Just Diagnosed as Bipolar. What Next?

So 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.

I’m going to assume that you ended up at a psychiatrist either because over time your life had degenerated into a bit of mess, or that 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, (2) that you have a lot of stuff to catch up on or fix because lots of things have gone wrong in the last few months, (3) that you don’t exactly understand what your diagnosis of bipolar means, but you know you are not crazy.

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 of the things you currently do
    3. Avoiding some things you currently do or might want to try.
    4. Adding in some new things to your daily activities
  3. In all three cases, you need to be aware of the symptoms to look out for when things are going wrong, and you need to learn to monitor yourself for these symptoms. And you need to know what to do when the 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.

So. Your diagnosis is for a physical illness which messes with how you feel. You aren’t crazy. You aren’t imagining things. You are not creating problems out of nothing to get attention or irritate other people.

If someone says your 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.

Right. So I’ve hopefully made you feel a bit more comfortable about being bipolar. So what do you actually do next.

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 probably a 66% 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.

Depression and Dogs

We’ve all heard about the healing and stress relieving power of pets. And stories from pet owners will always be full of the how marvellous and loving their pets are. I know, because I am one of them.

But do they help with stabilising mood swings? Can they help pull you out of depression? Should you get a pet in order to help with mood swings? Continue reading Depression and Dogs

Coming out of Depression

There is a tendency for other people (and us too) to think that once we come out of depression, life will be fine.

After all, we look alert, we are happy and chipper, we talk about what needs to be done, and we can get things done. So….all is well, right?


We are better, at least for a while again. But our lives are not in order, and in fact they are probably in quite a mess. Continue reading Coming out of Depression

Staying Home When I am Depressed

Someone once asked me how I cope with depression. It’s easy. When I’m depressed, I just sit in my house, don’t talk to anyone and wait for the depression episode to pass.

The reason I’m ok about sitting in my house is that I treat depression as a physical disease – thinking of it as, say, a really bad fever. If I have a really bad fever, I would stay at home and sleep and feel miserable, but the fever would pass after a week or so. If I have depression, I stay at home and sleep and surf the internet and feel miserable, but the depression would pass after a week or so. I don’t feel guilty about doing this for depression, because it is a real physical disease. It’s not just in my head. Continue reading Staying Home When I am Depressed

Can I Tell if I Am Manic?

Someone asked me – “When you are manic, is it was possible to tell if you yourself are manic, or do you just think you are acting normal.”

It is a good question.

The answer is – yes, it is possible for me to recognise the symptoms of mania while I am manic. But like everything else, it is a bit more complicated than just that. Continue reading Can I Tell if I Am Manic?

Things that might Cause or Trigger Manic Eposodes

I am of the opinion that generally the mood swings happen on their own, following a pattern or cycle based on your body’s internal rhythms.

I also think that these cycles is fairly resistant to external events or triggers. So the stuff happening in your life is generally not the cause for your mood swings. Rather your mood swings are what are causing your life to go wonky.

Here’s the fine print though. Continue reading Things that might Cause or Trigger Manic Eposodes

Knowing When You are Becoming Manic

In order to manage being bipolar, you have to be able to monitor your moods. Of course that is easier said than done. After all, what does monitoring mean? What do you look for?

Let’s just start with mania. Here’s how to know if you are becoming manic. Continue reading Knowing When You are Becoming Manic

Dealing with this manic episode

One of life’s little benefits is that you can use your mania to control your mania.

Here’s why. With mania, you tend to have high productivity and lots of manic energy. It turns out that you can channel some of the excess energy to monitor how you are feeling and what you are doing.

And then, armed with this information, you can then use your energy / productivity to take action to calm yourself down and reduce your mania. Continue reading Dealing with this manic episode

If You are Very Manic

If you are very manic, you MUST seek assistance from a psychiatrist.

There are no choices in this matter. Your decision making capabilities will be substantially impaired, even if you don’t think so, and even if you think you are functioning normally. You will not be able to sort this out on your own.

If you are very manic you will be doing some or all of the following: Continue reading If You are Very Manic

Quick Perfume / Moisturising Cream

Remember I was talking about scents being psychoactive in a mood elevating way.

Well, nutmeg is my thing – I kind of go crazy when I smell it (but in a good way). But you can’t find nutmeg based perfumes. You can get the essential oils, but essential oils will irritate skin if applied directly, and mixing it in with a carrier oil such as jojoba oil or avocado oil make everything too, well, oily.

Look, don’t ask why I know all this. Continue reading Quick Perfume / Moisturising Cream