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    Published on 17 July 2022

    If you or someone you know experiences prolonged bouts of extreme moods that affect the ability to cope well with daily life, it could signal a type of mood disorder.

    Two common mood disorders are depression and bipolar disorder. Depression – known clinically as Major Depressive Disorder – is characterised by persistent low mood or loss of interest, or the inability to experience pleasure in daily activities, said Dr Irene Tirtajana, Head & Senior Consultant, Psychiatry, Ng Teng Fong General Hospital (NTFGH). 

    It's also sometimes described as ‘unipolar depression’ to distinguish it from bipolar depression, explained Dr Tirtajana. “[With bipolar depression], there are typically two poles or extremes of mood – a high one and a low one,” she said. 

    These ‘highs’ are episodes of abnormally high mood that are beyond a normal, happy mood or a burst of energy or motivation. “The epitome of this state is called mania. It is an extreme high mood state characterised by extremely high energy, sociability, impulsivity, and sometimes abnormal thinking,” she shared. 

    Some people in this state believe that they have supernatural powers, or have a special mission to accomplish. Other typical symptoms of mania are talking very quickly in an uninterruptible way sometimes called “pressured speech”, inability to stay on topic, and making uncharacteristic grandiose plans.

    “They may inappropriately chat up strangers, spend excessively, be sexually promiscuous or take uncharacteristic risks in other ways,” Dr Tirtajana said, adding that these episodes can be so severe and prolonged that hospitalisation is needed to prevent untoward outcomes. If the episode is less intense, the state is called hypomania. However, similar to other psychiatric diagnoses, these symptoms need to be evaluated in context by a professional.

     Depression  Bipolar Depression
    ‘Unipolar’ – it does not have alternating episodes Consists of two phases – highs (mania or hypomania) and lows (depression)
    Not typically associated with obsessive or compulsive behaviours or anxiety Typically associated with obsessive-compulsive behaviours or anxiety 

    Depression is diagnosed according to the DSM-5 Diagnostic Criteria. Five or more of the following symptoms are experienced most of the day, nearly every day across a two-week period with at least one symptom of depressed mood or loss of interest/pleasure.

    • Marked diminished interest or pleasure in all, or almost all, activities

    • Significant unintended weight changes and changes in appetite

    • Observable slowing down of thought and a reduced physical movement

    • Fatigue or loss of energy

    • Feelings of worthlessness or excessive or inappropriate guilt

    • Diminished ability to think or concentrate, or indecisiveness

    • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

    Bipolar disorder exhibits both the symptoms of depression as well as symptoms of mania or hypomania (a less intense episode of mania), which can present as:

    • Restlessness, high energy, impulsiveness

    • Increased activity and/or sociability

    • Racing thoughts and speech

    • Distraction

    • Grandiose ideas or delusions (such as believing that they have supernatural powers)

    • Euphoria

    • Irritability, aggressiveness, or being quick to anger

    • Needing little sleep

    • High-risk behaviour and poor judgment

    • High sex drive 

     

    Managing depression and bipolar disorder

    The first step to managing these mood disorders well is obtaining an accurate diagnosis. Dr Tirtajana highlighted that this is important so as not to over-diagnose or over-medicalise normal mood variations. 

    “The cluster of symptoms need to fulfil the relevant diagnostic criteria and must cause significant impairment in day-to-day living,” she said. She elaborated that symptoms must not be attributable to substance abuse or another medical condition, and must cause significant distress or impairment in social, occupational, or other important areas of functioning.

    The good news: if someone is diagnosed with either of these mood disorders, there are treatments available. The mainstay of treatment for bipolar disorder is mood-stabilising medication which may be complemented with talking therapy, said Dr Tirtajana. 

    Because every case is different, mild cases of depression may be treated solely with psychotherapy, although medication has benefits as well. In general, the more severe the depression, the greater the reliance on medication. 

    “In more severe cases of both bipolar disorder and depression, neuromodulation technologies, such as electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS), may also be considered,” she added.

    Patient empowerment and lifestyle is also helpful in managing both bipolar and depressive disorders. These include:

    • Understanding the condition and its treatment

    • Routine exercise of moderate intensity two to three times a week

    • Having regular, sufficient sleep, and not staying in bed when not sleeping

    • A healthy diet with lower glycaemic load (i.e. moderating amounts of fast-absorbed sugars and highly refined carbohydrates)

    • Moderating the amount of social media, gaming, news consumption and other non-essential smartphone and online activities

    People suffering from either condition and most people in general, will also benefit from abstinence from potentially addictive substances such as nicotine, alcohol and illicit drugs.

    But regardless of treatment type, consistency is key. “What people don't expect is that talking therapy often requires many sessions over a few months before it starts having observable benefits, and it requires a certain amount of effort and commitment,” she stressed.

    Written in consultation with Dr Irene Tirtajana, Head & Senior Consultant, Department of Psychiatry, NTFGH.

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