SHE likes to cook different dishes, but when depression hits, she would cook the same thing for days on end.

Mrs Tan (not her real name), 75, would be easily agitated if her husband complained, so he has learnt to live with it.  But when she doesn't even have the energy to cook and just lies in bed all day, he knows she needs medical attention and takes her to the hospital.

Mr Tan, 84, said in Cantonese: "After a week, she's better. She's been warded so many times over the years. Every one or two years, she will go in once."

Mrs Tan was diagnosed with depression when she was in her 20s, after the birth of her third child. Now, she is in a growing group of elderly who have been diagnosed with depression. Dr Aaron Ang, a consultant from the department of psychological medicine at Tan Tock Seng Hospital (TTSH), said that some 5 to 10 per cent of the elderly are at risk of depression. But it can be managed if detected early and treated - as was the case with Mrs Tan.

Poor appetite                                                                                                                                        

She said: "I didn't feel like seeing people, I didn't feel like doing anything. My appetite was poor. I couldn't sleep - sometimes I would lie awake the whole night."

She has sought treatment with many clinics and doctors. At one point, she had to be injected every day with medication, said Mr Tan.

Fortunately, Mrs Tan's condition has improved, though she still has to take four types of medicine twice a day. "My husband makes sure I take them. If I can't sleep at night, I take a sleeping pill," said Mrs Tan, who has five grandchildren.

She sees a consultant at TTSH's department of psychological medicine every three months or so. The medication and consultation fees come to about $150 each time.  Besides taking medicine, Mrs Tan said she makes herself take part in activities like going to church every week and visiting friends.

"When I start feeling down, I cook something and share the food to feel better.  My doctor also advises me not to keep my feelings bottled up," she said.

Dr Ang said the risk of depression increases with age and can go up to as high as 40 per cent with certain groups of the elderly, such as those getting medical treatment and those living in nursing homes. He was giving a talk on depression in the elderly at the launch of a roving exhibition by the Health Promotion Board. It aims to raise awareness of depression among older persons and their caregivers. The exhibition, which is on in TTSH's atrium from yesterday until 18 Dec, is designed to resemble an art gallery, with stylised artworks showing some common signs of depression.

Dr Ang said there is anecdotal evidence that referrals from polyclinics and general practitioners involving patients with depression have gone up because awareness is increasing.

Challenges remain in the diagnosis of depression in the elderly because medical conditions and social circumstances, such as bereavement over the loss of a spouse, may mask or mimic some symptoms of depression. Also, many may mistakenly consider these symptoms to be a normal part of ageing.

Dr Ang said: "Elderly people tend to complain less of low mood and more of loss of interest and a sense of hopelessness when they are depressed. They may have more vague physical complaints, such as chest pains and breathlessness.

"Some patients can go to a doctor once a week with complaints, and they go through investigations for heart and lung, but in actual fact, they are depressed. When you treat the depression, these symptoms will go away."

A75-year-old retiree who was at the exhibition said his wife was diagnosed with depression three years ago after she started being hypersensitive and paranoid that he was having an affair.

Major operation                                                                                                                                       

"It happened soon after she had a major operation. "She would say I was hinting at wanting to pair up with someone else when I put my shoes in a pair on the floor, or when I left two bottles of mineral water next to each other.

"I would listen to a song that had the words, "If I didn't have you", and she would pick on that phrase and say I wanted to be rid of her. "She became very superstitious and would go to the temple repeatedly. But in other things, she lost interest," said the man, who declined to be named.

Today, she takes a low dose of medicine every other day and her condition has improved. The husband said: "It's good to have exhibitions like this so that we can learn about depression and know how to help rather than getting into arguments that will aggravate their condition."

6 COMMON SYMPTOMS OF DEPRESSION

1) Always feeling gloomy, sad and believing things can only get worse.

2) Constantly blaming oneself for everything that is wrong.

3) Having trouble falling asleep no matter how tired one is.

4) Refusing to eat or suddenly eating excessively.

5) Losing interest in the activities one used to enjoy.

6) Constant thoughts of suicide and death.

This article was first published in The New Paper.