It is normal for one’s mood to vary from day to day. But what if you keep experiencing extreme mood swings? You could be suffering from a psychiatric illness called bipolar disorder, which affects 1 per cent of adults in Singapore aged between 20 and 40.

People with bipolar disorder typically alternate between manic (“high”) and depressive (“low”) states. They may feel hyper energetic and euphoric one day, and sad and hopeless the next, without any external circumstances explaining the change.

“Although there is no cure for bipolar disorder, the mood swings can now be better managed with psychotherapy and medications called mood stabilisers,” says Specialists from the Department of Psychiatry at Singapore General Hospital (SGH), a member of the SingHealth group.

“Mood stabilisers are taken alone or together with anti-depressants to control the symptoms of bipolar disorder.”

The risk of bipolar disorder is higher if a parent or sibling has the disorder. Dysfunction in neurotransmitters like noradrenaline, serotonin and dopamine is a possible cause. Imaging studies also show that there are structural and functional changes in the brains of people with bipolar disorder.

People with bipolar disorder may experience distinct manic and depressive episodes or a mixed state with both manic and depressive symptoms. The frequency of these episodes of extreme mood swings can vary from several times a day to once every few months or years.

• Mania
  Mania is characterised by intense feelings of elation and excitement. Some people can be extremely energetic, talkative and restless. Others are very driven and fearless, engaging in risky and impulsive activities. Other features include increased distractibility, irritability and insomnia.
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• Depression
  Depression can be mild, moderate or severe in intensity. The person may feel very sad, hopeless, empty, restless and disinterested in activities previously enjoyed. A person suffering from depression may feel extremely tired, have difficulty concentrating or have suicidal thoughts.

To stop bipolar disorder from disrupting the patient’s life and affecting their work and home relationships, doctors increasingly recommend a combination of treatments:

• Psychotherapy
  Effective psychotherapy helps the person with bipolar disorder cope with depression and improves relationships affected by the illness. Therapies include:
  • Cognitive-behavioural therapy or CBT (to treat depression)
  • Interpersonal and social rhythm therapy (to help patients normalise sleep patterns and better social relationships)
  • Family-focused therapy (to enhance family relationships)
  • Group psychoeducation (to promote better awareness of bipolar disorder)
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• Medication
  Bipolar disorder can be treated with a combination of medications such as mood stabilisers (lithium, anticonvulsants), antidepressants and antipsychotics. Although medications may cause side effects, the risk can be minimised by working closely with your doctor so that the optimum dosage of the right medication is prescribed for you.
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• Hospitalisation
  Hospitalisation is only necessary if the person poses a risk to self or others, especially when either the depressive or manic symptoms are very severe.

1. Do not stop your treatment plan suddenly even if you feel better. Such abrupt interruption would promote relapse.
2. ​Avoid caffeine, drugs, alcohol or cigarettes.
3. Maintain a healthy diet.
4. Exercise regularly.
5. Take regular breaks. Learn to relax.
6. Maintain good sleeping habits.
7. Set realistic goals and manage expectations. Unrealistic goals and expectations can set you up for failure.
8. Divide major tasks into smaller chunks, set priorities, and do what you realistically can.
9. Do not engage in self-blame.
10. Build supportive relationships with friends and family.

Ref: L20