Major Depression: When Life Gets 'Too Much'… or 'Too Little'

Nature of the Illness

Everyone feels a little 'down', muddled or 'disconnected' every once in a while. When the feeling becomes difficult to shake off, however, beware, it could be depression, which is a potentially serious - and increasingly common - mood disorder that can occur in both children and adults.

In fact, studies reported last year the proportion of Hongkongers afflicted has reached a record high, with more than 1 in 20 exhibiting symptoms of the most serious form of depression - almost twice the 2014 level. Nearly 9% of respondents also admitted having had suicidal thoughts several times within the two weeks prior. Equally alarming, as many as 33,000 local children - or 1 in 10 primary students - similarly show signs of major depression, with the youngest case diagnosed being of age 10. Little surprise, then, the number of youngsters being treated for mental illness in public hospitals has increased dramatically in recent years (see table).

Given that depression is often overlooked and untreated in Hong Kong, it is clearly crucial for residents, including parents and parents-to-be, to be able to recognise the signs of the condition, and know where to get appropriate help.

The exact causes of depression are still unknown, but its mechanism has been widely researched in Western countries, and early detection has translated into full recovery in many cases.

Major depression shares the signs of mild depression, but its symptoms are more severe, and lead to obvious impairment of daily life functions. The predominant attributes are:

  • A persistent feeling of sadness
  • Diminished interest in outside stimuli
  • 'Low' (in adults) or irritable mood (in children)
  • Sense of hopelessness or worthlessness
  • Constant worrying (either generalised or about something specific)
  • Sleep disturbance (either insufficient or excessive)
  • Reckless behaviour (eg gambling, promiscuity, even binge eating or shopping)

The above symptoms could be experienced most of the time, lasting for weeks, and if left untreated, years. In the worst cases, there is detachment from reality (psychosis), and thoughts of self-harm or suicide.

Diagnosis is absolutely necessary in major depression, and may even be time-sensitive.

Treatment of the Illness

Unlike its mild counterpart, major depression is easier to diagnose (its effects being quite visible), but more difficult to resolve. Depending on the severity and type of depression, treatment generally involves all of the following:

  • Medication - more potent classes of antidepressants; if these don't work, sometimes electroconvulsive therapy (ECT) may be recommended
  • Psychological therapies - these are centred on in-depth talks with a specialist, but in very specific modes of discussion
  • Social support - ranging from psychoeducation, to community support with education, employment or accommodation

The patient may also need to stay in hospital for a short period. While treatment there is usually very effective, follow-up appointments are required for continuous monitoring.

What to Do

The first step towards recovery should be to seek medical help. A primary-care doctor can refer a candidate patient to a qualified mental health specialist such as a psychiatrist or psychologist for proper diagnosis based on DSM-5 criteria, after which a comprehensive management plan can be drawn up, and vital decisions regarding pharmacological, psychological, or combination therapies be made.

The logistics of this solution, though, can be another tough hurdle to overcome, as queues for specialist services at public hospitals in Hong Kong are notoriously long, with that for mental health in particular being the longest - at up to 166 weeks, or more than three years in certain districts. The alternative - turning to the private sector - doesn't make things easier, as the expenses involved can quickly drain a family of their hard-earned savings. Hourly sessions with a psychiatrist or psychologist can easily cost in the region of HK$1,300 to $1,800… and that's after the initial outlay of several thousand dollars for a detailed assessment.

While no one ever wishes to be ill either physically or mentally, the reality of living with modern-day stress - and possibly 'snapping' or falling into dis-ease when one least expects it - is certainly something to think about, and be geared up for. Families need to be prepared to meet these costs for the entire period of treatment, which can last several years depending on the severity of the patient's condition.


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