How to Cope With Bipolar Disorder During the Holidays - Everyday Health

While the holidays are a time of celebration for many, they can trigger stress and overstimulation for people with bipolar disorder, a mental health condition that causes extreme mood episodes of mania (abnormal happiness or irritability) and depression (deep sadness) lasting days to weeks at a time.

As many as 64 percent of people with a mental health condition like bipolar disorder feel their symptoms worsen during the holidays, according to a small survey conducted by experts at the National Alliance on Mental Illness (NAMI).

What is it about the holidays that ramps up stress and symptoms for people with bipolar disorder? A few potential causes are:

• Disrupted routines "We know it's very important for people with bipolar disorder to have structure, routine, and some groundedness. But with the holiday season, a lot of times, there are disruptions to your schedule, and routines get thrown out the window, says Thea Gallagher, PsyD, a clinical assistant professor in the department of psychiatry at New York University Langone Health in New York City.
• Sleep loss A busy, disrupted schedule that may include traveling to visit loved ones or hosting out-of-town guests is a lot to juggle, and it can lead to a disturbed sleep routine. Sleep loss was shown to trigger manic episodes in people with bipolar disorder in a  study published in September 2017 in the British Journal of Psychiatry.
• Holiday spending and finances Shopping for gifts is always a stressor for the average American, but managing holiday spending and finances can put extra strain on someone with bipolar disorder who may struggle with impulsive behaviors.
• Shorter and darker days It also doesn't help that the holidays come during the darkest days of the year, which can trigger seasonal affective disorder (SAD), or seasonal depression, in some people. Those with bipolar disorder are more likely to have SAD, which usually sets in during late fall, say Mayo Clinic experts.
• Alcohol use In general, people are much more likely to drink beyond their limits during the holidays, according to the National Institute on Alcohol Abuse and Alcoholism. But people with bipolar disorder are especially prone to the effects of alcohol or substance use. Approximately 30 to 50 percent of people with bipolar 1 or 2 disorder will also develop a substance use disorder, say experts at the Substance Abuse and Mental Health Services Administration (SAMHSA).
• Family and relationship issues Emotions can run high during the holidays, as many people cope with challenging situations, such as tense family dynamics, lost loved ones, or altered relationships. 

How to Keep Bipolar Symptoms in Check During the Holidays

While coping with the stress of the holidays can be more challenging if you have a mental health condition like bipolar disorder, there are some simple ways to lighten the emotional load and keep your mood stable. If you or a loved one has bipolar disorder, here are seven healthy strategies to help you stay grounded and make the most of the festive season.

1. Stick to a Routine, Especially for Sleep

Following a consistent daily routine may result in fewer new manic or depressive symptoms for people with bipolar disorder, according to the American Psychological Association.

One way to accomplish this: Research suggests that good sleep hygiene — which includes going to bed and waking up at the same times each day — can be helpful. The Centers for Disease Control and Prevention (CDC) recommends that adults get at least seven hours of sleep per night.

But managing your schedule can be tricky during the holidays, with late-night parties and events potentially throwing your routine out of whack. "It's okay to stay out late some nights, but be aware, so that it's not too many nights," says Po Wang, MD, a psychiatrist who specializes in treating bipolar disorders at Stanford Health Care in Palo Alto, California.

2. Get Your Body Moving

Exercise can be a great way to reduce stress and stabilize mood during hectic times like the holidays. A review published in July 2016 in the Journal of Affective Disorders found that physical activity was linked to fewer depressive symptoms, better quality of life, and increased functioning in people with bipolar disorder.

The Anxiety & Depression Association of America (ADAA) recommends exercising for 30 minutes a day, three to five days a week. Activities you could try, ADAA experts say, are:

• Biking
• Dancing
• Jogging
• Walking

3. Stay Consistent With Your Meds

Taking your prescribed bipolar disorder medications as scheduled is important, especially during the holiday season. According to research published in September 2019 in the International Journal of Bipolar Disorders, disrupted medication regimens are associated with more relapses, more suicide attempts, higher healthcare costs, and more hospitalizations. What's more, if certain medications are stopped abruptly, without a doctor's approval, worse symptoms can arise, say experts at the UK's National Health Service.

It's a good idea to take your meds at the same times each day, so it becomes a routine that you can easily follow. Some people use weekly sorting containers to keep track of their meds or set reminders on their phones.

4. Don't Be Afraid to Say No

The holidays are packed with all sorts of seasonal events, but you don't have to attend them all. "It's great to have social activities, but not too many to cause excessive mental activation or potential for interpersonal conflicts," says Dr. Wang.

If a party or time with certain family members is too stressful or triggers symptoms, simply decline the offer. The same goes for buying and exchanging expensive gifts as well.

"Don't host everything or go to everything or do everything. It's okay to say no," says Dr. Gallagher. "We're expected to do all and be all during the season, and it can be really important to scale back those expectations for ourselves and say no when it's necessary for our well-being. You don't have to be everything to everyone."

5. Avoid Alcohol

Drinking alcohol can worsen episodes of mood disorders like bipolar disorder, according to the ADAA. In fact, research suggests even small amounts of alcohol — one to four drinks a week — can trigger manic or depressive episodes. Alcohol can also interfere with certain bipolar medications, such as lithium. But avoiding a drink may be more difficult around the holidays when celebratory beverages are readily available.

According to experts at the Hazelden Betty Ford Foundation, you can stay sober during the holidays with these strategies:

• Try to avoid difficult situations and have an escape plan.
• Be prepared to politely turn down alcoholic beverages.
• Ask a family member or friend to support you.

6. Talk to Someone About What You're Going Through

The holidays can bring about negative feelings or difficult memories for some people. "Triggers from the past can crop up," Gallagher explains. "Processing some of those emotions can help. Writing down your feelings or talking to your therapist or someone you love about them are some helpful ways to do this."

Gallagher says, if possible, continue your therapy sessions with a mental health professional during the holidays. Or, if you've been out of therapy for a while, you might want to consider scheduling a booster session.  

7. Try Relaxation Techniques, Like Meditation

Relaxation techniques such as meditation may help lessen stress, which could improve your mood during the holidays. In a study published in December 2018 in the journal Clinical Psychology & Psychotherapy, researchers examined 311 people with bipolar disorder 2 and found meditation helped ease depressed mood, as well as feelings of guilt and hopelessness.  

"Having spaces where you can go inward, ground yourself, and connect with your senses to bring yourself back to your body, to bring yourself back to your breath, and to bring yourself back to the moment, is really what meditation is about," says Gallagher.

Popular apps, such as Headspace, Calm, and Buddhify, offer guided meditation sessions that you can practice on your own.

When Should You Ask for Help?

The biggest takeaway is to care for yourself and seek help if you need it, says Gallagher. "We have to put that oxygen mask on [ourselves] first, because then we're going to be the best version of ourselves for everyone else, and that will benefit everyone else, too," she says.

Contact your mental health provider if you experience symptoms of a manic or depressive episode. Symptoms of a manic episode, according to the NIH, may include irritability, feeling jumpy or more active than usual, talking fast, having racing thoughts, needing less sleep, and feeling powerful or important.

A depressive bipolar episode, NIH experts say, may cause sadness, loneliness, worthlessness, talking very slowly, forgetfulness, sleeping too much, lack of interest in usual activities, and thoughts of death or suicide.

Cleveland Clinic experts say you should go straight to the emergency room or call 911 if you are:

• Having suicidal thoughts
• Having thoughts of harming yourself or others
• Experiencing hallucinations or delusions

SAMHSA offers a free 24/7 helpline for people and family members facing mental health conditions or substance use disorders. Likewise, the 988 Suicide & Crisis Lifeline provides free emotional support to people in suicidal crisis or emotional distress.

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