Bipolar Affective Disorder
(formerly Manic Depression)

About Bipolar Affective Disorder
Treatments
Self-Management
Causes of Bipolar Affective Disorder
Where now?

SELF-MANAGEMENT OF MANIC DEPRESSION.

Self-management is the biggest breakthrough in the treatment of manic depression since the introduction of lithium. Results are dramatic, for instance, the time between relapses was postponed from 4 months to over a year, in one group receiving self management training (Perry A.1999, BMJ).

Self-management programmes help individual accept and take responsibility for their illness. This gives real of control mental health back to the individual. They learn to recognise signs of illness and take appropriate action. They learn to monitor their moods and to lead a life style that promotes mental health. This is analogous to a diabetic monitoring their blood sugar and adjusting their insulin and diet.

Bipolar affective disorder covers a wide range of individual experiences. Some people are ill every year, others only occasionally. It is even likely that several different conditions are described within the term 'bipolar affective disorder'. Thus each person finds different things helpful. There is a choice of medications as well as different self management skills. No one has all the answers so it is useful to read and discuss issues as widely as possible. It is better to borrow a little from everywhere, rather than believe one theory or individual absolutely. The process of self knowledge is a life long journey, as we get older we change and our own self knowledge changes us. Nevertheless self knowledge and insight is not enough, it must be combined with action make changes to improve your life.

FOUR STAGES OF SELF-MANAGEMENT

I     Acknowledgement  and Acceptance
The first step begins with acknowledging the condition. Mental illness goes to the core of the self. It can destroy self esteem and confidence. Yet without a level of acceptance, it is impossible to move forward. Shit happens, and it is not fair!

At this stage information is helpful. It can be helpful to meet other people, outside hospital, who have had similar experiences. Many community psychiatric nurses run small groups for manic depressive patients. The Manic Depression Fellowship, as well as producing some excellent leaflets, has an extensive network of self help groups.

 2     Awareness
Episodes rarely come out of the blue. Almost everyone has some warning of impending illness. Warning signs are individual, but might include; difficulty sleeping, irritability, feeling oversexed, staying out late, spending too much. Episodes of illness are often triggered by specific problems, such as personal relationship stresses or career difficulties. Mental health professional such as community psychiatric nurse or even close friends can be helpful to build a more objective picture of what happens during an episode of illness as it is difficult to do this alone.

3     Action
An action plan provides a list of actions to take should an episode of illness looks likely to develop. It is up to the individual to follow it where they can, but also indicate the point at which close friends and health professionals should intervene. The aim is to stop the episode developing into a full blow illness and to handle the situation as safely as possible. The plan includes information about treatment, the names and contact details of health professionals and psychiatric hospital. It includes a list of actions. These might include self medication with a course of haloperidol or other major tranquilliser, making a GP appointment, taking time off work, seeing your health professional as well as individual strategies. It is important to rehearse the plan and update it frequently.

4     Staying well
Self-management means maintaining good mental health between episodes. Monitoring small changes in mood and symptoms allows these to be acted on before true depression and hypomania get started.

If you are feeling miserable, then it is possible to do something about it - but first you need to recognise and know that you are feeling sad! This is the start of self knowledge.

Cognitive behavioural therapy helps people alter their own moods by showing them the choices they have about how they feel. For example, a friend does not turn up for an appointment. You can choose either to believe that your friend is a lovely person, they are often very busy, must have inadvertenly been delayed or even forgotten but will be upset to have kept you waiting. Or you can choose to believe that that person simply wanted to make a fool of you. Which is belief is better for your mental health? And if they are in the last category, perhaps you should not be their friend. After all staying well is about having good mental health, and good friends!

Often hypomania and depression are maladaptive responses to stress. They are ways of avoiding thinking about and facing up to real problems.  Facing those problems and sorting them out realistically will help your mental stability. Regularly reviewing your individual anxieties and stresses can stop them building up and causing a major crisis.

It is vital to take care of social networks. Close friends and relatives need to be included. Not only so they are not frightened away by the illness, but also because they can provide valuable feedback. They can often see before the individual themselves, that something is going wrong. Moreover, good social support improves mental health. Part of staying well is about looking after relationships so they can survive the storms of illness.

In addition, regular exercise, relaxation, a healthy diet, proper sleep patterns all contribute to good mental health.

Depression can be harder to manage than mania, it can come on quicker, can be more insidious and be harder to treat. Yet there are often early warning signs, such as tiredness, not wanting to visit friends, losing interest in sex. These make it harder to do the very things that might lift the depression before it gets a grip. Again, it is important to be aware of those very early changes. Furthermore, it is better to start antidepressants sooner rather than later, that way the depression will lift quicker.

In conclusion

Self management is not anti-psychiatry nor ant-medication rather it is about learning to work with psychiatrist and medications. It is often tempting to give up the struggle for autonomy and take on a dependent role permanently. It is a challenge and an effort to constantly monitor and take control of one's moods and mental state. But in the final analysis, self-management improves the outlook for mental illness in a way that drugs alone can never do. And by learning about the illness,  you can learn about yourself. 

Essential reading:
The Depression Workbook Mary Copeland ISBN 1-879237-32-6 $18.95