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4.0 How can I best take care of myself?


This article is from the Bipolar Disorder FAQ, by barry@webveranda.com (Barry Campbell) with numerous contributions by others.

4.0 How can I best take care of myself?

If you've been diagnosed with a form of bipolar disorder, you'll probably
find no shortage of people (doctors, family members, members of support
groups) offering advice, whether you ask for it or not. :-)

And now here we are, getting in line behind all of those people.

The advice we're presenting here is GENERAL. Everyone with this
illness is a unique individual, and individuals respond in
unique and sometimes unexpected ways; use your best judgment and
common sense about whether this advice is right for you.

That being said:

The most important general guideline for self-care is to establish
a sound therapeutic relationship with one or more doctors: a
psychiatrist or psychopharmacologist for drug therapy, and, if you
prefer not to use this person for more traditional forms of therapy
but want a professional to talk to, a psychologist, licensed
clinical social worker, or similar licensed counselor.

Bipolar Disorder is a lifelong, chronic medical condition. It cannot
be cured, but it can in almost all cases be managed to at least some

Some more general guidelines, which mostly fall into the category
of common sense but bear repeating (and please note that these are
GENERAL statements, and that everyone is an individual--your mileage
may vary!):

-- Take responsibility for your own well-being.

You can have the finest medical team in the world working on "your case,"
but if you don't first accept that you *have* a chronic medical
condition and take responsibility for doing what it takes to manage
it, you're wasting time and money. Obviously, if you're in the
throes of an incapacitating depression or mania, this can be hard
if not impossible to do, and someone else may (temporarily) need to
make these sorts of decisions for you; also, people respond in
different ways to various kinds of medication and therapy.

But in general, remember: you're the boss, you're the one calling
the shots and deciding which resources to utilize (or not.)

The key thing to remember is that there's a LOT of help out there
if you want to get things under control--but you have to decide
to seek it out, and you have to decide that you will commit to a
healthy course of action.

-- Work with your doctors, not against them--and insist that they work
with you.

It's vitally important that you be able to communicate with the doctors
and health-care professionals that you choose to use as resources.

If you're not comfortable talking with someone, or if they don't listen
to you, look for another therapeutic relationship. Period. It's
*vital* that you and your doctor(s) listen to and respect each other.

-- Develop a survival mentality.

A few of us who start medical treatment for Bipolar Disorder are pretty
much asymptomatic afterwards--in other words, we never, ever have another
flare-up. A few of us don't seem to respond satisfactorily to ANYTHING we
try. Almost all of us fall somewhere in-between-- we get some measure of
control over our bipolar disorder, but we still experiences ups and
downs, and still have tough times that must be endured.

A "survival mentality" means, first of all, deciding that there's life
after diagnosis. Getting the news that you have a medical condition
that you'll be dealing with (in all probability) for the rest of your
life can be a major shock to the system! Recognize that there are
literally *millions* of people around the world dealing with this
disorder; you're not alone, and there are many resources available
to help you cope.

Second of all, it means that when times DO get tough, you do what
it takes to get through it. In extreme cases, this may involve
voluntarily checking yourself in to a hospital under a doctor's care.
This isn't an experience that most people would seek out for themselves,
but when things get badly out of hand, it can literally be a lifesaver.

Remember: your first goal is to *survive*--to take care of yourself.
Your secondary goal might be to contribute as much as you can
to the lives of your friends, family, loved ones, co-workers, etc... or
it might be something else entirely.

But if you don't take care of the first goal, the other ones are
utterly meaningless.

-- Become aware of your mood states.

At first glance, this seems like a really stupid thing to say. If
you're depressed, you know damn well that you feel awful... though you
may not identify "depression" as the cause at the time. Hypomania
and mania can be harder to recognize when it's happening to you,
but as you gain more experience in dealing with this disorder, you'll
become more sensitized to your moods and their cycles.

If you become more aware and conscious of your mood states, however,
you may find that you can spot trends earlier and head off potential

Many bipolar folks chart their moods on a calendar or in a diary;
this helps them understand their cycles better, and can also provide
important clues about possible environmental stimuli that might either
be causing problems or giving relief. For instance, if you note
that your mood is generally better for a day or two after you work
out vigorously, you might want to consider making exercise a regular
part of your coping strategy... or if you notice that you feel
especially depressed after a certain activity or eating/drinking
certain foods or beverages, you might consider limiting that sort of thing.

One simple way to do this is to choose some kind of arbitrary numeric
scale... let's say that "1" is severe depression, "5" is
"normal," whatever that means, and "10" is severe mania. Something
as simple as jotting down a number reflecting your own assessment
of your mood state *at roughly the same time every day* can give
you very important information about the length and quality of
your mood cycles.

Also, many folks establish "contracts" with trusted friends or
family members--they work out ways in which the trusted outside
observer can communicate to them, in a friendly, loving, and
nonthreatening way, that they think that you are becoming
depressed or (hypo)manic.

Finally, remember that even though you have a mood disorder, you're
almost certainly still prone to everyday, ordinary moodiness! If you
wake up in the morning feeling bad, it might be a precursor to
a serious depression, or you might just be having a bad hair day. If
you wake up feeling on top of the world, you might be getting
(hypo)manic, or you might just be having, um, a good hair day. ;-)
Watch the overall *trends* over time, and try not to watch yourself
under a microscope and obsess over the tiny details. ;-)

-- Structure your life to the extent possible.

Without becoming fanatical about it, many bipolar folks find that sticking
to as regular a schedule as possible of eating, sleeping, working, and
so forth is helpful in stabilizing their moods. Sleep deprivation can
DEFINITELY precipitate (hypo)mania, for one thing.

-- Educate yourself about this illness.

Ignorance and fear are the Big Enemies. Educate yourself about your
condition. At a minimum, know what your diagnosis is and what the
symptoms are, and know what meds you're taking and what the
side-effects are likely to be.

-- Exercise regularly and vigorously, if you're physically able.

Many readers and participants in ASDM and SSDM say that regular
exercise really helps them stay on an even keel.

-- Avoid artificial stimulants and depressants.

Some bipolar folks tolerate caffeine (stimulant) and alcohol (depressant)
just fine in moderation--though both substances can potentially
interact in nasty ways with commonly used medications, alcohol especially.

Some folks find that they need to avoid these substances entirely.

If you ARE going to drink espresso and Scotch (hopefully not at the
same time!) make sure that your doctor(s) know(s) about it, and
that you're not setting yourself up for a nasty drug interaction...

...and remember that moderation, as in so many things, is key, and
abstinence might very well be the best choice.

-- Enlist the support of family and friends.

The importance of having a good support structure cannot be overemphasized.

Sadly, sometimes friends and family members can't handle the idea of a
loved one with a "mental illness." This is usually ignorance and fear
talking, and often these people can be educated and brought around.

If there are people that you can really trust and talk to, let them
know about what's going on with you.

-- Join a support group.

Check the "Resources" section of the FAQ for information on how to find
a "real-world" support group near you... but don't neglect the many
online support groups that are available. :-)


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