Anxiety and Bipolar Disorder

Posted on July 20, 2016 by JmaC

Many people with bipolar disorder also suffer from severe anxiety.

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Everybody feels anxious at times, and it’s only natural to have mood swings in response to the daily ups and downs of living. For some people, however, periods of depression, restlessness, irritation, and anxiety may become so severe that they interfere with work, relationships, and the ability to function normally in society. These may be symptoms of bipolar disorder, anxiety disorder, or a combination of both disorders.

“It is very common to see an anxiety disorder coexisting with bipolar disorder,” says Carolyn M. Drazinic, MD, PhD, assistant professor in psychiatry, genetics, and developmental biology at the University of Connecticut Health Center in Farmington. “Anxiety disorders seen with bipolar disorder include generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorders, and social anxiety. We also frequently see social anxiety and attention deficit disorder (ADHD) beginning in childhood or adolescence associated with bipolar disorder in later years.”

Diagnosing Bipolar Disorder and Anxiety Disorder

Bipolar disorder, formerly called manic depression, is a mental illness that results in extreme swings in mood, energy levels, and ability to function. More than 10 million Americans are diagnosed with bipolar disorder. “Mania is the word used to describe symptoms of bipolar disorder such as extremely elevated or irritable mood, pressured speech, high energy levels, decreased need for sleep, impulsivity, and risky behaviors that are ultimately self-destructive,” says Dr. Drazinic.

Symptoms of depression that are seen in bipolar disease include lack of energy, guilt, sadness, worry, hopelessness, inability to concentrate, trouble sleeping, and thoughts of suicide. Findings that may indicate the existence of an anxiety disorder along with bipolar disorder include:

  • Panic attacks. “Patients will usually tell you that they are anxious. They may describe racing thoughts, panic attacks, excessive worries, or difficulty sleeping,” notes Drazinic.
  • Obsessive-compulsive disorder. “These patients may have obsessive thoughts or actual compulsive behaviors, such as fear of contamination leading to hand-washing rituals, that make them very anxious,” adds Drazinic.
  • Substance abuse. “It is very common for patients with anxiety and bipolar disorders to medicate themselves with high doses of drugs or alcohol to be able to function socially or to be able to get some sleep,” explains Drazinic. “A typical example is a patient who needs to drink alcohol before going to a job in order to deal with the public. Unfortunately, this becomes a vicious cycle for patients with bipolar disease and anxiety because when the alcohol or drug wears off, the anxiety is worse.”
  • Delayed response to treatment. An anxiety disorder can make treatment of bipolar disorder more difficult. People with both disorders may have a poor response to initial treatment and may have persistent anxiety and trouble sleeping even when they are out of their manic stage. There may be increased side effects to medications, and it may take longer to find the right combination of medications.
  • Increased irritability. “In both cycles of bipolar disease, patients who also have anxiety may be more labile. When depressed, they may be very irritable and a small emotional upset can lead to rage or suicidal thoughts. When they are manic, their natural high may quickly change to anger or even violence,” says Drazinic.
  • Increased complications. “Patients with anxiety and bipolar disorders have a higher risk of suicide and injury due to reckless behavior,” warns Drazinic. People with bipolar disorder and anxiety disorder have a harder time functioning in society, and their quality of life can suffer.

Treating Bipolar and Anxiety Disorders

Bipolar disorder is a condition of recurring episodes of mania and depression that often starts in early adulthood and usually requires life-long treatment. For treatment to be successful, both anxiety and mood swings must be addressed.

  • Mood stabilizers. Lithium (Lithobid) and divalproex sodium (Depakote) are the two first-line mood stabilizers used for treating bipolar disorder symptoms. “Although these drugs are frequently effective for most bipolar symptoms, anxiety may require additional treatment,” says Drazinic.
  • Benzodiazepines. This class of drugs is frequently used to treat anxiety, but can be dangerous for people with bipolar disease because of their potential for abuse and addiction. “I tend to avoid benzodiazepines because they work on the same brain receptors as alcohol. Tolerance can build up and addiction is a significant risk,” says Drazinic.
  • Antidepressants. “Although selective serotonin reuptake inhibitor (SSRI) antidepressants can be effective for depression and anxiety, they are generally not used in bipolar disorder because they can switch depression into mania, causing anger, increased irritability, and suicidal thoughts,” warns Drazinic. An SSRI can trigger a manic phase even in a patient on a mood stabilizer and should only be used with careful monitoring.
  • Other medications. “If another medication needs to be added to treat anxiety, I will often use another anticonvulsant or mood stabilizer such as gabapentin (Neurontin), topiramate (Topamax), oxcarbazepine (Trileptal), or lamotrigine (Lamictal). These anti-convulsant medications treat anxiety symptoms by different modes of action,” adds Drazinic.
  • Cognitive-behavioral therapy (CBT). This is a type of talk therapy that can be used to treat anxiety. CBT focuses on understanding symptoms and working to change behaviors. It teaches people to develop skills to handle their anxiety in new ways. “There is good evidence that CBT can be very effective in treating anxiety disorder, especially panic attacks,” notes Drazinic.
  • Interpersonal and social rhythm therapy. This treatment stresses the importance of maintaining a regular schedule of sleep, work, and social interactions since people with bipolar disorder are very sensitive to changes in body rhythms. “Patients with bipolar disorder should avoid working night shifts. Maintaining a stable circadian rhythm and good sleep hygiene is important for these patients. Losing regular sleep time can trigger a flare-up of symptoms or be a warning sign of a manic episode,” explains Drazinic.

With proper treatment of bipolar disorder and anxiety disorders, most people can lead rewarding and productive lives. While medication is one key to successful treatment, psychotherapy, support, and education are also important parts of successful management for these disorders.

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The Course of Bipolar Disorder Over Time

Posted on July 20, 2016 by JmaC

For most people with bipolar disorder, strict adherence to medications is necessary to help keep episodes to a minimum.

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If you have bipolar disorder, you may be wondering what the future will bring. Will your bipolar symptoms get worse or can this disorder go away? What happens if you stop taking your medications or seeing your psychiatrist?

Bipolar Disorder: Treatment Over Time

“Having bipolar disorder is very different than having a blood pressure problem ordiabetes,” says Gary Sachs, MD, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School in Boston.

Dr. Sachs says that unlike other illnesses, in which patients accept the fact that they need to take medicine to control their disease, people with bipolar disorder often refuse to take their medications — an issue called treatment compliance. These patients often have trouble perceiving that they have a problem, even during a bipolar episode (a condition known as anosognosia, and therefore don’t believe they need treatment.

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Avoiding treatment, however, is the worst thing you can do with bipolar disorder. Why? Because bipolar disorder tends to get worse if it’s not treated. So to improve your prognosis — your future with this condition — you need to follow your doctor’s prescribed treatments.

Bipolar Disorder: The Timeline

Bipolar symptoms usually appear during the late adolescent years, but they can emerge at any time from early childhood to your 50s. For a very few people diagnosed with bipolar disorder, symptoms will improve with medication to the point that medications will no longer be necessary.

But most people won’t be that lucky, since it is typical for manic and depressive episodes to recur later on.

“If you have a single episode of mania, the chances that you are going to have another one over your lifetime is virtually 100 percent,” says Sachs.

And there is a good chance that your manic and depressive episodes will become more frequent and severe over time. According to Sachs, most people can also expect more depressive episodes and fewer manic ones. “You will have fewer highs and more depression,” he says. Your illness may even progress to what is called rapid-cycling bipolar disorder, which is when you have four or more episodes a year.

And, Sach adds, “If you’ve had several [bipolar] episodes, there is probably a 60 to 80 percent chance that you will have one episode every year if untreated.” But with treatment, you can probably cut your risk of having an episode by half.

Bipolar Disorder: Remission

Most people who have bipolar disorder will have normal moods in between their manic and depressive episodes. However, in almost every case, bipolar disorder is a lifelong illness requiring treatment.

While there is no cure for bipolar disorder, there is every reason to believe that with proper treatment, you will get better. Proper treatment means taking all your medications and attending therapy sessions as recommended by your doctor. It is important to take the bipolar medications even between episodes of depression or mania. Consistency in taking the medications can stabilize your mood swings.

By learning to recognize the early signs of a manic or depressive episode, you will be empowered to take control of your bipolar disorder and deal with your symptoms before they become a full-blown episode.

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Can a Person Be Diagnosed with Simultaneous Depression and Bipolar Disorder?

Posted on July 20, 2016 by JmaC

Depression and bipolar disorder are virtually never diagnosed together in the same person at the same time. Both are serious mental disorders that have many treatment options available to a person diagnosed with one of them. However, the treatments between depression and bipolar disorder are fairly significantly different, and the wrong diagnosis could start a person down a road of frustration and lack of improvement in how they’re feeling.

Depression is a symptom of bipolar disorder, and sometimes people can be misdiagnosed with depression because one of the person’s mental health professionals didn’t ask enough questions about possible past or present manic or hypomanic episodes. For instance, if a person is experiencing a depressed mood, they may seem to have no sign of energy or mania commonly associated with someone who has bipolar disorder. Many mental health professionals will sometimes not probe enough during the initial intake interview to ensure the person doesn’t have a history of such mania, or other symptoms that might suggest such a past manic episode or hypomanic episode.

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The opposite can occur as well. Someone who has been diagnosed with bipolar disorder may actually have depression instead, because of a mental health professional’s decision about what constitutes a manic or hypomanic episode. Some clinicians will be very aggressive in diagnosing a hypomanic episode (basically, a less severe type of mania), while another clinician might write off a single episode as a part of being a young adult, intoxicated, or some other external factor.

Generally, mental health professionals are encouraged to find the best diagnosis that fits within the client’s presenting picture, and to err on the side of caution when it comes to multiple diagnoses. Multiple diagnoses complicate treatment options for a person, and often confuse the issue of what is the primary problem in the person’s life right now. A good mental health professional will ask multiple probing questions surrounding possible past manic or hypomanic episodes in a person’s life if they present only with depression. The same is true if someone comes to a professional in a seeming hypomanic episode.

The key is for the mental health professional to ask the right questions and for you to be honest with them to find the right diagnosis that fits your symptoms. The right diagnosis means it is more likely you will receive beneficial treatments for the disorder sooner, and subsequently feel better soon as well.

Last Updated: 10/16/2008

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Bipolar Disorder: Questions to Ask Your Doctor

Posted on July 20, 2016 by JmaC

Get the most out of your visit to the doctor.

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While your doctor usually asks the questions during an exam, you can respectfully and proactively take charge, too. In fact, asking the right questions can make a big difference in the way you manage your bipolar disorder. Your health is important both to you and to your doctor, so don’t hesitate to inquire about any topic you feel is relevant to your condition, whether it’s a question about your bipolar diagnosis, something regarding your bipolar medication, curiosity about complementary or alternative therapies for bipolar disorder, or concern about your emotional health, your financial health, or any other lifestyle issue.

Engaging in a dialogue with your doctor will help educate you about bipolar disorder and the treatment options available to you, and it’ll give your doctor a better sense of who you are and how bipolar disorder is affecting your health and your life. With the lines of communication open, you and your doctor will be able to develop the best treatment plan for your individual needs.

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But remember, your time with your doctor is limited, so be sure to arrive at your appointment prepared and ready to discuss bipolar disorder and the questions that are important to you. Start by:

Researching bipolar disorder. It’s a good idea to get a better understanding of bipolar disorder before your appointment. Through research, you may even be able to answer some of your own questions. Visit Everyday Health’s Bipolar Disorder Center, the Depression and Bipolar Support Alliance, the National Institute of Mental Health, and MedlinePlus.
Strategizing. Your family doctor may not be able to answer all your questions about bipolar disorder; some may be better addressed by a psychotherapist or psychiatrist who specializes in treating people with bipolar disorder. Discuss this with your doctor, set up a plan for addressing your concerns, and follow up with a specialist, as directed by your doctor. You can also do additional research of your own.
Keeping records. Consider keeping a journal about your bipolar disorder between visits to the doctor, and share any relevant information with your doctor, such as changes in mood or behavior and how well your medicine is working. Taking notes during your appointments will help you remember important details after your visit. Alternatively, you may consider bringing a recording device or inviting someone to accompany you and take notes.
General Bipolar Disorder Questions

If you haven’t yet been formally diagnosed with bipolar disorder, talk to your doctor about arranging an evaluation with a specialist, such as a physician, psychologist, or psychiatrist with experience in diagnosing and treating mood disorders.

Once you have a formal diagnosis, your doctor will give you information about the condition and recommend a course of treatment. You may have questions or concerns about your diagnosis and how bipolar disorder will affect your health and your life. Consider asking your doctor the following:

What type of bipolar disorder do I have? How severe is it? Can you explain the disorder to me?
What is the best method (or combination of methods) of treatment for bipolar disorder?
Does bipolar disorder change with age? Do people ever outgrow it?
How will bipolar disorder affect me over the long term?
What are the key components for successfully managing the challenges of bipolar disorder?
Are there other types of medical or mental health specialists who should be involved in my care?
When might hospitalization be beneficial or necessary?
Should I (or a member of my family) alert you if there are any changes in my behavior? What kind of changes do you want to be informed about?
What should I do if I feel I’m in crisis or need emergency help?
Prescription Considerations

Mood stabilizers, like lithium, or anticonvulsant drugs are commonly prescribed to help manage the symptoms of bipolar disorder. Your doctor may also recommend other types of medication, such as antidepressants and antianxiety and antipsychotic drugs. It is important to understand the medication your doctor is prescribing. Ask your doctor about it, read the insert the pharmacy includes with your prescription, and take the medication as directed by your physician. Knowing how your medication is supposed to work will help you evaluate its effectiveness and whether it’s the right medication for you. Here are some questions you may want to ask your doctor about bipolar disorder medications:

Do I need medication, or can I be treated effectively without it?
What types of medications are used to treat the manic and depressive mood swings of bipolar disorder?
How often and for how long will I need to take this medication?
Is there medication that I can take on an as-needed basis?
What type of drug are you prescribing for me, and how does it work?
Where can I get more information about this drug?
How will the medication make me feel, and how will I know if it’s working?
When can I expect to notice improvements in how I feel?
What are the risks if I don’t take my medication as directed, or if I forget to take it?
How has this medication been tested? Are there any recent clinical studies on it?
What should I do if I experience any side effects? Are there any that may require me to call a doctor? Are there any that may require me to stop taking the medication immediately?
Is this drug habit-forming?
Can I take this on an empty stomach, or should it be taken with food?
Could this medication interact with other medication I’m taking?
Are there any foods, drinks (such as alcohol), vitamins, herbal supplements, or over-the-counter drugs that I should avoid while taking this medication?
Can other conditions affect or be affected by my medication? What if I have a family history of heart disease?
What is electroconvulsive therapy (ECT)? Is it still used to treat bipolar disorder?
Complementary and Alternative Therapies

Doctors often recommend a combination of therapies to treat the symptoms of mania and depression. In addition to your medication, you may consider complementary or alternative therapies, such as practicing meditation, taking a yoga class, or trying a dietary supplement. Ask your doctor whether any of these options might be beneficial for you:

Are there any complementary or alternative therapies I should consider?
Do any clinical trials or research support these complementary or alternative therapies?
Do you recommend any herbs or other natural supplements, like omega-3 fatty acids or Saint John’s wort?
Emotional Health

Bipolar disorder can take a toll on your emotional health and your relationships, but your doctor can help you find ways to cope with the emotional stress, manage your manic and depressive symptoms, and handle the impact bipolar disorder is having on your relationships. Psychotherapy, in particular, can help people with bipolar disorder recognize changes in their personality that may signal an oncoming mood swing. It can also help with other challenges, such as manic episodes, spending sprees, substance abuse, and withdrawal during depressed phases. Ask for a referral to a good therapist or support group and find out what else you can do to improve your emotional health while living with bipolar disorder.

Should I seek any emotional support from a support group or a therapist? Can you give me some referrals?
How will I know if my therapist is right for me?
Will I need to see both a psychologist and a psychiatrist? If so, why?
What is cognitive-behavioral therapy? Am I likely to benefit from this type of therapy?
Is social rhythm therapy effective at helping people with bipolar disorder improve their relationships and organize their daily routines?
How should I explain my condition to my spouse, family, and friends? What, if anything, should I say to my boss and co-workers?
How can my family and friends help me? Are there specific things I should ask of them?
What should I do if I feel I’m being discriminated against at work or school?
What should I do if I feel that I can’t keep up at work or school? What accommodations can I ask for? Where can I get more information about work- and school-related issues?
How is my condition likely to affect my relationships, and what can I do to improve my situation?
Health and Lifestyle Concerns

Maintaining a healthy lifestyle is one of the best ways to keep yourself in good shape. Participating in a physical fitness regimen, following a balanced diet, getting adequate rest and sleep, quitting smoking, moderating your alcohol consumption, and avoiding substance abuse of any kind can all contribute to your overall health. Check with your doctor to see whether you need to make any lifestyle changes or whether there’s anything he or she recommends that you do at home, work, or school to help you better manage your bipolar disorder:

Do I need to make any changes in diet, exercise, or how much I rest?
Can stress, drinking alcohol, smoking, or using drugs affect my condition?
Are there any activities I should avoid?
Should I make any special accommodations for school, home, or my work?
Can you recommend any good books, magazines, organizations, or online resources that focus on bipolar disorder?
Financial Health

The costs associated with your bipolar disorder treatment will have an effect on your finances. It’s crucial to find ways to balance your physical health with your financial health. Ask your doctor about ways in which you may be able to offset the cost of your treatment.

Will my medication be covered by my health insurance plan?
About how much will my medication cost?
Is there a generic version of the medication that would be more affordable? If not, are there other, equally effective medications that are available as generics?
Do you have any samples or discount coupons for my prescription?
If I need to be hospitalized, will the hospital accept my insurance? How much of my care can I expect to be covered? If my hospitalization is not covered by insurance, will I have any payment alternatives?
Are there separate fees or charges at the hospital for doctors, therapists, caretakers, or anything else? If so, what kind of charges can I expect?
If I choose a complementary or alternative therapy, is it likely to be covered by my insurance? If not, what kind of out-of-pocket costs can I expect?
Additionally, people with bipolar disorder sometimes get themselves into financial straits during manic phases in which they go on spending sprees or gamble. If this is a concern for you, consult your doctor or therapist and ask:

What can I do to control my spending during my manic highs?
How can I get help for a gambling problem?

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Bipolar Support and Self help

Posted on July 20, 2016 by JmaC

Bipolar Support and Self-Help

Living and Coping with Bipolar Disorder

Bipolar Support & Self-HelpYou’re not powerless when it comes to bipolar disorder. Beyond the treatment you get from your doctor or therapist, there are many things you can do to reduce your symptoms and stay on track, including educating yourself about bipolar disorder, surrounding yourself with people you can count on, and leading a healthy “wellness” lifestyle. With good coping skills and a solid support system, you can live fully and productively and keep the symptoms of bipolar disorder in check.

Living with bipolar disorder: What you can do to help yourself

Living well with bipolar disorder requires certain adjustments. Like recovering alcoholics who avoid drinking or diabetics who take insulin, if you have bipolar disorder, it’s important to make healthy choices for yourself. Making these healthy choices will help you keep your symptoms under control, minimize mood episodes, and take control of your life.

Managing bipolar disorder starts with proper treatment, including medication and therapy. But there is so much more you can do to help yourself on a day-to-day basis. The daily decisions you make influence the course of your illness: whether your symptoms get better or worse; whether you stay well or experience a relapse; and how quickly you rebound from a mood episode.

Bipolar disorder: Key recovery concepts

  • Hope. With good symptom management, it is possible to experience long periods of wellness. Believing that you can cope with your mood disorder is both accurate and essential to recovery.
  • Perspective. Depression and manic-depression often follow cyclical patterns. Although you may go through some painful times and it may be difficult to believe things will get better, it is important not to give up hope.
  • Personal Responsibility. It’s up to you to take action to keep your moods stabilized. This includes asking for help from others when you need it, taking your medication as prescribed and keeping appointments with your health care providers.
  • Self-Advocacy. Become an effective advocate for yourself so you can get the services and treatment you need, and make the life you want for yourself.
  • Education. Learn all you can about your illness. This allows you to make informed decisions about all aspects of your life and treatment.
  • Support. Working toward wellness is up to you. However, support from others is essential to maintaining your stability and enhancing the quality of your life.

Source: Depression and Bipolar Support Alliance

Bipolar disorder support tip 1: Get involved in your treatment

Be a full and active participant in your own treatment. Learn everything you can about bipolar disorder. Become an expert on the illness. Study up on the symptoms, so you can recognize them in yourself, and research all your available treatment options. The more informed you are, the better prepared you’ll be to deal with symptoms and make good choices for yourself.

Using what you’ve learned about bipolar disorder, collaborate with your doctor or therapist in the treatment planning process. Don’t be afraid to voice your opinions or questions. The most beneficial relationships between patient and healthcare provider work as a partnership. You may find it helpful to draw up a treatment contract outlining the goals you and your provider have agreed upon.

Other tips for successful bipolar disorder treatment:

  • Be patient. Don’t expect an immediate and total cure. Have patience with the treatment process. It can take time to find the right program that works for you.
  • Communicate with your treatment provider. Your treatment program will change over time, so keep in close contact with your doctor or therapist. Talk to your provider if your condition or needs change and be honest about your symptoms and any medication side effects.
  • Take your medication as instructed. If you’re taking medication, follow all instructions and take it faithfully. Don’t skip or change your dose without first talking with your doctor.
  • Get therapy. While medication may be able to manage some of the symptoms of bipolar disorder,therapy teaches you skills you can use in all areas of your life. Therapy can help you learn how to deal with your disorder, cope with problems, regulate your mood, change the way you think, and improve your relationships.

Bipolar disorder support tip 2: Monitor your symptoms and moods

In order to stay well, it’s important to be closely attuned to the way you feel. By the time obvious symptoms of mania or depression appear, it is often too late to intercept the mood swing, so keep a close watch for subtle changes in your mood, sleeping patterns, energy level, and thoughts. If you catch the problem early and act swiftly, you may be able to prevent a minor mood change from turning into a full-blown episode of mania or depression.

Know your triggers and early warning signs—and watch for them

It’s important to recognize the warning signs of an oncoming manic or depressive episode. Make a list of early symptoms that preceded your previous mood episodes. Also try to identify the triggers, or outside influences, that have led to mania or depression in the past. Common triggers include:

  • stress
  • financial difficulties
  • arguments with your loved ones
  • problems at school or work
  • seasonal changes
  • lack of sleep

Common red flags for bipolar disorder relapse

Warning signs of depression

  • I quit cooking meals.
  • I no longer want to be around people.
  • I crave chocolate.
  • I start having headaches.
  • I don’t care about anybody else.
  • People bother me.
  • I start needing more sleep, including naps during the day.
 Warning signs of mania or hypomania

  • I find myself reading five books at once.
  • I can’t concentrate.
  • I find myself talking faster than usual.
  • I feel irritable.
  • I’m hungry all the time.
  • Friends tell me that I’m crabby.
  • I need to move around because I have more energy than usual.

Source: BHI Clinicians Guidebook: Bipolar Spectrum Disorders

Knowing your early warning signs and triggers won’t do you much good if you aren’t keeping close tabs on how you’re feeling. By checking in with yourself through regular mood monitoring, you can be sure that red flags don’t get lost in the shuffle of your busy, daily life.

Keeping a mood chart is one way to monitor your symptoms and moods. A mood chart is a daily log of your emotional state and other symptoms you’re having. It can also include information such as how many hours of sleep you’re getting, your weight, medications you’re taking, and any alcohol or drug use. You can use your mood chart to spot patterns and indicators of trouble ahead.

Develop a wellness toolbox

If you spot any warning signs of mania or depression, it’s important to act swiftly. In such times, it’s helpful to have a wellness toolbox to draw from. A wellness toolbox consists of coping skills and activities you can do to maintain a stable mood or to get better when you’re feeling “off.”

The coping techniques that work best will be unique to your situation, symptoms, and preferences. It takes experimentation and time to find a winning strategy. However, many people with bipolar disorder have found the following tools to be helpful in reducing symptoms and maintaining wellness:

  • talk to a supportive person
  • get a full eight hours of sleep
  • cut back on your activities
  • attend a support group
  • call your doctor or therapist
  • do something fun or creative
  • take time for yourself to relax and unwind
  • write in your journal
  • exercise
  • ask for extra help from loved ones
  • cut back on sugar, alcohol, and caffeine
  • increase your exposure to light
  • increase or decrease the stimulation in your environment

Create an emergency action plan

Despite your best efforts, there may be times when you experience a relapse into full-blown mania or severe depression. In crisis situations where your safety is at stake, your loved ones or doctor may have to take charge of your care. Such times can leave you feeling helpless and out of control, but having a crisis plan in place allows you to maintain some degree of responsibility for your own treatment.

A plan of action typically includes:

  • A list of emergency contacts (your doctor, therapist, close family members)
  • A list of all medications you are taking, including dosage information
  • Information about any other health problems you have
  • Symptoms that indicate you need others to take responsibility for your care
  • Treatment preferences (who you want to care for you; what treatments and medications do and do not work, who is authorized to make decisions on your behalf)

Bipolar disorder support tip 3: Reach out to other people

If your loved one has bipolar disorder, you can be an instrumental support throughout the treatment and recovery process. Read Helping a Loved One with Bipolar Disorder.

10 tips for reaching out and building relationships

  1. Talk to one person about your feelings.
  2. Help someone else by volunteering.
  3. Have lunch or coffee with a friend.
  4. Ask a loved one to check in with you regularly.
  5. Accompany someone to the movies, a concert, or a small get-together.
  6. Call or email an old friend.
  7. Go for a walk with a workout buddy.
  8. Schedule a weekly dinner date
  9. Meet new people by taking a class or joining a club.
  10. Confide in a counselor, therapist, or clergy member.

Having a strong support system is vital to staying happy and healthy. Often, simply having someone to talk to face to face can be an enormous help in relieving bipolar depression and boosting your outlook and motivation. The people you turn to don’t have to be able to “fix” you; they just have to be good listeners.

  • Turn to friends and family – Support for bipolar disorder starts close to home. It’s important to have people you can count on to help you through rough times. Isolation and loneliness can cause depression, so regular contact with supportive friends and family members is therapeutic in itself. Reaching out to others is not a sign of weakness and it won’t make you a burden. Your loved ones care about you and want to help.
  • Join a bipolar disorder support group – Spending time with people who know what you’re going through and can honestly say they’ve “been there” can be very therapeutic. You can also benefit from the shared experiences and advice of the group members. To find a support group in your area, see Resources section below.
  • Build new relationships – Isolation and loneliness make bipolar disorder worse. If you don’t have a support network you can count on, take steps to develop new relationships. Try taking a class, joining a church or a civic group, volunteering, or attending events in your community.

Bipolar disorder support tip 4: Develop a daily routine

Your lifestyle choices, including your sleeping, eating, and exercise patterns, have a significant impact on your moods. There are many things you can do in your daily life to get your symptoms under control and to keep depression and mania at bay.

  • Build structure into your life. Developing and sticking to a daily schedule can help stabilize the mood swings of bipolar disorder. Include set times for sleeping, eating, socializing, exercising, working, and relaxing. Try to maintain a regular pattern of activity, even through emotional ups and downs.
  • Exercise regularly. Exercise has a beneficial impact on mood and may reduce the number of bipolar episodes you experience. Aerobic exercise is especially effective at treating depression. Try to incorporate at least 30 minutes of activity five times a week into your routine. Walking is a good choice for people of all fitness levels.
  • Keep a strict sleep schedule. Getting too little sleep can trigger mania, so it’s important to get plenty of rest. For some people, losing even a few hours can cause problems. However, too much sleep can also worsen your mood. The best advice is to maintain a consistent sleep schedule.

Healthy sleep habits for managing bipolar disorder

  • Go to bed and wake up at the same time each day.
  • Avoid or minimize napping, especially if it interferes with your sleep at night.
  • Avoid exercising or doing other stimulating activities late in the day.
  • No caffeine after lunch or alcohol at night. Both interfere with sleep.

Bipolar disorder support tip 5: Keep stress to a minimum

Stress can trigger episodes of mania and depression in people with bipolar disorder, so keeping it under control is extremely important. Know your limits, both at home and at work or school. Don’t take on more than you can handle and take time to yourself if you’re feeling overwhelmed.

  • Learn how to relax. Relaxation techniques such as deep breathing, meditation, yoga, and guided imagery can be very effective at reducing stress and keeping you on an even keel. A daily relaxation practice of 30 minutes or more can improve your mood and keep depression at bay.
  • Make leisure time a priority. Do things for no other reason than that it feels good to do them. Go to a funny movie, take a walk on the beach, listen to music, read a good book, or talk to a friend. Doing things just because they are fun is no indulgence. Play is an emotional and mental health necessity.
  • Appeal to your senses. Stay calm and energized by appealing to your senses: sight, sound, touch, smell, and taste. Listen to music that lifts your mood, place flowers where you will see and smell them, massage your hands and feet, or sip a warm drink.

Bipolar disorder support tip 6: Watch what you put in your body

From the food you eat to the vitamins and drugs you take, the substances you put in your body have an impact on the symptoms of bipolar disorder—both for better or worse.

  • Eat a healthy diet. There is an undeniable link between food and mood. For optimal mood, eat plenty of fresh fruits, vegetables, and whole grains and limit your fat and sugar intake. Space your meals out through the day, so your blood sugar never dips too low. High-carbohydrate diets can cause mood crashes, so they should also be avoided. Other mood-damaging foods include chocolate, caffeine, and processed foods.
  • Get your omega-3s. Omega-3 fatty acids may decrease mood swings in bipolar disorder. Omega-3 is available as a nutritional supplement. You can also increase your intake of omega-3 by eating cold-water fish such as salmon, halibut, and sardines, soybeans, flaxseeds, canola oil, pumpkin seeds, and walnuts.
  • Avoid alcohol and drugs. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression. Even moderate social drinking can upset your emotional balance. Substance use also interferes with sleep and may cause dangerous interactions with your medications. Attempts to self-medicate or numb your symptoms with drugs and alcohol only create more problems.
  • Be cautious when taking any medication. Certain prescription and over-the-counter medications can be problematic for people with bipolar disorder. Be especially careful with antidepressant drugs, which can trigger mania. Other drugs that can cause mania include over-the-counter cold medicine, appetite suppressants, caffeine, corticosteroids, and thyroid medication.
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