It was a routine check-up with Madam Wong for her high blood pressure, but there were niggling signs that she had a bigger problem.
I noted that the married mother of three, who is in her 40s, had neglected taking her medication. She also complained of headaches and poor sleep. After repeated probing, she revealed that she was feeling stressed.
She had found out that her husband had an extramarital affair six months ago, she said.
The discovery led to her having suicidal thoughts and she was then admitted to a hospital where she was treated for major depression.
However, she later stopped going for treatment and taking her prescribed antidepressant as she did not feel any improvement after following the regimen for a week.
She felt she could "snap out of her problem" on her own.
She did not seek further help until five months later when she went for a routine check-up at the polyclinic. That was when I noticed that she was still depressed.
Major depression is a major health problem and remains one of the top 10 leading causes of years lived in disability worldwide, according to the Global Burden of Disease study reported in the Lancet last year.
When she found out about her husband's infidelity, Madam Wong felt betrayed and angry. She cried every day, got tired easily and could not focus on her household chores.
Her fatigue and inability to concentrate were made worse by her lack of sleep and poor appetite.
She lamented to me that her husband was ungrateful. After all, she had made sacrifices for the family, including caring for her husband's father when he fell sick.
On further questioning, Madam Wong admitted that her depressed mood, fatigue and distractibility further led her to discontinue taking the medication for her chronic condition and depression.
SEEK HELP EARLY
Major depression is a major health problem and remains one of the top 10 leading causes of years lived in disability worldwide, according to the Global Burden of Disease study reported in the Lancet, a medical journal, last year.
The 2010 National Mental Health Survey reported that 5.8 per cent of the local population will suffer from major depression at some point in their lives.
Clinically, major depression is a multifaceted condition and can affect an individual in various ways. He may experience the following symptoms:
• Feeling down, irritable, loss of interest in daily events;
• Agitation or withdrawal from others;
• Poor sleep and appetite;
• Poor concentration, thoughts of guilt or worthlessness, suicidal thoughts.
They affect the individual's ability to function on a daily basis and affect his relationship with others around him.
When those with depression first seek help, they may have fewer or atypical symptoms. This is also the case when the individual is less forthcoming due to social inhibitions or the cultural taboo of not wanting to "air dirty linen in public". It is not true that people experiencing depression can just snap out of it. They should seek help early.
In addition, patients like Madam Wong may expect the effect of the antidepressant to be immediate.
Such expectations need to be managed with counselling and education about the gradual effect of these medications.
Madam Wong underwent treatment for her depression with our psychologist. She also saw our care manager, who counselled her on her hypertension. She continued her follow-up with the healthcare team at the polyclinic.
With the coordinated efforts of the healthcare team, Madam Wong understood her condition better and was compliant with her medication prescriptions.
With regular review and encouragement from our multidisciplinary team, Madam Wong slowly overcame her stressors and did not require antidepressants for her depression.
She has since taken up a diploma and has now rejoined the workforce, taking charge of her life.
Depression can be a draining illness. The individual should seek help early if there is evidence of any symptoms such as the loss of interest in activities he used to enjoy, especially if it also interferes with studies, work, and interpersonal relationships.
Together with their healthcare professionals, people with depression can overcome their condition and live meaningful and productive lives.
Those who have the above symptoms should speak with their doctors.
• Dr Winnie Soon is a family physician, consultant, clinical adviser for allied health (psychology services and medical social services) and programme director for Health & Mind Service at the National Healthcare Group Polyclinics.