NEW DIRECTIONS SUPPORT GROUP INFORMATION PACKET July 2007
Spread the word – Tell your friends – Tell your Doctor & Therapist
Welcome New Members!
Table of Contents:
History, Purpose, Mission Statement 1
So You Were Just Diagnosed – 2
A Good Psychiatrist: Choosing & Keeping One 3
Wellness Toolbox (Crisis Plan) 5
Medicine Tips 8
If You’re Feeling Suicidal 8
Sleep Hygiene 9
Written by ND members Gregg; Jessica; Judith Kroll, MA; Ruth Z. Deming, MGPGP
Be open-minded about treatment for your mood disorder. Keep all options in mind. What works for one person doesn’t necessarily work for another. BELIEVE in RECOVERY!
Print out this Info Packet & scribble on it with your own notes.
New Directions is a nonprofit organization founded in 1984 by Ruth Deming when she was diagnosed with bipolar disorder 1 (manic depression). Due to her own experiences with the illness, she founded the organization to help herself and others. She has a master’s degree from Hahnemann University in Group Process & Group Psychotherapy. She earned the degree in 1992 at age 45 after her diagnosis. On lithium with antipsychotic medicine added when she got manic and psychotic, she worked as a therapist at 2 agencies for 13 years before devoting herself fulltime to ND. She has 2 grown children who fortunately do not have the illness. New Directions has been fortunate to receive a number of grants to pay for Ruth’s salary plus expenses such as our website (NewDirectionsSupport.org), phone calls, and accounting services.
Purpose of Group
To provide emotional support to one another. And also as an emotional support to our family members.
We also educate one another on how to cope with the illness. Members are strongly encouraged to exchange phone numbers & become friends outside the group.
We schedule guest speakers once a month. Give us your suggestions and we’ll follow up!
We encourage people to become actively involved in the group. Share your talents with us. We have 6 Telephone Greeters who man the phones every single day of the week. Ada runs the Monthly Outing; Helen runs the Willow Grove Mall Talk; Jack runs the Movie Night at the Outside Office.
If YOU have an idea, we’d love to hear from. Call Ruth at home at 215-659-2142 or email her at RuthDeming at Comcast.net. Or call Ada, her assistant, at
215-947-2429 or email her at AdaFleisher at Yahoo. com.
We hold yearly Leadership Training Seminars on Jan. 1 to train facilitators for our small groups. All are encouraged to attend.
Our mission is to serve as a support and education group to help individuals with mood disorders (depression and bipolar disorder) achieve their highest potential; to move beyond their diagnosis to lead meaningful, productive and joyous lives, even if that means changing our goals and our lifestyles to accommodate our illness. We help members participate in society to the fullest: through work, volunteerism, and involvement in the community at large. We recognize that many of us have artistic, creative or intellectual abilities and encourage our members to utilize their gifts to the fullest.
We also serve as much-needed support to family members and friends.
We are also committed to educating the public about the treatability of depression and bipolar disorder to help dispel prejudice, and let society know that “for every sad story about someone with a mood disorder, there are a thousand success stories.”
Please give us your comments about this Info Packet so we can make it even better next time.
SO YOU WERE JUST DIAGNOSED
We all have different feelings upon being diagnosed with a mood disorder. For some, it’s a relief. “I KNEW there was something wrong with me.” Or others, “I can’t believe I have bipolar disorder. There’s such a stigma against it. Now I’m one of them.”
Accept your diagnosis. It’s an illness, a chemical imbalance of the brain. It’s not WHO you are. You are much more than your illness. And please do not say, “I’m bipolar.” Say, “I have bipolar disorder.”
See the difference?
We are all members of a club we did not wish to join. Medication and therapy are indispensable to help us lead active lives.
You’re in good company. Famous people with mood disorders include: Winston Churchill, Van Gogh, Virginia Woolf, Carrie Fisher, Dick Cavett, Kathy Cronkite. Helpful memoirs have been written by William Styron, Kay Jamison, Patty Duke, and Jane Pauley.
We don’t know why, but some people later in life, like Ruth Deming, achieve a full recovery from bipolar disorder. This is documented in the 1998 book “A Mood Apart” by Peter Whybrow, MD.
Constantly create new brain circuitry by doing new things, especially artwork. Research has shown that artwork such as painting, or sculpting with clay or wood creates new pathways in the brain’s limbic-cortical connection. Many of us are artists.
Educate yourself about the illness. We may have preconceived notions about mental illness and must learn the facts. Use the Internet. Read books. Ask questions to your doctor and therapist who have seen hundreds of patients with mood disorders.
Attend New Directions and learn how others manage their illness. It’s great to talk with others who share the same illness. There’s no feeling like that of being understood. You’ll also pick up coping strategies. You’ll notice that many successful people in our group possess an important quality called “common sense.” Either you have it or not. It has nothing to do with your illness. Cultivating common sense means thinking about consequences of our actions.
At our group, set a goal to accomplish by the next meeting. For example, one woman said she’d joined a gym but was now actually going to use it. Goal-setting is an extraordinarily effective tool in achieving your dreams!
ND can help you in many ways – and you can help us! We need you as much as you need us: a marriage of great minds.
A GOOD PSYCHIATRIST: CHOOSING & KEEPING ONE YOU LIKE
Have someone you trust recommend a psychiatrist. We keep a list of psychiatrists recommended by our members. Also, if you like a particular hospital, such as University of PA or Thomas Jefferson University, call and ask for a referral.
Some university psychiatrists are researchers. You’ll see them as part of a research study but probably not afterward. Be sure to inquire about follow-through after the study. Some patients have been left in the lurch.
Choosing a psychiatrist
Speak with him or her on the phone. Tell them your philosophy and see if they’re amenable to it. Your philosophy should be: (1) the least medication possible (easier said than done); (2) the doctor must be immediately available in times of crisis, as he or she is your lifeline. Establish this on the phone before your first visit. What good is a psychiatrist if you can’t reach them in a crisis?
First impressions are very important. The doctor should make you feel comfortable and should not be judgmental. Get a good vibe from your doctor since you will constantly be disclosing confidential information and must feel comfortable while doing so.
Make the most of each session. Don’t waste time. Visits are short. Come with a list of questions. Also bring your version of a “mood chart,” which tells how you’ve been feeling between visits.
In your initial session, bring a brief typewritten summary of your psychiatric history so you won’t waste time & keep repeating yourself, repeating yourself. Tell the doctor everything you think is important for him to know about you. This includes: extreme behaviors you’ve engaged in, mood patterns, triggers, average length of time of mood stabilization.
Include in your summary any physical ailments.
Have a separate sheet for the meds you take – psychiatric, other meds, and any vitamin supplements.
Keep a folder at home with the above info. Don’t depend on your doctor to keep all the notes. In this folder, keep records of your lab tests, per below.
After you and your doctor are comfortable with one another, ask if it’s OK to slightly adjust your meds if necessary. For example, if you’re not sleeping well, ask, How much extra sleeping med (or antipsychotic) can I safely take if I’m having problems? This avoids costly trips to the doctor.
If your doctor hasn’t found the right medication, get a consultation with someone else.
Keep your doctor’s name in your wallet.
If you start a new medication and have side effects, it is the new med that is undoubtedly causing the side effects. Can there be any other reason? Only YOU know how you feel. Your doctor doesn’t know. If your doctor says he’s never heard of these side effects, tell him nicely, “Well, then, I’m the first one you’ve ever heard with this side effect.” You are correct.
Some drugs are bad for us while we’re taking psych meds. Your doctor may not know this. Examples may be: steroids (can cause mania), allergy meds (can cause mania), antibiotics, blood pressure meds. Most meds have side effects. Yet they’re necessary to keep us well.
You must get regular lab tests if you’re on certain drugs such as lithium, Depakote and Tegretol. Keep track of when you need the tests done. Some doctors forget.
Meds help about 80 percent of all patients. If you are treatment-resistant you have options such as the newer more precise electroshock treatments (ECT) as described by Kitty Dukakis in her book: “Shock: The Healing Power of ECT.” Vagus nerve stimulation is also somewhat helpful.
Research centers tackle treatment resistant cases such as the Depression Clinic at University of PA under Jay Amsterdam, MD, and John O’Reardon, MD, at University of PA.
A radical new approach is described in “Healing Depression and Bipolar Disorder Without Drugs,” by former bipolar sufferer Gracelyn Guyol.
– Plan what to do in advance so if you find yourself in crisis you’ll be prepared. Discuss this with your doctor. Do not wait.
If your depression is worsening, call your doctor immediately. This is a crisis.
If you’re becoming manic, call your doctor immediately. Ideally, you’ll learn, with your doctor’s help, how to medicate yourself should you or a loved one perceive the arrival of mania.
If you’re feeling suicidal, take your cellphone with you and leave the house. Get away from anything lethal. Tell yourself, “I’m having a bad moodswing but it will pass. I won’t always feel this way.” Call people in your support group to hear the sound of another person’s voice, the most soothing sound in the world. Spend time with positive people when feeling suicidal. “Don’t give up. You have friends.” (by Peter Gabriel)
– Remain in the workforce if at all possible.
– If you can’t work, become a volunteer. All of us have artistic, creative or intellectual abilities that must be utilized or we’ll feel frustrated and depressed.
– Identify your own mood triggers. People with mood disorders often have difficulty processing their emotions because of the way our brains are wired. We feel things passionately, intensely and often take things too personally. We have exquisite sensitivity. It’s been described as “going through life without shock absorbers.”
– If anything bothers you, get on the phone immediately to express your feelings. Don’t keep your feelings bottled up. However, if angry about something do not call the person you are angry with until you’re sure you are in control of yourself. You don’t want to have any regrets. Yet it is necessary to express your anger to the right person.
– Identify the situations and people that stress you out. Examples include long supermarket lines, heavy traffic, rejection letters, not getting a job.
– Strategies to deal with the above are to call a friend, keep a journal, exercise vigorously, punch a pillow or punching bag, write a letter and then decide whether to mail it, take the phone off the hook to avoid intrusive phone calls.
– You do not have to be a victim of the illness. Decide whether or not you wish to play the victim or martyr role. Strong people accept the illness and do everything possible to move forward. A therapist is your best support for this.
– Even positive events can cause stress and act as triggers because they change our known routine and habits. This includes getting a new job, going back to school, getting married. We are very sensitive to change.
– Mania can be stopped in its tracks, but only if you recognize the symptoms. Many people do. If you can’t, alert your friends and loved ones, your doctor and therapist, so you can do a reality check with them. Once you become manic, you cannot stop it. By recognizing the early warning symptoms you can increase your medicine and avoid the devastation that occurs with mania.
– Always put yourself first. Only YOU know what makes you feel good.
– Have a daily schedule and write it on your Daily Calendar. Stay busy. Calendar entries may include doing the laundry, working, going to concerts, cleaning the house.
– Stay around people who make you feel good about yourself. Limit the time you spend with negative judgmental people, even if this includes family members.
– Work at a place you enjoy and where you like most of the people. It’s depressing if you don’t like your job or the people there.
– Acquaint yourself with your mood ebb and flow and embrace it. If you have more energy in the morning, utilize mornings.
– Maintain a regular schedule – awake at the same time each morning, take your meds at the same time, go to sleep at the same time.
– Have fun and laugh often. Rent funny movies. Laugh and smile often. It’s contagious.
– Vigorously engage in an aerobic exercise program. Fast walking is easy and cheap. Exercise creates endorphins in the brain the same as medicine does.
– Reduce “visual stress” around the house or your office. At home, stuff things in the closet until you’re ready to work on them. Buy organizational tools such as shelves or file boxes. Save cartons and shoe boxes.
– When cleaning out your house, throw away things that make you feel unhappy such as rejection letters, old love letters, or objects given to you by people you don’t like. Live in a positive energy field.
– Create a “feng shui” – uncluttered – living environment so energy can flow through.
– Don’t smoke cigarettes. True, smoking raises endorphin levels but you can quit if you put your mind to it. Learn to get natural highs from exercise, music, nature.
– Stop use of alcohol and recreational drugs. They interfere with your meds. Cocaine, often the choice of people with bipolar, increases the risk of heart attack seven times.
– Give up all caffeine. You’ll be surprised that you still have energy. Remember when you were a kid? You had energy galore. Also stay away from artificial sweeteners as they’re bad for the brain. Learn to taste food as it truly tastes without sweetening it.
– Be discreet when disclosing your illness. Don’t disclose on the job unless you’re certain you can trust the other person. The exception is if you’re hospitalized for depression. Better to say you were hospitalized for the latter than to say for bipolar disorder as people equate that with being crazy. Never say you were suicidal. A “bad depression” will suffice.
– Your support group is a great first step in making friends. People rally around each other. Get a phone list of people to call or get together with.
– Channel your feelings into art. You don’t have to be good at it. Write poetry, short stories, do artwork. Buy self-hardening clay and sculpt. Art is healing and keeps you in the present moment. Again, the more connections you create in your brain the better.
– Hot weather may be hazardous to people on lithium, Lamictal and antipsychotics. Drink plenty of water, wear sunscreen no. 15, as your skin is especially sensitive to the sun. Watch for lithium toxicity (dizziness, confusion, altered gait) and if you have symptoms go to the ER immediately.
YOU are the only one who knows how your mind and body feel. If you’re getting medication side effects and your doctor says, “I’ve never heard of that before, he’s right.” He hasn’t. But YOU are feeling these side effects and your doctor should open-mindedly listen to you.
Meds other than psych meds affect your moods. Check with your doctor about this when adding meds for other conditions. Steroids can cause mania. Anesthesia before surgery has a slight chance of causing depression. Antibiotics taken for several weeks may interfere with your meds. Prescription or over-the-counter allergy meds may cause devastating mania. Many doctors do not realize this. He or she must be our partner in recovery.
– Suicide is a real threat for many of us. If you have the urge to kill yourself, call someone immediately. Get the words out of your head and out in the open. Do not be embarrassed or ashamed to call someone. Your life is the important thing in the world.
– Remove yourself immediately from the suicidal situation. If you’re feeling suicidal at home, leave the house immediately. Go anywhere. Be around people. Go to a friend or family member’s house. Go to Barnes & Noble. The library. The mall. Do not be alone, as the feelings intensify when there’s no one around. Also remove yourself from people who aggravate you.
– Pick up the phone and call someone who understands. Get a list of names of people from your support group. An excellent suicide hotline is 1-800-SUICIDE (which is 1-800-784-2433).
– Also call your psychiatrist or therapist. Talk to your doctor and see if you need a med change. If necessary check yourself into the ER. It’s better than being dead.
– Consider these alternatives to suicide: Fast walking which get the endorphins flowing, journaling and writing about your feelings, playing rousing music, reading favorite passages from the Bible. If nothing works, check yourself into the hospital. In the Philly area, Horsham Clinic has an excellent reputation.
– Your suicidal feelings always pass. It’s a question of enduring them. Strong people ask for help. We can’t let our illness defeat us.
– Do things that have made you feel happy in the past. Keep a list of these items. Keep a picture of your loved ones or children on hand and look at at them often. Through the distorted lens of depression, you may feel it would be a blessing to kill yourself so your family won’t bear your sufferings anymore. Nothing could be further from the truth. Suicide leaves a terrible legacy.
– Pray to God to protect you to keep you safe. Establish a personal relationship with God. Think of God as all the infinite spirit of Love in the universe.
Good sleep is necessary for everyone. Every person is different as far as how much sleep they need. Older people need less.
– Have a regular bedtime.
– Your bed should be used for 2 things: sleep and having sex (with or without a partner).
– Establish a bedtime ritual so your body knows you’re getting ready for sleep. Ritual may include reading, watching TV, reading to your child. This is a way of winding down.
– Limit your intake of liquids before bed so you don’t have to get up & go to the bathroom.
– Take phone off hook.
– Sleep in a dark room with no noise. If you wish to block out noise from another room, use a fan.
– If having trouble sleeping, try natural remedies first before using medication such as Trazadone or benzos such as Klonopin or Ativan. Natural remedies include herbal teas such as chamomile. These are often useless if you are getting hypomanic or are depressed, in which case, stronger remedies – medication – are necessary.
“Logic won’t change an emotion. Action will!” – Anonymous.
Castle, Lana R. Bipolar Disorder Demystified: Mastering the Tightrope of Manic Depression. New York: Marlowe & Company, 2003.
Burns, David, MD. Feeling Good: The New Mood Therapy (pub. orig. in 1980 by William Morris. Updated version “Clinically Proven Drug-free Treatment from Depression, 1999). Cognitive therapy and other techniques. Avon Books, 1999.
Cronkite, Kathy. On the Edge of Darkness: Conversations About Conquering Depression. Cronkite, (b. 1950) who suffers from depression, interviews celebrities with depression such as Mike Wallace, Joan Rivers, Dick Clark, Kitty Dukakis, Rod Steiger, Jules Feiffer, John Kenneth Galbraith, and William Styron. Doubleday, 1994.
Dukakis, Kitty. Shock: The Healing Power of Electroconvulsive Therapy. Penguin, 2006.
Duke, Patty and Gloria Hockman. A Brilliant Madness: Living with Manic Depressive Illness. New York: Bantam, 1992.
Fink, Candida, MD and Joseph Kraynak. Bipolar Disorder for Dummies. New Jersey: Wiley Publishing Inc., 2005.
Gartner, John D. The Hypomanic Edge: The Link Between a Little Craziness and Success in America. New York: Simon & Schuster, 2005.
Guyol, Gracelyn. Healing Depression and Bipolar Disorder Without Drugs. New York: Walker Publishing, 2006.
Jamison, Kay R. An Unquiet Mind: A Memoir of Moods and Madness. New York: Vintage, 1996.
Milkowitz, David J., Phd. The Bipolar Disorder Survival Guide. New York: Guilford Press, 2002.
Pauley, Jane. Skywriting: A Life out of the Blue. Random House, 2004.
Styron, William. Darkness Visible: A Memoir of Madness. Random House. 1990.
Thich Nhat Hanh, Anger: Wisdom for Cooling the Flames. Penguin, 2001.
Whybrow, Peter C. MD. A Mood Apart: The Thinker’s Guide to Emotions and Its Disorders. New York: Harper Collins, 1998.
MHASP.org/coping – teens coping w/mentally ill parent
NARSAD.org – world’s largest private funder for mental illness
NIMH.nih.gov/healthinformation – top information
Psycheducation.org/ (Dr. Jim Phelps)
Psycom.net/depression.central.html (Dr. Ivan Goldberg)