By Ruth Z. Deming, MGPGP
New Directions Support Group
CONQUERING BIPOLAR DISORDER AND DEPRESSION
Doylestown Health & Wellness Center
847 Easton Road
Warrington, PA 18976
Saturday, September 6, 2008, 11 am to 12:30 pm
Intro – page 1
The Illness – 3
Definitions – 4
Keys to Recovery – 6
Medication – 9
Good Sleep – 13
Crisis Plan – 14
Stop-Suicide Plan – 15
Hospitalization – including “shame” issues – 16
Strategies to Regain Strength – 17
Other Options for Treatment – 17
Things to Know – 18
Resources (Internet sites and Books) – 18 – Always do your research!
Presenter: Ruth Z. Deming, MGPGP (Master, Group Process & Group Psychotherapy) is a psychotherapist in private practice, a journalist, and the founder/director of New Directions Support Group, Inc., the leading support group in the Philadelphia area for people with depression and bipolar disorder and their loved ones. As with many people later in life, Ruth is cured from bipolar disorder. To join the Glenside group call us at 215-659-2366 or view NewDirectionsSupport.org. Ruth is available for private consultations by calling 215-659-2142 or emailing RuthDeming at Comcast.net.
LIVING WITH A MOOD DISORDER
Introduction: Although you have been diagnosed with bipolar disorder or depression, you are capable of living a happy, meaningful, and productive life. You may, however, need to change your goals & lifestyle to accommodate your illness. If you can’t work, do volunteer work. All of us have artistic, creative or intellectual abilities that must be utilized or we’ll feel frustrated and depressed.
Your illness is a part of you but does not define you. You are a whole person with interests and talents. Don’t say, “I’m bipolar.” Say, “I have bipolar.”
Constantly create new brain circuitry by doing new things. Do them even if you’re afraid. Try to find activities that fit your current energy level. Our minds are capable of constant expansion. Feed your mind only the best ingredients: good people to hang out with and activities to stimulate your mind.
Bipolar disorder and depression are highly treatable conditions. Eighty percent of those affected respond well to medication. If meds do not work, other methods may do the trick. See below under “Other Options for Treatment.” There is always hope! Although bipolar and depression (together they are called “mood disorders”) are chronic illnesses of the brain, they are not progressive like ALS. There is every hope you can go on to live a happy and productive life. But you must be vigilant and disciplined!
Information and understanding are vital. That’s why taking the time to learn about your illness will ease your mind by letting you know what to expect and how to handle problems (called “symptoms”) when they arise. This course will give you many coping strategies and encourage you to develop your own.
Brain illnesses such as mood disorders make it imperative you know yourself. You must be brutally honest and acknowledge certain symptoms that may get you in trouble such as overspending, increased sexual appetite, and suicidal thinking.
Knowing yourself will also enable you to make reasonable assumptions about how you’ll react to future events such as moving, taking a new job, divorce, loss of a loved one, whether to become a parent.
These are difficult events for everyone, but worse for folks with mood disorders. When you’re able to successfully project yourself into the future, say, about moving to a new location, you’ll have a better chance to protect yourself from an unwanted high or low. You’ll learn the importance of planning ahead and anticipating consequences!
Then there is the ubiquitous question of: Who am I – versus who am I when ill?
Being aware of WHO you are and how you ACT will help you choose roles in life – careers, friends, partners – that are good for you and will not exacerbate your illness.
This is why it’s important to have “talk therapy” after your diagnosis. Read more about this under “Keys to Recovery.”
Bipolar disorder, also known as manic depression, is a brain disorder that causes a person’s moods to wildly fluctuate from normal to highs and lows. It also affects the person’s energy level and ability to function. Some mood shifts can be “mixed states” where the person experiences both highs and lows at the same time. Needless to say these moodswings cause great anguish. Highs in particular are exhausting.
Depression is a state of highly diminished energy and activity, in addition to a feeling of mental anguish. It is the opposite of a high.
Medication is necessary to stabilize a person’s moods. Moods are self-limiting, meaning they will usually end on their own without medication. However, with medication, a return to normalcy arrives much quicker.
If a person is treatment-resistant, there are other methods than meds that can be helpful. Read more under “Other Options for Treatment” below.
When a person is in the midst of a moodswing we say they’re “cycling.”
Moods influence one’s ability to think clearly, to function, and to do activities. A depressed person finds it difficult to perform her normal daily duties. She feels tired. She can’t get out of bed. How will she make it to work? Or take care of her family? Her appetite may diminish – or she may be ravenous. Thoughts of death and suicide may enter her head. She may even decide that life is not worth living and devise a plan for suicide. Read the “Stop-Suicide Plan” under Keys to Recovery.
When the depression lifts, she returns to normal. Or, she may go straight into mania or hypomania. “What goes down must come up” applies to bipolar disorder, as the brain attempts to balance its chemistry. But the balancing act is flawed. In its attempt to normalize itself, the mood spikes too far upward into the realm of mania or too far down into the realm of depression.
A mood disorder is no one’s fault. It is not your fault nor your parents’ nor your spouse or your children’s. There is most likely a genetic component to the illness. Traumatic events suffered during childhood or later, including emotional neglect or mistreatment by a close relative, may cause the malleable young brain to develop a mood disorder later in life.
When moodswings are out of control so is your life. Relationships may be strained or ruined. Jobs lost. Self-esteem damaged. The ill person may not know what’s hit him. If he hasn’t gotten treatment, he or she may attempt to self-medicate with alcohol or drugs. “I only want to feel normal,” they say.
This subjective sense of despair felt by the unmedicated individual is enough for most people – but certainly not all – to learn to get their symptoms under control. The main obstruction for getting help is the tremendous public stigma or private stigma toward mental illness.
Our brain condition is erroneously perceived by many as a character flaw. Education is the only way to counteract ignorance. People must learn the truth and understand mental illness is due to a faltering brain, just as heart disease is due to a faltering heart.
It helps that famous people acknowledge their mood disorders.
Famous people with mood disorders are legion: Mike Wallace, Jane Pauley, Patty Duke, Kay Jamison, Dick Cavett, Winston Churchill, Abraham Lincoln. Notably, our condition strikes artists such as van Gogh or Goya, which is why I call it the artist’s condition.
A FEW DEFINITIONS
Bipolar disorder 1 also known as manic depression consists of true mania plus depression. Only one mania is necessary for this diagnosis to be made. Mania consists of out-of-reality thinking known as psychosis. (“I am communing directly with Jesus. In fact I AM Jesus.”) Other symptoms are unstoppable energy, sleeplessness, lack of appetite, heightened sexuality, heightened religious feelings, racing thoughts, incessant talking known as pressured speech, flight of ideas (speaking about different topics which is a reflection of one’s mind going very fast), reckless indiscreet behavior (sexual liaisons, overspending), feelings of euphoria (elation) or dysphoria (despair), delusions of grandeur (“The President is expecting my call”), intense anger or irritability, aggression, violence. Symptoms may also include hearing voices.
The course of bipolar disorder changes over time according to your individual pattern. Your best predictor of future moods is your most recent mood history, not the distant past. Darlene, a 75-year-old photographer, hasn’t had true mania since she was in her 40s. Her condition has changed so that she gets depressed once every 2 years.
Oftentimes, but not necessarily, the illness lightens up as we grow older. Sometimes it goes away entirely. We have no idea why some people achieve a full cure and others do not.
Bipolar disorder 2, contrary to its name, is equally as serious as bipolar 1. This illness is characterized by hypomania plus depression. During hypomania the individual experiences heightened energy, an enhanced ability to do work and less need for sleep. He may also become irritable and annoyed at the least little thing.
The quandary about hypomania is that it is often a welcome feeling due to one’s productivity. However, it is usually accompanied by the exhaustion of doing too much. Judge for yourself from past experience whether you need meds to calm yourself down or can rely on the healing effects of time.
For many people, the chief mood state in bipolar 2 is depression.
Mood states include mania, hypomania, depression. Each mood state is temporary. It will pass by itself or faster with medication. All three mood states may contain varying degrees of anger and anxiety. When true mania hits for the first time, one’s family is befuddled by the individual’s out-of- character behavior, while the individual herself has no idea what hit her. She has little awareness of the spectacle she is creating around her.
True mania consists of intense energy, lack of sleep, racing thoughts and psychosis or out-of-reality thinking such as “I feel I’m in touch with my favorite rock star; they’re giving me messages” or “I’m certain this stock tip will pay off and I’ll become a billionaire.” No amount of reasoning can bring this person back down to earth. They are out of reality and do not know it. They lack insight. Once a person has reached mania, either an antipsychotic medication or the healing effects of time are necessary to quell the episode. Hospitalization is usually necessary to protect the individual – and others – from this aberrant and possibly dangerous behavior.
Hypomania is a mild form of mania. The person has lots of energy, doesn’t sleep, his mind is racing, he has an urgency inside propelling him to take on projects and activities, all the while recognizing he is hypomanic. This is a temporary situation. Unlike mania where the person has no insight about her behavior, the hypomanic individual is aware of her condition.
It is important to get a correct diagnosis from a psychiatrist so you know what illness you have and can get on the right medication. It is not uncommon for doctors to give you different diagnoses since a diagnosis is made from a patient’s verbal history. It is often helpful to have a loved one attend the initial session to report behaviors the patient may forget.
Depression without the highs is simply called depression or clinical depression. Its onset is usually over age 40.
Some 2.6 percent of the population suffer from bipolar disorder, and as many as 10 percent from depression. Because these conditions blend in so easily with normal behaviors, a mood disorder may not be detected for years or until the illness worsens and becomes obvious to the individual and the observer.
Bipolar disorder most often manifests itself in the teenage years. It is also found upon occasion in children. Many women have their first episodes after childbirth. There is also a late-onset bipolar disorder where people over 50 get it. Some of these late onsets are associated with surgical procedures.
As you can see, the illness is as complex as each individual who bears it. Always remember, though, help is out there. It’s a question of finding it. Do not be discouraged by our sometimes incompetent unwieldly mental health system. Be prepared for it and know that you will learn to navigate your way through.
Frequency of episodes. Everyone’s cycle is different. If a person cycles 4 or more times a year, we say they’re a “rapid cycler.” Certain meds are indicated for rapid cyclers.
The onset of the illness is associated with a convergence of dramatic events, called “triggers.” These can be both positive and negative events. It may occur from milestones in a person’s life such as an impending high school graduation. Traumas or losses may also trigger episodes. Loss of a love relationship is a prime trigger as is a job loss. Although these losses are natural throughout our lives and engender sadness in most people, the brains of the bipolar individual overreact and the sadness deepens into a debilitating depression or mania.
After the illness hits, further episodes may be precipitated by dramatic events per above but also by changes in your medication. Many people fiddle with their meds, lowering the dosages because they feel fine but in doing so they inadvertently trigger an episode. All med changes should be done by a doctor.
Caution: The surest way to end up in the hospital is to go off your medication. Many people succumb to the temptation when they are feeling good. The question you must answer for yourself is, “Why am I feeling so good?”
KEYS TO RECOVERY
1) Get a good psychiatrist. We may not like it but today’s psychiatry usually works like this: the patient has an initial diagnostic evaluation lasting 45 minutes to an hour. Some private practice psychiatrists take two or three hours to do a more thorough evaluation. A complete patient history is taken from infancy on up. Special attention is given to the “presenting symptoms” or what caused you to see the doctor.
Most likely you had prior symptoms of your mood disorder before you saw the doctor but they have worsened. The doctor will then suggest medications. It is fine for you to do research and think about going on meds. Talk to friends on medication. Attend a support group to find out more info. Most people with mood disorders, which are a serious and chronic illness, choose to go on meds so they can lead a healthy, productive life.
Further appointments with the doctor are called “med checks” and are painfully short – 15 to 20 minutes – unless, again, you are seeing a solo practitioner rather than one who works for an agency where the most pressing issue is quantity – seeing the most patients per day.
Med checks should be frequent after initial diagnosis – once a week – to make sure the meds are working and that side effects are at a minimum.
After that, monthly visits are usually scheduled. When you have achieved good stability you can go once every 6 months or once a year.
Choosing a doctor. First impressions, whether by phone or in person, are very important. The psychiatrist should make you feel comfortable. Get a good vibe from your doctor as you will constantly be disclosing confidential information to this person and must be comfortable doing so. After the two of you are comfortable together, ask, “Is it OK to slightly adjust my meds if necessary?” For example, if you’re not sleeping well and home remedies like drinking warm milk don’t work, ask, “How much extra sleeping med can I safely take?” Same holds true for antianxiety meds and antipsychotics.
After you have mastered the nuances of being on meds and becoming “stable,” as we call it, it’s advisable to try natural remedies instead of adding on more medication. Clearly, if your problems are severe, meds are called for. However, the standard rule is, the less medication the better. Make sure your doctor shares this philosophy.
Doctor’s visit. Make the most of your appointments since they’re so short. Take notes. Have a list of questions for your psychiatrist to answer. Questions may include “What can I do to shake the exhaustion I feel in the morning?” The answer may be as simple as changing the time you take certain meds.
Write down questions between sessions. Also attend the session with your version of a “mood chart.” A simple mood chart can be constructed on a daily calendar. Grade your mood from 1 (worst) to 5 (best), accompanied by any life changes that may have affected your mood (“got a promotion”). Look up “mood chart” on the Internet for a complete explanation of its importance.
During session make sure your questions are answered. Again,
between sessions keep a list of “Doctor Questions” lest you forget.
Keep the doctor’s business card in your wallet. Your doctor is your lifelife. Your doctor must be immediately available in times of crisis. Discuss this on your very first visit. If the doctor cannot be reached during crisis, find another one.
Crisis is defined as a noticeable change in mood. Do not hesitate to call your doctor. You would be surprised at the difficulty people have in calling their doctor. Realize this and make the call.
Strengthen your relationship with your doctor and allow her to take an interest in you by revealing some interesting personal history such as “I was the state ping-pong champion.” It is also helpful in these times of short appointments to present your doctor with a brief “personal narrative” of your life and meds. This saves time if you’re doctor-shopping and don’t want to keep repeating your story.
Again, get medication parameters from your doctor. In other words, how much extra medication can you take on your own if you can’t sleep or are becoming psychotic. I’m repeating this several times because so many people fail to take this all-important step.
A psychiatrist possesses one of two degrees: MD or DO (doctor of osteopathy). The degrees are equally effective.
2) Get talk therapy. After your diagnosis, it’s helpful to have guidance from an expert in aiding you to live with your illness. You are the same person you always were but you may need reassurance that you are capable of living a good life.
Most people find that therapy with a compassionate therapist speeds their recovery. Positive brain changes occur while talking to a therapist.
A psychotherapist may be called a psychologist, therapist (short for psychotherapist), a social worker, or even a nurse, depending on her degree. All are equally effective.
You yourself determine how long you stay in therapy. The purpose is to grow as a human being. Therapy should include goal-setting, short and long-term. If you have low esteem, your therapist will help you raise it by giving you heartfelt compliments or praising your ideas. We can say that therapy is an attempt to “re-parent ourselves.”
Therapy will help you examine a new “significant other” you are interested in. We don’t want to succumb to the “repetition compulsion” where we choose one bad partner after another.
If you’re unhappy with your therapist, it’s fine to switch mid-stream. Tell her why you are leaving. This builds assertiveness. One of life’s goals is to be assertive so you can achieve your goals.
3) Learn about Medication. The goal of medication is to feel as close to normal as possible and minimize cycles. You may still have “breakthrough” episodes than can be controlled with medication or lifestyle tweaks such as relaxing or getting away from stressful situations.
Take an active role in learning about your meds. Learn the categories of medication. The impact of meds is so highly individual that only YOU know how you feel and what side effects you can or cannot tolerate. Write down every med you take and keep it in a folder. Some meds are notorious for losing their effectiveness.
Lab tests are necessary when you take drugs such as lithium, Depakote or Tegretol. Make sure your doctor schedules lab tests at least once every six months. Clozaril requires weekly tests.
Med categories include Mood Stabilizers – Antipsychotics – Antidepressents – Antianxiety. There are also drugs used to ease side effects, such as Cogentin or Inderol, in a variety of different categories.
Mood stabilizers are the number one medication for a person with bipolar disorder. They include lithium, which is widely considered the “gold standard.” Although it works for about 66 percent of patients, it has unpleasant side effects that many people can’t tolerate. In addition to lithium, other mood stabilizers include Depakote, and Tegretol. The latter two are also used to treat epilepsy. Trileptal is a derivative of Tegretol and hasn’t been approved to treat bipolar disorder. Doctors prescribe it anyway, as it’s found to be helpful. We say it’s used “off-label.”
Lamictal, an anti-seizure med, is also considered to be a mood stabilizer. It’s particularly helpful as an antidepressant.
Mood stabilizers are divided into first-line treatment (the best) and second-line such as Topomax or Neurontin. Many doctors find these latter two drugs useless for mood disorders. Neurontin is mostly used as an effective pain management drug or antianxiety agent.
Drug manufacturers have exclusive rights to sell their name-brand product for 17 years. After that, other drug companies can manufacture them. These are called generics. Some generic drugs are not as effective as the original. Do Internet research before switching from brand name to generic.
Warning: While mood stabilizers are very effective, some have potentially dangerous side effects. In the summertime, people on lithium should be wary of lithium toxicity (dizziness, confusion, altered gait). Go to the ER immediately should you experience these.
In the summer drink plenty of water and wear sunscreen, particularly if taking a mood stabilizer or an antipsychotic. Check with your doctor or the Internet.
Antipsychotics are used (1) to stop mania and also (2) as mood stabilizers. Examples are Risperdal, Geodon, Zyprexa, Seroquel, Abilify. These are called the “newer” or second-generation antipsychotics, though the first generation (such as thorazine or Haldol) may work just as well. The side effects of the older generation are worse.
Still, the side effects from newer antipsychotics may be significant. Call your doctor immediately if you are experiencing stiffness, restlessness, muscle spasms, or difficulty moving. For the record, these are called extrapyramidal side effects or akasthesia. Relief is easy to obtain from a skillful doctor.
The great thing about antipsychotics is they usually work quickly to stop a mania. They can be added to your lithium or your Depakote and when your mania subsides, you can go off them. Remember, the less medication the better.
The worst thing about antipsychotics is their name. It reminds people of the media-bias and popular-bias against mentally ill people.
Taking an antipsychotic may also engender feelings of shame. Who can blame you when prejudice against the mentally ill is nearly as bad as ever? For many people, “bipolar disorder” has the connotation of being crazy. Think twice when telling people you have bipolar. Sometimes the term “depression” will suffice. Some people lose their jobs when it’s discovered they’ve been hospitalized for bipolar. Be discreet.
Antidepressants work by making changes in brain chemicals known as neurotransmitters. Newer antidepressants with fewer side effects were invented in 1987 with the introduction of Prozac. The older antidepressants, such as tricyclics or MAO inhibitors, are still available.
The newer antidepressants come in 4 different categories depending upon which neurotransmitters they affect. The category SSRI includes Prozac, Zoloft, Lexapro, etc. They are also used to treat anxiety as are most antidepressants.
Other commonly used antidepressants in other categories are Cymbalta and Effexor; Wellbutrin; and the popular antidepressant sleeping medicine Trazodone.
Antianxiety agents – Klonopin, Ativan, Serax, etc. These are all benzodiazepines and work very quickly. Be careful though about getting off these when you’ve been on them awhile, particularly Klonopin.
We remind you every brain is different. It may take a few times to get your medication correct. Most people are on several medications mostly to target the different brain chemicals involved including dopamine, serotonin, norepinephrine, GABA, plus hormones like melatonin. Use the Internet to find the 30 or so neurotransmitters that govern our minds.
Warning: Most medications must be carefully titrated, that is, the dosage must be raised or lowered slowly. Make sure your doctor is following common protocol so you won’t have bad side effects, especially withdrawal symptoms.
4) Follow a schedule or “To Do List.” This is vital particularly if you’re not working. The human brain is wired to work, to keep busy. In the midst of a depressive episode, keep working if at all possible. Many people can pull this off. They may do less work than usual or may find ways to postpone difficult projects until their depression lifts.
It is important you don’t blame yourself or feel guilty when your depression strikes. Remember, you did not ask for your depression and you are doing your best to cope with a difficult situation.
If you’re home during your depression, make a list of easy tasks you can do. Write them down and check them off when finished. This will make you feel good that you’ve accomplished things.
Decide which tasks are easy or hard. For some people, easy tasks include sitting at the computer surfing the net, reading the newspaper, getting your child off to school, doing the laundry. Hard tasks include bathing, house-cleaning, grocery shopping, meal preparation.
Have easy-to-eat foods at home when depression hits. These may include yogurt, fresh fruit, canned salmon or tunafish, canned fruit such as pineapple. Your appetite may also be poor when depressed. Find out which calorie-rich foods you can eat or drink to maintain your physical health. It’s important to remain nourished and hydrated.
5) Find people you can phone to “cheer you up.” The sound of someone’s voice is the best therapy of all. Have a list of people you can call. The more people you have, the better. Your brain will be stimulated by each phone pal. While on the phone, your symptoms will probably lessen. Be sure to phone people if you’re on new medication which is taking time to ramp up in your brain. Your phone pals will bolster your spirits.
6) Learn to process your feelings. Bipolar disorder is an emotional-processing illness. We don’t process our emotions like other people do. Many of us harbor secrets and don’t communicate well. Be aware of this quirk and work on it with the help of friends or a therapist.
People with bipolar also have issues with anger. Oftentimes, they let anger build to huge proportions. The simple but difficult technique of “walking away” from your anger – or “cooling off” or leaving home – may save you from actions you will later regret.
The person with a mood disorder may experience lots of stress, especially in the early phases of their illness or when medication is changed. It’s okay to rely on antianxiety medication to help you out until your mood levels out.
There is also the feeling of being overwhelmed when it seems impossible you’ll ever get things done. This may be a function of your depression and it will lift. Invite someone to help you with monumental tasks.
Aerobic exercise, such as walking or swimming, is also helpful to deal with stress. Many people find yoga and meditation of immense help for the overly stressed lives of most Americans.
7) Practice a healthy lifestyle: regular sleep, regular medication times, regular meals, prayer and exercise. Emulate the birds! They live a well-structured life, arising at the same time every morning, going to bed the same time in the night, eating nutritious foods that keep their constitution healthy. People with mood disorders need Structure in their lives!
8) Realize you are more than just a person with a mental illness. Do not let it consume you. Develop hobbies and interests so you can grow healthy new neurons. You are a whole person whose gifts and talents help the world move forward.
9) Compliment page or drawer. Raise lagging self-esteem by writing down compliments people pay you: “My boss said I’m intelligent and have a great sense of humor.” Or, “You play the cello like Yo-Yo Ma.” You may also have a drawer-full of things you’re proud of such as copies of letters you’ve written or that others have written to you, diplomas, awards, college papers, photos.
10) Recognize your Triggers. A trigger is anything that can bring on a moodswing. Here is where your ability to plan ahead is vital. What events – or triggers – have set you off in the past? Write these down. They may include: seeing an old love, a rejection of any sort, attending a wedding, new duties at work, getting divorced, moving to a new home, or returning to work after a hospitalization (ease yourself back to work through a “hospital day program” also known as a “partial hospital program.”).
Be solution-oriented! If you are triggered find out what actions you can take to get back to normal. More about this under “Strategies to Regain Strength” below.
Be aware that lack of sleep is the chief trigger for mania. Contact your doctor immediately should this symptom occur. Yes, it is possible to stop mania before it gets started.
11) Good sleep is essential for good mental health. Poor sleep is a prelude to mania or hypomania. Lack of sleep is a warning sign of incipient mania. Not everyone sleeps through the night, so don’t be concerned if you awake in the middle of the night. After you are stabilized on your meds, learn to get a good night’s sleep and if you have trouble sleeping, address the problem with natural remedies – such as warm milk or chamomile tea – instead of ingesting more meds. If your sleep deficit is so severe, meds are definitely indicated.
Establish a bedtime ritual so your body knows you are slowing down and getting ready to sleep. A ritual may include changing into pajamas, reading in bed, then switching off the light. Best to sleep in darkness to activate the sleep-producing brain hormone melatonin.
12) Your home, whether a room or an apartment or a house, is your comfort castle. When you enter, it should smell inviting. Jazz it up with smells from fresh fruit, scented candles, incense. Our moods are affected by aromas more than we know.
Live in as clutter-free an environment as possible. The state of messiness – or chaos – very much affects our brain. Hide things in closets or drawers until you’re ready to organize them. It’s a great feeling coming home to a neat house.
Lighting affects our moods. Decide where dim lights are needed as well as bright lights. Open your drapes or blinds to let in the sunshine.
The brains of many people with mood disorders do not like hot weather. It is definitely not your imagination if you feel down or dull during hot weather. Seek out air-conditioning. If at home, sit or sleep near a fan.
Put anything unpleasant away from sight such as bills. Everything you look upon in your home should give you a sense of peace. Remove from the premises anything hurtful such as old love letters or rejection letters. Out of sight, hopefully out of mind, and onto a new and better life.
Your home should be easy to move around in. No big objects to trip over. If you’re hypomanic use your energy to create a feng-shui atmosphere.
13) Develop a crisis plan. Print out a page called “Crisis Plan.” It might read as follows:
It’s important to PLAN AHEAD should a crisis arise. Prepare now with your doctor and family, particularly to get all-important medication parameters or “how much medication can I add to help me” on an as-needed basis. You must work with your doctor on this. Never change your medication on your own.
1) Call my psychiatrist. The partnership you have with your doctor will ease your mind during a crisis. If you’ve gotten medication parameters with her previously, take that extra antianxiety medication or antipsychotic or antidepressant you’ve previously discussed.
2) Call my therapist.
3) Leave home where my lethal weapons reside. Carry my cell phone to await my doctor’s call.
4) Be among people. Go to the home of a friend or relative who treats you well. Go to a soothing place such as the library, the bookstore, a coffee shop.
You needn’t interact if it’s too difficult, but it should help being around people. However, if you’re psychotic and paranoid, you may wish to avoid people and just wait around for your doctor to call. In this difficult state, you might listen to soothing music, watch TV if it doesn’t trigger bad thoughts, lie quietly with eyes closed, look at “coffee table books.” Also read “Strategies to Regain Strength” below.
5) Check yourself into a hospital if you believe you need a safe refuge. In advance, find good hospitals in your area such as Horsham Clinic, Abington Hospital Psych Unit, Friends Hospital. Not every general hospital has a psych unit so research this beforehand.
Don’t forget to add your own techniques in addition to the above. YOU know yourself best of all!
Depression is not a fatal illness but many depressed individuals experience a distorted view of themselves when depressed. Some false beliefs emanating from the distorted lens of depression are: the world would be better off without me, I’m a burden to my family, I want to be out of my misery. Nothing could be further from the truth!
When you are well, study “The Stop-Suicide Plan” below. Have it handy should you become suicidal. And add your own strategies. Know that suicidality is common among people with mood disorders. It is the most difficult part of our illness so please pay special attention to this section.
1) Call your doctor. Similar to the Crisis plan above, let him know through his answering machine or secretary that “This is an emergency, please call me back as soon as possible.” Don’t forget to leave your phone number!
Follow the 5 steps in the “Crisis Plan” above.
2) Call a trusted friend or loved one immediately. The sound of another person’s voice is soothing and reassuring. Print out a list of names to call. You needn’t tell the person that you’re suicidal. Use your judgment. You can simply keep on talking and listen to the soothing sound of the other person’s voice. Or you can start the phone conversation by saying: “I’m struggling, can we talk a few moments?” Or, if you know the person well you can say, “I’m feeling really suicidal now. Can we talk a few moments until the feeling passes?”
The feeling – or “urge” – will usually pass. You will probably need a medication adjustment.
3) Leave home to remove yourself from lethal weapons and be among people until the thoughts pass. You can visit with a relative, go to the bookstore, a public library, a park, a mall, a coffeeshop where you can engage in conversation with the employees or patrons. Consider it your job to go from place to place until the bad feelings pass.
If you’re overwrought with anger, it’s best not to drive but to walk quickly in an effort to dispel your anger. You can also do other activities that get out your aggression such as bounce a basketball, throw rocks on a pond or in the backyard, do gardening and pull out weeds, go for a run or fast walk.
Suicidal thoughts are intense and truly horrible. We must rely on all our powers to resist them.
4) Carry phone numbers of friends and loved ones in your wallet or in your cellphone. Also keep the phone number of the national Suicide Hotline in your wallet – 1 -800 SUICIDE.
When to go to the Hospital. When you need to be safe, check into a hospital per above.
Hospital aftercare. Transitioning from your hospital stay to living again at home is often best done by attending an outpatient program also known as a “partial hospital program.” Structured programs for half a day will ease the transition to independent living back home and returning to work.
There are many fine hospitals here in the Philadelphia area such as Horsham Clinic or Friends Hospital. Abington Memorial Hospital has a good small psych unit.
When we’re at our worst, we check into the hospital to keep ourselves safe from suicide or to alter our medication. You will be with all sorts of people with all different diagnoses including substance abuse. It may not be pleasant, but your goal is to get well and be discharged with new coping skills.
Make the most of your hospital stay. Chat with interesting patients or staff with whom you can learn coping skills. You’re there to get well and to learn.
Many folks feel ashamed to have a mood disorder or to be on medicine. Perhaps you will get used to it. Perhaps not. Attending a good support group and hearing the amazing success stories of people with your same illness – people on your same medications who have walked in your shoes – may ease these unpleasant thoughts of shame.
STRATEGIES TO REGAIN STRENGTH
When you’re knocked down, these strategies will help you rise again. Keep these handy and don’t forget to add your own. Action or moving your body is the best antidote to a moodswing.
Call a friend – exercise vigorously – go for fast walk or run – punch a pillow or punching bag (buy one if you experience lots of anger) – write a letter and then decide whether or not to mail it – take phone off hook to avoid intrusive phone calls – journal – express your feelings through poetry or visual art such as painting or sculpting with self-hardening clay available at craft stores.
OTHER OPTIONS FOR TREATMENT
The vast majority of people with mood disorders respond to medication. Unlike fast-working aspirin, though, antidepressants take an average of three to four weeks to work. During this difficult time, be sure to call your phone pals to bolster your spirits.
Research centers work on treatment-resistant cases. Two helpful centers are at the University of Pennsylvania. John O’Reardon, MD, sees patients for treatment-resistant depression, as does Jay Amsterdam, MD. The latter is a research psychiatrist so you must be part of a study to see him.
If meds don’t work, do not hesitate to consider alternative treatments such as: ECT (electro-convulsive therapy), a vastly improved treatment than it was years ago. Chief side effect is short-term memory loss which can be dealt with by keeping a “Remember This Journal.” For more info, read Shock: The Healing Power of ECT by Kitty Dukakis.
Vagus nerve stimulation, used to help people with epilepsy, is helpful as is Transcranial Magnetic Stimulation. They’re available at local hospitals such as University of Pennsylvania or Abington Memorial Hospital.
Other new “somatic” treatments include CES (cranial electro-stimulator device). There is also a new Deep Brain Stimulation (DBS) procedure that’s been studied for 4 years in Canada and is getting closer to being marketed. A surgeon enters the brain in 2 places and stimulates a region called the subcalossal cingulate gyrus with amazingly effective results. It is successfully used in treating Parkinson’s patients.
Remember that new meds and treatments are constantly evolving.
THINGS TO KNOW
…Although I have emphasized medication in this handout, medication is only half the picture. Lifestyle changes, therapy, good friendships are also crucial in helping your mood disorder.
…Develop interests and hobbies and meet new people. Read books about subjects other than mood disorders. Don’t let your illness consume you. Learn as much as you can after diagnosis but then plunge into the joy of living.
…Know that any medication change may bring about an altered mood. Whenever you can’t figure out why you’re cycling, ask yourself, “Have I changed my medication?” To prevent the all-too-common forgetting to take a medication dose, buy a pill box and keep it visible! This way it’s easy to make pill-taking a habit.
…Get plenty of light, especially in the winter. SAD (seasonal affective disorder) is as serious a form of depression as any other. SAD is treated with special light therapy. After researching and consulting with your doctor, purchase bright fluorescent lights, different than your home lamps, and learn how to sit in front of them daily, usually for a set time in the morning. Also read Winter Blues (rev. 2006) by Norman E. Rosenthal, MD.
…Avoid the tempting thought: I feel so good I’m going to go off my medication. Sad to say, you will most likely regret this as your symptoms will return and smack you in the face. This is the chief reason people go to the hospital.
….Keep in mind that many high achievers continue to live a great life despite their mood disorder. You will be among them!!!
Helpful web sites include:
TheSidewalkPsychiatrist.com by psychiatrist Dr. Dan Hartman
PsychEducation.org by Oregon psychiatrist Dr. Jim Phelps
McmanWeb.com – John McManamy, journalist with bipolar disorder, shares his impeccably researched findings complete with sources
BipolarHappens.com – written by a woman with bipolar
NIMH.nih.gov – informative US government website with up-to-date scientific info about all mental health conditions. Sign up for email alerts on new research discoveries. Go here for diagnostic criteria.
MayoClinic.com – excellent thorough info.
NARSAD.org highlights new developments such as research or new treatments (such as deep brain stimulation above) for people with mental illness.
Ruth Deming and members of New Directions Support Group wrote a helpful piece on Bipolar Disorder. Click on www.WikiHow.com and enter “Ruth Deming” in search engine.
An Unquiet Mind by Kay Redfield Jamison, PhD, her memoir of manic depression. 1997.
Bipolar Disorders and Recurrent Depression – Frederick Goodwin, MD and Kay Jamison, PhD. Your best source of information. Clinical, thorough and extremely long. Rev. in 2007.
A Brilliant Madness: Living with Manic Depressive Illness by Patty Duke. 1997.
Living Well with Depression and Bipolar Disorder: What Your Doctor Doesn’t Tell You…That You Need to Know by John McManamy. Comprehensive: covers meds, side effects, family relationships, paying for treatment, etc. A good roadmap for someone learning to live well with bipolar. 2004.
Unstuck:Your Guide to the Seven-Stage Journey Out of Depression by James S. Gordon, MD. Emphasizes medication is not enough. We must treat the whole person. The author believes that depression is not an end point but a journey of practical ways to climb out of the darkness. 2008.
Darkness Visible, A Memoir of Madness by William Styron. 1990.
A Mood Apart by Peter C. Whybrow, MD, subtitled A Thinker’s Guide to Emotions and its Disorders. This UCLA professor states that some of his patients no longer take meds. 1998.
Healing Depression and Bipolar Disorder Without Drugs by Gracelyn Guyol. Walker Publishers. 2006.