With its swinging moods, shifting energy levels, sleep difficulties and intrusive anxiety, bipolar disorder can feel overwhelming. Managing it can feel the same.
“There is so much to take care of, so there are so many ways to mess up,” said Julie A. Fast, a bestselling author of books on bipolar disorder, including Take Charge of Bipolar Disorder and Loving Someone with Bipolar Disorder.
But you can feel better and get better by taking small, feasible steps every day. “The symptoms of bipolar disorder vary greatly from person to person, and even within the same person,” said Sheri Van Dijk, MSW, a psychotherapist and author of five books, including The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder.
That’s why we asked the experts to share general effective ways to manage bipolar disorder. Here are 10 strategies to help.
1. Seek professional help.
If you’re not receiving any treatment for bipolar disorder, contact a practitioner. Medication is crucial for managing bipolar disorder. As psychologist John Preston, PsyD, has noted: “Bipolar disorder is probably the main psychiatric disorder where medication is absolutely essential. I’ve had people ask me if there’s any way to do this without medicine. [My answer is] absolutely not.”
Psychotherapy also is important for better understanding your symptoms and learning effective skills. Learn more in this article on the four keys to treating bipolar disorder.
2. Take medication as prescribed.
Follow your doctor’s precise instructions when taking medication. Don’t ever discontinue medication on your own (which can worsen symptoms and trigger an episode).
Instead, if you’re struggling with troublesome side effects or other concerns, talk to your doctor. Write down your specific concerns and questions, and call your doctor to schedule an appointment.
Remember that you are a team in treating your illness. You have every right to voice your questions and concerns. Doing so helps you find the most effective treatment for you.
3. Organize your medication.
Make it easy to take your medication. Fast fills three pillboxes at a time and keeps them in different places, such as her car, purse and kitchen. (Here are additional strategies on remembering to take your medication.)
4. Remind yourself racing thoughts are part of the illness (not the truth).
Fast, who also pens a blog on bipolar disorder, calls her brain racing “brain chatter.” “Imagine having a super noisy gymnasium in your head, and the main voice is your own.” Depression is an inflated inner critic.
For Fast such thoughts might look like: “You’re unlovable. That is why you’re single. Look at that couple over there. Everyone is happy and you’re not. Work is not even an option for you. Look at the wedding rings. Everyone is married and not you!”
This kind of chatter is typical of bipolar depression. When her negative thoughts start swirling, Fast reminds herself: “This is the depression, Julie. You are not like this when you are well. Don’t get caught up in what your brain is saying. Focus your energy on ending the depression so the chatter will stop.”
5. Chart your symptoms.
Keep a daily chart of your mood, sleep, irritability, anxiety, exercise and other important symptoms or habits, Van Dijk said. This is a helpful way to prevent a mood episode or lessen its severity. A chart provides you with information about your personal symptoms and how they manifest.
It helps you spot patterns as well. For instance, if you notice that your mood is lower, you’re sleeping more and you’ve stopped exercising, you know you need to check in with your doctor, she said.
Fast also stressed the importance of learning “what you think, say and do at the very beginning of a mood swing so that you can stop it before it goes too far.” For instance, one of her mania triggers is shopping. “If I suddenly want to get a new wardrobe and buy a lot of earrings, I know it’s mania and I had better take care of it quickly, or I will be in trouble.”
Suicidal thoughts are a sign of depression and mild psychosis. “[I]f I hear a voice that says, ‘You should walk in front of that bus and die,’ I know that I am depressed and mildly psychotic, and it’s time for more serious trigger management.”
6. Focus on the present.
“Focusing on the present, rather than allowing yourself to get stuck in thoughts of the past and future…help to reduce the emotional pain in your life,” according to Van Dijk. It also helps you notice your racing thoughts and take healthy action more quickly, she said. Plus, accepting your experience helps you lead a more peaceful life, she said.
One way to pay attention to the present is to focus on your breath. “Notice when your attention wanders, bring it back to the breath, and accept whatever comes into your awareness.”
Another way is to take a mindful walk. “Instead of letting your thoughts wander like you normally would, focus on the walk: the feel of your feet hitting the ground, the movement of your body, the things you’re seeing and hearing around you, and so on.” When your mind naturally wanders, simply bring it back to the here and now, and again, accept whatever enters.
7. Create a bedtime routine.
Sleep is critical for people with bipolar disorder. In fact, sleep deprivation “is one of the biggest triggers for a manic episode,” Van Dijk said. “[S]o it’s very important for people with bipolar disorder to have a regular sleep schedule.”
A bedtime routine is an effective strategy for facilitating sleep. It signals to your brain and body that it’s time for rest, relaxation and slumber. The key is to engage in calming activities. You might take a hot bath, meditate, say a prayer and do some light reading (but outside the bedroom), she said. (Find more sleep tips here.)
8. Avoid alcohol and drugs.
Both worsen symptoms of bipolar disorder and disrupt sleep. Alcohol and drugs elevate mood instability and impulsivity, and might even lead to a manic or depressive episode. They also sabotage treatment. If you’re struggling with substance abuse, contact a mental health professional.
9. WATCH your emotions.
Some individuals with bipolar disorder have a hard time experiencing their emotions. In her book The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder, Van Dijk features many valuable exercises for healthful coping. In one exercise, she suggests WATCHing your emotions, especially if you’re used to avoiding them.
- Watch: Watch your emotions by noticing the physical sensations in your body and the thoughts running through your head.
- Avoid acting: Don’t act right away. Instead, remind yourself that emotions are not facts. You don’t have to do anything about them.
- Think: “Think of your emotion as a wave. Remember that it will go away on its own as long as you don’t try to push it away.”
- Choose: Choose to let yourself feel this emotion. Remind yourself that it’s best to experience your emotions, instead of avoiding them.
- Helpers: “Remember that emotions are helpers. They all serve a purpose and are here to tell you something important.” Some emotions may signal that something needs to change. For instance, anger might hint that a situation is unfair, and needs remedying.
10. Work on activities that build mastery.
Building mastery gives you a sense of accomplishment, Van Dijk said. What activity you choose “will just depend on where [you are in your] life and what will create that feeling of being productive.”
For instance, she said, this might mean volunteering, getting out of bed at 9 a.m. instead of noon or going to the gym three times a week. Or it might mean checking “the mail if that’s something you’ve been avoiding, … gardening or going for a 5-minute walk.”
Bipolar disorder is a serious illness. The illness itself along with treating it can feel overwhelming. But by taking small steps every day, you can effectively manage and minimize symptoms and lead a healthy, fulfilling life. If you’re not involved in treatment, contact a doctor or mental health practitioner. The strongest and healthiest step you can take is to seek professional support.