4. Some women experience mood swings, for instance, during certain times of their menstrual cycle. When are "mood swings" not considered normal, and may warrant medical attention?
Many women may notice that they have dysphoric or irritable mood before and during their period, These mood changes are often described as mood swings. These mood swings are generally unrelated to Bipolar Disorder as there is no swing into a manic state. However, if the individual experiences irritability, tension or low mood severe enough to interfere with work, social relationships and activities, they may be suffering from Premenstrual Dysphoric Disorder (PMDD).
5. A local 2010 Singapore Mental Health Study found that the average time taken for bipolar disorder sufferers to seek help was 9 years. - Why do you think they take so long to seek professional help?
When the symptoms of Bipolar disorder is mild, it can be hard to detect. Most of the time, the afflicted individual may not have insight into their symptoms. In fact, many enjoy their "new found" confidence and inflated self esteem. Family members may think that the individual is just stressed out or being difficult instead of recognising the symptoms as due to Bipolar Disorder. The strong stigma that remains associated with psychological conditions also prevents individuals and there loved ones from seeking help with professionals until the condition becomes severe.
6. Based on your experience working with these patients, what usually prompts patients to seek medical attention for their symptoms?
Many seek help during their depressive phase, when they feel lousy about themselves. and through careful history taking with the patient and their loved ones, a history of previous manic episodes can be obtained. Many patients may be admitted by their loved ones to the hospital when they display unusual behaviours or become aggressive during their manic episodes.
7. How common is it for bipolar disorder to go undetected, or dismissed as something not serious? Why is that so?
Although there are no available data, Bipolar Disorder is one of the most likely diagnosis to go undetected. Unlike many medical condition where lab tests or objective testing is available in making a diagnosis, the diagnosis of Bipolar Disorder can only be based on the history provided by the patient and his loved ones and observations made by the psychiatrist during the consult. In milder case of Bipolar Disorder where the individuals present with issues such as irritability, restlessness, insomnia, and excessive alcohol consumption. For someone who does not know the individual intimately, the mood changes may be assumed to be normal. Even loved ones may sometimes find it hard to decide if the individual's mood is unusually high or he is an exuberant person to begin with. They may see the change as a change in his personality rather than him having a mental illness.
Showing posts with label side effects. Show all posts
Showing posts with label side effects. Show all posts
Thursday, 28 January 2016
Thursday, 21 January 2016
Bipolar Disorder FAQs Part 1
1. At what age does bipolar disorder typically surface, and why?
It typically surfaces during early adulthood, usually in the 20s. This is attributed to the natural history of the illness and the real reason is not known.
2. What are symptoms of bipolar disorder, and how are they different from depression? (I understand that bipolar patients experience periods of low moods too, so how to differentiate between the two?)
Patients with Bipolar suffers from episodes of mania or hypomania and depression. The depressive episodes of Bipolar Disorder are indistinguishable from clinical depression. As such patients who have depressive episodes are first diagnosed with clinical depression and the diagnosis will be revised should an episode of mania or hypomania surface. The symptoms of mania are elevated mood, increased energy, increased self esteem, decreased need for sleep, pressure to keep talking or unusual talkativeness, racing thoughts, distractibility, excessive involvement in harmful activities. The symptoms should last for at least one week. In Hypomania, the symptoms are milder and the duration may be shorter.
3. How quickly can a bipolar patient's mood swing from one extreme to another? What are the triggers for the mood changes?
Most bipolar disorder consists of mood episodes, depressive or manic, that typically last weeks to months if not treated. A typical example will be one month of mania followed by three months of depression and the rest of the year is normal mood. However, there are patients who suffer rapid cycling bipolar disorder who cycle four times of more a year. Whilst some patients are thought to cycle even more frequently than that, ie. days to even within a day, this remains controversial. Stresses in life, like work stress or family conflict, can sometimes trigger an episode. Sometimes a period of poor sleep, due to exams or work commitments can also lead to episodes.
It typically surfaces during early adulthood, usually in the 20s. This is attributed to the natural history of the illness and the real reason is not known.
2. What are symptoms of bipolar disorder, and how are they different from depression? (I understand that bipolar patients experience periods of low moods too, so how to differentiate between the two?)
Patients with Bipolar suffers from episodes of mania or hypomania and depression. The depressive episodes of Bipolar Disorder are indistinguishable from clinical depression. As such patients who have depressive episodes are first diagnosed with clinical depression and the diagnosis will be revised should an episode of mania or hypomania surface. The symptoms of mania are elevated mood, increased energy, increased self esteem, decreased need for sleep, pressure to keep talking or unusual talkativeness, racing thoughts, distractibility, excessive involvement in harmful activities. The symptoms should last for at least one week. In Hypomania, the symptoms are milder and the duration may be shorter.
3. How quickly can a bipolar patient's mood swing from one extreme to another? What are the triggers for the mood changes?
Most bipolar disorder consists of mood episodes, depressive or manic, that typically last weeks to months if not treated. A typical example will be one month of mania followed by three months of depression and the rest of the year is normal mood. However, there are patients who suffer rapid cycling bipolar disorder who cycle four times of more a year. Whilst some patients are thought to cycle even more frequently than that, ie. days to even within a day, this remains controversial. Stresses in life, like work stress or family conflict, can sometimes trigger an episode. Sometimes a period of poor sleep, due to exams or work commitments can also lead to episodes.
Sunday, 13 December 2015
Methylphenidate (Stimulant Medication For ADHD): 4 Points to Note From a Recent Review
A recent systematic review of 185 randomised controlled trials of methylphenidate, "Benefits and harms of methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)", found that:
1) Methylphenidate can improve some of the core symptoms of ADHD – reducing hyperactivity and impulsivity, and helping children to concentrate.
2) Methylphenidate can also help to improve the general behaviour and quality of life of children with ADHD.
3) There is no evidence to suggest that methylphenidate increase the risk of serious (life threatening) harms.
4) Methylphenidate is associated with an increased risk of non-serious harms such as sleeping problems and decreased appetite.
It is important to discuss the potential benefits and risks of starting ADHD treatment for your child with his or her psychiatrist. Whilst this review did not provide any new insights to the treatment of ADHD, it consolidates what we already know in helping children who suffers from ADHD and its related consequences. Future studies will surely shed more light and strategies on ADHD treatment.
Speak to a psychiatrist today should you suspect that your child, or yourself, has ADHD.
1) Methylphenidate can improve some of the core symptoms of ADHD – reducing hyperactivity and impulsivity, and helping children to concentrate.
2) Methylphenidate can also help to improve the general behaviour and quality of life of children with ADHD.
3) There is no evidence to suggest that methylphenidate increase the risk of serious (life threatening) harms.
4) Methylphenidate is associated with an increased risk of non-serious harms such as sleeping problems and decreased appetite.
It is important to discuss the potential benefits and risks of starting ADHD treatment for your child with his or her psychiatrist. Whilst this review did not provide any new insights to the treatment of ADHD, it consolidates what we already know in helping children who suffers from ADHD and its related consequences. Future studies will surely shed more light and strategies on ADHD treatment.
Speak to a psychiatrist today should you suspect that your child, or yourself, has ADHD.
Sunday, 20 October 2013
Side Effects of Antidepressants
Antidepressants do have side effects and if you are prescribed these medications, make sure your doctor discuss them with you. I will discuss the side effects of some of the usual classes of antidepressants used. It is also interesting to note that even sugar pills can cause side effects, read more about it here.
1. Selective Serotonin Reuptake Inhibitors (SSRI)
These include Escitalopram, Setraline and Fluoxetine.
SSRIs are probably the most commonly prescribed class of antidepressants. SSRIs are safe and used in various age groups from children to elderlies. They are not only given in clinical depression (description of clinical depression click here) but also in other disorders such as anxiety disorders and even in anger management.
Common side effects of SSRIs include:
- Tummy discomfort
- Nausea
- Headaches
- Drowsiness
- Anxiety
These side effects are usually transient and are worst in the first 4-5 days. In the long term, some people may experience gaining weight or sexual dysfunction with SSRIs. However these are reversible once the medication is stopped.
2. Selective Serotonin Norepinephrine Reuptake Inhibitor (SNRI)
These include Duloxetine and Venlafaxine.
SNRIs are newer antidepressants. They have the advantage of also working on the norepinephric neurotransmitters in the brain as well. Their side effects profile are similar to SSRIs but they are more likely to cause nausea, dry mouth and excessive perspiration. Venlafaxine may increase blood pressure and your blood pressure should be monitored if you are given this medication by your doctor.
3. Tricyclics Antidepressants (TCAs)
This is an older class of medication and include Amitriptylline and Clomipramine.
They are more likely to cause side effects like:
- somnolence
- drowsiness
- dry mouth
- constipation
- difficulty passing urine
- blurred vision
-weight gain
TCAs can be dangerous in overdose as they can cause heart irregularities. For this reason, they are seldom used these days.
REMEMBER: In any medical treatment, your doctor will consider and discuss with you the benefits and risks of the treatment as well as any alternatives available. Whilst antidepressants can cause side effects, they have been shown irrevocably to save lives and prevent suicide. During the initial phase of treatment, your doctor will monitor you closely for any side effects and to make any necessary adjustments to the dosage or to change the medication altogether.
Studies have also shown that only 40% of patients with side effects will tell their doctors. So if you have side effects with medication bothering you, do let your doctor know so that he can better tailor his treatment for you!
1. Selective Serotonin Reuptake Inhibitors (SSRI)
These include Escitalopram, Setraline and Fluoxetine.
SSRIs are probably the most commonly prescribed class of antidepressants. SSRIs are safe and used in various age groups from children to elderlies. They are not only given in clinical depression (description of clinical depression click here) but also in other disorders such as anxiety disorders and even in anger management.
Common side effects of SSRIs include:
- Tummy discomfort
- Nausea
- Headaches
- Drowsiness
- Anxiety
These side effects are usually transient and are worst in the first 4-5 days. In the long term, some people may experience gaining weight or sexual dysfunction with SSRIs. However these are reversible once the medication is stopped.
2. Selective Serotonin Norepinephrine Reuptake Inhibitor (SNRI)
These include Duloxetine and Venlafaxine.
SNRIs are newer antidepressants. They have the advantage of also working on the norepinephric neurotransmitters in the brain as well. Their side effects profile are similar to SSRIs but they are more likely to cause nausea, dry mouth and excessive perspiration. Venlafaxine may increase blood pressure and your blood pressure should be monitored if you are given this medication by your doctor.
3. Tricyclics Antidepressants (TCAs)
This is an older class of medication and include Amitriptylline and Clomipramine.
They are more likely to cause side effects like:
- somnolence
- drowsiness
- dry mouth
- constipation
- difficulty passing urine
- blurred vision
-weight gain
TCAs can be dangerous in overdose as they can cause heart irregularities. For this reason, they are seldom used these days.
REMEMBER: In any medical treatment, your doctor will consider and discuss with you the benefits and risks of the treatment as well as any alternatives available. Whilst antidepressants can cause side effects, they have been shown irrevocably to save lives and prevent suicide. During the initial phase of treatment, your doctor will monitor you closely for any side effects and to make any necessary adjustments to the dosage or to change the medication altogether.
Studies have also shown that only 40% of patients with side effects will tell their doctors. So if you have side effects with medication bothering you, do let your doctor know so that he can better tailor his treatment for you!
Wednesday, 10 April 2013
The Myths About Antidepressants
Antidepressants are the mainstay of treatment for clinical depression and anxiety disorders. These medications are effective and safe for the general population. However, many remain skeptical about antidepressant treatment and many myths remains.
1. I will become reliant on antidepressants and be addicted.
This is one of the main concern that my patients have when they have to be started on an antidepressant medication. It is important to realise that unlike sleeping pills, it is not possible to be addicted to antidepressants. Antidepressants do not cause tolerance or cravings like street drugs do. The fact that there are no street values with antidepressants attest to the fact that they are not addictive. However, if a patient is on high doses of antidepressants for a long time, it is best for him or her to seek the advice of the psychiatrist and not stop medication abruptly as this can cause "discontinuation syndrome". Discontinuation syndrome can lead to physical discomfort and can be completely avoided by weaning off the medication slowly in a few weeks.
2. My condition will become worse that when it started if I stop the medications.
Your condition will not worsen or rebound simply because you stop your medication. Antidepressants treats your depression or anxiety and also protects you from future episodes. If you stop the medication, it is like you taking off your armour. You will be vulnerable to depression or anxiety again.
3. Antidepressants have terrible side effects.
Newer classes of antidepressants like SSRIs are currently the mainstay of treatment. Unlike older antidepressants, these newer medications are well tolerated. At times, side effects can still occur to the minority of people. Known side effects include weight gain, sedation and rarely sexual dysfunction. These side effects are reversible and if any these side effects arises, you must inform your doctor who will switch you to another medication.
4. My brain will be affected by the medications!
Sometimes patients worry that they will be "changed" by the medications and their brain will become different. Antidepressants normalises the neurotransmitters in your brain and this in turn makes your mood normal again. Antidepressants are not "happy"pills. They help by making you cope better so that you can solve the problems you have in life and it is up to you to find new meaning and happiness.
5. I'll have to take medications forever!
Many patients are afraid that once they are on medications, they cannot come off it. Majority of patients will become better once they have been treated and will come off medications. Some patients who have multiple episodes of mood or anxiety problems and may decide to stay on the medications long term. Your doctor will discuss with you the pros and cons of taking medications and how long you will require them. Ultimately, you have the choice of whether to take medications and the choice to stop them.
1. I will become reliant on antidepressants and be addicted.
This is one of the main concern that my patients have when they have to be started on an antidepressant medication. It is important to realise that unlike sleeping pills, it is not possible to be addicted to antidepressants. Antidepressants do not cause tolerance or cravings like street drugs do. The fact that there are no street values with antidepressants attest to the fact that they are not addictive. However, if a patient is on high doses of antidepressants for a long time, it is best for him or her to seek the advice of the psychiatrist and not stop medication abruptly as this can cause "discontinuation syndrome". Discontinuation syndrome can lead to physical discomfort and can be completely avoided by weaning off the medication slowly in a few weeks.
2. My condition will become worse that when it started if I stop the medications.
Your condition will not worsen or rebound simply because you stop your medication. Antidepressants treats your depression or anxiety and also protects you from future episodes. If you stop the medication, it is like you taking off your armour. You will be vulnerable to depression or anxiety again.
3. Antidepressants have terrible side effects.
Newer classes of antidepressants like SSRIs are currently the mainstay of treatment. Unlike older antidepressants, these newer medications are well tolerated. At times, side effects can still occur to the minority of people. Known side effects include weight gain, sedation and rarely sexual dysfunction. These side effects are reversible and if any these side effects arises, you must inform your doctor who will switch you to another medication.
4. My brain will be affected by the medications!
Sometimes patients worry that they will be "changed" by the medications and their brain will become different. Antidepressants normalises the neurotransmitters in your brain and this in turn makes your mood normal again. Antidepressants are not "happy"pills. They help by making you cope better so that you can solve the problems you have in life and it is up to you to find new meaning and happiness.
5. I'll have to take medications forever!
Many patients are afraid that once they are on medications, they cannot come off it. Majority of patients will become better once they have been treated and will come off medications. Some patients who have multiple episodes of mood or anxiety problems and may decide to stay on the medications long term. Your doctor will discuss with you the pros and cons of taking medications and how long you will require them. Ultimately, you have the choice of whether to take medications and the choice to stop them.
Tuesday, 27 November 2012
Warning about side effects can increase their occurrence: an experimental model using placebo treatment for sleep difficulty
This paper by Australian researchers showed that when a patient is warned about the side effects of a medication, he is more likely to experience the side effects due to the placebo effect.
In this study, the subjects were give placebo (sugar pills) and told that this was medication for their insomnia. They were also told verbally and in writing of the possible side effects. Unsurprisingly, the subjects given the supposed medication had improvements in their sleep due to the placebo effect. However, surprisingly, 41% of the subjects also experienced the side effects that they were told!
Therefore, when patients experience side effects of medication, it may not be the medication that caused the side effect but the warning itself.
Talking about side effects of treatment has always been a dilemma. It has long been known from studies as well as personal experiences that warning patients of the side effects often lead to patients experiencing the side effects. Yet, as doctors, we have a responsibility and obligation to educate patients as best as we can and to facilitate informed consent.
In this study, the subjects were give placebo (sugar pills) and told that this was medication for their insomnia. They were also told verbally and in writing of the possible side effects. Unsurprisingly, the subjects given the supposed medication had improvements in their sleep due to the placebo effect. However, surprisingly, 41% of the subjects also experienced the side effects that they were told!
Therefore, when patients experience side effects of medication, it may not be the medication that caused the side effect but the warning itself.
Talking about side effects of treatment has always been a dilemma. It has long been known from studies as well as personal experiences that warning patients of the side effects often lead to patients experiencing the side effects. Yet, as doctors, we have a responsibility and obligation to educate patients as best as we can and to facilitate informed consent.
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