Take Control of Bipolar Disorder

Transcription

1 Take Control of Bipolar Disorder The Best Care Series by Manulife Financial

2 Take Control of Bipolar Disorder Each of us experiences a variety of moods throughout our daily lives including joy, sadness and anger. Sometimes these moods last a few moments and sometimes longer. For people with Bipolar Disorder, these moods are often more extreme and may cycle rapidly from high to low. There is good news for those experiencing Bipolar Disorder. With the right treatment, support, and self-care it s possible to restore mood balance and take back control. This guide is intended to provide information to help a person along that path the path of best care. What is Bipolar Disorder? Bipolar Disorder (sometimes called Manic-Depressive Illness) is a mental illness that causes dramatic mood change, extreme shifts in energy, and impaired ability to function in social and occupational settings. One s mood may swing from feeling euphoric and/or irritable to feeling sad and hopeless and then back again, often with periods of normal mood and normal functioning in between. In its early stages, Bipolar Disorder can masquerade as a problem other than mental illness (e.g., alcohol or drug abuse, poor work performance) and in its milder forms it can go unrecognized by family, friends and even health professionals. Without proper treatment, however, the symptoms can become more severe, social and occupational functioning can become impaired, and mood can quickly switch to depression. In more severe form, extreme highs (called mania) can be accompanied by psychotic symptoms such as hallucinations or delusions, sometimes requiring hospitalization. The exact cause of Bipolar Disorder is unknown but research points to biological and chemical contributors. The disorder typically begins in adolescence or early adulthood and continues throughout life. Diagnosis is through face-to-face evaluation by a psychiatrist or medical doctor with specialized expertise in mood disorders. Family and genetic factors can predispose certain people to Bipolar Disorder, and stress can trigger periods of mania or depression. Some people with Bipolar Disorder become suicidal, particularly in the early course of the illness, and it is the depression that most often leads people to seek treatment. Recognizing Bipolar Disorder early and learning to treat and manage it is vital to health and well-being. 2

3 Symptoms of Bipolar Disorder The highs and lows that characterize Bipolar Disorder are called episodes. The essential feature of Bipolar Disorder is the occurrence of one or more manic episodes. A Manic Episode is a period during which the person s mood is persistently elevated, unrestrained, or irritable for at least one week. A certain number of other symptoms need to be present and severe enough to impair the ability to function in social settings or at work. Examples include, but are not limited to: Inflated self-esteem, uncritical self-confidence and poor judgment. Fast-paced, nonstop and sometimes incoherent speech that others find difficult to interrupt. Disorganized, racing thoughts and distractibility. Pursuing sexual, occupational, political or religious activities with no regard for consequences or risks (e.g., spending sprees, foolish business investments, indiscriminate sexual encounters with strangers, reckless driving). Restlessness, pacing and decreased need for sleep for days on end without feeling tired. Inability to tell the difference between reality and unreality. For example, hearing or sensing the presence of things that others say are not there or strongly holding false beliefs that are not explained by logic or cultural concepts. Sudden irritability or angry tirades, often in response to having plans thwarted or propositions refused. A Depressive Episode is diagnosed if someone has symptoms that last most of the day, nearly every day, for an extended period of time (e.g., two weeks or more). These symptoms include: Feeling sad, anxious, empty, hopeless, worthless, or guilty. Having no interest in activities that were once enjoyable, including sex. Having difficulty sleeping. Feeling restless, lethargic or slowed down. Not being able to concentrate, remember or make decisions. Experiencing unintended weight loss or gain and changed appetite. Feeling persistent pain or physical symptoms that are not explained by an illness or injury. Thoughts of self-harm or suicide. No single symptom is diagnostic of Bipolar Disorder but all of these symptoms should be taken seriously and reported to a health care provider. 3

4 What is the typical course of Bipolar Disorder? Episodes of mania and depression typically come and go across a life span, with symptom-free periods in between. Some people experience these episodes within a single week or even within a single day. There are also subtypes of Bipolar Disorder. The classic form of the illness involves recurrent episodes of mania and depression and is called Bipolar I Disorder. Bipolar II Disorder Some people experience episodes of hypomania (similar to mania but causing less impairment of social and occupational functioning and not requiring hospitalization). Mixed Bipolar State Others experience manic and depressive symptoms together, having a very sad, hopeless mood while at the same time feeling extremely agitated. Rapid-Cycling Bipolar Disorder Some sufferers experience four or more episodes within a 12-month period. Cycling refers to the alternating between a depressive state and a manic state. A person with Bipolar Disorder doesn t generally have an episode of depression, then an episode of mania, in equal amounts. Although it is true that what goes up, must come down, the cycles are often unpredictable and of varying length. Most people with Bipolar Disorder have extreme cycles only once every few years. Treating Bipolar Disorder Bipolar Disorder is a recurrent illness, meaning that it can occur throughout one s lifetime. So the best treatment is usually long-term and involves acute management (to manage current symptoms), continuation (to prevent return of symptoms from the same episode) and maintenance (to prevent a recurrence of symptoms in the future). There is no cure for Bipolar Disorder, but it can be managed with medication, psychotherapy and life-adjustment skills. Not receiving proper treatment or stopping treatment despite others advice may cause moods to worsen and become severe. Even if following treatments as prescribed, any changes that are out of character or that might signal an onset of an episode should be reported. A health care provider may be able to prevent a full-blown episode by adjusting the treatment plan. Psychiatrists normally prescribe medications for Bipolar Disorder. Primary care physicians who do not specialize in psychiatry may also prescribe these medications, however, a psychiatrist should always be consulted for treatment. Some of the components of an effective treatment plan include: Mood-stabilizing medications, alone or in combination (e.g., Lithium, Valproate, Carbamazepine ). Antidepressant medications to help manage episodes of depression (e.g., Celexa, Prozac, Elavil, Anafranil, Nardil, Parnate ). Counselling. This helps identify triggers of mood episodes and early warning signs, develop a relapse prevention plan, improve communication and problem-solving skills to deal with behavioural consequences, and create stable daily routines and sleep schedules. Social support. Support is very important for the person with Bipolar Disorder and family members. Joining a Bipolar Disorder support group can be very helpful. 4

5 Questions to ask a health care provider It s important to be well informed about treatment for any illness, including Bipolar Disorder. Here are some general questions that may be asked of a doctor or pharmacist: When should I begin to notice an effect from the medication? How often, and how much medication do I take? What are the possible side effects of the medication, if any, and what can I do to best manage them? Will this medication interfere with other medication(s) or herbal remedies that I take? Do I have allergies to this medication? What should I do if I don t feel better or if I miss a dose? What should do I if start to feel better and want to stop taking the medication? Is there any written information I can get about this medication? Is there anything I should not do when taking this medication (e.g., operate heavy machinery, consume alcohol)? What is the best-tolerated treatment for my particular situation? Where can I get more information about Bipolar Disorder? Can you recommend any support groups that help in dealing with the impact of Bipolar Disorder? 5

6 The Importance of Self-Care When a person experiences Bipolar Disorder, key ingredients of a healthy lifestyle can suffer diet, physical activity levels and sleep. By the same token, stressors, lack of consistent routine and disrupted sleep can trigger a manic or depressive episode. Become educated Learn about Bipolar Disorder by reading books or checking out reputable websites, attending support groups, and talking with a health care provider. Stick to a regular sleep schedule Establish a regular, consistent time for sleeping and waking. Avoid rotational shift work. Do something relaxing before sleep like reading in a room other than your bedroom or taking a warm bath. Don t use your bedroom for non-sleep activities (e.g., watching TV or eating in bed). Avoid strenuous exercise, caffeine, alcohol or tobacco a few hours before bedtime. Try not to nap during the day. Get outdoors for some activity (e.g., a short walk) to refresh. If you are having trouble sleeping, talk to a health care provider about appropriate options. Stay active Choose activities that are enjoyable. Plan activities for the times when they can be performed without interruption. Be active on a regular basis. Aim for 10 minutes of continuous activity, three times a week, as a start. As fitness increases, the duration and intensity of activity can be increased. Keep up with proper nutrition Meals should be eaten at regular times (breakfast, lunch, and dinner plus a mid-morning and a mid-afternoon snack). Include a variety of healthy foods at mealtimes (e.g., whole grains, dark green vegetables, brightly coloured fruits, lean proteins, milk products). Avoid food with added fats, sugar and salt. Drink alcohol and caffeine in moderation. Drink several glasses of water each day (five to eight is a good goal). 6

7 Maintaining gains and preventing setbacks Early signs and symptoms of mania or depression are often predictable. Family and friends should be educated about these signs so they can recognize a potential onset of a manic or depressive episode. Here are some more tips that may help: Take medication as prescribed. Medication should not be discontinued if symptoms improve or if they are no longer a problem. Always consult a health care provider before making any treatment or medication change. Listen to the advice of friends, family and a health care provider. During a manic or depressive episode, judgment and insight are impaired and the person suffering from Bipolar Disorder may not recognize that their mood or behaviour is problematic. A plan should be in place to respond to this situation as it may be necessary for family or friends to contact a health care provider and/or to arrange for hospitalization. Keep up with self-care. Anything that helps to stabilize the condition or improve health should be noted. Participate in a support group. Participating in a mood support group may help in dealing with the impact of Bipolar Disorder. Create a Mood 911 plan. Develop a list of warning signs that can be shared with family and trusted friends, and have a plan ready to deal with stressful situations that may trigger a manic or depressive episode. Avoid alcohol and recreational drugs. These substances can slow or prevent full recovery, disrupt mood, and potentially trigger a manic or depressive episode. Learn to manage stress. Stress can trigger a manic or depressive episode. Learn ways to avoid, manage, or change stressors. Stay involved in productive work and social functioning. With the right treatment and support, Bipolar Disorder can be managed. There is every reason for a person with this illness to continue to pursue life and work goals, and to take part in enjoyable activities. Making the Return to Work Easier Sometimes with Bipolar Disorder, an individual will require time away from work to access treatment and stabilize their condition. If there has been an absence, an essential part of recovery is to return to work. These tips will help ensure that the return is successful. Think about what helps the most. Each person is different. Some people need more flexible work arrangements (e.g., reduced hours, modified job duties) and others feel capable of returning to full capacity immediately. Clearly understand the return to work plan and be an active participant in its creation. What are the hours? What are the expectations, roles and responsibilities? Who needs to be informed? Understand privacy rights and be prepared for any disclosure (if necessary). Details of an absence are private and confidential. However, there may be workplace policies that require that certain kinds of information be reported (e.g., safety sensitive positions, information needed for job accommodation purposes). If any disclosure is required, plan what to say and how much information to share. Questions about who to disclose information to, and how much information to disclose, should be directed to a third party such as a Human Resources representative or employee health professional. Learn about support options. Good support is essential to a successful return. Find out what resources are available. Continue self-care efforts. Be on the lookout for changes in mood. Apply the tools developed in counselling. 7

8 Remember With the right help, the right information, and the right support, Bipolar Disorder can be controlled and those experiencing this illness can lead a productive and rewarding life. If Bipolar Disorder persists despite following treatment recommendations, talk to a health care provider. Don t give up on your medications and counselling. Change takes time and may be a lifelong process. For more information, visit these websites: Mood Disorders Society of Canada: Canadian Network for Mood and Anxiety Treatments: Depression and Bipolar Support Alliance: Canadian Mental Health Association: National Mental Health Association: Please be advised that the content of this document is for information and educational purposes only and should in no way be considered as Manulife Financial Group Benefits offering medical advice. Please consult with your attending family physician(s) or other health care provider(s) as may be needed. The Best Care Series by Manulife Financial is offered through Manulife Financial and developed in partnership with Human Solutions. Author and professional advisor for this article is Scott Wallace, PhD, RPsych, Human Solutions. Manulife Financial is not responsible for the availability or content of external websites. Human Solutions is a recognized leader in the area of employee assistance programs, trauma services, e-health, selection and placement, relocation and coaching, and disability management.wellconnected and WellConnected Better Outcomes are offered through Manulife Financial The Manufacturers Life Insurance Company. All rights reserved. WellConnected, WellConnected Better Outcomes, Manulife Financial, Manulife Financial For Your Future logo and the block design are service marks and trademarks of The Manufacturers Life Insurance Company and are used by it and its affiliates under license. GC2455E 04/2011