Newsletter – June 2020 – Issue 123
In this issue:
Research and education:
Come and join us at our new Forum!
Bipolar Life have recently completed an online forum. This is the perfect place to discuss all things Bipolar.
Find upcoming events & meeting times, tell your story, find resources, discuss doctors and treatments, contact facilitators and message other members.
Go here: https://bipolarlifeforum.org.au/ to sign up.
Hope to see you there!
Upcoming Zoom Meetings
Our online Zoom Support Groups are proving popular and upcoming scheduled meetings are as follows:-
You can register anytime here: https://bipolarlifeforum.org.au/calendar/
Click on desired meeting date for connection details and RSVP to let the facilitator know you are coming.
Once we resume in-person meetings it will be important to account for numbers to comply with COVID-19 social distancing guidelines so please let us know if you are coming so we can plan ahead.
Alternatively email [email protected]
Tools to help people with Bipolar Disorder
Dr Alice Lam 17th May 2020
Dr Alice Lam has worked as a GP both in the UK and Australia and has advocated for countless patients. To find out more about her health writing service, please go to www.dralicelam.com/health-writer-service.html.
In this article, we’ll look at how tracking symptoms can help, then we’ll consider the range of different tools available including apps for people with bipolar disorder.
Many people already track their mood, sleep and energy as part of a treatment and maintenance plan. This is a good example of a way in which we can increase awareness of our moods, including early changes that might herald a mood episode, and monitor effectiveness of medications or other therapies1. Examples of printable trackers which you can of course customise can be found here and here. Making notes as you go along can help identify stressors and triggers too.
As a regular circadian rhythm with sufficient sleep is important in bipolar disorder, a decrease or increase in sleep could be a sign of impending mania or depression; or the other way round might be the case, that is, mania may cause decreased need for sleep or depression cause increased need. In either case, early intervention would probably be beneficial than if things were left to spiral out of control.
Perhaps you want to see the effect of walking 15 minutes a day on your mood and energy. Or you wonder if cutting out caffeine will improve your sleep. It may be that you are depressed and you’ve set a basic goal of showering three times a week because anything more feels overwhelming2. Recording via a paper or electronic tracker allows you to experiment with positive behavioural changes as you can measure when and how much of an effect a change makes. You can read more on how to use behavioural activation and goal-setting to beat low mood or negative thinking here and here.
It is important to note that some people with bipolar disorder may become over-energised by goal progress and rewards, which may lead to a manic episode3. Therefore, it is important to ensure that we avoid setting goals that will require excessive activity that could in turn affect sleep or circadian rhythms2.
If you’re feeling overactivated, you might use a tracker to add in regular calming activities such as relaxation and meditation, as well as avoiding too much goal seeking2. Here’s an online module on using behaviour to prevent mania.
There are also more sophisticated trackers available, such as the Quality of Life (QoL) tool4 produced by the Collaborative RESearch Team (CREST.BD). The QoL tool is a free online resource where you can intermittently fill in a simple questionnaire, rating satisfaction levels for energy, mood, sleep, work, money, relationships and other life domains. The tool then displays the data as a graph and table, helping you to see progress, which helps to validate your efforts and motivate ongoing efforts5.
Regular tracking may lead you to a routine that includes a healthy lifestyle (diet, exercise, relaxation, regular sleep pattern, avoiding alcohol and drugs, minimising stress and maintaining consistent sunlight exposure throughout the year) which should help keep your symptoms and mood symptoms to a minimum6.
Don’t forget that trackers are also a helpful way of showing your doctor or psychologist how you’ve been doing since your last visit.
You could also ask a trusted partner or friend how they think you’re going.
As the International Bipolar Foundation6 advises, “If you educate your family and friends and involve them in treatment when possible, they can help you spot symptoms, track behaviours and gain perspective.”
Many people with bipolar disorder turn to mobile apps and web programs (mHealth) to find information about the condition, to track symptoms, to record behavioural changes. Apps can appear attractive as they are easy to download, convenient, and are often low-cost or free.
A review by the Australian Communications and Media Authority7 confirms how prevalent mobile devices are in society. It was found that 89% of Australian adults accessed the internet in the six months to May 2018—74% going online three or more times a day. 90% of Australian adults were using more than one device to go online at May 2018.
Researchers from the Black Dog Institute and Sydney’s School of Psychiatry, decided to explore the apps aimed at bipolar disorder in both Google Play and iOS stores in Australia8. In particular, they evaluated the apps for features, quality and privacy.
Out of the 571 apps identified, they reviewed 82 apps. Here are some of their conclusions8:
- Apps that provided information only covered one-third of psychoeducation needed and only 15% followed best practice guidelines. No information apps suggested action plans
- None of the 35 monitoring apps had a duty-of-care alert, which was tested by entering three consecutive days of severely depressed mood and suicidal ideation. Seven of 13 monitoring apps failed to remind the user to track mood as directed.
- Some symptom monitoring apps did not monitor medication (57%), sleep (51%) and most self-assessment apps did not use validated (recognised, scientific) screening measures (60%).
- User reviews did not always correlate with an app’s quality or effectiveness.
This is not to say that all apps are no good, but from the research above it shows that it is a good idea to be cautious when choosing and using an app.
- Fink, C. and Kraynak, J., 2016. Bipolar Disorder for Dummies. 3rd ed. New Jersey, USA: John Wiley & Sons, Inc.
- Reiser, R.P., Thompson, L.W., Johnson, S.L., Suppes, T., 2017. Bipolar disorder, 2nd edition. ed, Advances in psychotherapy–evidence-based practice. Hogrefe, Boston, MA.
- Johnson, S., 2012. The Behavioral Activation System and mania. Annual Review of Clinical Psychology. Annu. Rev. Clin. Psychol. 8, 243–267.
- CREST.BD. 2015. Quality of Life Tool. [ONLINE] Available at: https://www.bdqol.com/. [Accessed 15 May 2020].
- Morton, E, 2019. Experiences of a Web-Based Quality of Life Self-Monitoring Tool for Individuals With Bipolar Disorder: A Qualitative Exploration. Journal of Medical Internet Research, [Online]. 6(12), e16121. Available at: https://mental.jmir.org/2019/12/e16121 [Accessed 15 May 2020].
- International Bipolar Foundation. n.d. Treatment. [ONLINE] Available at: https://ibpf.org/learn/education/treatment/. [Accessed 15 May 2020].
- Australian Communications and Media Authority Communications Report 2017-2018. 2019. AAA, [Online]. Available at: https://www.acma.gov.au/sites/default/files/2019-08/Communications%20report%202017-18.pdf [Accessed 15 May 2020].
- Nicholas, J., 2015. Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality. Journal of Medical Internet Research, [Online]. 17(8), e198. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642376/[Accessed 17 May 2020].
Surviving With Bipolar Disorder During COVID-19
We’re at an unprecedented point in time where nearly all of us are being profoundly impacted by the spread of the coronavirus. There have been a few other occurrences in our lifetimes where we’ve witnessed such a deep impact upon society. In terms of broad sociological disruption, I think it’s accurate to say that most of us have not been through anything like what’s occurring with the current pandemic.
Concerns about health, economics, and maintaining an adequate supply of resources to meet our basic needs are ubiquitous. But individuals with bipolar disorder are faced with additional challenges that don’t come under the heading of “shared experience.” Remember, bipolar disorder is shared by only about 2.5 percent of the population.
While symptoms of bipolar disorder (depressed mood or mood elevation) can sometimes become activated without any clearly identified external precipitant, we also know that bipolar disorder is strongly reactive to stress. Given a difficult set of sustained stressors, an individual with bipolarity can find themselves becoming strongly symptomatic in response to the sustained stress.
The issues I want to address in the remainder of this piece entail what you can pragmatically do over the next several months if you’re among the two and a half percent living with bipolar disorder. My recommendations are not new or different from many of the known practices related to living well with bipolar disorder. That said, they bear repeating at this critical point in time:
1. Remain in contact with your mental health providers
Most licensed professionals can provide telehealth mental health services and I strongly recommend that most who are living with bipolar disorder consider receiving ongoing telehealth services from licensed mental health providers during the extended period of time where we’re likely to be affected by this pandemic. This isn’t a good time to choose to go it alone simply because the usual routines and configurations of services have become disrupted.
2. Try to ensure you have an adequate supply of medication.
When you next speak with your prescribing provider, it would be a good idea to inquire as to whether your medication prescriptions can be written for a 90-day supply. You don’t want to risk an interruption of medication and you also want to minimize the extent to which you are going to your pharmacy. With regard to this last point, you should also explore whether the pharmacy you use offers mail-order options. If not, consider finding one that does.
3. Maintain regular structure within your daily routine
The loss of structure can be one of the most challenging aspects of being out of work. If your telecommuting, then hopefully you can treat your day as if it’s not any different than if you were going into the office.
But if not, if you’re essentially unemployed or out of school (or both), then it really behooves you to try to create a routine and a schedule for your day where you are engaged in different activities at designated times in the day. Even if those activities entail things such as reading, playing video games, exercising, talking with friends online, etc., there is no reason you can’t create a schedule where the structure of the day is predetermined. I can guarantee this will be a more effective approach to mood management than making choices according to whatever mood or preference you may have in the moment. You may also find that you will be able to get more accomplished through this approach, particularly if you have some “to do” tasks needing completion that are already structured into your daily plan.
Individuals with bipolar disorder do better with continuity of structure over time. If you’re able to divide your day up into several different segments (one to three hours duration), you’ll do better if specific activities are occurring at the same time each day. In other words, you should strive to achieve continuity of structure from one day to the next.
4. Practice good sleep hygiene
Healthy sleep habits are as important for the management of bipolar disorder as are medications. In fact, if everyone with bipolar disorder were able to effectively regulate their sleep schedule, we’d observe a significant lessening of bipolar symptom acuity across the bipolar population.
I understand this is wishful thinking.
In order to avoid excessive length in this post, here are two online sources that provide an excellent overview of why sleep is such a critical factor for the management of bipolar symptoms. One is psychiatrist, Dr. Jim Phelps’ site: www.psycheducation.org. The specific section is: “How Does the Biologic Clock Work?” Phelps’ discussion also sheds light on how lithium contributes to the regulation of the biologic clock which is often dysregulated in indivduals’ with bipolarity.
The second is a 2016 article titled The Role of Sleep in Bipolar Disorder written by Alexandra Gold and Louisa Sylvia and published in the journal – Nature and Science of Sleep. The full article is freely accessible online in Pub Med Central.
The important elements of healthy sleep hygiene that individuals with bipolar disorder should be attending to are:
1. Building on the theme of good structure, the individual with bipolar disorder should ideally go to sleep and awaken at the same times each day.
2. A low light environment is important during the couple of hours prior to sleep. Bright light is activating to the brain. Blue light, or that which is emitted, from electronic screens, is even more so. Try to minimize exposure to blue light before sleep. There are inexpensive glasses that block blue light as well as settings on personal electronic devices that minimize blue light.
3. Try to find relaxation before sleep. Strongly stimulating activities before bedtime will have the opposite effect. Computer action games or thriller genre movies are probably not the best fare just prior to sleep. Better to read or listen to soothing music. There’s a multitude of online relaxation and sleep induction recordings that one can listen to with earphones just before sleep.
4. Your bed should be the place you sleep. It shouldn’t be the place for all your other activities. For those of you who like to hang out in your bedroom and use your bed as a sofa, here’s the rub: Getting into bed should be a signal to your brain that it should prepare to enter sleep. But using your bed as a sleep signal will only be effective if your bed’s function is reserved for sleeping.
5. Avoid daytime napping. I understand that when you’re home for long stretches of time and feeling bored or fatigued (or both), it can be quite tempting to take a nap. But doing so further handicaps your ability to easily fall asleep at a desired sleep time. If your fatigued during the day, do everything you can to hold off from daytime napping. Being successful with this will greatly facilitate your ability to get a good night sleep during appropriate sleep hours.
If healthy sleep hygiene isn’t enough to help you get consistent restful sleep, then I strongly recommend that you speak with your prescribing physician about adjunctive medication approaches to assist with sleep.
5. Maintain an active home exercise routine.
Across the board, I observe patients who actively integrate regular ongoing exercise to do better with their bipolar symptom management than those who don’t. Just like a stable sleep cycle, it makes an enormous positive difference. Just because you’re home and without access to a gym, that doesn’t mean you can’t exercise. It does mean you probably won’t have a large array of fancy machines to help you with the endeavor. But if you just spend a few minutes doing some online browsing of home exercise routines, you’ll find a plethora of options. Identify one that works for you and work it into your daily/weekly schedule.
6. Get outside during good weather
Despite the Corona bad news, it’s springtime. In between the intermittent rainy days, the weather is gorgeous and very conducive for outside activities whether alone or with those in your immediate household. Adequate daylight and sunshine are excellent prophylaxis against depression. Morning sunshine is even better. So once the weather is warm enough get yourself up and out on a regular basis.
7. Maintain adequate social support
This is one of the tougher challenges we all face during periods of extended social distancing. Fortunately, most of us in contemporary culture engage in a fair amount of online interaction. This may be less so for older individuals who didn’t grow up with social media. But none of us are too old to be able to make some simple changes. Personally, I’m not a big fan of Skype or FaceTime. I far prefer to be physically present with those I’m engaging with. But these are different times where that which is healthy for us emotionally (being with others whom we feel connected to) may be unhealthy for us physically. So we’ve got to adjust if we’re going to maintain the extent of engagement that’s needed for positive mental health.
Additionally, when we’re doing poorly, it’s not uncommon that we withdraw from others. When we feel bad—when we’re not liking ourselves – we naturally conclude that others will feel the same towards us. That often represents a significant distortion that can become a slippery slope into a depressed mood. The reality is, you’ll be more resilient in the face of negative feelings if you’re able to reach out and receive support from others that are meaningful to you.
One of my strong concerns during this time of social distancing is that people will be isolated and struggling with bipolar destabilization while friends or family, who may be able to assist, won’t have a clue. It doesn’t have to be that way, but the onus is on you to reach out and talk with those who are able to provide important support. This includes your mental health providers. If you are not scheduled to talk with your therapist or psychiatrist for another two weeks, let them know you’re having difficulty and see if there’s any possibility of having a telehealth appointment sooner than what’s scheduled.
8. Refrain from regular and/or excessive substance use
Recreational drugs (alcohol, cannabis, cocaine, hallucinogens, etc.) can sometimes provide an effective buffer against anxiety and emotional pain. They can ease the monotony of being stuck at home 24/7. They can heighten our senses and temporarily change bad into something more tolerable. They can also do the opposite, and with enough frequency they can begin to feel like a necessary component of your pandemic crisis management. Not good.
I rarely see someone with bipolarity who attains sobriety following an extended period of substance abuse who then sincerely thinks, “I was truly better off when I was getting high.”
These are unusual times, to say the least. Look at the extent to which we’re implementing radical options to safeguard our physical health. How about considering the same in relation to your mental health?
Russ Federman Ph.D., A.B.P.P.
Once in-person groups resume…..
Come along to our newly formed Women’s Support Group held on the fourth Tuesday of every month at The Youth House next to the Monash Church of Christ, 44-48 Montclair Ave, Glen Waverley 3150, 7:30pm – 9:30pm.
Gain support, understanding and friendship in a safe and open environment.
You will always be made to feel welcome.
Food and refreshments provided.
Contact : Amanda 0403 535 332 or email [email protected]