My Program at the Doylestown Hospital Health & Wellness Center, May 11, from 1 to 2:30 pm - KEYS TO RECOVERY

Bruce Uhrich, program director, checked in the 20 people who came to my talk at $15 apiece.

Just like at a New Directions meeting I asked people how they heard of my talk: the Intell, NAMI, and Dialogue, the newsletter of Doylestown Hospital.

Told the group I'm 67 years old and have faced most of the challenges that bipolar offers, including an intense urge to kill myself when my psychiatrist yanked me off my lithium - an antisuicidal agent - w/o weaning me off.

We had a lively discussion from the audience. One woman has a son with Asperger's and wanted to start her own group. Another woman in red said you need to be highly trained and I said, No, you don't. You're the experts - you're living with your loved ones' condition. I encouraged her to start a group and get the contact info for the woman in red who wanted to join.

Interesting Qs included: How do you refer to bipolar - a disorder, an illness, a disease. I said, "It's really a disorder but I say illness. It sounds good."

Disclosure - don't disclose it, I said, but if you must, say that you have depression, b/c of the stigma against bipolar.

Several people enjoy meditating. They said it quiets their brain.

One woman journals and also colors.

I encouraged everyone to be proactive - to ask questions to their doctors, to get lithium level checks twice a year and keep a copy for yourself and know your creatinine level. One woman has been on it for 29 years and is calling her doctor on Monday for reassurance b/c of what happened to me after 16.5 years.

I showed them where Sarah's 39-yo kidney resides in my lower right abdomen. 

Everyone thanked me at the end and said they learned so many new things, as did I.

KEYS TO RECOVERY FROM BIPOLAR DISORDER AND DEPRESSION

by Ruth Z Deming, MGPGP, Founder/Director New Directions Support Group, Abington, PA

Presented on Saturday, May 11, 2013 at the Doylestown Hospital Health and Wellness Center

Warrington, PA

Contact me at RuthDeming@comcast.net or 215-659-2142

K E Y S   T O   R E C O V E R Y

Take heart! In this, the twenty-first century, treatment options for people with bipolar disorder and depression (collectively called “mood disorders”) couldn’t be better. Medication works in the vast majority of cases. Its effectiveness is far greater if used in conjunction with “talk therapy.” You will also want to incorporate “healthy lifestyle techniques” in your Recovery Plan. 

When you teach yourself these common-sense Keys, you are training your brain just as an athlete trains her body to run a marathon. This is the marathon of life. 

Did you know that people who suffer from depression say it is far worse than any physical illness they’ve ever had? Know that you are endlessly brave and tenacious in your struggle against the illness. If you experience flare-ups, this handout provides techniques to gracefully endure it.

Planning ahead is crucial. Most people think of planning ahead when they think about taking a trip or getting married, not when they deal with a serious, chronic illness. Planning ahead is a requisite for living well with your mood disorder. It requires Vigilance, Determination and Discipline. 

You can do it!!! 

The following Keys provide a roadmap for your journey to remain healthy and to avoid the “ups” and “downs” of the illness. For some of us, medication works just fine and we remain stable, on an even keel. Others experience “breakthrough” episodes of either mania or depression, as this is the nature of the illness. These cycles, caused by life’s inevitable stressors, can be resolved by learning to identify the onset of your moodswing and then take action by: adjusting your medication, discussing your current issues with a compassionate listener such as psychiatrist, therapist or friend, and taking a temporary respite from the stress in your life.

1) Get a good psychiatrist. A compassionate and knowledgeable psychiatrist is your lifeline to a successful life. To make the most of your painfully short appointment, come in with a list of questions you’ve jotted down between visits. Also come prepared with your version of a mood chart. You can create this on a calendar by marking your mood from 1 (worst) to 5 (best), accompanied by any life changes such as “got a new boss.” You can also print one out from the Internet. Write down everything your psychiatrist says during your visit. 

Get medication parameters from your doctor. In other words, how much medication can you safely take on your own if, for example, if you can’t sleep or are becoming anxious or psychotic. Psychosis usually requires putting in a call to the doctor for much-needed emotional reassurance and meds adjustment. Work with your therapist or support group members on EARLY-WARNING SIGNS OF MANIA or HYPOMANIA such as lack of sleep; the feeling that someone is watching you (paranoia); inability to stop talking (pressured speech); inability to shut off your mind (racing thoughts); inflated self-esteem (“I am so great nothing can stop me from gambling and winning millions”). 

Crisis management. Discuss with your doctor how to get in touch with her should a crisis occur. It is important you realize the importance of calling her quickly. Keep her business card in your wallet in case of crisis and also for reassurance. Delay in contacting your doctor may result in hospitalization.

While your doctor does his best, he may make mistakes. Keep your own set of records. Make you’re your doctor schedules you for lab tests every six months. And, if your meds are changed, be sure you are weaned off your current meds, if required. You must be an intelligent consumer who does not put your doctor on a pedestal.

2) Get talk therapy. After your initial diagnosis, it’s helpful to have guidance from an expert in aiding you to live with your illness. You are the same person you always were but may need reassurance that you are capable of living a good, productive life. It’s fine to have setbacks such as missing a couple semesters at college. You’ll catch up later. Most young people at New Directions (ND) have encountered that problem.

Positive brain changes occur when talking with a therapist. Therapy should include goal-setting, long and short-term, and a rudimentary training in cognitive therapy: thinking self-affirming positive thoughts and challenging negative thoughts.

The purpose of therapy is to grow as a human being and also to bring out the greatness inherent in every human being. Therapists help with issues like low self-esteem, anger management, accepting feelings of shame or sorrow from the diagnosis, assertiveness, choosing a healthy partner, grief over the loss of a relationship or job, plus grief at your diagnosis. 

Developing a healthy relationship with a wonderful therapist – or the unique psychiatrist who still does talk therapy - is the prelude to establishing good relationships for a lifetime.

3) Medication. A mood disorder is a serious, chronic illness that, if untreated or only partially treated, will impair your chances for a productive, happy life.

Remain hopeful that your psychopharmacologist (a psychiatrist who specializes in medicine) will find a combination of drugs that work for you. Medication is your first line of defense against depression and mania.

Take the least amount of medication possible. Make sure your doctor isn’t a pill-pusher. If he is, find a new one. All medications, whether for mood disorders or high blood pressure, have unwanted side effects. However, the benefits of taking meds heavily outweigh the negatives. 

Most people take more than one medication to stabilize their moods. Although brain researchers haven’t really figured out what causes a mood imbalance, it is thought that circuits of neurons and hormones are implicated. 

Three or four meds is not uncommon. Purchase a pill-box at your pharmacy to keep track of the dosing. You can also buy a pill-cutter. If you are on six or more meds, you are probably on too many, which can be counterproductive. Discuss this with your doctor.

Know that any medication change may bring about a change in mood. Whenever you can’t figure out why you’re not feeling right, ask yourself, “Have I changed my medication or dosage?” Or, “Maybe I’ve forgotten to take my meds.” To prevent this all-too-common problem of forgetting to take your meds, buy a pill box and keep it visible!

Avoid the always tempting thought: I feel so good I’m going to go off my medication, or lower the dosage. Sad to say, you will most likely regret this as your symptoms may return with a vengeance.

Take an active role in learning about your meds. Learn the categories of medication. The impact of medication is highly individual. Write down every medication you have ever taken and print it out. This way, if you change doctors, it will be readily available. Some antidepressants lose their effectiveness over the years. It is not your imagination!

Many people with mood disorders cannot tolerate hot weather. It is definitely not your imagination. If don’t have A/C, take frequent showers, cool off in air-conditioned facilities such as the local library, bookstore, movies, mall or coffee shop. At home, sleep near a fan.

Before you go outdoors in the heat, use suntan lotion, drink plenty of water (and bring some with you) and don’t stay outside more than half an hour. If you’re at the beach, sit under an umbrella and drink plenty of water. 

Peter Breggin, a maverick psychiatrist, writes on Facebook, “Reminder that anyone taking psychiatric drugs, especially antipsychotics needs to be very careful about heat exposure.”

Lithium users must be careful in the hot weather. If you feel dizzy, nauseous, confused, or have difficulty walking, go to the emergency room. You are having a toxic reaction to lithium. This is very serious!

Learn your diagnosis: Do you have Bipolar One or Bipolar Two? BP One is where you have true mania, with psychosis (feeling out of reality “I’m Beethoven”), plus depression. BP Two results in hypomanias  (tremendous energy) and depression. 

Learn what category of medication you are taking. Categories include Mood Stabilizers – Antipsychotics (which are often also mood stabilizers) – Antidepressants – Antianxiety meds. There are also stimulants and drugs for side effects.

Lab tests are necessary when taking drugs such as lithium, Depakote or Tegretol. Make sure your doctor schedules lab tests once every six months. Clozaril (for schizoaffective disorder) requires tests every month. 

Don’t forget the importance of weaning off a medicine – called “titration” -  to avoid painful withdrawal symptoms.

Explore the Internet to discover your favorite drug information sites such as PsychCentral.com.

Old vs. New Drugs. Thorazine, the first antipsychotic, came out in the 1950s, an era that produced a wave of new psychiatric drugs. Lithium appeared in 1970 and is still considered “the gold standard” for bipolar disorder. Due to its side effects, however, particularly on the kidneys, more modern drugs should be tried first. Lithium levels, which test kidney function and thyroid function, should be scheduled every 6 months.

In the rush to use newer drugs, which were once thought to have fewer side effects - they actually have different side effects - the old stand-by’s are often forgotten. However, if the new antidepressants don’t work for you, there’s a chance the older ones will! Many people remain on MAO inhibitors such as Parnate or newer ones, such as the Selegiline skin patch, or another one available in the UK and purchased from a Canadian pharmacy. 

Other older drugs still in use are the “tricyclics” such as Pamelor and Elavil. They’re cheaper because they’re available in generic. 

YOU must be your own advocate and suggest these options to your physician if he does not.

Generic drugs.  Theoretically, generic drugs should work the same as the name brand. This is not always  the case. While the active ingredient is the same, the “filler” material is different. Many people on Clozaril cannot take “clozapine” as it does not work well on them. Same for the generic Depakote.

What if Meds Don’t Work

Meds work for approximately 80 percent of those with a mood disorder. Certain psychiatrists specialize in hard-to-treat depression, such as the heads of the Mood Disorders Departments at University of PA and Jefferson University in Philadelphia. 

- ECT or electroconvulsive therapy. Read the inspirational book “Shock” by Kitty Dukakis to find out how it helps this successful, busy woman. Because of the side effects of memory loss ECT is rightfully considered a last resort. But it often works. But not always. 

- TMS or transcranial magnet stimulation. A noninvasive device is placed on the patient's head and electrical "zaps" are administered thru the scalp. Reports indicate an 80% effective rate on people who have not responded to meds. 

There is always hope!

The anti-medication view. There are valid reasons, chiefly the side effects, that people with mood disorders decide not to go on medication. Theirs is a difficult journey but many succeed. Read Gracelyn Guyol’s book "Healing Bipolar Disorder and Depression without Drugs."

Meds are not necessarily forever. No matter what you’ve heard, a healthy trend has begun. While it’s still advisable to stay on meds, it’s also possible to work with your psychiatrist and get off your medication entirely. I want to emphasize you mustn’t go off on your own, but consult your psychiatrist. It’s advisable that you are older when you do this, say, in your forties or fifties.

4) Follow a schedule or a “To-Do List.” The human brain is wired to work, to keep busy. In the midst of a depressive episode, keep working if at all possible. Many people can pull this off. They may do less work than usual or find ways to postpone difficult projects until their depression lifts. Use your discretion whether or not to disclose your illness to your boss. 

It’s better to say you suffer from “depression” than saying “bipolar disorder” because there’s as much stigma about the illness as there ever was. Trust me!

Get in the habit of writing things down, getting ideas out of your over-stuffed brain and onto a piece of paper. If you are depressed and home during the day, make a list of easy tasks you can do. As you know, depression makes everything you do difficult. This is one way the illness manifests itself.

It is important you don’t blame yourself or feel guilty when your depression strikes. It is absolutely not your fault. Just accept it the way you accept getting the common cold. Like a cold, it will run its course and you’ll be fine again. All depressions come in cycles. They are self-limiting which means they come to an end by themselves, just like the common cold. Meds make them go away faster. 

Make sure you keep moving while you’re depressed. 

Keep easy-to-eat foods at home in case depression hits. Although you may not feel hungry, you need to remain nourished until your depression lifts. Drink plenty of water to hydrate yours. Easy to prepare foods include canned goods such as tuna, salmon, sardines, corn, stewed tomatoes, baked beans, pineapple, soups, or the nutrition supplement Ensure. Also keep on hand fresh fruit. Yogurt is easy to eat and nutritious, as are juices such as V-8 or apple juice. 

It’s okay to eat your soup directly from the can. Remember, easy is best. That way you don’t have to worry about clean-up afterward. 

Decide which tasks are easy, which are hard. For some people, easy tasks include getting your child off to school, sitting at the computer surfing the net, reading the newspaper, doing the laundry. Hard tasks include showering, house-cleaning, grocery shopping, meal preparation.

5) Contact with people. Here’s the irony. When depression strikes, you probably want to isolate yourself, stay indoors and avoid all contact with people. Your bed or your couch is your best friend, along with the droning TV which can lull you into a numb zone where you may temporarily forget about your depression.

Although it feels very comfortable to succumb to your isolating behavior, do everything you can to avoid it, as the depression will worsen. Schedule events every single day to get out of the house. This is hard and takes all of your strength. Have a set time to get out of bed. Then avoid the temptation to return. Get dressed and get out of the house fast! As you know, by remaining in bed you are a victim of the terrible thoughts of the depressed: what a terrible person you are, how you don’t accomplish anything, you’d be better off dead.  The minute you get out of bed these thoughts recede slightly, not totally, of course, but you’ll get a break once you concentrate on doing an activity, once you take action and start moving, the very thing our brains are wired to do.

Stay out of the house for as long as possible. What might you do? Consider that you are recuperating from an illness. Visit friends or relatives. Go to the library, sit and leaf through magazines. Have a cup of hot chocolate, tea or coffee in a coffee shop, go to the movies. Sit in a park. As you know, once you return home you’ll return to “depression mode.”

Make a list of friends to phone to “cheer you up.” When you’re home and in a funk, call someone. “Do you have a minute? I’m a little down and just wanted to chat.” Simply call someone and start a conversation to get your juices flowing. Keep your list on your kitchen bulletin board or fridge. As you speak on the phone, your brain will be stimulated by each phone pal.

Be sure to phone people if you’re on a new medication which is taking time to ramp up in your brain. Your phone pals will bolster your spirits.

6) Learn to process your feelings. Bipolar disorder is what I call an “emotional processing illness.” We don’t process emotions like other people do. Many of us harbor secrets and don’t communicate well. Be aware of this quirk and work on it with the help of friends and a therapist. Although it’s hard to view feelings as concrete entities, they need to be nurtured and taken care of, not left to simmer untended in the brain. 

If a bad thing happens, we must acknowledge it, not “stuff” it, and then share our observations with someone close to us, to “talk it out” and not sweep it under the rug. Otherwise thoughts will take on a life of their own and come back to haunt us in the form of depression, anxiety, anger, or mania.

Anger issues are common for people with bipolar. Again, although anger is invisible it is as real as a brick sailing through a window. If someone makes you angry, you must figure out how to deal with them in a tactful constructive way rather than letting the anger build and make you sick. The simple but difficult technique of “walking away” from the person – or “cooling off” – is very effective but requires discipline. You must hold back your impulsive desire to fight back.

For example, say you receive an email that makes you angry. Walk away from the computer or go on to something else before addressing the email. Then type up your reply, save it and send it after you have re-read it and feel it is appropriate. You may also wish to call a friend to discuss the email and your response.

This is good practice in dealing with potentially destructive anger and dealing with it in a healthy, assertive manner.

In the difficult process of confronting someone who has verbally attacked you, you might say something like, “Becky, I felt very hurt when you said at the dinner table that I feel sorry for myself. I’d like to discuss this with you.”

How about journaling? I myself kept a diary from age 10 until today. Every nite before bed I would write in my diary, no matter what. I rarely read it back.

Process your deepest emotions in your journal. You can keep it for yourself alone or, as some people do, read portions to your psychiatrist or therapist.

Another unpleasant emotion is that of feeling overwhelmed, when it feels like you will never get all your work done. Take heed that our minds are capable of “compartmentalization.” This means putting different tasks in different sections of our brains so we can concentrate on one thing at a time. Write down all the things you need to do. You can also create folders or bins for each task. Just watching yourself organize your many projects may help you feel less overwhelmed. Then, of course, work on one thing at a time. Explain to yourself, “I’m working on cleaning off the dining room table now. When I’m finished, I’ll tackle that letter I want to write.” Set a timer for an hour to work on each project. Then cross it off your “to-do” list to feel a sense of satisfaction.

Many people feel overwhelmed at work, particularly today when companies lay people off and give each worker more responsibilities. Many people in ND face this problem and either find a new job or deal with the current situation. Learn to prioritize! What task must get done first. Check with your boss to make sure you’re on task. A “to-do” list is essential.

7) Practice a healthy lifestyle: regular hours for sleep, regular medication times, meals, prayer/meditation and exercise. Routine! The body loves routine. Emulate the birds! They live a well-ordered life. 

Aerobic exercise, only 20 minutes a day or three times a week - is great for relieving stress. Examples are a fast walk, stationary bike, swimming, the treadmill or elliptical machine. Get in the habit of parking far away and walking into the supermarket or your place of work.  

Mindfulness exercises like yoga and meditation calm our minds and help us live in the present moment. One 50-year-old family man in our group has been off meds for one year. Every morning he meditates for 20 minutes and swears it keeps his moods balanced. 

Change your diet. Avoid all junk food, processed food, and preservatives. Eat less meat, more fish for those valuable fatty acids. Eat plenty of high-fiber fresh fruits and vegetables, whole grain foods, olive oil, nuts. Visit EatingWell.com. Healthy foods are delicious foods!

Trouble with overeating? See Mary Ann Moylen, nutritionist, at the Willow Grove Giant Supermarket. Call her at 215-784-1960. Or The Beck Diet Solution at Beckdietsolution.com/diet-solution-blog/

Did you know that some psychiatric drugs, like the antipsychotic Zyprexa, may contribute to acquiring diabetes. Very true. Check this out on the Internet. By eating a healthy diet and by exercising and controlling your weight, you can avoid this disagreeable side effect.

8) Good sleep is essential for good mental health. Poor sleep may be a prelude to mania, hypomania or depression. Remember, though, not everyone sleeps through the night. Some people simply have odd sleeping patterns that work well for them. Most people get up in the night to go to the bathroom, a situation often remedied by not drinking caffeine after 3 pm, or not drinking too many liquids before bed.

Address sleeping problems by training your brain how to sleep properly rather than taking sleep medicine which will be yet another medication in your body. By taking your regular meds at night, your sleep may improve. Obviously if your sleep deficit is so severe, you may need sleep meds or train your brain per below.

Do not take Ambien for sleep. We’ve heard horror stories about it. When you look it up on the ‘Net, the fifth entry reads “Ambien emergency room visits increase 220 percent over 5 years.” It should be banned.

Establish a bedtime ritual so your body knows you are slowing down and it’s time for sleep. We did this as children and should continue as adults. A bedtime ritual may include changing into pajamas, reading or watching TV in bed, then switching off the light and the television set. A dark sleeping environment allows our brains to produce more melatonin, the sleep chemical. Yes you can fall asleep without the TV! But you may have to train yourself to do so. It may take a month or more to learn to fall asleep the way you did as a kid.

Many people take a brief nap during the day which, contrary to popular thinking, does not impair their night-time sleeping. You know yourself best of all!

9) Realize you a whole person, more than just a person with a mental illness. Develop hobbies and interests so you can grow healthy new neurons in your brain. In our complex American society many of us have a chance to live “many lives in one” whether it’s discovering a new career or a new hobby such as writing or painting. Begin a new hobby with the mindset “I’m not perfect. I’ll make some mistakes.” By freeing yourself from the idea of perfection, you give yourself freedom to succeed. Hobbies also allow us to practice mindfulness, to live in the present moment while we are writing or painting or sculpting, and discovering a deeper part of ourselves.

10) Compliment page or drawer. Raise lagging self-esteem by writing down compliments given by important people in your life. “My boss said I’m intelligent and have a great sense of humor.” You may also have a drawer-full of things you’re proud of such as letters from loved ones, diplomas, awards, college papers, photos. Call on these souvenirs whenever you need to bolster your self-worth.

And discard things that make you sad, old love letters or rejection notices from potential employers. Keep bills out of sight until you are ready to pay them.

11) Recognize your triggers. A trigger is anything that can bring on a moodswing. Here is where your ability to know yourself and to plan ahead can avert disaster. What events or triggers have set you off in the past? Write these down. Naturally we can’t control all of life’s stressors but we can certainly recognize a few on the horizon and learn how to cope with them.

Plan ahead. Discuss in detail with someone you trust how you might ideally respond to upcoming events that may “trigger” you such as a family wedding, new duties at work, a fight with your significant other, getting divorced, moving to a new home, returning to work after a hospitalization, a day with old friends who will ask you what you are doing with your life (practice a “rehearsed” answer for this if you haven’t worked in a while).  

In addition to mentally planning how to avert a crisis, exercise is most helpful. Get out of the house and go for a fast walk, walk away your frustrations and feel physically and mentally stronger.

Always be solution-oriented! Realize that for every problem there are dozens of solutions to choose from. Brainstorm with others to help you.

12) Your home environment should represent you! When you enter your home, whether it’s an apartment, a house, or a cardboard box, it should look inviting and smell inviting. Jazz it up, if you wish, with aromas from fresh fruit, cooking smells, scented candles, incense. Our moods are affected by aromas more than we realize. Open up the windows to aerate your place!

Live in as clutter-free an environment as possible. The state of messiness – or chaos – very much affects our ability to think straight. Hide things in closets or drawers until you’re ready to organize them. It’s a great feeling coming home to a neat house.

Don’t forget music! If you live alone, turn on your radio or stereo instead of the drone of the TV set. Listen to the radio while you’re doing hard work like house-cleaning or doing the dishes.

Lighting, temperature and color affect our moods. All mammals respond to the circadian rhythms of night and day. A chief problem of folks with mood disorders is our rhythms are out of order. Bring them back into alignment. In your home, observe the rules of the outdoors, of day and night. Since most people live a “9-5 life” we want to get on the same schedule as everyone else.

Decide where dim lights are needed as well as bright lights. Open your drapes or blinds to let in the sunshine, especially in the winter months. Keep a few easy- to- care- for houseplants around– and herbs such as rosemary and basil. And what could be better than to add fresh flowers that bloom indoors during the winter such as purple cyclamen or African violets. Their cheerful colors are infectious!

Your home should be easy to move around in. There should be clear walkways with nothing to trip over to break your big toe. This is especially important at night when you get up to go to the bathroom. Pay attention when you are going up and down the stairs. You don’t need a broken ankle which will take 6 weeks to heal.

Put anything unpleasant away from sight such as bills. Everything you look upon in your home should give you a sense of peace.

Remove from the premises anything that causes you extreme psychic pain like old love letters or letters of rejection.

13) Develop a crisis plan. Print it out and keep it handy. Then in a crisis take it out and read it over. The same is true for when you’re feeling suicidal. Remember that suicide is the most extreme symptom of your illness. You do not really want to kill yourself but the illness is urging you to do so. Here is the Crisis Plan and the Stop-Suicide Plan.

CRISIS PLAN

It is important to PLAN AHEAD should a crisis arise. Prepare NOW with your doctor and your support team. Plan a medication strategy with your doctor to get your all-important medication parameters in place or “how much is it okay to safely take” in case your mood worsens. You must work with your doctor on this. Never change medication on your own! That said, if you and your doctor have agreed on med changes in advance, then by all means, take the extra dose – or even a diminished dose to ensure the return to your good mental health.

During a crisis it’s best not to be alone. Have someone stay with you or go to someone’s home for safekeeping. You could even sit in the waiting room of your doctor just to be around people. Keep your cell phone with you at all times. It’s another lifeline and important security blanket.

Call your psychiatrist. The partnership you have with your doctor will ease your mind during a crisis. Leave a message on his voicemail. Again, have your cell phone handy for when he or she returns your call.

Call your therapist. The soothing sound of her voice – and her ability to help you remain calm and not panicky – will help you withstand this temporary crisis.

Leave home where your lethal weapons reside.

Be among people. Go to the home of a friend or a relative who treats you well. Go to a soothing place such as the library, the bookstore, a coffee shop, the mall, a park. Be comforted that people do not know you are in a crisis unless you tell them. You can therefore remain “invisible” when you are seeking comfort at public establishments.

No need to interact with people if it’s too difficult. If you’re psychotic and paranoid, you may wish to avoid people and just wait around the house for your doctor to call. In this difficult state, you might listen to soothing music, watch TV if it doesn’t trigger bad thoughts or if it begins to “talk to you,” lie quietly with eyes closed, take a shower or bath, surf the Internet, look at “coffee table books.” You may wish to revisit your Compliment Drawer or to read over the Crisis Plan or “Strategies to Regain Strength” below.

It might be good to have some “ambient” or “new age” music CDs on hand. Wordless, these are comforting to listen to. 

Every single person has a strong survival mode which is at the core of our being and is serving us well at this very difficult time.

Check yourself into a hospital if necessary. Your safety is paramount. If you are suicidal, get thee to a hospital. You will be surprised at the relief you will feel. In the Philadelphia area, good hospitals include Horsham Clinic, Brooke Glen (formerly Northwestern Hospital), Bryn Mawr Hospital, Abington Hospital and others. Not every general hospital has a psych unit. Research this in advance, not at the time of crisis!

STOP-SUICIDE PLAN

Depression is not a fatal illness but when the illness flares, a depressed person experiences a distorted view of herself that propels her to seriously consider suicide. This is different from the common passive thought “I wish I were dead.” Suicidal thoughts may be constant, an urge to take action. They may emanate from powerful erroneous messages your brain is giving you: “the world would be better off without me. I am a burden to everyone.” They may even be triggered by your medication – something new you are taking.

The truth is the world would not be better off without you. It would be infinitely worse! The legacy of suicide flows like a tidal wave, first devastating your own family members, then hurting everyone else who knows you. The world will never be the same after you take this drastic action. This thought alone has stopped many people before they attempt suicide.

I, myself, was extremely suicidal for the better part of a year when my psychiatrist took me off lithium cold-turkey and replaced it with Lamictal. While it was the most unbearable experience I’ve ever had, I did learn how not to take my own life. 

Know that it’s okay to fantasize killing yourself. Allow yourself a few moments to think what a relief life would be if you were not here. Then stop these thoughts and get to work on your Stop-Suicide Plan. In time, you won’t need the respite of your suicidal fantasies.

Journaling may be helpful when you are suicidal. 

When you are well, study the “Stop Suicide Plan.” Have it handy should you become suicidal. Know that suicidal thoughts are common among people with mood disorders. It is the most difficult symptom of our illness and calls for all of our strength. Talk to understanding friends about suicide. Get it out in the open. Don’t dwell on it, but don’t keep it a secret either. Two helpful websites are Metamoia.org/suicide and Suicide.com.

Call your doctor. Call your therapist. Similar to the Crisis Plan above, let them know through the answering machine or secretary that “This is an emergency. I am feeling suicidal. Please call me back as soon as possible. My phone number is ……”

Call a trusted friend or loved one immediately! You must talk to someone to divert your mind from the constant pressure to kill yourself. Refer to your “List of People to Call.” Then go down the list until you get someone.

When someone answers, you may say, “I’m feeling really awful. Do you have a few minutes we can talk?” Or, if you don’t want to disclose your intense pain, simply make it a friendly call and listen to the soothing sound of the other person’s voice. There is also a national suicide hotline. Keep their number handy: Call 1-800-SUICIDE or 1-800-784-2433.

Your own home becomes an echo chamber of your negative suicidal thoughts. Just leaving home will diminish them considerably. Again, do not remain at home.

Leave home to remove yourself from lethal weapons and to be among people. You can visit a long-lost relative, a friend who is home during the day, or go to a public place like bookstore, library, park, mall, or coffeeshop. Be creative. Visit a YMCA or fitness center and ask for information about joining, even if you’re not interested.

Again, do not remain at home.

If you live alone, stay with a relative or friend until the thoughts pass. Or ask someone to stay with you. If you’re married, share your feelings with your partner. 

If you’re overcome with anger, it’s best not to drive until you’ve got your feelings under control. Fast walking is great to discharge anger. Go to your fitness center to exercise. If you live near a park with fitness equipment, avail yourself of this option. You need to get your aggressions out of your body. 

Bounce a basketball. Hit a tennis ball. Throw rocks in a pond or in the back yard. Do some gardening and pull out weeds. Walk quickly around the block. Punch a living room pillow or punching bag.

Suicidal thoughts are intense and truly horrible. We must rely on all our powers to resist their pull.

Talk or sing out loud. Counteract your hammering thoughts with chipper conversation with yourself. Tell yourself what you see. “I am now looking out the window at Nancy’s house across the street. She’s opening the door and taking the dog for a walk.“ This is a very effective technique to keep you calm and grounded.

Carry phone numbers of friends and loved ones in your wallet or on your cell phone.

When to go to the hospital. When your thoughts are bombarding you nonstop and you feel you can’t avoid the temptation to kill yourself, check into a hospital. Pack your bags including your toiletries and PJs and drive off. Realize that it will take hours and hours to get checked into the hospital but that is fine. You are somewhere safe and on your way to getting lifesaving help.

HOSPITALIZATION

When we’re at our worst we check into the hospital to stay safe and also to be under the care of a physician for a medication change. You will be with all sorts of people with all different diagnoses including substance abuse. It may or may not be pleasant, but your goal is to take care of yourself and get well.

Make the most of your hospital stay. Chat with interesting patients or staff. Avoid people you’re not fond of. Don’t feel guilty if you don’t like everyone. It’s impossible!

At the hospital, you’re usually put on “too much” medication. The goal of the hospital is to discharge you, not to get you well. How can a person possibly get better after 3 to 8 days in the hospital? 

Hospital aftercare. Transitioning from your hospital stay to living at home again is often best done by attending a “partial hospital program” also known as a "day program." These structured programs for half a day feature wellness techniques that should help you transition back to life in the community.

Some people feel ashamed to have bipolar disorder or depression. Try to get over this sense of shame. It’s the main reason why the majority of people with bipolar or depression do not seek help. Imagine! Great help is out there but a person is too embarrassed to see a psychiatrist. They would rather live a life of misery than admit to having an illness.

Attending a good support group such as New Directions can be very helpful on your road to recovery. You will hear truly amazing success stories of people with your very same illness who have pulled themselves out of suicidal depressions and the depths of despair. Each person’s story is unique. You will feel comforted to know that other people have triumphed over their unwanted, unasked-for illnesses. A feeling of LOVE and DEEP CARING exists at New Directions. We can think of each individual person as a strong tree in a forest. Each tree is so different from the next but all arch upward toward the light and the sky, each seeking to share their love and beauty with one another.

STRATEGIES TO REGAIN STRENGTH

When you’re knocked down, these strategies will help you rise again. Keep these handy and don’t forget to add your own. Action or moving your body is the best antidote to a moodswing.

-Hang out with positive people. Limit the time you spend with negative relatives or friends. And don’t feel guilty! Your own welfare comes first.

-Aerobic exercise. Your brain endorphins will invigorate you better than a shot of caffeine.

-To alleviate anger, go for a fast walk. Use a punching bag or punch a pillow.

-To alleviate anger or sorrow, write an impassioned letter. Then let it rest. Read it to someone for feedback. Then decide whether or not to send.

-Take phone off hook when sleeping or napping. Or, when you need to concentrate or to eat your dinner. Phone calls can always wait but your dinner is hot only once.

-Keep a journal of your feelings. This is a way of processing your most intimate thoughts and feelings. As we’ve said, these thoughts must be acknowledged or they’ll develop a mind of their own. By acknowledging them to yourself through journaling, you are freeing your mind of the burden of carrying this heavy load.

-Affirmation cards. On an index card, write out your goals. “I will find a good job.” “I will find a way to pay for my college courses.” And “I will not kill myself.” Having written them, you are giving your unconscious valuable messages. At the same time, the direction of your life will head toward these important goals.

-Do artwork. Express your feelings through poetry or visual art such as painting or sculpting. Buy self-hardening clay available at craft stores and create little sculptures, bowls, or African masks. You can also create artwork with found objects. The joy and satisfaction in creating art is among the highest a person will ever experience. It’s called “self-expression.” Many people with mood disorders are artists. Achieve your human potential by nurturing the child within you by creating mature works of art.

THINGS TO KNOW

1- As we’ve seen, medication is only half the picture for your wellbeing. Also crucial in stabilizing your moods are lifestyle changes, therapy, choice of friends, choice of significant others, your home life, the way you organize your home and yard, and how you choose to spend your time. This will all become second nature to you once you understand its deep connection to your staying well.

2- Learn all about mood disorders after your diagnosis but then plunge into the joy of living. Be curious about this amazing world we inhabit. Meet new people. If you’re shy, hang out, for safety, with people at New Directions, but then widen your circle by going into society at large.

3- Get plenty of light, especially in the winter. SAD (seasonal affective disorder) is as serious a form of depression as any other. One way SAD is treated is with special lights. After researching and consulting with your physician, purchase bright fluorescent lights, different than your home lamps or your home fluorescent lights, and sit in front of them daily, usually for a set time in the morning. Read Winter Blues (rev. 2006) by Norman E. Rosenthal, MD. Find lights on the Internet. 

4- Later in life, a mood disorder may have run its course. If you are in your fifties, research this and if you wish, come up with an Action Plan to safely go off your meds. Many doctors will work with you on this all-important project. You may need to re-train your brain to live without drugs. Again, it has been done by many!

I have been off psych meds for a decade with nary a symptom of depression, anxiety, mania, hypomania or psychosis. I’d been on meds for nearly 17 years for all these problems.

5-  Should I disclose my illness? Know your audience. If your family is judgmental, no need to tell them. Most people, however, will tell their family, with a variety of results. “Have you taken your medication today?” Or, “I’m proud of you for handling your illness so well.”

It’s inadvisable to tell people at work because of the continuing stigma. If possible, do not say you have bipolar disorder – which is tantamount to saying you have leprosy – but use the term “depression.”

And, please, don’t say “I’m bipolar.” This is like saying, “I’m cancer, I’m diabetes.” You are a whole person who simply happens to have bipolar disorder. 

6- Reach out to help others. People with mood disorders are unusually compassionate. Many are in the helping professions. Or they are particularly skilled at helping people in need. You are most likely one of these people. Notice how good you feel when you engage in active listening. You can feel the gratitude of the other individual which, in turn, makes your brain chemicals turn somersaults of joy. 

Courage, hope and tenacity are your key words. As well as “Pursue the Wonderful!” 

Good luck!

FURTHER READING – Selected titles

There are literally hundreds of books and e-Books on mood disorders. Here are a few.

Living Without Depression and Manic Depression: A Workbook for Maintaining Mood Stability – Mary Ellen Copeland 

An Unquiet Mind: A Memoir of Moods and Madness - Kay Redfield Jamison

Take Charge of Bipolar Disorder - Julie A. Fast, John Preston, Psy.D. 

Hurry Down Sunshine: A Father's Memoir of Love and Madness - Michael Greenberg 

Bipolar Disorder: A Family-Focused Treatment Approach - David J. Miklowitz, Michael J. Goldstein, Lyman C. Wynne

Websites:

NIMH.gov - US govt site on mental illness, including definitions, stats

NAMI.org - National Alliance on Mental Illness. Check out their Family-to-Family program near you. This 12-week course explains the various mental illnesses. 

Brain & Behavioral Research – Excellent updates of research advances  

  

Dan Hartman, MD, of Philmont Guidance Center in the Philly area – See his TheSidewalkPsychiatrist.com. 

 

Daniel Carlat, MD, has several blogs on psychiatry such as ThoughtBrodcast.com. 

Ivan Goldberg, MD, is the founder of PsychCentral.com, an overwhelmingly huge compendium of articles on what ails you. 

Jim Phelps, MD, of Corvallis, OR has another comprehensive website Psycheducation.org

New Directions website – NewDirectionsSupport.org

T H E   E N D