Your Wellness: What You Can Do

bulletBy Terry J. Coyier, Bipolar World Columnist 
July 2001

Dealing with bipolar disorder dredges up different feelings for each patient.  But, no where does it say that you must behave like a victim.  There are many things you can do to keep the suffering to a minimum.  "Oh, I can't," you say, "My episodes come out of nowhere.  I never know how I'm going to feel from one moment to the next."  Well, sorry to say, that just isn't true.  It may seem true now, if you've never had a period of recovery with your illness, but once you've been episode-free for awhile you will understand my position.  Please don't become so offended that you don't continue to read because some of these suggestions might just help bring you to that place where you actually reach the light at the end of the tunnel.  It's tough to comprehend that people are responsible for their own illness.  Although it isn't our fault that we were inflicted with bipolar, just like it isn't a diabetic's fault that they were inflicted with diabetes, it is up to us to learn as much as possible about our infliction.  In the case of most illnesses, there are steps that can be taken to lessen the severity and frequency of reoccurrence and those steps fall on the shoulders of the patient.  Your family, spouse, psychiatrist nor therapist can make you do anythingŠit's up to you alone.

The first thing that must transpire is the acceptance of your illness.  If you have not reached the stage of acceptance then many of these ideas will fall upon deaf ears, reinforcing your notion that you have no control over your bipolar.  Bipolar is an illness that does not "go away," or "fix itself."  It is an illness you will always have, so the sooner you deal with it, the sooner you can concentrate on how to keep it under control so that it doesn't completely disrupt your otherwise productive and happy life.  Acceptance is easier said than done, I realize this.  In this area, I cannot help.  Bipolar, for me, wasn't a matter of acceptance; it was an explanation for many years of odd, unexplained, erratic behavior and was quite a relief.  I was thrilled to find out that there were medicines available that could help my mind make sense of the world around me.  For most people, this is not the situation.  Most people must go through the typical grieving process to get to the final stage of acceptance.  If you are not there yet, please work with your psychiatrist and therapist until you have fully accepted your illness.  To do this, you must be honest with them about your feelings and your reservations in regards to bipolar.  Also, read whatever information you can get your hands on.  Whatever you do, ignore the ignorant people that will say you don't have an illness, that you just need to "get a hold of yourself," or "snap out of it."   These are people who are not educated in the area of mental illness and want to make you feel inferior.  Don't let them succeed.

Once you have accepted bipolar for what it is, hopefully you will be inclined to do whatever it takes to prevent another full-blown episode.  Anyone who has been to Hell and manages to get back should be willing to go to great lengths to avoid another trip.  Unfortunately not everyone realizes that there are things they can do to help themselves prevent another trip.  Well, I'm here to tell you that there are many resources available to assist the proactive patient in doing just that.  Below is a list of absolutely every tip, trick and idea that I have tried, or heard was successful for someone else suffering through a life riddled with extreme mood swings.  I hope that you will try some or all of them and adopt the ones that work best for you.

Medications

The taking of daily medication is a big part of acceptance.  Bipolar medications are the best step you can take towards stability.  Of course, the bipolar memory makes it difficult to remember if you've taken them or not.  Try to get over the fact that you must take a pill, or usually several pills to stay well.  If you had diabetes and were dependent on insulin, you wouldn't just skip it.  If you had heart problems you wouldn't go without your nitroglycerin pills.  Any time you don't comply with your medication regimen you are jeopardizing your wellness.  Every time you stop taking your medications you become more treatment resistant.  So make sure you take your medications and take them as prescribed.  Here are a few suggestions.
bulletTake you medications at the same time everyday.  Try to coincide taking them with another event such as breakfast, lunch, dinner, bedtime or any other daily routine event.  If you forget take them as soon as you remember unless you are close to the time of your next dose, in which case you should skip that dose and take your next dose as scheduled.
bulletTo help remember try setting alarms, leaving sticky notes, having your SO or a family member remind you or even tying a string around your finger or wrist.  Do anything and everything to make sure you don't forget your medicine.  If you are still having a terrible time remembering, ask your doctor if your medications can be taken just once a day or if they have extended release medications that you could take instead.  Never change your medication schedule without checking with your doctor first.
bulletOrganize your medicines into a daily or weekly pillbox (available at the pharmacy).  I used a weekly pillbox in the beginning and always filled it on Sunday night.  This was a good indicator of how much medication I had left too, so I could get my refills before I ran out.  I also would carry a daily pillbox with extra doses incase I got to work and realized I forgot or got caught out late and needed to take an evening dose.  Although this isn't normally an issue, check with your doctor or pharmacist to make sure it is all right to store your medicines together.
bulletA few important things you need to know pertaining to medications are: know what you take, what the dosage is, what each medication is for, what the symptoms of toxicity and overdose are, what the pills look like and how long it will take to feel the effects.  Read the information about your medication that you receive from the pharmacy.  If you know these things you will be less likely to take wrong medication or the wrong dose and you will be able to recognize symptoms of toxicity before you become very sick. Also, don't forget to double check each prescription to make sure your receive the correct number of pills.  Even pharmacists can make mistakes.  It never hurts to carry a list of medications and dosage with you in case of an emergency.  Make sure to keep it updated if you change medications or doses.
bulletDon't forget to disclose ALL medications you are taking to ALL of your doctors, including your dentist.  Sometimes medications can counteract each other and can even be dangerous to take together.  Be sure to check with your doctor if you need to take any over the counter medications including aspirin, ibuprofen, cold medicine, cough drops, etc.  ANYTHING!  Also you need to make your doctors aware if you drink, use any street drugs or are taking any herbal remedies.   All of these items can effect your treatment plan and need to be considered by your doctor before a psychiatric medication is prescribed.

Your Treatment Team

Few things are as important to a person with bipolar disorder than the psychiatrist and therapist responsible for your treatment.  As much as the patient is responsible for following the advice of the doctors, you must make sure you have the right people for the job.  Here are a few pointers:

bullet If possible find specialists.  A psychopharmacologist is a psychiatrist who specializes in the effect of drugs on the mind and behavior.  In my opinion, if a psychopharmacologist is available to you, then that's who you want to manage your medications.

bullet Try to find a therapist who has experience in treating bipolar disorder and in any other psychiatric illnesses in your diagnosis.  Don't trust your health to a novice even if they have the best intentions.

bullet If you are in any way uncomfortable with anyone who is treating you then find a replacement.  If you do not feel safe being open and honest with your treatment team then you will only inhibit your progress.  And, you must be completely truthful with your doctors if you expect to have a life with any amount of normalcy.

Monitoring Tools

Self-monitoring of bipolar disorder is a very effective management tool, not only for the patient but for your treatment team as well.  The bipolar memory isn't always reliable, but when you add medications that sometimes nearly eliminate the memory, you're lucky to remember yesterday, no less a month ago.  I cannot impress upon you enough the importance of keeping track of your illness.  Although, you want to guard against becoming so obsessed with your monitoring that you are spending most of your time scrutinizing every moment of your life.  Available online are different sample forms and even an inexpensive computer program you can buy (which is what I use).  Here are some common tools:

bulletThe Mood Chart: lets you keep track of your mood using a numerical scale that is recorded daily in a log. Make sure to note if you have any major traumas that will effect your overall mood; i.e. fight with a spouse, loss of a pet or loved one, moving to a new house, marriage or divorce, promotion or loss of a job, etc.  Over a period of a month or more you can trace a pattern in your moods.  This is extremely helpful if you have any type of recurring or seasonal pattern associated with your illness.  It is also helpful in tracing the severity of your moods.  All of this information can assist your doctors with your treatment.

bulletThe Sleep Log: allows you to keep track of your sleeping patterns.  There should be a place to record what time you went to bed, what time you awoke and the total number of hours slept.  It is also helpful if there is a place to indicate what type of sleep you experienced.  Was it restful, interrupted, full of nightmares, very heavy, etc?  You also need to keep track of any naps you take and when.  When the sleep log is used in conjunction with the mood chart it will indicate how your sleep pattern effects your daily mood.

bulletSymptoms List: is a place to record any specific symptoms regarding your moods or reactions to your medications.  You can keep track of things like crabbiness, anger, racing thoughts, abdominal pain, headache, psychosis, etc.  Again, when this is used with the other monitoring tools, you and your doctor will have a more developed picture of your illness for a given period of time.

bulletOther tools: you can also keep track of things like your diet and how much you exercise.  If you are really sick or on disability you can keep track of your daily activities.  You can keep track of any of your goals.  If you are having a hard time getting out of bed, getting a shower and getting dressed then keep track of that.  If you are agoraphobic then keep track of how much time you spend outside of your home.  Just don't keep track of more than one or two goals at a time.  You will be more successful if you focus your concentration on only one or two things at a time.

Eat, Sleep & Exercise

Sometimes the most intrinsic activities are the ones that can throw our system into a tailspin and insight an episode.  Our diet, sleeping patterns and exercise regimen are just such trite routines.  Here are a few tips:

bulletIt has been suggested that our sleep patterns have a profound effect on our moods.  Too little sleep can decrease our stress threshold causing agitation and anger.  It can also be a sign that a manic episode is looming right around the corner.  Some studies have even suggested that sleep deprivation can trigger manic episodes.  Too much sleep can equate to tiredness, irritability, body aches and can be a sign of an upcoming depression.  If at all possible, try to go to bed and get up at the same time, 7 days a week.  If you can follow a schedule with your sleep then it will be easier to recognize any variance and thus help you to identify the possibility of an approaching episode.

bulletBipolar disorder exacerbates the already difficult task of maintaining a healthy diet. A common problem associated with bipolar is craving sweets.  Besides cravings, we spend so much time trying to handle our illness that we can even forget to eat.  Of course, every episode has a  large effect on our eating habits. During a hypomanic or manic episode the thought of food is often lost among the thousands of other thoughts flooding the mind.  Plus, when you think you are invincible, you certainly don't need food, right?  The opposite is true if you are depressed.  You don't usually think of food if you don't think you deserve to live. Then, of course, the medications we take to treat our illness can also alter our eating habits.  Even when stable, many medications stimulate the appetite center of the brain causing you to eat more than you would normally. All of these things can demolish a healthy diet.  So, we must at least try to eat healthy meals whenever possible.  In my case, that doesn't happen very often so I take a multivitamin everyday, which I highly recommend, with your doctor's approval, of course.

bulletExercise, as we all know, is important to good health for everyone.  Unfortunately, when you are bipolar, finding the energy and motivation to exercise is nearly impossible.  Not only does this illness rob you of the desire to do many things, but also the medications frequently make you lethargic, easily fatigued and often make you gain weight.  Since I have gained some 60 pounds I'm fond of saying, "the bigger you are, the more gravity there is pulling you towards the sofa!"  I have yet to find an effective motivator to get me back to exercising, but you should know that it is important and can improve your physical and mental health.  Finding a friend to exercise with can really help, especially if they are good at dragging you out the front door when you don't want to go.

Warning Signs

I actually have an entire article just on this subject, but it is integral to staying well, so I am willing to address it again.  Believe it or not, bipolar episodes to not just drop out of the sky without any warning.  Subtle hints and changes in behavior, if noticed, can be fair warning that an episode is about to irrupt.  If these signs are recognized immediately, steps can be taken that will derail the episode, sparing you another setback.  If you live with a SO or your family, it is wise to let them know what your warning signs are since they can sometimes identify them before you.  My rule of thumb for a symptom to qualify as a warning sign is that it must occur 3 days in a row and cannot be triggered by some major life event.  Samples of warning signs could be:

bulletLack of sleep or excessive sleep
bulletNot eating or overeating
bulletSeeing things out of the corner of your eye that are not there at all
bulletInability to concentrate on routine tasks
bulletThoughts of hurting yourself or someone else
bulletSaying inappropriate things
bulletChanges in established routines
bulletBecoming noticeably more or less active in support groups, social activities, etc.
bulletTalking too much or too little
bulletCommitting yourself too many projects
bulletIrritability or aggression for no apparent reason
bulletRacing thoughts or jumping from topic to unrelated topic in conversations
bulletNot wanting to participate in your favorite activity
bulletLoss or increase of sexual drive

For further examples and help to identify your warning signs, check out "The Depression Workbook: A Guide to Living with Depression and Manic-Depression," by Mary Ellen Copeland.  This book was a lifesaver for me at a time when I thought I would never again resemble even a shadow of my former self.  Luckily, I was wrong.

Routines

Yes, I know its boring!  As unexciting as routines are, for someone with bipolar they can be the foundation needed to reestablish a healthy and productive life.  Routines can help eradicate the unexpected out of your life.  They keep you from feeling overwhelmed at every turn.  I am the type of person who becomes bored by routines quite easily, but since my first inpatient treatment I have not been able to handle situations without advance preparation.  So I integrated some rituals into my life so that on days when I'm not feeling up to par, I can still function with minimal effort.  Everyone has a certain amount of routine in their life but when you are bipolar the more simplicity, the better.  If it helps, think of them as shortcuts.  Or think of them in terms of trash.  If trash collectors didn't have a scheduled day to pick up your garbage each week, how would you know when to put it out?  Here are some suggestions:

bulletI can be indecisive, so I pick out my work outfit the night before.  This way if I wake up late, which will fluster me, I don't have the added pressure of coming up with something to wear.  Some people take this idea a step further and actually hang their clothes in "preset" outfits so all they do is grab and go.  Customization is the key to making routines work for you.

bulletI am not a morning person so I try to do as much as possible the night before.  Just recently I started taking my shower when my 2-year-old gets his bath in the evening.  This was a difficult change for me since I have taken my shower in the morning for 25 years.  What I've discovered is that I haven't been late to work once in the past month. So the change in my routine not only makes better use of my time while my son bathes (which was my original reason for changing), it has eliminated a problem at work and has reduced my stress level tremendously.

bulletMake a schedule for repetitive tasks.  I have deviated from my schedule lately and have suffered from it.  It's easy to let chores pile up to the point that you can't even pick a place to start.  So do your tasks on the same day every week.  Make a calendar to keep you on track. For example:

bulletMondays you do vacuuming
bulletTuesdays you do dusting
bulletWednesdays you do household laundry
bulletThursdays you clean the bathrooms
bulletFridays you rent movies and relax
bulletSaturdays you do personal laundry and take the kids to the park
bulletSundays you go to church, fill your weekly pill reminder and have a nice family dinner

You get the idea.  Don't forget to schedule in personal time as well as chores and don't beat yourself up if you get off schedule.  Simply regroup and, if needed, even rearrange your schedule and start again.

bulletWriting
bulletJournaling
bulletDrawing or painting (I actual color in coloring books)
bulletGardening
bulletPlaying a musical instrument
bulletDancing
bulletFlower arranging
bulletMaking homemade greeting cards
bulletPlaying a game
bulletPhotography
bulletModel building
bulletSewing, needlepoint, quilting, cross-stitch, macramé, crochet
bulletSculpting
bulletDesigning or updating a website
bulletCreating photo albums or memory books

Self Esteem

This is one of the more complicated tools for the bipolar sufferer to master and use effectively.  Often, someone with bipolar has a self image that has been warped by years of irrational thinking or abuse.  It is difficult to maintain a healthy outlook when your mind swims with thoughts and ideas that don't seem to connect properly.  It's nearly impossible to have a clear picture of yourself under these circumstances.  At some point along your path to wellness you should take the time to evaluate your self esteem.  Most of us can use a refresher from time to time; one that assures our look inward reflects back the truth in our soul.  Here are a few ideas:

bullet Don't begin any large self improvement tasks unless you are stable.  You're not going to make a dent in your outlook unless you are thinking rationally and are free of any psychosis.

bullet Work with your treatment team on developing a course of action to build up your self worth.   They will, no doubt, be willing to work with you, offer advice on setting goals and even recommend reading materials and exercises.

bullet Use affirmations to change your inner "self-talk."  Don't underestimate the power of repeating positive phrases to yourself.  What you say in your mind, about yourself, reflects the health of your self esteem.  We believe something to be true when we hear it repeatedly.  If you are persistent enough with your affirmations you can produce a tremendous change in your attitude towards yourself and your value as a unique human being.  Don't let spoofs on late night TV convince you not to try a very effective tool.  Many books and tapes are available to help you get started.

bullet Improve on organizational and stress management skills.  Becoming more organized can help you value yourself to a greater degree.  If you are constantly losing things or unable to locate things when they are needed you are setting yourself up to be criticized by others and turning that criticism inward.  The same goes for handling stress.  You will be rewarded in many ways if you can learn to handle everyday stress.  Everyone falls prey to stress sometimes, but if you can eliminate minor stress then you will be able to cope better when a major stress invades your life.  There are books on these subjects and even classes.  I took a stress management class at the local community college about 13 years ago and I still use some of the skills I learned.

bullet Therapy is a valuable tool in building your self worth.  A therapist can guide you through problem areas that diminish your positive self reflection.  Nothing is better than having a trusted professional guide you in obtaining your goal of a healthy self esteem.  Of course, you must let the therapist know that this is your goal because they cannot read your mind.  Therapy, unfortunately, is not a viable option for everyone due to cost and managed health care restrictions.  If you do have therapy as an option, take full advantage of your sessions and be 100% truthful.  More than likely your therapist isn't going to hear something from you that he or she hasn't heard before.  Most of the time our problems are not as unique as we like to think.

I'm sure that other techniques and tools that have been successfully used by people trying to cope with this hideous creature that we call bipolar disorder.  Unfortunately, I haven't been able to canvass the entire population and this is everything that I can offer to you.  Our wellness is a fragile balancing act taking place within the confines of our own minds.  Most outsiders never see the cautious steps on the taunt high wire of our daily lives.  They are oblivious of the slow progress we are desperately trying to maintain, as we stand petrified between the point of insanity and the point of normalcy.  All that most see are the lofty, manic leaps that soar beyond comprehension or the precarious tumbles that leave us hanging on by a mere thread with no safety net to catch us.  Try some of the ideas above.  The more you can include in your life, the stronger your thread becomes until it is finally the safety harness that keeps you on the wire.  Sorry, you won't get a safety net in life; this isn't the circus you know!









 

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