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Bipolar disorder is one of the most difficult illnesses to treat because by addressing the depression part of the illness, you can inadvertently trigger mania or hypomania. Even in Bipolar II, where the hypomania is less destabilizing than the often-psychotic manic episodes of Bipolar I, persons often experience from a debilitating depression that can’t be lifted by mood stabilizers and antipsychotics. Antidepressants, though, can cause a person with bipolar to cycle between hypomania and depression.

I have worked with psychiatrists who were too afraid of cycling to risk using antidepressants for bipolar patients. They put me strictly on mood stabilizers and antipsychotics. However, I did not get well. I stayed depressed, and all original thoughts in my brain vanished. My current psychiatrist knows that depression is my primary threat, not so much the hypomania, so she was able to pull me out of the depression with the right combination of antidepressants, but is vigilant for any signs of hypomania. Because I know how vulnerable I am to hypomania, I have learned several strategies to help me stay grounded. By making them part of my life, I have been able to take less lithium, my mood stabilizer, which ensures that I continue producing original thoughts and not get too medicated. Here are 10 tools I use to avert hypomania.

1. Practice Good Sleep Hygiene

Developing good sleep habits is by far the most potent tool for preventing mania and hypomania. There are a handful of studies documenting that sleep deprivation is associated with mania and hypomania. By going to bed at 10 every night and sleeping a good eight or nine hours, we have the power to stop rapid cycling and to reverse mania or hypomania. In a study published inBiological Psychiatry a rapid-cycling patient was asked to remain on bed rest in the dark for 14 hours each night (gradually reduced to 10 hours). Times of sleeping and waking were recorded with sleep logs, polygraphic recordings, and computer-based event recordings. His sleep and mood stabilized when he adhered to a regimen of long nightly periods of enforced bed rest in the dark. The abstract’s conclusion: “Fostered sleep and stabilizing its timing by scheduling regular nightly periods of enforced bed rest in the dark may help to prevent mania and rapid cycling in bipolar patients.”

Good sleep hygiene means you go to bed at the same time every night, ideally before 10:30 p.m. — not one night 2 a.m. and another night 7 p.m.; you sleep at least eight hours a night; and you wake at the same time in the morning. Since many folks with bipolar disorder have sleep disorders, a nighttime routine is often needed. For example, I shut down my computer at 8 p.m. and try not to check my emails or messages on my phone. Reading a disconcerting email at 9 p.m. will keep me up all night. It takes me a good two hours to calm down, so I get out the lavender oil around 8:30 p.m., pull out a real book (not an iBook), and begin to tell my body it needs to seriously chill out.

2. Limit Your Screen Time

CNN did a story a few years ago on iPads (or LCD screens) and sleep. Journalist John D. Sutter asked Phyllis Zee, MD, a neuroscience professor at Northwestern and director of the school’sCenter for Sleep & Circadian Biology, if our gadgets can disturb sleep patterns and exacerbateinsomnia. Dr. Zee said:

Potentially, yes, if you’re using [the iPad or a laptop] close to bedtime … that light can be sufficiently stimulating to the brain to make it more awake and delay your ability to sleep. And I think more importantly, it could also be sufficient to affect your circadian rhythm. This is the clock in your brain that determines when you sleep and when you wake up.

I absolutely know that to be true, because for awhile, I was reading iBooks for a half-hour before bed and staying awake until 2 a.m. My concern with LCD screens isn’t limited to bedtime. I know from people in my depression community that persons with bipolar disorder have to be careful with LCD screens at all times, as they can make the highly sensitive person hypomanic if the person doesn’t take a break from them. For me and for many fragile persons with bipolar, looking into an LCD screen for too long is like keeping your light therapy sunbox on all day. I made the mistake of firing up that baby from 9 p.m. to midnight right after I got it, and I did not sleep one iota the next day, and felt hypomanic all day long. Keep in mind that not only is the light stimulating, but so is all of the messages and tagging and poking — especially if you have as many social media handles as I do.

3. Avoid Certain People and Places

Most of us have a few people in our lives that appear as though they’ve downed three shots of espresso every time we see them. They are usually great fun and make us laugh. However, the hyperactivity isn’t what you need if you haven’t slept well in a few weeks and are trying to calm down your body and mind. Same goes with places. I don’t dare step foot inside the mall, for example, between Halloween and New Year’s. There is just too much stuff being forced in front of my face. I also hate Toys-R-Us. I still have nightmares about the time my husband pressed three dozen Tickle Me Elmos and the entire shelf began to shake.

4. Pay Attention to Your Body and Breathe Deeply

Before attending the mindfulness-based stress reduction (MBSR) program modeled after the one developed by Jon Kabat-Zinn at the University of Massachusetts Medical Center, I did not pay attention to my body’s cues preceding a hypomanic episode. In fact, it was usually another person who would point out the embarrassing truth — like the time my editor wrote a letter to my doctor after I started publishing eight blogs a day thinking my traffic would go up. Now, though, when my heart races and I feel as though I have consumed eight cups of coffee, I know this is my opportunity to reverse my symptoms by doing lots of deep breathing exercises.

Of all the automatic functions of the body — cardiovascular, digestive, hormonal, glandular, immune — only the breath can be easily controlled voluntarily, explain Richard P. Brown, MD, andPatricia L. Gerbarg, MD, in their book The Healing Power of the Breath. They write:

By voluntarily changing the rate, depth, and pattern of breathing, we can change the messages being sent from the body’s respiratory system to the brain. In this way, breathing techniques provide a portal to the autonomic communication network through which we can, by changing our breathing patterns, send specific messages to the brain using the language of the body, a language the brain understands and to which it responds. Messages from the respiratory system have rapid, powerful effects on major brain centers involved in thought, emotion, and behavior.

5. Eliminate Caffeine

A good caffeine rush mimics hypomania. You feel more alive, more alert, like you could actually contribute something of worth to the world. That’s all fine and dandy except when you are teetering on the hypomanic edge. Caffeine can provide the ever-so-subtle push to the other side, especially if you aren’t sleeping well, which is when most people most crave caffeine. Stephen Cherniske, MS, calls caffeine “America’s number one drug” in his book Caffeine Blues because of the withdrawal our body goes through three hours after we’ve drank a cup of coffee or a Diet Coke. Persons with bipolar are even more sensitive to amphetamine-like substances that raise dopamine levels, so the safest way to prevent hypomania is to eliminate the stuff altogether.

6. Exercise

My best workouts have been when I’m either on the verge of becoming hypomanic or when I am ticked off. My usual 10-minute mile goes down to an eight. I start passing people along my route, at the Naval Academy, feeling like Lynda Carter in her Wonder Woman getup. And my swim interval is consistent with the people who swam across the Chesapeake Bay in under two hours. The truth is I have averted many hypomanic episodes by working out until I collapse or at least become tired, which can take a few hours. Two years ago, the only way I was able to sleep was by swimming more than 300 laps a day. There are people for whom vigorous exercise triggers mania, but most experts report on the benefits of exercise for bipolar disorder.

7. Watch Your Sweets

There is a reason why ice cream, Swedish Fish, and animal crackers are comfort food for the bipolar person. The rush of insulin generated by those foods will calm those carbohydrate-craving brain pathways for a bit, until a crash in blood sugar has the person binging again on sweets. It’s a vicious cycle, one that can keep a bipolar person cycling indefinitely.

I will tell you a true story about sugar and bipolar. About 16 years ago, before I knew I wasallergic to sugar and that a high-carb diet was the worst thing I could do for my mental health, I would sometimes drink two bottles of Arizona Iced Tea and eat two or three chocolate-chip oatmeal bars for lunch. One day, there was a Horizon milk truck in front of our house with a large cow on the side. I started mooing at the cow. My new husband, behind me, was truly frightened by this and told me to lay off the Arizona Iced Teas and granola bars for awhile. I haven’t mooed at a truck since.

8. Be Careful With the Opposite Sex

I am all for good, healthy friendships between men and women. If you’re not bipolar. Consider me a prude, but I know how difficult it can be to be consistent with good boundaries if you are even the tiniest bit hypomanic. You sincerely didn’t mean for something you sent in an email to sound flirtatious — you were just being playful, like you are with your girlfriends. However, when you do get a reaction from a person of the opposite sex, something in the least bit flattering, that communication can ignite a rush that sends a signal throughout your entire body that you want more of the feel-good hormone it just experienced — dopamine, essentially. It’s even riskier if you have a history of substance abuse and bipolar — because your body will compromise any moral agreements you have signed off on prior to that email in order to get that damn rush again. If you’re not careful, this dangerous game will trigger a full blown manic episode. I have had the best intentions with 85-year-old men, and still, somehow, found myself in trouble. So for the time being, I’m sticking to female friendships.

9. Use a Shopping List

One of the most common manic behaviors is uncontrollable spending or shopping. Therefore, it is sometimes helpful for persons with bipolar disorder to make out a list beforehand of the items you absolutely need to buy — be it a grocery list, a Home Depot run, or a mission to get a your daughter’s friend a birthday gift. That way you won’t end up with 20 different kinds of paint swatches for the kitchen and living room you’ve decided to paint while you were at the store.

10. Allow Time to Decompress

This one is probably the second most important for me to prevent mania. I would say meditate, but that word produces too much expectation and pressure for me right now. Decompressing means after you finish something like a blog post or after you’ve forced yourself to be social for a few hours at a party that you didn’t want to attend, you allow yourselves 15 to 30 minutes to look at the ceiling fan in your bedroom and think about just that: the ceiling fan.

The case has been made that persons with bipolar disorder are creative and therefore need more chill time than the average person. Our brains are operating at a faster pace and more intensely than our non-bipolar friends for the periods of time where we must appear normal. So it is absolutely imperative that we allow some time where nothing is required — where we can drool, or lie in the grass, or doodle, or collapse in front of the front door. Although it seems as though these hours are unproductive, this activity will rebuild the gray matter of our brains and safeguard us from a manic episode.

For people with bipolar, dating means taking it slow, minimizing anxiety, and putting yourself first.

For people with bipolar disorder, piloting the unpredictable waters of dating can mean much more anxiety than normal. Here, five adults with bipolar disorder talk about their dating experiences, and how they navigate both the dating scene and the crucial question of when to disclose their mental health issues.Melanie Greenberg, PhD, a clinical psychologist in Mill Valley, California, and author of the Mindful Self-Expresscolumn on Psychology Today, also weighs in.

First Dates: Manage Your Expectations and Have a Getaway Plan

“I’d just remind myself to cool it — it’s just a date,” says freelance writer Laura Dattaro, 28, of New York City. Dattaro was diagnosed with bipolar II disorder right after her 23rd birthday. “It can be easy to get carried away, especially if your mood is on the upswing.” That excitement and good feeling may make the new person seem like your soul mate or new best friend, she says, and when that doesn’t pan out it’s a big bummer.

Dr. Greenberg agrees, noting that in someone with bipolar disorder, that excitement can be heightened. So to those with bipolar who are entering the dating scene, she advises, “since bipolar people can be impulsive, you might want to prepare yourself for taking your time.” For example, you might not want to get too sexual prematurely.

Greenberg also says that your anxiety could be heightened. Leah Yegneswaran, 24, of Fredericksburg, Virginia, who was diagnosed with bipolar disorder at the age of 20, agrees. “I worry that I’ll be triggered over the course of the date,” says the University of Mary Washington student.

So Yegneswaran creates a backup plan to accommodate the possibility of ananxiety attack. “I tell friends in the area of the date that I might need a safe space in case something happens and I need to crash somewhere,” she says.

Elspeth Rawlings, 23, a student in Frederick, Maryland, tends to only date people she already knows, which helps minimize anxiety. At age 17, Rawlings was misdiagnosed with major depressive disorder. She was formally diagnosed with bipolar I in early 2015 and is now thriving with the right therapy and medicationregimen.

Low-key first dates — like watching movies together — are best for her, Rawlings says. “I don’t really like not having a place to retreat to or get away from crowds if I start to feel bad,” she adds, echoing Yegneswaran.

Ryan Zamo, 26, feels “highly nervous” about dating when he’s in a stable period. “I would be hoping that I don’t start swinging into mania, because then I just get erratic and start spending tons of money that I really shouldn’t be spending,” says the Los Angeles resident. Depressive periods make Zamo not want to go at all: “Nothing’s harder than trying to be interested in someone’s story when you’d rather just not be there.” Zamo, who is CEO of his own organic cosmetics company, says he showed signs of bipolar disorder when he was 18, but was only formally diagnosed at age 22.

Should You Disclose Your Bipolar Disorder?

“Definitely do not tell the person on your first date,” Zamo says emphatically. According to Greenberg, not disclosing right away is okay if doing so would be uncomfortable. But, she adds, “If the relationship is getting more serious, you should reveal it.”

“If you think you might behave in a way that is uncomfortable for the other person,” says Greenberg, that’s another reason to disclose.

Zamo has had that experience. When he discloses that he has bipolar disorder, it’s usually after he’s become “feisty and irritated during a low period.” Later, he’ll feel bad about it, and revealing his bipolar disorder is “the only way to explain being an ass to them,” he says.

Michelle Mallet, 32, of Seattle, describes herself as outspoken and open with friends and coworkers about her mental health. Mallet, who currently works as a chef, was diagnosed with the condition around age 18 or 19. Despite being outspoken about her condition, Mallet doesn’t reveal that she has bipolar disorder on a first date.

RELATED: Why Bipolar Disorder Is Often Misdiagnosed

“I want to know the people I tell this to first,” she says. Dattaro leans that way, too, in a mental balancing act of her own. “I try not to think about it as some scary secret that needs to be revealed,” she says. “It’s more an aspect of my life that’s just a little more personal than regular first-date fodder.”

Rawlings takes a different approach because she has anxiety and panic disorderalong with her bipolar. “I disclose as soon as possible just so I don’t scare someone, but also to protect myself from people who aren’t necessarily accepting when it comes to mental health issues,” she says.

The Risks (and Benefits) of Building a Relationship

When you have bipolar disorder, dating can make you feel like you’re not quite in control of your emotions, says Greenberg. You could feel like you’re becoming too angry or being ultra-sensitive, she adds. When it comes to relationship style,research has shown that adults with bipolar disorder display more insecure attachment styles when compared to people without the disorder. Zamo says he’s definitely scared people off, either because he cut off communication during a low spell, or because his manic behaviors were too much for someone else to handle.

The mood state does matter, according to Mallett. She once reached out to someone she was dating while she was in a “depressive, anxious cycle,” requesting that they turn their relationship into something more serious. Mallett’s request was rejected. “That triggered an anxiety spiral, which triggered my depressive cycle to the max, and I spent the next day in a super-duper fog and then drove myself to the hospital and checked in for suicide watch,” she explains. “I was in a serious, depressive state for two months,” she says, and had to take medical leave.

But what about the pluses of dating? Dattaro sees some possibilities. “One positive aspect is that it can show you that people aren’t really all that judgmental about it. If they are [judgmental], find new people!” Dattaro thinks that opening up to someone and seeing that they remain calm about it can “really bring trust into your relationship.”

Rawlings has found that all of the people she’s dated have had a form a mental illness, and that a good portion of her friends do, too. In fact, there are dating sites that cater specifically to bipolar matchmaking, like BipolarDatingSite. The ability to make jokes and talk about that shared experience can be a coping mechanism, she believes. On the flip side, though, is that you could become a “project” of some well-intended person who wants to help fix you without understanding that it’s not something they can do.

Know Yourself, and Get to Know Your Date, Too

Getting to know the person first makes a big difference. “Take things slowly,” Greenberg says. “Don’t let insecurity drive you, or feel less than [the other person] because you are bipolar.”

Be self-forgiving, too, says Yegneswaran. “Don’t berate yourself for not living up to what you think you ‘should’ be like,” she says. Rawlings agrees: “You should not let anyone tell you that you are broken or not good enough, even if it’s your own brain telling you that.”

“Don’t let being bipolar stop you!” says Mallett. She didn’t date for years because she was worried that she was too depressed or too manic to be attractive to someone without a mental illness. “But if someone likes and then loves you, they’ll love the whole you, and that includes your messed-up brain.”

When you have created an agenda for yourself, are you easily frustrated by people who evidently have no deadlines to meet and are enjoying a perpetual shortage of things needing to be done and, worse, who manage to inadvertently hinder your productivity? Apparently “normal” people don’t feel that they have to constantly utilize every waking second of the time during which they feel like being productive, whether it be work-related or personal productivity. However, what those people seem to neglect to consider is the constant race against time we who are learning to manage bipolar disorder remain incessantly engaged in.

I’d never really put much conscious thought into my need for speed on the few days each week in which I feel truly compelled to do something useful and productive – until a couple nights ago when situation after situation began “stealing” my time. At that point, it became apparent to me that I was absolutely furious at anyone who took more of my time than I believed they should require. For example, a friend had come by to help me with some household projects. In an attempt to decrease the amount of time I had to engage in actual interaction with him (& hoping to thereby extinguishing the need for potentially taking even more time with stray conversation and small talk!), I made a list of tasks I was delegating to him before he arrived. Everything was fine as I placed my headphones in my ears, iPod on as high as the volume would go, and prepared to enter my “zone.” However, when he came to me with question after question – the answers to which all seemed overly obvious, given the simplistic language my list for him had embodied, my mere annoyance began to intensify until it eventually became anger. Then, when he became defensive toward my frustration with his misunderstandings, I went from being just angry to being immensely irate! My friend and I eventually came to an understanding that night, but the question of how he couldn’t understand that I simply refused to expend my limited time on him by providing answers to every “what if” question he could think of or on stopping to listen to him make suggestions on topics that weren’t open for debate as far as I was concerned, remained in my thoughts.

After a few hours, it became clear to me that he’d probably never felt this intense demand to accomplish a week’s worth of tasks and goals in only a couple days. Since people who aren’t dealing with such limitations of bipolar disorder can always begin a task they previously left unfinished on the following day, or even further into the future, they likely can’t understand my passion for getting everything done as quickly as possible, staying up all night as many nights as I can in order to keep up the stamina until the things I’ve decided to do are completed. While I’m not sure whether bipolar disorder manifests in this increased emotional intensity aimed at accomplishing tasks I’ve appointed myself to do NOW, and not later, I can say that this behavior is at least somewhat indicative of hypomania (or mania in a more extreme form). Since hypomania, mania and bipolar disorder in general have had stigmas attached to them traditionally, few people truly understand that while I have to operate on a level “normal” people cannot possibly comprehend (especially when, as far as they know, there are no life-or-death consequences for tasks being finished when I say they need to be), consistently living at such a break-neck pace, I end up becoming frustrated and angry when they become obstacles to my successfully completing what I’ve decided I want to get done. Thus, they can’t fathom why it’s so very inconvenient to me if they put unnecessary obstacles in my path, particularly conversation that I could do without.

However, on the other hand, what they fail to realize is that when my mood swings into a depressive episode (or at least into a less hypomanic/manic phase), I’ll no longer be productive, regardless of how much I want to be or how few obstacles are in my path. I simply won’t feel like accomplishing anything and will lose time when I’m sluggish and unmotivated for a few days. As such, unbeknownst to them, in my mind it’s absolutely imperative that I maintain this level of frantic productivity throughout the days in which I feel compelled to do so – simply in order to “make up for” those days that I know are ahead of me during which NOTHING will be completed. Once I thought about this discrepancy between our thought patterns, I began feeling somewhat guilty for having had such impatience with him. However, I came believe that it’s as crucial for us with bipolar disorder to attempt to explain to people close to us that demanding minimal distraction is not a flaw or a form of us being inconsiderate, ungrateful, or selfish on days in which we feel up to being productive. We need to make them understand that while they have fairly consistent levels of productivity, sleep patterns, and motivation on a daily basis; we share the very same thoughts but simply do so on a somewhat different cycle of both productivity and lack thereof.

As more objective information is discovered and published concerning bipolar disease and its components, we come closer to all getting along and working effectively together, realizing that there’s no “right” or “wrong” way to live life; rather, there are different cycles and different schedules that all work in order to create the diversity that makes this world, and each life in it, beautiful and enticing. As such, the next time you’re feeling overly irritated at people “taking up” your time when you’re feeling “on top of the world” and capable of doing all the things that have been piling up on your to do list, try stopping just for a moment and providing them with the difference of their being able to work each day and sleep each night while you simply work better and have a preference to work harder and longer at a time, then resting longer. If we all keep an open mind and stray from making generalizations about “correct” behavior that we base on subjective interpretations and preferences, I believe bipolar disorder people will carve their own little niche in the world of work and productivity. Not only that, but I’m certain we’ll be admired and appreciated for our unique ability to work under differing conditions than have traditionally been accepted while still producing equally, if not superior, impressive and creative outcomes.

-Haley

Everyone feels anxious from time to time. Stressful situations such as meeting tight deadlines or important social obligations often make us nervous or fearful. Experiencing mild anxiety may help a person become more alert and focused on facing challenging or threatening circumstances.

But individuals who experience extreme fear and worry that does not subside may be suffering from an anxiety disorder. The frequency and intensity of anxiety can be overwhelming and interfere with daily functioning. Fortunately, the majority of people with an anxiety disorder improve considerably by getting effective psychological treatment.

What are the major kinds of anxiety disorders?

There are several major types of anxiety disorders, each with its own characteristics.

• People with generalized anxiety disorder have recurring fears or worries, such as about health or finances, and they often have a persistent sense that something bad is just about to happen. The reason for the intense feelings of anxiety may be difficult to identify. But the fears and worries are very real and often keep individuals from concentrating on daily tasks.
• Panic disorder involves sudden, intense and unprovoked feelings of terror and dread. People who suffer from this disorder generally develop strong fears about when and where their next panic attack will occur, and they often restrict their activities as a result.
• A related disorder involves phobias, or intense fears, about certain objects or situations. Specific phobias may involve things such as encountering certain animals or flying in airplanes, while social phobias involve fear of social settings or public places.
• Obsessive-compulsive disorder is characterized by persistent, uncontrollable and unwanted feelings or thoughts (obsessions) and routines or rituals (compulsions) in which individuals engage to try to prevent or rid themselves of these thoughts. Examples of common compulsions include washing hands or cleaning house excessively for fear of germs, or checking work repeatedly for errors.
• Someone who suffers severe physical or emotional trauma such as from a natural disaster or serious accident or crime may experience post-traumatic stress disorder. Thoughts, feelings and behavior patterns become seriously affected by reminders of the event, sometimes months or even years after the traumatic experience.

Symptoms such as extreme fear, shortness of breath, racing heartbeat, insomnia, nausea, trembling and dizziness are common in these anxiety disorders. Although they may begin at any time, anxiety disorders often surface in adolescence or early adulthood. There is some evidence that anxiety disorders run in families; genes as well as early learning experiences within families seem to make some people more likely than others to experience these disorders.

Why is it important to seek treatment for these disorders?

If left untreated, anxiety disorders can have severe consequences. For example, some people who suffer from recurring panic attacks avoid any situation that they fear may trigger an attack. Such avoidance behavior may create problems by conflicting with job requirements, family obligations or other basic activities of daily living.

People who suffer from an untreated anxiety disorder often also suffer from other psychological disorders, such as depression, and they have a greater tendency to abuse alcohol and other drugs. Their relationships with family members, friends and coworkers may become very strained. And their job performance may decline.

Are there effective treatments available for anxiety disorders?

Absolutely. Most cases of anxiety disorder can be treated successfully by appropriately trained mental health professionals such as licensed psychologists. Research has demonstrated that a form of psychotherapy known as “cognitive-behavioral therapy” (CBT) can be highly effective in treating anxiety disorders. Psychologists use CBT to help people identify and learn to manage the factors that contribute to their anxiety.

Behavioral therapy involves using techniques to reduce or stop the undesired behaviors associated with these disorders. For example, one approach involves training patients in relaxation and deep breathing techniques to counteract the agitation and rapid, shallow breathing that accompany certain anxiety disorders.

Through cognitive therapy, patients learn to understand how their thoughts contribute to the symptoms of anxiety disorders, and how to change those thought patterns to reduce the likelihood of occurrence and the intensity of reaction. The patient’s increased cognitive awareness is often combined with behavioral techniques to help the individual gradually confront and tolerate fearful situations in a controlled, safe environment.

Along with psychotherapy, appropriate medications may have a role in treatment. In cases where medications are used, the patient’s care may be managed collaboratively by more than one provider of treatment. It is important for patients to realize that there are side effects to any drugs, which must be monitored closely by the provider who prescribed the medication.

How can licensed psychologists help someone suffering from an anxiety disorder?

Licensed psychologists are highly trained and qualified to diagnose and treat people with anxiety disorders using techniques based on best available research. Psychologists’ extensive training includes understanding and using a variety of psychotherapies, including CBT.

Psychologists sometimes use other approaches to effective treatment in addition to individual psychotherapy. Group psychotherapy, typically involving unrelated individuals who all have anxiety disorders, can be an effective approach to delivering treatment and providing support. Further, family psychotherapy can help family members better understand their loved one’s anxiety and learn new ways of interacting that do not reinforce the anxiety and associated dysfunctional behaviors.

Individuals suffering from anxiety disorders may also want to consider mental health clinics or other specialized treatment programs dealing with specific anxiety disorders such as panic or phobias that may be available in their local area.

How long does psychological treatment take?

The large majority of people who suffer from an anxiety disorder are able to reduce or eliminate their anxiety symptoms and return to normal functioning after several months of appropriate psychotherapy. Indeed, many people notice improvement in symptoms and functioning within a few treatment sessions. The patient should be comfortable from the outset with the psychotherapist. Together the patient and psychotherapist should develop an appropriate treatment plan. The patient’s cooperation is crucial, and there must be a strong sense that the patient and therapist are collaborating well as a team to treat the anxiety disorder.

No one plan works well for all patients. Treatment needs to be tailored to the needs of the patient and to the type of disorder, or disorders, from which the individual suffers. The psychotherapist and patient should work together to assess whether a treatment plan seems to be on track. Patients respond differently to treatment, and adjustments to the plan sometimes are necessary. Anxiety disorders can severely impair a person’s functioning in work, family and social environments. But the prospects for long-term recovery are good for most individuals who seek appropriate professional treatment. People who suffer from anxiety disorders can work with a qualified and experienced mental health professional such as a licensed psychologist to help them regain control of their feelings and thoughts — and their lives.

Most people with anxiety disorders can experience great improvements with professional care.

There are a number of treatment approaches for anxiety disorders.

The type of treatment you receive will depend on your symptoms and type of anxiety disorder.

Not every treatment works for every person. You may need to try a number of treatments, or combinations of treatments, before finding what works for you.

The main categories of treatments for anxiety disorders include:

Medications
Psychotherapy (talk therapy with a trained mental health professional)
Natural remedies and complementary treatments
Anxiety Medications

A range of medications are available to treat anxiety disorders.
Anxiety medications often are used in conjunction with psychotherapy to treat anxiety disorders.

The two general types of medications used to treat anxiety disorders are:

Anti-anxiety medications (sometimes called anxiolytics)
Antidepressants
Psychotherapy for Anxiety

A form of psychotherapy called cognitive behavioral therapy (CBT) often is used to treat anxiety disorders.

CBT focuses on changing unhealthy thinking and behavior patterns through talk sessions with a trained therapist.

During CBT, you’ll work together with your therapist to develop positive techniques for coping with fear, anxiety, and other symptoms. You’ll also learn to identify and manage factors that contribute to your anxiety.

CBT may involve learning how to change harmful thought patterns so that you experience less anxiety over time. You also may learn relaxation techniques — such as deep breathing exercises — to help counteract anxiety symptoms when they occur.

CBT is not a quick fix. It may take up to three or four months before you see benefits from your therapy sessions.

Some people receiving CBT also take medications for their anxiety.

There are several different types of CBT. One type of CBT is called exposure therapy.
Exposure therapy is used to treat certain phobias. It involves gradually exposing you to a feared situation or object, causing you to become less fearful over time.

Natural Remedies for Anxiety

Certain alternative practices and natural remedies may be used alongside conventional treatments (such as medication and psychotherapy) to treat anxiety disorders.

These alternative remedies include:

Meditation: There’s some scientific evidence that meditation — especially a type of meditation training called mindfulness-based stress reduction — can help reduce anxiety and depression symptoms.

Regular exercise and yoga: Yoga combines physical postures, breathing exercises, and meditation.

Some studies suggest that practicing yoga (or performing other types of regular exercises, such as walking or jogging) can help reduce anxiety.

Acupuncture: Some scientific evidence suggests that acupuncture — the Chinese practice of inserting thin needles into the body at certain points — can help reduce symptoms of anxiety.

Acupuncture may be especially effective when combined with other treatments, such as CBT.

Kava: This dietary supplement comes from the crushed root of a Polynesian shrub. Some studies show that kava may be useful for treating anxiety symptoms.

Speak with your doctor before using kava. The Food and Drug Administration (FDA) warns that using kava supplements may lead to liver damage in some people.

Lavender: Lavender oil is commonly used in aromatherapy.

Some people believe that this scent has a calming or soothing effect, but there’s little scientific evidence to support the use of lavender for treating an anxiety disorder.

St. John’s wort: Supplements made from this plant have been used to treat depression, anxiety, and sleep disorders.
Some scientific studies show that St. John’s wort may be no more effective than a placebo (inactive pill) for treating these disorders.

Valerian: This medicinal herb has been used to treat anxiety and depression for many centuries.

Still, there isn’t enough scientific evidence to know whether valerian is an effective treatment for anxiety disorders.

Experiencing mood shifts based on seasonal sunlight? Exercise, stress reduction, and vitamin D may help.

Signs of seasonal bipolar disorder include feeling hopeless, tense, or stressed.

Seasonal Affective Disorder Versus Seasonal Bipolar Disorder

Doctors have long distinguished between seasonal depression and seasonalbipolar disorder. Seasonal depression — commonly referred to as SAD, for seasonal affective disorder — is a mood disorder brought on by the biologicaleffects of a lack of sunlight. Typically experienced in the late fall and winter, it is particularly prevalent in northern regions, according to the American Psychological Association (APA). What distinguishes seasonal bipolar disorder from SAD is the presence of a manic episode within a given period of time.

People must have a history of manic or hypomanic episodes (the extreme highs) to be diagnosed with a bipolar mood disorder, explains Ken Duckworth, MD, medical director for the National Alliance on Mental Illness (NAMI) and an assistant professor at the Harvard University Medical School. If that’s not part of their medical history, he says, then their seasonal winter response is a depressive disorder and not bipolar.

RELATED: What Psychologists Want You to Know About the Holiday Blues

Warning signs of seasonal affective disorder and an upcoming bout of depression can include feeling hopeless, tense, or stressed, and losing interest in people or activities you normally enjoy, according to Harvard University. You may notice this happens to you every year in late fall and early winter and doesn’t get better until late into the spring, Dr. Duckworth says.

Seasonal Shifts in Mood: Who Is Affected?

Why do some people experience a seasonal component to their bipolar disorder and others don’t? One of the most prominent developing theories has to do with circadian rhythms — the “biological clock” — the body’s internal, rhythmic response to changes in a 24-hour day, especially sunlight. This response is controlled by a complex set of genes commonly referred to as “clock genes.” If some of these genes are abnormal, you may have a higher risk of developing seasonal bipolar disorder, according to a study published in August 2015 in Frontiers in Psychology.

But while it’s likely that in some people there’s a bipolar-SAD connection, it hasn’t yet been proven. Duckworth says, “There’s nothing definitive.”

Gabe Howard, 38, of Columbus, Ohio, was diagnosed with bipolar disorder in 2003 and he also experiences SAD when it’s dark, cold, and snowy outside. “I definitely feel more sad in the winter,” he says. “I’m sleepier, and I’m more tired, and I can be more irritable.”

Howard has to work a little harder to stay on an even keel during the winter months. When he was first diagnosed with bipolar disorder and SAD, his doctor needed to adjust his medications for the seasons, but he hasn’t had to do that for years. Howard believes adding therapy skills — including radical acceptance, where you learn to accept what is and not turn things into catastrophes — to his treatment regimen helps him cope better with both illnesses. Also, during the winter he’s especially mindful of eating healthy and participating in activities he enjoys, such as watching hockey on TV. He also tries to sleep more, but not too much. “I find I need [to bank] more reserves in the winter,” he says.

7 Treatments for Bipolar Disorder and Seasonal Depression

If you and your doctor determine that your bipolar disorder has a seasonal component, the doctor may suggest various treatment options, particularly related to depressive episodes, which tend to be more severe among those with seasonal bipolar disorder.

1. Exercise. If the depression is mild, you may not need additional medication. Rather, you may be able to manage your depression with healthy lifestyle habits, including exercise. Take a brisk walk during the sunniest part of the day, the APAsuggests. Even short bouts of exercise can help lift your mood.

2. Maintain a routine. Keep your daily living patterns — waking, sleeping, eating — the same as much as possible, Duckworth says. “You can create a rhythm where your body will be well regulated.”

3. Light therapy. Light therapy, such as special light boxes used 30 minutes a day, can be helpful. Light therapy may work faster than medications in some people, according to NAMI. But light therapy must be used carefully. Light therapy has the potential of inducing a manic reaction in the person with bipolar disorder, Duckworth says. Too much bright light “tends to correlate with mania just as too little correlates with depression,” he explains.

RELATED: 5 Foods to Avoid If You Have Bipolar Disorder

Bright-light therapy should be seen as a regular antidepressant treatment in people who have seasonal bipolar depressive episodes, according to a study published in October 2015 in the journal L’Encephale. But it’s not a guaranteed treatment. Howard, for instance, found it didn’t work for him.

4. Melatonin. If the depression is severe, light therapy may be prescribed in combination with medications, such as melatonin. A naturally occurring chemical transmitter that helps regulate circadian rhythms, melatonin has long been used in synthetic form to reset the biological clock for people suffering from jet lag orinsomnia. But over-the-counter melatonin may not be enough. A study published in 2012 in the journal Expert Opinion on Investigational Drugs suggests thatantidepressants that regulate melatonin may be the best treatment for depressive disorders, including SAD and bipolar.

5. Stress reduction. Stress is a major contributing factor in SAD and can trigger bipolar episodes, NAMI says. It’s hard to avoid all sources of stress, but try to limit those you can. If you have seasonal bipolar disorder, don’t change jobs or your home in the dead of winter, Duckworth advises. Meditation and mindfulness also can help you manage stress, according to the APA.

6. Vitamin D. Low levels of vitamin D have been linked to depressive disorders. Researchers in Australia reported in 2014 in the journal Nutrients that for some people with a vitamin D deficiency, supplementation can work as well as antidepressants in managing depression. Howard takes vitamins, including D, year-round and finds this helps stabilize his moods. Ask your doctor to test your vitamin D levels and whether you should take supplements.

7. Plan ahead. Be proactive about your bipolar and SAD disorders, Duckworth says. Learn about your seasonal patterns of depression and know what can trigger them so that you can try to avoid them, especially in winter. Having a plan to deal with potential stressors can help, too. Know what you’ll do if a snowstorm leaves you homebound, for example. Knowing you have solutions will make it easier to deal with problems should they arise, states the bipolar caregivers guide of the University of Melbourne.

The good news about seasonal bipolar disorder relates to the management of your symptoms. Unlike people with bipolar disorder without a seasonal component, you can anticipate the coming of your mood shift simply by watching the calendar. You and your care team can be prepared with a solid treatment plan in hand.

Additional reporting by Beth W. Orenstein.

When combined with prescribed medication, these alternative approaches may help you better manage the symptoms of bipolar disorder.

Lower rates of self-harm, accidental injury seen.

People taking one of the alternative mood stabilizers were 40 percent more likely to harm themselves compared to patients on lithium.
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Thursday, May 12, 2016

Lithium outperforms newer mood stabilizers in the treatment of bipolar disorder, a new study has found.

In 1990, Congress designated the first full week of every October to be National Mental HealthAwareness Week. This year that week is October 7-13, 2007 and October 11th is both National Depression Screening Day, sponsored by Screening for Mental Health, Inc., and Bipolar Disorder Awareness Day. Bipolar Disorder Awareness Day is organized by the National Alliance on Mental Illness (NAMI), a non-profit group which is the nation’s largest grassroots mental health organization dedicated to improving the lives of persons living with serious mental illness and their families.

Bipolar disorder is also called manic depression or manic-depressive illness, but its treatment is different from that of depression (see below). It is a chronic brain disorder that causes extreme shifts in mood, energy and ability to function. It is characterized by episodes of mania (being overly ‘high’) and depression (being irritable, sad or hopeless) that can last from days to months. Symptoms often begin in adolescence or early adulthood and can result in poor school performance, poor job performance, damaged relationships, substance abuse, criminal or other irrational behavior and even suicide. Oftentimes depression dominates the clinical picture and mania may go unrecognized, especially if it is mild (called hypomania) or occurs only rarely. However, the recognition of mania is critical to the proper diagnosis of bipolar disorder, which might otherwise be diagnosed as depression (also called unipolar depression).

The treatment of bipolar disorder is different from the treatment of depression. Everyone knows that depression is treated with anti-depressants. But bipolar disorder, even though it has depression as a component, needs to be treated with mood stabilizers first and foremost. Anti-depressants play a much lesser role, if any, in the treatment of bipolar disorder, and they can actually make the illness worse (especially if used alone without mood stabilizers). You can see why proper diagnosis is so important.

In recognition of Bipolar Awareness Day, HealthTalk has created a Special Feature page with a wide variety of useful information, including treatment information, on this illness.

Bipolar Awareness Day was created by NAMI and Abbott Laboratories to, according to the NAMI Web site “increase awareness of bipolar disorder, promote early detection and accurate diagnosis, reduce stigma, and minimize the devastating impact on the 2.3 million Americans presently affected by the disorder.” The government’s National Institute of Mental Health states that about 5.7 million American adults have bipolar disorder in any given year. Other estimates put the number of people with bipolar disorder at 10 million.

Mood stabilizers are medications that can treat the extreme highs of bipolar disorder. Find out about the risks and benefits of these drugs.