Psychiatric Neurostimulation in Singapore.

Psychiatric conditions are estimated to account globally for 21.2% of years lived with disability (YLD) and 7.1% of disability-adjusted-life-years (DALYs),1 although the actual fi gure may be even higher.2 In Singapore, 12% of the population will have at least one lifetime affective, anxiety or alcohol use disorder.3 Treatment for psychiatric conditions is broadly divided into talking therapies, pharmacotherapies and neurostimulation. For more severe psychiatric conditions, the latter two therapies are often required. However, investment in psychiatric pharmacotherapies has diminished in recent years with most major pharmaceutical companies pulling out of or scaling back investment into psychiatric drug development.4 Psychoactive drug development is now the preserve of smalland medium-sized companies. The implication is that future advances in psychiatric treatment will depend increasingly on the development of neurostimulatory techniques. Neurostimulation is defi ned as modulation of the central or peripheral nervous system by electrical or magnetic impulses and has novel mechanisms distinct from the typical monoamine or dopamine pathways that the majority of psychiatric drugs are thought to function. The good news is that there have been rapid advances in the fi eld of neurostimulation over the past 20 years that portends hope for psychiatric treatment advances. We will describe briefl y the major psychiatric neurostimulation modalities currently available and on the horizon for Singapore.