Bipolar disorder – Symptoms and causes

Overview

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.

Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).

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Symptoms

There are several types of bipolar and related disorders. They may include mania or hypomania and depression. Symptoms can cause unpredictable changes in mood and behavior, resulting in significant distress and difficulty in life.

• Bipolar I disorder. You’ve had at least one manic episode that may be preceded or followed by hypomanic or major depressive episodes. In some cases, mania may trigger a break from reality (psychosis).
• Bipolar II disorder. You’ve had at least one major depressive episode and at least one hypomanic episode, but you’ve never had a manic episode.
• Cyclothymic disorder. You’ve had at least two years — or one year in children and teenagers — of many periods of hypomania symptoms and periods of depressive symptoms (though less severe than major depression).
• Other types. These include, for example, bipolar and related disorders induced by certain drugs or alcohol or due to a medical condition, such as Cushing’s disease, multiple sclerosis or stroke.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Although bipolar disorder can occur at any age, typically it’s diagnosed in the teenage years or early 20s. Symptoms can vary from person to person, and symptoms may vary over time.

Mania and hypomania

Mania and hypomania are two distinct types of episodes, but they have the same symptoms. Mania is more severe than hypomania and causes more noticeable problems at work, school and social activities, as well as relationship difficulties. Mania may also trigger a break from reality (psychosis) and require hospitalization.

Both a manic and a hypomanic episode include three or more of these symptoms:

• Abnormally upbeat, jumpy or wired
• Increased activity, energy or agitation
• Exaggerated sense of well-being and self-confidence (euphoria)
• Decreased need for sleep
• Unusual talkativeness
• Racing thoughts
• Distractibility
• Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

Major depressive episode

A major depressive episode includes symptoms that are severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships. An episode includes five or more of these symptoms:

• Depressed mood, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
• Marked loss of interest or feeling no pleasure in all — or almost all — activities
• Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in children, failure to gain weight as expected can be a sign of depression)
• Either insomnia or sleeping too much
• Either restlessness or slowed behavior
• Fatigue or loss of energy
• Feelings of worthlessness or excessive or inappropriate guilt
• Decreased ability to think or concentrate, or indecisiveness
• Thinking about, planning or attempting suicide

Other features of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include other features, such as anxious distress, melancholy, psychosis or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Symptoms in children and teens

Symptoms of bipolar disorder can be difficult to identify in children and teens. It’s often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Children and teens may have distinct major depressive or manic or hypomanic episodes, but the pattern can vary from that of adults with bipolar disorder. And moods can rapidly shift during episodes. Some children may have periods without mood symptoms between episodes.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

Despite the mood extremes, people with bipolar disorder often don’t recognize how much their emotional instability disrupts their lives and the lives of their loved ones and don’t get the treatment they need.

And if you’re like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.

If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn’t get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you have thoughts of hurting yourself, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

If you have a loved one who is in danger of suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Causes

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

• Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
• Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

• Having a first-degree relative, such as a parent or sibling, with bipolar disorder
• Periods of high stress, such as the death of a loved one or other traumatic event
• Drug or alcohol abuse

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

• Problems related to drug and alcohol use
• Suicide or suicide attempts
• Legal or financial problems
• Damaged relationships
• Poor work or school performance

Co-occurring conditions

If you have bipolar disorder, you may also have another health condition that needs to be treated along with bipolar disorder. Some conditions can worsen bipolar disorder symptoms or make treatment less successful. Examples include:

• Anxiety disorders
• Eating disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Alcohol or drug problems
• Physical health problems, such as heart disease, thyroid problems, headaches or obesity

Prevention

There’s no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you’ve been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

• Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you’re falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.
• Avoid drugs and alcohol. Using alcohol or recreational drugs can worsen your symptoms and make them more likely to come back.
• Take your medications exactly as directed. You may be tempted to stop treatment — but don’t. Stopping your medication or reducing your dose on your own may cause withdrawal effects or your symptoms may worsen or return.

Feb. 16, 2021

9 Most Common Triggers for Bipolar Mood Episodes

Bipolar disorder is characterized by symptoms including unusual shifts in mood and energy. These mood shifts or episodes last at least a week in the case of mania, and at least two weeks in the case of depression, according to psychiatrist Jeffrey Bennett, MD, an associate professor of psychiatry at the Southern Illinois University School of Medicine in Springfield.

There are several types of bipolar and related disorders. In order to be diagnosed with bipolar I, you must have had at least one manic episode that may have been preceded or followed by hypomanic or depressive episodes. In the case of bipolar II, you must have had at least one major depressive episode and at least one hypomanic episode, but never experienced a manic episode.

Both mania and hypomania share the same symptoms, which include feeling unusually upbeat, euphoric, or irritable, with increased energy, mood elevation, a decreased need for sleep, racing thoughts, trouble concentrating, and poor judgment. In cases of mania, these symptoms are severe enough to be causing significant problems in your day-to-day life.

For example, you might be unable to go to work or school, or you may be compulsively spending money. Hypomania is considered a less severe form of mania. In cases of hypomania, your daily functioning isn’t significantly impacted. For example, you are able to work and socialize.

When mood shifts are severe enough, they can have a profound effect on your life. Some episodes of depression and mania are accompanied by loss of reality or psychosis, characterized by hallucinations or delusions. “And unfortunately, suicide is common, with some sources estimating it to be as high as 10 to 15 percent,” explains Dr. Bennett.

Can these episodes be avoided? Perhaps not. But understanding certain triggers can help you better manage bipolar disorder.

One of the most common bipolar triggers is stress. In a study published in June 2014 in the Journal of Affective Disorders, negative or stressful life events were associated with subsequent mood swings. Earlier in their course, episodes of depression or mania in bipolar disorder appear to be triggered more often by stressful life events.

In addition, with recurrent episodes, some people with bipolar disorder may experience less complete periods of remission and a greater likelihood of relapse, either to depression or mania, according to Bennett.

While causes of stress are highly individual, certain life events and lifestyle patterns may act as triggers. Watch out for these common culprits.

Bipolar Episode Triggers | Everyday Health

Types of Bipolar Episodes

The main difference between bipolar disorder and conditions such as depression is the possibility of experiencing the overly excited state called mania, says Amit Anand, MD, a professor of medicine at the Lerner College of Medicine, vice-chair for research for the Center for Behavioral Health, and the director of the Mood and Emotional Disorders Across the Life Span program, all at the Cleveland Clinic in Ohio. People who are manic are unusually outgoing or happy. In some cases, mania also causes intense irritability and restlessness. During depressive episodes, intense sadness or hopelessness may lead to fatigue, trouble concentrating, and thoughts of suicide.

But bipolar mood swings are not always extreme, Dr. Anand notes. For instance, some people experience a less severe form of mania, known as hypomania. Those who are hypomanic may not feel anything is wrong, making diagnosis more difficult, he adds.

Complicating matters is that it’s possible to experience both mania and depression at the same time, known as mixed features. When this happens, you may feel overly energized yet be extremely irritated, sad, hopeless, or empty.

Understanding and Managing Bipolar Triggers

Bipolar episodes can be triggered by lifestyle and environmental factors. Recognizing your triggers and avoiding them, Anand says, is often key to managing the condition.

Factors that may worsen bipolar symptoms or trigger an episode include:

1. Stress In many cases, a major life change or stressful event, such as losing a loved one or having financial troubles, can trigger an initial episode. How you cope with stress can also affect how your bipolar disorder progresses. According to a meta-analysis published in January 2017 in the Journal of Affective Disorders, people with bipolar disorder having a relapse of their condition reported experiencing more stressful life events compared with those who were in a more stable mood phase. The researchers concluded that individuals with bipolar disorder tend to be more “sensitive” to stressors, suggesting that psychosocial treatments are an important component of successfully managing your condition. (Psychosocial treatments include psychotherapy, support groups, and education on the disease for loved ones so they can assist with coping strategies and spot the signs of relapse, according to NAMI.)
2. Childbirth The link between childbirth and bipolar disorder has been well documented in a number of scientific studies. A systematic review of nine papers published in October 2016 in the journal BMC Pregnancy and Childbirth found that the risk for mood disorder episodes increases during pregnancy in the postpartum period in women with bipolar disorder. In one of the studies included in the review, researchers found that nearly 50 percent of women with bipolar disorder experienced at least one mood episode during pregnancy or within 12 months after childbirth. It’s also worth noting that both men and women with bipolar disorder may be triggered by childbirth. While there is very limited research examining the effect of a new baby on fathers, a study published in May–June 2017 in American Journal of Lifestyle Medicine found that available evidence suggests fathers with bipolar disorder may have an increased risk of hypomanic episodes after the child is born.
3. Medication Treatment for bipolar disorder includes medications, such as mood stabilizers, antipsychotics, and antidepressants, according to NAMI. Interestingly, some antidepressants, such as Prozac (fluoxetine) and Zoloft (sertraline), may worsen bipolar symptoms and possibly even trigger a manic episode, Anand says, adding that if you have bipolar disorder, you should not take an antidepressant without also taking a mood stabilizer or antipsychoticmedication. Stimulants used to treat attention deficit hyperactivity disorder (ADHD) may also trigger a manic episode. If you have more than one condition (such as obsessive-compulsive disorder or ADHD) that is treated with medication, NAMI recommends that you develop a treatment plan with your doctor to best manage both conditions and monitor your side effects.
4. Seasonal changes For some people with bipolar disorder, there’s a seasonal pattern to mood episodes. Anand says there’s some evidence that more manias occur during the spring and summer months, while more episodes of depression take place in the fall and winter. But some people experience the opposite. According to an Austrian study published in January 2019 in the Journal of Affective Disorders, which examined data on over 60,000 people who were admitted to a hospital for a manic, depressive, or mixed featured episode between 2001 and 2014, seasonal patterns in hospitalization rates during manic episodes were found for both men and women. (Women were more likely to experience manic episodes in summer and autumn, depressive episodes in winter, and mixed features in summer, whereas men were more likely to experience manic episodes in summer. ) Women under age 35 were also more likely to have this seasonal pattern in manic and mixed episodes. There may be a seasonal pattern to your shifts in mood because of changes in sleep, intensity of sunshine, and number of daylight hours, as well as changes in melatonin levels. Closely monitoring your symptoms during seasonal changes can help you manage your bipolar disorder.
5. Poor sleep Lack of sleep is a frequent trigger of bipolar mood episodes, according to Anand. Poor sleep or a disruption in normal sleeping patterns, including jet lag, can trigger these intense mood swings. But there is evidence that psychological treatment may help. In a study published in June 2015 in the Journal of Consulting and Clinical Psychology, researchers treated half of the 58 study participants who had bipolar disorder and insomnia with a bipolar-specific modified form of cognitive behavior therapy that involved incorporating good sleep habits, relaxation, and dim lights at bedtime and reducing anxiety about sleep into daily routines. The other half of the study participants were given information about how sleep, stress, diet, exercise, and mood are related to each other but no plan or intervention designed to change behavior. The results were eye opening: Six months after these interventions, the people who received cognitive behavior therapy had experienced just 3.3 days in a bipolar episode compared with the 25.5 days experienced by those who were given only education materials. The cognitive behavior therapy group also had a lower rate of relapse and less severe insomnia. These results show that it may be beneficial for you to ask your doctor for a plan to ensure you’re getting enough quality sleep if you have bipolar disorder.
6. Drug and alcohol use According to NAMI, substance abuse is common among people with mental illness as a way to cope with their symptoms. In fact, 30 to 50 percent of people with bipolar disorder will develop a substance abuse disorder, notes the Substance Abuse and Mental Health Services Administration (SAMHSA). Anand cautions against using drugs or alcohol to “treat” symptoms of the condition. Drinking or taking drugs, he says, can worsen your bipolar mood swings and lead to an increase in suicidal thoughts or behaviors. As SAMHSA notes, substance use or withdrawal can cause symptoms attributed to bipolar disorder, including agitation, anxiety, and paranoia. Drinking alcohol in particular can make you less likely to respond to treatment and more likely to be hospitalized. Try medication and psychosocial therapy instead.
7. Caffeine Caffeine is a stimulant. As such, it may trigger manic episodes, change sleeping patterns, and affect the way your body breaks down the medications you take to treat your condition, according to a review published in September 2020 in the journal Bipolar Disorders. Talk to your doctor about your caffeine consumption and how it may affect your symptoms.

While these culprits can lead to a bipolar episode, it’s also important to keep in mind that episodes can occur even without a trigger. “Bipolar episodes can come out of the blue,” Anand notes. Do what you can to manage your stress, get good sleep, and avoid using alcohol or any other substance, and work with your doctor to find the best strategies for you to manage your bipolar disorder.

Additional Reporting by Jessica Migala

Bipolar Mood Swings, Stabilizers, Triggers, and Mania

It’s tough to go through the mood swings of bipolar disorder. Depression can make it hard to do the things you want and need to do. During manic periods, you may be reckless and volatile.

The best way to avoid mood swings is to get treatment. You may not be able to totally prevent bouts of mania or depression. Even people who always take their medication and take care of their health can still have mood swings from time to time. That’s why it’s important to catch changes in your mood, energy levels, and sleeping patterns before they turn into something serious.

Mood Swing Triggers in Bipolar Disorder

At first, mood swings may take you by surprise. But over time, you might start to see patterns or signs that you’re entering a period of mania or depression. Aside from a shift in your mood, look for changes in your:

• Sleep patterns
• Energy level
• Alcohol or drug use
• Sex drive
• Self-esteem
• Concentration

Mood episodes in bipolar disorder often happen suddenly, for no particular reason. Sometimes, you may notice that there are specific things that can trigger mania or depression, such as getting too little sleep, changes to your daily routine, or jet lag when you travel. Many people find they’re more likely to become depressed or manic during stressful times at work or during holidays. Some people see seasonal patterns to their mood changes.

One good way to spot your triggers is to keep a journal. Make note of big events, stresses, your medication dose, and the amount of sleep you’re getting. Over time, you might see some patterns.

Of course, there may be triggers that you just can’t avoid, like a serious illness or the death of a loved one. But if you can recognize the things that are likely to bring on mania or depression, you can prepare for times when you might be most vulnerable. Work with a mental health professional to plan what to do when you think a mood swing might happen. Ask for more help from family and friends. Have them check in more often so you get extra support.

If you see the signs of potential trouble, get help. Don’t wait for the mood episode to pass on its own. You might be able to stop a minor change from becoming a serious problem.

The Appeal of Mania in Bipolar Disorder

When people with bipolar disorder are depressed, they almost always know that something is wrong. Nobody likes feeling that way.

But it’s different for people who are manic. Often, they don’t think anything is wrong. Or if they notice a difference in their mood and personality, they think it’s an improvement.

Mania can be seductive. You might feel more energized, creative, and interesting. You might be able to get tons of work done. So what’s the problem?

Manic phases often turn destructive. You might wipe out your savings account on a shopping spree. You might have affairs that ruin your marriage. Most dangerous of all, mania can make you do things that risk your life or the lives of others. And it’s often followed by depression.

Although mania can feel good at the moment, in the long run, you’ll be happier, healthier, more productive, and more successful if you can keep a stable mood.

Bipolar Disorder: Preventing Manic Episodes

Introduction

The more you know about bipolar disorder, the better you will be able to cope with this lifelong illness. There are many steps that you can take—or help a loved one take—to recognize and better manage manic episodes.

• Learn the warning signs of a manic episode, and get early treatment to avoid disruption in your life.
• At the same time each day, record your mood and any symptoms.
• Take medicines as instructed by your doctor to help reduce the number of manic episodes.
• To help prevent a manic episode, avoid triggers such as caffeine, alcohol or drug use, and stress.
• Exercise, eat a balanced diet, get a good night’s sleep, and keep a consistent schedule. This can help reduce minor mood swings that can lead to more severe episodes of mania.
• Have an action plan in place so that if you do have a manic episode, those who support you can follow the plan and keep you safe.

How do I manage a manic episode?

Know the warning signs

Learn to recognize your early warning signs. One of the most important ways to avoid a manic episode is to identify early signs and seek treatment.

Common early warning signs of a manic episode include:

• Needing less sleep.
• Being more active.
• Feeling unusually happy, irritable, or energetic.
• Making unrealistic plans or focusing intensely on a goal.
• Being easily distracted and having racing thoughts.
• Having unrealistic feelings of self-importance.
• Becoming more talkative.

The best way to manage bipolar disorder is to prevent manic episodes. Although that is not always possible, you can identify and try to avoid the triggers that may lead to a mood swing. One of the most important aspects of managing your illness is to stay on a routine, particularly keeping a stable sleep pattern.

Managing a manic episode

• Maintain a stable sleep pattern. Go to bed about the same time each night, and wake up around the same time each morning. Too much or too little sleep or changes in your normal sleep patterns can alter the chemicals in your body. And this can trigger mood changes or make your symptoms worse.
• Stay on a daily routine. Plan your day around a fairly predictable routine. For example, eat meals at regular times, and make exercise or other physical activity a part of your daily schedule. You might also practice meditation or another relaxation technique each night before bed.
• Set realistic goals. Having unrealistic goals can set you up for disappointment and frustration, which can trigger a manic episode. Do the best you can to manage your illness. But expect and be prepared for occasional setbacks.
• Do not use alcohol or illegal drugs. It may be tempting to use alcohol or drugs to help you get through a manic episode. But this can make symptoms worse. Even one drink can interfere with sleep, mood, or medicines used to treat bipolar disorder.
• Get help from family and friends. You may need help from your family or friends during a manic episode, especially if you have trouble telling the difference between what is real and what is not real (psychosis). Having a plan in place before any mood changes occur will help your support network help you make good decisions.
• Reduce stress at home and at work. Try to keep regular hours at work or at school. Doing a good job is important, but avoiding a depressive or manic mood episode is more important. If stress at work, school, or home is a problem, counseling may help improve the situation and decrease stress.
• Keep track of your mood every day. After you know your early warning signs, check your mood daily to see whether you may be heading for a mood swing. Write down your symptoms in a journal. Or record them on a chart or a calendar. When you see a pattern or warning signs of a mood swing, seek treatment.
• Continue treatment. It can be tempting to stop treatment during a manic episode because the symptoms feel good. But it is important to continue treatment as prescribed to avoid taking risks or having unpleasant consequences from a manic episode. If you have concerns about treatment or the side effects of medicines, talk with your doctor. Do not adjust the medicines on your own.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
Patrice Burgess MD – Family Medicine
Kathleen Romito MD – Family Medicine
Christine R. Maldonado PhD – Behavioral Health

Current as of: September 23, 2020

Author:
Healthwise Staff

Medical Review:Patrice Burgess MD – Family Medicine & Kathleen Romito MD – Family Medicine & Christine R. Maldonado PhD – Behavioral Health

Understanding Bipolar Disorder Triggers | The Recovery Village

Bipolar disorder is a mood disorder in which people experience alternating states of “highs” and “lows.” The highs are called manic states (or mania) and the lows are called depressive episodes (or depression). Bipolar disorder is considered by the American Psychological Association to be a sort of bridge between disorders such as depression and schizophrenia.

Manic episodes include a range of symptoms such as high energy or activity, a decreased need for sleep, impulsive decision making, feelings of grandiosity and psychosis. Depressed episodes are characterized by feeling sad or worthless, a lack of interest in activities that one usually enjoys, low energy levels, difficulty sleeping, the inability to do simple things and thinking about suicide or death.

Bipolar disorder occurs on a spectrum. How symptoms are experienced differ from person to person. Some people don’t experience full manic episodes, but go through “hypomanic” periods, which is essentially less-severe mania. Other people “rapid cycle” and experience very quick, intense alternating periods of depression and mania.

While these states can seem to occur randomly and without reason for some people, there are bipolar triggers that can lead to these states. Oftentimes, episodes of mania or depression are triggered by specific events.

What Causes a Bipolar Episode?

Generally speaking, bipolar disorder develops as a result of a combination of genetics and environmental risk factors such as childhood trauma or another period of high stress. While the genetic factors of bipolar are not yet completely understood, it is clear that there are a variety of bipolar episode triggers.

Common Bipolar Triggers

What are common bipolar triggers? Why does a manic or depressive episode start? Some of the most common and problematic bipolar disorder triggers can be separated into groups:

• Sleep Disturbances: Sleep disturbances are warning signs of both mania and depression. In one study, less than three hours of sleep was associated with a change in mood in patients with bipolar disorder.
• Life-Changing Events: There are many life-changing events that can serve as a bipolar trigger. For example, giving birth to a child, getting divorced and even falling in love can trigger bipolar disorder.
• Seasonal Changes: Changes in the seasons have been associated with mood disorders, most notably seasonal affective disorder. Seasonal affective disorder has been proposed by some to be a variation of bipolar disorder. Changes in mood, such as those that occur during a bipolar episode, may be related to seasons due to changes in light, which influence circadian rhythms within the brain and body.
• Stress: Stress is a common bipolar trigger. Stress can be a result of anything from taking a test to going through a breakup or divorce. Stressful life events and general stress are associated with the depressive side of bipolar disorder.
• Trauma: While any trauma (which is essentially severe stress) can trigger a bipolar episode, childhood trauma is associated with severe bipolar clinical symptoms. Rapid cycling, in particular, is strongly linked with sexual abuse.
• Drugs or Alcohol Use: The use of drugs or alcohol can also trigger a bipolar episode, especially a manic episode.

Recognizing Bipolar Triggers and Warning Signs

There are many factors that trigger bipolar episodes. Each person living with bipolar disorder will have their own specific triggers they are more susceptible to and every person will display warning signs differently. Over time, a person will come to recognize their own bipolar triggers and warning signs.

In one study, “staying well” was associated with bipolar patients being mindful of their illness and warning signs. This mindfulness allowed them to develop an individual stay-well plan, including intervention strategies to prevent episodes.

Some warning signs might include:

• Insomnia (sleep disturbances)
• Trouble concentrating
• Impulsive behaviors and decision making
• Feeling sad
• Decreased (or increased) energy

Remember, the warning signs of bipolar disorder will differ based on whether a manic or depressive episode is about to begin.

Managing Bipolar Triggers

Managing bipolar triggers is hard, but it can be done. How to manage bipolar triggers will differ from person to person, but the best way to prevent bipolar episodes is to manage and minimize stress.

Some tips for managing stress include:

• Avoid drugs and alcohol
• Exercise
• Get more sleep
• Try relaxation and mindfulness techniques.

People also manage their bipolar disorder through a combination of medication and therapy. While medications (typically mood stabilizers in the case of bipolar disorder) help many people, they are most effective when combined with therapy.

Some people turn to substances in an attempt to self-manage their bipolar disorder. Such self-management of psychological conditions is dangerous.

Related Topic: Depression triggers

Triggers of mania and depression in young adults with bipolar disorder

Background:

Early intervention significantly decreases the impact of bipolar disorder. However, there is little research investigating triggers that may be unique precipitants of manic/hypomanic episodes, and how these may differ from triggers specific to bipolar depression, in young adults with the disorder.

Methods:

Individuals aged 18 to 30 years who had been diagnosed with bipolar disorder (n=198) completed an online survey to identify triggers unique to mania/hypomania and depression, as well as triggers which were common to both. Respondents rated how frequently a series of situations and behaviours had precipitated either a manic/hypomanic episode or a depressive episode in the past. Survey data was supplemented by in-depth face-to-face interviews (n=11).

Results:

Triggers specifically associated with the onset of manic/hypomanic episodes included falling in love, recreational stimulant use, starting a creative project, late night partying, going on vacation and listening to loud music. Triggers associated with depressive episodes included stressful life events, general stress, fatigue, sleep deprivation, physical injury or illness, menstruation and decreases in physical exercise. A further set of triggers were identified as being common to both manic/hypomanic and depressive episodes. Consistent themes arose from the analysis of face-to-face interviews, which extended and illuminated the findings of the survey data.

Conclusions:

Identification of a unique set of triggers for mania/hypomania and a unique set for depression in young adults with bipolar disorder may allow for earlier identification of episodes, thus increasing opportunities for early intervention.

90,000 What is bipolar disorder

Victoria K.

lives with bipolar disorder

The first signs of the disease appeared in my adolescence, and the psychiatrist diagnosed bipolar disorder at the age of 26.

According to the WHO, 45 million people worldwide have bipolar disorder. This disease greatly reduces the quality of life: in some periods you are overly energetic and do things that you can regret, in other periods you are not able to get off the couch to go about your daily activities.

I will tell you how my bipolar disorder proceeds and what I do to cope with the disorder and live like all ordinary people.

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What is bipolar disorder

Bipolar disorder, or bipolar disorder, is a mental disorder with alternating emotional ups and downs in mood. It is affective precisely because it is associated with disturbances in the emotional state, that is, mood, – in psychiatry, the expression and experience of emotions is called affect. Previously, this disease was called manic-depressive psychosis.

Bipolar Disorders – MSD Physician’s Manual

It is not known exactly why BAD develops.Among the reasons are heredity, traumatic events, disorders in the production of neurotransmitters – substances through which signals are transmitted between neurons in the brain. The disease most often manifests itself during adolescence or between the ages of 20 and 30.

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How does bipolar disorder manifest

Usually, bipolar disorder begins abruptly, then periods without signs of illness and periods of exacerbations alternate.The peculiarity of the disease is that during periods of exacerbations there are episodes, or phases, with different emotional states, which can replace each other in an arbitrary order.

Bipolar Disorder – Mayo Clinic blog article

So, when a disease worsens, the following conditions may occur.

Mania – a state of heightened or irritable mood. A person feels energetic, is actively engaged in something, for example, finds a new hobby or even tries to open a business.As a rule, he sleeps little, is confident, talkative, he has a lot of ideas, often crazy. Sensitivity to risk may decrease – for example, a person invests all their money in a hopeless business or borrows money. Hobbies for gambling and extreme sports are not uncommon. At the same time, a person feels great, but often cannot concentrate on one thing, work productively.

Extreme mania – manic psychosis, when delusions of persecution, hallucinations, excessive activity develop, a person can become dangerous to himself or others.

Hypomania is a kind of mild mania. The person is in a state of emotional uplift, but this upsurge is not so pronounced. However, the mood still improves, the need for sleep decreases, the person is creative, relaxed, feels euphoria, and his productivity increases. Although for some people, such periods may be accompanied by irritability and decreased concentration.

Depression – depressed mood, loss of interest in life, fatigue, guilt, indecision, decreased concentration.Sleep and appetite disturbances may occur. Sometimes there are thoughts of suicide, the uselessness of their own life.

In the intervals between exacerbations, a person can return to a normal state, although it happens that his performance is still reduced.

Manifestations of Bipolar Disorders, as reported by the US National Institute of Mental Health

Mood

Excitement, joy, irritability, touchiness

Dream

Reduced demand for sleep

Appetite

Loss of appetite

Communication

Talkativeness

Concentration

Thought jumping sensation, multitasking

Behavior

Risk appetite, rampant spending, promiscuous sex

Subjective feelings

Self-importance, talent and power

Mood

Sadness, depression, emptiness, anxiety, hopelessness

Dream

Problems falling asleep, getting up early or too much sleep

Appetite

Often increased appetite, weight gain

Communication

Slow speech, forgetfulness

Concentration

Problems with attention and decision-making, distraction

Behavior

Lack of pleasure and interest in something, decreased libido

Subjective feelings

Feeling worthless, suicidal thoughts, suicide attempts

According to the way the disease manifests itself, there are two main types of bipolar disorder:

1. When there has been at least one manic episode and depressive episodes recur.
2. When there are periods of depression and at least one episode of hypomania, but without full-fledged mania.

Bipolar Disorder – US National Institute of Mental Health

I just have type 2 bipolar disorder. This means that there are no full-fledged manias, but there are hypomania and severe depression.

Hypomania is a very cool time for me. You can do anything: get a second degree, run a marathon, learn English, go on an unplanned trip.And so for several months, during which you do not sleep, do not eat, you make new friends, you start novels, you end old relationships. All sensations are felt in the maximum range. During the day, he can quit several times from tears and the desire to die to incredible happiness.

This is exactly what bipolar mania looks like. Source: Twitter

Depression comes after hypomania. And immediately there is not enough strength not only for what was started during the previous phase, but also for ordinary affairs. The most understandable image of depression for me is “crushed by a concrete slab”.It becomes difficult to do the simplest things: wash the dishes, change clothes, go to the store.

Unfortunately, the brighter the hypomania goes, the worse then the depression – that’s why with experience I stopped enjoying the active phase. Now it is even more difficult for me: I understand what is happening to my brain, but I cannot control it.

As I remember now, my first hypomania happened when I was 12 years old. Then there were periods of exacerbation clearly in a year and a half: hypomania lasts 2-3 months, usually May – July, depression – 5-6 months, usually in October – March, in between, remission occurs when I feel normal.If I am in long-term remission, then I hardly notice the phase change: mood swings are smoothed out with the help of medications or psychotherapy.

Bipolar affective disorder usually proceeds as usual

Viktor Lebedev

psychiatrist, science journalist

During an exacerbation of bipolar disorder, episodes of mania or hypomania and depression may alternate. There is a clear division of phases: first, a hypomanic or manic episode, then a depressive episode, it happens that there are repeated episodes of depression, then hypomania.In the latter case, hypomanic phases are sometimes not noticed, a person can be diagnosed with recurrent, that is, recurrent depression, and the wrong treatment can be prescribed.

In fact, with bipolar disorder, the phases can alternate in any order; the diagnosis is made if there is any combination of manic and depressive episodes. The first time the illness usually begins with an episode of mania or hypomania, which escalates into depression. Less commonly, it begins with depression, then mania or hypomania occurs.But in any case, there must be affective disorders, that is, mood disorders.

Exacerbation of the disease lasts from several weeks to several months. This also depends on whether the person is receiving medication. If you react quickly to an exacerbation, sometimes you can return to normal well-being in a week. If left untreated, an exacerbation can last for several months – especially depressive phases, episodes of hypomania and mania usually go away faster.

Seasonality of the phases, when there is a connection between the manifestations of the disease and the change of seasons, occurs, but not all patients with bipolar disorder note it.

How I suspected I had BAR

The first time I thought I was going crazy was when I was 18 years old. The painful relationship ended, obsessive thoughts and images were spinning in my head, I listened to the same song in the player, walked for hours and could not stop. This went on for so long and was so unbearable that I almost decided to go to a psychiatrist. However, mental disorders were not discussed then, so I did not even know where to turn. Then this state passed by itself.

I came to a psychiatrist only seven years later, when I again had a similar grave condition: obsessive thoughts, inability to control emotions, self-harm, sleep and appetite disturbances. Before that, I had three episodes of hypomania every two years, but after them there was no severe depression, which means there was no reason to seek help.

Then I just went to the district polyclinic – it turned out that there was a psychotherapist. She tested my symptoms on the Beck Scale, diagnosed me with anxiety-depressive disorder, and prescribed a common antidepressant, which is often prescribed for depression.

Beck Depression Scale – Online Test

It seemed to me that antidepressants immediately helped me: my mood improved, energy appeared, I talked a lot with friends, hung out, worked. Now I know this is a bad sign. Antidepressants are usually slow to act: the effect appears after about three weeks, and I feel better after a few days. In addition, in bipolar disorder, antidepressants can cause hypomania if not mitigated with other drugs.

This meme is well understood by those who were not immediately diagnosed correctly. If you add Mentos to Coca-Cola, you get a foamy fountain that splashes out of the bottle. Antidepressants, in particular SSRIs – selective serotonin reuptake inhibitors – have the same effect on the mood of people with bipolar disorder

… I drank and smoked a lot, I had incredible emotional swings, I ruined my relationship with my best friend, I stopped eating and sleeping.

After a couple of months my condition stabilized a little, but I continued to drink antidepressants: I knew that they could not be canceled abruptly. Before canceling, I went for a consultation with another doctor, already at a paid clinic. She turned out to be a good specialist: she asked questions about mood swings, found out if I had had any earlier ups and downs of mood, depression. Then everything was fine because of the antidepressants, so I denied everything.

A year later, as the doctor prescribed, I gradually stopped drinking antidepressants, and after a few months I was covered with one of the most severe depressions.If last time I could attribute depression to circumstances – burnout, relationship difficulties, fatigue – now there was no reason for it. I had a favorite job, a great relationship with my husband, financial stability, a new city. I wanted to die.

This moment was a turning point in the diagnosis. I already knew that there is such a disease as bipolar disorder, what its symptoms and characteristics are. Information about BAR appeared in the media field: I read articles and blog posts, watched videos on YouTube.

I was able to describe the last 10 years of my life in phases: there was a strong rise, followed by a decline. For example, in hypomania in 2012, I worked two jobs, handed over state documents, wrote a diploma, hung out with friends until the middle of the night, and was fully engaged in the life of my family. In hypomania in 2014, she entered a magistracy, graduated from a driving school, traveled, and also ran a marathon.

Every climb was followed by a decline: I stopped running, did not pass the exam at the traffic police, and was expelled from the magistracy.Each such exacerbation generally lasts a year and a half, and then repeats itself.

How I was looking for a suitable psychiatrist

After collecting information about bipolar disorder, I decided to find a psychiatrist to confirm or deny the diagnosis. It didn’t work out right away.

First, I went to a psychiatrist on the advice of a friend, he helped her with depression. The doctor took in a paid clinic, the appointment cost about 3000 R. The consultation was unsuccessful: the doctor was clearly not interested in my condition, he indifferently asked questions about depression and prescribed antidepressants.And not the ones that were assigned to me last time, but others. I was too depressed to insist on my own, so I just started looking for another doctor.

The second doctor was in a state clinic, she was recommended to me on Facebook. At first, I waited a long time for an appointment – the doctor was half an hour late, then I started asking about birth injuries and vegetative-vascular dystonia. This consultation did not give me anything either. I paid for it 2000 R.

The third method turned out to be successful: I found a psychiatrist, whom I still go to.She works at the State Institute of Psychiatry, but I see her for a fee. One consultation costs 2500 R.

2500 R

I pay the psychiatrist at one time

The institute where the doctor accepts was advised to me somewhere in the comments on the Internet. I called the registry and asked to see a doctor specializing in mood disorders as soon as possible.

The search for a suitable psychiatrist took about a month, so I got to the doctor’s appointment in a completely crushed state, in tears and hysteria.The psychiatrist asked me about the illness, listened to me and offered free hospitalization. However, I refused: I felt that I was in control of myself so as not to commit suicide, and my husband was also nearby, who understood the seriousness of the situation. As a result, I continued the treatment at home.

When hospitalization is needed for bipolar disorder

Viktor Lebedev

psychiatrist, scientific journalist

Hospitalization for bipolar affective disorder may be necessary if during a manic episode the patient develops severe agitation, he completely loses a critical attitude towards his condition, hallucinations and delusions appear . ..This condition can end badly for the patient himself or his loved ones. In a depressive episode, the indication for hospitalization is suicidal ideation or attempted suicide.

Inpatient treatment may also be needed in case of a strong decrease in performance.

If you suspect you have bipolar disorder, but are not in the acute phase of the disease, and do not need help urgently, it is better to take the time to find a psychiatrist who specializes in bipolar disorder or mood disorders in general.Such a doctor will most likely make the correct diagnosis faster and better select the treatment.

Before taking it, it is worth writing down all the symptoms that bother you, and also, if possible, draw up a retrospective schedule of the alleged phases – mania and depression, write down when they occurred and how long they lasted. This will help the doctor know if it is BAR or something else.

This is how the BAR phase sequence looks like in my case

Treatment of bipolar disorder

Consultation with a psychiatrist and drug therapy

The psychiatrist first wrote me a prescription for several drugs: antidepressants and normotimics are mood stabilizers. They are usually prescribed for people with mood disorders.

As I was told, treatment is also a check on the correctness of the diagnosis, a way to distinguish depression from bipolar disorder. If the prescribed drugs help, the diagnosis is correct. About two months later, my diagnosis was officially confirmed: Bipolar Affective Disorder Type II.

How bipolar disorder is diagnosed

Viktor Lebedev

psychiatrist, science journalist

Bipolar disorder is diagnosed by what problems a person is concerned about.In his story, there should be a description of typical disorders of mood and behavior, usually the alternation of the phases of the disease is traced.

For the diagnosis, complaints and a history of the disease are enough, sometimes even testimonies from relatives who can tell about a person’s behavior are taken into account. It happens that a doctor can send to a clinical psychologist for a psychological examination, but usually a simple psychodiagnostic conversation is sufficient.

You can suspect the disease yourself, although during hypomania or mania, the criticality to your condition often decreases, that is, the person does not understand that something is wrong with him.Sometimes the patient’s relatives come for help, but not himself. It is better to seek diagnostics from a specialist who has worked with bipolar disorder, who knows what the manifestations of the disease look like.

The doctor selects the type of drugs and their dosage, taking into account the phase in which the patient is. Antidepressants are usually used in depressive phases and in combination with normotimics. Antipsychotics – only in manic episodes and also together with normotimics.

In severe cases, a person with bipolar disorder can take up to six different medications.But you need to strive to make do with one or two.

I started taking prescribed antidepressants and normotimics immediately after seeing a psychiatrist. This time, the process of getting out of the depression was long and smooth.

How therapy is selected for bipolar disorder

Viktor Lebedev

psychiatrist, science journalist

The psychiatrist selects treatment individually, taking into account the clinical picture: in the depressive phase – some drugs, in the hypomanic phase – others, in mania – others.

It is important to combine the drugs correctly. Thus, if a patient with bipolar disorder is given only antidepressants, it can worsen the situation, even if he is depressed. Antidepressants can “speed up” his condition into hypomania or even mania. It is necessary to normalize a person’s well-being, and not throw him into a state with the opposite sign, therefore therapy includes normotimics.

The fact is that depression in bipolar disorder is not the same depression as it usually is, they are not always similar even in appearance, there are differences from a biological point of view, that is, in how the processes in the brain change.

I go to my psychiatrist regularly: she adjusts the doses of drugs and monitors my condition. In the first year, I visited her six times – it cost me 15,000 R. Now I go to the doctor only during an exacerbation or a supposed change in phase – about four times a year, once every three to four months. It costs 10,000 RUR per year. In total, I have been seeing a doctor for three years.

Two years until recently, I have been taking antidepressants and normotimics in the minimum dosage.A pack of antidepressants for a month cost about 400 R, normotimics – 600 R. That is, during the period of remission, tablets took 1000 R a month.

1000 R

I spend on pills per month during remission

My prescriptions for drugs

However, a few months ago I had an exacerbation, I went into hypomania, so the regimen and dose of drugs had to be changed on the go. Within two weeks, my psychiatrist and I canceled antidepressants, significantly increased the dose of normotimics – 2.5 times, and added antipsychotics.During an exacerbation, which lasted two months, 4000 R per month were spent on pills. Now it will go to 2000 R – the dose of normotimics has been reduced by one and a half times and antipsychotics by half, antidepressants have been removed.

It is interesting to observe how quickly drug therapy changes the state of the body and how then it comes back to normal. Often drugs are not suitable the first time, so you need to regularly visit a psychiatrist and monitor your health. But after choosing the right therapy, you can live almost as before, except that you need to be more attentive to yourself.

Treatment for bipolar disorder cannot be matched once and for all

Every patient who is responsibly approaching the treatment of bipolar disorder and who is in contact with a doctor has his own scheme for changing the dosage or types of medications, taking into account their well-being. For example, you cannot sleep for more than a few days and you stop eating – you add an antipsychotic. You fall into the abyss of self-loathing and do not swim for more than a week – an antidepressant will help.

Of course, this does not negate regular meetings with a psychiatrist, because the process of choosing drugs and dosages is very complicated.Now I can regulate a lot myself, depending on my self-awareness, but I still see a specialist.

In this case, bipolar disorder cannot be cured once and for all – you can only enter into prolonged remission. As my doctor told me, this is five years without pronounced phases. In my case, I lasted two years without episodes, and now I need to start counting again.

Also, as far as I know from my own experience and the experience of people with the same diagnosis, at some point there comes an illusion that everything is cool, there is no illness, it seemed to you that you were doing an excellent job.At this point, people stop taking pills – this is a bad decision, never do that. If you feel good, first, you should check if this is the beginning of hypomania. And secondly, be glad that you are in remission.

During these three years I once stopped taking pills – depression happened, once I did not pay attention to the symptoms – I got severe hypomania, and now I am again trying to go into remission.

Treatment of bipolar disorder

Psychotherapy

For example, I have trouble admitting my own mistakes.Every mistake for me is a tragedy, and it seems to me that those around her will never forget. It is difficult for me to admit my own mistakes, mistakes cause great anxiety. I also have an ideal image of what I should be: reading a lot, making money, keeping my house perfectly clean, having blocks on the press, studying, knowing two foreign languages, going to exhibitions. Obviously, this is impossible, but the persistent desire to reach unattainable heights is also stressful. I am working on all this with a psychotherapist.

I started therapy only six months ago, on the advice of a doctor, before that I thought that I could cope on my own. First I was in therapy with a psychotherapist, which I found through the “Breathe” project, which helps burned-out employees from the charitable sphere. I worked with her on this project, then continued after completion.

We have dealt with situations that increase my anxiety, including fear of mistakes and judgments, as well as difficulties in life in general. The cost within the project was 400 RUR per meeting, about ten of them passed, then, already outside the framework of the project, the price increased to 2400 R.

Now I went to another psychotherapist – she has a more applied approach, we look for my cognitive distortions and try to remove them. For example, we work with my excessive anxiety about the impression I make on other people and the fear that I cannot control it.

The cost of sessions with this specialist is 2500 RUR per visit. Now I go to her every 10-14 days, that is, 2-3 times a month. In general, I have been working with my condition on my own for a long time, so the therapist only directs me in the right direction.

Is psychotherapy mandatory for bipolar disorder

Viktor Lebedev

psychiatrist, science journalist

Cognitive behavioral therapy is most often prescribed for bipolar disorder. This is an optional therapy, that is, an auxiliary method of treatment, you just need to take medications. However, psychotherapy can greatly improve the quality of life: it complements the action of drugs well, helps to control and change those things that the pills do not work on. First of all, cognitive-behavioral therapy helps to control emotions, to better cope with their illness.

Many people are also helped by support groups for people with bipolar disorder. I tried to go to such a meeting, but it didn’t fit me: I don’t want to define myself through illness, this is a part of my life – but not me.

The largest project holding such meetings is “Sunday BAR”. They support not only people with bipolar disorder, but also their loved ones. The meetings are held online and offline.

List of support groups in different cities for people with bipolar disorder and other disorders PDF, 275 KB

Treatment of bipolar disorder

Lifestyle

The universal advice given for bipolar disorder and not only includes the following recommendations: observe a sleep schedule and a balance of work and rest, eat right, do not drink alcohol, play sports.

All this really helps, but in reality it is difficult to organize your life: meetings with friends, vacations, unexpected work do not fit into the regime, you want to work more, and alcohol looks like an excellent way to cope with anxiety, although in fact it can lead to depression.

I try to follow the correct regimen as far as I can. True, it seems that depression comes naturally to me, without any triggers from the outside, and I cannot influence it.But hypomania is fueled by new projects, falling in love, and other emotions. For example, even a little falling in love causes hypomania, which, in turn, intensifies falling in love. It doesn’t end well.

I lived in St. Petersburg for quite a long time, there, during the white nights, I do not want to sleep at all – and this provokes hypomania. One of the psychiatrists even forbade me to go to St. Petersburg for a while.

Now I have a well-established regime of sleep and food, I quickly notice its violation – this is a signal that an exacerbation has begun. Unfortunately, sometimes the regime is confused by external circumstances, then the aggravation of BAR is more difficult to notice.

Sleep is very important to me – this is my priority. I try not to hang out until the middle of the night, and if I can’t get enough sleep, then I try to sleep during the day. Usually I go to bed around midnight, I get up at 8-9 o’clock in the morning – this is a comfortable regime for me and my work. Very rarely I do not sleep at night or get up later than 10 in the morning.

I have a fitness bracelet that tracks the phases and amount of sleep – it helps to see the dynamics and notice deviations.When I see sleep disturbance, I start drinking mild tranquilizers and antipsychotics to get me back into a comfortable regime.

Sleep less than seven hours on pills indicates an episode of hypomania, without drugs in this phase I would sleep less than four hours And sleep more than seven hours – already normalization of the state after adding other pills

Food is more and more difficult: I have a difficult relationship with my own body, so I take a decrease in appetite with enthusiasm. I am working on the problem with a psychotherapist, how to solve it, until I figured it out.My psychiatrist believes that sleep first, and then everything else, and my experience confirms this: sleep disturbances have a stronger effect on well-being. I also keep track of my alcohol consumption in the Alcogram app – abuse negatively affects my condition. When I see how many sober days there have been, it motivates me to control myself.

I am lucky that I take my work seriously: it is responsible and resource-intensive, it is important for me to be productive, it disciplines and helps to comply with the regime.

What to do to reduce the frequency of exacerbations

Viktor Lebedev

psychiatrist, science journalist

With bipolar disorder, a daily routine is important, which allows you to maintain normal behavior. This reduces the frequency of exacerbations, sometimes helps to completely avoid the recurrence of episodes of the disease. In addition to quality sleep and proper nutrition, you need to avoid overwork, work in an exhausted state, and give yourself some rest. Doctors usually insist on the elimination of alcohol, drugs are also dangerous, especially stimulants, which can cause psychosis in a healthy person.

Exacerbations of the disease can occur on their own, without the influence of external factors, and can be caused by external events, both tragic, such as the death of a loved one or the breakdown of relationships, and joyful. Therefore, it is important to learn to recognize your emotions, to identify in time what provokes a new episode, both independently and with the help of psychotherapy.

How I live with BAR now

Acceptance of the diagnosis was not easy: on the one hand, it finally became clear what was happening to me and that it could be regulated.On the other hand, it is a lifelong diagnosis. You need to constantly monitor your condition, take pills, consult with doctors.

The most difficult thing for me was the inability to separate myself as a person from the disease. Which of the things I have done in my life was the result of my choice, and which is a symptom of the disease? Moving from city to city, changing jobs, partners, hobbies – what if all this is just a disease, and I’m not behind it? Three years have passed – and I still cannot separate myself from the BAR, it seems impossible.

Now life has become easier: now I know what to expect in the near future, because the phase schedule is still being followed. It is clear when to slow down with the pace of life, and when to add antidepressants.

My work is connected with people. Of course, illness affects my mood and state: in depression I have less strength and ability to give emotions, in hypomania, on the contrary, there are a lot of emotions, but concentration is not enough. It’s good that work allows you to vary the load depending on the phase: in depression I can work a little less, and in hypomania – a little more.

At the time of my first diagnosed depression, I had an unloved job, it took up the whole resource. I cried in the morning, afternoon and evening, because it was difficult for me to keep working. Now I really love my job, it gives me more resources than it takes.

I continue to take my medications, see a psychiatrist several times a year and a psychotherapist several times a month. In March, at the most difficult moment of exacerbation, I spent 13,000 rubles on medications, an appointment with a psychiatrist and three meetings with a psychologist.

13,000 R

I spent on treatment at the time of exacerbation of the disease

At the moment, I am again going into remission and spend about 8,000-10,000 R per month on medications, a psychologist and periodic appointments with a psychiatrist. A significant amount, but it allows me to remain in a resourceful and efficient state.

A subtle difficulty in living with bipolar disorder is the need to be in strict control of your financial situation. In hypomania, money flies away easily, decisions are made instantly – for example, you can decide in a minute to fly to Spain and buy tickets.In depression, you spend less, but you also manage to earn money with difficulty. I try to keep a financial cushion in case of an exacerbation, and also take into account all expenses in the application so as not to get into debt. Fortunately, so far my financial anxiety is stronger than my bipolar, so I never got into credit card debt.

For the year I spent on BAR treatment – 58 800 R

Reception of a psychiatrist

10,000 R, in total 4 receptions of 2500 R

Reception of a psychotherapist

25,000 R, in total 10 receptions of 2500 R

Antidepressants

4800 R, 12 packs of 400 R

Neuroleptics

7000 R, 7 packs of 1000 R

Normotimics

12,000 R, 15 packs of 800 R

Have you also had an illness that affected your lifestyle or attitude? Share your story.

90,000 Recognition of Bipolar Trigger Disorders – WellOnward Russia

April 20, 2010

Living with bipolar disorder

can feel like riding a drag. Extreme ups and downs of the disease can disrupt the life of the patient and those around them. To make the disease more manageable, it is important for the patient and caregiver to know what can trigger episodes of mania and depression.

When one family member has

bipolar disorder

It is as if the whole family has a disease.Primary carers may need to help with medications, talk to doctors, and keep a predictable, low-stress household. It is also important for the groom to pick up on the sometimes subtle signs that their loved one is slipping into mania or depression.

Bipolar Disorder: Mania and Depression

Bipolar

disorder also known as

manic depression

is a serious mental illness that causes noted shifts in mood, energy and active levels, according to the National Institute of Mental Health. Extreme “high” is called mania. People in the manic phase are usually full of energy, overly agitated, and even irritable or jumpy. During an episode of Mania, the patient may feel invincible, take risks, engage in impulsive sex, go to great expense, or even have hallucinations. Worse, a bipolar person may not recognize that they are maniacs because they feel so good.

At the other end of the spectrum is depression, which can spiral into conversation, or even attempt, suicide.I always take seriously talking about suicide. If your loved one threatens to kill himself, call medical assistance or 911 immediately.

Although bipolar disorder is a lifelong illness, it is controlled. Usually patients are treated with salt

medication

, psychotherapy and lifestyle management. Many people go months or even years between mood episodes and report that they feel good at the time.

Bipolar Disorder: Trigger Tracking

Life events, anxiety, and even physical changes can trigger mood swings. What triggers an episode of mania or depression vary from person to person. Here are some typical physical triggers, according to the National Alliance for Mental Illness (Nami).

• Don’t get enough sleep
• Alcohol or drug use
• Stopping your medication
• Start
  
  Antidepressant medication
  
  (This can cause a switch to mania)
• 
  Hypothyroidism
  
  (
  
  Low thyroid gland
  
  function, possible side effect of
  
  lithium
  
  medicines commonly used for
  
  treat bipolar
  
  disease)

Emotional stress and big or small life changes can also cause mania or depression.The Depression and Bipolar Support Alliance provides the following examples:

• Main life changes, how to move or start a new job
• Argue with a friend or loved one
• Financial difficulties

Louisa Sylvia, PhD, a psychologist at the bipolar clinic and research program at Massachusetts General Hospital in Boston says:

mood swings

”

Sylvia explains that bipolar disorder interferes with the body’s circadian rhythm, 24-hour rhythms such as the sleep cycle. As a result, bipolar patients may have unregulated daily routines such as food and bed times. For example, they may wake up in the middle of the night or sleep late. They may not eat anything until noon. So, Sylvia says, it is imperative for the bipolar person and the rest of the family to maintain a normal routine to avoid mania or depression.

Since regular sleep is vital to keep bipolar episodes in check, watch your sleep patterns.Sleep changes and disturbances are often the first indicator of illness, according to the NAMI. Sleep is usually disturbed very early in an episode of mania or depression. If the mood swing is caught early, there is a better chance that it can be stabilized, perhaps by adjusting medications.

Bipolar Disorder: A Chart of Your Mood

Mood charts provide a visual reduction in changes in mood over the course of a month. Every day, the patient gummies the medication, the mood level and significant life events. Patient, family and doctors can see the outgoing patterns and are more accurate more accurate. Sylvia says customized charts are “a great resource for patients to monitor and are more aware of moods.”

90,000 Autumn aggravation. How people with bipolar disorder live

Focus talked to four people diagnosed with bipolar disorder and found out why all psychiatric hospitals are similar, happiness can be a symptom of an illness, and 15 extra pounds is not a reason for sadness

What is .A 60-year-old woman in a short skirt, with red cheeks from blush, an artificial flower in her hair, an eternal smile and a constant desire to buy everything in clothing stores, even if it means borrowing money. This or almost so, according to psychiatrist Gennady Zilberblat, a person in a state of hypomania, one of the poles of bipolar affective disorder (BAD), may look like.

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And such a person is also able to work 12 hours a day, sleep three hours a day, go to theaters and exhibitions, play sports and shower with ideas. Thinking that this is happiness, and then finding out that in fact it is a symptom of the disease. Hypomania is replaced by despair and hopelessness, unwillingness to get out of bed in the morning and live.

According to the World Health Organization, 60 million people worldwide suffer from BD.

Opinion of a psychiatrist .Psychiatrist, General Director of the Kiev Regional Psychiatric and Narcological Medical Association Gennady Zilberblat:

– In a person with bipolar disorder, depressive and manic phases alternate. In the manic stage, the patient is hyperactive, he has increased efficiency, quick speech, lively facial expressions and a bright appearance. In depression, a person wakes up in the morning, and he does not like the outside world. The sun is shining, but the person does not notice it, he goes to work and thinks that others are unhappy with something.At work, everything is annoying, and he does not have time to do what he usually did, he quickly gets tired. In the worst case of depression, the patient may commit suicide.

In autumn, bipolar people often fall into depression, in spring – into mania. But the degree of both conditions can be different. It happens that a person is slightly animated and approaches hypomania. Pushkin, for example, wrote “Eugene Onegin” and many other works during the autumn of Boldin. Yes, he suffered from emotional fluctuations, but he did not attempt suicide.But Yesenin did. In the fall, he wrote dark poetry, alcoholism manifested itself.

When you work hard and succeed in everything, this is not yet mania, this is happiness. Mania – when your activity interferes with the lives of others. You start to annoy them, offer a lot of ideas, including ridiculous ones, ask a lot of questions.

So it is with depression. A person who is trying to commit suicide in front of the audience or, knowing that they will appear, is simply looking for benefits and wants others to meet him halfway and fulfill his desires.Here we can talk about false depression of a person suffering from psychopathy or hysteria. In depression with bipolar disorder, the patient is immersed in himself, sits quietly, does not sleep until morning, and in the morning feels desperate. It is at this time that suicide attempts are usually made.

Evgeniy Mori, 24 years old, writer

-I don’t remember my childhood at all, but I know that I didn’t speak until I was six. And then the stress happened.A closet fell on me, and after that I began to speak. At first it was very difficult, I stuttered and lisped, it was difficult for me to understand. Speech defects did not go away, and it became clear that something was wrong with me.

Most of my school time was homeschooling. He rarely came to school, mostly only for tests, dictations and exams.

I had bouts of uncontrolled aggression. I didn’t remember anything after such outbursts, but I could wake up in a pile of broken glass or next to a broken door.The children shouted: “Crazy! Crazy! Crazy!” This was my nickname during my school years.

They treated me quite rarely and little. My mother tried to pretend that nothing was happening, that I was absolutely healthy. Nevertheless, I remember that when I was seven years old and they brought me to the doctor, he put a leather helmet on my head and used shocks to check my brain activity. Then he made a diagnosis. First “Asperger’s syndrome”, then “bipolar disorder” and prescribed gidazepam. In my opinion, this is not a treatment, but an attempt to drown out the symptoms.You are absolutely calm on gidazepam, but besides the fact that this drug is bad for the liver, it also makes you an emotional vegetable and is highly addictive.

As a child, I communicated only with the son of my mother’s friend. I was not particularly worried about social limitation and loneliness, because there was nothing to compare with. Alone with myself both then and now I am absolutely comfortable and well. But I want me to be calm when surrounded by people, and not just alone with myself.

When I graduated from school and entered the university, I decided to establish communication with people.To do this, I went to meetings on the interests of people who, like me, were fond of music and cinema. I was lucky because at that time there was a flourishing of subcultures in the country and they did not pay attention to deviations in behavior. Everyone was weird, and that helped me.

“I don’t remember being happy. I rarely feel something strong and express emotions. I am rather unemotional.”

All this time, there was a fear in me of being in a painful state, of becoming an outcast, sitting at home and collecting books and rubbish. I didn’t want to live like this. I wanted to achieve something and therefore constantly forced myself to leave my comfort zone and do something.

My condition worsened at the age of 19. Then my father died, and I began to blame myself for his death – that I did not dissuade me from quitting smoking, I could not say that I loved him. In our family, this was generally not accepted. I started drinking and smoking, drank every day, and a lot.

After university he began to travel to different countries, performing on stage with poetry and music. Speaking is excruciating for all people who don’t like to be the center of attention, and for people with mental illness it is doubly difficult.Each appearance on the stage was an attempt to step over oneself, and this gave results. Now I can hardly be distinguished from a normal person. True, some oddities remained. It’s hard for me to hug someone. If I walk with someone next to, I need to be on the left of him. I do not speak on the phone or skype. Such oddities are still there, but I do not understand why they appeared.

The final concert of my last tour took place in Odessa. After the performance, my company and I walked around the city, and at some point I felt devastated.I went to the beach, sat there, and then went into the sea. I was dimly aware of what I was doing. I came to my senses only when the water came up to my nose. Then I turned around and walked back. I was very scared, because another minute – and I would no longer be able to control the situation. I did not tell my friends about this, they thought that I just went swimming.

The last time I was with a psychiatrist was 14 years old. Since then I have not gone, because it is a shame and is not accepted. Rather, I would like to go, but I’m not ready for it yet.

I still have outbursts of aggression now, but much less often than before.I quickly light up and subside. I can hit myself, a wall or a door. I have already come to terms with this and I see that compared to what it was at the age of 15, the difference is huge. I think that over time it will go away if I continue to work on myself.

I’m very afraid to shut up again. If I am experiencing severe stress, then I either lose my ability to speak, or start to stutter and lisp heavily. I’m afraid not to cope with emotions, I’m afraid that I will not be able to stop, as I could the last time I entered the water.

I want to make contact with people, but it’s almost impossible for me to take the first step when meeting someone.I feel very petty and unworthy to disturb people. True, sometimes, being in a state of hypermania, when I feel like the king of the world, I can write to ten people and make an appointment. Then the state passes, but meetings are already inevitable.

I am often satisfied, I can be in a good mood. But I don’t remember being happy. Rarely do I feel something strong and express emotions. I’m pretty unemotional.

Alisa Chernikova, 38 years old, philologist

-About ten years ago, I began to understand that I was very different from other people in my mental structure. I realized that I have very bad periods when there is an internal jihad, I blame myself for everything and I feel very bad with myself. I thought it was the result of childhood trauma and learned to live with it. But when the doctor said last year that I had bipolar disorder, I was not at all surprised. That explained everything. I even felt relieved. After all, until you know what your problem is, nothing changes. I recognized its name and understood that there is psychotherapy, medications and the condition can be improved.

My first depression happened when I was 14 years old. It lasted until about 20, but I learned that it was depression after the fact. It was a difficult time, I tried to commit suicide three times.

Due to depression, I studied three times in my freshman year. Either I didn’t go to the university, or I rarely went, didn’t understand anything and just took the documents before the session. Relatives believed that this was a teenage whim, you need to pull yourself together and start learning.

Subsequently, there were also periods when the bad mood lasted for a long time and the working capacity fell.Moving was my way of dealing with depression in the past. I have moved seven times. Before the 2008 crisis, she lived for some time in St. Petersburg and worked in a book publishing house. Then I had a period of recovery, and I was making a career. She worked 12 hours a day, but she still had the strength to hang out and go to parties. For a year and a half, I became the second from the last person in the department. But then I got depressed and started working half-heartedly. Once a week I realized that I could not come to the office, called and said that I was sick.Then I was laid off. There are good periods, but there are fewer of them than depressions.

I changed a few more cities, went to work as a freelance and now I live in Dnipro. Moving requires the mobilization of all internal forces, and this pulls out of depression. The first time in the new city you feel good, you have euphoria, and it seems that you are finally doing what you need to do. But then apathy sets in again. Moving after all, in fact, does not change anything. A friend of mine with bipolar disorder is not being treated and is collecting money to travel to Thailand for a year.She thinks it will cure her. But it won’t help a damn thing.

My worst depression happened in 2016. I had just moved to Dnipro and after seven years of freelancing I went to work in an office. It was a completely different schedule, different people and a new job for me. Very stressful, and I could not cope with it.

“The day before going to the doctor, I woke up and, while I was having breakfast, I broke the teapot. I started crying. I got ready and cried, came to work and cried.I cried all day and stopped only in the evening when I returned home “

I didn’t want anything, nothing pleased me, I could hardly leave the house. The day before going to the doctor, I woke up and broke the teapot while I was having breakfast. I started to cry. I got ready and cried, came to work and cried. I cried all day and stopped only in the evening when I returned home. At work, I did not communicate closely with anyone, and people pretended that everything was fine, they did not seem to notice that I was crying.I was not hurt by their reaction. In depression, it seems that no one needs you and everything is in vain. The indifference of others fit quite well into this picture.

When I am depressed, I rarely leave the house. Only if you really need to. For example, psychotherapy. I wake up and, if I can, work. When I can’t, I read, I watch movies. Appetite becomes weak, you sleep either a lot or very little. At these moments I think that life has failed, I am a nonentity, everything is terrible, I do not have this and that, everyone around is so successful, but something is wrong with me.It seems like it will last forever and I don’t remember when I felt good. Now I already realize that during depression these are not my thoughts, but the thoughts of the illness. But I didn’t understand this before.

I have been taking medications for a year now, so I don’t have such drastic changes from rising to depression and back. If my mood begins to fluctuate in plus or minus, the doctor simply adjusts the medication for me. How do I feel now? Fine.

The best thing that I have learned over time is not to demand anything from myself.If you don’t have the strength, then you don’t have to do anything and try to overcome yourself. It still won’t work. I try not to delay the work and plan it so that there is a time gap. For the most part, I succeed.

Communication with loved ones and psychotherapy helps. In fact, this is also frank communication. Here in Dnipro, I created a support group for people with bipolar disorder. We can talk about everything, and that also helps.

I was lucky because all my close people accept me.When it’s hard for me, just their presence is very much. The main thing is to be near and not to offer any solutions. It’s bad when they start to say: maybe you will try this or that, maybe you will do exercises in the morning? What kind of exercise when you don’t have the strength to get out of bed?

I had no bias against drug treatment. When you feel so bad that you wake up every morning and think how to kill yourself, everything else is not scary. It would seem that depression is not some real thing, unlike losing a job or breaking up a relationship.But this is the worst thing that has happened to me in my life.

Psychotropic drugs have side effects. Last winter I gained 15 kg. But it is better to be plump and without depression than to be slim and depressed. Fortunately, I have no problems accepting my body, it’s just not the same as before. The wardrobe had to be changed, but you can live with it.

When someone commits suicide, people sometimes say that they have not thought about their family and other people. Personally, in this state, I had thoughts that no one needed me and people who are close to me actually communicate with me out of pity.You don’t feel that your loved ones really love you.

What I considered to be happiness for a long time turned out to be periods caused by illness, hypomania. Now, when I feel happiness, I need to understand whether it really is. I read books on neuroscience to understand how our brains work and what is wrong with bipolar people. But medicine does not really know the answer to this question. There is an assumption that this is a genetic predisposition, according to another theory, psychological triggers contribute to the development of the disease.I have my own intuitive guess. I think my illness came from a traumatic childhood. But I don’t know for sure.

During good times, I’m even glad that I have bipolar disorder. At this time, I understand that the world is beautiful, everything is interconnected and delightful, I can do anything. But when such a period passes, I think that it would be better to live without ups. They always end in depression, because the psyche is overloaded, tired and a rollback sets in.

Irina Vasilenko, 33 years old, PR consultant

-Bipolar disorder starts differently from person to person. Some with an episode of mania, others with depression. I started with a depressive episode two years ago in the spring.

Outwardly it looked like I was unhappy with my job. Then I worked in a PR agency and ran financial companies, but I wanted to write on social and cultural topics. At that time, my professional career was ten years old, but nothing had changed in it. I thought that was the reason.

At some point I became very scared, I stopped sleeping.Didn’t sleep for a week or two, and tremors began. You cannot sit and stand, you are constantly walking. Thoughts appeared that I was nobody, it seemed to me that I was dying. If I managed to fall asleep for an hour and a half, I had nightmares.

I stopped communicating with friends, and I started to panic before calling and talking with clients. Didn’t answer non-working calls and messages. I usually read a lot, but I didn’t feel like doing it anymore. In my free time, I just sat and stuck into an empty computer monitor.

It so happened that in May only me and my boss Marina remained at work. I had to organize an event for more than 100 people. Marina saw that it was hard for me and began to help. But one day she left, and I sat and filled out an Excel spreadsheet with a list of participants in the event. And then the thought rolled over that I was not even capable of filling out the table. Then, after the event, Marina came up to me and said: “Irusya, everything went so well. Thank you.” And I burst into tears.She asked why I was crying, and I replied: “Because I failed everything.”

Then I already understood that something was wrong with me, and told my psychoanalyst friend about it. She offered to go to a psychiatrist in Pavlovka. When we arrived at the hospital, the psychiatrist said that I urgently needed to go to the hospital.

In the hospital they take scissors, blades, handles and everything that can kill oneself with you. There are two departments – a woman’s and a man’s, with nine wards in each. The ninth chamber is called “observation chamber”.Those who have just entered the hospital are settled there. There you will see straitjackets and how demons are really chasing people.

“Mania is an interesting period. You feel very cool and you are in constant euphoria. It’s an awesome feeling, and I still sometimes remember it with nostalgia.”

Next to my bed was Christina’s girlfriend’s bed. They immediately put on a straitjacket and tied her with leather straps to the railing. She screamed that she was Jesus Christ, that she came down to earth to save us.When she didn’t scream, she made strange sounds, and then she started screaming again. There was also a grandmother whose husband had died a long time ago, but she still communicated with him. And then there was a young, benevolent woman who considered herself a healer. When antidepressants were taken, she became completely adequate. There was a girl-architect, all in tattoos, very beautiful. She walked around, constantly laughed and said that she had an affair with the head physician.

Nurses are a separate type of people. They are all the same, so it was difficult for me to remember their names.All are plump, loud, rude. Once we come to the toilet, and they stand there and smoke. One of the other says: “Why aren’t you finishing your cigarette? Don’t you know that if you don’t smoke, you will be bad?”

At first I had a panic. I saw the bars on the windows and the fact that there were no handles on the doors, and it began to seem to me that I was here forever. I ran up to the nurses and said: “Let me out! I don’t belong here!” And they started laughing and said: “You all don’t belong here! You all say that!”

On average, people stay in the hospital for three weeks. I was in bed for a month and a half because they could not find the drugs for me. I went either into mania or depression.

When I left the hospital, I returned to the same unloved job, that is, to a traumatic situation. I went there like a zombie for another ten months.

All this time the days were the same. I woke up, barely forced myself to go to the shower, put on the same as yesterday and the day before yesterday, went to work and worked there half-heartedly.In the evening I came home, had dinner and watched the series. I gained 10 kg from antidepressants, but that was the last thing I worried about. The pills did not affect my mood in any way, but they restored sleep and appetite.

I quit on March 30, 2016, and on April 1 I felt better. I realized that I was getting out of depression. I stopped drinking antidepressants. It was a mistake, in June the mania began.

Mania – an interesting period. You feel very cool and you are in constant euphoria.It’s an awesome feeling, and I still sometimes remember it with nostalgia. But there are a lot of disadvantages, and I entered the second episode of depression when I began to understand what I had done in mania.

Normally, I write three to four posts on Facebook a week, and in mania, five or six posts a day. Turks and Arabs began to add to me as friends, I corresponded with them. Nothing bothered me, and there was enough energy for everyone.

Then I started telling people that I earn 50 thousand a month.At that time, I did not work at all and took money from my parents. Without money, I wanted to rent an apartment in the center of Kiev. Once I came to a hardware store and asked them to calculate how much an iPhone, iPad and MacBook would cost. They told me: 45 thousand, and I asked to postpone them until tomorrow.

“Next to my bed was Christina’s girl’s bed. They put on a straitjacket and tied her with leather straps to the railing. She shouted that she was Jesus Christ.”

During the mania, I made many friends and boyfriends.They didn’t think there was anything wrong with me. They thought that I was super interesting, active, and such a person is just worth being. When I later became normal, some wrote to me on Facebook: “Ira, what happened to you? You were so interesting, and now it seems that you are constantly on sedatives. ”

My parents noticed that something was wrong with me, but I denied everything. I told them that I would go to the Carpathians to see a friend. I went there through Lvov, and during the night I made three friends on the train. Then I went to the platform, and there are my father, brother and his friend, a powerlifter.They grabbed me and carried me into my father’s car. I squeaked, screeched and tried to escape. They took me to the hospital in Lutsk, and all the way I screamed that after what they did to me, I am now an orphan. It was like a thriller scene.

I was in the hospital for three weeks, and there I was forced to take pills. Gradually, I became myself, but it began to seem to me that after the nonsense that I wrote on Facebook, no one would take me seriously and would not hire me. I got depressed.

It lasted three or four months, and then the director of a PR agency wrote to me and offered to cooperate. After some time, the former boss Marina turned to the same proposal. Now I am an independent PR consultant. I am engaged only in projects that are interesting for myself – social, cultural, lifestyle.

At the beginning of 2017, I started going to psychotherapy and continue to this day. My therapist and I got to the bottom of the true cause of my disorder, and it’s childhood trauma.

There was nothing terrible in my childhood. It’s just that sometimes parents said: today you are a good girl, because you got an A, and tomorrow you are bad, because you won not first, but third place in the English Olympiad. Dad always repeated that I should become the president of Ukraine and that if I work somewhere, then only at the UN. There is nothing wrong with that, but I drew the wrong conclusions from this.

I’m not afraid that the mania or depression will return. Now I know the real reason and I am working with a psychologist.My calmness is confirmed by dreams. When I got out of depression for the first time, everything seemed to be fine, but I constantly dreamed that I was back in a psychiatric hospital. Now I have good dreams.

The other day my brother called me and said that his friend’s wife had committed suicide due to postpartum depression. When I hear such stories, I understand that I cannot be silent about my own. Life is very long, and even successful people are not immune to depression. But a person in this state cannot say: “Get it together, rag” or “Go to work” or “Go for a walk in the park.”You just have to be there.

When I was depressed and did not answer calls, my closest friend sometimes wrote to me on Viber: “Ira, I miss you very much. Please come back.” I didn’t answer her, but it made me feel better.

The most interesting thing is that some of the things I talked about in mania are now being realized. I work for myself, I have a trusting and strong relationship. I’m finally happy.

Dmitry, 55 years old, theater expert

-In 1996, I was in a love relationship. I was already over 30 then, I received a personal scholarship at the institute where I studied, I was regularly published in various publications: quite a successful adult. But for some reason, how this completely trivial romance ended, I was knocked down.

Attacks of an extremely depressed state and hopelessness began, there were severe pains in the solar plexus area. At the peak moments of these states I thought that nothing good awaited me, that my whole life was a continuous ruin, that I had no strength and prospects.

In a maximum of half an hour, this was replaced by an attack of absolute euphoria. It seemed to me that all the bad was behind, and only shining peaks and bright paths were ahead. There were 20-30 such mood swings a day. Towards evening, everything calmed down a bit, and I slept more or less normally. But he often woke up in the middle of the night with a sticky sensation of terror.

In this grueling regime, it lasted about four months. Then I got a high-temperature flu, with which I lay for almost a week. After the flu, the depression subsided somewhat. But then there were days of oppressed anxious mood, alternating with irritation. Sometimes it passed in a few days, and then a wave of hopelessness and melancholy rolled over again.

At the same time, I became more and more socially successful. My career was developing, I made good money, began to travel around the world, bought an apartment. But external factors did not in any way affect the improvement of my condition. When I first went abroad, half of the trip I walked with a gloomy face and only in recent days I felt a euphoric rise, which is also a symptom of my disorder.I returned home, and again the bouts of melancholy began.

I went to two psychologists, but they didn’t help me in any way. One tried to conduct group meditation sessions, which were like a dead poultice, the second – a rude and not very competent lady – prescribed some semi-narcotic drugs, which also did not help.

“Until 1996, everything happened in life, but my inner core remained unaffected, there was no betrayal in my fortress”

Attended psychological role training.For a while, it leveled my mood, but the attacks returned pretty quickly. In the end, I decided that going to the doctors was a waste of time. Maybe my Soviet upbringing also worked here. Previously, it was believed that if you go to a psychiatrist for help, then who are you? Jerk. The Soviet Union was long gone, but it was still in the heads, including mine.

Even when I was depressed, I remained an active person. I got out of bed, had breakfast, wrote texts, went to work, to premieres and presentations, went on business trips, and met people.But from within me, fear, depression and melancholy eaten away. Even in the circle of my closest friends who loved me and said nice things to me, I sat with a sour face. The whole time was uncomfortable. This fear is like a parasite. It poisons any thoughts – about the weather, about art, about friends, family, memories of childhood or a favorite book. He spoils everything he touches.

This went on for 15 years. And then dyspepsia began. I almost stopped eating. I went to a gastroenterologist, and she said that my stomach is fine, but the problem is in my head and I need to go to a psychiatrist.The doctor listened to me, prescribed a course of antidepressants and prescribed changes in the daily routine. He said that you need to get up early, before 9 in the morning, in order to catch as much daylight as possible, to learn how to occupy yourself with something without a trace. I followed these recommendations, took a half-year course of antidepressants on drink, and it was all over. For five years I lived absolutely carefree.

Last year, due to a minor domestic incident, I had a relapse. It wasn’t nearly as strong as the first time, but the depression and melancholy returned.I already knew where to go and what to do. A new course of antidepressants helped.

This autumn I live without drugs, although I took them last fall and spring. The psychiatrist finally diagnosed me with bipolar II disorder. It cannot be identified until at least one depressive episode occurs with the person. In general, you can live with it, but from those hellish years I have increased anxiety and fears out of the blue.

Now my bad mood can last from the morning, when I wake up and my soul is out of place, and until 6-7 pm.After this time, I function absolutely normally, and even such dark days do not happen regularly.

For me, life is divided into periods before 1996 and after. Until that year, everything happened, including things that I would not even want to remember, but my inner core remained unaffected, there was no betrayal in my fortress. After 1996, the disorder manifested itself, and now I cannot say anything definite about my emotions.

In any case, from this experience I have deduced something like my own philosophy: it does not matter what life situation you are in.It is important how you feel about it, how you feel in it.

There was a time when I walked the streets of a stunning western city with my pocket full of money. I knew that I was loved and expected at home, that almost all my dreams came true. But I couldn’t enjoy it. There were also terrible moments – for example, in the army one of my colleagues got into the noose, and I, although I also had hard times, survived, and it did not break me. Memories of those years are not tinged with either horror or anger. The attitude to the situation is what is most important.

There is such a romantic idea of ​​neurological disorders – that they give a person the greatness of pain and suffering, make him wiser. In fact, they just interfere with life. If it weren’t for the frustration, I could do more interesting and enjoyable things, I would quarrel with people less, I would be easier. I haven’t changed for the better with my illness, but I don’t think it significantly affected who I am as a person.

How to live and work further, if you have been diagnosed with a psychiatric diagnosis / Habr

UPD Link to stream on youtube

Hello, Habr!

My name is Sania Galimova, I have been in advertising for 6 years, two of them have been the head of the marketing department in IT companies and have been taking psychotropic drugs as prescribed by a psychiatrist for 4 years.

Previously, it was very difficult for me to finish projects and even just stay in one place of work: I was over-emotional, it was difficult to negotiate with me, and sometimes I simply could not work – after 3-4 months of intensive work and demonstration of good results, I was “turned off “- I was sitting in front of the monitor and could not read even a line of text.

I was fired, my partners left me, I could barely make ends meet, but this was in no way comparable to hallucinations, obsessive suicidal thoughts and clinical depression.

It sounds like life was terrible, but I never thought so: life was wonderful, but very difficult, and I was constantly looking for the reason why it was so difficult – and at 21 I finally reached a psychiatrist who diagnosed me and I started to be treated.

Now I am in remission for the third year, my career has gone up, I can live, work and travel without worrying about my health and everyday things. In many ways, this is the correct diagnosis, selection of drugs and work with a psychiatrist, and this is exactly what I want to tell you about.

Brief introduction: what is “Big Psychiatry” and how did I get there

Disorders with a biological cause and based on a chemical imbalance in the brain are called big psychiatry, in other words, when there are simply not enough screws in the head. This is a group of psychotic-level diseases: psychosis, schizophrenia, bipolar disorder.

What is now politically correct bipolar disorder used to be called manic-depressive psychosis and I think the old name was better – it more accurately describes what happens to a person who is unlucky enough to get sick.I am bipolar – I have type I bipolar disorder, with full-fledged manias and depression.

The disease made her debut at the age of 13, while she was in school for gifted children and lived in a boarding house. From then until remission at 23, my life became an almost constant succession of episodes: manias and depression.

What is mania – depression, just the opposite

People with TIR regularly experience

episodes

– the so-called alternating states of mania and depression.

If everything is clear about depression: this is a depressed state in which cognitive abilities also suffer (the depth of depression depends on how much – in my case, there were different special effects, from hearing loss and the inability to read to the moments when food ceases to be absorbed and there is no strength get out of bed), then mania is an absolutely amazing thing.

In short, mania is the opposite of depression. In the beginning, it feels like an incredible emotional uplift: the most resourceful state, you can work without a break for several days in a row, get enough sleep in 3-4 hours. Vision becomes clearer, colors are richer, as if someone has twisted the contrast to the maximum; hearing picks up more, the brain works at a frantic pace. Music, painting, cinema – everything leaves an indelible impression and pleasure.

It is said that people on some drugs experience a very similar effect – I don’t know, I never tried it.

Mania in the early stages is very productive. You can come up with complex schemes, non-standard solutions, quickly implement them and show excellent results.

But gradually the mania unwinds and turns a person into a madman: sleep time is shortened, speech accelerates so that it is impossible to make out, a slightly raised voice turns into a frank shout (“DO THE PROBLEM ALREADY !!!!”). At the peak of episodes, psychosis occurs – the classic messengers of insanity. Little green men run into a meeting room during a meeting.Obsessive delusional ideas are born that cannot be ignored.

Once, in mania, I looked in the mirror and noticed that the reflection did not repeat my movements, but moved at will, and after a couple of minutes it began to try to break the mirror in order to go out and kill me.

Mania is adorable until it gets overclocked. And it always accelerates. And after it comes an exhausted state and the descent begins, directly into depression and fatigue.

It is especially difficult when episodes go one after another without interruption – there is simply no time to exhale.The endless succession of thrills is exhausting, when acute pain gives way to acute pleasure and pain again. While you are chained to the chair of a fucking roller coaster, the usual life of an adult goes on with his duties: earn money, build a career, relationships, raise a child, be able to help parents and yourself. All this is difficult to do in a stable and normal way while you are being carried at a speed of 200 km / h.

And the most important thing is that if you want to create something really wonderful, it does not require short bursts of activity, but regular work.Attention to detail. Operability. Ability to complete.

Everything that I am actively doing now cannot be done normally by swoops, but I want to do it successfully.

And what next, how to drive out of this into a normal person?

I can talk a lot about bipolar disorder and how to tame it – I have a whole youtube channel on this topic. But I would like to answer exactly those questions

that are of interest to you

– so I propose to write them in the comments, and I will answer everything during the live broadcast.

If you are shy or do not want to de-anonymize (and I understand you) – you can ask questions anonymously in this form.

I will be collecting questions until Tuesday night.

Where and when the broadcast will take place

I will be answering your questions during the stream

on Tuesday 23 June at 20:00

.

The air will take place on RUVDS Instagram, where I work.

If you don’t digest this platform at all, the stream will also be on YouTube.

Yes, my boss knows

Anticipating offensive comments about my management, which hired me like this and trusted by advertising budgets: yes, I warn my employers even before signing the contract that if the pills fail, I will have to take sick leave for a few weeks.So far, this has not happened in three years – but I always warn you. And I am very proud of the understanding and zero discrimination with which my leaders relate to this – it is to work in a team with such people that I am not sorry to spend the lion’s share of hours in a day.

According to the tradition of announcing our broadcasts, I will also outline the main topics in which I have experience and about which I can give useful information

• How depression differs from just a bad mood
• How to get back on your feet when the depression has already begun
• Alarm bells: how to know when it’s time to see a doctor
• How to accept a diagnosis
• Selection of drugs and long-term use: side effects, effect
• Is it possible to be treated with drugs and why mental disorders have forever discouraged me from trying psychotropics for other purposes
• Self-medication
• How a psychotherapist differs from a psychiatrist, to whom and when to contact
• How is an appointment with a psychiatrist
• What the psychotherapist helps and does not help
• How and where to find a good psychotherapist
• What to do if you suspect depression or illness in someone close to you
• A girl / boyfriend says he has a BAR – is it worth starting a relationship
• Suicidal thoughts and how to get rid of them
• Relationships with mental disorders: how not to go on, whether it is worth telling your partner
• How not to lose your job due to depression and procrastination
• What NOT to be treated with tablets
• How to understand that the problems are not from the disease, but from your established patterns of behavior
• Derealization and depersonalization – feeling the world through vata or leaving the body
• How to remain a normal parent when depressed

There are topics that I do not understand at all, these are bulimia and panic attacks, and, fortunately, I cannot tell you how to deal with them.

Why am I talking about it openly

There are two reasons. First, I would really like someone to tell me about mental disorders and how they work before I turned 23.

It took me almost 10 (!) Years of long and thoughtful searching for what was wrong with me before I understood what the problem was and was able to ask for help. When I say “search,” I mean active search: I kept diaries to keep track of my condition, changed jobs, cities, partners, put forward hypotheses and tested them.But it didn’t get any easier, because the problem was in the disturbed biochemistry of the brain, and not in external causes.

This is such a stigmatized and closed topic that people in the masses do not know anything but myths: those who consider themselves Napoleon and quite a cookie are sitting in the Durka, but my sad colleague the system administrator is definitely normal, just a little sad. So people think until the sysadmin one day opens his veins.

Over the 10 years of the development of the disease, I found myself in danger many times: attempts at suicide, dangerous behavior in mania (I was twice hit by a car due to low attention, once – with a fracture of the spine).I was very lucky, the car did not finish me off, and my friends thwarted the suicide, but this is more of luck.

If I had the slightest hint as to which way to dig, I would have figured it out earlier. And I believe that others are entitled to this hint, which is why I choose openness.

The second reason is the great return that I get. Several times a week people write to me who say that they have watched my videos, started treatment and now it is much easier for them to live and breathe. 40% of such messages begin with the phrase “I was going to commit suicide, but it turned out that there is another way out.”

Depression kills. Suicide is the second most common cause of death among young people aged 15 to 30, after road traffic crashes. She is ahead of violent death – that is, she kills herself more young men and women than die as a result of terrorist attacks, hostilities and any other conflicts combined, including criminal and domestic murders. Just some serious shit and it needs to be talked about.

There is a clear link between depression and mental illness and suicide.

I am not a doctor or an Emergencies Ministry, but an ordinary office worker and even 20 people a year is a good result for me.

In general, ask questions. I am open to dialogue.

How To Cope With Bipolar Disorder | Asya Melkonyan

I have put together some simple guidelines for the patients themselves and their families that will help in the fight against bipolar disorder.

How to deal with bipolar disorder?

1.Find a doctor. It is important to find not only a good professional, but also a person with whom you will be comfortable working. Treatment is a partnership, it is not only the doctor who is responsible for your well-being. It is your responsibility to: Adhere to your treatment regimen. If you feel changes, contact your doctor. Do not make changes to the schema yourself. Remember that the effect of drugs does not develop immediately. Side effects disappear after a while.If they persist or worsen, you should inform your doctor.

2. Know your symptoms depression and mania / hypomania. Someone in depression is more pronounced melancholy, some irritability, some anxiety. Someone in depression sleeps a lot, while others, on the contrary, have insomnia. Someone does not eat, but someone, on the contrary, eats a lot. It’s great if you have a list of such symptoms in a notebook or in notes on your phone, so that you can notice in time that you have gotten worse.

3.Know your first disease beacons . The episode often develops slowly and the first bells may be subtle symptoms that are not indicated in the diagnostic criteria. For example: feeling that something is wrong, color perception change, fatigue, desire to sleep more or less, difficulty making a decision, you procrastinate more than usual. These symptoms should also be noted down so that you always have them at hand.

4. Know your triggers. Situations that could trigger the development of an episode. For example, conflicts at work or in the family, heavy workload, unsuccessful projects, and so on. There may be less noticeable triggers: coffee, tea, alcohol, sleepless night.

5. Know what makes you feel better . For example, massage, movie watching, extra weekends.

6. Have a crisis plan. It should tell you what to do in case of a sudden onset of the disease.Also, it can be written there how you should act with people close to you and at what stage you should turn on. For example: if I walk gloomy for three days, then you should remind me that maybe I have depression. Or: if I lie down on the weekend and do nothing, then you should take me to the doctor.

7. If you have suicidal thoughts, you should have a anti-suicide plan.
Much has been written about mood diaries , but it is difficult for some to keep it daily.He can be consulted when there is a likelihood of depression or mania. For example, in case you have seasonal exacerbations. If you have recently had a trigger situation or you intuitively feel that your state begins to change a little.

How to maintain good health?

1. Treat yourself with care and concern. Try not to overexert yourself. Anything with the prefix pere- is harmful.
2. Attending support groups helps many to feel that they are not alone, to accept the illness and learn how to cope with exacerbations.
3. Psychotherapy. It helps to accept the disease, accept yourself, achieve remission faster and feel better.
4. Observe the daily routine. A simple recommendation, but difficult to implement. If you have trouble sleeping, discuss this with your doctor, as sleep is very important. Disrupted circadian rhythms can provoke new episodes.
5. Do not drink alcohol or use drugs. Sometimes even caffeine, chocolate and green tea are affected.
6. Reduce stress and increase rest as much as possible.
7. Reasonable sports are also useful.
8. Spend more time outdoors, interact with pleasant people, and do more often things that bring joy.

How to live in society?

1. If possible, do not quit working
2. Try not to be excluded from society. The support of friends and family is very important.
3. Whether or not to report the illness – everyone decides for himself. It’s as much a part of health as any other, and you don’t have to talk about it.
4. Remember that people can react in different ways. They may not know what it is, they may be frightened, they may try to deny: “Yes, this is all the Americans / psychiatrists have invented,” or they may react quite normally. BAR is not so rare and it may turn out that the one to whom you admitted is also sick with it.

How to be close and dear?

1. Examine the disorder, its manifestations and features.
2. Know the symptoms and early signs of the partner’s illness.At the same time, whether or not to report and in what form is the subject of your agreements. Some people do not like it when they are told about it, some on the contrary will be grateful.
3. Try not to see the manifestations of the disease in everything. A person whose BAR is the same as everyone else. And just like the rest, he can have fun, be sad or angry. Most often, these are not symptoms of the disease, but ordinary human emotions.
4. Do not put pressure on feelings of guilt: you sleep all day, do not wash, etc.Believe me, a person constantly blames himself. But you can gently suggest taking a walk or watching a movie together. Do some simple business.
5. Do not argue in mania. Reassuring someone with bipolar disorder can be difficult. Arguing with a person who is in mania, you can turn him against yourself and cause aggression. You can try to persuade, appeal to past experience and your agreement (for example, if you previously agreed that when symptoms of mania appear, you go to the doctor together).
6. Take care of yourself. Living with someone who has bipolar disorder can be difficult and their partners can become depressed or burn out. Therefore, maintaining your well-being is also important.
7. Contract. It’s great when someone with bipolar disorder can take care of themselves and their care. But sometimes he needs help with depression, or he may be driven into mania. It is best to talk about such cases in advance – what your partner allows you to do and what does not. Then in crisis situations it will be possible to refer to this agreement.In depression, a person is most often inclined to cooperation and treatment, and in mania, he will refuse him. In the most extreme cases, you can call an ambulance – if a person is dangerous for himself or others

# depression # bipolar disorder # bipolar

Why is it so difficult with you. How to love people with neuroses, depression and bipolar disorder – Julie Fast »📚 Bookworld – Free Online Library

• Strict deadlines

• Too many selected courses in class

• Difficulty interacting with colleagues or superiors

• Work that does not match your partner’s skills

• Work that is too demanding, time-consuming or unrealistic

• Examination papers (tests, term papers, etc.)

• Daily routine at work or school

• New place of work or study

• Unbearable work or study

Opportunity to spend money. Problems with spending money are often symptoms of mania, but there are situations and places that can trigger symptoms that can lead to problems with spending money. Spending problems during mania often lead to relationship problems. Please note that the following triggers can lead to a manic episode:

• Vacation

• Working in a provocative environment, such as a mall

• Exciting activities

• Opening a new credit card

• Visiting certain shopping malls or shops where past experience has shown the temptation to spend

• Belief in drug-induced change

• A Las Vegas-like environment that excites and encourages gambling

Medication. Medication problems can trigger symptoms of bipolar disorder in several ways. These triggers are related to both the medications themselves and the way your partner takes them. Some antidepressants are known to induce mania or rapid cycling ^[14] . It is important that your partner does not have mania when prescribing a new medication. Here are some examples of triggers for mania:

• Stopping medication because the condition improves

• Stopping medication because of side effects

herbs)

• Taking medications that exacerbate the symptoms of mania due to their own properties or incorrectly prescribed dosage

Defined environment. The environment your partner is in can either undermine stability, or, conversely, strengthen it. You may have noticed that your partner’s behavior is dependent on the environment. This is a sign that a certain environment may be the trigger for your partner. Review this list and see if these triggers of mania are right for you:

• Living conditions

• Clutter

• Noisy environment that does not allow normal sleep

• An environment conducive to smoking, alcohol and drug use

• Events that strongly affect emotions such as concerts, matches and casinos

• Work environment

• Family celebrations

Social life. Bipolar disorder greatly affects your partner’s social life. Depending on the symptoms experienced, his social behavior can jump up and down, passing from mania to depression and vice versa. You need to identify the community events that trigger these behavioral changes. With mania, you may have difficulty separating symptoms from triggers. Mania symptoms can easily turn into triggers, so you need to be clear about what the trigger is for your partner.Some of the social triggers of mania are:

• Parties

• Having fun with people who are known to be overly critical, who are prone to demean, argue or provoke

• Visiting places or events that intensely affect emotions

• Using drugs or alcohol in the company

• The need to entertain someone at work

• Pressure from friends who do not understand why your partner cannot rest with them, as before

Disruption of stability and changes in everyday life. A stable lifestyle is perhaps the best way to maintain a stable relationship. Even small deviations from the usual way of life can cause problems for your partner. Stability is one of the most effective medicines for all symptoms of bipolar disorder, especially mania. Keep in mind that the following changes can act as triggers for mania:

• Changes in your schedule

• Big changes in family life, such as having a baby or moving

• Travel (especially with jet lag)

• Translation hours (for example, changing to seasonal time)

• A friend or family member moved

• Changes at work or school, such as a promotion or graduation

• Any change in your life that may affect your partner

Very serious triggers .As mentioned earlier, there are triggers that cannot be predicted or prevented. It will be helpful to talk to your partner about the possibility of these triggers before they occur, so that you understand how to deal with them. Just knowing that these triggers can almost certainly exacerbate your partner’s illness will help you prepare for them. This is why it is important to discuss them in advance. Examples of very serious triggers of mania are:

• Media coverage of terrorist attacks, wars, natural disasters or human suffering

• Moving to a new location

• Major quarrels, especially when accompanied by physical or verbal violence

• Death or illness of a loved one

• Disturbing events such as robbery, rape or road traffic accidents

• Job loss or new job with oversupply of obligations

• Difficult exam or academic project

• Childbirth

• Marriage

Any • Divorce or termination relationships

• Any stressful event that can change the life of someone with bipolar disorder

As you can see, the triggers that cause mania can be very unusual.There are situations, events and behaviors that normal people can handle easily, but people with bipolar disorder simply cannot. You are required to examine your partner’s personal triggers and categorize them across all major symptom categories for bipolar disorder.

Once again, you will need time, as with the bipolar symptom chart. In total, it will take you one to two weeks to identify basic triggers, although many may take a year or more.As discussed, many of the triggers for mania can be triggers for other underlying symptoms at the same time. For example, anxiety events that cause mania in one person can cause depression in another. It all depends on the effect the trigger has on your partner.

Why is it so difficult with you. How to love people with neuroses, depression and bipolar disorder 9785041121181

A relationship in which one of the partners is suffering from a mental disorder is challenging.In times of crisis

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Table of contents:
Julie Fast, John Preston. Why is it so difficult with you. How to love people with neuroses, depression and bipolar disorder
Acknowledgments
Chapter One.Getting Started
Are you tired?
What is a comprehensive treatment plan?
Correct Diagnosis
How to Involve Your Partner
Crisis
The Reality of Bipolar Disorder
This Job Takes Time
Some Helpful Hints
Conclusion
Chapter Two. Priority for treatment of bipolar disorder
What is “priority for treatment of bipolar disorder”?
Lay a solid foundation
Think about bipolar disorder soberly
What are the main challenges you face?
Independent work
Needs, not punishment
Setting goals
What are goals?
Projecting Your Goals into the Future
Think Positively
Chapter Three.Multipolar disorder
Types of bipolar disorder
Bipolar I disorder type
Bipolar II disorder type
Cyclothymia
Rapid cycling bipolar disorder
The diversity of bipolar disorder
Depression
Major symptoms
Mania (severe psychosis)
Symptoms of depression
Mania (severe) Delusions in psychosis
Psychotic hallucinations
Paranoid symptoms
Severe anger and irritability
Anxiety
Feelings of overexcitement (overflowing with emotions)
Problems with concentration, attention and concentration
Suicidal thoughts and suicide attempts
Self-destructive behavior
Self-destructive behavior

Categorizing your partner’s main symptoms
Chapter Four.Basics of Drug Treatment
Be careful with stimulants
STEP-BD Research Project Conclusions: Structure Equals Stability
What You Need to Know About Drug Treatment for Bipolar Disorder
Side Effects in Brief
Smart Approach to Side Effects
Pharmacotherapy: Using Medications to Treat Disease Case One: Stefano’s Story
Case Two: Marsha’s Story
What are you going to do?
Six Reasons People With Bipolar Disorder Refuse To Take Medication
The person genuinely does not notice that they are sick
Medications hardly work
Friends and family members are not supportive
Someone else with bipolar thinks that someone else has a problem
The person with bipolar disorder self-medicates
There are unpleasant side effects
Remember, people can change, but life can improve
Will your partner have to take medication for life?
Your right to know and participate in your partner’s treatment
Your partner with bipolar disorder might get better
Chapter Five.Comprehensive Treatment Plan
Designing Your Own Comprehensive Treatment Plan
A Few Words of Support
Finding Specific Symptoms Within Categories
Identifying Symptoms
How to Use This Symptom List
Chapter Six. What Works List
This Difficult Illness Briefly
Get What Works: Look for What Doesn’t Work
Create a What Works List
Examine your partner’s wants and needs
Help your partner choose relationships wisely
Get fit
Finding Complementary Therapies
Helping with Medications
Finally, Don’t Forget Yourself
Example of “What Works” List
Chapter Seven.Triggers for Bipolar Disorder
Finding the Source
Symptoms Are Fruits and Triggers are Seeds
Finding Triggers: Modifying and Stopping Bipolar Symptoms
Why Is Your Partner So Damn Sensitive?
Root Trigger
Triggers in Brief
Finding Mania Triggers in Your Partner
How to Change and Stop Bipolar Triggers
How You Can Help
Hope for the Future
Root Trigger: A Final Example
Chapter Eight.The couple takes charge
That same trip
What’s wrong with her?
Step One: Prioritize Bipolar Disorder Treatment
Common Problem
Plan History
Goal Setting
Step Two: Divide Bipolar Disorder into Major Symptom Categories
Major Symptom Categories Pam
First Look at the List
Step Three: List Irritability Symptoms Pam
Symptoms of Pam’s Irritability
Symptoms Are Signs
Illness, Not Personal Disability
Step Four: Create a List of “What Works”
What Works to Fight Pam’s Irritability
Getting to Know New Tools
Step Five: Identifying Triggers
Why Pam is Difficult to Find Her root triggers
Finding root triggers
Step Six: Stop Triggers
How Pam and Carlos Live Today
Chapter Nine.Bipolar Conversation
Bipolar Conversation is a Sign
Put yourself in your partner’s shoes
What’s real?
Key Comment
Don’t be fooled!
How to respond to key comments
Try it, it works
Answer instead of reaction is not given immediately
Paul and Susan stop bipolar talk
How to prevent bipolar talk
Chapter Ten. Your emotional response to bipolar disorder
Fear
Unattractiveness
Anger
Pressure
Feelings of guilt
Frustration
Feeling trapped
Sadness
Despair
Letting go of hospitalization
Loneliness
Change your emotions
Allow yourself to take a vacation
Talk to yourself
There are no wrong emotions – they just are
Do not muffle your emotions
The right time to talk with your partner
Chapter Eleven.Work and money
Work
How to use this information
Finding alternatives
Money
Manic spending
When mania goes too far
Depression and money
Solving money problems
Create a system of checks and balances
Your partner also has feelings
How to help a partner
Chapter twelve. S-E-K-S
Priority for treatment of bipolar disorder
Medication
Depression
Mania
Psychosis
Lack of attraction
End of relationship
Forgiveness
On thin ice
Tips for improving intimate life
Chapter Thirteen.What about you?
Sick and healthy
Hypercarrier
Antiguardian
You always have a choice
Asking for help
People don’t know what to do
So, what about you?
Chapter fourteen. The harsh truth about bipolar disorder
The past hurts
Acceptance and loss
Let go of the past
Your partner won’t change
Your partner is too sick to change (right now)
Your partner’s family is not helping
People will talk stupid
Medication side effects
Medicines
Without proper treatment, bipolar disorder always creates problems
There is a limit to everything
Children will hear you
When bipolar disorder is too bad
Protect yourself
When your partner gets better
Always ask uncomfortable questions
Chapter Fifteen.How to bring laughter and joy into your relationship
Do what you love
Anti-bipolar zone
An evening of entertainment (at least) once a week
Laugh at serious things
“As if”
Final thought
Appendix
Medication at a glance
Mood stabilizers
Lithium
Anticonvulsant normotimics
Neuroleptics
Antidepressants
Anti-anxiety drugs
Benzodiazipines
Other medicines
Calcium channel blockers
Old generation neuroleptics
Anticholinergic drugs
OTC drugs
Observations
Author’s notes
OTC references
Observations
.