How to Reduce Bipolar Disorder Mood Swings

In a recent post, I described certain behaviors that help stabilize my moods. I thought that this was important enough information to feature in a distinct post, so here it is.

Get On and Stay On Effective Meds
Getting diagnosed and on the right medication is the single most important thing that someone with bipolar disorder can do to stabilize mood. Getting on the right meds is easier said than done, but well worth the effort. Click here for information on the bipolar meds I'm currently on.

Still meds aren't magic. Although they can reduce the severity of mood swings, they don't typically make mood swings completely disappear. A patient's behavior can also influence mood. I know, from experience, that some of my mood swings are impacted by my response, once I feel the swing coming. 

Behaviors That Impact Depression
If I feel depression approaching, I know that there are thought processes and behaviors I can engage in that make depression more likely, such as...

• Sleeping a lot
• Isolating myself/withdrawing
• Drinking alcohol
• Focusing on negative thoughts and memories 
• Not reliably taking my meds for depression (Wellbutrin)

...as well as thought processes and behaviors that can help me avoid or reduce a plummet in mood:

• Pull my butt out of bed and do something enjoyable (for me, that's usually gardening). I know that when depressed, everything is less enjoyable. But making an effort helps.
• Socialize or at least reach out to one friend 
• Reduce alcohol consumption
• Spend a little time every day thinking about all the things I am grateful for
• Take bipolar meds exactly as directed

Behaviors That Impact Mania & Hypomania
The same is true with mania. The following behaviors will very often trigger or worsen my hypomanic symptoms:

• Lack of sleep
• Being over-sheduled
• Stress from being over-scheduled
• Too much caffeine
• Not taking my meds for managing mania (Seroquel)

While the opposite behaviors will often help me head off mania:

• Get enough sleep  
• Eliminate non-essential tasks from to-do list
• Drink decaf or 1/2 caf coffee or sometimes tea if I feel I need to reduce my caffeine levels. Black tea has about 1/2 the caf as regular coffee. Green and white tea have very little caffeine.
• Take bipolar meds exactly as directed

Taking these measures doesn't always work, but usually has some degree of impact on where my mood is headed. Getting physical exercise is also very helpful for managing all aspects of bipolar, both the ups and downs.

Oops! I better take my Wellbutrin right now :)

Difficulty Accepting Criticism: A Bipolar Patient's Opinion

I don't know if it has anything to do with my mood disorder, but I have always been somewhat reactive and sullen when criticized. Sometimes critical remarks are just a case of haters entertaining themselves. But some criticisms can be valid and learned from. 

 
Communication With My Husband
Marriage takes hard work. My husband and I don't communicate all that well, but it's something we're trying to improve on. To encourage conversations about our relationship, and to help prevent our exchanges from feeling like personal attacks, we are trying to have a regular sit down, at a scheduled time, to discuss anything on our mind.

When we've tried to open up communication in the past, it usually consists of me doing most of the talking, and him getting defensive, and then me getting angry, and him getting angry...You get the picture. Not a constructive exchange. But yesterday we did much better than usual, and it wasn't just me talking. He also contributed to the exchange, including a couple of criticisms of my behavior. Even though I agreed with his observations, it was still hard to swallow.

Valid Criticisms of Me
When I think about what I don't do well, or what I can improve upon in my behavior and relationship with others, there are certain things about myself that I recognize to be true. I can be difficult to deal with, since my mood is not always so stable. My meds usually help eliminate big, destructive bipolar swings between mania and depression, but I'm still moody. Other things that I recognize about myself: I drink too much. I need to socialize more. I need to develop better work/life balance...just to name a few. But my husband had some new ones for me. 

As we discussed parenting, he pointed out that I don't consistently follow up on getting the kids to do things or on discipline. That's absolutely true. I'll say, "Clean your room", and then never check to see if it gets done. Or I'll start a "Healthy Eating Chart" for the kids, and, over time, stop tracking their progress. I know consistent behavior is one of my challenges, and being reminded of that is not a bad thing. My husband is getting sick of always being the "heavy" with the kids. He needs me to share some of the work.

He also made an observation that completely took me by surprise. He said that I get very short tempered and difficult just before my period. I always thought that my mood was just all over the place, never relating some of it to menstruation. He's very observant, so I tend to think there may be something to this. I'll keep a closer eye on my mood as my period approached each month.

How do you react to criticism? Do you share any of the same challenges that I need to work on? Leave a comment and share!

Bipolar Stats:

• Level of Mania (on scale of 1 - 10, with 1=none, 10=practically levitating): 0
• Level of Depression (on a scale of 1 - 10, with 1=none, 10=can't get out of bed): 0 
• Feel pretty good today!
• Medication Compliance (0 = not taking, 5=taking some, 10=taking all): 5 (not compliant with Wellbutrin for past few days)
  

I am recording my mania and depression bipolar data separately because I often have mixed episodes where manic and depressive symptoms occur at the same time.

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional, not a computer. 

Cool Looking Pill Case Container for Medication: A Bipolar Patient's Opinion

Medication compliance (taking meds as directed) is typically a big challenge for those with bipolar disorder. Actually consistent behavior in general is not easy for us. Well, for me, I am pretty consistent with my addictions, nicotine gum and alcohol :/.

To make remembering my meds a little easier, I always carry a pill case with my daytime medication (Wellbutrin). While in Chicago last year we went to the Museum of Contemporary Art Store and I found this adorable metal pill case that looks like, and opens like, a capsule. It's small, about a couple of inches long and easy to throw in a purse or a backpack. I don't see this pillbox on the MCA Store website, but do see it on the Exit9 website, under "capsule pill container".

Even with the pill box, I still sometimes manage to miss my day meds, because I don't take the pill as soon an I remember and eventually forget again. But the case certainly does help me more often take my medication as directed.

Bipolar Stats:

• Level of Mania (on scale of 1 - 10, with 1=none, 10=practically levitating): 0
• Level of Depression (on a scale of 1 - 10, with 1=none, 10=can't get out of bed): 0 
• Stable right now, but mood feels wobbly.
• Medication Compliance (0 = not taking, 5=taking some, 10=taking all): 5 (not compliant with Wellbutrin for past few days)
  

I am recording my mania and depression bipolar data separately because I often have mixed episodes where manic and depressive symptoms occur at the same time.

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional, not a computer. 

Bipolar Disorder & Happiness: Read Book "Happier"

There's definitely a plague of self-help books available these days, many written by entirely unqualified people. My mom didn't write a book (she could have), but one of her jems was "Smile more. It will make you happier", advice that I found rather insulting as a person with a mood disorder. Really mom, it's that easy? Poof! I'm still waiting for the scientific article, "Major depression vanquished by more frequent smiling."

In one of my least favorite self-help books,  Simplify Your Life, by Elaine St. James, the author recommends that readers throw out all medication other than aspirin. Honestly? That's some dangerous advice. I hope she has some hefty liability insurance.

Happier by Dr. Tal Ben-Shahar
Anyway, I have finally found a self-help book that appears to be different. It's called Happier. Ben-Shahar is a Harvard professor who teaches the most popular class ever offered at Harvard, Positive Psychology (PSY 1504). I have just started the book, which needs to be completed as a workbook, not just a magical thing you read that suddenly makes you happier. Since it requires an investment of time, I plan to complete it over the summer when I am done with school. I'll add updates to this post as I work through the book, to let you know what I find useful.

Why Is Happier Better Than Your Average Self-help Book?
Dr. Ben-Shahar has spent his life studying happiness, and what people can do to make themselves happier. He is not just pulling platitudes out of his bum. He is combining scientific info on the topic with his knowledge as a psychologist, as well as drawing on his experiences with disappointment after reaching various goals throughout his life and then finding that the good feelings associated with his achievements were fleeting. What he thought should be making him happy wasn't. In his book, he describes how to form habits associated with becoming a happier person. Then the reader does the hard work.

Habits Can Change a Person's Mood
I know, from experience, that some of my mood swings are influenced by my response once I see the swing coming. If I feel depression approaching, I know that there are thought processes and behaviors I can engage in that make depression more likely, such as...

• sleeping a lot
• isolating myself/withdrawing
• drinking alcohol
• focusing on negative thoughts and memories 
• not reliably taking my meds for depression (Wellbutrin)

...as well as thought processes and behaviors that can help me avoid or reduce the plummet in mood (the opposite of those I've listed). 

Same with mania...

• lack of sleep
• being over-sheduled
• stress from being over-scheduled
• too much caffeine
• not taking my meds for managing mania (Seroquel)

These behaviors encourage my hypomania, while the opposite behaviors will often help me head it off.

Give Happier a Try and Share What You Think
So, with this guys credentials, and the fact that the book is about developing habits (the daily practices that define how we live our lives), I think that it probably has something substantial to offer. 

If you feel so inclined, give Happier a read and post a comment on what you think. Perhaps this book could be especially useful for those of us with mood disorders. Let's find out!

Bipolar Stats:

• Level of Mania (on scale of 1 - 10, with 1=none, 10=practically levitating): 3
• Level of Depression (on a scale of 1 - 10, with 1=none, 10=can't get out of bed): 3
• Medication Compliance (0 = not taking, 5=taking some, 10=taking all): 5 (not compliant with Wellbutrin for past few days)
  

I am recording my mania and depression bipolar data separately because I often have mixed episodes where manic and depressive symptoms occur at the same time.

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional, not a computer. 

Bipolar Disorder and Stress: Decreased Ability to Deal With Minor Emotional Stressors

Today started with promise. I slept in until 10:00 am (sweet!) and then began preparing for my youngest daughter's dance recital. The entire family planned on attending, except for my oldest daughter who had been staying at a friends house, about an hour away, for the past several days. The friend's mom and I were planning to meet, at a half-way point, some time in the late afternoon or early evening. Then, as I was in the bathroom transforming myself from a sleep-hag into a presentable mom, it happened...the 10:45am text.

"Where are you?", a message from the mom who had been hosting my oldest daughter. She was at the drop off point. My response... "WHAAAAAAAT?!?!?!"

I had just finished beautifying myself and was working on getting my little one all fancy for her moment in the spotlight. My little dancer had to be at the venue an hour before show time, meaning we had to leave the house by 11:30. There was no way I could drive and hour round-trip to pick up my eldest, and still get my baby girl to her recital on time. The mommy-meltdown began.

I am lucky enough to have a sweet, helpful husband who was willing to go pick up my oldest daughter, while, after a series of stressful communications to handle the situation, I scrambled to get my youngest daughter ready and delivered backstage on-schedule.

As soon as my husband left, my two youngest kids switched into naughty obnoxious mode and my in-laws called to finalize plans for the recital. It was the perfect storm. Me scrambling to try and get out of the house on time, two kids with an excess supply of naughtiness, phone ringing and clock ticking, all while waiting for my husband to get back so that I could leave.

None of this is life-or-death stuff. I realize that. But, together, this collection of too many minor stressors is just the kind of situation that flips the switch in my brain from mental health to mental illness, from stable mood to wobbly mood. Although I am cool as a cucumber in a real emergency, this assortment of minor problems was just too much for me to deal with. I was on-edge, stressed, pissed and emotionally brittle...not a fun person to be around.

When I got my dancer to her backstage diggs, she became scared, clingy, and didn't want me to leave. I was the one designated to save seats for the entire family, since I was the first one there. More stress. I stayed with my baby until just before the curtain rose, and the family ended up saving a seat for me (Thanks guys!). The show was great, and kids so cute! Although I was still grumpy, finally being able to sit down and watch the recital mellowed me out a bit.

Picked up $29 worth of McDonald's food for the family on the way home (Don't think I have ever spent that much on a family meal a MickyDs). Delivered it home, ate, and while dad and the kids went to the neighbors for a swim, I went back to sleep. When I am faced with too much, drifting off to sleep, with my iPod reading me a Philippa Gregory audiobook bedtime story, is something that flips my switch back to normal. 

After my nap, I rounded up the kids and got Father's Day cards and presents prepared for tomorrow. A good ending to a chaotic day.

What type of stressors toss you into bipolar emotional storm? Share your experience!

Bipolar Stats:

• Level of Mania (on scale of 1 - 10, with 1=none, 10=practically levitating): 3
• Level of Depression (on a scale of 1 - 10, with 1=none, 10=can't get out of bed): 4
• Medication Compliance (0 = not taking, 5=taking some, 10=taking all): 5 (not compliant with Wellbutrin for past few days)
  

I am recording my mania and depression bipolar data separately because I often have mixed episodes where manic and depressive symptoms occur at the same time.

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional, not a computer. 

Bipolar Smokers: Implication of Nicotine Additiction and Other Substance Use Disorders

Last month (5/2012) a scientific article appeared in the Psychiatric Annals titled "Implications and Strategies for Clinical Management of Co-occurring Substance Use in Bipolar Disorder." It is not actually a new study, but a new article that examines what is currently known on the topic by looking at data from numerous studies. My last post, "Dual Diagnosis of Bipolar & Substance Use Disorder: Summary of New Scientific Article" summarized the general findings of this study.

Bipolar Disorder and Substance Use Disorders
Bipolar patients have an unusually high incidence of Substance Use Disorders (SUD), including nicotine addiction. When bipolar disorder and an SUD occur together, it is considered a dual-diagnosis condition, and described as co-morbidity. Previous studies have shown that 50-60% of bipolar patients will develop at least one SUD in their lifetime. 

Bipolar Disorder, SUDs & Cigarette Smoking 
Cigarette smoking (nicotine addiction) is also considered a Substance Use Disorder. The medical co-morbidities commonly associated with smoking, such as cardiovascular disease and metabolic syndrome (pre-diabetes), occur at higher rates in patients with bipolar disorder and, as would be expected, at even higher rates in bipolar patients with SUDs, particularly nicotine dependence. Smokers with bipolar disorder also have particularly low quit rates.

In addition to the overall impact that smoking has on health, cigarette smoking can reduce plasma levels of many medications used to manage bipolar disorder, making the disorder even more difficult for smokers to control.

The article also noted that even though smoking cessation could dramatically improve patients physical and mental health, few psychiatrists discuss this topic with their bipolar patients, and when the topic of nicotine addition is broached, smoking cessation medications are rarely prescribed. But I do wonder how many patients don't tell their doctor that they smoke.

My History of Smoking
I have smoked cigarettes, on and off, since adolescence. I have a lot of addiction vices, including alcohol as well.  Lately I have spent more days smoke-free than I have in the past, and currently I am not smoking, but am chewing nicotine gum to curb my cravings. The gum works very well to manage my nicotine addiction.

I am not sure, from this study, if nicotine alone lowers plasma levels of bipolar medications, or if smoking (and the additional chemicals it introduces) is the culprit. I will try to get hold of studies that specifically deal with cigarette smoking and bipolar disorder and see if there is data on this.

If you are a bipolar smoker, don't quit quitting. Discuss smoking with your psychiatrist, and see if he/she will recommend some smoking cessation tactics. If your therapist isn't helpful, consider trying nicotine gum, patches or look into the following free programs:

• Guide to Quitting Smoking from the American Cancer Society
• Smokefree.gov from NIH National Cancer Institute
• CDCs List of Government Resources on How to Quit Smoking 

Bipolar Stats:

• Level of Mania (on scale of 1 - 10, with 1=none, 10=practically levitating): 0
• Level of Depression (on a scale of 1 - 10, with 1=none, 10=can't get out of bed): 3
• Medication Compliance (0 = not taking, 5=taking some, 10=taking all): 5 (was not compliant with Wellbutrin yesterday)
  

I am recording my mania and depression bipolar data separately because I often have mixed episodes where manic and depressive symptoms occur at the same time.

This blog is for informational purposes only, it is not intended to be used for the treatment of mental illness. If you are having emotional troubles, please see a mental health professional, not a computer. 

Dual Diagnosis of Bipolar & Substance Use Disorder: Summary of New Scientific Article

As an educator, I have access to a database of current scientific research through my school's library, so I regularly check for new studies on bipolar disorder. When I find something good, I'll share it on the blog, translating some of the science lingo into regular-speak layman's terms.

Last month (5/2012) a scientific article appeared in the Psychiatric Annals titled "Implications and Strategies for Clinical Management of Co-occurring Substance Use in Bipolar Disorder." It is not actually a new study, but a new article that examines what is currently known on the topic by looking at data from numerous studies. There is so much info in this study, I plan to write a few blog posts, one to summarize each of the main findings, including the association between bipolar disorder and cigarette smoking.


Bipolar Disorder and Substance Use Disorders
Bipolar patients have an unusually high incidence of Substance Use Disorders (SUD). When bipolar disorder and an SUD occur together, it is considered a dual-diagnosis condition, and described as co-morbidity. Previous studies have shown that 50-60% of bipolar patients will develop at least one SUD in their lifetime. 

SUDs have been found to have a significant negative impact on the quality of life of bipolar patients. They are associated with higher rates of unemployment, violence and incarceration, as well as lower adherence to psychiatric treatment, longer and more frequent episodes, more mixed episodes, poor response to treatment, and double the number of suicide attempts.

It is not entirely clear why this co-morbidity occurs. No genetic or neurological explanation has been identified. The commonly held belief is that bipolar patients are self-medicating. Rates of substance use remain high even during periods of relatively normal mood, and rather than helping, can worsen symptoms of depression (alcohol) or mania (cocaine).


And if the bipolar + SUD association isn't problematic enough itself, nearly half of those diagnosed with bipolar disorder have at least one other co-occurring psychiatric disorder during their lifetime.

Treatment of Co-occurring Bipolar and Substance Use Disorder
Treating the bipolar disorder and SUD separately, as though they are not interrelated, doesn't work well. Researchers are beginning to encourage clinicians to consider bipolar disorder and the co-occurring SUD together, as if they are one disorder--bipolar substance abuse. In this integrated approach, the patient is responsible for his/her participation in treatment, such as taking bipolar meds as directed, abstinence from substance use and integrated group therapy. This approach was found to be twice as effective in reducing substance use as was group drug counseling alone. Still, there are currently no optimal treatment guidelines for co-occurring bipolar disorder and SUD.

Does Bipolar Medication Help Reduce Substance Use?
Yes and no. Atypical antipsychotics, such as Abilify (aripiprazole) and Seroquel (quetiapine), have been reported to help reduce stimulant abuse, such as cocaine and methamphetamine, but not use of alcohol. 

Anti-convulsant medications such as Depakote (valproate), used in combination with lithium, have been shown to reduce alcohol use in bipolar-SUD co-morbid patients. But a similar study of rapid-cycling bipolar patients showed that this drug combo was no better than lithium alone for reducing substance use.  In addition, the anti-convulsant/lithium combo was not found to be more effective than lithium alone in controlling bipolar symptoms in bipolar-SUD patients.

What the Hell Am I Doing?
Personally this paper was so striking because it seems that much of what they were describing pertained to me, and perhaps you as well. I am bipolar, have what I consider to be a moderate drinking problem, and, although currently not smoking, I've smoked intermittently throughout my life since I was a teen. Now I use nicotine gum to help me avoid cigarettes. (Soon I will create another post on what this study revealed about smoking and bipolar disorder.)

The paper even discussed how rates of metabolic syndrome (pre-diabetes) and cardiovascular disease are significantly higher for bipolar patients and even higher for those with co-occuring bipolar disorder and substance use. My family has a history of cardiovascular issues (what both my mother and grandmother died from). 

Considering all of this information together really shook me up and made me realize that in addition to the psychological dangers of bipolar disorder, its presence is associated with other medical problems, such an increased risk of dying prematurely from liver failure (alcoholism) or cardiovascular disease (smoking and family history).

Today one of my students told me that her mother had just died of cancer. Her mother was only was 44 years old. I am 44 years old, and acutely feeling my mortality. I want to live and see my children grow up.