Cognitive dysfunction in practice

Q. What are your thoughts about cognitive dysfunction in depression?

A. We probably don’t place enough emphasis on the cognitive effects when patients are complaining of depression. Obviously, those effects are there, and I think we must enquire more about it. Then we might be able to identify those patients and hopefully target some of those symptoms to improve their functioning.

Q. Is it your experience that cognitive dysfunction has an effect on reintegration into work.

A. I think so. We obviously try to optimize patients’ symptoms and achieve remission, but people are still struggling to be re-integrated into their working environment. So ultimately I have to refer them to an occupational therapist, who would do work assessment to try to get them back into their working environment, but obviously there are frequently many problems around this.

Q. You come from a very multiracial and multicultural society, do you have any comments on how you see depression as presenting in different groups in your society?

A. I think with differences in cultural backgrounds, many people might somatise more than others, so some cultures may complain of somatic symptoms more than anything else. And I think the entity of stigma is important. Many people are reticent to come to the psychiatrist because of the stigma associated with seeing a mental health professional. Once people are improving in their functioning and getting proper treatment, they definitely spread the message, by word of mouth. So I try always to see somebody who has been referred by a patient who had previously been treated by me.

Q. Do you use psychotherapeutic interventions as well as pharmacotherapy for your patients with depression?

A. Yes, I did my Postgraduate training at University of Cape Town, which was more psychologically based. So because I have a particular interest in it I do see quite a few patients. Percentage-wise, it’s quite low, but I do see people for psychotherapy.

Q. If you had to rank the most important advances in depression over the last decade, what would they be?

A. I think that is the huge shift in the way we think about the aims of treatment. In the past, treatment aim was initially for response, and ultimately for remission, whereas now we are aiming for full functional recovery.