Understanding Depression: Evolving Perspectives

 Biological Factors

As of 2023, there has been a significant shift in the understanding of the biological roots of depression. Thanks to advances in neuroimaging and genetics, we now have a better understanding of this illness. Recent studies suggest that depression may be caused by a complex interplay between genetic predispositions and environmental factors, rather than being solely caused by a chemical imbalance in the brain. Additionally, there is a growing focus on the role of inflammation and the immune system in depression, which challenges the traditional monoamine hypothesis.

Psychological and Social Aspects

The pandemic years highlighted the psychological and social dimensions of depression. Isolation, economic stress, and health anxieties have contributed to a rise in depression rates worldwide. Researchers are now looking at the long-term impacts of such societal stressors, emphasizing the need for holistic treatment approaches.

Treatment Innovations

Pharmacotherapy

In light of societal stressors, there is a growing need for holistic treatment approaches.

Regarding treatment innovations, there have been exciting developments in the realm of pharmacotherapy. While SSRIs and SNRIs remain the primary treatments, there is a growing interest in medications that target novel neurotransmitter systems. Drugs like ketamine, which work on the NMDA receptor, have shown promise in treating resistant depression.

Psychotherapy

Currently, precision medicine is gaining momentum, with efforts to personalize antidepressant therapy based on genetic profiles. In addition, Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) remain effective treatments. However, there is a growing emphasis on integrating

Integrative Approaches

AI-driven chatbots and virtual reality (VR) are being used to enhance accessibility and effectiveness. There is a growing interest in integrative medicine approaches, with mindfulness, yoga, and exercise being studied.

Societal Impact and Public Health Strategies

Awareness and Stigma

Public awareness campaigns now focus on reducing stigma and promoting mental health literacy.

Accessibility and Equity

The critical discussion of disparities in access to mental health care is leading to efforts to improve mental health services in underserved communities, which emphasizes the need for culturally sensitive approaches.

Workplace Mental Health

The importance of mental health in the workplace has led to a rise in corporate wellness programs, with many companies investing in mental health training for managers and resources such as counseling services.

Challenges and Future Directions

Diagnostic Challenges

Diagnosing depression is challenging due to its varied nature, but ongoing research seeks to refine diagnosis and develop biomarkers for personalized treatment.

Treatment-Resistant Depression

Treatment-resistant depression (TRD) remains a significant challenge despite ongoing research exploring combination therapies, novel drugs, and brain stimulation techniques.

Preventive Strategies

Preventive psychiatry is gaining momentum with a focus on early identification and intervention, especially among high-risk groups like adolescents.

Global Mental Health

Depression is a global challenge. There are ongoing efforts to create scalable interventions and policies that address the unique challenges of different regions.

Conclusion

As of 2023, there have been significant advancements in the treatment of depression. The understanding of its complex nature has led to more personalized and inclusive approaches to treatment. However, there are still some challenges involved, particularly when it comes to diagnosing the condition, treating those who are resistant to treatment, and ensuring that everyone has equal access to care. The future of depression treatment will require further research, innovation, and cooperation between biological, psychological, and social perspectives. Therefore, psychiatrists and mental health professionals need to stay informed about these developments to provide the best possible care for individuals dealing with depression.

How to Find The Best Psychiatrist in Singapore.

Which psychiatrist should we consult if we have depression? It may be hard to know who to seek help with. Many patients want to find the best psychiatrist available in Singapore. However commonsense tells us that there is no such thing as the best psychiatrist but maybe there may be the psychiatrist that suits me best! 

One way can be to search online. There are several websites that provide directories of psychiatrists in Singapore, along with patient reviews and ratings. 

One of the list online on 11 Best Psychiatrist in Singapore listed:

1. Dr BL Lim Centre For Psychological Wellness
2. The Psychological Wellness Centre
3.  Dr Adrian Wang Psychiatric and Counselling Care
4. Adult & Child Psychological Wellness Clinic
5. The Psychological Wellness Clinic
6. Mind Care Clinic
7. Solace Art Psychotherapy
8. Nicole Chew-Helbig
9. Neo Cooper Psychology Clinic
10. Promises Healthcare
11. Scott Psychological Centre

Another one listed the doctors per se:

1. Dr Lim Boon Leng (Dr BL Lim Centre For Psychological Wellness)
2. Dr Alvin Liew (Adult & Child Psychological Wellness Clinic)
3. Dr Thomas Lee (Resilienz)
4. Dr Adrian Wang (Dr Adrian Wang Psychiatric and Counselling Care)

5. Dr Nelson Lee (The Psychological Wellness Clinic)

However, we cannot be sure who compiled these lists and their reliability. There can be other ways to find the best psychiatrist. 

1) From my own experience, consult with your general practitioner or family doctor. They may have recommendations for reputable psychiatrists in the area.

2) Check with hospitals and clinics. Singapore has several reputable hospitals and clinics that provide psychiatric services. You can check their websites to find a list of psychiatrists and their qualifications.

3) Ask for recommendations from friends or family members who have sought psychiatric help in Singapore.

It's important to do your research and find a psychiatrist that you feel comfortable with and who has the qualifications and experience to help you with your specific needs.

Social media may increase depression

The link between the two has been talked about for years, but a causal connection had never been proven. For the first time, University of Pennsylvania research based on experimental data connects Facebook, Snapchat, and Instagram use to decreased well-being. Psychologist Melissa G. Hunt published her findings in the December Journal of Social and Clinical Psychology.

Few prior studies have attempted to show that social-media use harms users' well-being, and those that have either put participants in unrealistic situations or were limited in scope, asking them to completely forego Facebook and relying on self-report data, for example, or conducting the work in a lab in as little time as an hour. "We set out to do a much more comprehensive, rigorous study that was also more ecologically valid," says Hunt, associate director of clinical training in Penn's Psychology Department. To that end, the research team, which included recent alumni Rachel Marx and Courtney Lipson and Penn senior Jordyn Young, designed their experiment to include the three platforms most popular with a cohort of undergraduates, and then collected objective usage data automatically tracked by iPhones for active apps, not those running the background. Each of 143 participants completed a survey to determine mood and well-being at the study's start, plus shared shots of their iPhone battery screens to offer a week's worth of baseline social-media data. Participants were then randomly assigned to a control group, which had users maintain their typical social-media behavior, or an experimental group that limited time on Facebook, Snapchat, and Instagram to 10 minutes per platform per day. For the next three weeks, participants shared iPhone battery screenshots to give the researchers weekly tallies for each individual.

With those data in hand, Hunt then looked at seven outcome measures including fear of missing out, anxiety, depression, and loneliness. "Here's the bottom line," she says. "Using less social media than you normally would leads to significant decreases in both depression and loneliness. These effects are particularly pronounced for folks who were more depressed when they came into the study." Hunt stresses that the findings do not suggest that 18- to 22-year-olds should stop using social media altogether. In fact, she built the study as she did to stay away from what she considers an unrealistic goal. The work does, however, speak to the idea that limiting screen time on these apps couldn't hurt. "It is a little ironic that reducing your use of social media actually makes you feel less lonely," she says. But when she digs a little deeper, the findings make sense. "Some of the existing literature on social media suggests there's an enormous amount of social comparison that happens. When you look at other people's lives, particularly on Instagram, it's easy to conclude that everyone else's life is cooler or better than yours." Because this particular work only looked at Facebook, Instagram, and Snapchat, it's not clear whether it applies broadly to other social-media platforms. Hunt also hesitates to say that these findings would replicate for other age groups or in different settings. Those are questions she still hopes to answer, including in an upcoming study about the use of dating apps by college students. Despite those caveats, and although the study didn't determine the optimal time users should spend on these platforms or the best way to use them, Hunt says the findings do offer two related conclusions it couldn't hurt any social-media user to follow. For one, reduce opportunities for social comparison, she says.

"When you're not busy getting sucked into clickbait social media, you're actually spending more time on things that are more likely to make you feel better about your life." Secondly, she adds, because these tools are here to stay, it's incumbent on society to figure out how to use them in a way that limits damaging effects. "In general, I would say, put your phone down and be with the people in your life."

New Acne Diagnoses Linked to Depression

In the first year after being told by a doctor that they have acne, patients’ risk for a diagnosis of major depressive disorder spikes by more than 60 percent compared to the general population, a new study shows. Dermatologists and other doctors treating acne should keep an eye on patients' mood symptoms as well, and start treatment or make a psychological referral if depression is present, the authors write in British Journal of Dermatology. "

The idea for the current study came from another recently published study we did looking at the mental health effects of the acne drug isotretinoin (Accutane). Over the past few years, there have been numerous reports that isotretinoin (Accutane) has been linked to psychiatric disorders," lead author Isabelle Vallerand told Reuters Health by email. "Our recently published systematic review did not find an increased risk of psychiatric disorders among people treated with isotretinoin, but we wondered if acne itself may be contributing to mental illness," said Vallerand, a researcher with the Community Health Sciences department of the Cumming School of Medicine at University of Calgary in Canada. Acne, the most common skin condition in the U.S., includes whiteheads, blackheads, pimples, cysts and nodules that affect the face, shoulders, back, chest and upper arms. Past research has found that roughly two-thirds of acne patients are adults, not teenagers, and that depression is common, with about 10 percent of female acne patients also experiencing depression symptoms.

While it is intuitive that acne can have negative effects on mood, Vallerand said, the study team wanted to assess whether there was an increased risk of “true clinical depression.” Using a large UK database of medical records, they analyzed information on patients ages 7 to 50 years, focusing on 134,437 people with a new acne diagnosis and 1,731,608 similar patients without acne. After following both groups for up to 15 years, researchers found that among acne patients, the probability of developing major depressive disorder was 18.5 percent, while in the general population it was 12 percent. The risk was highest in the first year after a new acne diagnosis and then tapered off, the authors note. "We found that acne increased the risk of developing clinical depression by 63 percent in the first year following an acne diagnosis and that this risk remained elevated for five years after the initial acne diagnosis," Vallerand said.

Overall, acne patients had 46 percent higher risk for major depression than the comparison group. Women outnumbered men among the acne patients, and women were also more likely to develop depression. The authors did not have information about the severity of patients’ acne, but they speculate that more severe cases might lead to greater depression risk. Nor did they know what acne medications the patients were using, other than those on isotretinoin.

"While it has been known for many years that people with acne might have a lower mood resulting from their skin, this is the first study to show conclusively that acne can be more than just a skin blemish, and can have a substantial impact on mental health in the form of clinical depression," Vallerand said. “We believe that healthcare providers treating patients with acne should firstly be aware that acne is a risk factor for developing major depressive disorder and that they should encourage any of their patients with acne to feel comfortable raising any mental health concerns to their attention, as these should be taken seriously.” Physicians treating patients with acne should also help to coordinate mental health interventions for their patients who develop depression, when needed, she added.

Whilst this study is done in the UK, the large and representative cohort means that the results are likely generalizable to our population in Singapore. Do seek treatment with your psychiatrist in Singapore for an assessment if you suspect that you or your loved ones have depression.

Online CBT Effective for Depression?

Researchers found low patient adherence and engagement with computer-assisted cognitive behavioural therapy programmes

The benefits of computer-assisted cognitive behavioural therapy for tackling depression have been called in to question by a study that found low patient adherence and engagement with the treatment. Computer-assisted CBT (cCBT) is endorsed by the National Institute for Health and Care Excellence (Nice), and has been seen as a way of boosting access to talking therapies, for which patients often face lengthy waits. But an independent study by University of York researchers found that people who received usual GP care with one of two cCBT packages experienced no additional improvement in depression after four months, compared with those who solely received usual GP care. The results, published in the BMJ on Wednesday, led the authors to conclude that promotion and commissioning of cCBT should be reconsidered, because it is “likely to be an ineffective form of low-intensity treatment for depression and an inefficient use of finite healthcare resources”. They write: “We have found that participants offered cCBT were generally unwilling to engage with computer programmes and highlighted the difficulty in repeatedly logging on to computer systems when they are clinically depressed. “Participants said they wanted a greater level of clinical support as an adjunct to therapy, and, in the absence of this support, they commonly disengaged with the computer programmes.” The REEACT study, believed to be the largest of its kind, involved 691 patients with depression from 83 GP surgeries across England, who were randomly assigned into one of three groups – to have solely GP care, or to receive it with one of two cCBT packages. The cCBT packages were two of the most popular available, the commercial Beating the Blues, developed by King’s College London’s (KCL’s) Institute of Psychiatry, and the Australian National University’s (ANU’s) free-to-use MoodGYM. Developer-led trials of both have shown them to be efficacious in reducing symptoms of depression. But the REEACT researchers wanted to test their impact with a level of support akin to that typically offered in an NHS primary care setting. Advertisement Participants were called by a technician on a weekly basis to provide encouragement and support to complete the programmes, which consist of eight (Beating the Blues) and six (MoodGYM) one-hour sessions respectively. Each patient’s depression and health-related quality of life were assessed at four, 12 and 24 months. By four months, 44% of participants in the usual care group, 50% of patients in the Beating the Blues group and 49% in the MoodGYM group remained depressed. The authors write: “The main reason for this was low adherence and engagement with treatment, rather than lack of efficacy.” Computer login records showed that while 83% of patients assigned to Beating the Blues, and 77% of MoodGYM participants accessed the programmes after allocation, only 18% and 16% respectively completed the full course. Almost a quarter of patients dropped out of the study by four months. The only statistical evidence of a difference was in favour of MoodGYM versus usual GP care at 12 months but this was no longer evident at 24 months. A Nice spokeswoman said: “We recommend computerised CBT as one option for treating people with mild to moderate depression, but the decision to offer it should always be based on clinical judgement and the patient’s preference. If it is deemed appropriate, we recommend it is supported by a trained practitioner who reviews the patient’s progress and their outcome. “We are currently updating our guidance for the treatment and management of depression in adults. We will take all published evidence into consideration.” KCL said most of the research team who worked on Beating the Blues had left and so declined to comment. ANU could not be reached for comment before publication.

How Depression and Anxiety Impact Heart Disease

Everyone feels sad or anxious occasionally. But for some, depression and/or anxiety can be more extreme, affecting both psychological and physical health. Each year in the U.S., 6.7 percent of adults experience major depression and 18 percent of adults have an anxiety disorder, according to the National Institute of Mental Health.

Unfortunately, people with heart disease are more likely to suffer from depression and anxiety — which increases the risk of future heart attacks, strokes and even death. Some researchers also feel that depression may raise the risk of heart disease in otherwise healthy individuals.

“It’s a cycle of both cause and consequence,” says Meghan York, MD, a clinical cardiologist at Beth Israel Deaconess Hospital-Needham and the CardioVascular Institute at Beth Israel Deaconess Medical Center. “Anxiety and depression can place you at greater risk for heart disease. And patients who have experienced heart-related events may experience depression or anxiety, which raises the risk for future issues to occur.”

What are the Chances and Risks?

Growing knowledge about depression as a risk factor for cardiac disease prompted the American Heart Association to recommend that all cardiac patients be screened for depression. Studies have found that 9.3 percent of patients with heart disease experience major depression, compared with 4.8 percent for those without heart disease. The numbers are even higher for patients who have endured surgery or medical events related to heart disease.

“Stroke and heart attack survivors are more likely to be depressed than the general population,” says York. “For example, after a heart attack, about 20 percent of patients are diagnosed with depression. This mix of heart disease and depression has ramifications that extend beyond the symptoms of the two disorders.”

Recent research reflects the seriousness of this risk. People with heart disease who suffer from anxiety disorders have twice the risk of dying from any cause, according to a 2013 study published in the Journal of the American Heart Association. The study also found that the combination of anxiety and depression is even more lethal for heart disease patients, causing a three times greater risk of mortality. Conducted at Duke Medical Center, this research involved 934 heart patients with an average age of 62. During three years of follow up, 133 patients died and 55 of them had anxiety, depression or both. Most of deaths (93) were related to heart disease.

While increased risk for heart disease patients with depression has been well established for years, research also points to an elevated risk for future heart disease among those who suffer from depression.

One study found that men with major depression are twice as likely to develop heart disease. Conducted by Washington University School of Medicine and the Veterans Administration, the study involved more than 1,200 male twins who served in the military and found that, even among twins with similar genetic profiles, only the men with a history of depression had a higher cardiovascular risk.

What is the Connection to Heart Risk?

“Anxiety and depression each influence cardiovascular risk in different ways,” says York. “Continued anxiety increases nervous system activity, which can result in higher blood pressure and inflammation. In fact, some studies show that an emotional upset can even trigger a heart attack, raising the risk by 10 percent.

The impact of depression on health often involves lifestyle choices associated with the ailment, including lack of exercise, poor diet, smoking or consuming excessive alcohol.

“Depression may also result in people becoming less likely to take their medications as prescribed and get to regular doctor visits,” says York.

But there’s also evidence that depression may cause physical changes in the body that can damage the cardiovascular system. Research presented to the American Heart Association in 2011 found that depression may cause a higher risk of narrowed arteries in the legs and pelvis, a condition called peripheral artery disease (PAD).

Symptoms for Concern

How do you know that your depression or anxiety needs treatment?

For depression, symptoms may vary in severity, frequency, and duration, but a major depressive disorder prevents normal functioning and interferes with a person's day-to-day life. Symptoms may include continual sadness; feeling hopeless, helpless or worthless; fatigue; loss of interest in activities; insomnia; an inability to concentrate; or thoughts of suicide.

People with an anxiety disorder may have persistent fears or worries and difficulty relaxing or concentrating. Physical symptoms can include headaches, muscle or tension aches, fatigue, irritability, trembling, sweating, or feeling out of breath. In some cases, an anxiety attack may be so severe that the person visits the emergency room, thinking that they are having a heart attack.

Treating the Conditions

“Patients should be open about discussing feelings and fears with their physicians,” says York. “Many people, particularly women, tend to shrug off symptoms of anxiety, for example. It’s important to pay attention to events that bring you a surge of anxiety. And if you have pain or discomfort, you should tell your primary care physician right away.”

Treating anxiety and depression can involve counseling or medication, and sometimes a combination of the two. But lifestyle can also play a major role in easing or preventing the two disorders. In fact, engaging in regular exercise decreased depression symptoms for heart patients in a study conducted by Duke University. Duke researchers found just three 30-minute sessions weekly had an impact on easing depression, while also decreasing the risk of hospitalization and death.

“Patients can also learn relaxation techniques, such as breathing exercises or meditation,” says York. “And eating healthy foods, keeping fit, quitting smoking if needed, and drinking little or no alcohol can make a difference for both mental stability and heart health.”

For heart disease and heart attack patients, cardiologists conduct screenings for depression. Studies have not shown that treating depression can alter long-term outcomes for heart disease patients, but it most certainly affects long-term quality of life.

“If you’ve had a heart attack or a diagnosis of heart-disease,” says York, “it’s important to know that depression or anxiety is very common for those with these conditions. Reaching out to your physician is the first step to getting your feelings back under control and improving your ability to relax and enjoy life again.”

Germanwings crash: Lufthansa knew of co-pilot depression

From BBC:

The Germanwings co-pilot suspected of deliberately crashing his plane into the Alps had disclosed an earlier bout of depression, Lufthansa has said.

The airline, which owns Germanwings, said last week that Andreas Lubitz had taken a break from flight school training, but refused to say why.

It has now shared emails from 2009 which show Lubitz told instructors he had suffered from "severe depression".

Meanwhile, all human remains from the crash have reportedly been recovered.

French authorities told AFP news agency that the remains of all the victims had been removed from the remote ravine where the plane went down, but mountain troops would return to the scene on Wednesday to search for personal belongings.

The search for the second flight recorder will also continue.

Also on Tuesday, German newspaper Bild and French news magazine Paris Match said they had obtained a video showing the plane's last moments before the crash.

The footage was shot on a mobile phone inside the plane, and recorded the sound of passengers screaming and the sound of a metal object striking the cockpit door, the newspapers said.

'Suicidal tendencies'

A recording from the cockpit of the aircraft suggests Lubitz, 27, deliberately caused the disaster last Tuesday, which killed 150 people.

Lufthansa CEO Carsten Spohr previously said that the company was not aware of anything that could have driven the co-pilot to crash the Airbus A320.

"He was 100% fit to fly without any restrictions or conditions," he told reporters.

It has now emerged, as part of the airline's internal research, that Lubitz had sent information about his depressive episode to the Lufthansa flight school in Bremen, when he resumed training after an interruption of several months.

He subsequently passed all medical tests and eventually secured his license. He started working with Lufthansa subsidiary Germanwings in 2013.

German prosecutors said on Monday that Lubitz had received treatment for "suicidal tendencies" before completing his training.

But Lufthansa said his medical records were subject to doctor-patient confidentiality and it had no knowledge of their contents.

The company has set aside an additional $300m (€280m; £200m) to cover possible costs arising from the crash.

The money is separate from the $54,250 available to the relatives of each passenger to cover short-term expenses.

Airlines are obliged to compensate relatives for proven damages of up to a limit of about $157,000, regardless of what caused the crash. Higher compensation is possible if an airline is held liable.

None of the victims' bodies were found intact after the plane's 700km/h (430mph) impact, but different strands of DNA have been identified.

French President Francois Hollande said on Tuesday that all 150 victims would be identified by the end of the week.

Speaking at a joint news conference with German Chancellor Angela Merkel in Berlin, Mr Hollande said "exceptional scientific work" had been carried out by the recovery team.