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 Centre for Addictionand Mental Health |
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About Mental Health & Addictions
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Recovery and preventing recurrenceBipolar Disorder: An Information Guide On this page:
The goal in treating bipolar disorder is to help people get well again. This includes:
Time Frame for RecoverySome people may recover quickly from a manic, hypo-manic, mixed or depressive episode. For many others, it is more gradual. Often, it takes a few months for a person’s functioning to return to familiar levels. This may be true even if symptoms of the most recent episode have been fully eliminated. The time needed to recover often frustrates people with bipolar disorder. Health care providers often need to clarify the recovery phase for patients, their families and employers. A person recovering from a broken leg would increase activities gradually. Similarly, gradually increasing activities after a bipolar episode is advised. This approach allows people to take on responsibilities and build self-confidence more manageably. Some individuals rush back into full, if not increased, activities. They may be trying to convince themselves and others that they are fully recovered. This “flight into health” often exhausts and defeats people. Many individuals who expect a lot of themselves are unhappy with how slowly they recover. They feel demoralized by the delay. Recovery is a process that takes time. After a bipolar episode, people often feel fragile, vulnerable and at risk of more episodes. These feelings are a normal part of the recovery phase. It takes some time before a person’s confidence and performance return to normal. A social worker, occupational therapist or nurse can help plan a strategy for recovery. This strategy may include a balance of volunteer activities, leisure interests, school courses and work activities that reflect a person’s abilities. Is a Person Who Has Recovered “Cured”? Unfortunately, at this time there is no cure for bipolar disorder. Like a chronic medical disorder, such as hypertension or diabetes, bipolar disorder can be effectively managed and controlled by combining a healthy lifestyle and treatments. Role of Medications in Recovery Medications are the cornerstone of treatment in bipolar disorder. That is, they are needed to restore and promote wellness. There are several medications commonly prescribed for bipolar disorder. Finding the right dose for you will require monitoring and discussion with your physicians. The purpose of taking medications is to eliminate your symptoms and prevent their return. How long should a person stay on medications? Bipolar disorder is a highly recurrent, or returning, disorder. Most people who are untreated will experience a relapse within a couple of years. Medications not only treat symptoms but also prevent their return. People are much more likely to stay well if they remain on medications rather than stop them. Recommendations for maintenance, or longer-term, treatment depend on the type of illness. For some, staying on medications for one or two years may work. This strategy suits only people who have a mild single episode that is not very impairing. For most other individuals, longer-term treatments are recommended. In many cases, treatment may be needed indefinitely. If a person is well for a long time, does that mean medication is no longer needed? No, it is possible that the illness has entered into a quiet period. Or it may imply that the medication is working at preventing symptoms. If the person then stops the treatment, the risk of relapse is high: there is more than an 80 per cent risk of relapse within two years. Relapse may occur even after many years of stability. Is there a chance of becoming addicted to medications? And can they change personality? No, people do not become addicted to the main treatments for bipolar disorder. These are mood stabilizers, antidepressants and anti-psychotics. There is no evidence at this time that these medications change personality. However, caution is warranted with some anti-anxiety drugs, such as benzodiazepines, if taken for a long period of time. Do medication side-effects go away if a person takes medication for a long time? Many side-effects from medication do lessen with time. Other side-effects can be relieved with help from a physician. A physician will monitor not only the side-effects but also the medication dose. In some cases, the physician will monitor the blood level of medication and body organ functioning. With these checks in place, the risk for long-term physical complications from the medications is low. The risks of living with untreated bipolar disorder are much greater. Beyond Medications: Tips for Preventing Relapse and Promoting WellnessMany, but not all, people with bipolar disorder can benefit from counselling, psychotherapy or meeting with an occupational therapist, social worker or nurse. Using such resources can help to find coping strategies to reduce symptoms, effectively cope with day-to-day stress and lower the risk of recurrence. Health care providers should recommend treatment tailored to each individual.
Practical Aspects of RecoveryAn episode of either depression or mania usually disrupts daily routines as well as work, school, and home life. People may feel that life will never be the same. They may also feel unable to assume previous responsibilities and involvements. These feelings are natural and understandable. Yet, once properly stabilized on medication, most individuals with a diagnosis of bipolar disorder can return to their previous responsibilities and activities. Planning appropriate goals and setting priorities are essential to making this transition successful. Each plan and set of priorities is individual. However, it is important to discuss your ideas and concerns with your psychiatrist. Taking on too many or too few responsibilities can have a definite impact on recovery. Sometimes, people are advised to discuss their plans with other professionals, for example, an occupational therapist, social worker or psychologist. Family members may also need to know about your plans and concerns. Family can give important support and feedback as people resume responsibilities. The aim is to get the “just right” type of challenge. This is true whether people are returning to school or work, or taking on roles within their family and community. School If you are planning to return to school, you should discuss this with your psychiatrist and/or mental health professional (e.g., occupational therapist or social worker). Some people find part-time studies a necessary step. Many people experience problems with concentration and memory. Look for ways to improve or adjust your study habits. Study for shorter periods of time and avoid noisy or high-traffic areas. An inability to block out the surrounding sights and sounds is common. Sharing the nature of some of your difficulties with your teacher may be helpful. Many schools and most colleges and universities have a “special needs” office that may also be helpful. A counsellor at this office will ask about the reason for your absence. This information will help the counsellors work with your teachers and instructors. A counsellor can suggest the best change to a course load and responsibilities. Sometimes it may be helpful to give permission to these counsellors to speak with your health care providers. Work Returning to work may also include similar challenges and careful planning. It is important to discuss your plans for work with your psychiatrist. You may also need to discuss your concerns and plans with an occupational therapist who can give you additional advice and support about your return to work. Gradually assuming your responsibilities by either starting part-time or with a lessened workload is highly recommended. Your health care provider may recommend specific job accommodations to your work responsibilities and schedule that may also be helpful in this transition. Typical job accommodations include: more frequent breaks, time off to attend medical appointments and a change in non-essential job duties. Educating your employer and co-workers about some of the typical signs of mood changes may be helpful in some cases. However, some people prefer not to discuss their illness with employers. Although this will not allow for the opportunity to ask for any job accommodations, it does not mean that you will be unsuccessful in your transition back to work. Having support outside of work, to discuss your problems and concerns, can be especially important in this situation. Regardless, each situation calls for an individualized plan and support. Home and Community Responsibilities Home and community duties may also need to be resumed on a gradual basis. People must find that “just right” challenge of responsibilities and involvements. Reviewing priorities and developing a plan to resume activities may also be necessary. Look at what you can and have been doing, and plan accordingly. What you are currently able to do may not match what you were able to do in the past. Although this may be frustrating, set daily goals and monitor your accomplishments. Reflecting on and modifying your expectations is often an important part of this process. In the early stages you may need to rely on family members to absorb some of the household and daily responsibilities. As recovery continues, you can gradually resume your responsibilities. Recognizing and Responding to Mood ChangesLearning to recognize and respond to any subtle mood changes is important. This is true when returning to school, work, or home and community involvement. Focusing on ways to concentrate better and work more efficiently may also help. Individuals may benefit, too, from decreasing some of the external stresses in their environment. Depression Typical signs of starting to feel depressed are:
When depressed, you may find it helps to:
Hypomania Typical signs of starting to feel hypomanic are:
When hypomanic, you may find it helps to:
Concentration Whether you are feeling depressed or hypomanic, you may have trouble concentrating. At these times, you should:
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Last updated: Dec 07, 2006 11:50 AM Published: Aug 29, 2008 7:33 PM ID#P23345 |