Depression is in fact a very common mood disorder. According to the 2022 territory-wide Mental Health Index survey, on average roughly one in every ten people shows symptoms of depression. A diagnosis of depression must be confirmed clinically, and one common approach uses the DSM-V, published by the American Psychiatric Association, as its diagnostic (diagnosis) standard. Under the DSM-V criteria for depression, a person must experience five or more of the following symptoms within a continuous two-week period, of which at least one must be either 1) depressed mood or 2) loss of interest or pleasure.
1) Depressed mood for most of the time
2) Loss of interest in all or almost all activities, such as former hobbies
3) A marked decrease or increase in weight; poor appetite or sudden overeating
4) Insomnia or hypersomnia
5) Slowed or, compared with usual, agitated thinking and movement (psychomotor retardation or agitation)
6) Feeling fatigued or lacking in energy (fatigue)
7) Feelings of worthlessness, or excessive guilt
8) Reduced ability to concentrate, or indecisiveness and difficulty making decisions in daily life (indecisiveness)
9) Recurrent thoughts of death or suicidal ideation; or a suicide attempt or a specific plan for suicide
These symptoms seriously affect daily life, work or social activities. If you feel that you, or someone around you, fits the above, please seek professional help.
Types of Depression
While depression is one kind of mood disorder, it also comes in various forms of its own, including: 1) Major Depressive Disorder 2) Persistent Depressive Disorder 3) Seasonal Affective Disorder 4) Perinatal Depression 5) Psychotic Depression. Major Depressive Disorder (Major Depressive Disorder) is the most common category of depression; the sufferer's low mood and loss of interest in things are comparatively severe, and affect their daily life for at least two weeks. Persistent Depressive Disorder, on the other hand, denotes symptoms that continue to affect the sufferer for more than two years. When the effects come and go with particular seasons, the condition is classified as Seasonal Affective Disorder, which usually has its greatest impact in late autumn or early winter. Some expectant mothers may also develop Perinatal Depression during pregnancy or after giving birth. Psychotic Depression, which is accompanied by psychotic symptoms, is a comparatively severe category; sufferers may experience delusions — that is, distorted, false and fixed beliefs — as well as hallucinations, that is, symptoms such as hearing things others cannot hear or seeing things others cannot see.
Current Treatments for Depression
Different degrees of symptoms call for different treatments. For most cases of depression, doctors take two broad directions: medication and psychotherapy. The medications for moderate to severe depression fall mainly into three classes: tricyclic antidepressants TCA (Tricyclic Antidepressant, commonly known as the older drugs), SSRIs (Selective Serotonin Reuptake Inhibitors, commonly known as the newer drugs) and MAOIs (Monoamine Oxidase Inhibitors). TCAs are among the most traditional antidepressant medications, but their drawback lies in their side effects, such as cardiac arrhythmia. An overdose can be fatal. In recent years there has been a trend towards SSRIs replacing TCAs, as they are easier and safer to take and have a lower degree of side effects; the biggest drawback of SSRIs, however, lies in their relatively high cost. MAOIs are the earliest antidepressant medications and are not currently a first-line treatment, but for patients who do not respond to the traditional drugs, MAOIs are the most common alternative.
On the psychotherapy side, Cognitive Behaviour Therapy (CBT for short) is the most common and effective way of treating depression. According to the theory behind CBT, people react differently in different situations because of how they themselves make sense of them, and a person's thoughts, emotions, behaviour and physiological responses all influence one another. CBT holds that mood disorders stem from the sufferer's dysfunctional beliefs — that is, irrational beliefs that do not fit reality — which affect the sufferer's thinking, emotions and behaviour. These mistaken beliefs are also called cognitive distortions, and they cause the sufferer to experience many intense negative emotions.
Take an example. Imagine you have been through an exhausting day at work, and when you get home you find that your parents seem to be ignoring you. If you hastily jump to the conclusion that your family has something against you and does not like you, this can give rise to depressed feelings and even lead to unhelpful behaviour, such as losing your temper at them, creating a vicious cycle. Conversely, if we switch to another perspective, we could understand it as the family simply having no time, being busy dealing with work in hand. A CBT therapist uses cognitive restructuring to help sufferers reflect on, challenge and break down their dysfunctional beliefs, thereby improving their emotions and behaviour.
For sufferers with treatment-resistant depression, a doctor may consider Electroconvulsive Therapy (ECT for short), a treatment that induces a seizure in the patient by applying an electric current. ECT is, however, fairly controversial, and its points of contention include the side effects of the treatment. The most common side effects include short-term confusion, brief amnesia and the like. Even so, the therapeutic effect and the response depend on the strength of the current, and the therapist will, according to the patient's specific situation and needs, appropriately adjust and monitor the strength and frequency of the treatment current to achieve the best outcome.
Existing Depression Support in Hong Kong
Some people, for fear of being labelled or stigmatised, do not seek medical help even after noticing relevant symptoms; yet seeking help promptly is the most direct and effective solution. We are not asking you to view your condition in an overly positive, blindly optimistic way, but rather to try, from a more realistic perspective, to face the existence of the problem squarely and treat the symptoms. When facing problems with depression, talking things over with friends and family, practising meditation and the like are also good choices.
So what if I suspect I have depression — what should I do? In Hong Kong, both government and non-governmental organisations provide various kinds of support. We can go to a general out-patient clinic of the Hospital Authority to seek a professional diagnosis, or to an Integrated Community Centre for Mental Wellness run by the Social Welfare Department; these centres provide clinical psychology services and will also help refer cases in need to the Hospital Authority for clinical assessment and psychiatric treatment. In addition, other non-governmental organisations, such as the Hong Kong Psychological Society and The Samaritan Befrienders Hong Kong, also provide professional therapy or counselling services. At TreeholeHK we also offer psychotherapy services.
Suspect You Have Depressive Tendencies? First, Understand Your Own State
Many people suspect they have depressive tendencies but are not sure whether they need help. You can begin by getting an initial sense of your own state through a standardised screening tool — for example, the PHQ-9 depression screening questionnaire built into the MindForest App, which helps you clarify how much distress you are experiencing.
It is worth noting that PHQ-9 is only a screening tool, not a diagnosis. If the result shows a moderate level or above, it is advisable to contact a professional as soon as possible. AI cannot diagnose or treat depression, but it can serve as a starting point for taking that first step.
In fact, using AI to support mental health is a rapidly developing field — research suggests it can be helpful in certain contexts, but it also has some surprising side effects. If you want to understand what the current research says and what to watch out for when using it, you can refer to this article: Is AI Mental Health Counselling Really Useful? What the Psychological Research Says.
References
Cuijpers, P et al. "A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison With Other Treatments." Canadian journal of psychiatry 58.7 (2013): 376–385. Web.
Goldman, L. S., Nielsen, N. H., Champion, H. C., & Council on Scientific Affairs, American Medical Association. (1999). Awareness, diagnosis, and treatment of depression. Journal of general internal medicine, 14(9), 569-580.
Hollon, S. D., Thase, M. E., & Markowitz, J. C. (2002). Treatment and Prevention of Depression. Psychological Science in the Public Interest, 3(2), 39–77.
Ma-Li, W., & Licinio, J. (2001). RESEARCH AND TREATMENT APPROACHES TO DEPRESSION. Nature Reviews.Neuroscience, 2(5), 343-51.
Read, J. R., Sharpe, L., Modini, M., & Dear, B. F. (2017). Multimorbidity and depression: a systematic review and meta-analysis. Journal of affective disorders, 221, 36-4.
U.S. Department of Health and Human Services. (n.d.). Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression
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