National Prevention Week: How I Prevent Oncoming Bipolar Mood Episodes

The week of May 12-18 is National Prevention Week, so I’d like to talk about how I try to prevent oncoming bipolar mood episodes. Because I was diagnosed at twenty-two and started medication and therapy, I have a decade’s worth of experience in managing my bipolar disorder. Read on for a roadmap discussing how to tackle the prevention of mania and depression head on.

Fight Self-Stigma

Self-stigma is when you have absorbed the negative, inaccurate messages about your mental illness around you. This affects your perception of your mental illness and your need to treat it, which in turn affects your behaviors and actions in terms of seeking treatment. In order to face taking medication every day for the rest of your life, you need to fight stigma, especially self-stigma. The way I fought it was to recognize that I needed to be my best self for my newborn son, which entailed taking medications and going to therapy. I needed to treat my disorder so I could properly mother my son. It wasn’t just about me.

If you have a reason outside of yourself, awesome, but if you don’t, you still deserve treatment. You are better than your disease. You are a human being, a precious individual. Caring for yourself, especially in the pit of depression, is one of the hardest issues you’ll ever face. But you deserve proper care, even if it’s mostly self-care for a while.

Medication

I can’t recommend medication enough. In combination with therapy, medications saved my life. When I was first diagnosed, Depakote toned down my psychotic mania, and two years later, lithium lifted me from the black sucking hole of suicidal depression. Now I’m on Risperidone and Wellbutrin, and the combination has enabled me to be stable for over six years. Taking my medication daily has prevented the dizzying spin of mania and the pit of depression. Part of this is my fighting self-stigma, as I said above.

Therapy

Another tactic that has helped me remain stable for the past half-decade is attending counseling sessions with my therapist. Therapy has helped me learn coping mechanisms to handle my day-to-day life, including emergencies. I’ve been able to treat my manic and depressive episodes, and learn how to flourish. I am thriving, and I wouldn’t have thrived so successfully without those weekly appointments with my therapist.

Sleep

Proper sleep is crucial for managing your bipolar disorder. Sleep disturbances trigger bipolar mood episodes, especially mania, and too much sleep triggers the crash of depression–usually following mania. Problems with sleep are a common symptom of bipolar disorder; in a future post, I’ll be looking at how common insomnia is for this specific mental illness.

To ensure I sleep as well as I can, I practice what’s called good sleep hygiene. I don’t drink water or caffeinated beverages right before bed. I wind down before bed, taking a bath every night. I wake up every morning at 8:30am, if not earlier. I try to go to bed at the same time. I wake up frequently in the middle of the night with a racing mind, but I try to calm myself by praying or meditating. Generally, that works, and I’m able to get back to sleep within fifteen to thirty minutes; I recognize that I am lucky in that manner. Try to practice good sleep hygiene, and you, too, might be able to prevent oncoming bipolar mood episodes.

jessi RM
A picture of a smiling woman next to a frowning woman, in black and white. Credit to fliclr.com user Jessi RM. Used with permission under a Creative Commons license.

Final Thoughts

Fighting self-stigma, getting proper treatment for your disease (including medication and therapy), and sleeping properly are some of the best ways to prevent oncoming bipolar mood episodes. If you’re looking for a post on how to manage the most common bipolar triggers, click here.

You can do this.

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“How Do You Define Mentally Ill?”

“What do you mean he’s mentally ill?” the woman said. “He just needs to get his act together!” I was sitting in an Olive Garden the other day, and overheard part of a conversation from a very loud patron. I tried to ignore her, but she said something that caught my attention: “Well, how do you define mentally ill?”

Hearing that made me think about what a good question it was. How do you define mental illness? Mental disorders are more prevalent than heart disease, cancer, or diabetes. Twenty-five percent of American adults and thirteen percent of American children are diagnosed each year with a mental illness, per the National Institute of Mental Health (NIMH). The causes of mental illnesses are still unknown, though recent research points to genetics as well as environmental stressors.

According to the Mayo Clinic, “Mental illness refers to a wide range of mental health conditions–disorders that affect your mood, thinking and behavior.” Generally, these illnesses cause dysfunction in your life. Examples include schizophrenia, eating disorders, bipolar disorder, phobias, unipolar depression, and many more. These conditions are classified in the Diagnostic and Statistical Manual of Mental Disorders, 5th. Edition (DSM-V). Published by the American Psychiatric Association, the DSM-V is considered the guide to mental health issues. It covers five dimensions of mental illness:
• clinical syndromes, such as bipolar disorder
• developmental disorders and personality disorders, such as autism and borderline personality disorder
• physical conditions
• severity of psychosocial stressors
• and highest level of functioning in the last year, which is a measure of the mentally ill person’s ability to meet life’s demands on an annual basis.

dsm
Credit to flickr.com user Richard Masoner. Used with permission under a Creative Commons license.

But how does society define mental illness? There are stereotypes of the disordered person ranging from unpredictable to slovenly. Countless news stories report people with mental health issues as violent, while research shows that they’re no more violent than the general population. In fact, they are more likely to be the victims of violent crime. Thesaurus.com even lists “crazy” as the second synonym for violent.

What’s even worse is how society has treated the mentally ill. In Ancient Greece, physicians used to drill holes in people’s heads to let the evil spirits escape, and ostensibly cure their disorders. Institutionalism was rampant from the 1800s to the 1950s, and some patients were even chained to their beds and left in filth. It was as recent as the 1930s that lobotomies and malarial infections were the leading treatments for the mentally ill.

So, when the woman in the Olive Garden spoke about her friend’s husband, putting him down for suffering from mental health issues, I was irritated with her. People who endure these grueling conditions and their families have enough to deal with without others questioning their diagnosis.

Most people with mental illnesses are aware that they can sometimes be inappropriate or different than others. Mental disorders are not something you can just will yourself to cure. They require treatment ranging from talk therapy to medications, and some are even treatment resistant. Many people who do not receive treatment are unable to cope with their lives, which in turn causes them to not be able to keep the house clean or hold down a job. Many more can control their mental illness, or mitigate symptoms—with treatment.

Treatment has come a long way since the insulin-induced comas of the 1930s. But it’s not far enough. Communities have been slow to offer housing support and life skills training for the mentally ill who were deinstitutionalized in the 1950s. People who suffer from mental health disorders need more care than society has been willing or able to give.

Better funding for research into disorders would be a good start. The National Institutes of Health (NIH) estimated that the organization would spend $396 million on mental illness research in 2016, compared to $1 billion for diabetes research.

But what can individuals do for those of us who suffer from mental illnesses like bipolar disorder? Be kind to the mentally ill. Learn about various diagnoses and the stresses that trigger them. Advocate for better housing options and more funding for research. With these efforts, concerned people can make the world a better place for those with mental health conditions.

How do you define mental illness in your life?

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Are You “Covering” For Your Illnesses?

Credit to flickr user christine zenino.  Used with permission.
Credit to flickr user christine zenino. Used with permission.

Covering is a unique trick-of-the-trade known to anyone who has been chronically ill–mentally or otherwise. It is the art of straightening ones shoulders and schooling ones features to show that, no, really, we’re fine, so please don’t fire us or ask us to explain what’s going on. In short, we’re actors donning the mask of normalcy.

The first psychiatrist I met with outside of the mental hospital called it my “manic happy cheerleader face.” Julia Kovach touches on the subject in her post Being Bipolar, where she describes reactions to her diagnosis:

And because people don’t understand what they can’t see and sometimes say stupid things; like I look so normal that I must be mistaken. I guess I don’t act crazy enough. Ha ha. And if they should get a glimpse? They run. Fast and far.

The brilliant Ari Flynn, who suffers from chronic depression and on whose blog I first heard the term, offers a more complete description:

Telling your friends to treat you like everything’s normal is equivalent to playing a never-ending round of the Elephant Game (don’t think of an elephant — whoops, you lose!), so the only way for you to avoid that particular soul-sucking bog is to learn how to control how much information other people get about your internal state. It’s something nobody ever really talks about, but the bipolars and chronic depressives are all nodding to themselves — do it long enough, and you get very, very good at it. You have to; it’s a survival skill.

After a while it gets to the point where being able to cosplay as a functional human being is the only thing you feel like you can do even kind of right.

They are absolutely right. It is easier to pretend everything is fine than to explain why you had to limp to the shower due to fibromyalgia or why you bought $700 worth of chocolate in one go. Anything you say is by no means the complete picture, and often won’t alleviate your pain. The ability to cover is a hard-learned skill, due to fear of stigma, rejection, or unwillingness to overwhelm other people with your own suffering.

Additionally, this role is draining to play. We all have different strengths and weakness, but constantly monitoring speech and behavior is exhausting for anyone. Under stress, the performance breaks down. With regards to mood episodes, the lack of self-awareness during mania and the lack of grooming during depression are strong indicators that the mask is slipping.

Celebrities like Stephen Fry and Brooke Shields have started paving the way for discussions about mental illnesses. The more we all talk about bipolar to those who have it and those who don’t, the more people may understand and stick around. Building a community of peers is the best way to counteract this strenuous protective mechanism.

You’re not alone in hiding, so why not surround yourself with people who understand that burden?

When do you find that you cover the most?

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Why Medicinal Weight Gain is Devastating to the Mentally Ill

“Watch out,” the mental ward’s psychiatrist gently cautioned me. “It’s true that Depakote will stabilize you, but you’ll gain a lot of weight. Plus, anything you pack on will be harder to lose. Are you sure you want this medication?”

“Pish posh,” I said, manic and therefore invincible. “I don’t care about a measly ten pounds.”

At the time, I was seething. Were we, in considering my treatment plan, really going to prioritize my weight over my mental health? In the midst of my psychotic breakdown, I’d just realized that I was insane enough to need serious medical intervention. Was that really the time to caution me about maintaining thinness—especially considering I had given birth two weeks prior? And why were there no other options to treat my condition?

Sixty pounds and a few years later, I care a great deal about my muffin top. So much so that it has started to negatively affect both my health and self-esteem.

I’ve had young children ask if I have a baby in my belly.  I’ve been laughed at and called “fattie!” when dancing.  I’ve even had a certain insensitive business owner look at my four-year-old debit card and declare, “You used to be so skinny!  You know, when you were a teen.”

Ouch.

No one can tell from looking at me what my diet is or what medications I may be taking. Despite that, they feel free to comment on my body. I fully admit that my new curves are not entirely due to my nightly med cocktail. I am largely sedentary and my diet consists of the three major food groups—Grease, Sugar, and Dairy—both issues which I am addressing. But even with that lifestyle, I should not have gained thirty pounds in a year.

Weight gain is a huge factor preventing people from complying with a long-term drug treatment plan. In a 1999 study of the adverse effects of antipsychotics, more than seventy percent of participants reported weight gain as “extremely distressing”—far greater than any other side-effect.

Depakote, a gold standard in the treatnment of bipolar disorder, is one of the worst offenders. Studies have even suggested that women on the drug crave carbohydrates up to ten percent more than men do, and tend to gain more.

This is a three-fold problem:

1.  The mental health industry is a fledgling one, even though its business is currently booming. We just don’t know what a lot of these compounds do to the body yet, especially when blended. And not all drugs work for everyone. I myself am allergic to entire families of medications, including most of the new atypical antipsychotics and serious painkillers.

2.  People stop taking their prescriptions when they feel that the diseases are easier to bear than the side-effects.  In addition, this is often done abruptly, which can be dangerous as it may trigger a severe mood episode.

3.  Despite not being able to tell how healthy someone is by looking at them, many cultures shame fat people.

There is a stigma against having a mental illness. There is a stigma against needing medications to survive. There is a stigma against being fat. But what if you are the first already and have to choose between the second and third?

This is the kind of choice that breaks a person.

What sorts of things have you had to deal with on your meds? If you can bear to part with the numbers, how many pounds have you gained?

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