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
- 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!
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.
2. Berkman ND, Brownley KA, Peat CM, et al. Table 1, DSM-IV and DSM-5 diagnostic criteria for binge-eating disorder. Nih.gov. Published December 2015. Accessed January 6, 2020.