FOR months, Maggie Zhang has been unable to stay focused on anything or complete even one simple task such as doing the laundry, washing dishes or tidying the house.

"I find myself incapable of doing anything, even trifles," says Zhang, who is 60 years old and lives alone. Her husband died 20 years ago and her daughter lives in Germany. "There are so many things to do and I can never finish them by myself."

She is not only apathetic and lethargic but also worried and anxious; she has insomnia too.

Zhang has been hospitalized twice for recurring depression (yi yu), a problem that is widespread but little recognized and mostly untreated in China. She also has taken antidepressants and seen a psychotherapist; at this time she is still hospitalized.

She felt better when her daughter visited over the Spring Festival but her mood plunged when her daughter left.

A low mood, negative altitude, apathy, trouble concentrating, low efficiency, isolation, poor appetite and insomnia are typical symptoms of chronic depression (dysthymia disorder). Some professionals say it is becoming a public health issue.

Chronic depression is far from rare in China, according to Dr Shen Xianghui, chief of the Psychology Department of Ruijin Hospital. The rate is around 7 percent among ordinary people and 20-30 percent of those seeking help at general hospitals are diagnosed with depression, he says.

Its frequency has been likened to that of the common cold, though its impact is more severe.

High stress may contribute to the rising rate of depression, but more popular knowledge about the condition also means more people are seeking help and their cases are officially recorded.

According to Dr Shen, about 15 percent of depression sufferers seek professional help, while there were only 2 percent years ago.

While it is not acute depression, chronic depression also may have destructive consequences if not properly treated in time. It can lead to other health problems.

Around 250,000 people commit suicide each year in China and depression is a significant contributing factor, according to Dr Shen.

There is no universally accepted specific cause. Many scientists say the cause is brain chemistry and a lack of chemical neurotransmitters (serotonin), which is treatable with medication.

Factors include genetics, long-term stress, introversion and catastrophic events and crises (death of a loved one, job loss, serious accidents). Hormonal changes can cause post-partum depression or menopausal depression.

Traditional Chinese medicine regards depression and medical consequences to be a result of irregular qi (energy flow), according to Dr Yuan Canxin, head of neurology at Longhua Hospital attached to the Shanghai University of TCM.

"It often happens that depression leads to disease, or disease leads to depression," says Dr Yuan.

According to him, stress and a bad mood often disrupt the flow of energy in the body and this can damage organs in the long term. This is why patients with chronic depression often have discomfort in the stomach, heart and lungs.

In Western medicine the harmful effects of cortisol, the "stress hormone," are well known.

Depression, or dysthymia disorder, is often found in stroke patients and those with endocrine disturbance. Worry about the conditions as well as the conditions themselves play a role.

Unpreventable

"Everybody has low times throughout their lives, but not everybody will end up with dysthymia disorder," says Dr Yuan.

An optimistic attitude, good friends and supportive family can help depression sufferers, but depression is not something that can easily be prevented.

If a low mood persists for more than two weeks, professional help is generally recommended.

A great variety of antidepressants and anti-anxiety medications, as well as psychotherapy, exercise and behavior change are often prescribed in Western medicine.

By contrast, traditional Chinese medicine recommends herbs that help regulate energy flow, nourish blood and soothe nerves. Acupuncture is also used for energy regulation.

"But an illness in the 'mind' can only be cured by the 'mind'," says Dr Yuan, who insists that psychotherapy is extremely important, while medication only alleviates certain symptoms.

Talking to friends or family can help, but they are not professionals and seldom objective. A cheer-up, don't-worry-be-happy, get-a-hobby prescription is often simplistic.

It is widely known that physical exercise, especially regular exercise, improves blood circulation and mood and is believed to raise serotonin levels.

But exercise should be regular and the patient should try to clear his or her mind while exercising, says Dr Yuan. If a person isolates, getting out and being with friends can help.

Being optimistic is easier said than done, but 60-70 percent of patients with chronic depression can recover and function normally, he says.

TCM take on depression

Chinese patent drug "Xiao Yao Wan" is often prescribed for chronic depression (dysthmia disorder) to help regulate energy (qi) and improve mood.

The main ingredients are chai hu (the root of Chinese thorowax), dang gui (angelica), white peony root and bai shu (large head atractylodes rhizome).

If the patient has been depressed for a while, ongoing negative thoughts may have consumed much blood and energy in the "heart" (which controls the mind), according to Dr Yuan Canxin, head of neurology at Longhua Hospital attached to Shanghai University of TCM. This deficient energy can lead to insomnia and an even worse mood.

Licorice, wheat and jujube decoction is recommended to restore energy and soothe the nerves.

Patients with even longer depression may become extremely anxious due to deficiency of yin ("cold" energy) and excessive internal yang ("heat" energy).

They may have hot palms and feet and easily burst into anger. Lily root and di huang (rehmannia root) decoction can help nourish yin and dispel pathogenic heat.

Acupuncture may be prescribed to relieve energy stagnation.



Licorice, wheat? and jujube decoction

Ingredients: licorice (12g), wheat (18g), 9 jujubes

Preparation: Boil gently to decoct and obtain the essence of ingredients.

Dosage: Drink once in the morning and at night.

Benefits: Nourishes "heart" (mind), soothes nerves, reinforces spleen and regulate energy flows.



Lily's root and di huang (rehmannia root) decoction

Ingredients: 1 piece lily's root, rehmannia root juice (200ml)

Preparation:

1. Soak the lily in water overnight.

2. Prepare decoction of lily root and water.

3. Filter and cook together with rehmannia root juice.

Dosage: Drink once a day

Benefits: Nourishes yin and dispels pathogenic heat, improves concentration.