BIPOLAR AND MAINTAINING THE BALANCE
In my previous posts, I have written about how I got diagnosed with bipolar disorder and how I dealt with depression. The last few months I have been in remission. So this post is about how I maintain the balance and avoid the highs and lows of bipolar disorder. Highs and lows in mood are common with anyone, but for a person with bipolar disorder, these highs and lows are more accentuated. Therefore, some of these pointers may seem like wellness measures for those who do not have bipolar disorder. Further, there may be an overlap with my previous post on depression. This is because the steps you take to get out of depression, are required to be followed on a long term basis as well.
Once I got out of my depressive phase, I started following a repetitive and predictable schedule. The schedule gives me balance and rhythm. This aspect is applicable even for someone who is not in remission from a mental health illness. Having a fixed sleeping schedule, exercise regime, prayers and meditation helped me build a lot of confidence. I will discuss each of these aspects in detail in the subsequent sections.
Fixed Sleeping Schedule
I have been advised by my psychiatrist that I should have 6-8 hours of sleep every day. In addition to this, the sleeping pattern needs to be regular. Having said this, there have been times where I have had fewer hours of sleep due to personal commitments. The crucial part is that late nights cannot be a recurring event.
In addition to the amount of sleep, the quality of sleep is also very important. To monitor this, I got a Fitbit Versa which not only mentioned the hours, but also the quality of your sleep. Therefore, I would recommend that one employ means like these to monitor their sleep cycle.
There have been nights where I have not been able to sleep or have had disturbed sleep, the key is to not get anxious about it – eventually you will fall asleep. I sometimes take an anti-anxiety pill to sleep, if sleep has been disturbed for a few days. I have discussed the importance of relying on medicines below.
Therefore, ensure you have a good sleep cycle and it has definitely helped in me maintaining my balance.
One hour of exercise is mandatorily prescribed by my psychiatrist. The hormones (endorphin) that get released during the exercise not only enhances the mood, it also energises a person. While I try to be regular with this, I will not be entirely honest if I do not reveal that there have been a lot of days that I have missed exercising. Recently I shifted cities and I had a very close family member’s wedding as well; in the midst of these two, exercise went completely off the chart. While my mood has been stable in the absence of exercise, I will advise you to not miss exercise. Exercise should be part of the predictable schedule in such a way that you are compelled to do it even if you don’t want to. My aim is to achieve this.
It was in 2017 that I had my diagnosis of bipolar disorder, but my first manic episode was in 2006. In 2006 I was prescribed medicines by my doctor and was asked to have it for a few years. In a year’s time I got a lot better and decided to not take the medicines. I felt that the medicines lead to weight gain and also made me a weaker person because I felt I was dependent on it. After 11 years, I had a relapse and it was then the diagnosis had happened. Similar to my first episode, I knew that I needed the medicines to come out of mania and to get stability.
While I was recovering and even during my depressive phases, I used to keep asking my doctor if I can reduce the tablets. As time flew, I realised myself how these medicines have helped me come a long way and that they play a huge role in preventing a relapse. Between 2017 and 2021, I had two episodes of mania and both were due to inadequate medication. Therefore, eating your medicines regularly is a huge component to attain remission and maintain the stability.
There will be side effects to these medicines, at the end of the day these are psychiatric medicines. I have gained a lot of weight due to it, but I know I can reduce it through diet and exercise. However, there have been a lot of times, where I have felt bad about the weight gain. During these times, I tell myself how these medicines are helping me.
Secondly, the SoS tablets need to be used without any hesitation if required. I take my anti-anxiety pills if I have a bout of anxiety or if I have not slept well for a few days. There is no stigma attached to taking these tablets, the regular medicines or the SoS tablets. Please understand that they are key to recovery, and the illness cannot be ‘controlled by the mind’. Having said all of this, the most crucial aspect is that one should only take the prescribed medicines. Even in times of distress, only take the medicines advised by the doctor.
In my case, I am lucky that my husband, Srini, keeps a daily tab of my medicine intake. So either do it yourself or have a caregiver monitor your medicine intake.
Doctor Follow-up and Therapy
As I said in the previous section, I had discontinued medicines after my first episode. However, I was not aware of the diagnosis then. Consequently, did not meet the psychiatrist also. After 2017, we have been regular with our follow-ups. These consultations help you to check the status of your health, which definitely contributes in maintaining the balance. I have been fortunate to have a very approachable psychiatrist who I could text in case of any discomfort. Therefore, it would be ideal if you have a health professional you can reach out to, in case of any issue, which does not warrant a hospital intervention. Further, you should feel free to express your doubts and questions to your doctor so that you have a clear understanding of your recovery.
In addition to a psychiatrist, a psychologist or therapist plays an important role in the recovery of a bipolar patient. Unlike the case of a psychiatrist, it took me a lot of trials to find the right therapist. Currently, I am fortunate that I have a good therapist who has helped me a lot in being aware of my emotions, controlling them and achieving the balance. It is important to understand that the role played by a psychiatrist and therapist are very different. The former deals with the disorder by prescribing medicines while the latter understands the moods and the emotions. Bipolar disorder being a mood disorder it is important that the person consults with a therapist regularly.
In addition to the scheduled consultations, my therapist does not mind if I reach out to him with my questions or concerns. Similarly, I would recommend you find an approachable therapist. Secondly, a therapist can only help you if you let them help you. In other words, be free to open up to him or her and express your thoughts. In addition, don’t expect a miraculous change after the first or second consultation. It took me six to seven months to see the full effect of my therapy. I will discuss in the next section how my therapy has contributed to my recovery.
Being Aware of Thoughts
Therapy introduced me to cognitive behavioural therapy (CBT). CBT is a very effective therapy tool that helps a person deconstruct their thoughts and become aware of their emotions. My therapist taught me how to use CBT tools to tackle your emotions in a very phased manner. CBT cannot be mastered instantly and needs a lot of effort from the patient and the therapist. Through the methods suggested by my therapist, I started breaking down my thoughts and started going into the core of the genesis of my thoughts. I used to do this on a daily basis and maintained a journal for it. The changes that CBT brought to my behaviour including anxiety were really positive. Slowly, I was able to do CBT in my mind without the aid of my journal, and dealt with a situation. However, my therapist has advised me to continue with CBT using the journal method for at least once a week.
One’s thoughts lead to one’s emotions and moods. When these emotions and moods become too heightened or too low, there is mania and depression. While majority of it is triggered by the chemical imbalance, the thoughts that arise in your mind also contribute to the occurrence of mania and depression. Therefore, the key is to catch these thoughts when they start affecting you adversely. CBT helps you in being aware of your thoughts. It is important to remember that you cannot control your thoughts, you can only control your reaction to your thoughts. During my remission in the last few months, there have been couple of times where I have felt that my thoughts are rising. I immediately inform Srini (my husband), and we either do something to divert the thought or if need be take a SoS tablet. I have attained this level of awareness with the help of my therapist. Therefore, get professional help for this or at the least, you could read about CBT and how to be aware of your thoughts.
After you have become aware of your surging or dipping emotions, if you cannot handle it yourself, please immediately seek help. It is important to accept that you may not be able to handle it yourself, and will need intervention. This intervention can be as simple as a drive, or a chat with a friend or a walk. Recently, I was feeling slightly overwhelmed about a personal issue, and requested my friends nearby to drop by home and spend some time with me. This helped a lot in enhancing my mood. As mentioned in the beginning, a high or low is common for anyone, but if you have bipolar disorder, then you need to be more conscious of your emotions. Therefore, when you feel a dip or a high, do feel free to reach out because you don’t how much a friend or a family member can make a difference.
Spirituality and Meditation
Please see my previous post (https://www.thewholesomeliving.in/post/the-d-word-way-ahead) on how I discovered spirituality and meditation, and how it helped me face depression. My daily prayers and meditation have given me a lot of grounding and confidence to deal with challenges including mental health related. The calmness I feel during my prayers and meditation is inexplicable. I am not entirely sure if this will be acceptable to everyone, because one needs to believe in spirituality and its impact on the mind.
I would say even if you don’t believe in prayers, one should definitely spend a few minutes meditating. Meditation brings a lot of balance to your mind and contributes to a lot of mental strength. You could use apps like Headspace to help you with meditation.
Keep yourself Occupied
An idle mind is a devil’s workshop, right? So it is important that you keep yourself occupied in a healthy manner. In my case, prior to my diagnosis, I used to spend more than 80% of my time working. However, after 2017, when I got my manic episode, I was advised to take a break from work. Therefore, I was forced to find other ways of spending my time. I slowly started dancing and cooking. While I quite enjoyed doing these, I missed working. I had tried going back to work but failed a few times because of my anxiety. Finally, I have been able to successfully work without any hurdles.
Even though I am working now, work only forms a part of my life and I do find time for my dance, prayers and exercise. Therefore, I would advise to find things that you enjoy and make you happy. It need not be working or pursuing a profession. It could be cooking, gardening, dancing, music or anything else. To bring that balance and to avoid a relapse, it is important that you do not keep yourself idle. Having said this, I would remind you about what I said in my last blog (https://www.thewholesomeliving.in/post/it-is-ok-to-do-nothing), that there is no compulsion to do something all the time. If you feel like taking a break or not doing something for a day or two, it is fine. You do not have to measure your well-being basis that. But in the long run, find something that you like to do and enjoy, this will help you create the balance.
Patience – It is a long journey
It has been four years since my diagnosis, and it took me a lot of ups and downs to reach where I am. The journey towards my remission has not been easy. I have had two manic episodes and two episodes of depression during the last four years. It is very easy to give up and blame your fate for all that is happening. I did do this a lot of times. But thanks to the blessings of Almighty and my family and friends, I got the inner strength to stay strong.
The measures (mentioned above) I have suggested did not happen overnight or over a month or a year. It has been years of effort and trial and error methods. Therefore, please be patient and remember and accept that the road towards stability is a slow one. The key part is to stay afloat, and take small steps towards stability. Please do not expect dramatic changes in the beginning, but what matters is the effort. Results will soon show.
While I know that I have attained a lot of stability, I am always aware that I cannot forget all the processes that have helped me attain my stability, and need to continue to follow them. Further, one can always minimise the chances of a relapse, but that does not mean that it will not happen. Therefore, we should never let our guard down.
My journey and experience of last four years has taught me a lot of things, but what it has reminded me the most is a saying that my dad told me when I faced my first adversity (losing my mother)
“God, give me the courage to change what I can; the serenity to accept what I cannot and the wisdom to know the difference.”
A stable life with bipolar disorder has been definitely challenging, but it is not impossible.