Bipolar disorder can be treated with medication, therapy, and lifestyle changes, but sticking with treatment can be a challenge.
Unfortunately, bipolar disorder tends to get worse if you don’t get the proper care, says Carrie Bearden, PhD, an associate professor in the departments of psychiatry and biobehavioral sciences, and psychology at UCLA. "The episodes will only get more frequent and severe the longer their illness is untreated."
The good news is that there are many things you can do that help. Here are 10 tips for keeping bipolar symptoms under control.
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Don’t skip meds
"[Medications] can help you live a much more normal life if you choose to take them," says Cara Hoepner, a nurse practitioner who also has bipolar disorder.
But it isn’t necessarily easy. Lithium is a commonly used drug, but it requires monitoring with blood tests to make sure the dose is correct, as higher levels can be toxic.
And skipping doses of lithium or any drug due to side effects or other reasons can precipitate a relapse. There are ways to deal with side effects; some are even transient, lasting for only a week or two, says Hoepner.
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Get the right amount of sleep
People with bipolar disorder often have problems sleeping. Hoepner says about 25% of them sleep too much at night or take long naps, and about one-third have insomnia even when they aren’t having an episode.
Irregular sleep patterns can precipitate a manic or depressive episode.
Set an alarm and get up at the same time every day, Hoepner says. Even if you don’t have to get up for work, try to schedule regular morning activities such as walking or exercising with a friend (because exercise is important too).
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Use therapy too
"Therapy is really, really important," Bearden says. Some patients, if their mood is stabilized, see a psychiatrist only every month or two. But Bearden recommends more regular therapy, typically cognitive behavioral therapy, which can help people get on a good schedule and understand and interpret events and thoughts.
She also recommends interpersonal therapy, which can be helpful in maintaining stable friendships, relationships, and family interactionoften a problem with people who are bipolar.
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Connect with others
Try to strike a balance in your social life. Overstimulation can be stressful and trigger problems, but so can isolation.
"People who are bipolar tend to have trouble maintaining relationships; they wear friendships out," Hoepner says.
Aim for things that make you feel good: a hobby or sport, or volunteer for a cause that’s important to you. "You’re getting your mind off of yourself and focusing it on something else, which can be really therapeutic," Hoepner explains.
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Know the side effects
Depending on the type, bipolar medications can have side effects like pancreatitis or kidney problems, or more commonly metabolic syndrome (characterized by weight gain, high cholesterol, and insulin resistance).
The best way to combat side effects is to know as much as you can about the drug you are taking and watch for potential problems, Bearden says.
Some medications can’t be taken with certain foods, drugs, or alcohol. Ask your doctor about potential side effects and read about the medication to stay informed.
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Be wary of triggers
Stress, social isolation, sleep deprivation, and deviation from your normal routine can trigger episodes of depression or mania. Be cautious during life changes like starting a new job, going to college, or getting a divorce.
Also be aware that you can encounter problems even when it’s not a major event. "It doesn’t have to be a fight or a major disruption in your day," Hoepner says. "Anytime you are out of balance, it can be a trigger."
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Let your family and friends know what you are going through. They might be able to understand your triggers and help you avoid them, or may be able to realize before you do that you’re entering a manic or depressive episode.
On the other hand, family stress is also one of the biggest factors for relapse, Bearden says.
Doctors will often have you try different doses and combinations of bipolar meds to find the right cocktail, Bearden says.
If your side effects are intolerable or a drug isn’t working, discuss your options; don’t just stop taking it.
"People often think that the doctor knows best and they shouldn’t question their treatment," Bearden says. "But be a good consumer and take charge of your health." Ask questions and know what symptoms a drug is supposed to be helping so you will know if it’s working.
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Steer clear of drugs and alcohol
About 50% of bipolar patients have a problem with substance abuse, Bearden says. This is one of the biggest challenges to getting good treatment outcomes.
Although you might feel alcohol helps you cope with depression, it may actually be contributing to sleep disturbances and mood changes.
Bearden says patients who abuse drugs and alcohol have poor cognitive functioning and a lower chance for a full recovery of mood symptoms.
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Combat weight gain
Many of the medications used to treat bipolar disorder, including lithium and antipsychotics, can trigger metabolic syndrome or weight gain in some patients.
Bearden recommends keeping track of your weight and talking with your doctor if you notice a problem after starting a new drug.
The impact is very individualized; some people don’t have this problem while others do. Eating right and getting regular exercise can help control your weight.
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