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Depression

depression

What is depression?

Depression is a common mood disorder, characterised by symptoms such as persistently depressed mood, loss of interest and energy, and negative thoughts. It disrupts people's daily living, such as their work and social life. Severe depression may also lead to risk of suicide.

 

How common is depression?
Prevalence rate

According to the Hong Kong Mental Morbidity Survey (HKMMS) 2010-2013, about 3% of Hong Kong Chinese, aged between 16 and 75 years, suffer from depression at the time of survey.

Gender ratio

Women are more likely to be diagnosed with depression than men. In the HKMMS survey, the female to male ratio of having a depressive disorder is about 1.6:1.

Age of onset

The most probable period for the onset of the first episode of major depression extends from mid-adolescence to mid-40s. In terms of prevalence, the ratio of people suffering from depression increases with age, with people in the 66-75 age group showing the highest prevalence rate.

 

What causes depression?

what causes depression?

Medical researches and studies have discovered the following risk factors of depression and they are:

Genetic factors

People with one immediate family member (e.g. either parent, sibling) suffering from depression, have 1.5 to 3 times higher risk than the general population to suffer from depression.

Biological factors

Apart from the dysfunction of brain neurotransmitters, other physiological conditions such as hypothyroidism, systemic lupus erythematosus, and effects of drugs and alcohol also contribute to the development of depression.

Personality factors

People who are easily anxious, inflexible, and setting excessively high standards on themselves or others but lacking acceptance, are more prone to develop depression.

Environmental and societal factors

Stressful life events, family and interpersonal difficulties, excessive burden from school, workplace and family all contribute to mental stress. Failing to manage such accumulated stress effectively may induce depression.

 

What are the symptoms of depression?

what are the symptoms of depression?

When we experience frustrations in life, it is normal for us to feel disappointed and sad. However, if we experience multiple below listed symptoms, which have persisted for more than 2 weeks, and are significantly affecting our normal functioning like work and social relationships, then there may be signs of depression. Professional help should be sought.

Main symptoms of depression:

Emotional
  • Persistently depressed mood, such as feeling sad
  • Lose of interest, inability to feel pleasure
Behavioural
  • No longer doing things or joining activities previously enjoyable
  • Psychomotor agitation or retardation
  • Socially withdrawn
  • Self-harms, or even suicidal attempts or preparations, such as writing a suicide note or giving beloved belongings to others
Cognitive
  • Excessive guilt or self-blame, low self-esteem
  • Slowness of thinking, loss of concentration, indecisiveness
  • Thoughts of helplessness and hopelessness
  • Thoughts of suicide
Physical
  • Fatigue, loss of energy
  • Change of appetite and significant change of body weight
  • Somatic pains, sleep disturbance or hypersomnia

 

What is postnatal depression?

Please visit the following page for more information on Antenatal and Postnatal Mental Health. (https://www.fhs.gov.hk/english/health_info/woman/30098.html)

 

What are the treatments of depression?

There are effective treatments for depression, such as medications, psychological interventions and electroconvulsive therapy.

Medication
Type First generation antidepressants Second generation antidepressants
Common drugs
  • Tricyclic antidepressants (TCA), e.g.
    • Amitriptyline (Saroten)
    • Clomipramine (Anafranil)
    • Dothiepin (Prothiaden)
    • Imipramine (Tofranil)
  • Tetracyclic antidepressants, e.g.
    • Mianserin (Tolvon)
  • Selective Serotonin Re-uptake Inhibitor (SSRI), e.g.
    • Citalopram (Cipram)
    • Escitalopram (Lexapro)
    • Fluxetine (Prozac)
    • Paroxetine (Seroxat)
    • Sertraline (Zoloft)
  • Serotonin and Noradrenaline Reuptake Inhibitors (SNRI), e.g.
    • Desvenlafaxine (Pritiq)
    • Venlafaxine (Efexor)
  • Noradrenergic and specific serotonergic antidepressants (NaSSA), e.g.
    • Mirtazapine (Remeron)
Indications
  • Treatment of depression
  • Prevent recurrence of depression
Mechanism of action Work by regulating the neurotransmitters activities, such as norepinephrine and serotonin in the brain
Side effects/ Points to note
  • Tricyclic & tetracyclic antidepressants:
    • Dizziness, headache, sweating, tremor, somnolence, palpitation, dry mouth, constipation, blurred vision, difficulty passing urine, orthostatic hypotension
    • Other less-common adverse effects include seizure, liver dysfunction, ECG changes, abnormal blood count
  • Patients with or have a history of suicidal behaviour should avoid taking tricyclic antidepressants
  • SSRIs:
    • Nausea, vomiting, gastrointestinal discomfort, somnolence, dry mouth, tremor, headache, sweating, sexual dysfunction, weight loss
    • Some patients may experience excitement, anxiety, insomnia, restlessness or seizure
  • SNRIs:
    • Similar to SSRIs
    • May cause hypertension at high doses
  • NaSSAs:
    • Somnolence, tremor, headache, constipation, weight gain, hypotension
    • Some patients may develop seizure, abnormal liver function tests, blood disorder

If patients experience any undesirable side effects during drug treatment, please consult the doctor as soon as possible to clarify the worries and make appropriate adjustments.

Tips on medications:

  • Does antidepressant relieve symptoms immediately?

    Do not expect the antidepressants to work right away. It usually takes about 2 to 4 weeks (sometimes even longer time) for the antidepressants to start working. Patience and persistent compliance of treatment regime are needed.

  • Can continuous medication prevent recurrence of depression?

    Doctors generally recommend the patient to continue the antidepressant over a period of time after recovering from the first episode of depression, in order to consolidate the healing in brain. For those who have more than one episode of depression, they should continue the antidepressant for a longer period, in order to prevent a recurrence.

Psychological treatment

Psychological treatments, particularly Cognitive Behavioural Therapy, have good evidence for their therapeutic effect in depression. In depression, the patient loses the capacity to experience pleasure, and the absence of pleasures in life creates a very negative perspective for almost everything in life. By helping the patient to examine the current negative thinking and behavioural pattern, and to adopt new ways of thinking and acting, positive experiences can be accumulated in life, and therefore reducing the existing negative thinking and gaining a better mood.

Electroconvulsive therapy

Electroconvulsive therapy may be considered for severely depressed persons who are not responsive to medication and psychological treatment. Persons will be anesthetised and administered electric shock. The course of treatment depends on the individual condition. Click here for more information on electroconvulsive therapy.

 

How to support and help people with depression?
Tips for caregivers:
Watch out for early signs of relapse:

such as insomnia for unknown reason, and depressed mood, so that treatment can be sought promptly.

Avoid blaming:

People with depression may be mistaken as "lazy", "unmotivated" or "stubborn", but these are symptoms of the illness, instead of their true character. Avoid blaming them for their symptoms.

Be a good listener:

Encouraging, but not forcing, them to share their feelings and difficulties, listening to them patiently, showing acceptance, and giving time and appropriate supports to them.

Maintain regular life:

Providing a peaceful and comfortable environment for them, and facilitating them to engage in regular daily activities as far as possible.

Encourage social interactions:

Encouraging them to maintain personal interactions with others, such as keeping contacts with those they have good relationship or they feel comfortable to meet.

Get more understandings:

Helping them to gain more understanding of their course of illness, and encouraging or accompanying them to seek treatment and cooperate with mental health care professionals.

Monitor regularly:

Pay attention to any changes in mood and mental state of the individual. If any self-harming behaviours and/or abnormal behaviour are noted, one should seek help from health care professionals as soon as possible.

Take care of yourself:

Supporting emotionally disturbed people is a long-term challenge. So carers need to look after their own physical and mental health, to rest and regenerate, and then to accompany patients to get out from troubled time. Ask for help when necessary.

 

 

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Radio i Care 友心情網上電台 [彤你講心] 麥曦茵 - 我的電影世界 第二節 香港社會服務聯會- 社聯頻道 努力展新生 精神病康復者成勤奮好員工 Radio i Care 友心情網上電台YouTube channel中有關抑鬱症的短片

Reference source(s): Websites of the Institute of Mental Health Castle Peak Hospital and Kwai Chung Hospital