Understanding depression in all its complexity

  • December 9, 2021
Understanding depression in all its complexity

Richard Dear talks about his research into different forms of depression, driven by his own personal experience.

We haven’t made any major advances in treating depression in the last half a century and I believe we need to start from the fundamental questions.

Richard Dear

“Imagine if there were such a thing as a ‘Coughing Disorder’,” says Richard Dear. “Doctors can see that you are coughing, but have no idea if the cough is caused by Covid, tuberculosis or something stuck in your throat. These underlying causes all need different treatments, but imagine that doctors don’t even agree on the range of possibilities. That is where we are with depression today.” Richard wants to change this by applying big data and neuroscience to unravel the underlying biological causes of depression.

Richard [2021] has just begun his PhD in Psychiatry. His research will explore the biology of depression, asking  what are the different subtypes and true underlying biological patterns behind the overarching psychiatric diagnosis of Major Depressive Disorder, now identified by the World Health Organization as the leading cause of disability worldwise. Richard’s research will leverage large datasets of gene expression from post-mortem brains, applying natural language processing to patient clinical records to look underneath the traditional diagnostic categories. After identifying potential subtypes of depression, Richard hopes to validate his results by linking them to neuroimaging, genetic and blood test data from a randomised trial of a new antidepressant. 

For Richard, mental health research is personal, as he suffered and recovered from depression himself only a few years ago. At the time he was working as a data scientist in Silicon Valley, before which he lived several years in China, having grown up in Australia with his British father and Singaporean mother. Over time Richard has come to appreciate the rich complexity of his multiple identities and cultural backgrounds and this in particular makes him excited to join the diverse and international Gates Cambridge community. “There’s a common feeling among Gates Cambridge Scholars of having come from somewhere quite different which puts you outside your culture and being able to relate in this way is very meaningful,” he says.

Childhood

Richard describes himself as  “a cross-cultural child of academics”.  His Singaporean mother met his English father at the University of Reading where both were doing PhDs in statistics, but she soon tired of the wet UK weather. So the couple found postdoctoral positions at Harvard University and Richard was born in even colder Boston, USA. A year later the family moved to sunny Newcastle, Australia, and Richard spent his early childhood by the coast – often having dinner on the beach multiple times a week – until he was nine when the family made another move to Australia’s small but cosmopolitan capital Canberra.

Singapore was always a second home to Richard, as his sister Tara was born there and the family visited every year to see relatives. With three passports, Richard has never felt he fully belongs anywhere, but instead has always been curious to explore the privileges of his cosmopolitan background. For example, he intentionally learnt Mandarin to understand his Chinese side and has returned to Cambridge in part to experience the same university where his father studied as an undergraduate.

Prior to this move, Richard had visited the UK a few times, most significantly when a sabbatical in the UK gave his parents an opportunity to take him and his sister around the world. The impact of traveling to Asia at the age of 14 was enormous, Richard says, remembering in particular their journey from the airport in Delhi and all the children begging for money in the street. “I remember hundreds of faces not much younger than me and being overwhelmed with the feeling that it was impossible to help them all,” he recalls.

School and university

At school, Richard was a quiet student. His greatest mentor was his violin teacher Josette, an old, fierce French lady who taught him to set his own high standards and never care about comparing himself with others. “School was easy for me, but Josette was the one person who could push me to do more than I thought I was capable of,” he says. He played violin throughout high school and was first violin in the internationally-recognised school orchestra. At 16, Richard was even considering becoming a professional musician, but then had the opportunity to take part in the physics Olympiad. He took it. “I felt there was a bigger world out there,” he says. He made it onto the Australian team and competed in Shanghai.

The year before, when he was 15, Richard had spent half a year at an international boarding school in China with a friend. That allowed him to explore the Asian part of his background. The school was two years ahead in maths which gave him extra time to hone his physics ability on his return, leading to the Olympiad participation.

When he finished school, Richard had no idea what he wanted to do. He took a year off, spending six months learning Chinese and the rest of the year travelling around Europe and China and interning at a company in Melbourne. He won a scholarship to do a joint Physics degree across two universities, the Australian National University and the National University of Singapore.

He spent 18 months at each. Because of his work at the Olympiad he got free credits so he was able to take some philosophy classes. “I see philosophy as related to physics,” says Richard, “It looks at why we are here, what are the right questions to ask and how the questions we have asked change over time. Both subjects are essentially about the meaning of life.” But in his second year he already knew he didn’t want to be a physicist or a philosopher and became insatiably curious about the world beyond academia.

Work and travel

His degree course should have been four years, with the last year being an honours year, but, knowing he no longer wanted to be a physicist, Richard left after the third year and took up a job at a tech start-up in China, having interned at the company between his third and fourth year.  The company made competitive smartphone games. It was 2012 and smartphones were exploding across Asia and Richard had a ringside seat at the transformation they brought to society.  He experienced firsthand how a simple game could change, and even manipulate, the behaviour of thousands of people, and was also worried about the harmful, addictive nature of the games as well as fascinated by what it meant about how human brains worked.

He left after a year and went travelling and “soul searching”, trying to figure out what he wanted to do with his life. He went to Tibet, crossed the Himalayas into Nepal, and then continued to India. Eventually he returned to China and worked for another mobile games start-up in a job that involved constant travel until he felt so tired of living out of hotels and so burnt out that he quit. This coincided with the loss of his grandfather. 

Richard decided to change his life and he volunteered for an NGO consultancy based in Nairobi that designed healthcare systems before moving to South Africa to work on a health project with a local university. Richard questioned, however, if the work he was doing benefited anyone except himself. It was then that he went on a 10-day Vipassana silent meditation course, from which he emerged with a new decision to stop worrying so much about himself and instead try to be grateful for the privileges and opportunities he had.

He moved to the US to take up a job at Silicon Valley where he worked for Airbnb. It was exciting being in a growing tech company. Airbnb grew from 1.5K employees to 6K in the time Richard was there.  As a data scientist, he was dealing with big data sets and drawing on his computational training. “It was fascinating to have the chance to join a hyper efficient organisation that had huge influence in the world and to be in the position of asking questions about what it was doing, looking at the data to see how the momentum of the business could be guided in a positive way. The people there truly want to contribute positively to the world,” he says. 

Two years in, however, Richard started suffering from depression and wondered where his life was going. He started seeing a psychiatrist and taking medication and on another 10-day meditation course the idea came to him of becoming a neuroscientist to try and contribute to depression research. These revelations led him to Cambridge to begin his PhD, where he will be supervised by Dr Petra Vértes and Professor Ed Bullmore.

He will focus on understanding what depression is and developing novel treatments.  “We don’t really understand how antidepressants work,” Richard says. “We haven’t made any major advances in treating depression in the last half a century and I believe we need to start from the fundamental questions: What is depression? What is happiness? To what extent are these experiences ‘just biology’ or to what extent are they about who we are as individual people and our personal life stories?”

Looking back on his own life story, Richard states: “I spent my early 20s travelling, exploring the outside world and moving every few months. Then in my later 20s I instead started exploring the world inside me, struggling with the questions in my own mind. This led me to what I hope will be my life’s work, as a neuroscientist, trying to help others rediscover meaning and happiness in life, and now entering my 30s I am beginning this new path here at Cambridge.”

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