Six Tips for Managing Bipolar Illness

#1: Get involved in your treatment Be a full and active participant in your own treatment. Learn everything you can about bipolar disorder. Become an expert on the illness. Study up on the symptoms, so you can recognize them in yourself, and research all your available treatment options. The more informed you are, the better prepared you’ll be to deal with symptoms and make good choices for yourself. Using what you’ve learned about bipolar disorder, collaborate with your doctor or therapist in the treatment planning process. Don’t be afraid to voice your opinions or questions. The most beneficial relationships between patient and healthcare provider work as a partnership. You may find it helpful to draw up a treatment contract outlining the goals you and your provider have agreed upon.

Other tips for successful bipolar disorder treatment:

  • Be patient. Don’t expect an immediate and total cure. Have patience with the treatment process. It can take time to find the right program that works for you.
  • Communicate with your treatment provider. Keep the lines of communication open with your doctor or therapist. Your treatment program will change over time, so keep in close contact with your provider. Talk to your provider if your condition or needs change and be honest about your symptoms and any medication side effects.
  • Take your medication as instructed. If you’re taking medication, follow all instructions and take it faithfully. Don’t skip or change your dose without first talking with your doctor.
  • Get therapy. While medication may be able to manage some of the symptoms of bipolar disorder, therapy teaches you skills you can use in all areas of your life. Therapy can help you learn how to deal with your disorder, cope with problems, regulate your mood, change the way you think, and improve your relationships.

Tip #2: Monitor your symptoms and moods

In order to stay well, it’s important to be closely attuned to the way you feel. By the time obvious symptoms of mania or depression appear, it is often too late to intercept the mood swing, so keep a close watch for subtle changes in your mood, sleeping patterns, energy level, and thoughts. If you catch the problem early and act swiftly, you may be able to prevent a minor mood change from turning into a full-blown episode of mania or depression.

Know your triggers and early warning signs – and watch for them

It’s important to recognize the warning signs of an oncoming manic or depressive episode. Make a list of early symptoms that preceded your previous mood episodes. Also try to identify the triggers, or outside influences, that have led to mania or depression in the past. Common triggers include:

  • stress
  • financial difficulties
  • arguments with your loved ones problems at school or work
  • seasonal changes
  • lack of sleep

Common Red Flags for Bipolar Disorder Relapse

Warning signs of depression

  • I quit cooking meals.
  • I no longer want to be around people.
  • I crave chocolate.
  • I start having headaches.
  • I don’t care about anybody else.
  • People bother me.
  • I start needing more sleep, including naps during the day.
Warning signs of mania or  hypomania

  • I find myself reading five books at once.
  • I can’t concentrate.
  • I find myself talking faster than usual.
  • I feel irritable.
  • I’m hungry all the time.
  • Friends tell me that I’m crabby.
  • I need to move around because I have more energy than usual.

Source: BHI Clinicians Guidebook: Bipolar Spectrum Disorders Knowing your early warning signs and triggers won’t do you much good if you aren’t keeping close tabs on how you’re feeling. By checking in with yourself through regular mood monitoring, you can be sure that red flags don’t get lost in the shuffle of your busy, daily life. Keeping a mood chart is one way to monitor your symptoms and moods. A mood chart is a daily log of your emotional state and other symptoms you’re having. It can also include information such as how many hours of sleep you’re getting, your weight, medications you’re taking, and any alcohol or drug use. You can use your mood chart to spot patterns and indicators of trouble ahead.

Develop a wellness toolbox

If you spot any warning signs of mania or depression, it’s important to act swiftly. In such times, it’s helpful to have a wellness toolbox to draw from. A wellness toolbox consists of coping skills and activities you can do to maintain a stable mood or to get better when you’re feeling “off.” The coping techniques that work best will be unique to your situation, symptoms, and preferences. It takes experimentation and time to find a winning strategy. However, many of my clients with bipolar disorder have found the following tools to be helpful in reducing symptoms and maintaining wellness. If we have not discussed some of these tools, ask me about them in your next session.

  • Mood monitoring for early identification
  • The RRRR formula
  • Self talk
  • Sound/thought mindfulness
  • Breathing spaces mindfulness
    • Making G/O – G/G shifts
    • Talking to a supportive person
    • Getting a full eight hours of sleep
    • Eliminating or reducing stressors
    • Cutting back on activities
    • Take your meds as prescribed or talk with you MD about adjusting
    • Attend medical appointments and counseling sessions regularly
    • Do something fun or creative
    • Take time for yourself to relax and unwind

If the following are G/G:

  • Write in your journal
  • Exercise
  • Ask for extra help from loved ones
  • Cut back on or eliminate sugar, alcohol, and caffeine
  • Increase your exposure to light – go outdoors
  • Increase or decrease the stimulation in your environment

Create an emergency action plan

Despite your best efforts, there may be times when you experience a relapse into full-blown mania or severe depression. In crisis situations where your safety is at stake, your loved ones, doctor or counselor may have to take charge of your care. Such times can leave you feeling helpless and out of control, but having a crisis plan in place allows you to maintain some degree of responsibility for your own treatment. A plan of action typically includes:

  • A list of emergency contacts (your doctor, therapist, close family members)
  • A list of all medications you are taking, including dosage information
  • Information about any other health problems you have
  • Symptoms that indicate you need others to take responsibility for your care
  • Treatment preferences (who you want to care for you; what treatments and medications do and do not work, who is authorized to make decisions on your behalf)

Tip #3: Reach out to other people

Having a strong support system is vital to staying happy and healthy. Creating a supportive environment includes not just who you surround yourself with, but who you choose to avoid. Loved ones in your life can be an instrumental support throughout your treatment and recovery process. (Request a copy of material for them to read about how they can help.) But in order to take care of yourself, it’s necessary to limit your contact with people who drain your emotional energy or leave you feeling discouraged, ashamed, or guilty. Instead, spend time with people who truly value you and make you feel better.

  • Turn to friends and family – Support for bipolar disorder starts at home. It’s important to have people you can count on to help you through rough times. Isolation and loneliness can cause depression, so regular contact with supportive friends and family members is therapeutic in itself.
  • Join a bipolar disorder support group – Spending time with people who know what you’re going through and can honestly say they’ve “been there” can be very therapeutic. You can also benefit from the shared experiences and advice of the group members. If you would be interested in such group, please let me know.
  • Build new relationships – Isolation and loneliness make bipolar disorder worse. If you don’t have a support network you can count on, take steps to develop new relationships. Try taking a class, joining a church or a civic group, volunteering or attending events in your community.

      10 tips for reaching out and building relationships

  1. Talk to one person about your feelings.
  2. Help someone else by volunteering.
  3. Have lunch or coffee with a friend.
  4. Ask a loved one to check in with you regularly.
  5. Accompany someone to the movies, a concert, or a small get-together.
  6. Call or email an old friend.
  7. Go for a walk with a workout buddy.
  8. Schedule a weekly dinner date
  9. Meet new people by taking a class or joining a club.

10.Confide in a counselor, therapist, or clergy member.

#4: Develop a daily routine

Your lifestyle choices, including your sleeping, eating, and exercise patterns, have a significant impact on your moods. There are many things you can do in your daily life to get your symptoms under control and to keep depression and mania at bay.

  • Build structure into your life. Developing and sticking to a daily schedule can help stabilize the mood swings of bipolar disorder. Include set times for sleeping, eating, socializing, exercising, working, and relaxing. Try to maintain a regular pattern of activity, even through emotional ups and downs.
  • Exercise regularly. Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes you experience. Aerobic exercise is especially effective at treating depression. Try to incorporate at least 30 minutes of activity five times a week into your routine. Walking is a good choice for people of all fitness levels.
  • Keep a strict sleep schedule. Getting too little sleep can trigger mania, so it’s important to get plenty of rest. For some people, losing even a few hours can cause problems. However, too much sleep can also worsen your mood. The best advice is to maintain a normal sleep schedule, going to bed and waking up at around the same time each day.Healthy sleep habits for managing bipolar disorder
    • Go to bed and wake up at the same time each day.
    • Unless you have a physical illness that limits your energy throughout the day, avoid or minimize napping, especially if it interferes with your sleep at night.
    • Avoid exercising or doing other stimulating activities late in the day.
    • No caffeine after lunch or alcohol at night. Both interfere with sleep.

Tip #5: Keep stress to a minimum

Stress can trigger episodes of mania and depression in people with bipolar disorder, so keeping it under control is extremely important. Know your limits, both at home and at work or school. Don’t take on more than you can handle and take time to yourself if you’re feeling overwhelmed.

  • Learn how to relax. Relaxation techniques such as deep breathing, meditation, yoga, and guided imagery can be very effective at reducing stress and keeping you on an even keel. Studies show that a daily relaxation practice of 30 minutes or more can improve your mood and keep depression at bay.  Ask me about Mindfulness training. It has been shown to be most effective in helping to manage stress.
  • Make leisure time a priority. Play is an emotional and mental health necessity. So do G/G things for no other reason than that it feels good to do them. For example if it would be enjoyable, i.e. go to a funny movie, take a walk on the beach, listen to music, read a good book, or talk to a friend. Doing things just because they are fun is no indulgence. It’s s necessity, especially when there are many things you need to do.
  • Appeal to your senses. Stay calm and energized by appealing to the five senses: sight, sound, touch, smell, and taste. Listen to music that lifts your mood, place flowers where you will see and smell them, massage your hands and feet, or sip a warm drink.

Tips #6: Watch what you put in your body

From the food you eat to the vitamins and drugs you take, the substances you put in your body have an impact on the symptoms of bipolar disorder – both for better or worse.

  • Eat a healthy diet. There is an undeniable link between food and mood. For optimal mood, eat plenty of fresh fruits, vegetables, and whole grains and limit your fat and sugar intake. Space your meals out through the day, so your blood sugar never dips too low. High-carbohydrate diets can cause mood crashes, so they should also be avoided. Other mood-busting foods include chocolate, caffeine, and processed foods.
  • Get your omega-3s. Omega-3 fatty acids may decrease mood swings in bipolar disorder. Omega-3 is available as a nutritional supplement. You can also increase your intake of omega-3 by eating cold-water fish such as salmon, halibut, and sardines, soybeans, flaxseeds, canola oil, pumpkin seeds, and walnuts.
  • Avoid alcohol and drugs. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression. Even moderate social drinking can upset your emotional balance. Substance use also interferes with sleep and may cause dangerous interactions with your medications. Attempts to self-medicate or numb your symptoms with drugs and alcohol only create more problems.
  • Be cautious when taking any medication. Certain prescription and over-the-counter medications can be problematic for people with bipolar disorder. Be especially careful with antidepressant drugs, which can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.

If you would like more information or assistance in dealing with bipolar, please contact me.