Paragraph 30 reads: "Prozac is among the most popular antidepressants in China. Its name in Chinese, Bai You Jie, means "free of a hundred worries.'' Wang's hundreds of worries, however, grew despite his months on various antidepressants. He started to plot his suicide."

Paragraphs five through seven read: "There was no word for it in the Chinese vocabulary until relatively recently. It has now even become trendy to start a conversation by saying: "I am very yu men [depressed].'' Yi yu zheng, literally "the depression syndrome,'' has started to feature in the media, along with suicide stories. Cui Yongyuan, a popular CCTV talk show host, is the latest to announce that he too suffers from depression."

"Growing numbers of doctors from general hospitals or mental institutions have also jumped on the bandwagon to publicize their psychiatric services, although few qualify as psychotherapists or psychiatrists."

"On the same bandwagon are multi-national pharmaceutical companies and their mainland joint ventures, touting their wares to China's pill-popping millions. Official media report that sales revenues for antidepressants, mostly manufactured by foreign companies and their Chinese joint ventures, reached almost one billion yuan (HK$960 million) in 2004, up 40.6 percent from the previous year and more than double the 2002 figure. That figure is expected to skyrocket in 2005 to two billion yuan."

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Black cloud over China

Rose Tang

The Parkview Gardens complex, on a busy road opposite a tree-lined Guangzhou lake, looks like an upscale Hong Kong housing estate. Arab women in veils, blonde toddlers and Chinese residents walk briskly around the well-manicured gardens, tennis courts and giant swimming pool.

Yet, this yuppie paradise almost became suicide ground for Wang Liping, a 61-year-old retired banker. "I was just about to jump off from here,'' Wang says matter of factly, pointing out a small window on the 11th floor of his block.

I look through the window down a light shaft and cringe with vertigo. The shaft, its outlines broken by a net of clothes lines and window frames, is cold and silent. It would have been where Wang would have ended a five-year battle against severe depression.

He is not alone. He belongs to a startlingly large emerging legion of depressed urbanites in the Middle Kingdom. More than 26 million people have been diagnosed with depression throughout the country, according to figures released by the China Medical Association at a summit meeting of Asian psychiatrists last month. In Guangzhou, official news media estimate that at least 580,000 residents suffer from depression. That is almost 6 percent of the population.

There was no word for it in the Chinese vocabulary until relatively recently. It has now even become trendy to start a conversation by saying: "I am very yu men [depressed].'' Yi yu zheng, literally "the depression syndrome,'' has started to feature in the media, along with suicide stories. Cui Yongyuan, a popular CCTV talk show host, is the latest to announce that he too suffers from depression.

Growing numbers of doctors from general hospitals or mental institutions have also jumped on the bandwagon to publicize their psychiatric services, although few qualify as psychotherapists or psychiatrists.

On the same bandwagon are multi-national pharmaceutical companies and their mainland joint ventures, touting their wares to China's pill-popping millions. Official media report that sales revenues for antidepressants, mostly manufactured by foreign companies and their Chinese joint ventures, reached almost one billion yuan (HK$960 million) in 2004, up 40.6 percent from the previous year and more than double the 2002 figure. That figure is expected to skyrocket in 2005 to two billion yuan.

None of this helped Lu Ye, ironically a senior manager at the Guangzhou Health Bureau, who leapt to his death because of depression, according to The New Express News, a local paper.

Paradoxically, it appears to be China's burgeoning prosperity that has opened this can of worms, says Pan Jiyang, chairman of the Department of Psychiatry at Jinan University in Guangzhou. Pan says depression has always existed in Chinese history but has only come to be diagnosed during the last decade.

Lu was stressed out by his postgraduate studies and became more distressed after he missed out on a job promotion, Pan says.

"China is going through a dramatic transformation. Social conflicts have become more complicated. The pace of life is much faster. And competition for jobs is more fierce,'' Pan says. "But the welfare system and healthcare haven't caught up.''

There's an alarming increase in the number of elderly depressed who often lose much of their sense of identity on retirement and are not cared for properly by their offspring, who defy traditional values and are entangled in the everyday struggle to succeed, Pan says.

It is likely that depression has been a major factor in the lives of millions of Chinese for at least the last century given the wars, floods, famines, the Great Leap Forward and the Cultural Revolution that have repeatedly fractured the psycho-emotional bones of a nation in turmoil.

Wang, who has been treated by Pan ever since the retired banker looked down that air shaft, is typical.

"It has deep roots in my heart's wounds,'' Wang sighs, handing me a stack of neatly typed documents - his autobiography, which he hopes a newspaper will publish to enlighten other patients.

According to rigid Maoist doctrine, Wang was doomed even before his birth. His grandfather served as a diplomat in Germany for a Qing emperor and took a German woman as his concubine. Wang's father was a Kuomintang naval captain. His uncle, another KMT naval officer, escaped to Taiwan.

That upbringing was enough to pin down Wang as a class enemy. "I was very hurt and sad because of this heavy millstone [the family background] I had to carry on my back,'' he says.

After his university graduation, Wang's "bad birth'' earned him a job in a remote town in Guangdong.

When the Cultural Revolution began, he was among the first to be dragged to struggle meetings. He was forced to carry a huge placard emblazoned "Remaining evil elements of KMT'' around his neck and was tortured until he passed out.

But that didn't throw him. "I was young. And the whole of China was mad at that time,'' he recalls, adding that 20 percent of his bank's staff were branded "bad elements'' and persecuted.

He was later sent to work in a coal mine for 12 years and witnessed numerous mining accidents. By the time he returned to Guangzhou to work in a bank, he was 40. Grabbing at the last bit of his youth to relaunch his career, Wang worked diligently. He was promoted and was finally allowed to join the Chinese Communist Party.

"The political oppression was gone. So was the family millstone,'' he says.

Internal bank politics sidelined him and he was sent to another remote town to carry out the bank's poverty reduction campaigns. There he witnessed blatant corruption among rural cadres. He reported the cases but to no avail.

He began to experience migraine, insomnia, anxiety, sweating and bad moods. "I had all this anger inside me. I felt useless,'' he says.

Wang returned to Guangzhou in 2000. A physician prescribed him a large dose of antibiotics for his fever. For a week, even though drugged with sleeping pills, Wang could sleep for only about an hour a night. The suicidal thoughts began.

"I cried many times and didn't want to talk to anyone or answer the phone. I don't know where I got so many tears from,'' he recalls.

He sought help from a neurologist who had been giving him sleeping pills and painkillers for his migraine and insomnia. The neurology department of that general hospital normally looks after stroke patients.

By then, Wang had read about depression in the newspapers and asked the doctor about it. The doctor, agreeing with Wang's self-diagnosis, prescribed Alprazolam and Prozac. Wang was put on drips and kept in a ward for more than a month.

He has since also visited Chinese herbalists. He was hospitalized several times in different hospitals, where he shared wards with schizophrenics, Alzheimer's disease patients and other depression victims from all walks of life, including high school students, college professors, retired cadres and redundant workers.

Prozac is among the most popular antidepressants in China. Its name in Chinese, Bai You Jie, means "free of a hundred worries.'' Wang's hundreds of worries, however, grew despite his months on various antidepressants. He started to plot his suicide.

One night, minutes before his fateful appointment with the light shaft, his wife woke up and took him back to the hospital's neurology department.

Finally he was transferred to the psychiatric department of another hospital and was prescribed larger doses of antidepressants.

Five years on, Wang can sleep better and has even finished writing a novel about the Cultural Revolution. And he has become philosophical about his losses.

"It's a long war. I am old, I don't care,'' he says, adding that long-term medication has been his savior.

Wang is lucky. At least he can afford antidepressants costing more than 10 yuan a tablet. He can only claim about 100 yuan from medical insurance. Public health care is no longer free, he says. "It's now socialism with Chinese characteristics. Hospitals have become enterprises making money from patients,'' he says.

Wang is now on less medication, one tablet of Seroxat a day. Seroxat, manufactured by Tianjin Smith Kline & French Laboratories, is another popular antidepressant.

The precautions on Wang's medication include a long list of possible adverse effects: Insomnia, loss of appetite and sex drive, nausea, sweating, blurred vision, dizziness and liver problems.

"You wouldn't dare take it if you study the side-effects,'' says Wang.

Others are not so convinced that foreign drugs are the answer and have sought other treatment. Chen Gang, a high school teacher, says two years of acupuncture have ameliorated a nine-year battle against depression.

"My doctors didn't mention any side-effects,'' Chen says of the physicians who prescribed him anti-depressants. But, he says, he noticed on the packet that the drugs could have adverse side-effects.

Chen is a typical white-collar worker who was pushed into depression by stress. He became an insomniac and began to lose weight after taking a job at a private high school in Guangzhou. At one point, he says, he became so depressed he was unable to walk. He resorted to acupuncture for migraines.

Wei Fengpo, 77, head of the acupuncture center at Jinan University's affiliate hospital, prescribed acupuncture after he diagnosed Chen with "anxiety.'' His kidney qi was weak, his blood was "depressed'' and his liver needed to be "dredged.''

Chen complied with Wei's directives religiously for two years. "I have a philosophy major,'' he says. "I believe in the yin and yang in Chinese medicine.''

Wei remembers how weak Chen was on his first visit. "He leaned on his wife. His voice was so weak he sounded like a mosquito.''

Wei has been practicing traditional Chinese medicine since 1952. He recalls that depression was first diagnosed just after the Cultural Revolution ended and was branded a "neuro-dysfunctional symptom.''

"We didn't publicly announce it back then,'' he says. Nonetheless, as early as the 1970s, Wei was advocating incorporating acupuncture into psychiatry. No funding, however, has been available.

Wei's retired surgeon wife and sister-in-law don't follow his counsel. They have been on anti-depressants for years. Wei says they believe in drugs instead of Chinese medicine.

"They have all sorts of complaints from depression,'' Wei says. "It's like a frog has pains all over its body after being stepped on by a cow. That cow is depression.''

Jinan University's Pan Jiyang began to encounter growing numbers of depressive patients in the mid-1980s when he was studying psychiatry at Zhong-shan University in the city.

"At that time, the government's awareness [about depression] was low. And hospital staff training was insufficient,'' Pan says.

"Even now many so-called psy-chiatrists have only received training in applied psychology and very few in clinical psychology.''

The most common symptom of depression is loss of appetite, usually spurring patients to first visit physicians for digestive complaints, only to be dismissed by doctors who find few digestive abnormalities.

Most mainland psychiatry hospital sections merely brand depression as "psychological problems'' instead of depressive problems.

"The Chinese don't like admitting to depression. It's about face. Patients are still discriminated against,'' Pan says.

Having done post-doctoral studies and undertaken clinical training in psychiatry in the United States, Pan believes the Chinese have a genetic predisposition toward depression. He cites a report in Science magazine that people with certain variations in the 5-HTT (a neuro transmitter) gene exhibit more depressive symptoms. Pan believes most Chinese belong to this category.

"There has been depression since ancient times,'' he says. "Now there are more stimulants to trigger depression in our genes.''

Pan sees at least 15 patients each morning. He counsels them for five minutes before prescribing anti-depressants. "I don't have time to chat with them. We're like physicians, prescribing drugs,'' he says, acknowledging that almost all the major international drug companies aggressively tout their products to mainland hospitals. The most popular anti-depressants are Seroxat, Sertralin, Cipramil, Luvox and Prozac.

Brushing off questions over whether it is proper for him to have received commissions from drug manufacturers, Pan says the firms finance his travels to speak to seminars they sponsor. By contrast, Pan says, he receives only 50,000 yuan from the government for any research project on depression.

"The pharmaceutical factories promote their drugs in order to help doctors understand depression,'' he says.

rose.tang@singtaonewscorp.com

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