- Find a good doctor
- Become an expert
- Manage your illness
- Plan for a crisis
- Find a community
- Practical matters – work, school, and federal aid issues
- Other Resources – coping with mania, depression, and life with bipolar disorder
When we give lists of symptoms and medications for people with bipolar disorder, the entire thing can seem disarmingly simple. But anyone who has been there knows that there is nothing simple about accepting and living with a chronic illness, and it’s just as important to address the emotional and practical issues of bipolar as it is to know the diagnostic criteria and treatment guidelines. Those with other chronic diseases like diabetes, cystic fibrosis, or multiple sclerosis go through a similar process of grieving, accepting, learning, and adapting – and through this, begin healing and recovery.
A helpful outline to guide a healing and recovery journey is described in the acronym TEAR:
T = to accept the reality of loss. There are things that will be different after a diagnosis of bipolar, and it’s important to recognize these things rather than denying or hiding them.
E = experience the pain of the loss. You are allowed to grieve what you feel has been lost with the onset of this disease, both from your own life and the lives of others. You are allowed to mourn previous goals and aspirations that must be altered to this new reality.
A = adjust to the new environment without what was lost. Whatever was lost with your diagnosis doesn’t constitute the whole of your person. The core of you is still the same, and knowing about your illness now allows you to re-adapt to this new context of life.
R = reinvest in the new reality. Explore, create, engage, and live as the person you are, managing your own life and your illness as part of that life.
Below are some articles and resources that we hope will help you in your own life.
1) Find a good doctor.
Even if you already have your diagnosis, your doctor will be your ally and partner in treatment and recovery. It’s important to have a doctor you can speak openly with, who will listen to you as an equal and acknowledge your expertise on your own body, who will offer helpful suggestions and be invested in your recovery. Below are some resources on what to look for in a good psychiatrist and/or health care provider, and how to find one in your area.
- The Patient-Doctor Relationship: The Good, The Bad, and the Ugly – signs of each kind of relationship, and advice from someone who has experience as a psychiatric health care consumer.
- Mental Health Professionals: Who They Are and How to Find One – article provided by NAMI.
- Contact your local NAMI chapter or another support group, and ask people in the area who has provided quality care for them in the past. Ask family members, friends, other doctors, and anyone else who has had personal experience who they recommend as health care providers.
- A Bipolar Specialist Referral Database – provided and maintained by the Harvard Bipolar Research Program
- The Best U.S. Psychiatrists for Mood Disorders – names and contact info compiled (and kept current) by Dr. Ivan Goldberg, a psychiatrist and clinical psychopharmacologist in private practice in New York City.
2) Become an Expert.
Putting a name to what used to be a vague collection of debilitating symptoms puts you in control. Knowing your disease as intimately as you can gives you the tools to manage it effectively, rather than it managing you. It can also make your situation seem much less frightening when you can understand and recognize what is happening in your own body. Here are some resources to get you started.
- What Is Mental Illness? – it is not a choice, a weakness, a failing, or a sign of immorality. It is a biological disease based in the brain. This information from the American Psychiatric Association gives an introductory look.
- Manic Depressive Disorders and Schizophrenia are Diseases of the Brain – an introduction to the evidence, with references.
- Guide to Depression and Bipolar Disorder (PDF) – an easy-to-read pamphlet provided by the Depression and Bipolar Support Alliance.
- Understanding Bipolar Disorder – a comprehensive, 24-page information booklet provided by NAMI.
- What Causes Mood Disorders? – a short, understandable explanation of the brain chemistry that underlies mood disorders.
- Excellent books – a list of essential reading about bipolar disorder and mental illness [coming soon].
3) Manage your Illness – mood charting and meds.
One of the best coping strategies, suggested by professionals and patients alike, is using a mood chart to track your own episodes and symptoms. A mood chart can be a preventative tool to help identify early warning signs for relapse, a record for physicians and family to help assess the efficacy of different medications and treatments, and a therapeutic tool to organize a person’s daily routine and improve awareness of the illness.
The simplest method of mood charting is rating your mood (at the same time each day) on a scale of 1-10, with one being very depressed and ten being absolutely elated. A good place to keep a record is on a wall calendar or in a daily diary. Other methods involve more elaborate charts, and a more detailed rating scale (see the links below). Some people work better with graphs, others with numbers, others with writing lists of words or paragraphs to describe their feelings. The overall goal of the charts is to have a reliable and consistent record of how greatly your moods flucuate over a period of time, so develop the method that is easiest for you to achieve this goal.
- Mood charting resources:
- Mood Charting for Children – the Child & Adolescent Bipolar Foundation provides examples and resources for charting your child’s moods, and eventually helping him/her to track it themselves.
Another excellent coping strategy is learning how to manage your medications effectively. The first thing to do is know about what you are taking – ask your psychiatrist what symptoms your medication is treating, how long it might take to work, how much and how often you should take it, what you should do if you miss a dose, what side effects you might have and what you can do about them, and anything else that is on your mind. Keep track of your own medication information – names, dosages, how it makes you feel, what symptoms it makes better or worse – in a journal or diary. Having this information will help both you and your doctor find the medication regimen that works the best for you, and allow you to adjust it effectively as needed.
It can be an extremely frustrating trial-and-error process to finally find a medication that works for you. Please be patient and give the medications adequate time to do their job. Most people won’t feel better right away – it can take four to six weeks for a drug to get into your system and start noticeably helping. In the meantime, you can help yourself by trying some of the suggestions on this page, or finding a support group to help you through difficult times. By all means work with your psychiatrist to switch medications if you are unhappy with your current one; however, try to be realistic about what medications can and can’t do, and consider the relative benefits of staying on one versus trying to adjust to a brand-new one.
Simplify your medications as much as possible by putting them in separated daily pill boxes (you can purchase pill organizers with seven separate compartments, one for each day of the week), taking them at the same time each day, or taking them with a daily vitamin pill or something else that you do religiously. If you have a lot of trouble remembering, ask family members/roommates to help, or ask your doctor about the possibility of switching to long-acting injectable medications instead of pills.
Help your medication do their job by keeping healthy habits in your daily life.
- A reliable sleep routine is especially important for people with mood disorders – research shows that not getting enough sleep can bring on a manic episode.
- Making sure you get all your daily nutrients and vitamins – especially omega-3 fatty acids, which have been shown to help relieve the symptoms of psychiatric disorders – will keep you feeling better and more stable.
- Daily exercise will help your mood during a depression, will add structure to your day to help avoid mania, and will keep you looking and feeling better and healthier.
- More resources:
- Download Healthy Lifestyles (pdf file) – a brochure provided by the National Depressive and Manic-Depressive Association
- Bipolar Disorder Self Care – information on eating/sleeping/exercise habits, getting adequate nutrition, reducing stress, and avoiding relapse
- A Healthy Lifestyle Approach – tips and info from the Organization for Bipolar Affective Disorders Society (Canada)
4) Plan For a Crisis
Your mood charts (see above) will help you recognize what particular symptoms or behaviors tend to precede a manic or a depressive episode. Having a plan ready for relapse situations will help you get the care you need, and make sure other practical matters are taken care of, even if you are in a place where you can’t effectively make decisions. One of the most difficult aspects of bipolar to deal with is the seductiveness of mania – many people don’t seek help during a manic episode because they are feeling on top of the world. However, even though they can’t recognize it, they still present a danger to themselves or others via reckless acts, excessive spending, uncontrollable behavior, etc.
You can take some precautionary steps while you are stable to help get through a crisis situation as smoothly as possible. Put the following information (along with anything else that might be helpful) into a “crisis plan” folder, and distribute it to your doctor, your family members, and other trusted people who can help you.
- Make a list of people you trust (close family members, friends in the area, etc) who know about your disease and are willing to help you. Have their names and phone numbers together on a “crisis alert list”
- List the names and contact info of your psychiatrist, general practitioner, case worker, or any other professional that helps you manage your illness.
- Write out the particular signs that indicate a manic or a depressive episode, to help others recognize when you need help. (See some of the early warning signs compiled by bipolarsurvivor.com to use as a guide in making your list).
- Make another list of all your medications, what dose you take, and what side effects you experience. Note any medications you are allergic to or do not want to take under whatever circumstances.
- Leave directions for the care of your house, your pets, your plants, etc., in case you are hospitalized.
- Write down your insurance plan information
- Leave the names and numbers of family members and/or employers that need to be contacted in case of an emergency or an extended hospital stay.
- Leave any detailed instructions of what kind of care you do and do not want to recieve if you are unable to make your own decisions (the legal document for this is called a psychiatric advanced directive).
5) Find a Community
Having a supportive community is important for anyone, but particularly for someone dealing with a chronic illness. A support group of friends and peers can relate to what you go through like no one else can, offer support or a sympathetic ear, and give practical advice and solutions for difficulties as they come up. For the times when you are not feeling particularly social, an online discussion group or chatroom is a great option to keep yourself connected with others.
National U.S. support groups for people who have mood disorders:
- Depression and Bipolar Support Alliance – a comprehensive website w/ information, resources, advocacy materials, and a database of local chapters
- National Alliance for the Mentally Ill – free education programs and support groups in every state for patients and family members
- Children and Adolescent Bipolar Foundation – a comprehensive database with support orgs/chapters for every U.S. state. Also has online chatrooms and discussion boards
- Locate Regional Mental Health Services and Support Groups with a national database provided by the Substance Abuse and Mental Health Services Administration
Online Support Community:
International Support Organizations:
- Manic Depression Fellowship – U.K. based support and services organization
- International Society for Bipolar Disorders – requires a membership fee to join, but has some info available for free as well
- Mood Disorders Associaton of Manitoba, Canada
- Balance: New Zealand Manic Depressive Network
- Dutch Association for Manic-Depressives (Netherlands) – site in Dutch only
- Fundacion de Bipolares de Argentina (FUBIPA) – Spanish support organization and website w/ thirteen regional groups in Argentina
- German Society for Bipolar Disorder – site in German only
6) Practical Matters – work, school, and federal aid issues:
- How does a mental illness affect the way I function at school?
- Documenting your disability for an educational institution – recieve the resources and support you are entitled to
- Disclosing your Disability to an Employer – this is a personal choice and NOT required by law. This article outlines the pros and cons of both options.
- Handling your Psychiatric Disability at Work and School – lots of articles and links from the Center for Psychiatric Rehabilitation in Boston.
- What is Supplemental Security Income (SSI)?
- FAQs, advices, and articles about disability benefits – lots of information for most every situation.
7) Other Resources – coping with mania, depression, and life with bipolar disorder:
- Dealing Effectively with Manic-Depression (pdf) – an excellent pamphlet for patients from the Depression and Bipolar Support Alliance.
- How to avoid a manic episode
- 10 things to remember when you are manic
- 10 things to remember when you are depressed
- Should I take therapy or pills? – thoughts from someone with manic-depression
- Ideas for coping – advice from someone with manic-depression
- Myths about mental illness – good things for anyone to know, and occasionally remind themselves of.