Responding Reactively and Proactively to Bipolar Disorder

By Candida Fink, Joe Kraynak

Major mood episodes can sneak up on you with the silence of a brooding sadness or the furtive stirrings of enthusiasm. Maybe you feel a little less tired one day, a little more energetic. That’s normal. You figure it’s nothing to worry about. After all, you have every right to enjoy your life, and you’re looking forward to the weekend — TGIF! After work, you head to Wilma’s Watering Hole for an evening of rowdiness with your old college pals.

You get home a little late — actually, early Saturday morning — and you’re not even tired. You lie in bed for two hours, replaying the excitement of the evening on the insides of your eyelids. You finally manage to doze off, expecting to sleep until noon, but you wake up bright and early, raring to go. Why sleep when life’s smorgasbord summons you to its feast?

Requiring less sleep and more stimulation, you race through each day of the week. By week’s end, pedal to the metal, you’re highballing down the hypomanic highway, and you don’t even know how you got there. Now what?

Reacting: Extinguishing the flames

Enveloped by full-blown mania or depression, you face limited choices. If you pose no threat to yourself or others, you can choose to wait out the storm and hope the raging currents subside. But if your behavior becomes unbearable or dangerous — if you have suicidal or delusional — thoughts or become increasingly belligerent, for example — you or someone on your behalf may want to seek medical intervention in one or more of the following forms:

  • Hospitalization: The safety and retreat that hospitalization provides is a good choice when you pose a threat to yourself or others, even though you may not think so at the time.

  • Intensive outpatient therapy: A structured outpatient program allows you to focus on getting well by day and return home in the evening.

  • Medication: You may require medicine to lift the depression or quell the mania.

During a major mood episode, you may need to make some immediate changes, such as taking time off work and delegating responsibilities at home, especially if you’re hospitalized. But even if you decide to use outpatient resources, allow yourself time away from immediate responsibilities at least until the medication takes effect and you regain solid footing. Keep in mind that non-medication treatment options such as self-help and psychotherapy can be tough to get going and don’t work as quickly as medication during active episodes. Those types of intervention are often better suited to long-term recovery.

Preventing future flare-ups

How you respond to your diagnosis and how ambitiously you pursue treatment have a huge effect on your outcome. If you deny that you have a problem, lose hope, or try to self-medicate with alcohol and other substances, the disorder wins. If you discover the right medication, acquire some coping skills, confront your hidden demons through therapy, and remain vigilant, you prevail.

One of the best ways to derail a major mood episode is to remain attentive for signs of impending depression or mania and to consult your doctor or therapist if you observe any warning signs. A medication adjustment or some help dealing effectively with a situation that’s currently stressing you out may be all you need to avoid a major meltdown.