Living and Coping with Bipolar Disorder

Managing bipolar disorder

Although bipolar disorder is a lifelong, recurrent illness, you can manage its symptoms and reduce or prevent full-blown episodes by educating yourself and becoming actively involved in treatment.

Educate yourself

Learning everything you can about bipolar disorder is the first step toward managing the disease. Become an expert on the illness. Study up on the symptoms, so you can recognize them in yourself, and look in to all available treatment options. The more informed you are, the better prepared you’ll be to deal with mood symptoms and head off major problems.

Get involved in your treatment

Be a full and active participant in your own treatment. 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 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. Keep the lines of communication open with your doctor or therapist. Your treatment program will change over time, so keep in close contact with your provider. 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.
• Seek psychotherapy. 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.

Take charge of your recovery

To live fully and freely with bipolar disorder, your focus must be on more than just symptom reduction. A Wellness Recovery Action Plan is a personalized plan for total wellness and recovery. It includes strategies for achieving and maintaining emotional health

Developing a wellness toolbox is the first step in creating your recovery plan. 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 online workbooks in the table below are a good place to start.

Preventing bipolar disorder relapse

The best way to prevent bipolar disorder relapse is to keep close tabs on the way you feel and watch for red flags. Early detection of a developing problem, combined with immediate intervention, can prevent a minor mood change from turning into a full-blown episode of mania or depression.

Three steps are involved in early symptom identification and relapse prevention: Symptom and trigger tracking, daily mood monitoring, and crisis planning.

Identify early warning signs and triggers

It’s important to recognize the warning signs of an oncoming manic or depressive episode. Make a list of symptoms that preceded your previous mood episodes. Red flags to look for include changes in your energy level, appetite, self-esteem, or sleeping patterns. According to the National Alliance on Mental Illness, “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).”

Triggers—or the outside influences that jumpstarted an episode or exacerbated your disorder in the past—are also important to identify. Common triggers include:

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

Monitor your moods

Knowing your early warning signs and triggers won’t do you any 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 an effective way to monitor your recovery progress. A mood chart is a daily log of your emotional state, life events that contributed to your mood, 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.

Plan ahead for trouble

If daily mood charting reveals any early indicators of relapse, you should immediately take steps to head off the problem. Prompt intervention can keep your symptoms from getting worse. For such times, it’s helpful to have a plan of action for dealing with the situation. A plan of action typically includes coping techniques from your Wellness Toolbox, as well as specific steps for getting back on track such as calling your therapist or going to a support group meeting.

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 crisis plan should include emergency contacts, your treatment preferences, and information about your medications and any health problems you have.

Healthy lifestyle changes for controlling mood

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.

Healthy Habits for Bipolar Disorder
Stick to a daily routine	Developing and sticking to a daily schedule can help stabilize the mood swings of bipolar disorder. Build structure into your life, with 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	Regular 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 three times a week into your routine. Walking is a good choice for people of all fitness levels.
Keep a regular sleep schedule	Getting too little sleep can trigger mania, so it’s important to get plenty of rest. However, too much sleep can also worsen your mood. The best advice is to maintain a normal sleep schedule, going to bed and waking up at around the same time each day.
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-busting foods include chocolate, caffeine, and processed foods.
Avoid alcohol and drugs	Alcohol and drugs can trigger manic and depressive episodes, so their use should be strictly limited. 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 treat your mood symptoms, with drugs and alcohol only causes more problems.
Reduce stress in your life	Stress can trigger episodes in people with bipolar disorder, so keeping it under control is extremely important. It’s important to 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. Studies show that a daily relaxation practice of 30 minutes or more can improve your mood and keep depression at bay.
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.

Finding help and support for bipolar disorder

Having a strong support system is vital to staying happy and healthy. If you’re coping with bipolar disorder, there are several places you can turn for support:

• Your friends and family – Support for bipolar disorder starts at 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.
• A peer support group – Join a bipolar disorder support group in your community. 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 group, use the Depression and Bipolar Support Alliance’s Support Group Locator or contact your local branch of the National Alliance on Mental Illness.

Creating a supportive environment includes not just who you surround yourself with, but who you choose to avoid. In order to take care of yourself, it’s necessary to limit your contact with people who drain your emotional energy or leave you feeling discouraged, ashamed, or guilty. Instead, spend time with people who truly value you and make you feel better.

Advice for family and friends

If your loved one has bipolar disorder, you can be an instrumental support throughout the treatment and recovery process. Here are some tips for family members:

• Educate yourself about bipolar disorder and learn to recognize warning signs of relapse in your loved one.
• Let your friend or family member know that you’re there for them if they need a sympathetic ear, encouragement, or assistance with their treatment.
• Encourage your loved one to get treatment. Help them find a good therapist or a local support group. Set up an appointment or drive them to the doctor’s office if they’re not up to it.
• Get involved if symptoms get worse or you spot any red flags. Point out symptoms of bipolar episodes as they begin to emerge, and try to convince your friend or family member to see their doctor or therapist.
• If you’re in a crisis situation and worried for your loved one’s immediate safety, call 911. If he or she talks about suicide, take it seriously and seek help from a suicide hotline.

Related links for bipolar disorder

Coping with bipolar disorder

Dealing Effectively with Depression and Manic-Depression – Covers key recovery concepts and strategies, such as mood and symptom monitoring and crisis planning. (Depression and Bipolar Support Alliance)

Bipolar Affective Disorder: A Guide to Recovery (PDF) – Online booklet covers bipolar disorder, treatment strategies, what to do when drug therapy fails, and coping skills. (The Organization for Bipolar Affective Disorders)

Bipolar Disorder: Stories of Coping and Courage – Read the personal stories of real people dealing with bipolar disorder. Includes each individual’s experience of what helps them feel better. (Depression and Bipolar Support Alliance)

Developing a Wellness Recovery Action Plan (WRAP)

Working Toward Wellness – Online workbook you can use to track your treatment and progress. Includes sections on identifying triggers, dealing with drug side effects, and tracking your moods. (Depression and Bipolar Support Alliance)

Wellness Toolbox – Take charge of your treatment with wellness tools such as a symptom management worksheet, medication information charts, and a personal wellness checklist. (Depression and Bipolar Support Alliance)

Action Planning for Prevention and Recovery – Step-by-step guide to taking charge of your recovery from mental illness. Includes tips for developing a daily maintenance plan to help you stay well. (Substance Abuse and Mental Health Services Administration)

A Wellness Toolbox for Bipolar Disorder
Things you can do: Behavioural Strategies for Preventing Mania Behavioral Strategies for Managing and Preventing Depression
Changing your thinking: Cognitive Strategies for Preventing Mania Cognitive Strategies for Managing and Preventing Depression
Dealing with stress and solving problems: Coping with Psychosocial Stressors

Early intervention and relapse prevention

Self-Monitoring for Relapse Prevention (PDF) – Patient workbook with strategies for monitoring your moods and spotting signs of relapse. (Centre for Clinical Interventions, Western Australia Department of Health)

Early Intervention and Relapse Prevention Strategies – Learn how to recognize warning signs of depression and mania and identify your triggers. (Behavioral Healthcare)

Healthy lifestyle choices for bipolar disorder

Healthy Lifestyles: Improving and Maintaining the Quality of your Life – Advice on improving the quality of your life through healthy lifestyle modifications such as eating right and exercising. (Depression and Bipolar Support Alliance)

Developing A Recovery And Wellness Lifestyle: A Self-Help Guide – Booklet describes how to change your lifestyle to support your mental health. (Substance Abuse and Mental Health Services Administration)

Support for bipolar disorder

About Support Groups and Chapters – Learn about DBSA (Depression and Bipolar Support Alliance) support groups and how they can help. Includes a Support Group Locator. (Depression and Bipolar Support Alliance)

Find a Support Group – Search for a support group for children and adolescents with bipolar disorder. (Child & Adolescent Bipolar Foundation)

Advice for friends and family

Helping a Friend or Family Member with Depression or Bipolar Disorder – Learn what you can do to help a loved one with bipolar disorder. Includes information about involuntary hospitalization. (Depression and Bipolar Support Alliance

Bipolar Disorder Coping Resources for Family Members – Find tips for dealing with a bipolar disorder in someone close to you. Includes a list of recommended books. (Bipolar Focus)

Melinda Smith, M.A., Jeanne Segal, Ph.D., Tina de Benedictis, Ph.D., and Robert Segal, M.A., contributed to this article. Last modified on: 10/02/07.