By Russ Federman, PhD, as told to Hallie Levine
I’ve spent most of my 40-year career working with people with bipolar disorder. I also run a
support group for professionals with bipolar disorder. One of the biggest challenges is to help individuals accept the reality of their diagnosis. This is very common, especially among young adults. But it’s important that they come to terms with it.
We know that delays in appropriate treatment not only worsen symptoms, but more importantly, they affect the long-term prognosis. But while there are many challenges, there are also many ways to find success. Here’s what people with bipolar disorder should keep in mind.
There’s no one-size-fits-all approach.
Bipolar disorder can be challenging to treat because people present with such a broad array of symptoms. There are folks who have mild symptoms, who can live their daily lives without significant disruption, and folks who are constantly in and out of state mental hospitals, functionally disabled. When I craft a therapy approach for my patients, I consider three main things:
- What are their unique symptoms?
- How severe are their symptoms?
- How self-aware are they, and how motivated are they to do the work to get better?
Once I have a good sense of their background and symptoms, I ask what they feel like they need the most help with. Therapy must be tailored to their unique needs, otherwise it won’t do them any good, no matter how determined they are to succeed with treatment.
Lifestyle is key to managing bipolar disorder.
This is important for everyone, but it’s especially essential for those diagnosed with the condition in their teens or early adulthood. They’ll be living with this disease for decades. Oftentimes, this diagnosis is very painful for them, as they worry about the impact of their illness on their future. I explain that embracing a healthy lifestyle can make it easier to both accept and adjust to their disorder. Here’s what I focus on:
Establish a stable sleep schedule. When you get someone with bipolar disorder to start and maintain healthy sleep patterns, it can be as potent as the right medication. It’s very important to focus on an early bedtime and an early morning awakening to get circadian rhythms in sync. Consistency is also key: it serves as a protective guardrail against mood instability.
Avoid drugs and alcohol. They can enhance symptoms of bipolar disorder, such as depression or mania.
Exercise regularly. This is especially important when it comes to managing depression symptoms. When you exercise, your body releases chemicals called endorphins that trigger positive feelings.
Develop a healthy support system. If you have a strong set of friends and loved ones who can provide empathy and encouragement, your condition will be easier to manage.
A team approach works best. A psychiatrist is important when it comes to treatment of bipolar disorder, but they can’t do it alone. While they are often the ones to prescribe life-changing medications, people with bipolar also require talk therapy, too. This helps them sort through the range of issues they deal with every day.
They may also benefit from family-focused therapy (FFT), a form of short-term therapy that includes both them and their parents, partner, or other loved ones. This educates everyone about common symptoms and how they cycle over time, early warning signs of new episodes, and how to stop episodes from getting worse. Research shows this can help improve mood symptoms and functioning.
I also encourage all my clients, especially my teens and young adults, to join a support group. There’s still a lot of stigma associated with bipolar disorder. The truth is people who do not have a lot of exposure to this disease do not understand it. It helps to meet and talk with others of a similar age going through similar issues to find support.
Sometimes, baby steps are needed. Bipolar medications aren’t always pleasurable to take. They come with a whole slew of side effects, including weight gain, nausea, and tremors. People often want to manage the disease on their own. But that usually doesn’t work and can be a recipe for disaster. Instead, I encourage them to just pick a short amount of time -- say, 3 months -- to commit to taking their medications. Once they’ve gotten through that period, they usually see how much better they’re doing, which encourages them to stay the course.
There is a light at the end of the tunnel.
The good news is most people diagnosed with bipolar will improve over time if they’re motivated and able to devote time and energy toward living healthy and well. There’s no doubt that managing mood swings is tough. People with bipolar disorder face a seesaw of emotions, cycling through periods of depression and mania. When they sink into depression, they enter a deep, dark period that can last for months. When they rise up into mania, that sort of elevation is disruptive. It affects their judgment. People often wind up behaving in ways that lead to negative outcomes. So they go into depression again.
But on the positive side, navigating these highs and lows can be so unpleasant that it becomes a motivator for them to stick to treatment. I tell my younger clients that, thanks to advances in treatment, if they set their mind to it, there’s nothing holding them back from living a rich, meaningful life.
Russ Federman, PhD, psychologist, Charlottesville, VA; co-author, Facing Bipolar: The Young Adult's Guide to Dealing with Bipolar Disorder.