Monthly Archives: April 2015

Is it Depression or Depressive State in Bipolar Disorder?

I’ve previously written about patients with Bipolar Disorder taking only anti-depressant medication (see here for Case 1 & Case 2). As presented in these cases, quite often hypomania and mania do not lead to doctor visits, whereas usually people in depressive state will seek help, which then means that anti-depressant medications will more likely to be considered and used initially. But after a period of treatment, just like the teacher in Case 2 who thought she had recovered but all the colleagues and headmistress found her so hyper, and the man in Case 1 who refused to stop anti-depressants as they made him feel so strong, empowering and elated, these drugs could go all wrong without proper follow ups and assessments.

Anti-depressants (SSRI, Selective Serotonin Reuptake Inhibitor) such as Prozac, Lexapro, Luvox, Zoloft are some commonly used medications for anti-depressant. Sometimes they also work for anti-anxiety and treatment for obsessive compulsive disorders. When bipolar is involved, an antidepressant taken without the protection of a mood stabilizer can potentially induce mania or hypomania, and worsen the course of the illness.

So if the family members or the patient suspects that the depression is actually part of a bipolar disorder (based on patient’s presentation and past experience), it’s very important to make aware to the psychiatrist or attending clinician, so that a mood stabiliser can be used first. Even if the mood stabiliser cannot control the depressive state, it can be used in conjunction with anti-depressants, as a “protective shield” from switching to manic stage (though still, no guarantee, only reducing the chance).

Also, it usually takes at least 2 to 3 weeks for mood stabilisers and anti-depressants to kick in, and a much longer period till it becomes fully effective, sometimes seeing no effects may suggest that you need to be patient and in a month or so you will feel very different, while other times it could also suggest that you are not taking the right dosage, and this is to be judged by psychiatric doctor.

N.B. This is written by a psychologist based on her experience working with patients in psychiatric clinic (and some research); if in doubt please consult your doctor. 

本文写的是抑郁症 (depression) 与躁郁症 (bipolar disorder or manic depressive disorder) 里的忧郁的区别. 大部分时候, 狂躁 (manic) 的人都不会寻求医疗帮助, 都是在抑郁的阶段 (depressive state) 去看医生, 这样一来, 医生很可能就会用抗抑郁药物 (anti-depressant). 可是就如 案例 1 里的男人吃了抗抑郁的药不肯停下来, 因为它让他觉得很强大兴奋和 案例 2 里的老师在接受抗抑郁药物一段时间后以为自己好了不再老是悲伤哭泣, 但身边的校长老师都觉得她情绪过度高昂近乎狂躁.

所以如果家人或者病人本身, 根据过去的经验与病人的表现, 怀疑病人目前的忧郁是狂躁的一部分而不是单纯的抑郁病, 就一定要和医生讨论, 可先用情绪稳定剂治疗 (mood stabiliser), 避免单纯的应用抗抑郁药物 (anti-depressants) 而把病人推向狂躁 (mania).

值得一提的是, 大部分抗抑郁药物 (antidepressants) 和情绪稳定剂 (mood stabilisers) 都至少需要两到三个星期才展现效果, 并需要更长时间才更完整地见效. 所以要是一开始完全不觉得情况有改善, 一是你需要更多耐心, 在大概一个月后你的感觉会改善许多, 二是病人的药物分量不够, 这则需要专科医生的判断.

备注: 本文的作者是一名心理学家 (psychologist), 内容是依据与精神科病人工作的经验与研究所写. 如有任何疑问请寻求专业医疗帮助.

Can you control your thoughts and feelings?

Many of the self-help books out there teach people how to change their thoughts, physical sensations, feelings etc in order to feel better (including traditional CBT which targets automatic negative thoughts), if you’re one of those who have tried many of these techniques, how workable do you think they are? Do you think you really have so much control over your thoughts and feelings?

Try these:

(1) Try to recall something happened in the past week, anything — a dinner you had, a movie you went, a talk etc. [continue when you've got one] Now try to remove it completely from your memory, get rid of it so you will never think about it again in your life… Can you do it?

(2) Now, do not think about chocolate. As you read this, do not think about how a chocolate tastes, smells; do not think about its colour and texture; do not imagine how it feels when it melts in your mouth and how it feels when your tongue and teeth contact with it. Is it possible? Try again with honey maybe?

(3) Think about past experiences, whether when you have to give a public talks and feel very nervous; when a loved ones passes away and you feel really depressed; when your results doesn’t come out as good as expected and you feel disappointed etc etc. You hope you aren’t that nervous, depressed, disappointed, you try to get rid of these negative emotions as how they’re labelled, was the attempt successful? Did trying to control your emotions make it even stronger, ironically? So you’re more nervous trying not to be nervous?

So why ACT (Acceptance and Commitment Therapy)? Because in ACT, we understand in life negative emotions, thoughts, experience, sensations are all just as likely to happen as the positive ones, they are all part of our life, they are what make our lives meaningful, educational and contented. So in ACT, people learn to accept them, to live with them, instead of struggling with them, challenging them, changing them, getting rid of them.

Caregiver Education Course

The Malaysian Mental Health Association is running a Caregiver Education Course in April, which I think would be very useful and also a great opportunity for immediate family members and carers, especially for those taking care of people who suffer from chronic mental health problems. I believe they will also welcome anyone in the mental health profession to come to learn and share.

The course will cover a few mental disorders (e.g. schizophrenia, mood and anxiety disorders) and some modules like understanding the brain and psychiatric drugs, learning about handling crisis and communication skills etc.

What is even better is that the course is free of charge, and will be running on four consecutive Sundays in April starting on the 12th. So it shouldn’t affect those who work during the week. Though, participants should attend the entire course to get the full benefits. Also, this course will be provided in English, but the association is also looking to run more courses later this year, and hopefully some will be in Chinese.

For further information, please contact MMHA 03-7782 5499