Depression
 
At some point in their life, everyone experiences some sort of unhappiness, often triggered by a traumatic event such as the break-up of a relationship or a bereavement. Most people also feel 'down' from time to time. However this unhappiness can develop into a bout of depression, a real illness that often goes unrecognised, partly because sufferers are reluctant to seek help. This fact sheet explains the symptoms and possible causes of depression. A separate fact sheet Treatments for depression outlines the options for dealing with the condition.
 
Who is affected
 
Depression affects up to 40% of people at some point in their lives. It often appears first during a person's teens or twenties. Some people then experience recurrent episodes throughout their lives. It is twice as common in women than men.
 
Symptoms
 
The most common symptom of depression is low mood. In addition to feeling sad, some people are irritable and tend to lose their temper more easily than usual. Often, people notice that they feel worse either first thing in the morning or last thing at night.

Depressed people find that they can't get pleasure from events or activities that they normally would. They tend to feel different and separate from the rest of the world. Lack of energy, tiredness and poor concentration are also common symptoms. Additionally, sufferers find they don't sleep well, either waking up unrefreshed from a long sleep, or waking up very early in the morning. Loss of sex-drive (libido) and disturbed eating patterns - either loss of appetite or eating too much - are also common.

Symptoms of anxiety routinely occur with depression. People may experience fearfulness, palpitations and even panic attacks. Very often these feelings subside when the depression is treated.

Among the most serious aspects of depression are the thoughts people have about themselves and their lives. Sufferers start to judge themselves excessively harshly or critically. They may think of harming themselves or feel that life is not worth living. People who are depressed are more likely to attempt suicide.

Many people with depression turn to alcohol or illegal drugs to try and blot out their difficult feelings. Unfortunately, this tends to make things worse because alcohol lowers the mood further and, in excess, is harmful to physical health.
 
What causes depression?
 
Usually a bout of depression is set off by a stressful event, often involving some form of loss. This may be when somebody dies, or after a relationship breaks up. Financial worries, a stressful job, redundancy or fear of unemployment, even moving house can trigger depression in vulnerable people. New mothers are susceptible to postnatal depression. And long-term or serious illnesses such as diabetes or cancer can also trigger depression.
Relationship problems are common in depressed people. These may be part of the cause of a person's depression or a consequence.

Some forms of the illness seem to run in families but researchers have yet to find a simple genetic explanation. Unhappy childhood experiences have been shown to be important in the development of depression in adult life. For example, a child who loses his or her mother before the age of 14 and lacks adequate care from another person is more likely to have depression. Other difficult childhood events such as sexual abuse are linked to depression in adult life.

Finally, some people tend to always look on the darker side of things - it's part of their personality. These people are more likely to develop full-blown depression at some point in their lives.
 
The value of treatment
 
Depression interferes with the way people want to live their everyday lives. They may feel unable to go to work or do any of the things they used to enjoy: it is truly a miserable condition. Despite this, many people do not seek help for their problems. This may be because they feel embarrassed about their feelings - considering them a sign of weakness - or they blame themselves for their misfortune.

Fortunately, a number of treatments are available for depression and talking to a qualified professional about one's feelings is the first step.
 
Treatment options
 
The two main approaches to treating depression are psychological therapies, such as counselling, and medical treatment with antidepressants. These are described in greater detail in a separate fact sheet - Treatments for depression.

For mild forms of depression, psychological treatments are often sufficient. For more severe depression, a combination of psychological treatment and antidepressant drugs, or antidepressants alone is usually recommended.
 
Antidepressants
 
A wide range of antidepressant medication is now available. It is important to recognise that these are different from tranquillisers or anti-psychotic medicines. However, like all medicines, they can have some side-effects, but they are not addictive and do not change a person's personality.

The two main groups of antidepressants are known as SSRIs (which stands for selective selective serotonin re-uptake inhibitors) and tricyclics (the name refers to the molecular structure of the drug). They are both known to be effective in treating depression but SSRIs, a group of drugs which includes fluoxetine (Prozac), are now being more widely used because their side-effects tend to be less troublesome.

Most antidepressants take two weeks or so to start gradually working. They are then usually required for around six months to treat a single episode of depression, even if the symptoms clear up sooner. This is because it's been shown that a longer course makes a relapse of depression less likely.

St John's Wort is now a popular complementary medicine for depression that can be bought in health food stores and pharmacies. Some research studies have shown some promising results. If you take St John's Wort, it's important that you tell your doctor and pharmacist, as it does not mix well with some prescription medicines.
 
Psychological treatment
 
GPs can often arrange for sufferers to have counselling as part of their treatment. Counselling usually takes the form of a one-to-one session where you have an opportunity to express your feelings and problems, with the counsellor listening and asking questions. Generally in counselling, you won't be told what to do about these feelings. A typical course of counselling is around 6 sessions. More structured types of psychological treatment also exist. These include cognitive behavioural therapy and are described in greater detail in a separate fact sheet - 'Depression Treatments'.
 
Further help
 
For the majority of people, depression responds to antidepressants and simple counselling. If depression is severe, or intense thoughts of suicide are experienced, GPs often refer sufferers to a psychiatrist. Psychiatrists are qualified doctors who have specialist training in treating mental health and can suggest a wider range of therapy, medical and psychological.

Sometimes, people need to be admitted to hospital for severe depression. They (or their family) may feel they are unsafe to be looked after at home, due to suicidal thoughts. Depressed people are not typically a danger to others.
 
Prevention
 
An important factor in the prevention of depression is learning to manage stress. Stress is a highly individual experience; we all have different things in our lives that cause frustration or unhappiness. We all need to be aware of how we are feeling and of how to develop positive ways of coping. This may simply mean making more time to relax, exercise, or learning to talk more openly with people you are close to.
 
Further information
 
Hong Kong Mood Disorders Center (The Chinese University of HK)
Hotline : (852) 2833 0838 - 8
http://www.hmdc.med.cuhk.edu.hk/main.html

Mental Health Association of Hong Kong
http://www.mhahk.org.hk/

Hong Kong Christian Service (Counselling Service)
Address: 5/F, 33 Granville Road, Tsim Sha Tsui, HK
Tel. : (852) 2731 6251
Fax : (852) 2724 3655
Homepage: http://www.hkcs.org/
Email: cfle@hkcs.org

Caritas Family Service
Tel: (852) 2843 4670
http://family.caritas.org.hk/

St. John's Counselling Service
Address: 7D, On Hing Building., 1-9, On Hing Terrace, Central, HK
Tel: (852) 2525 7207/8
Fax: (852) 2524 2777
Email: counsell@stjohnscathedral.org.hk

National Foundation for Depressive Illness
http://www.depression.org/

Dr. Ivan's Depression Central
http://www.psycom.net/depression.central.html

The Depression Alliance
http://www.depressionalliance.org/

Internet Mental Health
http://www.mentalhealth.com/

The Royal College of Psychiatrists
http://www.rcpsych.ac.uk/info/help/dep/

American Psychological Association
http://helping.apa.org/therapy/depression.html
 
Healthwise (Health Information Resource Centre)
Tel : (852) 2849 2400
Fax : (852) 2849 2900
Email : info@healthwise.org.hk
Homepage : http://www.healthwise.org.hk/

This leaflet is for information only. For a detailed opinion or personal advice, please consult with your own doctor
 
 
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