Self-Care and Management of Manic-Depression

Manic/Depression, AKA Bipolar Disorder, is a medical condition thought to be caused by a chemical brain imbalance. Characterized by mood swings, sometimes swings so extreme as to cause a severe disruption in functioning, it can wreck havoc in terms of lost time, broken and damaged relationships, lost employment, financial ruin, and, sometimes, loss of life itself. There is help for bipolar disorder: help in terms of medication (new ones are coming out every year), and also steps you can take yourself to help ensure as few episodes as possible throughout your life.

Medication

The first line of defense in managing bipolar disorder is medication. A doctor, a psychiatrist or psychopharmcologist, are the only persons qualified to make an assessment, advise you, and prescribe medication. However, one general note on medication: except in rare circumstances (for example, toxicity, or allergic reaction), it should never be terminated abruptly, as that action, itself, can precipitate a mood swing. Medication should always be titrated up slowly (except in medical emergency), and always, if discontinuing, titrated down slowly, giving the body much needed time to adjust. Meds, taken on a scheduled basis and in correct dosages, can go a long way in putting bipolar disorder in remission; but that's not the whole story.

Other Drugs (including alcohol & pot)

Any over-the-counter drugs, including seemingly innocuous ones such as aspirin or cold remedies, should be checked for possible drug interactions with medications before being taken. Checking with the pharmacist before purchase is your best bet. Also, certain classes of drugs (corticosteroids, for example) have been known to bring on mania, as have some anti-depressants when taken without a mood stabilizer. Take care when considering any new medication. Alcohol and pot, with their well-known chemical effects on the brain are best--- best left in the bottle and unlit, that is.

Sleep

Sleep, or more accurately, sleep disturbances, seem to play an integral role at both sides of the pendulum of manic/depression. A hallmark of depression is sleeping too much (though insomnia can indicate depression as well), while (hypo)mania and mania are characterized by sleeping little, and seemingly needing very little sleep. It's only seemingly, though. Your body and brain still needs their rest, but are being prevented from getting it. This, itself, can lead to a spiraling of symptoms, and provoke them into worsening. If you notice you seem to be sleeping less and less, or more and more, it's time to take action and give your doctor a call before your symptoms spin out of control.

Stress

Stress is a fact of modern life. Some stress is "happy" stress--- going on vacation, starting a new job, buying a car; some stress is "unhappy" stress--- becoming sick, or being in an accident, or losing someone close. Stress, in either form, can be a trigger in either depression or mania. No one can avoid all stressors, (life would cease to be interesting!) but if you know something's coming up that might induce some heavy stress, you can prepare yourself for the effects it might have. Stress management classes are given at many local colleges for management of the everyday kinds of stress, or you might try less orthodox methods, such as yoga or Tai Chi. For the larger life stressors, just being aware of the effect they might have is your best defense.

Life-style Regularity

We're all creatures of habit to varying degrees. It's nice to know you can always count on finding your socks in the same general area, for example. Your body, normally, wants food at about the same time every day, and sleep at about the same time, and in the same amount, every night. Both depression and mania can disrupt your normal "body clock," but consciously establishing a regular routine, and sticking to it as much as possible, may help tremendously in keeping your own particular rhythm in sync.

Mood Journal

Manic/depression often follows a surprisingly regular cycle. Many people have found that keeping a daily mood journal helps them more easily recognize patterns within the cycle, and alerts them to possible problem times such as a particularly sensitive times of month or year. The journal can be as simple as a numerical notation on a calendar, as complex as a full daily diary, or anything in between. What's important is being able to discern patterns over time. Commercial "mood charts," designed specifically for this purpose, are also available at various WWW sites.

Diet & Exercise

Do medical schools offer a course called "Eat Right and Get Plenty of Exercise 101?" As simplistic as this advice might seem, there really are sound medical reasons for it, and it's generally a good recommendation for all humans. The right balance and amounts of healthy foods at regular intervals helps anyone feel better, but attention to diet can also help offset some of the side effects of some of the meds (weight gain or loss, for example). Exercise keeps your body strong, more resilient and able to avoid injury, and strengthens the immune system. Exercise itself can be a stress-buster, and endorphins released during exercise are particularly beneficial in counteracting and minimizing depression.

Breakthrough Mania or Depression

Bipolar disorder is a medical condition and does not always follow a predictable path. Despite the very best self-care and management, breakthrough mania or depression may sometimes occur, and are not necessarily due to carelessness or mismanagement, and definitely not due to any character flaw or moral failing. Because it's possible for a breakthrough episode of mania or depression to occur with little warning, it's important you have someone in your corner if this occurs. Someone you, yourself, have nominated that you implicitly trust -- a therapist, best friend, close family member, a spouse -- someone you can turn to and use as a "sounding board," who will tell you honestly if they're noticing something "off," and who, more importantly, you can turn to for help any time, any place and know they will be there. Don't try, out of fear, embarrassment, or just plain stubbornness, to "go it alone." A hallmark of our very humanness is that sometimes we all need each other. Above all, give yourself permission to be human.

Learning to live with manic/depression is just like learning anything in life: series of trials and error, what works and what doesn't, and few of us live exactly right, or get perfection the first time around. The key is to be aware, and take care of yourself. Manic/depression, though a serious, sometimes life threatening condition, can be managed, and many people do live full, productive, sometimes exceptional lives.


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9/3/2004