHelp: Macnaughton, E. (2003). “Module 3: Becoming an Active Partner in Treatment: Shared Decision-Making.” Depression Toolkit: Information and Resources for Effective Self-Management of Depression. Canadian Mental Health Association, BC Division.

About the author

The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.

© 2011 | Back to top | PDF | Managing Depression series | More info sheets

To get better, you need expert help. Many people with depression have a team working with them. This might include your regular health care provider, a psychologist or therapist, and a psychiatrist or psychiatric nurse.

But getting the right people may seem intimidating. Here are some answers to common questions about finding a doctor and psychologist or therapist. Following these questions, you’ll find a list of tips for how to prepare for your first appointment.

  • What kind of expert do I need to see? People with depression often see a few different experts. You might see a non-MD therapist as well as a doctor or nurse for medicine. The Mental Health Parity and Addiction Equity Act of 2008 requires that health insurance plans do not put restrictions on coverage for mental health services that are different from coverage for other medical or surgical treatment. The Patient Protection and Affordable Care Act provides federal support for low-income individuals to obtain health insurance. Some mental health professionals or clinics also offer a sliding scale based on income.
  • Why can’t I just see one doctor? Your primary care doctor can prescribe antidepressants, but family doctors usually don’t have expertise in prescribing drugs for treating psychological conditions. So if the first or second antidepressant you try does not help, your doctor may recommend that you see a psychiatrist who can better prescribe the medicines you need. Primary care doctors also are not trained to practice psychotherapy. So you may turn to a psychologist, social worker, or psychiatrist for therapy. Psychiatrists are doctors who can prescribe antidepressants and other medications and sometimes also offer therapy. They are, though, often more expensive than non-MDs.
  • How do I find a therapist or a psychiatrist? Ask your regular doctor for a recommendation. You can also get in touch with organizations such as NAMI, the National Alliance for the Mentally Ill, which can suggest experts in your area. Keep in mind that anyone can call himself or herself a “therapist.” Your therapist should be a licensed psychiatrist, psychologist, social worker, psychiatric nurse, or counselor.
  • What should I look for? Therapists and psychiatrists use many different approaches. Some focus on practical, here-and-now issues. Others go deeper, probing events from your past that might have played a role in your depression. There are specific forms of psychotherapy that have been shown to be helpful for depression – such as cognitive behavior therapy or interpersonal psychotherapy. Many therapists use a mix of styles. When you first talk to a potential therapist or psychiatrist, ask about his or her approach to see whether it seems appropriate for you and your condition. If it’s not a good fit, find someone else. If you don’t click with a person, therapy is less likely to help. You may also want to look for someone who specializes in your particular problem. For instance, if you have a problem with drugs or alcohol, find a doctor or nonmedical therapist who specializes in treating people struggling with addiction.
  • What if treatment doesn’t help? Once you’ve settled on a therapist and doctor, you need to give therapy and medication a chance to work. Getting better takes time, often several months. Treatment for depression can be hard at first. Opening up to someone about very personal things in your life isn’t easy. But most people do get better with treatment.

Depression

  • Asian Pacific Americans: Meeting the unique needs of immigrants and refugees, our Asian Counseling program offers culturally appropriate care.
  • Adults: With state-certified mental health professionals in 11 primary care locations, our integrated services help you get the care you need. Adults with private health insurance or who are interested in fee-based services receive expert treatment through our General Counseling Services. Adults with serious mental illness receive treatment and support through our Adult Community Support Services.
  • What is Depression?

    Everyone occasionally feels blue or sad from time to time. However, these feelings are usually short-lived and pass within a couple of days.

    When you have depression, you feel this way all the time. Depression interferes with your daily life.

    People with depression are often at risk for other conditions, including anxiety disorders, panic disorder and chemical dependency. If you already have another condition, depression can make it worse.

    What Causes Depression?

    Depression is one of the most common mental health conditions in the U.S. A variety of factors can cause depression, including:

    • Biology: Brain imaging studies, such as magnetic resonance imaging (MRI), have shown that the brains of people who have depression look different than those of people without depression.
    • Heredity: Some types of depression tend to run in families. However, depression can occur in people without a family history.
    • Stress: Stressful life events, such as losing a loved one or losing your job, may trigger the symptoms of depression.
    • Other medical conditions: Certain medical conditions, such thyroid disorders, can cause symptoms similar to depression.

    What Are the Symptoms of Depression?

    Everyone experiences the symptoms of depression differently. These symptoms may include:

    • Persistent sad, anxious or “empty” feelings
    • Feelings of hopelessness or pessimism
    • Irritability and restlessness
    • Loss of interest in once-pleasurable activities or hobbies
    • Difficulty concentrating, remembering details and making decisions
    • Trouble sleeping at night, early morning wakefulness or excessive sleeping
    • Overeating or appetite loss

    How Do We Diagnose Depression?

    We diagnose depression through an interview with one of our physicians or mental health professionals. During this interview, you discuss your symptoms; including how long you’ve experienced them and how they are affecting your daily life.

    How Do We Treat Depression?

    Even if you have severe depression, treatment can help you feel better. The sooner you receive treatment, the more effective it is. Common treatments include:

    • Counseling: Talking with one of our state certified mental health professionals can help you:
      • Learn how to process negative thoughts in a more constructive way
      • Change behaviors that may be making your depression worse
      • Find ways to work through troubled relationships that may be contributing to your depression
    • Medication: Your doctor, working together with our professionals, may decide that a medication, such as an antidepressant, should be part of your treatment for depression. If medication is recommended, it may take some time to find the right one for you.

    You should not expect to suddenly “snap out of” your depression. However, treatment can help your mood lift gradually.

    Common symptoms of Depression

    You are likely to be depressed if have the following for more than 2 weeks. (Source: DSM 5th) The more symptoms you experience, the more likely you are depressed.

    • Lousy mood
      • Nearly every day and all the time
      • Other similar feelings: sadness, tearfulness, hopelessness and feeling empty
    • Loss of interest
      • Can’t seem to find pleasure or fun in all or almost ALL activities in the day
        • Commonly seen in our clinics: loss of interest in sex, work, hobbies and child care
        • “Nothing seems interesting or fun anymore”
    • Drastic weight change
      • Includes weight loss or weight gain
      • When not intentionally trying to do so, i.e through dieting
    • Sleep disturbance
    • Can be sleeping a lot or cannot sleep
    • Extremely common in Singapore
    • Often the first complaint seen in our clinic
    • Unusual physical problems
      • Very common in the elderly
      • Can be a mixed bag of symptoms like: aches and pains, digestive issues, ear, nose, throat and eye problems, giddiness and headache
      • Normally would have seen many doctors and tried many treatments to no avail
    • “No energy”.
      • Severe soul sucking lethargy and tiredness
      • Movements, speaking and sometimes even eating can be slow
    • Feelings of guilt or worthlessness
      • Excessively blaming yourself for many things which are beyond your control
    • Decreased ability to work
      • Poor concentration
      • Severe indecisiveness, e.g. can spend an entire day thinking about whether you should leave your room or whether you should clear the bin
    • Suicidal thoughts
      • Thinking about dying as nothing is worthwhile anymore, and nothing is “working”
      • You might have a plan or no plans yet
      • If you have this, no matter what, don’t waste time reading, please SEEK HELP NOW.
        • Call 995
        • Call SOS: 1800 221 4444
        • Walk in to ANY nearest Clinic
        • Walk in to IMH Emergency
        • Talk to someone

    Am I depressed?

    As you can see above, there are many symptoms and they are quite common. So, am I depressed? What if I don’t have all the symptoms?

    For a start, I highly recommend this TEDed Video.

    “What is the difference between sadness and depression?”

    As you can see from above, depression is quite different from the usual sadness.

    Depression happens ALL THE TIME even when there can be no obvious triggers. It is also much more severe than the usual sinking sadness that everybody feels from time to time. Sadness is very much a normal human emotion.

    One way of differentiating sadness and depression is to use the Beck’s cognitive triad1.

    The triad consists of a distorted “self view”, “world view” and “future view”.

    Example 1

    Let’s use an example: say you lost your job today. You start to feel sad that you are possibly incompetent. You sulk at home, but as your bank account nears zero, you start looking for a job again. Before you know it, you are back on track again and your sadness lifts as you find yourself useful again.

    This is normal sadness.

    Another example

    OK, say you lost your job again today, and you start to feel sad that you are possibly incompetent. You start to think that perhaps you have been incompetent your whole life and right from the beginning since you were born (“distorted self view”). Then, you start thinking that everyone around you is against you, blaming you and have always been unhappy due to your incompetence (“distorted world view”). As you continue to starve at home and do “nothing”, you feel that the future is bleak as you are so useless anyway (“distorted future view”). Sometimes, you even contemplate suicide.

    This is NOT normal sadness, this is depression.

    But it’s OK if you still cannot differentiate between the two, you can always talk to one of us: our psychologist or our doctors to have a proper evaluation.

    Most importantly, it can be treated.

    What depression is not:

    • a sign of weakness
    • a character flaw
    • madness
    • contagious
    • something to be ashamed about
    • a punishment from God due to your heavy “sins”

    You CANNOT talk someone into depression, or for that effect out of depression (unless you are trained in therapy).

    What is depression then?

    Depression is an illness, much like fever, cough and flu, except that depression is much worse, much more disabling and much more chronic: think stroke, heart attack and renal dialysis. (These diseases are scary as they don’t kill, but they make you live on miserably)

    Although experts do not have a definite answer yet, most of us would agree that depression is an “end result” of many different physical, mental and biological stresses coming together.

    What we do know is that it is a REAL illness with physical deterioration, hormonal changes2 and shrinkage in the brain3.

    So asking someone to “snap out” of depression is certainly going to work as well as asking someone to “snap out” of his fever, for example.

    Why do I get depression?

    These are the known risk factors of depression4:

    • Internal Factors
      • Genetics
        • When doctors want to study genetic links, we normally look at twins who have the exact same set of genes.
          • For depression, the chance of the twin having it is 37%5 (compare that with type 2 diabetes: 90%6)
      • Neuroticism
        • Tendency for feeling sad
      • Low self-esteem
      • Early-onset anxiety disorder (younger than 18 years old)
      • Past history of major depression
      • Parenting factors7
        • Parents having a mental illness
        • Substance abuse in parents
        • Parents with criminal records or parents who are incarcerated in jail
        • Low parental warmth
    • External Factors
      • Substance misuse
      • Conduct disorder
    • Adversity in life
      • Trauma (emotional) during childhood or adulthood
      • Stressful life events in the past year
      • Loss of a parent
      • History of divorce
      • Marital problems
      • Low social support
      • Low education

    Different types of depression

    • Adjustment Disorder
      • Short duration of some of the above symptoms in response to an extremely stressful event.
      • Expected to recover after the event passes, if it passes.
    • Dysthymia
      • Persistent “chronic” depression.
      • Typically takes about 2 years to diagnose.
    • Bipolar Disorder
      • The depression is part of the cycle between mania and depression.
    • Postnatal Depression
      • Depression triggered by the burdens of caring for a newborn. It affects both males and females.
      • Risk increases if you have8:
        • psychological difficulties in the past
        • marital discord
        • have little support in childcare
        • other stresses while caring for the child (ie child has a medical or developmental problem)

    Symptoms | Treatment | Suicide | Community Resources

    How depression affects people at different stages of life

    In children

    The child’s mental health is heavily influenced by the environment on top of their genes. Children are dependent on their caregivers and circumstances and cannot fend for themselves.

    Severe adversity such as the loss of a loving parent or abuse from a caregiver could leave a child confused and traumatised.

    However, no two child are the same. Some children are more prone to developing problems than others. Once mental illnesses set in, changes in behaviour and daily functioning can be observed by caregivers and teachers.

    Common symptoms:

    • Increased irritability
    • Anger outbursts
    • Pain such as headache and stomachache that cannot be explained
    • Sudden drop in school performance and social withdrawal

    In teenagers

    Teenage years are punctuated with many roles to navigate — changing hormone levels, constantly growing physical body, adjustment to new schools, major exams such as PSLE and ‘O’/’N’/’A’ Levels, forming new friendships and romantic relationships… to name a few.

    In the face of constant changes, unpredictable outcomes and stormy emotions, it is no wonder that many teenagers find it difficult to cope. They may withdraw socially from time to time. While some manage to bounce back and fight on, others fall into depression.

    If the adolescent’s low mood, irritability, ability to connect with others and academic achievement are severely affected for more than two weeks, it could be a warning sign that depression has already crept in.

    In adults

    Adulthood is the time when all the responsibilities arrive at your doorstep at one go.

    Suddenly, you are responsible for the physical and mental well-being of your children, your parents and your partner, all in a limited time and space (yes, houses in Singapore are just too small!). While adulthood presents us with challenges in and of themselves, having had a rough childhood (e.g. having suffered emotional or physical abuse or losses) puts one at a higher risk of depression in adulthood.

    Adults with severe depression report strong and recurrent thoughts of hopelessness, self-blame and self-criticism. Thoughts take on a life of their own, and depressed people are well aware of this phenomenon. Anger is common. It is natural to feel angry with oneself when one cannot muster enough physical and mental strength to accomplish the work that needs to be done. Not having the “energy” to negotiate with and persuade others, a depressed person might find himself/herself lashing out at others while all he/she wanted to do was to problem-solve. What follows is more guilt, increased self-blame, harsher self-criticism and another downward spiral into deeper depression.

    In elderly

    Oftentimes, depression in elderly is a continuation of the disease since their younger years. While age-related changes and difficulties could lead to a brief period of reactive depression, a full-blown depression is often the result of the condition being untreated in their younger days.

    The golden years also herald the start of many chronic and medical illnesses. A crushing diagnosis of cancer or a terminal illness can bring even the strongest person to his/her knees. It can be very normal to experience reactive depression, which is depression directly due to a medical illness, but it doesn’t mean that it cannot be treated.

    “Hassles”9 , or small inconveniences in life, have been recognised to be related to depression in the elderly. Seemingly minor problems can accumulate and the more “hassles” there are, the more likely an elderly will suffer depression especially when the coping mechanism is unhealthy. Here are some of the commonly recognised “hassles”:

    • Difficulty walking and getting around
    • Caring for another sick family member
    • Physical pains
    • Financial issues
    • Eyesight and hearing problems

    Other than medical illnesses, close friends and family members will also start to pass on and the “survivor” can feel intense loneliness and social isolation, which can in turn predispose him/her to the onset of depression.

    Common triggers of depression in Punggol/Singapore

    Punggol is a new town teeming with young working families. Not surprisingly, common triggers of depression our clients have experienced include:

    • Marital discord and extramarital affairs
    • Childbirth (for the mother as well as the father!)
    • Highly stressful work environment (think: trainee teachers on practicum, National Servicemen, bankers etc).
    • Traumatic childhood experiences that can interfere with the ability to form stable and trusting connections as a person enters adulthood

    Symptoms | Treatment | Suicide | Community Resources

    Treatment

    When we feel completely stuck in this “cloud” of depression, we can easily lose sight of what we really NEED vs what we WANT.

    It is often helpful to talk to someone kind and supportive. It can be a friend, a relative, a spiritual mentor or a therapist. Sometimes, we just need someone to see that we are suffering. We see flickers of hope when we have someone to accompany us in this dark time. Sometimes we see solutions through talking. Sometimes the solution is simply to allow ourselves to grief without guilt.

    I encourage you to reach out – to yourself and to others. Sadness is a common suffering of humanity. It strikes everyone at least a few times in our lifetime.

    Talk to an agony aunt

    If you happen to be the person putting on this “agony aunt” or “counsellor” hat, here are some quick tips:

    DO NOT:

    • Ask them to snap out of it
    • Be judgmental
    • Offer quick judgement or a quick fix
    • Rush

    DO:

    • Listen attentively, lean your body forward and maintain eye contact
    • Be sensitive to his/her emotions (not the circumstance)
    • Resist the urge to do as much as possible. Try to refrain from providing “solutions” most of the time (Why? You are depriving someone of the joy of learning to overcome and improve themselves)
    • Allow your own emotions, such as crying if you feel like crying
    • Stay with the emotion
    • Refer him/her to a trained professional if you think that this is too much for you to handle

    Psychotherapy

    You could see a psychologist for therapy. Read this article for more details. Get to the root of the problems.

    Medications

    The success rate of treatment with medications for illnesses of mild to moderate severity is about 50-60% no matter which medication is taken10 with a higher success rate the earlier the illness is picked up11.

    The doctor might recommend the following types of medications for you:

    • Antidepressants
      • Broad class of medications thought to increase the energy levels and lift the mood.
      • The experts think that it works on the “serotonin pathway in the brain”, but the truth is that nobody really knows how exactly it works. For that reason, we also cannot predict exactly who will not respond to them.
      • A quick Google search will show many possible side effects. Keep in mind that they are only possible, not definite. Most people do well on these medications with no side effects.
      • The doctor must have weighed the benefits and risks before giving one to you.
      • If you have been prescribed one, please remember that the most important thing is to stay on it.
      • It takes some time for the full effects to kick in.
      • If you do experience any side effects, the one person you should talk to is your doctor.
    • Antipsychotics
      • Less commonly prescribed for depression, normally reserved for the patients whose conditions are more severe.
      • Again, if this has been prescribed for you, you are highly recommended to stay on it.
      • The doctor probably thinks that you are at a significant risk of harming someone/yourself, being admitted to a hospital or having a very serious illness.
      • Again, please stay on it, and if you do experience any side effects, the only person you should talk to is your doctor.
    • Sleeping tablets
      • For short-term use only to help solve sleep problems.
      • Long-term usage might be associated with addictions.

    “Do I need both medication and therapy?”

    The success rate is highest when both medication and therapy are used together.

    “Can I be treated?”

    …. and how long does it take?

    We understand that the longer the duration of untreated depression, the stronger the “imprint” and the higher the chance of “permanent” injury to your mind and body. Hence, the earlier we pick up this problem, the faster the patient can recover. The patient will also require less medications and a shorter duration of therapy.

    Depression in Singapore is often picked up very late and hence, treatment is started late. It is very sad when it happens and when it happens every day, it is a tragedy on a societal scale. So please, if you know someone whom you suspect could be sick with these symptoms, please ask them to seek help early. Speak to our psychologist or our doctors. You can also bring them to this FREE clinic at *SCAPE.

    Symptoms | Treatment | Suicide | Community Resources

    Community Resources

    Websites or readings

    Thrive: Khoo Teck Puat Hospital mental health website.
    Great patient information leaflet from AAFP about medications.

    Find a psychiatrist

    You can find one in any government hospital or private practice. Those in government hospitals will require a referral from a polyclinic.

    Find a family physician who has interest in psychiatry

    Sorry, IMH and AIC has taken the list offline. As of now, our doctor is the only one on this list. We are obtaining consent from the other doctors to be placed here.

    Find a psychologist

    You can leave us a request for therapy by leaving your details in the form below. We will contact you to book an appointment.

    Alternatively, you can check out a list of psychologists who have joined the Singapore Psychological Society.

    (Wondering what is the difference between a psychiatrist, psychologist, family physician and therapist? Read here)

    Find a therapist

    • FREE counselling by Silver Ribbon
    • CLARITY Singapore
    • Family Service Centres

    Find support

    • Walk in to a FREE clinic in Orchard hosted by CHAT
    • Join Hougang or Simei Care Centre

    Here is a wonderfully inspiring video by them.

    • Join CLUB HEAL and their activities. There is a centre at Bukit Batok.
    • Clean up your house: Habitat for Humanity

    If you think your website or organisation belongs here, please contact me now.

    Symptoms | Treatment | Suicide | Community Resources

    Suicide

    If you have 5 minutes in your life, please read this great article. If you don’t, please:

    • Call 995
    • Call SOS: 1800 221 4444
    • Walk in to ANY nearest Clinic/Hospital
    • Walk in to IMH Emergency
    • Talk to someone

    2. Vreeburg SA, Hoogendijk WJG, van Pelt J, et al. Major depressive disorder and hypothalamic-pituitary-adrenal axis activity: results from a large cohort study. Arch Gen Psychiatry 2009;66(6):617–26.

    3. Koolschijn PCMP, van Haren NEM, Lensvelt-Mulders GJLM, Hulshoff Pol HE, Kahn RS. Brain volume abnormalities in major depressive disorder: a meta-analysis of magnetic resonance imaging studies. Hum Brain Mapp 2009;30(11):3719–35.

    4. Kendler KS, Gardner CO, Prescott CA. Toward a comprehensive developmental model for major depression in men. Am J Psychiatry 2006;163(1):115–24.5. Sullivan PF, Neale MC, Kendler KS. Genetic epidemiology of major depression: review and meta-analysis. Am J Psychiatry 2000;157(10):1552–62.

    6. Barnett AH, Eff C, Leslie RD, Pyke DA. Diabetes in identical twins. A study of 200 pairs. Diabetologia 1981;20(2):87–93.

    7. Green JG, McLaughlin KA, Berglund PA, et al. Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry 2010;67(2):113–23.

    8. O’hara MW, Swain AM. Rates and risk of postpartum depression—a meta-analysis. International Review of Psychiatry 1996;8(1):37–54.

    9. Catanzaro SJ, Horaney F, Creasey G. Hassles, coping, and depressive symptoms in an elderly community sample: The role of mood regulation expectancies. Journal of Counseling Psychology 1995;42(3):259–65.

    10. Papakostas GI, Fava M. Does the probability of receiving placebo influence clinical trial outcome? A meta-regression of double-blind, randomized clinical trials in MDD. Eur Neuropsychopharmacol 2009;19(1):34–40.

    11. Ghio L, Gotelli S, Marcenaro M, Amore M, Natta W. Duration of untreated illness and outcomes in unipolar depression: a systematic review and meta-analysis. J Affect Disord 2014;152–154:45–51.

    We are all familiar with negative emotions. Depression, however, is something quite different. It’s estimated that over 300 million people suffer from depression (equivalent to 4.4% of the world’s population).

    The Singapore Mental Health Study (conducted in 2010), revealed that 5.8% of the adult population in Singapore suffered from Major Depressive Disorder at some point in their lives.

    How is depression dealt with in Singapore from a medical perspective? Psychiatrist Dr Ng Beng Yeong answered several questions related to depression. Here are some of his key points.

    A face-to-face assessment and the DSM 5 diagnostic criteria is used to diagnose depression

    Psychiatric conditions are often diagnosed through a face-to-face interview (known medically as a mental state examination).

    Dr Ng revealed that many doctors in Singapore tend to use the DSM 5 diagnostic criteria for depression.

    These criteria include:

    • Low mood, most of the day, almost every day
    • Lack of interest or pleasure in activities
    • Sleep disturbances
    • Changes in weight
    • Fatigue
    • Feelings of worthlessness, hopelessness or guilt
    • Poor concentration or indecisiveness
    • Recurrent thoughts of death

    Blood tests may also be required to exclude other causes for low mood

    If a patient is having anxiety or severe depression, psychiatrists may also decide to order a blood test.

    This is to investigate and exclude any abnormalities in the thyroid hormone level.

    Anxiety and depression often go hand-in-hand

    According to Dr Ng, these two conditions often coexist. In other words, a patient with depression is very likely to have anxiety as well.

    Concerned about treatment costs? Try the polyclinic

    If you think that you’re struggling with depression but worried about the treatment cost, Dr Ng recommends that you start seeking treatment at the polyclinic first.

    From there, you can get referred to a restructured hospital for further attention.

    Social workers at restructured hospitals help you look into your financial situation, and apply for assistance whenever needed.

    For private psychiatrists, don’t be afraid to call and ask for consultation charges

    If you choose to seek treatment from a private psychiatrist, Dr Ng suggests for you to call up the clinic and talk to the clinic staff who can advise you on the consultation charges.

    For a person who has the first episode of major depression, he/she would most likely need to take an antidepressant for about 6 to 9 months.

    The cost of the medication largely depends on the type of antidepressant that is chosen. In some cases, the cost of the medicine can be as low as $30 a month.

    You can also seek treatment from a GP for depression

    Aside from restructured hospitals, you can also seek treatment from a family physician/GP.

    However, you should find a GP who has an interest in treating mental health conditions. He will be able to diagnose your condition and start you on an antidepressant.

    Depression treatment often includes talk therapy

    Aside from medication, treatments may also include talk therapy.

    This allows your doctor to establish a more in-depth assessment of your mental condition. A popular example of talk therapy is cognitive behavioural therapy.

    What is cognitive behavioural therapy (CBT)?

    This type of talk therapy is usually more effective than simple counselling or supportive psychotherapy.

    It involves analysing a person’s thoughts and behaviour in order to modify his/her style of thinking and coping with challenges.

    CBT often involves ‘homework’ and must be done frequently to produce lasting improvements.

    Antidepressants take 4-6 weeks to take effect. Don’t give up!

    According to Dr Ng, the response from antidepressants takes time (4 – 6 weeks in some instances).

    Due to this, many patients make the mistake of giving up on their medication too soon.

    There are different types of antidepressants that work better for different patients

    A reader claimed that both antidepressants and talk therapy were not effective at all for her.

    Dr Ng explained that sometimes, this may be due to the “type” of antidepressant. It’s not uncommon for a person to not respond to one particular type of antidepressant, yet respond well to another.

    Many antidepressants fall within the SSRI (serotonin-specific reuptake inhibitor) family. Your doctor may consider switching you to another SSRI if the first one you take is not effective.

    Commonly used SSRIs in Singapore include sertraline, escitalopram, fluoxetine, fluvoxamine, and paroxetine.

    It’s also a good idea to note down all the medication that has been prescribed to you in the past, as well as the effects.

    Seek treatment early

    Depression in Singapore is a common mental disorder, and you should definitely get it treated as soon as possible.

    Help is readily at hand!

    Would you like to ask any related health questions?
    You can Ask A Doctor right away, or view the complete list of DoctorxDentist Sessions.

    1. The Modified Mini-Mental State Examination test: normative data for Singapore Chinese older adults and its performance in detecting early cognitive impairment | SMJ. Smj.org.sg. Published 2012. Accessed January 6, 2020.

    Through their publications and teaching, key psychiatrists influence how mental illness is diagnosed.

    They decide what goes into the Diagnostic And Statistical Manual Of Mental Disorders (DSM), which is used to classify mental illness.

    It is telling that the number of DSM diagnoses has swelled from the original 182 to 365 today. Of the 170 contributors to the current version of the DSM, some 95 have received money from Big Pharma, including every contributor on the DSM entry for depression.

    Most of the evidence that Prozac and other antidepressants seemingly work comes from very short-term studies.

    The Emperor’s New Drugs: Exploding The Antidepressant Myth (2010) by Irving Kirsch shows that even this unimpressive evidence depends on selective data cherry-picking by industry-linked psychiatrists.

    Using the Freedom of Information Act, Dr Kirsch, a University of Hull psychologist, procured all trial data that Big Pharma has to present to the US regulator (which only looks for positive data for efficacy.)

    His analysis of that unpublished data showed today’s popular antidepressants to be really just strong placebos.

    Thus, the finding that so many people seem to be severely depressed may reflect nothing more than Big Pharma’s marketing prowess.

    Diabetic? Get screened for depression early

    This article was first published in The Straits Times on Feb 9, 2011

    By Poon Chian Hui

    Depression may affect how patients manage their condition, say experts

    Early screening of diabetic patients for depression is critical, say the researchers of a study by the Institute of Mental Health (IMH) and Khoo Teck Puat Hospital (KTPH).

    Depression may influence how the patient manages his condition. “They may not diet properly, exercise regularly or take their medication,” said Associate Professor Swapna Verma, a psychiatrist who heads the IMH’s early psychosis intervention department and is a collaborator in the study.

    The study, done between August 2006 and February 2007, asked more than 530 diabetic patients – of whom 31 per cent had already been identified as suffering from depression – to give their perceptions of their quality of life in eight areas.

    These were physical functioning, physical role (how well they could do various activities), bodily pain, general health, vitality, social functioning, emotional role and mental health.

    Those suffering from depression gave negative responses in all eight areas.

    But other survey participants who were not depressed were more positive in their perceptions, even diabetes sufferers with serious medical complications.

    For example, those with complications like stroke and retinopathy, a potentially blinding eye disease, perceived they fared poorly in only twoareas – physical functioning and physical role.

    These findings were published in the latest edition of Annals, a journal by the Academy of Medicine Singapore.

    In Singapore, about 11 per cent of adults aged between 18 and 69 are diabetic. Most have Type 2 diabetes where cells fail to properly use insulin, a hormone that keeps blood sugar levels normal. Such levels are then maintained via an appropriate diet and exercise.

    Type 1 diabetes is where the body fails to produce enough insulin, and sufferers may need daily insulin jabs.

    Patients in the study who said they exercised regularly performed better than those who never exercised.

    They reported better physical functioning, vitality and mental health as well as less bodily pain.

    Researchers said early screening will be useful as many diabetic patients are unaware of their depression, with some symptoms, such as fatigue, viewed merely as a consequence of diabetes.

    “As a result, the symptoms get masked,” said Prof Swapna.

    Most diabetes clinics in private and public hospitals currently do not have a structured screening system in place.

    Endocrinologist Stanley Liew of Raffles Hospital, who is not part of the study, said most doctors here carry out “opportunistic screenings”.

    They look out for signs of depression during the patients’ regular consultation visits, and refer them to a psychiatrist where necessary.

    At KTPH, the study has spurred it to assess diabetic patients via three questionnaires that look at depressive symptoms, diabetes-related distress and quality of life.

    A preliminary review showed that patients managed better scores after going through a programme called Management of Depression and Distress in Diabetes, said Dr Chan Keen Loong, a senior consultant at the department of psychological medicine at KTPH.

    The programme offers counselling, education and anti-depressant medication.

    Dr Liew noted that doctors have traditionally focused more on the health aspects of diabetes, such as maintaining proper blood sugar levels.

    “But maybe we should also put more emphasis on the psychological and emotional effects,” he said.

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