Take Charge of Bipolar Disorder

If you purchase this book without a cover you should be aware that this book may have been stolen property and reported as "unsold and destroyed" to the publisher. In such case neither the author nor the publisher has received any payment for this "stripped book."

The advice herein is not intended to replace the services of trained health professionals, or be a substitute for medical advice. You are advised to consult with your health care professional with regard to matters relating to your health, and in particular regarding matters that may require diagnosis or medical attention.

Copyright © 2006 by Julie A. Fast and John Preston, PsyD.

All rights reserved.

Warner Wellness

Hachette Book Group

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Visit our Web site at www.HachetteBookGroup.com.

Warner Wellness is an imprint of Warner Books, Inc.

First eBook Edition: September 2006

Warner Wellness is a trademark of Time Warner Inc. or an affiliated company. Used under license by Hachette Book Group, which is not affiliated with Time Warner Inc.

ISBN: 978-0-446-55480-0

Book design and text composition by Stratford Publishing Services, Inc.

WHAT IS THE TAKE CHARGE 4-STEP TREATMENT PLAN?

This unique, personalized approach to controlling bipolar disorder combines medication and supplements, lifestyle changes like diet and exercise, and learning how to ask for help. Groundbreaking and comprehensive, this book gives you everything you need to implement a powerful four-pronged attack on the symptoms and cycles of bipolar disorder. You'll find an arsenal of tools to choose from, including:

•  Technical facts about bipolar disorder and how it's diagnosed

•  Real-life stories of people with bipolar disorder and how they cope

•  Sidebars packed with information especially for family and friends

•  Written exercises you can do on your own or with loved ones

•   A comprehensive overview of medications, their side effects, and how to find the right balance for you

•   Questionnaires and charts for keeping track of everything from your finances and work history to your medications and hospital visits

•   "Tool boxes" at the end of each chapter that review key points covered in each section

•  PLUS: A selection of online resources and suggested reading.

TAKE CHARGE OF BIPOLAR DISORDER

For my family,
Rebecca Alverson,
Ed Fast,
David Grayson Fast,
and
Ellen Schlotfeldt

—Julie A. Fast

For Matt and David

—John Preston

PREFACE

Many different people will read this book:

•   People recently diagnosed with bipolar disorder and ready to find a way to manage the illness successfully.

•   People living with bipolar disorder for many years who hope to find more tools to manage the illness more effectively.

•   Family members who just went through the harrowing experience of checking someone into the hospital.

•   Grandparents, parents, siblings, and friends of someone who is really struggling or refuses to get help.

•   Health care professionals who want to learn more effective techniques to use with their clients.

Whoever you are, Take Charge of Bipolar Disorder has something for you. A comprehensive treatment plan doesn't leave anyone out. Everyone matters, and everyone can help and find help. Bipolar disorder does not only affect the person with the illness. It affects everyone who has a close relationship with the person who has the illness. Because of this, this book discusses the needs of the person with bipolar disorder as well as the needs of family members, friends, and health care professionals.

YOUR CURRENT TREATMENT OPTIONS

Bipolar disorder is a very complex illness. It's also very serious and often life threatening. Thus, the person with the illness must use a variety of techniques to manage it successfully. Although some people can use medications alone to get back to a normal life, for many people this isn't the reality. In fact, many people with bipolar disorder realize that they need more than medications, but they aren't sure of their choices. It's the norm for people to struggle for a year or more until they find the correct treatment plan that combines medications and supplements, lifestyle changes, behavior modifications, and the most effective way to ask for help. The goal of this book is to help you find the right combination of treatments for lasting stability.

WHAT IS THE TAKE CHARGE 4-STEP TREATMENT PLAN?

The 4-Step Treatment Plan can be seen as a pie. One quarter of the pie is medications and supplements. The next quarter includes lifestyle changes. The third quarter covers behavioral changes, while the final piece of the pie teaches people with bipolar disorder how to reach out for support and ask for help from the right people.

WHY YOUR BRAIN IS DIFFERENT

The first step in starting the 4-Step Plan is reminding yourself that you're treating an illness, not a personal problem. You need help and treatment because your brain is different. Brains are designed to be flexible and responsive to the physical and emotional stresses in the environment. For many people, their brains do this effectively. Unfortunately, the brains of people with bipolar disorder don't function in the same way. To use the diabetes model, just as a person with diabetes can't by willpower alone regulate his or her insulin and blood sugar levels, you as a person with bipolar disorder have a brain that can't regulate itself chemically the way the normal brain can—especially when it comes to regulating emotions. This is nothing personal or bad. It certainly causes problems in your life and can be very frustrating, but with the correct treatment plan, you can learn to help your brain respond to life a bit more effectively. You do have options.

The following section is an overview of the book that will explain how the chapters fit into the 4-Step Treatment Plan. Though it may be tempting to skip this section and move ahead, it actually contains vital information that you will need to create your own successful and effective treatment plan. It is crucial to begin by having a glimpse of what is involved in a truly comprehensive approach to managing this illness. So read on.

OVERVIEW OF THE CHAPTERS

Introduction: What Is Bipolar Disorder? This book's introduction explores in great detail exactly what it means to have bipolar disorder, then covers the different symptoms people with the illness often experience. It really is true that bipolar disorder is much more than mania and depression. It's important for your future stability that you know all of your symptoms and how they impact your life as well as the lives of your family members and friends. The more information about bipolar disorder you have, the better you can decide what works for you personally to stay stable. The introduction builds the foundation for the 4-Step Treatment Plan. The remaining chapters then cover the plan in detail.

What Is a Comprehensive Treatment Approach?

A comprehensive treatment approach looks at the whole picture of bipolar disorder and manages the disorder through a variety of treatment ideas from many different disciplines and health care professionals. A comprehensive treatment plan doesn't focus solely on one treatment, such as medication. Instead, it looks at all your needs, from medications, psychotherapy, and physical health to your emotional, financial, and personal needs.

Step I. Medications and Supplements

Chapter 1: Medications and Supplements. How do you feel about your medications? It's normal to have a love-hate relationship with them. Extensive research shows that medications are the first line of defense against bipolar disorder mood swings. Finding the right medications can be very difficult. It can take a long time, and the side effects can range from mild to very severe. This is something all people with bipolar disorder have to deal with. This first step of the 4-Step Plan reminds you why trying to treat this illness without any form of medication can be very difficult. Yes, depending on the severity of the illness, some people can do it, but for the vast majority medications are an absolute necessity—especially for those who experience severe manic episodes.

Many supplements, including vitamins and herbs, have proven helpful in the treatment of bipolar disorder when combined with the correct medications. They also help keep the immune system strong, because the medications are sometimes quite hard on the physical body. There is little evidence that supplements alone can prevent serious bipolar disorder mood swings. Chapter 1 does not discount the people who have achieved stability through alternative means, but addresses the fact that for most people supplements are just that—a supplemental treatment that when combined with traditional medications can help improve stability and increase physical health.

Step II. Lifestyle Changes

Step 2 of the treatment plan covers the often significant lifestyle changes that are essential if you want to find and maintain stability. Many people with bipolar disorder learn ineffective and even dangerous ways of managing the illness. From caffeine, alcohol, and marijuana to heavy street drugs and erratic sleep patterns, this form of crisis management is normal and understandable, but these are solutions that always backfire in the long term. As the chapters on the lifestyle changes of the treatment plan explain, many lifestyle choices must be carefully examined and changed in order for you to reach stability.

Chapter 2: Sleep, Diet, Exercise, and Light. The way you manage sleep, diet, exercise, and bright light exposure can have a tremendous effect on the severity of your bipolar disorder symptoms. And the best part of these management suggestions is that they are often free and very easy to implement. This chapter helps you determine what you need to do first, and then helps you to make changes in all these areas in order to create more emotional stability in your life.

Chapter 3: Work and Money. As you probably know, almost everyone with bipolar disorder is challenged when it comes to work and money—sometimes significantly challenged. This is especially so in people suffering from Bipolar Disorder I, which involves severe manic episodes. Chapter 3 helps you assess your current work and money situation (which can be quite scary for many people) and then helps you tailor a plan to create a more stable work and money situation in the future.

Step III. Behavioral Changes

Step 3 of the plan helps you discover the changes you will need to make in order to stop the chaos that is often created by bipolar disorder behavior. The chapters in this section offer a powerful defense against the thoughts, words, and actions that you may feel compelled to use when you are in a bipolar disorder mood swing. The self-destructive thoughts and behaviors associated with bipolar disorder can often ruin quality of life and are especially hard on relationships. The ideas in these chapters take time and perseverance, but once you learn the techniques, life can become considerably more stable and pleasurable.

Chapter 4: Knowing Your Bipolar Disorder Triggers. Bipolar disorder can make you think and do some scary, dysfunctional, and downright weird things. Mood swings can cause poor judgment and impulsive decisions that create chaos and often result in disasters. For many people, this behavior is often triggered by outside events. Chapter 4 helps you discover and become familiar with your personal triggers so that you can significantly reduce your mood swings.

Chapter 5: The Bipolar Conversation. Of all the chapters in this book besides the essential medications chapter, chapter 5 can give you the quickest and most effective relief. The better you learn to recognize and ultimately prevent the often confusing and upsetting things you say when you're sick, the more chance you have of finding stability. The tools in this chapter teach you and the people in your life to recognize what you say and do at the beginning of a mood swing so that you can stop it before it goes too far. This can prevent relationship problems, work problems, and a variety of other issues you may have because of what you say when you're in a mood swing.

Step IV. Asking for Help

People with bipolar disorder often need a significant amount of help and support from the people in their lives. From family and friends to health care professionals, your needs can be tremendous. These needs are often compounded by money problems, lack of insurance, wearing out the people in your life with your neediness, choosing inappropriate people to help you, and ignoring the signs that some people are not capable of helping you the way you want them to. This final step in the 4-Step Plan teaches you how to spread out your needs so that you can ask for help from the appropriate people. It's critical that you have a strong support system around you to help you manage this illness, but it's equally important that you learn to recognize the right people to ask for help and how to do this effectively.

Chapter 6: Choosing a Supportive Health Care Team. People with bipolar disorder often spend more time picking out fruit in the grocery store than they do choosing their health care team. The health care professionals in your life play a vital role in your stability. It's therefore essential that you make sure the people on your team are helpful, compassionate, and qualified to give you the help you need.

Chapter 7: Teaching Family and Friends How to Help You Stay Stable. Have you ever overwhelmed your family or friends when you were in a mood swing? Most people have! There is a fine line between needing help and being too needy. Chapter 7 addresses the skills you will need in order to ask for help from loved ones. It's often the case that family members and friends have no idea what to do when you actually do ask for help. This chapter teaches you how to teach the people in your life what is effective for you personally in treating this illness, opening the lines of communication and helping improve relationships.

Chapter 8: Hospitals. The subject of hospitalization can be a touchy one for people with bipolar disorder as well as the people in their lives. There is often a lot of secrecy and shame when a person goes to the hospital, especially if you did something really embarrassing or dangerous before you were admitted. Chapter 8 helps anyone who has experienced a hospital stay learn to deal with the feelings that result from the experience, especially if you were hospitalized against your will. The chapter also teaches you how to recognize symptoms so that you can stop the mood swing early and prevent another trip to the hospital. For people who have never been hospitalized, this chapter will help you understand what others with bipolar disorder go through.

Chapter 9: Insurance and Paperwork. Asking for help often requires filling out paperwork and making sure you have the funds needed to cover your treatment. Chapter 9 offers you tools on how to best utilize your insurance and understand your options when you don't have insurance coverage. Dealing with paperwork is also addressed—all too often, it feels impossible to deal with the logistics of this illness when you're having mood swings.

Putting It All Together: Using the 4-Step Treatment Plan in Daily Life

Chapter 10: Specific Plans for Specific Problems. Chapter 10 asks you to use all of the tips in the 4-Step Plan to create your own system for treating very specific bipolar disorder symptoms. Once you have done this, you can use your plan to recognize and hopefully prevent bipolar disorder mood swings. Having a plan can make a significant difference in this illness. Stability instead of chaos really is possible if you are prepared for what you will encounter when you have bipolar disorder mood swings.

Chapter 11: Planning for the Future. Did you know that many people with bipolar disorder find stability and get on with their lives? Even if it takes a long time to find the right combination of medications and tools for your 4-Step Plan, you can get better. You will have to work on accepting the bipolar disorder diagnosis—it really is normal for you to fight the diagnosis for years, and you may have to change your expectations of what you thought your life should be like. You must let go of the past and accept that bipolar disorder may have ruined many things for you and deeply and often negatively impacted the lives of your family and friends. Once you have done this, however, and have a plan in place to help you find and maintain stability, your illness need no longer negatively affect your life on a daily basis.

And finally . . . The Toolbox. At the end of each chapter, you will find a toolbox that tracks the information you've learned. By the end of the book, you will have a large repertoire of tools that you can use, depending on which mood swing or situation you are experiencing because of bipolar disorder. If you turn to the last chapter of the book, you will see that your toolbox is full. There is hope for treating this illness; you can change the way bipolar disorder affects your life, and as you'll see in the toolbox, the 4-Step Treatment Plan can help.

The appendixes at the end of the book, including resources, a suggested reading list, charts, and a journal, will give you even more tools for the successful management of bipolar disorder.

A NOTE FROM JULIE FAST

Bipolar disorder has a bad reputation. I know this from personal experience because I was diagnosed with the illness in 1995. Many of us with the illness have faced years of pain and discrimination due to the mood swings that make us seem as though we're simply out of control and can't manage to have a normal life. Family members and friends are often frustrated with what they see as our unreasonable behavior, and we're regularly chastised for not working up to our potential, as though we choose to have over-the-top emotions in response to everyday life.

This book is a testament to what I went through the ten years after my diagnosis and how I managed to get my life back despite trying twenty-three drugs without finding relief. In 1999, I had had enough. I realized that my health was up to me. Even though I had been depressed 90 percent of the time and hypomanic the other 10 percent for a large part of my life, I realized I had a choice. Killing myself was not the only option. I could learn my symptoms and do something about the mood swings before they got out of hand. I could keep searching for the right combination of medications and lifestyle changes. I could improve my relationships and live more like a mentally stable person in the real world. Through research I knew what the illness was, but not how to treat it when the medications didn't give me total relief. So I worked on a treatment plan. I knew that I had to come up with something or I would kill myself eventually, just to end the constant pain of so many mood swings. This book is that treatment plan.

Today I have a medication that works well with my personal treatment plan. I can write books and am even thinking I'll finally be able to go back to school without getting paranoid and obsessive. Hopefully, I can travel again without getting severely ill. I now have friends who have been in my life for a long time. I no longer alienate them with my out-of-control bipolar disorder behavior. I use my treatment plan every day. My triggers are the same they have always been. Medications take the edge off and help clear my brain from excessive thinking, but I still have to watch my life daily. I still get severely depressed, and hypomania is always waiting for me if I don't take care of myself. But considering the life I led before, I'm now able to function without constantly wondering what is wrong with me and why I have such a terrible life. My family and the friends who managed to stick around when I was severely ill can really see the difference. Writing books on bipolar disorder has given me a career, something I have never had. Before you think I'm different than you are, you should know that I was alternatively depressed, hypomanic, paranoid, obsessive, and anxious off and on while I wrote this book. I just kept it under control.

I had two goals while writing Take Charge of Bipolar Disorder. First, I wanted to tell you that you're not alone and that there really is a way to effectively and successfully manage this illness by using the 4-Step Treatment Plan presented in this book. And second, I hoped to help family members, friends, and health care professionals experience—even externally—what it's like to have bipolar disorder, and then offer them proven and easy-to-implement tools they can use to help us stay stable.

Finding stability takes a lot of courage and even more hard work. Having a plan in place that works for you makes the task a lot easier. When family members, friends, and health care professionals are involved in this process, the dream of having a life that manages bipolar disorder instead of one controlled by it can become a reality. I hope you find the 4-Step Treatment Plan offered in this book to be as lifesaving as I have.

A NOTE TO FAMILY MEMBERS AND FRIENDS

While books for family members and friends often focus on what you can do to understand bipolar disorder from your own perspective, the goal of this book is to show you the perspective of people with bipolar disorder. If you're like many of those close to someone struggling with bipolar disorder, it may be very hard for you to truly understand what your loved one is going through. This book hopes to change your view of the illness and help you see that your understanding of the illness is often quite different from what a person with bipolar disorder actually experiences.

By reading about and accepting the many significant challenges people with bipolar disorder face, you may be able to have more compassion when you are confronted with a bipolar crisis or a chronic bipolar disorder problem in your loved one. Take Charge of Bipolar Disorder answers the question What do I need to do to help a person with bipolar disorder find stability? by offering practical ways to help this person achieve as normal a life as possible. It is especially effective if you can read this book with your loved one and do the exercises together, though doing them yourself is also very effective.

FAMILY AND FRIENDS SIDEBARS

In the following chapters, the main content was written for the person with the illness. You can read this content to get real insight into what your loved one must go through to understand, treat, and finally accept this illness. But you'll also find sidebars written especially for family members and friends. These sidebars will address the questions you may have about the 4-Step Plan as laid out in each chapter, and will help you deal with the sometimes overwhelming emotions that come up when someone you love is diagnosed with bipolar disorder.

You will notice that some chapters do not have a lot of information for family members and friends. Keep reading, however: Other chapters directly relate to how you can help your loved one while making sure you take care of yourself as well.

Family members and friends play an extremely important role in each section of the treatment plan. Management is a large and often unwanted role for family members and friends; the more skills you have in helping someone find stability, the more you can accept the role you may have to play, whether willingly or not. You can do the exercises in the chapters on your own, as noted, or complete them with your loved one. You are not just a bystander in this plan; you truly are an essential part of the system.

A NOTE TO FRIENDS

Friends are rarely spoken to concerning bipolar disorder—and yet you are often the ones who take care of someone with the illness or feel the brunt of his or her mood swings. You're also often more able to walk away from a difficult or impossible situation. If you feel totally used up, worn out, and left out to dry from trying to deal with a friend with bipolar disorder, this book will at least give you the skills you need to maintain a relationship with your friend without losing yourself along the way.

WHAT FAMILY MEMBERS AND FRIENDS NEED TO KNOW

There are a few truths regarding bipolar disorder that may go against your intuition. If you can learn to accept them, however, this can help you contribute to your loved one's treatment plan.

•   Bipolar disorder does not cover up psychological and emotional problems; it creates them. When a person with bipolar disorder finds stability, these problems often go away.

•   Drug and alcohol use are often used to self-medicate bipolar disorder. The more stability a person can find, the better are his or her chances of breaking the drug and alcohol cycle.

•   Friends of people with bipolar disorder are often understandably overwhelmed with the role they are asked to play. If you don't want to play this role, it's your choice. While commitment to this person is important, your health should not be compromised. Sometimes a friendship with someone who has bipolar disorder that is not well managed is impossible; it's okay for you to set firm limits, seek a counselor or therapist for your own emotional well-being, or cut off ties completely.

•   Bipolar disorder has a high suicide rate—more than 15 percent in some studies, according to the American Psychiatric Association. This is a real threat to your loved one and must be taken very seriously. You will need to know the signs of suicidal thoughts and have a plan ready the minute you believe your loved one may be thinking of suicide. Don't wait until he or she has already tried.

•   It can take a year or more to fully recover when someone with bipolar disorder has a severe episode—especially one that may have required hospitalization. The body and mind are worn out, and the person with bipolar disorder needs a lot of time and support to get better. As you watch a loved one go through this recovery, it is important to have realistic expectations of how long it will take.

•   If you have a young child or a teenager with bipolar disorder, it may be very difficult for you to differentiate between what is normal behavior for a growing child and what is behavior caused by bipolar disorder. As you read this book, you will learn to discriminate between your child's natural personality and the results of the illness.

•   Bipolar disorder is a genetic illness. As a parent, you have done nothing wrong and certainly did not cause your child to get sick. What you do now does affect how the illness manifests itself, however. You have the opportunity to play an important role in helping your child manage this illness.