Depression isn’t just an occasional feeling of sadness or moodiness experienced in response to life’s setbacks, like what most people experience from time to time.
A diagnosis of major depressive disorder is made if this overwhelming feeling of sadness or despair:
- Lasts two weeks or longer at a time,
- Interferes with daily routine, occupational functioning, and social life or if there is marked distress as a result of the depression,
- Represents a change from the person’s baseline personality, and
- At least 5 of these 9 symptoms present, nearly every day:
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Depressed mood or irritability most of the day
- Thoughts of death or suicide, or has suicide plan
- Feelings of worthlessness or excessive or inappropriate guilt
- Significant weight change (5%) or change in appetite
- Decreased interest or pleasure in most activities, most of each day
- Diminished ability to think or concentrate, or more indecisiveness
Other causes of low mood should also be screened and excluded:
- Substance abuse (e.g. drugs, alcohol, medications)
- Medical illness causing depressed mood
Updates to the major depressive disorder criteria in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) also state that a major depressive episode can occur in the context of bereavement or grief. The severity of the depressive symptoms, functional impairment and the prognosis are worse in this case, compared with a typical grief reaction that is not accompanied by major depressive disorder.
Management of Depression
Selective serotonin reuptake inhibitors (SSRIs) and serotoninnorepinephrine reuptake inhibitors (SNRIs) are generally considered safer and cause fewer side effects than other types of antidepressants. Cognitive-behavioral therapy is the most popular and commonly-used therapy for the effective treatment of depression.
Reference: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author
Community Mental Health Resources for GPs
The Community Intervention Teams (COMIT), that Agency for Integrated Care (AIC) oversees, support GPs who require help in caring for patients with mental health issues. The teams provide home-based needs assessment, counselling and other therapy for patients and/or their caregivers. They also support with case management, care coordination and monitoring of patient conditions.
For case referrals or clarifications about mental health services, GPs can email firstname.lastname@example.org with the patient’s name, NRIC number, home address, presenting issues and other useful information about the case. If you are interested in supporting the management of patients with
Written by By Adjunct Assistant Professor Tan Pei Lin Lynnette, Consultant, Department of Psychological Medicine