Ask the health expert: I have been feeling sad, how do I know if it is depression?

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Q: I have been feeling sad, how do I know if it is depression?

Case study: Mr S. is a 55-year-old Chinese man who started experiencing low mood after he was retrenched from his job a month ago. Over the past month, he has been having difficulties sleeping and wakes up in the early hours of the morning every day.

Apart from having a poor appetite and difficulties getting started in daily activities, he is unable to experience pleasure from activities he previously enjoyed, such as playing chess. Mr S confided in his wife after much persuasion, and shared that he has been struggling to get through the day and has thoughts of ending his life.

A: Such feelings of sadness and low mood that Mr S is experiencing can be a normal part of life that many people have gone through at some point in their lives.

However, when negative feelings such as hopelessness and worthlessness persist, and last more than two weeks in duration, you may be suffering from depression.

While depressive symptoms may vary from person to person, here are some common signs and symptoms:

1. Low mood for extended periods of time, which can manifest as feelings of sadness, emptiness, or hopelessness;

2. Loss of interest in daily activities;

3. Appetite and/ or weight changes (more than five per cent of body weight change in a month is considered significant);

4. Changes in sleep pattern: individuals who are depressed can have insomnia, or sleep excessively;

5. Feeling tired nearly every day;

6. Pessimistic thoughts e.g. thoughts of worthlessness or inappropriate and excessive guilt;

7. Difficulties concentrating; or

8. Recurrent thoughts of suicide.

Q: When should I seek help?

It can be convenient to disregard your symptoms and attribute these feelings of sadness to normal changes.

But when should you seek professional help?

1. When feelings of sadness are persistent, pervasive, and last more than 2 weeks;

2. The negative emotions are affecting your ability to cope at work, interfering with your social life, and/or you have difficulties getting through the day;

3. You start self-medicating to make yourself feel better e.g. excessive drinking, smoking or drug use; or

4. When you contemplate suicide as a solution to your problems.

Fortunately for Mr S, Mrs S. recognised his symptoms and brought him to seek professional help at the first instance. He was diagnosed with Major Depressive Disorder. With treatment, his mood improved and Mr S. was back to enjoying his hobbies. He also managed to get a new job.

Dr Poon Shi Hui, Associate Consultant, Department of Psychiatry, Singapore General Hospital