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Education as prevention:
Learning to cope with bipolar disorder

What if you feel like quitting your treatment?
How often should I talk with my doctor?

How can I monitor my own treatment progress?
What can families and friends do to help?

Is there anything I can do to help my treatment?

Another important part of treatment is education. The more you and your family and loved ones learn about bipolar disorder and its treatment, the better you will be able to cope with it.
Since bipolar disorder is a lifetime condition, it is essential that you and your family or others close to you learn all about it and its treatment. Read books, attend lectures, talk to your doctor or therapist, or even research on the Internet. You can use my links page as a start. It also contains a list of interesting books to read.
You can often help reduce the minor mood swings and stresses that sometimes lead to more severe episodes by paying attention to the following:

  • Maintain a stable sleep pattern. Go to bed around the same time each night and get up about the same time each morning. Disrupted sleep patterns appear to cause chemical changes in your body that can trigger mood episodes. If you have to take a trip where you will change time zones and might have jet lag, get advise from your doctor.
  • Maintain a regular pattern of activity. Don't be frenetic or drive yourself impossibly hard.
  • Do not use alcohol or illicit drugs. Drugs and alcohol can trigger mood episodes and interfere with the effectiveness of psychiatric medications. You may sometimes find it tempting to use alcohol or illicit drugs to "treat" your own mood or sleep problems-but this almost always makes matters worse. If you have problem with substances, ask your doctor for help and consider self-help groups such as Alcoholics Anonymous. Be very careful about "everyday" use of small amounts of alcohol, caffeine and some over-the-counter medications for colds, allergies, or pain. Even small amounts of these substances can interfere with sleep, mood or your medicine. It may not seem fair that you have to deprive yourself of a cocktail before dinner or a morning cup of coffee, but for many people this can be the "straw that breaks the camel's back".
  • Enlist the support of family and friends. However, remember that it is not always easy to live with someone who has mood swings. If all of you learn as much as possible about bipolar disorder, you will be better able to help reduce the inevitable stress on relationships that the disorder can cause. Even the "calmest" family will sometimes need outside help dealing with the stress of a loved one who has continued symptoms. Ask your doctor or therapist to help educate both you and your family about bipolar disorder. Family therapy or joining a support group can also be very helpful.
  • Try to reduce stress at work. Of course, you want to do your very best at work. However, keep in mind that avoiding relapses is more important and will, in the long run, increase your overall productivity. Try to keep predictable hours that allow you to get to sleep at a reasonable time. If mood symptoms interfere with your ability to work, discuss with your doctor whether to "tough it out" or take time off. How much you discuss openly with employers and co-workers is ultimately up to you. If you are unable to work, you might have a family member tell your employer that you are not feeling well and that you are under a doctor's care and will return to work as soon as possible.
  • Consider entering a clinical study.

What if you feel like quitting your treatment?

It is normal to have occasional doubts and discomfort with treatment. If you feel a treatment is not working or causing unpleasant side-effects, tell your doctor straight away, don't stop or adjust your medication on your own. Symptoms that come back are sometimes much harder to treat. Don't be shy about asking your doctor to arrange for a second opinion if things are not going well. Consultations can be a great help.

How often should I talk with my doctor?

During acute mania or depression, most people talk with their doctor or consultant at least once a week, or even every day, to monitor symptoms, medication doses, and side-effects. This is important when having bipolar disorder because your situation can easily change from day to day. As you recover, contact becomes less frequent. Once you are well you might see your doctor for a quick review every few months.
Regardless of scheduled appointments or blood tests, call your doctor or Community Psychiatric Nurse(CPN) if you have:

  • Suicidal or violent feelings
  • Changes in mood, sleep or energy
  • Changes in medication side-effects
  • A need to use over-the-counter medications such as cold medicine or pain relief medicine
  • Acute general medical illnesses or a need for surgery, extensive dental care, or other changes in the medicines you take

How can I monitor my own treatment progress?

Keeping a mood chart is a good way to help you, your doctor, and your family to manage your disorder. A mood chart is a diary in which you keep track of your daily feelings, activities, sleep pattern, medication and side-effects, and important life events. Its up to you what you enter each day. For instance you can just simply fill in the Mood and Sleep scales. This way you will be able to notice changes in sleep and any fluctuations in mood. Thus giving you early warning signs of mania or depression. You will also be able to find out what triggers lead to episodes. Keeping track of your medicines over many months or years will help you to figure out which ones work best.

What can families and friends do to help?

If you are a family member or a friend of someone with bipolar disorder, become more informed about the patient's illness, its causes, and its treatments. Talk to the patient's doctor if possible. Learn the particular warning signs for that person which indicate that he or she is becoming manic or depressed. Talk to the person, while he or she is well, about how you should respond when you see symptoms emerging.

  • Encourage the patient to stick with treatment, to see the doctor, and to avoid alcohol and drugs. If the patient is not doing well or is having severe side-effects, encourage the person to get a second opinion, but not to stop medication without advice.
  • If your loved one becomes ill with a mood episode and suddenly views your concern as interference, remember that this is not a rejection of you but rather a symptom of the illness.
  • Learn the warning signs of suicide and take any threats the person makes very seriously. If the person is "winding up" his or her affairs, talking about suicide, frequently discussing methods of suicide, or exhibiting increased feelings of despair, step in and seek help from the patient's doctor or other family members or friends. Privacy is a secondary concern when the person is at risk of committing suicide. Call 999 or a hospital emergency department if the situation becomes desperate.
  • Share the responsibility for taking care of the patient with other loved ones. This will help reduce the stressful effects that the illness has on caregivers and prevent you from feeling resentful.
  • When patients are recovering from an episode, let them approach life at their own pace, and avoid the extremes of expecting too much or too little. Try to do things with them, rather than for them. This way they are able to regain their sense of self-confidence.
  • Treat people normally once they have recovered, but be alert for telltale symptoms. If there is a recurrence of the illness, you may notice it before the person does. Indicate the early symptoms in a caring manner and suggest talking with a doctor.
  • Both you and the patient need to learn to tell the difference between a good day and hypomania, and between a bad day and depression. Patients with bipolar disorder have good days and bad days just like everyone else. With experience and awareness, you will be able to tell the difference between the two.
  • Take advantage of the help available from support groups.

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© Mark Hannant
Published 2nd May 2001