Bipolar You

The young adult's guide to bipolar depression.

Top Ten Resolutions for a Healthier Bipolar You

The 10 most important areas of change for those living with bipolar disorder

It's that time again where we use the occurrence of the New Year as a vehicle for thinking how we'd like to do better in the foreseeable future. Frequently these resolutions are not successful due largely to the arbitrariness of their timing. Change will occur when we really want it and not just because the Times Square ball has dropped.

If you've been diagnosed with bipolar disorder in the last couple of years, you'd probably welcome some guaranteed change. But the process of getting there is not as simple as losing ten pounds or organizing your closet. With weight loss or closets, the changes are attainable and the only thing standing in your way is you. With bipolar disorder you're faced with a much bigger question - What can you change vs. what must you learn to live with?

You're also faced with the reality that lessening your mood variability doesn't involve just one set of behaviors. Indeed there are multiple contributing variables that if approached as sets of smaller goals will carry a much higher likelihood of success. These goals or resolutions are listed below along with brief explanations. 

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Having had many years experience treating individuals with bipolar disorder, I’ve observed that when people are successful with these suggested objectives, the frequency and acuity of instability improves. Returning to the content of my first paragraph, the key with any resolution is that change or improvement must really be wanted. And I don't just mean you've got to be tired of your status quo. You've got to be hungry for change and you've got to be willing to face some of the discomfort that efforts to change will bring. Change is never easy; even positive change. We are creatures of habit and sometimes we cling to our old ones simply because they're more comfortable than establishing new patterns of behavior. So if you're considering one or more of the resolutions that follow, but you don't quite feel ready for the effort, you should hold off until the readiness is there. Otherwise, you may be left with one more disorganized closet.

10 Resolutions for a Healthy Bipolar You (written in first person language):

1.     If I think I may have bipolar disorder, I will find a mental health professional with bipolar expertise and make an appointment to be seen for an assessment.

Some folks are afraid to find out. Some don't trust mental health professionals. But the reality is there is little risk in meeting with someone who specializes in bipolar disorder. I've seen numerous patients over the years who have been referred or who seek help because they think they may have bipolar disorder, only to find that such is not the case. There are many times when mood variability, high energy, strong emotions, unique sleep patterns, etc., are not indications of bipolar disorder. You owe it to yourself to find out either way and stop wondering.

2.     I will establish a stable sleep cycle where I go to sleep and awaken at close to the same time each day. I will even apply this to weekends or other days were I can potentially sleep in.

For many with bipolar disorder, stable sleep is as potent and helpful as most medications prescribed. I would add that if you find that a medication prescription needs to be part of the sleep solution, then it's worth it, even if your preference is to try to manage your disorder without medicine.

3.     I will refrain from frequent and/or excessive use of alcohol or other non-prescription psychoactive drugs.

I don't mean to imply that any and all substance use is bad for you.  If you want to have an occasional beer or a glass of wine with dinner, that's no big deal. It's not poison. What is poison is frequently altering your mood state in a significant way as a result of drugs or alcohol use.   Quite simply, that will undermine your efforts to improve your mood stability. There's one other consideration here: I've seen some individuals with bipolar disorder whose mood state is highly sensitive to small amounts of substances (including alcohol). If you're among them, you'll do better to refrain entirely.

4.     I will talk with others about my bipolar disorder, particularly those who are important to me and who have significant influence upon my day to day experience.

Too often, particularly in the early phases of coming to terms with the disorder, people feel ashamed, embarrassed and fearful of negative judgment. Some of this isn't just your hypersensitivity or irrational fear. Within our society there exists a degree of social stigma and misunderstanding regarding psychiatric disorders. But living successfully with bipolar disorder isn't something you do on your own. Your chances for success will be improved considerably if you can benefit from the support and understanding of other key people in your life. This may even entail a boss, a supervisor or even some co-workers at your employment site. I'm not implying you become an open book, but using some discretion, in communicating with a select group of individuals, may make a strong positive difference in your day-to-day experience.

5.     I will strive to become highly effective with my own stress management.

If you've got bipolar disorder, high levels of sustained stress are not your friend. High stress creates vulnerability towards destabilization. If you can become effective at lessening your stress, you will do better in managing your mood. Stress reduction is different for each of us. For some it involves mediation, yoga, daily exercise ... and for others it's a matter of good time management and effective planning. The point is, whatever you can do to lessen your overall stress will be good for you.

6.     I will determine whether medication is necessary and, if it is, I will work with my psychiatrist (or prescribing physician) to find medications that are helpful and have low side effects.

Medication for bipolar disorder is always a mixed bag. Most would rather not take it and risk the negative side effects. Nevertheless, the progression of your decision process should involve two separate stages:

A.    If your mood variability is mild to moderate, you should determine whether there are lifestyle modifications you can make that will be sufficient to smooth out your mood and energy variability. If lifestyle modifications can adequately contribute to positive change, that's really excellent. I'm not of the mind that every individual with bipolar disorder needs to be on some form of psychotropic medicine. 

B.  However, if through those efforts you find non-medication approaches aren't sufficient, the next goal is to work towards finding the right medication (or combinations of medicine) that will facilitate your stability while also creating the least degree of unwanted side effects. Some are fortunate in that they can take medications prescribed for bipolar disorder and have no (or minimal) unwanted side effects. For others, it's not as easy, and they must go through multiple medication trials before they find a combination that works.

There is one important exception here: If you've already been through numerous medications without adequate stabilization but you and your psychiatrist conclude that you've achieved the best outcome, you may have to accept what is, at least for now. Research is gradually leading to better understanding of this disorder. With that comes the hopeful news that more effective pharmaceuticals as well as other groundbreaking neurobiologic interventions will be discovered. In another couple of years you may find there are several new and preferable options on the market and available to you through your treating professional.

 7.     I will explore possible benefits to my mood stability through the use of nutritional supplements.

 This is a bit controversial. There's not a lot of hard evidence out there that nutritional supplementation makes a big difference for those with bipolar disorder. But there is research which points to potential benefits. There are also a lot of anecdotal reports which support the use of nutritional supplements. The kinds of supplements I'm referring to include vitamins, minerals, omega-3 fatty acids, antioxidants, etc. If you go online you'll find a plethora of information - perhaps too much. However, if you do your research and then find a professional who actively uses supplements in his/her practice; you may find some excellent guidance that will assist you with your management of bipolar symptoms. Essentially, I'm saying don't leave any stone unturned. There are many different approaches to your bipolar disorder, and some may lie well beyond the traditional medical model.

 8.     I will try to assess my non-bipolar self and determine if there are ways I can improve my basic personality style.

We all have enduring ways of thinking and being that comprise our personality. Unless one puts forth a lot of effort, the configuration of patterns that is "you" remains pretty stable over time. Think about it - if you meet someone who you know quite well but haven't seen for ten years, he or she will likely be similar to how you remembered them (with exception of the physical changes common to the aging process).

When I'm seeing someone in therapy who has bipolar disorder, I often engage in a discussion of "who they are" apart from the effects of their disorder. Once we agree that we've accurately established that picture, I often ask ... "What aspects of your self do you think get in your way or create difficulties in your life?" We all have them - for some its anger, for others its neediness or narcissism or being overly care-taking of others. The point being - we each have patterns of behavior that we know are less than ideal but they nonetheless endure and create intermittent difficulties for us.

If you've got bipolar disorder all of your preexisting maladaptive traits can make things more difficult when you're in the midst of destabilized mood. The big challenge with this perspective is that altering these basic aspects of your personality isn't an easy task. The process usually requires some on-going psychotherapy or at least a deep desire to try to alter long-held patterns of behavior. That said, I always contend that where motivation is strong enough then change is always possible.

9.     I will investigate whether there is a bipolar support group offered in the area where I live. If there is, I will attend a few sessions and determine if the experience is helpful.

Bipolar prevalence is relatively low. NIMH places it at about 2.6% percent of the population annually. Amongst every 100 people there will be approximately two to three with bipolar disorder. Chances are, most others you speak with won't have a clear understanding of the disorder. In fact, it's often the case that the media misrepresents or sensationalizes incidents involving people with bipolar disorder which only serves to perpetuate inaccuracies. It's a given that having bipolar disorder often entails being misunderstood.

Now imagine being with others whose experience is not all that different from yours. They too are often misunderstood. They know what it's like to feel the insidious onset of hypomanic intensity or to plummet downward without any warning or clear reason why. They know what it's like to feel intensely ambivalent about taking medication. They know what it's like to live with bipolar disorder.

I've been leading bipolar support groups for the last six years and I can say unequivocally it's one of the most helpful things that people with the disorder can do, particularly if they are in the earlier phases of adjusting to bipolar disorder.

10.  I will work on emotionally accepting the reality of my bipolar disorder.

This may be the toughest resolution of all. In most respects it also needs to be the precurser for numbers 1-9.

No one truly wants bipolar disorder. But once it's emerged and you've become clear about the diagnosis, it's not likely to just go away; but it can improve through your sustained efforts. The challenge is how to manage your bipolar reality with patience and compassion for yourself. I wish I had a simple answer, but as with so many things bipolar, the answer is complex and unique to each individual.

What I can say is that it usually involves the process of mourning the loss of your ideal self and embracing (or accepting) the new self that has arrived on the scene. It also involves acknowledging what you do and do not have control over. It means accepting that sometimes your life’s progression will become temporarily derailed. It means coming to terms with the reality that life with bipolar disorder is different than life without it. All of this is much easier said than done and it's not uncommon to find that the endeavor will require your own psychotherapy. 

2013 is here.  And while the progression from 12 to 13 occurs in an instant, I would ask, how long have you been struggling?  You owe it to yourself to see what more you can do to make a positive difference in your life.                   

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Russ Federman, Ph.D., ABPP is a psychologist at University of Virginia’s Counseling and Psychological Services. He also conducts a part-time private practice in Charlottesville, VA. He is co-author of Facing Bipolar: The Young Adult’s Guide to Dealing with Bipolar Disorder (New Harbinger Publications). www.BipolarYoungAdult.com

Russ Federman, Ph.D., A.B.P.P. is in private practice in Charlottesville, VA specializing in psychotherapy with individuals having bipolar disorder.

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