April 2022 - Promises Healthcare
Alexis Fosler talks with the editor of ANZA Magazine on ‘Spring Cleaning Your Mind For Better Well-being’

Alexis Fosler talks with the editor of ANZA Magazine on ‘Spring Cleaning Your Mind For Better Well-being’

Visions by Promises’ Addictions therapist, Alexis Fosler, gave some great insights and tips for dealing with stress in an interview about “Spring Cleaning Your Mind For Better Well-Being” with ANZA Magazine’s editor.


Restrictions are lifting, the workforce is returning traditional office spaces, travel is go. On the outside many would say we are emerging into a ‘new normal’, but that doesn’t necessarily mean that our minds are at ease. Having a human brain, particularly right now, is stressful.

Much like how the homes we’ve become so bound to in the past few years have grown more cluttered, our minds are filled with chaotic debris and discontent too. Recent research by YouGov found that six in 10 Singapore residents have suffered adverse effects to their mental health due to the pandemic, with those aged 35 – 44 most affected.

“Covid-19 has certainly impacted both our thoughts and our behaviours, and studies have shown that population mental health has declined significantly during this period,” confims Alexis Fosler, psychotherapist at Promises Healthcare. “These same studies indicate that we may have given more time to think about our anxieties and our worries such as employment, health and our lack of social connection. We’ve put less brain power into thinking about others and about our future plans – both of which are associated with better wellbeing.”

Clutter-free environment

While we don’t experience seasonal changes in Singapore, the arrival of spring can serve as a natural point to take stock of our mental wellbeing and reconnect with the things that bring us purpose and joy. We know that positive outcomes are associated with physical decluttering. When we clean the messy spare room, give the kitchen a clear out or tidy the drawer that hasn’t closed properly since 2019, we experience lower levels of stress, greater productivity, better focus, higher self-esteem and increased mental health. Alexis believes that same positive effects can occur when you spring clean your brain.

“We know that our brains like order and are less likely to be distracted and overloaded in a clutter-free environment,” she says. “We live in two states: our external environment and our internal environment. Both can affect our overall wellness, so it’s equally important to live in an internal world that is not overwhelmed with noise and distraction.”

Creating a soothing internal landscape is easier said than done, but Alexis recommends achieving a calmer, clearer mind by “thinking about wellbeing as the house in which you live, which is supported by a number of important pillars”. Here are a few of her simple rules:

  • The first pillar to your house of wellbeing is exercise which improves mood and decreases feelings of depression, anxiety and stress. It also produces changes in parts of the brain that regulate stress and anxiety and boosts the production of endorphins, which are known to help produce positive feelings.
  • The second pillar is service to others. “The more I think about other people, the less I am concerned with myself, and the more I’m able to focus outwardly, and escape the natural whirlpools and eddies of my own mind,” Alexis says.
  • The third pillar is social connection. Research indicates that the number of social connections, and the type, quality and purpose of relationships, can affect brain function. So it seems that better social engagement is good for brain health (like we need another reason to love an ANZA Ladies Night!). There is also evidence that loneliness increases the risk of loss of thinking skills in older people.
  • The fourth pillar is learning or education. “At times in my life where I’ve felt stuck, picking up a new skill or a new degree has been a lifesaver – the rigour of studying hones our mental skills and keeps us engaged; it has a wider benefit of opening doors to new skills and relationships,” Alexis confirms.
  • The final and perhaps most significant pillar is meditation, something which many studies claim gives rise to mental focus and clarity. “I never really understood what this meant, but meditation completely changed my outlook,” admits Alexis. “Most people think about meditation as the absence of thought, but really, it’s the ability to observe your thoughts, thus allowing yourself to see where your mind takes you, and to press pause on negative thinking. If I’d known the power of meditation, I would have started many years ago!”

Having the ability to observe her thoughts, Alexis says she is much better able to detect negative thought patterns and allow herself to reframe situations she finds herself in. “The ability to monitor or control our thoughts allows for an internal – rather than external – locus of control, which is incredibly important in an era where there are so many things (a lingering pandemic, employment, war) that are beyond our control. She adds; “Once you realise that the power to change lies within the space between your ears, you can possess an unpolluted mind and the world can appear much more manageable.”

Promises Healthcare provides a comprehensive range of psychiatric, psychological & physical wellbeing services for children and adults.

*This article first appeared on ANZA’s website.

Dr Jacob Rajesh Speaks with Expat Living on the misconceptions of psychiatric medication

Dr Jacob Rajesh Speaks with Expat Living on the misconceptions of psychiatric medication

Psychiatry Questions … Answered!

What are some commonly used psychiatric medications?

Depression is a very common disorder, affecting between five to ten percent of people, so we use antidepressants quite often. The medications we’ve been using for the past 25 years are called Selective Serotonin Reuptake Inhibitors (SSRIs). These newer generation drugs have much fewer side effects than those used in the past.

They do have some side effects though, the most common being gastric distress, nausea, headaches and insomnia. Some people also report sexual dysfunction and decreased libido. However, these side effects can be managed once the medication and dose is adjusted. SSRIs are usually more tolerated than older antidepressants.

Another group of drugs is the antipsychotics, which are used to treat schizophrenia and bipolar disorders. The second generation antipsychotics have fewer side effects than older ones, along with fewer cognitive effects and extrapyramidal side effects such as causing tremors or stiffness. However, side effects such as weight gain, increased blood sugar and increased cholesterol can occur with some of these drugs; these side effects need to be screened for on a regular basis

promises healthcare psychiatric medicine and antidepressants

Is psychiatric medication an alternative to therapy? Or do they work hand in hand?

Medication and therapy usually work hand in hand. Being medication-compliant is another important part of the mental health recovery treatment as it helps bring stabilisation to the chemical and biological changes in the sufferer that cause the disorder.

For depression, we prescribe medication for moderate or severe symptoms if it’s causing impairment or distress. We also recommend psychotherapy in its various forms: cognitive behavioural therapy, dialectical behaviour therapy, acceptance and commitment therapy, interpersonal therapy or family therapy, depending on the psychosocial stressors.

For bipolar disorder or psychotic conditions like schizophrenia, medications are the mainstays of treatment. However, psychotherapy methods can also help with regulating emotions and give handles to help regulate distorted thoughts when mild symptoms occur. Psychological therapy also plays a role for Obsessive-Compulsive Disorder (OCD) and eating disorders. Here, psychotherapy has a much more important role.

What are some of the misconceptions people have about psychiatric medication?

The most common misconception is that all psychiatric medications make you feel like a zombie – you can’t function, you can’t go to work, your mental faculties are affected. While some of the older generation antipsychotic medications can cause mental fogginess, there are newer ones with fewer side effects. Some people also believe that if they start taking medication, they might become addicted. It is usually the benzodiazepine class of drugs that are addictive in the long term; antidepressants aren’t addictive in the long term. We also see many patients who’ve been taking medication on a long-term basis, but we work with them to minimise side effects. We do this by adjusting the dosage, changing the class of drugs used and lifestyle modification. It’s also worth mentioning that psychologists cannot prescribe any of these drugs, only psychiatrists can.

Can you tell us more about new techniques like Transcranial Magnetic Stimulation?

Transcranial Magnetic Stimulation (TMS) uses electromagnetic waves to stimulate the brain. Unlike electroconvulsive therapy, which is more for people with severe psychotic depression, TMS doesn’t require any sedation. The patient simply sits in a chair and has a device placed at specific parts of the brain where it sends small electromagnetic waves. It is an outpatient procedure and there aren’t usually any side effects.

TMS is used primarily for people with depression who haven’t responded to antidepressants or have severe side effects from medication. It’s not usually a first-line procedure.

Is it as effective as antidepressants?

It works in combination with them. If that alone isn’t helping, TMS can augment the medication. It can also help by itself, but once the treatment stops the patient can relapse, so it’s better to take medication along with it.

What are some psychiatric issues that people may not realise they have?

Many people don’t realise that depression or anxiety disorders are mental illnesses. They think it’s a weakness in their own personality or the result of external stressors they can’t handle. The stigma of mental disorders also plays a big part. People tend to be quick to seek help for physical issues but still feel uncomfortable seeing a psychiatrist. I think it’s becoming more accepted though. There’s a misconception that psychiatrists just provide medication.

What else do they do?

Psychiatrists work in teams. The team-based approach is very important because we have psychiatrists who are qualified doctors along with psychologists who are trained in psychotherapy. We also have social workers, case managers and occupational therapists.

It’s a misconception that psychiatrists cannot do therapy. There are many psychiatrists who are trained in many forms of therapy, but the psychologists are the professionals who study these critical areas in depth. We refer the patients to them because it is their area of expertise.

What would you tell someone who is unsure about seeking help?

Don’t be ashamed of your symptoms or be self-critical. Many feel their symptoms stem from a weak personality or an inability to handle stress. People need to understand that mental health issues can occur for people who’ve done everything right – people with a good job, a good family life, good support and no financial issues. Depression is a biological response and it can happen without any external stressors so there is no shame in seeking help.

Dr Rajesh is a Senior Consultant Psychiatrist at Promises Healthcare, a provider that offers a wide range of psychiatric and psychological services for patients of all ages. Promises is also the only private centre in Singapore to offer Transcranial Magnetic Stimulation.

For more information on psychiatric medication and treatments offered by Promises Healthcare, click here.
#09-22/23 Novena Medical Center | 6397 7309

This article first appeared in the February 2022 edition of Expat Living and was published on their website. 


Dinesh Ajith

Dinesh is a seasoned writer and editor with seven years of experience covering travel, restaurants and bars. His interests include film photography, cheesy 90s monster flicks, and scouring the island for under-the-radar craft beer bars.