Living with bipolar disorder
The great majority of individuals that suffer from a bipolar disorder are able to lead a normal family, working, and social life if they take certain precautions in their lifestyle, and continue the treatment. Many of the patients, after a period of taking the treatment correctly—perhaps having quite a few side effects—, regulating their habits and abstaining from taking alcohol and drugs, have been able to lead a normal life again, both as regards working, as well as social and family life. It is true that living with a chronic illness can be hard, but many people usually succeed in having a good quality of life.
The following are some practical tips on daily life, essentially to prevent relapses:
Self-observation. A correct self-observation is the best way to prevent relapses. Take account, particularly on the mood and, if this is not normal, analyse why. Pay particular attention to sleep, very often the feeling of “I don’t need to sleep” is the first sign of a decompensation. Observe also if you have argued more than usually lately, if things annoy you that were not important before, if you talk more or joke more. In general, mistrust of changes. It might be useful to make a daily record that includes the number of hours of sleep, important activities that you have carried out, and give a score of your mood. If you have had a relapse, try to remember or ask acquaintances what were the first symptoms that you had (prodromic symptoms) and have a list to be alert if these begin to appear again.
Sleep eight or nine hours a day. Recent studies have shown that the correct quality and quantity of sleep is a basic factor to prevent relapses. In general, it can be said that to sleep less than seven hours carries an elevated risk of having a hypomanic or manic phase, while to sleep more than 10 hours a day increases the possibilities of having a depressive episode.
Do not consume toxic substances. The consumption, even although it may be on a single occasion, of certain substances such as, cocaine, LSD, extasis, and other drugs is, apart from being harmful for the physical and mental health of any individual, sufficient to have a decompensation, complicate the course of the illness, and lead to the appearance of psychotic symptoms. The consumption of other substances like alcohol, marihuana, and its derivatives tends to trigger the appearance of new episodes and increases anxiety. As regards coffee, you should be aware that its effects on sleep (insomnia) last approximately 8 hours. Thus, it is not recommended to drink coffee after four in the afternoon.
Flee from stress. Try to put aside time each day for yourself and carry out pleasant, always relaxed, activities. Practice any activity that helps you to lower the pressure (moderate physical exercise, reading, painting), as well as trying to put the problems into context.
Listen to people in whom you have confidence. Look for someone among family and friends that can act as a reference point. Normally the people that we live with can detect the onset of a decompensation more clearly. Comments of the type “you seem a little strange lately” or “you seem to be in a different mood” may serve to be aware that, perhaps a relapse is starting. In this case, it is advisable to visit the psychiatrist.
Take the medication correctly. It is the best way to prevent relapses. To stop the medication on your own initiative carries the risk of creating resistance to the drug. On the other hand, to suddenly stop the medication considerably increases the risk of an immediate relapse. Despite all this, if the medication is not taken correctly, the best that can be done is to be sincere with the psychiatrist and mention it to him/her, otherwise it can confuse the doctor as regards the advantages of a particular drug, the dose, etc., which could have very negative consequences on the course of the illness.
Explain all the symptoms. Although it seems strange, sometimes, apparently irrelevant details (change in dietary habits, sexual habits, or in the way of dressing), can be a determining factor by which the psychiatrist knows at what phase of the illness the patient is in, and can prescribe suitable treatment.
Become accustomed to regularity. Regularity in sleeping habits, and activities and including dietary habits is basic in order to reduce vulnerability to relapses.
Do not confront the illness and try to understand how to live with it. Denial of the disorder just makes it worse. You are not bipolar, you have a mental disorder. Remember that this illness has nothing to do with personality: there are no two people with the same bipolar disorder.
SIMPLe project for recording mood and receiving psycho-educational messages
The SIMPLe Project has as its aim to study the usefulness of mobile devices in the follow-up of patients diagnosed with bipolar disorder, providing them with a tool for the constant recording of their mood, at the same time as receiving personalised psycho-educational messages to maintain their stability. All this through a simple, friendly, and discrete interface that tries to adapt to your normal daily activity with the minimum interference possible. It is a follow-up and psycho-educational strategy that can help patients with bipolar disorder to improve their quality of life, prevent relapses, complications, and hospital admissions. At the same time, this application can help contact the mental healthcare services in the event that urgent situations in mood state are recorded.
What to do if the onset of a Euphoria Phase is detected?
Take into account the following advice on the onset of a euphoria phase (manic or hypomanic):
Increase the number of sleep hours to a minimum of ten.
Limit the number of activities.
Dedicate a maximum of six active hours
Do not try to overcome the euphoria “by exhaustion”: the more activities performed, the more euphoric you will be.
Reduce mental stimulation by means of relaxation exercises or lying down in bed.
Avoid the consumption of stimulants, such as coffee, tea, cola refreshments, and energy drinks.
When faced with the impulse to make significant purchases, postpone any financial operation for at least 24 hours and ask someone of confidence for an opinion.
Submit the “fantastic ideas” for the opinion of another person.
Above all, get in touch with your psychiatrist as soon as possible.
What to do if the onset of a Depressive Phase is detected?
Sleep a maximum of nine hours.
Do not self-medicate.
Try to increase the number of activities.
Set yourself realistic objectives: step by step.
Do not make important decisions.
Do not feel guilty of the depression, in the same way that diabetic patients should not feel guilty about their sugar levels.
Nothing lasts forever: you are not always depressed.
Put into context the ideas of inferiority, pessimism, and despair: they are symptoms of the depression itself that do not respond to the reality.
Try to do physical exercise: it is often useful to feel more energetic.
Consult the psychiatrist.
Bipolar disorder and work
The fluctuations and relapses of the disorder can lead to doubts about work and how this situation should be faced in the work environment. It has to be made clear that health comes first and the stress and the working hours (avoid night shifts) have to be taken into account. Beyond these considerations, the disorder does not limit work during periods of stability.
On the other hand, there is always the doubt whether this information has to be shared with superiors or colleagues. The information of the state of health is somewhat personal, therefore everyone is able to decide what to explain and what not to in this regard and, in no case, it is obligatory to say that one has a particular illness.
Obviously, there are some situations in which it is recommendable—but not obligatory—due to common sense and practical purposes and sincerity, to share the information about the disorder. It is hard to believe, for example, that a couple with pretensions of stability can function correctly if such important information is hidden, such as the fact of suffering from a chronic medical disorder. Other types of more casual or sporadic relationships do not require such “sincerity” as regard the mental health state of any of those involved.
Bipolar disorder and the family
The family plays a fundamental role in all aspects of life and more so in the mental health. It is for this reason that the near family must be up to speed with the situation, and even more important, to know how to detect the onset of a relapse and to know how to act. The individual that has a bipolar disorder is, basically, most of the time, a “normal person”, and for this reason they should be treated in the same way as if they did not have any psychiatric illness. There is a risk of marginalising the patient when it is thought that they cannot take on certain responsibilities on being symptomatic, as if different from the rest, and one must not fall into this error. The family also plays an important role in the generating of a less stressful environment and in reducing the risk of relapses.
Approach by the family on depressive phases
Phrases like, “cheer up”, “it’s nothing”, “it’s for two days”, or “don’t look so glum”, can be counterproductive if it is remembered that many of the symptoms do not depend exclusively on the will of the patient. Sometimes, phrases like these, although said with the best intentions, can make the patient even worse. The majority of people that have had a depression have defined it as the most difficult period of their life, therefore it is important not to contribute to increasing their suffering.
Approach of the family in manic phases
The family must try and avoid arguments with the patient during manic phases, given that the state that the patient is in makes it difficult to view the reality objectively. It is advised to postpone important decisions until times of greater stability. An attempt can be made, particularly if the family or friends are aware of the illness, to make the patient understand that perhaps they are ill and should consult a doctor—at least to settle any doubts. If the illness is admitted, support must be offered to accompany him/her to see the psychiatrist. If there are situations that could put the patient or anyone else at risk, the emergency services should be called before trying to insist with any other measure.
Approach by the family during hospital admissions
The admission must be considered a necessary option at times when the illness significantly interferes in the life of the patient, or of those around them. It is a means towards gaining control over the illness and the freedom of decision.
Although it is difficult, during admissions, the family must try to act normally, like it would act if the admission was for another cause. They must not try to approach “great topics” or “philosophical conversations”, and agree to have daily life conversations. The patient must not be blamed for something they have done or not done before the admission, nor convey the feeling that life is chaotic without him/her, or it is much better at home now that he/she is in hospital.
After an admission, creating highly stressful situations must be avoided, and accept that the recovery of the person is gradual.
Practical advice for families: learn to detect symptoms
To identify a relapse early is fundamental in order to prevent it being severe. To do this, collaboration between the people that live with the patient is essential. They must also be alert to any change in the behaviour of the person affected, particular as regards:
Activity level. A sudden increase in activity is usually a good indicator of the onset of a euphoric phase.
Irritability. The appearance of constant disputes, excessive impatience, or intolerance can announce the onset of a manic or mixed phase.
Verbal productivity. The fact that the patient starts to be more talkative, speaks faster, and at a higher volume, constant changes in topic, or difficulty to interrupt their discourse can also indicate the onset of a euphoria phase.
Sleep. The decrease in the need to sleep is, very often, the earliest symptom of a relapse. At the onset of a euphoria phase, the patient goes to sleep later, or starts to wake up earlier than usual, gets up earlier, and usually takes advantage of doing things when they should be sleeping. To sleep less can act as a trigger of an episode and, on the other hand, the insomnia can be a symptom of the disorder and may appear during depressive, manic, or mixed episodes, aggravating the clinical picture. In depressions the opposite can happen: the patient gets up later and notably sleepier during the day; although there are patients that have insomnia.
Appearance of new interests, projects, or ideas. Particularly when they suddenly appear. Initiatives or decisions reasoned by the patient should not be systematically rejected at first. However, it may be worth postponing the evaluation and possible execution of these projects to times of greater stability. When the family considers that the plans and ideas of the patient may have negative consequences and have a high probability of failure, instead of entering into arguments over these new projects, it is advisable to point out that it may be a symptom of the illness and that they would feel better if the doctor was consulted. In any case, derogatory remarks and comments like “you are not very realistic” or “when do think you will grow up?”, must not be used.
Mood Swings. Attention must be paid to those mood changes that have not been caused by a particular factor or reason, or are too intense and prolonged in relation to the cause that triggered them. It may be very useful to warn of “character changes”, for example, if a person that generally used to be shy or introverted starts to be more of a joker and extroverted, he/she is probably starting a manic or hypomanic episode. On the other hand, if someone that habitually used to be good-humoured starts to be more bad-tempered or inhibited, they are surely starting a depressive episode.
When there are depressive and/or suicide symptoms
Depression is an illness that limits the ability to make decisions freely and that in some cases, can lead to a suicide attempt. Around 15% of patients with bipolar disorder die from suicide. The depressed patient can begin to contemplate suicide as the only way out to end the suffering, without appreciating that it is treatable and temporary. Ideas of suicide are a symptom of depression where the patients may believe that they have right to commit suicide and that there is no other solution, when in reality they are not the ones that decide, but the illness itself decides, since when the depression disappears the suicide ideas also disappear. For this reason, the families of the patients have the right and must prevent, where possible, the patient carrying out their suicide threats. Above all, they should be made to understand that they are not limiting their freedom or their rights when measures are taken against the suicide, but are increasing them.
Some measures recommended in case a patient has suicidal thoughts are:
Inform the psychiatrist.
Prepare everything necessary if the psychiatrist considers it reasonable to admit to hospital.
While the risk situation lasts, do not leave the patient at home alone.
Keep the medication out of their reach and be responsible for its administration. Keep the rest of the medication in a safe place, under lock and key where possible.