The First 48 Hours With Bipolar Disorder

Patient Expert

You've just been diagnosed with bipolar disorder. What now? Expert Patient John McManamy gives you his tips on coping.

You never find happy individuals walking into a psychiatrist's office for the first time. People with bipolar disorder only seek help when their life is going terribly wrong or when their brains have taken them hostage. Your situation is probably looking pretty bleak at the moment, and the last thing you need to be told is you are not normal--whatever normal is. "How can I live with a brain I can't trust?" you may be wondering. "How can I face my family and friends and colleagues--the ones who are still talking to me, anyway? Will I ever be able to get my old life back, or what's left of it?"

At the same time, you may be feeling an overwhelming sense of relief. Finally, someone has fingered your invisible nemesis and given it a name. Suddenly your whole life begins to make sense, and it has nothing to do with any moral or character weakness on your part. You've smoked the beast out into the open. For the first time in your life, you have a fighting chance.

But let's not kid ourselves. Bipolar disorder takes no prisoners. You're going to have to fight this with all you've got. Here's what you need to know now that you've been diagnosed.

Your Psychiatrist Is Your Partner, Not Your Boss

Your psychiatrist has probably sent you out of the office with a prescription for one or more psychiatric medications. [ Read more about medications and drug information.] If you're one of the lucky ones, the meds will work like a charm. Most likely, an extended adjustment period lies ahead. For starters, you are biologically unique, and no two cases of bipolar are the same. What works for one person may not work for you. Second, medications for bipolar disorder are by no means perfect. They may only get you half-well for now, and you may have to contend with troublesome side effects.

You have already passed your biggest hurdle: you sought help. Now comes your second-biggest hurdle: forging a working partnership with your psychiatrist. Forget about being a passive patient. Treating bipolar disorder is not the equivalent of taking statins and watching your cholesterol go down--if only life were that simple. All too often, patients quit in frustration when their meds aren't working right, only to find themselves back in crisis days or weeks or even months later. Often, the problem lies with a psychiatrist who doesn't listen. More often than not, the patient neglects to speak up.

The onus is on you. Psychiatrists these days have severe constraints on their time. If you don't badger them, they won't ask that vital extra question. Remember, psychiatrists are only as good as what you tell them. This is no time to be shy. Here's a brief list of what I consider to be your rights as a patient:

  1. Your psychiatrist has a duty to listen. If you feel this is not happening, find one who does.

  2. The American Psychiatric Association, in its 2000 Bipolar Treatment Guidelines, stipulates that the goal of treatment is to achieve remission. The APA goes on to say that this means having virtually no symptoms and functioning fully. Basically, your psychiatrist writing you off is not an option, no matter how bad things may be going for you at the time.

  3. You should not have to settle for dulled cognition and a diminished capacity to enjoy life as the price of reduced mood symptoms. Many side effects of major medication tend to go away as your body adjusts to the meds, and you should allow for this. But you should not have to put up with meds that make you feel worse. You can discuss the side effects of bipolar meds on our message boards.

  1. You have the right to give your psychiatrist the third degree concerning every medication he or she may prescribe. If you are not satisfied with the answers, you have the right to refuse to take that particular medication or medications.

  2. Less may be more. It's overkill is justifiable for a crisis, but is not the right strategy for long-term recovery. There may be valid reasons for remaining on many meds in high doses, but the onus should be on your psychiatrist to provide satisfactory explanations.

  3. You're entitled to timely responses from your psychiatrist. Phone messages should be returned at first opportunity, and your psychiatrist should be available in a crisis.

If you have just been diagnosed, you are probably in a crisis, or are just emerging from one. For the time being, your psychiatrist will be the lead partner. But once you start moving into the recovery phase, you need to show some initiative. Only an equal partnership will get the job done.

Lifestyle Is Just As Important As Meds

You may not want to commit yourself to an improved lifestyle regimen the way you are feeling right now, but your new meds may force you to take immediate action.

Some medications are notorious weight-gainers, and patients are often caught by surprise, with no warning from their psychiatrists. It is not uncommon for patients to put on 20 pounds in a matter of weeks or months and 60 pounds over a year. Sudden weight gain works against the intended result of medications, as the extra pounds contribute to feelings of sluggishness and low self-esteem, which are symptoms of depression. You may have no choice but to take these meds, but you do have the choice to start eating low-fat food. As soon as you're able, you can work on a more permanent diet and nutrition strategy.

It is wise to cut down on "mood-buster" foods. A 20-oz Coke contains 15 teaspoons of sugar. Sugar has been linked to depression and mood spikes and crashes. Caffeine should be used sparingly and alcohol only with your doctor's permission. Think before you drink (and eat). Folates, omega-3s, and various vitamins and minerals, on the other hand, have been linked to improved mood and brain function.

Just about everyone with a mood disorder has a sleep problem; they either are unable to fall asleep or sleep too much. A missed night's sleep can trigger a manic episode. Staying in bed can make depression worse. Sticking to some kind of regular schedule is vital, and establishing sound sleep hygiene is a must. Once sleep is resolved, often with the aid of medications, many mood and cognitive symptoms clear up.

Exercise has been linked to improved mood and brain function, increased energy and higher self-esteem. A regular exercise routine is an essential part of your wellness strategy, though right now you are probably in no shape to make the effort. Resolve to start small, perhaps with a five-minute walk, and add more as you progress through recovery.

Spiritual and religious practice has been linked to improved physical and mental health. This may be because prayer and meditation kick-start a number of beneficial biological processes. Then again, it could be pure God-power. You may feel God has abandoned you right now, but don't be afraid to rekindle the relationship.

Read more about Therapy and Lifestyle Changes.

Support Is Vital

Whether or not to disclose your illness to family, friends and colleagues is a tough call. Bipolar disorder still carries a heavy stigma that could result in your losing companionship and employment. For good reason, most patients choose to keep their illness a secret from their employers. But your job may be at risk if you don't clue your employer in on your situation. You may need certain accommodations in order to keep working, such as flexible hours, and you may be surprised at how enlightened some employers can be. If you choose to disclose the information, do it through your organization's human resources department.

Bipolar disorder is a burden you shouldn't carry alone. You will almost certainly need to disclose your condition to selected family and friends. Finding a network of people who share your illness is also essential. You are in the right place with this online community. You can find support through our message boards as well as a comprehensive list of other sites that offer support on our support groups page. Face-to-face support is also strongly recommended. The Depression and Bipolar Support Alliance has 1,000 support groups throughout the United States.

Coping Is Your Survival Tool

Over time, you will pick up an invaluable array of coping skills. Learning from fellow patients (such as people you meet in a support group) will help you avoid mistakes others have already made. Successful patients are acutely attuned to the subtleties of their moods and behaviors, and can often nip potential episodes in the bud, before they reach the point of no return. Sometimes it's as simple as ensuring you get a good night's sleep or some strategic downtime.

Any practice aimed at reducing stress is worth checking out. This includes meditation, yoga, breathing exercises, relaxation exercises, physical exercise, quality time to yourself, and selectively disengaging from potentially stressful family and work situations.

There are three main types of talking therapy aimed at helping you cope: cognitive therapy, behavioral therapy and interpersonal therapy. These therapies are about the "here and now." They do not get inside your head. By the end of 12 or so sessions, you will be on your way to turning your "It's the end of the world" thoughts into "Let's find a solution." Read more about therapy here.

Over the long term you may want to seek out talking therapy to help you resolve deep-seated trauma and abuse and other issues, but now is not the time. You are in no shape right now to deal with bad memories and past and present injustices. Work on getting stabilized first. If you are in a toxic working environment or a bad marriage, your meds aren't going to make your life better. They will help get you back on your feet, but you will find yourself right back in bed or bouncing off walls if you don't work on correcting the underlying problems.

Isolation Kills

Perhaps worse than the illness is the isolation it brings on. The depressed phase of our disorder turns us into wounded animals seeking the solace of a quiet cave. The manic phase is all about how to lose friends and alienate people. Add to that the stigma and the shame of bipolar disorder, and suddenly Robinson Crusoe looks like a party animal. Once deprived of meaningful human contact, the illness tends to feed on itself, starting a destructive cycle that sends us deeper into depression and robs us of the social skills needed to successfully negotiate stressful situations.

You may be in no mood to talk to others right now, but you can resolve to get out of the house once a day. You may be unable to work, but this should not stop you from performing volunteer work. You may despise egotistical loudmouths, but this should not prevent you from seeking out kindred spirits.

Finally, You Are Not a Helpless Bystander

By now you have learned that meds are just one part of the picture. The bad news is they are unlikely to get the entire job done. The good news is there is a lot you can do to help yourself.

You have just survived a horrific experience and are not yet out of the woods. Please take comfort in the fact that you are much stronger than you think. Living with bipolar disorder will always be a test, but a meaningful and productive life is not out of your reac--however, different it may turn out from your original expectations. Be hopeful. We all hate our illness, but we hardly hate what this illness has made of us. Yes, we would all trade it in in a heartbeat, but we would choose to hold on to the wisdom and insight and deeper sense of humanity and divinity we picked up along the way.

Live smart. Be well.

Read more stories by John McManamy.