A high-school student lies awake in bed even after burning the midnight oil to study for an exam. A 50-year-old mother, who suddenly finds that her children have grown up and do not rely on her anymore, starts losing her appetite and sense of orientation. A middle-aged businessman loses interest in subjects that used to excite him, like sales or social events, at the peak of his career.
According to psychiatrists attending the Asia-Pacific Neuroscience Summit, which opened in Taipei yesterday, these three people may be suffering from an invisible disease -- depression.
Medical professionals warned that depression is spreading in modern society, ignoring gender, age and social status differences. Figures from the World Health Organization (WHO) show that one in six people worldwide suffers from depression.
In Taiwan, the picture is even more dismal. The Department of Health's (DOH) data show that eight suicides occur here every day, and that 90 percent of suicide victims suffer from psychiatric problems.
"We want the public to know that these are preventable suicides. Depression is a preventable illness," said Hsueh Jui-yuan (薛瑞元), director-general of the DOH's Bureau of Medical Affairs.
In contrast to the normal emotional experiences of sadness, loss or passing moods, clinical depression is persistent and can interfere significantly with an individual's ability to function.
Medical experts at yesterday's meeting said that many people suffering from depression are unaware of what is wrong with them and only consult a doctor if they develop physical symptoms like headaches, sleep disturbances, nausea, vomiting and diarrhea. Yet depression is a systematic illness, with a wide spectrum of emotional and physical symptoms.
"Symptoms of depression include sadness, loss of interest in or pleasure derived from activities that were formerly enjoyed, energy loss, feelings of worthlessness or inappropriate guilt, difficulty in thinking or concentrating, and recurrent thoughts of death or suicide," said Lee Ming-been (
However, ignorance of the invisible disease makes timely diagnosis unlikely for those lapsing into depression.
"In Taiwan, an estimated 75 percent of depressed patients report physical symptoms as the reason for their visit. But because they seek help not from psychiatrists, only 20 percent of this 75 percent are diagnosed with depression," Lee said.
The later patients notice physical symptoms, the less efficacious the treatment becomes. Research has shown that depression is a life-long sporadic disorder in which specific areas of the brain are affected, with the probability of recurrence increasing with each subsequent relapse. If patients go untreated during the "window of opportunity" over the first few episodes of the illness, they appear to be less susceptive to treatment with antidepressants.
Lu Ru-band (
"Twenty years ago, Taiwanese sought medical care after they had been depressed for 60 weeks; after two decades, the period of procrastination has only been reduced to 40 weeks," Lu said.
Experts fear the spread of depression will have a negative effect on the world economy, as well as Taiwanese society. The WHO has ranked major depressive disorder as the fourth-greatest cause of global illness, leading to flagging productivity due to missed workdays and lower performance at work.
The stigmatization of depression also pushes patients into a dilemma. Some sufferers still feel ashamed to admit that they have depression.
"Sometimes I have to avoid direct discussion with my patients. I have to beat around the bush, test the water, and then phrase it in another way. I will probably say, `Well, I have some patients having similar problems, would you like to take similar pills and give it a shot?'" said Jeffery Kelsey, medical director of the Georgia Institute of Mood and Anxiety Disorders.
"We have launched public campaigns to reduce the stigma of depression. Obviously, our efforts are not sufficient. People still label depressed patients as `unsuccessful' or think it's their own fault," Hsueh said.
Not only patients themselves but also their families are affected by depression. Guilt affects patients' families and could also lead them into depression.
"One of my patients has been struggling with depression for years. She enjoys a good social standing as a teacher and has a happy family life. I could not find out the cause of her suffering until she finally unveiled her secret. She told me her mother killed herself when she was a little girl," said Daniel Lai, director of the department of psychiatry at the Chung Shan Medical University Hospital.
Since there are an unlimited number of factors that can lead to depression, prevention efforts need to be more diverse and comprehensive than mere medical treatment. According to Hsieh, the local community must spontaneously establish support networks, since traditional family structures are fading.
"Everyone wants to know they are not alone. Depressed patients are no exception," Hsieh said.
Also, people must stop linking unemployment with depression.
"Even when the stock market skyrockets or the economy recovers from a slump, people still commit suicide," Hsieh said.
The myth of accomplishment and productivity can easily pressure people into melancholia and self-depreciation.
"We make comparisons about who is more successful or who makes more money from the first day we enter the job market. However, we need to bear in mind that when we praise achievers, we also cast a darker light on many other people at the same time," Hsieh said.
Depression is a common and preventable medical condition, the experts agreed. People with depression need not suffer in silence.
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