A Guide to Bipolar Disorder

ADVICE, TIPS & RESOURCES

Hannah Oakland Prepared by

Being diagnosed with bipolar disorder can be scary, especially if you don't know much about it. I wrote this guide as a way to help both new and seasoned bipolar patients. I hope this helps someone out there. I tried to include as much information as possible

FYI: I’m in the US, so if you’re in another country, some things might not apply. However, the resources I provide at the end are broken down by country.

Summary

Be your own advocate!!

Talk to your doctor candidly Ask questions, always.

Research bipolar disorder. Research major categories of medications used to treat bipolar and related illnesses.

Research related illnesses.

Research Rx use cases for commonly used medication. Stay consistent with your treatment plan. Keep a digital record of mental health history and experiences.

Do what you can to minimize costs. Set healthy boundaries. Develop a support system. Develop healthy coping mechanisms

Be an educated financial consumer.

Important Disclaimer

Aside from the hotlines and resources, everything listed here is based on my own experiences and life lessons. It is not intended to be medical advice. Always consult your doctor before changing or quitting medication or trying any alternative or holistic treatments. None of the links in this document are sponsored.

I wish you much love and healing. You are loved, matter, and belong on this Earth. Never give up!

Bipolar Disorder 101

Being diagnosed with bipolar disorder is intimidating. Not all doctors explain what the disorder is, what it’s like, or anything like that And even if they do, it’s generally very brief and, in my experience, not super helpful. In the next section, I’m going to define bipolar disorder and give you some tips on approaching the topic with friends and family (if you choose to).

DEFINITION

“Bipolar disorder is a brain disorder that causes changes in a person's mood, energy, and ability to function. People with bipolar disorder experience intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes These mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood). People with bipolar disorder generally have periods of neutral mood as well.” 1

At its core, the word “bipolar” really means “two poles.” At one end of the pole is depression and at the other end is hypomania or mania. This means that people with bipolar disorder experience life in waves of highs and lows with occasional periods of stability in between. With the right treatment plan, the frequency of episodes should decrease, and the length of stability between each episode should increase.

diagnosis

mania depression

stablility

Psychiatrists use the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM V), and a myriad of assessment tools for diagnosing mental illnesses. Your doctor may also perform physical tests and blood tests to rule out any physical causes. The DSM V contains criteria that a patient must meet for a diagnosis to be made. It serves as a guide, not hard and fast rules. Doctors use these guidelines combined with assessments, their judgment, and sometimes second or third opinions to diagnose and treat patients.

Types of Bipolar Disorder

Bipolar disorder is an umbrella term for the 4 different diagnoses one can receive: bipolar I, bipolar II, cyclothymic disorder (aka cyclothymia), and bipolar unspecified or other.

bipolar I

Diagnosed when a person experiences a manic episode. A depressive episode is not needed for diagnosis

bipolar II

Diagnosed when someone experiences at least one major depressive episode and one major hypomanic episode.

cyclothymia

Diagnosed when someone experiences recurrent hypo/manic symptoms and depressive symptoms, but they don’t last long enough or aren’t severe enough to be categorized under I or II.

unspecified / other

Diagnosed when someone experiences periods of significant clinical mood elevation

It’s common for people with bipolar disorder to experience other mental illnesses, called comorbidities, such as major depression, anxiety, substance use disorder, or attention deficit/hyperactivity disorder (ADHD).

Depression

You may be familiar with the general idea of depression. Sadness, loneliness, tearfulness. But for people with bipolar disorder, the crushing wave of depression tends to be harder to manage due to the episodic nature of the illness. This isn’t to say that people with bipolar disorder have it “worse” than those with unipolar depression (clinical or major depression), but simply that it’s more difficult to manage because more chemicals are at play in the brain.

DEFINITION

“Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home ” 13

symptoms

A major depressive episode is at least two weeks in which a person has at least five of the following symptoms (including at least one of the first two symptoms):

Intense sadness or despair

Loss of interest in activities the person once enjoyed

Feelings of worthlessness or guilt

Fatigue

Increased or decreased sleep

Increased or decreased appetite

Restlessness or slowed speech or movement

Difficulty concentrating

Frequent thoughts of death or suicide

BIPOLAR DISORDER 101

Mania

A manic episode is a period (psychiatrists generally agree on one week) where a person experiences extremely elevated moods. During this time, they may be high-spirited and euphoric or extremely irritable, or a mixture of both.

When someone experiences these symptoms, they often don’t realize it. This is why having a friend or family member (or even hiring an aide) is important for helping monitor your moods.

symptoms

For the episode to be classified as manic by your doctor, you must experience at least three of the following changes in behavior:

Decreased need for sleep and/or boundless energy

Increased or faster speech

Uncontrollable racing thoughts or quickly changing topics when speaking

Distractibility

Increased activity (e.g., restlessness, working on several projects at once)

Increased risky behavior (e.g., reckless driving, spending sprees, unsafe sex)

BIPOLAR

DISORDER

101

Hypomania

A hypomanic episode is very similar to a manic episode, except that it’s less extreme and may last for a shorter period It feels very similar to a manic episode, so it’s difficult to distinguish between them.

A good rule of thumb to tell the difference is this:

Hypomania = ≤ 4 days

Mania = 7+ days

BIPOLAR DISORDER 101

Cyclothymia

I’d like to take a moment to talk about a type of bipolar disorder that isn’t talked about enough: cyclothymia. People generally sweep this diagnosis under the rug because it’s definition makes it out to be less severe than its bipolar I and II counterparts. But anyone living with mental illness knows that “less severe” is a sliding scale. What may affect one person immensely may not affect you the same way. For all of you with cyclothymia, I want you to know that your diagnosis is valid and that you, your feelings, and your experiences are also valid.

EXCERPT

“People with cyclothymia experience cyclic “highs” and “lows” as portrayed by large swings in mood and energy levels that negatively affect their ability to function These changes in mood can occur quickly and at any time. A person with cyclothymia generally experiences only short periods of normal mood.

An adult is diagnosed with cyclothymia when:

symptoms (alternating “highs” and “lows”) have been present for at least 50 percent of the time for at least 2 years, and there has not been more than a 2 month period of being symptom free, and symptoms are not due to substance abuse or a medical condition

In addition, symptoms must cause significant distress or impairment in daily functioning, but cannot be severe enough to meet criteria for either major depressive disorder or bipolar disorder.”

14

How to Talk About Bipolar

Now that you have the power of knowledge, it’s time for you to share it with your support system Everyone is different, and the way they take this information varies greatly. Use your best judgment, but below I’ve outlined how I handle these situations.

friends & Family work

I tend to be pretty up front with people about my illness. I don’t tell them outright that I have bipolar disorder, but I do tell them fairly quickly that I struggle with mental illness and that it’s a big part of my life. That way, they can leave right then and there if they decide it’s too much to handle. My friend group is very small, but all of my friends know about my disorder and life experiences. This is important to me because if I’m having a particularly bad day with my PTSD or moods, I can tell them about it and it won’t be this big weird thing where I have to dive into the backstory.

This one is tricky. I’ve tried both avenues: telling work about my illness, and not telling work about my illness. I’ll tell you about both experiences.

The time when I told my boss about my illness…

In my first professional job, I had a lot of tragic stuff going on, and it got to a point where I felt I didn’t have a choice but to tell them about my diagnosis. This turned out to be a bad move. My boss decided that I was too stressed out and decreased my workload without discussing it with me beforehand. At this point, I was regularly irritable and had severe anxiety at work. It impacted my ability to perform, and within a few months, I resigned

The time when I kept my illness under wraps…

In my most recent corporate role, I didn’t tell the company about my disorder in my last corporate role. The company wasn’t great, and I was scared about what they might do with the information. My boss was overbearing and hard to work with. Eventually, it all became too much. My mental health took a nosedive, and I ended up in the mental hospital I had a limited amount of phone time while I was there, so I used that time to talk to my partner and family. My boss reached out to my partner on Facebook and asked where I was and when I would be back. My partner gave a vague answer about me being in the hospital. After I got out of the ward, I returned to work immediately. I was let go two weeks later.

Final thoughts…

As you can see, in my situation, it didn’t matter whether or not I revealed my diagnosis. My moods and anxiety were obvious to anyone with eyes and ears, and were used against me in both cases My illness severely negatively impacted my work performance and relationships, and still does, but not to the same degree. I felt discriminated against in both cases, but I didn’t have proof, so I couldn’t take legal action.

It’s up to you whether or not you want to tell your workplace about your illness. Most people agree, however, that it puts you at a higher risk for discrimination It’s not their business why you need to go to the doctor or why you’re crying in your cubicle while trying to meet a deadline (been there, done that).

BOTTOM LINE

Do what you think is best for your situation.

Take into consideration the culture of your workplace. Consider telling your work bestie instead of your boss. That way, you have an additional pillar in your support system.

Know your rights! Read up on laws in your country surrounding medical leave.

Simplify Your Life

I've dealt with mental illness my entire life, both first hand and as a caregiver To put it plainly, it sucks But there are things you can do to make your life easier. Here are some things that I've learned along the way that might help you too!

set up a care plan

For starters, have an open, honest conversation with your psychiatrist or primary care doctor.

Talk to them about your concerns and main symptoms, your sensitivity to medication, what activities you do and habits you have that affect your mental health; and of course, come up with a plan for the best course of treatment for your illness. It’s definitely trial and error and is different for everyone.

Be sure to come up with emergency contacts, program them into your phone, and provide them to your doctor(s)

talk to your doctor

If it’s your first time on medications for mental illness, your doctor will most likely start out by prescribing one of the big ones that work for most people. Common medications used to treat bipolar include Seroquel, Zoloft, Lithium, Latuda, Geodon, Lexapro, Prozac, and others Those are just a few, but those will be the ones you see more commonly throughout forums and blog discussions. They may even try a combination of medications or other available therapies to help you start feeling better.

If you’ve been on medication before, be sure to write down the medication, dosage, and how it made you feel. This will help your doctor determine what might work best for you based on your history

The most common categories of medications used to treat bipolar disorder include mood stabilizers, antidepressants, and antipsychotics.

Do your research on the main categories of medication and other therapies used to treat not only bipolar but for similar illnesses like anxiety, depression, PTSD, OCD, etc. (These can also be comorbidities where you have more

than one diagnosis or an overlapping diagnosis). Even if you don’t have comorbidity, it can be helpful to know all the capabilities of the medication.

Knowing all of its uses can give you an idea of how you might feel physically when you take something new. Not necessarily symptoms, but just how it may impact other areas of your life.

For example, Prozac is used for many things: severe PMS, OCD, and bulimia. Knowing that information, a woman may glean that she may feel more relaxed, and have less intense periods

do your research

Research the hell out of bipolar disorder, specifically the type you were diagnosed with. I wish I did this sooner. Remember that scientific fact is always peer-reviewed. Don’t rely (heavily) on studies where more research hasn’t been done yet by other scientists, or that haven’t been reviewed by other scholars in the scientific community.

WHERE TO FIND SCIENTIFIC RESEARCH

International Journal of Bipolar Disorders

International Society for Bipolar Disorders

World Health Organization Mayo Clinic National Alliance on Mental Illness National Institutes of Health American Psychiatric Association

Royal Australian and New Zealand College of Psychiatrists British Association for Psychopharmacology and many more

You may have to search on the association's website if it’s not prominently shown. The papers usually include summaries, too, so you don’t have to read a bunch of jargon.

I would research facts first, and then look for stories from other people about their experiences. Reddit can be a really good resource for that, since it provides unfiltered, real accounts from real people around the world I digress.

My point is, your doctor knows best, but it’s good to be a well informed patient.

be aware of your moods & patterns

Stay in tune with your moods: this will help you and your doctor figure out what areas need to be prioritized.

Some people do this through journaling, mood trackers, or various apps. (I use the Bearable app - it’s easy to use, thorough and customizable.) You could also use two simple 1 5 scales for depression and mania every morning to come up with a baseline.

Over time, you might notice patterns and triggers: make a note of these too. For example, you may notice that your moods are linked to the seasons, like you may get more depressed in the winter and more hypomanic/manic in the summer.

Don't make big life-changing decisions during a hypomanic/manic or depressive episode. Your judgment is typically impaired during these times It's best to write down the idea or decision you want to make and reconsider it in a few weeks, or when you're out of the episode. Also, use someone from your support system as a sounding board for your plans or ideas.

Take note of physical symptoms, especially as you start new medications. Mental health can greatly impact your physical health, and the reverse is also true So, take care of yourself, inside and out

It’s a good idea to keep a digital record of your mental health history. It could include things like….

List of current triggers and coping mechanisms

List of current and past medications with their dosages and any negative side effects

List of past doctors and practices you’ve seen

List of past treatments you’ve received (i.e. ECT, EMDR therapy, etc.)

List of past diagnoses received (be sure to include timeframes here!!)

List of any hospitalizations: place, dates, duration, and the reason for admission

List of any traumatic experiences: suicide attempts, history of self injury, history of drug or alcohol abuse, domestic violence victim, sexual assault or abuse victim, miscarriages, death of loved ones, etc

educate yourself & be your own advocate

Being educated and well-informed in these different areas will help tremendously with navigating the experience of the disorder. Don’t be afraid to ask questions or request explanations: I encourage you to do both.

And if you don’t like your doctor (maybe they don’t listen well, or don’t value your input, etc.), you can always request a new one within the practice, or simply ask your primary care doctor for a referral to a new doc. The same goes with therapists, or any doctor, really.

develop a support system

A support system is crucial for people with bipolar. This can include friends and family, your doctor and therapist, and even someone close to you in your workplace*.

Some people don't have the luxury of good relationships with friends and family, but that doesn't mean you can't have a support system

You can find support in your local community through the National Alliance on Mental Health (NAMI) or something similar in your region. NAMI has in person and virtual groups, as well as a helpline and other valuable resources.

Regarding finding support at work or school, knowing who you can and cannot talk to about your illness can be tricky without risking discrimination. It's completely up to you if you want to tell your manager or colleagues about your diagnosis. Consider the culture of the company or university. Utilize employer provided resources available like Employee Assistance Programs (EAPs) or employer-paid subscriptions (like Calm, Headspace, etc ) that can help you manage your overall well being If you decide to discuss it with your colleagues, manager(s) or professors, you can be as vague or specific as you feel comfortable. Many people don't know about bipolar disorder, so educate people as often as possible, when needed. Do what makes you feel safest and supported.

Remember that you're not alone in this fight. There are groups on Facebook, Reddit, Tumblr, and the like that can provide support and new perspectives

Your doctor may also have resources they can provide you.

develop healthy coping skills

People deal with situations in different ways Identify what symptoms bother you the most. Then, work with your doctor or therapist to develop healthy coping mechanisms.

Some common examples include meditation, breathing exercises, listening to music, journaling, creative endeavors, and exercise. Coping skills are unique to you, so be sure to explore different methods.

Also, make sure you write down (or file digitally) what methods work best for you, so it's easily accessible.

I'd like to note that reducing stress in your life is important, as stress can exacerbate existing symptoms and even introduce new ones.

Be aware that if medications don’t work for you, that’s not the end of the road. Alternative treatments can be used with or without medication, such as electromagnetic stimulation (ECT), transcranial magnetic stimulation (TMS), ketamine, and likely others I’m unaware of.

It's common for bipolar patients to feel isolated and alone. Don't judge yourself too harshly: this is a tough illness to have and you're allowed to feel whatever it is that you're feeling. You are loved and you matter. Never give up.

Set boundaries with loved ones, friends, and colleagues. If you have toxic people in your life who just aren't good for you, remove them from your life, or limit contact.

Listen to your body. If something doesn't feel right, make note of it and talk to your doctor about it.

Live a full and healthy life: don't let bipolar disorder keep you from that. I know (trust me) how isolating depression can be, and how easy it is to drive people away with "unwanted" behavior on either end of the bipolar spectrum.

Force yourself to smile at least once a day. When you smile, whether it's real or not, your body releases cortisol and endorphins, which have many benefits for both your mood and body. Your body doesn't know the difference between a real and fake smile. Give it a try!

Don't be afraid to ask for help.

if medication isn't working be kind to yourself: you're human!

Let's Talk Money

Cost shouldn’t be a final deciding factor in your treatment plan, but it's definitely something to consider

making medications affordable

Medications, especially newer ones that go on the market, can be expensive. If you’ve seen a commercial for a drug, it’s likely pretty expensive If your doc prescribed something super expensive and you can’t afford it for whatever reason, that’s okay. There are a lot of options out there. Ask your doctor if there’s anything similar that you could try first.

This is probably common knowledge by now, but generic, non brand name medications are generally cheaper than their name-brand counterparts.

Utilize savings cards like GoodRx, Single Care, WellRx as often as you can. Some of these will also show you the cheapest option near you, so you can determine if you’ll save more at a different location. If this is the case, you can likely ask the pharmacy to transfer your prescription to the preferred pharmacy. I’ve never done this myself, or at least not more than once, but I’ve heard of others who have. It might take a few hours to be able to pick it up, but it may be worth it if there’s a big price difference

handling hospital bills

Being in the hospital is stressful enough as it is, and getting an enormous bill afterward can be scary.

Always call the hospital's billing office when you get out and see if they can provide some sort of discount. This applies whether or not you have insurance. They will often be open to making payment plans, too.

As a general piece of advice, I highly recommend building emergency savings to help buffer the cost of treatments and hospital stays and other life events. Having money on hand for emergencies can help provide emotional relief when you get a huge bill in the mail I recommend using a Betterment Cash Reserve Account to keep your savings in a safe place where you won’t be able to instantly spend the money.

dealing with manic spending

When a bipolar patient is hypomanic/manic, it's common for spending (and other) habits to be reckless. Here's some advice that may help minimize your spending during a manic episode.

Have a plan in place for how you're going to handle finances when manic so you're ready to take action immediately Reduce impulse buying in your everyday life. Having this mindset can reduce your risk of racking up a ton of debt when experiencing hypomania/mania

Lock your credit cards when entering a hypomanic/manic episode If possible, have your support system hold you accountable or even handle your finances when entering a hypomanic/manic episode. Keep the receipts for all items you purchased, both digital and physical; and be mindful of return policies

You can likely return many undamaged items or request a refund for digital products you bought

Digital items like in app purchases, course materials, and the like can be tricky, but it's always worth reaching out to customer service. When you have the urge to impulse buy, try going to a thrift store, dollar store, or garage/yard sale. You might not be able to return these items, but it'll satisfy the urge for a smaller price tag. Try using just cash instead of debit cards during a hypomanic/manic episode

You can pull out a certain amount of money from your bank and just use that money for all your spending for the following week, and keep doing that until you're out of the episode. This is best combined with someone keeping an eye out for you, as they can hold onto the money and give you a portion when you need it.

Lock your debit card, or give it to a friend for safekeeping Disable any digital spending cards you have on your devices. If you tend to go big or go home with your spending, I suggest you freeze your credit reports until you're out of your episode. This will make it nearly impossible to get a loan, like for a vehicle, home, or other large purchases. It will also prevent you from opening a new credit card.

Money can be a huge obstacle when manic/hypomanic, but it isn't impossible to navigate. These tips can help reduce (or even eliminate!) the amount of debt you incur during manic/hypomanic episiodes.

Digital Tools

Technology has changed the world, for better or for worse. Luckily, there are a ton of resources for bipolar patients and their families I'm going to share with you some golden nuggets I've found throughout my journey.

use your phone to your advantage

IPHONE: SET UP MEDICAL ID

You may already know this, but iPhone has a feature called Medical ID, as part of their Health app. Here's how you set it up: open Apple Health app > Summary > tap profile picture > Medical ID > Edit. Within the Medical ID, you can add things like conditions, allergies, medications, and emergency contacts.

ANDROID: ADD MEDICAL INFORMATION

A similar feature is on Android as well. To add in your medical info, go to Settings > Safety & Emergency > Medical Information. You can also add emergency contacts within the Safety & Emergency screen as well.

apps & podcasts that keep me sane

Note: None of these are sponsored. These are just apps that I use to help me manage my illness.

ROCKETMONEY APP

This financial app is great for budgeting, keeping track of bills, and seeing where your money goes. I've been using it since its inception, and it's only improved over time. They regularly ask for feedback and listen to their users.

CREDIT KARMA APP

This credit-monitoring tool lets you monitor your TransUnion and Equifax scores. It tells you what factors are impacting your scores, and provides a timeline view as well.

EXTRA CARD APP

This nifty FinTech company, Extra, is a lifesaver for those trying to build or rebuild credit. It's a debit card that acts like a credit card: you spend money using the card (physical and virtual cards provided!) and Extra withdraws whatever you spent within 24 hours from the purchase date Then, at the end of the month, they report those purchases to the credit bureaus to build your credit. There is a monthly subscription fee, but in my mind, it's totally worth it.

EXPERIAN BOOST

This is more of a tool within a website than an actual app. It's a feature offered by Experian that helps consumers boost their FICO score by reporting utilities, rent, streaming services, and other bills as credit worthy purchases. This will help improve your credit score over time. It's free, and requires little effort. You just create an Experian account and turn it on, and that's it! Did I mention that it's free?

PILLOW APP

This sleep tracking app is amazing, even with just the free version. It tracks your sleep cycles and sleep times, which can help you see sleep patterns over time. The premium version provides more in depth features.

SLEEPWAVE PODCAST & SLEEP MAGIC

I have terrible insomnia and sleep apnea. I found this podcast a month ago and I've been using it every night since. Sleep Wave is a podcast with sleep meditations that help you fall asleep quickly and in a peaceful state of mind. Sleep Magic is a sister podcast that focuses on sleep hypnosis. These podcasts are particularly helpful when my anxiety is rampant, or I don't feel the need to sleep when I'm manic. They are available on Apple Podcasts and Spotify, or wherever you listen to your podcasts. I use Spotify to listen to them: I set a sleep timer with Spotify, turn the volume up and stick my phone under my pillow so I can get comfy Works wonders!!!

WATERLLAMA APP

I'm really bad at staying hydrated; dehydration can majorly impact your mood and bodily and brain functioning This cute app gamifies the water (and other beverage) tracking experience Easy to use and customize

GOODRX APP BEARABLE APP

IThis app provides discounts on medications and where you can find the cheapest medication locally.

I mentioned this before as well, but the Bearable app will help you track your mood and the factors that impact your mood. From relationships to food to bowel movements, this app has every factor you could think of you can add your own, too And you can export your reports and send them to your doctor right in the app!