Every illness has a better prognosis when the people who have it are informed, invested, and involved in their treatment plans. This is especially true for serious mood disorders, including bipolar. In general, the more involved you are in your recovery and mood maintenance, the better the outcome. Here are ten strategies and skills for managing bipolar.
Team up with your doctor and therapist
Managing bipolar disorder effectively is a team sport. To win, all team members must respect each other and communicate openly so that everyone remains well informed and can work together to achieve common goals. To team up with your doctor and therapist, put these suggestions into practice:
Make and keep regular appointments. Regular may mean every six months when everything is going fine or once a week when warning signs appear.
Be open and honest. Doctors and therapists are only as effective as the accuracy of the information you provide them.
Consult your doctor before making any medication or treatment changes. If you feel the urge to reduce or stop taking a medication, contact your doctor before doing so. Your doctor may be able to suggest solutions for any concerns you have about your medications.
Ask questions. When you know why your doctor or therapist recommends a certain medication, treatment, or therapy, you're more likely to stick with the treatment plan.
Don't hesitate to speak up. You're a consumer of the medical services and products you're using, so you have a right to tell your doctor and therapist what's working and what's not, what you like and dislike, what makes you feel better or worse, and which side effects are unacceptable.
Take medications as prescribed
The single most important step for stopping and preventing a major mood episode is to take your medications as prescribed. Keep in mind that some medications require several weeks to establish a therapeutic level in the bloodstream and alleviate symptoms. When you start or change a medication, be sure to ask when (hours, days, weeks) you may notice any positive effects or side effects.
Don't stop taking your medication when you start feeling better. The meds are likely what's making you feel better. Plus, abruptly stopping an antimanic medication or antidepressant can trigger mania, depression, or seizures.
Regulate your sleep
Too much, not enough, or poor-quality sleep is both a symptom and a contributing factor to bipolar mania and depression. You should be getting eight to ten hours of quality sleep per day/night. Whether you sleep eight hours solid or divide it into smaller chunks is up to you, but try to establish a regular routine so you're sleeping at the same time(s) every day.
Develop daily routines
Daily routines relieve stress, level moods, and help regulate sleep. Start with the basics, such as a specific bedtime and wake time and then add in your mealtimes. Track your schedule over the course of a week to spot any severe variations and try to bring them more in sync with your scheduled times. Some variation, especially on weekends and over the holidays, is probably not a big deal, but work toward reducing any major deviations in your daily routine.
Build mindfulness and other self-centering skills
Mindfulness is a mental state of active attention to your present experience, which is conducive to deliberate thought and action. In mindfulness, you focus on your thoughts, feelings, and sensations in the here and now, trying not to attend to past regrets, future worries, and negative self-talk. In addition, studies show that mindfulness has positive effects on how the brain processes sensory information. Try these basic mindfulness exercises to help you center on the present:
Breathe.
Focus on sensations.
Shift from doing mode to being mode.
Observe thoughts without judging them.
Accept yourself.
Spend time in nature.
You can practice mindfulness regardless of what you're doing by taking a sensory inventory. What are you seeing, hearing, smelling, tasting, and touching right now? This sensory inventory allows you to focus on the here and now instead of getting lost in the usual mental chatter about past and future events and concerns.
Clearly communicate your needs
Even if you have the most supportive network of family and friends on the planet, get into the habit of advocating for yourself. Tell people what you need from them, express your preferences, and if they don't seem to understand, say so.
Asking for what you want and need isn't selfish. Thinking that others should know what you want and need is ineffective. It places unrealistic expectations on others — namely, the expectation that they can read your mind. When you tell others clearly what you need, you're doing them a tremendous service.
Avoid alcohol and stimulants
When you and your doctor are working hard to stabilize your moods with medication and therapy, avoid consuming any substances that may throw off that delicate balance. These include the following:
Alcohol: Moderate alcohol consumption when you are stable (one or two occasional drinks) is okay, but you're asking for trouble if you have more than that.
Stimulants: Caffeine, nicotine, energy drinks, and other stimulants can tip your mood balance, especially if they cause you to lose sleep.
Drugs and other substances: Marijuana, cocaine, meth, ecstasy, and other drugs and medications that your doctor hasn't prescribed for you may also contribute to severe mood instability.
Talk with your doctor about any supplements or over-the-counter medications you use or are thinking of using. Some of these products can have powerful effects on sleep, mood, and energy.
Monitor your moods
Early intervention is essential in preventing major mood episodes, and mood monitoring is the best way to tell when intervention is necessary. Hang a calendar on your wall, keep one in your purse or on your computer, or download a mood-monitoring app on your phone. Rank your mood and other symptoms such as sleep and energy on a daily basis. If your mood drifts from the middle ranges to higher or lower levels for more than a few days, contact your doctor.
You may not always be in the best position to assess your own mood. Consider enlisting a trusted friend or family member whom you see regularly to help you keep track of your moods.
Identify your early warning signs
Bipolar disorder has telltale signs, but they differ depending on whether you're experiencing mania or depression, and they vary among individuals. By learning what your early warning signs are and becoming more sensitive to these signs, you're in a better position to seek help before the mania or depression spirals out of control.
Common external signs of escalating mania include the following:
Missing an entire night's sleep and not feeling tired
Rapid speech or racing thoughts; people tell you to slow down
Being less sexually inhibited than usual
Spending significantly more money than usual
Engaging in reckless behaviors, including driving too fast
Dressing flamboyantly or wearing makeup that's out of the ordinary
Common external signs of escalating depression include the following:
Hearing more and more people ask you, "What's wrong?"
Getting plenty of sleep and still feeling tired
Eating a lot less or a lot more than normal
Being more socially withdrawn
Crying or being upset for no specific reason
Get help at the first sign of trouble
No matter how carefully you care for yourself, monitor your moods, and remain alert for early warning signs, you can't always prevent symptoms. Through early intervention, however, you may be able to reduce the severity and duration of a mood episode by following these suggestions:
Ask your doctor and therapist what to do if you begin to notice signs of depression or mania. Your doctor may be able to prescribe something for short-term relief.
Contact your doctor or therapist as soon as you notice your early warning signs or a shift in mood that causes concern.
Be prepared to call 911 or head to the emergency room if you feel that your moods are escalating out of control. (Don't drive yourself unless you're confident that doing so is safe.)