Bipolar Support Groups.com blog

Smoking is a common activity among people with mental illnesses, including bipolar disorder. But having bipolar disorder doesn’t mean you can’t quit.

Bipolar disorder and its treatment can put you under a lot of stress. Some people may turn to alcohol or drugs to try to escape those frightening feelings caused bybipolar disorder, while many others smoke cigarettes.

Why smoking is very common among people with mood disorders like bipolar disorder isn’t entirely understood. But the good news is that bipolar disorder doesn’t have to keep you from quitting smoking.

While the connection between smoking and mental illness isn’t thoroughly understood, one fact is clear: Many people with mood disorders smoke. One study shows that as many as 70 percent of people with bipolar disorder are smokers.

“Smoking is very prevalent among patients who have a history of schizophrenia or mood disorders [like bipolar disorder],” says Adele C. Viguera, MD, a psychiatrist and the associate director of the perinatal and reproductive psychiatry program at the Cleveland Clinic in Ohio.

“About 20 percent of people smoke in the general population. In folks with a history of psychiatric disorders, it’s about double that — about 40 percent on average,” says Dr. Viguera. But, she says, “I don’t think people really understand why.”

Bipolar Disorder and Smoking: Which Comes First?

Not only do they not know why, but experts aren’t completely sure which comes first. It’s not understood if smoking contributes to periods of depression and other mental health issues, or if poor mental health spurs people to light up.

Smoking can also lead to a vicious circle in people with bipolar disorder — difficulty managing the illness can lead to smoking and other addictions, and then when people find themselves unable to quit, depression and other symptoms may get even worse.

Viguera theorizes that bipolar patients might be more easily addicted because it’s possible that nicotine can help regulate mood for some people — what many people with bipolar disorder are looking for. Stress relief is another possibility.

“I have a feeling that when people are in distress, they want some relief — and maybe that’s just one way to get some relief and feel calmer,” says Viguera.

Bipolar Disorder and Smoking: No-Blame Game

But people with bipolar disorder shouldn’t blame their illness for finding it difficult to quit. Viguera says that the same treatment methods work on people with bipolar disorder as on people without a mood disorder, and that bipolar patients can be very responsive to these treatments.

Viguera says that a combination of counseling, medications like antidepressants, and aids like the nicotine patch or nicotine gum are the best bet to help anyone quit smoking. One antidepressant, bupropion (Zyban, Wellbutrin), is often used in people without a mood disorder to make quitting easier. If you are bipolar, your doctor will want to carefully consider if this drug is appropriate for you, considering your other medications and disease control.

Bipolar Disorder and Smoking: Quitting Tips

Here are some other tips to help put those packs away for good:

• Stay busy with fun activities like exercise, shopping, or a movie — particularly on the day that you quit Go to places where you aren’t allowed to smoke, like the library, a movie theater, a mall or store, and church.
• Hold things in your hand or put things in your mouth if that’s what you miss — fiddle with a pencil, hold a water bottle, or chew on carrots or a toothpick.
• Avoid smoking triggers, like alcohol.
• Try chewing sugar-free gum.
• Brush your teeth often — especially after meals when you want to smoke. Also try washing your hands or taking a shower when you get a craving.
• Hang out with people who don’t smoke.
• Take public transportation where you’re not allowed to smoke.
• Get physical — start exercising.
• When you feel anxious, take long, deep breaths and imagine peaceful, soothing thoughts.

It’s vital for people with bipolar disorder to get healthy inside and out. Smoking isn’t a healthy method of coping with the illness, and it’s only doing more harm to the body. Getting both the mind and body truly healthy is the best thing you can do — and it’ll make you feel good about yourself, too.

When in a manic mood, people with bipolar disorder can act recklessly. Here’s how to take responsibility and manage your emotions.

The dramatic mood swings of bipolar disorder can interfere with your ability to make good choices, particularly during a manic episode. Symptoms of depression include intense sadness, emotional indifference, fatigue, and feelings of despair, whereas mania often causes restlessness, anxiety, irritability, and impulsive behavior.

One recent study explored decision-making skills among manic patients. Study participants were given the Iowa Gambling Task, a psychological test that involves picking cards from different decks with the goal of winning money. Manic participants chose more cards from the decks of cards deemed “risky” than other people and did not learn from their mistakes as easily. The researchers found that manic people made poor decisions because of an inability to understand the consequences.

During a manic period, people with bipolar disorder often have impaired judgment and act recklessly. People with bipolar disorder often do not recognize just how ill they are (a condition known as anosognosia) and may blame their problems on outside factors.

One patient, a teacher in Pittsburgh named Susan, says she had trouble learning to take responsibility for her actions. Her “past faults and mistakes are too numerous to name,” she says.

“Admitting that I am wrong is so painfully difficult,” she notes. “Yet I have had occasions to [apologize], and there have been those who have received it warmly.”

Bipolar Disorder: Partners and a Plan

Experts recommend that a person with bipolar disorder have a care team in place. Care partners — friends, family and trusted health care providers — can help steer you away from the triggers that lead to manic episodes; if an episode does occur, they can help you take responsibility for your actions.

When you are not depressed or manic, make a pact with someone you trust. If you have a manic episode, tell that person to intervene by:

• Helping you avoid situations that intensify mood swings
• Providing feedback on your mood and behavior
• Giving you constant reassurance
• Contacting your doctor to make an appointment or to talk about treatment

Having such a plan will not only help you avoid mistakes, it will also help you cope with mistakes even if you do make them. You and the care partners can agree on additional parameters that are relevant to your personal circumstances.

According to Gary Sachs, MD, an associate professor in psychiatry at Harvard Medical School and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston: “You cannot rely exclusively on yourself and have much hope; you must have a plan in writing and care partners in place. This process is like physical exercise — if you keep working on it, you will be able to do it sooner or later. You have to work at the process.”

If you have bipolar disorder, he says, realize that your perception of a given situation may be biased and that you must have someone to help you “see accurately.”

Bipolar Disorder: Communication

Jair Soares, MD, professor of psychiatry at the University of North Carolina School of Medicine and director of the UNC Center of Excellence for Research and Treatment of Bipolar Disorders, says it is important to communicate honestly with your care partners after an episode. “When you are doing well, have a good conversation about the things that were done or said,” he says. This is also a good time to review your bipolar treatment with your doctor or therapist and admit past mistakes.

Bipolar Disorder: Support Groups

It may be helpful for you and your care partners to join a support group. Organizations such as the National Alliance on Mental Illness (NAMI) provide helpful information for people with bipolar disorder.

Of course, the best way to avoid making the same mistakes during future episodes is by recognizing the mistakes you have made in the past. When you realize you are experiencing familiar symptoms of mania (talking too quickly, not sleeping or eating well, needing instant gratification), be sure to contact your doctor or therapist as soon as possible.

Some bipolar patients may also have eating issues like anorexia and bulimia.

Patients with bipolar disorder must work to control mood swings that range from manic to depressive. Evidence is mounting that many bipolar patients also must struggle to control their appetite, as they are likely to have some sort of eating disorder.

Research has found that many people with bipolar disorder have eating issues like bulimia nervosa, anorexia nervosa, and binge-eating disorder. A recent study found one in five bipolar patients in its group of participants met the criteria for a lifetime eating disorder.

These studies are far from conclusive, as they often focus on small samples, or groups of patients. However, evidence does suggest that bipolar patients are more likely than the general public to have an eating disorder. Researchers are also trying to identify the links between bipolar disorder and eating disorders.

At Risk: Eating Disorders Among Bipolar Patients

The eating disorders most closely associated with bipolar disorder are:

• Bulimia nervosa. People with bulimia tend to gorge themselves on food, then immediately “purge” or rid their bodies of the food by vomiting or using laxatives or diuretics. Bulimia is the eating disorder most closely associated with bipolar disorder, as current research firmly supports a connection between the two.
• Anorexia nervosa. People with anorexia tend to develop an adversarial relationship with food. They generally avoid eating and skip meals. When they do eat, they may obsessively weigh their food and count calories or eat small amounts of a few, carefully chosen “acceptable” foods. Anorexics also tend to exercise obsessively. Anorexia is not as closely associated with bipolar disorder, although some studies have found a link between the two.
• Binge-eating disorder. Binge eaters tend to compulsively overeat, but unlike bulimics, they do not purge afterward. They tend to feel shame or guilt over their eating and often eat by themselves and very quickly. Many bipolar patients report periods of binge eating, although whether they have a full-fledged disorder is not certain. Some medications for bipolar disorder promote binge eating.

The Bipolar-Eating Disorders Connection

Researchers aren’t yet sure why bipolar disorder seems to be linked with eating disorders. However, the two problems share many characteristics, including:

• Eating irregularities
• Weight problems
• A tendency to act impulsively and rashly
• Behaving in a compulsive manner, repeating purposeless acts or following odd but well-established sets of rules
• A tendency to “cycle” — with eating disorders, it’s between bulimia and anorexia; with bipolar disorder, it’s between depression and mania

The severity of a person’s bipolar disorder may influence the development and severity of an eating disorder. One study found that people with worse bipolar symptoms and deeper mood swings were more apt to develop either bulimia or bulimia combined with anorexia.

Treating Both Bipolar and Eating Disorders

Managing both a bipolar disorder and an eating disorder can be challenging. For example, antidepressants are often used to treat eating disorders, but these medications are not recommended for bipolar patients, as they can prompt a manic mood swing. Doctors also need to be careful about prescribing mood stabilizers or anti-psychotics to bipolar patients who are either obese or binge eaters, as these drugs have been known to trigger binge-eating episodes.

Therapy can be helpful for coping with eating disorders. Psychotherapy, family therapy, and behavioral therapy are known to be beneficial in treating anorexia, bulimia, and binge eating.

Bipolar disorder develops in men and women in about equal numbers, but there are gender differences in the ways that the illness manifests itself. Women with the disorder tend to have more depressive and fewer manic episodes than men do. “The typical bipolar woman will start with a depressive episode, whereas a man will usually get a manic episode first,” says Michael First, M.D., professor of clinical psychiatry at Columbia University and editor of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s diagnostic guidelines. Women are also more likely to have bipolar II, which is a milder form of the disorder. However, women are more prone than men to rapid-cycling bipolar, which is characterized by four or more episodes of depression and mania in one year. Rapid-cycling bipolar appears to be more resistant to treatment than other forms of the illness.

Bipolar Disorder and Gender Differences: Women

Some research suggests that abnormal thyroid levels may contribute to the way bipolar disorder manifests in women. “There seems to be an elevated level of thyroid disturbances associated with rapid-cycling bipolar disorder,” says Carrie Bearden, Ph.D., a clinical neuropsychologist and associate professor of behavioral sciences and psychology at UCLA. Thyroid imbalances are more common in women than in men. Other associated medical conditions that are seen more often in bipolar women than in men include migraines, obesity, and anxiety and panic disorders.

Reproductive hormones may also play a role in bipolar disorder in women, since symptoms often worsen during perimenopause and menopause. “During perimenopause, women may be especially at risk for depressive episodes because of declining estrogen levels,” says Bearden.

Women also face the complications of managing bipolar disorder during and after pregnancy, when they appear to be more vulnerable to the condition’s symptoms. According to the National Alliance on Mental Illness, pregnant women and new moms with bipolar disorder have seven times the risk of hospitalization and two times the risk of a recurrent episode compared with women who aren’t pregnant or who haven’t recently delivered. Managing bipolar disorder during pregnancy and lactation can be a challenge because some of the medications used to treat the illness carry potential risks for developing fetuses and nursing infants. Research suggests that some anticonvulsants used to treat bipolar disorder — such as Depakote and Tegretol — can be harmful to fetuses, possibly contributing to birth defects. Lithium and first-generation antipsychotics such as Haldol and Thorazine are considered safer. Studies have found that they carry minimal risks to developing fetuses and nursing babies.

However, knowledge about the safety of bipolar medications during pregnancy and nursing is still evolving. “It’s important to discuss the risks and benefits of taking medications for bipolar disorder with your doctor if there is a possibility you may become pregnant,” advises Dr. First. It’s a delicate balancing act because depression during pregnancy can also be harmful to the health of a developing baby.

Bipolar Disorder and Gender Differences: Men

In men, bipolar disorder typically begins earlier and is more severe than in women. Manic episodes tend to be particularly pronounced. In addition, men are more apt to act out during mania. “Guys are more likely to be out drinking, fighting, and yelling at people on the street, which often lands them in jail or causes them to be hospitalized for mania,” says Bearden. Men with bipolar disorder are also more likely than women to have problems with drug or alcohol abuse. Despite severesymptoms, studies show that men are less likely than women to voluntarily seek medical care for psychological conditions, including bipolar disorder. The most serious consequence of untreated bipolar disorder is suicide — in fact, studies show that between 10 and 15 percent of people with the bipolar disorder will end their own lives. “Bipolar men are more at risk for suicide than women because suicide is more common in males,” says First.

Fortunately, bipolar disorder is a highly treatable illness. A combination of medicine and psychotherapy will reduce bipolar episodes in most patients. By working with a psychiatrist familiar with bipolar disorder, both men and women can find an appropriate treatment plan for their life stage and gender.

What if your bipolar becomes so severe that you can no longer work? Here’s what you need to know about getting disability benefits.

When you hear the word disability, chances are you think it applies to a physical injury rather than a mental illness. But does bipolar disorder qualify as a disability? Can you get the financial help you need if you are unable to work because of your bipolar symptoms? According to Stuart Gitlow, MD, associate clinical professor of psychiatry at Mount Sinai School of Medicine in New York City, the answer to both questions is yes.

Bipolar Disorder: Why Is It Disabling?

Dr. Gitlow, who has worked with the Social Security Administration as a consultant and medical expert for 20 years, explains that most people with bipolar disorder can work: Many find that they can return to their jobs once they receive proper medical care. However, certain people with this condition have such extreme episodes of depression and mania that they are unable to function, despite ongoingtreatment. Severe depression, for instance, impairs the ability to focus, to attend to tasks, and to respond at reasonable speed to others. And mania symptoms such as racing thoughts, rapid speech, and difficulties with concentration make relating to others or completing job-related tasks that much harder. The more frequent the cycling of mania or depression episodes, the greater the difficulty in keeping a job.

Bipolar Disorder Disability: Who’s Qualified?

To be eligible for disability, you must meet a number of specific medical and psychosocial requirements.

Accurate diagnosis. In order for someone with bipolar disorder to qualify for Social Security disability benefits, the first order of priority is an accurate diagnosis. “Mood variations are normal,” Gitlow says. “We all have highs and lows, and we all sometimes swing quickly from one to the other in response to life stressors. We don’t want to see normal human emotions turned into a disease state. Sometimes mood variations are the result of medications, drug use, or medical difficulties — these must be ruled out as possible causes before bipolar disorder can be diagnosed.”

History of both manic and depressive syndromes. Besides an accurate diagnosis of bipolar disorder, there are additional requirements to qualify for benefits, says Gitlow. “You must have bipolar disorder with a history of episodic periods manifested by the full symptomatic picture of both manic and depressive syndromes.” At least two of the following statements must also be true:

• You find it difficult to carry out the normal activities of daily living.
• You are unable to focus your attention long enough to complete tasks on time.
• You have a hard time getting along with other people.
• You have extended episodes of decompensation — meaning that your bipolar symptoms worsen and your ability to function in your daily life lessens during these periods.

Activities of daily living. Gitlow notes that you would fail to meet the disability criteria if you’ve never been hospitalized and if you are still able to perform such daily tasks as cooking, shopping, and cleaning; caring for children; spending time with family and friends; and keeping up with the news. You would also fail if your difficulties in these areas are only mild or moderate. However, circumstances vary, and there are other criteria that the examiners may consider when reviewing your application.

Applying for Disability Benefits

Going through the disability application process takes both time and persistence. To begin, you need to contact the Social Security Administration (SSA) either online, in-office, or over the phone. Their Web site has plenty of information on what to do and how to do it, but here’s a very general idea on how it works:

Step 1. SSA gets the application and makes certain that you qualify. If there’s an obvious technical reason not to even look at your medical records — for example, if you don’t meet the citizenship qualifications for legal residence — your application may not go beyond this point.

Step 2. If you do meet the requirements, your application is sent to a state agency (Disability Determination Services), which will gather all your pertinent medical records. If there isn’t enough information available from your prior health-care providers, the agency may ask you to undergo a medical examination. You will not have to pay for this exam.

Step 3. After your medical records and/or your examination results are reviewed, a decision will be made by the Disability Determination Services. If you’re approved, there’s about a five- month waiting period before you’ll get the first payment from the SSA. If you were denied benefits, you can appeal the decision.

Bipolar Disorder and Disability: Some Facts to Keep in Mind

Gitlow has some additional recommendations as you make your way through the application process:

• See a specialist. A truly disabled person doesn’t want disability; they want to get better. Demonstrate that this is your true goal by seeking help from an appropriate physician specialist, by being compliant with treatment recommendations, and by being willing to try several different therapeutic options as necessary to get the best possible outcome. Just as you would want to see a cardiologist if you suffer from heart disease, see a psychiatrist for treatment of bipolar disorder.
• Retain an attorney. If your application is denied and you apply for a hearing before an administrative law judge, retain the services of an attorney specializing in disability. While this is not a requirement, it will allow the process to go more smoothly and ultimately will improve your chances to be found disabled. The attorney can also discuss with you what other medical evidence might be important to obtain.
• Request medical records. Maintain your own copies of your medical records from every treatment source. While the physician creates the medical record, the content is yours. All you need to do is request a copy, and you should always keep copies of your records, particularly in the case of a chronic disease like bipolar disorder.
• Show up. If your state Disability Determination Service arranges for you to go to a consultative evaluation, don’t miss it. Your state agency will always assist if you have difficulty with transportation. Says Gitlow: “In my experience, having been scheduled to provide psychiatric evaluations for over 3,000 Social Security applicants, I am amazed that the no-show rate is one out of three.”

Dramatic mood swings between the highs of mania and the lows of depression can be exhausting for the person with bipolar disorder. Here’s how to cope.

Bipolar disorder is characterized by extreme mood swings from mania to depression. The pattern of highs and lows varies for each person: For some people, episodes of mania or depression can last for weeks or months, while for others, mood swings are shorter and more frequent. Coping with bipolar disorder — and the mood swings it brings — can be difficult. But understanding what causes mood swings can be the first step in coping with the ups and downs of bipolar disorder.

Bipolar Mood Swings: Causes and Triggers

Bipolar disorder is thought to be caused by a chemical imbalance that alters a person’s moods. This imbalance may be linked to irregular hormone production or a problem with chemicals in the brain called neurotransmitters that act as messengers to nerve cells. Because bipolar disorder tends to run in families, genetics are also thought to play a role; in fact, researchers believe that the chemical changes leading to the disorder result from a combination of genes and environmental influences. Some brain scans have revealed actual physical changes in the brains of people with bipolar disorder.

The best way to prevent mood swings is to get treatment for bipolar disorder. But it’s also possible to reduce the frequency and intensity of mood swings by being aware of situations or events that can trigger them.

“A number of triggers can set off or worsen bipolar episodes,” says Michael First, MD, a professor of clinical psychiatry at Columbia University and attending psychiatrist at NewYork-Presbyterian Hospital. The most common triggers for bipolar mood swings are:

• Stress from major life events, both positive and negative
• Lack of sleep
• Erratic schedules
• Caffeine and alcohol
• Certain medications, such as antidepressants and corticosteroids
• Seasonal changes (for example, winter can worsen depression, while summer can increase the risk of mania)
• Stopping bipolar meds or varying the treatment schedule
• Thyroid problems
• Substance abuse

Mood Swings: Coping Strategies

While some triggers — like seasonal changes or a stressful event — may be impossible to avoid, lifestyle changes and mood-management strategies can make a big difference. Try the following suggestions from experts for managing and coping with mood swings.

• Control stress. Stress is a major bipolar trigger. Do what you can to simplify your life and relieve stress in your work and personal life. See if your spouse, family members, and friends can help with household responsibilities. “If you have a job that requires crazy hours and lots of travel, you may want to switch to a less-stressful job,” suggests Dr. First. Stress-management techniques, such as meditation, visualization, and yoga, can also help.
• Keep a regular schedule. Stick to a routine to help control mood swings. “Bipolar people don’t do well with lots of changes,” says First. Have meals, do errands, exercise, and go to bed about the same time every day.
• Practice healthy sleep habits. Being overtired can trigger mania in some bipolar people. Relax before bed by listening to soothing music, reading, or taking a warm bath. Experts also recommend that you make your bedroom a calming place and use it only for sleep and sex. Be disciplined about your sleep habits. “It’s common for people with bipolar disorder to stay up late watching movies, playing video games, or surfing the Internet, which can make mood swings worse,” says Carrie Bearden, PhD, a bipolar-disorder expert and associate professor of psychology and behavioral sciences at UCLA.
• Get moving. Studies show that regular exercise can help improve mood. Start slowly by taking a walk around the neighborhood. Gradually work up to exercising on most days of the week.
• Avoid caffeine, alcohol, and drugs. Caffeine is a stimulant, which can keep you up at night and exacerbate manic episodes. Cut back on coffee and soda, especially at night. Alcohol and drugs can affect how your medications work and possibly trigger a mood episode.
• Write it down. Keep a journal that makes note of big events, stresses, how much sleep you’re getting, and what you’re eating and drinking. Over time, you may see patterns emerging. By knowing what your triggers are, you may be able to prepare for times when you might be most vulnerable to mood swings.

While these lifestyle changes and coping strategies can help manage mood swings, they won’t make bipolar disorder magically disappear. However, knowing what your triggers are and taking steps to manage them can help prevent a minor mood swing from becoming a serious problem.