Just Diagnosed as Bipolar. What Next?

You recently got diagnosed with Bipolar Disorder.
What should you do next?
The answer to that could fit an entire book. But here are some pointers.

You got diagnosed because things in your life went badly wrong.

I’m going to assume that you ended up at a psychiatrist either because (1) over the last few weeks or months or years your life had degenerated into a bit of mess, or that (2) you had done stuff that was sufficiently, er, awesome that your family insisted that you see a psychiatrist.

In either case, I’m assuming that (1) the daily organisation of life is in a bit of shambles right now, and that (2) you have a lot of stuff to catch up on or fix because lots of things have gone wrong in the last few months, and that (3) you don’t exactly understand what your diagnosis of bipolar means, but you know you are not crazy.

Bipolar Disorder is a physical illness.

Let’s start with the last one first.
Bipolar Disorder is a physical illness, just like an ulcer is a physical illness, or like diabetes is a physical illness.

We can call it a mental illness because it is happening in your brain, but that just determines location, just as we can say an ulcer is an abdominal illness because it is happening in your abdomen. Mental in this case does not mean imaginary.

Right. So what you were diagnosed with is a physical illness. Since you need to understand what it is like, it’s handy to have comparisons. It turns out that the features of the illness bipolar disorder are similar to the features of asthma or to diabetes. Be careful of what I am saying here. I am not saying that bipolar disorder is related to either asthma or diabetes. What I am saying is that they share very general commonalities. These commonalities are:

  1. If you have it, you probably have it for life. You generally do not get better from asthma or diabetes or bipolar disorder.
  2. But that’s ok, because in all three of these illnesses, you can take actions which minimise their effects so that the quality of your life is pretty good. The actions may include
    1. Taking medication.
    2. Adjusting the way you do some things.
    3. Avoiding some things you currently do or might want to try.
    4. Adding some new daily activities that help you cope better.
  3. In all three cases, you need to monitor yourself for symptoms of your illness which indicate things are going wrong. And you need to know what to do when these symptoms appear.
  4. In the case of bipolar disorder and diabetes, one of the symptoms of the physical illness is a change in your moods. If you deal with the underlying physical problem, the moods right themselves.

You aren’t making it up.

Item 4 above is critical. You have a diagnosis for a physical illness which messes with how you feel and how you think. This is unusual, because most physical illness cause pain, while the bipolar disorder illness does not cause physical pain. But it is NOT the only physical illness that affects how you think or feel.

So you aren’t crazy. You aren’t imagining things. You are not creating problems out of nothing to get attention or irritate other people. You are showing the symptoms of a physical illness that affects your feelings and your thought patterns.

If someone says you are making things up, it’s like them saying ‘Oh, you are making diabetes up. Your diabetes is just in your mind. Get your act together and snap out of it.’ Any comments like that are medically nonsensical, show a thorough lack of understanding of the illness, are insensitive to you, and most annoyingly, don’t really help you at all.

So what DO you do?

Right. So I’ve hopefully made you feel a bit more comfortable about being bipolar. So what do you actually do next? Here is a list – in no particular order – of things you can do.

Step 1: If your life is currently in a mess, stop stressing over the things that need to get done.

Well, ok, your life will still be a mess. However, the only way you can sort it out is piece by piece. You will probably have about 3-10 things which have gone critical and you need to deal with immediately, but you’ll still only be able to sort them out one by one.

Make a list of the critical items. Then start dealing with item 1 on the list.  Try to not fuss about the items you aren’t doing. You will get to them.

If you worry about the tasks you are not doing, chances are you will begin to feel panicky.  Worse, you may feel as if there is too much to do and you can’t possibly cope. In either case, your feelings may trigger you to fall into depression or into doing nothing at all. So the plan is to try to avoid worrying or stressing about things which are not done.

Great. I’ve said this, but it is surprisingly hard to do. But try.

Here’s something to think about that might help. If whatever you are worrying about hasn’t been done for a while, another day or two will usually not make a difference. If there are no critical deadlines, you can not worry about it for the next day or two.

Step 2: Ask for Help in sorting out Critical Tasks.
It may be that you want to sort out one of the things that needs to be done, but you are embarrassed that you are so overwhelmingly late about it. Or you might not feel like you are ready to deal with people or strangers. Or you might feel like the person on the other side will laugh at you or shout at you or criticise you in some way.

Believe it or not, how you are feeling is an aftereffect of the depression. The sensation of not wanting to deal with people is often an indicator that you might still be slightly depressed. You will eventually learn to cope with low levels of this feeling and get your stuff done, but in the early stages – like for the next 6 months or so – it is perfectly reasonable to ask people to help you.

Good people are parents, siblings, or good friends. They will ask why you can’t do it for yourself since you will look perfectly competent to them. Your response can be something like “I know I should, but I’m still slightly depressed and it feels as if the people on the other side will shout at me. It’s making it impossible for me to pick up the phone (or visit the office, or….). I’ve been told this happens with the mood swings. I need your help. As my moods get better, I’ll be able to do it myself.”

They’ll look at you funny, but they’ll probably help. If the situation requires your presence, ask them to come with you and be the person talking to the customer representative.

Step 3: Start plotting your moods. If you don’t know what is happening to you, you can’t fix it.
You’ll need either (a) An appointment book which has 1 day per page or (b) a notepad. Either works. I used to use an appointment book, but now I use a notepad.

If you haven’t already, see the link on Setting up a Mood Chart for more information on how to chart your moods. You can use the Signs of Mania,  and the Signs of Depression in determining your mood for the day.

Yes, the stuff you write will be scrappy and messy. Yes there will be days with no entries or partial entries. That’s normal.

It will take anywhere from about 2 weeks to about 1 month to get data that is useful in allowing you to make decisions or choices. Persevere.

Step 4: Take your meds.
They may or may not work, but it’s a good place to start. You can check this link on why you should take the medications.

Note that us bipolar persons have a terrible record of consistently taking medications. I strongly recommend that you ask someone living with you, or someone you see everyday, to be in charge of giving you the meds and making sure you take them.

There is no such thing as personal responsibility here – if we are depressed, we simply won’t be able to get our act together to take them.

Step 5: Ask family or a friend or two to act as your social interface.
This is related to step 2. Just as you would ask someone to help you sort out some of the critical tasks, it is handy to have one or two people to help you sort out the whole set of complications with friends and family.

It would be handy to have a family member who can tell others ‘They’ve been ill for the last two weeks (or six months, or…), that’s why you haven’t seen or heard from them” or “I’m sorry they couldn’t make dinner (or family gathering, etc.), they’re ill”.

If you have a friend who can do the equivalent for you with friends meeting, that would be useful.

If you are working, it can also be handy to have someone who will call in to say you are ill when you don’t make it to work.

Note that all of these arrangements have to be set up ahead of time. There will be times in the future when you won’t make it to a close friend’s party, or Thanksgiving dinner, or to work. In the first few months after diagnosis, you will very frequently miss these things. Having someone who can smooth things out a bit for you will make your life substantially easier when you do reconnect with these people.

Step 6: Just because you are diagnosed, you will not magically get better in two weeks.
This is a reminder to you. Things will get better, but it will take a while for you to get the hang of managing the moods. This is going to be measured in months, not weeks. And there will be setbacks. All of this is normal and not you being incompetent.

Assume it will take you the better part of 2-3 months after diagnosis to at put a stop to the process of your life unravelling. Yes, life will keep getting worse for a while after diagnosis. And then it will take more months to get things back onto something that you think is an even keel.

You will get frustrated and annoyed by the setbacks and length of time things are taking. That’s normal. But even as you do, have a little part of your mind thinking – “well, this is what I was told to expect.”

While you might be willing to accept that learning to cope will take time, your family will expect you to be back to normal quickly. You will probably find it annoying to have friends and family members who assume that now you are diagnosed and taking the meds, things are all hunky dory and back to normal . Meanwhile you’ll be struggling to keep thing afloat. Very annoying.

If you feel like shouting at these people, your response should at least include something like “I’ve am really ill and I’m recovering. My research indicates that having a depression episode (meltdown, nervous breakdown, etc.) is like have a major injury and takes months to heal. I may look physically ok, but that doesn’t show the real problems. I would really appreciate if you could stop assuming that I am back to normal.”

Step 7: The meds may not work very well.
The meds may not work very well. My calculations seems to indicate that there is around a 60% chance that what the doctor gives you first will not work properly. Expect to be experimenting with drugs for a while. Check this link for my thoughts on drugs.

Step 8: You are in charge.
Now that you know that you have a physical illness, you can do something about it instead of wondering what the heck is happening to you. But here’s the important thing – it’s gonna be up to you to steer your course.

The doctors and psychiatrists and others are going to be resource people along the way, offering good advice and experience, but you are going to have to be the one deciding what to do next. Because you are the one who is going to see your illness every hour of every day, you are in the best position to make decisions.

14 thoughts on “Just Diagnosed as Bipolar. What Next?

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  1. Awesome post and applicable to unipolar major depression too. I need to read this, like, every day, right now, because I am extremely impatient and dissatisfied with my continued lack of functionality despite an overall improvement after a recent change in meds! Thanks.


      1. Have you ever looked into ECT? I don’t know if it’s recommended for bipolar disorder.
        I’m intrigued by TMS (transcranial magnetic stimulation), but my insurance won’t pay, so it’d be about $9,500 USD out of pocket for a course of treatment. That should at least give me a good placebo effect! (Grin)


  2. I really like this post – well thought out, honest, and easy to understand, telling it like it from the trenches. Thank you for writing this.


  3. Thank you for writing this excellent post. I should read it regularly as a pep talk to remind myself how to handle this illness. You give such a realistic description of the bipolar experience (believe me, I know!) and yet you make it sound doable.
    Every so once in awhile, I read some more about bipolar, adding onto all of the other stuff I have read over the years, but it helps. You need to read it over and over again to remind yourself about things you have forgotten.
    This post did that for me, thank you! Keep up the good work!


  4. Really great post. They told me I’m bipolar but still have to go see psych. After doing research I’d have to say yeah I am. Probably bipolar ii. Reading what you wrote was like a windowing creaking open into my mind. Thank you for writing this.


  5. Hello, I am 17, and recent counselors/doctors I’ve been seeing have been telling me that I may be bipolar. I have a question about the sense of urgency bipolar people feel. What is it like? I’m a senior in high school, I took 9 classes and I’m lead in all the school plays. Every time I’m not working I’m hating myself for not working because I feel like I am wasting my life. I also start creative projects aside from acting -for instance writing a musical and writing songs. I also feel like I must say exactly the right thing in every social interaction, or I have failed in some egregious manner – this might be something else, I don’t know. I’m sure much of it is just being a teenager. Do you experience an insatiable urgency to DO or CREATE? It’s like I have a work bar that’s continuously depleting and I explode into anxiety if it is empty, and I can only refill it if I accomplish something.


    1. Dennis, I wonder what has happened in your life in the intervening years since you first wrote this comment?

      Are you continuing in your life to expend all of your vitality in the unending pursuit of external ‘achievement?’

      That sounds terribly exhausting. I hope if your life has continued at such a pace that you have remembered to find time to spend not just in service of yourself but others as well, for the sake of your soul.


  6. Thankyou.
    Have been having a meltdown and went to doctors for help 4 weeks ago. Was diagnosed fri with bipolar and seeing psychiatrist this week.
    Off work and looking after myself but can’t cope with the world at the moment.
    This helped loads. Makes it seem bearable. Wish my friends and family could read this because they are so used to me coping with everything on my own.


  7. I have been going through mild ups and downs since my 20s. And on various meds since my late 40s, with mixed results. (Now in my 60s.) However, I came across William Glasser talking about Choice Theory, as a means of establishing better relationships in our lives and he got me thinking. He also has an opinion about psychiatry which is a contrast to modern thinking. I am including a link to a brief talk he gave https://www.youtube.com/watch?v=AghOT3oCaM4 . However, depending on where you are right now, do not suddenly stop taking medication. You should be able to research Glasser’s ideas for yourself and discuss with your therapist.


    1. Noel,

      I’m not sure that I agree with Dr. Glasser’s Choice Theory concept that bioplar disorder can be sorted out with simply recognising and changing one’s behaviour. From my perspective, being bipolar means that there IS a physical medical disorder which then makes it difficult or impossible sometimes to control one’s behaviour.

      If this is the case, then Dr. Glasser’s Choice Theory alone will fail, because the physical component is not being treated. That said there are good ideas in Choice Theory, and they could be incorporated into the coping system that anyone creates for themselves.

      And it is never a bad thing to learn more about ways of establishing better relationships.


      NIMH review of Dr. Glasser’s book: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079702/


  8. Thank you at 46 diagnosed today, and finally everything makes sense. Always felt like didn’t react like other people , original diagnose was depression but that never fitted as I am the life of the party, the go getter who works at 150 miles an hour..of course I had never seen a doctor when I was up. Who would I can take on the world. Like you have spent an hour googling a lot of depressing life long condition do this and do that. Very happy to find a place that actually deals with how that all comes together.


  9. I came across this title recently: •” Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions”. It is another perspective on illness and worth reading. I fully endorse Jinnah’s post above, from 2013 on bi-polar, as it offers a practical day to day way to cope with the illness.


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