Zhang Jin’s breakdown began with insomnia, and quickly spiralled into loss of appetite, inability to focus, and long mornings spent sitting weeping on the edge of his bed. So in March 2012, the 40-year-old deputy editor of Caixin, a prestigious Chinese magazine, went to Beijing’s Anding hospital, the country’s top mental health facility, for treatment.
Zhang’s months-long battle with depression took him through three failed antidepressant prescriptions and two doctors ? he ditched the first after he recommended electroshock therapy. At one point, he grappled with thoughts of suicide. But eventually, things began to improve. He mustered up the energy to check his text messages; he rediscovered his appetite. Now he’s back at work, taking a delicate combination of six antidepressants. It’s not a perfect arrangement, but it reduces the risk that he’ll relapse.
“In the past, nobody [in China] knew what to do about depression,” said Zhang, who recorded his experience in a blogpost. “And now, people might not know what to do immediately, but there are so many more channels for them to learn ? friends, the internet. More and more people need antidepressants, and more and more people know what they are.”
Although China does not publicise official statistics on mental health, most evidence suggests that its depression rate is on the rise. Contemporary China is a psychologically taxing place ? as living standards improve, social competition has become fierce; for many, buying an apartment, finding a spouse, and supporting a family feel like insurmountable tasks. Awareness of the disorder, once stigmatised as a mark of weakness, is rising. Depression-related websites are proliferating, and antidepressant sales have risen sharply.
Yet according to experts, the country’s public health system is struggling to keep up with the demand. “Looking at the international incidence of the disorder ? the percentage of people who have depression ? China has very, very few psychiatrists,” said Jian Lili, a psychological counsellor in Beijing. Many Chinese people find psychotherapy prohibitively expensive, Jian said, so they turn to eastern remedies such as acupuncture and herbs; some refuse treatment entirely.
They’re also turning to drugs. China may be home to more than 30 million depression patients, according to a 2012 report by the market data company Research and Markets, and the country’s antidepressant market is booming. About ?326m of the drugs were sold in 2012 ? a small portion of China’s pharmaceuticals market as a whole, but growing quickly, with a 22.6% increase on 2011.
Wang Gang, the director of Anding hospital’s depression treatment centre, said that when the centre was founded seven years ago, it sold only a few thousand packs of antidepressants monthly; now it sells about 30,000. “I can’t say whether there’s been an increase in the number of people who suffer from depression,” he said. “But Chinese hospitals have improved their diagnoses and the number of patients in the centre has increased.”
Most people in China don’t have easy access to qualified specialists, especially outside cities such as Beijing and Shanghai. Between 2001 and 2005, 88% of China’s patients with mental disorders did not receive professional treatment, according to a 2009 survey by the Shanghai Mental Health Centre. Among depression sufferers who had received professional help, fewer than half had received any treatment within the past six months. Depression costs China about ?5.2bn annually in lost work days and other financial burdens, Caixin reported last year.
Last spring, a depressed college student in Nanjing posted a suicide note to Weibo, China’s most popular microblog, and took her life soon afterwards. “I am depressed and I have chosen death,” wrote the girl, under the handle Zou Fan. “There’s no good reason. Please don’t get serious about this.” The note was forwarded more than 80,000 times and received more than 100,000 comments; according to Jian, the counsellor, it was a watershed moment for public discussion of the disorder.
Even in small cities and towns, antidepressant use appears to be rising. “It might be because the internet is getting more and more popular, and people from smaller cities are starting to have more information,” Jian said. Or, the reason could be simpler: “Because medicine actually works.”
Additional reporting by Cecily Huang