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Bipolar patients want to know “Am I okay to drive?” Learn about the issues surrounding driving and bipolar disorder.

As an adult bipolar patient, one of the most significant lifestyle issues you take up with your doctor will likely involve driving, including questions like, “Am I okay to drive when I’m manic? What about when I’m depressed? What if I’m only mildly manic or mildly depressed?”

The answers to these questions are not clear-cut from the viewpoint of your doctor or even the law. Although there are specific state laws governing driving and some medical conditions like epilepsy, most states are hesitant to legislate driving and such a complicated, variable condition as bipolar disorder.

“Very disorganized, symptomatic people often continue to drive through their illnesses and have a perfect driving record,” says Paul S. Appelbaum, MD, director of the division of law, ethics and psychiatry in the department of psychiatry at Columbia University and a member of the American Psychiatric Association’s Council on Psychiatry and Law. “Alternately, there are a lot of people out there on the road with no psychiatric disorder whatsoever who are terrible drivers. There is not a good correlation between symptoms and driving ability, which makes it hard sitting in an office to know how good a driver is.”

Driving and Bipolar Disorder: Unique Circumstances

Whether you should drive most likely will come down to an open, honest discussion: with your doctor, who can only offer his educated opinion, and with your family members and loved ones, who can help convey to your care team the individual circumstances surrounding your bipolar disorder.

Those circumstances may include:

• The severity of your manic and depressive episodes. While manic episodes are legendary for causing reckless, aggressive driving within the bipolar population, depressive episodes, especially if you are suicidal, can also be problematic.
• The medications you are taking and whether they are stabilized. If you are just starting or changing your medications, particularly those known to have sedating effects, your doctor will most likely suggest you stop driving for a period of time to adjust to the changes in your body.
• Your driving record. Your doctor may want to know if you have a good driving record with plenty of previous driving experience or a previous record of poor driving.
• Your history of substance abuse, particularly while driving.Between 50 and 60 percent of patients with bipolar disorder will at some point in their lifetime struggle with substance abuse and addictionissues.

Your doctor will more than likely help you and your family come up with a variety of options on managing your driving needs. It may be that your moods are not so extreme and your driving routine doesn’t need to change at all. It may be that your moods are especially severe and that you should always have someone else drive you where you need to go. It may be that your depressive episodes are not that dangerous, but your manic episodes put you at risk, which is often the case with bipolar disorder.

The possibilities and varieties of options are endless, requiring your entire care team to be on board, perhaps most especially your family and loved ones.

Driving and Bipolar Disorder: Your Doctor’s Role

“The person in the manic episode 99 percent of the time will not have the insight to say, ‘Gosh, I’m manic — I shouldn’t drive.’ They will be thinking, ‘Gosh, nothing is wrong with me. I’m all-powerful — I’m amazed my car doesn’t fly,’” says Melvin G. McInnis, MD, director of psychiatry programs at the University of Michigan Depression Center in Ann Arbor. “It really becomes up to the family member to provide the guidance, counsel, and insight into the situation, to say, ‘Charlie, I’m taking the keys. You’re not driving.’”

Keep in mind that your doctor can only offer advice. While your partner or parent may choose to stop you from driving, your doctor is not in the position to take such action.

In some states, doctors are required by law to report to that state’s department of motor vehicles the names of patients who, because of their disorders or treatments, are “driving-impaired,” which can mean different things, depending on the state. In other states, doctors are required by law to report the names of those patients who have been advised not to drive, but continue to do so. However, statutes and laws vary widely.

Meanwhile, the American Psychiatric Association’s position paper, “The Role of the Psychiatrist in Assessing Driving Ability,” says that the doctor should talk about a patient’s ability to drive only “when appropriate.”

The onus is on you and your family members to be proactive on this important and potentially life-threatening activity, to offer honest information, to seek out experienced counsel, and to be courageous enough to ask your doctor the very important question: “Is there a reason I should not drive?”

“If the family is concerned,” says Dr. McInnis, “it’s up to them to have a chat with the doctor and to see what’s going on.”

Fluctuating hormones during menopause can worsen bipolar symptoms. Find out how to cope.

If you are a woman with bipolar disorder, you may experience a double whammy during a profound time in your life — menopause.

Bipolar Disorder and Menopause: The Estrogen Effect

“Unfortunately, menopause can exacerbate bipolar disorder,” says Ahsan Y. Khan, MD, professor in the department of psychiatry and behavioral sciences at the University of Kansas School of Medicine-Wichita and director of Via Christi Psychiatric Outpatient Clinic, also in Wichita. “You can be irritable and dysphoric [anxious] at the same time. And then here come hormones into play. They compound the problem.”

Although doctors don’t completely understand the complex biochemistry behind the reaction, clinical research consistently suggests that a significant number of women with bipolar disorder are more sensitive to hormonal shifts during menopause and the powerful changes going on in the body. At menopause in particular, they report more depressive episodes than women without bipolar disorder, at least partly because of a normal menopausal decrease in the powerful hormone estrogen.

The connection between estrogen and mood disorder is not completely clear. What researchers do know is:

• High levels of estrogen tend to have a “brightening effect” on mood, while low levels promote a dampening of mood.
• Estrogen will decrease during menopause and the five- to 10-year period before menopause, known as perimenopause.
• A drop in estrogen can have particular consequences for the bipolar patient, doubling susceptibility to depressive episodes.

Bipolar Disorder and Menopause: Not Everyone Gets an Increase in Symptoms

Does this mean all women with bipolar disorder will experience a return ofdepression and complications of mood as estrogen levels decrease during menopause? Not necessarily.

While psychiatrists consistently field an increase in depressive reports during their bipolar patients’ menopausal years, research suggests that a high percentage of, but not all, women experience an escalation of depressive symptoms during menopause.

By the time you’re in your mid-30s, your doctor should begin checking your hormone levels to make sure menopausal hormone fluctuations are not overlooked as a contributing factor to your mood issues.

“If there is a worsening of symptoms without any other change in life, I would ask my patient if they are going through menopause,” says Dr. Khan. “I would ask them to contact their primary care doctor to look at hormone levels.”

Khan recalls the case of a 51-year-old bipolar patient who was being unsuccessfully treated for a sudden increase in mood symptoms. It wasn’t until her doctors measured her hormone levels that they realized she was in menopause. As soon as she started on hormone replacement, her symptoms dramatically decreased, says Khan.

Bipolar Disorder and Menopause: Options for Treatment

If your doctor finds a hormonal imbalance, he or she may suggest one or both of these options:

• Hormone replacement therapy (HRT). If your symptoms don’t improve after adjusting the dosage of or otherwise make changes in your current regimen of bipolar medications, HRT might be beneficial. However, HRT must be considered carefully because it increases the risk of heart disease, stroke, and blood clots. Some women are advised against HRT because of existing health conditions that may be worsened by it.
• Talk therapy. Speaking with a qualified therapist may help. Some women may need or want to talk about pessimistic thoughts, about their life, and about the fact that they can no longer bear children, says Khan.

Sometimes the problem gets worse with treatment before it gets better. Synthetic estrogen, for example, has been known to increase stimulation and anxiety in some women — exactly what you don’t want. A lower dose or another hormone combination might work better. This may take time and patience to discover.

Indeed, just as there is no one way to combat bipolar disorder and just as it takes time to find the right combination of medications, so it is for managing your menopausal symptoms. Your care team is there to help.

Taking good care of yourself is perhaps the most important part of successfully managing bipolar disorder.

As important as your medications and therapy sessions are, what you do to care for yourself on a day-to-day basis is just as important in managing bipolar disorderand preventing episodes.

Bipolar Disorder: Adopting Healthy Habits

Getting plenty of sleep and having a regular sleep schedule is a good start to taking care of yourself and managing 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.

Eating a healthy diet with nutritious foods, as well as eating on a regular schedule to prevent getting too hungry, are also important self-care steps for people with bipolar disorder, Dr. Viguera adds.

It’s really important to watch what you eat, she says, because a lot of these medicines can promote weight gain. “So you really want to pay attention to nutrition.”

She also recommends taking omega-3 fatty acids and other nutritional supplements and vitamins along with — not instead of — medications.

Bipolar Disorder: More Healthy Tips

Other healthy habits to manage bipolar disorder symptoms include:

• Know what triggers your bipolar symptoms, and learn how to avoid them.
• Keep a diary of your mood swings, symptoms, and triggers.
• Devise a strategy to deal with symptoms when they start to arise.
• Join a support group for people with bipolar disorder.
• Get plenty of regular exercise.
• Find a hobby, sport, or game that you enjoy.
• Limit or avoid caffeine, alcohol, and sugary foods.
• Continue your therapy and counseling visits as long as your doctor recommends them.
• Give yourself some relaxation time.

Bipolar Disorder: Choosing the Right Doctor

You’ll need a close, ongoing relationship with your doctor, so it’s important to find the right fit — and someone who can truly help you.

“Finding a doctor who has some expertise in treating bipolar disorder is important,” says Viguera. “I would encourage the patient to see someone who sees a lot of those patients — those docs have a lot of experience.”

And your relationship with your doctor isn’t just between the two of you — your family plays an important role in your treatment, too. “Get family members involved — bring them to the appointments,” Viguera stresses.

It’s also important to establish up-front the friends and family members who can be contacted if your doctor has questions or needs help. Your loved ones should also be encouraged to reach out to your doctor if they notice strange behavior or symptoms of a bipolar episode.

Bipolar Disorder: Take Your Medications

Staying compliant with your medication is very important — even if it’s a challenge. Medication is “a cornerstone of treatment,” says Viguera. So instead of skipping pills, come up with tricks to make it easier to remember to take them, or talk to your doctor about an alternative dosage.

“It’s hard to take a medication three times a day, so there are creative ways where you can try to bunch medications together if you can,” Viguera says. She suggests linking them to a daily habit like eating a meal or brushing your teeth.

If you experience side effects like drowsiness or just can’t squeeze all those pills into a day, ask your doctor if you can take them at a different time of day or reduce the number of pills you need each day. Your doctor wants you to keep taking your medications, so he’ll be willing to work with you to help you successfully manage your bipolar disorder.