- Productivity. People with bipolar disorder sleep less as they become manic and have more energy. As a result, they are often more productive than their peers, at least for a while. The lack of sleep and high-energy work can eventually lead to burnout and may contribute to symptoms of psychosis, such as paranoia and hallucinations.
- Confidence. Feeling more self-confident is one of the benefits described by people with bipolar disorder. Unfortunately, as mania increases, this self-confidence can become unrealistic fantasies about power and success, leading to poor life choices and impulsiveness.
- Charm. Along with greater energy and self-confidence, people with bipolar disorder may be more outgoing and charming as their mood improves. This can draw people to them, making them the life of the party (for a while). However, as mania progresses, increasing irritability, impulsiveness, irrational behavior or speech, and risk-taking also can drive people away.
- Euphoria. Intense joy and pleasure in life, including a heightened awareness of details, may also be experienced by bipolar patients as they approach mania. This perception of the world in bright and beloved detail is often what patients cite as the most missed element of bipolar disorder.
- Insight. Many people with bipolar disorder experience a feeling of greater intellectual ability and insight as they approach mania.
The 4 Keys to Managing Bipolar Disorder
Bipolar disorder is a complex and chronic illness. It produces major shifts in mood and energy. It impairs all areas of a person’s life, including work, relationships and daily functioning. Fortunately, however, effective treatment exists, and you can get better. Below, two bipolar disorder experts share the four keys to successfully managing bipolar disorder, along with overcoming common barriers.
With most psychiatric illnesses, medication is optional, and individuals can improve with other treatments, such as psychotherapy, said John Preston, Psy.D, a psychologist and co-author of Loving Someone with Bipolar Disorder and Taking Charge of Bipolar Disorder. However, “Bipolar disorder is probably the main psychiatric disorder where medication is absolutely essential. I’ve had people ask me if there’s any way to do this without medicine. [My answer is] absolutely not.”
Patients typically need to take multiple medications. “On average, people with bipolar disorder take three medicines at the same time,” Preston said. A large study by the National Institute of Mental Health found that 89 percent of people with bipolar disorder who were doing well were taking several medications.
“Don’t be discouraged if it takes a while [to find the right medicine]. Almost everyone who’s successful has to go through the same process.” That’s because in order to find the best treatment for each individual, doctors prescribe various medications and combinations. The goal is to find the right combination with the fewest side effects.
Unfortunately, troublesome side effects are the rule, not the exception, Preston said. In fact, around 50 to 60 percent of patients stop taking their medication or don’t take it as prescribed. This is why having regular and honest communication with your prescribing physician is critical.
But many people feel uncomfortable. They don’t want to “complain,” or assume their physician will be upset with them, Preston said. “I find that clients often don’t think they’re allowed to disagree with their doctors, and often end up going off their meds rather than having candid discussions with their doctors,” said Sheri Van Dijk, MSW, a psychotherapist and author of five books, including The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder.
Remember that you and your doctor are a team. “You have every right in the world to talk about every problem you run into,” Preston said.
The other reason people stop their medication is denial or wishful thinking, he said. It can take months after stopping medication for an episode to occur. This only validates the person’s belief that they don’t have the illness.
But while episodes may not be fast, they tend to be furious. Episodes typically get more and more severe, Preston said.
“Long-term studies that have followed people with bipolar disorder who have stopped taking their medication and have current episodes show progressive damage to parts of their brain.”
According to both experts, cultivating healthy habits is paramount. Sleep deprivation and substance abuse exacerbate bipolar disorder and derail treatment, Preston said. Even patients who receive effective treatment don’t end up getting better if they’re abusing drugs and alcohol, he said.
If you’re struggling with substance abuse, seek professional help. Make sleep a priority. Try to get seven to eight hours of slumber per night, and wake up at the same time each morning. Consult your doctor if you’re traveling between time zones, which boosts the risk for manic episodes.
“Often the success or failure of treatment has to do with how the family is involved,” Preston said. Family can either play a positive part in treatment or unintentionally undermine it. For instance, a family member who finds out their recently diagnosed loved one is taking medication might say, “You don’t need to take medication; you can handle this on your own,” Preston said. Again, not taking medication for bipolar disorder “can spell disaster.”
On the other hand, families can advocate for their loved ones. For instance, a parent might accompany their child to therapy when they’re in the throes of an episode and can’t articulate their concerns or symptoms.
Support groups, whether in person or online, also can be helpful, Van Dijk said. They remind individuals they’re not alone.
“The backbone of treatment is medication. But psychotherapy is enormously important,” Preston said. “While medications help to stabilize mood, they don’t change our thinking patterns, and the way we think affects the way we feel,” Van Dijk said. For instance, learning to change the negative stories swirling in your head may help prevent depressive episodes, she said.
Take the example of a client who was upset because her family pretended to forget her birthday, so they could give her a surprise party. “Instead of focusing on the surprise and the thought that her family had put into the surprise party, she was focused on how ‘cruel’ it was for them to pretend they had forgotten her birthday,” Van Dijk said. She helped this client “take a less negative and more neutral perspective on these kinds of situations.”
Van Dijk also teaches her clients mindfulness or “living in the present moment and practicing acceptance.” This helps clients not only accept their diagnosis but also become more self-aware. “We become more aware of our thoughts, our emotions, and our physical sensations because we’re in the present moment more often, and because we’re working on allowing ourselves to have these experiences, even if they’re painful.”
This self-awareness may prevent symptoms from escalating. By being more mindful, patients can spot an emotion and figure out what to do about it — “if anything” – before letting it careen into a full-blown episode.
According to Preston, “Numerous studies show that family-focused psychotherapy plus medication is really successful.” The goal of family-focused psychotherapy is to help the patient and family fully grasp the gravity of the illness and the importance of ongoing treatment, he said. It also teaches families how to provide support.
Interpersonal and social rhythm therapy also involves the family or significant other. The goal of this therapy, Preston said, is for “families and couples to learn to communicate more effectively and reduce really intense emotional experiences. It also incorporates strategies for lifestyle management.”
A big problem with psychotherapy is that clinicians who specialize in these treatments can be tough to find. Preston recommended checking out the Depression and Bipolar Disorder Support Alliance for facts on finding a professional along with other valuable information.
Accepting that you have bipolar disorder can be difficult. But not following your treatment will create a life filled with “one catastrophe after another,” Preston said. Instead, as both experts stressed, be honest with yourself. And make a strong commitment to taking your medication as prescribed and practicing healthy habits, without abusing drugs or alcohol.
I’m a bit down tonight, and haven’t quite figured out why. Things at home are going well, the kids are healthy, the husband is healthy, and I’m stable. My blog and facebook page are exceeding my wildest dreams for interest and participation from people. And maybe that’s what is tripping me up. I am terrified of failure, it’s why I so rarely step out of my comfort zone and try new things…but I’m petrified of success as well, and if I manage to create a successful blog, then wow!, that would mean I can do things and be successful, and trying to believe that would be a huge paradigm shift for me.
Speaking of people who impact our lives, I think what’s got me down today is one of my best friends lost her daughter earlier this week. I’m just devastated over the pain my friend is going through and the fact that I can’t take it away. And she’s so intricately tied to my advocacy role for mental illness, because this is the friend that pushed and finally convinced me that what I had to say WAS important, and that my story could help somebody, somewhere. She said I had the power in me to not only write a great book, but to become a public speaker for the mentally ill, that I could proudly be a face for bipolar disorder. She inspired me so much that I started going to the NAMI groups, joined the NAMI board in my county, and I started taking classes to become a certified NAMI instructor.
She did so much for me in just that year’s time (we’re both so busy, we only manage to get together a couple times a year), and now when she needs help the most, I cant give it to her. I hate feeling so impotent and weak when there should be *something* I can do. I feel trapped and helpless watching her go through this loss.
If you’ve stuck around to this point and are of a prayerful sort, send out a prayer to my dear friend Tomi, that she may be comforted during this time of trial in her life, and I think you’ll be blessed for it.
I know this is my most rambling post yet, but I had some emotions I needed to sort through, and I want to share what I go through with the world so you too can see what the inner working of a bipolar patient’s mind looks like at times. Hopefully you weren’t bored to tears by this post, and hopefully I’ll be over this writer’s block soon and can start adding interesting posts again soon!
And I’m okay with that.
I hope you are enjoying my ramblings as much as I’m enjoying sharing them. I have been researching how to keep my blog interesting enough that people keep coming back to it, and I discovered that ‘Wow! I’m not the first person to write about being bipolar!’ I came across some other really good blogs that I want to share with you guys, so that way if you’re hungry for more reading, it’s here.
This first one is from bipolar veteran John McManamy, who is the dean of bipolar bloggers. A mental-health journalist who was diagnosed with bipolar disorder in 1999, at the age of 49, McManamy has maintained an encyclopedic website, McMan’s Depression and Bipolar Web, for nearly a decade. He writes about everything from treatment options to research news. He also has his own blog Knowledge Is Necessity, which provides a steady stream of funny and informative writing—and videos!—on mental health.
The second one of note is Amy, a 34-year-old mother of four who lives in Tennessee, who blogs at All About Bipolar under the handle “atorturedsoul”.
The next is Liz Spikol, who is the executive editor of an alternative weekly newspaper in Philadelphia. She also happens to have been diagnosed with bipolar disorder, obsessive-compulsive disorder, and dissociative disorder not otherwise specified. Her addictive blog, The Trouble With Spikol, grew out of an award-winning column of the same name that she writes for the Philadelphia Weekly.
And last, but certainly not least, is the entertaining online diary of a bipolar woman in England, who writes The Secret Life of a Manic Depressive. She is officially diagnosed with rapid-cycling bipolar I disorder and writes about her ups and downs in a lively, no-holds-barred style that will have you clicking the bookmark button for sure.
I know I’m super new on to the scene of things, but I hope to one day be as recognizable as these blogs are because although I’m writing for myself, I still have a strong desire to spread a message for the world too. I have no grand delusions of grandeur, lol, but I’ve always wanted to write, and to the biggest an audience I can reach. I know I can learn from these bloggers and gain more knowledge and expertise to help my own blog.
I’m sharing them with you so you have more resources than what my lonely little blog provides at the moment. Give me a few months, and watch my blog come alive with information, stories, and resources, just like the ones above have 🙂
I recently spent close to 3 weeks inpatient psych after 2 suicide attempts. 20 days away from my 4 kids. On one hand it sucked terribly, on the other, I suddenly was forced into discovering ME, and figuring out who Tricia was when she wasn’t being a mommy or a wife. Not that this was my first venture into a psych ward, I had severe postpartum depression after my last child was born and spent 2 weeks inpatient then. I also spent many weeks in the psych ward after a mental breakdown in my early twenties. Not to mention the in and out stays during my teen years. So, back to my most recent visits…
I actually had two forays into inpatient stay, one lasted 8 days, and the other lasting 11. The worst stay was those first 8 days I was gone…I had a terrible doctor who refused to put me on the right medication, instead she opted to put me on Haldol (an older antipsychotic used in the treatment of schizophrenia and acute psychotic states and delirium)which did me no good at all. She refused to prescribe my Concerta, yet continued my Suboxone, and refused and anti-anxiety medication at all, choosing to let Haldol replace any benzodiazepines. It did such little good because it caused such extreme sedation that I was practically a zombie. I gained no valuable experience from that stay, being unable to attend therapy or groups and whatnot. So after 8 days of no good at all, I was released because I was considered to “no longer be a threat to myself”. This clearly wasn’t true because not even a week later I had a much more serious suicide attempt, thus landing me in a different hospital further away from home and family.
As much as I resented it at first, this actually proved to be a godsend. I had a doctor who actually ‘got’ me, because he understood bipolar disorder. He immediately put me back on the medicinal regimen I had been on 6 months prior to my inpatient stays. He listened to me, he didn’t hide things from me, he was honest with me, and I felt I could be honest with him as well. He respected the fact that I knew my body best and was educated enough about my disorder to know what was effective and what wasn’t. I was back on my Welbutrin, Abilify, Xanex, Concerta and Ambien that day. (After my experience at the previous hospital, I quit the Suboxone and swore off all narcotics for good.) Now that I was in a controlled environment, I discovered that Xanex wasn’t the best anti-anxiety med for me, given it’s short half life, and my extreme anxiety. My doctor and I made the decision to try Klonopin instead, even though I had not had good results with it in the past, because I was willing to trust him and try it again. Miraculously enough it worked wonders for my anxiety this time, and it lasted much longer than the Xanex.
So with my meds fixed, I should have been good to go home after a few days right? Wrong! This hospital had several different psychiatric units, and I was on a unit exclusively for women who had suffered trauma or abuse at some point in their life. We had a very rigid schedule from 7 AM until around 4 PM, which is when we could finally have some downtime. We spent at least 6 hours a day either in therapy or in classes; learning valuable new skills and learning new coping skills and gaining new insights and perspectives on our lives. The therapy groups were very DBT based, and I’ll never forget some of the practices that were taught. We were given schema diaries, and had to discover our ‘life traps’, which are negative beliefs about the world that affected how we behave. I had done the schema diaries before, but never took it seriously until now. This time I was given a starter kit, if you will, on how to proceed with life going forward once I left the hospital.
I’ll never forget the staff there, ever. I’ve never been inpatient anywhere where there was so much true compassion and genuine caring for the patients in the staff’s care. From the head nurse to the therapists, to even the cafeteria staff, these people cared about us and we could feel it. It gave me the courage to actually reach out and allow myself to be vulnerable, and to open up about issues that had never seen the light of day. I actually did the homework assignments, I actually did the workbook assignments, and I actually discovered who I used to be, and who I could be again. It was liberating, and yet terrifying at the same time. I’d spent so many years suppressing my emotions, I had no idea how to handle them now that I was allowing them to surface out. I was in a great place to learn how to cope with them in a safe manner. I also finally had a clear game plan for therapy out in the real world. I knew what direction I wanted to take, and what I needed to work through. I went into that hospital as a broken woman, and left with a sense of purpose and hope that I’d never felt before upon any other discharge. My husband swears that if I ever relapse again, I’ll go back to this hospital because they did me the most good that he’d ever seen.
So how did I end up spending all this time in the hospital anyway? I mean, after going so long on the outside without needing to be admitted? You see, I had quit taking all my meds a few months prior, for a multitude of reasons… which did me no good at all, but for some reason seemed like an excellent idea at the time. I lasted about 5 months without any meds; five miserable months in which I had a few days of functioning, and then many days where I simply couldn’t even get out of bed to properly care for my family. It was a rough time and I feel horrid about how it affected everyone around me, especially my kids. I know they suffered the most by not having mommy totally there. Thanks be to God that I have a wonderful husband who was able to be there too and pick up all the pieces of the mess I was making.
It all really started spiraling downward when my cousin hung herself and left her family behind. I’d been having suicidal thoughts for awhile but couldn’t bring myself to do anything about it because I had my family to think of, right? Yet suddenly here was someone who was able to overcome that and leave it all behind, and if she could do it, why couldn’t I? Not very rational thinking I’ll admit, but what bipolar person thinks rationally when they’ve been off their meds for awhile? No justification there, just an observation. I got more and more depressed, I started fighting with my husband more and more, and there were more and more days that I couldn’t get out of bed and function.
The one who bore the brunt of this, to my shame, was my youngest, who I felt was to blame for all my woes. She suffered the most because she was the most helpless of my kids, the least independent and the one who needed her parents the most. She could sense my disinterest and clung to her dad all the more tightly, distancing our relationship even further, even to the point where I felt giving her up for adoption would be in her best interests because I felt I was doing irreparable damage to her, simply by being her mother. Fortunately, small children are quick to forgive, and also quick to give their love to those willing to receive it and much of the damage I had done has been repaired since I was released this last time. I’m so grateful to have been given a second chance with her and that she has responded so well to my new attitude and sudden interest in her. My other children don’t seem to have suffered as much, they were very happy to have mommy back home, and wanted a lot of snuggles at first, and I made sure they got them. I still make sure they get their snuggles now, in fact.
What was the point of this rambling post? I’m not sure really. Maybe someone will come across it and find some hope in that there is quality treatment out there, that there are good hospitals out there, or maybe someone will feel like trying therapy again, or maybe going to their doctor to try yet another medication again, or whatever positiveness that can be found here. I hope someone can find some positiveness in my little ramblings here because I found hope through what I went through, and I want to share that with the world.