Singapore — For years, Ms Elyssa Lim (not her real name) lived her life cycling through two extreme moods. During her low periods, she would lie in bed all day harbouring thoughts of death.

When she experienced bursts of maniac energy, she would shop impulsively for shoes, bags and clothes that she and her family didn’t need. In her teens, Ms Lim picked up drinking during her high periods.

“It was easy for me to wipe out my savings in a short period of time,” said Ms Lim, who is in her late 20s.

Despite her classic symptoms of bipolar disorder, it took one wrong diagnosis and a hospital admission in 2007 before Ms Lim was diagnosed with the condition and received the treatment for it.

Difficult to detect

About 1.2 per cent of the local adult population suffer from bipolar disorder in their lifetime, according to a 2010 Singapore Mental Health Study (SMHS). The same study found that the average time taken for a bipolar disorder sufferer to seek help from the start of illness is nine years.

From 2012 to 2014, the Institute of Mental Health (imh) saw an annual average of 1,200 patients with the condition.

Doctors today spoke to said the mental illness is notoriously difficult to detect and diagnose, given the duality of its symptoms. According to Dr Lim Boon Leng, a psychiatrist at Gleneagles Hospital, it is one of the most likely medical diagnoses to go undetected.

Bipolar disorder is believed to be caused by chemical imbalances in the brain, which control mood, perception and judgement. Sufferers go through repeated episodes of mania or hypomania (increased energy and elevated mood) and depression, with each episode lasting a few weeks to several months, said Dr Mok Yee Ming, chief of the Department of General Psychiatry and head of Mood Disorder Unit at imh.

For one, bipolar disorder typically surfaces during early adulthood, a stressful time full of changes and challenges, said Dr Mok.

He explained: “People with bipolar disorder may not recognise their emotional highs and lows as symptoms of an illness. People around them may also brush it off as puberty.”

Dr Lim said the individual might even enjoy “newfound” confidence and inflated self-esteem during an episode of mania. During these episodes, their energy increases and mood improves. They may also become unusually talkative, experience racing thoughts or be distracted, he said.

NOT DEPRESSION

Dr Lim added that many seek help during their depressive phase when symptoms may be “indistinguishable from clinical depression”.

Furthermore, there are currently no objective testing methods available.

Said Dr Lim: “A diagnosis is made based on the history provided by the patient and his loved ones, as well as observations made by the psychiatrist during consultation. For someone who does not know the individual intimately, the mood changes may be assumed to be normal.”

Noting her odd behaviour during her teenage years, Ms Lim’s parents sought professional help.

Thought to be depressed, she was prescribed antidepressants by her former psychiatrist.

“The manic highs came in after I took too many different antidepressants. At one time, I was taking five different types of medications,” said Ms Lim.

By 2006, she had dropped out of university because of poor grades. She had also gone through five relationships in less than six months during her manic episodes.

“I was eventually referred to imh to be hospitalised for over a month as my doctor noticed that I was becoming increasingly delusional and could be a danger to myself,” said Ms Lim, who is now on follow-up treatment at imh.

Dr Lim said hospitalisation is always the last resort when patients display unusual behaviour or become aggressive during manic episodes, and may harm himself or the people around him.

“For example, some patients develop grandiose delusions, thinking they are important people and may become paranoid about others harming them. They can become aggressive and violent towards the perceived perpetrators.

“There have been instances where patients think they have special powers, such as a young man believing he has superpowers like spiderman and attempted to scale walls,” said Dr Lim.

MEDICATIONS INVOLVED

The mainstay of bipolar disorder treatment involves mood stabilisers and antipsychotic medications, said Dr Lim.

Antidepressants may be used with a mood stabiliser if the patient is in the depressive phase, said Dr Mok.

“But this is done under careful monitoring as there is a risk that antidepressants may cause patients to switch from a depressed state to a manic one,” he said.

A clinical trial published in Journal of Affective Disorders last month found that antidepressants can increase episodes of depression and mood cycling in patients with rapid-cycling bipolar disorder.

Patients are considered rapid cycling in bipolar disorder if they experience at least four episodes within a 12-month period.

Besides medication, patients are also often offered psychosocial therapy, including cognitive behavioural therapy, said Dr Mok. This helps patients identify early symptoms of an episode and seek treatment to reduce negative emotions and avoid triggers.

Relapse triggers include stress, poor sleep, as well as alcohol and illegal drug use.

“The psychiatrist might also call for extended support in the form of a psychiatric nurse, a social worker or an occupational therapist to visit patients regularly at home to help them in the recovery journey,” said Dr Mok.

Highly treatable

There is currently no cure for bipolar disorder. Relapses may also occur but it is a highly treatable illness.

“The chances of remission is remarkably high at 80 per cent with the right treatment. Most patients return to where they were in their lives before the mood episodes,” said Dr Lim.

Currently on medication for life, Ms Lim shared that her moods have been very stable with the right treatment.

After her first hospital admission in 2007, she suffered a relapse and was admitted in 2009 and again in 2011, both times due to stress from holding down a full-time job and part-time studies.

Last year, Ms Lim graduated from university and now works as a manager. She hopes to settle down and start a family, but has been rejected by prospective partners when she tells them about her condition.

By sharing her story, Ms Lim hopes to ease the stigma of mental illness and encourage people to seek help early.

“Regardless of how aggressive awareness campaigns have been in recent years, the stigma of mental illness is still there. My hope is for society to accept people like me, because we are not defined by our illness,” she said.