Bipolar Disorder: Handling the Holidays

With a little planning you can avoid holiday depression, anxiety, and mania -- and enjoy the season.

From the WebMD Archives

The holidays can be a tricky for anyone. But people with bipolar disorder may anticipate November and December holidays with real dread -- and depression.

"The holidays can be very hard for people with bipolar disorder," says Raymond L. Crowel, PsyD, vice president for mental health and substance abuse services at the National Mental Health Association. You'll probably face loads of possible triggers: relatives, stress, exhaustion, and the temptation to overindulge, to name a few. Slipping into a mood swing may be much easier than usual.

So what should someone with bipolar disorder do when the holidays roll around? Be a Scrooge and opt out? Hibernate?

You don't have to do either. WebMD talked to experts about how people with bipolar disorder can weather the holidays -- with tips on avoiding depression and mood swings, planning, enjoying the season, and more.

Bipolar Disorder: Why the Holidays Can Be Hard

Experts say many things come together to make the holidays tough for people with bipolar disorder, including:

  • Disrupted schedules. "The biggest single problem with the holidays for people with bipolar disorder is that they take them out of their routine," says Ellen Frank, PhD, director of the depression and manic depression prevention program at the University of Pittsburgh's Western Psychiatric Institute and Clinic.

    Studies show that people with bipolar disorder do best when they're on a schedule -- getting up, eating, exercising, and going to bed at roughly the same time each day. Even the loss of just one night of sleep can trigger a mood swing. But during the holidays -- when you may be traveling across time zones, partying, or staying up until the wee hours -- it's all too easy to get off track.

  • Over-stimulation. Shopping, decorating, and preparing for the holidays can leave you excited and anxious. Some family reunions aren't always happy. Any excess stimulation can trigger a swing toward holiday depression or mania.

  • Shorter days and longer nights. Some people with bipolar disorder find their mood swings are related to the seasons. Depression is more common in the fall and winter in the northern hemisphere, says Michael E. Thase, MD, professor of psychiatry at the University of Pittsburgh Medical Center.

  • Holiday "cheer". The holidays are a time when excessive drinking is often tolerated, even encouraged. Though unwinding with alcohol can be tempting, it can be bad for people with bipolar disorder. Not only can it interfere with medicine, it may also ruin sleep and make you more prone to mood swings.

  • Excessive spending. It's the season when it seems everyone is running up their credit cards. If you have a history of excessive spending and grandiose gift-giving during hypomanic or manic episodes, you are clearly at risk.

  • Missing your medication. When you're busy, it's easy to forget about your medication. You may even feel tempted to skip a few doses on purpose: it might make it easier to tolerate alcohol, or being a little hypomanic may give you the energy to get errands done. But when you have bipolar disorder skipping your medication is always risky, since it makes your mood less stable.

  • Believing the hype. We all know how we're supposed to feel at the holidays: brimming with joy, good will, and love. But a lot of us don't really feel that way. Being depressed during the holidays can really make you feel out of step, which adds to feelings of isolation.

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Planning for Holiday Success When You Have Bipolar Disorder

It's very easy to let the holidays dictate your life. You have to go shopping. You have to go to your office party. You have to bake four batches of Christmas cookies. It can make you feel completely powerless. Your own needs become irrelevant.

The key is to take control before that happens. "Where is it written that you must do all these things?" says Frank. The key to a successful holiday is to plan for it well in advance, she says. Here are a few tips that may help ease your holidays:

  • Scale back your expectations. Be easy on yourself. "The gifts don't have to be perfect," Crowel tells WebMD. Neither do the decorations. Or the turkey. Or anything.

  • Think twice before playing host. The preparations for a holiday dinner -- shopping, cooking, cleaning -- can be overwhelming for a person with bipolar disorder. So make sure you are really up to it. If you do host, simplify. Pare down the guest list. Cook something you can prepare in advance. Ask for help from friends or family.

  • Be open and direct with your family. Tell them what you need this year. If the usual family gathering of dozens seems like too much, see if your family might cut down the guest list. Obviously, this could cause conflict with the rest of the family. But if the extended family members really care about the person with bipolar disorder they should understand, Frank says.

  • Make this year different. If holidays have not gone well in the past, make changes. Instead of doing the usual dinner at home, go to a restaurant. If staying with your in-laws hasn't been good for you, check into a nearby hotel instead. Or simply get away from all the holiday hubbub and go on vacation.

  • Spread out the visiting. Frank suggests shifting some of your visits into October and January, instead of trying to fit in everyone in November and December.

  • Increase the number of check-ins. You might want to step up the schedule of appointments with your therapist or check-ins with your family and friends. It's a good way of staying grounded.

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Facing Holiday Parties

For a lot of people with bipolar disorder, it's the holiday get-togethers -- family dinners, office parties, neighborhood caroling expeditions -- that cause the most anxiety. Here are some tips for getting through them unscathed.

  • Say "no" sometimes. "Don't overbook yourself," says Crowel. Most of us have more holiday obligations than we can handle. Decide which ones are most important and which aren't. Some events may simply be overwhelming. It's okay to say "no".

  • Have an ally. If going to a party is making you anxious, go with a friend, relative, or co-worker. Arrive and depart together. And your partner could watch your back, helping you avoid alcohol and other temptations.

  • Leave early. Going to a party doesn't mean you have to stay all night. Decide beforehand when you'd like to leave and stick to it. Even stopping in for just a few minutes is okay. Having a getaway plan may relieve a lot of anxiety.

  • Stick to your schedule. If you're having fun, of course you don't want to leave a party to make your bedtime. But you need to follow your regular non-holiday schedule as closely as possible. And make sure to keep up your normal exercise routine too -- or at least get out for quick walks.

  • Try not to overindulge. It's hard, but you really must stay away from alcohol, especially if you've had problems with it in the past. And despite the allure of all those sweets, try to stick to your normal diet.

  • Weigh the pros and cons. Even if it makes you anxious, it's generally a good idea to try going to your family's holiday dinner. But there are exceptions.

    "If you have a really stormy family history, and seeing your family tends to trigger problems, then staying away could be the right move," says Thase.

    But make this decision carefully. Weigh the benefits and the risks. Can you handle the guilt of not going? Most importantly, make sure you have something else planned. Don't just say no and then spend the holidays alone.

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Bipolar Disorder & Shopping Sensibly

It's very easy to get caught up in the frenzy of the season and become fixated on finding everyone the perfect gift. But again, you need to stay in control -- especially if you're prone to unhealthy buying sprees. Here are some suggestions:

  • Keep perspective. Don't get too caught up in finding the best gift for everyone. It's not worth the anxiety -- and besides, your nephew would probably be happy with a check anyway.

  • Stick to a budget. If you have a problem with overspending, come up with an explicit budget well before the holidays arrive. You may want the aid of a friend or family member to help you stick to it.

  • Spread out the shopping. Try to shop ahead. Frank suggests Halloween (or earlier, if you can manage it) as a great time to start looking.

  • Shop online. If you have access to the Internet, online shopping is a low-stress way to avoid the mall's hassles. For a little extra, some sites may even gift wrap.

  • Go for gift certificates. Just about everyone loves a gift certificate. And they don't have to be impersonal. Choose one that fits the person: get your sister one from her favorite boutique and your uncle one from a restaurant he likes.

Caring for Yourself

The holidays are a time when we're encouraged to think about other people instead of ourselves. That's fine, to a point.

But if you focus so much on other people that you neglect yourself, you're at higher risk of descending into mania or depression.That's not good for anyone.

"Your first order of business during the holidays has to be taking care of yourself," says Thase. "If you don't, all sorts of bad things can happen."

Thase compares living with bipolar disorder to diabetes. "Just as diabetics can't eat all of the sweets during the holidays, people with bipolar disorder have to take extra precautions," he tells WebMD. "But if you take those precautions, the holidays really can go well."

So this holiday season, plan ahead, keep to your schedule, and scale back your expectations. If you do, you can beat holiday depression, mania, anxiety, and hassles -- and enjoy the season. That's good for you as a person living with bipolar disorder -- and for your loved ones too.

WebMD Feature Reviewed by Brunilda Nazario, MD on November 30, 2007

Sources

SOURCES: Raymond L. Crowel, PsyD, vice president, mental health and substance abuse services, National Mental Health Association (NMHA), Alexandria, Va. Ellen Frank, PhD, director, depression and manic depression prevention program, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pa. Michael E. Thase, MD, professor of psychiatry, University of Pittsburgh Medical Center, Pa.

© 2006 WebMD, Inc. All rights reserved.

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