Bipolar Disorder: The Complete Guide Singapore (2022)

Updated: Jan 12


The complete guide to Bipolar Disorder in Singapore. Find out more about how to better help someone with bipolar disorder in this article.

In this article

  1. What is bipolar disorder?

  2. What are the types of bipolar?

  3. What causes bipolar disorder?

  4. What are symptoms of bipolar?

  5. How is bipolar diagnosed?

  6. What can trigger a bipolar episode?

  7. What does high-functioning bipolar look like?

  8. What are self-care strategies to help bipolar?

  9. When should I see a doctor?

  10. Emergency help for bipolar disorder

  11. Bipolar disorder in women

  12. Bipolar disorder treatments

  13. Where to get bipolar treatment in Singapore?

  14. Why shouldn't you use bipolar as an adjective?

  15. How can you help someone with bipolar disorder?


What is bipolar disorder?

Bipolar disorder (BD), also known as manic depressive disorder, is a mood disorder. It is characterized by cycles of mania and depression of varying severities, sometimes accompanied by psychosis. [1] Bipolar disorder has a high comorbidity rate, which means people diagnosed with one of the four types are likely to suffer from mental illnesses as well.


In 2017, it was estimated that there were about 46 million known cases of bipolar disorder. [2]


What are the types of bipolar disorder?

Bipolar disorder is commonly misunderstood as just severe mood swings. However, Bipolar disorder has four subtypes, distinguished by different levels of depression and mania, sometimes in cyclic recurrence though it is not a requirement for all subtype diagnoses.


Bipolar disorder I (BD-I)


BD-I is diagnosis involves intense bouts of manic episodes that last anywhere between hours to months. The Longitudinal Course of Bipolar I Disorder: Duration of Mood Episodes study found that on average, mood episodes for someone with a mood episode was about 13 weeks. [3]


Bipolar disorder II (BD-II)


People with bipolar II go between episodes of hypomania and depression. Hypomania is a less severe type of mania. BD-II is also characterized by more frequent, and sometimes longer and more serious episodes of depression. These depressive episodes may vary in length, but on average, can reach six to eight months. [4]


Due to the nature of the symptoms, bipolar-II is very often misdiagnosed as major depression. [5]


Cyclothymic disorder


Cyclothymic disorder is rarely diagnosed due to the ambiguous definition that the condition has. However, it was deemed necessary to include it so it could cover areas that the other bipolar diagnosis would not. In DSM-5, people who have cyclothymic disorder experience mood swings that do not meet the thresholds for formal mania or depressive episodes. [6]


Other specified and unspecified bipolar and related disorders


This diagnosis is given when one has symptoms of bipolar disorders like mania and depression but do not fit into the classifications of the other diagnoses.


In the Bipolar and Related Disorders and Depressive Disorders in DSM-5, an example of such shorter than average periods of mood episodes. [7]


What causes bipolar disorder?


Bipolar disorder does not have one exact cause. Scientists have found a few factors that can lead to the manifestation of the mental illness.


Causes of Bipolar disorder includes biology, genetics and the environment.

Biology


The biochemistry of bipolar patients show that they suffer from underdevelopment of certain parts of the brain, and chemical imbalances.


A Japanese study looking into the differences between Major Depressive Disorder and Bipolar Disorder found that BD patients had less gray matter. [8] Research has also drawn conclusions between higher levels of dopamine during manic episodes. [9]


Circadian cycles, or sleep cycles also contribute to relapses in bipolar episodes. Korean scientists discovered that mania seemed heightened during the spring and summer seasons due to the changes in day and night cycles. [10]


Genetics

Bipolar can be hereditary. Review article Genetics of Bipolar Disorder found that the chances of bipolar manifestation rose to 10% in people with one parent with bipolar. The odds increase to 40% if both parents have bipolar. [11]


Environment


It is not likely that environmental stressors are the cause of bipolar manifestations. However, environmental stressors can trigger recurrences in BD episodes. Stress can alter the body’s neural pathways to better handle high-stress events. This in turn, changes the body’s emotional processing that may trigger BD. [12]


What are symptoms of bipolar?


Misconceptions of bipolar disorders stem from misunderstanding the magnitude of manic and depressive episodes. They are beyond just feeling happy or sad.


Mania in the media often looks like happiness and hyperactivity. In some cases, this is possible – mania can stem from positivity in life. From falling in love and sex, to getting promotions at work, mania can be triggered because of one’s inability to regulate these heightened positive emotions that result in more energy, euphoria and very little sleep. [13]


Symptoms of Manic Episodes include High energy levels, euphoria, little sleep, racing thoughts, irritability and impulsivity.

However, mania can present itself as irritability and impulsivity. While it is a common symptom between mania and depressive episodes, more patients reported feeling irritable during manic episodes. One of the symptoms of mania is racing thoughts and high energy levels which other people may not be able to keep up with.


Mania-induced impulsiveness may also pose dangers to the person and people around them. [14]


Symptoms of a depressive episode are similar to someone with depression. They would feel deflated, sluggish and hopeless. A study looking into the physical effects of depression on people showed that speech and movements were all slower in people with depression. These episodes can leave an individual feeling suicidal and unable to concentrate, affecting their quality of life. [15]


How is bipolar diagnosed?


There are no particular tests that can diagnose bipolar disorder due to its likeness to many other mental illnesses. Doctors use a combination of these methods to determine whether or not someone has bipolar.


Physical assessments


Doctors check for underlying medical conditions such as thyroid disorders. Thyroid disorders are known to affect mood. In addition, thyroid medication is also known to cause medication-induced mood swings. [16]


Psychiatric assessments


Proper diagnostic tools are still being developed and tested to give accurate verdicts for bipolar disorder due to its complexity. Medical professionals do have questionnaires based on the DSM-IV criteria to use during evaluations for bipolar disorder. These interviews are also used to find out if there have been prior cases of bipolar within the family. [17]


What can trigger a bipolar episode?


Triggers are very individual and no two people have the same set of triggers. However, there are some common events that medical professionals have identified that can set off an episode due to the feelings that it may elicit. [18]

Possible triggers of mania include:

  • Alcohol or substance use

  • Medication (certain antidepressants may cause the onset of mania)

  • Stimulating activities (falling in love, going to the club, creative projects)

  • Lack of sleep (or changes in sleep cycle)

Possible triggers of depression include:

  • Stressful events

  • Changes in circadian rhythm

  • Physical injury or ailments

  • Lack of exercise

What does high-functioning bipolar look like?


Bipolar can be high-functioning, which means that one may be able to hide the symptoms unless they are very severe. Individuals that are high-functioning may be at more risk because their condition may be overlooked, or misdiagnosed. [19]


A qualitative analysis saw that most people that are diagnosed with bipolar are not likely to be employed. This shows that bipolar can hinder one’s life in terms of fitting into society. However, people with debilitating bipolar can also become high-functioning after getting help. [20]


What are self-care strategies to help bipolar?



There are some self-care practices that therapy introduces to someone with bipolar to help them manage their mental illness. Some important self-management strategies include but are not limited to:

  • A sleep schedule that they can follow

  • Proper diet and exercise

  • Mood tracking to take note of their highs and lows and what triggers them

  • Mindfulness strategies

  • Support systems that understand and can help them regulate their emotions.

Check out our self-care article for more strategies.

When should I see a doctor?


Consulting a doctor is advised as soon as possible if one experiences drastic mood swings that affect work, school or life in general. People who notice symptoms of bipolar disorder in their friends or family should also speak to the doctor to find out more since manic episodes may sometimes leave the patient unable to recall anything.


Emergency help for bipolar disorder


Individuals with bipolar are at higher risks of suicide. Up to half of bipolar patients attempt to take their own life. Suicide is not only a symptom of a depressive episode; mania can cause people to do life-endangering things to feed their high. [21]


There are medications and therapies that help with suicide ideation but have all proven non-effective in the long run. [22] Bipolar patients are also known for medication non-adherence, meaning that they refuse or forget to take their medication. [23]


As such, friends and family need to be aware of the individual’s condition in order to be able to call for help. These are some helplines to call:

  • SOS: 1-767

  • SAF Hotline: 1800 278 0022

Bipolar disorder in women

Bipolar disorder does not affect more women than men. However, the two populations may face different struggles when dealing with the mental illness.


Misdiagnosis


Women are more likely than men to be misdiagnosed to having unipolar depression(UD). UD and BD-II are characterized by major depressive episodes. Since both mental illnesses are more prevalent in women, they are more likely to be misdiagnosed as compared to male counterparts. [24]


Research also shows that women with severe PMS have been misdiagnosed with BD-II due to the similar symptoms shared. [25]


Comorbidities


Migraine is a frequently reported comorbidity of BD-II. Further tests show that people suffering from both BP-II and migraine also reported suffering from other comorbidities such as more frequent cyclic episodes, anxiety disorders and suicidal ideation.


Given that BD-II is more prevalent in women, they are more susceptible to these comorbidities as compared to their male counterparts. [26]


Women are also more likely to suffer from comorbid thyroid diseases and bulimia. [27]


Bipolar Disorder Treatments


Highs and lows in bipolar disorder can be very difficult to manage without medical care. It is encouraged to get professional help as soon as possible or symptoms may worsen, including suicidal ideation. [28]


Treatment for bipolar disorder is usually a combination of psychotherapy and pharmacotherapy. At the doctor’s recommendation, some people may also undergo electroconvulsive therapy.


Psychotherapy

  • Cognitive-behavioural treatment (CBT)

CBT is a type of talk therapy that helps to change distorted information processing. With bipolar disorder, CBT will help identify behaviors and emotional responses that need to be altered in order to react calmly and avoid the highs and lows.


In an analysis of the efficacy of CBT on bipolar patients, the treatment method yielded positive results in managing both depression and mania. [29]


  • Interpersonal and social rhythm therapy (IPSRT)

IPSRT was specifically designed to manage bipolar disorder. Bipolar disorder thrives off chaos – a disruption in one’s social life could affect other cycles like circadian cycles that triggers severe mood irregularities. [30]


IPRST focuses on creating routines, manage their relationships and learning to cope with stressful situations. The treatment has proven to be effective, with test subjects’ improvements showing no signs of deteriorating even after six months. [31]

  • Family-focused therapy (FFT)

People suffering from bipolar disorders do need a lot of support from people around them. They are prone to higher suicidal rates and during manic episodes, may pose a danger to themselves and others without realizing or recollection of it afterwards.


As such, FFT brings in caregivers for individuals with bipolar to educate them about the disorder and their role in keeping the individual safe. It also seeks to strengthen the communication between family members and the individual. [32]


An efficacy study showed that this method of therapy, used alongside medication, was effective in minimizing episodes the individual had in the following years. Scientists researching the field also hope to develop FFT as a preventative measure for worsening BD symptoms in adolescents. [33]


Pharmacotherapy

  • Mood stabilizers

Mood stabilizers, most commonly, lithium and valproic acid has the best record for long term treatment for mania and hypomania. [34]


However, lithium has a lot of side effects such as hand tremors, nausea and diarrhoea. More adverse reactions may lead to weight gain and hypothyroidism and even kidney-related diseases.[35]


  • Antipsychotics

Antipsychotics, or neuroleptics, act as aids to lithium medication during manic episodes. While lithium stabilizes mood, antipsychotics help with hyperactivity and psychosis. [36]


These drugs also have their lists of side effects. The most common are weight gain, sexual impotence, as well as heart-related diseases. [37]


  • Antidepressants

While mood stabilizers are still the first choice for treating bipolar, medical professionals might also prescribe either a Selective Serotonin Reuptake Inhibitor (SSRIs) or Monoamine Oxidase Inhibitor (MOIs) to manage depressive episodes. These drugs help to block the reuptake of neurotransmitters to regulate mood.


In the study, Antidepressants in Bipolar Depression: An Enduring Controversy, the risk of post-depression mania was highlighted. This means that more frequent cycling would occur, especially if the individual was not taking mood stabilizers. [38]

Similar to antipsychotics, antidepressants can also cause weight gain, headaches, nausea and reduced libido. [39]


  • Antidepressant-antipsychotic

Fixed medication combinations are also used to manage bipolar. Research shows that the efficacy of such medication was two times that of monotherapy. The most popular combination drug prescribed was olanzapine and fluoxetine. [40]


Due to the side effects like abnormal involuntary motor functions that cause accidents, and the possibility of increased suicide by lethal dose of the combination drug, prescription has been cut down. [41]


  • Anti-anxiety

Better known as benzodiazepines, or benzos, these are fast-acting medication that are usually used for the treatment of anxiety disorders. Due to its use as a sedative, it is usually prescribed to people with mania while other medication for mania takes its effect. [42] [43]


  • Other treatment

Another available form of treatment is Electroconvulsive therapy (ECT), or electroshock therapy. A form of short-term therapy, small electric pulses are passed through the brain to alter it slightly, changing the symptoms of some mental conditions. It is used mostly in severe depression, especially with suicidal ideation, when other treatment methods do not work. [44]


A study studying the effectiveness of ECT on bipolar depression showed high efficacy rates and low relapse rates. [45]


Where to get bipolar treatment in Singapore?



Clinic / Hospital

Address

Contact

Cost (subsidised)

Cost (unsubsidised)

Institute of Mental Health

​Buangkok Green Medical Park 10 Buangkok View

Singapore 539747


6389 2000 (24hr line)


imh_appt@imh.com.sg

​$42

$39 (subsequent visits)

​$105-$155

$72-$103

(subsequent visits)

National University Hospital

​5 Lower Kent Ridge Road

Singapore 119074


+65 6779 5555


For appointments:

65 6772 2002

appointment@nuhs.edu.sg


$38-$58

$36-$51 (subsequent visits)

$109.14-$145.52

$89.88-$108.07 (subsequent visits)

​Ng Teng Fong General Hospital

​1 Jurong East Street 21

Singapore 609606


Ng Teng Fong General Hospital

Tower A - Specialist Outpatient Clinics

Level 3


$38 (S’porean)

$56 (PR)


$36 (S’porean)

$51 (PR)


(subsequent visits)


​$107-$140

$70-$104 (subsequent visits)

​Khoo Teck Phuat Hospital

​90 Yishun Central

Singapore 768828


+65 6555 8000


enquiry@ktph.com.sg


For appointments:

+65 6555 8828


ktph.appt@ktph.com.sg


​$40 (S’porean)

$60 (PR)


$38 (S’porean)

$57


(subsequent visits)


Please note that extra charges may incur for longer consultations


$69 - $146


$61 - $106


(subsequent visits)

​Singapore General Hospital


​Singapore General Hospital

Outram Road

Singapore 169608


​+65 6222 3322

​$39 (S’porean)

$59 (PR)


​$114.49 - $146.59 (private) $126.26 - $161.57

(non-resident)

$79.18 - $107 (private) $87.74 - $117.70

(non-resident

​Novena Psychiatry Clinic

​10 Sinaran Drive

Novena Medical Center #10-21

Singapore 307506


Contact clinic for cost information

​The Psychological Wellness Centre

​#13-07 Royal Square Medical Suites 101 Irrawaddy Road Singapore (329565)

Contact clinic for cost information

​Dr BL Lim Centre For Psychological Wellness

​6 Napier Road, #09-09, Gleneagles Medical Centre, Singapore 258499

Contact clinic for cost information

​Promises Healthcare

​#09-22/23, Novena Medical Center, 10 Sinaran Drive, Singapore 307506

​+65 6397 7309

Contact clinic for cost information

Why shouldn’t you use "bipolar" as an adjective?


It is not uncommon to hear people refer to anything volatile or broken, be it a person or the weather, as “bipolar”. Using the diagnostic term with such carelessness poses certain problems.


It invalidates people with the actual disorder.


Bipolar disorder is very impairing for an individual because its symptoms usually render its patient too unpredictable and unable to do things like hold jobs. The condition also affects people around them.


People suffering from bipolar disorders are also more susceptible to attempting suicide or committing risky acts that can endanger themselves and the people around them, especially during a manic episode, where most people reported that they are not in control of their actions, or have no recollection of what happens during the manic episodes.


It reinforces the misconceptions of the disorder


Due to symptoms that could very easily point to another mental disorder, it is very difficult to diagnose bipolar disorder. People are often misdiagnosed. This means that people are not getting the help that they need.


By cementing the wrong ideas of the disorders, it makes it even more difficult for people to understand and pick up on bipolar disorder in their family or peers.


It implies that people with bipolar disorder are broken.


Like many mental disorders, people suffering from bipolar disorder are often thought to be broken, or less than a healthy individual. This can lead to shame on the part of someone with bipolar and prevent them from seeking help.


How can you help someone with bipolar disorder?


Supporting someone with bipolar disorders can be very daunting. They can be unpredictable. However, without support, symptoms are likely to worsen. Here are some ways that you can help someone with bipolar:


Education

Knowing how to identify the different episodes, and what actions to take during these episodes can help the individual recover from the episodes much faster.


Having emergency plans

Both mania and depression can make bipolar patients vulnerable to suicide and self-harm. Having plans on the right medical personnel to contact will be very helpful.


Conclusion


Bipolar disorder affects a lot of people in the world, and many more go under medical radars. Educating more people can help remove the stigma and identify people who are suffering and get them the help they need. If you feel that you have any of the symptoms that are highlighted, or knows anyone who does, please consult a medical professional as soon as possible.


 

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About Our Writer

Rachel is an anxious INFJ with a slightly concerning obsession with coffee and true crime. She loves feeling smart and dislikes playing games she knows she will lose. Learning about mental health is her way of helping people around her. If the world was perfect, she wishes she could bring her friends flowers in a little red wagon.

 

This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.

 

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