I’ve been diagnosed with Bipolar Disorder – Where do I go from here?
by Catherine “Katie” Ness, MA, LCPC
A diagnosis of Bipolar Disorder can be overwhelming. You may have suspected over the years that your moods seemed more intense than those of your family or friends, but actually hearing the diagnosis out loud can confirm that underlying fear that something is not quite right. It also means that you need to take action and find a way to manage your mood. The idea that you need to seek out formal treatment to feel more in control can feel simultaneously overwhelming and relieving. If you have gone to the trouble of getting a formal evaluation or you are at the point that you are considering an evaluation, there is at least a part of you that is ready to change and work towards keeping your mood from dictating your life. However, there may also be a part of you that keeps saying the moods are not that bad and I’ve been functioning fairly well up until now without support. This reaction is understandable, since making the decision to enter into treatment requires a commitment to prioritize your mental health and make some significant life changes.
Do I have to take medication?
One of the most common questions for someone newly diagnosed with Bipolar Disorder is, “Do I need medication?” This is a reasonable concern, since the idea of being on a mood stabilizer for a significant period of time is not appealing to anyone. And although every individual’s situation varies, the simple answer to this question is “yes.” Bipolar Disorder is a mental health issue where neurological differences can be observed between those who have and do not have this diagnosis. Although there is likely a genetic component (there is probably someone in your family that also struggles with Bipolar Disorder or another significant mood disorder) and environmental component that can play a role in how Bipolar Disorder is manifested, the preexisting or resulting neurological differences can be effectively managed with medication.
Is medication enough?
Again, each individual is different, but the simple answer to this question is “no.” Research has demonstrated that a combination of medication and psychotherapy (talk therapy) yields the highest success rates in mood management. Having a trusted professional who is able to understand the depths of your depression, the intensity of your anxiety, the frustration of not meeting your personal goals, and every feeling in between, makes the journey towards emotional stability significantly less daunting. In addition, a therapist can assist in helping you understand the triggers for your mood swings, offer tangible coping skills and address any additional underlying issues that can be masked by the symptoms of Bipolar Disorder.
So once my mood is stable, I’m cured?
Learning to manage Bipolar Disorder goes beyond just mood management. If you have suffered through severe mania or psychosis, your working memory and ability to focus may have been compromised, and learning skills to strengthen these areas can be helpful. Additionally, if you have been living with undiagnosed Bipolar Disorder for years, there is a significant chance it has impacted your relationships, schooling, or career. Learning to interact confidently with others when you are not in a manic state, or remain at work even though your boss is a jerk, may be skills that are underdeveloped because your actions have always been dictated by your mood. Furthermore, any underlying trauma, substance abuse issue, etc., that may have predated the mood swings or was in response to the development of Bipolar Disorder, needs to be addressed or these issues are likely to continue to interfere with reaching personal goals. Even in situations where there have been few consequences from mood swings, there is still a transition into living with “mood stability.” A client of mine once quipped that she spent over a decade trying to shut off all the noise in her head that was a result of Bipolar Disorder, but upon achieving this goal, she then spent the next few years figuring out how to add more excitement to her life because she found the quietness disconcerting.
The journey to emotional wellness is different for everyone. Although there are basic guidelines (like working with a psychiatrist and psychotherapist), and strategies that seem to be universally helpful in managing Bipolar Disorder, your personal goals, expectations and needs are uniquely your own. If you have contemplated moving forward in learning to manage your symptoms, I encourage you to take the next step and seek treatment. “The first step in getting somewhere is to decide you are not going to stay where you are” -JP Morgan
Listed below are strategies that are helpful in learning to manage your mood.
Essential skills when trying to stabilize mood
• Chart your mood
• See if there is a pattern to your mood. Look for specific triggers that push your mood to either extreme and then be mindful of those triggers.
• Learn to manage stress
• Stress and anxiety are two of the primary triggers for mood dysregulation. Check in with yourself 3 times a day and rate your level of stress. On a scale of 1-10, anything above a 4-5 (or whatever level you see as triggering), needs to be addressed. Take a break, go on a short walk, take some deep breaths or experiment with other strategies to decrease stress in the moment.
• Establish a daily routine
• Figure out what time of day you feel most productive and when your energy is lowest. Schedule difficult tasks and exercise when your energy is high and focus on self-care when your energy is low.
• Manage Sleep Hygiene
• If circadian rhythms get out-of-whack, there can be an enormous impact on emotional stability. Have a structured and relaxing bedtime routine (avoid electronics and anything too stimulating). Going to bed at the same time every night and getting up at the same time every morning also goes a long way in regulating mood.
• Develop a support system
• Have a group of trusted individuals who understand how your symptoms affect you. These support people can help alert you if your mood seems to be affecting your thought process and/or just be available to talk to if you need support or are feeling overwhelmed.
• Identify thought patterns that match emotional states
• Write down common thoughts in each mood state (depressed, “normal,” manic). For example, when feeling depressed you may feel like everyone hates you, when feeling “normal”, you may feel like most people get along with you and when feeling manic, you might think you are God’s gift to the world. Being able to match thoughts with an emotional state can help you identify if your mood is affecting your thoughts. Someone in your support system can also be useful in pointing out these patterns.