Controlling bipolar without meds

Natural remedies for bipolar disorder: Lifestyle and other remedies

Bipolar disorder involves extreme shifts in mood, energy, and levels of activity. Medications can help people manage symptoms, but these can have adverse effects. A number of natural remedies may also help.

The National Alliance on Mental Illness (NAMI) estimate that around 2.6 percent of people in the United States have bipolar disorder, and nearly 83 percent of cases are severe. On average, it starts when a person is 25 years old.

A person with bipolar disorder experiences times of severe depression and times of mania, or “high” mood. The risks during a low mood include an inability to function at work and in other areas of life.

During mania, the person may be at risk of making reckless decisions. If the mood becomes too high or low, psychosis can develop.

There is no cure for bipolar disorder, but treatment enables people to manage it. Some lifestyle adaptations can also help, alongside the medication.

Counseling, cognitive behavioral therapy (CBT), and a range of lifestyle changes can help people with bipolar disorder to manage their symptoms and improve their overall quality of life.

Sleep

Bipolar disorder can disrupt a person’s sleep. During a manic phase, an individual may sleep very little, but during a low phase, they may sleep for a long time.

Missing sleep can trigger a mood change, and getting enough sleep is essential to managing mood.

Good sleep hygiene can encourage people with the condition to have regular sleep.

Tips include:

going to bed and getting up at regular hours
making sure the room is comfortable
avoiding screen time and potentially stressful situations before bed
not eating a large meal too soon to sleeping
avoiding or limiting alcohol intake

People with bipolar disorder who have difficulty sleeping should speak to their physician.

Diet

A healthful diet is an important lifestyle habit for a person with bipolar disorder.

A 2011 study found that up to 68 percent of people seeking treatment for bipolar disorder have excess weight or obesity. People with bipolar disorder also had a higher risk of various other conditions, including diabetes, low bone density, and cardiovascular disease.

A healthful diet can help to reduce the risk of these conditions.

In 2013, another study found that people with bipolar disorder are more likely to engage in binge eating than the general population.

This may be a side effect of medication or due to overeating during episodes of depression.

Being overweight can complicate recovery and increase the risk of diabetes, high blood pressure, and anxiety.

Doctors do not know what causes bipolar disorder, but it may be due to an imbalance of chemicals in the brain. These chemicals, also called neurotransmitters, are noradrenaline, dopamine, and serotonin.

Serotonin can also affect appetite. It may be that when serotonin levels are low, people experience cravings for carbohydrates and sweet foods.

Tips for maintaining a healthful diet include:

keeping to regular eating times
ensuring that the diet is varied, well-balanced, and has plenty of fresh fruits and vegetables
making a meal plan for the week, preparing a list before going to the grocery store, and sticking to it

Learning and practicing new recipes during times of positive mood may help a person to establish these habits.

Exercise

Moderate and regular exercise can help to balance mood and prevent a number of health problems, such as obesity and cardiovascular disease.

There is a lack of evidence to show that physical activity can specifically help people with bipolar disorder, but some research suggests it may help to improve mood during a low phase.

A 2015 review of studies suggested that exercise “may be a viable and effective strategy to deal with the depressive phase of bipolar disorder.”

Another review, published in 2016, concluded that “generally, exercise was associated with improved health measures, including depressive symptoms, functioning, and quality of life. ”

More studies are needed to find out how much exercise an individual should have, how often, and how intense the activity should be, especially as bipolar disorder involves a number of physical and psychological factors.

Practicing moderation

People with bipolar disorder have a higher risk of engaging in addictive behaviors.

One study found that 56 percent of people with the condition had at some time experienced addiction involving either alcohol or drugs.

Certain circuits in the brain play a role in pursuing rewarding experiences. One study has suggested that people with bipolar disorder have stronger activation in these circuits.

This may be what drives the person towards risky behavior.

The positive side of this, say the authors of the study, is that it encourages people to work with energy toward their goals and ambitions.

On the other hand, it may mean that an individual focuses fully on the short-term rewards of a decision while disregarding the possible long-term risks.

Tips for avoiding these problems include:

becoming more aware of any tendency to engage in risky — for example, addictive — behaviors

seeking help if there is already a problem
asking friends and loved ones to support any decisions to avoid destructive or addictive behaviors

Friends who are aware of the risks might, for example, suggest going to see a movie instead of a bar on a night out.

Managing a manic episode

It is not always possible to prevent a manic episode, but as the condition progresses, the individual and their friends and family may start to notice the signs of a mood change.

Here are some tips when this happens:

See a doctor, if it is the first time, if you have discontinued treatment, or if treatment is not working.
Follow the treatment plan and keep all medical appointments, as medications may need adjusting.
Try to keep to a regular sleeping pattern and avoid unnecessary stress when possible.
Eat a healthful diet and get enough exercise.
Avoid alcohol and other substances.
Keep track of your moods and feelings.

If you have people around you, try to share with them what is happening so that they can support you.

Other remedies that do not involve the use of traditional drugs include supplements and counseling.

Herbs and supplements

Some people with bipolar disorder use herbs or supplements in an attempt to relieve their symptoms.

Omega-3

The fish oil extract omega-3 may help, according to some studies. Scientists have found that bipolar disorder is less common in countries where people consume a lot of fish. People with depression may also have lower levels of omega-3 in their blood.

Omega-3 fatty acids may have numerous health benefits, but it is best to eat them in their natural form. Cold-water fish, nuts, and plant oils are good sources.

Magnesium

Some scientists think magnesium has a role regulating mood and both manic and depressive episodes and work with the medications to make them work effectively.

As a result, some doctors may recommend magnesium supplements. Discuss magnesium supplements with your doctor. Taking a multivitamin will include the daily recommended dosage of magnesium.

Vitamins

Some people suggest that vitamins may help, specifically vitamin C and folic acid.

Researchers have found weak evidence that vitamin C may help, but none to support the use of folic acid specifically for bipolar disorder.

There is evidence that folic acid supports cognitive health, but it is not clear whether this or other vitamins can help with bipolar disorder.

Overall, it is not clear that dietary supplements can help people with bipolar disorder. More studies are needed to confirm the benefits of any supplement.

Nutrients in the diet

However, a diet that provides a variety of nutrients through fresh foods can help protect a person from a range of health problems. Green leafy vegetables are high in folic acid, and citrus fruits are a great source of vitamin C.

Anyone with bipolar disorder who decides to use complementary medicine should continue with their prescribed medication therapy sessions, and they should consult their physician before using supplements or an alternative therapy.

Choose “natural” products with care

People sometimes use St. John’s wort to treat depressive symptoms, but they may increase the risk of mania and interfere with antidepressants.

People with bipolar disorder should not use St. John’s wort.

Always speak to a doctor before trying any natural or alternative therapy. Some can interact with other drugs, and they may have adverse effects.

The FDA does not officially regulate supplements and herbal products, so people may not know exactly what they are buying.

Counseling and CBT

Counseling, for example, cognitive behavioral therapy (CBT) appears to be helpful in managing the symptoms of bipolar disorder.

A meta-analysis published in 2017 concluded that “CBT is effective in decreasing the relapse rate and improving depressive symptoms, mania severity, and psychosocial functioning. ”

The studies reviewed showed that the effects of CBT were “mild to moderate,” and the improvements were most significant if a person attended sessions of 90 minutes or longer.

CBT can help people to identify negative and destructive habits and behaviors, and to change them to more positive ones.

A psychiatrist who specializes in bipolar disorder will normally guide a person’s treatment.

Sometimes there may be a wider team of professionals, including a social worker and a counselor.

Medications

A doctor may prescribe mood-stabilizing medications during a manic episode.

These include:

lithium
valproic acid
carbamazepine
lamotrigine

Regular monitoring may be necessary, as the dose sometimes needs adjusting.

If a person experiences psychosis, they may also need an antipsychotic drug, such as:

olanzapine
risperidone
quetiapine
aripiprazole
ziprasidone
lurasidone
asenapine

Doctors do not usually prescribe antidepressants alone for a person with bipolar disorder, even during a low mood, because they can trigger a manic episode.

For this reason, the person will normally use an antidepressant with a mood stabilizer or antipsychotic.

A doctor may recommend hospitalization if a patient is experiencing psychosis or if their symptoms may pose a danger to themselves or other people.

Bipolar disorder requires lifelong treatment, even when patients with the disorder are feeling better.

However, some lifestyle considerations can help to make the condition more manageable.

Managing bipolar disorder without medication

Bipolar disorder is a diagnosis given to people who experience periods of intense low mood but also periods of elation and increased energy which can lead to impaired judgement and risky behaviour. The Royal College of Psychiatrists estimates that around 1% of the adult population experience bipolar symptoms at some point in their life.

UK guidance for the treatment of bipolar disorder has an emphasis on medication. However, more than 60% of people with the diagnosis stop taking their medication at some point. This is often because of the common and severe and unpleasant side effects that drugs such as lithium and olanzapine can produce. These include dizziness, diarrhoea, slowed movement and substantial weight gain.

Lithium – not for everyone. Lithium by Shutterstock

A recent review also suggested that medication only helps a small proportion of those it is prescribed to. The review looked at 12 different medication regimes used under several different circumstances and found the highest success rate was just 33%. And lithium, a drug that NICE recommends as the “first-line, long-term pharmacological treatment for bipolar disorder” was found to benefit only about one in seven patients. It is also a very toxic drug. Recent research has found that around one in three of those taking lithium over many years will go on to suffer from chronic renal failure.

Despite this, patient decisions to stop taking medication are typically regarded by mental health professionals as being due to “lack of insight” or “inaccurate concerns” about a drug’s safety or efficacy. Many are also concerned about what might happen to people not taking medication if they fail to recognise when their mood is causing them difficulties. As some researchers have suggested that as many as half of patients with a bipolar diagnosis can suffer from a lack of awareness of their mental health difficulties, a common fear is that someone who is off their medication will lose the ability to identify when they aren’t well.

To find out how people who stop taking medication manage, we conducted in-depth interviews with ten people with a bipolar diagnosis who had chosen to stop taking their medication for a period.

They told us that the first step they took was to conduct a cost/benefit analysis of the pros and cons of taking medication, and they described keeping this decision under regular review. They then asked themselves if their mood was actually causing them problems or concerns (some people do see positive aspects to experiencing their bipolar moods). Next they used their past experience to identify practical things they could do to help keep their mood at the level they wanted, or to adjust it if they felt it wasn’t “right”.

People use a wide range of strategies to manage their mood; the people we interviewed talked about more than 50 different approaches ranging from simple things like doing exercise, pampering themselves, talking to (or avoiding) specific friends or family members, to taking time off work, using techniques they had learned from psychological therapy, or even going on holiday or (in one case) moving temporarily abroad.

Running. Jogging by Shutterstock

The important thing for the people we talked to, however, was that the strategies they used had to fit their understanding of themselves, their identity and their goals in life. This was different for each person and each individual needed to identify what worked for them. For some people financial constraints also stopped them using all the strategies they would have liked to.

An alternative for some people experiencing a “high” mood was to take the extra energy it gave them and consciously channel it into something positive, such as their work or a hobby or project. However, some people we talked to suggested that just “going with” a high mood could make things worse. They worked to manage high moods by identifying people close to them who could provide them with an objective view of how they were behaving – someone around to “check in with”. These people could also help those with bipolar work out whether the strategies they were using were working.

These frequent evaluations were another important factor for those managing without medication. If the strategies they had been using were not working, people initially tried to find better ways to adjust their mood. However, if things were getting bad, then they might instead stop trying to change their mood and just withdraw from their normal daily activities (and perhaps take time off work) until their mood settled. Some also turned to friends or family for practical support and advice, and some would also consider a temporary return to using medication.

The conversations with our participants highlighted two key things. The first was that far from showing a “lack of insight”, the people who talked to us described careful, well-reasoned and considered decision making around stopping their medication. The approach to managing moods they all described was also in stark contrast to the usual approach taken by mental health services to people with a bipolar diagnosis.

Services tend to focus heavily on medication prescription, and while some psychological therapies are available to help people manage low mood, it has been suggested that talking therapies should target improving people’s compliance with taking medication.

Research, such as the recent review, seems to be pointing to the ineffectiveness of medication for most people with a bipolar diagnosis, we would argue that services could better use their resources by working with patients in a collaborative way, helping them identify and supporting them in implementing whichever strategies (which might include or exclude medication) work best for them personally in managing their moods and helping them live fulfilling lives.

People with bipolar disorder tell how to properly support them

March 30 is celebrated as Bipolar Day around the world. With this disease, it is important to monitor mood changes, which can be difficult to do alone. The founder of the Bipolar Association, Masha Pushkina, has collected stories of people who are helped by treatment partners.

At the initiative of public organizations that bring together scientists, doctors and activists, every year on March 30, World Bipolar Day is celebrated. The date chosen was the birthday of Vincent van Gogh, an artist who, according to researchers, was the embodiment of a "bipolar genius."

With bipolar disorder, a person lives either in a state of high emotional uplift and excitement (mania), or in depression. According to world statistics, about 2% of people suffer from bipolar disorder in various forms. This means that in Russia there are at least three million bipolar people - this is about half of St. Petersburg.

In most cases, this condition responds well to medication. But, unfortunately, many do not seek help or do not know how to find it. Without treatment, the disease progresses and ultimately leads to sad consequences: loss of family, job, disability in general, and in almost every seventh case, suicide.

These consequences can be avoided. The peculiarity of bipolar disorder is that the onset of remission depends not only on the doctor and medications, but also on the behavior of the patient himself. Very often, bipolar people provoke seizures "with their own hands." The mood of people with BAD (bipolar affective disorder. - Note ed. ) is very unstable, the balance is fragile, and you can “start” mania or depression in dozens of ways: the psyche is easily shaken by psychoactive substances, alcohol, lack of sleep, too intense work, travel and even love. So, a short time after the next course of treatment with powerful drugs, the person again ends up in the hospital. And each new attack reduces the chances of a long remission, affects social status, and even more painfully - self-esteem.

The experience of people with mental disorders around the world has proven that you are much more likely to cope with difficulties when you are supported by people who understand your problems and condition, but do not look at you as a patient. As practice shows, such a person can be not only a partner or close relative. An old friend, and even a person with whom you have never met in person, can help you get through the darkest times. Masha Pushkina, especially for Afisha Daily, spoke with several bipolar people about those in whom they found their support. The result is a story not about illness, but about friendship and trust, which can defeat even madness.

Details on the topic

How to live with bipolar disorder

Yana, 31 years old

Housewife, collects books and is fond of confectionery

. I have been sick for 15 years. The first person who looked after me was my best friend, and now it's my husband.

When my hypomania0013 Note ed. ) dispersed into a full-fledged mania (this state is also characterized by a one-sided attraction to some topic, sometimes accompanied by delirium. - Note ed. ), it became clear that I needed to be looked after. A friend began to pay attention to repetitive patterns of behavior in one phase or another, and we decided together to find out what helps in such cases. I think my friend was afraid to take responsibility for my condition, but she turned out to be generous and selfless. When I got married, a friend passed this knowledge on to her husband, and he already supplemented it, based on his own experience. The husband initially knew with whom he connects his life. He says it didn't scare him.

I have obsessions during manic episodes. My husband does not argue with me at this time, but he also does not feed them, trying to redirect my stormy energy in a different direction. You can’t argue, because the result will be the opposite: I will finally get stuck on the idea, I will consider that I must prove it at all costs, even if the whole world is against me, and there are enemies and conspiracies around. If this does not help, the husband agrees to discuss all these things, but at the same time tries to slow down their implementation by offering to draw up a specific and detailed plan. Sometimes it takes me a long time.

For example, I always want to move somewhere. Right now, and why aren't we packing our things yet? My husband tries to make me write down what are the pros and cons of different cities, what attracts us to them. As a result, I sit for hours on different forums, make lists, think about how we will arrange our life, calculate the budget for different countries of the world. There is also a manic passion for travel, but after preparation, we usually implement these plans. And many years ago, in a fit of mania, I bought an apartment - with a mortgage, with hellish payments. Then it took a long time to resolve this situation, but, fortunately, everything worked out well.

The husband initially knew with whom he connected his life. He says that it did not frighten him

My husband began to keep a graph of my mood. I also manage it, and we check the results so that they are objective. Quarrels due to the fact that the husband takes on the role of the elder often arise in the manic phase (never in depression). Then I become very suspicious, any attempts at control cause rage. But now the husband has learned from experience, so he does not react to attempts to unleash a conflict. With obvious attacks of rage and auto-aggression, he uses holding therapy (long strong hugs. - Note ed. ). We have seen this in autistic children, this is how their parents influence them.

When I'm depressed, he doesn't comfort me because it's pointless, but he tries to give reasonable arguments that this period has always ended and this time will also pass soon. We look at mood charts for the past months, discuss the duration of the attacks: two weeks have already passed and, judging by past experience, it should get better in a couple of weeks.

Such support from the husband helps in many ways. When I was being treated by two doctors, taking all the medicines, I didn’t have such support, everything was very bad. Over time, I stopped disappearing from home in a manic state and inflicting serious injuries on myself. All my super-ideas remain on paper in the form of graphs and tables, I don’t even have time to start putting them into practice, so that later I don’t have to deal with the consequences with the whole family.

Details on the topic

How to behave if a loved one is depressed? Psychologist explains

Alice, 27 years old

Biologist

To be honest, I do not always find understanding from my healthy environment, I often faced condemnation, devaluation of problems. But from a person who has a similar experience, you won’t hear “don’t invent”, “you can’t feel so bad”, “take a walk and it will pass”.

It so happens that my best friend also suffers from bipolar disorder. I did not look for support in specialized communities where patients communicate, we met by chance. My friend is much older, he has much more life experience, and he was able to become a real mentor for me. Not once did his actions worsen my condition - I hope that he can say the same about me.

During periods of upswing, I find it unpleasant when he tries to slow me down and reduce the degree of passions. But as soon as this state passes and I again take a sober look at the situation, each time I thank him for trying to stop the revelry and disgrace. My friend himself is currently not being treated, but he never imposed his position on me, and when I turn to doctors, he supports me in this.

From a person with a similar experience, you will not hear “don't make it up”, “you can't feel so bad”, “take a walk - and it will pass”

I told the doctor about this source of support - he is exclusively for it. Before meeting a friend, I had suicidal attempts, but during the entire time of our communication I never tried to say goodbye to life. When you know that there is a person who will understand everything and share warmth (while even my own family repels me), that there is a place where you can come in any condition and where they will accept me without unnecessary questions and teachings, this is a source of great strength. and hope.

When I was expecting my second child, I was depressed. My husband did not yet fully understand the features of the disease and did not want to admit obvious things - this added problems, and my emotional state became extremely difficult. It seems that only thanks to the participation of my friend, I did not do anything to myself and successfully endured the pregnancy. The child was named after him.

Sergey, 49 years old

Freelancer

At the height of the depression, I was looking for any available support and ended up in an online group of anonymous debtors (people who have taken on large loans). One of the participants drew attention to my condition and said that I urgently need medical help. Despite the fact that she lives in the USA, we began to communicate regularly via Skype. Olga literally brought me to the hospital and helped me prepare for the treatment.

Americans are a pragmatic people, many young and healthy people have folders with wills and instructions in case of their death. They also approach mental difficulties calmly and thoroughly. It is common practice for the patient to draw up detailed instructions in advance. In the United States, there is a practice of issuing Treatment Agreements for people with mental illness (Treatment Contract). This document is needed so that family, friends and doctors recognize the symptoms of deterioration in time and take into account your experience and wishes in the treatment. Typically, such a document contains: a list of trusted people; signs of a normal state; signs of an approaching episode; symptoms of mania and depression; actions that trusted people should take to help a person get better and keep him from destructive acts; plan of action in case of an emergency (for example, a suicide attempt). who and what will be done in case of his hospitalization, so that he can be treated without anxiety for household chores.

In a period of severe depression, there is a struggle inside a person between the craving for death and the desire to live - and many external things can outweigh in one direction or another. Every clue is important to help you get out. It is very difficult for one to cope with all this.

I madly didn’t want to go to the hospital and wouldn’t have made up my mind myself, until the last I hoped that somehow everything would go away on its own. But under the supervision of a friend, I drew up a preparation plan: warn the customer at work, arrange to look after my cats. Reported to her about every step. But then he could no longer simply “escape” [from hospitalization], because he felt obliged to both her and the doctor. During depression, one's own life has no value, but the people dear to me, the promises made to them, do.

It is a common practice for a patient to draw up detailed instructions in advance on who and what will be done in case of his hospitalization

At the most difficult moment, Olga became my “external brain”, who told me what to do when I myself did not understand anything. After I was discharged from the hospital, I turned to four friends for support. Usually we call each other once a week, I tell what my condition is. It is important not only to chat online, but also to hear the voice, you can understand a lot from it. Friends immediately pay attention, if I suddenly disappear and stop calling, then something is wrong.

I think it is possible to find such a person if you set such a goal. Take a closer look at people in support groups, religious or other communities - those who understand what compassion and mutual assistance are. This must be an internally mature person, ready to take responsibility for you in a difficult situation. If this person has similar problems, then he will better understand your experiences. For this reason, relatives are far from always suitable: they themselves can panic, seeing how bad you feel, choke you with their anxiety, overprotection.

It is necessary to establish the frequency of communication and observe it. And of course, in no case should you parasitize on someone else's kindness. The support system works when you yourself take responsibility for your life, and do not outweigh it completely on another.

Details on the topic

Psychiatrist Arkady Shmilovich on the mental health of Russians: “To remain mentally healthy, one must be a tolerant person”

Anna and Valeria, 21

Students

Anna: After a major depressive episode four years ago that almost ended in a suicide attempt, I started looking for information on [support]. I managed to find a guide in English for relatives and friends on how to behave with such a person. I have sent this list to all my friends so that they have an idea of what is happening to me. For the past few years, Lera has been monitoring my emotional state on a daily basis, and if, in her opinion, it goes beyond the norm, she tells me about it. Lera just asks every day how I'm doing, and if she sees that I'm reacting strangely, she wonders if something happened. At first, it was very difficult, because, in principle, I did not like to regularly share personal experiences. But by regularly receiving feedback, I can imagine the dynamics: do the pills help, how long do the side effects last, does the depressive phase go into a moderate and severe degree, do I lose my critical thinking during hypomania.

Valeria: We gradually established a very trusting relationship. Anya studied the topic of bipolar disorder up and down, and I read the articles that she sent me. The diagnosis did not change anything for me, because it remained the same. After that, we already discussed some formalities (for example, who to call in case of an emergency).

Anna: I asked Lera to monitor hypomanic manifestations in which I lose an adequate assessment of my actions: impulsive night walks, alcohol begin.

Valeria: My friend is a very responsible and conscious girl who takes care of herself, her health and her wallet. Before buying something expensive, she asks for my advice - and then we are already sorting out the situation. We can entrust accounts to each other and not worry. I also know where and to whom to run in cases of exacerbation.

This is not eating each other's emotional resources, but supplementing and supporting

Anna: I react badly to prohibitions and reminders of illness. Yes, I periodically have to turn to relatives for help, change treatment or take long breaks, but I expect mutual respect so that they don’t look at me through the prism of the disease.
When the mood is unstable, harsh phrases like “the disease speaks in you”, “these are not your real emotions” cause persistent rejection, even when they are true. The line between accepting a loved one's illness and identifying him with a diagnosis for healthy people is extremely thin. Therefore, those who were able to grope it deserve great respect.

Anna: In the last year, I go to see the doctor with my parents. When the doctor notices that I may not be able to do it alone, she duplicates the instructions and advice for them. I, in turn, am a friend. The doctor has repeatedly emphasized that the change of episodes is more noticeable from the outside.

Valeriya: We don't have any kind of hierarchy in relationships, so there is no pressure when one makes decisions for another. This is not eating each other's emotional resources, but complementing and supporting.

Anna: The main danger in a relationship with a person with a serious illness is to fall into codependency. This format is equally bad for both the "controller" and the "subordinate". Unfortunately, I have been in such relationships before. It is worth maintaining mutual respect and treating each other as equals. Illness should not dominate a relationship. In difficult episodes, it temporarily comes to the fore, but you should always remember that you are not a disease.

Anna: I have memory problems: I don't remember some episodes. In such cases, I can ask Lera for help. If you remember the last weeks, then these are regular reminders to call the doctor. In mixed episodes, this becomes an acute problem, because I can suddenly change my mind or forget. Against the backdrop of a severe episode, I may develop psychosis, and this is the most dangerous thing in the disease. Thanks to our format, I manage to avoid such exacerbations almost always.

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Psychoactivist Sasha Starost — about public self-flagellation, performances and schizophrenia

Maria Gantman

Psychiatrist, Candidate of Medical Sciences, Mental Health Center clinic

- this is an early response and the fact that he knows the usual behavior of the patient very well and can notice even small changes.

The main disadvantage is that normal friendly communication risks turning into constant monitoring of symptoms. Not every mentally healthy person is able to remain within the boundaries of reason.

It is important to agree in advance, before an attack, what is an undoubted sign of a worsening condition (for example, persistent insomnia), and what does not need to be given special attention (for example, loud indignation at something that you do not like). In a difficult situation, often a loved one begins to behave not as an equal, but as a “healthy” and “knowledgeable”. Not all relationships stand this test.

There is also a variant of "buddy" (when two people with mental disorders look after each other. — Note ed. ) - it is good precisely because it is the true request of the patient and more equal relations without mixing roles. But I don't know the buddy support system.

Alexander Palin

Psychiatrist, psychotherapist

To choose a person you can rely on in a critical situation, look at your surroundings. Above all, a high level of trust is needed. Your assistant should be open to nonjudgmental and open dialogue and at the same time emotionally stable and resistant to stress.

Anna Ushkalova

Psychiatrist

Support is extremely important for every person - very often we, mental health professionals, need it. And with bipolar disorder, this problem is especially acute. At the initial stages, those closest to you often ignore the presence of the disease, and friends advise you to either "pull yourself together" or, conversely, "relax", sometimes with the help of alcohol. When it becomes obvious to everyone that the “condition” will not go away on its own, urgent hospitalization is already required. The saved patient receives the "stigma".

Psychiatrists then make it the responsibility of the uninitiated next of kin (parent or spouse) to monitor any changes in the patient, and they really try to do so. At the level of "laughing out loud - hypomania has begun, upset - depression. " As a result, psychiatrists begin to treat quite normal human emotions based on complaints from relatives... and the circle closes.

For this to change, mental health literacy must play a major role. Relatives, in order to be able to help, need to understand well what is happening with a loved one. In many, including state clinics, groups for training relatives either already exist or are being created.

The support of loved ones in case of emergency is especially important. In deep depression or mania, a person is not able to independently control his behavior, this decision is made by relatives, sometimes without his consent. In the case of bipolar disorder, this should be the last option when all others have been exhausted.

symptoms of bipolar disorder, how it proceeds, how to find a psychiatrist, diagnosis and treatment

Victoria K.

lives with bipolar disorder

The first signs of the disease appeared in my teenage years, and the psychiatrist diagnosed BAD at the age of 26.

According to WHO, 45 million people worldwide suffer from bipolar disorder. This disease greatly reduces the quality of life: in some periods you are overly energetic and do things that you can regret, in other periods you are not able to get off the couch to do everyday things.

I will tell you how I have BAD and what I do to cope with the disorder and live like all ordinary people.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

What is Bipolar Affective Disorder?

Bipolar Affective Disorder, or BAD, is a mental disorder with alternating emotional ups and downs in mood. It is affective just because it is associated with violations of the emotional state, that is, mood - in psychiatry, the manifestation and experience of emotions is called affect. Previously, this disease was called manic-depressive psychosis.

Bipolar Disorders - A Physician's Handbook MSD

Why bipolar disorder develops is not exactly known. Among the reasons are heredity, traumatic events, violations of the production of neurotransmitters - substances due to which signals are transmitted between brain neurons. The disease often manifests itself in adolescence or in the period between 20 and 30 years.

How bipolar affective disorder manifests itself

BAD usually begins abruptly, followed by periods without signs of illness and periods of exacerbations. The peculiarity of the disease is that during periods of exacerbations there are episodes, or phases, with different emotional states that can replace each other in an arbitrary order.

Bipolar Disorder - Mayo Clinic Blog Article

For example, when the illness escalates, the following conditions may occur.

Mania - a state of elevated or irritable mood. The person feels energetic, actively engaged in something, such as finding a new hobby or even trying to open a business. As a rule, he sleeps little, is self-confident, talkative, he has a lot of ideas, often crazy. Risk sensitivity may decrease - for example, a person invests all the money in a hopeless business or gets into a loan. Hobbies for gambling, extreme sports are not uncommon. At the same time, a person feels great, but often cannot concentrate on one thing, work productively.

The extreme degree of mania is manic psychosis, when delusions of persecution, hallucinations, excessive activity develop, a person can become dangerous to himself or others.

Hypomania is a kind of mild mania. A person is in a state of emotional uplift, but this uplift is not so pronounced. However, the mood still improves, the need for sleep decreases, the person is creative, relaxed, feels euphoric, and his productivity increases. Although in some people such periods may be accompanied by irritability and a decrease in concentration.

Depression - low mood, loss of interest in life, fatigue, guilt, indecision, decreased concentration. Sleep and appetite disturbances may occur. Sometimes there are thoughts of suicide, the futility of one's own life.

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Between exacerbations, a person can return to normal, although it happens that his performance is still reduced.

Manifestations of the phases of bipolar disorder, according to the National Institute of Mental Health USA

Parameter	Mania	Depression
Mood	Excitement, joy, irritability, resentment	Sadness, depression, emptiness, anxiety, hopelessness
Sleep	Reduced need for sleep	Trouble falling asleep, getting up early or sleeping too much
Appetite	Loss of appetite	Often increased appetite, weight gain
Communication	Talkativeness	Slow speech, forgetfulness
Concentration	Feeling of jumping thoughts, multitasking	Problems with attention and decision making, distraction
Behavior	Risk appetite, runaway spending, promiscuous sex	Lack of pleasure and interest in anything, decreased libido
Subjective feelings	Feeling of self-importance, talent and power	Feelings of worthlessness, suicidal thoughts, suicide attempts

Mood

Excitement, joy, irritability, resentment

Sleep

Decreased need for sleep

Appetite

Loss of appetite

Communication

Talking

Concentration

The feeling of jumping of thoughts, multitasking

behavior

Risk, unbridled sex

Subjective sensations

Feeling and power

9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 Mood

Sadness, depression, emptiness, anxiety, hopelessness

Sleep

Trouble falling asleep, getting up early or sleeping too much

Appetite

often increased appetite, weight gain

Communication

Slow speech, forgetfulness

Concentration

Problems with attention and making decisions, Dispersibility

behavior

Lack of pleasure and interest in something, decrease in libido

Subjective feelings

Feelings of worthlessness, suicidal thoughts, suicide attempts

There are two main types of bipolar disorder according to how the disease manifests itself:

When there has been at least one manic episode and depressive episodes recur.
When there are periods of depression and at least one episode of hypomania, but without full mania.

Bipolar Disorder - National Institute of Mental Health USA

I just have bipolar affective disorder type 2. This means that there are no full-fledged manias, but there are hypomanias and severe depressions.

Hypomania is a very cool time for me. You can do everything: get a second degree, run a marathon, learn English, go on an unplanned trip. And so for several months during which you do not sleep, do not eat, acquire new friends, start novels, end old relationships. You feel all sensations in the maximum range. During the day, it can throw several times from tears and the desire to die to incredible happiness.

This is what mania looks like in BAD. Source: Twitter

After hypomania comes depression. And immediately there is not enough strength not only for what was started during the previous phase, but also for ordinary things. The most understandable image of depression for me is “pressed down by a concrete slab. ” It becomes hard to do the simplest things: wash the dishes, change clothes, go to the store.

Unfortunately, the brighter the hypomania goes, the worse the depression gets later — that's why, with experience, I stopped enjoying the active phase. Now it is even more difficult for me: I understand what is happening with my brain, but I cannot control it.

As I remember now, my first hypomania happened at the age of 12. Then there were periods of exacerbations clearly in a year and a half: hypomania lasts 2-3 months, usually May - July, depression - 5-6 months, usually in October - March, in between remission occurs when I feel normal. If I am in a long-term remission, then I hardly notice phase changes: mood swings are smoothed out with the help of medications or psychotherapy.

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The usual course of bipolar affective disorder

Viktor Lebedev

psychiatrist, science journalist

During an exacerbation of bipolar disorder, episodes of mania or hypomania and depression may alternate. There is a clear separation of phases: first a hypomanic or manic episode, then a depressive episode, it happens that there are recurring episodes of depression, then hypomania. In the latter case, hypomanic phases are sometimes not noticed, a person may be diagnosed with recurrent, that is, recurring depression, and may be prescribed the wrong treatment.

In fact, in BAD, the phases can alternate in any order, the diagnosis is made if there is any combination of manic and depressive episodes. The first time the disease usually begins with an episode of mania or hypomania, which develops into depression. Less commonly, it starts with depression, then mania or hypomania occurs. But in any case, there must be affective disturbances, that is, mood disturbances.

The exacerbation of the disease lasts from several weeks to several months. This also depends on whether the person is receiving medical treatment. If you respond quickly to an exacerbation, you can sometimes return to normal health in a week. If not treated, the exacerbation can last for several months - especially the depressive phases, episodes of hypomania and mania usually pass faster.

Seasonality of phases, when there is a connection between the manifestations of the disease and the change of seasons, occurs, but not all patients with bipolar disorder notice it.

How I suspected I had BAD

The first time I thought I was going crazy was when I was 18 years old. Painful relationships ended, obsessive thoughts and images swirled in my head, I listened to the same song in the player, walked for hours and could not stop. This went on for so long and was so unbearable that I almost decided to go to a psychiatrist. However, they didn’t talk about mental disorders then, so I didn’t even know where to turn. Then this state passed by itself.

I did not see a psychiatrist until seven years later, when I again had a similar severe condition: obsessive thoughts, inability to control emotions, self-harm, sleep and appetite disturbances. Before that, I had three episodes of hypomania every two years, but after them there was no severe depression, and therefore no reason to seek help.

Then I just went to the district clinic - it turned out that a psychotherapist was there. She checked my symptoms on the Beck scale, diagnosed me with an anxiety-depressive disorder, and prescribed a common antidepressant that is often prescribed for depression.

Beck Depression Scale - online test

It seemed to me that antidepressants helped me immediately: my mood improved, I got energy, I talked a lot with friends, hung out, worked. Now I know this is a bad sign. Antidepressants usually take a long time to work: it takes about three weeks for the effect to appear, and I got better after a few days. In addition, in bipolar affective disorder, antidepressants can cause hypomania if not mitigated by other drugs.

This meme is well understood by those who were not immediately given the correct diagnosis. If you add Mentos to Coca-Cola, you get a foamy fountain that will splash out of the bottle.

Antidepressants, in particular SSRIs - selective serotonin reuptake inhibitors - have the same effect on the mood of people with BAD

I went to this psychotherapist several more times, but she did not track my sharp mood swings, and I had one of the most severe hypomanias . I drank and smoked a lot, I had incredible emotional swings, I ruined my relationship with my best friend, I stopped eating and sleeping.

After a couple of months, my condition stabilized a little, but I continued to take antidepressants: I knew that they should not be stopped abruptly. Before canceling, I went for a consultation with another doctor, already at a paid clinic. She turned out to be a good specialist: she asked questions about mood swings, found out if I had previously had mood swings, ups and downs, depressions. Then everything was fine because of taking antidepressants, so I denied everything.

A year later, as the doctor ordered, I smoothly stopped taking antidepressants, and a few months later I was overcome by one of the most severe depressions. If last time I could attribute depression to circumstances - burnout, relationship difficulties, fatigue - now there was no reason for it. I had a job I loved, a great relationship with my husband, financial stability, a new city. And I wanted to die.

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This moment became a turning point in the diagnosis. I already knew that there is such a disease as bipolar affective disorder, what are its symptoms and features. Information about BAR appeared in the media field: I read articles and blog posts, watched videos on YouTube.

I was able to describe the last 10 years of my life in phases: there was a strong rise, followed by a decline. For example, in the hypomania of 2012, I worked two jobs, passed the state exams, wrote a diploma, hung out with friends until the middle of the night and completely took care of the life of the family. In hypomania in 2014, she entered the magistracy, graduated from a driving school, traveled, and also ran a marathon.

Every upswing was followed by a downturn: I stopped running, didn't pass the exam in the traffic police, and dropped out of the master's program. Each such exacerbation generally lasts a year and a half, and then repeats.

How I was looking for a suitable psychiatrist

After collecting information about BAD, I decided to find a psychiatrist to confirm or deny my diagnosis. It didn't happen right away.

First I went to a psychiatrist on the advice of a friend, he helped her with depression. The doctor saw me in a paid clinic, the appointment cost about 3000 R. The consultation was unsuccessful: the doctor was clearly not interested in my condition, he indifferently asked questions about depression and prescribed antidepressants. And not the ones that were assigned to me last time, but others. I was too depressed to stand my ground, so I just started looking for another doctor.

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The second doctor was in a state clinic, she was recommended to me on Facebook. At first, I waited a long time for an appointment - the doctor was half an hour late, then I started asking about birth injuries and vascular dystonia. This consultation didn't work for me either. I paid 2,000 rubles for her.

The third appointment was successful: I found a psychiatrist, whom I still go to. She works at the State Institute of Psychiatry, but I see her for a fee. One consultation costs 2500 R.

2500 Р

I pay a psychiatrist for one appointment

The institute where the doctor sees, I was advised somewhere in the comments on the Internet. I called the reception and asked to sign me up for a doctor specializing in affective disorders as soon as possible.

The search for a suitable psychiatrist took about a month, so I went to see a doctor in a completely crushed state, in tears and hysteria. The psychiatrist asked me about the illness, listened to me and offered free hospitalization. However, I refused: I felt that I was controlling myself so as not to commit suicide, and my husband was also nearby, who understood the seriousness of the situation. As a result, I continued the treatment at home.

When Bipolar Disorder Needs Hospitalization

Viktor Lebedev

Psychiatrist, Science Journalist

Bipolar Affective Disorder may require hospitalization if during a manic episode the patient develops strong arousal, completely loses critical attitude to his condition, and hallucinations appear rave. Such a condition can end badly for the patient himself or his relatives. In a depressive episode, indications for hospitalization will be suicidal thoughts or suicide attempts.

Inpatient treatment may also be needed in case of a severe decrease in working capacity.

If you suspect you have bipolar disorder, but are not in the acute phase of the disease, help is not urgent, it is better to spend time looking for a psychiatrist who specializes in bipolar disorder or affective disorders in general. Such a doctor is likely to quickly make the correct diagnosis and select the best treatment.

Before taking, write down all the symptoms that bother you, and also, if possible, draw up a retrospective graph of the expected phases - mania and depression, write down when they occurred and how long they lasted. This will help the doctor understand if this is BAD or something else.

This is how the BAR phase sequence looks like in my case

BAD treatment

Consultations with a psychiatrist and drug therapy

The psychiatrist first wrote me a prescription for several drugs: antidepressants and mood stabilizers. They are usually prescribed to people with affective disorders.

As they explained to me, treatment is, among other things, checking for the correctness of the diagnosis, a way to distinguish depression from bipolar disorder. If the prescribed drugs help, the diagnosis is correct. About two months later, my diagnosis was officially confirmed: bipolar affective disorder type 2.

How bipolar disorder is diagnosed

Viktor Lebedev

psychiatrist, science journalist

Bipolar affective disorder is diagnosed by the problems that bother a person. His story should contain a description of typical mood and behavioral disorders, usually there is an alternation of phases of the disease.

Complaints and a history of the disease are enough for diagnosis, sometimes the testimonies of relatives are also taken into account, which can tell about a person's behavior. It happens that a doctor can send you to a clinical psychologist for a psychological examination, but usually an ordinary psychodiagnostic conversation is enough.

You can suspect the disease on your own, although with hypomania or mania, criticality to one's condition often decreases, that is, a person does not understand that something is wrong with him. Sometimes relatives of the patient come for help, and not he himself. It is better to apply for a diagnosis to a specialist who has worked with BAD, knows what the manifestations of the disease look like.

In general, drug therapy for bipolar disorder consists of several types of drugs that relieve different manifestations of the disease. These are normotimics that stabilize mood, antidepressants that help to cope with depression, antipsychotics that relieve excessive arousal.

Medication for Bipolar Disorders - MSD Handbook

Bipolar Disorder in Adults: Choice of Therapy - Article for Physicians Uptodate

The doctor selects the type of medication and dosage based on the phase the patient is in. Antidepressants are usually used in depressive phases and in combination with mood stabilizers. Antipsychotics - only in manic episodes and also together with normotimics.

In severe cases, a person with bipolar disorder may take up to six different drugs. But you need to strive to get by with one or two.

I started taking prescribed antidepressants and mood stabilizers immediately after seeing a psychiatrist. This time, the process of getting out of depression was long and smooth.

How therapy is selected for bipolar affective disorder

Viktor Lebedev

psychiatrist, scientific journalist

The psychiatrist selects treatment individually, taking into account the clinical picture: in the depressive phase - some drugs, in the hypomanic phase - others, in mania - still others.

It is important to combine drugs correctly. So, if a patient with bipolar disorder is prescribed only antidepressants, this can worsen the situation, even if he is depressed. Antidepressants can "disperse" his condition to hypomania or even mania. It is necessary to normalize a person’s well-being, and not throw him into a state with the opposite sign, so therapy includes normotimics.

The fact is that depression in BAD is not the usual depression, they are not always similar even in external manifestations, there are differences from a biological point of view, that is, in how processes in the brain change.

I visit my psychiatrist regularly: she adjusts the doses of drugs and monitors my condition. In the first year, I visited her six times - it cost me 15,000 R. Now I go to the doctor only during an exacerbation or a presumptive phase change - about four times a year, once every three to four months. It costs 10,000 R per year. In total, I have been seeing a doctor for three years now.

For two years, until recently, I took antidepressants and mood stabilizers in the minimum dosage. A pack of antidepressants for a month cost about 400 R, mood stabilizers - 600 R. That is, during the period of remission, the pills took 1000 R per month.

1000 R

I spend on pills a month in remission

My prescriptions for drugs

However, a few months ago I had an exacerbation, I went into hypomania, so the regimen and dose of drugs had to be changed on the go. Within two weeks, my psychiatrist and I canceled antidepressants, significantly increased the dose of mood stabilizers - 2.5 times, and added antipsychotics. During the exacerbation, which lasted two months, 4000 R per month was spent on tablets. Now 2000 R will go away - the dose of mood stabilizers has been reduced by one and a half times and neuroleptics by half, antidepressants have been removed.

It is interesting to observe how quickly drug therapy changes the state of the body and how it then returns to normal. Often, drugs do not fit the first time, so you need to regularly visit a psychiatrist and monitor your well-being. But after choosing the right therapy, you can live almost as before, except that you need to be more attentive to yourself.

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BAD treatment cannot be found once and for all

Each patient who is responsible for the treatment of bipolar disorder and is in contact with the doctor has his own scheme for changing the dosage or types of medications, taking into account well-being. For example, if you cannot sleep for more than a few days and stop eating, you add an antipsychotic. If you fall into an abyss of self-hatred and don’t swim for more than a week, an antidepressant will help.

Of course, this does not cancel regular meetings with a psychiatrist, because the process of choosing drugs and dosages is very complicated. Now I can regulate a lot myself, depending on how I feel, but I still see a specialist.

At the same time, bipolar affective disorder cannot be cured once and for all - you can only go into a long remission. As my doctor told me, this is five years without pronounced phases. In my case, I lasted two years without episodes, and now I need to start the countdown again.

Also, as far as I know from my experience and the experience of people with the same diagnosis, at some point there is an illusion that everything is cool, there is no illness, it seemed to you that you are doing great. At this point, people stop taking pills - this is a bad decision, never do this. If you feel good, first of all, you should check if this is the beginning of hypomania. And secondly, be glad that you have entered remission.

During these three years, I once stopped drinking pills - depression occurred, once I did not pay attention to the symptoms - I got severe hypomania, now I am trying to go into remission again.

BAD treatment

Psychotherapy

The effectiveness of the treatment of bipolar affective disorder can be increased by combining drug therapy with psychotherapy. Cognitive behavioral therapy is often used for bipolar disorder. It teaches you how to cope with stress factors, monitor your condition, manage the symptoms of the disease. Even during the sessions, together with the doctor, they work out trigger situations, that is, what can provoke an exacerbation of the disease.

Bipolar affective disorder and supportive psychotherapies - an article on the Uptodate physician website

For example, I have trouble admitting my own mistakes. Every mistake for me is a tragedy, and it seems to me that those around her will never forget. It is difficult for me to admit my own mistakes, oversights cause great anxiety. I also have an ideal image of what I should be: read a lot, earn money, keep my house perfectly clean, have six-packs, study, know two foreign languages, go to exhibitions. Obviously, this is impossible, but a persistent desire to reach an unattainable height is also stressful. I work through all this with a psychotherapist.

I started therapy only six months ago, on the advice of a doctor, before that I thought that I could cope on my own. At first she was in therapy with a psychotherapist, whom she found through the Inhale project, which helps burnt out employees from the charitable field. I worked with her on this project, then continued after completion.

We looked at situations that increase my anxiety, including fear of making mistakes and being judged, as well as difficulties in life in general. The cost within the project was 400 R per meeting, there were about ten of them in total, then, already outside the project, the price increased to 2400 R.

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Now I went to another psychotherapist - she has a more applied approach, we look for my cognitive distortions and try to remove them. For example, we work with my excessive anxiety about the impression I make on other people, and the fear that I cannot control it.

The cost of sessions with this specialist is 2500 R per visit. Now I go to her every 10-14 days, that is, 2-3 times a month. In general, I have been working with my condition on my own for quite a long time, so the therapist only directs me in the right direction.

Is psychotherapy mandatory for bipolar disorder

Viktor Lebedev

psychiatrist, science journalist

Cognitive behavioral therapy is most often prescribed for bipolar disorder. This is an optional therapy, that is, an auxiliary method of treatment, you only need to take medication. However, psychotherapy can greatly improve the quality of life: it complements the action of drugs well, helps to control and change those things that pills do not work on. First of all, cognitive-behavioral therapy helps to control emotions, better cope with your illness.

Many also benefit from support groups for people with bipolar disorder. I tried to go to such a meeting, but it didn’t work for me: I don’t want to define myself through illness, this is part of my life - but not me.

The largest project holding such meetings is Sunday BAR. They support not only people with bipolar disorder, but also their loved ones. Meetings are held online and offline.

List of support groups in different cities for people with BAD and other disordersPDF, 275 KB

BAD treatment

Lifestyle

Universal advice given for bipolar disorder and beyond includes the following recommendations: maintain sleep and work-life balance, eat right, do not drink alcohol, play sports.

All this really helps, but in fact, organizing your life is difficult: meetings with friends, vacations, unexpected work do not fit into the routine, you want to work more, and alcohol looks like a great way to cope with anxiety, although in fact it can lead to depression.

I try to keep the correct regimen to the best of my ability. True, according to my feelings, depression comes by itself, without any triggers from the outside, and I cannot influence it. But hypomania is fueled by new projects, loves, and other emotions. For example, even a small amount of falling in love causes hypomania, which, in turn, increases falling in love. It doesn't end well.

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I lived in St. Petersburg for quite a long time, there during the white nights you don’t feel like sleeping at all - and this provokes hypomania. One of the psychiatrists even forbade me to go to St. Petersburg for some time.

Now I have an established sleep and eating regime, I quickly notice its violation - this is a signal that an exacerbation has begun. Unfortunately, sometimes the regime is knocked down by external circumstances, then it is more difficult to notice the exacerbation of BAD.

Sleep is very important to me - it's my priority. I try not to hang out until the middle of the night, and if I didn’t manage to get enough sleep, then I try to sleep in the afternoon. I usually go to bed around midnight, get up at 8-9hours of the morning is a comfortable mode for me and my work. I very rarely stay awake at night or wake up later than 10 am.

I have a fitness bracelet that tracks the phases and amount of sleep - it helps to see the dynamics and notice deviations. When I see a sleep disorder, I start drinking light tranquilizers and antipsychotics to return to a comfortable mode.

Sleeping less than seven hours on pills indicates an episode of hypomania, without drugs in this phase I would sleep less than four hours

And sleep for more than seven hours is already the normalization of the state after the addition of other tablets

Sleeping less than seven hours on pills indicates an episode of hypomania, without drugs in this phase I would have slept less than four hours And sleeping more than seven hours is already normalization of the state after adding other pills

Everything is more difficult with food: I have a difficult relationship with my own body, so I perceive a decrease in appetite with enthusiasm. I am working on the problem with a psychotherapist, how to solve it, until I figured it out. My psychiatrist believes that first sleep, and then everything else, and my experience confirms this: sleep disturbances have a stronger effect on well-being. I also keep a record of alcohol consumption in the Alcogram application - abuse negatively affects my condition. When I see how many sober days there were, it motivates me to control myself.

I am lucky that I take my job seriously: it is responsible and resource-intensive, it is important for me to be productive, it disciplines and helps me to keep the regime.

What to do to reduce the frequency of exacerbations

Viktor Lebedev

psychiatrist, science journalist

In BAD, it is important to have a daily routine that allows you to maintain normal behavior. This reduces the frequency of exacerbations, sometimes helps to completely avoid the recurrence of episodes of the disease. In addition to quality sleep and proper nutrition, you need to avoid overwork, work in an exhausted state, give yourself a rest. Doctors usually insist on the exclusion of alcohol, drugs are also dangerous, especially stimulants, which can cause psychosis in a healthy person.

Exacerbations of the disease can occur on their own, without the influence of external factors, or they can be caused by external events, both tragic, such as the death of a loved one or a break in relationships, and joyful. Therefore, it is important to learn to recognize your emotions, to identify in time what provokes a new episode, both independently and with the help of psychotherapy.

How I live with BAD now

Accepting the diagnosis was not easy: on the one hand, it finally became clear what was happening to me and that it could be regulated. On the other hand, this is a diagnosis for life. You need to constantly monitor your condition, take pills, consult with doctors.

The most difficult thing for me was the inability to separate myself as a person from the disease. What of what I did in life was the result of my choice, and what was a symptom of the disease? Moving from city to city, changing jobs, partners, hobbies - what if all this is just a disease, and I'm not behind it? Three years have passed - and I still cannot separate myself from BAD, it seems impossible.

Now life has become easier: now I know what to expect in the near future, because the phase schedule is still respected. It is clear when to slow down with the pace of life, and when to add antidepressants.

My work is related to people. Of course, the disease affects my mood and state: in depression I have less strength and the ability to give out emotions, in hypomania, on the contrary, there are a lot of emotions, but there is not enough concentration. It's good that work allows you to vary the load depending on the phase: in depression I can work a little less, and in hypomania - a little more.

At the time of my first diagnosed depression, I had an unloved job, it took the entire resource. I cried in the mornings, afternoons and evenings because it was difficult for me to keep working. Now I really love my job, it gives me more resources than it takes.

I continue to take medication, see a psychiatrist several times a year and a psychotherapist several times a month. In March, at the most difficult moment of the exacerbation, I spent on medications, an appointment with a psychiatrist and three meetings with a psychologist 13,000 R.

13,000 R

I go into remission and spend about 8,000-10,000 R per month on medications, a psychologist, and periodic appointments with a psychiatrist. A significant amount, but it allows me to remain in a resourceful and efficient state.

The unobvious difficulty of living with bipolar disorder is the need to strictly control one's financial situation. In hypomania, money flies away easily, you make decisions instantly - for example, you can decide in a minute to fly to Spain and buy tickets. When you are depressed, you spend less, but it is also difficult to earn money. I try to keep a financial cushion in case of an aggravation, and also take into account all expenses in the application so as not to get into debt. Fortunately, so far my financial anxiety is stronger than bipolar, so there has never been a credit card debt.

I spent 58,800 rubles on BAD treatment in a year

Treatment	Price
Psychiatric appointment	10 000 R, total 4 receptions of 2500 R
Psychotherapist appointment	25 000 R, total 10 receptions of 2500 R
Antidepressants	4800 R, 12 packs of 400 R
Antipsychotics	7000 R, 7 packs of 1000 R
Normotimics	12000 R, 15 packs of 800 R

Reception of a psychiatrist

10 000 R, total 4 receptions of 2500 r

Psychotherapist reception

25 000 r, total 10 doses of 2500 r

antidepressants

4800 r, 12 packages of 400 p

neuroleptic

7000 R, 7 packs of 1000 R

Normotimics

12000 R, 15 packs of 800 R

Books I recommend reading about bipolar affective disorder

The most famous book about living with bipolar disorder is The Restless Mind.

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