Are you just feeling sad or do you actually have depression?

Feeling a 'sense of heaviness' while going through it

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When Stacey*, 33, who works in the media industry, went through depression, the “sense of heaviness” she felt was hard to describe. She didn't feel like herself and everything felt very “flat” to her.

“If I had to use colour as an example, I felt like someone had desaturated my world to a sepia tone,” she recalls. “There's was a lot of self-loathing and self-blame too while, at the same time, being angry that all of this was happening to me as I didn't feel like I deserved any of it.

“My therapist gave me a great description of depression – anger turned inwards. I had so much anger towards a lot of circumstances in my life, but I had no idea how to deal with it that I turned all that emotion onto myself instead of processing it,” she adds.

Stacey knew she wasn't just feeling sad as, even though she had periods of overwhelming sadness, it didn't go away even when she did something fun. She was also fatigued all the time and would wake up and go to bed feeling tired even if she had at least eight hours of sleep.

“Brain fog was another big one and it felt like my brain was broken,” she says. “I always prided myself on being an ideas person and can rattle off tons of ideas and possibilities at the snap of a finger when it came to campaigns or projects, but I could barely think straight at this point in time. I was just exhausted all the time and couldn't shut off.”

Stacey soon had difficulty regulating her emotions and felt very emotionally unstable. When an unreasonable client berated her during a meeting, she went home and laid on her bed, just tearing up for two hours as she felt so defeated and tired from it all – even though she knew it was the client who was being unrealistic. In the past, if such a thing happened, she would have just gotten angry and stewed for a while before eventually moving on.

“I was never suicidal, but there were some moments where I did feel like maybe if I got into an accident and could just be away from it all and hide out in a hospital it would be great,” she shares. “The biggest red flag was just feeling overwhelmed all the time and I was crying for an entire month straight. Anything would trigger the crying, not just being sad. One time my housemate literally asked me if I was ok and I just spent the entire day fighting back tears.”

Know the symptoms to look out for

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What Stacey went through is in line with the symptoms of depression, as described by Dr Games. She says that you might be depressed if you're experiencing any of the following signs and symptoms for at least two weeks:

Persistent sad, anxious, or 'empty' mood
Feelings of hopelessness or pessimism
Irritability
Feelings of guilt, worthlessness or helplessness
Decreased energy or fatigue
Difficulty sleeping, early morning awakening or oversleeping
Loss of interest or pleasure in hobbies and activities
Moving or talking more slowly
Feeling restless or having trouble sitting still
Difficulty concentrating, remembering or making decisions
Changes in appetite or weight
Thoughts of death or suicide, or suicide attempts
Aches or pains, headaches, cramps or digestive problems without a clear physical cause that do not ease even with treatment

Unfortunately, depression seems to be more common in women. The Singapore Mental Health Study found that the lifetime prevalence of major depressive disorder (MDD) was higher among women (7.2%) than men (4.3%). It was also more prevalent among men and women who were divorced/separated and widowed women, as compared to those who were single.

Also, the triggers for depression are different between the sexes. Women tend to present with internalising symptoms (eg. sensitivity to interpersonal relationships) while it's more external (eg. sensitivity to external career and goal-oriented factors) for men. Additionally, women experience specific forms of depression-related illness, including premenstrual dysphoric disorder, postpartum depression and postmenopausal depression and anxiety. All these are associated with changes in ovarian hormones and could contribute to the increased prevalence in women.

Dr Games reveals that depression is unlikely to simply go away on its own. In fact, if ignored and left untreated, depression can go on for months, sometimes years, and can have many negative effects on a person’s life. Therefore, everyone needs to find the treatment that’s right for them. It can take time and patience to find a treatment that works, and different types of depression require different treatment.

For example, mild symptoms may be relieved by: learning about the condition, lifestyle changes (such as regular physical exercise), psychological therapy provided by a mental health professional or via online e-therapies. For moderate to more severe depression, medical treatments are likely to be required, in combination with these other treatments.

“Treatment for depression should start with seeing your doctor,” says Dr Games. “Your doctor may ask you to fill out a screening questionnaire or conduct some tests to rule out other conditions. Your doctor may refer you to a psychologist, social worker, counsellor or psychiatrist.”

Tips to manage depression

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In addition to getting specialist help, there are some ways that you can manage depression. Dr Games suggests staying active – even if you think you won't enjoy the activities you once loved, when you do it you actually may enjoy them more than expected. She also advises exercising daily, even if only for a short period of time.

Having a regular sleep pattern also helps. Dr Games shares some tips to achieve this:

Try to go to sleep and get up at about the same time each day.
If you’re worrying about things during the night, set aside some time for problem solving during the day.
Avoid drinking caffeine after 4pm and try not to drink more than two cups of caffeine-type drinks (such as coffee, strong tea, cola or energy drinks) each day.
Avoid using alcohol to help you sleep. As the alcohol is broken down in your body, it causes you to sleep less deeply and to wake more frequently.
Allow yourself time to wind down before going to bed. If you are working or studying, stop at least 30 minutes before bedtime and do something relaxing.
Give your mind a break from online activity such as social media for an hour before bedtime, and consider putting your phone in a separate room from your bedroom at night time.

It's common for people with depression to worry or think negatively. This then affects their ability to focus on getting better and makes them more vulnerable to unhealthy emotions.

Some ways to control worry and reduce negative thinking, according to Dr Games:

Write down what you are worried about. Go through each concern and think about how realistic your negative thoughts are. Explore alternative thoughts and explanations.
Try not to focus on the things you cannot change.
Focus on the present. Accept your thoughts without actively engaging with them.
Write down your problems and brainstorm solutions. Note down the pros and cons with each option and choose the one that seems the best. Review whether it worked to overcome the problem.
Avoid making major decisions about your life at this time.

When going through depression, some people experience irritability. And these feelings can become worse because of changes in sleeping patterns and lifestyle.

Dr Games suggests ways to deal with this:

Tell your friends, family and colleagues what you are going through and that you may appear to be irritable.
If you feel yourself getting angry, stop and take some time out to settle yourself down.
Practice regular relaxation to reduce the effects of irritating or frustrating situations.
Talk to people who are supportive.

Also of importance is connecting with others. “Seek out people who are supportive and who you can be honest with during this time,” Dr Games advises. “You may feel like isolating during this time but it’s helpful and important to stay connected. You can do this by talking or doing an activity together.”

Practice self-care and get the help you need

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As someone who has been through the motions of depression, Stacey has the following advice for anyone going through it now:
1. Talk to someone
"If you feel like your issues are more overwhelming than usual, try to reach out to a support system to let them know you're not okay. Your loved ones might be able to tell if you're more distressed than usual. But do take note that talking to your friends/family is not the same as a therapist and you shouldn't emotionally dump on them."
2. Don't be afraid to try therapy
"I was lucky that I had friends who gently brought up that what I was going through was not normal and recommended I talk to a professional. I don't find going to therapy taboo so making an appointment and sticking to a treatment plan wasn't difficult. The only barrier I faced was thinking my problem wasn't "severe" enough for therapy since I wasn't suicidal."
3. Don't belittle your problems.
"If your problems are debilitating to you (even if they aren't to others), acknowledge that. Often times we're so hard on ourselves and assume we should be able to cope and deal with things on our own, but honestly, it doesn't hurt to have help or learn new coping mechanisms to help us."
4. Practice self-care.
"Look into your life and ask yourself, are you REALLY taking care of yourself? When I'm stressed, my appetite is the first thing to go out of the window. So throughout this period, I ate very little. And after watching a YouTube video of a psychologist talking about one of his patients who did the same, he pointed out that the reason why she had no energy all the time was that she was slowly starving herself. And then it hit me – I was doing the same! So make sure you eat right and sleep well even if your mind/body is telling you to go against all of that – I'm sure a lot of my fatigue could be attributed to my poor habits."

*not her real name