There is no health without mental health.
More than the mere absence of mental disorders, mental health is a state of complete physical, mental and social well-being. While most of us are able to cope with the normal stresses of life, work productively, contribute to our community, and realise our abilities, persons with mental health problems may find it difficult to do so.
With 1 in 7 Singaporeans having experienced a mental disorder in their lifetime, it is time we shed light on this topic previously regarded as taboo and better understand the common mental conditions faced by Singaporeans.
As of 2019, the top 5 mental health conditions among Singaporeans are depression, anxiety, schizophrenia, bipolar disorder and substance abuse. This article will help you understand more about the conditions and their symptoms, the treatment options available, and how you can support a person with mental condition.
We all face bouts of sadness from time to time, but most of us take comfort in the fact that these feelings are temporary and that tough times will pass. However, for persons with depression, these feelings of sadness, hopelessness and worthlessness occur over prolonged periods and can be so crippling that it interferes with their day-to-day life.
If you experience five or more of the following symptoms for more than two weeks, it could be a possible indication of depressive disorder:
- Feeling sad, guilty or helpless
- Reduced sense of self-worth
- Insomnia or excessive sleeping
- Loss of interest in activities previously enjoyed
- Weight loss or gain; or decrease or increase in appetite
- Trouble concentrating, remembering details, and making decisions
- Digestive problems that persist even with treatment
- Physical aches, pains, headaches or cramps that do not go away
- Suicidal thoughts or attempts
Types of Depression
Did you know that there is more than one type of depression? While some forms of depression such as Seasonal Affective Disorder (SAD) and Premenstrual Dysphoric Disorder (PMDD) are cyclic in nature, others tend to be short-termed, such as postpartum and situational depression.
Major Depressive Disorder
With 1 in 16 Singaporeans having experienced it at least once in their lives, major depressive disorder is the most common mental health condition in Singapore. It is characterised by feeling depressed and experiencing other symptoms of depression daily, for at least two weeks.
Persistent Depressive Disorder (PDD)
Also known as dysthymia, persistent depressive disorder (PDD) is a long-term form of depression. Its symptoms are similar to other forms of depression, including feelings of sadness, reduced self-esteem and loss of interest in daily activities, but they tend to last for years and can significantly impact our daily life. This form of depression can be hard to diagnose as its chronic nature may lead people to accept it as a part of their character and personality.
When depression is accompanied by some form of psychosis such as hallucination and delusion, it is considered psychotic depression. Psychotic depression often results in one being out of touch with reality, hearing voices, or having strange and illogical ideas related to depression such as feeling worthless.
Postpartum Depression (PPD)
Commonly known as baby blues, postpartum depression (PPD) is caused by the hormonal changes associated with pregnancy. PPD often occur shortly after childbirth. While most mums experience mood changes, anxiety and irritability after giving birth, PPD symptoms are often more severe, ranging from a persistent lethargy and sadness that requires medical treatment to postpartum psychosis, a condition in which the mood episode is accompanied by confusion, hallucinations, or delusions. If left untreated, PPD can last for up to a year.
Premenstrual Dysphoric Disorder (PMDD)
Women commonly experience premenstrual syndrome (PMS) which include irritability, fatigue, anxiety, moodiness, bloating, increased appetite, food cravings, aches, and breast tenderness. Similarly, those with Premenstrual Dysphoric Disorder (PMDD) experience the same few symptoms, but at a more severe and debilitating intensity. Oftentimes, symptoms subside a few days after the period starts.
Seasonal Affective Disorder (SAD)
As the name suggests, seasonal affective disorder (SAD) is cyclic in nature and often comes and goes with the changes in season. This form of depression is less common in Singapore and tends to affect countries further from the equator, where the amount of sunlight varies enough to affect our normal circadian rhythm. For people with SAD, depressive symptoms tend to set in during winter and disappear by spring.
When we are stressed out, our body’s natural response is to feel fear or apprehension about what is to come. However, when these feelings of anxiety are extreme, last longer than six months, and interfere with our lives, it may be classified as an anxiety disorder.
Besides panic attacks, there are several common anxiety signs and symptoms to look out for.
- Feeling nervous, restless or tense
- A sense of impending doom, danger or panic
- An increased heart rate
- Hyperventilation or rapid breathing
- Increased or heavy sweating
- Weakness or lethargy
- Trouble concentrating or thinking about anything besides the present worry
- Having gastrointestinal problems such as gas, constipation or diarrhoea
- Having the urge to avoid anxiety triggers
Types of Anxiety
Generalised Anxiety Disorder (GAD)
1.6% of Singaporeans are affected by generalised anxiety disorder (GAD). This form of anxiety usually develops over time and is only noticed when it starts affecting day-to-day functioning. People with GAD tend to worry excessively about various issues, including health, money, family or work, even with no reasonable cause or trigger.
Social Anxiety Disorder
As its name suggests, people with social anxiety may feel excessively anxious and self-conscious in everyday social interactions. Some telltale signs include a fear of being watched or judged by others, or worrying excessively days or weeks before a social event.
Many of us may clam up when presenting in front of a crowd or feel dizzy when we look down from a high place, but did you know that these phobias are actually diagnosable? Individuals with phobias experience an extreme and irrational fear about a situation, living creature, place or object, sometimes to a point where we shape our life to avoid the cause of terror. Oftentimes, we know that our phobia is irrational but are unable to control the fear it induces.
People with panic disorder experience repeated episodes of sudden feelings of intense anxiety, fear or terror that reach a peak within minutes. These episodes, called panic attacks, usually pass in 5-10 minutes but can linger for hours. With symptoms such as an increased heart rate, sweating, trembling, shortness of breath, chest pain, nausea, and feeling dizzy or faint, many people wind up in the emergency room as it may feel like a heart attack or stroke. If you have experienced panic attacks at least twice and constantly change your daily routine to prevent it from occurring, you may have panic disorder.
Obsessive Compulsive Disorder (OCD)
People with obsessive compulsive disorder (OCD) tend to have recurring and unwanted thoughts and impulses that drive them to do something repeatedly. While many of us perform repeated actions and have our routines, it does not disrupt but rather adds structure to our lives. However, those with OCD spend so much time performing those tasks that it gets in the way of important activities, and not doing those tasks can cause great distress. Many understand that the thoughts do not make sense but are unable to stop the compulsion.
Post-Traumatic Stress Disorder (PTSD)
Does time really heal all wounds? While many of us who experience traumatic events are eventually able to cope and adjust given time and self-care, others may have symptoms such as flashbacks, nightmares, severe anxiety and uncontrollable thoughts about the event that worsen over time instead. If those symptoms start affecting day-to-day functioning, it could be an indication of post-traumatic stress disorder (PTSD).
Affecting 1.6% of Singaporeans, bipolar disorder is marked by extreme changes in mood from high to low and vice versa. Highs are called periods of mania and low are periods of depression. Sometimes, the changes in mood may even become mixed, causing a person to feel both elated and depressed at the same time. In some cases, an individual may experience the symptoms of mania but at a milder intensity. This is known as hypomania.
Symptoms of Bipolar Disorder
Here are some of the symptoms you may experience during the highs and lows of bipolar disorder:
Mania (and Hypomania)
Mania and hypomania are two distinct types of episode, but they have the same symptoms. Both episodes include three or more of these symptoms:
- Abnormally upbeat, jumpy or wired
- Increased activity, energy or agitation
- Euphoria: exaggerated sense of well-being or self-confidence
- Decreased need for sleep
- Unusual talkativeness
- Racing thoughts
- Poor decision making such as shopping sprees
Depressive episodes are severe enough to disrupt day-to-day activities and include five or more of these symptoms:
- Feeling sad, empty or hopeless
- Loss of interest in almost all activities
- Changes in weight
- Insomnia or sleeping too much
- Restlessness or slowed behaviour
- Fatigue or lethargy
- Feeling worthless or guilty
- Decreased ability to concentrate or indecisiveness
- Suicidal thoughts or attempts
Types of Bipolar Disorder
Bipolar disorder can be classified into three main groups: bipolar I, bipolar II and cyclothymic disorder. Those who exhibit some signs of bipolar disorder but do not fall under the above categories tend to be grouped under a fourth general category.
The characteristic trait of bipolar I is manic episodes. A person with bipolar I experience clear manic phases that are present most of the day, nearly everyday during the episode. The shifts in mood or behaviours are unlike a person’s usual behavior, and may last for at least a week or are so severe that immediate hospital care is required. Oftentimes, people with bipolar I have depressive episodes as well.
Bipolar II is the most common type of bipolar disorder. People with bipolar II experience both mania and depression, but tend to have less severe manic symptoms, known as hypomania.
A less common form of bipolar disorder, cyclothymic disorder involves changes in mood similar to the other two forms, but with less dramatic shifts. While milder in intensity, these symptoms must be present for at least two years before a diagnosis may be made. Many people may not seek treatment as the mood swings do not seem severe and the individual may just come across as being moody in general.
Often misconceived as having a split personality, schizophrenia is a condition that affects a person’s perception of reality. While the condition can seem vastly different from person to person, it is generally characterised by episodes of psychosis where the individual loses touch with reality.
When we think of schizophrenia, we often picture a person who sees things and hears voices that are not there. However, besides these positive symptoms, people with the condition experience other negative symptoms such as low motivation and difficulty forming social connections too.
It is important to note that symptoms of schizophrenia can vary from person to person, both in pattern and severity. To be diagnosed with schizophrenia, you must have two or more of the five following types of symptoms for at least 30 days:
- Delusions: A person with schizophrenia may have illogical and firmly-held ideas despite clear and obvious evidence that it is not true. For example, believing that others are out to get them, believing that a neutral environmental event such as coming across a billboard has a special and personal meaning, believing that you are a famous or important figure or have special powers, or believing that your thoughts or actions are controlled by outside forces.
- Hallucinations: A person with schizophrenia may think that certain sensations are real when they only exist in their minds.
- Disorganised speech: A person with schizophrenia may rapidly shift between topics with no connection between one thought and the next, use made-up words or phrases that have no meaning to persons besides themselves, repeat the same things over and over again, or use rhyming words without meaning.
- Disorganised behavior: A person with schizophrenia may experience a decline in overall daily functioning, express unpredictable or inappropriate emotional responses, exhibit behaviors that appear bizarre and have no purpose, or lack inhibition and impulse control.
- Negative symptoms: A person with schizophrenia may have a lack of emotional expression, interest in the world, interest or enthusiasm, self-care, or an ability to hold a conversation.
Types of Schizophrenia
Schizophrenia can be largely grouped into a few categories. Here are some of the common types of schizophrenia:
Those with paranoid schizophrenia exhibit positive symptoms such as hallucinations and delusions. Other symptoms such as disorganised speech and thoughts are often less prominent.
In a catatonic schizophrenia, a person completely shuts down emotionally, mentally and physically, with zero drive and motivation to do even daily tasks such as eating or urinating. On the other extreme, there may also be excessive, seemingly purposeless movements such as repeating others’ words or actions, stereotypical movements such as rocking or hand waving, or grimacing. If these behaviours last for hours, it could escalate to a medical emergency.
People with disorganised schizophrenia mainly exhibit symptoms of disorganised speech, behaviour, and flat or inappropriate expressions. Hallucinations and delusions may be present but are often less pronounced.
Sometimes, the positive symptoms of schizophrenia are effectively treated with medication but the negative symptoms remain, causing individuals to experience residual schizophrenia. This group of people often experience two or more positive symptoms such as delusions and hallucinations to a lesser extent or continue experiencing the negative symptoms.
People who may not fit into any of the above three categories but experience the symptoms of schizophrenia fall under the category of undifferentiated schizophrenia.
While the condition used to be divided into different subtypes, medical experts now refer to it as a spectrum disorder as the distinction did not appear to help with diagnosis. However, it is still common for people to refer to their condition by its subtypes.
Taking illegal drugs and using alcohol, prescription medicine and other legal substances too much or in the wrong way constitutes substance abuse, and can be detrimental to our physical, spiritual and mental well-being.
Substance Abuse Symptoms
While the symptoms vary depending on the substances used, here are some of the common signs of substance abuse and addiction:
- Cycles of increased energy, restlessness and inability to sleep
- Abnormally slow movements, speech or reaction time, confusion and disorientation
- Suddenly weight loss or weight gain
- Cycles of excessive sleep
- Unexpected changes in clothing such as wearing long-sleeved shirts to hide scarring at injection sites
- Suspected drug paraphernalia such as unexplained pipes, roach clips or syringes
- Chronic troubles with sinusitis or nosebleeds (for snorted drugs)
- Persistent cough or bronchitis, leading to coughing up excessive mucus or blood (for smoked drugs)
- Progressive severe dental problems (especially for methamphetamine)
Types of Substance Abuse
Here is a list of commonly abused substances:
Alcohol affects everyone differently. However, drinking too much and too often can damage the liver, indicate an alcohol disorder, and cause other health problems. For males, heavy drinking means having more than four drinks a day or over fourteen a week; for females, drinking more than three a day or over seven a week constitutes heavy drinking.
Prescription and Over-The-Counter Medication
Drugs are often prescribed or obtained over-the-counter to help us tackle physical discomfort such as headaches and cough. While legal, these drugs can be dangerous when abused too. Taking medicines prescribed for someone else, taking incorrect doses of the drug or taking the drug for non-medical reasons indicates a possible addiction. Commonly abused drugs include opioid pain relievers, medicine used to treat attention deficit hyperactivity disorder (ADHD), anxiety medication, as well as cough and cold medicine that contain dextromethorphan, which can make a person feel drunk or intoxicated when taken in high doses.
Besides being highly addictive, consuming illegal drugs can be dangerous and deadly. For example, heroin may lead to collapsed veins, increased risk of hepatitis and sexually transmitted diseases, lung diseases, miscarriages and heart or skin infections. Meanwhile, cocaine speeds up your body and may cause a person to do illogical things. The recovery process is not easy, but with rehabilitation and a proper support structure in place, these addictions can be successfully treated.
While medicinal uses of marijuana are increasingly legalised, it is still illegal in Singapore and many other places. Not everyone has the same experience with marijuana. While we often hear people describe their experience with marijuana as euphoric and relaxing, others may feel anxious, afraid or panicked instead. In fact, it may worsen the symptoms of existing mental disorders. In high doses, marijuana can also leave you feeling paranoid or make you lose touch with reality.
Mental health treatments often involve a multidisciplinary team of counselors, psychologists, psychiatrists, nurses, mental health aides and peer support professionals. Individuals respond to the various types of treatments differently, even if they have the same diagnosis. Here are some of the treatment options available for those battling mental conditions.
While medication does not cure the mental condition itself, it helps to manage the symptoms and may make other treatments such as psychotherapy more effective. Some examples include antidepressants, anti-anxiety, mood-stabilising and antipsychotic medications. The effectiveness of medication can vary depending on an individual’s situation and bodily response to it. Some medications may have side effects, but there are many ways to reduce it such as changing the dosage, changing the time of medication administration, or how you take the medication. However, make sure to consult your doctor before making any of these changes.
Also known as talk therapy, psychotherapy involves speaking about your condition and related issues with a mental health professional. Through dialogue, your therapist can help you better understand your condition, work through your problems and learn new skills to cope with future challenges. Therefore, it is important to choose a therapist that you trust, feel comfortable to speak openly with, and are confident that he or she is able to listen and understand what you have to say.
There are many types of psychotherapy. Most can be successfully completed in a few months, while others require long-term treatment. It can take place one-on-one, in a group or with family members.
Understandably, the stigma associated with getting help for psychological or behavioral concerns may hold you back from seeking help and going for therapy. However, psychotherapy can actually benefit everyone! Even people who are not diagnosed with mental health conditions, but are undergoing transitions in life such as a career shift can benefit from it too.
Hospital and Residential Treatment Programmes
In some cases, an individual may be voluntarily or involuntarily hospitalised as a result of their mental condition. This usually occurs when you are unable to care for yourself properly, or are in immediate danger of harming yourself or others.
Psychiatric hospitalisation treatment consists of stabilisation, close monitoring, medication, administration of fluids and nutrition and other necessary emergency care. There are various options available, including 24-hour inpatient care, partial or day hospitalisation, or residential treatment, which offers a temporary supportive place to live. Outpatient treatment options are available as well.
In Singapore, besides Institute of Mental Health, you can also get support from public hospitals such as Singapore General Hospital, Changi General Hospital, Tan Tock Seng Hospital, KK Women’s and Children’s Hospital and Khoo Teck Puat Hospital as they have a psychology department that can dispense drugs and offer psychotherapy.
Brain Stimulation Therapy
If medication and psychotherapy do not help, some people may consider brain stimulation therapy. In most cases, the procedure will not require invasive surgery, but rather, uses magnetic pulses and electric currents to stimulate the brain. Individuals are usually able to leave the recovery room and resume normal activities within half an hour with minimal and temporary side effects, if any at all.
Some of the procedures include electroconvulsive therapy (ECT), vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), magnetic seizure therapy (MST), and deep brain stimulation (DBS). Of these, only VNS, mainly used to treat epilepsy, and DBS, commonly used to treat the physical symptoms of Parkinson’s Disease and OCD, require invasive surgery for surgical implantations.
Taking good care of your physical, spiritual and emotional health can go a long way in your recovery. Here are some steps you can take to improve your mental well-being.
Having sufficient sleep can be beneficial to our mental health. Sleep deprivation is proven to increase our risk of developing mental conditions, and having a mental condition can reduce our sleep quality and quantity, resulting in a downward spiral of poor mental health. If you face problems sleeping, consult your doctor and get it fixed to improve both your physical and mental well-being.
Eat better and feel better! Have a healthy and balanced diet as recommended by Health Promotion Board’s (HPB) My Healthy Plate to stay well-nourished. Limiting your intake of caffeine, alcohol, drugs and nicotine may also help stabilise moods and reduce dependence on such substances.
Besides physical health benefits, exercise also produces “happy hormones” known as endorphins that help to lift moods and relieve stress. Even a modest amount of exercise can make a difference in improving our mental health. Stick to a regular exercise schedule to better cope with mental conditions and prevent relapse!
One of the best ways to help a loved one battling a mental condition is to provide emotional support. Set time aside with no distractions and create an open and non-judgemental space for them to speak about the issues they face.
Let them lead the discussion and avoid putting pressure on them to share anything they may not be ready to talk about. Listen carefully to what they are sharing and repeat it back to them to assure them that you understand. While it may be good to ask questions from time to time, make sure to keep them open-ended. For example, rather than saying “I can see that you are feeling low”, ask “why don’t you tell me how you are feeling?” instead.
Offer your help and provide them with information on where they can get help. If you believe that they are in immediate danger of harming themselves or others, you or they should contact a doctor or emergency helplines such as Samaritans of Singapore (SOS) at 1800-221-4444 or Institute of Mental Health (IMH) at 6389 2222.
If you are caring for a loved one with depression, here are some caregiving tips that may help.
Caring for a loved one with mental condition
Being the primary caregiver for a loved one living with a mental condition can be challenging. When the going gets tough, take a deep breath, be patient and understand that your loved one does not mean to be intentionally hurtful and that it is the condition that’s causing them to act that way.
While you focus on helping your loved one, make sure to take care of your physical and mental health too so that you don’t end up becoming burnt out. It is important to recognise and acknowledge the limits of what you can give, and reach out for help – for both you and your loved one – when necessary. After all, we cannot give what we don’t have.
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