How I manage bipolar disorder

Content warnings: mention of self harm and suicidality

You may know from earlier blog entries that I have Bipolar 2. This means I never get fully manic, but have episodes of depression, hypomania, and mixed states. It is this condition that I perhaps consider the most disabling of my diagnoses, I think mostly because of the gap between the social model and these impairments. I’m pretty sure there’s no combination of supports and decreased access barriers that could fully prevent me from having bipolar episodes through the rest of my life. While I am not reliably stable enough that you should consider my self-care a perfect way to prevent bipolar episodes, I have picked up some useful skills over the years that do keep me more stable than I used to be. I will tell you about some of those now in case they are helpful.

Sleep: I require extra sleep in order to function, usually ten hours a night. What is even more important than the amount is that I keep to a strict schedule, especially for bedtime. Getting too little sleep is a risk for hypomania, and getting too much is a warning sign I might be entering a depression.

Walks outdoors: Please don’t read this as the infamous “have you tried exercise?”, because it’s only a small part of my self care and not everybody finds it helpful. But it does seem for me that going for a walk every morning helps me stay sane. I am not sure whether it has more to do with moving my body, soaking up vitamin D, and/or the reassurance of routine itself that is useful. Oh, and it is a good time to listen to wizard rock, a special interest thing for me – I think engaging in special interest stuff can be a positive thing for many autistic people’s mental health.

Meds: I love my meds. I especially find antipsychotics useful for my brain, but of course “your mileage may vary”. I am usually diligent about taking pills – my emotional support animal and I have a system. I’m not allowed to feed her until I’m taking my meds – and, conveniently, she gets hungry twice a day when my doses are scheduled. Thus I can’t stall too long or skip them entirely because she’ll cause havoc until I comply with her dinner plans. Unfortunately, I am liable to skip a pill or two when I’m hypomanic, under the illusion it will keep me feeling good longer. This is a bad idea. This is a classic feature of bipolar disorder though – the brain’s wheedling that skipping meds is okay.

Moderating stress and outside commitments: this isn’t doable for everyone – if employment is your only chance of income or you have dependents, there may be stressors you just can’t get out of. For me, trying to hold a job was a huge stress (not least because it involved a lot of masking my autistic traits), and I feel supremely lucky to have gotten on SSDI. It’s also important for me to only take a class or two at a time and to be wary of adding any other new commitments to my life. Certainly having some regular activities can be nice structure/routine, but my history clearly demonstrates that “normal” amounts of work/commitments/stress/etc put me at huge risk for increased mood episodes.

Community: Everyone has different needs around amount and type of social interaction, but personally I’ve found I do benefit from some interaction with people I can relate to. This is carefully curated, however, given my autistic traits. For offline interactions, I do best when I can build friendships by seeing someone in the same time/place/activity every week. This makes the hangout much less stressful and I am better able to connect than I am when coping with unpredictable elements. I am lucky to have friends who are amenable to this accommodation. Besides that, most of my social life is online, and that suits me well. Not only is the method of communication easier than the speech people typically expect in person, but the reach of the Internet allows me to connect with people who have similar experiences as me. Through Twitter I feel like part of a larger community of queer and disabled people, and it’s good for my brain to feel like I have a place in the world.

Supports for co-occurring conditions + masking less: My bipolar episodes seem less frequent and milder over the last year or two, and I think one of the changes that has affected this is the fact that I have been able to incorporate more disability supports into my life and decrease the amount I mask my neurodivergencies. (I’m placing these components together because for me they both have to do with claiming my disabled identity, decreasing shame, and asserting my rights.) As I use AAC, let myself stim more, utilize academic accommodations, explore executive function supports, structure my life to avoid PTSD triggers, and try to find environments where it is safe to be noticeably disabled, I experience less distress. This appears to be decreasing my vulnerability to bipolar episodes. (It should be noted that it’s not safe to be noticeably disabled in many environments, especially for multiply marginalized people, so not everyone is able to make these kind of changes to their life.)

Symptom tracking: I developed a system for monitoring some of my warning signs and significant symptoms that takes about a minute a day and results in charts my providers and I can look over to discuss how I’m doing. This can help identify potential episodes early on, giving me a chance to intervene before things get too bad. The items that you choose to monitor should really vary from person to person, but the items I track are: mood on a scale of 1-10 (morning and evening), sleep, anxiety, irritability, intrusive thoughts, sensory overwhelm, self harm, suicidality, whether I took my meds properly, and whether I cancelled plans/missed commitments.

Therapy/group therapy: I’m not someone that thinks disabled people have to be “compliant” with treatment a doctor dictates in order to successfully manage our conditions, but I’ve often gotten something out of showing up for my appointments. It’s a huge cost benefit analysis, because treatment can so easily be harmful to trans and autistic people, but given my brain I kind of feel like I’ve had no choice but to risk the bullshit in order to try to glean the potential benefits. I’m lucky that my current therapist is decent. I’m not able to see him often enough for deep trauma work or anything, but he serves as a sort of check in/case management/sounding board type person that is still useful to me.

Okay, those are the major components that come to mind, but I’ll note a few extra topics that I’ve found useful at various points in case you want to look into them more: vitamins/supplements, connecting to my spirituality, peer-run support groups, dietary changes (this one’s complex for me due to eating disorder, but still worth mentioning), journaling, creative writing, engaging in special interests, and routines.

Do you have tips from managing your own mood disorder you want to share? Please comment!

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