We experience happiness and sadness in our everyday life. You might ask, "I feel sad so easily and the sad mood last for the whole day or even more than one day. Do I have depression? What is the difference between having a bad mood and being depressed?"

Having a bad mood, even last for days, can be a normal life experience for anyone. However, having depression is a clinical feature which may need both medication and psychotherapy. Depression is also called "common cold of mental disorder". It is time-limited and usually resolve within 3-6 months without proper treatment. However, relapse is frequent if no treatment is received and about 15-20% of people turn into chronic course. According to studies in western countries, an individual may have 4-8% probability in their life to be suffered from Major Depression. 15-20% of adults suffer significant levels of depressive symptomatology. Moreover, consistent findings show that women suffer depression twice the time of men. Their gender difference can be explained by the multiple roles women played in society; the traditional roles that molded women to be dependent, less assertive, low self-esteem, passive, etc.; difference in hormonal change between women and men such as menstruation, postpartum depression and menopause; chances of being physcially and sexually abused; as well as life crisis like divorce.

Depression affects our life including our behaviours, our interest, our attitude and motivation, our mood, our health, our skills and job performance as well as our role functioning. A person can check from the following list to see whether he/she has depressive symptoms which last 2 weeks or more. The more one has, the more he/she needs help from professionals. The symptoms listed are not designed to make a diagnosis of depression.

• I do things slowly
• My future seems hopeless
• It is hard for me to concentrate on reading
• The pleasure and joy has gone out of my life
  
• I have difficulty making decisions
• I have lost interest in aspects of life that used to be important to me
• I feel sad, blue, and unhappy
• I am agitate and keep moving round
• I feel fatigued
• It takes great effort for me to do simple things
• I feel that I am a guilty person who deserves to be punished
• I feel like a failure
• I feel lifeless---more dead than alive
• My sleep has been disturbed---too little, too much, or broken sleep
• I spend time thinking about how I might kill myself
• I feel trapped or caught
• I feel depressed even when good things happen to me
• Without trying to diet, I have lost, or gained, weight

If one suspects that he/she may have depression, consults an EAP professional as soon as possible.

There are 3 types of depression. Major Depression is a serious form of depression. It can affect all aspects of a person's life or even lead to committing suicide. "Dysthymia" is a more common and a mild form of depression. People may have such depression in react to any loss in life or triggered by situations. Manic- Depression or Bipolar Disorder manifest itself in a cycle of mania and sadness.

One might be interested in knowing what leads to Depression. Unluckily, there is no universal theory that can explain the cause of depression. The interplay of different factors may best explain its etiology at this moment. They include biological factors such as genetics and neurotransmitters, significant stressful life events, maladaptive coping response as well as effects of early environment such as family history (e.g. depression or alcoholic history?) and events in childhood (e.g. parental separation?).

Case Illustration: Mrs. A, 40/F

Early Experience

Mrs. A is the younger child of a two children family. She used to be picked on by her parents as "stupid" and "ugly" since childhood. Her parents and relatives also made unfavorable comparison with her elder brother about their academic performance and characters frequently. When Mrs. A started her primary school life, she also tended to make self- criticism and comparison with her own peers in both appearance and academic performance.

Dysfunctional assumptions

As she grown up, she worked in a big company for 12 years after her master-degree graduation and she was highly appraised by co-workers and superiors. She was even awarded the "best employee of the year" in her department. Although her efforts and performance were being appraised, dysfunctional assumptions formed since her childhood which made her difficult to appreciate her own achievements. Examples of such dysfunctional assumptions were "I am inferior and useless", "My worth depends on what other people think of me", " Unless I do what other people want, they will reject me".

Important loss in life

Recently, her department was undergoing restructuring and the function she used to do was eliminated. She was offered by the company for a new function which she was totally ignorant about it. She was extremely angry about the company's arrangement and she resigned. After her resignation, she could not find a job in her expertise and she was idling at home for about one year.

Symptoms and Negative automatic thoughts

Mrs. A came to seek help with her husband as she had strong suicidal ideations. She cried all the days whenever she came across anything which reminded her about her lost of job. She lost her appetite. Her weight fell from 60kg to 45kg in 2 months. She also had severe insomnia. She could not perform her role as a housewife as she lost motivation to do anything. She became lethargic and forgetful. For example, her utility bills and bank statements were unsealed for months. When she failed to do something she planned to, guilt and anger came out. Then she criticized herself, hit her head against wall, yelled or thought of killing herself. Moreover, she used to ruminate about her negative automatic thoughts such as "I am a failure --- I can never achieve anything", "People who do not have a job are not worthless---Every person should have a job", "I am stupid --- My life is useless". Such negative automatic thoughts acted to trigger her sadness, guilt, anger and frustration which, in turn, paralyzed her daily activities and affected her role functioning. Vicious cycle was formed and perpetuated when no proper treatment was provided.

The above case illustration demonstrated how depression could be developed and the interplay between cognition, emotion and behaviors. Depression is an illness. It can be well treated with a combination of both medication and psychotherapy. As depression caused by normal life stress can resolve itself without proper treatment, it is commonly ignored by people until it turns chronic. Early proper treatment can certainly prevent suffers and tragedies as well as reduces chances of relapse. Last but not least, to prevent oneself from suffering depression is better than seeking ways to treat depression. Self help tips to prevent depression are provided in the second article.