Understanding Bipolar Disorder: Part 1 of 4

Understanding Bipolar Disorder: Part 1 of 4
                                                 What You Need to Know About This Medical Illness

Introduction                                                   Recognizing Bipolar Disorder
     Bipolar disorder, formerly known as manic-                    Episodes of bipolar disorder involve significant
depressive illness, is a medical illness that affects nearly   changes in a wide range of areas, including activity,
3% of Americans. Bipolar disorder is highly treatable,         energy, sleep, appetite, speech, thinking, and judgment.
and new options are continually improving the outlook
for consumers and their loved ones. (The term consumer,        Bipolar disorder involves cycles of mania and
short for consumer of mental health services, is preferred     depression.
over patient by most people with serious mental
illnesses.) Despite impressive progress, two thirds of         Mania describes the activated phase of bipolar disorder.
people with bipolar disorder are not properly diagnosed        When it is less severe, it is called hypomania. Signs and
or treated. With accurate diagnosis, effective medication,     symptoms of mania include:
and proper support, many people with bipolar disorder          • Increased energy, activity, restlessness, racing
can lead productive and fulfilling lives.                              thoughts, and rapid talking
     However, when left untreated, bipolar illness can         • Excessive “high” or euphoric feelings
have destructive and costly effects, not just for the ill      • Extreme irritability and/or distractibility
person, but also on the lives of their family members and      • Decreased need for sleep
society. Roughly 40 percent of people with untreated           • Unrealistic beliefs in one’s abilities and powers
bipolar illness abuse alcohol or drugs, and 60 percent         • Uncharacteristically poor judgment
will have marriages that end in divorce. Job loss is not       • A sustained period of behavior different from usual
uncommon, and suicide is too often a consequence of the        • Increased sexual drive
illness.                                                       • Abuse of drugs, particularly alcohol, cocaine, and
                                                                      sleeping medications
What is Bipolar Disorder?                                      • Provocative, intrusive, or aggressive behavior
    Bipolar disorder is a disorder of the brain involving      • Denial that anything is wrong
episodes of mania and depression. The person’s mood
swings from overly “high” and irritable to sad and             Depression is the other phase of the illness.
hopeless and then back again. These episodes can last          Signs and symptoms of depression include:
from days to months. Between episodes, most people             • Persistent sad, anxious, or empty mood
have periods of relatively normal moods and activity,          • Feelings of hopelessness or pessimism
and may even go years or decades without a major               • Feelings of guilt, worthlessness, or helplessness
episode—indeed, with little or no sign of illness. For         • Loss of interest or pleasure in ordinary activities,
others, managing their illness poses a greater challenge               including sex
either because their symptoms respond only partially to
                                                               • Decreased energy, a feeling of fatigue or of being
treatment or recur even with ongoing treatment. These
                                                                       “slowed down”
consumers require careful self-monitoring and frequent
                                                               • Difficulty concentrating, remembering, or making
medication adjustments.
    Bipolar disorder typically begins in adolescence or
early adulthood and continues throughout life. Bipolar         • Restlessness or irritability
disorder is seen equally as often in men and women. In         • Sleep disturbances - either increased need for sleep
contrast, depression alone is more common in women. A                  or tiredness and an inability to fall or stay asleep
major life event may trigger the first episode. In its early   • Loss of appetite and weight loss or gain
stages, bipolar disorder may masquerade as a different         • Chronic pain or other persistent bodily symptoms
problem, such as alcohol or drug abuse or poor                         not caused by physical disease
functioning at work or school. Bipolar illness has been        • Thoughts of death or suicide; suicide attempts
diagnosed in children under age 12, although it is not
common in this age bracket as it can be confused with          It may be helpful to think of the various mood states in
attention-deficit/hyperactivity disorder.                      bipolar disorder as a spectrum or continuous range. At
    Bipolar disorder is a chronic condition with recurring     one end is severe depression, which shades into
episodes, much like diabetes, and it generally requires        moderate depression; then come mild and brief mood
ongoing treatment. If it is left untreated, it tends to get    disturbances that many people call “the blues,” then
worse, and the symptoms become more pronounced.                normal mood, then hypomania (a mild form of mania),
With proper treatment, it can be controlled.                   and then mania. Severe depression or mania may be
accompanied by symptoms of psychosis. These                    got too low and there was very little middle.”
symptoms include: hallucinations (hearing, seeing, or
otherwise sensing the presence of stimuli that are not         The Experience of Mania and Hypomania
there) and delusions (false personal beliefs that are not           People on the “high” side of bipolar disorder may
subject to reason or contradictory evidence and are not        feel on top of things, productive, sociable, and self-
explained by a person's cultural concepts). Psychotic          confident—but the feelings are exaggerated. Many have
symptoms associated with bipolar typically reflect the         described the “highs” of hypomania as feeling better
extreme mood state at the time.                                than at any other time in their lives. They cannot
     The pattern of untreated episodes varies markedly         understand why anyone would call their experience
both among individuals and at different times in a given       abnormal or part of a disorder. They feel excited, have
individual’s life. Some with untreated bipolar disorder        surges of energy, and describe feeling more creative,
have only an occasional episode of mania and repeated          active, intelligent, and sexual. They can often
episodes of depression. Others experience mania or             accomplish tremendous amounts of work. Hypomania is
hypomania as their main symptom and have few                   particularly appealing to individuals who have recently
episodes of depression. Symptoms of mania and                  come out of a period of depression.
depression can also occur together in what is known as a           Unfortunately, the “high” frequently does not stop
mixed state of bipolar disorder. Often a period of             with hypomania. The mood becomes more elevated or
depression will follow a manic episode, and sometimes          irritable, behavior more unpredictable, and judgment
people go directly from depression into mania.                 more impaired as mania develops. People often make
    Rarely, individuals may develop rapid cycling, which       reckless decisions during periods of mania. Spending
is regularly alternating periods of mania and depression.      sprees, alcohol and drug abuse, and hyper-sexuality are
Rapid cycling is more common in women, and it may be           common. These periods of perceived self-importance
triggered by antidepressant treatment. What is called          and unencumbered empowerment can cause confusion
ultradian cycling—in which significant mood changes            and loss of contact with reality for the person with the
occur several times during the day—is less well studied,       disorder; and more often than not, he or she is oblivious
and both its relationship with classic bipolar disorder and    to the negative consequences of extreme actions. People
its response to classical treatments are less clear.           with bipolar disorder rarely seek treatment during a
    You may also hear the terms bipolar I and bipolar II.      manic episode because they do not recognize that
If someone has experienced at least one manic episode,         anything is wrong.
the illness is called bipolar I; if the individual has
experienced only hypomania, the illness is called bipolar      “It does come to a point of accepting the fact that you have
II. Some people who initially have only hypomania              a medical illness, very similar to high blood pressure or
(bipolar II) will later have a manic episode (thus             diabetes and one in which you have to monitor over time
developing bipolar I), while others have only recurring        shifts in mood, changes in behavior and just be really
hypomania.                                                     observant of it.”
    It is extremely important to recognize mania and
depression early in the course of bipolar illness because      The Experience of Depression
early diagnosis and treatment can help prevent the                 Clinical or medical depression goes far beyond a
harmful consequences of untreated episodes such as             normal sense of sadness. When depressed, people with
school failure, loss of employment, damage to important        bipolar disorder are often in a profoundly sad, irritable or
relationships, divorce, and suicide.                           “flat” mood. The inner pain may be intense and result in
    However, particularly in its early stages, bipolar         feelings that life is totally without pleasure and not
illness may be hard to recognize. And even if others see       worth living. When depressed, people with bipolar
signs of trouble, it may be very difficult to get the person   disorder lose interest in their usual activities. Even
with symptoms to seek help. During hypomania or                eating and sex are no longer enjoyable. Former interests
mania, mood is often elated and judgment impaired.             seem boring or unrewarding, and the ability to feel and
People often deny that their changed mood and behavior         offer love may be diminished or lost.
is an illness. During depression, a sense of hopelessness          The “lows” of depression are often so physically
or guilt or a lack of energy may be so profound that           debilitating that people in this phase of the illness may
seeking help seems useless or impossible. Friends and          even be unable to get out of bed. Sleep is disrupted.
family members may need to intervene actively and              Typically, depressed individuals have difficulty falling
assertively.                                                   asleep, waken throughout the night, and waken an hour
                                                               to several hours earlier than they’d like to. However,
“It became tough to live my life with the depression and       about 20 percent of depressed people sleep more than
with the manic side. The highs got too high and the lows       usual. In either case, they awaken without feeling rested.

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Most depressed people lose their appetites, and weight       What Causes Bipolar Disorder?
loss can be significant. About 15 percent will have an            While no one knows the exact cause of bipolar
increased desire to eat and gain weight, but most will        disorder, research shows changes or chemical
report that the food they eat does not actually appeal to     imbalances in certain parts of the brain. Researchers
them.                                                         exploring the origin of the disorder have uncovered a
   The most frightening part of bipolar disorder to people    genetic link to the illness. Because bipolar disorder tends
who are depressed is often their inability to concentrate,    to run in families, close relatives of someone with the
remember, and make decisions. In the midst of a severe        disorder are more likely to be affected by the disease.
depression, people may not be able to follow a                Heredity, however, is not always apparent in people with
newspaper story or a television comedy. Major decision-       bipolar disorder, and not everybody with a genetic
making is impossible. Even minor decisions such as            predisposition becomes ill.
what to have for dinner can seem overwhelming.                    Sometimes a serious life event is said to “cause”
    Self-esteem is very low in a depressed person, who        bipolar illness. A better way to think about this is to
often dwells on memories of losses or failures and feels      realize that a serious loss, chronic illness, very difficult
guilty and helpless. “I am not worth much” and “the           relationship or financial problem, or any major change in
world is a terrible place” are common negative thoughts.      life can trigger an episode in some individuals with a
    Symptoms of depression often come together in a           predisposition to develop the illness. But episodes can
strong feeling of hopelessness, a belief that nothing will    also occur without an obvious trigger because of the
ever improve, and exaggerated pessimism. Periods of           cyclical nature of bipolar disorder.
depression can lead to the wish to die or thoughts of             There are two other “triggers” of bipolar episodes
suicide—or actual suicide. Suicide is always a danger,        worthy of special mention. Treatment of a depression
because ill people may become overwhelmed by what             with antidepressant medication can trigger a switch into
they have done while in a manic state.                        hypomania or mania. This can often be avoided by
    It is important to realize that not everyone with         starting treatment with a mood stabilizer before the
bipolar disorder experiences periods of mania and             antidepressant. And hypothyroidism can contribute to a
depression with the same intensity. People will more          depression or mood instability. Hypothyroidism can be
often seek treatment during a depressive episode because      treated with small replacement doses of thyroid
they can better recognize these symptoms as disruptive        hormone.
to their daily life.
                                                              “Well the question that nagged me the most was why did
“If I’m an artist and I’m bipolar and I take the              I end up like this? What caused it? Could it have been
medication, what happens, where does my creativity fall       prevented?”
into that spectrum of who I am on or off medication?”
                                                              Can Bipolar Disorder Be Cured?
Difficulties Diagnosing Bipolar Disorder                         Currently, bipolar disorder cannot be cured, but it can
    Even for a trained professional, bipolar disorder can     be controlled. It is a chronic disorder that requires
be difficult to diagnose. If someone with bipolar disorder    ongoing treatment, but almost all ill people can get
seeks treatment during a depressed period, he or she may      substantial relief from their symptoms with proper
be misdiagnosed as having clinical depression,                therapy. Medication is often prescribed indefinitely to
especially if the physician is unfamiliar with the person’s   maintain a normal pattern of mood. While no cure exists,
previous life events and moods. On the other hand,            most who seek and continue treatment can lead stable
people rarely seek treatment during a manic episode           and satisfying lives. Without proper treatment, however,
because they do not realize that they have a problem. A       many have repeated episodes of illness that may become
correct diagnosis is more likely when the physician           progressively more severe.
knows the patient’s history and observes mood-swing
patterns. Information from family members and friends          “It doesn’t bother me much to take medication every
is often crucial to a correct diagnosis because people in     day because then I get to function, you know, that’s the
the midst of an episode may not recognize, remember, or       gift it gives.”
report important symptoms and behaviors.
                                                              For more information about mental illnesses - Contact:
  “Everybody with this illness struggles and denies that                    The Alliance on Mental Illness
they’re sick or denies that they have it and denies that                          NAMI Chicago
their life has to change. But it’s like any other chronic              1536 W Chicago Ave, Chicago, IL 60642
illness, if you have rheumatoid arthritis you’re not going           Phone: 312-563-0445 Fax: 312-563-0467
to be opening jars for a living.”                                               info@namigc.org
5/12                                                                                                                    3
Understanding Bipolar Disorder: Part 2 of 4
                                                                Getting Treatment for Bipolar Disorder

Is Bipolar Disorder Treatable?                                      anxiety and improve sleep.
      Fortunately, the answer to this question is “yes”.            Lithium
The most effect treatment for bipolar disorder is a                       Lithium (Carbolith, Duralith, Lithobid, Lithizine,
combination of medication, counseling, and support. For             Eskalith, Lithane) has been the primary medication used
many, this enables a return to a satisfying and productive          to treat mania because of its ability to stabilize mood. It
life. On the other hand, if not diagnosed and not treated,          has been in use for more than 50 years. Lithium is
the impact of the illness can be devastating to the                 effective for preventing episodes from occurring and for
individual, significant others, and society in general.             treating an episode after it has begun. Manic and
                                                                    depressive episodes occur less frequently and are less
How Is Bipolar Disorder Treated?                                    severe when people take lithium regularly. It can take
    Medications form the core of treatment for bipolar              about seven to 14 days to respond to lithium.
disorder. Without medication, the likelihood of a return                The therapeutic dose of lithium varies a great deal
to a satisfying and productive life is slim. At the same            among individuals and even as phases of the illness
time, medications alone are rarely sufficient.                      change. Blood levels of lithium must be monitored
Psychotherapy is needed to effectively deal with stressors          because many factors—such as kidney function, fluid
that either precipitate or aggravate episodes and with the          intake, and salt intake—can influence an individual’s
psychosocial complications of the episodes themselves.              blood level of this drug even when he or she regularly
Support groups are important to help people understand              takes a specific oral dose. During severe episodes,
the impact the illness has on their lives and their families’       doctors try to keep doses and blood levels higher than
lives and to learn how to cope with the stresses that can           during a stable, maintenance phase of the illness.
trigger episodes. A person with bipolar disorder—and his                Lithium has side effects—including hand tremors,
or her family—should learn as much as possible about                excessive thirst, excessive urination, and memory
the illness and become involved in the treatment plan               problems—but they often become less troublesome as the
from the time it starts and through all of its stages or            body adjusts to it. Particularly bothersome tremors can be
adjustments. Changes in medications or doses may be                 treated with an additional medication. In a very few
necessary, and treatment plans may change during                    people, long-term lithium use can interfere with kidney
different stages of the illness.                                    function. Decreased thyroid function should be treated
    Education for the person with bipolar disorder and his          with thyroid hormone. Consumers should not
or her significant others is the key to learning to cope            dramatically change salt and fluid intake while on
with this serious mental illness.                                   lithium, and athletes may need to use salt tablets to
                                                                    replace salt loss.
Sources of Information about Medications                                Doctors have found many anticonvulsant medications
   Detailed information about all medications you
                                                                    (for example: Depakote, Stavzor, Lamictal, Epitol,
consider taking can be obtained from your doctor, the
                                                                    Tegretol, Neurontin, Zonegran, Topamax) helpful in
pharmacy, guides to psychiatric medications you find in
                                                                    treating bipolar disorder.
bookstores, drug manufacturer websites, and from NAMI
                                                                        Divalproex sodium (Depakote) has been used to treat
fact sheets.
                                                                    epilepsy since 1983, and was approved as a treatment for
                                                                    the manic episodes of bipolar disorder in 1995. Depakote
Medications for Bipolar Disorder                                    appears to be as effective as lithium for treating mania. It
    Your doctor is your best source of information about            typically takes five to ten days after starting treatment for
the medications being prescribed for you. The                       people to respond to Depakote. In addition to its having
information presented here is a brief overview of some,             fewer side-effects and its taking effect quickly, Depakote
but not all, of the medications commonly used in the                appears to be useful for treating various types of bipolar
treatment of bipolar disorder.                                      disorder, including rapid cycling (at least four episodes of
    The medications most commonly used to treat bipolar             mania or depression within a year) and mixed mania.
disorder are called mood stabilizers and include lithium                Liver problems and problems with white blood cell
and anticonvulsants. Antipsychotic medications are also             count and blood platelets, which can be severe, may
being approved for the treatment of acute mania.                    develop while taking Depakote, especially during the first
Antidepressants are often added to treat depressive                 six months of treatment. Therefore, blood tests to monitor
symptoms. Antianxiety medications may help with
liver function and blood cells are an important part of        occurring electrical activity, as well as chemical activity.
treatment with Depakote. Depakote is not given to those        It is believed that ECT causes changes in the chemistry
with liver disease. Other common side effects of               that lead to improvement in mood. While ECT can cause
Depakote are nausea, drowsiness, dizziness, and tremors.       temporary memory loss and confusion, today it is safe
For many taking this medication, however, these                enough to be used for women who are pregnant.
problems lessen or go away over time.                              Pregnancy is a special concern with all medications,
    Another anticonvulsant, carbamazepine (Tegretol), is       and women should discuss the risks and benefits of
also a helpful treatment, and it is used by some doctors       various treatments with their doctors if they are, or plan
for consumers with rapidly changing cycles of mania and        to become, pregnant.
depression or for those who cannot take lithium. Apart             Medications—and often specific combinations of
from relatively minor side effects, the major concern with     medication—are quite effective in treating the symptoms
carbamazepine is a decrease in white blood cells, which        of serious mental illnesses, but consumers must learn to
may in very rare cases be fatal. Because of this risk,         recognize their own patterns of illness and ways to cope.
doctors monitor consumers’ white blood cell count.             Taking the medication prescribed by a doctor is an
Frequent dose adjustment and monitoring of drug levels         essential way to control the illness, but psychotherapy,
in the blood may also be needed early in treatment.            education, and supportive counseling are often critical to
Antipsychotics                                                 effective treatment as well.
    Mania may also be treated with antipsychotic
medications (for example: Clozaril, Zyprexa, Risperdal,        Other Treatments
Invega, Seroquel, Abilify, Geodon, Saphis) usually in              “Talk” therapies that concentrate on behaviors, current
addition to a mood stabilizer. Side effects depend on the      conflicts, or relationships with others come in many
particular medication but can include weight gain,             varieties and are offered for groups, families, couples, or
sleepiness, tremors, blurred vision and rapid heartbeat.       individuals. Psychotherapy can help consumers and
Antianxiety Agents                                             families understanding the illness, learn how to cope with
      Antianxiety medications (for example: Klonopin,          it, and change self-defeating patterns of thinking or
Ativan, Valium, Librium, Niravan, Zanax) may help with         interacting. It is best to clearly understand how a
anxiety and improve sleep. Side effects can include            particular therapist or group approaches psychotherapy or
drowsiness, reduced muscle coordination, and problems          counseling before making a commitment to it, just as it is
with balance and memory.                                       important to understand the effects and side effects of
Antidepressants                                                specific medications.
    Consumers with bipolar disorder may need                   Cognitive Behavioral Therapy is a common form for
antidepressant medication (for example: Wellbutrin,            individual therapy for bipolar disorder. The focus of
Prozac, Celexa, Zoloft, Paxil), during periods of              cognitive behavioral therapy is identifying unhealthy,
depression. Because of the risk of triggering mania,           negative beliefs and behaviors and replacing them with
doctors often prescribe antidepressants with a mood            healthy, positive ones. It can help identify “triggers” and
stabilizer. Tricyclic antidepressants (TCAs), and              teach effective strategies to manage stress and to cope
monoamine oxidase inhibitors (MAOIs), are also used to         with upsetting situations.
treat depression.                                              Psychoeducation is counseling focused on learning
    Antidepressant medications relieve depression, elevate     about bipolar disorder. Knowing what is going on can
mood, and activate behavior, but it often takes three to       help consumers and significant others to get the best
four weeks for a consumer to respond to them. Doctors          support and treatment, as well as learning signs to
will sometimes try a variety of antidepressants and doses      recognize mood swings.
before finding the drug or drug combination that works
best for the individual. As treatments begin to take effect,   “I didn’t think I needed medical help. I thought I could
the ability to make decisions and take action returns          deal with it on my own. I thought I was tough enough to
before mood improves. It is during this time, when             be able to take care of this myself...”
depression may still be severe, that the consumer is at
greater risk for acting on suicidal thoughts. For this         How successful are treatments for a person
reason, in the early stages of treatment it is especially
important that consumers and their family members
                                                               with bipolar disorder?
                                                                   After an accurate diagnosis, most people with bipolar
remain cautious, and monitor and report any changes.
                                                               disorder can be successfully treated with medication.
Electroconvulsive Therapy
                                                               Early treatment may help keep the illness from becoming
    Electroconvulsive therapy (ECT) may be used if a
                                                               more severe, and for many patients continued treatment is
consumer is intensely suicidal or cannot take
                                                               critical for maintaining stability. Good treatment includes
antidepressant medication. With ECT, electric currents
                                                               educating the consumer, family, and friends about the
are passed through the brain. Brains have naturally
                                                               disorder and its treatment. This education should also
teach how to identify specific warning signals of               associated with bipolar disorder.
recurrence and the best response if they occur.                     Psychiatric or clinical social workers have advanced
    How well treatment works depends on the severity of         degrees in social work and are trained in counseling and
the bipolar disorder, how long the consumer has had             psychotherapy. They are additionally trained in client-
symptoms, how he or she responds to medical and                 centered advocacy, so they can offer information,
psychological treatments, and how much responsibility           referrals, and help when consumers and families must
he or she takes for maintaining a balanced lifestyle. In        deal with government and local agencies.
combined treatment, medications treat the symptoms of               Mental health counselors provide professional
bipolar disorder while talk therapy may help with the           counseling services that involve psychotherapy, human
problems the disorder causes in daily living.                   development, learning theory, and group dynamics. Their
    Consumers may need more intensive treatment when            goal is to promote and enhance healthy, satisfying
their symptoms of bipolar disorder are extreme or when          lifestyles. These counselors can be found in mental health
the symptoms continue for long periods. Although most           centers, private practice, or community agencies.
people with bipolar disorder can be treated successfully            Pastoral counselors are trained members of the clergy
as outpatients, severe episodes may require brief               who work with their parishioners and family members to
hospitalization for careful evaluation, protection, and         help them understand their illness, solve problems, and
medication adjustment.                                          manage situations that could result in another episode of
    For some people whose illness does not respond fully        mania or depression.
to medication and therapy, managing bipolar disorder can            The best treatment is sometimes provided by several
be a continuing challenge that requires excellent ongoing       professionals working together to address the varied
treatment, adjustments of medications, careful attention        needs of the individual and their significant others. It is
to maintaining a stable lifestyle, refraining from alcohol      important for consumers to understand that bipolar
and drug abuse, and continuing support from family,             disorder will not go away, and that continued compliance
friends, and peer support groups.                               with treatment is needed to keep the disease under
“As hard as it sometimes is, I try to get out of bed. It’s as       Many people with bipolar disorder or those trying to
simple as getting out of bed at a regular time every            help an ill friend or family member start by seeking help
morning. For me that’s very beneficial.”                        from a family physician. Because the symptoms of brain
                                                                disorders can be caused by other illnesses, a complete
Where can treatment be found?                                   physical examination is essential for an accurate
                                                                diagnosis. When other medical conditions are ruled out,
    •   University or medical school affiliated programs
                                                                the family practitioners can either treat the consumer for
    •   Hospital departments of psychiatry                      bipolar disorder or refer him or her to a mental health
    •   Private practice psychiatric offices and clinics        specialist for further evaluation and treatment. The
    •   Insurance companies and HMOs                            treating physician should have experience with bipolar
    •   Family physicians, internists and pediatricians         disorder, its diagnosis, and the full range of appropriate
Which professionals are qualified to treat                          Community mental health centers provide help at a
bipolar disorder?                                               cost based on a person’s ability to pay, and some
    Because proper diagnosis is essential for effective         hospitals and universities have special research centers
treatment, it is important to see a professional who is         that study and treat bipolar disorder in exchange for
knowledgeable about bipolar disorder. Family physicians,        participation.
clinics, insurance companies, health maintenance
organizations (HMOs), and NAMI all may refer to                 “I try to structure my life so I know where I’m going and
mental health specialists who treat bipolar disorder.           I don’t have free time. And that’s not saying that
    A psychiatrist is a medical doctor who specializes in       everybody should do that, but for me, free time is
mental disorders and is the only mental health                  dangerous.”
professional who may legally prescribe medications. It is       For more information about mental illnesses - Contact:
important to find a psychiatrist who knows about all                          The Alliance on Mental Illness
medications, including new treatments for bipolar
                                                                                    NAMI Chicago
disorder. It may be helpful, too, if the physician is                    1536 W Chicago Ave, Chicago, IL 60642
familiar with the American Psychiatric Association’s
                                                                       Phone: 312-563-0445 Fax: 312-563-0467
treatment guidelines for bipolar disorder.                                        info@namigc.org
    A clinical psychologist conducts psychological                              www.namichicago.org
evaluations and psychotherapy and works with                                                                             5/12
individuals, groups, and families to resolve problems
Understanding Bipolar Disorder: Part 3 of 4
                              Managing and Coping With Your Own Bipolar Disorder

What Can A Person With Bipolar Disorder                     don’t let guilt or frustration about mistakes impair
Do To Cope?                                                 your ability to continue the process.
    Everyone learns to cope with bipolar disorder               Bipolar disorder presents a special challenge
differently, and accepting the diagnosis of bipolar         because its manic or hypomanic stages can be
disorder is the critical first step. Proper diagnosis and   seductive. Consumers may be afraid that they will feel
treatment will help, but so will knowledge about the        flat, be less capable, or be less creative if they seek
disorder. Accurate information from doctors, books,         treatment; however, these fears must be judged
inserts in medication packages, libraries, support-         against the benefits of getting well. Consumers may
group programs, and community lectures will make            feel “good” while manic, but may make choices that
the illness less mysterious. As people become more          could seriously damage their relationships, financial
familiar with their disorder, they learn to recognize       situation, health, home life, or job prospects. And they
abnormal patterns of behavior. If consumers recognize       may later discover that the product of their “creative
these signs and seek appropriate and timely care, they      energy” is really nonsensical, unfocused, or even
can often prevent relapses.                                 harmful to them. Often people who are manic feel
     The provider/consumer relationship is also             irritated or out of control or they have delusions. And
fundamental to successful management of bipolar             a mixed or depressive state may closely follow the
disorder. Consumers and their providers should view         feeling of energy or confidence. Such volatile
each other as partners in treatment. The provider           emotions can lead to despair, pain, and even suicide.
should play an active role in the consumer’s recovery           Many people who accept treatment for bipolar
and offer advice and information to help the consumer       disorder are leaders of industry, entertainers, artists
manage side effects and cope, in general, with the          and craftsmen, successful men and women in any line
disorder.                                                   of work. Treatment is not the end of the possibility for
    Consumers also benefit tremendously from taking         achievement; it is the beginning.
responsibility for their own treatment regimen. Once            It is very common for people with bipolar disorder
the illness is under control, they must report side         to want to discontinue their medication, a thought that
effects, changes in mood, and changes in lifestyle. The     may be appealing because side effects of drugs may
provider and consumer should be able to discuss—            be uncomfortable or life-altering or because it has
with respect for each other—changes in medication,          been a long time since the last episode of illness.
dose, or any other aspect of fine-tuning treatment for      Consumers should remember, however, that the
successful “maintenance.”                                   current medications cannot cure bipolar disorder.
                                                            Discontinuing medication carries the very real risk of
“If something bad happens, I catch my breath after          a devastating relapse. A discussion of all options with
getting knocked down and I say to myself, the first         a doctor is essential before any treatment changes
thing is I got to be able to eat and I got to be able to    should be made.
keep myself safe.”
                                                            “Read everything you can on the subject. Be as smart
                                                            as your doctor. Ask your doctor all kinds of questions
Acceptance                                                  and take your medication.”
    Recovery is an on-going, daily process. No one can
manage an illness as well as the person who is
experiencing it. However, no one would truthfully say       Coping Strategies
it is easy. Every day give yourself credit for having           Developing a balanced lifestyle will help make
the courage to make the necessary changes in your           living with bipolar disorder easier. Incorporating
life. Acknowledge that this process is hard, that even      strategies that promote wellness will help consumers
taking medication every day can be hard. The changes        take control of their illness. Other people with bipolar
you may have to make, and the changes to your               disorder have said the following strategies are helpful:
external life you may have to accept, are major ones.
Family and friends should appreciate the difficulties       • Be an expert on the disorder.
you face. However, like life adjustments made by            There are many excellent sources of information,
people with diabetes or hypertension, these changes         including books and other publications suggested in
are the necessary price for a reclaimed life. Celebrate     this paper. Being well informed includes knowing
the life you reclaim; learn from any setbacks, but          about medications by reading medication inserts in
packaging and fact sheets or by consulting a doctor or      early indicators are unique. Ask a few caring,
pharmacist. Keep up with current research and               trustworthy people to note changes in your behavior
treatment options by reading newsletters such as the        or mood, to be honest about them, and to speak up if
NAMI Advocate or those published by other reputable         signs of reoccurring illness appear.
groups, attending conferences, enrolling in credible        • Attend support groups.
listservs, and networking with other consumers at           You will find reassurance, information, friendship,
support groups.                                             empathy, and encouragement when you talk and listen
• Become a partner in treatment.                            to people who face similar issues, problems, and
To be a partner, you must develop a give-and-take           feelings.
relationship with your doctor or other mental health        • Develop a personal support system.
provider. Provide the information he or she needs to        Find people among your friends, family, and
treat you effectively, including complete and honest        acquaintances who are willing to learn about bipolar
reports about reactions to medications, symptoms that       disorder, accept that treatment is necessary, and
are improving or worsening, and new stresses. Ask           support your recovery. Choose those who can be
questions; write them down before appointments. You         trusted to tell the truth, even if it’s unpleasant.
must work as a team to fine-tune doses, adjust              • Try regular exercise.
appointments, or make any other helpful changes.            Scheduled exercise has great emotional and
• Develop a plan for emergencies with your                  physiological as well as physical benefits.
    therapist or doctor.                                    •    Follow a regular schedule.
Know what to do in a crisis no matter where or when         A schedule adds much-needed structure to your life.
it occurs. Almost all communities have crisis hot lines     Be sure you include personal time to spend alone.
or emergency walk-in centers, even if they’re housed        • Consider volunteer work or hobbies.
in the local hospital’s emergency room.                     If paid employment is not an option now, both these
• Avoid alcohol and illicit mood- or mind-                  activities will enrich your life, teach useful skills, and
    altering substances.                                    give you a sense of purpose and—again—structure.
These drugs destroy the emotional balance that can be       • Set and respect your limits.
so hard to maintain. They may also interact                 When you must tell others about those limits, be
dangerously with medications. Both depression and           friendly but firm.
mania make these drugs dangerously attractive as            • Identify and reduce sources of stress.
ways to “slow down,” “perk up,” or “forget it all,” but     Journal about or make lists of the situations or
the damage they can do can seriously block your road        interactions that are stressful for you.
to recovery.                                                • Balance periods of activity with time for quiet
• Beware of interactions.                                       and relaxation.
Make sure that any food, additional prescription            Provide incentives or rewards of quiet times to
drugs, over-the-counter medications, or herbal              balance periods of activity.
supplements you consider or take will not interact          • Continue with life.
adversely with either your disorder itself or the           Don’t let your illness take control, but recognize
medications used to treat it. Discuss adding anything       that—as with any chronic illness—some plans may
to your daily regimen with a doctor or pharmacist.          have to be changed, canceled, or postponed. Perhaps
• Eat for health.                                           vacation or other leave time can be reserved for a
Many consumers find that eating a well balanced diet,       “tune-up” hospitalization or time off, if needed.
avoiding caffeine, and limiting sugar improves how          • Be patient, but persistent.
they feel.                                                  Accept that it takes time for medications to take
• Stay on a regular sleep schedule.                         effect, and it takes time to find the right combination
Lack of sleep can bring on symptoms, and sleeping           of treatments for each individual. Don’t give up after
much more than normal or being unable or unwilling          one or two attempts don’t live up to your expectations.
to sleep can indicate the beginning of an episode of
illness.                                                    “I was scared [that when taking medication] I was
• Know what may be signaling a relapse.                     going to be like a zombie, you know, that I was going
What have been the first symptoms before? Common            to be walking around like you see in One Flew Over
ones include irritability or agitation, changes in sleep,   the Cuckoo’s Nest or something.”
feeling overwhelmed or “stressed out,” loss of interest
in activities or people that were enjoyed before, or        Monitoring for relapse: a shared task
feeling uncharacteristically impulsive. Problems with
                                                               Learn to recognize warning signs that symptoms
mood, concentration, sex drive, appetite, or self-
                                                            are developing. This vital coping strategy needs
esteem may also be signs of relapse. Every person’s
further comment. Since the best intervention occurs
early, before symptoms become severe, recognizing
early signs of an episode is a major key to living
successfully with bipolar disorder. On one hand, early
recognition is vital; on the other, you can’t constantly
ask yourself how you are feeling or become totally
focused on your behavior or emotions.
    Consumers and their families must work together
and discuss past episodes so they can clearly
recognize the early signs of a developing episode.
While people’s symptoms vary, sleep is one of the
best indicators of illness because it is usually
disturbed very early in an episode, easy to observe,
and an objective activity to evaluate (in contrast to
feelings). Sleep is also important to monitor because
episodes can be triggered by sleep deprivation, even if
caused simply by travel or work or social events.
    Whatever the indicators of possible relapse,
consumers and families or friends should agree on
what the objective signs of a possible episode are.
When they appear, they should prompt a call to the
therapist, who may adjust medications.
    Remember that if relapse is imminent, you may
need assistance from others in order to get the help
and treatment that you need.

 “Sometimes it’s very sudden. And sometimes I try and
stop it before it even becomes hypomania because I
know the course it takes. It always takes this
degenerative course.”

Advance Directives
   Be prepared. Plan in advance. When you are
stable, discuss with your significant others your
wishes for treatment and money matters should
another episode occur. It may be possible to agree on
a set of protections if another episode occurs. Write
these plans down, either formally, as in what is called
an advance directive, or in an informal letter.

For more information about mental illnesses - Contact:
             The Alliance on Mental Illness
                  NAMI Chicago
        1536 W Chicago Ave, Chicago, IL 60642
      Phone: 312-563-0445 Fax: 312-563-0467

Understanding Bipolar Disorder: Part 4 of 4
                                          Coping With a Loved One’s Bipolar Disorder

What can a family member or friend do                     • Accept reality and reach out to others.
                                                          Learning to accept the illness (and how to adjust to the
to cope?
                                                          differences it makes in your life) and developing your
    Family members and close friends need support
                                                          own support system will help with both everyday
and the opportunity to talk to people who care and can
                                                          problems and major crises.
help, too. Bipolar disorder causes its own problems
for friends and family members. In order to be            • Find resources.
supportive and willing to listen to their ill loved one   Seek help in finding and taking advantage of
talk about his or her feelings, people need to be         everything you now need, from a good doctor or
nurtured themselves. Both the person with the illness     therapist, to assistance programs, to decent and safe
and family members will likely experience grief           housing for people with mental illnesses. Your local
because of the drastic changes in their lives and the     NAMI affiliate is a good place to find suggestions and
trauma caused by previous episodes of illness.            direction. In many areas, family support groups or free
    Family and friends find it easier to handle this      family education classes like the NAMI Family-to-
sometimes frustrating illness if they learn what is       Family Education Program offer both support and
possible with good treatment, stay positive about the     education.
future, become partners in the process of recovery,           Research is yielding important information about
and accept and respect whatever independence their        bipolar disorder, and physicians understand more
loved one attains. It’s worth repeating that the more     about the disorder’s social, physiological, and
families and friends know about the illness,              psychological effects than ever before. In most cases,
symptoms, and treatment, the better they, too, will be    bipolar disorder can be successfully treated with
able to cope with it. Education is the key.               medication.
    Although the ultimate opportunity for managing an
illness and working toward recovery lies with the         What Supports are Helpful?
consumer, a supportive and informed group of family           Psychotherapy—or talk therapy—can help
members and friends can make both easier and more         consumers and significant others learn to deal with the
likely. Family and friends should read as much as they    disruption bipolar disorder can cause in everyday
can about the illness. Especially helpful is reading      living. Emotional support from others living with the
personal accounts of both family members of people        disorder and from family members and friends is also
with bipolar disorder as well as of those who have the    an important part of treatment. Too often people with
illness themselves. Another good source of                bipolar disorder and their significant others are
information is family support groups. In addition to      unaware that there are other people who have the
providing valuable insight, they offer empathetic         illness and have had similar experience. It is helpful
support to families and friends that can make their       for consumers and family members to share their
own coping easier—and that can therefore make them        thoughts, fears, and questions with others with the
more effective supports for their ill loved one.          same illness.
                                                              Family, friends, the community, and healthcare
Try some of these additional coping strategies:           professionals are important sources of support,
                                                          especially when consumers with bipolar disorder are
• Be honest about feelings and fears.                     too ill to carry out their normal activities.
Talk about your own emotions and anxieties—as well            Family and friends can encourage consumers to
as your hope—with others who are trying to                seek and continue treatment. They can be very
understand.                                               supportive and helpful, especially if they are educated
• Develop specific and realistic plans.                   about the disorder. Family and friends can also try to
Know exactly what you will do for the person with         create a low-stress, comfortable environment for the
bipolar disorder in an emergency or during a relapse,     ill person by reducing stimulation, keeping life
but keep clearly in mind that everyone has good and       predictable, talking calmly and clearly, and boosting
bad days, that a change in mood is not necessarily the    self-esteem and confidence.
start of a new episode                                        People close to someone with bipolar disorder can
• Heed talk of suicide.                                   show caring and respect by maintaining as normal a
Take any warning signs of suicide seriously and seek      relationship as possible, pointing out distorted
help.                                                     thinking in a noncritical way, and offering help,
kindness, and affection.                                     disorder. Resources may include consumer/peer self-
                                                             help support groups, family support and education,
What to do if Someone May Be Suicidal                        vocational           rehabilitation,       social-skills
    With appropriate help and treatment, it is possible      training/feedback, and/or housing or living
to overcome a suicidal crisis or suicidal tendencies.        arrangements designed to support an individual’s
Sometimes friends and family members must deal               special needs. People with bipolar disorder have
with this dangerous situation by taking vigorous and         different life activities they may need support or
assertive action. During a depression, suicide may be        assistance with.
a significant danger. Asking someone who is                      “Wraparound”        services,    which      provide
depressed whether he or she has thoughts of                  comprehensive assistance in managing life’s various
suicide does NOT increase the chance it will                 activities, should be related to those specific areas in
happen. Actually, the ill person is often relieved to        which a consumer needs help. Case managers,
learn that these thoughts are part of the illness and that   therapists, doctors, or your local NAMI group should
sharing them can offer protection until treatment            be knowledgeable about the resources in your
relieves the depression. When someone is suicidal,           community.
guns and extra medications should be removed from
the house. If the depression and suicidal thoughts are       Family Support Groups
severe, a friend or family member may have to insist             Family members and friends also need support.
on contacting a professional and explain to the              The daily problems of living with someone with
consumer that hospitalization will offer safety.             bipolar disorder can be enormous and extremely
Remember that severely depressed people may not be           stressful. Groups like NAMI provide support for both
able to make decisions to seek treatment without help.       consumers and their family members. For both,
Friends or family members may have to be                     sharing experiences is an excellent way to learn new
persistently and assertively involved.                       coping skills and to stay up to date about current
                                                             treatments and services.
Other Potential Problem Areas
    It may be difficult or impossible to get someone         Consumer Support Groups allow people with
with bipolar disorder to seek treatment—especially           chronic mental illnesses to share their thoughts and
during early episodes of illness, before the ill person      experiences with others who know what they are
has learned about the consequences of untreated              going through. People in such self-help groups
mania. To avoid damage to relationships and                  provide emotional support for each other; share their
employment, families and friends might suggest a             feelings of grief, frustration, and hope; and exchange
leave of absence from a job.                                 current information about resources, research, and
    Because both overspending and poor judgment are          treatment options. Peer support groups offer the
common symptoms in the manic phase of bipolar                unique understanding and insight that can make life
illness, relatives and friends may have to protect a         easier and hope more real. Families and significant
consumer’s financial assets.                                 others can encourage participation in peer support
Advance Directives
    It’s a good idea to discuss issues such as treatment     “You feel expansive. You’re laughing at things
and money when the consumer is stable. It may be             whether they’re funny or not. You’re talking. You’re
possible to agree on a set of protections if another         ready to go spend money, but for me that quickly
episode occurs. Write these plans down, either               degenerates into anxiety and irritability and then
formally, as in what is called an advance directive, or      finally depression...this can all happen in one day.”
in an informal letter.
                                                             For more information about Mental Illnesses - Contact:
Meeting Individual Needs                                                  The Alliance on Mental Illness
   Services, like medications, must be selected on                             NAMI Chicago
their ability to meet the individual needs of the                    1536 W Chicago Ave, Chicago, IL 60642
consumer. Programs and resources are available in                  Phone: 312-563-0445 Fax: 312-563-0467
each community that may improve the quality of life                           info@namigc.org
and daily functioning of a person with bipolar                              www.namichicago.org

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