Credit card forgiveness for bipolar

How to Get Out of Debt Racked Up During Depression

Image: Paul Thuysbaert / Getty Images

Compulsive spending often goes hand-in-hand with certain mental illnesses. For people who have clinical depression, comfort spending is a common way to self-soothe, while individuals with bipolar disorder often go on impulsive shopping sprees during manic episodes. These behaviors can lead to credit card debt that outlasts the mental health episode, and that can make it difficult to fully enjoy life again. When you finally have the energy to go out and spend time with friends and enjoy the simple pleasures in life, it can be devastating to read financial advice that urges you to cut every single corner until your balance is paid off.


There is a way to pay off your debt without sacrificing time with friends or enjoyable experiences—it just requires some more thought and creativity.

Create a Budget That Allows Resources for Fun and Addresses Paying Off Debt

A lot of us associate the term “living on a budget” with only eating the cheapest items we can find at the grocery store and eliminating any expense that’s not an absolute necessity. But budgets are meant to create room for things you enjoy, too, and setting a little money aside for those expenses is especially important for anyone who is trying to improve their mental well-being.

Emin Gharibian, a licensed psychologist and founder of Verdugo Psychological Associates, said the first step is to work with your therapist to establish a budget and determine how much you can afford to spend per month on leisure and fun activities, like a weekly meal with friends or other self-care activities, such as taking up a new hobby, in addition to paying down debt. “It’s unreasonable to tell someone that they can’t spend any money for leisure if they have credit card debt,” Gharibian said. “It’s all about budgeting and figuring out what you can afford and sticking to that budget.” As long as you have a plan to pay off your debt and are actively working at it, there’s no need to punish yourself or swear off every “frivolous” activity that boosts your mood or allows you to spend quality time with good friends.



How to Stop Avoiding Your Bank Account When It Stresses You Out

Caitlin Flynn

Although therapists aren’t financial planners, Gharibian said many providers can help with basic financial literacy, helping you set priorities for spending and saving and organize your finances based on what’s most important in your life. If you don’t have a therapist already, Gharibian emphasized the importance of being upfront and honest about your behavior and the problems you’re looking to resolve when you start the process. Try to find a provider who is equipped to address the root cause of your spending and is willing to work with you on a budget. He said that it’s best to bring up the issue of debt and budgeting during a consultation call—otherwise you may end up going through several sessions before realizing that a therapist simply isn’t comfortable getting involved with your budget.

If you need more in-depth guidance, Gharibian recommended seeking out a financial planner or accountant—but for basic advice and accountability, the right therapist will suffice.

Focus on Learning Healthy Coping Mechanisms

Even if you know you’re going to have to answer to your therapist eventually, you may still have stressful moments where you’re tempted to open a new credit card, or use the money in your checking account to shop instead of toward paying off your debt as planned. In a difficult moment when you’re feeling tempted and your natural inclination is to buy things to self-soothe, it’s important to have a healthy coping mechanism to turn to.

Work with your therapist to make a list of alternatives to turn to when you’re tempted to spend. What will be most effective depends on the person. Gharibian said calling a trusted friend, reading a book, taking a walk, or listening to music have been effective techniques for his clients, and that mindfulness exercises, meditation, and guided imagery might also be worth trying.


Find Low-Cost Activities

Isolation is a common symptom of depression, and prioritizing quality time with friends is important for improving and sustaining good mental health. Many of us have friends who are in different financial situations and may default to suggesting expensive activities that you’ve historically enjoyed doing. But it’s important to decouple the ideas of spending money and having fun, and to get comfortable with suggesting activities that will allow you to spend time together without breaking your budget.

Lauren Bringle Jackson, accredited financial counselor at, suggested organizing social activities like movie or game nights at someone’s home. Instead of going out to dinner, organize a potluck where everyone brings a dish or drinks to share and you can enjoy each other’s company without the hefty bill that arrives at the end of the meal.

Jackson also recommended finding free events and activities in your area. For example, public libraries often offer free craft or movie nights, and many museums have designated days that offer free admission. Outdoor activities are another way to spend quality time with your friends for free. “Get some friends together and play a sport or have a picnic,” Jackson suggested.

“Free events don't limit your fun,” she added. “They expand your opportunities for doing new things in a different way, which is what healing is ultimately all about.”


Remove the Temptation From Your Home

Of course, none of these money-saving activities are going to be particularly effective if you continue to break out the credit cards during a rough patch. Because shopping—particularly online—can be incredibly tempting, Gharibian recommended giving your credit cards to someone you trust. “Just like people with substance abuse problems shouldn’t be going to bars and nightclubs, people with spending problems shouldn’t have easy access to their credit cards,” he said.

Gharibian emphasized the importance of working out an agreement when you hand over your cards. “Be clear and tell [the trusted person], ‘If I come to you asking for my credit cards, don’t just give them to me. I have to tell you exactly what I need it for, and to be supervised while I use it.’” And make sure you’re on the same page about exceptions and instances when you’re required to have a credit card on file (like at a doctor’s office, for example).

If you can’t find someone who is comfortable with this arrangement, it’s even more important for your therapist to be involved in the financial aspect of recovery. Steve Sexton, financial consultant and CEO of Sexton Advisory Group, recommended reviewing your credit card and bank statements with your therapist on a monthly basis.

Remember That You’re Not Alone

Just like there’s a stigma attached to mental illness, many people feel ashamed of racking up credit card debt, so this situation can feel like a double whammy. Gharibian emphasized that, although compulsive spending is not a particularly healthy behavior, it’s still fairly common. “It happens to a lot of people, so they shouldn’t feel like they’re the only ones that made this mistake, or that they’re ‘stupid’ or anything like that,” he said. “It happens and it’s not unusual.”

Credit card debt isn’t a problem that has a quick and easy fix, but being proactive and taking control of the situation will put you on the right path to digging yourself out of debt.

Sign up for our newsletter to get the best of VICE delivered to your inbox daily.

Follow Caitlin Flynn on Twitter.

Mental Illness Cleaned Out My Bank Account And Destroyed My Credit

Three years ago, I hit financial rock bottom.

Rent was due and, once again, I didn’t have it. I did, however, have three maxed-out credit cards, a negative account balance, and a closet full of useless junk I’d bought during a 2 a. m. online shopping binge a few weeks prior.

I wasn’t financially illiterate. I knew how credit scores can be damaged and interest charges accumulate over time thanks to my mom, a single parent who taught me to prioritize financial independence and frequently references the teachings of financial expert and lesbian style icon Suze Orman.


I fully understood what I was supposed to be doing with my money, and that I didn’t have much of it. As a freelance writer, I don’t make the kind of money to support a fun, quirky shopping addiction a la ”Confessions Of A Shopaholic.” I wasn’t trying to live out a broke-but-fabulous Carrie Bradshaw fantasy, and I was way past the point in my 20s when being broke stops being cute.

My credit tanked as I kept racking up online shopping debt I knew I couldn’t pay off, and I couldn’t stop. I also couldn’t sleep, but I didn’t need to. Sitting in front of my computer all night impulse-buying clothes, shoes, gimmicky skincare products, or a high-end espresso machine gave me an undeniable rush. It didn’t matter what I bought, only that I wanted this stuff because this stuff would make me feel better, and somehow the details of how I would pay for it would all work themselves out.

I felt unstoppable, untouchable, until the rush died down, and I’d crawl into bed for the next five days terrified by the depth of the financial hole I’d dug myself into—an exhausting cycle that started in my early 20s and seemed like it would never end until I ruined myself financially.

Around this time, I started seeing a therapist to help me cope with the constant anxiety of my mounting money problems. I told her about my ongoing financial problems, and the euphoria I sometimes felt that seemed to come in waves before an eventual crash into severe depression that lasted for weeks until the cycle began again. But most of the time I could barely get out of bed.


“The double stigma of struggling with both mental illness and financial instability can feel embarrassing or shameful.

After a few sessions, she referred me to a psychiatrist who explained that drastic and unpredictable mood shifts like mine—periods of high energy, hyperactivity, and loss of touch followed by depressive episodes—are typically associated with bipolar disorder.

Not only that, but the feelings of impulsivity, restlessness and delusion that often accompany these manic periods can lead some people with bipolar toward risk-taking behaviors like self-harm, unsafe sex, and in some instances, shopping binges and spending sprees. I learned that most people who live with bipolar manage their symptoms through a combination of medication and talk therapy, and fortunately, I was able to start a course of treatment.

Though classic symptoms of a bipolar disorder can include what some people might describe simply as “highs” and “lows,” or what pop culture portrays as a “split personality,” getting a diagnosis and learning to live with these symptoms is much more complex.

Compulsive shopping isn’t typically discussed in relation to bipolar, and “financial destruction” doesn’t typically show up on the lists of common symptoms. However, chronic overspending is fairly common among people living with bipolar disorder, and it can be just as destructive to long-term health and wellbeing as any other behavioral symptom left untreated.


Before I was formally diagnosed, I never suspected I could be experiencing symptoms of bipolar disorder. Instead, I told myself I was just bad with money, bad at relationships, terrible at my job, and that my fluctuating moods were just bad PMS (that somehow lasted for months on end.) I believed recklessness and impulsivity were just part of my personality, rather than a symptom of a common and highly treatable mental illness.

I do occasionally behave in ways that could be described as reckless, impulsive, and financially irresponsible that have nothing to do with having bipolar, but before I sought treatment, these impulses were much more difficult to control.

Bipolar disorder can complicate work, relationships and other aspects of everyday life in a variety of ways, but the financial consequences can be some of the most devastating and most stigmatized.

Living with mental illness of any kind is shockingly expensive. The cost of therapy, medications and missed work days can add up, fueling the cycle of depression and instability. The double stigma of struggling with both mental illness and financial instability can feel embarrassing or shameful.

“I still feel the urge to spend when I’m anxious, stressed, or even feeling exceptionally good, but now those compulsions feel more like background noise I can easily tune out.”


I not only live with a bipolar disorder, which itself is highly stigmatized and stereotyped, I’ve also made some remarkably irresponsible financial decisions that had substantial, long-lasting consequences. Credit and debt can take years to rebuild and pay off, not to mention how long it can take to set aside money for a savings account.

After experimenting with a few different combinations of medication with the help of my psychiatrist, my symptoms are generally under control. I still see my therapist for regular visits to help me cope and stay focused on my progress, financial or otherwise. I still feel the urge to spend when I’m anxious, stressed, or even feeling exceptionally good, but now those compulsions feel more like background noise I can easily tune out. I also deleted the shopping apps from my phone and unsaved my credit card information from the websites I visited regularly, so I’ll be less tempted the next time I hit a rough patch.

I’m steadily making progress toward improving my credit score, paying bills on time, spending far less and adding to my savings. The impact of my mental illness on my financial health security will likely follow me into future financial decisions and possibly my personal relationships, but I’m not ashamed to admit that I’ve struggled with mental illness, or that living with bipolar disorder complicates my financial present and future.

Money talk can be embarrassing, but it also sheds light on the complexities of bipolar beyond a surface-level understanding of “highs” and “lows.” Radical transparency is critical to eliminating shame and stigma surrounding both mental illness and financial instability.

Do you have a compelling personal story you’d like to see published on HuffPost? Find out what we’re looking for here and send us a pitch!


Before You Go

Popular in the Community

You May Like


Newsletter Sign Up

Must Reads

Look under the hood, and take a behind the scenes look at how longform journalism is made. Subscribe to Must Reads.

Successfully Signed Up!

Realness delivered to your inbox

By entering your email and clicking Sign Up, you're agreeing to let us send you customized marketing messages about us and our advertising partners. You are also agreeing to our Terms of Service and Privacy Policy.

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 BAD 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 Disorder Manifests

BAD usually starts abruptly, followed by periods without symptoms 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.


“It reminded me of a strict regime sanatorium”: how much I spent on treating depression

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 Excitation, 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 Feeling of worthlessness, suicidal thoughts, suicide attempts


Excitement, joy, irritability, resentment


Decreased need for sleep


Loss of appetite




The feeling of jumping of thoughts, multitasking


Risk, unbridled sex

Subjective sensations

Feelings of their own importance, talent and power

Depression 9000 9000 9000 9000 9000 9000 9000 Mood

Sadness, depression, emptiness, anxiety, hopelessness


Trouble falling asleep, getting up early or sleeping too much


often increased appetite, weight gain


Slow speech, forgetfulness


Problems with attention and making decisions, Dispersibility


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:

  1. When there was at least one manic episode and depressive episodes recur.
  2. 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's even more difficult for me: I understand what is happening with my brain, but I can't 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.

10 podcasts about health and medicine

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 polyclinic - 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.


How to choose a psychotherapist

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 searched 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.

6 useful services for finding a psychotherapist

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 visit

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, it is worth writing down all the symptoms that bother you, and also, if possible, make 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 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 same depression as usual, 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.


How I live with obsessive-compulsive disorder

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 - I got depressed, once I did not pay attention to the symptoms - I got severe hypomania, now I'm trying to go into remission again.

BAD treatment


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 psychotherapy - 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.


How much does it cost to treat borderline personality disorder

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


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.


How much does it cost to support a relative with a mental disorder

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 is 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 sleep 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 medicines, 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

Reception of a psychotherapist

25 000 r, total 10 doses of 2500 r


4800 r, 12 packages of 400 r

neuroleptic neuroleptic

7000 R, 7 packs of 1000 R


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. My Victory Over Bipolar Disorder by Kay Jamieson. Its author is a clinical psychologist with bipolar disorder.

Another great book is Wishful Drinking, but it's in English. This is the autobiography of Carrie Fisher, the actress who played Princess Leia in Star Wars. The author has struggled with bipolar disorder and drug addiction all her life, but the book is surprisingly funny.

Of the Russian-speaking authors, it is worth reading the books of Masha Pushkina - she was the first in Russia to write about bipolar disorder for a wide audience. Her books: “Bipolar. How people with bipolar disorder live and dream” and “Bipolar people. Without masks. Candid stories of people who changed themselves and changed the world.”

Did you also have an illness that affected your lifestyle or attitude? Share your story.


John Hemingway: "Grandfather was next to his father because of bipolar disorder"

In early September, Ernest Hemingway's grandson John Hemingway came to Russia for the Moscow International Book Fair at the invitation of the Montegrappa brand. At the MIBF, he presented to the Russian public his book Strange Tribe, a family memoir about the difficult relationship between Father John Gregory and his famous grandfather. Gregory Hemingway had bipolar disorder, he himself was a doctor, and in the middle of 19In the 90s, he decided to change his gender, because he had long felt like a woman, not a man. Gregory changed his name to Gloria and underwent several surgeries, but never completed the transformation due to his death in a women's prison in 2001. Buro 24/7 caught up with John Hemingway to talk about his book, bipolar disorder and the difficult relationship between his father and grandfather.

John Hemingway

I prefer to think that my book is a biography of my father. I did not want to write about my grandfather, because many books have already been written about him and they continue to be written. It's almost impossible to find anything completely new about Ernest Hemingway. Although I think my book brings something new to his character. The fact is that when I wrote about my father, I found new information about his father too. I read a couple of books about him when I was a teenager, but I never thought that my father and grandfather were alike. My father had many difficulties in his teenage years and later had sex reassignment surgery. I loved my father and thought my grandfather was a great person, but I never thought they had anything in common. I was surprised that there were similarities.

Ernest Hemingway Gregory Hemingway

They were both very smart and funny. My father was a good hunter - even better than my grandfather. When he was 12 years old, he won the senior shooting competition. Moreover, these were national competitions. My grandfather reacted violently to this because hunting was something of a family religion. My grandfather was given this idea by his father, and hunting was an important part of maintaining family relationships through the male line. My grandfather was a doctor and a writer, my father too, and I'm just a writer. There are many similarities.

My first wife received various scholarships for research work, and one of them was for research on Hemingway, but I myself had not yet thought about such a direction for myself. I think I was a little afraid to do it. I was terrified at the thought that my father and grandfather were similar in some way. I finally realized that if I want to write my father's story, I need to understand what happened before him, add information about my grandfather's generation. It opened my eyes, and so I began to read about the grandfather generation and found interesting connections. I began to understand what was happening around my father, and I realized what kind of conflict had occurred between my father and his father.

Hemingway's Sons

When I was reading my grandfather's works written in the 1920s, I found something that struck me: there was a story about an engaged couple and their games of pushing gender boundaries. He tried to understand how a man and a woman are connected, he tried to find the point at which the masculine begins and the feminine ends. He had many such stories. Now, my book examines what he wrote and tries to guess what was behind it. He wrote about it because he was interested in it. He saw some potential in it, and it was part of his personality, and I thought it was interesting.

So I decided to study this aspect. Two different generations of men were interested in the connection between gender identity and sexuality, but they had two different views on it. The first was a writer, and the second was a doctor. They both studied the issue, but the other was able to look deeper into it by changing gender from male to female legally and physically. And after my father went through the operations, some part of his mind told him that this was the best thing he had done, and another part that he had become just a freak. And I have never been able to find a point that unites both of these views.

I think we all combine masculine and feminine traits in our personalities, but we don't realize it most of the time. It was important for my father to find that balance. In his case, it was more of a physiological balance. And I think it's a completely different dimension when compared to my grandfather's work. He was definitely macho. He loved women, participated in the First World War, he was married four times, he liked alcohol, hunting and fishing. But he also had another side. He was a complex man, made up of many dimensions. And the more dimensions you saw, the better you understood it. I think the dimension of Ernest Hemingway that I'm talking about, I myself did not expect to find. I thought I would just write the story of my father, but it turned out to be a story of forgiveness, love, difficulties and problems in communicating with parents.

Gregory Hemingway with his wife

Gregory Hemingway at home

My father had bipolar disorder. In all the years I've been talking about this, a lot of people have come up to me and told me about their bipolar disorder or the disorder of one of their relatives. And I can understand how they feel, and I'm happy that this story helps people with such a problem and gives them the realization that there is a way out, they can count on understanding and that they will be accepted as they are. And it is not very easy, especially during exacerbations. They need other people, and of course it's more a matter of forgiveness than anything else. The way my father lived and died is a tragedy. He blamed his wife for his condition, which was wrong. It was hard for her, and she died the same day after their next quarrel. By the way, my father died on the same day and at the same hour, only 50 years later. And this ring structure is also in my book. My editor said that many would not understand my book because of this structure, but it seems to me something natural.

I had a letter that my father sent to Ernest. This letter had already been published, but no one could understand the context, the pain, the despair, and the guilt that my father had. My grandfather was always with him when his father became incapacitated due to bipolar disorder and took him to clinics. It mattered to my grandfather. He cared about his children, and especially about my father, because when a parent sees how his child suffers, he wants to somehow help him. And I can't understand how my grandfather felt because he couldn't find a solution to his son's problem. This was before lithium was discovered as a drug to help people with bipolar disorder. It was very important for me to read this letter and at the same time painful, because I wanted to help him, and I thought that all I could do was write about it.

Patrick, Ernest and Gregory Hemingway

To anyone with a family member with bipolar disorder, I would like to say that family support is very important to that person. In their own way, they have a special gift. In any case, those who have bipolar disorder usually say that they would not like to be different. To lose it for them is like losing an arm. This is part of their personality. The way they define themselves. They are phenomenal, their brain works on a completely different level. But when a person cannot control their bipolar disorder, it can turn into a serious illness, become clinical depression. And this is where the problems begin. People commit suicide in this state, so they need to be protected. They need to be taken care of, they need to be understood. I realize it's difficult.

Bipolar disorder used to seem uncontrollable, but now it is possible at some level, there are drugs for this. So you can lead a normal life with him. I remember when my father took lithium he hated it because, as he said, the drug made him feel like a cow and took away half of his emotional spectrum. But now the drugs work more gently, and people do not become so emotionless and can live life to the fullest.

Actually, I was very scared because I knew that my father and grandfather were very similar, and what can be said about me? I knew I didn't have bipolar disorder because I would already have a lot of symptoms.

Learn more