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Bipolar Disorder: Preventing Manic Episodes

Introduction

The more you know about bipolar disorder, the better you will be able to cope with this lifelong illness. There are many steps that you can take—or help a loved one take—to recognize and better manage manic episodes.

• Learn the warning signs of a manic episode and get early treatment to avoid disruption in your life.
• At the same time each day, record your mood and any symptoms.
• Take medicines as instructed by your doctor to help reduce the number of manic episodes.
• To help prevent a manic episode, avoid triggers such as caffeine, alcohol or drug use, and stress.
• Exercise, eat a balanced diet, get a good night’s sleep, and keep a consistent schedule. This can help reduce minor mood swings that can lead to more severe episodes of mania.
• Have an action plan in place so that if you do have a manic episode, those who support you can follow the plan and keep you safe.

How do I manage a manic episode?

Know the warning signs

Learn to recognize your early warning signs. One of the most important ways to avoid a manic episode is to identify early signs and seek treatment.
Common early warning signs of a manic episode include:
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• Needing less sleep.
• Being more active.
• Feeling unusually happy, irritable, or energetic.
• Making unrealistic plans or focusing intensely on a goal.
• Being easily distracted and having racing thoughts.
• Having unrealistic feelings of self-importance.
• Becoming more talkative.

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The best way to manage bipolar disorder is to prevent manic episodes. Although that is not always possible, you can identify and try to avoid the triggers that may lead to a mood swing. One of the most important aspects of managing your illness is to stay on a routine, particularly keeping a stable sleep pattern.

Managing a manic episode

• Maintain a stable sleep pattern. Go to bed about the same time each night, and wake up around the same time each morning. Too much or too little sleep or changes in your normal sleep patterns can alter the chemicals in your body. And this can trigger mood changes or make your symptoms worse.
• Stay on a daily routine. Plan your day around a fairly predictable routine. For example, eat meals at regular times, and make exercise or other physical activity a part of your daily schedule. You might also practice meditation or another relaxation technique each night before bed.
• Set realistic goals. Having unrealistic goals can set you up for disappointment and frustration, which can trigger a manic episode. Do the best you can to manage your illness. But expect and be prepared for occasional setbacks.
• Do not use alcohol or illegal drugs. It may be tempting to use alcohol or drugs to help you get through a manic episode. But this can make symptoms worse. Even one drink can interfere with sleep, mood, or medicines used to treat bipolar disorder.
• Get help from family and friends. You may need help from your family or friends during a manic episode, especially if you have trouble telling the difference between what is real and what is not real (psychosis). Having a plan in place before any mood changes occur will help your support network help you make good decisions.
• Reduce stress at home and at work. Try to keep regular hours at work or at school. Doing a good job is important, but avoiding a depressive or manic mood episode is more important. If stress at work, school, or home is a problem, counselling may help improve the situation and decrease stress.
• Keep track of your mood every day. After you know your early warning signs, check your mood daily to see whether you may be heading for a mood swing. Write down your symptoms in a journal. Or record them on a chart or a calendar. When you see a pattern or warning signs of a mood swing, seek treatment.
• Continue treatment. It can be tempting to stop treatment during a manic episode because the symptoms feel good. But it is important to continue treatment as prescribed to avoid taking risks or having unpleasant consequences from a manic episode. If you have concerns about treatment or the side effects of medicines, talk with your doctor. Do not adjust the medicines on your own.

Panic Attacks and Panic Disorder

Topic Overview

What are panic attacks and panic disorder?

A panic attack is a sudden, intense fear or anxiety that may make you short of breath or dizzy or make your heart pound. You may feel out of control. Some people believe that they are having a heart attack or are about to die. An attack usually lasts from 5 to 20 minutes. But it may last even longer, up to a few hours. You have the most anxiety about 10 minutes after the attack starts. If these attacks happen often, they are called a panic disorder.
Panic attacks can be scary and so bad that they get in the way of your daily activities. Treatment can help most people have fewer symptoms or even stop the attacks.
More women than men get panic attacks.

What causes panic attacks and panic disorder?

Experts aren’t sure what causes panic attacks and panic disorder. But the body has a natural response when you are stressed or in danger. It speeds up your heart, makes you breathe faster, and gives you a burst of energy. This is called thefight-or-flight response. It gets you ready to either cope with or run away from danger. A panic attack occurs when this response happens when there is no danger.
Panic attacks and panic disorder may be caused by an imbalance of brain chemicals or a family history of panic disorder. They sometimes happen with no clear cause.
Panic attacks may also be brought on by:

• A health problem such as an overactive thyroid (hyperthyroidism), or heart or breathing problems.
• Depression or another mood disorder.
• Heavy alcohol use.
• Using too much nicotine or too much caffeine.
• Taking certain medicines, such as those used to treat asthma and heart problems.
• Using illegal drugs, such as marijuana or cocaine.
• Living with high levels of stress for a long time.

You have a higher chance of getting panic disorder if you have a parent with depression or bipolar disorder.

What are the symptoms?

Symptoms of a panic attack may include:

• A feeling of intense fear, terror, or anxiety.
• Trouble breathing or very fast breathing.
• Chest pain or tightness.
• A heartbeat that races or isn’t regular.
• Sweating.
• Nausea or an upset stomach.
• Dizziness and shaking.
• Numbness or tingling.

Symptoms of panic disorder may include:

• Repeated panic attacks when there is no reason for the fight-or-flight response.
• Changing your daily activities because you worry that you will have another attack.

Some people have a fear of being in crowds, standing in line, or going into shopping malls. They are afraid of having another panic attack or of not being able to escape. This problem is called agoraphobia. It can be so bad for some people that they never leave their homes.
People who have panic disorder often have depression at the same time.

How are panic attacks and panic disorder diagnosed?

Your doctor will ask about your past health and do a physical examination. The examination may include listening to your heart, checking your blood pressure, and ordering blood tests to look for other causes of your problem.

How are they treated?

Treatments for panic attacks and panic disorder include counselling, especially cognitive-behavioural therapy (CBT). Medicines may also help. Treatment can help most people control or even stop attacks. But symptoms can come back, especially if you stop treatment too soon.
Early treatment of panic attacks is very important. It can prevent other problems related to panic disorder. These problems include depression, anxiety disorders, and substance abuse.

The two types of medicines used most often are antidepressants and benzodiazepines. Some people use both.

• Antidepressants. These include:
  • Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, paroxetine, or sertraline. These are the most common medicines for panic disorder.
  • Tricyclic antidepressants (TCAs), such as clomipramine or imipramine.
  • Monoamine oxidase inhibitors (MAOIs), such as phenelzine or tranylcypromine.
  • Antidepressants with mixed neurotransmitter effects, such as venlafaxine.
• Benzodiazepines, such as alprazolam or clonazepam. They are sometimes used for panic disorder. They may be used alone or with an antidepressant.
  • These drugs can help you feel better right away. They may also be used as a part of long-term treatment, either alone or with an antidepressant.
  • They may be especially helpful if you have agoraphobia.
  • They can be taken as needed. But they can cause addiction (dependence). Symptoms often come back when you stop taking them.