Monday, October 5, 2009

Ruth Deming's Keys to Recovery from Bipolar Disorder

Here are my Keys to Recovery which I suggest you print out and make a part of your daily life. In time, they will become second nature.


Take heart! In this, the twenty-first century, treatment options for people with bipolar disorder and depression 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 depression. 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, as is discipline and vigilance.

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 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 spare 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.

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. 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 your mind off (racing thoughts).

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.

2) Get talk therapy. After your 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 life.

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.

Developing a healthy relationship with your therapist 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.

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 cons.

Most people take more than one medication to stabilize their moods. This is because our brains consist of numerous neurotransmitters and hormones and each medicine targets a specific chemical. 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.

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 keep it in a folder. This way if you change doctors, it will be readily available. Some antidepressants lose their effectiveness over the years. It is not your imagination!

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 two weeks. Don’t forget the importance of weaning off a medicine to avoid painful withdrawal symptoms.

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

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 testing kidney function and thyroid function should be scheduled once every 6 months.

In the rush to use newer drugs, which were once thought to have less 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 Nardil. Or on tricyclics (such as Pamelor or Elavil).

YOU must be your own advocate and suggest these options to your physician if they do not.

Also, if meds do not work for you, consider the much-improved and, yes, much-maligned electroconvulsive therapy or ECT. 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 works! For treatment-resistant cases, consider VNS - vagus nerve stimulation - where a device is inserted into your vagus nerve in the neck and bursts of electricity are sent to your brain.

Perhaps the best and most effective alternative treatment for depression is TMS - transcranial magnetic 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. Read about the New Directions' TMS seminar here.

There is always hope!

The anti-medication view. There are many 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."

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 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.

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.

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 bathing, house-cleaning, grocery shopping, meal preparation.

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 yourself. Easy to prepare foods include canned goods such as salmon, sardines, corn, stewed tomatoes, baked beans, pineapple, soups or the nutrition supplement Ensure. Also keep on hand fresh fruit such as bananas and apples. Yogurt is easy to eat and very nutritious. Also have a stock of nutritious juices like V-8, apple juice, orange juice.

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

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. 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. The minute you get out of bed these thoughts recede, not totally, 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 in a coffee shop, go to the movies. Sit in a park. As you know, once you return home you’ll return to your 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.” Or, don’t mention it at all. 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, 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.

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 never read it back.

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 your brain “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.

Aerobic exercise, only 20 minutes a day, is great for relieving stress. Examples are a fast walk, stationary bike, swimming, the treadmill or elliptical machine.

Mindfulness exercises like yoga and meditation calm our minds and help us live in the present moment.

The above two life-enhancers take discipline to achieve. Challenge yourself to succeed in doing them.

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

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 Healthy foods are delicious foods!

Did you know that many psychiatric drugs are implicated in getting 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 life-threatening side effect.

8) 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, and discovering a deeper part of ourselves.

9) 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.

10) 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, a day with old friends who will ask you what you are doing with your life (practice a “pat” answer for this), new duties at work, a fight with your significant other, getting divorced, moving to a new home, or returning to work after a hospitalization.

In addition to mentally planning how to avert a crisis, exercise is most helpful. Get on that stationary bike, pedal out your frustrations and feel physically strong.

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

11) Good sleep is essential for good mental health. Poor sleep may be a prelude to mania or hypomania. 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 can be addictive and 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.

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!

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 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 such as cyclamen or African violets. Their cheerful colors are infectious!

Many people with mood disorders cannot tolerate hot weather. It is definitely not your imagination if you feel awful during the heat. Cool off in air-conditioned facilities such as the local library, bookstore, movies, mall or coffee shop. At home, sleep near a fan.

Your home should be easy to move around in. There should be clear walkways with nothing to trip over to break your big toe. Read books on feng-shui, the Chinese art of object placement to ensure an unimpeded flow of energy.

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. Remember that 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.


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. 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.

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!


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 you. 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.

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.

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 and

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. Test-drive a new car but only if you’re not manic! Or drive around and sight-see.

Again, do not remain at home.

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. If you’re 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.


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!

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 transition you 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.


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 difficult 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 a 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.


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.

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.

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!

Get plenty of light, especially in the winter. SAD (seasonal affective disorder) is as serious a form of depression as any other. SAD is treated 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.

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.

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!

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 satisfaction.

Courage, hope and tenacity will get you everywhere. And so will the words “Pursue the Wonderful!” Good luck!


  1. SAD lights are easy to find nowadays, Michaels has them (Ott Lights.) Get the strongest light available. When using do not look at the light, only look at reflected light, Shine the light onto a book or magazine. Read for 10 minutes to begin and increase the time to 15 or 20 minutes as the year progresses. Start in Sept.and continue all winter. It's amazing how it helps! I feel great all winter, instead of increasing depression. What it is - some of us are sensitive to the sun's moving away from the earth as it does every winter, we feel the loss of light. And it's light entering through our eyes that works.

    I found that if I read for longer than 15 minutes, I begin to feel hyper, which could trigger mania for me. This is an important tool to prevent winter depression - find out by experimenting or watching your moods what is your best time with the light and use it. Also when outside in the daytime, look up at the sky as much as possible to let in as much light through your eyes (don't look directly at the sun.) --Gretchen Altabef

    1. Forgot to say that when I feel hyper, I just cut back on my reading time by a few minutes. Also that my light is an enormous (4' x 3') old one from 20 years ago. It's like an indoor sun when I turn it this could be why I get hyper. The new lights are much smaller.

  2. Thanks Ruth for all the amazing information, can't find this anywhere else! I also want to add a little something about alternatives or additions to medication.

    There are natural supplements that work well for depression and have no side effects. It has been my experience that Sam e is better than medications and as a side benefit, also treats other problems such as arthritis, fibromyalgia, liver problems, etc. There are warnings for folks with bipolar but if you want to try it, do so with the help of your Dr. I have bipolar and my psychiatrist prescribed it for me, so far no problems. But lots of benefits. It works right away, no waiting like medication, and works very well for me. As you’ll see in the links, it works for some for whom medication doesn’t work, it doesn’t work for everyone (what medication does?) From my experience, it works for SAD, too, which none of the links mention. Be careful adding supplements if already taking medication, some, like St. John's Wort must be taken without any medication. Do this with your Dr's help and you will also be turning them on to something new.
    Here's a link:
    Thanks, Gretchen