Medications

For the treatment of my bipolar disorder (manic-depressive illness), currently, I am taking 2 medications ie. mood stabiliser (lamotrigine 100mg, brand name Lamictal) and anti-psychotic (quetiapine 25mg, brand name Seroquel) to be taken every night. Whenever I am down with severe depression, I will need to take an anti-depressant ie. 20mg Fluoxetine (or common brand name Prozac) for 7 to 10 days. The anti-depressant does not cure me but it lifts me up to a more functional level. Then I am able to make use of other helps such as reading the Bible, pray, regular exercise, reduce stress, recreation or breaks (see my coping strategies).

My Doctor said I will probably need to be on Lamictal for lifelong as it will help to stabilise my mood on the long term basis. As bipolar disorder or manic-depressive illness is a chronic and lifelong condition, mood-stabiliser is crucial in the management of it. Lamictal is less toxic than Lithium salts and it is another option available that helps in treating bipolar. My Doctor said I probably will need Seroquel too as Seroquel will help to prevent relapses of depression. Seroquel is an anti-psychotic and it works by changing the actions of chemicals in the brain. Seroquel is used to treat the symptoms of psychotic conditions such as schizophrenia and bipolar disorder.

But medications alone is not enough. Medications can only help if used together with other management techniques or helps which I am learning use to manage my condition. I am learning to recognize what can trigger off my episodes and look out for early symptoms so that I can either prevent or shorten the episodes. I discovered that stress and strain over a period of time will bring about a relapse severe depression. Hypomania behaviours will worsen if I have little sleep or rest, or take on more and more projects. After months of hypomania, depression will follow. It is like a cycle. I am learning to arrest these cycles earlier or use various helps to shorten them. By God's mercies, I am making small progress which I am thankful for. Thank God for providing various helps.

I have also been taking large dosage of Omega-3 fish oil supplements through the kindness of 2 church friends for the last 9 months or so. Omega-3 fish oil is said by some writers to help with bipolar disorder in the long run when taken on a regular basis.

I hope that one day, by God's enablement, I can manage my condition so well that I can be on lower dosage of medication or without medication eventually. But I know that at this point of time, I still need to continue with the medication in order to be more functional. Although the medication have their side-effects, at least at this moment they helped me to be more functional. Without the help of medication, I will still be in severe depression and will have to wait for the cycles to run their courses before I can function which is usually after 3 to 6 months or sometimes longer. And the frightening truth is that my condition has worsened over the years. My interval of my relapses were closer and my symptoms were more severe and less bearable. My severe depressive episodes have become more suicidal and these suicidal tendency are harder to fight. Thank God for preserving me. I believe that medication and other helps will help me to get better and cope better. So I am learning prayerfully to use other coping helps.

I hope that with the various helps, my down time will be lesser and lesser and I can contribute more to the Lord's works, my family and the society at large. I thank God that there are various helps available now for bipolar and other mental health condition so that we may be able to continue to live in the society and contribute in small ways. In the past, without these helps, people with mental health conditions are confined to institutions and isolated from the society.

I know that ultimately it is God who preserves and restores me. But it is also my responsibility to take care of myself by using the means and helps God has made available to me. There has to be a balance between God's sovereignty and man's responsibilities. So I make use of these means (see my coping strategies) prayerfully, looking to God to use these for my recovery. I pray daily for God's guidance to me to the right helps and learn to manage my condition so that I can be more functional and able to continue to serve our Lord.

I know that our Lord will preserve and strengthen me for as long as He wants me to serve Him here. When my service are done, He shall call me home to be with Him, to enter into my eternal rest and to enjoy communion with Him forever. So meanwhile, I look to Him daily, for grace and strength to run this race that is set before me, looking unto Jesus the Author and Finisher of my faith.

Finding a Good Doctor

I thank God for providing for me a very good lady doctor early in my endeavour to seek medical help, through the recommendations of my former employer who knows this lady doctor. I was treated by Dr Pauline Sim of LP Clinic in Singapore. Some details on her Clinic are given on my "Who to Contact in Singapore" page.

Dr Sim is a very concerned and kind psychiatrist. She always has a smile on her face. She listens attentively to my description of my symptoms and experiences. She reassures me that with the right medications and other helps, my condition will improve and I can lead a close to normal life and be useful to the society. She is always very positive, hopeful and encouraging. I thank God for using Dr Sim to help me.

For some months after I first got better in April 2007, I did attempt to seek medical help from a hospital where I can get subsidized fees for consultation and medications, due to financial constrain. But somehow I find it difficult to really communicate with this male doctor. He is a very nice doctor and genuinely concern for his patients. He is also very humorous and I always found myself laughing at his jokes when I go for my reviews. He always complained that I should have stayed on with Dr Sim as in the hospital they already have too many subsidized patients to handle ! He said this to me on my every visit for review. Hmm.... I honestly do not know whether he is joking with me or he is seriously unhappy about it :-)

I somehow do prefer a lady doctor and due to other reasons, especially a bad relapse in end of 2007, I saw it as providence and of necessity to make a switch back to Dr Sim when the Lord provided for me financially through the kind love gifts of some church friends. Thank God that my condition has improved tremendously under Dr Sim’s care once again. Dr Sim not only monitor my medications and adjust the dosage accordingly, she also taught me how to recognize early symptoms, how to adjust my medication when necessary, how to arrest a relapse or shorten an episode by using other coping strategies. She is equiping me to handle this illness so that I can be more functional.

I realize that it is important to find a good Doctor as well as a Doctor that I can work together with on a long term basis. My Doctor is my partner in treatment and recovery. It is important for me to find a Doctor that I can speak openly with, who will listen to me and emphatize with me, who will offer helpful suggestions and be invested in my recovery. I also appreciate Dr Sim's honesty and firmness with me. When I am better, I am often hypomanic and sometimes I have unrealistic expectations of myself or will try to undertake projects that are beyond my ability or more than I can handle. Thank God that Dr Sim will help to analyse my thoughts and redirect me back to reality! She said she will help "to bring me back to earth" :-)

This condition is not like other medical conditions where a Doctor just need to know the symptoms and then prescribed the standard medications. Bipolar disorder or manic-depressive illness is a life-threatening and chronic illness that affects different individuals in different ways. It is there necessary to find a Doctor who is willing to understand me, my make up and personality, how this illness is shaping or effecting my life and help to work with me on the medications that will help me to function more stably in the long run. A Doctor who is willing to explore with me the possibilities of my relapses or the causes of worsening symptoms and advise me how best to manage my medications and illness. This I have found to be possible with Dr Sim’s help.

I thank God for His kind provisions of love gifts through various friends in my church who gave of their substance anonymously and very generously. It is with this merciful provisions of God through them that enable me to continue treatments with Dr Sim. I thank God for my part-time job assignment recently that enable me to earn some income and continue with my treatments besides meeting my daily needs. Now I am benefitting from a combinations of different coping means. Thank God for His ever provisions.

Medical Help and Medications

Some people are apprehensive of seeking medical help when they suffer from severe or prolonged depression as they did not want to be put on medications due to the side-effects of medications. Some may not want a diagnosis by the Doctor or Psychiatrist.

For a long time, I didn’t want to seek professional or medical helps. Partly because I didn’t know or didn’t think my condition is a medical illness. Partly also because I believe as a Christian I should weather the episodes by looking to God and waiting on Him alone. I often searched my heart and find many past sins which I may have committed unknowingly. I saw my own pride, self-centredness, selfishness, unbelief and other sins. I prayed and asked for God's forgiveness over and over again. But often no amount of soul searching or repentance bring about deliverance. It is often 3 to 6 months later, or sometimes longer, that I began to get better and more functional. Whenever I am better, I will be very cheerful and happy most of the time, more creative, more energetic and more talkative, and more productive in my work and service for the Lord.

It was during a very severe relapse of clinical depression in Dec 2006, through the encouragement of my former employer (who is my good friend) and my 2 colleagues, that I was led to seek medical help as I was extremely suicidal and could not cope with my work and life. Thank God that by His mercies I reacted well towards the medication. After a week of being on an anti-depressant (fluoxetine or common brand name Prozac), I began to feel better. I was more functional and able to continue with my work. I did experience some side-effects of the medications such as dry mouth, constant waking up in the night, etc but I got over them after sometime.

The anti-depressant didn't cure me. It only lifted me up to a more functional level so that I can make use of other helps to get better. I was able once again to read the Bible and pray, and found comfort in God's Words. These I could not experience when I was going through severe depression as my thoughts and feelings are flat, I have difficulties concentrating in reading and I could hardly absorb what I read. Thank God that medication did lift me up to a level that I can benefit from spiritual means.

From thereon, I went for counselling to manage my thoughts and understand what I was going through and what might help. I also go for regular walk and make use of other coping means.

Through this experience, I began to read and do my own research in order to understand depression. In my experiences thus far, it is most important to find a good doctor/physician/psychiatrist.