How to Anticipate and Manage Bipolar Mood Swings - Everyday Health

1. Take Your Meds as Prescribed — No Ifs, Ands, or Buts

Why it's important Most people with bipolar disorder are prescribed medications to manage their condition — and failure to take those medications can trigger severe discomfort (withdrawal symptoms), as well as increase your risk of mood episodes, says Cara Gardenswartz, PhD, a clinical psychologist in private practice in Los Angeles and New York City.

What to do It's simple: Don't skip doses of your medication, decrease your dose, or add a dose without first talking to your doctor, Dr. Gardenswartz says.

If you're experiencing negative side effects, reach out to your prescriber right away to check that you're taking your medication correctly. They may also change your dose or switch you to a different medication.

They'll likely check that your medication isn't interacting with any other prescription drugs. They may also ask you about any over-the-counter remedies or herbal or nutritional supplements you're taking, as these could negatively interact with your bipolar medication, according to the International Bipolar Foundation (IBPF).

Bottom line Abrupt changes to your medications can have serious consequences, including new mood episodes.

2. Nurture and Grow Your Support System

Why it's important The support of family, friends, and peers is key to staying well with bipolar disorder, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). People with whom to safely process emotions, struggles, and thoughts are necessary for anyone's overall health, a study published in the journal Current Opinions in Psychiatry concluded.

What to do Deepen your bonds by reaching out to people you already trust and enjoy spending time with, suggests Emily Carol, PhD, the clinical director of the Support, Treatment, and Resilience (STAR) Program at McLean Hospital, a psychiatric hospital in Belmont, Massachusetts.

You might start by telling friends and family how much you appreciate them and making it a point to stay in touch with phone calls, texts, and emails. Share as much as is comfortable about your diagnosis, treatment plan, and how you're feeling right now. Foster openness by asking your loved ones to share how they feel, not just about your news, but about what's happening in their lives, too.

One very important tip: When friends and family offer to help, let them, and try to be specific about what you need. For example, ask them to learn more about bipolar disorder by reading articles and books. Or maybe you'd like them to be more active in your treatment by checking in with you every day or helping you set up reminders for taking your medication. "Support can look different for different people," notes Dr. Carol.

Also, consider joining a support group for people with bipolar disorder. Meeting regularly with others who know firsthand what you're going through can make you feel less alone, and make it easier to address problems and find solutions quickly. Organizations like the Depression and Bipolar Support Alliance (DBSA) offer online support groups.

The bottom line Life with bipolar disorder isn't always easy. Surround yourself with people who you know care about you and want to help and you'll alleviate some stress and thus help prevent relapses of bipolar symptoms, according to the IBPF.

3. Plan to Be Physically Active Most Days of the Week

Why it's important Exercise does wonders for people with bipolar disorder by stimulating the release of mood-stabilizing brain chemicals such as endorphins, dopamine, and serotonin, Gardenswartz explains.

What to do People with bipolar disorder should break a sweat for 30 minutes each day, three to five days a week, say experts at the Anxiety and Depression Association of America. Activities like walking, jogging, biking, and dancing all count.

Need help getting started? Set a goal. "Instead of just saying you will exercise more, it's more likely to happen if you say, 'I plan to exercise three times a week for 20 minutes at a time,'" Carol explains. The "SMART" way to do that, she says, is to be:

• Specific Zero in on which activities you will do.
• Meaningful Choose activities you enjoy. For example, is exercise more fun if you're outdoors or indoors? Is the activity muscle-building or fat-burning? Will you do it alone or with others?
• Achievable and realistic Choose activities that fit well into your daily routine.
• Time-limited Decide when and for how long you'll exercise.

Another way to create an exercise routine, says Gardenswartz, is to have an exercise buddy, whether it's a friend, a trainer, or even an in-person or online exercise class. "[A buddy] holds you accountable," says Gardenswartz.

Be sure to check with your doctor before you start any new exercise routine.

The bottom line Exercise is proven to help stabilize mood and reduce the risk of future mood episodes. Since it can be hard to get started, do what you can easily manage right now. Even a 10 minute walk around the block can have a positive impact on your mental health.

4. Set Up and Stick to a Sleep Schedule

Why it's important "A sleep schedule is beyond important," says Gardenswartz. "It might be one of the most important factors in preventing manic episodes, because the first indicator of a manic episode for most people is decreased sleep."

In fact, while impaired sleep can both predict and cause manic episodes, the opposite is also true: Restful, restorative sleep can help prevent manic and depressive episodes, according to research published in the American Journal of Psychiatry.

What to do Set up a consistent bedtime routine that is doable for you in the long run, Carol advises. To boost your odds of getting a good night's sleep every night, Sleep Foundation experts suggest the following measures.

• Go to sleep and wake up at the same time every night and every morning. This helps program your body to feel drowsy at bedtime and to wake up refreshed.
• Budget 30 minutes before lights out to wind down. Spend the time doing anything to soothe your busy mind, whether it's reading a book, listening to calming music, doing light stretches, or anything else that works for you.
• Keep your bedroom dark so that light doesn't interrupt your sleep. Try hanging heavy blackout curtains or using an eye mask. Natural light sneaking into your bedroom can make you wake up extra early.
• Shut off electronics 30 minutes to an hour before bed — and stash them out of the bedroom. Doing this routinely can help your brain know it's time to prepare for bed. More importantly, light from screens — whether it's your phone, tablet, computer, or television — can make your brain think it's still daytime, which, in turn, can make it harder to fall asleep.
• Keep your bedroom cool. The ideal temperature for sleep is 65 degrees Fahrenheit, but this can vary by a few degrees from person to person.
• Shut out noises that might keep you awake. If you live in a noisy area, try using white noise machines or fans to drown out unwanted sounds.
• Skip the nightcap. Don't be fooled: Although alcohol may help you fall asleep, it typically disrupts sleep as the night wears on. What's more, people with bipolar disorder are more likely to develop an alcohol use disorder, so it's best to avoid drinking altogether, according to the Mayo Clinic.
• Cut out caffeine after noon. Consuming too much caffeine — found in popular beverages including coffee, tea, certain sodas, and energy drinks — in the afternoon and evening can keep you from falling asleep in the first place. Individuals who are highly sensitive to the stimulating effects of caffeine may need to stop consuming it even earlier in the day.

The bottom line "Sleep disturbances are both a symptom and a trigger [of] mood episodes," Carol says. Sticking to a consistent bedtime routine and forming healthy sleep habits is proven to keep future mood episodes at bay.

5. Start a Mood Journal

Why it's important A mood journal — whether a plain notebook that you write in or a structured journal with specific spaces to record your mood, sleep, exercise, and other factors — allows you and your therapist to track your mood each day and develop a record of mood episodes over time. This awareness, in turn, helps you identify triggers, activities, and even people that may negatively affect you, Carol says.

"By keeping a journal, we know that if, all of a sudden, a person's mood on a one-to-10 scale is a 55, we can try to make an adjustment in treatment such as talk therapy or medication before it turns into a full-blown episode," she explains.

What to do Set up a weekly chart on which to note symptoms such as increasing irritability, how severe those symptoms were (using your own words or on a scale from 1 to 10), and when and where the symptoms occurred.

With your therapist, you can use your journal to identify patterns, so you can recognize when a future mood episode is building. Once you're able to recognize these patterns — changes in sleep, for example — you can come up with ways to avoid your triggers or take control of a mood episode preemptively before it impairs you, says Carol.

The bottom line Mood charting is a simple way to record your daily highs and lows and develop a personalized "early warning" system to help you manage your bipolar symptoms more effectively. There are several free, downloadable examples of charts, including one from the University of California in Irvine.

6. Prepare for Changing Seasons

Why it's important Bipolar symptoms often exhibit a seasonal pattern. Data shows, for example, that depressive episodes tend to peak in winter, while manic episodes tend to peak in spring, according to a review published in July 2021 in the journal Translational Psychiatry.

The likely cause in people with bipolar disorder is a disruption in your circadian rhythm — the body's internal clock, per Harvard University. Changes in hours of daylight — which are shorter in winter and longer in spring — can throw off your circadian rhythm and your sleep routine, leaving you more vulnerable to a mood episode.

What to do Plan ahead for the changes in daylight that happen as the days get shorter in the fall and longer again in the spring. You might try interpersonal and social rhythm therapy (IPSRT), a type of psychotherapy that helps you establish a consistent routine so that you avoid sleep deprivation; this in turn will lower the likelihood of mood episodes.

Another strategy is to use bright light therapy in winter when there is less daylight. This involves special lights that stimulate the retinas in the eyes, which connect to the part of the brain that controls circadian rhythms, according to a Harvard Health Blog article.

One small study of people with bipolar I and bipolar II disorder, published in the American Journal of Psychiatry in October 2017, found that using midday bright light therapy alongside antimanic medication improved bipolar depression far better than a placebo.

Be sure to ask your doctor if bright light therapy is safe for you first, though. If it's not done safely, bright light therapy can induce manic symptoms in some cases.

The bottom line Be aware of how the change in seasons might affect your mood, and plan ahead to minimize disruptions to your daily routine, especially sleep.

7. Reduce Stress Whenever and However You Can

Why it's important Any stress — whether caused by a difficult relationship, job pressures, unexpected changes in plans, illness, and the like — can set off a mood episode.

What to do While stress isn't always avoidable, planning how to handle it when it happens can prevent or lessen shifts in your mood, Carol says.

Proven ways to reduce stress, according to the IBPF, include many of the coping strategies already mentioned, such as:

• Take your medications exactly as prescribed.
• Exercise regularly.
• Cut back on caffeine.

Other helpful steps, according to the IBPF, include:

• Identify and avoid behaviors that worsen stress.
• Learn and use relaxation techniques such as deep breathing and meditation.

If a stressful event is on the horizon — such as moving, surgery, or a job change — plan in advance with your therapist strategies to use to manage that stress. And when unexpected stresses pop up, keep your therapist in the loop.

Also, try to limit time spent with — or completely avoid — people who stress you out or who are a negative influence, especially if spending time with them often includes alcohol or causes you to disrupt your sleep schedule, Carol advises.

The bottom line Stress is a major risk factor for manic or depressive episodes in people with bipolar disorder. Learning how to minimize its effects can help you stay emotionally, physically, and behaviorally safe.

8. Just in Case, Plan for Emergencies

Why it's important It's critical for people with bipolar disorder and their support system to know what to do in a crisis situation. Coping strategies can go a long way in heading off a severe mood episode, but they can't guarantee that one will never happen.

What to do Ask your friends and family to plan now how to handle a mood episode if one happens and let them know which behaviors might mean you need immediate professional help.

"Have a written agreement with everyone about what the plan of care will be, such as going to the hospital," Carol advises. Doing this in advance allows you to have a say now in any decisions made if you're experiencing an emergency.

According to the National Alliance on Mental Illness, your crisis plan should include:

• Contact information for doctors, therapists, and other medical professionals involved in your treatment
• Your current diagnosis and medications
• Your basic medical history, including any history of crises, hospitalizations, or suicide attempts
• The addresses of nearby walk-in crisis centers and emergency rooms
• Phone numbers of family members and friends who would be helpful in a crisis
• A list of possible triggers, as well as strategies that helped in the past

Signs it may be necessary to go to the hospital, according the DBSA, include:

• Aggressive, destructive, or self-injurious thoughts or behaviors, including threats of suicide
• Psychotic symptoms in which you cannot distinguish between what is real and what is not. This may be marked by bizarre or paranoid ideas or by hearing, seeing, smelling, or tasting things that aren't real.
• Severe mood swings that could lead to dangerous of harmful behaviors
• Out-of-control use of alcohol or recreational drugs

The bottom line A crisis plan protects your safety and lets your loved ones know exactly what actions to take if your bipolar symptoms go out of control.

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