Dee Smith showed the signs of bipolar disorder for years before she knew she had it.

The 47-year-old retired paralegal from Murfreesboro, TN, used to stay awake for 3 to 5 days without eating. During those periods, she was irritable, high-strung, argumentative, and sometimes violent and destructive. Her husband of 29 years tells her that she was always like this. But it wasn’t until 2011, when a fight with her husband led Smith to destroy his car, that they learned there was more to her behavior.

“I always assumed I was just this person with issues, and it was pent up, and this is the way I expressed it,” Smith says. Instead, a doctor told her she had bipolar disorder.

This brain condition causes dramatic mood changes. On one side, there’s mania -- a period of high energy, productivity, and risk taking. People might stay awake for days, talk at a mile a minute, wipe out savings accounts with shopping sprees, or exaggerate their own abilities or accomplishments. The other side of the mood swing is depression, when people feel hopeless or worthless and sometimes can’t bring themselves get out of bed. Some people think about suicide.

Between these episodes, though, people with bipolar disorder are emotionally stable. Usually, it takes specific triggers, such as stress, a lack of sleep, or fights with family or friends, to give them a push into a mood swing.

Life with bipolar disorder can seem like a balancing act -- an effort to keep your mood stable and out of mania or depression. But there are many tools people can use to steady themselves: medication, therapy, basic lifestyle changes, and avoiding triggers.

Smith, like many of the 5.7 million Americans who live with bipolar disorder, has learned to stay in control. “It’s a slow process, but it can be done,” she says. “I am living proof. I’ve been this way since I was 18, and only now in my late 40s am I really seeing what life is supposed to be about: living. And it’s 1,000 times better than it was.”

Two Halves of Bipolar Treatment

For most people with bipolar disorder, successful treatment includes two key things: medication and talk therapy.

Many drugs treat bipolar disorder. Some manage mania, while others keep depression at bay. It takes time to find the right mix of medicines that will keep your mood stable and not cause too many side effects, like restlessness, weight gain, drowsiness, or dizziness. It also takes a lot of open communication with your doctor, often a psychiatrist, to get it right.

“The goal of treatment is 100% symptom control -- no cycling, no episodes, and zero percent side effects. And we tweak until we get there or until the patient says, ‘That’s far enough. I’m close enough now,’” says Jim Phelps, MD, a bipolar disorder specialist in Corvallis, OR.  

To keep that level of control, you must take the medications every day. It’s likely that you'll take them for the rest of your life.

Sue Atkinson, 66, of Batavia, IL, was diagnosed 30 years ago and sees her bipolar disorder just like any other long-term condition. “It’s like diabetes. You can’t ignore it. It’s there and you have to take care of it. You have to take your medication,” she says.

The other half of treatment, psychotherapy or “talk therapy,” can teach you how to live with the symptoms of your condition. You might work with a therapist on how you can avoid your triggers or change the way you think about them. She can also help you learn to recognize the signs of an oncoming mood swing and what to do about it.

Not all forms of psychotherapy are designed specifically for people living with bipolar disorder. “You need to do some homework, learn about the kinds of psychotherapies that are specific for bipolar disorder, find a technique that matches your symptoms and needs, and find a therapist who knows how to offer that therapy,” Phelps says. 

Sleep, Eat, Exercise, Repeat

A daily routine sounds pretty basic, but it’s a powerful tool against bipolar mood swings. It’s not necessarily a schedule, with set times to start and finish an activity. Rather, it means you consistently doing things in the same order. For example, get up, take your medication, take a walk.

Good sleep habits are part of a healthy routine. For some people with milder forms of bipolar disorder, a single medication and a sleep schedule or treatment for insomnia can be enough to manage symptoms, Phelps says. “That’s all they need to do, and it’s remarkable. Their life just tunes up.”

Atkinson swears by her routine, which includes taking her medication, going to bed, and getting up at the same time every day. That makes it easier for her to notice any new patterns that could signal an approaching bout of mania or depression. “If I don’t sleep for a few nights, I’m on the phone to my doctor or therapist. I try to get it under control right away.”

For Smith, healthy diet and exercise gave her a sense of greater control over her condition. She started because her medications made her put on some weight. With a healthy diet and exercise every day, she’s lost 20 pounds of what she calls her “medication weight.” “I no longer blame the medication. I now give credit to my diet and exercise. That’s a positive slant instead of looking at it negatively like I used to.”   

Many people with bipolar say a busy life, without spreading yourself too thin, can also help. Smith volunteers, goes to the gym, and leads a Depression and Bipolar Support Alliance (DBSA) support group.

Jeff Fox, a real estate agent in Northridge, CA, who was diagnosed with bipolar 17 years ago, works and runs several local DBSA support groups. “Too much time on your hands can be poison for somebody struggling to get through this,” he says.

Find Your Peace

Stress is a common trigger for bipolar mania or depression. You probably can’t avoid it completely, but the trick is to learn how to manage it and keep it from knocking your mood off balance.

For Smith, worrying about her sons, who live out of state and struggle to make ends meet, is a trigger. Meditation and self-help books on positive thinking help her keep that stress in check. 

For Fox, financial concerns are a trigger. He can’t control the uncertainty of the real estate market, but he can control his response to it. He manages stress and anxiety by reading everything he can about his condition. He says a better understanding of bipolar disorder makes it easier to live with. “Education has been paramount in my recovery. The more I educated myself, the better I felt.” 

Fox also finds peace in helping others. He manages five support groups in his area and passes on the information he reads about bipolar to the members of his group. He tries to teach them what he has learned in the 17 years since he was diagnosed.

“Accepting what I have, not judging myself, not judging other people -- it makes life so much easier,” he said. “Getting there is a hard journey, but it starts with one step.”

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