Depression

If it is too hard to bear right now, please do not stay alone. Call one of the numbers below.
They are open 24 hours a day.

☎ 109 — the suicide prevention hotline (자살예방 상담전화)

It runs 24 hours a day.
Since January 2024, the many separate hotlines that used to exist have been merged into one number, 109.

Family problems, relationships, psychiatric difficulties, money trouble, physical illness —
you can talk about anything.
After the call, they will connect you to a community mental health welfare center (정신건강복지센터) or a suicide prevention center near you.

☎ 1577-0199 — the mental health crisis hotline (정신건강 위기상담전화)

It runs 24 hours a day.
Mental health nurses, mental health social workers, mental health clinical psychologists —
mental health professionals (정신건강전문요원) like these answer the calls.

You can also get information about mental health services,
and if they judge it to be an emergency, they will link you to a hospital and work with 119 and 112.

☎ 129 — the Health and Welfare Call Center (보건복지상담센터)

This number gives guidance on welfare and medical support in general.

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If you feel you are in danger right now

Call 119, or go to the nearest emergency room.
Tell your family, or someone next to you, how you are right now.

This is not something you have to bear alone.

This page is reference information summarised from official sources.
Always talk to a medical professional about diagnosis and treatment.

At a glance

Asan Medical Center (서울아산병원) describes depression as
**"a state in which overall mental functions — thinking, motivation, drive, interest, behavior, sleep, physical activity and more —
are continuously lowered, so that daily life is badly affected as well."**

Feeling sad about a sad event is a natural reaction.
Depression is a medical condition that is different from that.

The cause is not your state of mind

These are the causes of depression as explained by Asan Medical Center.

• Biochemical factors — problems with neurotransmitters such as serotonin and norepinephrine, changes in thyroid and adrenal hormones, changes in the body clock
• Genetic factors — if one identical twin has major depression, the other twin also develops it with a probability of about 50%
• Environmental factors — stress, loss, money problems, shocking events, divorce, bereavement
• Psychological factors — low self-esteem, a dependent personality, perfectionism
• Physical factors — thyroid disease, endocrine diseases such as diabetes, stroke, tumors

It is not true that "you just have to pull yourself together."
Changes in the brain are involved, and physical illness can bring it on too.
That is why it is an illness that needs treatment.

It gets better

Asan Medical Center explains that when antidepressants are used at a high enough dose and for long enough,
two thirds of all patients see an effect.

It also explains that normal low mood recovers within a few days, but
depression as an illness lasts longer if it is not treated.

Treatment makes it better, and using medicine together with counselling can also stop it coming back.

The line is '2 weeks'

These are the symptoms of depression as explained by Asan Medical Center (서울아산병원).
What matters is whether they last for 2 weeks or more, almost every day.

• Low mood — lasting almost every day for 2 weeks or more
• Less interest and pleasure in daily life — things you used to enjoy feel flat
• Eating less, or eating more (enough to change your weight by more than 5% in a month)
• Not sleeping, or sleeping too much
• Moving more slowly, or the opposite — being restless
• Feeling tired and having no energy
• Feeling worthless, and feeling excessive guilt
• Not being able to concentrate or make decisions
• Thoughts of death coming back again and again

How the diagnosis is made

It is diagnosed when 5 or more of the symptoms above are present,
when at least one of them is low mood or loss of interest,
and when they seriously interfere with daily life.

Do not put these off

• When thoughts of death keep coming back
• When eating and sleeping have broken down badly
• When you can no longer do what you used to do at work, at school or at home
• When it is too hard to carry on your own

Matching a few items on the list above does not mean you have depression.
But if it has gone on for more than 2 weeks and your life is falling apart, it is worth having it checked.
And seeing a doctor does not mean you will be diagnosed with an illness.

It can also come from a physical illness

Depression can also come from a physical illness, such as thyroid disease, diabetes or stroke.
In that case, treating the underlying illness makes the depression better too.

That is why blood tests and the like are sometimes done at the same visit.

There are two ways in. You can use both.

1. The community mental health welfare center — it is free

Every city, county and district in Korea has a community mental health welfare center (정신건강복지센터).
There are mental health professionals (정신건강전문요원) there, such as mental health nurses, social workers and clinical psychologists.

• Counselling is free
• They give you guidance and a link to a hospital that may suit you
• You can join local programs

If you do not know where yours is, call ☎ 1577-0199 and ask.
They will tell you the center for your area.

If going to a hospital first feels like too much, you can start here.

2. The psychiatry department (정신건강의학과)

This is where you get a diagnosis and treatment.
Many local clinics have one. You do not have to start at a large hospital.

• Psychiatry — the department that diagnoses and treats depression
• Family medicine (가정의학과) / internal medicine (내과) — many people go here first with physical symptoms (poor sleep, tiredness, indigestion). They can also pass you on to psychiatry

When you need a large hospital

• When symptoms are severe and you need to be admitted
• When the medicine is hard to settle even after several changes
• When another mental illness is present too and a detailed assessment is needed

If you go to the outpatient clinic of a tertiary hospital, you need a referral letter (진료의뢰서) for national health insurance (건강보험) to apply.

When you choose a hospital

Treating depression does not end after one visit.
You will be going for several months, so somewhere close and easy to get to is best.

You can look for local clinics on the map.

Depression is not diagnosed by taking blood or by taking pictures.
Talking is the most important test.

The interview

You talk with a psychiatrist.
They check when it started and how it has been, how you sleep and eat, and how your life is affected,
and they see whether it fits the diagnostic criteria.

Do not worry that you will not be able to explain it well.
Not being able to put it in order is itself one of the symptoms.
You can write notes beforehand, or simply say "I don't really know."

Psychological tests

Questionnaires and tests are used to check
whether another mental illness is present too, and which parts are hardest for you.

Blood tests and brain imaging

These are done to sort out whether the depression comes from a physical illness.
Thyroid disease, other endocrine diseases, stroke and tumors can be the cause.

Having several tests does not mean your case is serious.
It is to make sure no cause is missed.

Useful things to sort out before your visit

• When you started to feel bad (roughly is fine)
• How you sleep — not sleeping, or sleeping too much
• Changes in eating and weight
• What you can no longer do in daily life
• A list of any medicines you are taking now

You can write it on paper and simply show it to the doctor.
You do not have to explain it all out loud.

Medicine — it takes time

This is the part people misunderstand most.

This is how Asan Medical Center (서울아산병원) explains it.

• Antidepressants start to show an effect from 2 to 3 weeks after you begin taking them
• A full effect appears only after about 4 to 6 weeks
• Used at a high enough dose and for long enough, they work in two thirds of all patients

"I took it for a week and nothing changed" does not mean the medicine is not working.
It is simply not yet time for the effect to show.
A great many people stop here, and that is the greatest pity of all.

Do not stop as soon as you feel better

Asan Medical Center says that "you have to keep taking the medicine to prevent a relapse",
and explains that it is kept up for roughly 6 months or more.

Feeling better means the medicine is working. It does not mean you are fully cured.
Always talk with your doctor about when to lower the dose and when to stop.

Will I get addicted?

About antidepressants, Asan Medical Center explains that
there is no particular danger in using them for a long time, and they are hardly addictive at all.

Psychotherapy (counselling)

It builds your strength to cope with stress, which controls the symptoms you have now and prevents a relapse.

Asan Medical Center explains that with effective psychotherapy, symptoms not only improve, but
"overall mental health improves as well, so that some people come to live a more satisfying life than before treatment".

Using medicine and counselling together works well to prevent a relapse.

Other treatments

• Electroconvulsive therapy (ECT) — one of the most effective treatments; an effect can be expected within a few days to 1 or 2 weeks. It is used when the risk of suicide is high, when the body is very weak, or when there is no response to antidepressants, and the chance of complications is low.
• Repetitive transcranial magnetic stimulation (rTMS) — a treatment that adjusts the brain with magnetic stimulation; it is known to be effective for depression.

Which treatment you have differs from person to person.
Talk it over fully with your doctor before deciding.

To the owner: please write this section carefully.
"Will it stay on my record?", "Will it count against me when I buy insurance?", "Will it be a problem for getting a job?" are
the most common questions, but the answer differs case by case and the rules change.
I have not put in any definitive statements.
Both giving unverified reassurance and giving unverified worry are risky.
I recommend adding content only after you have checked the facts exactly.

If something worries you, ask about it first

Many people hesitate because of records, insurance or work.
You can bring that worry itself up at your appointment, just as it is.

"I hesitated to come because I was worried about this — how does it actually work?"

The medical staff will explain it for your situation.
You can also call and ask beforehand.

If seeing a doctor feels like too much, start here

A community mental health welfare center (정신건강복지센터) is not a hospital.
There is one in each city, county and district, and counselling is free.

You can talk here first, and be pointed to a hospital if you need one.
If you call ☎ 1577-0199, they will tell you the center for your area.

You can also use only the phone lines (☎ 109, ☎ 1577-0199).
Both run 24 hours, and you do not have to give your name.

About the things people often say

"It is because your will is weak"
No. Asan Medical Center (서울아산병원) lists the causes of depression as problems with neurotransmitters, hormone changes,
genetic factors and physical illness. It is not a matter of your state of mind.

"It gets better with time"
Normal low mood recovers within a few days, but
depression as an illness lasts longer if it is not treated.

"Once you start the medicine you can never stop"
Asan Medical Center explains that antidepressants carry no particular danger with long-term use
and are hardly addictive at all.
When to lower the dose and stop is decided together with your doctor.

Cost

Psychiatric care is covered by national health insurance (건강보험) too.
The out-of-pocket cost differs with the type of test or counselling.
You can call the hospital in advance and ask.

What the people beside someone do changes a great deal.

Things that help

• Just listen. You do not have to give solutions
• Words that accept how they are now, like "That must have been so hard"
• Going to the hospital with them — booking and getting there alone is hard work in itself
• Quietly keeping an eye on whether they are taking their medicine (without pressing them)
• Having regular meals and taking walks together

Things to avoid

• ❌ "Pull yourself together", "Everyone lives like this"
• ❌ "Plenty of people have it worse than you"
• ❌ Forcing their mood up, or pushing trips and gatherings on them
• ❌ Telling them to stop their medicine
• ❌ Being impatient — medicine takes several weeks to show an effect

If you see warning signs

If they talk about death, put their affairs in order,
or suddenly look strangely calm, do not let it pass.

• You can ask them directly. Asking does not plant the idea
• Do not leave them alone
• Call ☎ 109 or ☎ 1577-0199 and ask what to do. They are open 24 hours
• If it feels urgent, call 119 or go to the nearest emergency room

Carers get worn out too

It is natural for the family to get worn out.
☎ 1577-0199 and your local community mental health welfare center (정신건강복지센터)
also offer counselling for family members.

You do not have to carry all of it alone.