Living with BiPolar Disorder

Effective treatments and self-help techniques can limit the impact on your everyday life.





Staying active and eating well


Eating well and keeping fit are important for everyone. Exercise can also help reduce the symptoms of bipolar disorder. Particularly the depressive symptoms.


It may also give you something to focus on and provide a routine, which is important for many people.


Weight gain is a common side effect of medical treatments for bipolar disorder. A healthy diet and regular exercise may help limit this.


Some treatments also increase the risk of developing diabetes. Or make it worse if you already have it. Maintaining a healthy weight and exercising can help limit the risk.


Have a check-up at least once a year. This will monitor your risk of developing cardiovascular disease or diabetes.


This will include:

  • recording your weight

  • checking your blood pressure

  • having any appropriate blood tests


Self-care and self-management


Self-care is an essential part of daily life. It means taking responsibility for your own health and wellbeing. You do this with support from those involved in your care.


It includes:

  • staying fit and maintaining good physical and mental health

  • preventing illness or accidents

  • caring more effectively for minor ailments and long-term conditions


People with long-term conditions can benefit a lot from being supported to improve their self-care.


They can:

  • live longer

  • have less pain, anxiety, depression and fatigue

  • have a better quality of life

  • be more active and independent


Self-management programmes


These aim to help you take an active part in your own recovery, so they're not controlled by their condition. They may be helpful to people who feel distressed and uncertain about the disorder.


Talking about it


You may find it easy to talk to family and friends about their condition and its effects. Or you might find it easier to turn to charities and support groups.


Many organisations run self-help groups. They can put you in touch with other people with the condition. This can help you get helpful ideas and realise you're not alone in feeling the way they do. Some organisations also provide online support in forums and blogs.


Some useful charities, support groups and associations include:

Talking therapies are useful for managing bipolar disorder, particularly during periods of stability.


Services that can help


You might access many different services during treatment. Some through referral from your GP, others through your local authority. Community Mental Health Team.


Community mental health teams (CMHT)


These provide the main part of local specialist mental health services. They offer assessment, treatment.


Crisis home-based treatment services


These allow you to be treated at home, instead of in a hospital, for an acute episode. These are specialist mental health teams. They deal with crises that occur outside normal office hours.


Acute day hospital


These are an alternative to inpatient care in a hospital. You can visit every day or as often as you need.


Assertive outreach teams


These teams offer intensive treatment and rehabilitation in the community. The teams assign a keyworker to meet the needs of individuals living with severe and constant mental health challenges. They can provide help in a crisis situation and are good at supporting individuals to prevent crises from developing.


Keyworkers (mental health nurses, support workers or social care workers) often visit people at home. They also liaise with other services, such as your GP or social services.


They can also help with practical problems.


For example:

  • helping to find housing and work

  • support with household tasks and daily activities


Avoiding drugs and alcohol


Some people with bipolar disorder use alcohol or illegal drugs to try to cope with pain and distress. This can cause harm and is not a substitute for effective treatment and good healthcare.

You may have separate but related problems with alcohol and drug use. This may need to be treated separately.


Avoiding alcohol and illegal drugs is important for recovery.


Living with or caring for someone with bipolar disorder


People living with or caring for someone with bipolar disorder can have a tough time. During episodes of illness, the personalities of people with bipolar disorder may change. The illness may cause them to behave out-of-character.


Sometimes healthcare professionals or the Gardai may become involved. Relationships and family life are likely to feel the strain.


You may be the closest relative of someone with bipolar disorder. If so, you have rights you can use to protect their interests. Ask mental health services to decide if they should be admitted to hospital involuntarily. This can happen if they cannot identify that there is a problem needing intervention.


You may feel at a loss if you're caring for someone with bipolar disorder. Finding a support group and talking to other people in a similar situation might help.


If you're having relationship or marriage difficulties, contact specialist relationship counsellors. They can talk things through with you and your partner.


Dealing with suicidal feelings


Having suicidal thoughts is a common depressive symptom of bipolar disorder. Without treatment, these thoughts may get stronger.


If you have bipolar disorder, the risk of suicide is 15 to 20 times greater than the general population.


As many as 25-50% of people with bipolar disorder attempt suicide at least once.


The risk of suicide seems to be higher earlier in the illness, so early recognition and help may prevent it.


It is very important to create a crisis plan to prepare for a time of serious suicidal thoughts.

The plan should include contact details for people who can offer support, including:


  • GP

  • Support person - family or friend)

  • Keyworker

  • Community mental health team


Make sure to check availability especially ‘out of hours’ and keep contact details up to date. It’s a good idea to update this plan when reviewing the overall treatment plan.


If you’re feeling suicidal or having severe depressive symptoms contact your GP, keyworker

Call 999 or 112 if you or someone you know is about to harm themselves or someone else


Self-harm


Self-harm is often a symptom of mental health problems such as bipolar disorder.

For some people, self-harm is a way of gaining control over their lives. It can also be a temporary distraction from mental distress. It may not be related to suicide or attempted suicide.


Treatment options for bipolar disorder


If you don't get treatment, episodes can last for between three and six months. Episodes of depression tend to last longer, for between 6 and 12 months.


With effective treatment, episodes usually improve within about 3 months.

Treatment can be with one or more of the following.


Medication


Medication can prevent episodes of mania, hypomania (less severe mania) and depression. These are called mood stabilisers.


Short-term medication can reduce distressing symptoms during an episode. Longer term preventative (prophylactic) medication will reduce the chances of relapse.


Medication will also treat the main symptoms of depression and mania when they occur.


Psychological treatment


Talking therapies can help you deal with depression. They can also give you advice on how to improve relationships and address any unresolved trauma or emotional distress.


Lifestyle advice


Lifestyle advice can include information about:


  • regular exercise

  • planning activities you enjoy that give you a sense of achievement

  • improving your diet

  • getting more sleep


Most people get the most of their treatment without having to stay in hospital.

You may need hospital treatment if your symptoms are severe. You might also need it if you are in hospital involuntarily. In some circumstances, you could have treatment in a day hospital and return home at night.


Medication


Several medications are available to help stabilise mood swings. These are mood stabilisers and include:


  • lithium carbonate

  • anticonvulsant medicines

  • antipsychotic medicines

If you're already taking medication for bipolar disorder and you develop depression, your GP will check the dose. If you aren't taking the right dose, the GP will change it.


Episodes of depression are treated slightly differently in bipolar disorder. This is because the use of antidepressants alone may lead to a hypomanic relapse.


Depression in bipolar disorder can be treated with a mood stabiliser and psychological supports and therapy.


Your GP or psychiatrist may recommend you stop taking medication for bipolar disorder. If so, the dose will be reduced over at least 4 weeks. It can be up to 3-months if you are taking an antipsychotic or lithium.


You may wish to try to gradually stop taking medication. It is always best to do this with professional advice and support. An advanced directive is very useful in this circumstance.

If you have to stop taking lithium for any reason, see your GP about taking an antipsychotic or valproate.


Lithium carbonate


Lithium carbonate is the medication most commonly used to treat bipolar disorder.

It is a long-term method of treatment for episodes of mania, hypomania and depression. It's usually prescribed for at least 6 months.


Stick to the prescribed dose and don't stop taking it suddenly (unless told to by your doctor).

For lithium to be effective, the dosage must be correct. If it's incorrect, you may get side effects such as diarrhoea and vomiting. But tell your doctor immediately if you have side effects while taking lithium.


You'll need regular blood tests at least every three months while taking lithium. This is to make sure your lithium levels aren't too high or too low.


Avoid using non-steroidal anti-inflammatory drugs (NSAIDs) with lithium, unless prescribed by your GP.


Your community pharmacist will advise about all over the counter (OTC) preparations which may interact with lithium. It is always a good idea to attend the same community pharmacy each time you need one.


Lithium and aripiprazole are the only medications given to adolescents over 13 years of age with bipolar disorder.


Unlicensed medicines may be prescribed for children. This is only if there are no suitable alternatives and it can be justified by expert agreement.


Anticonvulsant medicines


Anticonvulsant medicines include:

  • valproate

  • carbamazepine

  • lamotrigine

These medicines are sometimes used to treat episodes of mania. They're also long-term mood stabilisers.


Anticonvulsant medicines are often used to treat epilepsy. But they're also effective in treating bipolar disorder.


A single anticonvulsant medicine may be used. They may also be used with lithium when the condition doesn't respond to lithium on its own.


Valproate


Valproate isn't usually prescribed for women of childbearing age.

This is because there's a risk of physical defects to babies, such as:


  • spina bifida

  • heart abnormalities

  • cleft lip


There may also be an increased risk of developmental problems, such as:


  • lower intellectual abilities

  • poor speaking and understanding

  • memory problems

  • autistic spectrum disorders

  • delayed walking and talking


Your GP may use valproate if there's no alternative. Or if it's unlikely you'll respond to other treatments. They'll tell you about the risks and check you're using reliable contraception.

You'll need to visit your GP to have a blood count when you begin the medication. You'll need to do this again 6 months later.


Carbamazepine


Carbamazepine is usually only prescribed an expert in bipolar disorder. To begin with, the dose will be low and then gradually increased.


Your progress will be carefully monitored if you're taking other medication. This includes the contraceptive pill.


Your liver and kidney function will be checked when you start and after 6 months.

You'll also need to have a blood count at the start and after 6 months. You may also have your weight and height monitored.


Lamotrigine


You'll usually start on a low dose and gradually increase.

See your GP immediately if you're taking lamotrigine and develop a rash. You'll need to have an annual health check, but other tests aren't usually needed.


If you are on the pill, talk to their GP about different methods of contraception


Antipsychotic medicines

Antipsychotic medicines are sometimes prescribed to treat episodes of mania or hypomania. Antipsychotic medicines include:


  • aripiprazole

  • olanzapine

  • quetiapine

  • risperidone


They may also be used as a long-term mood stabiliser. Quetiapine may also be used for long-term bipolar depression.


Antipsychotic medicines can be useful if symptoms are severe or behaviour is disturbed. The initial dose may be low, as they can cause side effects. For example:


  • blurred vision

  • dry mouth

  • constipation

  • weight gain


You'll need to have health checks at least every 3 months. These might be more often, particularly if you have diabetes. If your symptoms don't improve, you may be offered lithium and valproate as well.


It is also recommended for moderate to severe manic episodes in adolescents with bipolar disorder.


Rapid cycling


You may need lithium and valproate if you experience rapid cycling. This where you quickly change from highs to lows without a "normal" period in between.


If this doesn't help, you may be offered lithium on its own. Or a combination of lithium, valproate and lamotrigine.


Learning to recognise triggers


You can learn to recognise the warning signs of an episode of mania or depression.

Someone close to you may be able to help you identify your early signs of relapse from your history. For example, a mental health professional, peer support worker, family member or friend. Wellness Recovery Action Plans (WRAP) are very useful. Your local community mental health team can advise you on how to develop this plan.


This won't prevent the episode from occurring, but it will allow you to get help in time.

This may mean making some changes to your treatment. Your GP or specialist can talk to you about this.


Psychological treatment


Some people find psychological treatment helpful.

This may include:


  • psychoeducation – to find out more about bipolar disorder

  • cognitive behavioural therapy (CBT)

  • family therapy

  • Supportive psychotherapy (counselling)

  • Trauma informed psychotherapy


Psychological treatment usually consists of around 16 sessions. Each session lasts an hour and takes place over a period of 6 to 9 months.


Pregnancy


Managing bipolar disorder in women who are pregnant or trying to conceive is complex.

The risks of taking medication during pregnancy aren't always that well understood.

The risks of treating or not treating women with bipolar disorder during pregnancy will be discussed. The specialist mental health services will need to work closely with maternity services.

The services will develop a written plan for managing the treatment.


The plan should be drawn up with:


  • patient

  • partner

  • obstetrician

  • midwife

  • GP

  • public health nurse

The following medication isn't routinely prescribed for pregnant women with bipolar disorder:


  • valproate – there's a risk to the foetus and the subsequent development of the child

  • carbamazepine – it has limited effectiveness and there's risk of harm to the foetus

  • lithium – there's a risk of harm to the foetus, such as cardiac problems

  • lamotrigine – there's a risk of harm to the foetus

  • paroxetine – there's a risk of harm to the foetus, such as cardiovascular malformations

  • benzodiazepines – risks during the pregnancy and immediately after the birth


You may become pregnant while taking medication prescribed to treat bipolar disorder. It's important that you don't stop taking it until you've discussed it with your doctor.

If you are prescribed medication after the birth, it may affect your decision to breastfeed. Talk to your pharmacist, midwife or mental health team.







If you need further support remember to let us help you here at #talktotom. We can be your guide - contact us on (0818) 303061or via Whats App.  To launch a chat now click here.  You can find out more about our counselling service here.





Other services you where you can reach someone to talk to:

Samaritans offers a 24 hour listening service over text message, text 'Hello' to 087 260 9090 to get started (standard text messaging rates apply) or call 116 123 to talk to someone over the phone.

Childline text and instant messaging services are available from 10am - 4am every day to young people under 18, text 'Talk' to 50101 to talk to a trained counsellor by text message or call 1800 66 66 66.



Visit Your GP:

We always recommend that you visit your GP with whatever health issues you are facing.  Don’t feel embarrassed or ashamed.  Your doctor is a professional health care provider and will be familiar with how you are feeling.  You mental health is just that - your health.  You would visit your GP if you had been feeling physically unwell right ?  Your emotional health is just as important as your physical well-being - in fact the two go hand in hand.  If you don’t have a current GP you can find a list of services in your area here.  You can also contact the CareDoc service on 1850 334 999




Contact the Emergency Services:

If you are an immediate danger to yourself and are going through a suicidal crisis  please contact the emergency services by dialling 999 or visit your nearest Emergency Department.

All information from HSE.ie