In previous blogs, I pointed out how frighteningly little the psychiatric profession knows about hypomania and its treatment. The best information we have, believe it or not, comes from our fellow patients.
In an eye-opening article in the March 2005 Australian and New Zealand Journal of Psychiatry, Sarah Russell PhD of the Melbourne-based Research Matters reported on her survey of 100 bipolar patients who were doing well and what they did to stay well. So novel was the idea of a researcher actually seeking advice from patients that I awarded Dr Russell with “Study of the Year” honors in a newsletter I publish.
Dr Russell’s findings were recently expanded into a small but highly informative book, A Lifelong Journey: Staying Well with Manic Depression/Bipolar Disorder. The book deals with how patients successfully manage all phases of their illness, but what they have to say about controlling their swings into hypomania is particularly insightful:
Jodie, who has been free of serious episodes for three years, has learned to take her pills without resentment, has limited her social activities and involvement in various projects, and has established a regular sleep schedule and other routines. Especially important, Jodie has developed "the capacity and insight to see episodes coming on." For example, when she finds herself talking very quickly and craving excitement, she implements her "action plan."
By the time the hypomanic good times start to roll, Dr. Russell points out, it’s generally too late for most of us. Instead, the people she talked to were microscopically attuned to far more subtle shifts in their moods and behaviors and energy levels, as well as their environment. Rather than simply taking their meds and forgetting about their illness (an impression created by their doctors), patients would “move swiftly to intercept a mood swing.” Moving swiftly often meant a decent night’s sleep and other strategic stop and smell the roses moments.
Susie, for instance, knows her main triggers are family stress and caffeine. When she finds herself buying more than one lotto ticket, visiting adult bookshops and writing late at night, she goes to battle stations. This includes limiting her coffee, restricting her access to cash, turning off her computer after 6 pm, and not going to night clubs on her own.
The people Dr. Russell talked to were uniformly fanatic about maintaining their sleep. When disruptions to their routines did happen, these individuals did not hesitate to take a sleep medication. Adjusting meds doses was par for the course, but meds changes were seen as minor compared to the life and lifestyle changes Susie and Jodie and the others were willing to make.
Common tools included yoga and other stress-busters, but Dr. Russell was quick to note that some found these practices boring. Basically, we are all unique and need to come up with our means of coping. The people in Dr. Russell’s study were smart enough to do just that.
To be continued …
Part VII: We Are Not Helpless Bystanders
Published On: March 31, 2006
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