When day is a every Struggle...

While it’s still not fully understood why, certain mental illnesses tend to develop or show symptoms in early adulthood – including bipolar disorder, where the average age of onset is around 25 years old. Women are also more prone to develop rapid-cycling bipolar, experiencing four or more episodes of depression and mania in a year.

Also known as manic depression, bipolar is a mood disorder that causes a person’s emotions to alternate between two extremes: a high (manic episodes) and a low (depressive episodes). According to a Singapore Smart Report Mental Health Study, 1.2 percent of the adult population here have suffered from bipolar disorder during their lifetime. The male to female ratio is almost equal, and it occurs most commonly in people aged 18 to 34.

We still don’t know exactly what causes it. However, we do know there are a multitude of factors – including genetics and environmental causes – that can contribute to it, according to Dr Mok Yee Ming, senior consultant and chief of the Institute of Mental Health’s (IMH) Department of General Psychiatry & Head, Mood Disorders Unit. “The onset of bipolar disorder may be directly linked to external stresses, which may exacerbate an underlying genetic or biochemical disposition,” says Dr Mok.

People with bipolar disorder suffer from episodes that can last for weeks or even months if left untreated, and significantly affect their day-to-day functioning. The first type is a manic or hypomanic (which is less severe) episode, where your mood is elevated, and you have increased energy. Symptoms include talking excessively, being easily distracted, and expressing grandiose or unrealistic ideas. Those going through an episode of mania may experience a decreased need for sleep, sometimes running on just a couple of hours a day, and become very impulsive. It’s not unusual for bipolar patients to get into debt due to excessive shopping during an episode of mania.

On the other end of the spectrum, there are depressive episodes, where a person experiences lower energy levels and is overwhelmed by feelings of sadness. They may also suffer from a lack of appetite, lose interest in things they used to enjoy, and harbour ideas of suicide or self-harm. There are also mixed episodes, where the patient experiences both mania and depression. “The symptoms may alternate rapidly, from day-to-day or even hour-to-hour,” says Dr Mok.

For Carrie*, a 30-year-old PR professional, her battle with bipolar disorder began four years ago. She was prescribed steroids and muscle relaxants to suppress pain caused by an autoimmune disease. After two weeks, she stopped taking the relaxants and relied only on the steroids. That was when her behaviour started to change.

“I barely slept. I was sleeping for only about a couple of hours a day, I ate a lot, and I spoke very fast,” says Carrie. She was going through a mania episode that lasted for over a week, but she didn’t realise it then. “I was just very high. Plus, my career was going very well at that time, so I felt like I could do anything.” Her family could tell something was off, and suspected it may have had something to do with her mental health. They soon brought her to IMH where she was admitted for a week. After she was discharged, she had to be on bed rest for six months to recover.

“The first three months were very difficult. I couldn’t remember much because I was so sedated. I felt like a living corpse. I was just so exhausted all the time,” says Carrie. “It was difficult for me to look at myself in the mirror – certain medications made my hair drop out, others caused hair to grow on my face and all over my body, and there was this one medication that made me put on a lot of weight.”

There’s still a considerable amount of social stigma attached to mental health issues. In a survey called The Mind Matters: A Study of Mental Health Literacy, which involved 3,000 residents aged 18 to 65, nine in 10 respondents felt that those who suffered from mental illness can get better “if they want to”, and half of them believed that having one is a sign of personal weakness. That is not true, of course. But unfortunately, this stigma and misperception stops people from seeking psychiatric help.

Having experienced extreme mood swings since childhood, Debbie* knew from the age of eight that “something wasn’t right” with her. She recalls being easily irritable and violent, and during her low episodes, she would cry for hours or even days. She suspected she had a mental illness all this while, but the 35-yearold working mother of two didn’t seek treatment until three years ago. “I wasn’t functional anymore... I didn’t deliberately attempt suicide, but I was suicidal. I refused to wake up and I remember just wanting things to end there,” she says. That was when she realised she needed to seek treatment. Her employer wasn’t aware of her condition, because she would lock herself in the toilet cubicle whenever she was having a panic attack, and she withdrew from her colleagues. “I felt like it was something shameful I shouldn’t tell anyone about… I had another colleague who suffered from depression, and she was constantly on medical leave. Other colleagues would gossip about her, so I hid my own mental illness from them.”

“Sometimes, I would speak up [for my colleague], telling them they don’t know what she’s going through. But they would just go, ‘Well, work is work.’ So when I was on leave, I would work from home, even though I was experiencing a low,” says Debbie. She says it would have helped if people had been more understanding and she could have taken longer breaks to get better without having to worry. For Carrie, the silver lining was that her experience with bipolar disorder led her to realise she had much to be thankful for – her supportive friends and family members who had shown her much-needed patience and kindness. “When I was manic, I would call people in the middle of the night – like at 3am – to ask how they are doing,” she recalls. Whenever that happened, her family would then have to do a follow-up call to tell her friends she’s sick and apologise for her behaviour. “I lost a lot of friends, but I also weeded out a lot of toxic people. I really saw who my true friends were,” says Carrie.

Treatment for bipolar disorder comes in the form of both medication and psychosocial therapy. Mood stabilisers, antipsychotics and antidepressants are prescribed as part of the treatment for episodes. There’s also maintenance therapy, which uses medications and psychosocial interventions to prevent further episodes. Dr Mok adds that going for therapy can also help patients recognise early symptoms so they can seek treatment. It’s also useful for identifying triggers so patients can implement lifestyle changes to avoid them. “With the appropriate treatment and follow-up, it can be well-controlled. People with bipolar disorder can and do lead fulfilling lives,” says Dr Mok. He also adds that support is “equally important” in the treatment of bipolar disorder.

For Debbie, what she needed most was understanding from her family, friends, and colleagues. She is now in recovery, and has signed herself up for IMH’s Peer Support Specialist programme, where she will go through training before providing support and feedback for others who have bipolar disorder. Studies have shown that peer involvement can have a significant positive effect on those who are dealing with mental health Smart Report issues. “People need to understand that we’re trying our best to function and be consistent,” says Debbie.