Depression

Depression was formerly considered as one kind of neurasthenia under the category of mild mental disorder. People with depression have prolonged low mood, a loss of interest in everything and a lack of energy. Their feelings are so bad that they interfere with everyday life.

According to the American Psychiatric Association's diagnostic criteria, you are said to have depressive disorder when you have 5 or more physical or psychological symptoms of depression for more than 2 consecutive weeks, including low mood and a lack of energy. You are constantly bombarded by negative thoughts and your daily life is significantly affected.

Depression is linked to bio-chemical changes in the brain.  The brain sends signals from one brain cell to another using chemicals called neurotransmitters.  These neurotransmitters include serotonin, noradrenaline and dopamine.  They are responsible for regulating various physical and psychological functions, such as mood, thinking and behavior etc.  The neurotransmitters are out of balance and don't work properly in people with depression. 

The following steps can help:

• Try to talk about your feelings and channel your stress properly.
• Maintain a healthy lifestyle, e.g. engage in healthy activities or hobbies.
• Adopt an open and positive attitude towards depression. 
• Actively seek help to solve problems.

People of all ages can be affected by depression. The precise reasons for developing depression are different for each person. It may develop due to physical, psychological, environmental and genetic factors. Sometimes the exact cause is not known.

Physical factors
Changes in brain due to various disease, e.g., infection, hypothyroidism and trauma, and alcohol or drug abuse can cause depression.

Psychological factors
1) Health-realted anxiety, painful experiences that lead to negative thoughts and emotions
2) Certain personality traits, such as being overly stressful or stubborn  

Environmental factors
Pressure in life and work, financial problems, losing a job, unachieved goals, work or school problems, love trauma, marriage problems, family conflicts, relationship difficulties, illness of family members, family burden, children grow up and leave home, bereavement, etc.

Genetic factors
Depression somtimes runs in families. If you have a family history of depressive disorder, you will be more likely to get this disease.

Physical symptoms:

• Headache
•  Insomnia
•  Feeling of generalized weakness
•  Nausea
•  Shortness of breath
•  Digestive problems
•  Fatigue and lack of energy
•  Having a lot of dreams and feeling like you haven’t slept all night
•  Unexplained pains

 Emotional symptoms:

• Irritability
•  Feeling nervous
•  Low mood and a lack of motivation
•  Loss of interest in things
•  Recurring thoughts of unpleasant experiences
•  Feelings of worthlessness, low self-esteem and guilt
•  Difficulty concentrating
•  Feeling of hopelessness
• Thoughts of death or suicide

According to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, diagnostic criteria for Major depressive disorder include:

1.At least one of the following three abnormal moods which significantly interfered with the person's life:

  a. Abnormal depressed mood most of the day, nearly every day, for at least 2 weeks
  b.Abnormal loss of all interest and pleasure most of the day, nearly every day, for at least 2 weeks.
  c. If 18 or younger, abnormal irritable mood most of the day, nearly every day, for at least 2 weeks.

2. At least five of the following symptoms have been present during the same 2 week depressed period.

  a. Abnormal depressed mood (or irritable mood if a child or adolescent)
  b. Abnormal loss of all interest and pleasure
  c. Appetite or weight disturbance, either:
     i.  Abnormal weight loss (when not dieting) or decrease in appetite.
     ii. Abnormal weight gain or increase in appetite.
  d. Sleep disturbance, either abnormal insomnia or abnormal hypersomnia.
  e. Activity disturbance, either abnormal agitation or abnormal slowing (observable by others).
  f. Abnormal fatigue or loss of energy.
  g. Abnormal self-reproach or inappropriate guilt.
  h. Abnormal poor concentration or indecisiveness.
  i. Abnormal morbid thoughts of death (not just fear of dying) or suicide.

The above symptoms cause you distress or impair your ability to function in your daily life.  They disrupt your work, school, social interaction or family life.

(a)  Medications
Doctors may prescribe medications to treat depression. There are 2 main types of medications:

• Antidepressants work to normalize neurotransmitters in the brain.
• Tranquillizers help to temporarily reduce anxiety.

Medications can alleviate depression symptoms in 3 to 4 weeks and patients can get better in 4 to 6 weeks.  In general, patients should continue taking medications for at least 4 to 9 months after the symptoms are gone. For severe or frequently recurrent depression, patients have to stay on the medications for longer period of time. Medications should be stopped only under a doctor’s instruction.

Side effects of medications (depending on which type of anti-depressant you are taking) include:
Constipation, diarrhea, dry mouth, vomiting, drowsiness, insomnia, dizziness, headache, tiredness, weight gain, blurred vision and shortness of breath. 

Not everyone experience the same side effects. Moreover, the side effects are usually temporary and will subside over time.

Caution:
Do not change or stop any of your medications without consulting your doctor first.

(b) Psychotherapy
Cognitive behavioral therapy (CBT) and psychoanalytic therapy (or psychodynamic therapy) are types of psychotherapy commonly used in Hong Kong.

Psychotherapy aims to help patients change their negative styles of thinking and behaving into positive ones, so as to solve their emotional problems objectively and efficiently. The medical professionals will help patients to find out the triggering factors of their depression. When necessary, it is used along with medications to get a better outcome.

 - Cognitive behavioral therapy
It seeks to help patients develop new ways of thinking and lifestyle through thought analysis. The treatment period is usually short-term with pre-determined therapeutic targets.

 - Psychoanalytic therapy
It seeks to help patients understand unconscious mind which affect current emotions and behaviors by analyzing past experiences and thoughts. It is an intensive and rather long-term therapy process.

(c) Electroconvulsive therapy (ECT)
Doctors may suggest electroconvulsive therapy for people with severe depression who don't get better with medications and psychotherapy. In electroconvulsive therapy, electrical currents are passed through the brain to relieve depressive symptoms. The treatment course depends on the needs of the individual.

Before ECT is administered, a patient is put under brief anesthesia. An electric shock will be applied to the patient's head which can raise the levels of the mood-related chemicals such as serotonin and noradrenaline in the brain.

• Seek advice from professionals such as clinical psychologists, family doctors, psychiatrist , nurses, social workers, professional therapists etc. They have professional skills in counseling and can help you solve problems positively.
• Let your family and friends know your emotions
• Seek help from others
• Set realistic goals for yourself and avoid unbearable obligations.
• Exercise regularly to relieve pressure

• Offer support, understanding, patience and encouragement. 
• Encourage them to express their feelings and problems
• Encourage them to engage in social activities.
• Seek professional advice once you notice their strange behaviors.