Bipolar4LifeSupport

What are Depression and Bipolar Disorder?

Depression and Bipolar Disorder are mood disorders, medical illnesses characterized by changes in mood, thought, energy and behavior.Depression is the most common mood disorder, affecting approximately 20 million Americans each year. Symptoms of depression include:

• Prolonged sadness or unexplained crying spells
• Significant changes in appetite and sleep patterns
• Irritability, anger, worry, agitation, anxiety
• Pessimism, indifference
• Loss of energy, persistent lethargy
• Unexplained aches and pains
• Feelings of guilt, worthlessness and/or hopelessness
• Inability to concentrate, indecisiveness
• Inability to take pleasure in former interests, social withdrawal
• Excessive consumption of alcohol or use of chemical substances
• Recurring thoughts of death or suicide

Bipolar Disorder is another common mood disorder which affects more than two million Americans. Bipolar disorder usually causes a person’s mood to alternate between symptoms of depression and mania, a heightened energetic state characterized by:

• Increased physical and mental activity and energy
• Heightened mood, exaggerated optimism and self-confidence
• Excessive irritability, aggressive behavior
• Decreased need for sleep without experiencing fatigue
• Grandiose delusions, inflated sense of self-importance
• Racing speech, racing thoughts, flight of ideas
• Impulsiveness, poor judgment, distractability
• Reckless behavior such as spending sprees, rash business decisions, erratic driving and sexual indiscretions
• In the most severe cases, delusions and hallucinations

Mood disorders are treatable. With the right combination of medication and/or talk therapy, you can stabilize the moods that interfere with your life. By using self-help skills and strategies that work with your treatment plans, you can experience levels of wellness, stability and recovery you may never have thought possible.

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Key Recovery Concepts

Six key concepts provide the foundation of effective recovery work. They are:

• 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 Bipolar Disorder 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.

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Beginning the Journey

As you begin your journey to recovery, there are three important things you should do for yourself:

1. Seek good medical care.

At least once a year, and whenever your symptoms change or worsen, have a complete physical examination. This will determine if a medical problem is causing or increasing your symptoms. When you see your doctor, take a written listing of:

• All medications and health care preparations you are taking.
• Any new, unusual, uncomfortable or painful symptoms, and when you experience them.
• Any questions you need to ask your doctor about the above or other issues. Be prepared to take notes on your doctor’s answers.

2. Manage your medications carefully by taking the following steps:

• Learn about your medications, how they work, what to expect, possible side effects and dietary/lifestyle restrictions. Take them only as prescribed. Learn how a local DBSA support group can help with medication management.
• Use a daily reminder/medication saver system to make sure you are taking all of the necessary medications.
• Throw away old medications or those you are no longer taking.
• Realize that medications work best when you are making other healthy choices. Don’t expect a pill to fix a bad diet, lack of exercise or an abusive or chaotic lifestyle.
• Reduce or discontinue the use of alcohol. Alcohol is a depressant and makes recovery even more difficult. It can also interfere with the way your medication works.

3. Seek psychotherapy (talk therapy)

• Choose a psychotherapist with whom you feel comfortable.
• Work with your psychotherapist to find a treatment plan that works.
• Stay in touch with your psychotherapist and other health care providers. “Booster” visits can be useful in keeping symptoms from returning.

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Monitoring and Responding to Symptoms

Through careful observation, you will learn what you need to do every day to keep yourself well. You will also gain the ability to recognize external events that may trigger an increase in symptoms, and you will be better able to spot early warning signs of an episode and symptoms that indicate you are in trouble. With this knowledge and perspective, use the tools listed here and others you have discovered for yourself. You will be able to develop a system for monitoring and responding to symptoms that will help you keep your moods stabilized. This system should include:

• Daily routines you need to follow to stay well, such as eating three healthy meals, getting adequate sleep, limiting or avoiding alcohol and exercising regularly.
• A plan for coping with external events that can trigger symptoms, such as an argument with a friend or an unexpected bill, and ways to cope with these events and keep them from causing or worsening your symptoms.
• A way to spot early warning signs, such as irritability, changes in sleep patterns or anxiety, that indicate your symptoms may be worsening.
• A way to recognize symptoms that indicate real trouble, such as reckless behavior, isolation or suicidal thoughts.
• A response plan for dealing with warning and/or trouble signs; concrete actions you can quickly take to stabilize your situation, such as calling a doctor, therapist or trusted friend, or arranging a brief hospital stay to stabilize your mood.

Wellness Toolbox

The following practices may help you to maintain wellness as you develop a system for monitoring and responding to symptoms:

• Attend a local DBSA support group regularly. If there is no group in your community, call DBSA and we’ll help you start one.
• Talk to your doctor, therapist or other health care professional regularly, especially when you are having trouble.
• Share talking and listening time with a friend often, especially during difficult times.
• Do exercises that help you relax, focus and reduce stress.
• Take a walk each day regardless of the weather. This keeps you in touch with the elements and connects you to the world around you.
• Develop problem-solving skills you can depend on.
• Participate in fun, affirming and creative activities.
• Record your thoughts and feelings in a journal.
• Create a daily planning calendar.
• Limit alcohol and avoid illegal drugs.
• Keep a regular sleep schedule.
• Improve your diet. Avoid caffeine, sugar and heavily salted foods.
• Seek opportunities to be exposed to light.
• Try to maintain a calming, safe environment.
• When you are confronted with troubling circumstances, stop, analyze your situation and make a positive choice.

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Crisis Planning

Prepare a personal crisis plan to be used if your symptoms become so severe and/or dangerous that you need others to take over responsibility for your care. Your crisis plan may include:

A list of your supporters, their roles in your life and their phone numbers.

A list of all medications you are taking and information on why you are taking them, and the name and telephone number of your doctor and pharmacy.

A list of symptoms that may indicate the need for supporters to make decisions for you and take over responsibility for your care, such as:

• Uncontrollable pacing
• Severe, irritable depression
• Inability to stop compulsive behaviors
• Self-destructive behavior
• Abusive or violent behavior
• Substance abuse
• Thoughts or threats of suicide
• Significant changes in sleep patterns — inability to sleep or difficulty getting out of bed
• Refusal of food
• Instructions that tell your supporters what you need them to do for you.
• Directions for care of your children and/or pets in the event of hospitalization.
• Directions for notifying your employer in the event of your hospitalization and what he or she should be told.
• Insurance information to use in the event that emergency medical care and/or hospitalization is needed.
• A list of medications that have worked in the past to stabilize you in crisis situations and a list of any medications you do not wish to take, doctors you do not wish to see and hospitals where you do not wish to be treated.

Give completed copies of your plan to your supporters and explain your needs to them. Update your plan as needed. Your local DBSA support group can help develop your plan. You may also want to consult your health care provider to determine whether you should develop a medical advance directive, and consult legal counsel to determine if a statement of Power of Attorney is appropriate.

Addressing Traumatic Issues

If you feel traumatic events are causing or worsening your symptoms, seek a treatment program or additional support group that:

• Validates your experiences.
• Empowers you to take positive action on your own behalf.
• Helps you establish a connection with other people.

Suicide Prevention

Mood disorders are serious illnesses and can be life threatening. People with mood disorders who do not receive effective treatment have a suicide rate as high as 20%. Your life is important, and you can help yourself stay well by adhering to the following strategies:

• Treat your symptoms early. Don’t wait until you are in a complete funk to act. Seek help from a qualified mental health care provider that you trust and respect.
• Set up a system with others so you are never alone when you are deeply depressed or feeling out of control.
• Have regularly scheduled health care appointments and keep them.
• Throw away all old medications. Have firearms or other things you could use to harm yourself locked away where you do not have access to them.
• Keep pictures of your favorite people in visible locations at all times.
• Instruct a close supporter to take away your credit cards, checkbooks and car keys when you are feeling suicidal.
• Make plans for the future that you can look forward to, and try to keep the present in perspective, remembering that the painful times will not last forever.

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Developing a Wellness Lifestyle

  The way we live our daily lives has a strong impact on how we manage our moods and minimize our symptoms. Develop a lifestyle that supports your overall wellness by:

• Using therapy and educational materials to improve your self-esteem and change negative thoughts and beliefs into positive ones.
• Enhancing your life with things like pets, music and activities that make you feel good.
• Receiving treatment for an alcohol or substance abuse problem, if necessary.
• Having a comfortable living space where you feel safe and content.
• Establishing a career or hobby that you enjoy.
• Discovering a passion and becoming engaged in it.
• Keeping your life calm and peaceful.
• Taking good care of yourself.
• Eating well, getting plenty of rest and exercising regularly.
• Managing your time and energy well.
• Spending time with affirming, fun people.

Strategies for dealing effectively with mood disorders include an effective treatment plan that you follow; an attitude focused on hope, responsibility and recovery; an effective support system; healthy eating, sleeping and activity habits; recognition of symptoms and trouble signs and a response plan for crises. You can incorporate these strategies into your life in your own way and at your own pace. Everyone develops a different wellness plan, and the right one is the one that works for you.

Who Is Affected by Depression?

• Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older, in a given year. (Archives of General Psychiatry, 2005 Jun; 62(6): 617-27)
• While major depressive disorder can develop at any age, the median age at onset is 32. (U.S. Census Bureau Population Estimates by Demographic Characteristics, 2005)
• Major depressive disorder is more prevalent in women than in men. (Journal of the American Medical Association, 2003; Jun 18; 289(23): 3095-105)
• As many as one in 33 children and one in eight adolescents have clinical depression. (Center for Mental Health Services, U.S. Dept. of Health and Human Services, 1996)
• People with depression are four times as likely to develop a heart attack than those without a history of the illness. After a heart attack, they are at a significantly increased risk of death or second heart attack. (National Institute of Mental Health, 1998)

Depression often co-occurs with other illnesses and medical conditions.

• Cancer: 25% of cancer patients experience depression. (National Institute of Mental Health, 2002)
• Strokes: 10-27% of post-stroke patients experience depression. (National Institute of Mental Health, 2002)
• Heart attacks: 1 in 3 heart attack survivors experience depression. (National Institute of Mental Health, 2002)
• HIV: 1 in 3 HIV patients may experience depression. (National Institute of Mental Health, 2002)
• Parkinson’s Disease: 50% of Parkinson’s disease patients may experience depression. (National Institute of Mental Health, 2002)
• Eating disorders: 50-75% of eating disorder patients (anorexia and bulimia) experience depression. (National Institute of Mental Health, 1999)
• Substance use: 27% of individuals with substance abuse disorders (both alcohol and other substances) experience depression. (National Institute of Mental Health, 1999)
• Diabetes: 8.5-27% of persons with diabetes experience depression. (Rosen and Amador, 1996)

Depression and the Elderly

• About six million people are affected by late life depression, but only 10% ever receive treatment. (Brown University Long Term Care Quarterly, 1997)
• Fifteen to 20% of U.S. families are caring for an older relative. A survey of these adult caregivers found that 58% showed clinically significant depressive symptoms. (Family Caregiver Alliance, 1997)

Women and Depression

• Women experience depression at twice the rate of men. This 2:1 ratio exists regardless of racial or ethnic background or economic status. The lifetime prevalence of major depression is 20-26% for women and 8-12% for men. (Journal of the American Medical Association, 1996)
• Postpartum mood changes can range from transient “blues” immediately following childbirth to an episode of major depression and even to severe, incapacitating, psychotic depression. Studies suggest that women who experience major depression after childbirth very often have had prior depressive episodes even though they may not have been diagnosed or treated. (National Institute of Mental Health, 1999)
• Depression may increase a woman’s risk for broken bones. The hip bone mineral density of women with a history of major depression was found to be 10-15% lower than normal for their age–so low that their risk of hip fracture increased by 40% over 10 years. (National Institute of Mental Health, 1999)

Economic Impact of Depression

• Major depressive disorder is the leading cause of disability in the U.S. for ages 15-44. (World Health Organization, 2004)
• Major depression is the leading cause of disability worldwide among persons five and older. (World Health Organization, “Global Burden of Disease,” 1996)
• Depression ranks among the top three workplace issues, following only family crisis and stress. (Employee Assistance Professionals Association Survey, 1996)
• Depression’s annual toll on U.S. businesses amounts to about $70 billion in medical expenditures, lost productivity and other costs. Depression accounts for close to $12 billion in lost workdays each year. Additionally, more than $11 billion in other costs accrue from decreased productivity due to symptoms that sap energy, affect work habits, cause problems with concentration, memory, and decision-making. (The Wall Street Journal, 2001, National Institute of Mental Health, 1999)

Depression and Suicide

• Depression is the cause of over two-thirds of the 30,000 reported suicides in the U.S. each year. (White House Conference on Mental Health, 1999)
• For every two homicides committed in the United States, there are three suicides. The suicide rate for older adults is more than 50% higher than the rate for the nation as a whole. Up to two-thirds of older adult suicides are attributed to untreated or misdiagnosed depression. (American Society on Aging, 1998)
• Untreated depression is the number one risk for suicide among youth. Suicide is the third leading cause of death in 15 to 24 year olds and the fourth leading cause of death in 10 to 14 year olds. Young males age 15 to 24 are at highest risk for suicide, with a ratio of males to females at 7:1. (American Association of Suicidology, 1996)
• The death rate from suicide (11.3 per 100,000 population) remains higher than the death rate for chronic liver disease, Alzheimer’s, homicide, arteriosclerosis or hypertension. (Deaths: Final Data for 1998, Center for Disease Control)

Treatment for Depression

• Up to 80% of those treated for depression show an improvement in their symptoms generally within four to six weeks of beginning medication, psychotherapy, attending support groups or a combination of these treatments. (National Institute of Health, 1998)
• Despite its high treatment success rate, nearly two out of three people suffering with depression do not actively seek nor receive proper treatment. (DBSA, 1996)
• An estimated 50% of unsuccessful treatment for depression is due to medical non-compliance. Patients stop taking their medication too soon due to unacceptable side effects, financial factors, fears of addiction and/or short-term improvement of symptoms, leading them to believe that continuing treatment is unnecessary. (DBSA, 1999)
• Participation in a DBSA patient-to-patient support group improved treatment compliance by almost 86% and reduced in-patient hospitalization. Support group participants are 86% more willing to take medication and cope with side effects. (DBSA, 1999)