Tuesday, April 24, 2007

Depression and Suicide

I have never met Ms X. She was a Chinese National who married a local Singaporean man. My first contact was with her newborn and I was curious that it was the grandparents who were the main caregivers. During their second visit for the baby's vaccination, I found to my horror that Ms X had committed suicide. She had been suffering from post-natal depression.

I think one of the most devastating things in life is to find out that someone you know has committed suicide. And it doesn't have to be someone you know very well. I remember when Leslie Cheung committed suicide, I was somehow affected by the news even though I can't even remember watching any of his movies. Last year, a friend of mine whom I had shared some makan adventures with was found dead at the bottom of his HDB flat. I cried, even though I did not really know him that well.

These suicides were a culmination of months of depression. They could have been helped. In Singapore, it is reported that there is one case of suicide everyday.

It is important to be able to recognize that your friend, colleague or family member may be suffering from depression and quickly get them assessed by the Doctor. It can potentially be life saving.

How to recognize Major Depression
(Modified from the DSM IV criteria)

Five of the following symptoms have to be present for at least 2 weeks:

1. Depressed mood
2. Diminished interest or pleasure in all or most activities
3. Significant weight loss or gain, or decrease or increase in appetite nearly every day
4. Unable to sleep or sleeping too much
5. Slowing of mental or physical activity or agitation
6. Fatigue or decreased level of energy
7. Feeling of worthlessness or inappropriate guilt
8. Poor concentration or indecisiveness
9. Recurrent thoughts of death or suicide


If you think that someone you know might be suffering from major depression, it is important that you seek medical help ASAP. The patient can be helped with medication and therapy. This is especially important if the patient has expressed a desire to commit suicide which should never be taken lightly. If the doctor determines that the patient may indeed be at risk of suicide, he has the legal authority to detain the patient in a medical facility (IMH) against the patients' wishes. Friends and family members thus have a very important role to play in preventing suicide by being able to recognize the symptoms of major depression.


Anonymous said...

The word “Suicide”, one of the many words that never or should ever cross anybody’s mind. Especially not in my vocabulary. But, you never know! I don’t actually mind sharing problems with anyone but of course one that knew me well and must be someone that I could turn to and trust (it’s very important, though!). But these few days have been a torment and it always does go right into your brain, into the mind and believed me, it won’t stop there! Try getting near to the ever-open window and it’s so inviting to just end it there and so persistent “JUMP”. The thought just makes it so scary and so impossible not to ever think about it. It scares me but like I said, you never know and can’t even imagine? So what should I do? Pray to the Lord. Asked him for forgiveness, repent and forgive. PTL!

Dr Leslie said...

Please seek professional help, faith and make sure you keep all your windows locked. Don't ever put your self in a position that you may be tempted to do something at the spur of the moment.

Anonymous said...


What form of treatment is available and is it costly?

I think I may be depressed although I am not habouring thots of suicide.


Dr Leslie said...

There are many medications available and they range from affordable to costly ie <$20 to >$100 per month. Best thing is to check with your GP

Anonymous said...

I went through post-natal depression, it was horrible. However, I dun think that I am going through a depression at that time. I just feel that everybody was ill treating me.

I was the main caregiver to newborn and I remember trying to total breastfeed him and crying at the same time. I was entertaining the thought of jumping off my flat then it occur to me that I dun want to "give" my son to my in-law and they will not even be bother about my life. So I start thinking about jumping off with my son.

I was hitting myself too. I will hold my son in one hand, breastfeeding him, took my son toys with the other and hit myself on my head. Lucky, I did hit some sense to myself. I quit thinking about suicide. Instead, I focus on how to run away with my son. I realise that my son was too cute to die with me.

I realise that I was suffering from depression when my son was around 7 month old. I do not know how to get help when I need to breastfeed my son every 2 hour. I do not want to take medicine that stop me from breastfeeding. If I divorce with my husband, I will still want my son and I do not want a record that said I was suffering from depression.

And when I finally talk some sense and gather all my courage to see a doc about this, I decided to tell my gynae about it when I do my pap smear test. Guess what my gynae told me, "depression? what depression? No lah, you are just feeling tired." I walked out of his clinic feeling so stupid that I told him asked him about depression.

I am ok now, kept telling myself to take things lightly. The most I will run away only.

Dr Leslie said...

Thanks for sharing your story. I think you should still try to seek medical help. Have a look at the criteria I listed in the blog. If you feel that you do have depression, please see your Family Doctor. It may turn out that you may not have major depression, but have some other illness that can be treated.

Anonymous said...

Hi doc,

thanks for your blogs, i frequent the food blog for places to eat and sometimes pop by here to read the updates.

i heard that anti-depressant medication side effects such as suicidal tendencies, which really shocked me, as i know someone on anti-depressants. this is a potentially dangerous situation as u need anti-depressants to get deal with the depression, but the side effect is that you'd want to jump??

is there any truth to that rumour? also, besides directing him/her to professional help, what else can i do to help someone who is depressed?

thanks, would really appreciate your feedback!

Dr Leslie said...

There is a lack of evidence that this is so. Please have a look at this article:


At any rate it is not just medications, the suicidal patient needs to be managed by a qualified doctor who can help with psychotherapy as well.

Anonymous said...

Thanks for the adv. After reading all the comments, I guessed, I'm sometime left with nothing! Not that I don't really know where to get help or what to do. But things were'nt this bad then but now... Ever wonder what it's like being neglected and completely neglected and no one can help? Though, I do talk to someone that I think I should trust and can be trusted, but realized that that person will only be your listener and say things sometimes he/she may not know what to say. Put yourself in that listener's position. What will you say at the end of the day?

Anonymous said...

I was seaching on the internet on "How to commit suicide" and your blog pop out. And reading from the Major Depression, it seem like I have almost all of them. I can go without food and purely survive on water only and still doesnt feel hungry. I would purposly walk slowly crossing road and pray that a car will crash me...I really dont know what to do.

Dr Leslie said...

Please see your family doctor who will assess and may arrange for a psychiatric assessment for you. Some forms of depression are due to chemical imbalance in the brain and can easily be rectified with medications. You may also be referred to a psychologist for counselling who will be able to give you some tools to overcome your negative thoughts.