Depression in Hong Kong: Symptoms, Treatment & Support

Living in a busy city like Hong Kong amongst the fast pace, pressure and intense work schedules can cause many of us to feel overwhelmed and often unintentionally neglect our mental and emotional needs. Lack of awareness of our mental health can allow negative emotions to build up over time. If you feel that negative thoughts keep coming back and you are unsure of what to do to get back on track, it is best to speak to a specialist. Here is a practical guide to depression, to help you understand it better and take action.

Mental Health in Hong Kong

Although mental health is an essential part of our overall health and well-being, it still remains stigmatized unfortunately. Thankfully, over the past few years, there has been heightened attention on the importance of mental health: at home, in the workplace and beyond. The efforts to raise awareness globally have called upon governments and large corporations to invest greater resources to cater for mental health related issues.

In Hong Kong, there are now a greater number of targeted efforts and resources available to support mental well-being.

What is Depression?

Depression is a common mental health disorder that involves an ongoing period of sadness, low mood and a loss of interest in regularly enjoyable activities, which usually lasts for a period of two weeks or more. Other symptoms of depression may include a sudden gain or loss of appetite, insomnia or excess sleeping, feelings of guilt, hopelessness or worthlessness, anxiety and thoughts of self-harm or suicide.

According to the WHO, currently, more than 300 million people of all ages suffer from depression globally, and the condition is the highest affecting disease on a global scale.

Depression is treatable, and treatment options generally include talking therapy, antidepressants or a combination of the two. However, unfortunately only a small proportion of people suffering from depression get treated. Factors that contribute to this situation include a lack of resources, limited numbers of trained professionals available, and the issue of social stigma that still makes too many people reluctant to seek professional help.

Differentiating depressive moods from Depression

Experiencing negative emotions such as sadness or grief are part of the natural process in our journey of life; having these emotions as a reaction to situations such as loss of a loved one, ending of relationships or losing a job can be tough to endure. Some may even describe themselves as ‘depressed’. Although these emotions may resemble the symptoms of depression, experiencing sadness is not the same as having depression. Indeed, a range of emotions like sadness may come and go in phases and there will be mood fluctuations but when negative emotions are prolonged and at moderate to intense levels, depression may become serious and calls for medical attention.

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Depression numbers in Hong Kong

According to GovHK, 3 out of 100 adults in Hong Kong have depression and 1 in 10 elderly persons have depressive symptoms. According to Hospital Authority, only less than 25% of those suffering actually seek treatment. In the year 2017, there were over 800 deaths due to suicide in Hong Kong.

Risk factors for Depression

There can be a wide range of contributing factors to developing depression. Below are some possible factors that may influence it:

Biochemistry: Deviations in the levels of certain chemicals in the brain may contribute to the development of depression.
Genetics: There is a chance that a history of depression in the family history leads to a higher chance of depression, although there is not yet any clear indication of how this occurs.
Death or loss: Feelings of loss and sadness are part of life but when feelings cannot be acknowledged and become overwhelming, they can become contributing factors of depression.
Conflict: Complications in our relationships can be a stress factor, which under some circumstances can contribute to depression.
Abuse: Past or present experiences of physical, sexual or emotional abuse can contribute to developing depression.
Other illnesses: other conditions such as insomnia, anxiety and chronic pain can lead to depression as a reaction of the stress experienced due to the condition.

Other factors: substance abuse, medication side effects, social isolation.

Experiencing the ‘Baby Blues’ and Postpartum Depression (PPD) in Hong Kong

Symptoms of Depression

Psychologists or psychiatrists will diagnose depression through consultations with patients, by asking them questions about their mental and emotional states in order to assess whether they are experiencing symptoms typical of depression.

According to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-5), which offers guidelines used by mental health professionals for diagnosing conditions; to be diagnosed with depression, an individual must be experiencing five or more of the following symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure. 

1. Depressed mood most of the day, nearly every day.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Other symptoms not included but may also be indication signs include:

  • Sleep changes: loss of sleep (insomnia) or sleeping in excess
  • Reckless behaviour: a higher tendency to engage in dangerous behaviour, such as substance abuse, gambling, or reckless driving.
  • Unexplained physical pains and aches: a rise in aches and pains where no explanation can be found.

Although to fulfill the criteria of a clinical diagnosis of depression one must show at least 5 of the above-mentioned symptoms, it does not mean that you shouldn’t consider reaching out to professionals who are more than willing to help you out. If the above symptoms are experienced and they interrupt with the carrying out of daily functions at work, school, social or familial interaction, then it is best to seek help from a professional.

Even if only a few of the symptoms can be recognized, they can still be used as indicators for the monitoring of your own mental health, to see whether you ought to pay some extra attention to your emotional needs.

Depression in Children and Adolescents in Hong Kong

Mental health in youth and adolescents is an issue of continual concern in Hong Kong. Busy schedules, academic pressure, lack of sleep and lack of exercise often carry negative impacts on children and teens in Hong Kong. Each year in Hong Kong, death by suicide in youth takes up one third of all unnatural deaths in 15-24 year olds. Studies have found that more than 50% of young people have expressed to be struggling with depressive symptoms. Other than personal growth, future prospects, social relations or even family disputes, teenagers and young adults also experience emotional stress with regards to the city’s political and social turmoil. In recent months, suicide prevention services have reported a sharp increase in hotline calls mainly from young people, following Hong Kong’s June protests. There are constantly signals of cries for help amongst young people in Hong Kong, but there still needs to be more awareness around this topic, for people to take the issue more seriously.

The Ultimate Guide to Psychiatrists in Hong Kong

Treatment Options for Depression

1. Psychotherapy and Counseling:

While the same therapist may provide both counseling and psychotherapy, psychotherapy is conducted by professionals trained to practice psychotherapy such as a psychiatrist, psychologist or a trained counselor. While a psychotherapist is qualified to provide counseling, a counselor may or may not possess the necessary training and skills to provide psychotherapy.

There are two common types of psychotherapy:

    • Cognitive Behavioural Therapy (CBT)
      Cognitive Behavioral Therapy is an effective combination of talk therapy and behavioral therapy. CBT is a type of psychotherapy in which patients re-frame negative thinking patterns into positive thoughts. Transforming one’s thoughts will ultimately result in positive actions and behaviors in difficult moments.
    • Psychoanalytic/Psychodynamic Therapy
      Through analyzing past experiences and thoughts, patients are guided to understand the relations between the state of their conscious mind and their current emotions. This gets to the root cause of the problem and doesn’t just treat the symptoms, so will likely be more of a long-term process.

Other types may include:

    • Supportive psychotherapy
      This method implements various direct measures to try to provide better support for patients, as to enhance their self-esteem and reduce their symptoms.
    • Eye Movement Desensitization and Reprocessing (EMDR)
      This approach aims to reformulate responses to distressing triggers by introducing new external stimuli along with emotionally disturbing materials so to initiate new responses.
    • Family Therapy
      This is where family members may be involved in the therapy sessions in order to implement more of a combined effort to provide support to patients, but also to take a treatment approach that focuses more from the family perspective.

Psychotherapy is implemented to try to guide patients to find new ways of thinking; during the process, the psychologists/psychiatrists will try to help patients identify possible triggers that are responsible for their conditions, so to try to tackle how to alleviate the stress that is inflicted. If necessary, psychiatrists may decide to prescribe medications alongside the application of psychotherapy to facilitate the treatment process.

2. Medication

Doctors e.g. psychiatrists may prescribe medications, which can include:

Antidepressants – used to normalise neurotransmitters that maintain balance of moods and thinking behaviours. Antidepressants are commonly classified into 5 categories:

    • Tricyclic antidepressants (TCAs) – usually not the first-line of treatment prescriptions due to their tendency to induce numerous side effects such as dizziness, anxiety, dry mouth, and blurred vision
      e.g. amitriptyline, clomipramine, imipramine and nortriptyline
    • Monoamine oxidase inhibitors (MAOIs) – another type of antidepressant that has a wide range of side effects, usually prescribed when other types are not giving satisfactory effects, e.g. moclobemide
    • Selective serotonin reuptake inhibitors (SSRIs) – better known for being safer, with fewer side effects, They are the most commonly prescribed type of antidepressant
      e.g. fluoxetine, paroxetine, sertraline and escitalopram
    • Serotonin and noradrenaline reuptake inhibitors (SNRIs) – an alternative to SSRIs, designed to function better than SSRIs but the comparison is still uncertain
      e.g. duloxetine, venlafaxine and desvenlafaxine
    • Atypical antidepressants – these are atypical medications that don’t necessarily fit into the other categories
      e.g. bupropion and trazodone

Signs of improvement will usually show from 3 weeks and patients should feel noticeably different by 4-6 weeks. The length of time you need to take medication will depend on your individual circumstances and the severity of your depression.  Please consult your doctor before making any changes to taking any prescribed medication.

3. Befriending, Peer support and volunteering schemes

General practitioners or counsellors may recommend forming new healthy relations by having someone get in touch with a struggling individual, to offer some assistance to their daily routines, as well as be a companion to support them on their journey.

They may also present volunteering opportunities for individuals to be more integrated in their community through helping someone else in need.

4. Art Therapy

These sessions make use of art, music, writing or drama to allow individuals to express themselves, some may be able to use these approaches as a channel to process through past traumatic experiences that may have contributed to their emotional struggles.

5. Electroconvulsive Therapy (ECT)

Electroconvulsive Therapy is a much rarer treatment method, but it involves the application of electromagnetic currents through the patient’s brain, after being put under anesthesia, to stimulate the production of mood related chemicals such as serotonin and noradrenaline in the brain. The use of ECT is not common, and is used mainly as a solution for more severe cases of depression. ECT tends to be prescribed when patients’ symptoms of depression are not improved after undergoing talk therapy treatment in combination with taking medication.

Your Guide To Psychologists in Hong Kong

Professionals for Depression in Hong Kong

There are many professionals available for you to see in Hong Kong. They are all professionally trained in counselling and can be very helpful and supportive, to assist you with your depression.

These may include:

  • Clinical Psychologists
  • Family Doctors
  • Psychiatrists
  • Nurses
  • Social workers
  • Counsellor
  • Psychologists

Social Services

The Samaritan Befrienders Hong Kong – Suicide Crisis Intervention Centre (SCIC)
Address : Unit 1, Block B, 3/F, Shui Tin House, Pak Tin Estate, Shek Kip Mei, Kowloon
Phone : +852 2341 7227

Helpful Links

If you need instant support, here is a list of 24/7 Hotlines you can call:
Caritas Family Crisis Support Centre → 18288
Hotline Service (Family Crisis)
Hospital Authority → +852 2466 7350
Mental Health Direct
Social Welfare Department → +852 2343 2255
Hotline Service: 24 hours
Suicide Prevention Services → +852 2382 0000
Hotline Service: 24 hours
The Samaritan Befrienders Hong Kong → +852 2389 2222
Hotline Service: 24 hours
The Samaritans → +852 2896 0000
Multi-Lingual Suicide Prevention Hotline: 24 hours

For a list of other useful mental health services, please click here.

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This article was reviewed by Dr. Sharmeen Shroff on July 11, 2019. Dr. Sharmeen Shroff is Founder and Clinical Psychologist at Central Minds. The information and all content contained in this article is for general information purposes only and should not be used as a substitute for professional help or advice.
This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.