Following is a question by the Hon Lam So-wai and a written reply by the Acting Secretary for Health, Dr Libby Lee, in the Legislative Council today (March 13):
Question:
It has been reported that a study has pointed out that about 18 per cent of the patients suffering from depression do not have an adequate response to medications (i.e. they are suffering from treatment-resistant depression), and they are more prone to have suicidal tendencies and other illnesses than ordinary patients suffering from depression. In this connection, will the Government inform this Council:
(1) whether it knows the current number of patients suffering from treatment-resistant depression who are receiving treatment at the psychiatric departments of the hospitals under the Hospital Authority (HA);
(2) as it has been reported that a study has confirmed that an antidepressant drug that targets the glutamate system can, within a few hours, alleviate the suicidal thoughts of patients suffering from treatment-resistant depression, and that approval was given by the Department of Health in July last year for the inclusion of the drug in the Drug Formulary of the HA, whether it knows (i) the hospitals whose psychiatric departments are currently prescribing the drug, and (ii) the number of patients who have received treatment with the drug so far, with a breakdown by hospital cluster; and
(3) whether it knows if the HA will allocate additional resources so that more patients suffering from depression can benefit from medication treatment with a better and faster curative effect; if the HA will, of the details; if not, the reasons for that?
Reply:
President,
The reply to the question raised by the Hon Lam So-wai is as follows:
(1) In 2022-23, the number of psychiatric patients diagnosed with depression in the Hospital Authority (HA) was around 66 800 (including in-patients as well as specialist out-patient clinic and day hospital patients). The HA does not maintain statistics on the number of psychiatric patients with treatment-resistant depression.
(2) The first antidepressant targeting the glutamate system, Esketamine, has been included in the HA Drug Formulary as a Special drug since mid-2023. Special drugs are used under specified clinical application with specific specialist authorisation. These drugs are provided at standard fees and charges in public hospitals and clinics when prescribed under specific clinical conditions. Psychiatrists of the HA will prescribe HA patients suitable and an appropriate amount of medications (including Esketamine) based on professional diagnosis and the patients’ clinical conditions to ensure that patients receive timely and appropriate treatment. In 2023-24 (as at the end of February 2024), 17 patients were prescribed Esketamine for treatment of depression, and the breakdown by hospital clusters is as follows:
| Hospital cluster |
Number of patients prescribed Esketamine |
| Kowloon Central |
1 |
| Kowloon East |
2 |
| New Territories East |
15 |
| Total |
17 |
Note: One of the patients has received treatment in two hospital clusters.
(3) The HA provides mental health services in an integrated and multi-disciplinary approach. Psychiatric doctors, psychiatric nurses, clinical psychologists, occupational therapists and medical social workers provide comprehensive medical services, including in-patient services, out-patient services, day rehabilitation training and community support services, to patients with mental health needs (including those suffering from depression), according to their medical conditions and clinical needs.
The HA has been expanding the coverage of its Drug Formulary through an established mechanism to provide long-term sustainable, affordable and appropriate support to patients with mental health needs. Apart from drug treatment, the HA currently provides Electroconvulsive Therapy and Transcranial Magnetic Stimulation for the treatment of depression. Healthcare professionals will refer patients with depression to receive appropriate treatment according to their medical conditions and clinical needs.
The HA will continue to review its mental health services and treatment options (including the prescription of newer drugs) to provide appropriate support to patients in need.
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