World Mental Health Day: Understanding Depression

Understanding Depression: Symptoms and Treatments

October 10th is World Mental Health Day, the goal of which is to raise awareness of mental health issues and ultimately improve the attitude toward and provision of mental health care worldwide.

Expatriate mental health

Living overseas is a difficult adjustment. Language differences and distance from extended family and social support can make for an isolated existence. Culture shock, poor psychological adjustment and an inability to cope are factors that increase the risk of developing mental health problems(1). This is more pronounced when there is a significant cultural difference between one’s home country and the host country(2). Consequently expatriates are at high risk for depression(3) however they tend not to seek counseling services or are unaware that such services exist(4). Mental health problems play a prominent role in the return of an expatriate to their home country prior to completion of their overseas assignment(3), and thus for the benefit of the expatriate and their family it is important that they recognize symptoms of depression and the treatments that are available to them.

What is depression?

Depression:
- Is a common mood disorder that can last for weeks to years and is often recurrent
- Can interfere with a person’s ability to function at work and cope with daily life
- Affects the way you feel, think, and act

What are the symptoms of depression?

Symptoms of depression include:
- Persistent sadness
- Decreased motivation or interest
- Feeling tired or having little energy
- Experiencing a lack of pleasure from activities that you would normally enjoy
- Abnormal hunger: either having no appetite or eating uncontrollably
- Racing thoughts, talking quickly or excessively, being unable to sit still
- Difficulty concentrating or focusing your thoughts
- Thinking, speaking, or moving more slowly than usual
- Having trouble falling asleep, staying asleep, or sleeping too much
- Regularly drinking excessive amounts of alcohol or using recreational drugs
- Feeling hopeless or that you are worthless and have let yourself or others down
- Having thoughts that you would be better off dead or of hurting yourself in some way

Talk to your doctor about depression

If you are experiencing some of these symptoms then you should talk to your doctor. If you feel uncomfortable talking about depression, remember that your mental health is just as important as your physical health. If you had a head cold or injured limb then you would go to see your doctor. The same logic applies to feeling sad, demotivated or lethargic. Talk to your doctor to see if they can suggest ways that will help you to feel better.

What types of treatments are available for depression?

In cases of mild depression your doctor may recommend relaxation therapies such as yoga, meditation, tai chi and massage, in addition to encouraging healthy lifestyle choices including exercise and nutrition. Your doctor may also refer you to a counselor, therapist or psychologist to monitor your depression and provide psychotherapies such as cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT). In cases of moderate to severe depression your doctor may refer you to a psychiatrist for further evaluation and prescription of antidepressant medications.

While depression is commonly treated with antidepressant medications and psychotherapy, not all patients respond well to these treatments. Furthermore antidepressants can cause unpleasant side effects including weight gain, nausea, blurred vision, sleep problems and sexual dysfunction.

An alternative treatment for depression with few adverse effects is non-invasive brain stimulation. Transcranial magnetic stimulation (TMS) therapy uses magnetic pulses to stimulate the area of the brain involved in depression, while transcranial direct current stimulation (tDCS) uses less intense stimulation to help increase activity in that area of the brain. Brain stimulation treatment should be considered if your mood does not improve with antidepressant medications or you suffer adverse effects from them.

Where can I learn more about mental health care in Hong Kong?

Mind HK
https://www.mind.org.hk/

HKFP comprehensive guide to mental health services in Hong Kong
https://www.hongkongfp.com/2016/06/26/hkfps-comprehensive-guide-to-mental-health-services-in-hong-kong/

GovHK Health and Medical Services
https://www.gov.hk/en/residents/health/mental/mentalhealth.htm

If you have questions about mental health and depression, please consult your doctor.

Author
Dr. Michael Koval (PhD) is a Clinical Neuroscientist and TMS Specialist based in Hong Kong.

References
1. Valk, T. H. Sending employees and families overseas: Mental health in the workplace abroad. Ment. Heal. Product. Work. A Handb. Organ. Clin. 155–170 (2003).
2. Black, J. S. &Gregersen, H. B. Antecedents to Cross-Cultural Adjustment for Expatriates in Pacific Rim Assignments. Hum. Relations 44, 497–515 (1991).
3. Truman, S. D., Sharar, D. A. &Pompe, J. C. The Mental Health Status of Expatriate Versus U.S. Domestic Workers. Int. J. Ment. Health 40, 3–18 (2011).
4. Thornberry, N. Counseling and expatriate adjustment. Diss. Publ. 1–180 (2015).