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Bipolar treatment can be tricky when pregnancy enters the picture. Learn how to take your bipolar meds safely and keep your baby safe, too.

Are you tossing and turning at night, unable to get to sleep? It could be related to your bipolar disorder.

If you have bipolar disorder, keeping to a regular sleep routine is crucial to keeping moods in check. But people with this disorder often have insomnia or other sleep issues. In fact, the relationship between sleep and bipolar disorder is very complex, says Ellen Frank, PhD, distinguished professor of psychiatry and professor of psychology at the University of Pittsburgh School of Medicine’s Western Psychiatric Institute, and one of the country’s leading researchers in this area of study. “Restless sleep when you have bipolar disorder can mean two very different things,” explains Dr. Frank. “One, it can signal that an episode of mania or depression is coming. Or two, it can mean something external disturbed your usual sleep pattern. In that case, the sleep problem — even one night of missed sleep — can trigger a mania episode that might not have otherwise happened.” What’s more, says Frank, when manic symptoms occur as a result of poor sleep, you may begin to believe that you don’t need to take your medications — which will likely have serious consequences.

Bipolar Disorder and Sleep Problems: What’s the Connection?

Each body organ — from kidneys to muscles — has a gene that puts it on an internal 24-hour clock. These are called circadian genes, and the sleep-wake patterns, or rhythms, they produce are known as endogenous rhythms because they are produced within the body. However, as Frank explains, the sleep-wake cycle is also influenced by exogenous rhythms outside the body — such as the rising and setting of the sun, or mealtimes. “For instance,” Frank says, “if my plane lands in Italy at seven a.m. and my gut’s still on Pittsburgh time, where it’s the middle of the night, I won’t want to eat. But once I see sunshine, smell food cooking, and put something in my stomach, my organs will wake up: ‘Hello! Something different is going on here.'” In people with bipolar disorder, both exogenous and endogenous rhythms are much more sensitive than in people without this condition, says Frank, which makes them prone to sleep disturbances.

Bipolar Disorder: Getting a Good Night’s Rest

So how can people with bipolar disorder get the sleep they need? Frank suggests the following:

Track your daily patterns. Filling out a daily form called a “Social Rhythm Metric” can help identify your daily sleep-wake patterns as well as other regular activities, and also track how your mood corresponds to each. “It takes two minutes a day. You record when you got up, when you first had contact with another person, when you started work or school, when you had dinner, and when you went to bed,” says Frank. By using the form over several weeks or months, you can figure out which bedtimes and wake times correspond to your best mood state.

Look out for zeitstorers! The German words “zeitgeber” (time-giver) and “zeitstorer” (time-taker) are used by researchers to describe different cues in your environment that can affect your schedule. A zeitgeber, says Frank, is an event or person that helps you maintain your routine — for example, a cat that should be let out at a given time or a spouse who must catch the same train daily. A zeitstorer, conversely, disturbs your routine, the way a business trip or overnight guests might. Figuring out how to maximize the use of zeitgebers and minimize the effect of zeitstorers will ultimately help improve your sleep and mental health.

Try IPSRT. Interpersonal and social rhythm therapy (IPSRT), developed by Frank and colleagues about 20 years ago, helps you understand the importance of regularity in your daily routines, especially how a consistent sleep/wake cycle can stabilize your mood and help to prevent new episodes of illness. “You learn to anticipate changes in routine, such as a vacation or a time when your spouse will be away, and how to maintain — as closely as possible — your usual sleep patterns in spite of these changes. You also learn how to carefully adhere to your usual medication regimen,” says Frank.

Accept the situation and work with it. “This problem isn’t going away,” says Frank. Just because your spouse can choose to go to bed at eight p.m. one night and one a.m. the next and suffer no ill effects, you can’t. You must make your sleep routine a priority of the household.

Like a Finely Tuned Watch

Frank sympathizes with how difficult it can be for people with bipolar disorder to regulate their sleep and other activity routines. “But I like to use an old TV commercial for Timex watches as an analogy,” Frank says. “A Timex was thrown off the top of the Empire State Building, and when it hit the ground, it was still ticking. Well, you wouldn’t get the same result if you threw a Piaget watch off the top of that building. It’s an exquisitely sensitive instrument. And that’s what we tell our patients: You aren’t a Timex. You’re a Piaget.”

It’s a common — and dangerous — combination: bipolar disorder and addiction.

Bipolar disorder and addiction often go together. As many as 60 percent of people with bipolar disorder will have some form of substance abuse during their lifetime, and research is underway to better understand this “dual diagnosis” — the term used for the combination of addiction and a mental disorder. Both of these disorders tend to first emerge during the teenage years, says Ken Duckworth, MD, medical director of the National Alliance on Mental Illness (NAMI), and studies have found that teens with bipolar disorder are more likely to experiment with drugs and alcohol.

Those with bipolar may turn to depressants — such as alcohol or pain pills — to try to manage their mania, or to stimulants — such as cocaine or methamphetamines — to cope with depression. In both cases, the usual result is that the substance abuse kicks the bipolar disorder into the opposite state — depression or mania — rather than fixing anything. “Short term, drugs and alcohol do change how you feel,” notes Duckworth. “But long-term it tends to be very counterproductive.”

Bipolar and Addicted: One Woman’s Story

For Jacqueline Castine, alcohol was a part of life. While growing up, everyone in her family drank. So when she became an adult, her own drinking didn’t seem that out of the ordinary in comparison.

Castine recalls drinking heavily on a daily basis for years, all while being a self-described overachiever with a high-profile career, a “perfect family,” and the “perfect marriage.”

“I was a functional alcoholic, from a family of functional alcoholics,” she says. “We didn’t realize what we were really doing was self-medicating for a mood disorder.”

Castine followed her twin sister’s lead into the world of sobriety at the age of 48. Around the same time, she also divorced and left her high-profile corporate position. That’s when “the dragon I always kept on the back porch,” as she describes it, wouldn’t stay outside any longer.

For seven years, she struggled to manage her swings between depression and mania with willpower and denial, but after a period of mania and some risky financial decisions, Castine’s life came crashing down and she lost her home, her life savings, and her grasp on reality. “I was homeless, suicidal, and psychotic,” she says. “That was the point where I realized I needed help.”

Castine was hospitalized, diagnosed with alcoholism and bipolar disorder, and began taking mood-stabilizing medication. “I was ready for treatment,” she says. “I knew that I was sick and I was willing to take the medication.”

Bipolar and Addicted: Getting Help

If you have bipolar disorder and think you may have a problem with drugs or alcohol, says Duckworth, both issues should be addressed together — in fact, he believes that anyone with substance-abuse issues should be screened for bipolar disorder or other mood disorders. Mood-stabilizing medications won’t fix the struggles with addiction, but they may reduce the drive toward it once the mania and depression are addressed.

Jacqueline Castine is living proof of this approach. Although she continues to struggle with managing the ups and down caused by her bipolar disorder, she believes it is now mostly under control. Today, at age 68, Castine has rebuilt her financial life, has written several books about her experiences (including Recovery From Rescuing and I Wish I Could Fix It, But…), and has a career she’s passionate about: She works as a community education specialist to raise awareness of mental-health issues and as a spokesperson for the Depression and Bipolar Support Alliance.

More information on bipolar disorder, including information about bipolar disorder and addiction, living with bipolar disorder, treatment options, support groups, advocacy, resources, and educational programs and events, can be found at the web sites of the Depression and Bipolar Support Alliance and the National Alliance on Mental Illness.

Spending sprees may be a part of manic episodes for many people with bipolar disorder.

Manic episodes of compulsive spending are a problem for many people who havebipolar disorder. During these episodes, people feel richer than they really are, more powerful, and willing to take more risks. In a recent study, people with bipolar disorder were twice as likely to have a problem with gambling compared to those without bipolar disorder.

There are several ways to avoid and control compulsive spending related to bipolar disorder. The first rule is to maintain your treatment schedule.

Bipolar Disorder: The Need for Consistent Treatment

Jair Soares, MD, a professor of psychiatry at the University of North Carolina (UNC) School of Medicine and director of the UNC Center of Excellence for Research and Treatment of Bipolar Disorders, both in Chapel Hill, N.C., says that the best thing people with bipolar disorder can do is receive consistent treatment with medications.

Besides taking their medication, Dr. Soares also encourages people with bipolar disorder to maintain their health by exercising regularly, eating healthy foods to maintain an optimal weight, getting enough sleep, and avoiding alcohol and recreational drugs.

Bipolar Disorder: Have a Plan and a Care Partner

Gary Sachs, MD, an associate professor of psychiatry at Harvard Medical School and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston, says that people with this condition need care partners. “Every highly successful person who has bipolar disorder has several care partners who check in multiple times a week,” he says.

Dr. Sachs says all patients should have a “collaborative care plan” that outlines a care partner’s role. “For instance, if a patient wants to spend $50 or $100, he should run this by his care partner first.” And if overspending does occur, he says patients should “take responsibility and apologize,” and try to mitigate the consequences.

Bipolar Disorder: The Reality of Binge Spending

One middle-aged patient with bipolar disorder says that being diagnosed in 2007 helped her deal with her binge spending. Prior to her diagnosis, she and her husband had many arguments, “due in part to my mismanagement, misspending, overspending and binge spending.”

This patient, who is a teacher in Pittsburgh, said her husband is a member of her support team. “We are learning to work together as a couple, a team. Some days are better than others. It’s those good days when we’re able to discuss how I’m feeling and thinking. On the bad days, when I’ve made poor financial choices, we’re able to talk about what we can do to correct the situation. I feel relieved and I am grateful for the guidance.”

Bipolar Disorder: More Advice

Here are other practical tips to help compulsive spenders with bipolar disorder:

• Keep only one credit card with a low limit.
• Have several care partners in place.
• Let one trusted care partner monitor your bank account and credit cards.
• Keep most of your money in non-liquid investments, such as CDs.
• Take classes in financial planning.
• Join Debtors Anonymous, a 12-step program that helps participants deal with many different aspects of overspending.

With prior planning, consistent treatment and a lot of support, you can keep your finances in good health, even through the manic episodes.

Whenever someone commits suicide, whether they’re a celebrity, acquaintance, or even a family member, the question often asked by those left behind is why. “At least 90 percent of the time, an untreated or undertreated mood disorder is to blame,” says Ken Duckworth, MD, medical director of the National Alliance on Mental Illness (NAMI).

Those with bipolar disorder, sometimes also called manic depression, are especially at risk for suicide. Statistics are sobering: As many as 15 percent of people with bipolar disorder will die by their own hands, half will attempt to, and nearly 80 percent will contemplate doing so. Jacqueline Castine, who is bipolar herself and a spokesperson for the Depression and Bipolar Support Alliance, knows it was bipolar disorder that led her son to take his own life in October 2007. It was his fifth suicide attempt. “Nobody wants to talk about suicide,” she says. “The stigma, shame, and suffering are, for most, unspoken.” And yet, for those withbipolar disorder and their families, the threat of suicide is very real.

What Are the Signs That Someone May Be Suicidal?

People with bipolar II disorder have a particularly high risk for suicide, particularly when they are in the depressive phase of their illness. Individuals with mixed-manic episodes (states in which they exhibit intense signs of both depression and mania simultaneously) may have an even higher chance of becoming suicidal.

According to the National Institute of Mental Health, the following factors increase the risk that someone may be suicidal:

• Talking about feeling suicidal or wanting to die, discussing death or writing about it
• Feeling hopeless, trapped — that nothing will ever change or get better
• Feeling helpless — that nothing one does makes any difference
• Feeling like a burden to family and friends, that others would be “better off without me”
• Feeling a lack of purpose in one’s life
• Withdrawing from friends, family, activities
• Experiencing recent loss of a significant relationship
• Abusing alcohol or drugs
• Having a personality disorder
• Making previous suicide attempts
• Experiencing recent loss of a friend or acquaintance through suicide
• Having family members who have committed suicide
• Putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one’s death)
• Writing a suicide note
• Engaging in risky behavior, putting oneself in harm’s way or in situations where there is a danger of being injured or killed
• Being incarcerated

Bipolar Disorder and Suicide: What Can You Do?

Someone who is talking about suicide should always be taken seriously and receive immediate attention, preferably from a mental-health professional or physician. If someone you know is contemplating suicide, you should:

• Call a doctor, emergency room, or 911 right away to get immediate help.
• Make sure the person’s immediate family members know how he or she is feeling.
• Make sure the suicidal person is not left alone.
• Don’t let the individual drink or use drugs.
• Make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm.
• Reassure the individual that there is help available.
• Contract with the individual for safety.

If you are feeling suicidal:

• Tell someone you can trust — a family member, friend, teacher, minister, or rabbi.
• Call a doctor, emergency room, 911, or a suicide-prevention hotline.
• Stay with other people — don’t put yourself in the position of being alone.
• Stay away from drugs and alcohol.

“Suicidal feelings pass if they are not acted on, at least most of the time, for most of the people,” Duckworth says. “I would encourage anyone considering suicide to consider getting treatment for their depression first before making such a big decision.”

Where to Turn for Help

Trained counselors are available to talk with people considering suicide or friends and family members of someone considering suicide by phone, toll-free, 24 hours a day at 1-800-SUICIDE (1-800-784-2433) or at 1-800-273-TALK (1-800-273-8255).

Medications used to treat bipolar disorder are intended to help stabilize mood and ease depression, but they often come with a significant side effect: weight gain.

Drugs that are especially associated with this issue include:

• Mood stabilizers such as lithium and divalproex (Depakote)
• Antipsychotics such as risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa)
• Antidepressants such as paroxetine (Paxil) and isocarboxazid (Marplan)

Drugs are not always solely to blame for weight gain during bipolar treatment: It’s also common for a person’s appetite to naturally increase along with his or her emotional wellness as the treatment takes effect.

Bipolar Disorder and Weight Gain: Why It Matters

Regardless of the cause, increases in your weight can have negative effects on your heart health, cholesterol levels, and blood pressure. Weight gain may also elevate your risk for diabetes, metabolic syndrome, cancer, sleep apnea, osteoarthritis, and other complications. And finally, gaining weight can contribute to low self-esteem and undermine your desire and commitment to eat healthfully and exercise regularly.

Bipolar-Related Weight Gain: How Can You Avoid It?

If you’re taking medication to treat bipolar disorder and have experienced weight gain, Everyday Health’s Emotional Health Expert, Ruth Wolever, PhD, a clinical health psychologist and the research director at the Duke Center for Integrative Medicine at Duke University School of Medicine, offers the following tips:

• Eat nutritious foods.

A balanced diet is the foundation of good health and also a key component of weight management. Go for fresh fruits and vegetables, beans and legumes, whole grains, lean meats and fish, tofu, and low-fat, low-cal dairy options. Avoid trans fats, simple carbohydrates, and processed and fatty foods whenever possible.

• Reduce your portion sizes.

Smaller servings will add up to fewer pounds. If you’re having trouble figuring out what an appropriate portion size looks like, check out the portion guidelines on

MyPyramid.gov

.

• Eat more slowly.

Taking time to chew and leisurely make your way around your plate will allow your body to catch up with your meal. It takes from 20 to 30 minutes for your brain to register that your stomach is full, so eating slowly may actually help you eat less.

• Exercise regularly.

Being active is one of the best things you can do for your body. Exercise is great for your overall health and well-being, weight management (and weight loss), and mood.

• Manage stress.

Feeling stressed can lead to emotional and binge eating, which in turn lead to weight gain. Additionally, stress can interfere with your sleeping habits, which studies show may also contribute to weight gain. Getting a handle on stress will help you gain control of your weight.

Sara Biel, LCSW, a psychotherapist in Oakland, California, also suggests the following:

• Get professional guidance.

Consult with a nutritionist to set up an individual diet plan that works for you.

• Write it down.

Keeping a food diary can help a person with bipolar disorder gain insight into eating habits by tracking caloric intake and seeing a connection between daily/monthly eating patterns and emotional states.

Talk to Your Doctor About Weight Concerns

According to Dr. Wolever, if you’re worried about your weight or if you think your medication is already causing you to pack on the pounds, it’s important to tell your doctor and/or your psychiatrist. There may be other bipolar medications that are appropriate for you that don’t cause weight gain. However, you shouldn’t discontinue your current medication or change your treatment regimen without first speaking to your doctor.

“Bipolar disorder is a chronic illness,” adds Biel, “and people need to find a medication regimen they can tolerate for the long haul.” Since every person has a unique body chemistry, Biel emphasizes that it is important for those with bipolar disorder to closely work with their own doctors to find a regimen that addresses their particular symptoms and minimizes side effects.

A varied, healthy diet is your best source of vitamins. Some researchers believe that people with bipolar disorders may metabolize certain vitamins differently, and therefore require either careful intake via food or supplementation.

If you plan to pursue vitamin therapies, purchase a basic guide to vitamins andminerals that includes information about toxicity symptoms. Some people metabolize vitamins and minerals differently, and may be more or less susceptible to potential toxic effects. Along with your doctor’s guidance, a good reference book can help you avoid problems.

Also, take vitamin company sales pitches and dosage recommendations with a grain of salt. The testimonials these companies produce are intended to sell their products, not to help you develop a treatment plan. Consult a physician or a professional nutritionist who does not sell supplements for unbiased, individualized advice.

Vitamins often cited as important in mood regulation include the B vitamins. If you are deficient in any of the Bs, depression, anxiety, and fatigue can result. The B vitamins work together, so it’s best to take a B-complex supplement that mixes them in proper proportions along with folic acid. The Bs have a generally energizing effect and help build up the immune system. Some alternative practitioners recommend vitamin B-12 shots for depressed patients. They don’t always work, but sometimes they can have surprisingly quick mood-elevating effects. Because of that energizing effect, however, they may not be a good idea for those who are hypomanic or manic. B vitamins are used up more quickly when the body or mind is stressed, so supplementing during these times could have a preventive effect. A list of B vitamins follows:

• Vitamin B-1 (Thiamin). Alone, or in addition to a regular B-complex pill, B-1 might be a good idea for bipolar patients who suffer from circulation problems, tingling in the extremities, anxiety, irritability, night terrors, and similar symptoms.
• Vitamin B-6 (Pyridoxine). In addition to a regular B-complex pill, B-6 might be indicated for bipolar patients who present with a great deal of irritability, and for those with marked premenstrual symptoms and/or motion sickness. If you start to experience tingling in your hands or feet, reduce or discontinue the B-6.
• Vitamin B-12. Helps your body turn food into energy, and without enough of it you are likely to feel listless and fatigued. Vegetarians may also be deficient in B-12, as it’s found mostly in meat.
• Vitamin E. An antioxidant that also seems to reduce the frequency of seizures in some people who have epilepsy. It’s especially important to take vitamin E if you take Depakote, Depakene, or another anticonvulsant, as these drugs deplete vitamin E. If you have high blood pressure, monitor it carefully after starting vitamin E, and reduce the dose if your blood pressure rises.

Vitamins A and D are fat-soluble, so they are stored in the body’s fat cells for later use. Having a little socked away for a rainy day is probably okay, but if you take too much, hypervitaminosis may develop.

Symptoms of hypervitaminosis A include orangeish, itchy skin; loss of appetite; increased fatigue; and hard, painful swellings on the arms, legs, or back of the head. Symptoms of hypervitaminosis D include hypercalcemia, osteoporosis, and kidney problems.

Don’t overdo it with any fat-soluble vitamin, and also be careful with fish-oil supplements (and cod liver oil), which are high in both vitamins A and D.

Folic acid can counteract the effects of Depakote, Depakene, and some other anticonvulsants if taken in large amounts. It may also cause manic mood swings.

There are many psychological, social and biological benefits of eating meals with other people.

Sharing mealtimes is good for your mental health. Whether it be through sharing experiences with family and friends, winding down with company, bonding with family members or just having someone to talk to, mealtimes provide a great opportunity for us to set aside a specific time of the day or week to give us time to socialise, relax and improve our mental health.