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Bipolar disorder carries a high lifetime risk for suicide. Protect yourself by knowing the risk factors and suicide prevention steps to take.

If you have bipolar disorder, you may have suicidal thoughts at some time during your life. There are almost two million Americans living with bipolar disorder, and bipolar treatment helps most of them control their symptoms. But even though bipolar treatment works 80 to 90 percent of the time, bipolar disorder is a lifetime disease, and the suicide risk numbers can’t be ignored.

“Half of all people with bipolar disorder attempt suicide at least once, and up to 20 percent will eventually succeed,” warns Keming Gao, MD, PhD, a professor of psychiatry at Case Western Reserve School of Medicine and clinical director of the Mood Disorders Program at University Hospitals Case Medical Center in Cleveland.

The highs of bipolar disorder are very high and the lows are very low. That explains why the risk for suicide is high. And because substance abuse among those with bipolar disorder is very common, the lifetime risk is among the highest of any illness.

Suicide Risk Factors for Bipolar Disorder

One of the biggest suicide risk factors is stopping your bipolar treatment medication. Bipolar treatment with lithium is effective for suicide prevention, but suicide rates in the first year after stopping lithium are 20 times higher than when a person stays on lithium. Rule number one is to never stop or change bipolar treatment on your own.

“Eighty percent of suicidal ideation [thinking about suicide] occurs during depression, but most suicide attempts occur in a mixed state when a ‘high’ provides the energy to actually carry out the plan,” explains Dr. Gao.

Here are some other suicide risk factors:

• Alcohol or drug use
• A coexisting anxiety disorder
• Legal problems
• Relationship problems
• Having guns around the house
• Isolation
• Recent hospital discharge
• A family history of suicide
• Previous suicide attempt

Suicide Warning Signs for Bipolar Disorder

Though you can’t predict when a suicide attempt may occur, there are some red flags you can look for.

Friends and family may notice certain events that can predict a suicide plan. “A warning sign can be like an ‘ugly duckling.’ Watch out for unusual changes in behavior, like taking a trip or giving belongings away,” says Gao.

Here are some other signs for you and your loved ones to be aware of:

• Feeling like there is nothing to live for
• Feeling hopeless
• Talking or writing about death
• Feeling uncontrolled anger or the need for revenge
• Engaging in reckless activities
• Feeling too anxious to sleep
• Experiencing wild mood swings

Getting Help for Suicide Prevention

The first step is to talk to somebody, such as a trusted friend or family member. “Let someone know if you have any thoughts of death or suicide, even if they do not seem serious yet. The worst thing to do is keep it to yourself and isolate yourself,” advises Gao.

Here are the other steps for suicide prevention:

• Call your doctor right away.
• If nobody is available to talk to you, call the National Suicide Prevention Lifeline at 1-800-273-TALK.
• If you feel you are in immediate danger, call 911 or get to a hospital emergency room at once.

When you have bipolar disorder, even when you are on bipolar treatment, suicide is too big of a risk to ignore. Take all thoughts of death or suicide seriously and ask for help immediately.

After living more than a decade misdiagnosed with depression and powerless to her extreme mood swings, Mary Ann Ceron finally received the right diagnosis — bipolar disorder — and she took back control of her life. Now she’s helping others do the same.

Mary Ann Ceron doesn’t throw her own pity parties any more. After all, she says, everyone has “something” they deal with, and feeling sorry for yourself accomplishes nothing.

She delivers that message with empathy and conviction as a volunteer facilitator at the New York City affiliate of the nonprofit National Alliance on Mental Illness (NAMI). Ceron, 45, teaches courses that are focused on managing life with mental illness. Her students are both people living with mental health conditions and their family members.

The management techniques she shares are comprised of lessons she’s learned in her own life: Like nearly 6 million Americans, Ceron has bipolar disorder, a generally lifelong condition characterized by extreme shifts in mood, energy, and level of functioning.

But this wife and mother of three wasn’t always so tuned in to her condition — and neither was her psychiatrist. For a decade, Ceron says she endured a roller-coaster existence, in part because her psychiatrist misdiagnosed her with depression. Her bipolar disorder threatened her health, as well as her job as an administrative assistant at a major accounting firm. “I missed so many days there, I don’t know how I didn’t get fired earlier,” she recalls.

The First Signs of Bipolar Disorder

Bipolar disorder, as with other mental disorders, often runs in families. Growing up in Brooklyn, Ceron remembers her mother sleeping frequently to escape depression. Later, as a young adult, Ceron recalls being so blue herself that she’d spend days hibernating in bed.

Throughout her teenage years and early 20s, Ceron’s emotions ricocheted as she abused alcohol, drugs, and cigarettes. At 23, she took a year-long, self-imposed break to “get clean” before her son was born. But the unbearable stress of her son’s premature birth along with his serious medical problems precipitated even deeper depression. Ceron soon returned to substance abuse, accompanied by promiscuous behavior that fed an insatiable sex drive.

“I felt so alone and so misunderstood,” Ceron says. “I woke up with people I didn’t know, went on wild spending sprees, and did things I wouldn’t have done in the past.”

At 29, Ceron finally saw a psychiatrist to get help for rock-bottom depression, at a time when her rage, impulses, and grandiose thinking — all symptoms of mania — weren’t plaguing her.

People with undiagnosed bipolar disorder often seek help when they’re feeling depressed, not when they’re in a state of mania. In fact, they may face up to 10 years of juggling symptoms before getting an accurate diagnosis; only one in four people with bipolar disorder are properly diagnosed in less than three years. One study shows that 40 percent of bipolar patients, like Ceron, previously received a misdiagnosis of only major depression.

Ceron’s doctor asked a few cursory questions and then hurriedly wrote a prescription for an antidepressant. The medication worked for a short time until Ceron decided to discontinue taking it. In hindsight, she believes its unpleasant side effects made her manic.

Finding the Right Diagnosis

On a highly charged day at work in 1999 after an argument with a colleague, an agitated Ceron shoved the colleague, exhibiting what she now recognizes as more symptoms of bipolar mania — impulsiveness, reckless behavior, and poor judgment. Her employer had only one response for her actions: “Please don’t come back.”

“I felt like a failure, unworthy to be a part of this world. My eyes felt like lead and my forehead hung over my face like a dark cloud,” she remembers. Her bipolar “lows” brought with them decreased motivation and lack of interest and concern: “My children ate cereal all day.” But when she’d enter a manic phase, she’d fly on grandiose highs before having another crash.

In her 30s, and on Medicaid due to her job loss, Ceron was forced to find a new psychiatrist. Fortunately, she found one who asked the right questions, and she finally received the proper diagnosis — Ceron had bipolar disorder. After so many years of wondering what was going on, dots were finally connected in a way that allowed Ceron to accept the diagnosis and move forward.

Her psychiatrist prescribed a mood stabilizer and SSRI (selective serotonin reuptake inhibitor) antidepressant. Cognitive behavioral therapy was ordered to help her identify and manage negative or inaccurate thoughts.

“The difference was night and day,” Ceron says “I felt calm, patient, and in control.” Despite the medication and therapy, she still faces bipolar battles: She’s since been hospitalized five times and found that life’s stressors can trigger a downward spiral. Tolerating the side effects of the medication is also a challenge, but Ceron remains positive

“It’s all a battle,” she says, “but one worth winning.”

Ceron now takes an anticonvulsant used to treat bipolar disorder, along with a different SSRI, plus a benzodiazepine for anxiety and as a sleep aid. She continues with her therapy, which she says prevents her illness from controlling her.

With her treatment program stable, so is Ceron. “I’m also lucky to be so supported by my family and my friends,” she says. She’s counsel to her children, ages 20, 16 and 6, all of whom also have mental health conditions.

Living Well with Bipolar Disorder: Mary Ann’s Tips

Ceron knows support groups can make a real difference. At NAMI, she found a spot as a member and a volunteer. “I found others like me, and that changed the course of my life. Once I realized I was not alone, the possibility of getting better was real,” she says.

Now the lessons Ceron teaches at NAMI elicit similar positive responses. “I can see the students ‘light up’ when they finally understand,” she says. “When I teach, it reinforces and reminds me what I need to do to stay well. It’s also great to be around people I can relate to.”

Ceron shares this advice for managing bipolar disorder:

1. Have at least one friend you can vent to.
2. Read self-awareness books to help you grow. She suggests Addiction and Grace by Gerald G. May, M.D. and Battlefield of the Mind by Joyce Meyer, among others.
3. Be completely “gut honest” with your therapist. You’ll teach him things, too.
4. Faith can be a major help in recovery, as can people who are positive.
5. Bike riding, swimming, and other activities are great for the mind. Free the body to help free the mind.
6. Spend time alone, to process your thoughts and reflect on what you’re feeling and thinking.
7. Get in touch with your “inner child,” with past experiences from growing up, and your relationships with family. Who you are now comes from how you grew up.
8. Discuss all medical conditions with your medical team. Remember: Mind and body connect.

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At the peak of mania, bipolar symptoms may look like schizophrenia. At a deep low, it’s hard to distinguish between depression and bipolar disorder. How can you tell the difference?

The first step to successfully managing bipolar disorder? Getting an accuratediagnosis.

But because symptoms of other mental health conditions — such as depression and ADHD — can mimic bipolar disorder, getting to that diagnosis can be tricky. Even experienced mental health professionals can find it hard to diagnose bipolar disorder, especially if all they have to work with is a person in crisis or the statements of the bipolar patients themselves.

“When someone with bipolar disorder goes for treatment, they fairly naturally will downplay their hypomanic or manic episodes,” explains Michael Otto, PhD, professor of psychology at Boston University and author of Living with Bipolar Disorder. That’s why it works best when friends and family are involved, he says. People with bipolar disorder may not recall how bad their episode was or may try to minimize it because they are embarrassed. Yet it is those extremes and overall patterns that ultimately distinguish bipolar disorder from other conditions.

Here’s a look at six other mental health conditions that often get mistaken for bipolar disorder — and how you can tell the difference.

Is It Bipolar Disorder or ADHD?

Sure, there’s some overlap between bipolar disorder and ADHD, a common behavioral problem characterized by distraction and impulsiveness. In fact, the two conditions often get misdiagnosed for each other in kids — but getting an accurate diagnosis is extremely vital, says Otto. “ADHD drugs are not meant for someone with bipolar disorder.”

Similarities:

• Similar symptoms include being restless and easily distracted.

Differences:

• ADHD symptoms often begin to appear in early childhood, and people with ADHD cope with them all the time. Says Otto, ADHD symptoms are continuous and affect all aspects of life.
• Bipolar symptoms are temporary and usually start to appear in young adulthood — the average age of onset is around 20. With rapid cycling bipolar disorder, symptoms may come on in the teen years.

Is It Bipolar Disorder or Borderline Personality Disorder?

Since many symptoms of borderline personality disorder and bipolar overlap, these conditions are often mistaken for each other. But the two are different illnesses, each with their own symptoms and treatments.

Similarities:

• “Both have harmful acting out and unstable mood as symptoms,” says Otto. Observing the patient over time is necessary to distinguish bipolar symptoms from borderline personality disorder.

Differences:

• “With borderline personality disorder, mood changes tend to be rapid across the day and much more linked to interpersonal challenges,” Otto says. Most people with bipolar disorder have longer mood cycles with quiet periods in between, although rapid cycling bipolar disorder can strongly resemble borderline personality disorder.

Is It Bipolar Disorder or Depression?

Bipolar disorder often gets misdiagnosed as depression. In fact, until fairly recently, bipolar disorder was often called manic depression. Personal medical history and family history can help identify the type of depressive episode — unipolar or bipolar — you might be having.

Similarities:

• The symptoms of depression may look the same for unipolar depression as they do for a depressive episode of bipolar disorder.

Differences:

• The main difference between bipolar disorder and depression are the mania symptoms — characterized by excessive excitement or irritability, extreme elation, and delusions of grandeur — that are associated with the bipolar condition.

Is It Bipolar Disorder or Schizophrenia?

The pattern of symptom onset is the important marker to distinguish between bipolar disorder and schizophrenia.

Similarities:

• Both conditions may begin in young adulthood, and recent research suggests they have similar genetic links.

Differences:

• Symptoms of schizophrenia tend to emerge gradually but more or less progressively over time. Bipolar episodes, however, seem to cycle, with periods of being relatively “normal” in between.
• “With schizophrenia you are not going to have a rapid recovery or the rapid onset like you see with a manic episode,” points out Otto.

“A full manic episode can occur with psychosis. In the midst of that, it is hard to differentiate it from any other psychosis, like schizophrenia and affective psychosis,” adds Otto. The good news is that the newer antipsychotic medications seem to work well for all psychoses, whether they are caused by bipolar disorder or not. On the other hand, the mood-stabilizer lithium works for most people with bipolar disorder, but is not useful for people with schizophrenia. After treating the initial psychosis, a clinician can focus on making a diagnosis.

Is It Bipolar Disorder or Anxiety?

Anxiety disorders such as obsessive compulsive disorder, panic disorder, and post-traumatic stress disorder frequently coexist with bipolar disorder. Each one occurs in as many as one-third of bipolar patients. This complicates treatment and makes diagnosis challenging, says Otto — but the conditions are separate.

Is It Bipolar Disorder or Substance Abuse?

Although not strictly a mental health condition, Otto emphasizes that using alcohol or drugs to cope with stress or to self-medicate mental health symptoms can make bipolar diagnosis more difficult. “If you take depression and add coping with alcohol or drugs, that’s another tough mimicker for bipolar disorder because when people drink or do drugs, they may do irresponsible things, which can look like the other symptoms of mania,” he points out.

Work with your clinician to get the necessary information from family and friends to help you get an accurate diagnosis. Stresses Otto, your family will probably need to be part of recovery: “The family suffers from episodes, too. They lose their family member for a while. It’s during the full manic episodes that savings are spent, affairs happen.” Working together, you can all heal.

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Bipolar disorder is characterized by dramatic shifts in mood, but when you cycle through episodes over the course of week — or even a day — the condition becomes even trickier to manage.

For one in every five people with bipolar disorder, they must deal with an even more complicated aspect of their condition. These people have rapid cycling bipolar disorder — a subtype of the condition in which the patient cycles through ups and downs at a much faster pace.

With rapid cycling bipolar disorder, moods may shift over the course of a day or a week, explains Jeri Brasch, a 32-year-old Colorado Springs, Colo., resident who has the condition.

“It’s really hard to gain self-awareness with this illness, but once you’re at that point, it’s like an asthma attack — you can feel it coming and you try to do something about it,” she says.

Her rapid cycling bipolar disorder is now manageable with the help of treatment and therapy. But when she was diagnosed as a teenager in 1996 — four years after her first episode — she says the road was rocky at best.

Recognizing the Signs of Rapid Cycling Bipolar Disorder

Prior to the current definition of rapid cycling bipolar disorder, people received the diagnosis if their bipolar signs and symptoms failed to respond to lithium. But experts now know that this is a unique form of bipolar disorder.

A diagnosis of rapid cycling bipolar disorder is made when you experience four separate episodes of bipolar signs and symptoms — such as major depression, mania, hypomania, or mixed symptoms — within one year.

Rapid cycling disorder complicates the strategy for treating bipolar, but with the right diagnosis and ongoing treatment, most people are able to manage their illness.

“There has to be a period of ‘quiescence’ in between the episodes,” emphasizes psychiatrist Jeffrey Bennett, MD, an assistant professor of psychiatry at the Southern Illinois University School of Medicine in Springfield. This period of returning to “normal” is important for the diagnosis, to avoid misdiagnosing another condition, such as depression, or failing to treat bipolar correctly. For some people, rapid cycling bipolar disorder means moods that shift over the course of a week or a day, not merely over the course of an entire year.

This type of bipolar disorder is more common in women and in those whose first episodes were in childhood or adolescence.

Some of the first rapid cycling bipolar signs Brasch noticed were:

• Rapid talking. Even if she doesn’t notice this herself, people will tell her to slow down, she says.
• Catastrophic thinking. Brasch knows she is starting to cycle when, in response to simple frustrations during the day such as bad traffic or a flat tire, her thoughts tell her nothing will ever go right.
• Apathy. Brasch is typically energetic and committed to being engaged in her life, so when she lacks the motivation to get going, she knows she’s at risk for an episode.
• Distrusting medication. Brasch knows that when she begins to think her medication isn’t working and considers not taking it, it’s time to call her doctor or therapist instead.

Because rapid cycling disorder can also include periods of depression, people have their own individual bipolar signs that could signal an episode. Some will experience classic signs of mania, others will have signs of depression, and yet another group goes through the dangerous mixed state of being depressed yet full of manic energy.

“Some people have this up-and-down as part of one episode,” notes Dr. Bennett. Even for people who only go through a mild episode, such as a period of hypomania, “people around them experience them as having a discrete period of changing personality,” he says.

What to Do if You Have Rapid Cycling Bipolar Disorder

Brasch has dedicated herself to speaking publicly about rapid cycling bipolar disorder. She volunteers with the Depression and Bipolar Support Alliance (DBSA) and participates in as many public events as she can.

“Bipolar disorder can be fatal if untreated, and that’s scary,” she says. “It’s scary to know that 15 percent of people with bipolar disorder complete suicide, because I do get those thoughts.”

Treatment for rapid cycling bipolar disorder will typically involve therapy and medication. Many people need a mood stabilizer as well as antidepressants or antipsychotic medications to manage the disorder.

Brasch offers these six important tips for surviving rapid cycling bipolar disorder:

• Stay in treatment. Treating bipolar disorder is complicated for everyone involved. You might need to try several different medications under the supervision of your doctor before you find the right one for you. Even then, you should stay in touch with your medical team. “I have a therapist on standby,” Brasch jokes.
• Find your perfect match. Brasch says she feels that her psychiatrist listens to her experiences with medication and her moods and takes them seriously. For her part, she tries to comply with her doctor’s recommendations. It’s a two-way relationship, she says.
• Try cognitive behavioral therapy. Brasch’s personal experience with therapy included talk therapy, which she said wasn’t really effective for her. When she switched to cognitive behavioral therapy and started to learn how to identify and alter the thought patterns that signaled or triggered mood shifts, she gained more control over her bipolar disorder.
• Build social support. Relationships can be difficult if you don’t have a handle on your bipolar disorder, but it’s important to reach out to others. Brasch says her support network is invaluable, and she also feels good about the ways she is able to give back to others through her volunteer work. If you don’t have support you can lean on, Brasch recommends joining a support group through the DBSA or an online community likeEveryday Health.
• Get organized. Creating a schedule that guides you through your days helps. “This morning I woke up and thought, ‘I don’t want to get out of bed,’” she admits. “But I did it anyway.” Commitment to a healthy routine provides a sound foundation on most days. A therapist can help you with this.
• Give yourself credit. “Trying to stay alive and well with anything like bipolar is a constant day-to-day struggle, and it’s exhausting,” she says. But if you get to the end of the day and you are stable, that’s an accomplishment to be proud of.

If you or someone you love has rapid cycling bipolar disorder, it is important to get a diagnosis and get started with treatment.

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From fatty snacks to morning cups of joe, these foods may trigger mood swings in people with bipolar disorder.

Can an unhealthy diet play a role in triggering bipolar mood swings? According to recent research, the answer is “yes.” In fact, certain foods — such as caffeine, alcohol, and fatty foods — could lead to worse outcomes, finds research in the September 2015 issue of the Journal of Psychiatric Research. It’s a good idea to follow national healthy diet guidelines, such as eating more vegetables, fruits, whole grains, and lean meats. But you may also want to pay attention to some of the subtler points raised in this study.

“Evidence of poor diet in people with bipolar disorder is found in the altered metabolism of important healthy fats and is consistent with an imbalance in the ratio of omega-6 to omega-3 intake in diet,” says study authorMelvin G. McInnis, MD, the Thomas B. and Nancy Upjohn Woodworth professor of bipolar disorder anddepression, and director of the Prechter Bipolar Research Program in the department of psychiatry at the University of Michigan Health System in Ann Arbor.

Dr. McInnis explains that this means people with bipolar disorder should rebalance the types of fats in their diets to include more omega-3 fats, and fewer omega-6 fats. You only need a small amount of omega-6 fats each day, which come primarily from vegetable oils. Omega-3 fats come from sources such as salmon and other fatty coldwater fish, flaxseed, nuts, and certain plants, such as basil.

If you choose to eliminate bipolar-offending foods from your diet, you’ll do more than keep mood swings in check and reduce periods of mania: You’ll also improve your heart health. That’s important, because with bipolar disorder you’re at a greater risk of obesity and heart and vascular disease, according to the National Institute of Mental Health.

“People with bipolar disorder have, in general, poor diets and are not good at planning healthy diets with appropriate foods,” McInnis explains. One particular problem is fast food, which is a primary food source for a good number of people with bipolar disorder, he says. “It’s convenient, cheap, and provides satisfaction — albeit short-term.”

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Other factors that could lead to poor dietary choices include medication side effects, inadequate exercise, smoking, and lack of access to care, explains psychiatrist Jess G. Fiedorowicz, MD, PhD, an associate professor in the departments of psychiatry and internal medicine at the University of Iowa Carver College of Medicine in Iowa City.

Your first step? “While there’s been some speculation regarding specific diets forbipolar disorder, simply eating a healthy, balanced diet is an important start,” Dr. Fiedorowicz says.

Foods and Drinks You Should Ditch

The fundamentals of a healthy diet include not just what to eat, but also what not to eat. Consider skipping these choices that could worsen your bipolar symptoms:

1. Caffeine

“Stimulants can trigger mania and should be avoided,” Fiedorowicz says. “Caffeine is an underappreciated trigger and can also impair sleep,” and sleep deprivation is a notorious trigger for bipolar mood swings and mania, he says.

The National Sleep Foundation points out that caffeine can increase irritability andanxiety, in addition to affecting sleep, and recommends avoiding caffeine as you approach bedtime. Fiedorowicz adds that some over-the-counter medications — such as pseudoephedrine, which is found in some cough and cold medications — have stimulant properties similar to caffeine and can also trigger bipolar mood swings.

2. Alcohol

Bottom line: Alcohol and bipolar disorder make a bad combination. Alcohol can negatively affect bipolar mood swings and may also interact negatively with medications such as lithium, according to the National Institutes of Health Clinical Center (NIHCC). People with bipolar disorder are also more likely to die prematurely if they use alcohol or other substances, according to an analysis of data that included more than 11,000 people with bipolar disorder published in the September 2015 issue of The Lancet Psychiatry.

3. Sugar

Eating a diet high in sugar can make it harder to control weight, and obesity — including related belly fat — may make some bipolar disorder drug treatmentsless effective, according to results of a multicenter study published in the June 2015 issue of Acta Psychiatrica Scandinavica. If you need to satisfy a sweet tooth, reach for fruit.

4. Salt

If you’re on lithium, moderating salt intake can be tricky, because a change in salt intake — either a sudden increase or a decrease — can affect lithium levels, according to the NIHCC. Talk with your doctor about how to safely manage the salt in your diet to stay within a healthy range. The American Heart Associationrecommends consuming less than 1,500 milligrams a day. Equally important when taking lithium is to make sure you drink enough fluids: Dehydration can cause dangerous side effects, Fiedorowicz cautions.

5. Fat

Fiedorowicz suggests following the heart-healthy recommendations from the American Heart Association to limit the amount of saturated fat and trans fat in your diet. That means opting for lean protein and low-fat dairy products when choosing animal products. You might have heard that the fat in foods could alter the way your body uses medications: Generally, your medications will still be effective, but eating a lot of fried, fatty foods just isn’t good for your heart? And remember that the oils used for frying are high in the omega-6 fatty acids you want to avoid.

Healthy Food Swaps to Try

Planning a healthier diet doesn’t have to be drudgery. McInnis advises going to your local farmers’ markets, exploring the options, and talking with the farmers themselves about how to enjoy their produce. And for quick stops at the store, he recommends sticking to the periphery, where whole foods, such as produce and fish, are usually found. For more ways to make your diet healthier, McInnis says:

• Instead of potato chips or fries, munch on crispy vegetables with a savory dip, such as hummus.
• Skip the sweet pastry and instead top a slice of whole-grain bread or a few crackers with fruit preserves.
• Instead of a fourth or fifth cup of coffee, choose a decaf latte or an herbal tea.
• Skip the fast-food burger and fries and order a fresh salad instead.
• Swap a fried entrée for steamed or broiled fish.

Building the best diet often takes teamwork, including help from your medical team. If your diet and lifestyle need a complete makeover, reach out to your doctor or dietitian for help.

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Diagnosed nearly two decades ago, Victoria Maxwell shares what she’s learned about living with bipolar disorder.

Living with bipolar disorder is an ongoing life struggle, but Victoria Maxwell has turned her personal story into art.

Maxwell, now 43, of Vancouver, British Columbia, Canada, was diagnosed with bipolar disorder in 1992. “It probably took five or six years for me to come to terms [with] the diagnosis and the fact that I had a mental illness,” she says.

Originally trained as an actor, Maxwell later trained as a mental health worker and ended up writing three one-person plays about coping with bipolar disorder —Crazy For Life; Funny, You Don’t Look Crazy; and a third as-yet unnamed play scheduled to premiere in October 2010.

“I have been presenting my plays at health conferences, to give people insight into what it’s like to live with bipolar disorder,” Maxwell says. “I never thought I would get back into acting. It just happened to work out that the skills I’ve been trained in are an advantage to what I’ve been trained to do.”

Living With Bipolar Disorder: Before the Diagnosis

Prior to her diagnosis, Maxwell had been going through severe depressive episodes. She was oversleeping, wrestling with fatigue and hopelessness, andbinge eating. Following a meditation retreat, Maxwell experienced a mood swinginto mania. She began thinking and speaking very quickly, having odd thoughts and delusions, getting very little sleep, and becoming very promiscuous.

Her manic swing ended in a full-fledged psychosis. “It was so vivid. I really thought I was supposed to meet God,” she says. In the grip of the psychotic episode, Maxwell stripped off her clothes and ran down the street naked.

“I was lucky, I guess, that I did it in a very safe neighborhood, but I was caught by police and taken to the hospital,” she remembers. “Obviously, that was a very big wake-up call.” Maxwell’s first reaction to her diagnosis was denial. “I didn’t really agree with the doctors. I just felt it had to be something else other than mental illness.”

Her family recognized and accepted her bipolar disorder years before she was willing to. “My mom was diagnosed with bipolar when I was 8 or 9 and she got treatment,” Maxwell explains. “Their acceptance of it did not necessarily help me out. [But] they did everything they could to help me see what I was going through.”

Part of that support involved inviting her to come back home to live while she dealt with her bipolar disorder. “It meant I had a stable place to stay,” she says. “It was a safe place that wasn’t around drugs or alcohol. They gave me some parameters — they set some good boundaries for me, and I didn’t walk all over them.”

Maxwell’s bipolar disorder also helped her discover who her true friends were. “I had some friends stay and support me, a couple of friends in particular. I burned a lot of bridges and lost friends,” she recalls. “I was doing very odd and unusual behaviors that I think could make people uncomfortable, and they didn’t know what to do.”

Getting the Right Bipolar Treatment

Before she got serious about her treatment, Maxwell flirted with alternative therapies. “I tried a lot of different things,” she says, including Reiki and taking St. John’s wort and valerian. “None of the alternative stuff was able to take root, so the things I tried didn’t work. They didn’t seem strong enough to affect long-term change. But to be honest, I didn’t give it a fair shot.”

Coping with bipolar disorder is an ongoing challenge for Maxwell. “My energy level still fluctuates a lot,” she says. “There are times when I may only be able to work for only two hours or four hours. The benefit of being self-employed is that I can set my own hours.”

Maxwell’s husband also provides invaluable support. “He’s quite good at checking in with me,” she says. “What happens often is when I’m working I end up getting carried away with work. He’ll sort of tap me on the shoulder and say, ‘You didn’t go to bed until 11:30 or midnight and then you got up at 6.’ I’ll say, ‘Yeah, I need a nap, I need to go to bed early.'”

Maxwell currently takes a mood-stabilizing, anti-epileptic drug as well as an antidepressant. She also sees a psychiatrist for cognitive-behavioral therapy and talk therapy and finds that regular physical activity helps, explaining that exercise has become a big part of coping with bipolar disorder. “I run — I’m not an excessive exerciser, but I run two to three times a week. That’s something that has helped me manage my mood,” Maxwell says.

Maxwell hasn’t needed to try any of the newer treatments for bipolar disorder, but she expects that might change in the near future. “I anticipate that as I get closer to menopause, I will need to be more vigilant,” she says.

She is concerned that those who need to take medication might be misunderstood or looked at as different by the general population, rather than supported for their commitment to getting treatment. “I think sometimes people are worried about what medication can do,” Maxwell says. “Just because we have a mental illness doesn’t mean we’re violent and doesn’t mean we’re unpredictable. Lots of people are good workers, dedicated to managing their illness. You don’t know about it because they’re managing it well, and they are as reliable as anybody else. It’s possible to have a really enjoyable life, a good quality of life, even when you have to manage a mental illness.”

When people think of treating depression, it’s often thought that the best treatment comes in a bottle. But that’s not necessarily true, and some of the key triggers that can help eliminate depression are simple life changes.

To begin with, one of the biggest changes a person can make in their lifestyle to help combat depression is to get enough sleep. There’s nothing like being awake all night to put one in a bad mood. Going to bed at the same time each day, turning off the phone, TV and computer screen a bit earlier than a person is used to is a great first step towards eliminating depression.

Another important change a person can make to eliminate depression is getting more exercise. It’s well known that exercise is valuable for an overall healthy body, but it also has many mood-boosting effects. A person doesn’t need to run a marathon to gain the benefits of exercise, but exercising a few times a week will reduce a person’s cortisol levels (a body’s stress hormone).

Changing one’s diet is also necessary to help eliminate depression. One of the biggest factors to someone’s health is their blood sugar level. Eating a sugary snack that results in a spike and a crash an hour later is enough to put anyone in a miserable mood. It’s now thought that sugar may play a bigger role in depression than previously thought. So eating healthy snacks, especially ones that are a good source of protein, is certainly a good way to help eliminate depression.

Another important part of a person’s diet is healthy fat. Omega-3 polyunsaturated fatty acids, similar to those found in fish, help reduce depression symptoms. Flaxseeds are also an excellent source of omega-3s, as are walnuts.

Lastly, one of the biggest triggers to eliminating depression is finding a passion and purpose for life. Eating healthy, getting enough sleep and exercising will help with boosting a person’s mood, but having a sense of purpose, a reason to get up every day, is key to combating and eliminating depression. This type of change is probably the most difficult to accomplish, so people need to really find something that they enjoy doing. Whether that be changing careers, or finding a hobby that they truly enjoy, making these changes will give them a sense of purpose and meaning.

Depression is a difficult condition to overcome, and those who battle it on a daily basis often times feel that there is no hope. Seeking out medical help will certainly be beneficial to battling and eventually eliminating depression from their lives, but making these small, but meaningful life changes will certainly play a big role in overcoming this condition. People looking to make these changes should start small by choosing one of these triggers and initiating that change. Each time they feel a sense of accomplishment in that change, move on to the next one. Eventually combining all of these triggers and working them into one’s daily lifestyle will help them move past depression once and for all.

Obsessive-compulsive disorders are a group of psychiatric disorders characterized by some combination of repetitive thoughts, distressing emotions, and compulsive behaviors. The specific types of thoughts, emotions, and behaviors vary according to each disorder within this group.

The idea of a spectrum of disorders with obsessive-compulsive features is nothing new. Indeed, evidence spanning over a 20-year period has continued to accumulate. This research supports the theoretical and clinical utility of grouping these disorders together. As research continues, the types of disorders included in this group may change. Moreover, our understanding of this obsessive-compulsive spectrum will continue to be refined.

The Diagnostic and Statistical Manual of Mental Disorders- Edition 5 (DSM-5; APA, 2013) places these disorders into a category called obsessive-compulsive and related disorders (OCRDs). The DSM-5 is a manual used by mental health professionals to diagnosis mental disorders. The primary purpose of theDSM-5 is to help clinicians reliably identify and diagnose various mental disorders.

Each disorder in the DSM-5 includes a list of symptoms associated with that disorder. The manual also includes additional features of the disorder (e.g., age of onset, family history, etc.). It further provides criteria for distinguishing the disorders from each other. This is particularly important as many mental disorders share similar symptoms. Accurate diagnosis aids clinicians to identify which people may benefit from treatment. Perhaps more importantly, it helps clinicians select the most effective treatment approach. Just as there are many cancers with different methods of effective treatments, so too are there many mental disorders with different forms of effective treatments.

The following disorders are included in the DSM-5 category called obsessive-compulsive and related disorders category (OCRDs):

• obsessive compulsive disorder (OCD);
• body dysmorphic disorder (BDD);
• hoarding disorder;
• trichotillomania (hair pulling); and,
• excoriation (skin picking) disorder.

In addition, several other “lower order” disorders are included in this category:

• substance/medication-induced obsessive-compulsive related disorder;
• obsessive-compulsive and related disorder due to another medical condition;
• other specified obsessive and compulsive and related disorders; and,
• unspecified obsessive-compulsive and related disorders (such as body-focused repetitive behavior disorder and obsessional jealousy).

Decisions about which disorders are grouped together in the DSM-5 are based on whether there is some underlying relationship between two or more disorders. In other words, do these disorders have something in common with each other? With respect to mental disorders, there are several things that suggest a similarity between disorders. Some examples are: symptom similarity; frequency of co-occurrence (called comorbidity); the onset and usual pattern of the disorder; genetic risk factors; environmental risk factors; neural substrates, biological markers; and treatment response. To date, the strongest evidence for similarities among the OCRDs comes from symptom similarity, as well as the high degree of co-occurrence (comorbidity) among the disorders.

It is interesting to note the rationale used to organize the entire DSM-5 manual is similar to the rationale used for grouping the obsessive-compulsive and related disorders (OCRDs) together. For example, the chapter on anxiety disorders precedes the chapter on OCRDS. The purpose behind this placement is to inform clinicians there is a similarity between anxiety disorders and OCRDs. While anxiety is a key feature in OCRDs, there are enough unique differences between anxiety disorders (e.g., panic disorder, social phobia) and OCRDs to justify a separate category.

To recap, the hallmark features of OCRDs are repetitive thoughts, distressing emotions, and compulsive behaviors. Although there is symptom similarity and overlap, each disorder has its own unique features. These differences affect treatment decisions in several ways: 1) the choice of treatment type; 2) the ordering, and pacing of therapeutic interventions; and, 3) setting realistic goals and expectations for clinicians, patients, and family members about treatment progress. These differences are discussed in the treatment section.

In the next section, we describe the diagnostic criteria for OCRDs. We also compare and contrast the disorders to highlight their similarities and differences.