The Rising Toll of Depression in Singapore
Across Singapore, depression—a misunderstood and often stigmatized illness—is on the rise. It typically begins in adolescence, shaped by cyberbullying, academic pressure, and body image anxiety. By adulthood, it calcifies into something harder to shake.
We spoke to two senior consultant psychiatrists at Private Space Medical, Dr Tabitha Mok and Dr Tay Kai Hong, to better understand this growing mental health challenge.
Dr Tay Kai Hong (left) and Dr Tabitha Mok (right), Private Space Medical
According to Dr Mok, the age of onset has shifted markedly. “We are increasingly seeing younger children present with symptoms traditionally associated with adolescent or adult depression,” she noted.
A 2023 study by the Institute of Mental Health paints a sobering picture:
Nearly one in three Singaporeans aged 15 to 35 exhibit symptoms of severe stress, anxiety, or depression. Most never receive professional help. Many don’t even ask.
The human toll is staggering. In a case that drew national attention, 30-year-old Zabelle Peh was charged after her two-month-old daughter died from injuries she inflicted. Peh had been suffering from undiagnosed postnatal depression, a tragedy that might have been prevented with timely intervention.
Cases like this are rare. Most people with depression do not harm others. They go to work, care for their families, and carry the pain quietly. Their struggle does not make headlines, but it still demands attention. Without proper support, that pain can deepen. It can pull a person away from their life, their relationships, and their sense of self. Preventing the worst begins with recognising the quiet suffering early.
Bringing New Therapies into Focus
Patients with depression go through months, even years, of antidepressants and therapy without relief. Up to half may fall into what psychiatrists call treatment-resistant depression. These are not isolated cases. They reflect the limits of a system that still leans heavily on older medications and long wait times.
“Traditional antidepressants work on serotonin, noradrenaline, and dopamine,” explained Dr Tay. “Esketamine, on the other hand, works by targeting the glutamate system, providing symptom relief within days.” This difference positions esketamine as a significant option for individuals battling hard-to-treat depression.
In 2020, Singapore approved esketamine treatment, a nasal spray derived from ketamine, as an option for those who do not improve with standard care.
The treatment is administered under strict conditions. Patients inhale the spray under clinical supervision, then stay for observation. Side effects, such as dizziness or dissociation, usually pass quickly.
The Ministry of Health reinforced its position in Parliament:
“Clinical trials have demonstrated that the use of ketamine nasal spray resulted in improvements in symptoms of major depression, with mild side effects and minimal addictive potential. Overall, the benefits of ketamine nasal spray outweighed its risks.”
Dr Tay added, “Studies show that 79.4% of patients respond to esketamine, with 52.7% achieving remission. Its speed of response is more comparable to electroconvulsive therapy than to traditional antidepressants or psychotherapy.” This rapid efficacy offers new hope, particularly for those at risk of hospitalisation.
Yet stigma remains a powerful barrier. Ketamine’s association with recreational drug use, often known by its street name “Special K,” casts a shadow over its medical use. Even under clinical supervision, fears of addiction or judgment deter many from seeking out esketamine treatment in Singapore.
A Path to Healing, Paved in Thousands
The promise of esketamine treatment in Singapore comes with a cost. At Private Space Medical, the first month of treatment is priced at approximately $12,000 before GST. As the frequency of sessions decreases, the cost drops to $6,000 in the second month and $3,000 in the third. These figures do not include the additional expenses of oral medication and psychotherapy, which many patients continue alongside the treatment.
“In an ideal world, a person’s financial capacity should have no bearing on treatment decisions,” said Dr Tay Kai Hong. “In reality, it is a factor we have to consider and discuss transparently with patients, especially for costlier treatments.”
Because esketamine is classified as a controlled substance, sessions must take place under tight regulations. Each requires medical supervision and trained staff throughout, which increases operational costs.
Insurance coverage remains limited. Many providers either classify esketamine treatment in Singapore as experimental or restrict coverage to narrowly defined cases, leaving patients to pay out of pocket.
When asked how financial barriers affect treatment planning, Dr Tay shared, “After diagnosis and case formulation, we customise a personal treatment plan and discuss all options, including their cost considerations, with the patient and their family.”
For patients who qualify medically but cannot afford a full course, doctors commonly adjust their approach.
“We usually embark on more accessible treatments and medications first,” Dr Tay explained. “Esketamine is reserved for cases where first- and second-line treatments have failed or when suicidal ideation is severe.” In such instances, alternatives like psychiatric admission or electroconvulsive therapy are considered, though they come with their own risks and stigma.
“It is worth emphasising that the cost of esketamine treatment should be compared with alternatives like psychiatric admission and electroconvulsion therapy,” he added. “Esketamine enables patients to recover at home, avoiding hospitalisation and its associated distress.”
Some patients manage partial coverage through employer insurance plans, but widespread support remains lacking.
Alternatives on the horizon with personalised TMS
As access to drug-based treatments like esketamine in Singapore remain limited, researchers are locally advancing a new non-pharmaceutical approach. In 2024, the Institute of Mental Health and NUS Medicine launched two clinical trials to study personalised transcranial magnetic stimulation, or TMS, for patients who have not responded to conventional care.
The trials, SPARK-D and APIC-TMS, are the first of their kind in Southeast Asia. Standard TMS targets the same region in every brain, whereas this approach uses individualised MRI scans and machine learning to identify the most affected areas in each patient.
A robotic arm delivers magnetic pulses to the precise spot, guided by a protocol developed at Stanford. Early studies showed remission rates of up to 80% higher than standard TMS or electroconvulsive therapy.
Dr Tor Phern Chern, lead investigator of both studies, sees the technology as a potential breakthrough.
“Personalised TMS can potentially bring about a paradigm shift in the management of treatment-resistant depression. Going from a months-to-years long treatment to a rapid procedural one that delivers significant outcomes in a much shorter period.”
The National Medical Research Council and Temasek Foundation funded the trials, each with a S$1 million grant. Researchers conduct fMRI scans to map brain networks and analyse the results using an algorithm developed at NUS.
Image credit: NUS Yong Loo Lin School of Medicine
Clinicians use the data to guide real-time stimulation to the optimal site and adjust for any patient movement during treatment.
Assoc Prof Thomas Yeo, who helped develop the algorithm, says the goal is precision without invasiveness.
“We are able to locate the exact spot unique to each patient and stimulate it to treat their depression disorder as accurately as possible.”
Personalised TMS is already showing promise as a faster, more targeted alternative to treatments like esketamine in Singapore. As a publicly funded initiative within national healthcare institutions, it also holds potential for broader access and scalability, particularly if local results reflect the success seen in earlier international studies.
Why Affordability Must Be Part of the Mental Health Conversation
Innovation in mental health care is moving fast. Esketamine and personalised TMS show that science is finally catching up to the complexity of depression. Still, one truth continues to shape outcomes: access often depends on wealth.
“We recognise that cost can influence treatment decisions,” said Dr Mok. “That is why we encourage early, open conversations about care planning and sustainability.” A multidisciplinary approach, combining psychiatrists, psychologists, and counsellors, allows for more flexible pathways even when finances are a concern.
Beyond cost, stigma remains a major barrier. As Dr Mok observed, “Delays in help-seeking are often driven by stigma, limited mental health literacy, and difficulties navigating the care system.” Adolescents may fear judgment from peers, while adults may view emotional distress as a personal failing rather than a health condition that deserves treatment.
A person’s ability to recover should not depend on their bank balance. However, without insurance support or public subsidies, advanced options like esketamine treatment in Singapore remain out of reach for many.
From their clinical experience, Dr Mok shared, “Patients who complete the full course of esketamine, especially with psychological support, are more likely to experience meaningful, lasting improvement.” Interrupting treatment prematurely often leads to only partial recovery and a higher risk of relapse.
Doctors see the divide daily: some patients afford cutting-edge care; others are forced to choose between mental health and financial survival. This inequity undermines the promise of innovation.
Progress in treatment only matters if everyone has a fair chance to benefit. Clinics like Private Space Medical demonstrate what is possible when multidisciplinary teams work together to deliver personalised, evidence-based care.
Expanding such models more widely will require systemic investment, public support, and a stronger national commitment to mental health equity.
