Depressive Illness

According to the estimation of the World Health Organisation, depression will become the second leading disease in the world by the year 2020. In Hong Kong, according to the survey conducted by the Department of Health in 2003/04, about 1.5% of the population aged 15 and above self-reported depressive symptoms and were diagnosed to suffer from depression. The prevalence is higher in females.

Depression can be in the degree of mild, moderate, or severe. It is a disorder that is characterized by lowering of mood, reduction of energy, and loss of interest or pleasure in activities that are normally pleasurable. The sufferer may also complained of loss of self-confidence or self-esteem; excessive and inappropriate guilty; poor concentration and inability to think; sleep disturbances; change in appetite; and recurrent thoughts of death or suicide, or suicide behaviours. It is also common to have unspecified physical complaints and discomforts, similar to Ms Chan. For some sufferers, they may find the physical complaints to be the most disabling. They often seek help from various medical specialties but no definite causes can be determined. Due to the stigmatization of mental illness, many sufferers may delay their treatment, as they do not accept their diagnosis.

Management of depression is usually divided into medication, psychological, and social. Anti-depressants may be prescribed depending on the degree of the patient’s depressive illness. There are many various types of anti-depressants available with many of these having very few side effects and are well tolerated by patients. Many patients do not need to be on long-term medication and may be able to gradually stop their medication, under their psychiatrist’s advice, six to nine months after their mental state became stable. Psychological management including cognitive behavioural therapy is useful for those suffering from the milder forms of depression and may not need medication. Psychological therapies such as stress and emotions management are also useful for all depressed patients. Social aspects of management will include helping the patient with their psychosocial stressors such as work and family related problems.

Ms Chan finally agreed to be seen by a psychiatrist and to receive the appropriate treatment and management for her depressive illness. She admitted that she had not been able to cope with her work for at least 18 months since the workload significantly increased after one of her colleagues resigned and no replacement was found. She was started on an anti-depressant and her mental state gradually improved after a month. During this period of time, she also learnt stress management techniques as well as coping strategies to help her deal with the stress she encounters at work. She was encouraged to discuss with her supervisor at work regarding the workload as well as the various work-related problems she had. Her supervisor was not aware of her difficulties and was understanding towards her difficulties. Her mental state continued to improve and she felt she was back to her normal self after 3 months. She remained on her anti-depressants for another six months and then gradually her medication was stopped. She saw her psychiatrist for another three months and then she no longer needed to be reviewed on a regular basis.