During bipolar depression activity levels decrease dramatically. Even a relatively mild slump in mood brings with it a sense of heaviness and fatigue. It’s easier to let things slide and to drop out of previous arrangements. Concentrating on anything takes huge effort.
If the depression becomes more severe, activity levels decrease even further. Just trying to link thoughts together becomes a struggle. Sleeping too much is common (although some people find their insomnia increases). Some lose their appetite while others “comfort eat” and put on weight.
The less we do the less we want to do. Depression casts a shadow over everything so even the things you previously enjoyed doing seem like a distant memory. It’s a downward spiral made worse by the fact that necessary tasks aren’t completed or even started, and the mere thought of trying to get on top of things becomes overwhelming.
Knowing this, it becomes crucial to use activity techniques that will reduce the chances of a depressive relapse. Because many people with bipolar are extremely sensitive to changes in routine and sleep habits it’s important to embrace techniques that restore activity levels to normal.
The prospect of dealing with work can seem so monumentally off-putting that it seems simpler to do nothing at all. However, your brain is yearning for the odd sense of reward that comes from the ‘pleasure’ hormone alongside task completion, and it’s surprisingly easy to achieve this.
For example, every text you answer, every email you read, is a small accomplishment. If you have a mountain of ironing waiting to done, don’t think about tackling the mountain; just select four or five items and consider that your task. A wipe over with a duster, the replacement of a book on the shelf: these things seem trivial, but together they are all individual accomplishments.
The symptoms of depression mask the fact that you are more capable than you think you are. Your challenge is to maintain some form of activity but not at the same level of detail or complexity as when you are free from depression. Reward yourself with pleasurable activities and your mood will begin to respond. You may have to put specific time aside for something interesting, amusing or entertaining, and that’s because it’s too easy to ignore it when your mood is slipping. Just a few minutes a day can be enough to escape a low mood.
And no, you aren’t cheating or pretending by taking these small steps. What you’re actually doing is resisting a powerful force through a series of small but very effective countermeasures.
Your depression wants you all to itself. It wants you to become self-absorbed, isolated and detached. As a result, probably the last thing you want is to make arrangements to see friends, but with a little thought you can tailor activities to your requirements.
If the prospect of a full evening out is daunting, consider arranging something in the day, like coffee. If that’s not to your liking, then how about cinema movie? The great thing about the cinema is you sit next to a friend, but you don’t have time to speak all that much. So yes, it may be an effort to stay in contact, but it can be done and the dividends are huge.
Getting back into the swing of normal life isn’t quick or straightforward. You may, for example, find your mornings are worse, but you see improvements in the afternoon. During the better moments it’s a good thing to work out a structure for your day. If afternoons are better, you might consider introducing a small activity in the late morning (maybe a walk or a few stretches) and then perhaps moving it forward as you make progress.
As mood improves, the temptation to get on top of all the things you’ve let slip can be huge. Be careful this doesn’t result in overstimulation. You may also find it useful to monitor your mood after activities. If you already use a mood-rating chart keep an eye on both your activities and your moods. It’s a way of controlling whether you need to slow some things down, introduce others and keep activities balanced.
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Jerry Kennard, Ph.D., is a chartered psychologist and associate fellow of the British Psychological Society. Jerry’s clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.