Depression and bipolar disorder

Depression is not sadness with the volume turned up. It is a change in how a person functions, and for a significant number of people it is episodic rather than permanent.

What it is

Major depressive disorder involves a sustained low mood or loss of interest, lasting at least two weeks, together with changes in sleep, appetite, energy, concentration and self-worth. It is diagnosed by pattern and duration, not by how understandable the circumstances are.

Bipolar disorder involves episodes of depression alternating with episodes of elevated mood, energy and activity. It is distinct from depression, it responds to different medication, and treating it as depression alone can make it worse. This is one of the reasons an assessment matters more than a self-diagnosis.

How it shows up

• Withdrawal from people and activities that used to matter.
• Sleep that has changed direction, either much less or much more.
• Slowed thinking, difficulty deciding, difficulty starting.
• Irritability, which is often how depression presents in men and in adolescents.
• Physical complaints with no clear cause: fatigue, pain, digestive problems.
• In elevated episodes: reduced need for sleep, rapid speech, expansive plans, spending or risk-taking that is out of character.

Getting help in Singapore

A GP or polyclinic can assess, treat, and refer. A polyclinic or CHAS clinic referral is what opens subsidised access to public specialist care. National mindline 1771 is available 24 hours for anyone who wants to talk through what is happening before deciding what to do.

Treatment usually combines psychological therapy and medication, adjusted over time. Antidepressants take weeks to work and the first weeks can be the hardest, which is when people most often stop taking them.

What it costs

What help costs

Start with what is free, because a good deal of it is.

• National mindline 1771, 24 hours. Phone 1771, WhatsApp 6669 1771, or webchat at mindline.sg. No cost, no referral.
• Samaritans of Singapore on 1767, and CareText on WhatsApp 9151 1767. Also 24 hours, also free.
• Community Outreach Teams (CREST) are the general first stop. Community Intervention Teams (COMIT) go further, with counselling, case management and psychosocial support from qualified mental health professionals. Both are government funded and free to you. The wayfinding tool at aic.sg will match you to a team near where you live.
• Family Service Centres take walk-ins and there are 49 of them across the island. They handle counselling and money trouble in the same conversation, which is often exactly what is needed.

None of these asks you for a diagnosis, a referral or a card.

Subsidised treatment

Four mental health conditions are on the Chronic Disease Management Programme: anxiety, major depression, bipolar disorder and schizophrenia. Being on that list is what lets you claim CHAS subsidies at a GP and use MediSave for outpatient treatment. Dementia is on the programme too, handled as an ordinary chronic condition rather than under the mental illness heading.

At a public specialist outpatient clinic, including the Institute of Mental Health, subsidies run from 30 to 70 per cent for citizens depending on household income per person, and a flat 25 per cent for permanent residents. The referral is what unlocks that rate. Get one from a polyclinic, or from a CHAS clinic if you hold a CHAS card. Turn up without one and you pay private rates.

MediSave

You can use MediSave for outpatient treatment of those four conditions. The limit is $500 a year, or $700 if your case is complex. Both rise, to $700 and $1,000, in January 2027. Until then the lower figures are what you have to work with.

A 15 per cent co-payment normally applies. It is waived if you use MediSave at the clinic you enrolled with under Healthier SG. Ask your clinic whether that is you.

If someone is admitted

MediShield Life pays $230 a day for psychiatric inpatient care, for up to 60 days a policy year. For a standard ward stay that is not psychiatric it pays $830 a day. That difference is built into the scheme, and it matters if a long admission is a possibility.

What people actually pay

Once subsidies are applied, most people being treated for these conditions pay somewhere between $300 and $500 a year, depending on how complex the treatment is.

If money is the thing standing between you and treatment, say so at the clinic rather than quietly stopping. Medical social workers at the public hospitals assess for further help, and Family Service Centres and Social Service Offices deal with the financial side alongside everything else.

If you are the caregiver

Depression is exhausting to live alongside, and the exhaustion is not a sign that you are doing it badly. The most useful things are unglamorous: keeping a routine going, staying present without demanding conversation, handling one practical task, and holding the appointment date in your head when the person cannot.

Do not carry this alone. Caregiver courses and support groups are listed on the caregiver support hub.

When it is urgent

Depression carries a risk of suicide. If someone has told you they intend to end their life, do not leave them alone, remove immediate means of harm where you safely can, and call 995. Samaritans of Singapore is on 1767, 24 hours. National mindline is on 1771.