Bipolar Disorder is a brain disorder entailing mood swings from Depression to Hypomania/Mania with normal moods in between. Whereas most of us experience some sort of mood shifts, the mood swings in Bipolar Disorder are extreme and can affect a person’s ability to carry out day to day tasks. These mood shifts are accompanied by shifts in energy and the need for sleep.
Is it possible to lead a normal, functional life if one has a diagnosis of Bipolar Disorder?
Yes, it is!
With a combination of treatment as prescribed by a Psychiatrist based on a thorough assessment, therapy and a 360 degree approach, one can tame the condition. Bipolar Disorder may not be curable but it is surely manageable.
Psychoeducation is a good place to begin…
So, let’s understand the various moods of Bipolar Disorder before we head to the coping tips.
Depression is one of the mood cycles of Bipolar Disorder and in many cases is the predominant mood phase. It is characterised by low mood, a sense of worthlessness, lack of energy/drive, disruption in sleep patterns (sleeping too much or inability to fall asleep), changes in appetite, feelings of sadness and isolation, withdrawal from social contact, inability to perform day to day tasks and thoughts of suicide/self harm.
Hypomania is an elevated mood phase which many of us affected by Bipolar Disorder actually do not want to get out of! Why is that? Hypomania is associated with high energy levels, less need for sleep and high motivation levels. So, if one is coming off a protracted period of Depression, Hypomania comes as a breath of fresh air. Creativity and productivity are known to be at its peak.
So what are the concerns associated with Hypomania?
Hypomania can cause lack of ability to focus for long on one activity/project, is associated with excesses such as over spending, verbosity, launching of ambitious projects which lose steam after the phase has subsided and may lead to reckless behaviour. An even bigger concern is a switch over to Mania.
Mania is the most elevated mood phase of Bipolar Disorder. During this mood phase, the affected person may need very little sleep and in fact may go for days without sleeping a wink. Energy levels are at a peak but there is a marked inability to focus and concentrate. High verbosity, rapid flow of thoughts, extreme irritability, grandiose thinking, recklessness bordering on dangerous behaviour, promiscuity, substance abuse, over spending can happen during Mania. It is marked by a heightened belief in one’s ability which is not based in reality. (Mania is associated with Bipolar Type 1 and the symptom distinguishing it from Bipolar Type 2.)
Psychosis in Bipolar Disorder can occur both during Mania and severe Depression but is more common during full blown manic episodes. Psychosis is associated with hallucinations (hearing and seeing things that others can’t) and delusions (irrational and grandiose beliefs about possessing exceptional talents or superpowers) and in general, being distanced from reality.
In between these mood phases a Bipolar Disorder affected experiences normal moods.
Coping with these various moods of Bipolar: seeking Professional help is the starting point but there are a lot of self help tips which can accentuate recovery and ensure our moods remain stable over long periods of time.
Coping with Depression:
1) Medication forms the essence of Bipolar Disorder treatment. Mood Stabilisers and/or Antipsychotics help treat Depression in BD and keep moods stable. Antidepressants need to be administered with caution because of the risk of triggering Mania.
2) Psychotherapy can be a huge help, especially in the Depressive phase. CBT is known to be very effective as it helps correct faulty thought processes.
3) Exercise is one of the most natural and effective forms of antidepressants known. Not only does it keep fatigue at bay but helps in overall wellness. Yes, it can be challenging to even get out of bed when very depressed: but even a fifteen minute walk helps. Gradually, activity level can be scaled up.
4) Yoga and Pranayam help calm you down and are known to reduce stress and anxiety.
5) The role of nutrition in mental wellness is often underestimated. Eschew foods which can trigger mood swings such as sugary and junk food, caffeine, etc and nurture yourself with the right foods. You could consult your Doctor and inquire if supplements such as Omega 3 might help you.
6) Read: FEELING GOOD by Dr David Burns, a fantastic Book which is much recommended!
7) Engaging in creative pursuits: we are known to have a creative streak and expressing it can be therapeutic. So engage in art, singing, writing or whatever is your gift.
8) Being amid nature is therapeutic (and costs us nothing!). Haven’t you noticed the calming effect of walking on a beach or being surrounded by greenery?
9) Mindfulness practice is known to reduce anxiety and help us live in the present moment. Breathe slowly and watch and feel each breath…
10) Procrastination is a bugbear which often weighs us down. Ensure that you set small goals for yourself, create a to do list which is not too overwhelming. Every task accomplished sends a positive signal to your mind (while clearing your backlog).
11) The attitude of gratitude is indeed a super power!! It helps shift our mindset from one of lacking and deprivation to one of being empowered. Practice it consciously to notice how it uplifts your spirits!
12) Join a Peer Support Group such as ours~ you’ll benefit immensely from the collective lived experience of peers. Knowledge sharing, coping tips and recommendations make such communities worthwhile. They also tend to ensure greater adherence.
13) Develop a circle of friends or colleagues who nurture you (especially when you need them the most). You are never alone. Contact the 24 x 7 Helpline numbers when you feel down and out.
14) taking care of ourselves can make us self obsessed. We need to spare a thought for our family members who try their best to support us. How about expressing our appreciation and bonding with them?
What few people know is that Bipolar Disorder also affects Cognitive function (memory, focus and concentration) in varying degrees. The more severe the mood episode, the greater the impairment. Some of the above self management tips will contribute to improved cognitive ability as well.
Know your rights as a Person with Mental Illness:
The Mental Health Care Act, 2017 has empowered our vast community in numerous ways and some of the changes which it seeks to usher in are path breaking. Make yourself aware of all the rights conferred on you under this Act as well as under Rights of Persons with Disabilities Act.
The all important role of Caregiver/s.
During our severe mood episodes we might be unable to spot or act upon our symptoms and therefore a Caregiver who is aware about the condition is literally worth her/his weight in gold!
I have stressed on coping tips for Depression, but not those for Mania or Hypomania. While there is a common and consistent approach we need to maintain, during the highly elevated mood phases, a Caregiver has to step in. (Applies in severe Depression too).
During Hypomania/Mania, we are often in denial of our symptoms. This can lead to dangerous consequences especially if the treating Psychiatrist is not informed about change in mood phase.
1) Maintain a Mood Chart: symptoms such as changes in sleep/energy/motivation are easy giveaways and alert you about a change in mood cycle. You can use readily available Apps on the internet or a custom Mood Tracker such as this one.
2) Our medication needs to be altered according to spikes in our moods/symptoms. Inform your Doctor if you sense you are headed towards Hypomania/Mania.
3) Also, it is important that a Caregiver steps in to prevent excesses of Mania such as over spending or borrowing. Chart out a plan re: money and investments in advance so that you cede control of Credit cards, cheque books, etc to a Caregiver at such times.
4) Tendency to stop medication is highest during Mania, be wary of this tendency.
5) Execute an Advance Directive about how you want to be (or do not want to be) treated in case of your mental health worsening and appoint a Nominated Representative to ensure your wishes are followed.
If you are a Caregiver reading this article, you might benefit by downloading our Caregivers’ Manual especially created to impart knowledge and share coping tips.
If you are struggling at the moment, you would do well to remember that with determination and discipline, many of us have attained a great degree of stability and functional recovery.