Author: Melissa Howard

 

There are many aspects to my daily life that I can attribute my many years of stability to.

The skills I have acquired did not happen overnight, it has taken me over two decades to discover and implement a care plan that was realistic and lowered my likelihood of a relapse. My care team, medications, learned skills, consistency and commitment to my mental health have all contributed to my euthymic state (euthymia is a normal, tranquil mental state. Without the presence of mania or depression. In those who live with bipolar disorder, euthymia is the goal of the treatment for bipolar patients.)

Throughout my journey there was an exhaustive amount of time spent on trial and error. Finding the proper medication combination, a psychiatrist I could trust, building a consistent routine that I felt I could manage on a daily basis and the acceptance of my diagnosis were the building blocks that set me up for success. This process evolved over time and as my life circumstances changed. I continue to be mindful that living with bipolar disorder will progress and be altered as I age.

In the beginning, understanding and caring for my mental illness was uncomfortable and felt foreign to me. I had so much stigma directed towards myself that admitting I was mentally ill and required treatment was overwhelming, embarrassing and created an immense amount of shame. In my late teens when I received my bipolar 1 diagnosis it was suggested that I create a lifestyle that put my mental illness first, not exactly what I expected to be doing at nineteen.

For my childhood and teen years, I desperately tried to mask my mental health struggles. Now I was expected to put them first, something I had no idea of how to do.

I relied heavily on my psychiatrist not only for support but also for the resources I could use to educate myself about my illness. I was inundated with negative articles and books of what my illness was, the untoward symptoms and how it was one of the most difficult mental illnesses to treat. I was left feeling hopeless and feared what my future had in store for me.

Only when I stopped fighting against my mental illness and made the decision to accept it, did I see an improvement in my moods.

I applied for disability in order to fully look after myself. Working full time had become stressful and challenging—often triggering mood episodes. I received disability benefits for six years, allowing me to create a structure for self-care that bipolar disorder demands. I was able to maintain a part-time job during this time, which gave me the confidence and understanding that I could thrive with the disorder.

When I married my husband, I no longer required the disability benefits but what I took away from that experience was invaluable. Being on disability at the beginning was shameful for me, however it gave me the time to establish a s self-care routine that allowed me to thrive and live my version of a normal life.

My current self-care routine:

⁃ I take my medication religiously and have it easily accessible in the morning and at bedtime so I remember.

⁃ I maintain a standing appointment with my psychiatrist. I check-in every eight weeks to discuss my current mood, medications, any new symptoms or side effects I am concerned about and if there have been any changes to my life that could trigger and episode.

⁃ I see my psychotherapist monthly to continue working through any issues from my past and any current circumstances that are affecting my life. These appointments are a combination of cognitive and dialectic behavioural therapy as well as transactional writing.

⁃ I am a stay-at-home mom and grateful that I could create a daily routine that includes healthy eating habits, exercise, connecting with friends and family on occasion, minimizing my stress by being firm with my boundaries, walking my dog by the lake, enjoying a coffee and listening to music.

⁃ I was able to work as a part-time dog walker. This allowed me to be in nature and around my favourite animal.

⁃ I practice sleep hygiene. For me, it is waking up and going to bed at the same time, getting 7-8 hours of uninterrupted sleep at night and unwinding an hour before going to bed. This can be anything from watching a show, reading or playing a brain agility game on my phone.

⁃ I manage my alcohol intake. Having little to no alcohol. (I must admit this is sometimes challenging for me to adhere too but I understand the need for it.) It is frowned upon while taking psychiatric medication.

⁃ I ask for extra support from my care team if I become concerned with any mood shifts. This is in the form of scheduling additional appointments.

⁃ I respect my limitations, knowing that if I do not, I could experience an episode. Balance is key in maintaining my stability.

⁃ I engage in enjoyable activities like travelling, socializing with my friends and family, practicing yoga and Pilates as well as appreciating my alone time.

This list was created over time and has evolved with my changing life circumstances. Getting married, having children, moving homes, just to name a few. I kept what worked for me and tried new suggestions when I found my routine was waning and needed adjustments.

A letter to my younger and newly diagnosed self.

So, you have been diagnosed with bipolar 1 disorder. This is not your fault. Please do not look at this as a negative life sentence, rather, the beginning of a lifelong journey with stability being the goal.

I understand that isolating yourself could be an appealing option right now, however, it will make your symptoms worse and more difficult to manage.

You have every right to be angry. Your frustrations, fear and disappointment are all valid. Alternatively, you may also feel relieved because there is an explanation for the extreme polarity of your moods. Your behaviour is not a character flaw, it is caused by a mental illness that you do not know how to manage yet.

First, let’s begin with your support team. It is imperative you find people who you can trust and are dependable. This may look like your primary care practitioner, psychiatrist, person of faith, teacher, spouse/partner, parent, friend, sibling, extended family member or employer. It will look different for everyone.

You were probably diagnosed by a psychiatrist and have been prescribed medications to stabilize your mood. This could be mood stabilizers, antidepressants, second generation antipsychotics or a combination of them. This process may be long and arduous, however, if you stay the course the likelihood of stabilizing will be much higher than if you cycle through starting and stopping medications when you feel like nothing is making a difference.

You have every right to seek a second opinion or find another practitioner if your current one is not aligning with your needs or expectations.

Learn to self-advocate for yourself. It is a skill that will serve you well in life. What this looked like for me was asking questions, if I did not understand the language my doctor was using when we discussed the disorder, I always asked for clarification. I was nervous to go on medication, my doctor provided me with the resources to research the medications she was prescribing. Your psychiatrist or health care provider can be a great asset for information and ally when learning more about your diagnoses. I see that the internet has a wealth of information available. This is a great place to start learning about your diagnosis. Be wary, there is a lot of misinformation, make sure to look at government run websites as well as foundations and medically reviewed materials. ( I wish all of this information was easily accessible when I was newly diagnosed.)

I was honest about my symptoms in order for my psychiatrist to prescribe the correct medications. I always asked what type of side effects I could experience and what to do if I became concerned or was having an adverse reaction. I made sure to mention that I hated the feeling of brain fog and I asked that I not be prescribed something that could mimic this sensation. (Some psychiatric medications have a higher chance of creating this side effect than others.) On one occasion I had a horrible physical reaction to a mood stabilizer that was prescribed. My doctor worked quickly to change the medication and found one with less side effects. I was placed on an antidepressant at the beginning of my journey that made my depressive episode worse. I was quick to discuss this symptom with my doctor and they were able to find one that was more effective and did not aggravate my episode further.

It is key to have a conversation about everything that is worrisome to you. Because finding a combination of medications that work in unison can be a difficult process, you have every right to participate in your care plan. Your doctor is there to listen to you and wants you to be well. If for any reason you do not feel heard, you can look elsewhere for a health care practitioner that aligns with the type of care you would appreciate. No two people will experience bipolar disorder in the same way. What works for one may not work for another. That is what makes this disorder a challenge to treat. It is a process of trial and error. Patience and practicing kindness towards yourself can go a long way during this process.

I cannot stress enough, the importance of educating yourself about bipolar disorder. It is a complex illness, however, knowing the basics and how it can affect you will aid in better managing your episodes.

• Understand that you cannot do this on your own and asking for help is not a sign of weakness but of strength.

• Using the internet to search for support groups in your neighbourhood is a great place to start. Some are drop ins, and others, you will have to register for with little to no financial burden. The facilitator of the groups may also be a conduit for finding more individualized care as well as connecting you to others with a similar lived experience.

• Know the crisis hotline in your area as well as where you can access emergency health care if you need it.

I understand how overwhelming and life changing this disorder is. Please know that with medication, support, consistency and a mindful lifestyle will contribute to your long-term stability. It is possible to live a fulfilling life with a bipolar diagnosis.

 

The content of the International Bipolar Foundation blogs is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician and never disregard professional medical advice because of something you have read in any IBPF content.