Staying well with manic depression

1. Staying well with manic depression/bipolar disorder Dr Sarah Russell Many people with bipolar disorder are living happy and fulfilling lives. This presentation discusses many different ways that people with bipolar disorder prevent episodes of illness and stay well. It uses some examples from my recent book �A life-long journey: staying well with manic depression/bipolar disorder�. In this book, people from different walks of life describe how they stay well. It is rarely just about seeing a psychiatrist and taking prescribed medication. It is often about so much more. Many people with bipolar disorder are living happy and fulfilling lives. This presentation discusses many different ways that people with bipolar disorder prevent episodes of illness and stay well. It uses some examples from my recent book �A life-long journey: staying well with manic depression/bipolar disorder�. In this book, people from different walks of life describe how they stay well. It is rarely just about seeing a psychiatrist and taking prescribed medication. It is often about so much more.

2. Defining �staying well� �Staying well� means a range of things. For some, it means being free of symptoms. For others, it means being able to make choices and take control of their condition. By gaining greater control over bipolar disorder, people learn to minimise the impact that the condition has on their lives. Although there is no �one-fix-fixes-all�, people living with bipolar disorder learn � mostly through trial and error � what works for them, and what does not work. Many factors help people with bipolar disorder to stay well and live life to the full. Not surprisingly, many of these factors are things that help all of us to stay well. �Staying well� means a range of things. For some, it means being free of symptoms. For others, it means being able to make choices and take control of their condition. By gaining greater control over bipolar disorder, people learn to minimise the impact that the condition has on their lives. Although there is no �one-fix-fixes-all�, people living with bipolar disorder learn � mostly through trial and error � what works for them, and what does not work. Many factors help people with bipolar disorder to stay well and live life to the full. Not surprisingly, many of these factors are things that help all of us to stay well.

3. We all benefit from eating healthy foods, going for a bike ride or a walk, joining a local sports club, relaxing in front of the TV, drinking less alcohol or caffeine, reducing our recreational drugs, sleeping well, spending time with our loved ones (including our pets), having quiet times, sunshine, managing stress by taking regular holidays, or using day-to-day strategies like knitting, having fun, laughing and so on.] However, people with bipolar disorder also describe the need to make specific changes to stay well. Most importantly, they describe needing to remain mindful that they have bipolar disorder, including during periods of wellness. They also describe the importance of stay well plans in helping to prevent episodes of illness. Personal, social and environmental factors play an important role in helping people to prevent episodes of illness. These are discussed on the next slide. We all benefit from eating healthy foods, going for a bike ride or a walk, joining a local sports club, relaxing in front of the TV, drinking less alcohol or caffeine, reducing our recreational drugs, sleeping well, spending time with our loved ones (including our pets), having quiet times, sunshine, managing stress by taking regular holidays, or using day-to-day strategies like knitting, having fun, laughing and so on.] However, people with bipolar disorder also describe the need to make specific changes to stay well. Most importantly, they describe needing to remain mindful that they have bipolar disorder, including during periods of wellness. They also describe the importance of stay well plans in helping to prevent episodes of illness. Personal, social and environmental factors play an important role in helping people to prevent episodes of illness. These are discussed on the next slide.

4. What is a stay well plan? Stay well plans come in many shapes and forms � they may be written, spoken, drawn or even sung. They are �living� documents that are regularly up-dated. Rather than being �set in stone�, stay well plans are adapted and revised as an individual�s personal circumstances require. A stay well plan is a guide. The aim is to help people with bipolar disorder to clearly identify their own individual triggers and specific warning signs. Given that these triggers and warning signs may change with time, a stay well plan is flexible and responsive. Stay well plans describe preventative strategies that help people to manage their illness during periods of wellness. These strategies are based on an individual�s needs and social contexts. Stay well plans also include interventions that are appropriate for an individual to use when they feel early signs of things going wrong. For many people, staying well is not a solitary activity. It is, therefore, worthwhile to develop stay well plans with partners, family, close friends, neighbours, work colleagues and health professionals. Keeping others �in the loop� is also useful if interventions ever need to be implemented. Stay well plans come in many shapes and forms � they may be written, spoken, drawn or even sung. They are �living� documents that are regularly up-dated. Rather than being �set in stone�, stay well plans are adapted and revised as an individual�s personal circumstances require. A stay well plan is a guide. The aim is to help people with bipolar disorder to clearly identify their own individual triggers and specific warning signs. Given that these triggers and warning signs may change with time, a stay well plan is flexible and responsive. Stay well plans describe preventative strategies that help people to manage their illness during periods of wellness. These strategies are based on an individual�s needs and social contexts. Stay well plans also include interventions that are appropriate for an individual to use when they feel early signs of things going wrong. For many people, staying well is not a solitary activity. It is, therefore, worthwhile to develop stay well plans with partners, family, close friends, neighbours, work colleagues and health professionals. Keeping others �in the loop� is also useful if interventions ever need to be implemented.

5. Preventing episodes of illnessPart 1 The next 3 slides describe preventing episodes of illness. Although bipolar disorder can not be cured, people are able to prevent episodes of illness. Like others with chronic conditions, people with bipolar disorder can develop stay well plans to help them manage their condition. Many people gain expertise in managing bipolar disorder from their own life experiences, including experiences of illness. Sleep is a crucial ingredient in staying well. When things start to go wrong, the most common initial strategy is a good night�s sleep. Rather than lie awake at night, buzzing with ideas or thinking about something stressful, it is often healthier to take a prescribed sleeping tablet. Manageable levels of stress at both work and play is often easier said than done. Although it is not always possible to avoid stress, it is possible to develop strategies to minimise the impact of stress. These strategies may include regular holidays, talking with friends, meditation or even ballroom dancing. However, strategies to minimise stress may not always work. It may be necessary to alter medication during particularly stressful periods. There are times when lifestyle activities are difficult to implement. For example, when feeling down, it may be difficult to exercise. A stay well plan which includes cycling to work or a daily dog walk can be helpful. The next 3 slides describe preventing episodes of illness. Although bipolar disorder can not be cured, people are able to prevent episodes of illness. Like others with chronic conditions, people with bipolar disorder can develop stay well plans to help them manage their condition. Many people gain expertise in managing bipolar disorder from their own life experiences, including experiences of illness. Sleep is a crucial ingredient in staying well. When things start to go wrong, the most common initial strategy is a good night�s sleep. Rather than lie awake at night, buzzing with ideas or thinking about something stressful, it is often healthier to take a prescribed sleeping tablet. Manageable levels of stress at both work and play is often easier said than done. Although it is not always possible to avoid stress, it is possible to develop strategies to minimise the impact of stress. These strategies may include regular holidays, talking with friends, meditation or even ballroom dancing. However, strategies to minimise stress may not always work. It may be necessary to alter medication during particularly stressful periods. There are times when lifestyle activities are difficult to implement. For example, when feeling down, it may be difficult to exercise. A stay well plan which includes cycling to work or a daily dog walk can be helpful.

6. Preventing episodes of illnessPart 2 Social support networks Although staying well is rarely just about taking prescribed medication, medication is an important component of many stay well plans. To be more precise, the right medication at the right dose. Many people choose to complement prescribed medication with other therapies, such as massage, yoga, and meditation. It is important to work with reliable and trustworthy professionals. People with bipolar disorder often work with a number of different health care professionals (GPs, psychiatrists, psychologists, social workers, occupational therapists, case managers etc), acknowledging that each professional has different expertise. Even in supportive workplaces, stress at work can make people with bipolar disorder vulnerable to an episode of illness. Developing personal strategies to manage workloads, and minimise stress, helps people to stay well at work. People with bipolar disorder often benefit from joining local community groups - sport clubs, community choirs, book clubs, churches etc. At my local tennis club, people have always been much more concerned about my forehand drive than my medical diagnosis! Partners, lovers, parents, children, brothers, sisters, friends and colleagues gain insight into bipolar disorder. I call this �outside insight�. Outside insight often helps people with bipolar disorder to manage their illness. Although staying well is rarely just about taking prescribed medication, medication is an important component of many stay well plans. To be more precise, the right medication at the right dose. Many people choose to complement prescribed medication with other therapies, such as massage, yoga, and meditation. It is important to work with reliable and trustworthy professionals. People with bipolar disorder often work with a number of different health care professionals (GPs, psychiatrists, psychologists, social workers, occupational therapists, case managers etc), acknowledging that each professional has different expertise. Even in supportive workplaces, stress at work can make people with bipolar disorder vulnerable to an episode of illness. Developing personal strategies to manage workloads, and minimise stress, helps people to stay well at work. People with bipolar disorder often benefit from joining local community groups - sport clubs, community choirs, book clubs, churches etc. At my local tennis club, people have always been much more concerned about my forehand drive than my medical diagnosis! Partners, lovers, parents, children, brothers, sisters, friends and colleagues gain insight into bipolar disorder. I call this �outside insight�. Outside insight often helps people with bipolar disorder to manage their illness.

7. Preventing episodes of illnessPart 3 Interventions to deal with triggers and warning signs A number of different factors may trigger an episode of bipolar disorder. These �triggers� may include sleep deprivation, shift work, fatigue, jet lag, hormonal fluctuations, change of seasons, stress, grief, and all night partying. It is possible to avoid some triggers, but not others. It is important to know your early warning signs � physical, mental, and emotional changes that may indicate the onset of an episode of illness. Many people with bipolar disorder have tell-tale warning signs such as changes in sleep, speech, sex and spending. Others experience unique early warning signs. With experience, people learn how to respond to triggers and early warning signals to ensure they avoid episodes of illness. Stay well interventions may involve cancelling a few social engagements, getting a good night�s sleep, meditation, yoga, increasing medication, minimising external stimulation, taking long quiet walks, eating healthy foods, or making an appointment with a health care professional. A number of different factors may trigger an episode of bipolar disorder. These �triggers� may include sleep deprivation, shift work, fatigue, jet lag, hormonal fluctuations, change of seasons, stress, grief, and all night partying. It is possible to avoid some triggers, but not others. It is important to know your early warning signs � physical, mental, and emotional changes that may indicate the onset of an episode of illness. Many people with bipolar disorder have tell-tale warning signs such as changes in sleep, speech, sex and spending. Others experience unique early warning signs. With experience, people learn how to respond to triggers and early warning signals to ensure they avoid episodes of illness. Stay well interventions may involve cancelling a few social engagements, getting a good night�s sleep, meditation, yoga, increasing medication, minimising external stimulation, taking long quiet walks, eating healthy foods, or making an appointment with a health care professional.

8. A stay well plan in action Rob�s main triggers: Jet lag Increased work demands Change of seasons Rob�s warning signs: Obsess about a work problem or idea Talk faster than usual Feel a sense of urgency Difficulty completing tasks Wake up in the middle of night thinking about work problem or idea This last slide provides an example of how Rob developed his personal stay well plan. Rob is a 40 year old merchant banker. His job requires frequent overseas travel between offices in London, New York and Melbourne. His first episode of mania occurred soon after flying home from New York. After this, Rob developed a stay well plan to avoid �jet lag mania�. His stay well plan outlines seven specific strategies for when he is travelling overseas. These strategies include travelling with sleeping tablets and anti-psychotic medication, just in case. Later, Rob also experienced an episode of mania during a very busy period at work. He therefore added new strategies to his stay well plan for those times when his workload increases and he needs to work back late at night. Several of these strategies include assistance in �mood checking� from his wife and colleagues. Finally, Rob recognised that he often becomes depressed during Spring. So he added strategies in his stay well plan to cope with the change of seasons, including taking his annual leave in September.This last slide provides an example of how Rob developed his personal stay well plan. Rob is a 40 year old merchant banker. His job requires frequent overseas travel between offices in London, New York and Melbourne. His first episode of mania occurred soon after flying home from New York. After this, Rob developed a stay well plan to avoid �jet lag mania�. His stay well plan outlines seven specific strategies for when he is travelling overseas. These strategies include travelling with sleeping tablets and anti-psychotic medication, just in case. Later, Rob also experienced an episode of mania during a very busy period at work. He therefore added new strategies to his stay well plan for those times when his workload increases and he needs to work back late at night. Several of these strategies include assistance in �mood checking� from his wife and colleagues. Finally, Rob recognised that he often becomes depressed during Spring. So he added strategies in his stay well plan to cope with the change of seasons, including taking his annual leave in September.

9. Rob�s stay well plan (and several others) are available in my book �A life-long journey: staying well with manic depression/bipolar disorder� (published by Michelle Anderson Publishing). These examples illustrate different types of stay well plans in various life situations. They demonstrate how people use their own life experiences and current circumstances to develop unique stay well plans. From these examples, others with bipolar disorder will be able to create their own individual stay well plan. By providing a wellness view of manic depression, �A life-long journey: staying well with manic depression/bipolar disorder� provides hope for people with bipolar disorder, their families and friends. It may also provide important new insights for health care professionals and policy makers. Rob�s stay well plan (and several others) are available in my book �A life-long journey: staying well with manic depression/bipolar disorder� (published by Michelle Anderson Publishing). These examples illustrate different types of stay well plans in various life situations. They demonstrate how people use their own life experiences and current circumstances to develop unique stay well plans. From these examples, others with bipolar disorder will be able to create their own individual stay well plan. By providing a wellness view of manic depression, �A life-long journey: staying well with manic depression/bipolar disorder� provides hope for people with bipolar disorder, their families and friends. It may also provide important new insights for health care professionals and policy makers.