Download Document - 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
Contents:
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 215-6592366 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.”
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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.”
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THE ILLNESS
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 selflimiting, 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
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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.
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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-ofcharacter 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.
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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
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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”).
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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
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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 secondline 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.
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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.
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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, housecleaning, 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
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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 emotionalprocessing 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 wellstructured 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
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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.
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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:
CRISIS PLAN
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.
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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!
STOP-SUICIDE PLAN
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.
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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.
HOSPITALIZATION
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.
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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.
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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!!!
RESOURCES
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
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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.
Books include:
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.
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