Excerpts from a recent interview:

1) It has been projected that depression will be the 2nd leading cause of disease by 2020. Why are we seeing this increase in cases of depression worldwide?

It has been postulated that modernisation is correlated with an increase in the prevalence of depression. This may be related to modern diet and a lack of activity, resulting in obesity and more health problems like diabetes. Chronic health issues are factors in precipitating depression. The decrease in exposure to sunlight as we tend to stay indoors more and decrease in sleeping hours can lead to circadian dysregulation resulting in depression. The ready availability and willingness of people to take illicit drugs and abuse alcohol may also increase the rates of depression. From a social perspective, urbanisation and having to live in crowded quarters, a decrease in faith towards religion and an emphasis on individualism and social isolation can all contribute to this trend of depression

2) In Singapore, are there any groups of people who are more at risk of having depression? (in terms of age/race/gender/socioeconomic background etc)

Generally, women are more at risk of have depression. This may really be related to women being more in touch with their emotions and being more likely to present with depression whilst men turn to alcohol and substance abuse. Teens and the elderly are also more at risk of developing depression.

3) Why is depression a form of disability? How does it manifest as one?

Depression can be debilitating. Even in mild form of depression, the patients can have difficulties concentrating, making decisions, feel lethargic and experience a slowing in their thinking processes, making everyday activities and work hard to accomplish. In severe forms, they may be incapacitated and housebound, losing all energy to go out and having no confidence to face the world.

4) Other than the fear of stigma, what are the difficulties that your patients face when they seek treatment for depression?

The understanding of depression is poor. Many still do not see it as a multi-factorial medical condition and think that there is a root cause that they can get rid of. Sufferers often think that they can snap themselves out of depression just by being positive. Often even when they want to seek treatment, they may meet resistance from family members who urge them not not to have treatment but instead advise them to do the impossible by snapping themselves out of depression. Many also view treatment with suspicion and think of antidepressants as dangerous drugs. They believe erroneously that medication will numb the mind, cause addictions and dependency and cause long time physical problems. For therapy, they assume that it is something didactic and are not willing or motivated to put the hard work and hours necessary to improve.

5) Can patients get an MC (medical leave) when they have depression? If so, are there any criteria they have to meet?

Yes, they can get MC. As long as they are having clinical depression and this is affecting their work or social life, MCs may be warranted. In Singapore, the problem is that even when MCs are offered, patients often decline as they cannot afford to rest from work.

6) Can depression be treated or can it only be suppressed with medicine?

They can be treated effectively with antidepressants and many will recover. Conversely, if depression is not treated, it can become long term and chronic. That is when a person will have to take long term medications and be reliant on treatment.