James Donaldson on Mental Health - Bipolar Disorder: Why It’s Often Misdiagnosed

And how behavioral treatment, along with medicine, improves outcomes

Writer: Caroline Miller

Clinical Expert: Jill Emanuele, PhD

What You'll Learn

- What is bipolar disorder?
- Why is bipolar disorder hard to diagnose, especially in teens?
- How is bipolar disorder treated in adolescents?
- Quick Read
- Full Article
- What does onset of bipolar disorder look like?
- How is bipolar disorder diagnosed?
- Treatment

A person with bipolar disorder has very extreme mood swings, from feeling very low or depressed to high or “manic.” They may have psychotic episodes, which means they hear or see things that aren’t real.

Bipolar disorder is usually diagnosed in adolescence, though it can also be diagnosed in children and older adults.  Since teens are known for being moody, those who develop bipolar disorder often wind up getting the wrong diagnosis or none at all.

Bipolar disorder usually shows up first as bad depression. Symptoms include not only sadness but feeling like a failure, feeling confused, and being very tired. A teen may even think about suicide. Since a manic episode may not appear for months or even years, this is often treated just as depression, so they miss out on treatment for bipolar that could help them.

Bipolar disorder can also show up as either a big manic episode or a milder one called “hypomania.” A teen may seem way too happy for no reason. They also may think and speak very fast, do dangerous things and need very little sleep. This can be mistaken as the impulsiveness or hyperactivity of ADHD.

Sometimes the first episode of either mania or depression can include breaks from reality, such as hallucinations or delusions. When this happens, it can be misdiagnosed as schizophrenia.

It takes an expert to figure out if a teen has bipolar disorder. Doctors rely on family members to describe the teen’s moods and symptoms over time. Getting the diagnosis right is important because the longer someone has symptoms, the higher their risk of suicide.

The best treatment for bipolar disorder in teens is medications called mood stabilizers combined with specialized therapy. There are three kinds of therapy that have been shown to work well for bipolar disorder in adolescence. Family-focused therapy gets everyone at home involved and is aimed at lowering the stress level at home. Cognitive behavioral therapy (CBT) is aimed at changing negative ways of thinking. Interpersonal and social rhythm therapy (IPSRP) focuses on what are called “social rhythms,” and it helps a teen reduce stress by keeping a regular schedule for things like eating and sleeping, going to school or work, and seeing friends. For more information about these therapies, see the full article below.

Bipolar disorder is a mood disorder characterized by dramatic highs and lows — periods of depression alternating with mania, or extremely elevated mood.

Bipolar disorder is most often diagnosed in adolescence or early adulthood, though it can be diagnosed in childhood or in later adulthood. The mean age of onset is 18, and between 15 and 19 is the most common period of onset. But the disorder’s first signs are very often overlooked or mischaracterized. At the outset, bipolar symptoms are commonly mistaken for ADHD, depression, anxiety, borderline personality disorder, and, in its more severe manifestations, as schizophrenia.

That’s because the first symptoms of this disorder are unusually varied. Only over time does the pattern of alternating high and low moods become clear, meaning that in many cases people with bipolar disorder are left waiting months, or even years, for an accurate diagnosis. And that waiting can have serious consequences, including treatment that’s not effective.

What does onset of bipolar disorder look like?

In some patients, the first sign of bipolar disorder is what appears to be a major depressive episode.   Others experience full-blown mania or hypomania — a less extreme form of mania. Still others experience a confusing combination of symptoms called a “mixed episode,” which has elements of both depression and mania.

Here is a closer look at what a first episode might look like:

Depression: When the first episode of bipolar disorder is depression, symptoms can develop slowly, reports Michael Strober, PhD, who is Distinguished Professor of Psychiatry, and Senior Consultant to the Youth Mood Disorders Treatment and Research Program at the David Geffen School of Medicine at UCLA. Bipolar depression usually includes not only the sadness or irritability we associate with depression, but delusions of failure, exaggerated feelings of guilt, mental confusion, and profound physical slowness.

Despite these differences, Dr. Strober notes that symptoms of bipolar depression are often misdiagnosed as major depressive disorder early on, because alternating periods of mania (or hypomania) may not appear until months or years later.

Mania: Unlike the gradual descent into depression, when the initial episode is mania the onset can be “like a thunderclap,” says Wendy Nash, MD, a child and adolescentpsychiatrist. An initialmanic episode might be characterized by grandiose thinking, risk-taking, accelerated speech and thought, and euphoria or irritability.

It’s not unusual for the behavior to be so extreme that the patient ends up hospitalized — or even arrested. Dr. Nash gives an example of a college student who inexplicably shifts from normal behavior to overdrive: Suddenly they’re up all night, hyper-talkative, loud, and combative, maybe even getting into fights, acting so rashly and erratically that police are called.

In younger children, mania may be misinterpreted as the hyperactivity and impulsivity of ADHD.

Hypomania: Sometimes the initial episode of bipolar disorder is the less extreme form of mania called hypomania, and these episodes are often missed, Dr. Nash notes. The person may be talkative, grandiose, highly productive, a little moody and irritable, but the symptoms aren’t as disruptive or dangerous as in full-blown mania, and patients themselves don’t perceive themselves as disordered.

“Hypomania is trickier to diagnose,” adds Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders. “Adolescents with hypomania aren’t as flagrantly out of control as those with full-fledged mania, who can be dangerously impulsive and reckless.”

Mixed episode: Finally, some people with bipolar disorder experience what’s called a mixed episode, which includes characteristics of both depression and mania. In a mixed episode, a patient has a depressed mood but racing thoughts and speech, agitation, and anxious preoccupations — what one patient describes as being over-caffeinated and tired at the same time.

In a mixed episode, obsessive negative thoughts can be misdiagnosed as anxiety, notes Dr. Strober.

Psychosis: Some first episodes of either mania or depression can be so severe they include psychotic symptoms — breaks from reality such as hallucinations or delusions. When this happens, it can be misdiagnosed as schizophrenia.

How is bipolar disorder diagnosed?

A diagnosis of bipolar disorder is based on a detailed history that tracks changes in mood over time; as one expert puts it, think of it as a movie, not a snapshot.

“You need to get the timeline of mood shifts,” notes Dr. Emanuele, “and that takes a very careful diagnostic assessment.” Without treatment, bipolar episodes usually last from several weeks to several months. Periods in between episodes, without symptoms of either mania or depression, can last weeks, months or years.

Interviewing family members or friends can be important, since patients themselves may not recognize manic or hypomanic symptoms as harmful or disordered. Eliciting a family history is also important because bipolar disorder is more common in people who have first-degree relatives (a parent or sibling) with the disorder.

To determine whether elevated or depressed moods meet the criteria for bipolar disorder, a clinician looks for these criteria:

 Signs of mania:

- Drastic personality changes
- Excitability
- Irritability
- Inflated self-confidence
- Extremely energetic
- Grandiose/delusional thinking
- Recklessness
- Decreased need for sleep
- Increased talkativeness
- Racing thoughts
- Scattered attention
- Psychotic episodes, or breaks from reality

Signs of depression:

- Depressed or irritable mood
- Loss of interest or pleasure in things once enjoyed
- Marked weight loss or gain
- Decreased or increased need for sleep
- Prolonged sadness
- Restlessness
- Lethargy
- Fatigue
- Feelings of hopelessness, helplessness, worthlessness
- Excessive or inappropriate guilt
- School avoidance
- Avoids friends
- Cloudy or indecisive thinking
- Preoccupation with death, plans of suicide or an actual suicide attempt
- Psychotic episodes — breaks from reality

These criteria describe the most severe form of the disorder, called bipolar I disorder. People may also be diagnosed with bipolar II disorder, in which less severe episodes of hypomania replace manic episodes.

One of the most concerning things about bipolar disorder is that the lifetime suicide risk is 15 times that of the general population. Factors which elevate this risk for individuals include the severity and persistence of depression and the presence of mixed episodes, which combine depressive symptoms and the activation of mania.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Treatment

While medication has for many years been the first-line treatment for bipolar disorder, over the last several decades specialized forms of psychotherapy have been developed to work alongside medication. Research shows that the most effective treatment for bipolar disorder combines medication and psychotherapy.

Medication: The go-to treatment for bipolar disorder is usually a group of medications called mood stabilizers, including lithium and some drugs called anticonvulsants. Mood stabilizers are generally effective at treating manic symptoms and lowering the frequency and severity of both manic and depressive episodes. But the depression is tougher to treat than the mania, and antidepressants are sometimes added to treat bipolar depression. Given alone, antidepressants can trigger manic symptoms, so they need to be prescribed with great care.

Atypical antipsychotics are also used, especially in adolescents, Dr. Nash reports. While mood stabilizers are very effective in adults, she says, in adolescents an atypicalantipsychotic is often more effective.

Many people with bipolar disorder take more than one medication and the drugs can have complex interactions, leading to significant side effects if they are not effectively monitored by an experienced clinician.

Therapy: Several forms of psychotherapy adapted for bipolar disorder have been shown to speed recovery from an acute episode of mania or depression, delay recurring episodes, decrease suicide attempts, and increase medication adherence.

“A major challenge to treatment is compliance with medication,” notes Dr. Emanuele, and psychotherapy increases compliance. It also helps people make changes in their lives to avoid triggering symptoms. “Psycho-education helps people manage their lives with the disorder, and psychotherapy helps them deal with thoughts and feelings.”

An NIMH-funded study of bipolar patients found that treatment with one of three psychotherapies along with medication “significantly enhance a person’s chances for recovering from depression and staying healthy over the long term.”

The three therapies are:

- Family-focused therapy (FFT): FFT engages parents and other family members in keeping track of symptoms and improving communication and problem-solving in the home, to avoid spikes in family stress, which can lead to episodes.
- Cognitivebehavioral therapy (CBT): CBT focuses on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness
- Interpersonal and social rhythm therapy (IPSRT): IPSRT focuses on helping the patient stabilize daily routines and sleep/wake cycles, and solve key relationship problems, to avoid triggering an episode.

IPSRP, the most recent of these therapies, is based on the concept that a healthy person has regular social rhythms — when you get up, eat meals, go to school or work, see other people, sleep, etc. — and bipolar disorder may be caused by those rhythms being destabilized.

IPSRT focuses on helping patients reduce interpersonal stressors and disruptions to a stable lifestyle, in order to forestall new episodes of mania or depression. Patients learn to improve relationship skills and keep regular patterns of eating, socializing, and sleeping.

While IPSRT was developed for adults, it has been adapted for adolescents and is especially suited to the latter, notes Ellen Frank, an expert in mood disorders treatment at the University of Pittsburgh who, with colleagues, developed the therapy. Adolescence is a particularly sensitive period for interpersonal turmoil, and adolescents are prone tochronic sleep deprivation and radical shifts in sleep patterns, she writes. “They often have very dysregulated sleep and social routines that would be especially harmful for a teenager with BD.”

Contrary to earlier thinking, research shows that the course of the disorder is no different whether it develops before or after age 18, Dr.

https://standingabovethecrowd.com/james-donaldson-on-mental-health-bipolar-disorder-why-its-often-misdiagnosed/

And how behavioral treatment, along with medicine, improves outcomes

Writer: Caroline Miller

Clinical Expert: Jill Emanuele, PhD

What You'll Learn

- What is bipolar disorder?

- Why is bipolar disorder hard to diagnose, especially in teens?

- How is bipolar disorder treated in adolescents?

- Quick Read

- Full Article

- What does onset of bipolar disorder look like?

- How is bipolar disorder diagnosed?

- Treatment

A person with bipolar disorder has very extreme mood swings, from feeling very low or depressed to high or “manic.” They may have psychotic episodes, which means they hear or see things that aren’t real.

Bipolar disorder is usually diagnosed in adolescence, though it can also be diagnosed in children and older adults.  Since teens are known for being moody, those who develop bipolar disorder often wind up getting the wrong diagnosis or none at all.

Bipolar disorder usually shows up first as bad depression. Symptoms include not only sadness but feeling like a failure, feeling confused, and being very tired. A teen may even think about suicide. Since a manic episode may not appear for months or even years, this is often treated just as depression, so they miss out on treatment for bipolar that could help them.

Bipolar disorder can also show up as either a big manic episode or a milder one called “hypomania.” A teen may seem way too happy for no reason. They also may think and speak very fast, do dangerous things and need very little sleep. This can be mistaken as the impulsiveness or hyperactivity of ADHD.

Sometimes the first episode of either mania or depression can include breaks from reality, such as hallucinations or delusions. When this happens, it can be misdiagnosed as schizophrenia.

It takes an expert to figure out if a teen has bipolar disorder. Doctors rely on family members to describe the teen’s moods and symptoms over time. Getting the diagnosis right is important because the longer someone has symptoms, the higher their risk of suicide.

The best treatment for bipolar disorder in teens is medications called mood stabilizers combined with specialized therapy. There are three kinds of therapy that have been shown to work well for bipolar disorder in adolescence. Family-focused therapy gets everyone at home involved and is aimed at lowering the stress level at home. Cognitive behavioral therapy (CBT) is aimed at changing negative ways of thinking. Interpersonal and social rhythm therapy (IPSRP) focuses on what are called “social rhythms,” and it helps a teen reduce stress by keeping a regular schedule for things like eating and sleeping, going to school or work, and seeing friends. For more information about these therapies, see the full article below.

Bipolar disorder is a mood disorder characterized by dramatic highs and lows — periods of depression alternating with mania, or extremely elevated mood.

Bipolar disorder is most often diagnosed in adolescence or early adulthood, though it can be diagnosed in childhood or in later adulthood. The mean age of onset is 18, and between 15 and 19 is the most common period of onset. But the disorder’s first signs are very often overlooked or mischaracterized. At the outset, bipolar symptoms are commonly mistaken for ADHD, depression, anxiety, borderline personality disorder, and, in its more severe manifestations, as schizophrenia.

That’s because the first symptoms of this disorder are unusually varied. Only over time does the pattern of alternating high and low moods become clear, meaning that in many cases people with bipolar disorder are left waiting months, or even years, for an accurate diagnosis. And that waiting can have serious consequences, including treatment that’s not effective.

What does onset of bipolar disorder look like?

In some patients, the first sign of bipolar disorder is what appears to be a major depressive episode.   Others experience full-blown mania or hypomania — a less extreme form of mania. Still others experience a confusing combination of symptoms called a “mixed episode,” which has elements of both depression and mania.

Here is a closer look at what a first episode might look like:

Depression: When the first episode of bipolar disorder is depression, symptoms can develop slowly, reports Michael Strober, PhD, who is Distinguished Professor of Psychiatry, and Senior Consultant to the Youth Mood Disorders Treatment and Research Program at the David Geffen School of Medicine at UCLA. Bipolar depression usually includes not only the sadness or irritability we associate with depression, but delusions of failure, exaggerated feelings of guilt, mental confusion, and profound physical slowness.

Despite these differences, Dr. Strober notes that symptoms of bipolar depression are often misdiagnosed as major depressive disorder early on, because alternating periods of mania (or hypomania) may not appear until months or years later.

Mania: Unlike the gradual descent into depression, when the initial episode is mania the onset can be “like a thunderclap,” says Wendy Nash, MD, a child and adolescentpsychiatrist. An initialmanic episode might be characterized by grandiose thinking, risk-taking, accelerated speech and thought, and euphoria or irritability.

It’s not unusual for the behavior to be so extreme that the patient ends up hospitalized — or even arrested. Dr. Nash gives an example of a college student who inexplicably shifts from normal behavior to overdrive: Suddenly they’re up all night, hyper-talkative, loud, and combative, maybe even getting into fights, acting so rashly and erratically that police are called.

In younger children, mania may be misinterpreted as the hyperactivity and impulsivity of ADHD.

Hypomania: Sometimes the initial episode of bipolar disorder is the less extreme form of mania called hypomania, and these episodes are often missed, Dr. Nash notes. The person may be talkative, grandiose, highly productive, a little moody and irritable, but the symptoms aren’t as disruptive or dangerous as in full-blown mania, and patients themselves don’t perceive themselves as disordered.

“Hypomania is trickier to diagnose,” adds Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders. “Adolescents with hypomania aren’t as flagrantly out of control as those with full-fledged mania, who can be dangerously impulsive and reckless.”

Mixed episode: Finally, some people with bipolar disorder experience what’s called a mixed episode, which includes characteristics of both depression and mania. In a mixed episode, a patient has a depressed mood but racing thoughts and speech, agitation, and anxious preoccupations — what one patient describes as being over-caffeinated and tired at the same time.

In a mixed episode, obsessive negative thoughts can be misdiagnosed as anxiety, notes Dr. Strober.

Psychosis: Some first episodes of either mania or depression can be so severe they include psychotic symptoms — breaks from reality such as hallucinations or delusions. When this happens, it can be misdiagnosed as schizophrenia.

How is bipolar disorder diagnosed?

A diagnosis of bipolar disorder is based on a detailed history that tracks changes in mood over time; as one expert puts it, think of it as a movie, not a snapshot.

“You need to get the timeline of mood shifts,” notes Dr. Emanuele, “and that takes a very careful diagnostic assessment.” Without treatment, bipolar episodes usually last from several weeks to several months. Periods in between episodes, without symptoms of either mania or depression, can last weeks, months or years.

Interviewing family members or friends can be important, since patients themselves may not recognize manic or hypomanic symptoms as harmful or disordered. Eliciting a family history is also important because bipolar disorder is more common in people who have first-degree relatives (a parent or sibling) with the disorder.

To determine whether elevated or depressed moods meet the criteria for bipolar disorder, a clinician looks for these criteria:

 Signs of mania:

- Drastic personality changes

- Excitability

- Irritability

- Inflated self-confidence

- Extremely energetic

- Grandiose/delusional thinking

- Recklessness

- Decreased need for sleep

- Increased talkativeness

- Racing thoughts

- Scattered attention

- Psychotic episodes, or breaks from reality

Signs of depression:

- Depressed or irritable mood

- Loss of interest or pleasure in things once enjoyed

- Marked weight loss or gain

- Decreased or increased need for sleep

- Prolonged sadness

- Restlessness

- Lethargy

- Fatigue

- Feelings of hopelessness, helplessness, worthlessness

- Excessive or inappropriate guilt

- School avoidance

- Avoids friends

- Cloudy or indecisive thinking

- Preoccupation with death, plans of suicide or an actual suicide attempt

- Psychotic episodes — breaks from reality

These criteria describe the most severe form of the disorder, called bipolar I disorder. People may also be diagnosed with bipolar II disorder, in which less severe episodes of hypomania replace manic episodes.

One of the most concerning things about bipolar disorder is that the lifetime suicide risk is 15 times that of the general population. Factors which elevate this risk for individuals include the severity and persistence of depression and the presence of mixed episodes, which combine depressive symptoms and the activation of mania.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Treatment

While medication has for many years been the first-line treatment for bipolar disorder, over the last several decades specialized forms of psychotherapy have been developed to work alongside medication. Research shows that the most effective treatment for bipolar disorder combines medication and psychotherapy.

Medication: The go-to treatment for bipolar disorder is usually a group of medications called mood stabilizers, including lithium and some drugs called anticonvulsants. Mood stabilizers are generally effective at treating manic symptoms and lowering the frequency and severity of both manic and depressive episodes. But the depression is tougher to treat than the mania, and antidepressants are sometimes added to treat bipolar depression. Given alone, antidepressants can trigger manic symptoms, so they need to be prescribed with great care.

Atypical antipsychotics are also used, especially in adolescents, Dr. Nash reports. While mood stabilizers are very effective in adults, she says, in adolescents an atypicalantipsychotic is often more effective.

Many people with bipolar disorder take more than one medication and the drugs can have complex interactions, leading to significant side effects if they are not effectively monitored by an experienced clinician.

Therapy: Several forms of psychotherapy adapted for bipolar disorder have been shown to speed recovery from an acute episode of mania or depression, delay recurring episodes, decrease suicide attempts, and increase medication adherence.

“A major challenge to treatment is compliance with medication,” notes Dr. Emanuele, and psychotherapy increases compliance. It also helps people make changes in their lives to avoid triggering symptoms. “Psycho-education helps people manage their lives with the disorder, and psychotherapy helps them deal with thoughts and feelings.”

An NIMH-funded study of bipolar patients found that treatment with one of three psychotherapies along with medication “significantly enhance a person’s chances for recovering from depression and staying healthy over the long term.”

The three therapies are:

- Family-focused therapy (FFT): FFT engages parents and other family members in keeping track of symptoms and improving communication and problem-solving in the home, to avoid spikes in family stress, which can lead to episodes.

- Cognitivebehavioral therapy (CBT): CBT focuses on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness

- Interpersonal and social rhythm therapy (IPSRT): IPSRT focuses on helping the patient stabilize daily routines and sleep/wake cycles, and solve key relationship problems, to avoid triggering an episode.

IPSRP, the most recent of these therapies, is based on the concept that a healthy person has regular social rhythms — when you get up, eat meals, go to school or work, see other people, sleep, etc. — and bipolar disorder may be caused by those rhythms being destabilized.

IPSRT focuses on helping patients reduce interpersonal stressors and disruptions to a stable lifestyle, in order to forestall new episodes of mania or depression. Patients learn to improve relationship skills and keep regular patterns of eating, socializing, and sleeping.

While IPSRT was developed for adults, it has been adapted for adolescents and is especially suited to the latter, notes Ellen Frank, an expert in mood disorders treatment at the University of Pittsburgh who, with colleagues, developed the therapy. Adolescence is a particularly sensitive period for interpersonal turmoil, and adolescents are prone tochronic sleep deprivation and radical shifts in sleep patterns, she writes. “They often have very dysregulated sleep and social routines that would be especially harmful for a teenager with BD.”

Contrary to earlier thinking, research shows that the course of the disorder is no different whether it develops before or after age 18, Dr. Strober reports.

Bipolar disorder is a chronic disorder, but with a combination of medications, psychotherapy, stress management, a regular schedule, and early identification of symptoms, many people live very well with the diagnosis. https://standingabovethecrowd.com/james-donaldson-on-mental-health-bipolar-disorder-why-its-often-misdiagnosed/

And how behavioral treatment, along with medicine, improves outcomes

Writer: Caroline Miller

Clinical Expert: Jill Emanuele, PhD

What You'll Learn

- What is bipolar disorder?

- Why is bipolar disorder hard to diagnose, especially in teens?

- How is bipolar disorder treated in adolescents?

- Quick Read

- Full Article

- What does onset of bipolar disorder look like?

- How is bipolar disorder diagnosed?

- Treatment

A person with bipolar disorder has very extreme mood swings, from feeling very low or depressed to high or “manic.” They may have psychotic episodes, which means they hear or see things that aren’t real.

Bipolar disorder is usually diagnosed in adolescence, though it can also be diagnosed in children and older adults.  Since teens are known for being moody, those who develop bipolar disorder often wind up getting the wrong diagnosis or none at all.

Bipolar disorder usually shows up first as bad depression. Symptoms include not only sadness but feeling like a failure, feeling confused, and being very tired. A teen may even think about suicide. Since a manic episode may not appear for months or even years, this is often treated just as depression, so they miss out on treatment for bipolar that could help them.

Bipolar disorder can also show up as either a big manic episode or a milder one called “hypomania.” A teen may seem way too happy for no reason. They also may think and speak very fast, do dangerous things and need very little sleep. This can be mistaken as the impulsiveness or hyperactivity of ADHD.

Sometimes the first episode of either mania or depression can include breaks from reality, such as hallucinations or delusions. When this happens, it can be misdiagnosed as schizophrenia.

It takes an expert to figure out if a teen has bipolar disorder. Doctors rely on family members to describe the teen’s moods and symptoms over time. Getting the diagnosis right is important because the longer someone has symptoms, the higher their risk of suicide.

The best treatment for bipolar disorder in teens is medications called mood stabilizers combined with specialized therapy. There are three kinds of therapy that have been shown to work well for bipolar disorder in adolescence. Family-focused therapy gets everyone at home involved and is aimed at lowering the stress level at home. Cognitive behavioral therapy (CBT) is aimed at changing negative ways of thinking. Interpersonal and social rhythm therapy (IPSRP) focuses on what are called “social rhythms,” and it helps a teen reduce stress by keeping a regular schedule for things like eating and sleeping, going to school or work, and seeing friends. For more information about these therapies, see the full article below.

Bipolar disorder is a mood disorder characterized by dramatic highs and lows — periods of depression alternating with mania, or extremely elevated mood.

Bipolar disorder is most often diagnosed in adolescence or early adulthood, though it can be diagnosed in childhood or in later adulthood. The mean age of onset is 18, and between 15 and 19 is the most common period of onset. But the disorder’s first signs are very often overlooked or mischaracterized. At the outset, bipolar symptoms are commonly mistaken for ADHD, depression, anxiety, borderline personality disorder, and, in its more severe manifestations, as schizophrenia.

That’s because the first symptoms of this disorder are unusually varied. Only over time does the pattern of alternating high and low moods become clear, meaning that in many cases people with bipolar disorder are left waiting months, or even years, for an accurate diagnosis. And that waiting can have serious consequences, including treatment that’s not effective.

What does onset of bipolar disorder look like?

In some patients, the first sign of bipolar disorder is what appears to be a major depressive episode.   Others experience full-blown mania or hypomania — a less extreme form of mania. Still others experience a confusing combination of symptoms called a “mixed episode,” which has elements of both depression and mania.

Here is a closer look at what a first episode might look like:

Depression: When the first episode of bipolar disorder is depression, symptoms can develop slowly, reports Michael Strober, PhD, who is Distinguished Professor of Psychiatry, and Senior Consultant to the Youth Mood Disorders Treatment and Research Program at the David Geffen School of Medicine at UCLA. Bipolar depression usually includes not only the sadness or irritability we associate with depression, but delusions of failure, exaggerated feelings of guilt, mental confusion, and profound physical slowness.

Despite these differences, Dr. Strober notes that symptoms of bipolar depression are often misdiagnosed as major depressive disorder early on, because alternating periods of mania (or hypomania) may not appear until months or years later.

Mania: Unlike the gradual descent into depression, when the initial episode is mania the onset can be “like a thunderclap,” says Wendy Nash, MD, a child and adolescentpsychiatrist. An initialmanic episode might be characterized by grandiose thinking, risk-taking, accelerated speech and thought, and euphoria or irritability.

It’s not unusual for the behavior to be so extreme that the patient ends up hospitalized — or even arrested. Dr. Nash gives an example of a college student who inexplicably shifts from normal behavior to overdrive: Suddenly they’re up all night, hyper-talkative, loud, and combative, maybe even getting into fights, acting so rashly and erratically that police are called.

In younger children, mania may be misinterpreted as the hyperactivity and impulsivity of ADHD.

Hypomania: Sometimes the initial episode of bipolar disorder is the less extreme form of mania called hypomania, and these episodes are often missed, Dr. Nash notes. The person may be talkative, grandiose, highly productive, a little moody and irritable, but the symptoms aren’t as disruptive or dangerous as in full-blown mania, and patients themselves don’t perceive themselves as disordered.

“Hypomania is trickier to diagnose,” adds Jill Emanuele, PhD, a clinical psychologist who specializes in mood disorders. “Adolescents with hypomania aren’t as flagrantly out of control as those with full-fledged mania, who can be dangerously impulsive and reckless.”

Mixed episode: Finally, some people with bipolar disorder experience what’s called a mixed episode, which includes characteristics of both depression and mania. In a mixed episode, a patient has a depressed mood but racing thoughts and speech, agitation, and anxious preoccupations — what one patient describes as being over-caffeinated and tired at the same time.

In a mixed episode, obsessive negative thoughts can be misdiagnosed as anxiety, notes Dr. Strober.

Psychosis: Some first episodes of either mania or depression can be so severe they include psychotic symptoms — breaks from reality such as hallucinations or delusions. When this happens, it can be misdiagnosed as schizophrenia.

How is bipolar disorder diagnosed?

A diagnosis of bipolar disorder is based on a detailed history that tracks changes in mood over time; as one expert puts it, think of it as a movie, not a snapshot.

“You need to get the timeline of mood shifts,” notes Dr. Emanuele, “and that takes a very careful diagnostic assessment.” Without treatment, bipolar episodes usually last from several weeks to several months. Periods in between episodes, without symptoms of either mania or depression, can last weeks, months or years.

Interviewing family members or friends can be important, since patients themselves may not recognize manic or hypomanic symptoms as harmful or disordered. Eliciting a family history is also important because bipolar disorder is more common in people who have first-degree relatives (a parent or sibling) with the disorder.

To determine whether elevated or depressed moods meet the criteria for bipolar disorder, a clinician looks for these criteria:

 Signs of mania:

- Drastic personality changes

- Excitability

- Irritability

- Inflated self-confidence

- Extremely energetic

- Grandiose/delusional thinking

- Recklessness

- Decreased need for sleep

- Increased talkativeness

- Racing thoughts

- Scattered attention

- Psychotic episodes, or breaks from reality

Signs of depression:

- Depressed or irritable mood

- Loss of interest or pleasure in things once enjoyed

- Marked weight loss or gain

- Decreased or increased need for sleep

- Prolonged sadness

- Restlessness

- Lethargy

- Fatigue

- Feelings of hopelessness, helplessness, worthlessness

- Excessive or inappropriate guilt

- School avoidance

- Avoids friends

- Cloudy or indecisive thinking

- Preoccupation with death, plans of suicide or an actual suicide attempt

- Psychotic episodes — breaks from reality

These criteria describe the most severe form of the disorder, called bipolar I disorder. People may also be diagnosed with bipolar II disorder, in which less severe episodes of hypomania replace manic episodes.

One of the most concerning things about bipolar disorder is that the lifetime suicide risk is 15 times that of the general population. Factors which elevate this risk for individuals include the severity and persistence of depression and the presence of mixed episodes, which combine depressive symptoms and the activation of mania.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Treatment

While medication has for many years been the first-line treatment for bipolar disorder, over the last several decades specialized forms of psychotherapy have been developed to work alongside medication. Research shows that the most effective treatment for bipolar disorder combines medication and psychotherapy.

Medication: The go-to treatment for bipolar disorder is usually a group of medications called mood stabilizers, including lithium and some drugs called anticonvulsants. Mood stabilizers are generally effective at treating manic symptoms and lowering the frequency and severity of both manic and depressive episodes. But the depression is tougher to treat than the mania, and antidepressants are sometimes added to treat bipolar depression. Given alone, antidepressants can trigger manic symptoms, so they need to be prescribed with great care.

Atypical antipsychotics are also used, especially in adolescents, Dr. Nash reports. While mood stabilizers are very effective in adults, she says, in adolescents an atypicalantipsychotic is often more effective.

Many people with bipolar disorder take more than one medication and the drugs can have complex interactions, leading to significant side effects if they are not effectively monitored by an experienced clinician.

Therapy: Several forms of psychotherapy adapted for bipolar disorder have been shown to speed recovery from an acute episode of mania or depression, delay recurring episodes, decrease suicide attempts, and increase medication adherence.

“A major challenge to treatment is compliance with medication,” notes Dr. Emanuele, and psychotherapy increases compliance. It also helps people make changes in their lives to avoid triggering symptoms. “Psycho-education helps people manage their lives with the disorder, and psychotherapy helps them deal with thoughts and feelings.”

An NIMH-funded study of bipolar patients found that treatment with one of three psychotherapies along with medication “significantly enhance a person’s chances for recovering from depression and staying healthy over the long term.”

The three therapies are:

- Family-focused therapy (FFT): FFT engages parents and other family members in keeping track of symptoms and improving communication and problem-solving in the home, to avoid spikes in family stress, which can lead to episodes.

- Cognitivebehavioral therapy (CBT): CBT focuses on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness

- Interpersonal and social rhythm therapy (IPSRT): IPSRT focuses on helping the patient stabilize daily routines and sleep/wake cycles, and solve key relationship problems, to avoid triggering an episode.

IPSRP, the most recent of these therapies, is based on the concept that a healthy person has regular social rhythms — when you get up, eat meals, go to school or work, see other people, sleep, etc. — and bipolar disorder may be caused by those rhythms being destabilized.

IPSRT focuses on helping patients reduce interpersonal stressors and disruptions to a stable lifestyle, in order to forestall new episodes of mania or depression. Patients learn to improve relationship skills and keep regular patterns of eating, socializing, and sleeping.

While IPSRT was developed for adults, it has been adapted for adolescents and is especially suited to the latter, notes Ellen Frank, an expert in mood disorders treatment at the University of Pittsburgh who, with colleagues, developed the therapy. Adolescence is a particularly sensitive period for interpersonal turmoil, and adolescents are prone tochronic sleep deprivation and radical shifts in sleep patterns, she writes. “They often have very dysregulated sleep and social routines that would be especially harmful for a teenager with BD.”

Contrary to earlier thinking, research shows that the course of the disorder is no different whether it develops before or after age 18, Dr. Strober reports.

Bipolar disorder is a chronic disorder, but with a combination of medications, psychotherapy, stress management, a regular schedule, and early identification of symptoms, many people live very well with the diagnosis. https://standingabovethecrowd.com/?p=15889

James Donaldson on Mental Health - What Are the Kinds of Depression?

The sadness and irritability of depression can take several different forms

Writer: Caroline Miller

- Major Depressive Disorder
- Persistent Depressive Disorder (Dysthymia)
- Disruptive Mood Dysregulation Disorder (DMDD)
- Premenstrual Dysphoric Disorder (PMDD)
- Seasonal Affective Disorder (SAD)
- Treatment for depression

Depression is a common mental health condition that causes someone to be in a sad or irritable mood for an unusually long period of time. It’s normal for children to feel down when bad things happen, but a child with depression doesn’t feel better if things change. Children and teenagers who are depressed usually have trouble enjoying things they used to love and have low energy. They might think about or attempt suicide.

Depression usually begins during the teenage years, but younger kids can also be diagnosed. Girls are diagnosed twice as often as boys.

Depression can take a number of different forms. The disorders below are all forms of what experts call “unipolar depression.” The term “unipolar” is used to distinguish them from bipolar depression, which involves a combination of extreme lows and highs — episodes of depression alternating with episodes of mania — and is treated differently from other forms of depression.

Major Depressive Disorder

This is the most familiar kind of depression, in which someone experiences severe symptoms that last between two weeks and several months. An episode of depression may occur only once, but in most cases the depression will return multiple times.

The biggest sign of depression is a change in mood. A depressed child will feel sad or irritable —quick to anger over very small things — most of the time, and lose interest in things they normally enjoy.

Other symptoms include:

- Feeling hopeless
- Lacking energy or being tired all the time
- Trouble concentrating
- Poor performance or poor attendance at school
- Low self-esteem or saying negative things about themselves
- Eating too little or too much
- Gaining or losing a lot of weight
- Trouble sleeping
- Thinking about or attempting suicide

Some children with depression no longer look forward to things they used to enjoy, but they can enjoy them in the moment. This is unusual and is known as atypical depression. It can trick parents, making them think their child doesn’t want to cooperate when they are actually depressed.

Persistent Depressive Disorder (Dysthymia)

This is a form of depression in which someone experiences the same symptoms as major depressive disorder, but in a milder form. And instead of occurring in episodes of several weeks or months, the symptoms last for a year or more. In persistent depressive disorder, the symptoms may get more or less severe at different times, but they don’t go away for more than two months at a time.

Since the symptoms of persistent depressive disorder can last for years, it can appear that a downbeat mood, low self-esteem or irritability is just a part of a child or teenager’s personality. But treatment can make a big difference.

Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a relatively new diagnosis that is given to children who have frequent, explosive temper tantrums in reaction to things that don’t seem like a big deal. In between tantrums they are irritable most of the time. They have a short fuse, and low frustration tolerance. The DMDD diagnosis recognizes that for young children, depression can look more like anger than sadness.

Symptoms of DMDD usually show up before age 10. It is not diagnosed before age six because temper tantrums are normal for young kids. To be diagnosed with DMDD a child must have major temper tantrums three or more times a week on average. This behavior has to show up when the child is with family, friends and teachers— if it’s only in one situation it’s probably not DMDD.

Unlike kids with oppositional defiant disorder (ODD) these kids aren’t focused on defying authority. They act out because they experience feelings more powerfully than other kids, and they lack self-regulation skills. 

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder is a condition that affects some women and girls in the week before their period, when hormones spike. Symptoms are similar to PMS but so severe that they have a serious impact on daily life. While PMS may be troubling, a girl with PMDD is likely to experience feelings closer to a major depressive episode.

Girls with PMDD might feel depressed, anxious or angry. They may cry for little or no reason. They may also have trouble concentrating and staying on task. They may feel overwhelmed, and worried that everyone is mad or unhappy with them. Physical symptoms like cramps, headaches, body aches and tender breasts are common.

Symptoms typically start 5–8 days before their period but can begin earlier, and they go away once the period begins. Onset of PMDD can be any time after puberty.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Seasonal Affective Disorder (SAD)

Seasonal affective disorder (SAD) is a type of depression that comes and goes with changes of seasons. It has all the same symptoms as major depressive disorder, but it only happens during specific months of the year. The technical name for it is “major depressive disorder with seasonal pattern.”

Most people who experience seasonal affective disorder get depressed in the fall and winter — possibly because getting less sunlight in the winter affects brain chemicals that impact mood and energy levels. But for some people, depressive episodes are triggered by summer.

To be considered signs of SAD, the symptoms can’t be related to something that happens during the time period when they appear, such as events at home or school during the winter.

Treatment for depression

Treatment can be very effective for children and teenagers struggling with depression. It includes both medication and several different kinds of therapy.

Many clinicians recommend that if a child is takingantidepressant medication they should also be participating in therapy. Medication can reduce symptoms of depression, but therapy teaches kids skills to manage their moods and cope in a healthy way with uncomfortable feelings.

Frequently Asked Questions

What are the different types of depression?

There are several different types of depression including major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder (DMDD), premenstrual dysphoric disorder, and seasonal affective disorder (SAD).

What is Major Depressive Disorder?

What is Persistent Depressive Disorder (Dysthymia)?

What is Disruptive Mood Dysregulation Disorder (DMDD)?

What is Premenstrual Dysphoric Disorder (PMDD)?

What is Seasonal Affective Disorder (SAD)?

What is the treatment for child and adolescent depression?

https://standingabovethecrowd.com/james-donaldson-on-mental-health-what-are-the-kinds-of-depression/

The sadness and irritability of depression can take several different forms

Writer: Caroline Miller

- Major Depressive Disorder

- Persistent Depressive Disorder (Dysthymia)

- Disruptive Mood Dysregulation Disorder (DMDD)

- Premenstrual Dysphoric Disorder (PMDD)

- Seasonal Affective Disorder (SAD)

- Treatment for depression

Depression is a common mental health condition that causes someone to be in a sad or irritable mood for an unusually long period of time. It’s normal for children to feel down when bad things happen, but a child with depression doesn’t feel better if things change. Children and teenagers who are depressed usually have trouble enjoying things they used to love and have low energy. They might think about or attempt suicide.

Depression usually begins during the teenage years, but younger kids can also be diagnosed. Girls are diagnosed twice as often as boys.

Depression can take a number of different forms. The disorders below are all forms of what experts call “unipolar depression.” The term “unipolar” is used to distinguish them from bipolar depression, which involves a combination of extreme lows and highs — episodes of depression alternating with episodes of mania — and is treated differently from other forms of depression.

Major Depressive Disorder

This is the most familiar kind of depression, in which someone experiences severe symptoms that last between two weeks and several months. An episode of depression may occur only once, but in most cases the depression will return multiple times.

The biggest sign of depression is a change in mood. A depressed child will feel sad or irritable —quick to anger over very small things — most of the time, and lose interest in things they normally enjoy.

Other symptoms include:

- Feeling hopeless

- Lacking energy or being tired all the time

- Trouble concentrating

- Poor performance or poor attendance at school

- Low self-esteem or saying negative things about themselves

- Eating too little or too much

- Gaining or losing a lot of weight

- Trouble sleeping

- Thinking about or attempting suicide

Some children with depression no longer look forward to things they used to enjoy, but they can enjoy them in the moment. This is unusual and is known as atypical depression. It can trick parents, making them think their child doesn’t want to cooperate when they are actually depressed.

Persistent Depressive Disorder (Dysthymia)

This is a form of depression in which someone experiences the same symptoms as major depressive disorder, but in a milder form. And instead of occurring in episodes of several weeks or months, the symptoms last for a year or more. In persistent depressive disorder, the symptoms may get more or less severe at different times, but they don’t go away for more than two months at a time.

Since the symptoms of persistent depressive disorder can last for years, it can appear that a downbeat mood, low self-esteem or irritability is just a part of a child or teenager’s personality. But treatment can make a big difference.

Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a relatively new diagnosis that is given to children who have frequent, explosive temper tantrums in reaction to things that don’t seem like a big deal. In between tantrums they are irritable most of the time. They have a short fuse, and low frustration tolerance. The DMDD diagnosis recognizes that for young children, depression can look more like anger than sadness.

Symptoms of DMDD usually show up before age 10. It is not diagnosed before age six because temper tantrums are normal for young kids. To be diagnosed with DMDD a child must have major temper tantrums three or more times a week on average. This behavior has to show up when the child is with family, friends and teachers— if it’s only in one situation it’s probably not DMDD.

Unlike kids with oppositional defiant disorder (ODD) these kids aren’t focused on defying authority. They act out because they experience feelings more powerfully than other kids, and they lack self-regulation skills. 

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder is a condition that affects some women and girls in the week before their period, when hormones spike. Symptoms are similar to PMS but so severe that they have a serious impact on daily life. While PMS may be troubling, a girl with PMDD is likely to experience feelings closer to a major depressive episode.

Girls with PMDD might feel depressed, anxious or angry. They may cry for little or no reason. They may also have trouble concentrating and staying on task. They may feel overwhelmed, and worried that everyone is mad or unhappy with them. Physical symptoms like cramps, headaches, body aches and tender breasts are common.

Symptoms typically start 5–8 days before their period but can begin earlier, and they go away once the period begins. Onset of PMDD can be any time after puberty.

#James Donaldson notes:
Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.
Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.
Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticle
Find out more about the work I do on my 501c3 non-profit foundation
website www.yourgiftoflife.org Order your copy of James Donaldson's latest book,
#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Seasonal Affective Disorder (SAD)

Seasonal affective disorder (SAD) is a type of depression that comes and goes with changes of seasons. It has all the same symptoms as major depressive disorder, but it only happens during specific months of the year. The technical name for it is “major depressive disorder with seasonal pattern.”

Most people who experience seasonal affective disorder get depressed in the fall and winter — possibly because getting less sunlight in the winter affects brain chemicals that impact mood and energy levels. But for some people, depressive episodes are triggered by summer.

To be considered signs of SAD, the symptoms can’t be related to something that happens during the time period when they appear, such as events at home or school during the winter.

Treatment for depression

Treatment can be very effective for children and teenagers struggling with depression. It includes both medication and several different kinds of therapy.

Many clinicians recommend that if a child is takingantidepressant medication they should also be participating in therapy. Medication can reduce symptoms of depression, but therapy teaches kids skills to manage their moods and cope in a healthy way with uncomfortable feelings.

Frequently Asked Questions

What are the different types of depression?

There are several different types of depression including major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder (DMDD), premenstrual dysphoric disorder, and seasonal affective disorder (SAD).

What is Major Depressive Disorder?

What is Persistent Depressive Disorder (Dysthymia)?

What is Disruptive Mood Dysregulation Disorder (DMDD)?

What is Premenstrual Dysphoric Disorder (PMDD)?

What is Seasonal Affective Disorder (SAD)?

What is the treatment for child and adolescent depression? https://standingabovethecrowd.com/james-donaldson-on-mental-health-what-are-the-kinds-of-depression/

SINGAPORE - Suicide is a subject which is often avoided – but that could be the last thing that someone who is expressing suicidal thoughts needs.

“When someone says, ‘I’m going to kill myself’, the usual response would be: ‘You shouldn’t say that’ and it shuts them down,” said Rui (not his real name), who is in his 30s and has struggled with suicidal thoughts.

Helplines

Mental well-being

- National helpline: 1771 (24 hours) / 6669-1771 (via WhatsApp)

- Samaritans of Singapore: 1-767 (24 hours) / 9151-1767 (24 hours CareText via WhatsApp)

- Singapore Association for Mental Health: 1800-283-7019

- Silver Ribbon Singapore: 6386-1928

- Chat, Centre of Excellence for Youth Mental Health: 6493-6500/1

- Women’s Helpline (Aware): 1800-777-5555 (weekdays, 10am to 6pm)

- The Seniors Helpline: 1800-555-5555 (weekdays, 9am to 5pm)

Counselling

- Touchline (Counselling): 1800-377-2252

- Touch Care Line (for caregivers): 6804-6555

- Counselling and Care Centre: 6536-6366

- We Care Community Services: 3165-8017

- Shan You Counselling Centre: 6741-9293

- Clarity Singapore: 6757-7990

Online resources

- mindline.sg/fsmh

- eC2.sg

- tinklefriend.sg

- chat.mentalhealth.sg

- carey.carecorner.org.sg (for those aged 13 to 25)

- limitless.sg/talk (for those aged 12 to 25)

- shanyou.org.sg

Rui, who attends meetings with the Light in the Dark support group launched by Samaritans of Singapore, said he wishes people understood that suicidal thoughts are a painful, overwhelming reality for many, and not attempts at seeking attention.

“People who say ‘I’m going to end it’ are asking for help in the only way they can,” he said.

Experts say the key is to treat ideation as a signal that support is needed.

People often think that asking loved ones in distress if they are suicidal might plant the idea in their heads, when the truth is that it might actually protect them, say experts. 

There are many misconceptions around suicide, including that suicidal thoughts affect only individuals who have mental illnesses.

However, they can also occur in people who have not been formally diagnosed with a mental health condition, or, at least, are not known to have had a mental illness before their deaths, said Associate Professor Mythily Subramaniam, assistant chairwoman of the Institute of Mental Health’s (IMH) medical board for research.

“In these cases, the trigger may be a major life event like humiliation, loss, failure or conflict, combined with poor coping resources, social isolation or a sense of being utterly overwhelmed,” she said.

The risks may be even greater for adolescents.

A February study by KK Women’s and Children’s Hospital (KKH) found that young patients who had tried to hurt themselves typically did not have serious mental health disorders, but instead had psychosocial problems and emotional regulation difficulties.

The study looked into the psychosocial stressors and risk profiles of adolescents who visited KKH’s emergency department for suicidal or self-harm attempts from January to December 2021. The authors reviewed 221 medical records of patients aged 10 to 19.

The most frequently observed mental health challenges were stress-related and emotional coping difficulties, which were present in 50.7 per cent of patients, and mood and anxiety symptoms, present in 53.4 per cent of patients.

Left unassisted, their mental health distress can rapidly escalate and manifest in behaviour that is a risk to themselves, the authors of the study said.

Awareness and prevention a whole-of-society effort

Bringing the topic of suicide into the open has become paramount, as it remains the leading cause of death among young people aged 10 to 29 for the sixth consecutive year. 

It is one of the most urgent public health challenges for Singapore, said Prof Mythily.

The issue requires a whole-of-nation approach, with a lead agency to coordinate proven prevention efforts, training for the community to recognise warning signs, and continued research funding to find better ways of preventing it, she said.

Both Prof Mythily and Professor Chong Siow Ann, a senior consultant at IMH’s Research Division and Department of Psychosis, said that those who come into contact most often with youth, such as teachers, national service (NS) officers, human resources staff and community volunteers, should be better trained to recognize the warning signs if someone is at risk.

Schools, NS units and workplaces should also provide stronger support to those affected by a suicide to reduce risk and promote healing.

Prof Mythily and Prof Chong recently concluded a study where suicide survivors were interviewed.

They said mental health hotlines such as the Samaritans’ hotline 1767 and the national mindline 1771 should have youth-friendly chat and text options, as these are young people’s preferred communication channels. Currently, the two hotlines offer a text option only through WhatsApp.

National efforts must also address stigma, so that young people feel they can seek help without fear, the healthcare professionals added.

Ms Chan May Peng, lead counsellor and senior manager at the Samaritans, said suicide ideation is more common than many realise.

It can stem from stressors and traumatic experiences at different stages of life such as childhood trauma or abuse, relationship breakdowns, employment or financial struggles, or living with a chronic illness.

Those who are vulnerable could also be suffering from social isolation and loneliness, mental health conditions, a lack of support systems, and cultural or societal stigma that discourages them from seeking help.

There could be broader influences, such as neurological or genetic vulnerabilities, or social media, in the form of cyber bullying, online harassment or platforms that may unintentionally normalise or romanticise suicide, Ms Chan said.

“The more people are aware of and willing to talk about suicide, the wider the community safety net becomes, so that no one falls through the cracks,” she said.

In Singapore, there were 434 suicide deaths in 2023, and 476 in 2022.

In 2024, the provisional number of suicide deaths was 314, but the final number will likely be higher after investigations into cases are concluded.

For instance, the provisional number of suicide deaths in 2023 was 322, a figure that was then widely reported as the lowest in two decades. However, the final figure turned out to be 35 per cent higher, at 434.

Project Hayat, the group behind Singapore’s first suicide prevention White Paper in 2024, has launched a study to better gauge the true number of suicides as a better guide for policies.

Critically, these numbers tell just part of the story.

According to the World Health Organisation, more than 720,000 people die by suicide every year, and for each suicide, there are an estimated 20 suicide attempts.

Project Hayat has called for a coordinated approach to suicide prevention, with a central body to spearhead efforts.

Spotting the warning signs

IMH, which conducted face-to-face interviews with suicide survivors for a recently concluded study, said in a Sept 17 press release that key risk factors include previous suicide attempts, having a mental health condition, ongoing physical health challenges such as greater functional limitations and insomnia, and relationship breakdowns.

Prof Mythily, the study’s principal investigator, said a significantly higher number of acute warning signs tends to appear in the week before death. These include substance abuse, a sense of purposelessness, heightened anxiety and social withdrawal.

Other signs could include changes in sleep patterns – either sleeping too much or too little – and saying things like “You’d be better off without me”, said Ms Charlene Heng, deputy director of SOS Academy, the training wing of the Samaritans.

Prof Chong, the co-investigator of the IMH study, said: “Look out for someone talking about death, feeling like a burden, or saying they have no future. Notice if they are searching online for ways to harm themselves, withdrawing from friends, school or work, or showing severe insomnia, agitation or reckless behaviour.

“Red flags include extreme agitation, or, paradoxically, a sudden calmness after a period of great distress, which can mean they have made a decision to kill themselves.”

Mr Alex Yeo, executive director of suicide prevention charity Caring for Life, said that one warning sign is the act of posting farewell messages on social media.

These can be very short. For instance, someone might send a message to his friends on social media, expressing gratitude for their support, and ending it with “but I think it’s time for me to rest”.

“How many people actually realise that this is an indirect cry for help and you need to do the right thing to prevent a potential attempt,” Mr Yeo said.

“At the end of the day, when it comes to suicide ideation, it’s really a presenting symptom of a deeper root problem.”

A mother who lost her child

A mother in her 40s, who lost her 12-year-old daughter to suicide in 2024, said the happy-go-lucky and feisty child had shown mostly very general signs of stress, apart from one sign that she found out about only after the girl had died.

After her daughter’s death, the mother sought out her notebooks and a suicide note, and realised her child had developed a highly critical inner voice that was not expressed outwardly.

Her daughter had loved to draw and write stories, but the girl later discredited them, even writing “failed” in a huge font across one of them.

Despite being of average height, the child lamented that she was short, and her lethargy, likely due to depression, fuelled her belief that she was lazy. She did not own any devices, but would secretly sneak the common phone or tablet into her room to read manga or watch anime at night.

She looked tired in the day and would doze off, which was something that did not happen before, said the mother, who started attending counselling sessions by the Samaritans, as well as its support groups, after the organisation reached out to her through its suicide survivors programme.

The mother noted from her daughter’s writings that the child would binge to “take care” of her mental health, but she had thought her child’s good appetite was a sign that she was growing.

A school journal showed that she would draw a lot when she was sad or angry, and she produced her most vivid drawings in the months before her death.

Going through that book after her child’s death, the mother found writings about how she did not seek help for a big challenge because she thought that she could manage on her own, and had doubts that talking to others would help.

And so, the child hid her struggles from her family well.

“The challenge is how we, as parents, can discern between signs of depression and behavioural traits typical of children of her age,” said the mother.

“(For the child), there is a difference between (the) feeling (of) being loved and (the) feeling (of) being unneeded – which surfaced recently in a conversation with a suicide survivor and also my daughter’s suicide note; not sure how to address the latter, but, nonetheless, (awareness of) these aspects can be strengthened,” said the mother.

Conversations must be held; everyone can help 

Caring for Life’s Mr Yeo emphasized that new stresses such as being scammed can lead to suicidal thoughts. He said people under severe stress may no longer be capable of seeking help, and it would be up to those around them – family, friends, colleagues and superiors – to step up.

The people closest to them can help them to re-anchor themselves and find a reason to live, and to seek help to address the deeper issue that had led to the suicide ideation, said Mr Yeo.

Action should be taken the moment suicidal thoughts are disclosed. Even if there is no plan, early intervention in the form of listening with empathy, linking the person to support, and reducing his or her isolation can dramatically lower the risk of an attempt, said Prof Chong.

The Samaritans’ Ms Heng said that, as a society, all of us can learn to spot risks earlier, and create spaces where people feel safe to talk about their struggles without judgment.

“For members of the public, it can be as simple as checking in with your community and network,” she said.

“Struggles are not always obvious, but providing an empathetic listening ear can help your friends and family feel safe about sharing these hidden troubles.”

SOS Academy offers community-based programmes, such as Be A Samaritan, where the public can learn how to support someone in a suicide crisis, Ms Heng said.

Ultimately, the key to reduce stigma around suicide is to have open discussions about it, so it becomes as normal and acceptable as talking about any other health concern, said Prof Mythily and Prof Chong.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

If someone tells me he or she is feeling suicidal, what should I do?

- First, do not react with panic or threaten to call the police. Stay calm and listen without judgment. Acknowledge that he or she has trusted you enough to disclose this. Ask gently if the person has a plan or the means to self-harm.

- If the person has a plan or access to means, or refuses help, stay with him or her and call 995 for an ambulance, or take the person to the nearest emergency department. Call the police on 999 if safety cannot be ensured.

- If there is no immediate danger, link the person to support right away: Call the Samaritans’ hotline on 1767 (24/7), or the national mindline 1771.

- Ask for the person’s consent to involve his or her next of kin, refer the person to professional mental health providers, such as the Samaritans, or encourage the person to see a doctor or counsellor as soon as possible. The Samaritans offer free counselling and have free support groups for anyone who is thinking about, facing or affected by suicide.

- Avoid minimising the person’s pain by saying “I have gone through much worse” or offering quick fixes (“This will pass before you know it”). The most powerful thing you can do is stay present and keep the person safe until professional help is in place.

- When a child or elderly person expresses suicidal thoughts, keep him or her safe, do not leave the person alone, and get urgent professional assessment – through a general practitioner or polyclinic, or directly at IMH or the children’s emergency department. For older adults, involve caregivers and check for treatable contributors such as pain, grief or dementia. https://standingabovethecrowd.com/?p=15878

The sadness and irritability of depression can take several different forms

Writer: Caroline Miller

- Major Depressive Disorder

- Persistent Depressive Disorder (Dysthymia)

- Disruptive Mood Dysregulation Disorder (DMDD)

- Premenstrual Dysphoric Disorder (PMDD)

- Seasonal Affective Disorder (SAD)

- Treatment for depression

Depression is a common mental health condition that causes someone to be in a sad or irritable mood for an unusually long period of time. It’s normal for children to feel down when bad things happen, but a child with depression doesn’t feel better if things change. Children and teenagers who are depressed usually have trouble enjoying things they used to love and have low energy. They might think about or attempt suicide.

Depression usually begins during the teenage years, but younger kids can also be diagnosed. Girls are diagnosed twice as often as boys.

Depression can take a number of different forms. The disorders below are all forms of what experts call “unipolar depression.” The term “unipolar” is used to distinguish them from bipolar depression, which involves a combination of extreme lows and highs — episodes of depression alternating with episodes of mania — and is treated differently from other forms of depression.

Major Depressive Disorder

This is the most familiar kind of depression, in which someone experiences severe symptoms that last between two weeks and several months. An episode of depression may occur only once, but in most cases the depression will return multiple times.

The biggest sign of depression is a change in mood. A depressed child will feel sad or irritable —quick to anger over very small things — most of the time, and lose interest in things they normally enjoy.

Other symptoms include:

- Feeling hopeless

- Lacking energy or being tired all the time

- Trouble concentrating

- Poor performance or poor attendance at school

- Low self-esteem or saying negative things about themselves

- Eating too little or too much

- Gaining or losing a lot of weight

- Trouble sleeping

- Thinking about or attempting suicide

Some children with depression no longer look forward to things they used to enjoy, but they can enjoy them in the moment. This is unusual and is known as atypical depression. It can trick parents, making them think their child doesn’t want to cooperate when they are actually depressed.

Persistent Depressive Disorder (Dysthymia)

This is a form of depression in which someone experiences the same symptoms as major depressive disorder, but in a milder form. And instead of occurring in episodes of several weeks or months, the symptoms last for a year or more. In persistent depressive disorder, the symptoms may get more or less severe at different times, but they don’t go away for more than two months at a time.

Since the symptoms of persistent depressive disorder can last for years, it can appear that a downbeat mood, low self-esteem or irritability is just a part of a child or teenager’s personality. But treatment can make a big difference.

Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a relatively new diagnosis that is given to children who have frequent, explosive temper tantrums in reaction to things that don’t seem like a big deal. In between tantrums they are irritable most of the time. They have a short fuse, and low frustration tolerance. The DMDD diagnosis recognizes that for young children, depression can look more like anger than sadness.

Symptoms of DMDD usually show up before age 10. It is not diagnosed before age six because temper tantrums are normal for young kids. To be diagnosed with DMDD a child must have major temper tantrums three or more times a week on average. This behavior has to show up when the child is with family, friends and teachers— if it’s only in one situation it’s probably not DMDD.

Unlike kids with oppositional defiant disorder (ODD) these kids aren’t focused on defying authority. They act out because they experience feelings more powerfully than other kids, and they lack self-regulation skills. 

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder is a condition that affects some women and girls in the week before their period, when hormones spike. Symptoms are similar to PMS but so severe that they have a serious impact on daily life. While PMS may be troubling, a girl with PMDD is likely to experience feelings closer to a major depressive episode.

Girls with PMDD might feel depressed, anxious or angry. They may cry for little or no reason. They may also have trouble concentrating and staying on task. They may feel overwhelmed, and worried that everyone is mad or unhappy with them. Physical symptoms like cramps, headaches, body aches and tender breasts are common.

Symptoms typically start 5–8 days before their period but can begin earlier, and they go away once the period begins. Onset of PMDD can be any time after puberty.

#James Donaldson notes:Welcome to the “next chapter” of my life… being a voice and an advocate for #mentalhealthawarenessandsuicideprevention, especially pertaining to our younger generation of students and student-athletes.Getting men to speak up and reach out for help and assistance is one of my passions. Us men need to not suffer in silence or drown our sorrows in alcohol, hang out at bars and strip joints, or get involved with drug use.Having gone through a recent bout of #depression and #suicidalthoughts myself, I realize now, that I can make a huge difference in the lives of so many by sharing my story, and by sharing various resources I come across as I work in this space.  #http://bit.ly/JamesMentalHealthArticleFind out more about the work I do on my 501c3 non-profit foundationwebsite www.yourgiftoflife.org Order your copy of James Donaldson's latest book,#CelebratingYourGiftofLife: From The Verge of Suicide to a Life of Purpose and Joy

Click Here For More Information About James Donaldson

Seasonal Affective Disorder (SAD)

Seasonal affective disorder (SAD) is a type of depression that comes and goes with changes of seasons. It has all the same symptoms as major depressive disorder, but it only happens during specific months of the year. The technical name for it is “major depressive disorder with seasonal pattern.”

Most people who experience seasonal affective disorder get depressed in the fall and winter — possibly because getting less sunlight in the winter affects brain chemicals that impact mood and energy levels. But for some people, depressive episodes are triggered by summer.

To be considered signs of SAD, the symptoms can’t be related to something that happens during the time period when they appear, such as events at home or school during the winter.

Treatment for depression

Treatment can be very effective for children and teenagers struggling with depression. It includes both medication and several different kinds of therapy.

Many clinicians recommend that if a child is takingantidepressant medication they should also be participating in therapy. Medication can reduce symptoms of depression, but therapy teaches kids skills to manage their moods and cope in a healthy way with uncomfortable feelings.

Frequently Asked Questions

What are the different types of depression?

There are several different types of depression including major depressive disorder, persistent depressive disorder, disruptive mood dysregulation disorder (DMDD), premenstrual dysphoric disorder, and seasonal affective disorder (SAD).

What is Major Depressive Disorder?

What is Persistent Depressive Disorder (Dysthymia)?

What is Disruptive Mood Dysregulation Disorder (DMDD)?

What is Premenstrual Dysphoric Disorder (PMDD)?

What is Seasonal Affective Disorder (SAD)?

What is the treatment for child and adolescent depression? https://standingabovethecrowd.com/?p=15883