What is Depression?

“Depression is an illness in which low mood impacts the way you feel, think and behave, making you feel like you can no longer cope with things in your life”

Depression is more than just feelings of sadness and gloominess. Everyone experiences bouts of low mood from time to time, but depression is a mood disorder when patients experience symptoms such as persistent feelings of sadness, fatigue and loss of interest that makes them feel that they are unable to deal with their everyday lives. Sometimes, patients might even think that they may be better off dead. These symptoms, lasting at least two weeks or more, are not a sign of weakness and are more than a feeling of ‘just a bit down’. This mood disorder requires medical attention, and patients simply cannot be asked to ‘snap out of it’ or force themselves to recover.

According to the Hong Kong Mental Morbidity Survey, published in 2015, approximately 3% of the population suffer from a depressive episode. When grouped together with anxiety, which often comes together with depression (leading to a diagnosis of mixed anxiety and depressive disorder), the prevalence increases to nearly 1 in 10 of the population. However, most people with these illnesses do not seek any medical treatment, especially amongst men. Depression is an illness that can be treated effectively, and it is advisable to seek treatment earlier before the disease progresses.

What are the symptoms of depression?

Symptoms of depression affect a person both day and night, making one feel down for at least two weeks. Depression also comes in episodes, and it is common for one to experience similar symptoms later in life. The typical symptoms include:

• Prolonged and intense feelings of sadness
• Fatigue and constantly feeling tired
• No longer finding things pleasurable that were once enjoyable, including various activities or meeting up with friends and family
• Reduced appetite
• Weight loss, sometimes more than 5% of your usual body weight
• Difficulty falling asleep or waking up way earlier than usual
• Difficulty in concentrating
• Feelings of guilt and low self esteem
• Hopelessness towards the future
• Reduced sexual drive
• Feeling irritated or angry
• Physical discomfort with unexpected aches and pains, such as headache and low back pain
• Slowed response or constantly feeling ‘on-edge’

Children with depression may experience similar symptoms or refuse to go to school. They might also seem to be excessively clingy and do worse at school. Elderly patients with depression might even experience symptoms of memory loss, more physical symptoms and aches and thoughts of suicide.

How can one tell if it is depression or simply ‘feeling down’?

Whilst it is normal for someone to experience changes in mood, sometimes in response to life events or illness, depression is much more than a transient feeling of unhappiness. Those with depression will struggle to even cope with everyday activities, such as tending to personal hygiene, cleaning the house or going to work. Those around depressed patients will find it very difficult to ‘cheer someone up’. The symptoms often last for more than two weeks, and in severe cases might even lead to suicidal thoughts and psychotic symptoms, including hallucinations and delusions.

How does one get depression?

No one knows for sure why one experiences depression, but there are certain risk factors that research has suggested that would increase the risk of one experiencing depression. Such risk factors include:

• Genetic factors – those who have a family member with depression are of higher risk
• Biological factors – certain illnesses, such as chronic alcohol consumption, low thyroid levels or brain injury, can lead to depression
• Environmental factors – long term struggles in life with financial, interpersonal relationships and work problem may contribute to depression
• Personality factors – those who are easily anxious, have low self-esteem or have had a rough childhood are more prone to the illness

How is depression treated?

Treatment of depression may involve a combination of interventions. These interventions may focus on how we think (talking therapy or psychotherapy), what we do (behavioural interventions) and what we take (medications).

Psychotherapy is the term for psychological treatments. The most common types of psychotherapy used in depression are cognitive behavioural therapy and interpersonal therapy. Both therapies aim to help patients change the way they think, identify the automatic negative thoughts that might arise and suggest alternate ways of thinking. They will also help patients to learn of ways to interact with their friends and family. Behavioural strategies encourage activities and behaviours which promote positive mood.

Antidepressants can lead to noticeable improvements within two to four weeks in most cases, and patients should continue to take these medications for six months or more. In certain cases, doctors may also prescribe medications to soothe anxiety symptoms or help one go to sleep. Antidepressants are particularly useful when a patient feels suicidal, experiences psychotic symptoms or if a patient has found antidepressants useful in the past.

Treatments for depression can be delivered by family doctors, psychiatrists, psychologists or a combination.

What can I do if I have depression?

The most important thing to do is to seek professional help. Trained professionals in mental health diagnosis and treatment can help identify any symptoms and offer the relevant treatment plan. They can also investigate whether there are other medical illnesses that may contribute to the depression and explore other environmental and social factors.

Other things that one can do include:

• Learn about the illness and tell your family and friends about the problem, can also help with the disease. This would allow your loved ones to help and support you along the way.
• Stick with the treatment plan, as many patients often stop their treatment way too early, thinking that they have fully recovered.
• Avoid excessive alcohol, which would worsen the illness
• Exercise regularly and get plenty of quality sleep

How can I help loved ones with depression?

The most important thing is to demonstrate that you care and you want to support them. Understanding their problems and talk to them regularly will help and make them feel valued. Encourage them to lead a healthy lifestyle and meet up with others without pushing too hard or forcing them to do things. Learn about the illness and pay attention to any changes in mood or acts of self-harm.

Depression is a mood disorder with proven highly effective treatment. Those with the illness will benefit from early intervention before their condition worsens with impacts on their daily lives, school, work and relationship with others. If you suspect that you, or someone you know, is suffering from depression, seek professional help so you can get your life back on track.

Reference

1. Lam LC, Wong CS, Wang M, Chan W, Chen EY, Ng RM, et al. Prevalence, psychosocial correlates and service utilization of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey (HKMMS). Soc Psychiatry Psychiatr Epidemiol 2015 09;50(9):1379-1388.