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Guide to Bipolar Disorder
The bipolar disorder guide has been developed for people with bipolar disorder, their family members, relatives and friends. The guide provides guidelines, tips and practical tools that can be useful in everyday life. You can choose to read the chapters in order or simply what is relevant to your current situation. You can easily navigate through the left side menu (if you’re using a desktop device) or through the menu above (if you’re using a mobile device).
Learn to live with bipolar disorder
It is sometimes assumed that the symptoms of mental conditions such as bipolar disorder are due to some kind of weakness or character fault in those they affect. This is untrue. People with bipolar disorder do not choose their illness any more than those with diabetes or arthritis choose theirs. Bipolar disorder occurs when something goes wrong within the brain. It is nobody’s fault and no one is to blame. Psychiatrists use the words ‘depression’ or ‘depressive episode’ to describe the unhappiness seen in bipolar disorder and ‘mania’ or ‘manic episode’ to describe the euphoria. There is also a milder form of mania known as ‘hypomania’. In truth, rebuilding your life can be as challenging as treating the disease itself. It may require learning new skills and changes to your lifestyle. Tackling prejudice takes courage and perseverance. But if bipolar disorder is affecting you, either as a patient or a carer, you should take comfort in knowing that thousands of people like you are living fulfilling and productive lives. It may not always be easy, but living with bipolar disorder does not mean you have to give up your ambitions and goals. No one with bipolar disorder should be defined by his or her illness. With good guidance and skilful management, living with bipolar disorder can become as much about living as it is about the disease. “Caring for someone with bipolar has been a real rollercoaster ride. I have been through every emotion imaginable. Anger, denial, grief, and panic. But also hope, joy, and pride. I have given up a lot – my job, my social life, many friends – and my marriage came under considerable strain. Later my daughter told me she was so glad that the family stayed together. But it was touch and go for a while. The more I have learned about the disorder, the easier it has become. Today, my daughter is stable and independent and has moved on with her life. I am involved in several carers’ organisations both on a national and international scale. It’s hard work, but very satisfying. It’s not the life I dreamed of. But it is a good life, and you can’t ask for more than that.” A mother’s view “I felt very alone for a long while. Nobody understood what I was going through, because I didn’t really understand it myself. I didn’t know whether the problem was with me or with the world outside. There were times when I felt great, so my family and friends couldn’t understand it when I suddenly couldn’t get out of bed. They thought I was being lazy or arrogant or going through some sort of phase. So I ended up feeling guilty and worthless as well as depressed. Later, when I was diagnosed and got treatment, I realized that I didn’t have to feel bad about myself anymore. I’m taking more control over my life now and mending broken bridges with my family. There are some friends I’ll never get back. But that’s OK. I’m making new ones all the time.” Emily’s view Rebuilding your life may require acquiring new knowledge and a lifestyle change. Facing all of this requires courage and perseverance. However, if you’ve been affected by bipolar disorder, whether as a patient or a family member, you must still have confidence in the fact that thousands of people with the same diagnosis lead meaningful and productive lives. It may not always be easy, but living with bipolar disorder does not mean having to abandon your dreams and goals. No one with bipolar disorder should be defined by their diagnosis. Managed properly and with good guidance, life with bipolar disorder can allow for a fulfilling life. Different people suffer bipolar disorder in different ways. Some experience severe unhappiness but only mild episodes of euphoria. Others have extremely troubling manic episodes and very little depression. Some switch between different moods several times a year, while others remain stuck in one mood or another for many months. Psychotic symptoms such as hearing voices or unrealistic beliefs are also common. Once you have been diagnosed, your doctor will decide which type of bipolar disorder you have. You may then work together with your mental healthcare team to decide the most appropriate treatment.
Bipolar disorder is a serious mental illness that affects mood and behaviour.
Indeed bipolar disorder is one of the more common mental illnesses. It affects between three and five per cent of all adults throughout the world . Men, women and children are all affected.
For most the condition will persist for many years. It may last a lifetime, sometimes fading away, sometimes returning months or even years later.
Living with bipolar disorder is tough. This is just as true for carers, friends and family members as it is for people living with the disease themselves.
The disorder causes severe changes in mood, from intense unhappiness, to energetic euphoria, to mixed moods in which a fidgety energy is combined with feelings of desperate sadness.
These moods can last many weeks or months and go far beyond the kind of mood swings that might be considered ‘normal’.
The result is often difficult behaviour, damaged relationships and severe restrictions on performance at school or in the workplace. Unfortunately the disorder also carries a stigma that can lead to unfair discrimination and isolation. All of this significantly reduces quality of life.
The good news is that once bipolar disorder has been diagnosed, all of these negative consequences can be addressed. Effective treatments can bring the severe changes in mood under control. This, in turn, can allow patients and those around them to start putting their lives back together.Perspectives
It can be just as challenging to regain control of your life as treating bipolar disorder itself
Types of bipolar disorder
This means their treatment is either inadequate or non-existent. Their mental condition deteriorates, their physical health may also suffer and untold damage may be done to their lives and the lives of those around them. Early diagnosis is therefore extremely important. However, bipolar disorder is not an illness you should try to diagnose yourself. For a proper medical diagnosis you must consult a doctor. Guidebooks, such as this one, will list symptoms and risk factors. On the internet there are a number of sites that claim to help you assess your own bipolar risk. But these can only ever give a rough indication. They are no substitute for a proper medical examination. Indeed, there are a number of conditions that may have similar symptoms to bipolar disorder (see table 1), so if you have any concerns at all about your mental health it is important to consult a doctor without delay. Anyone can get bipolar disorder. The condition affects men, women, children and adolescents. However, some people do seem to be more at risk than others. Risk factors include: Bipolar disorder can begin with a whole range of different signs or symptoms depending on the individual. None of these symptoms on its own means you definitely have bipolar disorder. However, if you have noticed a number of these symptoms occurring at the same time, or find yourself switching from manic symptoms to depressive symptoms, you should seek medical help. Here’s how some people with bipolar disorder have described their symptoms: ‘Like I’m drunk on life’ HYPOMANIA ‘It feels good at first then it turns into a monster’ ‘Like falling into a well’ DEPRESSION ‘Everything is out of synch’ MIXED STATE One of the barriers to prompt diagnosis of bipolar disorder is the widespread ignorance that surrounds the condition. This has led to many myths and misconceptions about the illness. Some of these have little truth to them. Others are simply rubbish. Here we address some of the most commonly held beliefs about bipolar disorder:
One of the unfortunate aspects of bipolar disorder is that many people spend years with the wrong diagnosis or no diagnosis at all
Who gets bipolar disorder?
Other explanations for bipolar disorder-like symptoms
Early signs and symptoms
Symptoms of mania
Symptoms of depression
What bipolar disorder feels like
‘Joy is surging through my veins’
‘My creativity goes into overdrive’
‘I’m so agitated I want to smash everything around me’
‘I’m totally out of control’
‘I’m drowning in black treacle’
‘Everything just grinds to a halt’
‘It’s an emotional overload’
‘Like standing on shifting sand’Myths and misconceptions
So, where should you seek this help? The answer may vary according to your own personal circumstances and how you feel about the healthcare services available to you. In most instances the first port of call should be your family doctor. He or she will be able to make an initial assessment and decide if you should be referred for a specialist opinion. In some instances you may be able to seek specialist care yourself through a mental health outpatient facility. Or, if you have concerns about consulting directly with medical staff, you may prefer to talk to a social worker, a member of a community group or someone at your place of worship. They will be able to direct you, and possibly accompany you, to the best place to get medical care. Groups set up by people with bipolar disorder themselves, or by carers and family members, are also a valuable source of information and advice during the early (and later) stages of bipolar disorder. The big message is that, whoever you decide to talk to about your concerns, it is important that you TELL SOMEONE. Don’t suffer in silence. This will only make things worse. Often the secret of accurate diagnosis and optimal treatment is to keep talking with your healthcare team. Communication can be the key to effective care. Having decided to seek help, your next task is to decide what information to take. One of the reasons that bipolar disorder is so often misdiagnosed is that the doctor is given only half the story. People with bipolar disorder may not feel ill during periods of excitement or euphoria, so they only consult their doctor when depressed. The doctor only sees half the disease and may make the wrong diagnosis. This may delay adequate treatment. To ensure your doctor has all the information needed to offer a comprehensive diagnosis you should: Most doctors will want to assess both your mental and physical health before deciding what to do next. Techniques they may use include: Based on the results of these tests the doctor may then decide to refer you to a psychiatric specialist. Or you may be asked to monitor your mood, feelings and ability to function over a period of time. If your symptoms are diagnosed as due to bipolar disorder, your doctor should then explain what happens next in terms of treatment and continued monitoring. This can be a very upsetting and confusing time. You will, most likely, have many questions you want to ask so it would be helpful to think about these in advance so that you can get as much information as possible. Here are some suggestions: If you are a carer or family member, there may be times when you think your loved one should seek medical help, but they are reluctant to consult a doctor. This can be an extremely difficult situation that needs very delicate handling. You know your loved one best, so only you can decide the best way to proceed. Techniques that can help include:
If you are concerned that you or someone you care for may have bipolar disorder, it is time to seek professional help
Talk to about your concerns
What to say
What to expect from your doctor
On diagnosis
Reluctance to seek help
To some people, the diagnosis of bipolar disorder offers a welcome explanation for the way they have been feeling. To others, it comes as a crushing blow. Many more have mixed feelings. Whichever way you feel about it, you are likely to have a number of concerns and questions surrounding your diagnosis and what it will mean for your life. It is likely that your life will change now you have been diagnosed. On the positive side, you are in a much better position to receive the most appropriate treatment for your disorder to help reduce and alleviate your symptoms. There is no doubt that this should improve your life immeasurably. On the other hand, you will have to come to terms with the fact that you have a chronic mental illness. This is undoubtedly a challenge. But, with the right help and guidance, it is a challenge that can be overcome. Most people with bipolar disorder find their condition improves significantly once they begin appropriate treatment. There is no ‘cure’ for bipolar disorder, but effective treatment will enable you to control the illness. In time you will learn how to monitor your condition, recognize the triggers, and work with your healthcare team to tailor your treatment accordingly. Equally, you will learn how to adjust your lifestyle to minimize the impact of your condition. This will allow you to live a full and active life. With good treatment most people with bipolar disorder will have periods of their life when they are free of symptoms. However, manic and/or depressive ‘episodes’ are likely to recur from time to time. How often this happens and how long you will have between recurrences depends on the individual, on how well the treatment is working and on other issues such as whether or not you have other illnesses. Left untreated, bipolar disorder tends to get worse over time, which is why it is so important to get an early diagnosis and begin appropriate treatment. Many newly diagnosed people are understandably afraid that they may have to be admitted to hospital. This is not usually necessary once the disorder has been diagnosed and is being effectively managed. However, untreated or poorly treated bipolar disorder can lead to manic or depressive episodes that may make you act in a way that puts your own wellbeing or that of others at risk. Under these circumstances, you may be admitted to hospital to get your condition back under control. Quando qualcuno riceve la diagnosi di disturbo bipolare, i familiari a volte si chiedono se hanno causato il disturbo. Ma la verità è che il disturbo bipolare non è colpa di nessuno. Il disturbo si manifesta a causa di diversi fattori, molti dei quali non sono ancora del tutto compresi dal momento che i ricercatori stanno ancora cercando di comprenderne lo sviluppo. Se hai il disturbo bipolare, è improbabile che tu o la tua famiglia avreste potuto fare qualcosa per prevenirlo. “In many ways the day I was diagnosed was a good day for me. Here was proof that I wasn’t imagining it all. There really was something wrong with me and maybe now I could get help. But at the same time, I was really afraid of losing control over my life. I did not want to be defined by my illness.”
What now?
How will bipolar disorder affect my life?
Will I ever get better?
How will the illness progress?
Will I need to go to hospital?
Am I to blame?
La prospettiva di un padre
“Per me il giorno in cui mio figlio Mikael è stato diagnosticato è stato devastante. Fino ad allora avevo sempre pensato che il suo comportamento strano fosse una sorta di fase o qualcosa che sarebbe passato col tempo. Improvvisamente ho capito che né la mia vita, né quella di Mikael o della nostra famiglia sarebbero mai state normali di nuovo. Ci è voluto molto tempo per accettarlo.”Sometimes a diagnosis of bipolar disorder can lead the patient or family members to question whether it is something they have done that has led to the onset of the illness. The truth is that bipolar disorder is nobody’s fault. It occurs due to a number of factors, many of them still poorly understood. If you have bipolar disorder it is unlikely that there is anything you or your family could have reasonably done to prevent it.Michael’s view
There are four cornerstones to the treatment of bipolar disorder:
You might think that ‘psychotherapy’ would involve lying on a couch in a darkened room while a bearded analyst asks you difficult questions about your childhood. In fact psychotherapy is usually a lot more enjoyable than that. Mostly it involves simply sitting down with a therapist, either one-to-one or in group sessions, and talking about your condition and how to cope with it. Indeed, psychotherapy is often referred to as ‘talking therapy’.
Psychotherapy – A part of treatment
Psychotherapy is an important part of managing bipolar disorder and is used in conjunction with medication. Its aim is to ensure that once your symptoms are under control, you have the skills and strategies to take charge of your condition and put your life back on track.
Psychotherapy will help you manage your mood, respond positively to whatever triggers your symptoms and build a supportive environment in which to live with your condition. It will also focus on some of the life skills you need to put your life back together once you have started out on the road to recovery.
There are a number of different approaches to psychotherapy which are delivered in slightly different ways. You can therefore choose the approach and the therapist with whom you feel most comfortable. Your healthcare team will be able to guide you towards the best approach for you. Or you can obtain contact details through therapists’ professional organizations or through bipolar support groups.There are several types of psychotherapy used to treat bipolar disorder:
Perhaps understandably, many people with bipolar disorder are nervous about taking medicines that act on the brain. However, it is important to understand that bipolar is a disorder of the brain, so this is where the medication must act if it is going to work. Bipolar medicines work by correcting faults in the way your brain regulates mood and thinking. Once the medication has begun to have an effect and you start to feel better, it can be tempting to start skipping doses. However, if you stop taking your medication, it is likely that your symptoms will return. Also, in some instances, suddenly stopping your medication can cause symptoms such as insomnia and confusion. You should, therefore, never stop your medication unless advised to do so by your mental healthcare team. Above all, if you do decide to stop your medication, it is important that you tell someone. Because bipolar is a variable disorder that goes through phases and affects different people in different ways, there are a number of medicines used to treat it. As time goes by, it is likely that your doctor will occasionally change your medication, either by increasing or decreasing the doses you take or by switching you to a different medication altogether. This does not necessarily mean that the medication has stopped working; it could mean that your condition has moved on to another phase. Medications for bipolar disorder can be divided into three main categories: those used for stabilization and to prevent new episodes; those used to treat manic or mixed episodes; and those used to treat depression. The doses of medication used to treat manic, mixed, or depressive episodes tend to be higher than those used for stabilization. So, if you are suffering side effects during treatment for an acute episode, these may disappear once your condition has stabilized and the doses of your drugs are lowered. If you are experiencing an acute manic or mixed episode there are a number of drugs that can help you regain control of your feelings and behaviour. The type of medicine used will depend on the severity of your symptoms, what type of bipolar disorder you have and on what has worked for you in the past. Depressive episodes are often the most difficult part of bipolar disorder to treat. The aim is to bring your mood back up to a level where you can function normally. The challenge is to do this without triggering a manic or hypomanic episode. Different kinds of drugs are used to treat depression in bipolar disorder. For example, some drugs that were originally used to treat psychosis (antipsychotics) or epilepsy (anticonvulsants) can improve depressive symptoms and mood stabilizers can also be used – either in combination or alone – to treat depression. In the past, it was quite common to use antidepressant drugs to treat depression in bipolar disorder. However, we now know that, while these drugs can help some people, this is not always the case. There is also a risk that antidepressants could trigger a manic or mixed episode. For this reason, doctors are often cautious about using antidepressants in bipolar disorder and usually combine them with a mood stabilizer. ECT may be offered in hospital to some patients who have been admitted for very severe mood episodes that do not respond to normal therapy. ECT uses electrical shocks to induce epileptic fits. This can produce a rapid improvement in symptoms. ECT is a very effective and safe procedure, although it may cause some problems with your memory. These usually disappear within a few months. Because ECT is a major procedure it involves a detailed informed consent process. This allows you to ask any questions and discuss concerns you may have with your doctor. You may then make your decision on whether or not to go ahead with the procedure. During stabilisation, different types of drugs are used alone or in combination to stop your mood swinging from one extreme to the other and to keep you functioning normally. The treatment is designed to prevent the return of acute manic or depressive episodes, reduce any other symptoms you may have and help improve the way you feel in your day-to-day life. Drugs used to prevent relapses are sometimes known as mood stabilisers. Some of these only protect against relapses into a manic phase whereas others only protect against relapses into depression. Some (such as lithium) protect against both. Sometimes drugs that were originally used to treat psychosis (antipsychotics) or epilepsy (anticonvulsants) are also used in stabilisation. Often a combination of drugs is needed. Your doctor will choose the combination that is best for you, based on whether your biggest problem is with mania or depression and on which drugs have worked for you in the past. Therapy for stabilisation and prevention of new episodes is designed to be taken in the long term. It does not always begin working straight away and you may not notice much improvement in your symptoms during the first two or three weeks. Nevertheless, you should keep taking your medication, as it is usually more effective if it is taken continuously rather than on and off. In the long term, continuing your medication should help prevent relapses. After two or three weeks your symptoms should begin to improve. If they do not, make sure you let someone in your healthcare team know. Once your symptoms have begun to improve, the next goal of treatment is to keep you free of symptoms for as long as possible. These symptom-free periods are known as remission and will help you begin to recover and live the life you want to live. The risk of having a relapse depends on how good you are at taking your medication, how serious your symptoms are and on whether or not you have other mental health problems. Recovery can be achieved by effectively preventing relapses over the long term. Like many medicines, the drugs used to treat bipolar disorder can have unpleasant side effects. Your healthcare team is well aware of this and should be monitoring your progress once you have begun your treatment. Some drugs are more likely to cause side effects than others, and some drugs produce different side effects at the beginning of the treatment than later on. In any case, your doctor will be able to help reduce the unpleasant effects of medication, either by adjusting your dose or by switching you to a different drug all together. “The treatment is working. It’s such a relief. My wife is so much calmer now. Before she began treatment, the whole family was frantic with worry. We didn’t know what she was going to do next. Everybody was anxious and it was impossible to have a normal family life. Now she is calmer we can all relax a little.” Side effects of medications used for bipolar disorder include:
Medication is almost always an essential part of the effective care of bipolar disorder.
Treatment for manic or mixed episodes
Treatment for depressive episodes
Electroconvulsive therapy (ECT)
Stabilisation and prevention of new episodes
Medicines used
Side effects
Husband’s view
Side effects of medications used for bipolar disorder
Stress is a major trigger in bipolar disorder and, unfortunately, virtually impossible to avoid completely. It is, however, possible to reduce the impact stress has on your life. The first step to dealing with stress is to recognize when it is affecting you. There are a number of warning signs It’s easy to say, but a lot harder to do, especially if you are already feeling stressed. In your mind In your body -Hands tremble and feel sweaty Once you know you have bipolar disorder it makes sense to avoid the stressful situations that can trigger episodes. For instance: Bipolar disorder can interfere with the way you think, causing you to get confused easily and become forgetful. This can make it difficult to carry out even simple organisational tasks. There are, however, a number of tools you can use to make these tasks easier to handle. Ranging from simple diaries, calendars and memory joggers to sophisticated pocket computers, these devices can help to bring even the most chaotic life back under control. Many people with bipolar disorder learn to predict the onset of manic or depressive episodes. For instance, by keeping a mood diary you can check to see if there are any patterns of events or feelings that commonly occur before an episode. This can then allow you to take pre-emptive action. When we are feeling fine, most of us just get on with living our lives. We don’t think too hard about all the things we are doing well. But if we are feeling low, we all tend To focus on the negative things in our lives. This makes us feel even worse. So, next time you are feeling good about yourself, take a moment to think about why. Write down all the things you enjoy about your life. What are the five best things about your life right now? While support groups can be an enormous help to anyone living with bipolar disorder, it is important not to surround yourself completely with people from the ‘bipolar world’. Try not to lose touch with friends and family. If possible, continue with activities that have nothing to do with bipolar disorder. Nobody wants to live in a bipolar ghetto. Living with bipolar disorder can be lonely. You may feel that you are facing insurmountable problems and have no one to turn to for help. This is where support groups can be of huge assistance in helping you move forward with your life. There are a number of different support groups available, both for people with bipolar disorder and for those who care for them. Working at local, national, and international levels, these groups can help people with bipolar disorder in a number of different ways. Most work on the principle that there is strength in numbers and that problems are better shared with people who really understand them. Through a support group, you will be able to join forces with people who have been through similar experiences to yourself. By meeting up, talking through problems, or simply by socializing with people who really know what it is like to live with bipolar disorder, you may find that many of the problems in your life become easier to resolve. Different groups specialize in different areas of support. So it is worth looking around for one that is most likely to meet your own specific needs. Who knows, you may decide to join several. Most support groups have been set up by people who have been through similar experiences. It can be a huge relief simply to sit down in a safe and relaxed atmosphere to chat with someone who really knows what you are talking about. It may help you express your feelings more freely and start to resolve some of the confusion that often surrounds people affected by bipolar disorder. If you are feeling angry or frustrated about your situation or the care you have received, it is much easier to express these views to someone who might share them than to a professional who may be part of the service you are angry about. The only real experts on living with bipolar disorder are those who are already doing so. As a result, most support groups are full of people who can share how they have managed to cope and move on with their lives. They may be able to deal with your questions themselves or know where to go to find the answers. Many support groups have used this expertise to produce helpful information in leaflets, videos, and on websites. People affected by bipolar disorder can sometimes find themselves in conflict with the law, in financial difficulties, struggling with the benefits system, or facing discrimination at work. In these situations, it is a lot easier to stand up for your rights when you have a strong, well-informed support group behind you. Many bipolar support groups have extensive links with groups in other areas of mental health and beyond. This enables them to join forces and campaign on a wide range of issues that may affect people living with bipolar disorder. It also enables them to join in consultation exercises that can be hugely influential in deciding future government policy. It is not just people with bipolar disorder who need to know more about the illness. Society at large remains extremely ignorant of the disorder. This can lead to misconceptions, prejudice, and abuse. Many support groups seek to address this ignorance through awareness-raising initiatives and educational campaigns. There are a wide variety of groups and organizations that can offer support, guidance, or even just a friendly ear. “It was only after joining the support group that I began to feel I wasn’t alone. The group has allowed me to share my experiences, and I have learned an enormous amount from other members. Sharing the same experiences creates a bond of friendship within the group, and it is a kind of healing experience to meet other people who know and understand what it is to live with bipolar disorder. The support groups are a kind of safe haven. Here, people with bipolar disorder can meet and share stories with peers who have had the same experiences as themselves. All of us understand what it means to have been through a disruptive manic episode and through a terrible deep depression. Often, you find that the person you are speaking to understands what you are saying before you have even finished your sentence. The support group is the only place where I can speak frankly about my problems and fears. I know that the others understand me and that everything I say will be kept confidential. This has given me a lot of strength and enabled me to find hope again after a very disruptive episode that changed my life completely. I have also started to volunteer with the group, and this is extremely rewarding. It has helped me regain confidence in my own abilities and given me the courage to rebuild my life. I have made a number of changes to enable me to cope with my disorder, and through the group, I have been able to pass on my experience. I have been able to use the suffering that I have gone through in a positive way to help others facing the same questions that I did. The outside world does not always understand what it means to be depressed or manic. In the group, everyone understands, and this has been a great help with my recovery.”
There are a wide variety of coping techniques that you can use to manage your mood and protect yourself from the impact of your condition.
Dealing with stress
Learn to relax
Here are a few strategies you could try:Stress Warning Signs
– Thinking about your problems
over and over again
– Circular thinking – being worried about being worried
– Becoming confused
– Feeling afraid
– Feeling out of control
– Feeling something terrible is going to happen
-Dry mouth and throat
-Heart beats too fast
-Tightness in the chest
-Headache
-Tense neck muscles
-Tingling fingers
-Shortness of breath
-Feeling dizzySimplify your life
Use assistive technology
Understand your mood
Dealing with low mood
Boost your confidence
Life beyond bipolar
Join a Support Group
Shared experiences
Information and expertise
Advocacy
Networking
Fighting ignorance and prejudice
Daniel’s view
Psychoeducation uses this principle within a clearly defined therapeutic programme in which a trained therapist delivers targeted information that is designed to reduce both the frequency and the severity of your symptoms. Psychoeducation should be an integral part of your overall treatment plan. It will increase your knowledge and understanding of your illness and treatment and help you cope more effectively. It may also help you to keep taking your medication. Many people find that they benefit not only from the information they receive during psychoeducation, but also from the learning process itself. There are several different ways in which psychoeducation can be delivered. These include one-to-one sessions with a therapist, sessions aimed specifically at carers and family members, group sessions attended by several people with bipolar disorder, and mixed group sessions attended by a number of people with bipolar disorder and members of their family. A course of psychoeducation should include a series of sessions over a period of months or even years. It is likely to be most effective if given during your more stable periods when you are most able to absorb the information. Family-focused psychoeducation may also cover such issues as the financial, social, and psychological strains that can be caused by looking after someone with bipolar disorder.
The more you learn about your condition the better placed you will be to take control of it.
A typical psychoeducation programme would cover issues such as:
You can access psychoeducation services either directly by contacting the psychoeducation coordinators in your region, or through your mental healthcare services, your family doctor, or via a mental health support group.
It puts an often unbearable strain on relationships which can begin to crumble and crack. If you are in the midst of a manic or depressive episode, you may be unaware of the damage being done to your friendships and family relations. Then, when you emerge into recovery you can find that your life has become a rather lonely place. Caring for someone with bipolar disorder can also put relationships with friends, colleagues and family under huge strain. Indeed, it is at times like these that you find out who your real friends are. You may find that people you thought were friends slowly stop coming around. Even family members may become distant. Existing tensions in your close relationships can start to rise to the surface. There are no easy answers to any of these problems. However there are some practical steps you can take to make things easier “My husband Graham has had bipolar disorder since before we were married 30 years ago. He’s always managed really well. Taken his medication, held down a high-pressure job and helped bring up our two children. But everything changed when he retired last year. He stopped taking his pills, became very agitated and started making ridiculous plans and buying things we didn’t need. Eventually he moved out. I was so worried and missed him so much. As a family, we made sure that Graham had good support from the psychiatry outreach team. But sometimes I wondered: ‘What about me? Where’s my support?’ I got in touch with a local carers’ group. Just having someone to talk to was a tremendous help and helped me realise that none of this was my fault. Slowly, with some gentle persuasion, I managed to convince Graham to come back home. It’s wonderful to have him back. Things are still hard, but they are getting better” “When I retired I thought: ‘This is great. Now I can really live my life like I’ve always wanted.’ I bought a faster car, moved into an expensive new apartment, decided to learn the piano and joined the golf club. Six months later I found myself living alone, surrounded by unused sports equipment and a piano I could neither play nor afford. I must admit I got very low. Things seemed very bleak at the time.
Bipolar disorder is not easy to live with.
Elaine’s view
Graham’s view
Fortunately my family were incredibly supportive. When I left home, my daughters kept an eye on me and made sure I kept in touch with the healthcare team. Then, when I started to get depressed, my wife came round and made sure I was eating properly. Eventually she was coming round so often it made more sense for me to move back home.
I’m starting to feel a bit better now. I feel so grateful to everyone who has helped me, quite humble and very embarrassed for all the trouble I’ve caused.”
There are several reasons for this. The symptoms of bipolar disorder can make it difficult to lead a healthy, stable life and can encourage certain unhealthy activities and behaviour, such as drinking, taking illicit drugs and smoking. Some side effects of the treatments used for bipolar disorder can have an effect on general health. And bipolar disorder also tends to occur in conjunction with a number of other physical and mental disorders (comorbidities). While it is not the intention of this guide to preach about how healthily you should live your life – you can make your own decisions about how much exercise to take or what to eat – it is worth pointing out that there are a number of areas where looking after your general health will help in the overall management of your bipolar disorder. These include: If you have any concerns or queries about your general health, make sure your communicate these to your healthcare team.
Many people with bipolar disorder struggle with their physical as well as their mental health.
to improve your mental health. It is believed that hormones released during exercise
can help to lift mood. Exercise can be used to bring a healthy routine to your life and
to improve the way you sleep.
affect both those with the condition and those who care for them. This can make
dealing with the disease particularly challenging, sometimes leading people to
become isolated and alienated. The more you can learn about your disorder, the
better equipped you will be to fight this stigma.
As you begin to recover from your illness it is likely that you will also want to start regaining control of your life. Controlling your own recovery is an important part of the healing process as the more independent you become, the better placed you will be to keep your condition at bay. Bipolar disorder touches all areas of life, so there may be some difficult decisions ahead. For example: What should I tell the children? – this is a difficult decision for anyone to make. But it is important that your bipolar disorder does not become a secret that nobody talks about. Children naturally want answers and if they don’t get them they may come up with their own. No one knows your children better than you. So you must decide how much to tell them and when. You may find that talking to someone at a support group helps you make this decision. Some medications used in bipolar disorder should not be used by women who are pregnant. So if you are trying to conceive, you should discuss this with your doctor. Before planning a family there are a number of issues that you will need to discuss with your partner such as: the genetic risk that your child may also develop the condition; how you will cope with having a child; the possibility of relapse after giving birth or during the pregnancy. These will never be easy questions. But by seeking information from your healthcare team you and your partner may be in a better position to answer them. Many people with bipolar are able to continue working normally. Others decide to adjust their working lives to better suit their condition. This might include moving to a less stressful role, reducing your hours of work, avoiding night shift work or taking up a job share. Some employers are much better than others at allowing these adjustments to be made. However, as an employee you are protected by both national and international law against discrimination in the workplace. If you need to stand up for these rights there are a number of sources of help and guidance. These include: your workplace’s human resources department; your union; citizen’s rights organisations; support groups. If your condition has placed limitations on your ability to work you may be entitled to benefits. Sometimes abnormal behaviour during manic episodes can have legal implications – for instance if you spend money that you cannot afford. Advice on your welfare and legal rights can be obtained from your healthcare team, citizen’s rights organisations and support groups. One way of ensuring that you retain control over your life, even in the event of a crisis, is to write out a plan of how you would like to be treated if such a crisis should occur. For instance, if you know you are prone to excessive spending during manic episodes, you might authorize a family member to confiscate your bank cards. There may be treatments you wish to receive and others you wish to avoid. Or people you would like to be informed if you are admitted to hospital. You can record these ‘advance directives’ on a simple card such as the one included on page 77. Or you could even video yourself repeating them. Then you can always be sure that these are the instructions that you drew up yourself.
Family life
Family planning
Work life
Financial planning and legal issues
Advance planning
Bipolar disorder is not just a personal tragedy for individuals with the disease. It can also be hugely disruptive for anyone who is close to them. Parents, children, wives, husbands, partners, and friends can all find themselves thrown into a role for which they feel completely unprepared. Time and again, though, these carers rise to the challenge, helping their loved one through the worst of their disorder and giving them the support to rebuild their lives. It is also important to stress that having a family member with bipolar disorder does not mean you have to miss out on the enjoyment of family life. Many family members and carers are in close contact with the mental healthcare team looking after their loved one. This team is likely to be a good source of information and advice. Here are some questions you might like to ask them: Clearly, any decision you take that may result in someone you care for being compulsorily admitted to hospital will not be taken lightly. It may cause great distress, both to yourself and your loved one, and may seriously damage your relationship. Nevertheless, there may be times when the person you care for is no longer able to make important decisions about their own healthcare. Their condition may deteriorate to the point where it begins to put their safety or the safety of others at risk. Under these circumstances compulsory admission to hospital may be appropriate. You can obtain advice on the legal process for seeking a compulsory admission/treatment order, from your healthcare team, citizen’s advice agencies or from many support groups. The human rights of anyone detained under a compulsory admission order are protected by Articles 5 and 6 of the European Convention on Human Rights. This includes the right to be properly informed of the reasons for detention, the right of appeal and the right of access to legal representation. While many people with bipolar disorder live long, productive, and fulfilling lives, it would be wrong to pretend that the condition cannot have tragic consequences. Suicide is the most tragic consequence of all. Unfortunately, while there are a number of things that carers can do to reduce suicide risks, some suicides simply cannot be prevented. So, if the worst does happen, it is important that you realize THIS IS NOT YOUR FAULT. When experiencing the deep sorrow of losing someone close to you, please look after yourself and don’t compound your pain with feelings of guilt. Suicide Warning Signs:
“Why did this have to happen to us?” It is a question asked, at some point, by many people whose family has been affected by bipolar disorder. And with good reason.
There are a number of things you can do to help your loved one through their illness without missing out on a life of your own:
Questions to ask
Seeking compulsory admission and/or treatment
Dealing with risk of suicide
Measures you can take to reduce the risk of suicide include:
Plan in advance – together with your loved one, write down a ‘plan for life’. This might include:
