Learning to Cope With Bipolar Disorder

Concrete methods for maximizing effectiveness of your bipolar disorder treatment.

Another important part of treatment is education. The more you and your family and loved ones learn about bipolar disorder and its treatment, the better you will be able to cope with it.

Is there anything I can do to help my treatment for bipolar disorder?

Absolutely, yes. First, you should become an expert on your illness. Since bipolar disorder is a lifetime condition, it is essential that you and your family or others close to you learn all about it and its treatment. Read books, attend lectures, talk to your doctor or therapist, and consider joining a chapter of the National Depressive and Manic-Depressive Association (NDMDA) or the National Alliance for the Mentally Ill (NAMI) near you to stay up to date on medical and other developments, as well as to learn from others about managing the illness. Being an informed patient is the surest path to success.

You can often help reduce the minor mood swings and stresses that sometimes lead to more severe episodes by paying attention to the following:

• Maintain a stable sleep pattern. Go to bed around the same time each night and get up about the same time each morning. Disrupted sleep patterns appear to cause chemical changes in your body that can trigger mood episodes. If you have to take a trip where you will change time zones and might have jet lag, get advice from your doctor.
• Maintain a regular pattern of activity. Don't be frenetic or drive yourself impossibly hard.
• Do not use alcohol or illicit drugs. Drugs and alcohol can trigger mood episodes and interfere with the effectiveness of psychiatric medications. You may sometimes find it tempting to use alcohol or illicit drugs to "treat" your own mood or sleep problems but this almost always makes matters worse. If you have a problem with substances, ask your doctor for help and consider self-help groups such as Alcoholics Anonymous. Be very careful about "everyday" use of small amounts of alcohol, caffeine, and some over-the-counter medications for colds, allergies, or pain. Even small amounts of these substances can interfere with sleep, mood, or your medicine. It may not seem fair that you have to deprive yourself of a cocktail before dinner or a morning cup of coffee, but for many people this can be the "straw that breaks the camel's back."
• Enlist the support of family and friends. However, remember that it is not always easy to live with someone who has moodswings. If all of you learn as much as possible about bipolar disorder, you will be better able to help reduce the inevitable stress on relationships that the disorder can cause. Even the "calmest" family will sometimes need outside help dealing with the stress of a loved one who has continued symptoms. Ask your doctor or therapist to help educate both you and your family about bipolar disorder. Family therapy or joining a support group can also be very helpful.
• Try to reduce stress at work. Of course, you want to do your very best at work. However, keep in mind that avoiding relapses is more important and will, in the long run, increase your overall productivity. Try to keep predictable hours that allow you to get to sleep at a reasonable time. If mood symptoms interfere with your ability to work, discuss with your doctor whether to "tough it out" or take time off. How much to discuss openly with employers and coworkers is ultimately up to you. If you are unable to work, you might have a family member tell your employer that you are not feeling well and that you are under a doctor's care and will return to work as soon as possible.
• Learn to recognize the "early warning signs" of a new mood episode. Early signs of a mood episode differ from person to person and are different for mood elevations and depressions. The better you are at spotting your own early warning signs, the faster you can get help. Slight changes in mood, sleep, energy, self-esteem, sexual interest, concentration, willingness to take on new projects, thoughts of death (or sudden optimism), and even changes in dress and grooming may be early warnings of an impending high or low. Pay special attention to a change in your sleep pattern, because this is a common clue that trouble is brewing. Since loss of insight may be an early sign of an impending mood episode, don't hesitate to ask your family to watch for early warnings that you may be missing.
• Consider entering a clinical study.

What if you feel like quitting bipolar treatment?

It is normal to have occasional doubts and discomfort with treatment. If you feel a treatment is not working or is causing unpleasant side effects, tell your doctor-don't stop or adjust your medication on your own. Symptoms that come back after stopping medication are sometimes much harder to treat. Don't be shy about asking your doctor to arrange for a second opinion if things are not going well. Consultations can be a great help.

How often should I talk with my doctor?

During acute mania or depression, most people talk with their doctor at least once a week, or even every day, to monitor symptoms, medication doses, and side effects. As you recover, contact becomes less frequent; once you are well, you might see your doctor for a quick review every few months.

Regardless of scheduled appointments or blood tests, call yourdoctor if you have:

• Suicidal or violent feelings
• Changes in mood, sleep, or energy
• Changes in medication side effects
• A need to use over-the-counter medications such as cold medicine or pain medicine
• Acute general medical illnesses or a need for surgery, extensive dental care, or changes in other medicines you take

How can I monitor my own bipolar treatment progress?

Keeping a mood chart is a good way to help you, your doctor,and your family manage your disorder. A mood chart is a diary in which you keep track of your daily feelings, activities, sleep patterns, medication and side effects, and important life events. (You can ask your doctor or the NDMDA for a sample chart.) Often just a quick daily entry about your mood is all that is needed. Many people like using a simple, visual scale—from the "most depressed" to the "most manic" you ever felt, with "normal" being in the middle. Noticing changes in sleep, stresses in your life, and so forth may help you identify what are the early warning signs of mania or depression and what types of triggers typically lead to episodes for you. Keeping track of your medicines over many months or years will also help you figure out which ones work best for you.

What can families and friends do to help?

If you are a family member or friend of someone with bipolar disorder, become informed about the patient's illness, its causes, and its treatments. Talk to the patient's doctor if possible. Learn the particular warning signs for that person which indicate that he or she is becoming manic or depressed. Talk with the person, while he or she is well, about how you should respond when you see symptoms emerging.

• Encourage the patient to stick with treatment, to see the doctor, and to avoid alcohol and drugs. If the patient is not doing well or is having severe side effects, encourage the person to get a second opinion, but not to stop medication without advice.
• If your loved one becomes ill with a mood episode and suddenly views your concern as interference, remember that this is not a rejection of you but rather a symptom of the illness.
• Learn the warning signs of suicide and take any threats the person makes very seriously. If the person is "winding up" his or her affairs, talking about suicide, frequently discussing methods of suicide, or exhibiting increased feelings of despair, step in and seek help from the patient's doctor or other family members or friends. Privacy is a secondary concern when the person is at risk of committing suicide. Call 911 or a hospital emergency department if the situation becomes desperate.
• With someone prone to manic episodes, take advantage of periods of stable mood to arrange "advance directives" - plans and agreements you make with the person when he or she is stable to try to avoid problems during future episodes of illness. You should discuss when to institute safeguards, such as withholding credit cards, banking privileges, and car keys, and when to go to the hospital.
• Share the responsibility for taking care of the patient with other loved ones. This will help reduce the stressful effects that the illness has on caregivers and prevent you from "burning out" or feeling resentful.
• When patients are recovering from an episode, let them approach life at their own pace, and avoid the extremes of expecting too much or too little. Try to do things with them, rather than forthem, so that they are able to regain their sense of self-confidence. Treat people normally once they have recovered, but be alert for telltale symptoms. If there is a recurrence of the illness, you may notice it before the person does. Indicate the early symptoms in a caring manner and suggest talking with the doctor.
• Both you and the patient need to learn to tell the difference between a good day and hypomania, and between a bad day and depression. Patients with bipolar disorder have good days and bad days just like everyone else. With experience and awareness, you will be able to tell the difference between the two.
• Take advantage of the help available from support groups.

Bipolar Support Groups: Information, Advocacy and Research

Below, you'll find some advocacy groups — grass-roots organizations founded by patients and families to improve care by providing educational material and support groups, helping with referrals, and working to eliminate stigma and to change laws and policies to benefit individuals with mental illness. The support groups they sponsor provide a forum for mutual acceptance and advice from others who have suffered from severe mood disorders — help that can be invaluable for some individuals. The last 3 organizations, headed by medical researchers, provide education and can help with referrals to programs and clinical studies that provide innovative and state-of-the-art treatment.

• National Depressive and Manic-Depressive Association(NDMDA)
• 35,000 members in 250 chapters
• For information: 730 N. Franklin St., Suite 501 Chicago IL, 60610-3526
• 800-82-NDMDA (800-826-3632) www.ndmda.org
• National Alliance for the Mentally Ill (NAMI)
  140,000 members in 1,000 chapters
  For information: Colonial Place Three 2107 Wilson Blvd., Suite 300 Arlington, VA 22201-3042
  800-950-NAMI (800-950-6264) www.nami.org
• National Mental Health Association (NMHA)
  300 chapters
  For information: National Mental Health Information Center
  1021 Prince St. Alexandria, VA 22314-2971
  800-969-6642www.nmha.org
• National Foundation for Depressive Illness, Inc.
  (NFDI) PO Box 2257 New York, NY 10116-2257
  800-248-4344
• Madison Institute of Medicine
  Home of the Lithium Information Center and the Stanley Center for the Innovative Treatment of Bipolar Disorder
  Distributes very useful consumer guides to mood stabilizers
  7617 Mineral Point Rd., Suite 300 Madison, WI 53717
  608-827-2470 www.healthtechsys.com/mim.html
• Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)
• Project that is conducting studies involving 5,000 bipolar patients treated in different centers in the United States. The goal is to improve effectiveness of treatment for bipolar disorder. If you are interested in participating, visit: www.edc.gsph.pitt.edu/stepbd

Psychotherapy for Bipolar Disorder

Psychotherapy for bipolar disorder helps a person cope with life problems, come to terms with changes in self-image and life goals, and understand the effects of bipolar illness on significant relationships. As a treatment to relieve symptoms during an acute episode, psychotherapy is much more likely to help with depression than with mania - during a manic episode, patients may find it hard to listen to a therapist. Long-term psychotherapy may help prevent both mania and depression by reducing the stresses that trigger episodes and by increasing patients' acceptance of the need for medication.

Types of psychotherapy

Four specific types of psychotherapy have been studied by researchers. These approaches are particularly useful during acute depression and recovery:

• Behavioral therapy focuses on behaviors that can increase or decrease stress and ways to increase pleasurable experiences that may help improve depressive symptoms.
• Cognitive therapy focuses on identifying and changing the pessimistic thoughts and beliefs that can lead to depression.
• Interpersonal therapy focuses on reducing the strain that a mood disorder may place on relationships.
• Social rhythms therapy focuses on restoring and maintaining personal and social daily routines to stabilize body rhythms, especially the 24-hour sleep-wake cycle.

Psychotherapy can be individual (only you and a therapist), group (with other people with similar problems), or family. The person who provides therapy may be your doctor or another clinician, such as a social worker, psychologist, nurse, or counselor who works in partnership with your doctor.

How to get the most out of psychotherapy

• Keep your appointments
• Be honest and open
• Do the homework assigned to you as part of your therapy
• Give the therapist feedback on how the treatment is working. Remember that psychotherapy usually works more gradually than medication and may take 2 months or more to show its full effects. However, the benefits may be long lasting. Remember that people can react differently to psychotherapy, just as they do to medicine.

Source: Kahn DA, Ross R, Printz DJ, Sachs GS. Treatment of Bipolar Disorder: A guide for patients and families. Postgrad Med Special Report. 2000(April):97-104.

next: Managing a Manic Episode
~ bipolar disorder library
~ all bipolar disorder articles